Search the Community

Ok I've been reading this thread for days. Round and round we go. This is my personal experience with carbonated beverages post sleeve. It is not to be construed as advice one way or another. Just one person's take on this subject. I drank a few sips of Dr Pepper about a week post op. Only 3 or 4 small sips because the carbonation made me feel like I'd explode. Nothing bad happened. I drank a little of it here and there, never could manage more than a few small drinks but I certainly had some any time I wanted it. Nothing bad happened. At 3 years out I will sometimes get a small Coke or whatever at 7-11 if I want one. I can drink the small size but it takes a while due to the carbonation making me feel like a big balloon. I prefer Slurpees. I can drink a small one in about 30 minutes and it satisfies any urge I have to drink Cokes. I have one or 2 each week ( ok maybe 3 sometimes) and they are delicious. Again, nothing bad happened. My sleeve works great, it sure as heck hasn't stretched, and I do not have a problem with gaining weight. If I gain a pound or 2 occasionally I just cut out the candy and slurpees for a few days and the pounds fall off. I eat what I want, drink what I want, and have done so since week 2 post op. I'm healthy, have a fully functioning sleeve, and am doing very well. No stretching of the sleeve, no uncontrollable weight gain, no adverse consequence.

How does zero calorie and zero sugar diet pop cause you to gain weight? I see Chrystal Light talked about here a lot and it has aspartame and a list of chemicals longer than diet pop. Why is that recommend over diet pop? Just because a doctor says so is not good enough for me. When I was a kid our family doctor told us we would all have heart attacks if we continued to eat eggs. Anti eggs was the fad back then and most doctors went with it. Now eggs are considered a super food. What happened? Why did doctors suddenly change? Diet pop has been out for 50 years and yet there are very few studies that actually study causation. The ones I have found show that people do not gain anymore weight by drinking diet pop. I personally have lost 70 pounds and counting drinking diet pop. None of the ingredients in diet pop has been proven to cause weight gain. Diet pop is just a carbonated version of Water and Chrystal Light.

Hello all! I am 41, married with 2 grown kids and 3 grandkids that all live out of town...(husband is 15 yrs older so I inherited all the kids and grandkids!) No children of my own, but we have 2 dogs that get treated better than most humans! I have had back problems since I was a teenager (and in shape) but that has been made worse by my weight gain over time. My breaking point to decide to do this has been pretty recent when both my back and my knees got so bad I could barely walk. It is such an embarrassment every day at work as I hobble down the hall to the ladies room, out to the parking lot, etc... I work with a bunch of fit people that work out multiple times daily, so I feel so judged most of the time. Whether they are actually judging me...who knows but that is how I feel. Some folks won't even look me in the eye anymore as they pass me in the hallway. I live in the Houston area and I am getting banded a week from today, April 4th by Dr. Spivak. I don't have any pre-op diet to follow but I have started replacing at least 1 meal a day with a protein shake more as a way to test out a few different brands/flavors. My husband is incredibly supportive as well as the few people I have told. I was so embarrassed that I let myself get into the position of neeeding surgery, but everyone I have told has been so supportive since it is obvious my weight is really beginning to take a toll on my body. I am having sugery on a Monday and my husband convinced me to take the entire week off so I could heal properly. Not an ideal way to spend vacation time, but I know it will be worth it in the long run! At this 10 seconds I am not nervous about the actual procedure, but I am really scared about everything that follows. Knowing that when I wake up in the recovery room, my life will be different is hard for me to get my hands around. I am ready to make this change, but if I am to be completely honest I am scared too. Don't get me wrong...I am excited too! I have never been a great fan of exercise, but since walking is so painful for me now I have to say I am looking forward to being able to move again. Just dropping 20-25 lbs will help in that respect. I don't think I will take being ABLE to exercise for granted again! I am tired of living in pain, having no clothes that fit, etc. I am looking forward to being able to shop somewhere other than Lane Bryant and Avenue. I have shopped there for so many years I cannot even begin to imagine what that will be like. Anyway, that is a little about me. It's been nice reading about everyone and I am looking forward to hearing about everybody's experiences as we all go thru this in the next few weeks.

