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Is weight loss surgery tax deductible?

Many patients ask the question – Is weight loss surgery tax deductible?

This is a question that we actually do not get asked very often because many patients think that if their insurance isn’t covering a procedure that it isn’t medically necessary. In actuality, whether a treatment is covered or not has nothing to do with medical necessity – that is something that is determined by your physician! Even if your insurance is covering your procedure, especially if you have a higher deductible plan, you may still qualify. Keep on reading to find out more!

Understanding the Tax Deductibility of Weight Loss Surgery

Weight loss surgery, also known as bariatric surgery, can be a significant financial investment. Especially if you are self-paying for a procedure such as a gastric sleeve or bypass! However, many people may not realize that some of these expenses can be tax-deductible, potentially easing the financial burden. Here’s a comprehensive look at how you can leverage tax deductions for weight loss surgery.

Eligibility for Tax Deduction

To qualify for a tax deduction, weight loss surgery must be deemed medically necessary. This means that the surgery is not elective but is required to treat a specific medical condition, such as obesity, which is recognized as a disease by the IRS1. The surgery must be prescribed by a physician and aimed at treating or preventing a disease. At JourneyLite this will always be the case!

Qualifying Expenses

The IRS allows you to deduct medical expenses that exceed 7.5% of your adjusted gross income (AGI). For example, if your AGI is $50,000, you can deduct medical expenses that exceed $3,7502. Qualifying expenses include:

Non-Qualifying Expenses

Certain expenses related to weight loss surgery are not deductible. These include:

How to Claim the Deduction

To claim the deduction, you must itemize your deductions on Schedule A (Form 1040). Here’s a step-by-step guide:

  1. Gather Documentation: Collect all receipts, bills, and documentation related to your medical expenses.
  2. Calculate Total Medical Expenses: Add up all qualifying medical expenses.
  3. Determine Deductible Amount: Subtract 7.5% of your AGI from your total medical expenses to find the deductible amount.
  4. Complete Schedule A: Enter the deductible amount on Schedule A (Form 1040) under medical and dental expenses1.

Conclusion

Understanding the tax deductibility of weight loss surgery can help you manage the financial aspects of your health journey. By ensuring that your surgery is medically necessary and keeping thorough records of your expenses, you can take advantage of potential tax savings.

If you have any specific questions or need further assistance, consulting a tax professional or the IRS guidelines can provide additional clarity.

1: IRS Publication 502 2: IRS Topic No. 502

Feel free to ask if you need more detailed information or have other questions!

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Bariatric surgery vs. GLP-1’s, which is better?

Bariatric surgery vs. GLP-1’s is a hotly-debated topic today. Surgical procedures such as gastric sleeve and gastric bypass, have long been recognized as effective tools for significant and sustained weight loss. In recent years, GLP-1 receptor agonists, a class of medications that includes drugs like semaglutide (Ozempic, Wegovy) and tierzepatide (Mounjaro, Zepbound), have emerged as a popular non-surgical alternative for weight loss and type 2 diabetes management. However, recent studies and cost-effectiveness analyses suggest that bariatric surgery may provide more lasting and cost-efficient results compared to GLP-1 medications over the long term.

The Rise of GLP-1 Receptor Agonists

GLP-1 (glucagon-like peptide-1) receptor agonists work by mimicking the action of the GLP-1 hormone, which helps regulate blood sugar and appetite. These drugs have gained considerable attention due to their dual benefits: improving glycemic control for individuals with type 2 diabetes and promoting significant weight loss in people with obesity. Semaglutide, in particular, has shown dramatic results in clinical trials, with some patients losing up to 15% of their body weight.

However, despite the clinical efficacy of GLP-1 receptor agonists, they come with significant financial costs. Long-term use of these medications requires ongoing prescriptions, and depending on insurance coverage, patients may face high out-of-pocket expenses. For instance, the cost of semaglutide can reach upwards of $1,000 per month, making it a costly lifelong intervention.

Bariatric Surgery: A Proven, One-Time Solution

Bariatric surgery, including procedures like gastric bypass, sleeve gastrectomy, and adjustable gastric banding, has been a cornerstone of obesity treatment for decades. Unlike GLP-1 medications, which require continued use, bariatric surgery is a one-time procedure that offers sustained weight loss and improvement in obesity-related comorbidities such as diabetes, hypertension, and sleep apnea.

According to data from long-term studies, bariatric surgery can result in weight loss of 25-30% of total body weight, which is significantly higher than the average weight loss achieved with GLP-1 medications. Furthermore, the metabolic changes induced by surgery, particularly in procedures like gastric bypass, can lead to the remission of type 2 diabetes in many patients, further reducing healthcare costs associated with managing the disease.

