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I too have waited many years thinking about WLS. I work in healthcare and see so many bypass complications that haunt patients for years. I don't see band patients though (I work in a bariatric hospital). I have the issue that even though I know I'm overweight I don't feel overweight. I'm very active and "see" myself skinnier then I really am. I lost 110 lbs in one year (11 yrs ago) doing Atkins/exercise.....kept it off for 2-3 yrs then it started to creep back. I've gained 60 back total, so not a total loss! I decided on getting banded this past fall, have done all the work for approval (lost 18 lbs too!) and got my surgery date today! April 16th will be here before I know it!! I wish you the best with your band and know that we are taking a great step towards healthier lives!!!

Ah, the head work, the emotional work, the mysteries of why I'm the only one in my family to have severe issues with weight. I'm finally in therapy about these issues, but don't have any woo-woo answers yet -- other than the obvious ones of a) I drew the short metabolic straw in my family, I love food, c) I don't love exercise, and d) my chosen work / lifestyle has become increasingly sedentary. My VSG surgery will finally happen in mid-August. I've been seriously considering and investigating WLS as "the ultimate solution" since July 2013, when I attended an introductory WLS lecture. That it's taken over a year to get to this point is partly due to my slowness in getting here and partly due to my local bariatric center being overwhelmed with patient applications. But a part of the truth is that a year ago I wasn't fat enough for this surgery. I recall my weight was 212 when I went to the intro lecture -- a BMI of just under 35 and considerably lower than 40, the BMI that would net me a slam-dunk insurance approval. I hate to admit that I spent the last year gaining weight to have WLS, but in some ways that's part of my truth. I also apparently (?) needed to spend this last year meditating on how miserable my future life would be if I didn't have WLS. A year ago I already knew I was unwilling to diet to lose and regain 45-50 pounds even one more goddamn time. I had demonstrated clearly that I could lose weight -- and that I could regain it. Looking back, it seems my regain phases were always preceded by some "perfect storm" of life changes and stresses. Needless to say, it was severe life changes and stresses, e.g., caregiving for an Alzheimer parent, to name only one, that drove me to this current mess I'm in. I knew that life's changes / stresses are never going to ease up, and at my age they're going to get more frequent and more severe. So, rather than acting insanely (doing the same thing over and over, hoping for different results), I realized I needed to try something different. Three months ago, I started gathering my strength to prepare for surgery. I've lost 10 pounds, am now exercising, have surely added important muscle mass, and have tripled my daily steps. By my standards, I'm still in pitiful shape, but not nearly as pitiful as I was. I would encourage anyone who's now waiting for WLS surgery to try now to change some things. Move more. Drink more Water and less coffee. Use My Fitness Pal. Buy a Fitbit. Do what you can do, no matter how little it is. Next week, you can do more. It's amazing how quickly you will improve. The sleeve part -- that's something I can only talk theory about. It's coming soon. And I'm as nervous as anyone else here is / was pre-op. We're all newbs together.

I am going nuts waiting to hear back from Tricare and of course I have to wait til Tuesday. His office girl told me that even though he is a network provider (general Surgery), he is not contracted for Bariatric surgery and therefore they can charge. If that was the case then why did he accept my insurance for the Bariatric evalution? Kinda contradicting if you ask me.

Good afternoon Have diabetes 2 and obesity for many years, now endocrinologist consultant recommends bariatric surgery, most likely Gastric bypass. Since 2015 keeping balanced diet and portion control, doing walking, swimming, lost 20kg in 2018-2020 but unfortunately not much weight loss recently. It would be interesting to hear from people of similar age and health profile who had bariatric surgery 4-5 years ago - is weight loss sustainable in long term? Any side effects - short and long term? Male in early 60s with sleep apnea and high blood pressure. BMI 49. Angiogram found no cardiac blockages but chest tightness happens often especially in warm humid weather. Physical activity is mainly walking, average 5-6 K steps daily, also swimming, outdoor stretching and breathing exercises Thanks

I think there is a lot of misunderstanding about bariatric surgery in general. I found the idea of the sleeve to be very barbaric when I had my first consult. The permanence of it made it very scary for me as well. Maybe take your mom along for your next appointment? Best of luck to you.

