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My surgeon recommended Slim-Fast Optima for the pre-surgery diet. 3 per day along with a Bariatric protein shake or 4 Slim-Fast Optima per day if you didn't buy the Bariatric shakes.

Hi Lou I'm also a WA country girl to be banded on 17 April by Dr Cohen at Mercy Bariatrics. I don't see his name on this site. Any reason why? I'm doing two weeks Optifast pre-op so running out of days right now. Pretty nervous though but I've learnt so much since discovering this site. I agree its great to see the way everyone is so supportive. Well done! SusieP

I, too. am waiting for insurance approval. I requested a copy of my insurance company's policy on weight loss surgery. I reviewed it, and my primary care physician and endocrinologist agreed with me that I met all of their criteria. Letters of medical necessity from my doctors were mailed out last week. I enclosed all information I gathered about the Bariatric Program at Portstmouth Regional Hospital, New Hampshire. So now I am playing the waiting game. Next week I am meeting with the Bariatric Coordinator, Nutritionist, Physical Therapist, and Psychologist - all on the same day, as I live 2 hours away. I will be staying the night before, as I plan to attend the Support Group that evening. I am determined, and I feel I have done my homework, so to speak. I found on the website that there are sample letters of appeal you can send to your insurance company. Be strong, be determined and don't give up. Best of luck to you sweetie. You will be in my thoughts and prayers. Rachel

YOU ARE NOT GOING TO BELIEVE THIS. My policy does not have an exclusion for bariatric surgery. BCBS of Illinois admitted that my denial was a MISTAKE. BCBS is now going over my file and an approval should be coming within 24 hrs. They apologized for the error, will re-evaluate my request for surgery and hopefully get back to me quickly. The Dr's office has also been informed by me that I want my surgery scheduled as soon as they get the approval. ENOUGH IS ENOUGH! WHAT A JOKE. It looks like the last 24 hrs of torture were a character building experience. I don't have the approval yet, but am confident it should be forthcoming. Prayers really do work. I thank everyone of you who sympathized with me. Your responses of support were really helpful. Again, sincerely, I thank you. Me

Thanks Babb's my point of reference for such will hit at holidays, since I'm still pre-surg but I'll take it to heart. And To Rayolite you're a shining star to those coming into Bariatric land. Keep on keeping on *Rosey Posey Sent from my S55 using the BariatricPal App

check this link http://www.bariatricpal.com/topic/309765-questions-i-need-answers-too/ they are listing some recipes...there are others on this website if you search for recipes... also a great source is The World According to Eggface...she has some great recipes for bariatric members!

I use Dr Christopher Ibikunle. Great staff and they have been very accommodating with my phone calls and making appointments when needed. Offices in Loganville and Monroe off of 78. Georgia Surgicare-Bariatrics. Sanji the NP is great as well.

