What Are Bariatric Surgery Requirements? Is Weight Loss Surgery Right for You?

Like other weight-loss surgeries, bariatric procedures alter the digestive system of patients who are unsuccessful in losing weight the traditional way—by improving their diet and exercising more. As a direct result, bariatric surgery can limit how much you eat, reduce fat, and absorb calories. Although metabolic and bariatric surgery promotes significant weight loss, it is essential to recognize that it is not always ideal for everyone.

Let’s explore the weight loss surgery options at RMC, delve into the requirements and evaluation process, and answer frequently asked questions to help you determine if it’s a suitable path for your weight loss journey.

Understanding the Requirements for Weight Loss Surgery

To ensure the best outcomes and minimize risks, candidates must meet specific criteria before undergoing bariatric surgery. Let’s break down the general requirements:

• Body Mass Index (BMI): A BMI of 40 or more indicates severe obesity and qualifies you for surgery. Candidacy for surgery is higher for patients with a BMI of 35-40 if they also have a clinical diagnosis for weight-related health problems like type 2 diabetes, sleep apnea, or severe joint pain.
• Previous Weight Loss Attempts: Candidates must provide evidence of prior weight loss attempts, including diet, exercise, and medications, to show that other methods have been unsuccessful.
• Medical Evaluation: Blood tests, imaging studies, and consultations with various doctors might be necessary to identify health conditions that could increase surgical risk. Candidates may also undergo a psychological evaluation to ensure they’re mentally prepared for surgery and subsequent adjustments.
• Age: Many bariatric surgery patients are between 18 and 65 years old. However, there might be exceptions for younger or older individuals based on specific health circumstances.
• Absence of Contraindications: Certain medical conditions, such as severe heart disease, advanced liver disease, or cancer, may contraindicate surgery. Additionally, a qualified physician must address any active substance abuse issues a patient has before allowing them to consider surgery.
• Insurance and Financial Considerations: Candidates should verify their insurance coverage and understand any out-of-pocket costs.

Specific Requirements for Different Bariatric Surgeries

There are different types of bariatric surgeries, each with its distinct candidate criteria. Let’s analyze the requirements for various surgical procedures.

Gastric Bypass (Roux-en-Y)

In this procedure, the bariatric surgeon creates a small pocket in the patient’s upper stomach and reroutes the small intestine. The limited capacity of the patient’s stomach causes them to get full faster and eat less. With the intestinal rerouting, the digestive tract will not be able to absorb the same amount of calories, further precluding dietary causes of weight gain. 

Patient Criteria:

• A BMI of 40 or higher
• A BMI of 35 to 39 with a comorbid diagnosis of any serious health condition causing or worsening their weight gain like type 2 diabetes, sleep apnea, or severe joint pain
• Age 18-65 (though some programs may have exceptions)
• Willingness to make significant lifestyle changes, including diet and exercise programs

Sleeve Gastrectomy

In this procedure, a surgeon removes approximately 80% of the patient’s stomach, creating a banana-shaped sleeve; it limits how much food they can eat daily and the production of ghrelin (the hormone in your stomach that makes people feel hungry).

Patient Criteria:

• Moderate to severe obesity.
• Must have special clearance if they have a history or symptoms of gastroesophageal reflux disease (GERD), as this surgery can worsen symptoms

• Must be psychologically stable and capable of complying with dietary restrictions and lifestyle changes
• Must attend follow-up appointments to monitor weight loss and nutritional status. This procedure also affects nutrient intake but to a lesser extent than gastric bypass.
• Having a BMI of 35 or higher (though some programs may accept a BMI of 30 with significant health problems)

Laparoscopic Adjustable Gastric Band (LAGB)

For this procedure, a surgeon will place a band around the upper part of the patient’s stomach, creating a small pocket and limiting the amount of food that passes through it.

Patient Criteria:

• A BMI of 40 or higher
• A BMI of 30-39.9 with at least one serious obesity-related health condition

• Moderate to severe obesity
• Must have the psychological and physical ability to adhere to mandatory follow-up visits for band adjustments, dietary restrictions, and lifestyle changes.
• Must have special clearance if they have any autoimmune diseases
• Must inform physicians and surgeons if they have allergies to certain implant materials; they can only have the surgery if an alternative material is available to accommodate the allergy. 

Biliopancreatic Diversion with Duodenal Switch (BPD-DS)

This procedure bypasses most of the stomach and small intestine, combining restrictive and malabsorptive properties to achieve significant weight loss.