Something isn't adding up here. If she's getting in 109g protein, that's 436 calories right there. If she's only taking in 662 calories, then her protein would be about 65% of that. Maybe some misinterpretation of what MFP is reading? I can see that they might "recommend" 35% protein for her low calories - a typical normal diet might be 15-20%, and a bariatric weight loss diet might well be 50-60% (or more, at the beginning when we are eating little else other than protein.) 60-80g would be a typical recommendation for a woman with a sleeve, as there is no significant malabsorption involved, though some go higher than that as a means of avoiding "carbs", or under the false assumption that the extra will help avoid loss of muscle mass (it will to the point that one is actually working to build muscle mass, but the only thing the excess does, other than make expensive urine, is to avoid deficiency, but one doesn't need much extra to avoid that - the typical bariatric recommendations will cover it.) It does sound like a bariatric RD would be a good person to consult, and if she is truly only getting 6-700 calories and still struggling, then there may be some other metabolic issue going on, and some other appropriate specialist may be in order. But a good RD would be a great start in getting a good baseline of what is really happening dietwise. Starting at 400 lb, a sleeve is often somewhat marginal for getting to normal, particularly for a woman of that size (how tall is she - that's a factor as well in determining an appropriate goal and understanding metabolic issues.) You say that she recently moved cross country - where is she now - that can be a help in finding new specialists. It might be that the VSG is indeed marginal for her needs, and she really needs something stronger. A DS is a straightforward conversion from the VSG (as it uses the sleeve as its basis) and is typically the strongest metabolic tool of the mainstream procedures, so that is also a longer term consideration.

I had surgery eight years ago at age 55. No diabetes, though - just obesity. SUPER obesity. Also, borderline sleep apnea that I didn't know about until I did a sleep test for surgery. I lost 235 lbs and gained back about 20 lbs in year 3 post op (a 10-20 lb rebound weight gain after you hit your lowest weight is very common). Maintained ever since, but it's work. On the other hand, before I had surgery, the most I could lose was about 50-60 lbs, and every ounce of it would come back. Happened dozens of times. So yes - weight loss is sustainable after bariatric surgery as long as you monitor yourself. I had strictures at two months out and four months out. Very easy fix. The PA at our bariatric clinic told me it was the most common complication, and that they happen to 5% of gastric bypass patients (and if they're going to happen, it'll be during the first three months post-surgery - they're very rare after that). I personally wouldn't call something that happens to 5% of people "common", but that does give you an idea of how common complications are. Basically - they're not very common. about 30% of bypass patients have dumping syndrome. I've never had it and most of the people I know haven't had it, but some of us do. It's caused by eating too much sugar at one sitting (or for some, too much fat at one sitting seems to set it off). It's because food passes through to your small intestine much more quickly once you've had bypass, and your intestines go into overdrive trying to deal with the sugar (or...fat). It can be prevented by limiting the amount of sugar you eat at one sitting (which we should be doing regardless, even us non-dumpers). good luck in your decision. Honestly, I should have done it years ago. My only regret is that I waited that long to have it done. My life has changed dramatically for the good. I'd go back and have the surgery done every year if I had to - it's been terrific!

Top 10 Bariatric Mistakes! I needed reminding!!! http://www.bariatriceating.com/2015/03/02/top-10-bariatric-post-op-mistakes/

