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Body Mass Index (BMI)
 Your height   feet  inches 
 Your weight   pounds
 


Are you a candidate for Weight Loss Surgery?
  1. Do you have a Body Mass Index (BMI) of 40 or more?
    (Find your BMI in the left column)
    Yes  No 
  2. Do you have a BMI of 35-40 with co-morbid conditions such as high blood pressure or diabetes?
    Yes  No 
  3. Are you at least 100 lbs over your ideal body weight?
    Yes  No 
  4. Do you weigh more than twice your desirable weight?
    Yes  No 
  5. Are you morbidly obese?
    Yes  No 
  6. Have you repeatedly failed to lose weight through dietary control or exercise?
    Yes  No 
  7. Do you have a stable support system?
    Yes  No 
  8. Are you free from serious heart disease, inflammatory bowel disease, or hepatic (liver) or renal (kidney) disease?
    Yes  No 
  9. Are you free from endocrine (thyroid, adrenals) causes for obesity?
    Yes  No 
  10. Are you willing to make the necessary lifestyle changes?
    Yes  No