Do I Qualify for Bariatric Surgery?

The most common question I’m asked is: “Do I qualify for bariatric surgery?”

Unfortunately, the answer is not a simple yes or no.

Bariatric surgery is major surgery that requires a great deal of preparation and attention to health and risk. Further, the degree of obesity as well as method of payment can change the qualifying criteria for any given surgical procedure. Patients can use the following criteria as a guide to see if they may be a candidate for the gastric sleeve:

First is the body mass index or BMI, which is a measure of weight in relation to height. If the patient’s BMI is 35 or over with 2 obesity-related diseases, or if the BMI is 40 or over, regardless of diseases associated with obesity, insurance companies may pay for bariatric surgery, if that particular’s companies other requirements are met. These other requirements may include a psychological evaluation , and a medically supervised diet for three to six months.

Patients with a BMI of 30 to 34.9 usually will not qualify for coverage of bariatric surgery. These criteria are based on a National Institute of Health consensus over 20 years ago, when bariatric surgery was much more risky and had a much higher mortality, and before laparoscopic surgery. With these regulations, patients already have the diseases associated with obesity. It also excludes many patients with BMI’s between 30 and 35 who already have diseases stemming from obesity. In addition, there are many patients with BMI’s less than 35 who are still healthy, who with continued weight gain or in time will go on to become ill due to their obesity. We feel that it is better to prevent than to treat, thus with this intent, in our practice, we operate on patients with a BMI as low as 32. There are other areas in the world, such as India, where the qualifying criteria is down to BMI of 30, for these same reasons. How a patient pays for surgery will also make a difference in their qualifying criteria. Those who are financing the procedure themselves often are not subject to these stringent criteria.

General health will also play a large role in whether patient qualifies. We will only perform a gastric sleeve on those whose surgical risk is significantly lower than the risk of living with obesity. That means that our patients will have their cardiac, pulmonary and renal functions evaluated, in order to ensure that the patient is a suitable candidate for bariatric surgery. In addition our patients undergo an upper endoscopy to assess the stomach anatomy and to look for a hiatal hernia (which we will repair at the time of the gastric sleeve), and an esophageal manometry to evaluate the sphincter between the esophagus and stomach to determine the risk of reflux postoperatively.