April 8, 2010 Today I had a visit with my pcp. We were on vacation in Gatlinburg the week before. I felt terrible the whole trip...headache, nausea, shortness of breath. I made an appointment the day after returning home. I had already decided I would ask his opinion about weight loss surgery as an option for me. He was not against it, but he did not offer much encouragement. April 15, 2010 Today I had the test done that were ordered by my pcp. First was an intensive stress test. He said no surgeon would operate without it. I doubted this and should of let the surgeon decide if it was necessary. This was the second time I've gone through all these tests. I had to have a cardolite IV. It involved walking on a treadmill and pics taken by a machine that gives images of the arteries in the heart. The images take 20 minutes (two sessions) of laying completely still. Then it was on to the echo cardiogram. Basically it was an ultrasound of my heart. It's interesting to watch the screen and see the valves in my heart working! Next it was on the lab to have blood drawn. The tech was a newbie and since my "good" vein in the right arm already had an IV in it (for the stress test) she called a veteran tech to poke me in the left. It hurt like heck...she said she must have hit a nerve...I'LL SAY! My loving hubby came into town and took me to breakfast, then I went back for the second injection of cardiolite and the second set of images. It all went really well. The tests results showed no problems. Later in the day I called a nearby hospital in Bowling Green Ohio that has a well known weight loss program to register for one of their seminars. They were totally booked for the two seminars in April. I am registered to attend the one on May 15th. I'm hoping my hubby can go with me. They are a Center of Excellence hospital so I feel confident with them. Also, I know of at least 3 people who had bariatric surgery done there. April 21, 2010 Wednesday morning I got my test results. All the heart and stress tests looked good. The stress test tech noted that I tired easily on the treadmill. (I would of liked to put her on there with her smokers breath to see how she would of done ) My blood test came back alright, but my BP was up a little more. He had suggested in Jan. that I add a 3rd BP med and I had resisted. Now, I'm ready...bring it on! Add another co-morbidity link to the list. I called Anthem yesterday and grilled them to see if they covered the Sleeve Gastrectomy. The rep said it is included along with all the other WLS as long as the diagnosis is morbid obesity and I meet all the criteria. Looks like I may be on the way! I registered and got the ball rolling with the surgeon by going to the seminar at Wood County Hospital. May 15, 2010 Today dh and I went to the seminar in Bowling Green Ohio. It was held in a meeting room at Wood County Hospital. The surgeon, Dr. Lalor, was the first speaker. He explained all the different surgeries he preforms, sharing all the good and bad. After the seminar we got to talk to him one on one. It seemed to me that he really is sold on the sleeve gastrectomy. He likes the fact there isn't any malabsorbtion involved. He even mentioned that BC/BS is not approving many sleeves, but since I've had 4 open abdominal surgeries and already had surgery on my colon that they might consider the sleeve for me! Then the dietition spoke and lastly the ins rep for Dr. Lalor's office. Doc answered every single question he was asked through his whole presentation, which impressed me! He stayed and answered questions till the last person finally left. I have my surgeon's consultation on June 17th. I feel really good about him, his staff and the facility!! May 24, 2010 I decided to attend one of the support meetings at Wood County Hospital Mon. May 24th. I was waiting outside with some supper when hubby got off work and I kidnaped him and took him along. Bless his heart! He just finished a 12 hour shift, was tired and dirty, but he seemed anxious to go. The meeting was okay, it was sort of disorganized. They sometimes have guest speakers. Two women took control of this, meeting talking about all their personal problems. [Note to me: Remember to talk with the appropriate person at the appropriate times about personal problems.] Nothing to do but wait and worry till my surgical consultation June 17th! June 17, 2010 This was my first surgeon's visit. The nurse took me back and had me step on the scales. Then she had me take my shoes off to measure my height. So, I got to weigh with my shoes on, but measured with them off, making me weigh heavier and measure shorter! YEA!! I was worried about my BMI not being high enough so this was important to me! She asked me a ton of medical questions and we talked a little about which surgery I was leaning toward. I said the sleeve I thought was the best choice for me and that I would not have gastric bypass, due to the malabsorbtion issues. Next the doc came in and he asked me some more medical questions and questioned me alot about my previous surgeries. Then we discussed the sleeve and he said he would fight BC/BS if necessary to get me the sleeve. He said if they tried to push gastric bypass he would tell them that he felt it would be alot more risky for me. My impression of him is that he is very careful and very honest. He took all the time I needed to answer all my questions, which were numerous! He took me to the front desk and went over all the paperwork that included the tests I needed to schedule, the visits with the nutritionist and the visit with another doctor, who interprets the tests results and does a more thorough medical workup and physical. Next I went down the hall to have my first visit with the nutritionist. I will have a total of 3 visits, to satisfy BC/BS for a 3 month surprised "diet" to satisfy their requirements. I was really impressed with Beth. She gave me alot of information, answered all my questions and we worked on goals. They like patients to lose 5% of their weight before surgery, which is 10lbs for me. Doesn't sound like much, but I have so much pain in my hips and my feet that it will be a struggle. July 13, 2010 Today I met with the shrink. He basically had me go through my whole life history starting with when and where I was born. We discussed my weight issues along with family and even school issues. Then I had to do a personality test with over 100 questions...it took forever! Oh well it's done and over with and I think I did well. Next I went down to Dr. Lalor's office (same building) and met with Beth for my second nutritionist visit. That went really well again! I find myself becoming obcessed with WLS websites (this one and Obesityhelp.com). I am reading stories and looking at before and after pictures. I think it helps keep me going until I am approved and get a surgery date. Looks like the end of September or October would be the earliest I could have surgery.

