Are You Sure You're Ready?
Weight loss surgery is only a tool. It is a very powerful tool. It is a tool that has aided successful weight loss in many patients who were unable to lose weight with just diet and exercise. The key to making this tool work for you is to do your part. Before getting weight loss surgery:
- Understand that it's not a quick fix. Achieving your goal weight can take years, even if you have no complications
- Commit to the diet and other lifestyle changes that are necessary for weight loss and health
- Understand and accept the risks of bariatric surgery
- Carefully consider each weight loss surgery option and choose the one that is best for you.
Contraindications: Who Shouldn't Get Weight Loss Surgery?
Contraindications are conditions that prevent you from being a good candidate for weight loss surgery. They may make the procedure more dangerous or make you less likely to lose weight after surgery. General contraindications for weight loss surgery include:
- Alcohol abuse or drug dependence
- Uncontrolled psychiatric disorder, such as depression or schizophrenia
- Cardiopulmonary (heart and lung) disease that makes the surgery risky
- Barrett's esophagus or esophagitis
Is Bariatric Surgery For Me? (Eligibility)
Eligibility criteria are the requirements that you have to meet before you can get weight loss surgery. These are the standard criteria for all types of bariatric surgery.1
- BMI at least 40 kg/m2 OR
- BMI at least 35 PLUS
one or more serious obesity-related comorbidities such as severe sleep apnea, uncontrolled type 2 diabetes or heart disease OR
obesity-related physical problems, such as joint pain or lack of mobility
- At least 100 pounds of excess body weight; that is, at least 100 pounds over a recommended BMI of 25
- A history of failed diet attempts
- The knowledge that your obesity isn't caused by a metabolic disorder, such as hypothyroidism
- Age under 60 years old, although this isn't an absolute requirement.2 Bariatric surgery has been successful for many older patients, and individual surgeons can decide whether they think it is the right choice for you
- Age over 18 years old, although some adolescents can have success with bariatric surgery.3
- Understanding that weight loss surgery is not an “obesity cure.” It is a tool for you to use, and your own actions greatly affect weight loss.
- Willingness to follow the required diet and attend post-surgery care appointments and support group sessions.
- Mechanick MD, Kushner RF…Dixon J. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Obesity, 2009;17(S1):S3-72.
- Gagnon L, Sheff Karwacki EJ. Outcomes and complications after bariatric surgery. AJN. 2012;112(9):26-36.
- Kelleher DC, Merrill CT, Cottrell LT, Nadler EP, Burd RS. Recent National Trends in the Use of Adolescent Inpatient Bariatric Surgery: 2000 Through 2009. Arch Pedatr Adolesc Med, 2012;17:1-7.
Which Surgery is Right For You?
Certain surgeries are better or worse for certain candidates. For example:
- The adjustable gastric band (lap-band) is better for lower-BMI candidates
- The vertical sleeve gastrectomy is safer for higher-BMI candidates
- The BPD-DS (which starts with a partial gastrectomy) may be best for the highest-BMI candidates because of its combination of restriction and nutrient malabsorption
- The Roux-en-Y gastric bypass is often recommended for candidates with a sweet tooth because the RYGB diet does not allow sweets
- Adolescents might opt for the lap-band because it is the least invasive
- The lap-band is adjustable, so women who become pregnant can reduce restriction and increase dietary intake to support the baby
- The lap-band is the least expensive surgery
- The Roux-en-Y gastric bypass is most likely to be covered by insurance; sometimes, one or more of the other procedures are considered experimental and not reimbursable treatments for obesity