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How to Qualify for Bariatric Gastric Bypass or Lap Band
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Best Patients/Candidates for Bariatric Operations to Reduce Morbid Clinical Obesity

Weight Loss Surgery - Benefits and Risks

Weight Loss Surgery - Potential Candidates

  • People who may consider gastrointestinal surgery include those with a body mass index (BMI) above 40 - about 100 pounds of overweight for men and 80 pounds for women.
    See Body Mass Index).
  • Increased abdominal fat or "central obesity" (apple shaped as opposed to pear shaped) is an important risk factor associated with the major complications of obesity.
    See Body Fat
  • Functional impairments associated with obesity are also important deciding factors for surgical treatment. Patients judged by experienced clinicians to have a low probability of success with non-surgical measures, as demonstrated, for example, by failure in established weight control programs or reluctance by the patient to enter such a program, may be considered for surgical treatment.
  • People with a BMI between 35 and 40 may also be candidates for surgery. Included in this category are patients with high risk co-morbid conditions such as life threatening cardiopulmonary problems (e.g. severe sleep apnea, Pickwickian syndrome, obesity related cardiomyopathy, or severe diabetes mellitus).
  • Other possible indications for patients with BMI's between 35 and 40 include obesity-induced physical problems that are interfering with lifestyle (e.g. musculoskeletal or neurologic or body size problems precluding or severely interfering with employment, family function and ambulation).
  • Some candidates for surgical treatment of severe obesity have such impaired health that they must be hospitalized pre-operatively and undergo treatment to improve their operative risk.

Weight Loss Surgery - Evaluation of Potential Candidates

Patients seeking weight loss surgical therapy for the first time should be evaluated by a knowledgeable physician and provided with sufficient information on which to make a reasonable choice for therapy.

In spite of the failure of medical therapy by drugs, diet, behaviour modification and exercise to achieve documented long term weight loss in the morbidly obese, it is accepted practice to require that the potential candidate for surgical treatment have made good faith attempts to achieve weight loss by dietary means. Although the segment of the morbidly obese population able to lose significant weight by non-surgical means is miniscule, candidates for surgery must be given the opportunity to try, a proposition which justifies insistence on at least one attempt at dietary weight loss prior to acceptance into a bariatric surgery program.

Decisions on what therapy to recommend to patients with clinically severe obesity should depend on their wishes for outcomes, on the need for therapy, and on the physicians explanation of options for therapy and the current information on probable safety, efficacy, advantages and risks. The need for close nutritional monitoring during rapid weight loss and the need for lifelong medical surveillance after surgical therapy should be made clear to the prospective patient and their relatives.

The operation should be carried out by a surgeon substantially experienced with the appropriate procedures and working in a clinical setting with adequate support for all aspects of perioperative assessment and management. These include hospital facilities geared to care for the morbidly obese patient, medical specialty availability, psychological support, dietary and nutritional counseling, and patient support groups.

 

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