Knowing the process of qualifying for bariatric surgery is usually the first step that potential surgical patients have to do in order to make their decision about this weight loss treatment method. At BodEvolve Bariatric Surgery Center in Texas, Dr. Frenzel and Brian Holt see many patients every week who are amazed at being eligible for bariatric surgery, and there are even some who are sure that they are eligible but they should do some things before surgery.
Here you can read everything you need to know regarding the criteria of qualification for bariatric surgery.
Do You Qualify for Bariatric Surgery?
For most of the patients reading this, the short answer will be yes. The criteria for bariatric surgery were set by the National Institutes of Health. They are used in almost all certified bariatric programs in America, including BodEvolve.
And here is the basic criteria:
- BMI ≥ 40 – qualifying independent of any other medical conditions
- BMI 35 to 39.9 – qualifying if you have at least 1 obesity-related health condition (Type 2 diabetes, hypertension, obstructive sleep apnea, hyperlipidemia, fatty liver disease or joint problems)
- BMI 30 to 34.9 – qualifying only in certain circumstances, especially with severe Type 2 diabetes or metabolic syndrome, based on your surgeon’s assessment
It all starts with the most crucial number – your BMI.
BMI Requirements for Bariatric Surgery
| BMI Range | Qualifies for Bariatric Surgery? | Condition Required? |
|---|---|---|
| 40 or higher | Yes | None required |
| 35 to 39.9 | Yes | At least 1 obesity-related condition |
| 30 to 34.9 | Case by case | Severe diabetes or metabolic syndrome |
| Under 30 | Generally no | Does not typically qualify |
See our guides BMI for gastric sleeve and BMI for gastric bypass. General BMI criteria for bariatric surgery are discussed in our guide BMI for bariatric surgery.
Note on BMI: BMI is a screening test but not the sole criteria. People with BMI between 35 and 39.9 and multiple obesity-related medical complications are great candidates for surgery. Individuals with BMI above 40 who suffer from serious medical problems are usually preferred. Dr. Frenzel reviews your entire medical profile and not just one criterion.
Medical Qualifications for Bariatric Surgery
In addition to BMI criteria, other bariatric surgery requirements relate to your medical history. The following aspects are included in your medical assessment:
Obesity-related complications which increase your chances of undergoing surgery:
- Type 2 diabetes – one of the strongest indications for the procedure. Type 2 diabetes will be cured in 80-85% of people undergoing the procedure. More information can be found at our article which bariatric surgery is best for type 2 diabetes.
- High blood pressure – is observed in most candidates for the procedure. Hypertension will be cured in about 75% of cases. Additional information can be obtained in our article: does being overweight cause high blood pressure.
- Obstructive sleep apnea – resolves or significantly reduces in 80-85% of patients who had the procedure performed. Detailed information is provided in our article: bariatric surgery for sleep apnea.
- High cholesterol – normalizes in about 70% of patients after the procedure. Our article bariatric surgery for high cholesterol contains more information.
- Fatty liver disease (NAFLD, MASH) – resolves in 65-90% of cases. Information can be found at our article: weight loss for fatty liver disease.
- Joint disease – severe knee, hip, ankle arthritis caused by obesity.
- Gastro-esophageal reflux disease (GERD), acid reflux – particularly important when choosing a procedure.
- Metabolic syndrome – complex of conditions treated at once by the procedure.
The more of these criteria that you have, the better your qualifications are from the medical and insurance perspective.
Medical issues that can affect the timing of surgery or must be optimized prior to it:
- Uncontrolled cardiac disease – must be stabilized first
- Active cancer treatments – surgery should be postponed until completion of treatment
- Uncontrolled psychiatric conditions – must be treated and stabilized first
- Severe liver disease/cirrhosis – must undergo evaluation by hepatologist
- Substance abuse – must have proven period of sobriety
None of the above criteria is a definite exclusion for lifetime.
The Weight Loss History Requirement
All insurance companies and majority of bariatric centers require documentation of weight loss attempts under medical supervision. This requirement is usually not well understood.
Here is what it usually means:
- Documented history of attempts at weight loss through dietary or medical interventions
- All insurances require 3-6 months of dietary weight loss attempt documentation before surgery approval
- Documentation must be provided by physician, registered dietician or medical program
- Participation in weight loss program, physician-directed diets or pharmacologic intervention counts
What it DOES NOT mean:
That you have failed. It means that you have done all non-surgical methods that have been possible in order to get down to a certain level of obesity, and have not worked. It is always the case with most people who have high BMI over 35 or 40. The supervised diet requirement is a documentation requirement, not a punishment.
At BodEvolve, our professionals help patients prepare and collect documentation as a part of the pre-surgical requirements. If the patients are not yet in any supervised program, our non-surgical and GLP-1 weight loss programs will make this documentation possible, along with losing weight before the surgery.
The Psychological Evaluation Requirement
Each program of bariatric surgery requires the patient to take the psychological evaluation test before the surgery. There is no way around it, and you should not be afraid of it. It is just a normal safety measure taken to make sure that patients are ready for the huge lifestyle changes after the surgery.
