Who Qualifies for Bariatric Surgery? What to Know About the Requirements

Maybe you've tried diet changes, medication, and other approaches to weight loss but haven't been able to achieve your health goals. You may be wondering if bariatric surgery is an option for you. The answer isn't always as simple as a number on the scale. 

“Bariatric surgery isn't a one-size-fits-all treatment,” says Aaron Sachs, MD, a surgeon with UVA Health Haymarket Medical Center specializing in weight loss and anti-reflux surgery. “We look at a number of factors when determining whether someone is a good candidate.” 

What Are the Qualifications for Bariatric Surgery?

At your initial appointment, your healthcare team will review your medical history, discuss your weight loss experiences and talk with you about your health goals.

Obesity is a chronic disease, and bariatric surgery is one treatment option. It’s not a cure or a procedure that allows you to forget about weight management afterward. Instead, bariatric surgery can be a tool to help you make lasting changes and improve your overall health.

If you have obesity-related health conditions, such as type 2 diabetes or high blood pressure, bariatric surgery may help improve your health over time. Other conditions that may be relevant to your evaluation include:

• Arthritis or joint pain
• Sleep apnea
• High cholesterol
• Polycystic ovary syndrome (PCOS)
• Fertility concerns

“Our number one goal is to help all of our patients get healthier,” says Sachs.

What BMI Do You Need for Bariatric Surgery?

BMI is one part of the evaluation, but it doesn't tell the whole story.

According to Sachs, updated guidelines from the American Society for Metabolic and Bariatric Surgery (ASMBS) and other surgical societies support considering bariatric surgery for adults with:

A BMI of 35 or higher, regardless of whether they have an obesity-related health condition.

A BMI of 30 or higher with an obesity-related health condition, such as type 2 diabetes or high blood pressure.

BMI is an imperfect measure of health, and it does not account for every individual's circumstances. Your healthcare team will consider your overall health and medical history when determining whether surgery may be appropriate.

What Happens During a Bariatric Surgery Evaluation?

Bariatric surgery is not something that should be approached as a single appointment followed immediately by a procedure. At UVA Health, the evaluation process includes education, medical assessment, and opportunities to explore different treatment options.

Your care team may include:

• A bariatric surgeon
• Registered dietitians
• A nurse practitioner
• Medical and behavioral health professionals

You will learn about nutrition, lifestyle changes, and the bariatric surgery process. Depending on your needs, your evaluation may also include a sleep study, endoscopy, or other testing. The program gives you time to consider all your options, so you’ll feel confident with your decision. Some patients may lose weight through lifestyle changes or medication during the evaluation process.

Can You Take Weight Loss Medication Before or After Bariatric Surgery?

GLP-1 medications have become an important part of obesity treatment. For some people, medication may be an appropriate treatment on its own. For others, medication and bariatric surgery may be used together.

“It's a synergy,” says Sachs. “Now there are multiple options. We can use medication, surgery or a combination of the two. Each case is different, and we look at what makes the most sense for each patient.”

What Are the Different Types of Bariatric Surgery?

The two most common bariatric procedures are sleeve gastrectomy and gastric bypass. Both can help people lose weight and improve obesity-related health conditions, but they work differently.

Sleeve gastrectomy removes part of the stomach, leaving a smaller, tube-shaped stomach. It does not involve rearranging the intestines and may worsen or contribute to acid reflux, particularly in people who already have it.

Gastric bypass changes the size of the stomach and the way food moves through the digestive system. It may be especially helpful for people with acid reflux and can result in somewhat greater or faster weight loss for some patients.

Your surgeon will consider your medical history, health conditions and goals when helping you choose a procedure.

Is Bariatric Surgery Safe?

Like any surgery, bariatric surgery carries risks. But advances in surgical techniques, including minimally invasive and robotic approaches, have made these procedures safer than they were in the past.

“We've come a long way in the last 30+ years,” says Sachs. “It's gotten to the point where weight loss surgery is very safe.”

Your healthcare team will discuss the potential benefits and risks with you during the evaluation process.

What Happens After Bariatric Surgery?

Bariatric surgery is not the end of treatment. Long-term follow-up and nutrition support are important parts of maintaining your health after surgery.

At UVA Health, patients typically have follow-up visits at two weeks, two months, six months and one year, followed by annual visits.

“We want to see our patients every year,” says Sachs. “We want to check in. We want to see how they're doing. We want to make sure everything is going well.”

Patients take a bariatric multivitamin for life and have regular blood work to monitor for nutritional deficiencies. Follow-up also gives the care team an opportunity to address concerns early, including weight regain, and discuss treatment options.

What If I Regain Weight After Bariatric Surgery?

Some people worry about regaining weight after bariatric surgery. While weight regain can happen, it does not mean the surgery has failed or that patients haven't benefited from treatment.

“The goal is not a number on the scale,” says Sachs. “The goal is to help people get healthier, and that looks different to everybody.”

For one person, that may mean better blood sugar control. For another, it may mean walking more comfortably, sleeping better or keeping up with their grandchildren.

What Should I Do If I'm Considering Bariatric Surgery?

If you're wondering whether bariatric surgery may be right for you, talk with your primary care doctor or a bariatric surgery specialist to learn about your options.

“We are a no-pressure program,” says Sachs. “Our goal is to help you get to a healthier place.”