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On June 8, 2018, EmblemHealth GHI also changed their criteria by "remov[ing] pre-surgical dieting prerequesite and statement that member must not have a life threatening condition". Of course, my surgical center didn't know this until I brought it to their attention yesterday (just as I am completing my six months of pre-surgical dieting and monitoring (I started the process in March). Of course, this is annoying for those of us that were stuck in the middle, but it's a good thing overall--since you're not going to rejected from coverage because of any weight gain or lose (or insufficient loss) etc. These changes are consistent with American Associate of Metabolic and Bariatric Surgery recommencations and position paper from 2016 and all the latest studies which show that these approval requirements are not supported by any medical evidence. To the contrary, the evidence shows these requirements are harmful. I expect more insurance carriers have changed their policies are will soon be changing their policies to fall in line.

With the sometimes significant loss of tissue That accompanies bariatric surgery, it only makes logical sense that BMR would drop. There is simply less tissue metabolizing nutrients to stay alive. But is there a systemic/hormonal drop in BMR on top of that more mechanical one? Is that why caloric needs for Bariatric patients seems to be relatively lower than the general population? I am a large man even after weight loss, 6 foot one and 230 pounds. Yet my body fat percentage is 19% which is just barely within the normal range. I have very high muscle mass. So according to the inbody analyses I have had done at my local YMCA, my BMR alone based on muscle mass is close to 2600 calories a day. But then I am also super active on top of that, I exercise hard and regularly, and according to the standard model of 1 mile running equals 100 cal burned, it would seem that I would be burning another 500 to 1000 cal a day on top of BMR. But then when I see my dietitian she says my goal should be under 1500 cal of intake. Generally I am under 2000 for sure. And all my food is good quality non processed, protein centric, etc. All of this, and my weight has stayed within 5 pounds for two years. It would seem if the math were as simple as it sounds, I should be losing a lot of weight still. But something seems to be happening metabolically. Does anyone have any knowledge about what percentage of standard BMR having had bariatric surgery reduces?

12 days until surgery!! Yes I am counting down and trying to get all the things I need beforehand. Here is what I have so far: Gas-X thin strips Liquid tylenol Magnesium Citrate Dulcolax (for day before) Biotene Gentle Mist Moisturizing Mouth Spray Genepro flavorless protein powder Stur drinks natural flavored water enhancers Premier protein - vanilla, chocolate, orange mango clear (for day before) Organic baby food (meat & vegetable) comfy clothes, shorts for walking the halls Vionic Orthaheel sandals (I have plantar fasciitis) overnight toiletries pillow for car ride home ask about a bariatric surgery girdle tiny spoons to eat with If you have any other ideas, please let me know

I was so scared when i found out what happens to bariatric patients that don't take their vitamins, it may not happen today or two years from now but eventually it will happen (teeth chipping or falling out, fragile bones etc. ... that should help motivate you. I hope this helps motivate you a little, i know its super hard to change our bad habits, It will be a lifetime battle for most of us. Good luck!!

Hi, I'm new to this forum but would like to receive some feedback from those that have had gastric sleeve surgery in Mexico. I have been thinking about having this surgery and researching the surgeons in Mexico for quite a while now. I believe that I have narrowed my search to 3 doctors who specialize in this type for procedure. Their names are Dr. Juan Corvala who based on my research is one of the leading doctors worldwide in bariatric surgery. Dr. Jaime Ponce De Leon who also has performed extensive surgeries and Dr. Armando Joya..only negative information that I could locate on him was that one of his patients didn't believe that he did a good job at pain management. I couldn't find any additional negative feedback on him. Is anyone in the forum familiar with the work of these doctors are know anyone who have had any type of bariatric surgery with any of these doctors? Thanks.

