Denied Weight-loss Surgery...

HealthyChubbyMe

Well I contacted my insurance plan and found out that gastric sleeve is a cosmetic surgery, even if I'm morbidly obese. BUT I'm going to take it as a sign that it wasn't meant to be. So I'm here and feeling pretty sick of being fat.

I'm just going to eat what I want in moderation. I hope that I can do it, I'm trying to stay away from fad diets. I'd love to have some friends on my way!

Height: 5'5"
Current Weight: 240
Goal Weight: 140

100 pounds to go. Woo...

tiptoethruthetulips

Is there an appeal process? I can't see that weight loss surgery could be considered cosmetic surgery - do you have any weight related health issues?

Jana_2020

It's very surprising what you learn when you start tracking. Portion control for me was what I needed to do. I was hungry for the first week or so but eventually your body adjusts. I just kept telling myself it's okay to feel hungry; I've eaten enough. Some good days, some not so good, but overall slowly starting to do this! Good luck with your journey! Perhaps pick a 10 or 20 lbs goal to start?

ronjsteele1

HealthyChubbyMe wrote: »

Well I contacted my insurance plan and found out that gastric sleeve is a cosmetic surgery, even if I'm morbidly obese. BUT I'm going to take it as a sign that it wasn't meant to be. So I'm here and feeling pretty sick of being fat.

I'm just going to eat what I want in moderation. I hope that I can do it, I'm trying to stay away from fad diets. I'd love to have some friends on my way!

Height: 5'5"
Current Weight: 240
Goal Weight: 140

100 pounds to go. Woo...

I would encourage you to look into Blossom Bariatrics in Las Vegas, NV. They will check your out of network insurance coverage and give you a contracted rate that they will not go over. It allowed me to skip all of the pre-insurance in-network stuff they normally make you do to have VSG surgery (6 months of pre-op work ups). Their cash price (no insurance) is $15K total. That's your hotel, surgery, all lab work, etc. That is literally everything except your plane ticket. It's also transportation to and from airport, hotel, surgery center, etc. It was quite probably the best surgery experience I've ever had. Top notch care, excellent people to work with, etc. If you have out of network benefits, they will figure out how much they can get your insurance to pay out of network and subtract that from the $15K. Then you pay the difference. If your insurance refuses to pay, you never pay more then the amount they quoted you in the beginning. They guesstimated they could get my insurance to pay $5K of out of network benefits and so my contracted rate was $10K. And that's exactly what I paid. But if my insurance had not paid anything, I still would have only paid $10K. They have the system totally figured out.

Look into Blossom Bariatrics. It's the best decision I ever made.

Lynatea

Hello! I'm 5'4 and started at 235. I'm now down to 197 since January doing nothing more than maintaining a calorie deficit slowly moving in to cycling. Please have faith and confidence that you CAN do this without surgery, you just have to start making small changes and stick with it. If I can do it, I know you can too. 😁

lynn_glenmont

ronjsteele1 wrote: »

HealthyChubbyMe wrote: »

Well I contacted my insurance plan and found out that gastric sleeve is a cosmetic surgery, even if I'm morbidly obese. BUT I'm going to take it as a sign that it wasn't meant to be. So I'm here and feeling pretty sick of being fat.

I'm just going to eat what I want in moderation. I hope that I can do it, I'm trying to stay away from fad diets. I'd love to have some friends on my way!

Height: 5'5"
Current Weight: 240
Goal Weight: 140

100 pounds to go. Woo...

I would encourage you to look into Blossom Bariatrics in Las Vegas, NV. They will check your out of network insurance coverage and give you a contracted rate that they will not go over. It allowed me to skip all of the pre-insurance in-network stuff they normally make you do to have VSG surgery (6 months of pre-op work ups). Their cash price (no insurance) is $15K total. That's your hotel, surgery, all lab work, etc. That is literally everything except your plane ticket. It's also transportation to and from airport, hotel, surgery center, etc. It was quite probably the best surgery experience I've ever had. Top notch care, excellent people to work with, etc. If you have out of network benefits, they will figure out how much they can get your insurance to pay out of network and subtract that from the $15K. Then you pay the difference. If your insurance refuses to pay, you never pay more then the amount they quoted you in the beginning. They guesstimated they could get my insurance to pay $5K of out of network benefits and so my contracted rate was $10K. And that's exactly what I paid. But if my insurance had not paid anything, I still would have only paid $10K. They have the system totally figured out.