Hello everyone. I've struggled with weight almost my entire life. Now, I'm only 19 as of April, but growing up and living in today's society is a struggle. Luckily I was hardly ever bullied on growing up in school. They had the "decency" to laugh behind my back. I'm a social butterfly whenever it comes to people. Growing up I had a lot of friends, and to this day I only speak to TWO of the ten friends I used to have and hang out with. I'm glad that they are still with me and have encouraged me through everything. Whenever I was a Junior(2011), near the end of my last semester I had decided for the first time about having Bariatric surgery. At the time I was at 416 pounds. Whenever I saw that number pop up on the weight scale I just thought about a tiger. I weigh as much as a full grown tiger. I was so embarrassed. Whenever she read the number out loud to double check I just about lost it. I never thought I would ever get to this weight. My surgeon told me that my next appointment would be in about 4 months. He had said to follow my diet and to have lose close to 40 pounds. I felt that was easy enough seeing as how overweight I was and that I knew that if I tried that I could lose over that amount. After the seminar was over and I met with my surgeon I was feeling more than ready. I was feeling so excited and ready to start my new life. Next I speak with the dietician and then it hits me again. Just hearing myself tell her everything I consume in one day was just phenomenal. I couldn't believe it! I left that day with a diet plan and a change of mind! After following the diet for about a month I just started feeling like I was wanting to give up. I was feeling depressed as I lost some weight. It wasn't happening fast enough for me. Sadly, I fell out of the Bariatric process. I was so disappointed in myself. Soon after that I just gave up entirely. I started eating worse than ever before. I wouldn't go anywhere near a scale. I was so intimidated by them. Also, I forgot to add that I've been in Marching Band since the 8th grade. Because of all of this my band unifor.m started getting tighter, and tighter. At the end of the marching season I could barely zip it up. I was so ashamed. After I graduated (2013) I had met an amazing guy named Ryan. I started dating Ryan June 21st, 2013. He was my everything. Soon after about 5 months things started turning for the worst. We would fight constantly and it would never end well. Being with Ryan for the first 5 months I had lost around 15 pounds if I had to guess. We were on and off for a little while after. Finally I done a little maturing I had considered Bariatric surgery yet again. This time was the real deal. So I packed up with my mom and Ryan and off to Indianapolis we went. I went through the seminar and everything was fantastic. After everything was over and we got back in the car my mom had called my dad and told him how much he would have to pay (half because of the divorce.) My mom fell silent on the phone and then said, "Okay well we will be home in about 3 hours." After she hung up I asked what was said and she said that he told her he just couldn't afford it. I was completely heartbroken. I was so devastated. Yet again, I thought it was too late. I didn't want to try anymore. Months after that Ryan joined the gym and we both would walk down there. The gym was 3 blocks away from my house so to start off we would walk down there and he would work out and then walk back. I was so winded from walking those 3 small blocks I could find it in me to exercise. Eventually I started working out and I wanted to actually stay over there for an hour and a half working out, and then would walk back home. I started feeling so much better. After a while, Ryan and I weren't doing all that well so I lost all motivation to go. Again, with the giving up. Anyways, here I am in 2014. I'm 19 years old and weigh approx. 380 pounds. Ryan and I are doing extremely well and just had our 15 month anniversary September 21st. He is supporting me as well as my dad and his sisters (my aunts). I meet with my surgeon December 2nd to discuss the possibility of having the Sleeve procedure done versus the RNY. I'm in this 100% this time and I hope to be able to have a happy life for as long as I'm allowed. As soon as I get closer to my surgery date, (whenever that is) I will be uploading pictures on my progress. If anyone has any advice for me I would be so grateful to hear it. Thank you (:

It’s pretty normal to feel fatigued this soon out so I wouldn’t worry TOO much about it if you’re being compliant and taking your vitamins/eating properly etc. Shots can definitely help, but a sublingual B12 is definitely a good idea if you haven’t tried it yet. I like Vita4Life’s sublingual because it contains B complex Vitamins and it is made to dissolve slower than most sublingual B12 sublinguals on purpose. This is so the sublingual doesn’t just dissolve in our saliva in 3 seconds and get swallowed, then become non absorbable. The price is unbeatable too. Check them out sometime. Good luck and keep up the good work! http://vita4life.net/bariatric-vitamins-b-12-sublingual.html

What risk to health concerns you, with increased Protein intake? A body with healthy kidneys is able to deal with any potential protein overload. ETA: Bone loss is generally not an issue unless protein is eaten to the exclusion of other necessary macronutrients. But eating a high protein diet that includes vegetables and/or fruits--which tend to buffer the acidity of the urine produced by a high-protein diet--prevents the "withdrawals" from the body's calcium stores and bone loss.) But the point is, really, that for many of us, there IS no overload. Getting 80 g of protein permits maintenance of muscle mass while losing weight (when combined with exercise), helps with healing from surgery, and may help prevent the hair loss that plagues so many bariatric patients. My doctor monitors kidney function routinely, so I'm not concerned about potential health risks from protein. But then, while I do think it's tremendously important, I don't think that achieving a set number of grams is the most important thing on the planet. I aim for it, but if I don't get it, I'm comfortable that most days, I do.

Yep. During my one-month post-op appointment, the nutritionist suggested I reintroduce crackers into my diet. I told her that wouldn't be a good idea because crackers are a trigger food for me. Prior to bariatric surgery, I would literally graze my way to the bottom of a box of flavored Triscuits, Cheez-Its, or Pepperidge Farm Goldfish crackers. Since I'm not the type of person who can stop at 5 crackers, it's best that I not eat them on a regular basis. Besides, crackers don't have enough protein to be worthy of my time.

Yes, I definitely get your point. My Nut specializes in bariatric patients and has told me that she had to adjust what she had been taught to the bariatric patients needs since they (we) are different. That is a good point. Not all Nuts are educated about our particular needs.

I started by going to the seminar held at a local hospital that has a bariatric center. and I called my ins co. to find out their requirements. Ended up a self pay.