The Cost-Effectiveness Analysis

A growing body of research has compared the cost-effectiveness of bariatric surgery and GLP-1 receptor agonists. The findings consistently show that bariatric surgery is more cost-effective in the long run due to its durability and one-time cost structure. A study published in JAMA Surgery in 2023 revealed that, over a 10-year period, patients undergoing bariatric surgery had significantly lower healthcare costs compared to those using GLP-1 medications, even when considering the upfront costs of surgery. Also, recent 2024 data published out of Northwestern University found that weight loss surgery saves patients an average of about $9000 a year and delivers 2 additional years of healthy life over GLP-1’s.

The cost savings stem not only from weight loss but also from the resolution or improvement of obesity-related conditions, particularly type 2 diabetes. Bariatric surgery has been shown to reduce or eliminate the need for diabetes medications, including insulin, in many patients. In contrast, GLP-1 receptor agonists, while effective, require continuous use, and their benefits may wane if the medication is discontinued.

Quality of Life and Long-Term Outcomes

In addition to cost, quality of life (QoL) improvements are a critical factor when evaluating treatments for obesity and related conditions. Both bariatric surgery and GLP-1 medications have been shown to enhance QoL by reducing body weight, improving mobility, and decreasing the burden of comorbidities. However, bariatric surgery’s more significant and sustained weight loss often leads to greater improvements in physical and mental health.

Studies have also suggested that bariatric surgery may have a more profound impact on long-term mortality and morbidity. A 2019 meta-analysis found that bariatric surgery reduced the risk of all-cause mortality by nearly 50%, compared to non-surgical interventions. The long-term benefits of surgery in reducing cardiovascular disease, cancer, and diabetes complications contribute to its favorable cost-effectiveness profile.

Challenges and Considerations

Despite its advantages, bariatric surgery is not without challenges. It is an invasive procedure with potential risks, including surgical complications, nutritional deficiencies, and the need for lifelong medical monitoring. Additionally, not all patients are eligible or willing to undergo surgery. Meanwhile, GLP-1 receptor agonists provide a non-invasive option, making them attractive to individuals who prefer to avoid surgery or who may not qualify for surgical interventions.

There is also the issue of accessibility. Bariatric surgery, while cost-effective over time, requires a significant initial investment, and not all insurance plans cover the full cost of the procedure. On the other hand, GLP-1 medications are more readily accessible but may become prohibitively expensive without insurance or discounts.

The Future of Obesity Treatment

As obesity rates continue to rise globally, healthcare systems must carefully consider both the clinical outcomes and economic impact of treatments. While GLP-1 receptor agonists offer an exciting pharmacological option for weight loss, bariatric surgery remains the gold standard for achieving significant and sustained weight reduction and resolving related comorbidities.

For many patients, bariatric surgery may offer a more cost-effective solution over time, especially when taking into account the reduced need for medications and healthcare interventions. However, the choice between surgery and medication should be tailored to the individual, factoring in their health status, preferences, and ability to afford long-term treatments.

As research progresses, it is likely that the optimal strategy for obesity management will involve a combination of medical, surgical, and behavioral interventions to ensure the best possible outcomes for patients.

Conclusion

Bariatric surgery has been shown to be a more cost-effective approach than long-term use of GLP-1 receptor agonists for weight loss and the treatment of type 2 diabetes. While GLP-1 medications offer a non-surgical alternative with significant short-term benefits, the one-time cost and lasting effects of bariatric surgery make it a superior option for many individuals struggling with obesity and its related health issues. The decision between the two should ultimately be personalized, balancing cost, efficacy, and patient preference to optimize outcomes in the fight against obesity. Fortunately, our team at JourneyLite offers a wide range of treatments including medications, surgical procedures, and non-surgical options such as gastric balloon. Schedule a consultation with our team to find out which option is best for you!

Request Appointment!

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Unlock Your Weight Loss Potential with JourneyLite’s GLP-1 Program!

Tired of diets that don’t work? Struggling with weight management? At JourneyLite, we’re here to help you reach your health and weight loss goals with a groundbreaking approach using GLP-1 medications.

Our GLP-1 program features safe, effective, and FDA-approved treatments like Tirzepatide and Semaglutide that are designed to help you lose weight and improve your overall health. These medications target key areas in your body that regulate hunger and blood sugar, making it easier than ever to:

🌟 Lose Weight
🌟 Control Cravings
🌟 Boost Energy Levels
🌟 Improve Your Metabolic Health

Why Choose JourneyLite?

✅ Medical Supervision: Our experienced team of medical providers and registered dietitians offers personalized care and guidance every step of the way.
✅ Proven Results: Patients see real, sustainable weight loss with GLP-1 treatments.
✅ Comprehensive Support: From meal planning to fitness advice, we help you build healthy habits that last.

Join the thousands who have transformed their lives with JourneyLite’s GLP-1 program! Take the first step to a healthier, happier you today.

Schedule your consultation now and take advantage of our 3 month semaglutide special for $900 – includes all visits, medication, and shipping cost!

Book now!

