How Fat is “Fat Enough” For Gastric Sleeve Surgery?

As a bariatric surgeon I hear—and relieve—many concerns from my VSG patients. Among the questions I get is whether a patient is at a “correct” weight for gastric sleeve surgery. Usually it’s a matter of “am I too obese for the procedure?” but sometimes patients worry they aren’t overweight enough. With the standard caveat that every patient and every body is different, let’s delve into the question of weight and how it affects the decision to perform VSG.

Our guidelines
First of all, when we talk about weight, what we really mean is Body Mass Index (BMI), a measurement that takes into account your height and weight. It’s possible for people to be approved for bariatric surgery whether they weight 200 pounds or 500 pounds, depending on how their BMI shakes out. At Endobariatric, a candidate must typically have a BMI of at least 35, though patients with a BMI between 30 and 35 and with medical conditions like high blood pressure, diabetes, sleep apnea, arthritis, etc., may be eligible for gastric sleeve surgery. We have an online form that prospective patients can fill out, and, yes, I go over these forms personally.

The Endobariatric difference
When people ask, “Why gastric sleeve in Mexico?” I often point to this topic as one reason. Some of my patients do have insurance that covers their procedure, but most are self-pay. At Endobariatric, our price is a fraction of what gastric sleeve costs in the U.S. but with the same standard of care and safety track record (or even better) than what’s found north of the border. Because patients don’t usually have to worry about meeting their insurers’ requirements, we’re able to help them sooner than doctors in the U.S. would. And by sooner, I mean when they’re at a lower BMI. The National Institutes of Health considers a BMI of 40—or, alternatively, a weight that’s more than 100 pounds over a patient’s ideal—as the minimum for bariatric surgery. Those with health conditions like I listed above may qualify for surgery if their BMI is 35 to 40. That’s a five-point difference from Endobariatric, which may not sound like a lot until you do the math.

A woman who stands 5’6”, weighs 186 pounds (BMI of 30), and suffers from a painful joint condition that likely would get better with weight loss might be a candidate at Endobariatric. She would have to weigh 217 pounds—31 pounds more—to reach the BMI of 35 that might make her eligible according to most U.S.-based guidelines. Imagine trying to decide whether you should try to gain another 30-plus pounds in order to get the gastric sleeve surgery you need.

Why lower is sometimes better
In trying to get insurance approval for bariatric surgery, most patients must first do things like a year-long medically supervised weight-loss programs, undergo psychological exams, and other requirements that eat up valuable time. I mean, if diets worked for you, would you be considering bariatric surgery? No! But it’s simply not considered a first-line therapy in the war on obesity. But a new study suggests that maybe it should be.

The study, conducted by a team from the University of Michigan, Wayne State University, and Henry Ford Health System, and published in JAMA Surgery, found patients had far more success getting to a BMI under 30 in one year if they were well below the “BMI of 40” standard at the time of surgery. Well, duh, right? The more weight you have to lose going into gastric sleeve, the longer it will take you to get to a healthy BMI. So why wait until losing weight, even with a sleeve, will be more of a struggle?The longer a patient stays overweight, the more damage obesity-related diseases can do. This study found that patients whose BMIs fell below 30 were more likely to get off high blood pressure, blood sugar, and cholesterol meds, and resolve their sleep apnea.

Approving patients for gastric sleeve surgery isn’t something we take lightly. It’s surgery, after all. Don’t come to us because you’ve gained a few pounds over the holidays. But if you’re experienced in the struggle to achieve a healthy weight, get in touch with us sooner rather than later to begin a journey to lasting health and happiness.

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“Changing lives…one sleeve at a time”.