Look into Blossom Bariatrics. It's the best decision I ever made.

In-network v.out of network is a completely different issue from whether something is a covered procedure or not, unless someone is going to lie to the insurance company on the patient's behalf about the procedure that was performed, which would be insurance fraud.

xGreatWhiteNorthx

I wouldnt persue bariatric surgery for that amount of weight loss anyway after seeing my cousins experience.

It's an entire lifestyle change with potemtially huge life long side effects for a small amount of weight in comparison to someone who is actually morbidly, life threateningly obese. I've been through a lot of major surgeries and I tend to be pretty flippant about them, but the side effects I've seen arent worth it for that amount of weight loss.

I am 5'4ish and started at 235lbs. My goal is about the same as yours. My lowest is 156lbs a month or two after giving birth and honestly, it wasnt excruciagingly difficult. I didnt have to deprive myself. I just ate at a calorie deficit and found exercise I enjoyed and tracked it all. Took only about 9 months to get from 235lbs to 175lbs when I got pregnant. I was 185ish when I was 40 weeks pregnant
173lbs when I left the hospital and within a couple months of just walking my dogs 5km per day with my baby in a carrier on my back, still tracking everything etc,.I was about 156lbs.


You can do it!

alteredsteve175

My sister has a sleeve. It did help her lose weight, but she has had some other issues related to the sleeve. She can only eat small meals now and does not eat regularly. That leads to low blood sugar and fainting episodes. I had the pleasure of an ambulance ride with her when she passed out in a department store last summer.

As others have noted here, you can lose the weight without surgery. Please make a serous effort to do this on your own. You will get lots of support and encouragement here from others who have done it.

harper16

OP you totally got this! My starting weight was 225. Goal weight is 135-140. So 90 lbs to lose. I've lost 21 lbs since joining MFP. I focus on being mindful of my calories, and setting small goals. My first goal is to get under 200 and at 203.8 I'm almost there. On here I've also joined a daily and a couple weekly weigh in threads. They help keep me motivated and accountable.

Lots of good luck on your journey.

age_is_just_a_number

I 100% agree with great white north. My mom had gastric bypass surgery when she was 250. Initially she was rejected because she was not heavy enough to qualify. I was 16 when she had it done. I’m not sure how she got it approved. But honestly, it ruined her life. She was 44 when she had the surgery. She had post surgery complications with an infection. Then she really was never able to eat regular food ever again. Even decades later, if she didn’t chew her food to a pulp, it would come back up.
In the first year post surgery she did lose weight. Probably got down to about 150. But then a few years later she was back at 210. After a few more years, she decided to start to eat differently and got back to 150 with making better food choices. She joined TOPS (take off pounds sensibly). I think it is kind of like weight watchers. In other words, it look support from others and a lifestyle change to get to and maintain her weight.
She did have some excess skin that she wanted to have removed, but it was a lower priority when she was diagnosed with bladder cancer. Depending on how old you are and how long you’ve been at 240, your skin may retract naturally.

Don’t do the surgery. Surgery is not a guarantee to success, especially in the long term.

Embrace a new lifestyle of healthy food choices, tracking what you eat, and when you are ready adding some exercise.
You can do it!!!

Diatonic12

"...had the pleasure of an ambulance ride with her when she passed out in a department store last summer.

As others have noted here, you can lose the weight without surgery. Please make a serous effort to do this on your own. You will get lots of support and encouragement here from others who have done it."

Understood and appreciated.

I have more than a handful of relatives who've opted for WLS. Not one has maintained their weight loss. They ate it all back. One died from surgery complications. Her young children came home from school in the afternoon and found her deceased. They're still suffering without their mother.

Some of their surgeons prescribed the pre-op dieting phase to see if they were mentally prepared. That only worked until after the surgery. After the first year, they all started eating it back. Some went bald but all had complications within 5 years of the surgeries. Dumping, ulcers, low blood sugar. The radical drop in weight without doing any exercise aged them. Any thoughts for an easy fix became imaginary thinking.


If you can conduct the pre-op dieting phase then keep on going. Learn how to moderate yourself with foods and portions. Rebound weight gain with friends happens to the WLS patient just like the yo-yo dieter. I refuse to start over and over and over again.

