Who Should Consider Surgery

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Weight loss surgery is commonly recommended by physicians and approved for coverage by insurance companies when the perceived risks of continued obesity are greater than the risks of surgery. In general, the risks of obesity are thought to outweigh the risks of surgery when a patient is 100 pounds or more overweight or has a Body Mass Index (BMI) * of 40 or greater.

*BMI is defined as weight in kilograms divided by height in meters squared (kg/m2).

"When the BMI is >35 and comorbidities exist, gastrointestinal surgery becomes a consideration. When the BMI is>40, surgery is the treatment of choice." from Obesity and Heart Disease. A Statement for Healthcare Professionals From the Nutrition Committee, American Heart Association

Patients of lesser weights are sometimes approved if they have a "life-threatening" co-morbidity such as diabetes, high blood pressure, severe sleep apnea, etc. The underlying rationale is that the overall risk to life is reduced by surgery for patients who meet the above criteria. However, this line of reasoning ignores the roles of symptom relief and quality of life.

We know that patients have potentially life-threatening operations like hip-joint replacements to relieve pain and increase mobility not to lengthen their lives but to increase comfort. Similarly, patients commonly have slightly less risky operations to improve social and emotional aspects of their lives; cosmetic procedures are an easy example. So it follows that patients with BMI's below 40 might choose to have weight loss surgery for other than life-saving reasons. They must, however, be extremely well informed as to the risks and benefits associated with surgery.

Who is NOT a Candidate for Surgery

People at the extremes of life, women who are pregnant, alcoholics and drug addicts, and patients with certain psychological diagnoses, are not eligible for weight loss surgery. People with life expectancies of only a few years are virtually always not candidates.

Other conditions like prior gastric surgery, limited intelligence, inability to chew, extremes of youth and age, inability to exercise, and poor motivation to change all weigh against surgery.

Who Will Benefit the Most From Surgery

Those patients do best who are most unhappy with their current condition and who are most willing to make a lifestyle change. Since the problem is largely genetic and at present is incurable, a life-long commitment to all aspects of treatment is necessary. Regular exercise, dietary discipline, support group participation, and occasional visits to a bariatric surgeon are important components of post-operative success.