I am guided by the main clinical criterion — body mass index (BMI). According to modern recommendations, I consider the possibility of bariatric surgery when BMI ≥ 35 kg/m². With a BMI of 30–34.9 kg/m², surgery may be justified if the patient has severe, poorly controlled type 2 diabetes or other significant metabolic disorders. These approaches reflect current international guidelines and allow for an individualized decision.
When I can recommend surgery at a lower BMI
Even with a BMI of 30–34.9, I consider surgery reasonable if the patient has uncontrolled diabetes or other serious metabolic issues. In such cases, surgery offers a real chance for long-term remission and a significant improvement in quality of life.
Mandatory preparation before surgery
I do not make a decision about surgery without a comprehensive multidisciplinary assessment. Mandatory steps include:
- consultation with an endocrinologist and a dietitian;
- psychological/psychiatric evaluation;
- anesthesiology assessment and a basic set of examinations (blood tests, ECG, etc.).
The goal is to confirm the patient’s understanding of the expected outcome, assess motivation, and evaluate the ability to follow the postoperative regimen.
Contraindications and situations when surgery is postponed or not performed
I do not operate in cases of:
- active alcohol or drug abuse;
- uncontrolled psychopathology (e.g., severe psychosis, active suicidal risk);
- terminal or progressive diseases that significantly reduce expected lifespan and quality of life.
The presence of a mental disorder itself is not an automatic contraindication. However, if the patient is objectively unable to follow postoperative recommendations, surgery is not advisable.
Honestly about what to expect after surgery
Surgery is a tool, not a “magic pill.” I emphasize the need for long-term or even lifelong follow-up: regular laboratory monitoring, intake of vitamins and micronutrients, nutritional adjustments, and behavioral changes. The expected health benefits include significant weight reduction, improved diabetes control, and reduced sleep apnea symptoms — but there are also risks of complications and the possibility of repeat interventions.
Special patient groups
- Adolescents: in our practice, we do not consider surgery before the age of 18. For severe weight problems, we work in a multidisciplinary team (family, pediatrician, endocrinologist, psychologist), using conservative programs and monitoring until adulthood.
- Older patients: decisions are made individually; the priority is functional status rather than chronological age.
- Patients with high surgical risk: before surgery, we strive to optimize the condition to reduce risk and improve outcomes.
Practical checklist before the first consultation
Please prepare:
- BMI calculation (height, weight);
- history of weight-loss attempts (diets, medication, rehabilitation programs);
- list of comorbidities and current medications;
- brief information about your psycho-emotional status and family support.
It is also helpful to discuss your postoperative recovery plan with your family in advance — support is crucial for success.
Want to know if this is your path? Send me your details — I will advise
Please send your height, weight, age, and a short list of medical conditions — I will make a preliminary, rough assessment based on current recommendations. This does not replace an in-person consultation, but it will help you understand the next step.
Author
A bariatric surgeon with many years of experience helping patients improve their health and quality of life.
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