Congratulations to all of you. Denise, yes most people do lose some of their hair after surgery. It is due to the stress to your body of surgery and also lack of Protein and the results of anesthesiology. This happens from most surgeries not just bariatric ones. Just be sure to keep your protein intake up as much as possilbe to prevent losing any extra. Best wishes with your surgery. Don't let the hair loss get to you. It will grow back.

Both professionals in the field and those who have had or are considering having surgery themselves seem to be involved in an ongoing debate over what is the best type of weight loss surgery. The three most common forms of surgery in Australia at present, gastric band, gastric bypass and sleeve gastrectomy all have loyal fans and big opponents. In my Nutrition for Weight Loss Surgery Support Group the pros and cons of the different surgery types are regularly discussed by those who have been through the various procedures. Whilst technically different, what is common to all forms of weight loss surgery is that the surgery itself is just one part of the picture of weight management. Surgery alone does not guarantee you will lose weight; it is a tool that can assist you to lose weight when teamed with lifestyle change. Colleen Cook is a successful weight loss surgery patient from 1995 and is the author of the best selling weight loss surgery book, The Success Habits of Weight Loss Surgery Patients. It is based on her research of the most successful long-term patients and the habits they have in common as they maintain their weight over time. Colleen is also the President of Bariatric Support Centers International, a company that specialises in providing education and support services for those who have had weight loss surgery and the professionals who work with them. Following is a comment from Colleen that stood out to me when reading her work recently: “Successful patients took personal responsibility for staying in control. They were found to have a general feeling that maintaining their weight was indeed their own responsibility and that surgery was a tool that they used to reach and maintain a healthy weight.” Colleen’s words illustrate perfectly that weight loss surgery itself does not cause weight loss. Those undergoing weight loss surgery will need to take responsibility for their lifestyle choices. To achieve the best weight loss results and maintain that weight loss in the long term, you will need to choose healthy and nutritious foods, increase physical activity and maintain regular follow up with your support team. Are you maximizing the support available to you? Do you regularly follow up with your surgeon or bariatric GP to check your progress? For those with a gastric band, have you worked with them to find the green zone? Have you had the blood tests recommended to you to monitor any medical conditions or detect nutrient deficiencies? Have you seen an exercise physiologist or physiotherapist regarding an activity program tailored to you? Did you see your dietitian for the pre and post surgery info but never returned for ongoing support? Are you comfortable with the support team at your clinic? If not, you need to seek out a new support network. Ultimately it is up to you to utilise the support and resources available to you for a successful journey,

I made this as a microwave version when I was on mushies. I used the low fat soup and canned chicken. It was really delish and satisfying. And perfectly on plan. I put it up in small 1/4c portions and froze it. Then i'd take one out per meal and nuke it for like 1 minute 20 seconds and had a meal of which I ate maybe 1/2 of it. The bariatric version isn't carb heavy at all. Here's my recipe for it, but now I just omit the COC soup and use COM.

Thanks Alot for the info. i will surely tell him about my coveraged. So after u got refered to a bariatric surgeon is he the one whos gonna guide u to the psyc and seminar and all those good stuff?

The type of surgeon who does the lapband and gastric bypass is called a BARIATRIC (bear-ee-ack-tric) SURGEON. Just be sure that the one that he refers you too is covered by your insurance. Mine tried to refer me to a specific surgeon and I think it was because he gets a cut for referring patients.....lol. Best of luck!

