Research shows that weight loss surgery can be beneficial for individuals between 35 and 39.9 BMIs with comorbidity (obesity-related health conditions) such as obstructive sleep apnea, high blood pressure, high cholesterol and Type II Diabetes.
While overall requirements vary depending on each weight loss surgery, a person could be a candidate for weight loss surgery if they are more than 100 pounds over their ideal body weight, have a BMI of 40 or more or 35 and more with one comorbidity or unable to achieve a healthy body weight for a long period of time even with medically-supervised dieting. Those seeking weight loss surgeries must be ready to commit to a healthy and active lifestyle. They also should not have any medical conditions that could put them at risk for serious complications during or after surgery. Ideal candidates are 18 years of age or older.
During an initial consultation with a weight loss surgeon, the details of several procedures will be discussed. Depending on one’s weight, health goals and overall health, various surgical procedures will be recommended. Each surgery has different requirements for candidacy although overall there are similarities to all of the weight loss procedures available.
Lap Band Requirements
Ideal candidates will be 18 years old, have a BMI of 30 or more, have been overweight for longer than 5 years, do not have a disease that caused weight gain, are committed to a healthy lifestyle and have made past attempts to lose weight on their own with no success.
Gastric Sleeve Requirements
This restrictive operation does not require any type of maintenance like that of gastric banding. An ideal gastric sleeve candidate would have a BMI of over 30 and/or suffer from obesity-related health conditions such as high blood pressure, Type II Diabetes, obstructive sleep apnea or heart disease. They also will have attempted to lose weight in the past without much success. They must be mentally capable (a psychological evaluation will be required). Candidates must be drug and alcohol free. This is ideal for someone looking for a low maintenance weight loss surgery with no adjustments needed. Oftentimes the gastric sleeve surgery is done as a part of a two-part weight loss surgery procedure. This allows patients to lose a good amount of weight before embarking on gastric bypass surgery.
Gastric Bypass Requirements
Ideal gastric bypass candidates have a BMI of 40 or more, suffer from comorbidities such as sleep apnea, Type II Diabetes, high blood pressure or cholesterol and have attempted to lose weight in the past without success. They also must be mentally capable and free from all alcohol and drugs before surgery. Ideally this surgery is for those morbidly obese who are at a weight that is negatively affecting their health and can or will lead to a shortened life expectancy.
Insurance Coverage
Generally many insurance companies will cover 50% or more of bariatric surgeries especially if the surgery itself is considered a medical need and the patients meet the requirements needed to qualify. For those on Medicare, 90-100% of all costs will generally be covered.
Ultimately, specific coverage will vary from insurance companies. However, a qualified surgeon can help interested patients pre-qualify and go through the pre-authorization process. During this pre-authorization process, a doctor will have to show documented proof and medical history to showcase how weight is affecting the patient’s overall health and quality of life.
Many insurance companies will want potential patients to go through a six month diet with a medical professional before even considering them for the surgery itself. Generally a patient must go through an entire psychiatric evaluation as well as a nutritional evaluation in order to be recommended and approved by one’s insurer for coverage. This will demonstrate whether or not the particular person is ready for a total lifestyle change and is commitment to remaining healthy and active for a lifetime.
All of these requirements help to guarantee as safe and effective procedure as possible for various patients. While each patient has different weight loss goals and medical history, by setting forth a variety of requirements qualified surgeons can better prepare patients for the most success by only offering surgery to those that can see real results from it.