Qualifying for Weight Loss Surgery

Posted On : October 23, 2010

Written by Ara Keshishian, MD, FACS, FASMBS
Last updated: October 23, 2010

The National Institutes of Health (NIH) has set the criteria for qualifying for weight loss surgery. Most surgeons and insurance companies abide by these guidelines. Surgery should be considered for individuals who can show that dietary attempts at weight control have been ineffective and have a BMI greater than 40 or greater than 35 in the presence of comorbidities. If your BMI is between 35 and 39.9 your insurance company may require that that you also have at least one of the following obesity related comorbidities: sleep apnea, diabetes or hypertension. Check with your insurance company on their policy. Patients considering weight loss surgery should be well-informed and motivated with acceptable operative risks. The patient must clearly and realistically understand how their lives may change after operation and be able to participate in treatment and long-term follow-up. These guidelines apply to adults only.  

BMI Calculator

Body mass index (BMI) is a measure of body fat based on height and weight that applies to both adult men and women. BMI does not differentiate between body fat and muscle mass. Therefore, body builders and people who have a lot of muscle bulk will have a high BMI but are not overweight. A BMI > 35 indicates you may qualify for weight loss surgery. Calculate you Body Mass Index (BMI)  Free BMI Script by BMI-Club  Waist circumference  BMI Range     Meaning < 18.5            Underweight 18.5 – 24.9     Normal 25.0 – 29.9     Overweight 30.0 – 39.9     Obese 40.0 – 49.9     Morbid Obesity > 50              Super Morbid Obesity

Obesity Comorbidities

To follow is a list of comorbidities (additional conditions or diseases) related to obesity which may help you in qualifying for weight loss surgery.

• Family history of heart disease
• Family history of stroke
• Family history of diabetes
• Family history of heart attacks
• Hyperinsulinemia
• Diabetes
• High blood pressure
• Coronary-artery disease
• Hypertension
• Migraines or headaches directly related to obesity or cranial hypertension
• Congestive heart failure
• Neoplasia
• Dyslipidemia
• Anemia
• Gallbladder disease
• Osteoarthritis
• Degenerative arthritis
• Degenerative disc
• Degenerative joint disease
• Recommended joint replacement from specialist
• Accelerated degenerative joint disease
• Asthma
• Repeated pneumonia
• Repeated pleurisy
• Repeated bronchitis
• Lung restriction
• Gastroesophageal reflex (GERD)
• Excess facial & body Hair (Hirsutism)
• Rashes
• Chronic skin infections
• Excess sweating
• Frequent yeast infections
• Urinary stress incontinence
• Menstrual irregularity
• Hormonal abnormalities
• Polycystic ovaries
• Infertility
• Carcinoma (breast, colon, uterine cancer)
• Sleep apnea
• Pseudotumor cerebri
• Depression
• Psychological/sexual dysfunction
• Social discrimination
• Premature death

  For more information on the NIH qualifications for weight loss surgery:  Gastrointestinal surgery for severe obesity. Proceedings of a National Institutes of Health Consensus Development Conference, March 25-27, 1991.