Welcome to Bariatric Pal from me, a gal in Central Ohio. I have 11 days to go until my RnY surgery, I've worked 👣so long towards it, 3 years ,so I can hardly wait for September 5th.👍😛

This is an oddly specific question, but I'm just wondering: post-sleeve (and I don't mean immediately, I mean longer-term), are you all able to eat maki (sushi rolls)? I mean, probably not an entire roll to yourself, but part of a roll? Those are real big bites, which seems problematic for a bariatric patient. If you are able to eat it, are there any special things you do? Take bites, even though that's super awkward? Deliberately find smaller rolls to order? Make your own, so you can control the roll size? Obviously, if I'm weighing getting my arthritis under control versus eating sushi, it's clear which one wins. I'm not canceling my surgery if everyone says "Nope, can't do it," or "can only eat sashimi." (Not my favorite, honestly. I'd rather have the miso soup than the sashimi. And I do realize "only the miso soup" is an option, though the wait staff will be confused and potentially appalled.) But sushi is on the healthier side of restaurant foods (especially if you can find a place that will let you sub in brown rice) and is a date my spouse and I really enjoy. It's a food I like. So it's something I wonder about. Thanks! 🍣🍵

And Pinterest. Just search for “bariatric” or “gastric sleeve” recipes. I don’t save it unless it has nutritional info posted (too lazy to calculate myself and find out it isn’t in my macros) and I’ve pinned a fair amount.

I get migraines too. I was concerned because all surgeries or treatments give me migraines. And I knew I couldn’t take imitrex by mouth. So I got several imitrex stabbers (auto inject pens) for post surgery. While I was still in the hotel I know I took them 3-4 times. Worth every penny. good news: before surgery I had 3-4 migraine days a week. Average. Post surgery I’d go maybe 3 weeks with no migraine. I was incredulous. Shows you how diet related migraines are. Now even 1 year out, while I still might have a 3 day migraine, I go routinely a week or two with no migraine. That never happened to me before. I can now afford the amount of imitrex I need, and it works very well for me now thst I am not popping them like candy any more. i would say I have maybe 4 migraine days a MONTH now and not a week. Bravo, Bariatric surgery. I never had any idea this would be a side effect!!

I had my resleeve done at mexico bariatric center in Tijuana. My cost was right around 5800.00

I think you need to talk with a sports dietician. It's taken me a bit to find someone who is comfortable with a hard training bariatric patient. My bariatric team is great but they don't have any sports people on hand. I'm doing a resting metabolic assessment tomorrow, but I would think you need more carbs - I have found that my body has changed since I added more carbs in - which was really scary. Good Luck!

I cheated on the pre-op diet once, with food from Panera Bread. It was worth it IMO and on surgery day my liver was perfectly pink and smooth--according to the surgeon's medical student they were astonished that it had no sign of fat whatsoever and said it was probably my genetics rather than the liquid diet. I basically skipped the pureed stage and went straight to soft foods because during week 3 I was having extreme food aversion where I struggled to get in anything that wasn't a Premier Protein shake. So as long as I mashed up the food really well in my mouth I counted that as puree and was just thankful to get the calories and protein in. I don't separate eating and drinking at all. And I use a straw in my water cup. Neither of these things bothers my pouch in the slightest and haven't caused any increase hunger or problems with my weight loss, so even though I know it's a big sin not to separate the eating and drinking, I just can't bring myself to do it. I eat lots of carbs including rice, potatoes, and whole grain bread. Also bananas. This isn't a cheat or confession for me personally because this type of eating is encouraged by my RD, but I know it's a big sin for most bariatric patients so I figured I'd mention it. Hmm. I think that's about it. I've had a few not-so-healthy food choices over the 14 weeks since surgery, including a spoonful of my grandmother's banana pudding and two tiny forkfuls of some friends' desserts at a fancy restaurant, but overall I've been very pleased with my food choices and ability to limit myself to tiny samples of less healthy foods.

