When is surgery an appropriate option for weight loss?
The best candidates for the surgical treatment of obesity are patients who have a body mass index of 40 or greater, or 35 or greater and associated obesity-related conditions, such as diabetes, heart disease and sleep apnea. In terms of pounds, qualifying for surgery equates to being about 100 pounds above ideal body weight. If you take a person who is five foot, six inches tall, they might have to weigh something in the neighborhood of 260 pounds or more in order to qualify for surgery.
One of the nationally accepted criteria is that patients have to have been through some form of organized weight loss program in the past and failed to maintain that weight loss. What that exactly consists of might vary from one individual to another, and what a surgeon might accept as a failure of medical management might vary from one surgeon to another.
In general, children should not be candidates for the surgery, except when offered an operation in the setting of a trial, perhaps in an academic center where those patients will be studied quite intensely over the course of years.
How are counseling and other treatments woven into a treatment plan that might call for surgery?
We feel that it's very important to include a multidisciplinary approach to the education and screening of patients before surgery. Screening should be done in order to identify individuals who have psychopathology that might suggest they shouldn't have the surgery. And we need to educate the patients about the changes in their eating behavior that will occur with the operation. Otherwise the patients may be completely surprised to learn that in order to lose weight after surgery, they have to eat very small meals and sometimes eat very frequently in order to get adequate nutrients and liquid intake.
