In 2019, 17.8% of patients who had weight loss surgery chose to have gastric bypass. But having this surgery is not as easy as just choosing to have it. Since it’s a major surgery, insurance companies and surgeons want to make sure that you are ready in mind and body before letting you go under the knife. Therefore, one must be of a certain weight, among other things, before gaining approval for gastric bypass. Read below to learn more about gastric bypass surgery, reasons to consider gastric bypass, and what guidelines you must follow to gain approval for gastric bypass.
About gastric bypass surgery
Gastric bypass surgery, also known as Roux-en-Y, involves the surgeon stapling off a large portion of the stomach and attaching the small intestine to the remaining small stomach pouch.
This surgery can help to:
- Reduce the risk of weight-related health problems like gastroesophageal reflux disease (GERD), heart disease, type 2 diabetes, as well as some fertility issues
- Improve range of movement and in turn, increase the quality of life
- Lower risk of sleep issues like sleep apnea
But, like with any surgery, there are also risks. Since gastric bypass surgery reroutes the small intestine, people who receive it may be at risk for vitamin deficiencies like iron, calcium, vitamin D, and vitamin B12.
And people who receive this surgery can also be at risk for issues like:
- Blood clots
- Bowel obstruction
Because of such risks, one must have screening done to lower the chance of such issues.
Gastric bypass requirements
To meet basic guidelines to qualify for gastric bypass, the American Society for Metabolic and Bariatric Surgery (ASMBS) requires that patients have:
- A body mass index (BMI) of 40 or greater, or more than 100 pounds overweight
- A BMI of 35 or greater as well as one or more weight-related health issues such as type 2 diabetes, high blood pressure, sleep apnea, non-alcoholic fatty liver disease, osteoarthritis, or heart disease, to name a few
Some doctors may also have weight limits for gastric bypass patients based on how much weight their imaging equipment can handle. In such cases, the surgeon would require the patient to lose a certain amount of weight before gaining approval for surgery or would refer them to another program that could meet their needs.
Besides weight guidelines for gastric bypass, health insurance companies will sometimes want patients to meet other guidelines to increase their risk of success after surgery.
Such guidelines may include:
Mental health meetings
One may need to have a certain number of meetings with a licensed mental health provider before gaining approval for gastric bypass. These meetings can help to ensure a patient’s success since gastric bypass can impact daily life in a big way. Therefore, it will be vital for the medical team to assess any mental health issues, eating disorders, compliance issues, or substance abuse issues that could place the patient at risk for complications if they had the surgery.
A person who hopes to have gastric bypass would meet with a registered dietitian to make sure they know fully the many changes they will have to make to their daily eating after surgery.
These meetings would include:
- Talking with the patient about their current eating habits
- Finding out about any foods that may not be able to tolerate or that they may be allergic to
- Looking for any barriers they may have to eating healthy, such as income issues
- Making sure the patient is ready to make the needed dietary changes to be successful with gastric bypass surgery
The dietitian will explain to the patient during such meetings the stages of textures they will be able to tolerate after gastric bypass as well as the supplements they will have to take daily to prevent any nutrient deficiencies post-op.
Weight loss planning
In some cases, the patient will have to lose a bit of weight before gastric bypass to meet the requirements. This may seem like a strange guideline since many who seek out weight loss surgery do so because they have trouble losing weight on their own.
Some reasons for this weight loss guideline though may include:
- Shrinking the liver and abdomen to make it safer for the surgeon to perform the gastric bypass
- Having the patient show their willingness to learn and change their eating habits so they can enjoy success post-op
Patients who want to have gastric bypass will need health screening done pre-op to make sure that surgery is a safe option for them. This screening includes lab testing for nutrients like vitamin D and iron, screening for blood glucose and liver enzymes, as well as a blood panel to assess the risk of blood clots of excess bleeding during surgery.
Other tests that may be done to assess the patient include a heart health test as well as a sleep study to assess any breathing issues the patient may have that could make surgery unsafe.
Some patients, especially those who have had surgery before, may need to have imaging done before gaining approval for gastric bypass. This is because such images will help the surgeon to view the patient’s anatomy in their gut to be sure the patient receives the weight loss surgery that is safest and of most benefit to them. It can also help the surgeon to view the liver and gallbladder to make sure the patient is not at risk for any complications due to the impaired health of such organs.
Along with the above, those patients who smoke will be referred to resources to quit smoking before surgery. The reason for this is because experts report that smoking can impact the body’s ability to heal after surgery as well as increase the risk of heart attacks, blood clots, and breathing issues soon after surgery.
Patients will also be encouraged to quit drinking alcohol since doing so after surgery can place the patient in harm’s way. This is because smaller amounts of alcohol can cause a person who has had gastric bypass to become impaired sooner since the alcohol absorbs into the bloodstream quicker. Not to mention that alcohol will stay in the system of those who have had gastric bypass surgery longer. These factors can put those with gastric bypass surgery at greater risk for developing an alcohol abuse issue post-op.
What to do if you don’t qualify for gastric bypass surgery
If for any reason you don’t qualify for gastric bypass surgery, there is no need to worry. This is because there are several other options to assist you with your weight loss journey. First of all, you can see if you might qualify for another type of weight loss surgery that is less permanent such as an adjustable gastric band.
Other weight loss options your medical team may recommend include:
- A prescribed weight loss medicine
- Healthy lifestyle weight loss programs
- Regular visits with a registered dietitian
- Hormone testing to see if any imbalances may be impacting your weight
What to do if you are considering gastric bypass surgery
If you’re thinking about having weight loss surgery like gastric bypass, the first step is to contact your local hospital for more information. To ensure your safety, it can help to choose a weight loss surgery or bariatric, program that is a Center of Excellence. Such programs use a multidisciplinary approach and perform at least 125 weight-loss surgeries each year. Therefore, you can ensure the highest level of care during your weight loss surgery journey in such centers.
Once you have found a program you trust, you should call your insurance company to find out what their guidelines are to gain approval for weight loss surgery and what weight loss surgery appointments and procedures they cover.
Finally, once you have all the information you need to make your weight loss surgery center appointment, you should start reading up on weight loss surgery options like the gastric bypass to see which option may be ideal for you. A reputable resource for such information is the ASMBS which provides answers to any questions you may have about your weight loss journey from pre-op through post-op.