Bariatric Surgery Requirements: Am I A Candidate?

Bariatric surgery is a term used to describe gastric bypass and a variety of other weight-loss surgeries. It is commonly referred to as weight loss surgery and is becoming a very common procedure. This surgery involves altering the digestive system, resulting in lesser food intake or reduced absorption of food. 

Unfortunately, not just anyone can have bariatric surgery. To qualify and receive insurance payment, you must meet certain criteria, including multiple screenings, body mass index (BMI) evaluation, and required documents to be sent to your insurance company.

In addition, you must not be too overweight. Your doctor may ask you to lose weight prior to the procedure. 

Though standard diet and exercise is the key to weight reduction prior to your surgery, there are many ongoing studies about CBD for weight loss.

If you are curious as to whether you are a good candidate, here is everything you need to know about the requirements for bariatric surgery. 

Requirements for Bariatric Surgery

Here are a few basic requirements that must be met to proceed with the process of bariatric surgery.

BMI Requirements 

• You must have a BMI, or body mass index greater than 40 which is usually around 100 pounds overweight.
• A BMI between 35 and 40 is considered if you struggle from a health condition that is related to obesity such as diabetes mellitus, heart disease, hypertension, or disc problems.
• A BMI between 30 and 34 is only considered if you have serious obesity-related health problems.

Age Requirements 

There typically is not an age requirement to have bariatric surgery.

As technology has advanced, it appears bariatric surgery is acceptable for a large range of age groups and surgery can safely be performed in teens to older adults.

A newer study^[2] has shown bariatric surgery may be safe and effective for screened participants over the age of 70.

Previous Effort

If you have tried in the past to lose weight but were unable to maintain it for a long period or eventually gained more weight, this will also be taken into consideration by your surgeon. 

Bariatric surgery is typically only performed in those who have been unsuccessful at losing weight despite following a structured diet and exercise plan.

Pre-Surgery Requirements

Since bariatric surgery is a permanent solution to weight loss and those having the surgery will have to commit to lifelong changes, there are other healthcare providers you must meet with in addition to being in the right “BMI range”. 

Here are some of the additional health providers you may be required to visit before surgery.

• A visit with your primary care doctor will evaluate your overall health history and determine any significant risk associated with weight loss surgery. They may also check to make sure you are not pregnant and not planning to become pregnant in the future.

• A visit with a psychologist to be sure you do not have any prior history of eating disorders, depression, anxiety, or any other serious mental health concerns. They may also screen to make sure you do not have a history of drug or alcohol abuse.

• A visit with a nutritionist or registered dietitian to make sure you have the motivation to adhere to strict diet change immediately following the procedure as well and adhering to lifestyle change for a lifetime to prevent weight regain. The surgery will cause you to feel full faster resulting in limited food intake and/ or absorption which can lead to nutrient deficiencies if the proper diet is not followed.

Those Not Eligible for Surgery

As mentioned above, despite the “BMI” requirements for weight loss surgery, one must also meet additional criteria to be deemed an appropriate candidate. 

The healthcare providers may choose to refuse, delay, or cancel your surgery due to the following:

• Smoking
• Weight gain since the initial assessment
• Alcohol or substance abuse
• Any major psychological problems 
• If you no longer fall within the necessary BMI range
• Not adhering to initial bariatric surgery diet/exercise plan
• Underlying health conditions (digestive issues, severe heart disease, unfit for anesthesia)

Insurance Requirements

Though most people experience little to no issues with insurance covering their surgery, some insurance companies may refuse to cover your bariatric surgery.

Your health provider will first need to determine that the procedure is medically necessary. This may include a comprehensive medical evaluation and documentation of your failure to lose weight in the past despite following a structured diet and exercise plan.

Not all insurance companies cover weight loss surgery or, if they do, you may have a very high deductible. It is extremely important to research coverage and out-of-pocket expenses well ahead of time to begin planning for your surgery and navigating payment options including possible financial assistance. 

Risks

As with any procedure, there are a few risks associated with bariatric surgery. Some potential risks after surgery are:

• Diarrhea 
• Malnutrition
• Stomach ulcers
• Bowel obstruction 
• Gallstones 
• Acid reflux 
• Need for additional surgery or revision

According to one study^[3], bariatric surgery is the surgery of choice in obese patients, and the risk of complications is similar to that post-gallbladder surgery.

The Bottom Line

Bariatric surgery is a popular answer to obesity that has been scientifically proven to aid in weight loss and help those that adhere to proper diet and exercise keep weight off long term.

Not everyone is a candidate for bariatric surgery. 

You must meet specific BMI or “numbers” criteria to be considered. Once determined to be an appropriate candidate for surgery, one must undergo fairly complex additional health screenings and meet the requirements listed above. 

This requires meeting with a team of healthcare professionals including nutritionists, psychologists, and your primary care providers. 

Once you meet the initial criteria, it must be maintained throughout the duration leading up to your day of surgery. 

It is also extremely important to reach out to your insurance company and become familiar with any out-of-pocket expenses you may incur to prepare for payment once the surgery is planned.

As with any surgery, there are risks associated with bariatric surgery, but it remains the solution of choice for weight loss in those with severe obesity. 

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