More People Are Now Eligible for Weight Loss Surgery

New guidelines will allow more people to have bariatric surgery and get the healthcare they need. Two national organizations dedicated to fighting obesity updated their guidelines for the first time in more than three decades.

“The previous guidelines were largely based on bariatric surgeries that aren’t performed anymore,” says Linden Karas, MD, a bariatric and reflux surgeon at the University Hospitals Digestive Health Institute. “The new guidelines reflect the safety and effectiveness of the newer laparoscopic and robotically assisted weight loss surgeries that we perform routinely today.”

The change addresses the obesity epidemic in the U.S. and elsewhere.

Who Is Eligible for Bariatric Surgery?

A person qualifies for weight loss surgery based on their body mass index (BMI). The number is calculated by dividing a person’s weight by the square of their height. Doctors use BMI to categorize people into four general weight types: underweight, healthy weight, overweight and obese.

Under the previous guidelines, a person was required to have a BMI of 40 or higher, or a BMI of 35 to 39.9 and at least one obesity-related medical condition such as heart disease or hypertension. Under the new guidelines, eligibility extends to:

• People with a BMI higher than 35, regardless of whether or not they have accompanying health problems.
• People with a BMI of 30-35 who have a coexisting medical issue. This now includes diabetes, which was excluded in the previous guidelines.
• People of Asian descent with a BMI of 27.5 or higher, because they often have weight-related health issues at a lower body mass.
• Children and adolescents with severe obesity.

Dr. Karas says, “The new guidelines are much more nuanced than the previous ones, taking important factors into consideration such as age, sex, ethnicity, whether a person’s body fat is concentrated centrally or peripherally, and whether or not the obesity is associated with a myriad of other diseases or conditions.”

Weight Loss Surgery Helps Improve Overall Care

Dr. Karas says that the new guidelines will help more patients get other important healthcare procedures, which often require a certain BMI. This requirement exists because the risk of dangerous complications in many surgeries is significantly higher for people who are obese.

“I’ve performed bariatric surgery on a number of patients who, for example, had debilitating osteoarthritis of the hip or spine, but did not qualify for the surgeries they needed until they got their BMI under 40.”

“In making weight loss surgery more accessible to the people who need it, those people can then get approved for joint replacement surgery, spine surgery, kidney and liver transplant, hernia repair surgery, and a number of other procedures,” says Dr. Karas.

Dr. Karas also notes that many patients who experience dramatic weight loss from bariatric surgery, often find they don’t need additional surgeries. Conditions that they suffered with when they were obese also improve following weight loss surgery.

Insurance Coverage Still Lagging

The new guidelines make weight loss surgery more accessible to those who need it. However, until federal health insurance and private insurance companies update their coverage to comply with the guidelines, the recommendations remain just that.

“The new guidelines are based on 148 studies, all of which show the same thing,” Dr. Karas says. “Modern weight loss surgery is an extremely safe and effective tool for curbing the obesity epidemic. What’s important now is to keep getting this message out to patients, physicians and the media so that changes in insurance coverage can happen sooner rather than later.”

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University Hospitals Digestive Health Institute’s Nutritional Health & Bariatric Surgery Center is the only program in Northeast Ohio with four accredited bariatric centers. Our experts can help patients lose weight through a multidisciplinary program that includes dietary and lifestyle changes, medications and surgical interventions.