The following four basic criteria are used for patient selection:
- BMI >40 or BMI > 35 with an associated weight related comorbidity. Patients with BMI 30 to 35 will be considered on a case by case basis.
- A failure to control their weight by any other means. A history of prolonged attempts at weight reduction by multiple means. In general, there should be evidence of involvement in multiple significant programs for weight loss.
- The presence of problems associated with the obesity. These may be medical, physical, psychosocial, or future health and life expectancy problems.
- An ability to participate in treatment and long-term follow-up.
A successful outcome after surgery requires a partnership in which both the surgeon and the patient have clear responsibilities. Both need to understand those responsibilities and have a commitment to do their best to fulfill them.
- Age - With increasing age, weight loss is less effective and the risks of the procedure are greater. We are generally reluctant to consider someone older than age 65 years for these reasons. At the other end of the scale, we would not accept patients under the age of 18 years.
- Presence of severe, irreversible medical illness - In the presence of severe irreversible disease, the benefit of weight loss will be lessened and the risks of surgery are increased. A judgment needs to be made in each case to determine the wisdom of proceeding.
- Reduced mental status - Obtaining a successful outcome after surgery requires a partnership between the surgeon and the patient, with both committed to fulfilling their role optimally. This cannot happen if there is a lack of understanding by the patient.
- The presence of medical conditions that would deem any surgery unacceptably risky (eg portal hypertension).
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