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Very High BMI? 3 Important Considerations Before Bariatric Surgery

by Terry Wilson

People with a very high body mass index (BMI) may want to have bariatric surgery, but there are special considerations with the procedure. Due to the elevated chance of complications associated with bariatric surgery in people with a BMI over 50, surgeons may have extra criteria you have to meet.

Surgical Technique

Most bariatric procedures are done through laparoscopic surgery. The advantage of this technique is improved healing and recovery time versus an open procedure. For larger people, especially those who carry more of their weight in their abdomen, a laparoscopic procedure may not be possible. Many surgeons will want you to lose weight before you can qualify for surgery. Not only does this reduce the potential for complications, but it is also less likely that the doctor will have to switch to an open procedure during the surgery. If you have diabetes or other medical conditions that increase your risk of infection and slow healing, having a laparoscopic approach to bariatric surgery is even more important.


Some people can manage to retain some of their mobility, even with a high BMI. For those who are significantly impaired or confined to their bed, their lack of mobility can compromise their recovery and weight loss after surgery. Anyone who has surgery is encouraged to begin moving around shortly after the procedure to reduce the chances of blood clots. After the patient is discharged from the hospital, the surgeon will recommend they routinely walk around to keep the blood flowing to and from their legs. People with significant physical limitations may need to engage in a weight loss plan before bariatric surgery that is combined with physical therapy to increase their mobility. Even once they have surgery, additional precautions might be required, such as the use of pressure cuffs on the legs to prevent clots.

Surgery Type

You will need to discuss which type of bariatric surgery is best for someone with your BMI. Generally procedures with a malabsorption component, such as gastric bypass or duodenal switch, are preferred over the vertical sleeve gastrectomy. The malabsorption part of the procedure usually means weight loss in the beginning is more rapid, and with gastric bypass, your stomach is typically smaller than with the other procedures. Losing weight faster in the months after surgery can improve chronic diseases that often occur in people with a high BMI, so these individuals may be able to be more mobile and engage in exercise once some of the excess weight is lost.

Although bariatric surgery can be life-saving in some people with a very high BMI, there are also realistic concerns before having the procedure. Working with your surgeon to prepare for bariatric surgery will help the process go smoothly. To learn more about weight loss surgery, contact a doctor in your area.