Bariatric (Weight Loss) Surgery

What is bariatric surgery?

Bariatric surgery, also known as weight loss surgery, is a medical procedure designed for individuals grappling with severe overweight or obesity. Its primary objective is to assist them in achieving substantial and long-lasting weight loss. Typically, this surgery is considered when other weight loss methods, such as diet and exercise, have not yielded successful results, or when obesity-related health problems pose a significant threat to the patient’s overall well-being.

Topics covered on this page

• Cost of weight loss surgery
• Factors affecting the cost
• Are you a candidate?
• Insurance coverage
• Types of weight loss procedures
• Recovery time
• When to expect results

Cost of weight loss surgery

The cost of weight loss surgery can vary significantly based on several factors. According to the American Society for Metabolic and Bariatric Surgery (ASMBS), the average cost of bariatric surgery ranges between $17,000 and $26,000.

Here are the average costs for some of the most popular types of bariatric procedures:

• Gastric Sleeve Surgery (Sleeve Gastrectomy): $10,000 to $20,000.
• Gastric Bypass Surgery: $15,000 to $30,000.
• Adjustable Gastric Banding (Lap-Band): $8,000 to $15,000.
• Duodenal Switch: $20,000 to $35,000 or more.

To obtain a quote based on your individual circumstances, schedule a consultation with an experienced bariatric surgeon near you.

Factors affecting the cost of treatment

Numerous factors can influence the cost of your procedure. Here are some key factors that impact the cost:

• Your Bariatric Surgeon: The experience and reputation of your bariatric surgeon can affect the cost. Surgeons with extensive training, certifications or specialized expertise often charge higher fees.
• Location: The geographical location of the medical practice can influence the cost. Bariatric practices in urban areas or regions with a higher cost of living generally come with a higher price tag compared to rural areas.
• Type of Procedure: Different bariatric procedures come with varying costs. Commonly performed procedures include gastric sleeve surgery, gastric bypass, adjustable gastric banding, and duodenal switch.
• Anesthesia: The administration of anesthesia involves the expertise of an anesthesiologist. Factors such as the type of anesthesia used, the duration of the procedure, and the qualifications of the anesthesia provider can affect anesthesia fees.
• Surgical Facility: The facility where your weight loss procedure is performed may impact the cost. These fees cover the use of the operating room and related services.
• Complexity of the Case: The complexity of your case can influence the treatment cost. Cases requiring extensive work may necessitate more advanced treatment techniques, devices, and additional time, resulting in higher costs.
• Medical Care: The care provided before and after surgery contributes to the overall cost. This includes preoperative consultations, medical tests, prescription medications, and follow-up appointments.
• Insurance: Bariatric surgery may be covered by insurance under certain criteria.

If you are considering weight loss surgery, it is advisable to schedule a consultation with an experienced bariatric surgeon near you. This will allow you to discuss your weight loss goals and gain a comprehensive understanding of the specific cost breakdown and factors relevant to your individual case.

Are you a candidate?

The eligibility criteria for bariatric surgery were established by the U.S. National Institutes of Health in 1991 and have remained unchanged. The criteria include:

Are you a bariatric surgery candidate?

• BMI (body mass index) of 40 or higher without significant obesity-related health conditions, or
• BMI of 35 or higher with at least one serious obesity-related health condition, such as Type 2 diabetes, high blood pressure (hypertension), obstructive sleep apnea, high cholesterol (hyperlipidemia), NASH/NAFLD (non-alcoholic steatohepatitis/non-alcoholic fatty liver disease), or obesity hypoventilation syndrome.

Patients must also be willing to adopt and maintain significant lifestyle changes after the procedure. Bariatric surgery does not grant the freedom to consume unrestricted diets or lead sedentary lifestyles without consequences. Weight regain is possible if these lifestyle changes are not adhered to.

Specific dietary precautions are necessary on an ongoing basis following surgery. These precautions may include adjusting the amount of food ingested, avoiding certain foods, and potentially using nutritional supplements, depending on the type of surgery.

Weight loss prior to surgery is often required by most surgeons. This helps demonstrate the patient’s ability and commitment to meaningful lifestyle changes and reduces the risk of complications during surgery. Even modest weight loss before surgery can shrink the liver’s size, making the procedure easier and safer to perform.

Obesity is a significant public health concern in the U.S. and globally, with more than two-thirds of adults in the U.S. being overweight or obese, and 42% classified as clinically obese, according to data from the CDC. It is associated with a range of health problems and increased morbidity and mortality.