sleep apnea (i.e., patient meets the criteria for treatment of obstructive sleep apnea set forth in Aetna CPB 004 - Obstructive Sleep Apnea); or 4. Medically refractory hypertension (blood pressure greater than 140 mmHg systolic and/or 90 mmHg diastolic despite optimal medical management); and 2. Member has completed growth (18 years of age or documentation of completion of bone growth); and 3. Member has attempted weight loss in the past without successful long-term weight reduction; and 4. Member must meet either criterion 1 (physician-supervised nutrition and exercise program) or criterion 2 (multidisciplinary surgical preparatory regimen): 1. Physician-supervised nutrition and exercise program: Member has participated in physician-supervised nutrition and exercise program (including dietician consultation, low calorie diet, increased physical activity, and behavioral modification), documented in the medical record at each visit. This physician-supervised nutrition and exercise program must meet all of the following criteria: 1. Nutrition and exercise program must be supervised and monitored by a physician working in cooperation with dieticians and/or nutritionists; and 2. Nutrition and exercise program(s) must be for a cumulative total of 6 months or longer in duration and occur within 2 years prior to surgery, with participation in one program of at least three consecutive months. (Precertification may be made prior to completion of nutrition and exercise program as long as a cumulative of six months participation in nutrition and exercise program(s) will be completed prior to the date of surgery.); and 3. Member's participation in a physician-supervised nutrition and exercise program must be documented in the medical record by an attending physician who supervised the member's participation. The nutrition and exercise program may be administered as part of the surgical preparative regimen, and participation in the nutrition and exercise program may be supervised by the surgeon who will perform the surgery or by some other physician. Note: A physician's summary letter is not sufficient documentation. Documentation should include medical records of physician's contemporaneous assessment of patient's progress throughout the course of the nutrition and exercise program. For members who participate in a physician-administered nutrition and exercise program (e.g., MediFast, OptiFast), program records documenting the member's participation and progress may substitute for physician medical records; or 2. Multidisciplinary surgical preparatory regimen: Proximate to the time of surgery, member must participate in organized multidisciplinary surgical preparatory regimen of at least three months duration meeting all of the following criteria, in order to improve surgical outcomes, reduce the potential for surgical complications, and establish the member's ability to comply with post-operative medical care and dietary restrictions: 1. Consultation with a dietician or nutritionist; and 2. Reduced-calorie diet program supervised by dietician or nutritionist; and 3. Exercise regimen (unless contraindicated) to improve pulmonary reserve prior to surgery, supervised by exercise therapist or other qualified professional; and 4. Behavior modification program supervised by qualified professional; and 5. Documentation in the medical record of the member's participation in the multidisciplinary surgical preparatory regimen at each visit. (A physician's summary letter, without evidence of contemporaneous oversight, is not sufficient documentation. Documentation should include medical records of the physician's initial assessment of the member, and the physician's assessment of the member's progress at the completion of the multidisciplinary surgical preparatory regimen.) and 5. For members who have a history of severe psychiatric disturbance (schizophrenia, borderline personality disorder, suicidal ideation, severe depression) or who are currently under the care of a psychologist/psychiatrist or who are on psychotropic medications, pre-operative psychological clearance is necessary in order to exclude members who are unable to provide informed consent or who are unable to comply with the pre- and postoperative regimen. Note: The presence of depression due to obesity is not normally considered a contraindication to obesity surgery. 2. Vertical Banded Gastroplasty (VBG): Aetna considers open or laparoscopic vertical banded gastroplasty (VBG) medically necessary for members who meet the selection criteria for obesity surgery and who are at increased risk of adverse consequences of a RYGB due to the presence of any of the following comorbid medical conditions: 1. Hepatic cirrhosis with elevated liver function tests; or 2. Inflammatory bowel disease (Crohn's disease or ulcerative colitis); or 3. Radiation enteritis; or 4. Demonstrated complications from extensive adhesions involving the intestines from prior major abdominal surgery, multiple minor surgeries, or major trauma; or 5. Poorly controlled systemic disease (American Society of Anesthesiology (ASA) Class IV) (see Appendix). Aetna considers VBG experimental and investigational when medical necessity criteria are not met. 3. Repeat Bariatric Surgery: Aetna considers medically necessary surgery to correct complications from bariatric surgery, such as obstruction or stricture. Aetna considers repeat bariatric surgery medically necessary for members whose initial bariatric surgery was medically necessary (i.e., who met medical necessity criteria for their initial bariatric surgery), and who meet either of the following medical necessity criteria: 1. Conversion to a RYGB or BPD/DS may be considered medically necessary for members who have not had adequate success (defined as loss of more than 50 percent of excess body weight) two years following the primary bariatric surgery procedure and the member has been compliant with a prescribed nutrition and exercise program following the procedure; or 2. Revision of a primary bariatric surgery procedure that has failed due to dilation of the gastric pouch is considered medically necessary if the primary procedure was successful in inducing weight loss prior to the pouch dilation, and the member has been compliant with a prescribed nutrition and exercise program following the procedure. 4. Experimental and Investigational Bariatric Surgical Procedures: Aetna considers each of the following procedures experimental and investigational because the peer reviewed medical literature shows them to be either unsafe or inadequately studied: * Loop gastric bypass * Gastroplasty, more commonly known as ?stomach stapling? (see below for clarification from vertical band gastroplasty) * Sleeve gastrectomy * Mini gastric bypass * Silastic ring vertical gastric bypass (Fobi pouch) * Intragastric balloon * VBG, except in limited circumstances noted above. * LASGB, RYGB, and BPD/DS procedures not meeting the medical necessity criteria above. Cholecystectomy: As a high incidence of gallbladder disease (28%) has been documented after surgery for morbid obesity, Aetna considers routine cholecystectomy medically necessary when performed in concert with elective bariatric procedures. Notes: Calculation of BMI: *BMI is calculated by dividing the patient's weight (in kilograms) by height (in meters) squared: BMI = weight (kg) * [height (m)]2 Note: To convert pounds to kilograms, multiply pounds by 0.45. To convert inches to meters, multiply inches by 0.0254. or For a simple and rapid calculation of BMI, please click below and it will take you to the Obesity Education Initiative. *BMI = weight (kg) * [height (m)]2 See also CPB 039 - Weight Reduction Medications and Programs.

