Contrary to popular belief, having weight loss surgery IS NOT the easy way out. If you talk to any successful bariatric surgery patient, they will tell you about the amount of determination AND effort it took to have a better quality of life and healthier lifestyle.

The decision to have weight loss surgery is a major decision that will significantly impact your health, in the best way possible. So, congratulations on taking the first step to transform your life. However, there are bariatric surgery requirements to meet. Now that you have decided to pursue bariatric surgery, you are probably wondering where to start and if you even qualify.

Qualifications for Weight Loss Surgery

The commonly recognized criteria for determining who qualifies for weight loss surgery has to do with the body mass index (BMI). This criterion states that a bariatric patient must have a BMI greater than 35 with two or more weight-related medical problems, or a BMI greater than 40 without existing medical problems. 

The BMI criteria came about after The National Institute of Health (NIH) published guidelines on obesity and weight loss surgery qualifications in 1991. Oftentimes, bariatric patients with a BMI greater than 35 is when we start to see a significant health risk resulting from their obesity. 

However, most surgeons nowadays will perform a risk analysis to determine a patient’s qualifications for surgery, such as the risk of a patient having surgery versus the threat a patient faces if they continue to live with obesity. Often, bariatric surgeons would consider a person with diabetes who has a lower BMI (between 30 and 35) a candidate for weight loss surgery in an effort to cure their diabetes.  

As surgeons, we are beginning to recognize that a significant improvement in diabetes will occur post weight loss surgery. Therefore, many medical groups are recommending that the current criteria change for diabetics. 

Unfortunately, though, we’re still going by almost thirty-year-old criteria for these procedures as most insurance companies still adhere to the strict 1991 NIH guidelines mentioned above. 

If you have diabetes and have a BMI between 30 and 35, I encourage you to still call our bariatric clinic. Some insurance companies have lowered their BMI criteria as the risk of diabetes and obesity continues to grow. 

*Note: We are not guaranteeing that you will be able to have bariatric surgery if you have a BMI between 30 and 35; this will be dependent upon your surgeon’s evaluation and what your insurance company requires. 

Steps to Start Your Weight Loss Surgery Journey

Once you know you qualify for weight loss surgery, I encourage you to follow the steps below to ensure you are adequately prepared for your first visit. 

1. Call your insurance company to see if you have Bariatric coverage.

Although most bariatric clinics will perform a complete insurance verification before your first visit, it is good to have an idea of what you can expect to pay for all associated costs.

2. Identify a Bariatric Surgery practice that you want to use.

As the prevalence of obesity rises, more surgeons are becoming fellowship trained in Bariatric Surgery. Therefore, there is likely a bariatric practice close to home. Yet, you still want to evaluate bariatric clinics, understand their experience, and ensure the clinic is a Center of Excellence.

3. Do online research.

Most bariatric patients conduct 2 to 3 years of research online before deciding to have weight loss surgery. I encourage you to research the different weight loss procedures, the associated risks, and the lifestyle change that comes with bariatric surgery.

4. Schedule an appointment with a Bariatric Surgeon.

Once you have figured out what practice you want to have your surgery with and you have thoroughly researched the different bariatric procedures, go ahead and make your appointment!

Bariatric Surgery Requirements: Insurance

Once you have made your appointment and attended your new patient consultation, most insurance companies will require the completion of the following steps before approving your surgery. 

1. Surgical Consult with the surgeon stating the medical necessity of bariatric surgery
2. Supervised Physician Diet (The number of visits can vary between different insurance companies)
3. Dietitian Evaluation or a group nutrition class
4. A weight history from your primary care physician that can range from 2 to 5 years, depending on your insurance. 
5. Psychological Evaluation and Clearance
6. Any Medical Clearances, such as a cardiac or pulmonary clearance
7. Any additional specialty Clearances, which may be required depending on your insurance and medical history
8. EGD and/or Upper GI, which will be decided based on your medical history and the surgeon’s discretion. 
9. Any laboratory studies, such as a sleep study, which is again based on the insurance requirements

 Although this may sound like many steps to complete, it is important to remember that you will be supported at every step of the way. At the bariatric clinics, we work with, you will be assigned a patient navigator who will walk with you through this journey, will be there to answer any questions, and will cheer you on along the way. So again, congratulations on taking the first step to a new you!