Weight-loss surgery: Is it an option for you?

November, 15th, 2023

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Weight-loss surgery changes the shape and function of your digestive system. This surgery may help you lose weight and manage medical conditions related to obesity. These conditions include diabetes, obstructive sleep apnea, and risk factors for heart disease and stroke.

Weight-loss surgery is also known as bariatric surgery. There are various surgical procedures, but all of them help you lose weight by limiting how much food you can eat. Some procedures also limit the amount of nutrients you can absorb.

In the U.S., the most common weight-loss surgery is sleeve gastrectomy. In this procedure, the surgeon removes a large portion of the stomach to create a tubelike sleeve.

Weight-loss surgery is only one part of an overall treatment plan. Your treatment will also include nutrition guidelines, exercise and mental health care. You’ll need to be willing and able to follow this long-term plan to achieve your weight-loss goals.

If you’re considering weight-loss surgery, you’ll meet with a number of specialists to help you decide if weight-loss surgery is an option for you.

Medical guidelines

The general medical guidelines for weight-loss surgery are based on body mass index (BMI). BMI is a formula that uses weight and height to estimate body fat. Weight-loss surgery might be an option for an adult with a BMI of 40 or higher.

The surgery may also be an option for an adult who meets these three conditions:

• BMI of 35 or higher
• At least one obesity-related medical condition
• At least six months of supervised weight-loss attempts

In some cases, weight-loss surgery may be an option for adolescents. The guidelines include:

• BMI of 40 or higher and any obesity-related medical condition
• BMI of 35 or higher and a severe obesity-related medical condition

Instead of using these BMI numbers as a guideline for surgery, a surgeon may use growth charts for adolescents. These charts show the standard BMI range for each age. The surgeon may recommend the procedure based on how much the adolescent’s BMI is above the standard BMI range.

Depending on the type or severity of an obesity-related illness, some adults or adolescents with lower BMIs may be able to undergo weight-loss surgery.

How to know if you’re ready for surgery

If you’re considering weight-loss surgery, you’ll meet with a health care team that may include the following:

• Primary care doctor
• Surgeon
• Anesthesiologist
• Dietitian
• Nurse specializing in weight management
• Psychologist or psychiatrist
• Other specialists depending on your medical conditions

Members of your team will explain what to expect before and after the procedure. They will evaluate whether you’re ready for surgery and help you decide if it’s an option for you. They may identify concerns to address — medical, behavioral or psychological — before you’re ready for surgery.

Medical concerns

You’ll have a medical exam to diagnose any unknown obesity-related conditions. Your doctor also will test for problems that could make surgery more complicated. You may undergo tests for:

• Sleep apnea
• Cardiovascular disease
• Kidney disease
• Liver disease

You’ll likely not be able to have surgery if you have these conditions:

• Blood-clotting disorders
• Severe heart disease that prohibits the safe use of anesthesia
• Other conditions that increase the risk of using anesthesia

Behaviors and mental health

Weight loss after surgery depends on your ability to change behaviors in eating and exercise. Also, being in good mental health is important for the demands of following your treatment plan. Your team’s goals are to identify psychological or behavioral risk factors, address any problems, and decide whether you’re ready for surgery.

Your health care team will talk with you about the following:

• Motivation. Are you motivated to embrace lifestyle changes, set goals and educate yourself about healthy nutrition? Your team will track your ability to follow recommended changes to your diet and exercise routine.
• Weight-loss history. What dieting and exercise plans have you used in the past to lose weight? Did you lose weight or regain weight? Patterns in weight loss and weight gain can help your team understand challenges for you and recommend strategies for post-surgical plans.
• Eating behaviors. Irregular eating behaviors or eating disorders may contribute to obesity. These include binge eating, nighttime eating and unplanned grazing between meals. Some eating disorders are associated with other mood disorders and other mental health conditions.
• Mood disorders. Depression, anxiety, bipolar disorder or other mood disorders are associated with obesity, and these conditions may make it difficult to manage your weight. Also, people with untreated mood disorders often find it difficult to stick with new diet and exercise habits after surgery.
• Alcohol and drug use. Problems with alcohol or drug use, as well as smoking, are associated with poor weight loss and continued substance use problems after surgery. Untreated or unmanaged problems likely prohibit the option of weight-loss surgery.
• Suicide risk. There is an increased risk of suicide among people who have undergone weight-loss surgery. The risk is higher among people with depression, anxiety, bipolar disorder, substance use disorder, schizophrenia or other disorders.

Pre-surgery expectations

If your team members recommend bariatric surgery, they will work with you to develop a treatment plan. This may include:

• Nutrition guidelines. The dietitian will help you with nutrition guidelines, vitamin supplements and menu planning. The guidelines include changes before and after surgery.
• Exercise plan. A nurse, occupational therapist or other specialist will help you learn appropriate exercises, develop an exercise plan and set goals.
• Weight loss. You may be encouraged or required to lose some weight through diet and exercise before you can have surgery.
• Psychotherapy. You may be required to begin talk therapy, drug treatment or other mental health therapy to treat an eating disorder, depression or other mental health condition. Your therapy may include developing new coping skills or addressing your concerns about body image or self-esteem.
• Smoking. If you smoke, you’ll be asked to quit smoking or participate in a program to help you quit.
• Other treatments. You’ll be expected to follow treatments for other medical conditions.

These requirements are intended to help you achieve the best possible weight-loss outcomes after surgery. Also, your ability to follow through on these plans will show your team how motivated you are to follow guidelines after surgery. Weight-loss surgery can be delayed or canceled if your health care team determines that:

• You’re not psychologically or medically ready for surgery
• You haven’t made appropriate changes in your eating or exercise habits
• You gained weight during the evaluation process

Paying for surgery

Your insurance company may cover the costs of weight-loss surgery. Your team will need to show that the procedure is medically necessary. Also, you may need to provide documented evidence that you weren’t able to lose enough weight with a supervised program of diet and exercise. Medicare and some Medicaid programs may cover the costs.

It’s important to research your insurance coverage and your expected out-of-pocket costs. Your hospital may have services to help you explore options for financing your surgery.

Is bariatric surgery right for you?

A team of doctors, nurses and other specialists will help you determine whether this is an appropriate option for you.

The process the team uses to determine if you’re ready for weight-loss surgery is also there to help you make an informed decision. You will need to consider the benefits and risks, follow through with pre-surgery and post-surgery plans, and make a lifelong commitment to a new nutrition and exercise program.