Search the Community

Many trainers have no experience with bariatric patients. A suggestion, Start with 1000 cals as a goal. (I personally gain if I eat over 1200) find your own weight loss cal range.. Don't risk your health by eating 600-700 calories. (that is surgery first stage cal range) Eat meals frequently to increase your calories to 900- 1100. Follow your real food stage weight loss instructions. How did you gain 25 pounds on 600-700 calories?

I read about something like that on this and other bariatric forums once or twice a year. So it doesn't seem like it happens very often, and certainly not to everyone, but it does happen. Sorry it happened to you. And yes, people who've had WLS are at greater risk of stomach ulcers - which is why they advise against NSAIDs and other things that could irritate your stomach and possibly cause them (that's not to say you were taking any of this, because ulcers can happen regardless - just saying that that's why they advise against them because they're known stomach irritants, and we're at higher risk of ulcers than the normal population is).

During a phone appt. with my bariatric nurse practitioner last week, I commented the scale hasn’t been moving despite 600-700 cal. daily, 2 mile walks every morning and working out with weights afterward. She reminded that for some of us, actually for all of us but at different points, the body fears it’s being starved and holds onto weight in self preservation. She suggested on days where energy expenditure is up, my caloric intake be upped by at least half the calories I expended. She advised I go to 800-1,000 on those days. The weight should begin to move once the body is happy knowing it’s not being starved. Sounds like your trainer knows his/her stuff, Kimyana1. Good luck and please keep us posted!

Yay! I have a date of May 15th, so looks like we’ll be Bariatric buddies!

That is standard. Don’t forget the psychologists need to take the information you gave them, score and analyze the results from any testing you did, synthesize that all together and write up usually a 3 to 4 page report (it’s written separately for each person, not a canned and short report that is dictated to someone). That’s quite a lot of work to be done in an instant. It’s unfortunately something too many people put off to the end and then want immediate results, not meaning you but meaning, it’s not like walking in to a hospital and asking for a chest x-ray (and even that takes time for a report). To those who find it all laughable, anxiety and other psychological problems can have a huge effect on bariatric surgery. Remember that when a psychological evaluation is done they are going to put the general results in addition to the specific results. It is quite relevant to surgery whether someone has psychosis, too much stress in their life to safely undergo the surgery, is not intellectually able to truly care for themselves, and other such issues. It may seem funny to you, but it can be a life-and-death issue. They are being not required just to irritate you. All the prerequisites are there are a reason, usually a really good reason. P.S. While some providers have fewer requirements, you risk having your assessment rejected by an insurance company since there are some clear bariatric standards set for for what kind of testing and other procedures should be done. For example, psychological testing is always a necessary per guidelines (test results offer some objective data beyond the Provider’s opinion). Using a provider willing to cut corners or someone without experience with these assessments means you risk wasting a lot of time and money (and having a delay in surgery).

most insurance companies won't, but if you have a flexible spending account, I've known people who've gotten vitamins covered if they have a prescription for them - which your bariatric clinic might be willing to do. Vitamins have to be considered medically necessary to be eligible under FSA - and in our case, they kinda are. I don't know if anyone's ever gotten protein covered under FSA, though (maybe they have - but if so, I haven't heard..) although you might want to check first - the rules on FSA's can change from year to year (that is, if you even have an FSA...) P.S. i Just checked the FSA rules for 2020. It says vitamins may be covered if you have a Letter of Medical Necessity and a prescription. But again, this is for an FSA or an HSA. Having regular health insurance cover it would be unusual, but you never know. It'd be worth it to ask them.

its been 13 weeks since bariatric surgery still feeling sick EVERY morning for about a hour or so..I've lost 2 and half stone there's no food that I enjoy just drink water and take my vitamins every day could anybody tell me if I can use a vibrating plate part of my exercise please

Following. also where do you live Machta? There are three doctors in Florida, good reviews, to it bariatric centers of excellence, cash price 10,000 to 11,500.

Are you a dietician? Not sure why you are telling people what they should or should not eat when a lot of bariatric patients are successful with Keto, which is high fat. I wouldn't do it, but I wouldn't tell people not to either.