I plan fully on committing to this. I never said I wasn't going to. I was asking if this can help when weight gain before was from eating crap vs eating large portions of everything.

You sound pretty determined. Your determination will be your strongest asset in regaining your health and staying healthy. I will double down on what others have already said -- that WLS long-term success requires significant lifestyle and behavioral changes -- re what you eat, how much you exercise / move, your eating habits (eating slower, not drinking with meals, etc.), and for many people changing the ground rules for many of their relationships, both personal and professional. Some resources that have been hugely helpful to me in addressing these changes in my own life include: * I've been in therapy for two years (started just before WLS -- I'm sleeved). It's been so helpful in helping me learn how to care for my own needs before caring for others' needs. My greatly improved self-care has been critical to my losing 100 pounds and maintaining that weight loss for a year. * I'm a pretty regular measurer of my foods and liquids. Without that consistency I'd definitely be experiencing "portion creep." Two of the foods I consistently underestimate are cheese and nuts. My eye thinks that 1.5 - 2.0 ounces of cheese is 1 ounce. And my guesstimates about nuts are just, well, nuts! As high-calorie as both these foods are, they can present problems over time. And they're not the only ones. * I have planned and tracked all my meals / Snacks / everything on the online food tracker at www.myfitnesspal.com. * I weigh every morning. Not everyone can or even should do this. But everyone should weigh at the same interval -- whether it's once a day, every week, every month, etc. It's easy when you don't weigh regularly to ignore the impact of developing eating problems and the resulting weight gain. That's how some people wake up one morning and realize they've "suddenly" regained 20 pounds. Re measuring and tracking, I do not know how anyone knows for sure how much they're eating without measuring and tracking or how their intake might be slowly changing over time. I challenge everyone pre-op to measure and then track their food intake for at least one week to learn and/or confirm just how much they're actually eating in terms of macronutrients (calories / Protein / carbs / fat). Finally, the folks who seem (to me) to have the most problems along the way are those who have WLS so they'll "never have to diet again." Usually what they mean is that they don't want to ever have to make any future tough choices about what to eat or how much to eat -- because they expect their new gastrointestinal system will make those choices for them or somehow negate the impact of the bad choices they do make. Please believe me when I say that even after WLS you will still have to make plenty of tough choices about what to eat and drink. You're about to put your foot on the road to health. That road and your journey will never end. Good luck to you.

I got mirena in March of 09. I have had a slow steady weight gain since then. Almost 30 pounds!!! I had it removed on Monday and have already lsot 5 pounds. My Doc doesn't believe the mirena had anything to do with my weight gain, but I have found plenty of women with the same problem. I am just praying my weight loss will continue!

