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He Hey guys !my insurance said they cover all the bariatic services my PA asked me to ask them. The requirements I believe they said there was no required supervised diet however I do have some history with phertamine. My bmi is right at 40.4. I’m gonna ass a screen shot of the blue home plan for bariatic ! I think it should be an easy process as far as what they’re asking for. I hope to have my surgery by June fingers crossed. Anyone have experience with novant ? In Nc Pasted what the picture has in case visibility is hard.  A thorough preoperative evaluation for bariatric surgery must include all of the following: 1. Evaluation of the patient's understanding of the procedure to be performed, including the procedure's risks and benefits, length of stay in the hospital, behavioral changes required prior to Page 8 of 21 An Independent Licensee of the Blue Cross and Blue Shield Association Bariatric Surgery and after the surgical procedure (including dietary and exercise requirements), follow up requirements with the performing surgeon, and anticipated psychological changes. 2. 3. Evaluation of the patient's family/caregivers support and understanding of the information in #1. Within 12 months prior to surgery, a thorough nutritional evaluation by a physician, registered dietician, or other licensed professional experienced in the issues of bariatric surgery, who has had a meaningful conversation with the individual regarding the dietary and lifestyle changes required to ensure a successful outcome over time. Nutritional assessment must follow American Society for Metabolic and Bariatric Surgery (ASMBS) guidelines. Pre-operative assessment must document that the patient has a good understanding of the diet and nutritional changes that are associated with bariatric surgery and has the capacity to comply with these changes. Per the ASMBS guidelines, " *..it is essential to determine any preexisting nutritional deficiencies, develop appropriate dietary interventions for correction, and create a plan for postoperative dietary intake that will enhance the likelihood of success. Not only should the practitioner review the standard assessment components (i.e., medical co-morbidities, weight history, laboratory values, and nutritional intake), it is also important to evaluate other issues that could affect nutrient status, including readiness for change, realistic goal setting, general nutrition knowledge, as well as behavioral, cultural, psychosocial, and economic issues." 2019 guidelines for perioperative nutrition, metabolic and nonsurgical support are available at: 4. https://journals.aace.com/doi/pdf/10.4158/GL-2019-0406 Within 12 months prior to surgery, a formal psychosocial-behavioral evaluation performed by a qualified behavioral health professional (i.e., licensed in a recognized behavioral health discipline, such as psychology, social work, psychiatry, psychiatric nursing, etc., with specialized knowledge and training relevant to obesity, eating disorders, and/or bariatric procedures), which assesses environmental, familial, and behavioral factors, as well as risk for suicide. Any patient considered for a bariatric procedure with a known or suspected psychiatric illness, or substance abuse or dependence, should undergo a formal mental health evaluation before the procedure. 2019 guidelines for perioperative nutrition, metabolic and nonsurgical support are available at https://journals.aace.com/doi/pdf/10.4158/GL-2019-0406 5. Appropriate medical work up may include a chest x-ray, upper gastrointestinal series, endoscopy, appropriate pre-op labs and ECG. A complete physical examination by the attending surgeon and an assessment of thyroid levels is required. If the patient has comorbid conditions (e.g. diabetes or 6. cardiovascular disease) the patient must be capable of undergoing the procedure. Anesthesia clearance for surgery. The first five criteria must be met before seeking prior plan approval for adults and adolescents; the sixth must be met prior to surgery. Surgical procedures must be performed at a facility capable of providing gastrointestinal and biliary surgery (preferably JCAHO accredited), AND that has equipment and staff capable of managing a morbidly obese patient (appropriate instruments, beds, lifts, monitoring equipment) AND that can manage short and long term complications of bariatric surgery.