Being in quarantine with so many other people doesn't just sound tough, it sounds difficult to the power of 12! I hope that with so many other things to deal with right now, you’ll lend yourself some compassion and not deplete yourself psychologically over a bit of up and down with weight. Most people generally adapt well over time to life-changing and stressful situations, and you will, too. You already have the fortitude to want to deal with this head-on, are finding creative ways to carve out alone time, are getting in a lot of steps each day, and probably a bunch of other things you haven’t even mentioned here. Earlier today I posted an article from the latest issue of Bariatric Times magazine; hopefully there'll be something in there that might prove useful for you? One thing that is helping me is developing some realistic goals and doing something regularly — even if it seems like a small accomplishment — that enables me to move toward the things I want to accomplish, such as continuing to lose weight. Instead of focusing on tasks that seem unachievable, each morning I ask myself, "What's one thing I know I can accomplish today that helps me move in the direction I want to go?" For example, I've set up an eating schedule for myself and I only eat at the designated times (breakfast, lunch, snack, dinner). If it's not time to eat, I don’t eat, end of story, so I never have to wonder about whether I'm eating out of stress, boredom, craving, or hunger — all I have to do is look at the clock, and if it's time to eat, then I eat. The lockdown is demanding and challenging, but it is temporary and absolutely does not have to determine the outcome of our WLS for this year. The outcome is entirely up to us.

