Who Needs Bariatric Surgery?

Insurance companies and most official guidelines today will tell you that in order to qualify for bariatric surgery, your body mass index (BMI) should be above 40 kg/m2, or it should be above 35 kg/m2 with some ongoing medical problem associated with the weight (e.g. diabetes, hypertension, sleep apnea).  These guidelines were established in 1991 by the National Institute of Health (NIH) because at the time there was data available indicating that someone with a BMI over 40 kg/m2 had about an 11x higher chance of dying than someone the same age of normal weight.

But a lot has changed over 24 years.  Bariatric surgery has become a much safer for patients than in the past, and most surgeries are being performed laparoscopically (with small incisions and a thin telescopic camera).   Most importantly, our understanding of how bariatric surgery actually works has completely changed over the past 7-8 years, with the discovery of hormones that regulate appetite, weight regulation and insulin sensitivity.  Research has shown that bariatric surgery will even improve or cure diabetes even independent of a person losing weight after surgery.

With this in mind, many bariatric surgeons are supportive of changing the guidelines to a lower BMI requirement for surgery, particularly for those who have medical conditions like diabetes that are difficult to control with medications.

Unfortunately, it’s hard to say if and when the criteria qualifying people for bariatric surgery will change and be more readily available to people struggling with obesity.  Even today there are still stigmas and misperceptions about the causes of obesity and how to best treat it, even if surgery is a good option to begin with.  Hopefully, as more and more data is available, physicians and the healthcare system in general will be more receptive to bariatric surgery.

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