Just home from having my sleeve converted to bypass on Friday at the Northern General in Sheffield by Mr Ackroyd who did the original sleeve, severe reflux and gain. Feel amazing compared to last time around. Good luck and plenty of health sent to anyone on a revision journey [emoji3] Kim Sent from my SM-G960F using BariatricPal mobile app

Ok folks I want to pick your brains. I am 18 months out from surgery, I got really sick a couple weeks ago and my doctor put me on steroids and an antibiotic. I finished the course of meds in 10 days, and ever since then it has been nearly impossible to eat. I gained 6 pounds in water weight while ON the steroids and then proceeded to drop all that and 5 more pounds I did NOT want to lose just because I am not eating enough. I'm dangerously close to slipping into double-digit weights and I'd really like to stop this before I end up there. I've gone back to basics and have mostly been consuming things that are really soft like soup and making sure I chew everything very well, but my portion sizes are TINY (again, I'm 18 months out. My breakfast the other morning was 3/4 of a scrambled egg and a forkful of hash browns, as an example. I should be, and have been able to, eat more than that.) Every time I eat, no matter what it is, I get this sharp pain around the left side of my rib cage and my left shoulder has been aching for days. I went to my general practitioner (who himself is a gastric sleeve patient) who said that I probably am just having a harder time recovering from being ill because I'm not 20 anymore and that steroids can wreak havoc on our systems for weeks after we're done taking them, and sent me for some blood tests that I haven't gotten the results back yet from. Before anyone makes this suggestion, yes I am drinking shakes to supplement and I'm having a hard time getting even those down. I feel like I'm starving to death. I just want to not be in pain anymore.

You definitely look younger!!! What a change! Congrats!

Thank you Arabesque, I'm actually back on track, I was taking care of my mother-in-law who was visiting and was hospitalized while here, and another family member who was visiting, but they are both gone this week. I went back to meal prepping for myself and cooking 3x a week enough for it to last the others a couple of days and put myself in the front line, not going down that rabbit hole again.

Harness those feelings, and use them to make better choices in the future! Think about the guilt/shame/embarrassment that you felt after that meal, maybe even journal about it. What can you do next time to make sure you don't feel bad about yourself next time you are presented with temptation? Now picture "next time." Your daughter asks you why you don't want pizza or dessert. Picture yourself telling her, that you want to get XYZ instead (salad, salmon, etc), and that you are too full for dessert. Think about how you will feel afterwards, proud of yourself for fueling your body properly, and proud to set such a great example of healthy eating for your daughter. You can do this!!! Best of luck for your surgery!

Is there a big market for this? Seems like a one-way trip to gaining back every ounce you lost and more. I guess some people like feeling like they have a "safety net" which is why the dangerous gastric balloon seems to keep sticking around.

Aww thanks so much! It's been a month now so I think I'm in the throes of the 3/4 week stall as I'm now on soft foods/semi-normal foods. I haven't weighed myself since the last time I wrote in here and my mental health is a lot better for it. I've noticed my jeans fit a lot looser around my waist, but that's about it. I'm going to perhaps weigh myself at the end of march and see if there's a difference.

I found a good quality supermarket that did mini meals. I liked the minced meat and gravy topped with mashed potato. Fish pie and a mild minced meat curry and rice. There was plenty of protein in them. I also made a tummy friendly Moussaka with baked aubergine instead of fried. I make a lot of soup, big soup fans. Mushroom with added bacon, blitzed at the end with extra cheese and or a light cream. Pea soup or carrot, sweet potato and red lentil are also great because they are good and thick when blitzed and full of protein. As you can tell I had my surgery in our winter months and needed warming foods. I was allowed melba toast and cream cheese, pate or peanut butter. I had a ton of protein yogurts, soft scrambled and boiled egg, tuna mayo. Good luck with finding suitable foods, it is a bit of a head scratcher in the early days

All of you are right. But why is is so hard to just DO IT!! I feel like some days i've had the courage to tell him to get out, but then i don't. I don't know if it's cause i feel bad for him or what....I just don't know. thank you guys for listening as i feel i can't talk to anyone about this. It's embarrassing that I won't do anything about it.