Weight-loss surgery: Is it an option for you?

By Mayo Clinic Staff

Weight-loss surgery changes the shape of the digestive system and how it works. This surgery may help you lose weight and manage weight-related health conditions. These conditions include diabetes, high blood pressure and obstructive sleep apnea. It also can help you manage risk factors for heart disease, stroke and some cancers.

Weight-loss surgery also is called bariatric surgery or metabolic surgery. There are different types of surgeries that help you lose weight in many ways such as:

• Making it harder for the body to process nutrients from food, called malabsorption.
• Changing the size and shape of the stomach so that it can't store as much food, called restriction.
• A combination of both malabsorption and restriction.

Some weight-loss surgeries also change the hormones that control your sense of hunger and when you feel full. These changes help you lose weight.

In the U.S., the two most common weight-loss surgeries are sleeve gastrectomy and gastric bypass, also called Roux-en-Y gastric bypass.

• During the sleeve gastrectomy procedure, the surgeon removes a large portion of the stomach to create a smaller tubelike sleeve.
• In the Roux-en-Y (roo-en-wy) gastric bypass procedure, the surgeon creates a small pouch from the stomach and connects the newly created pouch directly to the small intestine.

Weight-loss surgery is only one part of an overall treatment plan. Your treatment also will include nutrition guidelines, exercise and mental healthcare. You'll need to be willing and able to follow this long-term plan to meet your weight-loss goals.

If you're thinking about weight-loss surgery, you will need to meet with many specialists to help you decide if weight-loss surgery is an option for you.

Medical guidelines

The general medical guidelines for weight-loss surgery are based on body mass index (BMI). BMI is a formula that uses weight and height to estimate body fat. In the U.S., weight-loss surgery generally may be an option for an adult with a BMI of 40 or higher.

A surgeon also may recommend surgery if your BMI is between 35 and 40 and you:

• Have metabolic syndrome. This means you have one or more conditions that increase the risk of heart disease, stroke and type 2 diabetes. These conditions include high blood pressure, high blood sugar, too much fat around the waist, and high cholesterol or triglyceride levels.
• Have type 2 diabetes. Type 2 diabetes happens when the body can't use insulin correctly and sugar builds up in the blood.
• Have not been able to lose enough weight by improving your exercise or eating habits to treat other weight-related conditions. Examples of weight-related conditions are heart disease, obstructive sleep apnea and high cholesterol levels.

Bariatric surgery also may be considered for some people with BMIs in the 30 to 35 range. There is no specific age limit for weight-loss surgery. People older than 65 after weight-loss surgery have similar results as younger people do. Weight-loss surgery may be an option for some children and teens who have:

• BMIs of 40 or higher and any weight-related health condition.
• BMIs of 35 or higher and a serious weight-related health condition.

Instead of using these BMI numbers as a guideline for surgery, surgeons may use growth charts for children and teens. These charts show the standard BMI range for each age. A surgeon may recommend surgery based on how much an adolescent's BMI is above the standard BMI range.

Depending on the type, severity or risk of a weight-related illness, some adults and teens with lower BMIs may be candidates for weight-loss surgery.

How to know if you're ready for surgery

If you're thinking about weight-loss surgery, you'll meet with a healthcare team. The team may include:

• Your primary healthcare professional.
• A surgeon.
• A specialist who gives you medicine to put you in a sleeplike state during surgery, called an anesthesiologist.
• A healthcare professional who specializes in food and nutrition, called a dietitian.
• Nurses with special training in weight management.
• Mental health professionals such as psychologists or psychiatrists.
• Other specialists depending on your medical conditions.

Healthcare team members will explain what to expect before and after the procedure. They will talk about any medical, behavioral or mental health concerns with you before surgery. They will assess whether you're ready for surgery and help you decide if it's an option for you.

Medical concerns

You'll likely have a medical exam before surgery to look for any unknown weight-related conditions. Your healthcare professional also may test for health conditions that could make surgery more complicated. You may have tests or screening for:

• Obstructive sleep apnea.
• Heart and blood vessel disease, called cardiovascular disease.
• Kidney disease.
• Liver disease.
• Thyroid disease.
• Gout.
• Certain cancers, including breast, endometrial and prostate cancers.

Weight-loss surgery may not be safe for you if you have certain conditions such as:

• A blood-clotting disorder.
• Severe heart disease that makes it unsafe for you to have anesthesia.
• Other conditions that raise the risk of using anesthesia.
• Mental illness or psychosis that is not treated.
• An eating disorder that is not controlled or treated.
• A substance use disorder.