How Do You Know When You Hit a Plateau? Simply enough, a plateau is when you stop losing weight even though you want to. It’s not just a day or two without weight loss. It’s a period of a few weeks or more when you keep trying to lose weight, but the scale does not budge. You think you are doing everything you can and should be doing to lose weight, but still you do not see results. That is a plateau. It can be frustrating and discouraging and seem to be unfair. Stay Positive Plateaus can be maddening, but the absolute worst thing you can do during a plateau is to give up. If you decide that your diet is not worth the effort, you are almost certainly going to gain weight. Going back to your old, pre-surgery diet habits, taking oversized portions, and eating high-fat, high-sugary foods will not just make you gain weight. These bad habits can erase your health gains. Worse, they could cause some of the weight loss surgery complications that you already know about, such as the following: Stretching of the sleeve in vertical sleeve gastrectomy Dumping syndrome in gastric bypass Esophagitis with the adjustable gastric band (lap-band) Feeling nauseous or having diarrhea Another reason to stay positive is to keep up your motivation to continue all of the other healthy behaviors in your lifestyle. Don’t fall into the trap of “all-or-nothing,” in which you decide to give up all of your healthy efforts just because your weight loss isn’t quite what you want it to be. These include: Taking your daily vitamin and mineral supplements Getting enough protein and fluids each day Following your regularly exercise routine It Could Be Worse And it will be worse if you give up. It may sound strange, but you can stay positive by thinking about how much better your weight is now than where it could be if you gave up trying. If your careful diet is not leading to the weight loss you had hoped for, it is still preventing weight gain. If you give up, you will gain weight, and probably be pretty disappointed in yourself. Measure Success in Other Ways Another way to stay positive is to stop focusing on the scale. Find other ways to measure your progress. Tracking your body measurements, for example, can let you know that you are shrinking and building muscle even if your total weight is not decreasing right now. Tracking behaviors instead of measurements is another strategy. For example, you assess your success according to whether you eat well, such as hitting your protein goals or sticking to your planned menu. Other successful behaviors to be proud of yourself for are planning and preparing meals ahead of time and making sure you drink enough fluids at times other than meal times. Be Honest and Go Back to the Basics “Why me?” That’s a natural question when you hit a plateau, but most people don’t ask it seriously. However, if you think seriously about what is causing the plateau and how you can fix it, this question can actually help you break through the barrier and get back to losing weight. In many cases, you can figure out “why me” by asking yourself these questions. “Am I logging every single bite that goes into my mouth?” “Am I following the meal plan my nutritionist or surgeon gave me?” “Am I measuring – not eyeballing – all of the foods I eat?” “Am I exercising as much as I am supposed to be?” “Am I getting in my protein each day?” “Have I been too busy or preoccupied to plan my meals and snacks in advance?” If you answer these questions honestly, you might discover that you have slipped up and are not keeping up your good habits quite as well as you thought you had. Go back to the basics of meal planning and nutritious eating, and you are almost sure to see the scale move again within weeks. You’re in Charge! Plateaus are frustrating and nobody wants to experience them at some point, but almost everyone does. These steps can help you when you notice that you are in a plateau. Stay positive and keep up your healthy behaviors. Focus on other measures of success besides the scale. Assess your diet honestly. Make any necessary changes. You can get over your plateau, and you will be stronger for it! Just be patient and do what you know is right for your health.

I am curious to hear from other bandsters who have had a tummy tuck and then gained some weight back. How does your stomach 'feel' now? I was banded on 1-12-07 and had a tummy tuck on 2-19-08 after losing about 50 pounds. Since that time, I have had to start taking a couple of different medications for almost daily migraines, and have gained back around 15 pounds. I am so disappointed and just feel miserable about it. I am going to work really hard to get the weight off again so that I don't feel like a COMPLETE failure, but am having a hard time ending my pity-party . . . I need one more fill to hopefully get me back to my 'sweet spot' (life was good when I was at my sweet spot!) and I have that appt. scheduled for next Tuesday morning. I know that not having enough fill for the past 6 months has allowed me too much room for error in my eating. I have got to get the structure back and then figure out how to deal with the medications. I am concerned too, because before I had the TT, my stomach felt 'normal' other than being able to feel the port. Now I often have discomfort in my abdomen that feels like it is sometimes going to pop. It feels so tight and uncomfortable and my upper abdomen looks like a watermelon. I didn't start this thread to whine, I just wanted to see if there were others out there who either had, or are experencing the same things I am. I would love to hear from you if you don't mind sharing. Thanks in advance for your input.

So true, but the Band does help. I would do it again, even though all my family members think the Lap-Band has been a failure. Losing 95 pounds when you want to lose 150 is like the old half-full/half-empty debate. I still love to eat. Food has been my companion (though not my friend) ever since I was a child. I used to be skinny (my nick-name in high-school) until I hurt my leg playing football in college, then my calorie output dropped, but my calorie input rose. Result: 80 pound weight gain in 8 months. Since the Lap-Band surgery, I have grieved like I lost a friend, but it was only a companion, no make that an acquaintance. Sometimes when I got stuck at a weight and just could not lose, it was because I wasn't eating enough and my (prehistoric) thermostat drove my metabolism to protect me from starving. Instead of cutting back, I ate a little more including fat. I did not eat huge amounts of fat, but I stopped avoiding fat. Someday, I hope to start losing again. I seem to be in a stuck situation again, but I seem to keep injuring myself every time I start back to the gym. My body doesn't respond to training the way it used to. Hope my rant helped.

