Revised Guidelines for Bariatric Surgery. Are You a Candidate?

“Sure, you are struggling with your weight,” well-meaning friends might say when you tell them you’re exploring weight-loss surgery. “But isn’t surgery extreme?”

The rules have changed, that’s why. Since late 2022, people who have BMIs of 27 and up (depending on ethnicity and other medical issues) have been candidates for bariatric procedures — 5 points lower than in the past. The reason, in part, is that today’s operations are safer and less invasive than they used to be, while the benefits have been proven repeatedly.

The medical community followed guidelines from 30 years ago until a new study was released about a year ago. Three decades is eons, considering how medicine has progressed. Now doctors use a set of parameters based on a wealth of extensive research involving hundreds of studies performed since 1991, plus experience, and advanced medical techniques and technologies, that didn’t exist back then.

Who Is Eligible for Weight-loss Surgery?

The new guidelines spell out specifics for people who would benefit from bariatric surgery, especially sleeve gastrectomy and Roux-en-Y gastric bypass — the minimally invasive procedures that are used in all but 10 percent of weight-loss operations globally today. Surgeons perform the procedure laparoscopically, meaning they make small incisions and specialized cameras instead of large incisions. The criteria:

• BMI of 30 or higher. The minimum used to be a body mass index (BMI) of 35. People of Asian descent, and those with certain co-morbilities, are candidates with a BMI starting at 27.
• Inability to control weight. You lose 30 pounds, then gain it back during a single holiday season. You’ve tried gym memberships, stringent diets and/or other means to shedding weight permanently and have been unable to attain, or retain, a healthy body weight.
• You’re not frail. Patients of any age, even 70+, are now considered eligible for bariatric surgery as long as they’re not frail.
• Children and teens. If you’re under 18 and unable to maintain a healthy weight, the Roux-en-Y gastric bypass might help — after stringent vetting that will deem you “appropriately selected.” It has been shown not to affect puberty-related development, yet help with blood pressure, blood sugar, cholesterol and heart issues.
• Type 2 diabetes. If your blood sugar level is too high, losing excess weight might bring it back down naturally. In fact, since 2016 the American Diabetes Association has recommended weight-loss surgery for Type II diabetics who can’t control their blood sugar with medical pills or injections.

How Will I Benefit from Weight-Loss Surgery?

If your health profile fits with the medical conditions listed in the new guidelines, you are a perfect candidate. Complications are very low today, and good outcomes are very high. Surgery is the only method proven to help you lose the weight and keep it off in the long term. It changes your biology, your anatomy, while still guiding you to a healthier life with good diet and exercise habits built in. These issues might naturally disappear, or at least not get worse, as you lose weight:

• High blood pressure
• Infertility
• High cholesterol
• Sleep apnea
• Heart issues
• Fatty liver
• Polycystic ovaries
• Gastroesophageal reflux (GERD)
• Chronic kidney disease
• Intracranial pressure

Plan ahead

Surgery is no small undertaking, both because all operations have built-in risk and because you’ll need to eat differently for the rest of your life. Do your research in advance.

• What’s required to prepare? Most bariatric practices and/or insurance companies require nutrition counseling and a psychiatric assessment before scheduling you for surgery.
• What sacrifices will I need to make? You’ll need to follow a strict liquid diet immediately before and after surgery. With most procedures, you’ll also need to take vitamin supplements for the rest of your life, since your body might not absorb nutrients sufficiently.
• Will insurance cover my surgery? Two esteemed medical groups, the American Society for Metabolic and Bariatric Surgery, and the International Federation for the Surgery of Obesity and Metabolic Disorders, embrace the new guidelines and published them together. Still, many insurance companies make coverage decisions based on the outdated guidelines. Contact your insurance carrier to learn more.

More than 40 percent of Americans are technically obese, according to the Centers for Disease Control and Prevention. The extra weight can cause many medical ailments. If you’re struggling with extra pounds — even with a BMI of 30, ask your doctor to discuss the pros and cons of weight-loss surgery. It might improve your life.