Offer good until 12/31/2024 only.

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FDA Removes Tirzepatide from Shortage List

Dr. Trace Curry
Medical Director
JourneyLite
tirzepatide 3d rendering

GlP-1 receptor agonists have quickly become one of the most popular categories of medications on planet earth. Used for both diabetes and weight loss, there are many patients who could potentially benefit from these drugs. In fact, they became so popular that the manufactures could not meet demand and some of them were placed on the FDA drug shortage list.

When a drug is on this list, compounding pharmacies are allowed to make a generic version of the medication, despite the fact that it is still covered by a patent.  Many patients were able to get less expensive forms of these medications due to this exception. Earlier in the month of October, however, the FDA removed tirzepatide from their drug shortage list as the manufacturer had reportedly caught up with demand.

What does this change mean? Well, basically it means that patients who have been using generic compounded tirzepatide will no longer be able to get it. They will have only 3 choices:

 

    • Stop the medication
    • Transition over to semaglutide, which is still on the list and can be compounded
    • Transition over to brand-name tirzepatide, which is Zepbound

Zepbound is more expensive than compounded tirzepatide, but Eli Lilly the manufacturer does offer a savings program where patients can get it without insurance coverage for around $650/month. Still, this is nearly twice as much as the compounded version.

The good news is that there are many different weight loss options that patients can consider, and our team of trusted experts can help you figure out an option that can be both effective and within your budget! If you’re interested in learning more about GLP-1 receptor agonists, more traditional and affordable weight loss medications, or even procedures such as gastric balloon or gastric sleeve, contact our team for more information!

 

 

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5 Reasons Weight Loss Surgery Beats GLP-1’s

dr. trace curry

Dr. Trace Curry
Medical Director
JourneyLite

We know that weight loss surgery is superior to GLP-1’s for many overweight patients, so I thought I would compile a list of 5 reasons why weight loss surgery beats GLP-1’s (GLP-1 receptor agonists, or GLP1RA’s). As a weight loss specialist treating patients for over 20 years with both medications, surgeries, and procedures such as gastric balloon, there has never been a time where patients had more options to investigate to help them lose weight. Unfortunately, sometimes more options bring more confusion in terms of the best path for somebody who wants to knock out some unwanted pounds. So lets try to make a clearer picture out this crowded field of options!

GLP-1 receptor agonists such as Wegovy, Ozempic, Zepbound, and Mounjaro are in the news every day. Will these medications cause weight loss surgery to become obsolete? The answer is no, according to a lot of current data including some unveiled at a recent poster presentation at the American Society of Bariatric Surgery. The presenters looked at ~25,000 gastric sleeve/gastric bypass patients and compared the results to around 12,000 patients being treated with semaglutide and 3200 patients on tirzepatide.

After analyzing these results, here are 5 reasons that, for some patients, weight loss surgery is better than GLP-1 receptor agonists.

  1. Amount of weight loss
    • In the lifestyle-only group, meaning they did not receive and medications or surgery, patients lost a mean total body weight loss of 7.4%. Patients universally regained weight with time and went back to their pre-intervention weight within around 4 years.
    • In the GLP-1 group:
      • Treatment with semaglutide weekly injections for 20 weeks resulted in a mean total body weight loss of 10.6%
        • Percent total body weight loss is calculated by multiplying the percentage loss by the patient’s weight. So if you’re 300 lbs and you lost 10% of your total body weight, that would be 250 x .10 = 25 lbs
      • Treatment with weekly tirzepatide injections for 36 weeks yielded a mean total body weight loss of 21.1%
      • While this seems promising on the surface, about half of the weight was regained within a year after stopping the injections, whereas continuing the medications indefinitely provided little additional weight loss.
        • Even if the 250 lb patient continues the medication, the thought of injecting yourself with a ~$1000/month medication weekly for the rest of your life to maintain a 25 lb weight loss is daunting!
    • In the surgical group, outcomes were significantly better:
  2. Long-term success rate
  3. Cost
    • GLP1-RA’s
      • The cost of GLP1RA’s both to individual patients and society in general is enormous:
        • Estimates are that it would cost the health care system around $600 billion a year to treat all eligible patients with GLP1RA’s.
        • For individuals, the cost of brand-name medications such as Wegovy or Zepbound out-of-pocket can be $500-$1200/month.
        • Even for compounded versions of semaglutide and tirzepatide, the cost is $300-$500/month including office visits required for the prescriptions.
      • Few healthcare plans cover GLP1RA’s for weight loss. Medicare and Medicaid do not.
      • Surgery
        • Weight loss surgery is covered by Medicare, Medicaid, any most commercial carriers.
          • Coverage is determined by employers, not by commercial carriers.
          • With employer-directed healthcare plans like Surgery Plus, Luminary, Barinet, and Carrum patients can have weight loss surgery with little-to-no out-of-pocket cost.
        • For self-pay patients, gastric sleeve can be found in many parts of the country for as little as $10,000.
  4. Side effects
    • GLP1-RA’s
      • There are many side effects from these medications, such as nausea, vomiting, reflux, constipation, and gastroparesis.
      • In rare cases, these medications have been associated with serious thyroid cancers
    • Surgery
      • Gastric sleeve and gastric bypass carry well-defined risk.
      • Unlike for medications, most side effects after surgery such as pain, nausea, and vomiting are temporary and resolve after a few weeks.
  5. One-time Procedure
    • Although we are talking about a surgical procedure instead of injections, it is a one-time procedure which for many patients is much more appealing than a daily or weekly injection for the rest of their lives.