14 weeks out from surgery and I'm 75 pounds down from the first day of the liquid diet, which I started about 4 months ago. I've gone from 358 to 283 and, if I include the pre-op diet, I'm losing about 18-19 pounds per month on average which I'm very happy with. July was sort of meh for weight loss, not exactly sure of the stats but I know I stalled for awhile in the low 300's. August has been better, I've lost the last 10-15 pounds pretty rapidly here in the last two to three weeks. I saw my surgeon last Friday for my three month follow-up and she was really happy with my weight loss. We discussed "goal weight" sort of, I said I'd like to be normal BMI but would settle for 29.9 BMI. She said it might be more realistic to be around 30-31 BMI. So that puts my "goal" range from 164 (24.9 BMI) to 210 (31.9 BMI). I think I will set my goal as 29.9 BMI which is 196 pounds... so basically anything under 200 will be good for me. Although I doubt I will keep losing 20 lbs a month, it's crazy to think that I could, hypothetically, be to that 196 pound goal in 4-5 months! I discussed my issues with getting sick with both the surgeon and the dietitian and they suggested avoiding any foods that I know for sure are irritating me - the dietitian assured me again that my tendency/desire to eat more carbs than most bariatric patients is totally fine and that she encourages the whole wheat toast, cereals, fruit, brown rice, etc. for health reasons (and especially if that's what I'm able to tolerate vs. beef and chicken). She also recommended that I refocus on chewing really well and honestly since trying to take that advice I think that was the problem all along - going too fast because I wasn't chewing enough. In the last week since seeing her I've only felt ill a couple times and they were mild, not as bad as the intense nausea and sometimes heaving/vomiting I had been getting. Yay for eating with proper bariatric etiquette!

Losing weight is about eating the right things, in the right amounts, everyday. - Dr. Sudhakaran, Bariatric Surgeon

Oh, I just remembered something I was told. I am having my Surgery at my,states Land Grant university. I was told if one of their students requires this or similar surgery, even if they are already covered under parents insurance they pro-rate the surgery as a courtesy gift to the student and family. Now it might be just an urban legend but check with insurance brokers, your state , if the have any money left over from Rod B. and company maybe there# s an untapped s5are program you could squeeze into. See I do want you to have yours and your daughter too. sO would never wish obesity and it's sorrows on a young 👧, this casts a shadow over her college years and future. I never was duplicious. but maybe one of you would need a Hiatal Hernia repair, that would be cheaper, they could bill for that instead and save money.There has to be another answer we haven't explored.We used to have insurance workers on Bariatric Pal, maybe one of them has some clues on how to make insurance work for you instead of against you. If insurance is a racket, surely we have a racket-buster in the house G9nna still puzzle on this.

I'm not a huge fan either and I'm really tired of sweet things. I found the Bariatric Fusion chicken soup protein mix to be awesome for breaking that up. I just ordered a 2 lb. tub to get me through the next couple of weeks.

@Last Resort you are in Illinois and it is one of the states that requires insurance cover bariatric surgery, even state medicaid patients can get it - they only pay for nutrition appts ($385 total). So your daughter could get a job that covers it in the near future. You should def do the surgery so your health can have the best chance to improve. Don't pass up the opportunity. Good luck. https://www.insure.com/health-insurance/weight-loss-surgery.html

Yes check in with your insurance, Matt Z made a suggestion I confess I wouldn't have thought of. She,is still in your policy, isn't she? Being in college she would be,right? What I am going to suggest- get your surgery,first. You cannot,put out your daughter's fire if you have burned up, if you can't get her scheduled with yours , and there are a least a couple mom'daughters doing it,onBariatric Pal, get yours. Are you,sure anyway that she is also at this emotional point that you are? You are ready but she may not,have reached that point. Say Mom is at the point she is checking into bariatric surgery, would you like to go with me? Do you think you would like to do it yourself? If you want to, great but Mom is doing this. I put my family ahead of me, my parents , my late husband, my kids, all they had to do,was look at me wrong and I caved in. Now I am 72, facing a surgery that would have been easier in my 50s my 60s, oh I will still make it through I am in remarledly good health other than arthritis and obesity. My son attended the seminars at this new hospital with me, see I had finished prep twice before, long story there, at a BMI of 37,with a comorbid he might of also qualified but he's not emotionally ready at this point, oh he's supportive, supportive to the inth degree, but not yet for,him. His weight doesn't yet distress him, sure he is chunky but it's still a healthy chunky lows the yard, clears branches to the back,of the property etc but he sees I Do Need It whereas his sister RD short for Rotten Daughter is self-centered , doesn't much care, reached out to her, her answer' Whatever", sad but it's the truth. But I will save my life, make it better, give,myself a future obesity denies me. So heartless and strong sounding as this is. Save Yourself So That YOU can Save Your Daughter! Much love from me in Ohio Frustr8

