Can Your BMI Be Too High for Bariatric Surgery?

We must always discuss minimum qualifying criteria for bariatric surgery with our patients. For insurance coverage, a patient’s body mass index or BMI must be at least 35 with one or more obesity-related comorbidities or 40 or more regardless of comorbidities. Recent guidance from ASMBS and IFSO has reduced those recommended BMI levels, but insurance has yet to cover lower BMI surgery. That said, we discuss the upper limits of BMI far less commonly because no official guidelines to that end exist. With TV shows showing extreme BMI patients going under the knife (Think “My 600Lb Life) it’s certainly worth discussing because we see more high BMI patients than ever before. So, what are the challenges of working with a very high BMI patient?

Surgical Equipment Limitations

A few decades ago, before the advancement of laparoscopic bariatric surgery, performing a bariatric procedure on a patient with an extreme BMI was difficult, risky, and sometimes impossible. Today, however, advances in technology and refined techniques have allowed us to perform surgery on higher BMI patients. We routinely see patients with a BMI of 50 or 60 and over. While their risk of complications is somewhat elevated due to health concerns, they are often good candidates for surgical intervention.

Surgical Risks

The surgical risks of operating on a patient with a very high BMI are significant. Obesity causes many related and consequent cardiovascular and pulmonary diseases, amongst others. Virtually every extremely obese patient has one or more severe comorbidities that can make anesthesia and the trauma of surgery more risky. Some suffer from liver cirrhosis (nonalcoholic fatty liver disease), a common reason to cancel the surgery or delay it. That said, for most, the benefits will still significantly outweigh the risk of surgery, and bariatric surgery, in these cases, can be a life-saving intervention. However, getting on a diet or even medication to drop some weight before surgery is a good way to reduce the risk.

Hospital Facilities

Patients with high BMIs cannot be operated on at an outpatient surgical center because of the abovementioned risks. These procedures must be performed at the hospital. But not all hospitals are equipped for bariatric patients. For example, anything from beds to MRI and CT machines must be able to accommodate obese patients. If they don’t, this can’t be problematic. Fortunately, we can accommodate our patients with modern, high-quality machines and equipment.

The Bottom Line

Ultimately, BMI and the patient’s size are less of a concern these days than in the past. To be sure, the bigger the patient, the higher their risk. Our job is all about safety and minimizing risk while maximizing the benefit. Therefore, we evaluate every patient’s health to ensure a safe procedure. For many, this will require additional organ function testing and a closer look at their medical history.

Most importantly, patients who recognize the health risks associated with excess weight can contact us to learn more about their bariatric surgery options and the best procedure for them.

We look forward to speaking with you and having you visit our office for a consultation. In the meantime, please watch our online bariatric surgery seminar to learn more about our program and the options available to most patients.