Medical Candidacy

General Guidelines
In order to medically qualify for obesity surgery, the National Institutes of Health (NIH) have established general guidelines that any clinician should follow. The NIH has established that bariatric (weight loss) surgery is not an option unless you are morbidly obese. This typically means that an individual would require a Body Mass Index (BMI) of 40 or greater. However, an individual may be considered a candidate for bariatric surgery if he or she has a BMI of at least 35 if suffering from co-morbid illnesses. A co-morbid illness (or co-morbidity) is any disease or medical condition directly related to an individual’s excess weight. Examples of these are: diabetes, sleep apnea, high blood pressure and heart disease to name but a few. Co-morbidities and other health risks associated with obesity are discussed in further detail in the Co-Morbid Diseases section of this website.

Roughly, the NIH standard of BMI 35 with associated co-morbidities equates to about 80-pound weight excess for women, and about 100 pounds excess weight for men.

Dr. Nowzaradan will assess you medical candidacy, including your overall health evaluation and determining if any other medical conditions you may have are related to your weight, and if they are considered co-morbid diseases. It is important to have an open, honest and frank discussion with Dr. Nowzaradan’s staff about your physical and emotional health in order to accurately establish your candidacy for bariatric surgery.

Insurance Guidelines
Insurance companies are compelled to adopt the same base guidelines as those established by the NIH from a medical point of view; however, insurance companies may also require: additional historical personal health documentation; documentation of one or more attempts at alternative, non-surgical methods of weight control; psychological counseling; and/or, require you to meet any number of additional administrative criteria in order to approve your insurance claim. More detail on overcoming these potential additional insurance requirements are covered in the Insurance Challenges, Insurance Verification, and Appealing Your Insurance sections of our website.