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He Hey guys !my insurance said they cover all the bariatic services my PA asked me to ask them. The requirements I believe they said there was no required supervised diet however I do have some history with phertamine. My bmi is right at 40.4. I’m gonna ass a screen shot of the blue home plan for bariatic ! I think it should be an easy process as far as what they’re asking for. I hope to have my surgery by June fingers crossed. Anyone have experience with novant ? In Nc Pasted what the picture has in case visibility is hard.  A thorough preoperative evaluation for bariatric surgery must include all of the following: 1. Evaluation of the patient's understanding of the procedure to be performed, including the procedure's risks and benefits, length of stay in the hospital, behavioral changes required prior to Page 8 of 21 An Independent Licensee of the Blue Cross and Blue Shield Association Bariatric Surgery and after the surgical procedure (including dietary and exercise requirements), follow up requirements with the performing surgeon, and anticipated psychological changes. 2. 3. Evaluation of the patient's family/caregivers support and understanding of the information in #1. Within 12 months prior to surgery, a thorough nutritional evaluation by a physician, registered dietician, or other licensed professional experienced in the issues of bariatric surgery, who has had a meaningful conversation with the individual regarding the dietary and lifestyle changes required to ensure a successful outcome over time. Nutritional assessment must follow American Society for Metabolic and Bariatric Surgery (ASMBS) guidelines. Pre-operative assessment must document that the patient has a good understanding of the diet and nutritional changes that are associated with bariatric surgery and has the capacity to comply with these changes. Per the ASMBS guidelines, " *..it is essential to determine any preexisting nutritional deficiencies, develop appropriate dietary interventions for correction, and create a plan for postoperative dietary intake that will enhance the likelihood of success. Not only should the practitioner review the standard assessment components (i.e., medical co-morbidities, weight history, laboratory values, and nutritional intake), it is also important to evaluate other issues that could affect nutrient status, including readiness for change, realistic goal setting, general nutrition knowledge, as well as behavioral, cultural, psychosocial, and economic issues." 2019 guidelines for perioperative nutrition, metabolic and nonsurgical support are available at: 4. https://journals.aace.com/doi/pdf/10.4158/GL-2019-0406 Within 12 months prior to surgery, a formal psychosocial-behavioral evaluation performed by a qualified behavioral health professional (i.e., licensed in a recognized behavioral health discipline, such as psychology, social work, psychiatry, psychiatric nursing, etc., with specialized knowledge and training relevant to obesity, eating disorders, and/or bariatric procedures), which assesses environmental, familial, and behavioral factors, as well as risk for suicide. Any patient considered for a bariatric procedure with a known or suspected psychiatric illness, or substance abuse or dependence, should undergo a formal mental health evaluation before the procedure. 2019 guidelines for perioperative nutrition, metabolic and nonsurgical support are available at https://journals.aace.com/doi/pdf/10.4158/GL-2019-0406 5. Appropriate medical work up may include a chest x-ray, upper gastrointestinal series, endoscopy, appropriate pre-op labs and ECG. A complete physical examination by the attending surgeon and an assessment of thyroid levels is required. If the patient has comorbid conditions (e.g. diabetes or 6. cardiovascular disease) the patient must be capable of undergoing the procedure. Anesthesia clearance for surgery. The first five criteria must be met before seeking prior plan approval for adults and adolescents; the sixth must be met prior to surgery. Surgical procedures must be performed at a facility capable of providing gastrointestinal and biliary surgery (preferably JCAHO accredited), AND that has equipment and staff capable of managing a morbidly obese patient (appropriate instruments, beds, lifts, monitoring equipment) AND that can manage short and long term complications of bariatric surgery.

I know that with bariatric patients, abdominal pain shouldn't be ignored - no matter how far out we are. I'd really be inclined to ask about a scan, or ultrasound, or something.

