Getting Started

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 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.

Prospective bariatric patients want to know what options they have for paying for surgery. Certainly not to be taken lightly, payment options are varied – each with their benefits and drawbacks. Generally speaking, patients either use financing or insurance to pay for part or all of their procedure while others pay for the entire procedure out of pocket. The following is a quick guide to the different payment options available today.

• Insurance: If a patient’s insurance policy covers bariatric surgery at all, it may pay for a significant portion of the procedure. Depending on co-pays and deductibles, the patient may be responsible for some of that cost. While insurance coverage may reduce the cost of surgery significantly, patients will also encounter a strict set of qualifying guidelines. If these guidelines are not met, coverage may not be available. These criteria may include anything from certain weight characteristics to the presence of diseases and the completion of a medical weight loss program.
• Financing: There are many third-party medical financing companies that specialize in coverage of bariatric and other surgical procedures. Financing offers a patient a greater deal of flexibility as strict insurance coverage requirements do not necessarily apply. There is also the option of a personal loan in the form of a home equity loan, borrowing from friends and family and using credit cards. Please note that it may require a certain credit score to qualify and there are ramifications of non-payment which should be explored fully. Further, be sure to understand the finance and interest charges as they may be significant.
• Cash Pay: Self-pay patients have the greatest degree of flexibility since they don’t have to worry about insurance guidelines or credit score and interest. Cash payers may also be able to bundle their services by speaking to their bariatric surgeon and hospital. The result may be a lower overall cost.

Paying for surgery is a big decision and time must be taken to evaluate all the options. Speaking to our office or the bariatric surgeon’s office in your area is the best way to figure out which payment option is right for you.

Most patients don’t realize that the process of evaluating and preparing a patient for bariatric surgery is just as important as both the surgery itself and post-surgical life. A patient will contact our office as a result of their obesity and the likelihood is that traditional diet and exercise has not worked in the past. While obesity and its related diseases may preliminarily qualify a patient to undergo a bariatric procedure, it is not the only consideration before approving them to undergo major surgery.

Physical testing before bariatric surgery is one of the most important parts of developing a patient’s risk profile. This helps us determine if the bariatric procedure will be effective and most importantly, safe. Understanding a patient’s general health or lack thereof as well as their lung, kidney and heart function will allow us to learn more about the surgical risk that the patient faces. We then measure that against the short and long-term benefits of bariatric surgery and the gastric sleeve. Of course, if the risk of surgery outweighs the benefits, the procedure is not right for them.

Patients will also have to be in the right frame of mind for long-term lifestyle change before surgery. Patients will meet with our bariatric team to make sure that they understand their responsibilities after surgery, which will include significant dietary and exercise changes. Exceptional weight loss may seem like a given after surgery; however the patient will go through many emotional, hormonal and life changes as they lose weight. They must be prepared to commit to those long-term changes for the betterment of their health and their lives in general.

Patients will have to stop smoking at least 6 to 8 weeks before surgery and preferably longer. Smoking constricts blood vessels, which in turn slow circulation and can cause a host of complications both during and after surgery.

Finally, patients should try to lose some weight before the surgery. Losing even a little bit of weight can improve a patient’s health enough that it could avoid some of the common complications associated with an obese person’s poor general health. While it may seem counterintuitive to lose weight before a weight loss procedure, it will jumpstart the patient’s lifestyle change and make the transition to post-surgery life easier.

Ultimately, knowledge is power. The knowledge that a patient gains by attending a weight loss surgery seminar and/or multiple consultations with their surgeon and/or through the internet is important. So too is the knowledge that our office gleans from preoperative testing. The process makes the entire bariatric surgery process more effective and safer. While the pre-surgical testing routine may seem like a nuisance, it actually represents our office’s dedication to the safety and long-term effectiveness of the procedure.

Many of our patients use the BMI (or body mass index) calculator as the be-all and end-all to see if they qualify for bariatric surgery. While the BMI calculator is a very useful tool, it is simply an approximation of whether a patient is obese or overweight. The main concern with regard to the BMI calculator’s accuracy is what it does not factor into his calculations:

• First and foremost, the BMI calculator does not account for gender differences. Different body types between men and women can change a BMI calculation significant.
• Secondly the BMI calculator does not account for muscle mass. Muscle is heavier than fat meeting that those with a significant musculature may be mistaken for suffering from obesity when, in fact, that is not the case.
• Further, a patient’s body frame is not taken into account when making the calculation. We’ve all heard the term “big boned.” While it is not literally correct, people do have different frame sizes which can alter their BMI.
• The BMI calculator does not take into account a person’s age. As we age, our muscle mass to decreases which can significantly alter the BMI calculation.

All in all, for an average person, a BMI calculator is useful as a step toward understanding if they qualify for bariatric surgery. Several other qualification criteria must be met before bariatric surgery becomes an option for someone who is obese. As such we encourage prospective patients to use the BMI calculator as a general guide and nothing more.

Once you contact our office we will be able to take that BMI calculation and with an evaluation of other criteria, we will be able to help you decide of bariatric surgery, and specifically which procedure, is right for your particular circumstance.