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Gastric bypass surgery: Who is it for?

Learn about the criteria you must meet to have this kind of weight-loss surgery.

By Mayo Clinic staff

It's best to lose weight with a healthy diet and regular physical activity. However, if you've tried to lose weight that way but haven't been able to — and you have health problems because of your weight — gastric bypass surgery may be an option.

Gastric bypass surgery (Roux-en-Y gastric bypass) is the most common type of weight-loss surgery, also called bariatric surgery. In gastric bypass surgery, the stomach is divided into two parts. Food travels from the smaller upper part of the stomach, called the "pouch," to the small intestine. Food no longer travels through the remaining larger part of the stomach. This change in the anatomy of your digestive system limits the amount of food that you can eat and that your body can digest, which helps with weight loss.

Gastric bypass surgery isn't for everyone, however. Like any major procedure, it has significant health risks and side effects. In addition, long-term success ultimately depends on your ability to make permanent changes in your lifestyle. For all these reasons, candidates for gastric bypass surgery are carefully screened to determine who is likely to benefit from gastric bypass surgery despite the risks.

Guidelines to qualify for gastric bypass surgery

You must meet certain medical guidelines to qualify for gastric bypass surgery. In general, you must:

  • Be unable to achieve or maintain a healthy weight through diet and exercise
  • Have a body mass index (BMI) of 40 or higher (extreme obesity)
  • Have a BMI of 35 to 39.9 and also have a serious weight-related health problem, such as diabetes or high blood pressure

The criteria aren't without controversy, though. Some advocates of gastric bypass surgery believe that the criteria should be relaxed to make it an option for people with a BMI lower than 35.

Evaluating if you're ready for gastric bypass surgery

A team of health professionals — usually including a doctor, dietitian, psychologist and surgeon — will evaluate whether gastric bypass surgery is appropriate for you. The evaluation essentially determines if the health benefits outweigh the potentially serious risks of this major procedure. Even if you meet the criteria for gastric bypass surgery, you will still need to be evaluated to see if you're psychologically and medically ready to undergo the procedure.

When conducting an evaluation, the team will consider:

  • Your nutrition and weight history. The team reviews your weight trends, diet attempts, eating habits, exercise regimen, stress level, time constraints, motivation and other factors.
  • Your medical condition. Some health problems increase the risks associated with having surgery or may be worsened by surgery, such as blood clots, liver disease, heart problems, kidney stones and nutritional deficiencies. The team will evaluate what medications you take, how much alcohol you drink and whether you smoke. You also will have a thorough physical exam and laboratory testing.
  • Your psychological status. Certain mental health conditions may contribute to obesity or make it more difficult for you to maintain the health benefits of gastric bypass surgery. These may include binge-eating disorder, substance abuse, depression, anxiety disorders and issues related to childhood sexual abuse. While these may not prevent you from having gastric bypass surgery, your doctors may want to postpone surgery to ensure that any condition is appropriately treated and managed.
  • Your motivation. The team will also assess your willingness and ability to follow through with recommendations made by your health care team and to carry out prescribed changes in your diet and exercise routine.
  • Your age. Although there's no specific age limit for gastric bypass surgery, the risks increase if you're over age 65. The surgery remains controversial in people under age 18.
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References
  1. Collazo-Clavell ML, et al. Assessment and preparation of patients for bariatric surgery. Mayo Clinic Proceedings. 2006;81(suppl):Sll.
  2. Mun EC, et al. Surgical management of severe obesity. http://www.uptodate.com/home/index.html. Accessed Aug. 11, 2009.
  3. Ahima RS. Should eligibility for bariatric surgery be expanded? Gastroenterology. 2008;134:15.
  4. Bariatric surgery for severe obesity. National Institute of Diabetes, Digestive and Kidney Diseases. http://win.niddk.nih.gov/publications/gastric.htm. Accessed Aug. 10, 2009.
  5. Buchwald H. Consensus Conference Statement: Bariatric surgery for morbid obesity: Health implications for patients, health professionals, and third-party payers. Surgery for Obesity and Related Diseases. 2005;1:371.
  6. Flum DR, et al. Toward the rational and equitable use of bariatric surgery. Journal of the American Medical Association. 2007;298:1442.
  7. Safadi BY. Trends in insurance coverage for bariatric surgery and the impact of evidence-based reviews. Surgical Clinics of North America. 2005;85:665.
  8. Frezza EE. Six steps to fast-track insurance approval for bariatric surgery. Obesity Surgery. 2006;16:659.
  9. Collazo-Clavell ML (expert opinion). Mayo Clinic. Rochester, Minn. Aug. 24, 2009.
  10. Anderson CF (expert opinion). Mayo Clinic. Rochester, Minn. Aug. 12, 2009.

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Oct. 6, 2009

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