There is a honeymoon phase with any WLS, weight loss surgery. Talk to them at the 5 year mark and you'll get a truer picture of their struggles. Long term weight stability requires the ability to focus on what's really important.
The best diet is the one that improves your health.

paperpudding

OP is 5' 5" and weighs 240 lb.

Her starting calorie allowance would be well over 1200 calories - and that is net, eat back at least some excercise calories on top of that.

OP I am bit shorter than you and probably older - and I started at about 160lb - and my calorie allowance was 1460.

Don't make this harder than it needs to be by incorrectly aiming at 1200.

and dont make it uneccesarily harder by any of the rules in wolftrucking's post.

Just put your stats in to MFP and then aim for that many net calories.
( for health sake also aim for a reasonably nutritious diet - but this does not have to be precise and certainly does not have to be keto.)

Do whatever excercise you like - or none if you really don't want to.

Of course be sensible about it - if you have not been doing any regular excercise start with walking or gym for beginners or some other beginner level activity. Common sense.

hmaddpear

You have totally got this. 7 years ago, I started here at 5'5'', and 238lb. I lost 80lb by watching what are and walking. I've fallen of the wagon, and got back on, many times, but I'm still plodding along. It takes time, but set yourself a doable calorie goal (I picked 1640 kcal), and log everything. Work out what gets and keeps you full, and what you get to only have occasionally, and what is just not worth the calories. Read the forums, there's great advice on here, get yourself some friends to cheerlead and chivvy you. Make a commitment every day to do a little bit better. You don't have to be perfect from day one. And you don't fail if you pick yourself up and start again.

Much luck to you.

Edited to add a must read: https://community.myfitnesspal.com/en/discussion/1080242/a-guide-to-get-you-started-on-your-path-to-sexypants/p1

Hagensieker

I lost 100 lbs once the old fashioned way. I have a co-worker who got the surgery and while he lost a lot of weight he did it by eating a minuscule amount of food every day. Also his choices that I saw were poor. He was eating lots of junk food and he threw up quite a bit especially during meals. He's a lot younger than me and it wouldn't surprise me to ever hear that he had serious health issues or worse.

You are in the right place.

age_is_just_a_number

As you can see from these replies, there is no quick fix to health and there are a lot of different people with different opinions. I’ve read really compelling studies that support vegan, vegetarian, high protein, low or even no carb diets. At the end of the day, you have to do what works for you. Everyone is different.
Regarding wolf trucking08’s rules: they are from someone who has made a drastic change to their life and have had incredible success with that approach. If you are exactly like them, then that approach may work for you. If you are different, then you may need to act differently.
1) I agree. This is a lifestyle change. But to change everything overnight is very drastic and can lead to not being sustainable. You may find making small realistic and sustainable changes every couple of weeks. At the end of a year, you will have made a big change to your lifestyle.
2) I agree with calorie deficit. But I’ve never heard about training your body to operate on a caloric deficit.
I agree with “ You must HONESTLY measure, weigh and log everything you eat and drink, including your exercise.”
3) I agree. Water is your friend. Drink it all throughout the day.
4) I’ve already addressed this. I agree with ditching the “SAD” or Standard American Diet. I support the new Canada Food Guide, which was developed without food marketing boards at the table, instead it was developed based on scientific evidence. The overall guideline is half your plate should be vegetables, a quarter of your plate should be complex carbohydrates and a quarter of your plate should be high quality lean protein.
5) exercise: I agree, you need to add exercise to your day. You need to take it one step at a time. If you push yourself too much you increase your risk of injury, soreness and worst of all giving up. Listen to your body. Do what you can. But continue to increase what you can do.

Caloric deficit will result in weight loss.
Exercise, especially weight or resistance training, will result in muscle gain. You need to add muscle to your body.

You can do it!

age_is_just_a_number

Hagensieker wrote: »

I lost 100 lbs once the old fashioned way. I have a co-worker who got the surgery and while he lost a lot of weight he did it by eating a minuscule amount of food every day. Also his choices that I saw were poor. He was eating lots of junk food and he threw up quite a bit especially during meals. He's a lot younger than me and it wouldn't surprise me to ever hear that he had serious health issues or worse.

You are in the right place.