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So what is a bariatric plan friendly way to drink decaff coffee? So before getting myself weaned off caffeine I enjoyed cold brew coffee with vanilla creamer. My surgeon does not allow caffeine after surgery (or at least for awhile). So I have already got myself drinking decaf cold brew with a splash of sugar free creamer. What does everyone drink in their coffee that is bariatric plan friendly? Also yes I know everyones plan is different but Id like to hear ideas.

I am self pay and hesitant about rny in Mexico. My insurance has a bariatric exclusion and won’t cover complications. In fact, I am pretty sure United Healthcare is so terrible that they would find a way to link any future issues to the surgery just to deny me. They stopped paying for a medication I was on for five years with other insurance. I am alone and have zero family and the sleeve seems like a simpler option. I know that I am not ready to consider rny at this time. I will wait until I can get more testing in the states. An endoscopy with my insurance is $1000. Eventually I will find the right answer. Many thanks.

Before moving forward with a bariatric procedure, you might want see a gastroenterologist to get to the root of the problem and see what treatments are available and which WLS would be best with your history and condition. Dr. Alvarez has done over 20K VSG surgeries and is a Master Surgeon of Metobolic & Bariatric Surgery but he focuses strictly on VSG, which may not be the best option for you. I can feel your frustration when reading your posts and my heart goes out to you. Please move cautiously and seek the proper specialists so that your GERD is not worsened. Once the cause is identified, a plan of action can be devised to address both the GERD and WLS. Best you you.

I just had my 1st tele-appointment with my surgeon and the dietician. I have been reading and talking to people the last few years about bariatric surgery. Friends with different surgeries, different goals and different outcomes. They have told me the good, bad and the real uglies too. They all seem to have had it slow movement the first couple months then within 10-12 months from surgery date they have lost right about 100 pounds. I know that there are recommendations for how much and of what needs to be consumed before and after…. It is very important to follow those as close as possible. Your body will not react how it should if you don’t nourish it enough . My Grandma always said your body is like a furnace; it has to have fuel or food to burn to work. So if you don’t put wood in your furnace then it won’t heat up to burn. (I think I may have not remembered it exactly right) but you can get the idea. Lol I am looking forward to the long term weight loss & will keep what you are going through in mind. Please do keep updating your status; I can’t wait to see how it goes once your body has healed and out of the “what the hell just happened” stage. That is all it is doing right now.

This is something you would need to talk to your HR dept about. My understanding (and I could be wrong) is that each company negotiates their rates with the insurance company, and there are things they can choose to not cover in order to keep the costs down for ALL employees. They can't just add it for one person. Bariatric surgery is getting more common, so maybe your employer might choose to add it durning the next open enrollment period, or, to cut rising costs, eliminate services. Unless you have a life event (like loosing your job, marriage, birth of a child etc) your husband can only add you to his plan during open enrollment. And your company's plan can't change until the next open enrollment. Most companies that wouldn't be effective until Jan 1 2024 (but not all, my company has open enrollment in the spring) Find out first if your husbands plan even covers it, and what the deductible/co-pay would be. You could start all the presurgery requirements now, as that usually takes about 6 months. Sounds like IF, everything works out, the soonest you could have the surgery under insurance (and a lot of things could go wrong to not align) would be Jan 2024. Or, do self pay and you could be recovering in a matter of weeks. There are low to 0 interest medical financing plans, and you can even pay those bills with an HSA or FSA card. It all depends on your financial situation and patience. I totally understand your disappointment, I felt the same way when I found out it wasn't covered under my insurance. I had determined the VSG was the right path for me and had my hopes up, and was crushed. I didn't want to wait any longer, and self pay was the best option.

My insurance didn't cover it either, as Catwoman mentioned, your employer needs to add it to their plan, and I was told no going around that. I ended up as self pay, and using my HSA savings. Because I have a high deductible plan, I figured even if I was able to go the insurance route, it would cost me 7K in my deductible, and I would lose months and months of time jumping through insurance hoops. There are clinics I'm sure all over the country that specialize in just bariatric surgery, I went through West Medical in LA and had a great experience, it was $10K and only took 3 weeks from 1st consult to surgery. Mexico clinics start around $5k, and while I know some have had great experiences that route, I just wasn't comfortable. It's very possible you have a local bariatric Dr. that takes self pay. There are also financing options with credit cards like Care Payment that offer no/low interest rates. Don't let money hold you back!

