Diabetes Health Center

Weight Loss Surgery and Type 2 Diabetes

Who Is Eligible for Weight Loss Surgery?

The National Institutes of Health has created eligibility guidelines for weight loss surgery. The guidelines are based on body mass index (BMI) and obesity-related medical problems such as type 2 diabetes. BMI is a measurement based on weight and height. The Centers for Disease Control estimates that almost 27% of Americans are obese -- a BMI of 30 to 39.9 -- and that 6% have a BMI of 40 or greater. The latter group is said to have clinically severe obesity or morbid obesity.

Generally, weight loss surgery is not advised for people who simply want to lose a few pounds. It is considered a treatment for people who are severely obese -- with a BMI of 40 or greater, which is about 100 pounds overweight for men and about 80 pounds overweight for women -- or moderately obese with obesity-related medical conditions.  This second group includes people with a BMI between 35 and 40. Examples of obesity-related conditions are type 2 diabetes, coronary artery disease, hypertension, arthritis, or sleep apnea.

In early 2011, however, the FDA approved the use of Lap-Band surgery in those with a BMI of 30 or higher who have at least one obesity-related condition. This makes the surgery an option for more people.

Another eligibility requirement is failing to lose weight through a medically managed diet and exercise program. Many insurance plans require patients to complete a six- to 12-month, physician-approved diet and exercise plan before they'll cover weight loss surgery.

Deciding on Weight Loss Surgery

Gastric banding is less invasive and a less risky procedure. Gastric bypass provides immediate negative feedback after overeating: nausea, vomiting, and flu-like symptoms that help keep chronic overeaters from indulging. There's an Achilles heel to both weight loss surgeries. After surgery, people with diabetes still have to make a lifelong commitment to diet and exercise. Some people learn to "eat around" their gastric band. For instance, they may continue to overindulge in milkshakes and ice cream and never lose a pound.

Not everyone is a good candidate for weight loss surgery. Exclusion criteria include:

• Obesity due to a metabolic or endocrine disorder
• Current substance abuse
• Untreated psychiatric disorders
• Heart disease or other medical conditions that make any surgery high risk
• Women planning pregnancy within 18 months of surgery

Ideal weight loss surgery candidates are people who are motivated to lose weight and who are not yet so obese that they're wheelchair bound. If you've lost weight before but can't seem to keep it off with diet and exercise alone, you've proven that you can change your eating habits, at least for a time. Being diligent in changing your diet and lifestyle is key to the success of the surgery.