Congratulations!!
Your friend sounds like my mom. She couldn’t eat regular food after the surgery. The surgery does not teach you how to eat properly. There is no quick fix. There is no magic pill. You can’t wish for it, you have to work for it. You’ve done it and now You are an inspiration for others.

jjlbrick

I have 12? Relatives several friends that have had weight loss surgery. Near as I can tell this surgery works because it forces you to change your diet. If you think that you can ever go back to your old habits you will gain weight.
I went to a lecture to learn about lap band procedure. The doctor said that you wouldn’t be able to eat as much. But if you had a large sweetened, coffee drink every day. It would mess with your weight loss, same with alcohol.
It should be a crime that insurance doesn’t pay for weight loss surgery. Or weight loss programs.

ninerbuff

Surgery DOESN'T change the reason why you got 100lbs overweight. Many people who do have bariatric surgeries, never addressed issue of wny they did and turned their food addicition, to another. Example would be, now that they can't eat as much, they may turn to gambling, alcohol, drugs, etc.

A.C.E. Certified Personal and Group Fitness Trainer
IDEA Fitness member
Kickboxing Certified Instructor
Been in fitness for 30 years and have studied kinesiology and nutrition

Diatonic12

This. ^^ Cross-addiction.

https://pubmed.ncbi.nlm.nih.gov/27400415/

https://www.obesityaction.org/community/news/bariatric-surgery/transfer-addiction-following-bariatric-surgery/
https://www.mdedge.com/psychiatry/article/126520/addiction-medicine/alcohol-use-disorders-after-bariatric-surgery-case

The appetite control center is located in the brain and not the stomach. We can remove most of a stomach but it's the head that needs fixing. If WLS fixed the head no one would ever eat it all back.

paperpudding

Well, yes - but one would hope part of the WLS process included counselling to address underlying issues.

Katherinelittle24

I am so sick of multiple people here judging for someone, or stopping someone from getting Weight Loss Surgery. Believe me, its not the easy way out! and some people cant just lose it the old fashion way. I am 460lbs and I am 29 years old. For anyone that is interested in WLS, I support you completely! it's your body and your life, after all. I had to do three months of intense classes and seeing a nutritionist as well that went over the whole procedure and what food looks like for post-opp. I will most likely be getting the Gastric Sleeve in September after I lose 10% of my body fat.

I'm nervous of course because it is surgery but I am also excited to begin my new life. I have been big my entire life and I have struggled with diets, left and right. This surgery is not just surgery, its not going to solve every problem. It's a tool to help those that get the surgery maintain a healthy balance in life. I've spoken to others that have had the surgery and from what I have gathered, its difficult in the beginning of course but what isn't? Nobody has told me though that they regret the surgery because it give them back their life. I'm young. If I was going to do it, now would be the time For those that are considering WLS, add me! lets talk and support each other on this journey!

cgcdavis7

Katherinelittle24 wrote: »

I am so sick of multiple people here judging for someone, or stopping someone from getting Weight Loss Surgery. Believe me, its not the easy way out! and some people cant just lose it the old fashion way. I am 460lbs and I am 29 years old. For anyone that is interested in WLS, I support you completely! it's your body and your life, after all. I had to do three months of intense classes and seeing a nutritionist as well that went over the whole procedure and what food looks like for post-opp. I will most likely be getting the Gastric Sleeve in September after I lose 10% of my body fat.

I'm nervous of course because it is surgery but I am also excited to begin my new life. I have been big my entire life and I have struggled with diets, left and right. This surgery is not just surgery, its not going to solve every problem. It's a tool to help those that get the surgery maintain a healthy balance in life. I've spoken to others that have had the surgery and from what I have gathered, its difficult in the beginning of course but what isn't? Nobody has told me though that they regret the surgery because it give them back their life. I'm young. If I was going to do it, now would be the time For those that are considering WLS, add me! lets talk and support each other on this journey!

I don't see any judgement toward WLS. It's not for everyone and they're just voicing what they've seen with loved ones hence concern, not judgment. Good luck with your journey and I'm glad you're making the right choice for yourself.

gadorlogor

If you're losing weight track your macros as well as your micros. I see to many people eat sub 2,000 calories but around a hundred grams of fat and then wonder why they are gaining weight.
Good luck.

gadorlogor

Katherinelittle24 wrote: »

"some people cant just lose it the old fashion way."

Everyone can, don't make excuses this is why you're fat.