@@doingitmyway I lost 64 Ib (29 kg). Probably would have lost bit more, but I was bit slack with my exercises lately. I gained 90 Ib (41 kg) in 2 years 2014-2016 partly due to my Graves Disease (hyper-thyroid) doing 180 degree turn, and mucking up my metabolism. I developed awful sweet and fatty foods cravings, so I had a massive, rapid weight gain. I would love to lose another 33 Ib. My weight loss has slowed down a bit when I hit 6 months post op. So, I am plodding along .....

I've been reading some old post on those of you that have Mirena for heavy bleeding. I'm wondering if there is anyone that it didn't help with this problem? Has anyone had weight gain since getting put in? Have you noticed a change in how fast your losing weight since you had it put in? And, this may be awkward...but how do you check the"threads"? I've looked on the Mirena website and can't find that...it says your healthcare provider will show you how? Do you check the threads monthly? One of the older post someone states that her partner didn't like nuva ring because he could feel it? Has anyone had there partner tell them they can feel it? I've had my tubes tied since 1990.....never had any reason to give bc a second thought.... there are so many different choices now. I was only on the pill for 3 years before I had my daughter and not quite 3 years after...same pill both times and weight gain was the only problem I had with it. So, that's my excuse for asking dumb questions...naive. Ruth

Hi Everyone! I am a 35 years old. I've been married for 3 years and together with my DH for 12 years total. I was a marketing exec for a bunch of large Fortune 500 companies up until the end of October (60 hour work weeks, traveling, drinking too much, eating way too much, etc.). I am taking 6 months to take care of myself. The most important is my new band! I have struggled with weight gain since about age 23. It just creeped up every year until I am where I am today - 98 lbs of fat, sleep apnea, difficulty breathing, cholesteral creeping up, blood pressure creeping up, etc., etc. I finally gave in to my need for this change when I call home and my mom has had 2 mini strokes, a heart attack, diabetes all before the age of 60. I don't want to die young and/or be disabled by health problems before I can even collect my SS checks:-) I stuggle because my DH is handicapped and this has really prevented me from being the active person I used to be. As part of my 6 months of time off, I need to get adjusted to eating healthy with the help of my band and finding a way to exercise properly. The Merry Losers Rock!!!

I second what Nika said. Just hang in there! I had some serious regret my first week with all the complications I had, but every week has gotten better and better and so has my outlook. Don't beat yourself up too badly about not losing a bunch of weight yet. It'll come in time. I was very frustrated because I came home weighing more than what I did my day of surgery. Having to lose the "hospital" weight gain made the first week and a half frustrating, but once I got past that hump things were better. I will say the better I do on my fluids, Vitamins, and Protein the better the weight seems to come off. It does make a difference. Keep your chin up!

