Head - General, MI & Bariatric Surgery, Artemis Hospitals, Gurgaon, India
Part 3 of 9 in Diagnosis and Management of Obesity and Metabolic Syndrome: The Role of Bariatric Surgery
Who Qualifies for Bariatric Surgery? Patient Selection Criteria
September 6, 2026
Bariatric surgery is not the right option for every patient carrying excess weight. Dr. Rakesh Durkhure's practice at Artemis Hospitals applies a specific set of selection criteria before recommending surgery over continued medical management.
BMI and Comorbidities
The starting threshold is a BMI above 40. Patients above 120 to 130 kilograms who are otherwise happy and free of comorbidities are not pushed toward surgery; it is offered to patients who are unhappy with their weight and are also dealing with associated conditions such as diabetes, hypertension, breathlessness or obstructive sleep apnea.
A Documented Attempt at Weight Loss First
Patients must have already tried some form of weight loss, whether diet, exercise or medication, for at least three months before surgery is considered. The criteria are built around patients who are motivated to change and unhappy with the effects of their weight, not patients who are comfortable at a higher weight and free of health consequences.
Age, Mental Health and Motivation
The accepted age range runs from 18 to somewhere between 65 and 70. Candidates must be free of active psychological illness or active cancer, and must be genuinely motivated to follow through with the lifestyle changes surgery requires, since the procedure changes eating capacity permanently but the outcome still depends on the patient's own follow-through.
← Metabolic Syndrome: The Five Components and the Early Warning Signs of Obesity | Series index | Intragastric Balloon, Sleeve Gastrectomy or Gastric Bypass →
This article is based on a Jivo Masterclass session conducted by Dr. Rakesh Durkhure, Head - General, MI & Bariatric Surgery, Artemis Hospitals, Gurgaon, India. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
This guide is based on a live Jivo Masterclass: Dr. Rakesh Durkhure taught doctors across Africa on May 4, 2025.
FROM THE LIVE Q&A
Dr. Al-Mustafa Nuruin
What is the relapse rate after the different weight-loss surgeries?
Dr. Rakesh Durkhure
Relapse is highest with the intragastric balloon: because it has to be removed after four to six months, about 80% of patients regain the weight. With sleeve gastrectomy, around 40% of patients report weight relapse within two years. With gastric bypass, only 5 to 10% of patients report weight regain, which is why I recommend bypass specifically when a patient's weight is above around 125 kilograms.
Book a Consultation with Dr. Rakesh Durkhure
Book on WhatsAppOr message us on WhatsApp: +91 98182 98669
Frequently Asked Questions
Does that cost range apply to all four surgical options, or just the one with the lowest relapse rate?▼
That figure is for the option with the lowest relapse rate, gastric bypass. The other options cost somewhat less, roughly $1,000 less.
What is the risk of internal hernia following surgery, and what about the risk of leakage?▼
I can say with complete confidence that I have never seen an internal hernia, because every possible site where one could form is repaired during surgery. Leakage is the most feared complication, and we haven't seen that either, because we run a puncture test during surgery to check for any leak before closing. I also record the video of every surgery and give it to the patient at discharge, so they can show it to their own doctor back home.
Given that some patients trust surgery while others fear relapse, how can African doctors approach counseling patients on this?▼
Dr. Durkhure pointed to his own track record: he has operated on patients referred from Kenya, Nigeria, Mozambique, Ghana, Chad, Rwanda, Burundi and Congo. Those success stories can be shared directly with patients, and follow-up online consultations can address whatever questions remain.
How does the cost of surgery compare with the lifetime cost of medical management, in terms of return on investment?▼
Ozempic and Mounjaro cost about $500 a month in India and have to be taken indefinitely. The cost of surgery is recovered within about a year of what that ongoing medication would have cost. After that, the only requirement is vitamins and good nutritious food.
Beyond bariatric surgery, what other conditions can African doctors refer to your service?▼
The scope goes well beyond bariatric surgery. It includes hiatus hernia, where the stomach moves from the abdomen into the chest, gallbladder stones, particularly complicated cases where a stone has slipped into the bile duct, and problems of the colon and small intestine. It also covers complex abdominal hernias, including inguinal, umbilical, and recurrent hernias that have come back after a local repair, as well as rectal prolapse, complex piles and haemorrhoids, and fistulas near the back passage. All of these can be managed and the patient sent back with a satisfactory outcome.
What BMI is required to qualify for bariatric surgery?▼
A BMI above 40 is the general threshold used, alongside a documented attempt at weight loss and the presence of associated conditions such as diabetes or sleep apnea.
Do patients need to try weight loss before surgery is considered?▼
Yes. Dr. Durkhure requires a documented attempt at weight loss, through diet, exercise or medication, lasting at least three months.
In This Series: Diagnosis and Management of Obesity and Metabolic Syndrome: The Role of Bariatric Surgery
- 1.Diagnosis and Management of Obesity and Metabolic Syndrome
- 2.Metabolic Syndrome: The Five Components and the Early Warning Signs of Obesity
- 3.Who Qualifies for Bariatric Surgery? Patient Selection Criteria
- 4.Intragastric Balloon, Sleeve Gastrectomy or Gastric Bypass: Comparing the Weight-Loss Surgery Options
- 5.How Bariatric Surgery Reverses Type 2 Diabetes
- 6.Bariatric Surgery Outcomes: What the Data Shows on Sleep Apnea, Blood Pressure and Quality of Life
- 7.Inside a Safe Bariatric Surgery Program: Team, Technique and Complication Rates
- 8.Cost of Bariatric Surgery in India Versus a Lifetime on Weight-Loss Medication
- 9.Beyond Bariatric Surgery: When to Refer a Patient for General and GI Surgery