This is the first question that a person should ask when thinking on this great option, but as you will read it is not an easy decision either for whoever is interested or for your surgeon, we explain why.
There is a moment in which a person who has struggled with weight issues all or part of their life should consider thinking “out of the box”, looking for “drastic measures” to really achieve the goal they have probably searched for years, when this happens is when weight loss surgery can be considered as an option, and even like that it is not for everyone, simply because not every obese person is a good candidate for weight loss surgery because they do not have the proper mindset to undergo through the process weight loss surgery requires.
You must keep in mind that any kind of bariatric surgery is usually the last resort and not the first option if you haven’t tried losing weight by other means; the long-term success of obesity surgery depends on the ability to make permanent changes in lifestyle.
As you might already know, obesity is due to several factors and behavioral is one of them, so definitely having bariatric surgery involves commitment and compliance from the patient, many people believe that it will work like “magic” and make them skinny and healthy without any effort, unfortunately, this concept is far from the truth.
It is definitely, though, the best tool to really achieve considerable and most importantly, maintained weight loss on high BMI patients, but it should be considered as a turning point for a new way of eating, thinking and living.
While weight loss surgery candidates can certainly reduce risks on weight-related health issues, such as diabetes (Type 2), high blood pressure, sleep apnea etc, it is a major surgery that could involve risks and complications, thankfully on experienced hands and with the proper patient selection these risks are very low and are far surpassed by all the benefits.
That being said, there are actually very well established guidelines (by the NIH, National Institutes of Health) that should be followed in order to consider a patient as a candidate for weight loss surgery.
- Have failed to lose weight with diet and exercise after trying for 6 or more months under medical supervision
- Are Morbidly obese (Body Mass Index) BMI > 40)
- Are severely obese (BMI 35 to 39.9 with co-morbidities*)
- Are 100 pounds or more over your ideal body weight
- Patients with BMI 30 to 35 are candidates for Lapband Surgery (See below)**
- Are mentally prepared to change eating habits
- Free from any substance dependency (drugs/alcohol)
- Are well informed on the treatment options and what bariatric surgery can and cannot accomplish
- Are in good mental health (free from psychological or emotional conditions that may contraindicate bariatric surgery)
- Have acceptable operative risks
*By comorbidities there is a long list of diseases that could be related to obesity such as Diabetes, High Blood Pressure, High Cholesterol, Sleep Apnea, heart disease, osteoarthritis, fatty liver disease, etc.
**In 2011, the FDA criteria to consider a person candidate for Lapband was “expanded” or lowered down to BMI 30 with co-morbidities, and in the last few years it has also been put “on the table” the idea of lowering the BMI required for patients with an index of 35 in order to be accepted as candidates for gastric sleeve surgery even without any comorbidity, something that I personally believe is on the spot since it is proven that these patients benefit tremendously from a procedure such as the vertical sleeve gastrectomy.
If you want to know your actual BMI, go to our BMI calculator.
Besides these general guidelines, your surgeon will likely suggest you to go through a screening process to certify that you are a candidate for weight loss surgery, we should be able to determine by thorough evaluation of your particular case if the health benefits outweigh the potential risks.
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Nutrition and weight history
As we all know, the main reason besides the genetic factor involved in obesity, is adopting bad eating habits over the years, this could be a learned behavior starting during childhood by imitation of parents and family members or “self adopted” by the patient due to several environmental and personal reasons.
The weight history can lead us to discover where was the turning point of the patient from being on a healthy weight to becoming obese (if there actually was a turning point, since unfortunately some patients suffer from obesity since they are toddlers and we know how hard this is for them). This can let us “attack” and analyze the triggering factor(s) and individualize every case.
No matter how the person got to develop these bad eating habits, the important thing is that he/she needs to be aware of them and make sure it is motivated and committed to change them; this might sound like a contradiction since if that were possible the patient would be able to lose weight without the need of any “risky” procedure, here’s where the “beauty” of weight loss surgery shows up: bariatric surgery is the best tool that modern medicine has developed over decades to help these patients to really lose weight on a considerable amount and more importantly to keep those pounds off permanently.
How? by helping the patient not to feel those terrible hunger pangs, stopping them from binge eating and from eating carbohydrates in excess, this leads to the weight loss and motivation necessary to keep on going until reaching ideal body weight or getting close to it.
Patient’s actual medical condition
This specific factor is mostly to determine the risk of undergoing any kind of major surgery and not exclusively weight loss surgery, so the purpose is to perform a proper preoperative evaluation to assess the risks. The majority of the cases the risk is acceptable and after putting on the scale the benefits they outweigh the minor possible risks of surgery. In other words, having chronic diseases does not avert patients from having bariatric surgery, on the contrary, makes them an even better candidate for weight loss surgery instead.
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The purpose is to assess how suitable will weight loss surgery be for you. Only in extreme cases is where the patient has a psychological or psychiatric condition that makes it a contraindication for having bariatric surgery.
Motivation and willingness to commit to change bad habits
This topic might be one of the most relevant, because to be fair, most of the persons seeking for help with their weight problems is because they fulfill with all the previous aspects we mentioned. But definitely the mindset of the patient should be the proper one, if you think that by having weight loss surgery you will be able to disregard what you eat quality/quantity wise, you are not a good candidate for a bariatric procedure.
It is very important to be aware that any kind of bariatric procedure is a tool and not a “magic wand”, the expected results will only come if you are decided and committed to a change in your lifestyle and eating habits. So in simple terms we change in different manners the anatomy and function of the gastrointestinal tract and the patient should change the “brain”, the mindset.
Every case can be considered but usually surgery is not recommended on patients under 18 years of age and over 65 years of age, it is very relative though and will have to do more with the general health condition of the patient in the case of patients over 65 years and on the psychological aspect in the patients under 18 years of age. But in properly selected cases we have operated patients that are under or over those ranges.
Even though some may say that weight loss surgery is not effective in 100% of the cases, this concept should be taken with resere since we have never seen a patient who is well informed, motivated, committed and truly decided, that has not lost enough weight to consider they made the right choice and had success in achieving their weight loss goals after having surgery
In case you are interested in knowing if you are a good candidate for weight loss surgery let us know and we can review in detail your medical background and let you know if weight loss surgery is a good fit for you.
Written by: Gabriel Rosales
Dr. Gabriel Rosales is a highly skilled, board certified surgeon in constant pursuit of learning the latest innovations in the weight loss surgery field to give his patients the best care possible.