What psychological evaluation includes:
- History of Mental Health – screening for conditions that may impact your surgical outcome
- Understanding of what surgery entails – verification of realistic expectations
- Support system – verifying that you have people around you during recovery
- Eating habits – verification of disordered eating disorders that need to be addressed
- Motivation and readiness – verification that you are doing the right thing for the right reasons
What psychological evaluation is not about:
It is not a test that you will fail if you answer honestly. It is not supposed to exclude candidates. Most patients pass the evaluation successfully. Patients who are treated and stable in terms of mental health including patients with depression and anxiety frequently qualify – these are extremely common among obese patients and will not disqualify you.
The evaluation usually consists of one or two visits to a licensed psychologist or clinical social worker. To know more check out our article on bariatric surgery psychological evaluation.
Age Restrictions
- Standard age group: 18-65 years old is the standard qualification age range at most centers.
- Under 18 years: adolescent bariatric surgery is performed at specialized pediatric centers under additional criteria. BodEvolve works with adult patients only.
- Over 65: Age is not a reason to deny surgery. Every patient over 65 years old is assessed as an individual according to overall health status, physical condition, and level of risk.
Insurance Requirements for Bariatric Surgery
If you have any type of health insurance that covers bariatric surgery, you need to go through the insurance process. Here is what needs to happen in most cases:
Step 1: Check if your insurance plan covers bariatric surgery
Not all plans provide coverage for this procedure. You may check this information by looking at your insurance card and/or policy papers or we will assist you with this during the consultation.
Step 2: Pass the medical criteria of your insurance company
Most plans use NIH guidelines (BMI 40+ or BMI 35+ with comorbidities) but some plans have different standards. We will inform you about the criteria of your specific insurance plan.
Step 3: Follow the required supervised diet program
The supervised diet period of 3 to 6 months is usually required for most of the insurance companies. It should be supervised by a physician or nutritionist.
Step 4: Meet insurance evaluation requirements
Psychological assessment, nutritional assessment, and medical clearance are generally necessary for both insurance companies as well as for BodEvolve prior to surgery.
Step 5: Apply for pre-authorization
Our staff will take care of the insurance application procedure. All paperwork will be gathered and submitted for you.
Complete step-by-step insurance guide can be found here: How to make insurance pay for weight loss surgery.
For those without health insurance coverage:
BodEvolve has self-pay bariatric surgery options and bariatric surgery financing. For specific cost information see bariatric surgery cost without insurance.
What Actually Disqualifies You From Bariatric Surgery
Many patients are concerned about any possible disqualifications. Below is the list of things that may cause a delay in or stop your surgery:
Absolute contraindications (very rare):
- Untreated cancer
- Untreatable organ failure without transplantation
- Untreated substance abuse
- Unable to meet the post-surgical requirements
Temporary disqualifications (solvable):
Many patients are concerned about contraindications. Here is the honest list of items that will cause a delay or even disqualification from surgery:
Contraindications absolute (rare):
- Untreated active cancer
- End-stage organ failure with no intent on transplantation
- Untreated active substance abuse
- Inability to cooperate with post-operative regimen
Contraindications temporary (treatable):
- Untreated active diabetes — must be optimized prior to surgery
- Active smoking — usually a minimum of 6 weeks abstinence before surgery is required by most programs
- Untreated active unstable cardiac disease — must have a cardiology clearance
- Untreated active severe depression or psychosis — must be stabilized by treatment
- Untreated H. pylori infection
The important thing here is that all “contraindications” are treatable conditions that just need to be corrected before the procedure, not any absolute bars for surgery. Dr. Frenzel and his team do everything to bring patients to the operating room — not to refuse them.
The Step-by-Step Qualification Process at BodEvolve
Here is what will occur from your initial contact to surgery day:
Step 1: Initial Consultation
Consult with either Dr. Frenzel or Dr. Holt. Review your BMI, medical background, history of weight loss attempts, goals and discuss surgical options available to you. Learn about life after surgery from our post-bariatric surgery Dallas.
Step 2: Insurance Verification
Our office contacts your insurance company to verify your insurance specifics.
Step 3: Pre-Surgical Evaluations
Complete blood work, heart evaluations if needed, nutrition evaluation done by our dietitian and psychological evaluations.
Step 4: Supervised Diet Period
Complete the required supervised diet period. Your history may allow you to start partway through this process.
Step 5: Insurance Submission
All your documentation will be gathered and submitted for pre-authorization.
Step 6: Pre-Operative Preparation
Complete your pre-bariatric surgery diet and liver shrinking diet protocol. Complete pre-op class.
Step 7: Surgery
Surgery usually takes place over 1-2 days. Patients are usually discharged in 24-48 hours.
The entire time from first visit to surgery day takes approximately 3-6 months depending upon insurance requirements.
Which Procedure Is Right for You?
Eligibility for bariatric surgery and determining the best kind of procedure are two different decisions. We provide the following options at BodEvolve:
1. Gastric Sleeve Surgery – most common operation with good results for majority of eligible people
2. Gastric Bypass Surgery – works best for patients with severe diabetes or major acid reflux
3. Duodenal Switch Surgery – produces greatest weight loss for patients
4. SADI-S Surgery– new procedure with great results
5. Revision Surgery – recommended for those who previously undergone bariatric surgery
For more information about the which is the most effective weight loss surgery, that would work for you visit our page which bariatric surgery is the most effective for weight loss.
Bariatric Care Across Texas
BodEvolve provides treatment services to all patients within the Dallas-Fort Worth Metroplex and East Texas regions. Our board-certified bariatric doctors are available at Richardson, Arlington, Dallas, and Texarkana.
Call us at 817-342-0232 or Book Your Consultation today.