Is RNY not an option? If GERD is a concern but bariatric surgery is the goal, I would consider RNY and see if that fits your needs.

My primary insurance thru my employer (united healthcare) does not cover it. Im fortunate my husbands new insurance (Aetna) does have bariatric surgery coverage. But before he got this insurance I was seriously looking into going to Mexico for my surgery. There's some financing options available too.

Is self-pay an option? I found a great surgeon in Alabama because bariatric surgery was excluded from my insurance as well. I had very few pre-op requirements and the cost was $8995. You could always go to Mexico too which is the cheapest but I was too nervous to go that route.

most insurance companies will cover it, but it's usually not part of their "core" coverage. In order to offer it, employers need to buy a rider for it. So although her company uses Cigna, they probably decided not to have their policy include the optional bariatric surgery rider.

I got Cigna at the start of this year as my job switched insurance companies. My surgeons office was preparing me with steps toward surgery when I got a call today saying that bariactic surgery isn't covered under my plan. I feel so disappointed. Now what? How can I get coverage? Anyone experienced this? Sent from my SM-N970U1 using BariatricPal mobile app

The long term success of either surgery depends upon you. Many of the initial benefits of bariatric surgery fade over time. Your hunger comes back, your restriction can soften, it is possible to eat around your smaller tummy & your body’s new set point, etc. What the surgery does do is give you time. Time to make changes to your relationship with food: the why you eat, what you eat, when you eat, how you eat. Time to understand your cravings & develop strategies to better manage them. Time to establish new habits about eating & exercise. Time to work out how you want to eat in the future & what works for you & your body. Regain occurs for many reasons: psychological, physiological, behavioural. Bounce back regain (usually 20%+/- of the weight lost) around the third year is common. It can be because your body settles into the weight it is happiest at (your set point). Medication changes. The crap life can throw at you (employment, relationships, health, pandemics). Complacency. A too restrictive way of eating or too demanding exercise regime. Not dealing with your relationship with food. And for some it can be a deliberate choice as they themselves feel happier at a higher weight or they make adjustments to their food choices to better suit their life. Not failure of the surgery but the impact of outside factors. The average weight loss for both sleeve or bypass at the three year mark is about 65% of the weight to be lost. Of course as with all statistics there are some who lose more & some who lose less. If you are considering revision surgery of sleeve to bypass as a sign of the failure of the sleeve, remember many who have revision surgery do so because they developed GERD not necessarily weight gain. I have a sleeve & lost more than my goal and have pretty much maintained though at only almost 4 years post surgery I’m still somewhat of a bariatric baby. I settled at 49kg (48.5-49.5). I unexpectedly gained about 2kgs about 18months ago (50.5-51) but recently we discovered I wasn’t absorbing my HRT meds. Changed to a patch & my weight is slowly decreasing (49.2-50). Small numbers I know. Has it been difficult? No, not really. It was very obvious what I had been doing wasn’t working for me & I needed to make changes. I put myself & my health first. I changed my relationship with food. Made a decision to change what, when & how I ate. It became a new mindset. The changes have been sustainable & haven’t restricted my life. I still enjoy food & eating but my desire is for healthier, more nutritious foods. And no I’m not running marathons or spending hours in the gym just some at home stretching & resistance bands. Sorry long post.