My dietician put me on a schedule to eat 3 meals every 4 hours. She also told me that if I feel like i have been eating all day then she will know for sure i am following the diet plan correctly. If i feel like i have not eaten hardly anything, then she told me this is a sign of not properly following her diet. All Dr.'s and dietitians are different I would consult your bariatric surgeon and dietician to see if they can put you on a schedule. I hope all is well with your Hubby in Iraq, as well as your weight loss!

Thanks a lot for the advise, I will keep that in mind. I took the Bariatric Advantage Protein shake, it actually tastes pretty good and I was not hungry at all.

JoJo, My surgeon said if I really wanted the diet pop, I could have it *but* that most people have a problem with the carbonation. He suggested that if I really wanted it to let it go flat first. It's a myth that the carbonation will expand your pouch. Some people's comfort zone is in obedience without question to their doctors...and that's ok...but they find it difficult to deal with people who see their caregivers as just one more 'book' of knowledge. I've gone to great lengths to choose my doctors. I made appointments, paid their office fee and 'interviewed' many before choosing them. Not just my bariatric surgeon, but my gynecologist, internal medicine, endocrinologist, etc. I respect their knowledge and judgment immensely...but ultimately, this is my body and *I* will make the final decision on how to treat it. I require a 'reason' for why I should or should not do something. In the case of the pop, there was no surgical/health reason to give it up *BUT* there were other reasons. Studies show that the 'sweetness' (even of diet pop) and sodium actually increase the cravings to eat. Also, the chemicals used to create carbonation prevent our bodies from absorbing the Calcium our bones need (if I understand the explanation correctly) increasing our risk of osteoporosis. Based on that information, I chose to give up the pop, but others may not find the reasons compelling enough. I agree with you, by the way, on the craving issue. If I'm craving something, I'll tell myself, not today, but if I want it tomorrow, I'll have it. Usually, the next morning, I don't want it...but if I do, I'll have it. Sometimes those cravings go away because they're just a momentary weakness. My doc and I were talking about this and she said that's a very healthy way to deal with our cravings because she agreed that if we completely deny ourselves, at some point we'll go overboard and binge. We won't have that *one* cookie we've been craving. We'll eat the whole bag. .

Has anyone ever been lied to regarding the complications with the band? I was looking back at my lap-band journal to the notes I had taken when I was first looking at, and shortly after I got the band, and I feel like people were not exactly truthful, for instance, about complications. I feel like I need to vent a little and share the things that were told to me, 'cause I think it's unethical to misinform patients. 1. I was told that it's really rare for bands to have to be removed, although I see a disturbing number of surgeries here, to remedy slippage, infection, kinks, port repositioning etc. 2. When I asked about the port flipping, quite a few places said they'd never heard of it, and that the patients from whom I'd heard of this, must be mistaken. 3. When I asked about the port sticking out when people lose their weight, my surgeon said that would not happen, but I've already seen pictures of people whose ports show. 4. When I went to the fill doctor that my surgeon sent me, I asked if the doctor would be seeing me and they said yes, when I saw him in the hall and asked him a question, he said I could only be seen by his assistants, as I was a liability since my surgery was done by another doctor. 5. When I was researching clinics to do the surgery, a representative from NWWLS in Everett sent me gristly pictures of a supposed counterfeit gastric band that had been put in by a Mexican doctor and removed at the NWWLS. I google image searched the name of the image and found 3 other websites for bariatric surgeons claiming they'd removed the same counterfeit band themselves. I wish I could find the picture... it was scary and unprofessional. Anyway, those are the things I was told that were a little misleading. Have you guys ever been told stuff like that?

@@Kindle, I hope things work out and I love that your bariatric team all the way in MX still has a vested interest in your overall health and participate in your care. Totally cool.

I had been Struggling at over 300 Pounds since I quit smoking back in 2008. When I quit I was @ 275 and ballooned to over 300 in months. I looked at bariatric Surgery in 2010 and actually took my insurance required classes and decided not to because of the restrictions of certain foods and told myself I could drop from the 315 i weighed at that time. In 2016 I had got to my heaviest at 366 pounds. 2017 was the year I said i was making changes and dropped to 333 I also started looking at bariatric surgery to help me, then i started taking the weight loss surgery classes again from Kaiser. After the 12 weeks of classes I had dropped to 310, and by March 2018 I was 306 on surgery day. Now I do say why didn't I do it sooner, we all end up saying that after, but I do recognize that mentally I was not ready 9 years ago. I did meet one guy who decided not to have surgery and has lost 60lbs on his own, to date and I commend him on his hard work and changes. I know that the surgery was the tool to help me make the correct choices to keep myself at a healthy weight. Good luck with your decision. 👍

If you your insurance company has a bariatric coordinator then the best thing you can do is ask. In the long run studies have shown that insurance companies save money by covering weight loss surgery. The health problems associated with obesity are expensive. But honestly you are having surgery next week! In my experience once your approved and have a date then your submission process is over. It sounds like you have good coverage. Most likely what people who work with benefits call a "cadillac plan". How generous your insurance plan is allowed to be determines how you are treated.

