Criteria for bariatric surgery should consider more than just patient’s weight

July 24, 2019
Thousands of patients who don’t meet BMI to qualify would benefit from surgery

More than one-third of Americans are obese, and while more than 250,000 bariatric surgeries are performed annually in the United States, experts at The Ohio State University Wexner Medical Center and 45 worldwide scientific and medical societies say surgery should be an option for many more patients.

Dr. Stacy Brethauer says the standard criteria to qualify for bariatric surgery are nearly three decades old and are arbitrarily based on a patient’s body mass index (BMI). For example, if there are two patients with uncontrolled diabetes, the one with a BMI of 35 will qualify for surgery, while the patient with a BMI of 34 is often denied by insurance companies, he said.

“The patient who doesn’t get the operation, we know very well that their disease will progress and their lifespan will be shortened,” said Brethauer, a surgeon at Ohio State Wexner Medical Center’s Bariatric Surgery Center of Excellence. “Continuing to increase their insulin requirements will not change the trajectory of the disease. Surgery does.”

That disease progression not only comes with complications of diabetes but may include conditions such as heart disease and cancer. “You wouldn’t wait until a patient has advanced-stage cancer to treat their disease, and the same should be true for obesity,” said Brethauer. “Too many see obesity as a problem of willpower, and it’s simply not. Patients must participate in their care by making healthy lifestyle changes, but the most effective treatment is often surgery, and that should be an option for patients who would benefit.”

Multiple clinical studies have proven the benefits of bariatric surgery in patients with lower BMIs, and the American Society for Metabolic and Bariatric Surgery have drafted new criteria that would make these patients eligible. Brethauer says it’s now up to referring physicians and insurance companies to more widely adopt these new standards so that more patients can receive the treatment they need.