Coping with Stress During COVID-19: What Bariatric Patients Need to Know May 1, 2020 by Harold Bays, MD, FOMA, and Lydia C. Alexander, MD, FOMA Dr. Bays is Medical Director and President of the Louisville Metabolic and Atherosclerosis Research Center in Louisville, Kentucky. Dr. Alexander practices obesity medicine at Kaiser Permanente Medical Weight Management Group in San Francisco, California. Funding: No funding was provided. Disclosures: Harold Bays, MD, FOMA is Trustee, Chief Science Officer, and Lydia C. Alexander, MD, FOMA, is Secretary/Treasurer for the Obesity Medicine Association. During this most unique of times, as frontline healthcare workers and hospital staff, we frequently face difficulties when treating patients threatened by a rapidly increasing pandemic. This is made even more difficult with the stress of limited essential medical supplies. Among all the turmoil and disruption, the emergence of COVID-19 has created special challenges for patients with obesity. Many patients with obesity have impaired immunity, impaired lung function, sleep apnea, and hypoxia, making a virulent upper respiratory tract infection especially perilous. Added to this are obesity-related debilitation, immobility, orthopedic changes, polypharmacy, more limited access to medical/preventive care, and adiposopathic complications of diabetes mellitus, and cardiovascular disease.1 Collectively, patients with obesity are more susceptible to COVID-19 disease and have worse outcomes once infection occurs. For many bariatric patients, the rise of the novel coronavirus has created additional challenges, such as the effect of mental stress on their lives. Increased mental stress can worsen complications from obesity, such as hyperglycemia, high blood pressure, dyslipidemia, and might also worsen obesity itself. The good news is that if clinicians are attuned to the physical impacts of mental stress, then proactive measures can be taken to mitigate the potential adverse consequences of mental stress. Acute Stress, Chronic Stress and COVID-19 Acute, or short-term, stress is a function of the natural “fight or flight” response. One of the systems activated by the stress response is the sympathetic nervous system, which increases production of hormones epinephrine and norepinephrine. The acute stress response can be beneficial—it can increase visual acuity, decrease pain, increase blood flow, and boost the immune system. This complex sequence of hormonal changes and physiological responses helps people when they need to fight or flee to safety. Conversely, chronic, or long-term “submit and stay” stress has the potential to worsen health outcomes. Chronic stress can increase cortisol production, which might promote visceral fat accumulation.2,3 Symptomatically, chronic stress can cause decreased cognitive ability, diminished healthful decision-making, and more pronounced pain. Physiologically, chronic stress can impair immune function, impair sleep patterns and increase blood sugar, high blood pressure, and body weight.4 The Toll of Chronic Stress on Patients with Obesity During COVID-19 Stress and anxiety are understandable during the COVID-19 situation. We are living in a time of an unprecedented global pandemic crisis. Doom and gloom are everywhere. Good news is rarely reported. Stress is to be expected. However, clinicians can assist patients with proactive stress management techniques, especially for people living with obesity. Many patients are staying home to keep themselves and others safe and limit the spread of the novel coronavirus. Other patients are staying home because of governmental mandates. But while “distancing” from others could have potential benefits in preventing viral spread, staying home might result in less healthful nutrition and reduced physical activity. As we navigate the unparalleled COVID-19 crisis, it is critical that clinicians, including bariatric surgeons, counsel patients to recognize the signs of mental stress, as well as its potential negative impact to health. This would include increased blood sugar, high blood pressure, increased body weight, and challenges fighting viral respiratory infections. Bariatric patients should receive specific and actionable guidance on safely optimizing nutrition and physical activity during periods of shelter-in-place orders.5 Coping with Stress During COVID-19 As we await a cure or vaccine for the novel coronavirus, one of the most important measures clinicians can take in the interim is to address potential mental stress head-on, as one of the first topics of discussion during patient encounters (e.g., via telemedicine or otherwise). When appropriate, clinicians can then recommend patient-centered stress management techniques that might prove helpful. Here are some ways to get started: Feel your feelings. While it might seem intuitively obvious, many patients might not truly recognize the degree by which mental stress is altering their behavior, lives, and overall health or might be avoiding addressing feelings of sadness or loss of previous routines and lifestyle. This should be a prime topic to discuss during any patient encounter. Patients should be educated to become in touch with their feelings and recognize how those feelings might be affecting their behavior. Negative or unproductive feelings and the potential adverse effect on behavior cannot be resolved until it is first acknowledged. Take it one moment at a time. At this time, no one knows how or when the COVID-19 crisis will end. It is likely nothing will ever go back to “normal.” This might be a daunting notion to patients with obesity, who might already have a sense of hopelessness. Thus, instead of focusing on the seemingly unending days of isolation ahead, patients should be encouraged to focus on manageable, demonstrable, and accountable healthful measures that can be accomplished today. Behavior changes that are doable, accountable, and sustainable represent the mainstays of a behavior modification plan. Perform a food inventory. It is common that patients with increased mental stress resort to “comfort food,” which is often energy dense and highly processed. Temptation to consume these foods is increased if these nutrition-deficient foods are in the location where people live. Thus, patients might best be advised to perform an inventory on the nutritional quality of food where they live. When ordering food or grocery delivery, patients should virtually shop when they are not hungry or exceptionally stressed. Having friends or family review the list might also be helpful for some to ensure healthy foods are chosen. Stay physically active. When shelter-in-place regulations prevent leaving the house, patients can be advised to look for novel ways to keep moving. Pacing while on the phone, putting the laundry away one item at a time, listening to music and dancing, and taking a lap around the house or backyard are all ways to remain physically active while sheltering in place. Passive stress relievers, such as surfing the internet, watching television, and playing video games might seem like an ideal way to pass the time. But these do not contribute much to energy expenditure and might worsen anxiety. Too much time spent with passive screen activities can have a negative impact on health. It is a good idea for clinicians to specifically talk to their patients with obesity about limiting screen time. Stick to routines and care plans. Now is not the time for patients to fall out of previous healthful routines and self-care that was either promoting health, or helping with health maintenance. Patients should be encouraged to think beyond COVID-19. They should avoid having these few months negate years of potential progress that were so hard to achieve. Patients should especially be advised to monitor their sleep patterns. Poor sleep can contribute to worsening metabolic disease, cardiovascular disease, and obesity. Closer clinician contact with bariatric patients at this time is critical to identifying early maladaptive behaviors and routines and ensure continued long-term success Practice active stress reduction. Patients should be encouraged to explore activities, such as walks (where permissible), puzzles, books, yoga, meditation, and other hobbies. Maintaining social connection via phone and video calls while physically distancing can be an important method of stress reduction. These pastimes can have a soothing effect during this stressful time. Look for the helpers. Fred Rogers said it best, “Look for the helpers. You will always find people who are helping.” During times of crisis, finding a way to join the helpers can be gratifying not just for the one being helped, but also the one doing the helping. Participating in community efforts to improve the lives of those affected by the COVID-19 crisis can have a relieving impact for everyone. Maintain social connectivity. While the recommended jargon of “social distancing” is prevalent, perhaps the implication of this approach is not what was intended. Perhaps a better term is “physical distancing.” Remaining socially distant is not always the best plan, especially for patients with obesity who are already stressed and who might already feel isolated. For many patients, it might be best to recommend to seek and maintain social connection via a simple phone call, or FaceTime, Zoom, Google Hangouts, or any of the myriad digital communication solutions available. As clinicians continue to look for ways to help their patients during these stressful and uncertain times, bariatric surgeons can empower patients via implementing simple techniques, such as the ones described here. The Obesity Medicine Association (OMA) offers a trove of resources for clinicians and health care professionals, including continuing medical education, American Board of Obesity Medicine (ABOM) exam preparation, Obesity Treatment Proficiency Badges™, and The Obesity Algorithm®, which offers comprehensive clinical guidance on the latest obesity management trends and evidence-based medical approaches to treatment.6–8 To become an OMA member, visit: https://obesitymedicine.org/join/. For more obesity medicine resources, visit: www.obesitymedicine.org. References Scott KA, Melhorn SJ, Sakai RR. Effects of chronic social stress on obesity. Curr Obes Rep. 2012;1(1):16–25. Joseph JJ, Golden SH. Cortisol dysregulation: the bidirectional link between stress, depression and type-2 diabetes mellitus. Ann N Y Acad Sci. 2017;1391(1):20–34. Kyrou I, Tsigos C. Chronic stress, obesity and gonadal function. Hormones (Athens). 2008;7(4):287–293. Yaribeygi H, Panahi Y, Sahraei H, et al. The impact of stress on body function: a review. EXCLI J. 2017;16:1057–1072. Bergmann N, Gyntelberg F, Faber J. The appraisal of chronic stress and the development of metabolic syndrome: a systematic review of cohort studies. Endocr Connect. 2014;3(2):R55–80 Obesity Medicine Association. https://obesitymedicine.org/badges/. Accessed March 24, 2020. Obesity Medicine Association. https://obesitymedicine.org/. Accessed March 24, 2020. Obesity Medicine Association. https://obesitymedicine.org/obesity-algorithm/. Accessed March 24, 2020

