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Getting Started

In this section, we will explain the criteria we look at in order to make sure that you are both clinically ready for weight loss surgery and that weight loss surgery is the best option for you.

Indication for Surgery — Are You Within the Criteria

Eligibility for weight loss surgery is assessed based on BMI (Body Mass Index) and the presence of other clinical conditions, called “comorbidities”. Surgery for obesity is considered an appropriate choice you if you have:

  • a BMI greater than 40
  • a BMI greater than 30 and one or more obesity-related comorbidities (e.g. type II diabetes, insulin resistance, obstructive sleep apnea, infertility, polycystic ovarian syndrome, high blood pressure — etc.), and have tried non-operative weight loss solutions without long-term success

In certain circumstances, if you have a BMI lower than 30 you may be a candidate, if you e.g., have poorly controlled diabetes. Though medication and lifestyle changes are normally recommended.

You can calculate your BMI using our BMI calculator. You can also read more about weight loss surgery in our patient introduction guide.

Age Criteria

If you are very young or above 65, weight loss surgery might not be the best option for you.

For underage patients (or pre-puberty patients); both you and your family will need to show that enough effort has been put to lose weight with non-surgical alternatives. We will also need proof that your family has visited obesity clinics in pediatric hospitals, or endocrinologists.

For patients aged over 65; the benefits of weight loss surgery will be reduced with age and might even be harmful for you. You should have realistic goals and expectations, and good health and clinical circumstances for weight loss surgery to be a viable option for you.

We recommend booking a consultation with our specialists to evaluate your options.

Suitability for Anesthetic

Your suitability for anesthetics will be assessed during consultation. If you are at high risk of a reaction to anesthetics, we will arrange a review and a consultation with our anesthetist. Depending on your situation, you might be asked to have a consultation with other specialists as well.

Surgical Suitability

Your surgical suitability will be assessed during consultation, where we look at previous abdominal surgeries and how they impacted your abdomen. Previous weight loss surgeries are also considered.

Routine Investigations

We perform routine investigations and specific blood tests as well, to make sure that all parameters are in line with the norm pre- and post-surgery. In some cases, other tests (like ECG) are recommended.

Psychological Suitability

A good number of people living with obesity suffers from depression and/or anxiety. To us, this can be attributed to the poor public perception and stigmas around obesity. Due to the ignorance of the public and some medical professionals, obesity is often blamed on the person. We understand that this is an oversimplification and misleads most people into wrong opinions around obesity and its causes. SMS is here to help you achieve your goals.

While we do not ask for all our patients to be reviewed by a psychologist, those with recognised conditions will be asked to provide a letter from their psychiatrist or to be reviewed and supported by their psychiatrist before weight loss surgery.

Medical Comorbidity Assessment and Medication Adjustment

At SMS we do a thorough assessment of all your medical conditions and medications during your consultations.

Bringing a printed list of all medications you are taking and all allergies you have will ease the consultations.

Examples of medical morbidities and the medication adjustment:

  1. Diabetes
    We will review with you your medication plan. Usually, we half the amount of medication you are normally taking during pre-operative dieting. Medication will be stopped during the day of surgery. We will then look closely at your sugar levels during the two days after surgery, and plan your medication based on that.
    Often times, we see diabetes quickly go into remission after surgery.
  2. Obstructive sleep apnea
    You will not be using your CPAP machine in the first 3 weeks after surgery. In many cases the CPAP machine is not needed after weight loss.
  3. Osteoarthritis
    In many cases, you can stop taking your medication a few days before surgery and restart (if needed) after 4-6 weeks post-surgery, when you tolerate a full diet.
  4. Cardiac medication
    We try to not alter your routine. In most cases you will be able to take your medication regularly on the day of surgery.
  5. Lung and respiratory conditions
    Chest x-ray and spirometry test might in some cases be needed. Oral steroids should be stopped, as acute exacerbation might cause the surgery to be postponed.
  6. Blood pressure
    You might be able to take your medication regularly on the day of surgery. We will monitor the pressure during your hospital stay and resume medication depending on your situation.
  7. Fatty liver disease
    It is often hard to detect early cirrhosis pre-surgery, which is why we carefully evaluate fatty liver disease as cirrhosis. Cirrhosis might make surgery an invalid option.
  8. Acid reflux
    A good number of patients will lose their reflux after surgery. During the consultations at SMS, we thoroughly cover the effect of surgery on your pre-existing gastric refluxes.
Pre-operative Diet

Some patients will need to follow a strict diet for weight loss surgery to be a viable option. On average, a weight loss of 5 – 10 kilos is sufficient to proceed with the weight loss surgery.

The diet helps making weight loss surgery safer by softening the liver and allowing more space to operate. Following the diet is therefore essential.

Deciding on Type of Weight Loss Surgery

We are now performing mostly sleeve gastrectomy (more than 90% of the procedures performed). Sleeve gastrectomy has proven to generally have better outcomes than gastric bands and gastric bypasses.

When assessing what type of weight loss surgery is best for you, we mainly look at three factors:

  1. Effectiveness and longevity of weight loss
  2. Post-surgery lifestyle
  3. Complication rate


We will of course also take your situation and personal preferences into account and consult your choice.

It is our experience that gastric sleeves are most suitable for patients with no previous weight loss surgery, with a few exceptions for patients with:

  1. Esophageal dilatation (or stretching from previous lap band surgery)
  2. Esophageal motility problems
  3. Acid refluxes and hiatus hernias might be considered by some surgeons as contraindications. We have successfully treated hiatus hernia and performed sleeve within the same operation with good outcomes
  4. Poor eating habits, like frequent grazers and excess sweet eaters, who might struggle to reach their goals

Research suggests that gastric bypasses cause diabetes remission more than sleeve gastrectomies, but there is still no academic consensus on the topic.

Gastric bypass is not a suitable option for:

  1. Smokers, Unless you stop smoking, you should avoid bypass as you are predisposed to the risk of severe bleeding from the gastric pouch
  2. Patients with predisposition to alcohol dependence. The gastric bypass procedure might predispose you to alcohol dependence
  3. Patients with severe abdominal adhesions, scarring, or previous complex abdominal surgeries


Gastric band surgery is not being performed at SMS. We believe the surgery to be outdated and, although it has fewer potential complications and is reversible, the risks of ruining the esophagus, stomach erosion or slipping are too high in the long term for this option to be preferred to other surgeries. Quality of life is also more heavily impacted by banding than the other options available.

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  • Learn more about obesity
  • Understand your procedural options
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