I cant seem to figure out where I can update my surgery stats, any help would be appreciated.

is there anyway you can keep the insurance you have by applying for insurance on your own with a bcbs plan that does offer the bariatric surgery? So frustrating, I hope this works out for you.

First let me say what a spectacular job you are doing! You are changing your life for the better and in doing so, probably doing the same for your children. Congratulations on your success! The divorce rate for bariatric patients is high. You are making changes that can affect your entire family's life style; your husband is fighting these changes. For your sake and the sake of your children you need to decide if you are going to allow him to sabotage these changes and potentially your continued success. His other choice is to hop on board and be a part of something wonderful. I don't know a lot about bipolar disorder but it sounds like a really convenient excuse to blame his sh***y behavior and allow a vicious circle of verbal abuse to continue. If it truly is his bipolar he needs to figure out a way to fix it, be it meds, counseling or both. Please don't allow yourself to get sucked in and try to deal with his insecurities. You will never be able to fix it, he has to want to do that! You can support him but you can't do it for him. Good luck!

Ambivalence can be paralyzing or, probably more accurately, is a device some of us use to stay put. The alternative certainly seems making a decision, but there's another route that worked for me. I can't even recall how or why the idea of surgery first occurred, but I was no where near ready to say "Yes, this is for me." In order to begin exploring the possibility I chose to play any head game necessary to take any step at all. All along the way it was "Just do [this] to see what it's like and then you don't have to do anything else." The first move was to attend an info seminar: "Go see what they have to say, what it's like, and then you won't have to do any thing else." Okay, that wasn't so bad. Next was an initial appointment with the bariatric practice -- same thing, "Go to the appointment, see what it's like and then you won't have to..." Each subsequent step followed in the same pattern. Finally, when I made appointments for endoscopy and [gulp] colonoscopy (both required probably because of my age, but I don't remember for sure), I knew I meant it: No one consents to endoscopy or colonoscopy just to see what they're like. My whole deal was walking backward toward the OR. When I actually walked in, the entire crew was robed, gloved and masked. Each person turned toward me with a rousing greeting, making me feel as though I'd arrived at a surprise masquerade party in my honor. My best suggestion to you is just attend the initial info seminar and ask questions. Going to the practice's support group can also be helpful -- hearing others' experiences with the ease of face-to-face communication helps, especially since more questions will occur to you as time goes by. (Certainly bring your questions and concerns here, too.) My other best suggestion is to begin a running, handwritten list of reasons (a nice notebook) beyond the healh concerns you mentioned. Add to the list as new things occur to you. Keep each reason narrow in scope, e.g., "So that my favorite gold chain hangs lower instead of fitting like a choker" instead of "So that necklaces look better on me." Another might be "To wear size 6 knickers" instead of "To wear smaller sizes." No reason is shallow, silly or vain. Certainly include the health considerations and any/everything else that has significance to you. Each reason/goal should be what you want for yourself for a lifetime. (There are those who'll squawk at me, but I think that reasons such as special occasions, e.g., weddings, are solid for the long term. They have expiration dates; the wedding lasts a day and then what?) Then, as you lose weight and achieve the goals, you can check them off in your notebook. When you have clearer clarity (?!) on what you really want and why, you'll know that you can do anything. Even better, you'll have confidence to make the choice.

I'm set to go to Mexico next month for my surgery, since I'm self pay, but when I initially started into the process my pcp simply suggested that I consult with a bariatric specialty clinic (preferably through a center of excellence program) and to follow their process. I later found out my insurance wouldn't cover the surgery, so I went an alternate route. I'm in Denver, so can't really suggest anyone in your area, but I would do some online research and talk to people you know who've been through the process. Also, feel free to contact more than one clinic and compare programs to see which one works best for you. Good luck!