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According to the American Society for Metabolic and Bariatric Surgery (ASMBS), fewer than 1% of people eligible for metabolic and bariatric surgery have it in any given year.
That means many people who may meet the criteria for metabolic and bariatric surgery never take the first step. Some don’t know they qualify. Others aren’t sure what getting ready involves, and that uncertainty is enough to keep them waiting.
This guide covers the whole process, from finding out if you qualify to the day before surgery. Your care team will tailor every detail to you, but knowing the road ahead makes the first appointment much easier.
The Short Version
Preparing for bariatric surgery usually means confirming you’re eligible, completing medical and psychological testing, meeting with a dietitian, following a pre-op eating plan, addressing tobacco and nicotine use, and getting insurance approval. The timeline varies by patient, program, and insurer, so ask your surgeon for your own schedule.
Step 1: Find Out If You Qualify
Eligibility is based mostly on body mass index (BMI) and your overall health. The 2022 guidelines from the ASMBS and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) updated the old 1991 standards. Here’s what they say now:
Surgery is recommended for a BMI of 35 or higher, whether or not you have other health conditions.
For people with type 2 diabetes, surgery is recommended starting at a BMI of 30.
For a BMI of 30 to 34.9 without diabetes, surgery should be considered when nonsurgical methods haven’t produced substantial or lasting weight loss or health improvement.
Insurance plans don’t always match the newest medical guidelines, so your coverage requirements may differ. Your surgeon will look at the whole picture, not only a number.
Step 2: Book Your Consultation
This is a two-way conversation. Your surgeon reviews your medical history, current medications, past weight loss attempts, and goals. You get to ask everything you’ve been wondering about, including the risks.
Bring a list of your medications and supplements, any previous weight loss efforts, and your questions. Write those questions down beforehand, because most people forget half of them once they’re in the room.
Step 3: Complete Your Pre-Op Testing
Expect blood work, imaging as needed, and a psychological evaluation. The evaluation isn’t a pass/fail test. It helps your team understand your relationship with food, your stress patterns, and what support you’ll need afterward.
Nutrient screening matters more than most people expect. ASMBS nutrition guidelines note that it’s common for people heading into weight loss surgery to already have at least one vitamin or mineral deficiency, and that screening for these hasn’t always been routine. Catching a low level now is far easier than fixing it after surgery.
Step 4: Meet Your Dietitian
Your dietitian builds your before-and-after eating plan and sets your daily protein and fluid targets. In general, the pre-op plan focuses on three things:
Less added sugar and fewer processed foods. This starts the habits you’ll rely on later.
Enough protein. It protects muscle and supports healing.
Steady hydration. Water becomes a daily job after surgery, so practice now.
Some programs also ask for a short, tightly controlled diet before surgery. One review describes very low energy ketogenic diets used to reduce liver size and body weight, followed by clear liquids and protein shakes for the 24 hours before the operation. Whether you need this depends on your surgeon and your health. Never start a restrictive diet on your own.
Vitamins matter too. Nutrition guidelines stress taking adequate vitamin and mineral supplements both before and after surgery.
Step 5: Learn Your Procedure Options
Your surgeon will recommend a procedure based on your health, your goals, and your history. The two most common are:
Sleeve gastrectomy. The surgeon removes a large portion of the stomach, leaving a narrow, sleeve-shaped pouch. You feel full on much less food.
Roux-en-Y gastric bypass. The surgeon creates a small stomach pouch and connects it directly to the small intestine, so food bypasses part of the digestive tract.
Sleeve gastrectomy and gastric bypass account for the vast majority of bariatric procedures performed. The 2022 ASMBS/IFSO guideline reports that they together accounted for approximately 90% of metabolic and bariatric operations worldwide. In the U.S., ASMBS estimates for 2023 show about 157,000 sleeves and 63,000 bypasses, compared with fewer than 800 adjustable gastric bands.
Because the adjustable gastric band has become rare, ask your surgeon which procedures are right for you and why.
Step 6: Quit Smoking and Talk to Your Team About Nicotine
Smoking increases the risk of complications after bariatric surgery, including marginal ulcers after gastric bypass. These ulcers form at the connection between the stomach pouch and the intestine and, in some cases, can lead to more serious problems like perforation. Vaping and other tobacco products may also affect your surgical risk.
Many bariatric programs require patients to stop using tobacco and may test for nicotine or cotinine before surgery. Some bariatric guidelines recommend quitting at least six weeks beforehand, but the exact timing and rules vary from program to program.
Nicotine replacement products such as patches or gum may have different requirements depending on your program. Ask your surgeon exactly which products you need to stop and when. If quitting is difficult, tell your care team early so they can connect you with appropriate support.
Step 7: Sort Out Insurance
Ask your care team to help you confirm what your plan requires. Many plans ask for documented visits, diet counseling, or records of past weight loss attempts before approving surgery. We accept the Inland Empire Health Plan (IEHP), and our staff can help you check your specific coverage.
Starting this step early can help prevent insurance or documentation requirements from delaying your surgery timeline.
