Why do you feel patients that are above a BMI of 55 should lose weight to get to that level prior to surgery?.

First, there is good evidence that risks of bariatric surgery increase as the BMI increases. Having the patient reduce their weight to a BMI of 55 is one way to decrease many of those risks. My plan is that my patients have an uncomplicated recovery after surgery. I do not want to have patients in the ICU on ventilators and have other problems. This is by far the most important reason to reach a BMI of 55 prior to surgery.
Secondly, the result will be much better. I have spoken to many people that had bariatric surgery when they had a BMI over 55 at the time of their operation. They often express disappointment in their overall outcome. They had lost 150 to 200 lbs but they still weighed 300 to 400 lbs and still had many of the medical problems they had hoped to have resolved. They assumed that once they had bariatric surgery they would lose their excess weight and reach a weight close to their ideal weight. Unfortunately, the fact is that even if they chose a Roux en Y gastric bypass for their operation, a gastric bypass operation usually results in about 150 to 200 lbs weight loss at the maximum. Therefore the operation is not designed to deliver the 300 to 400 lbs of weight loss they needed.
I have helped many people lose weight to reach a BMI of 55 or less prior to surgery. In our program we will use whatever approach will work for the patient. Sometimes this is dietary changes alone with frequent follow up appointments with the dietitians and me. At other times we use medications such as Meridia or Adipex-P. Often we also use a Very Low Carbohydrate Diet that will help a patient lose about 60 to 70 lbs over 12 weeks.
The bottom line is this. If someone really wants to get better they will be willing to do what it takes to work with us to decrease their risks and reach a preoperative weight that will help them obtain their best result from surgery.
There are many other very good bariatric surgery programs that have other approaches that may be equally valid. Many programs will operate on patients regardless of size and deal with the problems if they happen. However this is our preferred approach and it has worked very well for many patients.
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