15-07-2025
Bariatric Surgery: Who's Eligible Now?
This transcript has been edited for clarity.
Bariatric surgery is a powerful tool for long-term weight loss, but it requires lifelong commitment to healthy eating, physical activity, supplements, and behavior change.
When should you refer for bariatric surgery? The 2019 AACE/TOS/ASMBS guidelines recommend considering surgery for individuals with a BMI over 35 and at least one obesity-related condition — like type 2 diabetes, sleep apnea, or hypertension — or anyone with a BMI over also note that patients with a BMI from 30 to 34.9 and poorly controlled type 2 diabetes may be considered.
The updated 2022 ASMBS guidelines recommend expanding eligibility to include a BMI over 30with weight-related conditions, especially for Asian populations who experience metabolic risk at lower most insurance plans still only cover surgery for a BMI over 35 with associated conditions or a BMI over 40.
Because long-term weight loss is difficult due to biologic adaptations, I offer surgery as an option to all eligible patients so they can make an informed choice. Surgery may be especially appropriate for patients who prefer surgery over lifelong obesity medications — though they'll still need lifelong vitamin supplementation — those who have not achieved long-term success with lifestyle interventions and/or obesity medications, or those who have higher BMI, for whom obesity medications and lifestyle modifications may not be sufficient to lead to resolution of weight-related complications.
Importantly, this does not have to be an either/or patients benefit from a combination of bariatric surgery and obesity medications to achieve meaningful, lasting weight loss and improvements in health. As always, shared decision making is key, including a clear discussion of risks, benefits, alternatives, and patient goals.
