Why are there so many restrictions on the Bariatric/Gastric bypass surgeries? I am 5'7.5" and weigh 190, but i'd have to gain another 100+ pounds to qualify for the surgery. Why can't I qualify for it now considering the average chart would say I'm "obese"?
Why Am I Not Qualified for Bariatric Surgery?
Doctor Answers 3
Guidelines for Bariatric Surgery
The NIH (National Institute of Health) set forth some guidelines for weight loss surgery. These guidelines are followed by insurance to allow "coverage" for these procedures. If a person's BMI is 35 to 40 AND that person also has conditions associated with being overweight such as Diabetes and Hypertension then that person may qualify for surgery. If a person is significantly overweight that they have a BMI > 40 then they also may qualify. There may be a situation in which a patient has a BMI of 36 (for example) and no other medical conditions, then this patient would not typically be covered by insurance. Consult with your insurance company and ask if you have bariatric benefits and the criteria for this type of surgery.
Weight requirements for bariatric surgery
The criteria to qualify for weight loss surgery is a BMI of 40 with no medical problems or a BMI of 35 with medical problems related to obesity. The Lap-Band procedure should be approved for BMI 30 - 35 in the very near future but will probably not be covered by insurance. The reason is that it has only been shown to improve medical problems when you meet these criteria and then considered medically necessary.
Risk of surgery vs. reward
The guidelines for bariatric surgery are based on balancing the risk of surgery with the health benefits of losing weight. Yeah, sure, it would be nice to be thinner, but with a BMI less than 30, the surgery would be more dangerous than staying overweight. It's true that surgery is much safer these days, but we still are obligated to "first do no harm" in our recommendations.
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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.