Do I Qualify For Weight Loss Surgery?

Do I Qualify For Weight Loss Surgery?

Most people think that you must be “morbidly” obese (I hate that term), to qualify for weight loss surgery. This likely stems from watching television where only the most severe cases, typically patients weighing 500 lbs or more tend to be shown. 

While we certainly do operate on patients in that “superobese” range, the truth is the overwhelming majority of our patients are nowhere near that level of severity. In fact, if you walked down a typical street in North America, you would be shocked at just how many people would qualify for weight loss surgery.

Who qualifies for weight loss surgery?

Most people are surprised to learn that the rules for who qualifies for weight loss surgery were conceived almost 30 years ago and have remained largely unchanged since then! At the time, there wasn’t much research available on this topic, so a group of experts at the National Institute of Health (NIH) simply came up with a set of criteria that they felt were reasonable.

Weight loss surgeries were quite different in the ’90s compared to today. Back then, surgeries were: 

  1. Riskier and carried significant rates of complications
  2. Much more invasive and performed through a large incision rather than laparoscopically
  3. More limited in terms of options since less technically complex surgeries like the gastric sleeve did not yet exist
  4. Required a substantially longer recovery time. 

Given these facts, it’s not surprising that the experts came up with criteria that limited surgeries to patients who were on the more severe end of the spectrum. Their criteria, which is still used to this day, is as follows:

  • BMI ≥ 35 with obesity-related medical conditions (e.g., diabetes, high blood pressure, high cholesterol, sleep apnea, coronary artery disease, etc.)
  • BMI ≥40 with or without obesity-related medical conditions

Notice that the qualifications for gastric sleeve surgery rely on a person’s BMI (“body mass index”) rather than weight. Have a look at this blog post to better understand what BMI is.

What if I want gastric sleeve surgery but my BMI is not quite high enough? 

Since the original eligibility criteria for weight loss surgery were originally conceived almost 30 years ago, a large amount of research has emerged showing that many more patients than those who currently qualify, would unequivocally still benefit from bariatric surgery.

Considering the dramatic health benefits of bariatric surgery as well as its minimally invasive nature and excellent safety profile, many leading professional organizations now recommend that surgery be offered to patients with a lower BMI

Specifically:


Great news, right? Well, not so fast. 

Unfortunately, most healthcare plans are not keen to incur the extra costs of covering this expanded group of patients with a lower BMI despite the clear benefits of weight loss surgery. 

So what does this mean? 

It means that in practice there are in essence two different sets of criteria for weight loss surgery: insurance/healthcare plan and out-of-pocket/private healthcare. For patients willing to pay out of pocket, most bariatric surgeons will readily perform surgery at the lower BMI range. However, for patients paying via insurance or a healthcare plan, the original criteria in determining weight loss surgery eligibility from 1991 still stand.

Are you considering weight loss surgery? Complete our Qualification Questionnaire here and find out if you qualify.

Hear it From Others

 

As one of the leading weight loss surgeons in Canada, Dr Gmora has gained a reputation for being a master of his surgical craft and producing outstanding weight loss results.

 

SEE WHAT OTHERS ARE SAYING