Requirements for Weight Loss Surgery

Although counting calories and working out can lead to weight loss for many people, some still find themselves unable to lose weight. For people with underlying medical conditions, weight loss to be virtually impossible without medical intervention. Those who have exhausted all traditional options for weight loss may want to consider Weight Loss Surgery or a weight loss procedure.

First, only certain people qualify for weight loss surgery, and there are several different types to choose from. Each surgeon has a list of items required before a candidate can qualify for each surgery, and each surgeon’s requirements may be slightly different. A good website to start with to learn more about the requirements of weight loss surgery is

Requirements and considerations for weight loss surgery may include:

  • A person’s body mass index (BMI),
  • comorbidities,
  • the person’s overall health,
  • and previous documented attempts at weight loss.

Body Mass Index is a Big Deciding Factor

A person’s BMI is a major factor in deciding if a candidate qualifies for weight loss surgery. A good candidate needs to be not just slightly overweight, but typically in the Obese I, Obese II, or Obese III categories. It’s important to note that each type of weight loss surgery has a different BMI requirement, which will be covered later. If a person is just slightly overweight, and they plan to pay for the procedure with insurance, the insurance may not cover the surgery unless the patient has additional comorbidities.

Comorbidities Help People Qualify for Weight Loss Surgery

If a person is just shy of qualifying for weight loss surgery based on their BMI, comorbidities can qualify them at the surgeon’s discretion. Comorbidities include health conditions like diabetes, pre-diabetes, heart disease, polycystic ovary syndrome (PCOS), high blood pressure, sleep apnea, nonalcoholic fatty liver disease, and stroke.

Other conditions may also be considered as comorbidities, so it’s important to speak to a medical provider who can help determine if certain medical conditions qualify a patient for surgery. Many times, having one of these additional health conditions can help a person qualify for surgery through their medical insurance. The surgeon may need medical records from the patient’s primary care doctor to submit to the insurance company as proof of poor health.

The Patient Needs to Be Healthy Enough for Surgery

Typically, those seeking weight loss surgery may not be as physically healthy as someone who has been fit their entire life. A surgeon must consider if the patient is healthy enough both mentally and physically to undergo this life-changing surgery. While each surgeon has their own pre-surgery health screening requirements, many insist on clearance from a cardiologist or a heart stress test.

If the patient has a history of bipolar disorder, depression, or suicidal tendencies, mental health screenings and counseling may also be required. A cash patient with no history of mental illness may be able to skip the mental screenings. If the patient is seeking insurance approval for the surgery, these screenings may be required.

An Upper GI may also be ordered to look for pre-existing conditions such as hiatal hernias or esophagus erosion. Many people have this medical condition and aren’t even aware. Having a hernia in the esophagus may disqualify a patient from certain procedures such as the gastric balloon, however, it can be fixed during other procedures such as with the gastric sleeve. If a patient is paying cash for their weight loss surgery, their medical insurance may cover the portion of the surgery for the hernia repair.

Documented Previous Attempts at Weight Loss

Weight loss procedures and surgeries are not for everyone, but they can be a great resource for people who feel they tried everything to lose weight but were not successful. When deciding if the person is a candidate for weight loss surgery, the doctor will ask for a list of weight loss methods the person previously attempted. Counting calories, professional weight loss programs such as Jenny Craig, meal delivery services, and even previous weight loss procedures, will all be taken into consideration. If the person was able to lose weight before but was unable to keep the lost weight off, this will also be noted.

Weight loss surgery is typically a last effort for many people after all other resources have been exhausted. If the person hasn’t tried to lose weight before on their own, or they have no documented efforts, the surgeon may suggest programs or additional programs for the person to attempt before surgery approval. If the patient is going to use insurance to pay for the procedure, the insurance company may also require additional attempts at weight loss before they will cover the procedure.

Weight Loss Success Can Be Affordable

Attempting to lose weight isn’t cheap, especially when a person isn’t getting results. Many people spend thousands a year on gym memberships, monitored weight loss programs, diet shakes, and fitness equipment, and still never lose a pound. A benefit of having weight loss surgery is that the expense is a one-time fee and the person is pretty much guaranteed to lose weight. Many of the procedures do not allow the patient to eat much of anything, giving the body no choice but to use stored fat for energy instead of daily ingested calories.

If the patient’s insurance covers the procedure, the out-of-pocket expense can be minimal. Some insurance may completely cover all costs, which means zero spent out of pocket. Because these procedures require a complete lifestyle change, many patients report saving money after surgery. Savings come from no longer going through fast-food, drive-through lanes on a daily basis, no longer spending money on late-night binges at the bar, having to buy less food overall, and no longer spending money on the latest weight loss fads.

Again, weight loss surgery isn’t an option for everyone, but it can be a lifesaver for those who really need it. There are many different options and procedures available, each with their own risks and benefits. While qualifying and preparing for surgery, it may feel like there are a few hoops to jump through, but in the end, the health benefits and weight loss will be worth it.

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