This shouldn't be a binary choice between your health and that of your daughter. I see you live in Illinois and have private insurance, which assume is through your employer (Hospitals usually offer good health plans that cover bariatric surgery). With a BMI of 46 and assuming you are healthy enough for surgery, you should be able to qualify for coverage under your insurance policy. If you're daughter is 21 and a college student, she should also still be covered under your insurance plan (assuming you have a family plan). If you don't have a family plan, you should upgrade your policy to family so your daughter is covered. If that's the case, you should both be able to have the surgery (assuming your daughter also meets the criteria). If you have health insurance provided by your employer doesn't cover bariatric surgery (some policies don't provide this coverage), you may want to change policies. Your employer may offer a better policy (for a higher monthly premium) that provides coverage for bariatric surgery and it would probably be more cost effective to pay a higher premium for a better policy with bariatric coverage as a family plan (which would be paid for using pre-tax dollars deducted from your pay check) than going to the private market for a better policy or paying for the procedure out of pocket (for one or both of you). If going through your employer's health insurance options doesn't get you and your daughter the coverage you need, you can purchase an individual family plan through the open market or, better yet, you may (depending on your state law) purchase a group policy (which will have a much lower premium). I know in New York, all you need to qualify to purchase a group policy is to own a company that has three members (they don't have to be paid). So if you form a corporation (costs very little to do), and you make yourself president, your daughter secretary or your husband or other relative treasurer, you quality to purchase a small group policy for your business and employees. You only have to offer that policy to all your "employees" even if you're the only one that buys the family policy through this group plan (at least in NY--but I wouldn't be surprised if Illinois has a similar provision). You can pick an excellent plan with bariatric coverage for your family, which would be much cheaper than going out and buying an individual plan through open market. You and your daughter cannot be denied coverage for pre-existing conditions, so that is not a concern. Even if this type of plan would cost $20,000 for the year, it would be a hell of a lot cheaper than paying for even one bypass or sleave out of pocket. To set this up, you would need to talk to smart and experienced insurance broker (broker won't cost you anything) and maybe an attorney (setting up a corporation, even through lawyer, should only cost $500 to $1000 dollars). The option to go to one of the lower cost centers in Neveda or Mexico (Tijuana) is not terrible choice either. The reputation for the facility in Tijuana is actually really good, but it would be better to have it done by a surgeon that's close enough to you that you can go him or her for follow up and they will be accessible if an issue arises. If none of these options works (for whatever reason) and you are left with a binary choice between you and your daughter, at your age, I would suggest you have the surgery first. Your risk factors are likely higher and your state of disease is likely more advanced due to age. Your opportunity to benefit from this surgery and reduce the harm caused by obesity and any morbidities is higher now than it will be in 5 years. At 21, your daughter will have more time to have and benefit from this surgery during her life. Obesity is terrible for anyone, but at 21 her body can handle the stress from obesity better than yours over the next five years. Look at it this way, it's like the safety instructions they give you on the plan. If the air masks drops from the ceiling due to sudden decompression, you put the mask on yourself first than on your child. Same rule applies here IMHO. Again, this should not have to be a binary choice. If you are creative, you should both be able to get this surgery. If there are any specifics about your situation that is preventing you and your daughter from both getting the surgery through insurance, please let us know and that might change the guidance we give.

Had a weigh-in yesterday on my 9-month surgiversery - happy to report that I've lost 81 pounds in total (including my pre-op weight loss) and met the 9-mos goal my bariatric team set for me! Over the next 3 months, they want me to lose another 15-20 lbs. It feels daunting but I know I can do it as long as I keep up the new habits I've adopted over the last year.

