Is weight-loss surgery right for you?

With more than a third of American adults now considered obese, weight-loss surgery has become an increasingly sought-after option.

Surgeons today can perform various procedures designed to lower food intake and hunger, which, in time, equals weight loss. Though that might sound like an ideal equation for people seeking to shed a significant number of pounds, weight-loss surgery comes with risks and long-term challenges. It's not seen as the ideal solution for everyone.

For the right people, however, weight-loss surgery not only reduces pounds but can do much more as well. It also can ease or even eliminate medical conditions like diabetes, helping restore health and well-being. To that end, 150,000 to 160,000 people nationwide have weight-loss surgery each year, according to the American Society for Metabolic & Bariatric Surgery.

Answers to key questions can help determine whether someone is right -- or wrong -- for weight-loss surgery.

1. How overweight do you have to be to qualify?

The most important criterion is that the person qualifies as obese, although not every obese person can undergo any procedure.

The key detail is body mass index (BMI), a proportional measure of weight and height. Higher BMI numbers translate to more excess weight.

Health officials consider people with a BMI of 30 or more to be obese. A person who is 5-foot-9 needs to weigh 203 pounds or more to cross that threshold.

According to guidelines, a BMI of 40 or higher instantly qualifies someone to be considered for weight-loss surgery, said Dr. Shawn Garber, director of bariatric surgery for the Catholic Health Services and director of the New York Bariatric Group in New Hyde Park. Bariatrics is the branch of medicine that deals with the causes, prevention and treatment of obesity.

People with BMIs from 35 to 39.9 can qualify for surgery if they also have diabetes, sleep apnea or high blood pressure, Garber said. Those with at least one of those conditions plus a BMI of 30 to 34.9 are eligible only for the lap-band type of weight-loss surgery.

Essentially, Garber said, simply being 40 to 50 pounds overweight makes you a candidate for some type of weight-loss surgery.

2. Are you highly motivated?

"A good candidate for surgery is one who meets the criteria, is motivated to lose weight for health reasons, has researched all options, is knowledgeable, takes an active part in the decision-making process, is compliant, comes for regular follow-up visits and has very supportive family or friends," said Dr. Venkatesh Sasthakonar, director of bariatric surgery at Nassau University Medical Center in East Meadow.

On the other hand, people who don't fit these categories -- such as the unmotivated and those with poor support systems -- can be the wrong candidates for surgery, Sasthakonar said. Other potential no-go issues include drug abuse, severe cirrhosis, psychiatric problems (such as eating disorders), significant lung disease and severely impaired intellectual capacity, he said.

"Some centers limit patients' maximum weight based on the equipment they have," he said. "Our center is capable of operating on patients up to 600 pounds."

3. Do age and gender matter?

At first, adults 18 to 65 were considered appropriate for weight-loss surgery, but "now there is no upper limit for age in most centers," Sasthakonar said. "However, those above 65 are considered on a case-by-case basis, and the risks and benefits weighed prior to a decision on surgery [because] increased age is associated with increased risk factors."

Some bariatric centers also do surgery on teens, he said.

Gender isn't an issue, although women seem to be more willing to undergo the procedures. "Though males have an increased incidence of [being] overweight and obesity, about 60 to 70 percent of bariatric patients are females," Sasthakonar said.

4. Is one procedure better than others?

In the United States, bariatric surgeons generally do one of three types of surgery: gastric bypass, gastric sleeve resection, and lap-band. Each one is different in terms of typical weight loss, risk for side effects and impact on other medical problems, Sasthakonar said, adding that surgeons choose the best procedures for patients based on their particular weight and medical conditions.

Lap-band surgery offers the least weight loss and resolution of other medical problems, he said, but it's also the least risky. Gastric bypass offers the highest rates of weight loss and resolution of medical problems, but it also posts the highest risk, he said.

5. Does the surgery cure obesity?

Surgery "is a tool, not a cure," Garber said. People who have the surgery must make efforts to get the best results, he said, and "there are obviously patients who don't follow instructions."

For instance, patients might try to bypass the limits on food intake. To limit the amount of food the body can process, bariatric surgery shrinks the size of the stomach and ideally reduces hunger, too.

But some patients try to cheat the surgery by consuming foods such as milkshakes that can get past the body's new limits on food intake.

Still, success rates can be high. "At our center, we have operated on patients with BMIs from 35 to 84," Sasthakonar said. "About 80 percent have lost more than 50 percent of their excess weight and have maintained it over three to five years."