The aim of gastric bypass surgery is to make the patient lose weight and avoid the morbidities associated with obesity. Patients who are morbidly or severely obese are at increased risk for health problems, tend to have a shortened life span and are at an added potential risk from continued weight increase. The risk of severe obesity, however, has to be weighed against that of the surgical treatment, and the benefits derived from it. The logical question that comes to mind is: Are you eligible for a gastric bypass, just because you are overweight? Meta-analysis of reported studies indicates that patients lose, on average, about 70% of their excess weight in the first year after gastric bypass, and up to about 80% of their excess weight by the end of the second year. In general, more than half of the surgery patients find an improvement of their high blood pressure, nearly 80% of non-insulin dependent diabetes is controlled without medication after surgery. Obesity related respiratory problems, including sleep apnea and shortness of breath with minimal exercise, are known to improve or completely resolve. Arthritis, urinary incontinence, acid reflux, menstrual irregularity, and certain types of headaches are also benefitted with weight loss after surgery. The surgery, however, can cause a variety of complications, including electrolyte abnormalities, nutrient deficiencies, infections, kidney stones, osteoporosis and even death. The criteria for patient selection for the procedure thus, are very stringent and exact. A risk benefit analysis by a multidisciplinary team, on a case to case basis is imperative for optimal results. This team consists of physicians, therapists, counselors and dieticians, apart from the surgeons, to manage associated co-morbidities, nutrition, physical activity, behavior and psychological needs of the patient. The National Institutes of Health sponsored a consensus panel whose recommendations have set the current standard for consideration of surgical treatment. They recommend that gastric bypass should be advised in people who have a BMI of 40 or higher, or, with a BMI of 35 or higher with one or more related co-morbid conditions. The body mass index (BMI) is defined as the body weight (in kilograms), divided by the square of the height (in meters). A BMI below 18.5 is considered underweight, while a BMI between 18.5 and 24.9 is in the healthy category. A BMI between 25 and 29.9 is overweight, while 30 to 39.9 is considered obese. Any BMI over 40 is morbidly obese. To calculate your own BMI, multiply your weight in pounds by 703.Divide that answer by your height in inches and divide this answer by your height in inches again. American Society for Bariatric Surgery (ASBS) has revised these criteria and made them more comprehensive. They have recommended that you are eligible for gastric bypass if: - You weigh twice your ideal body weight or are overweight by 100 lbs or more - You have a BMI (body mass index) more than 40 - You have a BMI more than 35 with co-morbidities (illnesses related to being overweight). - You have been overweight for 5 years or more and have failed to lose weight or sustain weight loss under supervision - You are willing to comply with lifestyle and diet changes that require you to eat multiple small meals. This implies that your dietary intake will be under close supervision by a qualified nutritionist in consultation with the surgeon, together with regular monitoring of the blood levels of essential nutrients and nutritional supplements. - You realize that surgery is not a solution but it only helps train you to eat much less. To achieve long-term weight-loss and avoid complications from the procedure, you must exercise, eat properly and obtain appropriate follow-up care. - You have a clear understanding of the principles of the surgical options available, long- and short-term risks, complications, and the need for follow up visits. - In case you are planning to get pregnant, you must realize that you will need to delay it by at least eighteen months until after surgery, so that your body has time to recover from the surgical stress. You must also remember that the weight loss usually results in a rebound boost in fertility, so you must use birth control measures. Surgery is not recommended for those with diagnosed alcoholism, overt psychosis, and major cardiopulmonary disease, which can increase the risks of surgery. You as a patient have to understand that gastric bypass is not a panacea. Results vary from person to person, and very often the results are evident gradually. Also, in the absence of proper postoperative care and lifestyle modifications, the health hazards are many. It is therefore essential that you take a decision regarding gastric bypass in consultation with a multidisciplinary bariatric team, only once you and your treating surgeon are absolutely convinced of the need for surgery.