The requirements for weight loss surgery generally revolve around body mass index (BMI) and other underlying health conditions that may be present. Your care team may also need to consider other factors, such as your mental health and surgical history.

Bariatric (weight loss) surgery is a major procedure, so you’ll need to meet certain conditions before getting the surgery. You’ll also need to complete an in-depth preparation process.

Keep in mind that the information presented here is general guidelines. Your care team will have the most relevant information for your personal requirements.

You may qualify for weight loss surgery if you have:

  • a BMI of 40 or higher
  • a BMI of 35 or higher with serious health conditions associated with obesity, like sleep apnea or heart disease
  • a BMI of 30 or higher with type 2 diabetes that’s difficult to manage with other treatments

What’s BMI?

Body mass index (BMI) is a screening tool for overweight and obesity. It compares a person’s weight to what is considered “normal” for their height.

In adults, obesity is diagnosed when BMI is 30 or higher.

Other factors

In general, you may also be a good candidate for weight loss surgeries if you:

  • have tried nonsurgical methods, like medication and lifestyle changes, and have been unable to lose weight or maintain a moderate weight
  • understand the risks and benefits of the surgery
  • are willing to continue lifestyle changes after the surgery, such as eating a balanced diet and getting regular physical activity
  • have considered the follow-up care required after surgery

To prepare for the actual surgery, you may need to complete the following:

  • Psychological evaluation: To ensure you’re mentally ready for the procedure, you’ll need to meet with a psychologist. They will also consider your history of health conditions like depression and eating disorders. The evaluation may also help your care team ensure that you understand the long-term ramifications of the surgery.
  • Nutritional evaluation: A registered dietitian will help you manage any nutritional deficiencies and explain the dietary changes you’ll need to make before and after surgery.
  • Weight loss plan: Some insurance companies may require a specific amount of weight loss before approving surgery.
  • Medical clearance: Your healthcare team will review your medical and surgical history and laboratory tests, which may influence weight loss after surgery. You’ll also need to be screened for sleep apnea and heart disease.
  • Presurgical imaging: If you’ve had past surgeries involving the gastrointestinal tract or other gastrointestinal issues, your healthcare team might request certain imaging tests. This can help determine the best type of weight loss surgery for you.

Depending on your medical history and needs, you might need additional evaluations, such as a sleep study. For example, if you have diabetes, your care team will help you manage your blood sugar levels first.

The exact cost of weight loss surgery can vary depending on many factors, including:

  • the type of surgery
  • your geographical location
  • your surgeon
  • your specific needs

A 2023 study evaluated the costs of two types of bariatric surgery in the United States using data from 2016 to 2019. The median cost of laparoscopic sleeve gastrectomy was $10,900, and the median cost of Roux-en-Y gastric bypass surgery was $13,600.

If you have health insurance, your plan may cover some or all of the costs if you meet the requirements for surgery. The amount you’ll need to pay out of pocket depends on your specific insurance company and plan.

Medicare covers some weight loss surgeries. You’ll still need to meet certain requirements set by your Medicare plan. Visit the Medicare website to learn more about estimating your weight loss surgery costs.

If you’re thinking about getting weight loss surgery, talk with a doctor. Depending on your health history, you might consider talking with a primary care doctor, endocrinologist, cardiologist, or other healthcare professional.

Your doctor can determine whether you’re a good candidate for the procedure.

When talking with your doctor, consider asking the following questions:

  • Do I qualify for weight loss surgery?
  • How might weight loss surgery benefit me?
  • Are there any nonsurgical methods I should try first?
  • Do I have any health conditions that increase my risk of postsurgery complications?
  • Which type of weight loss surgery is best for me?
  • What does weight loss surgery involve?
  • What do I need to do before and after surgery?
  • How much weight can I expect to lose?

If your insurance plan covers weight loss surgery, you’ll also need to meet certain guidelines. You may need to provide:

  • proof of medical issues related to your weight
  • proof of previous participation in medical weight loss programs
  • a letter of medical necessity from your physician
  • documentation for completed health evaluations

Some insurance plans may also require a certain percentage of weight loss before approving surgery to demonstrate that someone can follow the dietary or lifestyle changes that may increase the likelihood of long-term success of the surgery. Often, this pre-surgery weight loss may be accomplished with medications.

It may take weeks to months for your insurance company to approve your surgery.

If you’re not a good candidate for conventional weight loss surgery, or if you don’t want the procedure, there are some alternatives.

Your doctor might recommend:

  • Endoscopy: In an endoscopic weight loss procedure, a doctor inserts a thin, flexible tube into your digestive tract via your mouth. This is used to place medications or devices in your digestive tract to reduce the amount of food you can eat.
  • Medications: Your doctor may recommend weight loss medications, including glucagon-like peptide-1(GLP-1) receptor agonists.
  • Lifestyle modifications: Dietary changes and physical activity are important for weight management, whether you get a procedure or not. You’ll also need to adopt these habits if you’re taking weight loss medications.

To get approved for weight loss surgery, you’ll need to meet certain requirements. These guidelines are often set by your healthcare team and insurance company. You might be a good candidate if you have a BMI of 40 or higher or have serious health conditions related to weight.

If you’re interested in the procedure, talk with your doctor. They can let you know whether you’re a good candidate for the surgery and how it may benefit you.