Morbid obesity is a life sentence without surgical intervention. Despite endless debate about the relative value of different approaches — in every scientific head-to-head comparison, diet plans that provide the same exercise and calories through different types of food lead to similar weight loss and regain within similar timeframes. The science could not be clearer: there is no diet that overrides the basic complex biological reality of obesity. Bariatric surgery is currently the only way to permanently alter your genetics, reset your defended weight or set point, lower your metabolism, and alter the pathways and production of brain and gut hormones such as PPY, GLP-1, CRF, CCK, NPY, leptin, ghrelin, dopamine, cortisol, etc. *Edited to add that I regret squandering several years of optimal health and well-being by attempting overcome biology and evolution with a WFPB diet, instead of just having WLS. Good on you for not doing that! WLS got you to where you are now, and WFPB will keep you there for life.

I have only lost 2 pounds since last time I posted. I hit 174 on Easter and have only managed to lose 1 pounds since Easter. I am beyond frustrated. BMI is 29.7 so I am in the overweight category but nothing I do is working to lose. I was eating between 700-800 calories per day and increased to 800-900 which has been hard as I am very restricted still. I have to eat 6 times a day to get 900 calories in. I am getting in 80-100 g of protein on average and less than 50 g of carbs. Most days under 30. Occasionally up to 60. I know I have some loose skin but still. I am happy about what I lost because 142 is a large amount to lose but also feel like a failure for still being overweight. I see other bariatric patients wearing a size 6/small and here I am in a 14/large.

I think you're seeing/hearing a lot of outdated information or reading about very rare complications. Complications aren't much more common than they are with sleeve (in other words, they're not very common) and malabsorption-related issues are really rare as long as you keep on top of your vitamins. You have to take vitamins with the sleeve, too (my surgeon has both types of patients on the same vitamin regimen), so there's really no difference there, other than not taking them is more of a problem with bypass patients than it is with sleeve patients. The ASBMS (American Society of Bariatric and Metabolic Surgeons) as well as many surgeons now recommend that sleeve patients avoid NSAIDs as well (and there aren't many medications that bypass patients can't take - really just NSAIDs and extended release versions of drugs. There are other drugs that may require an adjustment of dosage, but none that I can think of that are "banned" for us) Malnutrition issues are pretty rare with bypass unless you're not taking vitamins, as I mentioned above. just like with sleeve patients, the vast majority of us have had no complications or only minor ones that are easily "fixable". You can read horror stories about both surgeries - and yes, there are people who have had major complications with both surgeries. But you can have major complications after a tonsillectomy - or a wisdom tooth extraction. But how often does that happen? Same with weight loss surgeries. I've had no issues (I had bypass because I had GERD prior to surgery - and sleeve can make that worse (doesn't happen with everyone, but it IS a risk of the sleeve)). I've been very happy with it and would have it again in a heartbeat. I am 60 years old.

