Patient Selection for Bariatric Surgery

A body mass index (BMI) of 40 kg/mē or above represents clinically severe obesity, is medically necessary* and warrants operative treatment, if requested and otherwise acceptable to the bariatric surgeon. Patients with a BMI of 35 to 40 should be considered for operative treatment if they have a medical condition that would benefit sufficiently from weight loss. Diabetes mellitus and hypertension that are difficult to control because of intractable overweight are two such conditions.

Because it is difficult for the general public to understand the meaning and calculation of BMI, guidelines are also stated in closely equivalent terms that are more familiar. These guidelines require use of the 1983 Metropolitan Height and Weight Tables derived from survival data published by the Metropolitan Life Insurance Company or comparable national tables.

Therefore, either of these two guidelines may be followed:

° The patient should have a BMI of 40 kg/mē or above, or be 45 kg. or more above ideal weight according to the 1983 Metropolitan Height and Weight Tables (midpoint for medium frame) or equivalent national weight tables.

° If the patient has a BMI of 35 to 40 (weight less than 45 kg above ideal weight), there should be a serious medical problem that requires weight reduction and warrants the risk of the proposed operation.

Patients must be able to care for themselves, or be adequately cared for to insure their return for needed follwo-up. The patient`s prognosis, given weight reduction, should warrant the risk of the treatment.


*"Medically Necessary" is that which is appropriate and necessary for the symptoms, diagnosis or treatment of a given medical condition

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