Insurance coverage

In general, insurance companies may cover the cost of bariatric surgery if specific criteria are met. These criteria often include:

• Body Mass Index (BMI): A BMI of 40 or higher, or a BMI of 35 or higher with obesity-related health conditions such as diabetes, hypertension, sleep apnea, or heart disease.
• Documentation of Weight Loss Attempts: Documented evidence of prior attempts to lose weight through medically supervised diets or weight loss programs.
• Bariatric Surgeon Evaluation: An evaluation by a bariatric surgeon to determine if the patient is a suitable candidate for the surgery.
• Psychological Evaluation: A psychological evaluation to assess mental and emotional readiness for the procedure.
• Authorization & Pre-approval: Prior authorization or pre-approval is often required before scheduling the surgery.

Some insurance policies may provide coverage only for specific types of weight loss surgery methods. Others may cover the surgery itself along with related expenses. It is essential to understand your insurance coverage before scheduling the surgery.

The Centers for Medicare & Medicaid Services (CMS) have determined that coverage is reasonable and necessary for laparoscopic gastric bands, gastric sleeves, and gastric bypass procedures for individuals who meet their criteria. These criteria are slightly more stringent than the general eligibility criteria for bariatric surgery. Your surgeon’s office will have detailed information about Medicaid/Medicare coverage.

For expenses not covered by insurance, various payment plans and financing options are available. Consult your surgeon to explore options to make weight loss surgery financially feasible.

To determine your eligibility for coverage, contact your insurance company to learn more about the specifics of your policy.

Types of weight loss procedures

Traditionally, bariatric procedures have been categorized as restrictive, malabsorptive, or a combination of both. Restrictive procedures reduce the size of the stomach, limiting the amount of food that can be consumed, while malabsorptive procedures disrupt the body’s ability to absorb nutrients.

Here are some of the most popular types of weight loss procedures:

• Roux-en-Y Gastric Bypass: This procedure involves both restriction and malabsorption. The stomach is divided, creating a small pouch that holds approximately one ounce of food. The pouch is then connected to the small intestine in a way that bypasses a portion of the intestinal tract. Read more.
• Vertical Sleeve Gastrectomy: Gastric sleeve surgery is primarily a restrictive procedure. About 80% of the stomach is removed, leaving a small tube-like “sleeve” stomach. This reduces the stomach’s capacity and accelerates the emptying of food. Read more.
• Biliopancreatic Diversion with Duodenal Switch: This is a mixed surgical procedure involving a sleeve gastrectomy and the attachment of the lower part of the small intestine to the stomach, bypassing a significant portion of the small intestine (specifically, the duodenum). It is less commonly performed due to a higher risk of complications. Read more.
• Gastric Banding: In this restrictive procedure, a band is placed around the stomach, creating a small pouch and a restricted stomach outlet. Some gastric bands are adjustable, allowing for changes in pouch size and stomach emptying rate through a balloon device accessed via a skin port. The Lap Band System is an example of adjustable gastric banding. A similar technique, vertical banded gastroplasty, involves using a band and surgical staples to divide the stomach. Read more.
• Endoscopically Placed Devices: Several incision-free devices and procedures placed or performed using minimally invasive scopes are in development or early clinical use. For example, the gastric balloon procedure involves inserting a balloon into the stomach to reduce available food space and was approved for use in the U.S. by the FDA. The balloon may remain in place for up to six months. Another endoscopically placed device is the endoluminal sleeve, a thin plastic sleeve placed in the upper part of the intestine to block food absorption.

Vertical sleeve gastrectomy and Roux-en-Y gastric bypass are the most commonly performed bariatric surgeries in the U.S. The choice of a specific surgical approach should be discussed in close consultation with your doctor, as no single technique is suitable for all patients and depends on your unique situation.

Recovery time

The recovery period following bariatric surgery can vary based on the specific procedure performed and individual factors. For instance, a Roux-en-Y gastric bypass typically necessitates a hospital stay and bed rest, while many laparoscopic procedures can be done on an outpatient basis. Your surgeon will provide specific information regarding the duration of recovery, functional limitations, and the time needed off work for your particular procedure.

When to expect results?

According to the American Society for Metabolic and Bariatric Surgery (ASMBS), during the initial 30 days following weight loss surgery, the average patient may experience weight loss ranging from 5 to 15 pounds per week. Males tend to lose weight at a faster rate than females.

After two months, most patients achieve an average of a 20% reduction in excess weight. Some individuals may lose 30 to 50 percent of their excess weight within the first six months, with up to 77 percent of excess weight loss possible as early as 12 months after surgery.

It is important to understand that results can vary among patients, and bariatric surgery should not be regarded as a “quick fix” for weight loss. It requires a commitment to sustained lifestyle changes and ongoing medical follow-up to achieve and maintain successful outcomes.

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