I wanted to wait to respond until I could find the literature to back this. These procedures do not work solely through physical restriction/malabsorption of what you eat (that is part of it but a surface level reason), there are hormonal changes that occur. Not all of the ways that Bariatric surgery works is known but here’s what has been proven: Cellular changes to the gastrointestinal tract occur post surgically that are significantly different to a pre surgical obese people. One difference between your current GI tract and one of a post Bariatric person is the increased amount of active and local GLP-1 positive cells. Because of the (controlled) injury that happens during surgery, some of the cells are reprogrammed to permanently change the gastrointestinal track the lining into more Glucagon-Like Peptide-1 (GLP-1) positive cells. GLP-1 is responsible for many things but most notably here for regulating glucagon/insulin balance (glucose homeostasis) & delayed gastric emptying. GLP-1 is found in other places besides the the GI tract. It’s also found in the central nervous system where it help regulate the feeling of satiety. There are other hormonal changes (gherlin) however I focused on GLP-1 because new classes of diabetes/obesity medications called GLP-1 agonist have been very popular lately for their ability to mimic the hormonal effect of naturally occurring GLP-1. But once you stop taking those, the hormonal changes will likely revert. But the post surgical changes are permanent. No matter how much you diet, you will likely never be able to spontaneously create more GLP-1 positive cells that aid in glucose homeostasis. I hope that helps ❤️

Okay I had a sleeve 3/9/2021 and lose a pretty good chunk of weight but since I have gained it all back. My doctors have tested me for many things hoping to find answers to why I am so hungry and I am still waiting on a couple more results but it is looking more and more like I just failed. I am meeting with the bariatric doctor again tomorrow to see if they think revision is an option for me (assuming the rest of those tests come back fine as well). My question is, for those of you who revised because of weigh gain, did it work the second time around and if so what changed? What did you do different?!

Hello @pintsizedmallrat I had my sleeve surgery in December of 2021. Hence, I am about 14 months postop. To date, I have lost 153lbs. from my highest pre-surgery weight. Interestingly enough, you had your surgery at the same location where I had my surgery...that is if there is only one Dr. Trace Curry who does bariatric surgeries. I did not have any complications from my surgery that were any different than situations that have been described on this site. As a male, I haven't experienced anything different than what others, male or female, have described. I will try to highlight some of the things I have experienced. I only used the pain medication for the first day. The gas from the surgery was the worst part for me. Once the gas went away, everything else was pretty smooth. I stayed at a hotel near the surgery center the first night. The next morning, I went home with someone else driving. I followed the doctor's instructions very closely when it came to food, vitamins and movement. I count every calorie for which I eat and/or drink. I was very cold for the first few months. Approximately 30 days after surgery, I was permitted to begin exercising. (walking) Once permitted, I began other forms of cardio like biking, jogging and the elliptical machine. Once permitted, I began to lift weights. I have continued the exercise regimen every week since. I weigh myself every week in order to track my progress. I don't know if any of this will be helpful to you. I hope your husband has a great experience. Best wishes to you and your family!

Please don’t do a pouch reset. I’ve seen at least half a dozen bariatric dietitians explain why it’s so bad for you. You are only on fluids when you come home from surgery to help your pouch heal, not to lose weight. You’ll just be starving yourself and when you go back to solids you’ll gain. Just start tracking and make sure you’re hitting your macros and water goals.

Congratulations on your successful surgery and progress so far! Regarding your questions, it is common for patients to struggle with certain foods and fluids after bariatric surgery, especially during the early stages of recovery. It's important to follow your surgeon's post-operative guidelines regarding food and fluid intake, as well as to consult with a registered dietitian who specializes in bariatric nutrition to ensure that you are meeting your nutritional needs while promoting weight loss and healing. As for your specific questions: Fries: It's possible that you may be able to eat fries again, but it will depend on your individual tolerance and the type of fries you consume. Fries are typically high in fat and carbohydrates, which can be difficult for some patients to digest. It's important to start with small portions and pay attention to how your body responds. You may also want to consider air-frying or baking fries to make them a bit lighter and more bariatric-friendly. Bread: There are many bariatric-friendly bread options available on the market today, such as high-protein or low-carb breads. However, it's important to keep in mind that bread can be difficult to digest for some patients, and you may need to start with small portions and chew thoroughly to avoid discomfort. To promote continued weight loss after bariatric surgery, it's important to focus on making healthy food choices, portion control, and regular physical activity. Again, consulting with a registered dietitian can help you develop a personalized nutrition and exercise plan that works for your individual needs and goals. Regarding your dizziness and exhaustion, it's important to talk to your surgeon or primary care physician to rule out any medical complications. Walking is a great way to increase physical activity after surgery, but it's important to start slowly and gradually increase your activity level over time. Remember to listen to your body and rest when you need to.