My PCP has been involved and supportive. I worked with a nut pre op to break bad habits and know what to expect. Be careful with that. Make sure to pick one who works with bariatric surgical patients. Lots of misinformed badly educated nutritionists out there. Going to Mex for surgery (and dental, prescriptions, etc) is very common here in AZ. Get all your program/surgeon info so your dr. Has it and tell him you need his support.

My surgery is scheduled July 14th and I'm getting nervous. My bariatric surgeon instructed me to avoid patches and gummies. I'm going to try the patches anyway better that then nothing at all. I'm going with the patches because most supplements have soy, eggs, yeast, wheat, gluten and plant based properties in them. I'm intolerant (significant bloat throughout body, skin irritations, canker sores, irritability, dumping--mainly due to having my gallbladder removed) of all the above. I'd be curious to hear from others who find the patches effective and the results of bloodwork to back up your claim. Thanks!

So I called the surgeon's office on April 1st to find out what the hell was going on. It was then I was informed that I was basically denied, though no one was exactly sure why. I requested the bariatric coordinator connect me with the financial person involved with CMS (my insurance) to try to figure out why the hell I was denied. That was a Wednesday, and it was after 5pm before she got back to me to tell me the insurance people had already left for the day. Thursday, I contacted her again and she tried to contact the insurance company all day without any success. :smile2: Friday, April 3rd, I got a call around 11am. It was the bariatric coordinator. She literally said, "I have a question for you. Do you want to have your surgery Monday?" (April 6th). I was screaming yes, yes, yes! Then I remembered the cruise was scheduled for April 8th and I couldn't cancel that close to the date. So I had to decline the April 6th date. But I am approved! :thumbup: And my surgery date is June 15th. The coordinator told me she is going to try to get my surgeon to do some Tuesday surgeries, and that if she can she will be moving my surgery date up - or if there are any cancellations. But, cancellations and Tuesday surgeries aside, I have 61 days until my surgery. 61 days and an unknown amount of pounds to lose prior to surgery. I am just going to do what I was doing - going to the gym and trying to watch what I eat - and hope the pounds have come off. My mom's (and dad's) birthday is June 4th, and my godmother and best friend's birthdays are June 10th. So June is an active month for me. Not to mention the two kids I watch are out of school as of June 6th, so it will be their second full week without school when I have my surgery. Someone else will need to be watching those kids! And the unemployment rate in Florida is officially at 9.4%, according to Fox News. Just incase anyone wanted to know, haha! Okay, off to walk the dog then make my way to her house to take a brief siesta before waking up the kids and driving them to school. Ciao. :tongue2:

