There are different types of weight loss surgery, which are generally known as bariatric surgery, but the purpose of all weight loss procedures is always to help patients lose weight and improve their overall health. When patients struggle with obesity and exercise and diet are not successful, weight loss surgery is often an option. To do so, surgeons limit the size of the stomach and the amount of food that can be ingested, while in some cases the digestive system itself is also altered.
Despite the fact that having surgery to facilitate the process of losing weight may seem appealing, it is not for everyone. It is a surgical procedure and therefore has risks and contraindications associated with it. As a result, there are bariatric surgery eligibility criteria that need to be met for patients to be submitted to bariatric surgery, while there are also recommendations that should be followed to decrease risks and increase the success of the procedure.
Bariatric Surgery Eligibility Criteria
All patients considering bariatric surgery at Penn must meet specific criteria before they can be considered for a screening evaluation.In order to qualify for bariatric surgery, patients need to have a Body Mass Index (BMI) higher than 40, or more than 100 pounds overweight. In the case of at least two obesity-related co-morbidities such as type II diabetes (T2DM), hypertension, sleep apnea and other respiratory disorders, non-alcoholic fatty liver disease, osteoarthritis, lipid abnormalities, gastrointestinal disorders, or heart disease, the BMI required is 35 or higher.
Each case is specific and a medical team, often including a doctor, dietitian, psychologist and surgeon, will analyze not only the requirements, but also other features to declare a patient’s eligibility for bariatric surgery. If a patient hasn’t tried other non-surgical methods to lose weight, it is often recommended as a first option. The medical team will evaluate the patient’s nutrition and weight history to understand weight trends, efforts to lose weight, exercise regimen, levels of stress, timing and other criteria.
The patient’s medical history is also analyzed to seek comorbidities associated with obesity and other medical conditions that may increase the risks of having a surgery. In specific cases, the medical team may recommend bariatric surgery to patients with a BMI between 30 and 34 and severe medical conditions, as well as to underage patients.
A documented history of weight management and weight loss attempts with supervised diets and exercise programs.
No indication of active alcoholism, active drug addiction or major psychiatric disorder.
Surgeons at the Penn Metabolic & Bariatric Surgery Program will evaluate other criteria, such as a patient’s age and general health, to determine if bariatric surgery is appropriate.
Bariatric Surgery Screening Process
Once it has been determined that there are no medical issues that would preclude a patient from surgery, a nutritional evaluation is conducted. In some cases, patients are also evaluated by physical therapy and social service professionals to ensure that they have all the necessary support structures in place at the conclusion of surgery and upon discharge.
In some cases, the type of surgery desired by the patient will not offer optimal outcomes. For these individuals, a different type of bariatric surgery or an alternative treatment may be recommended.
Periodically, a patient will be required to meet certain criteria — such as losing weight, attending counseling or undergoing physical therapy — before surgery is scheduled. This course of action helps to ensure that the patient will have the best possible chance of recovering from the surgery and succeeding at weight loss.
Patients who successfully complete the screening process and obtain insurance approval may now schedule and prepare for surgery.
Pre-operative Psychology Screening
Surgical treatment for morbid obesity changes a person’s relationship with food. Therefore, it is essential as part of the pre-operative assessment process that all patients undergo a psychological evaluation.
Patients are assessed for their:
- Psychiatric history
- Current psychological function
- Weight and dieting history
- Current eating behaviors
- Level of physical activity
During the evaluation, patients are also educated on the behavioral changes necessary to ensure good post-operative results, as well as any psychological changes that can be anticipated after surgery.
Pre-operative Medical and Surgical Screening
The pre-operative medical and surgical screening determines whether patients are healthy enough for bariatric surgery. The screening involves a series of tests to rule out a medical issue as the cause of obesity.
Tests are also performed to determine if patients have any obesity-related diseases such as diabetes, heart disease, hypertension, pulmonary disease, sleep apnea, vascular disease or depression and how these disorders affect their health. It’s important to note that patients with advanced heart or lung disease may not be appropriate surgical candidates.
Some of the pre-operative tests that may be required include:
Blood studies including a complete blood count (CBC), blood urea nitrogen (BUN), cortisol, creatinine, electrolytes, prolactin and thyroid-stimulating hormone (TSH)
Liver function tests
Pulmonary function tests
Upper gastrointestinal (GI) evaluation
Patients also keep a food diary to record their daily intake and learn the principles of post-operative gastric bypass, including dietary progression, protein and fluid requirements, and lifelong vitamin and mineral supplementation.