There are more than 5 reasons weight loss surgery beats GLP-1’s, however, as with any surgical procedure or medication, you should talk to your doctor about your specific case and what any risks, benefits, and costs would be. At JourneyLite, we have a comprehensive team of weight loss specialists and Registered Dietitians with extensive experience in medications, weight loss surgery, and non-surgical procedures such as gastric balloon.

If you would like to make an appointment to discuss these options with me, or my associate Dr. James Augusta, just click on the appointment button below!

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Vitamins after weight loss surgery: 90 days and beyond

Pharmaceutical-grade vitamins are critical to avoid vitamin deficiencies after weight loss surgery. At JourneyLite Physicians, we carry only Bariatric Advantage vitamins, the industry standard for vitamin quality and effectiveness for bariatric surgery patients. Did you know that your vitamin regimen changes when you are 90 days post-op?

To make this simpler for our patients, we have assembled vitamin kits for each procedure! Just click on the link below for your specific surgery to learn more; also listed below is an optional biotin supplement which can help prevent post-op hair loss.

 

*Each vitamin kit provides a 90-day supply for your specific procedure. If you check out with Paypal, deferred payment options are available!

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Semaglutide special at JourneyLite!

Did too many summer barbeques and cocktails lead to a bump in the scale over the summer? The kids are going back to school and it’s time to get back into your regular routine of healthier eating and regular exercise! Sometimes, though, this isn’t enough to get the scale moving in the right direction to shed those summer party pounds. At JourneyLite Physicians, we have a strong GLP-1 program with experienced medical providers and licensed/registered dietitians. We also use a trusted, vetted compounding pharmacy partner (MediVera – formerly University Compounding Pharmacy) to provide compounded semaglutide injections shipped directly to your home.

To help you with achieving your weight loss goals, for a limited time we are offering a 3-month complete semaglutide program for $900! This includes all of your provider+dietitian visits, medication, and shipping costs.  Take advantage of this back-to-school savings to get the scale moving in the right direction now before the holidays get here!

Don’t use some faceless online company to help you with your weight loss needs, choose your trusted weight loss partner, JourneyLite!  Just fill out the no-obligation appointment request form below and one of our patient service representatives will contact you with all the details and answer any questions you might have.

Note: Program cost is non-refundable, but can be transferred to other products and/or services. Offer good for appointment requests received by 9/30/2024.  Offer valid in Cincinnati, Columbus, Dayton, Northern Kentucky, and Indianapolis locations.  Starting dosages only–does not apply to patients already on semaglutide.

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Does Insurance Cover Weight Loss Surgery?

When considering weight loss surgery, one of the most pressing questions on many people’s minds is, “Does insurance cover weight loss surgery?”

As obesity rates continue to climb globally, weight loss surgeries such as gastric bypass, lap band, and gastric sleeve procedures have become critical tools in managing severe obesity and related health conditions. These surgeries help reduce weight and improve various obesity-related health issues like diabetes, hypertension, and sleep apnea, highlighting their medical necessity. 

Given the significance and potential health benefits of these procedures, understanding insurance coverage is essential for anyone considering surgical options for weight management. This article will explore whether insurance covers weight loss surgeries, reviewing the specifics of coverage, requirements, and how to handle potential denials.

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How Much Does Weight Loss Surgery Cost?

Before we examine whether insurance covers bariatric surgery, we should discuss the associated costs. The cost of weight loss surgery ranges into the tens of thousands of dollars and can extend well beyond the initial surgical procedure. Typically, these costs include:

  • Surgical fees
  • Hospital charges for the room and nursing care during the stay
  • Anesthesia fees
  • Expenses related to post-operative follow-up care, which is crucial for monitoring recovery and ensuring the success of the surgery

In addition to these direct surgical costs, patients must also consider additional expenses that are often not covered by insurance. For instance, most weight loss surgery patients require ongoing nutritional counseling to help them adapt to their new dietary requirements and ensure they receive adequate nutrition. 

Many patients also must take lifelong supplements, such as vitamins and minerals, to compensate for the reduced ability to absorb nutrients following procedures like gastric bypass. These supplements and the cost of dietary consultations can represent a significant part of the post-surgery expenses. 