Right now I am so devastated I can barely type. My process began on March 20 2013, when I notified BCBS of Illinois concerning Bariatric Surgery. Below is a copy of the correspondence: 03/20/2013 18:44:00 -- Member Question: Hello Unfortunately, at this time I am looking into Bariatric Surgery at the recommendation of my internist. We have a Blue Distinction Bariatric Center in Portland. What are the different steps that Blue Cross requires, under my plan for this surgery. Response: Bariatric Surgery 03/21/2013 15:12:31 - HCSC Response: Hi Patrice, Surgical treatment of morbid obesity may be considered eligible for coverage when all of the physical, clinical and psychological indications are documented according to Blue Cross Blue Shield of Illinois current medical policy. A letter of support and/or explanation is helpful but alone will not be considered sufficient documentation to make a medical necessity determination. We are not in a position to consider the request for surgical treatment of morbid obesity due to the lack of available medical documentation to determine medical necessity based on Blue Cross Blue Shield of Illinois medical policy. The following documented clinical information is necessary for further review. For a member to be considered eligible for benefit coverage of bariatric surgery to treat morbid obesity, the member must meet the following two criteria: 1. Diagnosis of morbid obesity, defined as a: - Body mass index (BMI) equal to or greater than 40 kg/meter (* see guidelines below for BMI calculation); OR - BMI equal to or greater than 35kg/meters with at least two (2) of the following comorbid conditions related to obesity that have not responded to maximum medical management and that are generally expected to be reversed or improved by bariatric treatment: o Hypertension, OR o Dyslipidemia, OR o Diabetes mellitus, OR o Coronary heart disease, OR o sleep apnea, OR o Osteoarthritis; AND 2. Documentation from the requesting surgical program that: - Growth is completed (generally, growth is considered completed by 18 years of age); AND - Documentation from the surgeon attesting that the patient has been educated in and understands the post-operative regimen, which should include ALL of the following components: 1. Nutrition program, which may include a very low calorie diet or a recognized commercial diet-based weight loss program; AND 2. Behavior modification or behavioral health interventions; AND 3. Counseling and instruction on exercise and increased physical activity; AND 4. Ongoing support for lifestyle changes to make and maintain appropriate choices that will reduce health risk factors and improve overall health; AND - Patient has completed an evaluation by a licensed professional counselor, psychologist or psychiatrist within the 12 months preceding the request for surgery. This evaluation should document: 1. The absence of significant psychopathology that would hinder the ability of an individual to understand the procedure and comply with medical/surgical recommendations, AND 2. The absence of any psychological comorbidity that could contribute to weight mismanagement or a diagnosed eating disorder, AND 3. The patient's willingness to comply with preoperative and postoperative treatment plans. The member and their physician(s) are urged to review the full text of the Blue Cross Blue Shield Illinois (BCBSIL) medical policy on this subject on the BCBSIL Website at www.bcbsil.com. Choose the "provider" link at the top of the Website and select medical policies: Surgery for Morbid Obesity (search by policy title). If you any further questions or concerns, please contact our customer service department at the toll-free number on the back of your Blue Cross Blue Shield identification card or via the Message Center on Blue Access for Members. Sincerely, Cheryl M. Blue Cross Blue Shield Illinois Customer Service Center For the last six months I have seen the Bariatric Centers Dr's, nutritionist, physical therapist, psychologist and 80% of every appointment was covered by my policy. I have pain my 1500.00 out of pocket expenses and ready to go. Today I found out that my insurance policy has an exemption on Bariatric Surgery. WHAT?????? The insurance company gave me the info above and paid all of the pre surgery visits. I assumed the Dr's office did their job, Submit an electronic Eligibility & Benefits Inquiry (ANSI 270 transaction) to BCBSIL through your preferred online vendor portal. Now I am left disappointed and totally depressed. I just can't understand how this happens.

Hi, congratulations on making the decision to have WLS. I'm Kaiser Southern CA and the first thing you should know is that the insurance requirements vary greatly, not only from company to company, but area to area with the same insurance. Kaiser is a very good example. So what I'm describing here could be very different for you. I started my journey back in August 2014, which was when I first talked to my PCP about the possibility. He was very supportive and told me that all I needed to do to start the ball rolling was to call the Wellness Center in San Diego. When I placed the call I was told that I would be sent an info packet and after reading, if I decided to proceed, to call back to schedule a date to attend two mandatory seminars. One for weight management and one an intro to the Options program. I attended both seminars on 09/11. There they gave us a 10 page questionnaire to fill out that had to do with medical history, past weight loss attempts (you only have to describe them not provide actual proof), etc. After about a week I received an email telling me to get a few pre program labs, blood draw, EKG, stool sample, fasting glucose, and I think that was it. The faster you comply with their requirements, the faster you move along. A week or so after this I was contacted again to make an appointment for a one on one meeting with the head of the Bariatric Options program. Mine was for 10/06, and it only lasted about 20 minutes. The weight for this appointment is considered your Options starting weight. There I was told that I had been approved to enter the program and I would be contacted with the information on when my Options classes would begin. For my area Kaiser requires 24 weeks of classes (or 6 months), one class a week. But most other areas of Kaiser in CA only require 12 weeks (or 3 months of classes). I was also told that I will be required to lose 10 percent of my weight, which in my case was 24 pounds. My classes started in November and meets each Thursday night. This week will be class #11 and I've been surprised by how fast the time goes by (mine end in mid May). For the most part they're interesting and last 90 minutes. Last week we had a speaker, which was a former student who had the sleeve about 1 1/2 years ago. You can only miss four classes, and have to make up each one you miss. If you miss five you're out, and this has actually happened to a couple of people in mine. You're weighed each time and will be required to keep food and exercise logs. In my area Kaiser contracts out to Pacific Bariatric in San Diego, and the surgery is done at Scripps Mercy, also in SD. We are required to attend one of their seminars. I go next month. From the workbook material I've read that after graduation, if you've lost the 10 percent you then wait to be contacted to take a stress test. If you pass, then your file is forwarded to Pacific Bariatric. You will be asked to get a series of pre surgical labs/tests, not sure which. Then PB will contact you to schedule an all in one appointment for psych eval, surgical consult, and I think a medical internist. And at some point in all this you will get your surgery date. They do the sleeve or bypass. They no longer offer the band. If you don't lose the 10 percent there's an extra step before the stress test where you have to go back and have a consult with the head of the program. We were told in the intro seminar that the process averages about 9 months and it's been on line for that. Good luck with your journey!