Behaviors and mental health

Successful and sustained weight loss after surgery depends on being able to change what and how you eat and how much you move your body. Meeting your health and weight goals after weight-loss surgery is more likely if you are in good mental health and ready to follow your treatment plan. Your healthcare team will screen you for any mental health or behavioral factors that might affect weight-loss success. You and your team will try to address any problems when deciding whether you're ready for surgery.

Your healthcare team will talk with you about the following:

• Motivation. Are you motivated to accept lifestyle changes, set goals and learn about healthy nutrition? Your healthcare team may track your ability to follow recommended changes to your diet and exercise routine.
• Weight-loss history. Patterns in weight loss and weight gain can help your healthcare team understand challenges for you and recommend tips for postsurgical plans.
• Eating behaviors. Irregular eating behaviors or eating disorders may lead to obesity. These include binge eating, nighttime eating and unplanned grazing between meals. Some eating disorders are related to other mental health conditions.
• Mood disorders. Depression, anxiety, bipolar disorder or other mood disorders are linked to obesity. These conditions may make it hard for people to manage their weight. Also, people with untreated mood disorders can find it harder to stick with new diet and exercise habits after surgery.
• Alcohol and drug use. Problems with alcohol and drug use are linked with poor weight loss and continued substance use issues after surgery. Weight-loss surgery may not be an option for people who have problems with substance use.
• Smoking. If you smoke cigarettes, you may have a higher risk of infection and other problems after weight-loss surgery.
• Suicide risk. There is a higher risk of suicide among people who have had weight-loss surgery. The risk is higher among people with depression, anxiety, bipolar disorder, substance use disorder, schizophrenia or other disorders.

Presurgery expectations

If your healthcare team members recommend weight-loss surgery, they work with you to create a treatment plan. This may include:

• Nutrition guidelines. The dietitian will help you with nutrition guidelines, vitamin supplements and menu planning. The guidelines include changes before and after surgery.
• Exercise plan. A nurse, occupational therapist or other specialist will help you learn appropriate exercises, develop an exercise plan and set goals.
• Weight loss. You may be encouraged or required to lose some weight through diet and exercise before surgery.
• Mental health services. You may be encouraged to begin treatment for substance use or other mental health therapy for an eating disorder, depression or other mental health condition. Your therapy may include learning new coping skills or talking about your body image or self-esteem concerns.
• Smoking. If you smoke, you'll be asked to quit smoking or join a program to help you quit smoking before surgery.
• Other treatments. You'll need to follow treatments for other health conditions.

These requirements can help you reach the best possible weight-loss outcomes after surgery. Some weight-loss surgery programs may recommend or require you to take part in programs to help change your lifestyle before your surgery. Also, your ability to follow through on these plans to change your lifestyle will show your team how motivated you are to follow long-term lifestyle guidelines after surgery. This may affect whether you're considered a candidate for surgery.

Your healthcare team may delay or cancel your weight-loss surgery if:

• You're not mentally or physically ready for surgery.
• You have a current drug or alcohol use disorder.
• You have other health conditions, such as heart disease, that make anesthesia or surgery unsafe.
• You are pregnant or want to get pregnant before weight-loss surgery. Healthcare professionals typically counsel people desiring pregnancy to wait for their weight to stabilize after weight-loss surgery, which can take 1 to 2 years.

Paying for surgery

It's important to research your insurance coverage and your expected out-of-pocket costs. Your medical center may have services to help you explore options for paying for your surgery. Not all insurance companies or plans cover the costs of weight-loss surgery. Medicare and Medicaid programs may or may not cover the costs of weight-loss surgery.

Insurance companies can require your healthcare team to show that surgery is medically necessary for insurance to pay for it. Your insurance company may require you to show you are active in weight loss, diet and exercise programs.

Is weight-loss surgery right for you?

Your healthcare team will help you decide whether weight-loss surgery is the appropriate option for you. Weight-loss surgery isn't for everyone who is severely overweight. Care team members will work with you to decide whether you're ready for surgery. They provide you with the information you need to make an informed decision in which you:

• Think about the benefits and risks of weight-loss surgery.
• Agree to participate in long-term follow-up plans that include keeping track of your nutrition, your lifestyle and behavior, and your medical conditions.
• Understand that successful weight-loss surgery requires making permanent changes to lead a healthy lifestyle.