Referring a Patient for Weight Loss Surgery

A Guide for Providers- Refering a Patient for Weight Loss Surgery

The National Heart, Lung, and Blood Institute recommends surgery for weight loss as an option for “carefully selected patients with clinically severe obesity (BMI ≥ 40 kg/m² or ≥ 35 kg/m² with comorbid conditions) when non-surgical methods have failed and the patient is at high risk for obesity-associated morbidity and mortality”
American Heart Association (AHA) March 2011 scientific statement states that bariatric surgery can result in long-term weight loss and significant reductions in cardiac and other risk factors, noting the benefits of bariatric surgery may outweigh the risks for the severely obese
American Diabetes Association (ADA) Guidelines 2009 recommends bariatric surgery be considered for adults with BMI > 35 kg/m² and type 2 diabetes
International Diabetes Federation (IDF) 2011 guidelines state bariatric surgery should be an accepted option for people who have type 2 diabetes and BMI ≥ 35 kg/m²

The risk of death from bariatric surgery is less than 0.1%
Overall likelihood of major complications is less than 2.5%
The risks of living with severe morbid obesity now outweigh the risks of undergoing bariatric surgery

Surgery results in improvement or resolution of more than 30 obesity related conditions
Gastric bypass resolves type 2 diabetes in nearly 85% of patients
The risk of developing coronary artery disease is decreased by 50%
Obstructive sleep apnea resolves in more than 85% of patients
High blood pressure eliminated in 62% and improved in 79% of patients

Patients may improve life expectancy by 89%
Patients may reduce their risk of premature death by 30 - 40%
The risk of death secondary to diabetes is decreased by 90%
The risk of death due to a diagnosis of cancer is decreased by 60%
The risk of death due to complications from coronary artery disease is decreased by 56%

Patients are eligible for weight loss surgery with a BMI of ≥ 40 kg/m² or ≥ 35 kg/m² with obesity-related comorbidities
For those patients with BMI ≥ 50 kg/m² or BMI ≥40 kg/m² who also suffer from obesity-related comorbidities, earlier surgical consultation may be warranted as their success rates for nonsurgical weight loss are poor
Ineligible patients include those who do not meet the criteria for bariatric surgery based on BMI <35 kg/m², those with uncontrolled major psychiatric illness or eating disorders, people with current alcohol or drug abuse, or children under the age of 18 (UIHC policy)

A multidisciplinary approach to the treatment of obesity incorporating diet and nutritional education, lifestyle/behavior changes, and surgical options at an approved Comprehensive Center by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)
Monthly free bariatric support group meetings
100% laparoscopic surgery rates providing for decreased post-operative pain, wound complications and time for convalescence
Life-long follow-up
Behavioral therapy with goal setting
A thoughtful consideration on the available operative approaches and a discussion with each patient on which procedure is best suited to their case based on his or her medical comorbidities, surgical history and expectations

UI referral line for physicians: 1-800-322-8442
Digestive Disease Clinic office phone: 1-319-356-4060

UI call center for patients: 1-800-777-8442
Digestive Disease Clinic office phone: 1-319-356-4060