I thought things were supposed to be pretty bad in NJ. Looks like you guys are just two days out from the peak in deaths (and a couple weeks out from the peak in resources). Plus the hospital is probably trying to reschedule all those surgeries that got backed up because of COVID - not just bariatric surgeries, but hip replacements, etc. They'll get you in - I'm sure of that.

Hello all! I’ve been going through this journey for a painstakingly long amount of time! I’ve been trying to get the gastric sleeve surgery for years. My old insurance started off telling me they do cover the procedure, so I went 6 months into the process for the program coordinator at the hospital to call me last minute and tell me that it was not in fact covered under my insurance. So at the beginning of this year when it was time to choose a new policy, I specifically picked one that would cover it. I even called to confirm. BUT! When I received the updated overview of coverage for 2020, they had JUST amended the policy to exclude bariatric surgery. How crummy?!? So since I cannot win, and insurance companies do not want to play nice, does anyone recommend or has had surgery at Blossom Bariatrics in NV? I’ve read testimonials but only from their website and YouTube page. I wanna hear from an actual patient, so I know it’s not all fluff. Their website also states their doing $6K pricing right now. So is that everything? Even without insurance? If anyone has any insights, and can tell me if it’s legitimate. Please let me know!! Thank you all!

Hi Dana and transitionkate. Im considering the ESG with dr. Gomez. She's a great doctor but I'm completely self pay. The surgery is supposed to be about $11000... that's fine but there is another $10,000 worth of required appointments with therapist , nutritionist and the bariatric surgeon. That may be a deal killer for me... Dana, what did you end up doing?

Had anyone tried the Bariatric Advantage non-chewable calcium tablets? How big are they?

I agree, PollyEster, that the two most life changing decisions I have made are 1) bariatric surgery and 2) going WFPB. My life is 180 degrees from where it was before. I am so much healthier. Going WFPB changed all my labs, even more dramatically that the weight loss surgery. Even after reaching goal weight with a loss of over a hundred pounds, my total cholesterol was still 235. A few months with WFPB, it dropped to 152! I feel so much better and have so much more energy and mental clarity, that I do not miss animal based foods at all. My family is also starting to eat more plant based meals - simply because they feel good after ward and can eat a lot of volume without a lot of calories. An added bonus is that when I think of meal shortages in the stores now, it doesn't phase us one bit. We know we can eat good, nutritionally sound meals indefinitely with no distress or worry about where our next meal will come from.

The ASMBS held a webinar yesterday for bariatric surgeons discussing the topic of how and when to resume bariatric surgery in the COVID-19 era. You can watch the webinar at https://asmbs.org/resources/restarting-surgery-issues-to-consider If your surgeon called you tomorrow to schedule surgery within the next 1-2 months, are you comfortable having your surgery?

Where are you in NJ? If you are in South Jersey, def check out Dr. Balsama. He was my surgeon and was great, but his staff are just as great, which is really important! They know what needs to be done to get insurance approval, and will hustle to get everything approved. If you aren't in South Jersey, then I would suggest googling to find out who your local bariatric surgeons are. I would look for one who offers multiple classes per month, ideally once or twice a week. To me, this means they do a high volume, but also the more classes they offer, the more flexible it will be for you, and hopefully the quicker you can get in. My guess is there are no in-person classes right now, but hopefully they are doing via Zoom, etc. No need to go to PCP first, but if your insurance requires a referral, call your PCP office to get that before your first class. At the first class, the staff will tell you everything you need to do to get insurance approval (lab work, sleep study, EKG, etc). Good luck!!!