Right after surgery I was able to lose weight faster than a speeding bullet, my restriction was more powerful than a locomotive and my metabolism could easily leap a tall building with a single bound. Today, my kryptonite is time. Time has made me once again a weight loss mortal. I am able to gain weigh even though my diet has remained healthy. I don't lose the weight gained as fast and I am able to eat more. What to do? I actually fore saw this problem. The first year of my WLS journey when I was researching and going through the process to be approved I went to as many group meetings that I was allowed to attend. I always picked the brain of the people in attendance. Like many on this board they were ALL newbies with the success stories only newbies can tell. Not a single failure in the group. That is until one day a woman showed up and started telling us her story. She was five years out from surgery lost a lot of weight and put most of it back on. She warned everyone that things would change as you get further out from surgery and that it wouldn't necessarily be for the better. She had wished that she did not get caught up in the euphoria of her early success. She said that it's like winning the lottery. One day you have more money than you'd ever dream of having. If you don't plan on saving it you'll go bankrupt. That's what happened to her. She won the weight loss lottery. She lost more weight than she could have dreamed losing. Trouble was, she didn't plan her long term weight loss and now, she went "bankrupt". As I went through my daily routine I came across others who had WLS and many had indeed gained the weight back. I was in my doctors office and the medical attendant there told me about her failure when I told her that I was going through the process to get approved for WLS. She told me that it creeps up on you. Two pounds turns to four, four to eight than you're back to where you started. You start to Feel helpless and give up. As I went to the group meetings pre and post surgery I noticed not many people stuck around. There were no veterans in the group just eager newbies who can attest to the success of WLS. Seems as if the veterans drift away and either gain the weight back in silence or just get tired of hearing the same stories of success over and over. I knew that I would probably lose my WLS super powers someday and I had hoped to plan for it. First, I did lose a lot of weight in the mid 90's and I never thought that I'd get back to being obese. I was so wrong. Like my medical attendant experienced, five pounds turned to ten then to 20 and you know the rest. It took me less that four years to gain back the weight and then some. It took another 17 years to get WLS. I decided that I would use every tool that I could in order to keep the weight off and maintain my health. I joined Over Eaters Anonymous. It's another support group away from the support group my surgeon has. I started seeing a therapist who specializes in eating disorders. ( I'm a compulsive over eater) and I have family and friends who have had WLS who I can call to get and give support to. I also weigh myself every week at the same time on the same scale and set a "Red Alert" weight of 160lbs. ( Have a log since the day of my surgery) If I go above the 160 I know that I must redouble my efforts. Here is where my lost WLS super powers comes in. Despite all this I am having a difficult time losing the five pounds that I am over. I feel as if I am now a mere weight loss mortal who has to work two to three times harder to lose and maintain the weight loss. I can't say it wasn't expected. From all the people I spoke to I knew this day would come. It's that, I was once a WLS immortal and now I have to struggle like all others to lose weight. My saving grace (I hope it is) I planned for it since I went through it before and I took the advice of those who went before me seriously. For all of you newbies who are experiencing the euphoria of being WLS immortal plan for day like me when you lose that super power. Just a note, there are many who do maintain their WLS super powers. They are on this forum and they are truly superstars. They unfortunately are the exception to the trend. I find their advice to be invaluable and I look for their posts for such advice. To everyone, good luck with your new found health.

I have never had it before i have been tested many times and always normal untill now. So that still isn't the reason for the weight gain.

I can't help much, the accident I was in was when I was 9. The guy hit us after running a stop sign. I had multiple MRI's, had to go to physical therapy for a couple of years, and think the pain and injury had a lot to do with my rapid weight gain during those years. My lower back and neck still hurt on occasion, but have really gotten better with my weight loss. I know we had to go through a lawyer and it took a couple years at least to get the settlement. My mom received $20,000 for her, she had severe shoulder problems that has needed multiple surgeries and I received $18,000 that was put into a CD until I turned 18. I do not know any other specifics or what the lawyer made on the whole deal.

How does zero calorie and zero sugar diet pop cause you to gain weight? I see Chrystal Light talked about here a lot and it has aspartame and a list of chemicals longer than diet pop. Why is that recommend over diet pop? Just because a doctor says so is not good enough for me. When I was a kid our family doctor told us we would all have heart attacks if we continued to eat eggs. Anti eggs was the fad back then and most doctors went with it. Now eggs are considered a super food. What happened? Why did doctors suddenly change? Diet pop has been out for 50 years and yet there are very few studies that actually study causation. The ones I have found show that people do not gain anymore weight by drinking diet pop. I personally have lost 70 pounds and counting drinking diet pop. None of the ingredients in diet pop has been proven to cause weight gain. Diet pop is just a carbonated version of Water and Chrystal Light. Never listen to a doctor. Just do what ever you think is right.

I take this mainly because I need the Wellbutrin part of it, but am terrified of taking a depression/anxiety medication on its own because of potential weigh gain side effects. My doctor thought this would be a good fit because I would still get the wellbutrin benefit without having to worry about weight gain. So far so good and I was able to lose the last 10 pounds I wanted to get off.