Understanding these costs is vital, as they impact your overall investment in your health and well-being.

Although insurance charges vary greatly depending on each contract, JourneyLite believes in transparent pricing for self-pay patients and provides a comprehensive outline of your overall costs so you can clearly understand your financial obligation. For insurance patients, our team can estimate your out-of-pocket expenses once we analyze your policy and coverage benefits.

Does Insurance Cover Weight Loss Surgery?

The short answer is “sometimes.” Certain insurance plans will cover weight loss surgery if it’s deemed medically necessary. This may include insurance coverage for gastric sleeve, lap band, or gastric bypass procedures.

does insurance cover gastric sleeve lap band gastric bypass

Significant Differences in Coverage

Weight loss surgery coverage can vary significantly among different providers and plans. But many health insurance policies commonly cover several aspects of weight loss procedures. Typically, insurance will cover the major expenses of the surgery itself, including hospital stays, surgeon’s fees, and anesthesia, provided that the surgery is deemed medically necessary. This determination of medical necessity usually requires documentation from healthcare professionals indicating that the surgery is essential for the treatment of obesity-related health conditions that could be life-threatening if left untreated.

Varying Coverage for Procedures

The extent of coverage can differ significantly. Some insurance companies may cover all types of weight loss surgeries. In contrast, others might only cover specific procedures like gastric bypass or sleeve, excluding others such as adjustable gastric banding. Additionally, coverage might include all associated hospital charges for the duration of the stay required by the surgical procedure, but this, too, can vary. Each insurance provider has its own criteria for eligibility and coverage, including different deductible levels, co-payments, and out-of-pocket maximums that can affect your overall cost.

The Need for Reviewing Coverage

Patients considering weight loss surgery should closely review their insurance plan or speak directly with their insurance provider to understand what is covered. Our team of professionals can also help you determine what is covered. Reviewing your coverage is essential for financial planning and to ensure there are no surprises during the billing process after the surgery has been completed.

Insurance Coverage Requirements for Weight Loss Surgery

Although each plan differs, securing insurance coverage for weight loss surgery often involves meeting a set of stringent criteria established by insurance companies. One of the primary requirements is related to body mass index (BMI). Typically, insurance providers require a BMI of 40 or higher, which indicates severe obesity. Alternatively, a person with a BMI of 35 to 39.9 may also qualify if they have significant obesity-related health conditions, such as hypertension, type 2 diabetes, or severe sleep apnea.

what insurance companies cover weight loss surgery

Additional Documentation

Beyond BMI, insurance companies usually require documented evidence of weight-related health issues that could improve with surgery and a history of previous weight loss attempts through non-surgical methods like diet, exercise, and perhaps medical therapy, proving that other methods have been ineffective over a significant period. This documentation often includes detailed medical records, a physician’s recommendation, and sometimes a psychological evaluation to assess the patient’s mental readiness and support system for post-surgery lifestyle changes.

Preoperative Testing

Additionally, prospective patients are typically required to undergo several preoperative medical assessments to ensure they are fit for surgery. These assessments might include lab tests, heart and lung evaluations, and consultations with nutritionists and psychologists. Gathering and presenting this comprehensive documentation is crucial to demonstrate the necessity of the surgery and facilitate the approval process with your insurance provider.

What Insurance Companies Cover Weight Loss Surgery?

Many major insurance companies provide coverage for weight loss surgery, but the specifics of this coverage differ based on state regulations and individual policies. Examples of health insurance plans accepted by JourneyLite include:

  • Aetna
  • Anthem/Blue Cross-Blue Shield
  • Cigna
  • Humana
  • Medical Mutual
  • Surgery Plus
  • Transcarent
  • United Healthcare

Our expert patient service representatives can help you explore your options and provide useful tips for pursuing insurance coverage for your weight loss surgery.

What To Do if Your Claim Is Denied

If your insurance claim for weight loss surgery is denied, it’s essential to understand that you can appeal the decision. Initially, you should request a detailed explanation of the denial from your insurance provider. This information is crucial as it will guide your next steps and help you address specific reasons cited for the denial.

Review the Denial Letter

Carefully read the denial letter to understand why your claim was rejected. Look for any errors or misunderstandings regarding your medical information or the insurance policy’s criteria.

Gather Additional Documentation

Collect further medical evidence that supports the necessity of the surgery. This could include more detailed letters from your healthcare providers, new medical test results, and records of your ongoing health conditions.

Formal Appeal

Submit an official appeal to your insurance company. This typically involves filling out an appeal form provided by your insurer and attaching all relevant documentation to strengthen your case. Be sure to adhere to any deadlines and procedural requirements specified by your insurance plan.

Be Proactive and Organized

By taking these steps, you increase your chances of having your appeal accepted and become more informed about your insurance plan and its processes. It’s essential to be proactive, organized, and persistent when appealing a denial, as this can significantly affect whether you receive the treatment you need.