So I just started this journey last week. I'm 55 with a 46 BMI. Sigh. How did this happen? I work in a hospital that has a Bariatric Center of Excellence accreditation weight loss program with a wonderful surgeon. My children are grown and I've run out of excuses to get my weight under control. So I did the first hard thing you have to do and that is make the first appointment. Boy are things moving fast now! Some of my fears are being alleviated and I'm coming to terms that this is what I must do in order to get healthy. BUT my concern is my daughter. She is a very beautiful, bright 21 year old college student who with all of the stress over the past 3 years has really put on an extensive amount of weight. She is so unhappy with her self. She tries everything only to fail. She is so miserable and I cannot stand seeing her in so much pain. Financially as a college student she cannot afford the procedure and unfortunately I cannot afford it for both of us. I feel so selfish. I know it is going to be painful for her watching the weight come off of me and her not having the tools she needs to help herself. She has her life ahead of her and mine is half over. I'm almost to the point of offering up the option to her instead and paying for her to get the help she needs. I'm really torn. It's like "who's life do you save? Yours or your daughters?" I am at a loss and I'm hurting too.

For me it pretty much was a realization. I fear surgery with all its ramifications far less than continuing to just exist, one step away from bedfast, obese, in pain that only increased day by day, watching my friends die, even the ones I thought looked healthy, hardly able to breath under much stress, unable to move fast enough to elude a burglar, robber or rapist, seeing the Death Angel lurking not too far in the distance. Being told your good life is over, might as well die. Oh I was so bull-headed, thought I could beat weight on my own. it had to be a loud wake-up call to reach me. I had been taught if something's not broke,don't try to fix it! Well I was pretty well broke, ready to grasp at a straw, and Bariatrics was that straw. Oh people told me I was old, foolish and silly for trying but I didn't want to sit in a rocker and die. And it has been a struggle, but I found strength within to endure, and it has been ROUGH but on September 5th 2018 at 7 AM EDT I will receive the surgery I started seeking 3 years ago this month. And as soon as I can lose enough to jump up and down I am going to be my BIGGEST CHEERLEADER, I will be the Litttle Engine That Could and I'll be pulled into the Grand Central Station of Health. If I can one more year of Health, good, if I survive longer, wonderful, but I will have loved myself enough to have given this 🎁 present of a greater life! So watch me if you like, join me if you can, GOOD TIMES ARE AHEAD.

I'm 8 mos post-op. In general, I have a history of intolerance to most multi-vitamins- my doctor thought it could be the binders used. I've been taking flintstones (2 a day) with an extra 100mg b1. This was recommended by my doctor. Recent bloodwork was perfect. It's possible that the bariatric vitamins are better or have more- but if you can't tolerate them or if you're not going to take them, then they are useless to you. Also, 2 days of no vitamins isn't the end of the world if you waited on a re-order of your usual. (And of course- something is better than nothing!)

I researched and verified all the requirements for my Cigna insurance before getting started. I started my process on May 29, 2018. This was my first of the 90 days worth of appointments for medically supervised diet. I attended seminar on June 10, and saw surgeon for initial on June 26. I attended my nutrition class, for my psych eval. Then on July 15,2018, Cigna put out a NEW policy on Bariatric surgery coverage and requirements. Really?? Who does that in the middle of the year?? Anyway.. the new policy does not require the 90 days anymore. It requires a letter stating you have failed medical weight loss in the past and that it is medically necessary and that you are cleared for surgery. No mention of records to back that letter up. So, I called CIGNA to find out how long the letter needs to state that has been a problem, and if records are needed to go along with it. All they can tell me is that records are not listed as a requirement. In a way this put me ahead of the game, because my last weight-loss appointment isn’t scheduled until the last day of August. My paperwork was submitted to Cigna yesterday. Has anyone had to deal with this since July of this year with the changes to the Cigna policy?

You may want to check out the ASMBS (American bariatric society) guidelines... do some research before you provide inaccurate information. There are many patients that are years out from surgery and very deficient in many vitamins and minerals bc they take this advice. This can be serious. It’s recommended pts take up to 3000-5000 IUs of vit D3, 500-1000mcgs B12 daily, calcium CITRATE 1200-1500mg daily, and some pts may also need additional iron, not all. Not to mention flinstone vitamins DO NOT CONTAIN: various minerals required for healing the body needs: manganese, selenium, etc. A MVI should be 200% of the DV for pts as their needs double compared to the what typical person needs. This is why I don’t recommend them. A majority of ppl DO NOT read supplement facts labels, they simply take the recommended dosage without knowing what they SHOULD be taking. It may be smarter to base your Recs off of professionals rather than your own googling efforts.