Do You Qualify for WLS? Here Are the New Guidelines

Article By: Whittany Gibson, RDN

Whittany is a Registered Dietitian Nutritionist who specializes in bariatric nutrition counseling, providing education and support prior to and following weight loss surgery.

Are you thinking about weight loss surgery but haven't been considered “heavy" enough or “unhealthy” enough to qualify due to strict criteria? Soon, you may be able to explore your options as there have been significant changes to the selection criteria and recommendations that are worth checking out! In October 2022, the 1991 NIH Consensus Statement that was used for the last 30 years to determine bariatric eligibility was replaced by the ASMBS/IFSO Guidelines on Indications for Metabolic and Bariatric Surgery. The new criteria will tremendously impact the accessibility of weight loss surgery for millions of people in need. These criteria are used by hospitals, insurers, and providers as a means for determining bariatric surgery eligibility and have been long overdue for change.

Since the 1991 NIH Consensus Statement, there have been hundreds of high-quality studies and advancements, which have given the medical community a better understanding of obesity. These improvements warranted a change in determining the who, what, and when of metabolic and bariatric surgery. Obesity, as we know, is an epidemic. Almost 50% of America’s population and 13% of the global population is considered obese... With this comes a significant risk of disease, especially in the morbidly obese. In case you’re wondering what all this means and exactly what changes have occurred, let’s break it down!

1) What do the new guidelines mean? Millions of people who have been ineligible for bariatric surgery in the past due to tight BMI restrictions will now have more of a chance to qualify. In general, qualifying candidates will have expanded access to bariatric surgery for earlier intervention so they may prevent the development or worsening of health conditions and obesity-related comorbidities. In turn, they can experience a higher quality of life and longevity.

2) What is ASMBS/IFSO? The American Society for Metabolic and Bariatric Surgery (ASMBS) and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) are medical groups that serve as the world’s leading authorities on bariatric and metabolic surgery. Together they have replaced the 1991 NIH Consensus Statement.

3) What is BMI, and why does it matter? Body Mass Index (BMI), while it does present limitations in determining health risks, is the most appropriate way to identify the overweight and obese population. Obesity is classified as a BMI of 30-34.9 (Class I), BMI 35-39.9 (Class II), with morbid obesity at a BMI of 40 or greater (Class III). It has been long argued BMI is an arbitrary system that cannot conclusively define someone’s health status or the future risk of disease.

4) What’s the new selection criteria? Those who meet these criteria should be eligible for bariatric surgery:

• BMI 30-34.9 with DM2 or metabolic disease, and also considered for those who have not been successful with substantial weight loss through nonsurgical methods

• BMI >35 without the presence of comorbidities or obesity-related health conditions

• Consideration in children/adolescents with BMI >120% of the 95th percentile and a significant co-morbidity or BMI >140% of the 95th percentile

• Consideration of individuals >70 years of age, based on the assessment of health, risk of surgery, morbidity risk of obesity-related conditions

• Asian population should be considered starting at BMI 27.5

5) What's the catch? It’s still being determined if/when insurance companies will update coverage to follow the new guidelines and standards. However, we know insurers and their level of coverage usually reflect changes made by other medical organizations such as the American Heart Association and the American Diabetes Association, which are updated every year or two.

So hold on tight, stay informed, and don’t give up exploring your weight loss surgery options. It’s always a great idea to meet with a surgery center with a good reputation and a board-certified surgeon to discuss your options around eligibility and coverage.

BariMelts provides general recommendations, not to be construed as medical advice. Please consult your doctor.