Criteria for weight loss surgery

The following guidelines are used to determine suitability for obesity surgery:

The criteria as defined by NICE (National Institute of Clinical Excellence) are:

  • You have a BMI (Body Mass Index) of 30 and above. This defines you as ‘obese’. It tends to be a BMI of 30 plus an obesity-related condition or 40 and upwards (morbidly obese).
  • Lower age limit of 18 and an upper age limit of 60.
  • You have been obese for the last five years and have tried all forms of weight management strategies. These include diet and exercise plans and weight loss medication. You will need to prove that you have tried these but without any success. This means that you have either failed to lose weight or have managed to do so but have been unable to maintain it.
  • There is a substantial risk to your health (now or in the future) or you are suffering from an obesity-related illness.
  • You are fully committed to the aftercare programme. You are prepared to make lasting changes to your current lifestyle. This means attending regular follow up sessions, following a set diet and exercise routine and taking vitamin/mineral medication if required.

These criteria may seem stringent but they are designed to protect you and the surgeon. They are there to ensure that you know exactly what is required before committing yourself to surgery.

Obesity surgery is a major undertaking and one that you need to be absolutely clear about. Even when you have had surgery you will need to monitor your progress on a regular basis or else you run the risk of regaining weight.

Another factor here is the danger of you undergoing unnecessary surgery: obesity surgery is for those patients who are facing long term dangers to their health. If you are overweight rather than obese then this type of surgery is not required. A well planned diet and exercise regime is one option. As we have already mentioned, it is risky so if you don’t need it why put yourself through it.

As well as being suitable another issue is that of what procedure you should have. All patients are individuals, with different needs and requirements and even though there is a set of criteria, your surgeon will take other factors into account. Your own personal health profile will be considered as well as your personality and lifestyle.

Depending on your personal circumstances, a particular procedure such as gastric banding might be a more suitable option than gastric bypass.

It may be a good idea to talk to a healthcare professional with expertise in this area. He/she will be able to talk you through the different procedures. You can then weight up the pro’s and cons of each before deciding which one to choose. You may prefer to do this with your surgeon but your surgeon tends to be skilled in a particular procedure (e.g. Roux-en-Y bypass) and so will only be able to recommend that procedure. Try and get an objective opinion in respect of these procedures.

Your healthcare professional will take the following factors into account before recommending a particular procedure:

  • Your current weight and BMI (body mass index).
  • Sex
  • Ethnic background. There is some evidence to show that some ethnic groups are more prone to excessive weight gain than others.
  • Body type (somatype), body fat distribution and waist measurement.
  • Age. Are you under 18 or over 60?
  • General health. Are you suffering from an obesity-related illness such as Type II diabetes? Are you generally in poor health? Are you taking any medication and if so what type?
  • Psychological factors. Are you suffering from anxiety and depression? There are some medications for mental illness which include weight gain amongst there side effects. For example, several known anti-depressants can cause weight gain.
  • Weight management history.
  • Genetic factors. Do you suffer from a genetically based condition which causes weight gain?

Your BMI (Body Mass Index) is a very important factor when deciding upon a procedure. The level or classification can determine which type of surgery you should have and why. In order to help you with this decision the following table contains a list of BMI classifications and suggested procedures.

BMI

Obesity Procedures

27 - 29

This is classed as ‘overweight’.

Short term weight loss is recommended. To be followed a long term commitment to a healthy lifestyle.

Procedure: Non-surgical. Gastric balloon (BIB system).

30 - 35

This is classed as ‘obese’ (lower end of the scale).

Long term weight loss plan is needed.

Procedure: Gastric band (LAGB) is recommended.

35 - 45

This is classed as ‘severely obese’ (middle of the scale).

Long term weight loss plan is needed.

Procedures: Roux-en-Y gastric bypass
Sleeve gastrectomy

Gastric band is still an option but is not usually recommended for this classification.

45 - 50

This is classed as ‘morbidly obese’.

Long term weight loss plan is needed.

Procedures: Roux-en-Y gastric bypass
Sleeve gastrectomy

Gastric band is still an option but is not usually recommended for this classification.

50 - 60

This is classed as ‘super obese’.

Long term weight loss plan is needed.

Procedures: Roux-en-Y gastric bypass
Sleeve gastrectomy
Biliopancreatic diversion (with or without
duodenal switch).

If your health is good then gastric banding is still an option but this would only be used as preliminary measure before a biliopancreatic diversion.

60+

The most extreme classification – ‘super-super obese’.

Long term weight loss plan is needed.

People with this classification are either in poor health or are suffering from an obesity-related illness.

Procedures: Roux-en-Y gastric bypass
Sleeve gastrectomy
Biliopancreatic diversion (with or without
duodenal switch).

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