Evamutt

I agree that it is right for some people but please at least try to change your eating habits & lose weight that way first. I worked in ICU for 10 yrs & there was almost always someone in there from complications / infection. Most made it out but some also died. We do know a couple who had it many years ago & are still doing well but they were more than 100 lbs overweight. There are so many on here who have lost 100+ lbs. Do it slowly & change your food choices over a period of time

Kaitie9399

While weight-loss surgery will get the weight off pretty fast...it is not going to solve your problem. My husband had gastric bypass surgery in 2011 and went from 485 to 300 pounds--a remarkable achievement. However, he never went to the support group sessions and he tested his body at every chance to eat crappy foods and before he knew it he was back to over 450 pounds. He didn't solve his mental issues with food.

So, no amount of surgery is going to help you---address your issues with food, track every morsel you put in your mouth and walk every day for an hour and the weight will come off.

Diatonic12

This is a judgment free zone and I'm in agreement with the comments above.

WLS removes most of a stomach but does not fix the appetite control center which is located in the brain. WLS patients can eat it all back just like serial dieters do. Know this going in to surgery. My loved died due to complications from WLS. I have 6 relatives who've ate it all back with WLS. Not one of them is maintaining any of the original weight loss at the 5 year mark.

Most of them started eating it all back at the 2 year mark.

Speaking in general and to no one particular, can you answer this question: What was going through your mind as you were eating yourself into the highest weight you've ever been in your life?

Pre, Mid or Post-surgery. With or without surgery.

Why didn't your brain stop you one single time during the eating it all back phase and send out an alarm or even a word of caution. Why did your brain allow the eating phase to keep going and going and going without any kind of a stop-gap measure? Not stopping one single day to stop and look around. Not once.

That's the brain and the appetite control center. These things won't change after surgery. There will be a major weight loss within the first year followed by more surgery to remove the loose skin. After all of that, the brain can kick it right back into those old eating patterns without new major cognitive behavior skillsets and subsets.

A good surgeon will require counseling with a trial period to see if you can actually take off some of the weight before surgery. Many do and some decide to go on without the surgery.

Removing most of a stomach doesn't fix what's really going on in the brain. It's the brain that needs fixing and the body will follow. T2 diabetes is often the underlying cause of a ravenous appetite that will not be abated. If you can get your blood glucose levels under control it makes all of this easier.

People often overlook the underlying causes of what's really going on inside of their pancreas and other internal organs that are the largest contributor to obesity. We have to dig deep and get down to the root causes of what's really causing obesity.

T2 and binge eating go hand in hand. Binge eating earlier in life can be the handwriting on the wall for your diabetes diagnosis coming later in life. It's all connected.

nanastaci2020

I hope you're doing well - I see this thread was started a month ago.

WLS is a tool. But its not the only tool available for you on this journey.

nanastaci2020

100 grams of fat = 900 calories, and if their calorie target daily is 2000: that leaves 275 grams @ 4 calories each for proteins/carbs. Nothing wrong with this.

If the people you 'see' are not losing weight on 2000 calories, then 2000 calories is either not a deficit for them OR they are eating more than they think.

Eating fat does not make one gain weight. Consuming too many calories makes one gain weight.

gadorlogor wrote: »

If you're losing weight track your macros as well as your micros. I see to many people eat sub 2,000 calories but around a hundred grams of fat and then wonder why they are gaining weight.
Good luck.

Evamutt

as with any tool, it can help but can't work on it's own. I believe some ppl do need it. Anyone watch My 600 lb life? it says in the beginning that only 5% are successful. I think the % is fairly low for the rest of us who don't have to lose that much weight

Diatonic12

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6728934/

Does binge-eating matter for glycemic control in type 2 diabetes patients?




Conclusions
The pool of evidence regarding the association between ED and T2DM seems to justify screening diabetic patients for abnormal eating behaviors. In addition, when obesity is present, eating psychopathology investigation is even more recommended, since it may disrupt obesity treatment and indirectly affect diabetes control.

Although the objective negative clinical impact of an ED on type 2 diabetes control is yet to be confirmed, is possible to speculate that the remission of binge episodes could play a major role in diabetes treatment. The clinical control of eating psychopathology could enhance nutritional recommendations adherence and may diminished post-prandial glycemic peaks. Nevertheless, although the spectrum of the clinical significance of the comorbidity of ED and T2DM has not been extensively studies, treatment of binge-eating related disorders could improve perception of self-efficacy of patients toward the diabetes dietary carbohydrate goals and, ultimately improved diabetes-related quality of life.


https://pubmed.ncbi.nlm.nih.gov/32341661/


Binge Eating Disorder in Patients with Type 2 Diabetes: Diagnostic and Management Challenges