All you have to do is go to your primary for six consecutive months and have them document your attempts at weightloss. Your surgeons office can let you know what wording is required to get approval. All my doctor wrote was I exercise 3 days a week and have making various attempts to loose weight either but cutting carbs, no soda etc and it was sufficient and by the way I didn't loose one pound during the six months. It seems to be a formality.