HOW OVERWEIGHT DO YOU NEED TO BE FOR LAP-BAND SURGERY?


Scale BMIThe question how heavy you have to be to be a candidate for the lap-band is likely the most often asked question by our consultation candidates. While the FDA states that lap-band is recommended for patients with BMI of 30 and higher, the final answer whether you qualify will depend on your physician and/or requirements on your insurance policy.

FDA’S WEIGHT MINIMUM FOR LAP-BAND SURGERY

When first approved by FDA in 2001, the LAP-BAND was recommended for patients with BMI of 35 with two or more weight-associated conditions or BMI of 40 and higher. This weight recommendation remained in place for a decade. Nevertheless, in 2011 FDA lowered the BMI requirement to 30 BMI with one or more co-morbidities and 35 BMI with no co-morbidities. The requirement was lowered after it was established that the lap-band surgery can be used as prevention to developing conditions associated with obesity. While the FDA requirements usually serve as a guideline, a weight-loss physician always determines whether a patient is a good lap-band candidate on case-by-case basis.

BARIATRIC SURGEON WEIGHT REQUIREMENTS

When a patient visits for a consultation he or she will most likely be automatically recognized as acandidate for the lap-band surgery if his or her BMI is above 30. Nevertheless, in some cases weight-loss surgeon may decide that the weight-loss surgery may be a good option for patients with BMI as low as 28. The surgeon makes the decision on basis of the overall assessment of patient’s health. In other words, if a patient has weight associated conditions surgeon may recommend the surgery even though the patient does not meet the FDA’s weight recommendations.

That is especially true for patients whose weight concentrates in their midsection. The fat concentrated around the waistline may be an indicator of high visceral fat that is considered to be far more dangerous than the subcutaneous fat (under your skin). The visceral fat is a fat that surrounds your internal organs such as heart, stomach, liver, and intestines which, if high, it may put you at significantly higher risk of developing conditions such as hyperlipidemia (high cholesterol), diabetes, hypertension, and heart disease. Because prevention is the best way to treat some of the more serious health conditions, your surgeon may recommend the surgery even if your BMI has not reached 30.

INSURANCE WEIGHT REQUIREMENTS

While FDA and a surgeon have their recommendations in regards to a lap-band candidate, the insurance companies have their own requirements which deviate from the other two. Most of the insurance policies require patients to have a BMI of at least 35 and have at least two weight-associated conditions (co-morbidities). The conditions that are currently recognized by health insurance are:

  • diabetes
  • hypertension
  • hyperlipidemia
  • asthma
  • sleep apnea

In order for the co-morbidity to be recognized by your insurer, you have to indicate treatment with medication and that the condition is not responding to the treatment. In terms of sleep apnea, a patient has to undergo a sleep study to confirm the condition.  

Patients who surpass BMI of 40, usually don’t need to indicate any weight associated conditions or treatment to have their weight-loss surgery covered. The exception to that rule are health benefits provided via unions which sometimes may require a patient to be over 45 BMI to qualify for the procedure. To learn what are your weight requirements for the lap-band you will need to contact an insurance person at the clinic to verify your coverage.     

If you would like to learn more about the lap-band surgery and determined if you are a candidate, you can contact our patient advocate at 312-548-1483 or schedule your one-on-one consultationwith a bariatric surgeon.