I'd go to urgent care. I've never heard of people reacting to the surgery like that, but some people are allergic to certain meds or to the surgical glue or tape they use. Are you taking ursodiol? (the med some surgeons put their patients on for a few weeks to help prevent gallstones). Hives can be a side effect of that (not a common one, but I know it's a side effect because I was one of those people who got hives from it). Or it could be some other med you're reacting to. Just check with your PCP or go to urgent care. I reacted to either the surgical tape or glue when I had plastic surgery (although I didn't react to it with my RNY, oddly - but maybe it was different brand of tape/glue) - they put me on prednisone for a few days so I'd quit reacting to it. With the ursodiol I was taking after my RNY, the PA at my bariatric clinic just had me quit taking it. anyway, I doubt it was the surgery per se - but it could be some med or something that you're reacting to. They'll know what to do.

I’m a military veteran and the VA just sent me the Bariatric Pal MultiVit ONE like in the photo. Amen! I hate the other chewables! I’m 5 weeks post gastric bypass. Good luck!

Hi Krasavitza, Im on day 13 of 14 on a liquid diet. I went with the milk and yogurt diet. I had also the option of 2 shakes and 300cal meal with extra veg. But the first was easier to go with. Day 3 is hardest, but after that it gets so much easier. Spoke to my bariatric nurse on friday and she said as Id lost 20lb in 10 days to swap out some of my yogurts and add a 300cal dinner. So if after a week you are still struggling speak to your nurse to see what options you have or swap outs you can do. Good luck, you’ve got this [emoji1303] Sent from my SM-A528B using BariatricPal mobile app

Have you discussed your desire to lose weight & your interest in bariatric surgery with your endocrinologist? Are they aware of how little you eat now which must be a concern with your malabsorption issues. Unfortunately, the surgery won’t stop the weight gain side effect of the meds you have to take. Medications are one of the causes behind weight regain after surgery. Are there alternative meds you could take that don’t cause an increase of appetite/weight gain? Malabsorption issues are a possible side effect of weight loss surgery which would only add to your existing situation. Being aware of your nutrient intake & meeting protein goals is a lifelong consideration for everyone after weight loss surgery. Many will always need to take vitamins to supplement their intake via food. Just some things to consider.

Surgery 2/10. First 24 hours was pretty rough with the gas but lots of laps in the hospital helped. During the two week postop diet, I was struggling with fluids and protein because I was just so over it. I’m not stressing about it. I just do what I can. I’m now 16 days postop and it’s easier to get my fluids in but I’m still so sick of protein shakes. I found Oikos Greek yogurt with 15 grams of protein. The vanilla flavor is amazing…. Yum! I’m on puréed diet for the past three days, threw up twice just eating too fast because I was starving. But now I have adjusted to eating more slowly so I don’t throw up. The only issue I have is the bariatric vitamins. I’ve been taking the chewable ones and they are absolutely awful and they make me vomit. I’ve taken them on a full stomach too, and they still make me sick. I’m trying to find a good vitamin to take that doesn’t upset my stomach. I just ordered the Barimelts which I know are not recommended by my doctor, but they are known to be gentler on the stomach, so something is better than nothing. I have the calcium chews and those are fine. Does anyone have a good vitamin that they like it doesn’t make them sick? Also, I’m down 18 pounds and I’m fine with that as I am a lower BMI.