Qualifying for Surgery
Obesity surgery is major surgery and carries with it risk, discomfort and cost. It is important, therefore, that this treatment for obesity be reserved for individuals whose obesity is so severe that their health and even life are at significant risk from complications of the obesity.
To assure that we perform surgery only on individuals who can benefit from it, the Obesity Program at Hennepin County Medical Center (HCMC) evaluates each candidate for surgery carefully. This evaluation includes examination by a dietitian, a psychologist and an internist (if needed). If, at the end of the evaluation process, an individual appears to be a good candidate for surgery, she or he is referred to one of the Obesity Program surgeons, who discusses the surgery with the individual thoroughly.
Bariatric surgery process
- Register for and attend the general and nutrition information classes. Access the evaluation process page for schedules and program registration.
- Complete a medical and weight history questionnaire. We will give this to you at the end of the nutrition information class. Bring this questionnaire with you when you meet with one of our dietitions.
- Consult with one of our program's registered dietitians to evaluate your current dietary and exercise pattern and begin working on any changes that may be needed to insure that you get the best possible result from your surgery. We will let you know how to make an appointment for this when you attend the classes.
- Complete a psychological evaluation with a psychologist affiliated with our program. The dietitian will give you a list with contact information at your first consultation.
- Consult with our program's specialist in internal medicine if you have a complicated medical history or if you have more questions. We will evaluate your medical history based on what you provide in your questionnaire, so, please be very careful to complete it fully and accurately.
- Consult with one of our bariatric/weight loss surgeons who will request authorization from your insurance company to bill for the surgery.
- Choose a date for surgery once we have received authorization from your insurance company.
We are often asked how long it takes to get from the information class to the day of surgery. The answer is that it depends most on how much work you have to do to make the changes in your diet and exercise pattern that will help you get the most from your surgery. It can be as little as two months, but most people need more time than this to get ready. For most people, it may take from four to six months to get from attending the class to the day of surgery. The dietitian, psychologist, internist, nurse, and surgeon all work with you to determine when it will be safe for you to have the surgery and when you have made the lifestyle changes that will help you succeed.
The criteria we use to determine whether an individual is a suitable candidate for weight loss surgery has to do with weight, physical and mental health and specific mental health issues.
An individual needs to be severely obese in order for the risk of weight loss surgery to be justifiable. We determine how obese an individual is by calculating her or his body mass index (BMI). This is done because individuals of different heights have different healthy weights. For example, a person who is 5 feet tall is healthiest at around 110 lbs., while a person who is 6 feet tall is healthiest at around 160 lbs. Calculating the BMI corrects for the differences in height and allows us to use a single range of numbers to describe healthy weight, overweight, obesity, and severe obesity.
The BMI is calculated as follows: BMI = (body weight in lbs. x 704)/height in inches squared.
BMI= 18.5-25 is healthy
BMI=25-30 is overweight
BMI greater than 30 is obese
BMI greater than 40 is severely obese
An individual may be a candidate for weight loss surgery even if he or she is otherwise in good health, if his or her BMI is greater than 40. For an individual with other significant medical problems that are made worse by obesity such as diabetes mellitus, sleep apnea, severe arthritis in weight-bearing joints, difficult to control cholesterol elevation, and others, weight loss surgery may be appropriate at a BMI of greater than 35.
Physical and Mental Health
It is important that an individual’s physical and psychological condition be good enough to tolerate the stress of surgery. If you have physical or psychological problems that would make anesthesia, surgery, and the recovery after surgery too risky or that would reduce the benefit you might get from the surgery, the Obesity Program staff will work with you, your primary care provider, and other doctors involved in your care to see whether those problems can be corrected to the point at which surgery can be done safely. It is rare for such problems to be so severe that we cannot proceed with weight loss surgery, but it may require considerable effort on the part of patient and doctors to achieve this.
Specific Mental Health Issues
Individuals who are currently suffering from binge eating disorder may need eating disorder treatment to address their binge eating before surgery. Those who are currently suffering from bulimia nervosa definitely will need eating disorder treatment to control the bulimia before surgery. Those who have ever suffered from anorexia nervosa cannot, generally speaking, ever safely have obesity surgery because of the risk of reactivating the anorexia.
Alcoholism, Chemical Dependency, or Chemical Abuse
Those with a history of any of these conditions need to have been free of any use of the chemical they have abused for one year prior to surgery. Obesity Program staff can help individuals with alcohol or drug problems get treatment that can lead to sobriety and eventually to effective surgical treatment for their obesity.
Primary Care Provider
It is vital that everyone who goes through surgery for obesity have a primary care provider. This may be a medical doctor or registered nurse practitioner. Your primary provider coordinates all aspects of your medical care including immunizations, cancer-related screening, blood pressure and cholesterol checks, advice on health risk management and treatment of all sorts of medical problems. The Obesity Program can only help you with obesity-related problems and will not complete the initial evaluation on any individual who has not established a primary care relationship with a provider. A written referral from your primary care provider must be given in order to proceed with the obesity evaluation process.
Insurance / Prior Authorization
Your insurance company requires careful medical, psychological, and nutritional evaluation and it will review these evaluation records before they authorize you to have a procedure. If the surgeon and the patient agree to go ahead with surgery, the surgeon writes to the patient's insurance company to request authorization for payment for the surgery. If the insurance company approves payment, the surgeon's office calls the patient to arrange a time for the surgery.