Step 8: Prepare for Life After Surgery
After surgery, you’ll eat much smaller portions, prioritize protein, take vitamin and mineral supplements, and attend regular follow-up visits. It helps to plan for these changes now, including how you handle stress and emotional eating, since food often plays a role in both.
A few things to do before surgery:
Look into support groups, in person or online.
Think through what you’ll do when you’d usually reach for food to cope.
Tell the people at home what practical help you’ll need.
Bring any worries about the process to your care team. They’ve heard them before.
Medications and Pain Relievers: Ask Before You Take
Some common over-the-counter pain relievers can matter after bypass surgery. Research links NSAIDs, along with smoking and corticosteroids, to symptomatic marginal ulcers. Ask your surgeon which pain relievers are safe for you now and after surgery, and don’t stop or start any prescription without their guidance.
The Day Before Surgery
Follow your written instructions exactly. They cover when to stop eating and drinking, which medications to take or hold, and when to arrive. If something in the instructions is unclear, call the office. Nobody minds that call.
Recovery and Long-Term Follow-Up
After surgery, your team supports you with pain control, a gradual move from liquids to soft foods to regular meals, gentle activity, and follow-up visits. Vitamin and mineral supplements are part of daily life afterward, and regular dietitian check-ins help you stay on track. Support groups can provide ongoing practical and emotional support.
Frequently Asked Questions
What BMI do I need for weight loss surgery?
Current guidelines recommend surgery for a BMI of 35 or higher, regardless of other health conditions, and for a BMI of 30 or higher if you have type 2 diabetes. For a BMI of 30 to 34.9 without diabetes, surgery should be considered when nonsurgical treatment hasn’t produced substantial or lasting results. Your insurer may set its own rules.
How long does it take to prepare for bariatric surgery?
It depends on your health, your program, and your insurance. Testing, nutrition counseling, tobacco and nicotine requirements, and insurance approval all take time. Your surgeon can give you a realistic estimate after your first visit.
Do I have to lose weight before surgery?
Not always. Some surgeons ask for a short pre-op diet to reduce liver size and make the operation safer. Others focus on building habits instead. Follow the plan your team gives you.
Do I have to stop smoking before bariatric surgery?
Smoking raises the risk of complications, including marginal ulcers after gastric bypass, so programs commonly require patients to quit tobacco before surgery. Some bariatric guidelines suggest at least six weeks, but requirements vary. Ask your surgeon which products you need to stop, including nicotine replacement, and when.
Will insurance cover bariatric surgery?
Coverage depends on your plan. We accept IEHP, and our team can help you check what your specific plan requires, including any documentation you need to collect.
How do I know whether sleeve or gastric bypass is right for me?
Your surgeon will weigh your BMI, health conditions, eating habits, past surgeries, and goals, then talk through the benefits and risks of each option with you. Both are well established, and the right choice depends on your individual situation.
Will I need vitamins after surgery?
Yes. Nutrition guidelines call for vitamin and mineral supplements before and after surgery, since deficiencies are common and can develop or worsen afterward. Your dietitian will set your plan and your lab schedule.
What should I do the day before surgery?
Follow your written instructions closely. Some programs use clear liquids and protein shakes for the final 24 hours, but your surgeon’s directions come first.
Ready to Take the First Step?
If you’re considering bariatric surgery in Riverside, our surgeons and dietitians will walk you through every step above, at your pace. Call (888) 294-5296 or request a consultation on our website.
About Mission Surgical Clinic: Our team of surgeons specializes in general surgery, bariatric surgery, carotid artery surgery, thoracic surgery, and hernia surgery. We also treat conditions including gastroesophageal reflux disease (GERD), esophageal diseases, fistulas, and gallbladder disease.
Disclaimer: This article is for education and doesn’t replace personal medical advice. Talk with your surgeon about your own situation.
Sources
Eisenberg D, et al. 2022 ASMBS and IFSO Indications for Metabolic and Bariatric Surgery. Surg Obes Relat Dis, 2022. Supports the BMI criteria and the approximately 90% worldwide share for sleeve and bypass. https://pmc.ncbi.nlm.nih.gov/articles/PMC9834364/
ASMBS. Bariatric Surgery Procedures Fall Below 200,000 (news release). Supports the “less than 1% of eligible people” statement. https://asmbs.org/news_releases/bariatric-surgery-procedures-fall-below-200000-first-time-since-2020-new-research-finds/
ASMBS. Estimate of Bariatric Surgery Numbers, 2011 to 2023. Supports U.S. sleeve, bypass, and band volumes. https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers/
ASMBS Integrated Health Nutritional Guidelines, 2016 Update: Micronutrients. https://asmbs.org/resources/integrated-health-nutritional-guidelines/
Smoking-associated postoperative complications of bariatric surgery. Bariatric Times. Supports the marginal ulcer, NSAID, and corticosteroid points. https://bariatrictimes.com/hemen-smoking-october-2018/
Tobacco use in bariatric patients. Metabolic & Bariatric Care Times. Supports the six-week recommendation and nicotine or cotinine testing. https://bariatrictimes.com/tobacco-use-in-bariatrc-patients/
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