The Importance of BMI in Determining Eligibility for Stomach Reduction Surgery

A stomach reduction helps people who are obese to lose weight permanently. However, you are not just a candidate for this operation. Why is a stomach reduction only reimbursed with a BMI of 40?

Laura Tenret29 June 2023, 10:00 p.m

Whether someone who wants a stomach reduction gets it depends on his or her BMI (Body Mass Index). It shows the body ratio between weight and height. You have a normal weight with a BMI between 18 and 25. Anyone with a BMI of 25 to 30 is overweight. This is the case for half of the adults in the Netherlands. Above a BMI of 30 you are seriously overweight, or obese.

A distinction is made in three classes, of which the highest category 3 has a BMI above 40 and is regarded as very serious and sickening overweight (morbid obesity). There is then a high risk of diabetes, high blood pressure, sleep apnea, various types of cancer and infertility in young women.

“We see these diseases develop with a BMI of 35 and in particular with 40 or higher,” says Dennis Smit, doctor at the Dutch Obesity Clinic (Nok), the center that performs about half of the stomach reductions in the Netherlands.

Two types of interventions

In the Netherlands there are two types: 70 percent is a gastric bypass, a stomach reduction with also a bowel bypass. The other variant is the gastric sleeve, in which the stomach is reduced to a thin tube stomach. As a result, you can eat smaller portions and absorb fewer calories, losing up to 30 percent of your weight. This way you can also cure diseases related to overweight, or limit the consequences thereof.

Stomach reductions have been performed in the Netherlands since the 1980s. Smit: “Health insurers and the National Health Care Institute already decided at that time that the limit for implementing this is a BMI of 40 or more. A consideration was made between the costs on the one hand and the health gain per patient on the other.” If you are not overweight, you will be operated on with a BMI of 40, if you are overweight, the limit is 35.

Diabetes

At least in the Netherlands. In America, that limit was lowered by 5 BMI points last year. But Zorginstituut Nederland, which monitors whether care in our country remains good and affordable on behalf of the government, has not adopted this change.

“A few weeks ago it was decided to lower the limit for diabetes: soon people with type 2 diabetes that is difficult to treat can be operated on with a BMI of 30 or more,” says Smit. Smit sees an increase in the number of stomach reductions and expects that the Netherlands will eventually follow America in lowering the surgical threshold.

“There is not much increase in obesity in the Netherlands, but there is an increase in overweight. And if I look at the Nok, for my Haaglanden region, the number of stomach reductions has tripled since 2014 to 1500 annually.” Smit attributes this to the increased attention for stomach reductions among GPs and in the media. “It is still the very best way to get people who are seriously overweight healthier.”

In the Netherlands, a stomach reduction is included in the basic insurance. Can you still get one if you pull the cut? “There is not a single clinic in our country that performs gastric reduction for a fee. This is possible abroad, for example Turkey or Belgium. This is not recommended, because if you run into problems due to a foreign operation, you cannot be helped in the Netherlands.”

In Het Consult, experts answer readers’ health questions every week. Also a health question? Send an email to [email protected].

2023-06-29 20:00:01
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