Insurance Coverage Alternatives

If your appeal is denied, don’t lose hope. We offer several financing options to help you meet your goal. You can find financing plans through Kemba Financial Credit Union, CareCredit, and Prosper Healthcare Lending. Flexible savings accounts (FSAs) and health savings accounts (HSAs) also can be used to pay for a portion of your surgery.

Trust JourneyLite With Your Weight Loss Surgery

Ready to transform your life and health with weight loss surgery? Contact JourneyLite! Our team of dedicated professionals is here to guide you through every step of the process, from understanding your insurance coverage options to preparing for surgery. We believe in personalized care tailored to your specific needs and goals. Schedule a consultation today to learn what JourneyLite can do for you.

Request an appointment!

Frequently Asked Questions About Weight Loss Surgery

As a leading weight loss surgery provider, JourneyLite has a wealth of knowledge to share. Read the following question for the answers you’ve been looking for.

How Do People Afford Weight Loss Surgery?

Many insurance companies cover weight loss surgery under specific circumstances. If your plan doesn’t cover your procedure, we offer several financing options to help you afford it.

What Types of Weight Loss Surgery Are Typically Covered by Insurance?

Insurance typically covers surgeries deemed medically necessary, such as lap band and gastric bypass or sleeve procedures. Coverage can vary by provider, so it’s essential to check with your insurance company for specifics.

How Do I Know if My Insurance Covers Weight Loss Surgery?

To determine if your plan covers weight loss surgery, review your insurance policy’s benefits booklet or contact your insurance provider directly. You can also speak with one of our knowledgeable representatives, who can help clarify coverage details.

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Gastric Sleeve Requirements Guide

Also called a sleeve gastrectomy, gastric sleeve surgery is a popular weight loss procedure designed to help obese individuals achieve significant weight loss by surgically reducing their stomach size. Understanding gastric sleeve requirements is crucial for anyone considering this life-changing procedure. By adhering to specific criteria, patients ensure their eligibility, maximize the surgery’s effectiveness, and minimize health risks associated with the operation.

This article will review gastric sleeve surgery requirements and how Journeylite can help.

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Gastric Sleeve Requirements

Why Get a Gastric Sleeve?

The purpose of gastric sleeve surgery extends beyond mere weight reduction; it aims to improve overall health and quality of life. Several conditions can see marked improvements post-surgery, including:

  • Diabetes
  • Hypertension
  • Sleep apnea

Meeting gastric sleeve requirements is a fundamental step toward achieving lasting health benefits and ensuring the safety and success of the surgery. Each requirement is carefully set based on extensive research and clinical experience to tailor the best outcomes for each patient.

How to Qualify for a Gastric Sleeve

Gastric sleeve requirements take the patient’s Body Mass Index (BMI) into account. Based on recommendations from the American Society for Metabolic and Bariatric Surgery, gastric sleeve candidates generally fall within two categories:

Patients With a BMI of 35 or Higher

The society recommends gastric sleeve surgery for those having a BMI of 35 or higher, regardless of whether they have other weight-related health issues. The rationale behind this guideline is rooted in the significant health risks associated with such high levels of obesity.

Individuals with a BMI over 35 often face a higher risk of severe health conditions, including heart disease, stroke, severe joint pain, and certain types of cancer. Gastric sleeve surgery can help by reducing stomach size, typically leading to significant weight loss and a lower risk for these health conditions.

Wondering if you qualify for a different surgery? Our guide to bariatric surgery requirements will help.

Patients With a BMI of 30 or Higher

Depending on your circumstances, a BMI of 30 may qualify you for gastric sleeve surgery.

Patients With Type 2 Diabetes

For patients who have type 2 diabetes, the criteria for gastric sleeve surgery include a recommended BMI of 30 or higher. The link between this condition and obesity is well-documented, as excess body weight contributes to insulin resistance, a hallmark of type 2 diabetes.

Gastric sleeve surgery can be pivotal in managing type 2 diabetes by helping patients achieve and maintain significant weight loss. In many cases, this weight loss can help control blood glucose levels and, in some instances, may even result in the remission of diabetes.

Patients Who Can’t Experience Significant Weight Loss

Gastric sleeve surgery is considered for individuals with a BMI between 30 and 35 who have not experienced substantial or lasting weight loss through nonsurgical methods. Many patients in this category struggle with persistent obesity despite attempts at diet, exercise, and other medical interventions. These traditional weight loss methods can often fail for individuals slightly lower on the BMI scale but still significantly affected by obesity.

By opting for gastric sleeve surgery, these individuals may achieve more significant weight loss, leading to improvements in obesity-related conditions and overall health outcomes. This surgical intervention becomes a viable option after other methods have failed.

Other Considerations

JourneyLite bases your qualification for gastric sleeve surgery on more than just BMI. Although this procedure is a versatile option suitable for patients across various BMI categories, it might not be the best choice for everyone.

