Endo Bariatric Eligibility

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name: endo-bariatric-eligibility
description: Determines if a patient is a candidate for bariatric surgery using BMI thresholds: BMI ≥35 kg/m2 with comorbidity or BMI ≥40 kg/m2 regardless of comorbidities. Triggers include when a clinician asks, 'Is this patient eligible for bariatric surgery given their BMI and comorbidities?' or 'Should I refer a patient with BMI 38 and sleep apnea for surgical evaluation?'.
---

# Assess bariatric surgery eligibility based on BMI/comorbidity

## STEP 1 — Gather Information
Collect current BMI (kg/m2) and document presence of obesity‑related comorbidities such as type 2 diabetes, hypertension, dyslipidemia, obstructive sleep apnea, NAFLD, osteoarthritis, or cardiovascular disease.

## STEP 2 — Rule In / Rule Out
Is BMI ≥40 kg/m2?  
- **Yes** → Patient meets surgical threshold regardless of comorbidities; proceed to STEP 4.  
- **No** → Proceed to STEP 3.

## STEP 3 — Classify or Stratify
Is BMI between 35.0–39.9 kg/m2 **and** at least one comorbidity present?  
- **Yes** → Patient meets surgical threshold with comorbidity; proceed to STEP 4.  
- **No** → Patient does not meet surgical criteria; proceed to STEP 4 for alternative management.

## STEP 4 — Decide
If criteria met (BMI ≥40, or BMI 35‑39.9 with comorbidity): refer for bariatric surgery evaluation and discuss risks/benefits.  
If criteria not met: optimize lifestyle intervention, consider pharmacotherapy per guideline, and reassess in 3–6 months.

## Clinical Guardrails / Mimics / Pitfalls
Do not base eligibility on BMI alone without verifying comorbidities; avoid referring patients with BMI 35‑39.9 lacking documented comorbidity; screen for contraindications (uncontrolled psychiatric illness, substance use, inability to adhere to postoperative follow‑up); ensure shared decision‑making and informed consent before referral.

## Concrete Clinical Example
A 45‑year‑old with BMI 38 kg/m2 and documented obstructive sleep apnea presents for weight management. BMI is 35‑39.9 with a comorbidity → eligible for surgical referral; patient is counseled on surgery risks/benefits and scheduled for bariatric surgery evaluation.

**Source:** Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2015, DOI: 10.1210/jc.2014-3415