I am not certain if Harbor City is presently doing Lap Bands, but they have a beautiful, fairly new Bariatric Operating facility there, so I am quite sure that they do. I will tell you, though, that the Chief of Bariatric Surgery there is opposed to the Lap band, so they might NOT be doing them at that facility. I do not know if he is personally still doing them....but, if he IS, and if you DO have a band there, have him (dr robert Zane) put it in for you. Even though he is opposed to the band, he is regarded as an expert in things that can go WRONG with the band. People who have band problems come from all over to have him repair their problem. He is an oustanding surgeon, and wonderful guy. Because of his unique knowledge, you can be certain that he knows how to do it CORRECTLY. I consider him to have saved my life, and I highly recommend him, and the Harbor City team in general. He WILL try and point you toward a Gastric Bypass....he has seen a LOT of suffering from the band. But, he is a talented Surgeon and he knows his stuff! HH

Boopie! It turned my doctor was able to send a referral out to Options, I can't believe it after 4 or 5 years I got a doctor that understood!!! Orientation is coming now on second week of Jan 09. I know my BMI is an issue at 39 and I will probably see the bariatric doc at Panorama City just like you did to see if he ok me right? Well, just wondering what's new with you, after orientation what happens? I am also attending Panorama City so keep in touch and wishing you a Happy New Year, hope this will be the year of real changes for all of us!:party:

I think most of us would be confused and unsure in your situation.It is difficult to be objective when things hit so close to home. Like Isereno said, health risks need to be considered. Your sister and friend had VERY serious health problems that have nothing to do with bariatric surgery. Your sister was saved because of having VSG, so if anything, she is the perfect example of why we chose to do something as drastic as surgery to treat our obesity. Going in to this I knew death and serious complications were a risk (as with any surgery) but inaction was going to bring me the same results, so I went for it. Your sister and friend had no symptoms and nothing came up during all the pre-op testing. Thanks to bariatric surgery they had a chance to fight their liver disease and cancer. When taking risks, sometimes we lose and sometimes we win, but I would rather go down fighting. I hope you choose to fight. Lastly, I suggest you call your surgeon today. He/she can answer some questions for you and can be more compassionate tomorrow. A big hug to you!!!!!

Not a doctor, but I worked in metabolic physiology research labs for many years, and I disagree with this idea. Children grow. It takes enormous amounts of calories to grow, especially during times like puberty. Not to mention nobody has studied the potential long-term consequences of this surgery on children. It's possible he had a genetic mutation that prevents his body from making the hormone leptin. If this is the case, injections of leptin would have been just as effective (if not more so) than any bariatric surgery. Note: leptin injections are extremely effective for people that are truly leptin-deficient. The results are usually more robust than any weight-loss surgery. Turns out that most obese people actually do make leptin, so the shots wouldn't help most of us.

Sorry that this has happened. I know when i started my process i went to my PCP to have her start the 6 month documented diet only to realize that she was not the best person to follow me given she hardly recorded anything and I found out the surgeons office would need more info. So, I started over with the bariatric center of excellence that my insurance company recommended. Thankfully i was only one month into the process. I got much better guidance working with the nutritionist, physcologist and bariatric nurses and doctors in that 6 months. It set me up for success.