Individuals suffering from severe GERD (gastroesophageal reflux disease) or acid reflux issues might find that gastric sleeve surgery exacerbates their condition.

Similarly, those with a history of bile reflux gastritis should also exercise caution, as the gastric sleeve could potentially aggravate this issue.

Discussing your complete medical history and any existing gastrointestinal conditions with our team is crucial to determining the most appropriate surgical option for your health needs.

Calculate Your BMI

Gastric Sleeve Requirements

Pre-Surgery Requirements and Preparation

Before proceeding with gastric sleeve surgery, there are other gastric sleeve requirements to plan for. We perform a rigorous pre-surgical evaluation and require a thorough preparation process to ensure the safety and success of the procedure. This process begins with comprehensive steps designed to assess your suitability for surgery.

Potential patients undergo a detailed medical evaluation to determine their physical readiness for surgery. This includes a variety of tests to ensure their bodies can handle the surgery and the subsequent changes. Psychological assessments help to ascertain their mental and emotional readiness to undergo such a significant procedure and maintain the lifestyle changes necessary for long-term success.

Prior to surgery, you must demonstrate a willingness to adopt significant lifestyle changes, particularly in your diet and physical activity levels. We often require patients to start making these changes during the pre-surgery phase to establish healthy habits that must be maintained post-operation.

Your commitment is crucial for the success of the surgery and your long-term health and well-being. Sessions that discuss nutritional changes, physical activity, and emotional adjustments are a routine part of the preparation phase, providing the support and guidance you need.

Gastric Sleeve Risks and Considerations

Beyond gastric sleeve requirements, you must also consider the potential risks associated with this procedure. While gastric sleeve surgery offers significant benefits for weight loss and related health improvements, there are risks and potential complications. Like any major surgical procedure, the gastric sleeve involves inherent risks such as:

  • Infections
  • Bleeding
  • Adverse reactions to anesthesia

Specific to this procedure, patients may experience longer-term issues such as:

  • Nutrient deficiencies, the result of the reduced stomach size, which limits food intake and absorption.
  • Sleeve stenosis, where the stomach tube created during surgery narrows, causing vomiting and difficulty in swallowing.
  • Leaks from the staple line used to create the smaller stomach pouch, which can lead to severe infections and require additional surgeries.
  • Relapse in weight gain if you don’t comply with the dietary and lifestyle changes recommended post-surgery.

Weigh the surgery’s risks against the anticipated benefits. The decision to proceed with a gastric sleeve should come after a thorough discussion with our team, taking into account your medical history, current health conditions, and the overall impact on your quality of life. For many, the potential to significantly lessen life-threatening issues related to obesity — such as hypertension, diabetes, and heart disease — can justify the risks involved. However, this assessment must be personalized based on your own circumstances and our expert advice.

If you have questions about gastric sleeve surgery cost, read this guide.

What to Expect From Gastric Sleeve Surgery

Once we’ve determined you meet gastric sleeve requirements, you must clearly understand the procedure and post-surgery routine.

The Procedure

Gastric sleeve surgery removes part of the stomach to reduce its size by about 80%, which in turn limits food intake and helps to promote weight loss. This minimally invasive procedure typically takes less than an hour.

Immediately Post-Surgery

After gastric sleeve surgery, many patients can return home on the same day. Patients start with a liquid diet and gradually progress to pureed foods as they can tolerate them.

Short-Term Recovery

The initial weeks after surgery are crucial for healing. Patients must also adhere strictly to their prescribed diet, which progresses to solid foods over several weeks. This dietary progression is essential to avoid complications such as blockages or staple line ruptures. Read our guide to gastric sleeve recovery for additional details.

Long-Term Requirements

Recovery extends beyond physical healing, requiring significant lifestyle adjustments. Patients must commit to lifelong dietary changes, including eating more frequent, smaller meals and focusing on high-protein, low-carb foods to meet their nutritional needs. Regular follow-up appointments are critical to monitor weight loss, nutritional status, and overall health. We offer virtual visits to minimize travel time for out-of-town patients.

Gastric Sleeve Animation.

Watch this brief video to learn the steps involved in gastric sleeve surgery.

Frequently Asked Questions About Gastric Sleeve Requirements

As a leading provider of gastric sleeve surgery, JourneyLite is ideally situated to answer your questions. Read on to learn more about gastric sleeve requirements.

Is a Gastric Sleeve Safe?

If you meet gastric sleeve surgery requirements and follow your post-surgery regimen, a gastric sleeve is a relatively safe procedure.

What Is the Minimum Weight for a Gastric Sleeve?

Gastric sleeve requirements don’t focus on weight. They’re based on each patient’s BMI.

What Disqualifies the Gastric Sleeve?

A gastric sleeve may not be the best procedure if you have GERD or bile reflux gastritis.

