As discussed in the criteria for surgery section, the selection of patients has to have these criteria, but not only that extreme obese patients are different from other type of patients in having an added burden of comorbidities, (diseases associated with obesity), and also, their cardiovascular, and pulmonary reserve is diminished due to all the changes the burden of excess weight puts on these patients bodies. research has detected 5 factors that pose the most risk for these patients, these factors, some can be modified in order to control and/or resolve comorbidities, and some are not modifiable, (age), it is imperative to modify these factors previous to surgery so we can prepare our patients in order to have a safe surgery. These factors are.

1.- Age over 55

2.- Male Gender

3.- High blood pressure.

4.- High blood triglycerides.

5.- BMI over 50

Patients with extreme high cardiovascular risk or super super obesity require the attention and care of a multidisciplinary team in order to get to a safe point at which surgery can be done with acceptable risks, some of the actions to prepare patients towards surgery can be, cardiovascular assessment and interventions, colocation of intragastric balloon for lowering bmi prior to surgery just to name a few.

Also the selection encompasses which surgery (Sleeve, ByPass, etc.) would be the best for each patient according to their individual characteristics (age, bmi, presence or absence of diabetes, reflux, etc).

Dr.Galileo Villarreal

Bariatric Surgeon