Patient Criteria:

• 50 or higher BMI
• BMI of 40-49.9 with severe obesity-related conditions
• Valid medical documentation of previous failures to lose weight with diet, physical activity, or medication.
• Must have confirmation of overall good health and suitability for this procedure from a comprehensive medical evaluation, including results from nutritional deficiency screenings
• Must pass a psychological assessment confirming that the patient understands the surgery’s risks and the required lifelong commitment to nutritional supplementation

Evaluating Your Suitability for Bariatric Surgery

At RMC, we take a comprehensive approach to assessing your candidacy, including consultations with surgeons, dietitians, psychologists, and other healthcare professionals. Our process involves:

• Medical History Review: Your healthcare team will review your medical history, taking into account any previous surgeries, current and past medications, and other relevant disorders presently impacting your health, such as heart disease, diabetes, or high blood pressure.
• Physical Examination: This exam involves checking vital signs (blood pressure, heart rate, temperature, respiration), body composition (weight, height, BMI), and overall physical health to ensure optimal health for the procedure.
• Psychological Evaluation: It might explore your motivation for seeking surgery, your understanding of the risks and benefits involved, your ability to commit to long-term dietary and exercise changes, and any underlying mental health concerns that could affect successful outcomes.
• Nutritional Assessment: A registered dietitian will evaluate your eating habits and nutritional status and recommend diet changes for optimal bariatric surgery results. These recommendations can include advice on portion control, nutrient-dense foods, and potential supplements to support your health during the weight loss journey.

Insurance and Financial Considerations

You may find the expense of bariatric surgery intimidating. However, your health insurance provider may significantly cover the cost if you​​ meet these specific requirements:

• Evidence of medical necessity for surgery: Your surgeon will gather your medical history and document any weight-related health issues.

• Completion of a supervised diet program: Before approval, you should finish a 6-month weight-loss program with regular visits to your doctor or bariatric surgeon’s office to show your commitment to long-term lifestyle changes.
• Psychological assessment: This evaluates your understanding of weight loss surgery and assesses for any untreated binge eating or psychological issues.
• Nutritional assessment: You’ll collaborate with a nutritionist to establish dietary changes tailored to your needs and habits.

Even if you have insurance, expect and prepare for out-of-pocket expenses such as deductibles, co-pays, and post-surgical needs like nutritional counseling, vitamins, or support groups.

If you have insurance through a large employer with over 50 employees, lack health insurance coverage, or reside in a state where bariatric surgery isn’t part of essential health benefits, you may need to cover the total cost out-of-pocket. Fortunately, many weight loss surgery centers offer financing options, and you can take out a loan and pay it back gradually over several years.

Reasons Weight Loss Surgery Might Not Be Right For You

Your surgeon can delay weight loss surgery or cancel it altogether in the event of:

Steps to Qualify for Weight Loss Surgery

Qualifying for bariatric surgery involves more than just a desire to lose weight. It requires careful consideration of various health factors and a commitment to improving overall wellness. Here are critical tips to boost your eligibility for weight-loss surgery:

Understand Your BMI Requirements

Surgeons will usually perform these procedures for adults with either a BMI of 40+ or both a BMI of 35+ and a severe obesity-related health condition (e.g., type 2 diabetes, heart disease, or sleep apnea.

Research

Find a qualified bariatric surgeon who performs the specific weight loss surgery you are considering. You can also attend support groups to get advice and encouragement from others who have undergone the surgery. 

Manage Your Comorbidities

In the realm of weight loss, comorbidities refer to health conditions co-existing with obesity that can significantly worsen due to it. They include sleep apnea, diabetes, high cholesterol, high blood pressure, and depression. 

Uncontrolled comorbidities can affect your eligibility for bariatric surgery, increase the risk of complications, and hinder your recovery process. Before planning bariatric surgery, physicians must take proactive measures to address comorbidities, such as taking all prescription medications as their doctor instructs and adopting healthy habits like stress management, regular exercise, and a balanced diet.

Complete the Required Evaluations

An extensive medical evaluation of your eligibility and overall health is a fundamental requirement of bariatric surgery for all patients. This evaluation typically includes physical examinations, laboratory tests, and consultations with specialists to evaluate your cardiovascular health, respiratory function, nutritional status, and psychological readiness for surgery. Comprehensive preoperative assessments help identify potential risks and ensure surgery is safe and appropriate for your individual health needs.