Dear Doctor Column, May 19, 2008

Am I a Candidate for Weight Loss Surgery?  

Question:

How overweight does a person have to be to qualify for a stomach bypass?

Answer:

A stomach bypass, known medically as gastric bypass surgery, is one type of weight loss, or bariatric, surgery. All weight loss surgeries work on the same principle: they change the anatomy of your digestive system to limit the amount of food you can consume and digest.

There are a number of different weight loss surgeries, but the two used most commonly today are gastric bypass and adjustable gastric banding.  Adjustable gastric banding is commonly called a “lap band” procedure because it involves laparoscopic (minimally invasive) placement of an inflatable silicon band into the upper stomach. The band sections the stomach into two parts, creating a small pouch that limits the amount of food one can consume. A surgeon can adjust the band if needed. It also can be removed, though it is meant to stay in place indefinitely.  

Weight loss surgery isn’t right for everyone with weight issues. People interested in gastric bypass, lap banding, and other types of weight loss procedures go through an extensive screening process to ensure they meet the required physical criteria and are willing and able to commit to the significant and permanent changes that come along with surgery.   

Who’s a Candidate?

Weight loss surgery is best for people who have tried but have been unable to lose weight through more traditional methods – eating a healthy, low calorie diet and exercising – who are severely overweight, or who have serious weight-related health problems.  Bariatric surgery is generally reserved for people who are 80 to 100 pounds over their ideal wight or whose body mass index (BMI) meets certain thresholds. You may be eligible for weight loss surgery if: 

Ø      Your BMI is 40 or higher. (Click here to calculate your BMI.)

Ø      Your BMI 35 to 39.9 and you have serious weight-related health problems such as diabetes, high blood pressure, or heart disease.  

Being above a certain weight threshold isn’t the only criteria people must meet to qualify for bariatric surgery. Once you start the screening process, you’ll be evaluated by a medical team that typically includes a physician, surgeon, dietician, and psychologist. The team’s goal is to make sure you’re healthy enough to undergo surgery safely and that you are emotionally prepared to make the changes needed for good long-term results.  

Before going ahead with surgery, the team may advise you to make changes in your lifestyle, such as limiting certain foods and beverages, getting more exercise, and quitting smoking. How well you follow these recommendations will help the team gauge how ready you are to make the permanent lifestyle changes required for a successful outcome.  

Paying For It 

Some insurance companies cover weight loss surgery, others cover it only in particular circumstances, and some offer no coverage at all. In some cases, Medicare covers weight loss surgery. Medicare coverage is provided only if prospective patients meet certain criteria and have the surgery performed at a medical center designated a Center of Excellence by the American Society for Metabolic and Bariatric Surgery (ASBS) or certified a  Level 1 Bariatric Surgery Center by the American College of Surgeons (ACS).  

Once you complete the screening process and are medically approved as a surgical candidate, you’ll need to check with your insurance companies and review their policies for coverage. Most bariatric surgery programs have staff who can assist you with this process.  

Choosing a Surgeon

Bariatric surgery has various risks and benefits, which you should discuss with a surgeon who has significant experience performing weight loss procedures. Look for a surgeon who is board certified by the ACS or ASBS. Certification indicates a high level of training and experience. Visit the ACS or ASBS sites to find a board certified surgeon.  

To read more, visit the National Institutes of Health page on weight loss surgery. This site offers in-depth information about all aspects weight loss surgery.