AM I A CANDIDATE FOR SURGERY?
In 1991 the National Institution for Health (NIH) created criteria for weight loss surgery. At the time gastric bypass was the only weight loss surgery offered in the United States. The guidelines established by the National Institute for Health (NIH) for weight loss surgery are as follows:
Body Mass Index (BMI) greater than 40 - OR - BMI 35 to 40 with 2 or more obesity-related medical conditions
Since obese people are clearly at an increased risk for multiple, potentially life threatening medical conditions, there is universal agreement that substantial, long-lasting weight loss should be the treatment goal for obesity. We know that the majority of obesity related medical conditions will resolve or significantly improve with substantial, sustained weight loss.
A clinical description of the degree of obesity helps determine if a person is a candidate for weight loss surgery. Obesity is defined by a Body Mass Index (BMI) greater than 30. Body mass index is calculated by a person's weight in kilograms divided by their height in meters squared (BMI = weight/height2 or kg/m2). This can also be calculated by a person's weight in pounds divided by their height in inches squared multiplied by a correction factor (lbs/inches2 X 703).
| BMI RANGE |
CATEGORIES OF OBESITY |
| 18 - 24 |
Normal Weight |
| 25 - 30 |
Overweight |
| 30 - 35 |
Obesity, Class 1 |
| 35 - 40 |
Severe Obesity, Class 2 |
| 40+ |
Morbid Obesity, Class 3
|
The BMI is a formula that uses weight and height to estimate health risk. If your BMI is between 18 and 24.9, you're considered in a healthy weight range for your height. If your BMI is between 25 and 29.9, you're considered overweight. And, if the figure is 30 or greater, you're considered obese. The following table shows examples of healthy weight, overweight and obese weight ranges for several heights.
| HEIGHT |
HEALTHY WEIGHT
|
OVERWEIGHT |
OBESE |
5 feet 2 inches
(62 inches) |
101 to 136 pounds |
137 to 163 pounds |
164 pounds or more |
5 feet 6 inches
(66 inches) |
115 to 154 pounds |
155 to 185 pounds |
186 pounds or more |
5 feet 10 inches
(70 inches) |
129 to 173 pounds |
174 to 208 pounds |
209 pounds or more |
6 feet 2 inches
(74 inches) |
144 to 194 pounds |
195 to 233 pounds |
234 pounds or more |
A threefold approach can help determine whether you need to lose weight for medical reasons. These include body mass index, waist measurement and personal medical history.
Waist Measurement
If you carry most of your fat around your waist or upper body, you may be referred to as apple-shaped. If you carry most of your fat around your hips and thighs or lower body, you may be referred to as pear-shaped. When it comes to your health, it's better to have the shape of a pear than the shape of an apple. If you have an apple shape - a potbelly or spare tire - you carry more fat in and around your abdominal organs. Abdominal fat increases your risk of many of the serious conditions associated with obesity. Women's waist circumference measurements should be less than 35 inches. Men's should be less than 40 inches. These are rough cutoffs, but in general, the smaller the waist measurement the better.
Medical History
You may benefit from weight loss surgery if you have other health conditions such as high blood pressure and diabetes. Also, if you have a family history of obesity, cardiovascular disease, diabetes, high blood pressure or sleep apnea, you may have an increased risk of developing weight-related complications.
A person with a BMI of 30 or greater is considered obese. Losing weight will considerably improve health and reduce the risk of health-related illnesses.
The decision to have surgical treatment for weight loss requires a careful assessment of the risks and benefits in each individual case. Occasionally, there are people who would benefit from weight loss surgery despite the fact that they do not strictly meet the NIH guidelines; ideally, they are are well-informed, motivated, and have acceptable operative risks. They should be able to participate in treatment and long term follow-up.
We rarely decline a person for surgery. Some people, however, with significant psychological or physical problems are not candidates for surgery. Some psychological conditions may jeopardize informed consent and cooperation with long-term follow up. The preoperative psychological evaluation serves the purpose of helping people plan for the emotional changes that occur with massive weight loss. Occasionally, the evaluation will identify untreated depression; in that case we help the person get their depression treated prior to surgery.
Becoming overweight doesn't happen overnight. It happens over time when the energy we take in by eating is not balanced with the energy we burn from physical activity.
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