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Am I a Candidate for Metabolic and Bariatric Surgery?

If you are reading this, you may be asking one of two questions:

• Do I qualify for metabolic and bariatric surgery?
• Is surgery the right choice for me?

Those are different questions.

Qualifying is based on numbers and medical criteria. Being a good candidate also depends on readiness, safety, expectations, and whether surgery is the right tool for your situation.

You may meet every guideline on paper and still need time to prepare. You may also be a better candidate than you realize. The purpose of an evaluation is to look at the complete picture—not just one number.

Obesity Is a Chronic Disease

Obesity is not a character flaw, a failure of discipline, or a lack of effort.

Your body actively defends its weight through hormones, hunger signals, and changes in metabolism. This is one reason diets may work temporarily and then become difficult to maintain. It does not necessarily mean that you did something wrong. Your biology may have been working against long-term weight loss.

Metabolic and bariatric surgery is one of the most effective long-term treatments available for obesity and related metabolic disease. It is not a shortcut and it is not cosmetic surgery. It is a medical treatment for a chronic medical condition.

Do I Meet the Criteria?

The 2022 guidelines from the American Society for Metabolic and Bariatric Surgery and the International Federation for the Surgery of Obesity and Metabolic Disorders are broader than the older criteria many patients still hear about.

You may be a candidate if:

• Your BMI is 35 or higher, whether or not you have another obesity-related health condition.
• Your BMI is between 30 and 34.9 and you have metabolic disease, most commonly type 2 diabetes that is not adequately controlled. Other metabolic conditions may also be considered.
• Your BMI is 27.5 or higher and you are of Asian descent. Health risks associated with excess weight may begin at lower BMI values in Asian populations. A BMI of 25 or higher in this population already indicates clinical obesity.
• You are over age 70. Age alone is not necessarily a barrier. Older adults may be considered after an individualized review of the potential risks and benefits.
• You are an adolescent with a BMI above 120% of the 95th percentile for age and related medical problems, or above 140% of the 95th percentile.

A Note About BMI

BMI is an imperfect tool. It does not distinguish muscle from fat, and it does not show where fat is stored in the body. It is used because it is a standard measurement, not because it tells us everything about your health.

Your evaluation will consider much more than BMI.

If your BMI is below 35 and you do not have metabolic disease, current guidelines generally recommend beginning with nonsurgical treatment. This does not necessarily mean that future options are closed. It means that treatment should begin with the approach most appropriate for your current situation.

Conditions That May Improve After Surgery

Excess weight is associated with many health conditions that may improve—and in some cases resolve—after metabolic and bariatric surgery.

Tell us about any conditions you have, because they are important both medically and when determining insurance requirements. These may include:

• Type 2 diabetes or prediabetes
• High blood pressure
• Obstructive sleep apnea
• Fatty liver disease
• High cholesterol or high triglycerides
• Osteoarthritis of the knees or hips
• Acid reflux
• Polycystic ovary syndrome or infertility
• Urinary stress incontinence
• Heart disease

In some circumstances, weight-loss treatment may also help make another necessary operation safer or possible—for example, joint replacement, hernia repair, or organ transplantation.

When Surgery May Not Be the Right Choice

Being honest about safety is an important part of the evaluation. Surgery may not be safe or appropriate in certain circumstances, including:

• Severe heart failure or unstable heart disease
• End-stage lung disease
• Active cancer, until treatment has been completed
• Cirrhosis with portal hypertension
• Active, uncontrolled drug or alcohol dependency
• Crohn’s disease, depending on the situation and procedure being considered
• Current pregnancy or plans for pregnancy within the next 12 to 24 months
• An inability to understand the procedure or participate in the changes required after surgery

Some of these situations may be temporary. If one applies to you, ask what steps may be needed to improve your health and whether surgery could become an option later.

What Makes Someone a Good Candidate?

Meeting the medical criteria is only the beginning. Long-term success also depends on preparation and follow-through.

A good candidate understands that:

Surgery Is a Tool—Not a Cure

Surgery changes your anatomy and affects hormones involved in hunger, fullness, and metabolism. It does not make decisions for you or eliminate the need for ongoing healthy behaviors.

Vitamins Are Lifelong

You will need to take recommended vitamins and supplements every day for the rest of your life. This is essential. Skipping supplements can lead to serious and sometimes permanent problems involving your blood, bones, and nervous system.

Follow-Up Care Matters

Regular follow-up is important—not only during the first year, but over the long term. Staying connected with your surgical team helps identify nutritional problems, weight changes, and other concerns early.

Eating Habits Will Change

After surgery, you will need to permanently adjust how you eat. This may include:

• Eating smaller portions
• Prioritizing protein
• Avoiding drinking with meals
• Chewing food thoroughly
• Following the nutrition plan provided by your care team

Support Helps

Support from family, friends, a support group, or behavioral-health professionals can make the process easier. If you do not currently have support, we can discuss ways to build it.

Mental Health Should Be Addressed

Depression, anxiety, binge eating, and a history of trauma do not automatically disqualify you from surgery. However, untreated or unrecognized mental-health concerns can make preparation and recovery more difficult.

The purpose of a mental-health evaluation is not to judge you or create a test you can fail. It is an opportunity to identify support that may help you before and after treatment.

What Happens During the Evaluation?

Qualifying on paper is the beginning of the process. Every patient undergoes a comprehensive evaluation designed to promote safety and help determine which treatment is most appropriate.

Medical History and Physical Examination

We review your health history, weight history, previous weight-loss attempts, medications, supplements, and other medical conditions.

Laboratory Testing

Blood tests may be used to evaluate your surgical risk and identify vitamin or mineral deficiencies. Many patients have nutritional deficiencies before surgery, and correcting them beforehand is important.

Nutrition Evaluation

A registered dietitian will evaluate your current eating patterns and help you begin preparing for the nutritional changes required after treatment.

Mental-Health Evaluation

This evaluation helps identify concerns that may benefit from treatment or support. It is part of preparing you for the best possible outcome.

Additional Testing When Needed

Depending on your history, additional evaluation may include:

• A sleep study
• An upper endoscopy
• Cardiac testing
• Evaluation by another medical specialist

Pregnancy and Contraception Counseling

If pregnancy is possible or relevant to your care, we will discuss timing, contraception, and the recommended waiting period after surgery.

Insurance Requirements

Insurance requirements vary by plan. Some plans may require a supervised diet program, documentation of previous weight-loss attempts, or records of obesity-related medical conditions.

Our team can help you understand what your insurance plan requires.

Choosing the Right Procedure

There is no single best procedure for every patient. The best procedure is the one that fits your individual health needs, goals, and circumstances.

The recommendation may depend on:

• Your BMI
• Whether you have diabetes or other metabolic disease
• Whether you have acid reflux
• Previous abdominal surgery
• Your other medical conditions
• The level of lifelong nutritional monitoring required
• Your ability and willingness to follow the necessary postoperative plan

During your consultation, we will discuss the available treatment options and explain why one approach may be more appropriate for you than another. The decision is made together, and no one procedure is automatically right for everyone.

You may also review our separate guides for the procedures we perform. These guides provide additional information about each operation, including expected results and other considerations.

You can also watch the related educational video: https://youtu.be/CbzHQ2lmODA

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