Wow, it took me a few days to figure out how to get back into this forum. I'm grateful for the many comments on here. It's gives me hope. I heard the wrong things early in my glory days of weight dropping off. " if you are able to keep the weight off 3 years you will not have any problems ". Unfortunately I took it to heart and allowed myself to eat whatever I wanted. My weight did go up and down some about 10lbs. I worked full time at a physical job and exercised my days off. I hit 40, job change, weight gain. Found out about disabilitys more weight gain. Lost our home in a house fire, more weight gain. I have always known I'm a sugar addict. Most of the time Doctors and professionals laughed like I'm Kidding. I wish, but notice they don't laugh at alcoholism or drug addiction. So long story short I lost my job, home, had a scary gun accident that left me with PTSD and 75lbs of extra fat. I'm feeling depressed beyond understanding to most. Sugar feels like my only comfort in life. Sent from my iPhone using the BariatricPal App

Sleeved on 5/22 and went in at 299.5, highest weight of my life. This morning I was 275. Thankfully I didn't have the water weight gain but we all have our problems. Maybe it was a trade out for the vomiting blood, and severe spasms due to hernia repair (I didn't know I had). Ill admit day 1-3 I was hating life and was definitely one of the 'OMG what have I done!' people. Today tho is day 12, and each day has gotten a little better. I track EVERYTHING on my fitness pal app and I'm getting at least 60oz of liquid and 60 protein....finally. Still having spasms occasionally and the tightness/bloating nearly every time I eat. I'm guessing from hernia repair. My diet phases seem to be different then most i've seen on here. I went home on full liquids and moved to soft foods after one week. Everything seems to be looking up. I'm starting to get excited about losing weight

I was sleeved 7/28 After watching several friends evolve into thin healthy people who work out everyday, they still go out to dinner with friends, family they just eat less on their plate. Tonight My family is ordering Chinese for dinner, I'm having miso Soup broth instead, but, I remember clearly that firm salty texture of lomein noodles, I use to sit on the couch with the noodles resting in my chest with my chopsticks expertly in place. I felt I was eating healthy because I ordered chicken and vegetables with that as well. I ate till I was stuffed. Then several hours later I ate again because we all know what happens the Chinese food. Food was heaven but, the weight gain was hell. Hell on my diabetes, Hell my cholesterol, Hell on my ankles, knees, back and heart. Food was making me feel BAD. I'm craving food even as I sit here writing about how bad it has hurt me. It's a habit I need to break and like most things will happen in time. My recommendation is to follow your heart. Tammy

Melissa- I have Empire BCBS of NY. I was told by one coordinator that the 6-months diet was mandatory, but by a second coordinator (two days later) that it was not?! I submitted paperwork that listed 5 months and was approved very quickly (2 days). I had an arsenal of met requirements and left nothing to chance. Document EVERYTHING, fax a copy to your surgeon and keep one for yourself. I think my submittal had over 100 pages of "stuff" including: PCP letter personal "mission statement" lol psych eval/support cardiologist suport/EKG/Echo nutritional eval pulmonolgist support/eval apnea study/report endocrinologist report/support letter dr's visits for over 5 years (including thyroid issues, pregnancy...weight gain & loss) gym membership receipt weight watchers "thru the years" I copied & faxed myself silly. My surgeon's office said it was the quickest approval they've see. I suppose my OCDs pay off sometimes. I'm not certain that all I did was necessary....but it was all well worth it. I'm 16 days post-surgery and feel better than I have in YEARS. Best of luck to you!

