The requirements for bariatric surgery and the ideal candidate for the procedure

Story by: Sara Thompson on January 5, 2023

Considering weight loss (bariatric) surgery? Here are some requirements and guidelines you’ll need to understand before the procedure.

Candidates for bariatric surgery

Body mass index (BMI) is a formula that uses weight and height to estimate someone’s percentage of body fat. You may be a candidate for weight loss surgery if you have:

• A BMI of 40 or higher
• At least one obesity-related medical condition such as Type II diabetes
• Participated in at least six consecutive months of supervised weight-loss attempts

Depending on the severity of the obesity-related illness, some people with lower BMI may be eligible for weight loss surgery.

According to Jeff W. Allen, M.D., medical director of bariatric surgery with Norton Weight Management Services, there are also some less concrete criteria for patients to be ideal candidates for weight loss surgery.

“Patients who understand that surgery is a tool, not the only answer [to a weight loss issue], do much better,” Dr. Allen said.

Motivation to do the work at home in terms of eating well and moving their body is just as important as having the required BMI, if not more so, according to Dr. Allen.

Preparing for weight loss surgery

Your medical team will develop a treatment plan for you that may include:

• Weight loss: Losing even a small amount of weight before surgery can lower risks of complications and reduce fat around the liver, which helps the surgeon reach the stomach more easily.
• Smoking cessation: Smoking increases risk of post-surgical complications. You will be asked to stop smoking before weight loss surgery, or asked to join a program to help you quit.
• Behavioral modification: Therapy can help treat eating disorders or other mental health conditions. You may address your self-esteem around body issues or learn new healthy coping skills.
• Nutrition plan: The dietician will guide your meal planning to ensure you get adequate nutrition before and after weight loss surgery. You may need supplements or other support.
• Exercise: A specialist can help you create an exercise plan, set goals and more.
• Liver-shrinking diet: You might be asked to eat a specific diet meant to reduce the size of your liver. If the liver is too large, it is difficult for the surgeon too reach the stomach laparoscopically, which can cause other complications as well.

Types of bariatric surgery

“Patients ask for ‘the best surgery,’ and to that I say, there are several good surgeries we do right now. It really depends on the patient,” Dr. Allen said. “We use these procedures for different people with different situations.”

There are three main types of bariatric surgery:

1. Gastric bypass: During this procedure, the surgeon cuts most of the stomach out and connects the remaining egg-sized pouch to the small intestine. Food goes directly into the small intestine. Not only is the amount of food restricted, but the food eaten is not all absorbed.
2. Gastric banding: A surgeon places an adjustable silicone tube around the top of the stomach, limiting the amount of food the stomach can hold. The band can be adjusted by adding or removing saline in the tube.
3. Sleeve gastrectomy: This procedure removes 80% to 85% of the stomach, creating a banana-shaped pouch. This reduces the amount of food the stomach can hold.