Bariatric Surgery

Bariatric Surgery

Causes of Obesity
Evaluation
Treatment

Evaluation

There are several medically accepted criteria for defining morbid obesity. You might qualify for a bariatric procedure if you meet any of the following critiera:

• Weigh more than 100 pounds over your ideal body weight.

• Have a body mass index (BMI) of over 40. BMI is a number based on both your height and weight. It can help determine the degree to which a person is overweight and assesses their total body fat. The normal BMI is 20-25. Use our Body Mass Index Tool to check your BMI.

• Have a BMI of over 35 and suffer from conditions such as high blood pressure or diabetes, related to being severely overweight.

Obesity Health Risks

If you are obese or morbidly obese, you are at risk for developing a number of serious health problems. The most common conditions include:

• Depression — Depression is very common after repeated failure with dieting and disapproval from family, friends and the public.

• Diabetes — Obese individuals develop a resistance to insulin, which regulates blood sugar levels. Over time, high blood sugar can cause type 2 diabetes that can lead to serious damage to the body.

• Gastroesophageal Reflux or Heartburn — When acid escapes from the stomach into the esophagus through a weak or overloaded valve, gastroesophageal reflux can occur, causing "heartburn" and acid indigestion. Gastroesophageal reflux disease can lead to Barrett's esophagus, a pre-cancerous change in the lining of the esophagus and a cause of esophageal cancer.

• High Blood Pressure and Heart Disease — Excess body weight strains the heart. This may lead to high blood pressure, which can cause strokes as well as heart and kidney damage.

• Incontinence — In obese people, a large, heavy abdomen may cause the valve on the urinary bladder to weaken, leading to urinary stress incontinence or the leakage of urine with coughing, sneezing or laughing.

• Infertility — Obese women may experience infertility — an inability or diminished ability to become pregnant.

• Menstrual Irregularities — Morbidly obese women may experience disruptions of menstrual cycles as well as abnormal flow and increased pain.

• Osteoarthritis — The weight placed on joints, particularly knees and hips, results in rapid wear and tear of joints as well as pain caused by inflammation, called osteoarthritis. Excess weight puts a strain on bones and muscles of the back, which can cause disk problems, pain and decreased mobility.

• Sleep Apnea and Respiratory Problems — Fat deposits in the tongue and neck can cause intermittent obstruction of your air passage, called sleep apnea. Because the obstruction is more severe when sleeping on your back, you may wake frequently to reposition yourself. Loss of sleep often causes drowsiness and headaches.

Evaluation Process

To be considered for bariatric surgery, you must weigh less than 450 pounds because our hospital X-ray equipment can't accommodate patients who weigh more. A nutritionist is available to help you lose weight to meet this requirement, if necessary.

You also must complete medical evaluations, and attend an orientation meeting and initial consultation with a surgeon. You should coordinate most of your medical evaluations with your primary care doctor. A psychological evaluation with a certified mental health professional as well documentation of a consultation with a dietitian also are required.

The evaluation process consists of the following steps:

Step 1 — Mail the following four items in one envelope to the Bariatric Surgery Center:

• Completed new patient medical history questionnaire.
• Formal letter from your primary care doctor, including a three-to-five-year summary of diet and weight history; a list of "comorbid" conditions or other conditions you have in addition to obesity; and why you are being recommended for bariatric surgery.
• Current authorization for an initial surgical consultation.
• Photocopy of the front and back of your insurance card.
  
  If the packet of information is not complete, it will be mailed back to you.

Step 2 — After we review your information packet, we will contact you to schedule your first visit with a surgeon and a new patient orientation to meet our team.

Step 3 — During your first visit with a surgeon, you will receive a list of required tests and consultations. Please work with your primary care doctor to complete these tests. Provide all written reports and letters regarding test results.

Step 4 — When you complete all required tests and evaluations, please mail all reports to the Bariatric Surgery Center in one envelope.

Step 5 — We will review all test results and will call you to arrange another consult with your surgeon, unless results indicate the surgery should not be performed. If there are "contraindications" or risks, we will call you to discuss.

Step 6 — During your visit with your surgeon, we will develop a plan for your operation. Typically within a week of this visit, we will schedule a date for your operation.

Step 7 — After your operation is scheduled, an appointment at the Prepare Clinic, the anesthesia and surgical evaluation program, will be scheduled. Anesthesiologists will develop a plan for the day of your operation.

During your consultation with your surgeon, you will have plenty of time to ask questions about your procedure. We want you to feel comfortable about your operation.

Reviewed by health care specialists at UCSF Medical Center.
Last updated February 17, 2009