http://mcgs.bcbsfl.com/ Note the timeline on this: 02-40000-10 Original Effective Date: 10/15/99 Reviewed: 04/27/06 Revised: 05/15/06 Next Review: 04/26/07 Subject: Surgery for Clinically Severe Obesity (Bariatric Surgery; Gastric Bypass Surgery) DESCRIPTION: Clinically severe obesity is a result of persistent and uncontrollable weight gain that constitutes a present or potential threat to life. For purposes of this medical coverage guideline, clinically severe obesity is defined as a body mass index (BMI) of 35 kg/m2 or greater. See the height and weight tables for Men and Woman, BMI tables (100-195, 200-295, 300-400, and formula for calculating a BMI. Several surgical (bariatric) procedures are used for the treatment of clinically severe obesity. These procedures can be categorized as follows: <LI class=bulletedList-1>Malabsorptive procedures - alteration of the intestinal absorption limiting nutrients available to the body OR Gastric restrictive procedures - reduction in the capacity of the stomach thereby limiting the amount of food ingested. Gastric surgical procedures for the treatment of clinically severe obesity include: <LI class=bulletedList-1>gastric bypass where approximately 90% of the stomach is bypassed and reattached to the proximal jejunum OR gastric stapling, vertically banded gastric partition, or vertically banded gastroplasty where a proximal pouch of 30-60 ml and a one centimeter outlet are created by a row of vertical staples and a horizontally placed reinforcing band. WHEN SERVICES ARE COVERED: Effective January 1 2005, weight loss surgery is not covered for most contracts. Please refer to the individual member’s contract benefit language. NOTE: The primary care physician must provide a letter with facts supporting medical necessity, for review by the Medical Director. Certain surgical procedures performed for the treatment of clinically severe obesity may be considered medically necessary when ALL of the following conditions are met: The member: <LI class=bulletedList-1>meets the above definition of clinically severe obesity, <LI class=bulletedList-1>has been severely obese for at least five (5) years, <LI class=bulletedList-1>has attempted a physician supervised (by the primary care physician) non-surgical management weight loss program (e.g., diet, exercise, drugs) for six (6) consecutive months <LI class=bulletedList-1>has received psychological or psychiatric evaluation with counseling as needed, prior to surgical intervention; does not have a medically treatable cause for the obesity, (e.g., thyroid or other endocrine disorder). The following procedures may be considered medically necessary when the above criteria has been met: Vertical-Banded Gastroplasty (CPT code 43842) Vertical-banded gastroplasty was formerly one of the most common gastric restrictive procedures performed in this country but has more recently declined in popularity. In this procedure, the stomach is segmented along its vertical axis. To create a durable reinforced and rate-limiting stoma at the distal end of the pouch, a plug of stomach is removed, and a propylene collar is placed through this hole and then stapled to itself. Because the normal flow of food is preserved, metabolic complications are uncommon. Complications include esophageal reflux, dilation, or obstruction of the stoma, with the latter 2 requiring reoperation. Dilation of the stoma is a common reason for weight regain. Vertical-banded gastroplasty may be performed using an open or laparoscopic approach. Roux-en-Y Gastric Bypass (CPT code 43644, 43846) Gastric bypass may be performed with either an open or laparoscopic technique. The original gastric bypass surgeries were based on the observation that post-gastrectomy patients tended to lose weight. The current procedure involves a horizontal or vertical partition of the stomach in association with a Roux-en-Y procedure (i.e., a gastrojejunal anastomosis). Thus, the flow of food bypasses the duodenum and proximal small bowel. The procedure may also be associated with an unpleasant “dumping syndrome,” in which a large osmotic load delivered directly to the jejunum from the stomach produces abdominal pain OR vomiting. The dumping syndrome may further reduce intake, particularly in “sweets eaters”. Operative complications include leakage and marginal ulceration at the anastomotic site. Because the normal flow of food is disrupted, there are more metabolic complications compared to other gastric restrictive procedures. These complications may include iron deficiency anemia, vitamin B-12 deficiency, and hypocalcemia, all of which can be corrected by oral supplementation. Another concern is the ability to evaluate the “blind” bypassed portion of the stomach. Long Limb Gastric Bypass (i.e., more than 100 cm) (CPT code 43847) Recently, variations of gastric bypass procedures have been described, consisting primarily of long limb Roux-en-Y procedures, which vary in the length of the alimentary and common limbs. For example, the stomach may be divided with a long segment of the jejunum (instead of ileum) anastomosed to the proximal gastric stump, creating the alimentary limb. The remaining pancreaticobiliary limb, consisting of stomach remnant, duodenum, and