I was WFPB for years before being sleeved, am still WFPB, and will remain WFPB for the rest of my life. For me, a WFPB diet has been as instrumental in improving my health and well-being as having WLS: before going plant-based, I had extremely high CRP, cholesterol, and triglyceride levels, was pre-diabetic, had severe IBS and allergies, was exhausted all the time and had zero energy, and was depressed. Within a few months of going plant-based every single one of these health issues reversed, I got off statins, I lost weight, my sleep improved, and I felt fantastic and had more energy than I had in years. Since being sleeved, my labs are perfect, I have enjoyed an astonishing rate of weight loss, have even *more* energy than before, and continue to enjoy even lower CRP, cholesterol, triglyceride, and glucose levels. It's highly unusual for WFPB eaters to experience GI issues after transitioning. Fibre is present in all unprocessed plant foods in high amounts. Fibre what makes up the structure of the plant, and the more of it you eat, the more you access all of its benefits. While you may have more gas than usual during the first few weeks if you don’t prepare your beans properly (by pre-soaking, rinsing well before cooking, and either pressure-cooking or boiling with added kombu until fully cooked to break down the sugars that cause flatulence), eating a plant-based diet improves the health of your gut so you are better able to absorb the nutrients from food that support your immune system and reduce inflammation. The increased fibre lowers cholesterol and stabilizes blood sugar, and it’s the best medicine for optimal bowel management. In fact, many people who had IBS prior to going plant-based find that they no longer have IBS, myself included. You could go cold turkey, or start out by eliminating meats while cutting back on dairy. There are no specific foods to either focus on or avoid, other than incorporating more of the flavours and textures you like most into your diet each day. In addition to plenty of fresh fruits and veggies each day, incorporate a wide variety of beans, lentils, legumes, pulses, seeds, and nuts, as well as seitan, tofu, tempeh, nutritional yeast, whole grains and sprouted whole grains (buckwheat, teff, amaranth, quinoa, farro, spelt, etc.), wild rice, hemp hearts, chia seeds, spirulina, nut butters and nut milks (homemade when possible), spices, herbs and other natural flavourings, minimal added oils, green smoothies, etc. Supplement with faux meats once in awhile for variety and pleasure, always checking the ingredient list and trying to consume the least highly processed varieties (i.e. soy curls). You do NOT have to worry that you won't get enough protein or enough of the "right" kinds of it: protein "combining" was never medically or scientifically legitimate and was discredited almost as soon as it first appeared over 50 years ago (for a very brief overview see https://en.wikipedia.org/wiki/Protein_combining). In my opinion, WFPB eating really is the anti-diet: you can eat a lot of delicious food, never feel hungry, never gain weight, and enjoy remarkable physical and mental health benefits. More important than opinion and personal experience, however, is evidence-based nutrition. A few good places to start learning include: The Physicians Committee for Responsible Medicine: https://www.pcrm.org/news/exam-room-podcast/vegan-after-weight-loss-surgery and 21 Day Vegan Kickstart https://kickstart.pcrm.org/en Dr. Garth Davis (bariatric surgeon): http://proteinaholic.com/lifestyle-first-and-always/ and http://proteinaholic.com/ Dr. Matthew Weiner(bariatric surgeon): https://www.youtube.com/user/DrMatthewWeiner and https://www.poundofcureweightloss.com/ Plant Trainers: https://www.planttrainers.com/eating-plant-based-after-weight-loss-surgery-ptp082/ And: If you’re neither a reader nor inclined toward research, it would definitely be worthwhile to invest in an online visit or three with a WFPB bariatric nutritionist to fine-tune your new diet to meet your individual health needs and taste preferences. Another option, though not inexpensive, is the online plant-based nutrition course from the T. Colin Campbell Center for Nutrition Studies at Cornell. It's a superb resource for anyone, especially those new to a WFPB lifestyle.

For me, it began with a trip to my general doctor. We had a long talk and he referred me to a bariatric surgeon in our area that took my insurance (make sure you check with your insurance that they cover it...every insurance is different with what they look for in order to be approved). The journey is long. Once you have that initial consult with the bariatric surgeon, you then have to decide what surgery you want to have, and then you have to meet with a nutritionist. The nutritionist will go over your pre-op diet plan (most people have to do this to a.) meet insurance requirements and b.) test your discipline to make sure you can follow a diet). Depending on your insurance requirements, you might also have to attend required WLS support group meetings (though I'm sure that's changed since the pandemic) and attend sessions with a counselor. Mine required me to see a counselor, attend support group meetings, and undergo a bunch of medical tests and blood work to make sure it was safe enough for me to get it done. All of this usually spans out through a six-month period. In addition to seeing a nutritionist, I also had to attend nutrition classes. My insurance required a lot from me in order to have it approved. Like I said, everyone's insurance is different. And every surgeon is different. I wish you the very best of luck. Please keep in mind, this journey isn't for everyone. It requires A LOT of discipline and lifestyle changes. You also have to understand there could be complications. I had complications, and it was scary. But, I'm still blessed that I was able to get it done. If you do everything right, it will work out.