Trust Your Gastric Sleeve Surgery to JourneyLite

Now that you know the gastric sleeve requirements, you’re ready for the next step. Our team is prepared to help you decide the best option for your weight loss program. We have the expertise and knowledge to craft the right strategy to meet your goals. Contact us today to see how we can help you.

Schedule an Appointment

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Weight Loss Surgery vs GLP-1 Receptor Agonists-Which is Better?

Dr. Trace Curry

If you need to lose a lot of weight, you may be asking yourself which is better, weight loss surgery or GLP-1 receptor agonists? These include medications such as Wegovy (Ozempic & semaglutide) and Zepbound (Mounjaro & tirzepatide). Many people think that these medications much be better because they are newer, and you can’t even turn on the TV or browse the internet without seeing a zillion stories about them. So what are the real-world expectations for these two powerful weight loss methods? Let’s take a look!

Being both a weight loss surgeon and obesity management physician for over 20 years, I have seen many medications and treatment options come and go. With respect to these new medications, although they have been around for a while for treating diabetes, we really don’t have any significant long-term data on using them forever at the higher dosages required for weight loss. Also, studies are now coming out that show nearly all patients will regain their weight after stopping the drug. So, many patients aren’t aware that, if they want to keep the weight off, they must stay on a drug forever that has not been studied over a time period anywhere near forever. In contrast, weight loss surgeries such as gastric sleeve (VSG), gastric bypass, and SADI have been studied and results have been published in some series spanning over 20 years.

So, we have to look beyond the short-term and think about where patients might be in their weight loss journey in five, ten, or even twenty years.

GLP-1 Receptor Agonists

semaglutide

If, for example, a patient opts for Wegovy–what will be the scenario? Here are some things to think about:

  • Most insurance plans do not cover Wegovy. It’s very expensive at over $1000 a month for the brand-name medication.
    • Even though Wegovy is still under patent, since the FDA placed it on their shortage list, the generic equivalent (semaglutide) is currently available.
    • This ranges anywhere from $300-$500 per month, including required office visits.
    • If at any time the patient chooses to stop semaglutide, the weight will almost certainly return.
    • If the patient continues on medication, they will have paid out-of-pocket around $24,000 at 5 years, $48,000 at 10 years, and $96,000 at 20 years!
  • The patient will be injecting a medication once a week that has not been tested at these high dosages beyond a couple of years. We have no idea what will happen to patients who use these medications on a permanent ongoing basis.
  • The amount of weight loss with a surgical procedure such as a VSG, gastric bypass, or SADI is typically two to three times more than with even the most potent of these drugs.
    • At the 5 year mark, semaglutide patients lost on average 16% of the total body weight. For a 300 lb patient, that would equate to only 48 pounds, leaving the patient still morbidly obese.

Surgical Weight Loss

SADI-S Procedure

When considering weight loss surgery vs. GLP-1 receptor agonists, we should look at the surgical options next. Since we are considering the most powerful weight loss medications, let’s also look at the most powerful weight loss surgery–the SADI-S procedure. SADI-S stands for single anastomosis  duodeno-ileal bypass with sleeve gastrectomy. The SADI-S is definitely number one in terms of total weight loss and long-term success rate. Studies show weight loss results of:

  • 5 years
    • 87% excess body weight loss
      • This means if a patient is 100 lbs over their ideal body weight, they would lose 87% of that, or 87 lbs.
    • 38% total body weight loss
      • This means that if a patient weighs 300 lbs going in to surgery, they would lose 38% of that, or 114 lbs.
  • 10 years
    • 80% excess body weight loss
    • 34% total body weight loss

No GLP-1 medication can come anywhere close to these numbers! In addition to the weight loss, SADI-S is very effective at controlling or eliminating diabetes, high blood pressure, high cholesterol, and sleep apnea.

Now, with regard to cost comparison, even in the worst-case scenario where the patient has no surgical weight loss coverage, the current self-pay pricing at JourneyLite is $15,900. This is equivalent to about four years of treatment with semaglutide. So even self-pay surgery is much more cost effective in the long-run. Obviously, if a patient has insurance coverage, then the benefit can be even more pronounced. Other surgical options such as VSG/gastric sleeve, although not as potent as SADI-S, are also more affordable and have somewhat lower short and long term risk.

Conclusion

At JourneyLite, we offer many different programs to help patients lose weight. Our experienced team knows that there is not a one-size-fits-all solution to obesity and that patients must make their own individual choices based on their specific goals. Although surgical procedures such as SADI-S, VSG/gastric sleeve, and gastric bypass provide 2-3 times greater weight loss than GLP-1 medications, there can be a role for these drugs. However, the long-term side effects have not been well studied and the weight regain rate approaches 100% if patients choose to come off of them.

Want to learn more about your options?

Schedule a consultation with our team to find out which plan might be best for you. Simply complete an appointment request form and one of our patient service representatives will contact you to answer all your questions and get you set up for success!

Request an appointment!