Is Surgical Weight Loss Right for Me?

1. Are you younger than 21, or older than 64?

Yes
No

2. Have you ever had a Surgical Weight Loss procedure?

Yes
No

MaleFemale
HeightIdeal WeightHeightIdeal Weight
4' 6"70 lbs.4' 6"70 lbs.
4' 7"76 lbs.4' 7"76 lbs.
4' 8"82 lbs.4' 8"80 lbs.
4' 9"88 lbs.4' 9"86 lbs.
4' 10"94 lbs.4' 10"90 lbs.
4' 11"100 lbs.4' 11"96 lbs.
5' 0"106 lbs.5' 0"100 lbs.
5' 1"112 lbs.5' 1"106 lbs.
5' 2"118 lbs.5' 2"110 lbs.
5' 3"124 lbs.5' 3"116 lbs.
5' 4"130 lbs.5' 4"120 lbs.
5' 5"136 lbs.5' 5"125 lbs.
5' 6"142 lbs.5' 6"130 lbs.
5' 7"148 lbs.5' 7"135 lbs.
5' 8"154 lbs.5' 8"140 lbs.
5' 9"160 lbs.5' 9"145 lbs.
5' 10"166 lbs.5' 10"150 lbs.
5' 11"170 lbs.5' 11"155 lbs.
6' 0"178 lbs.6' 0"160 lbs.
6' 1"184 lbs.6' 1"165 lbs.
6' 2"190 lbs.6' 2"170 lbs.
6' 3"196 lbs.6' 3"175 lbs.
6' 4"202 lbs.6' 4"180 lbs.
6' 5"208 lbs.6' 5"185 lbs.
6' 6"214 lbs.6' 6"190 lbs.
6' 7"220 lbs.6' 7"195 lbs.
6' 8"226 lbs.6' 8"200 lbs.
6' 9"232 lbs.6' 9"205 lbs.
6' 10"238 lbs.6' 10"210 lbs.
6' 11"244 lbs.6' 11"215 lbs.
7' 0"250 lbs.7' 0"220 lbs.

3. Are you 100 lbs. or more over your ideal weight?

Look at the table at right. Is your weight at least 100 lbs over the ideal weight for your height?

Yes
No

Gender:
Height: ' "
Weight: lbs
BMI:
Ideal Weight: - lbs
Assessment:

4. Does your BMI, or Body Mass Index, indicate obesity?

Surgical Weight Loss procedures are usually reserved for those having a BMI of at least 40.

Enter your height and weight, or pull the red handles on the bars at the calculator's edges to arrive at your Body Mass Index figure.

Check the measure that shows where does your BMI fall?

< 24
< 34
< 40
40 or more

5. Do your medical records state that you suffer from health problems caused by excess weight?

diabetes
sleep apnea
high blood pressure
urinary stress incontinence
gastroesophageal reflux/heartburn
menstrual irregularities
depression
none of the above

6. Do you have a history of weight loss programs or diets, on your own and physician directed, only to gain the weight back?

Yes
No

You're not a candidate for a surgical weight loss procedure at this time. May we connect you to nutrition and exercise programs offered through In Motion locations at the Health Center at Virginia Beach and the Health Center at Harbour View?

Yes or No

The answers you've given indicate that your health and weight issues could be helped by a surgical weight loss procedure. Would you like us to contact you about attending a free Bon Secours Surgical Weight Loss seminar in Hampton Roads?

Yes or No