length of proximal jejunum is then anastomosed to the ileum, creating a common limb of variable length in which the ingested food mixes with the pancreaticobiliary juices. While the long alimentary limb permits absorption of most nutrients, the short common limb primarily limits absorption of fats. The stomach may be bypassed in a variety of ways (i.e., either by resection or stapling along the horizontal or vertical axis). Unlike the traditional gastric bypass, which is essentially a gastric restrictive procedure, these very long limb Roux-en-Y gastric bypasses combine gastric restriction with some element of malabsorptive procedure, depending on the location of the anastomoses. NOTE: Coverage of long limb Roux-en-Y procedures is limited to 150 cm. Adjustable gastric banding (i.e., Lap-Band Adjustable Gastric Banding System) (CPT code 43770, 43771, 43772, 43773, 43774) Adjustable gastric banding involves placing a gastric band around the exterior of the stomach. The band is attached to a reservoir that is implanted subcutaneously in the rectus sheath. Injecting the reservoir with saline will alter the diameter of the gastric band; therefore, the rate- limiting stoma in the stomach can be progressively narrowed to induce greater weight loss, or expanded if complications develop. Because the stomach is not entered, the surgery and any revisions, if necessary, are relatively simple. Complications include slippage of the external band or band erosion through the gastric wall. Adjustable gastric banding has been widely used in Europe. Currently, the U.S. Food and Drug Administration (FDA) has approved one such device for marketing in the United States, Lap-Band (BioEnterics, Carpentiera, CA). The labeled indications for this device are as follows: "The Lap-Band system is indicated for use in weight reduction for severely obese patients with a body mass index (BMI) of at least 40 or a BMI of at least 35 with one or more severe comorbid conditions, or those who are 100 lbs or more over their estimated ideal weight according to the 1983 Metropolitan Life Insurance Tables (use the midpoint for medium frame). It is indicated for use only in severely obese adult patients who have failed more conservative weight-reduction alternatives, such as supervised diet, exercise and behavior modification programs. Patients who elect to have this surgery must make the commitment to accept significant changes in their eating habits for the rest of their lives." Biliopancreatic Bypass with Duodenal Switch (43845) The duodenal switch procedure is essentially a variant of the biliopancreatic bypass. However, instead of performing a distal gastrectomy, a “sleeve” gastrectomy is performed along the vertical axis of the stomach, preserving the pylorus and initial segment of the duodenum, which is then anastomosed to a segment of the ileum, similar to the above procedure, to create the alimentary limb. Preservation of the pyloric sphincter is designed to be more physiologic. The sleeve gastrectomy decreases the volume of the stomach and also decreases the parietal cell mass, with the intent of decreasing the incidence of ulcers at the duodenoileal anastomosis. However, the basic principle of the procedure is similar to that of the biliopancreatic bypass (i.e., producing selective malabsorption by limiting the food digestion and absorption to a short common ileal segment). WHEN SERVICES ARE NOT COVERED: Surgery for clinically severe obesity is not covered when these services are excluded from the member’s contract benefits. Studies are needed to determine the long-term health outcomes of the following procedures, therefore the procedures listed below are considered investigational when performed for the treatment of clinically severe obesity: Biliopancreatic Bypass Procedure (i.e., the Scopinaro procedure) (CPT code 43847) Biliopancreatic bypass (BPB) procedure, developed and used extensively in Italy, was designed to address some of the drawbacks of the original intestinal bypass procedures that have been abandoned due to unacceptable metabolic complications. Many of the complications were thought to be related to bacterial overgrowth and toxin production in the blind, bypassed segment. In contrast, BPB consists of a subtotal gastrectomy and diversion of the biliopancreatic juices into the distal ileum by a long Roux-en-Y procedure. This procedure consists of the following components: <LI class=bulletedList-1>A distal gastrectomy functions to induce a temporary early satiety OR the dumping syndrome in the early postoperative period, both of which limit food intake <LI class=bulletedList-1>A 200-cm long “alimentary tract” consists of 200 cm of ileum connecting the stomach to a common distal segment <LI class=bulletedList-1>A 300- to 400-cm “biliary tract,” which connects the duodenum, jejunum, and remaining ileum to the common distal segment <LI class=bulletedList-1>A 50- to 100-cm “common tract,” where food from the alimentary tract mixes with biliopancreatic juices from the biliary tract. Food digestion and absorption, particularly of fats and starches, are therefore limited to this small segment of bowel (i.e., creating a selective malabsorption). The length of the common segment will influence the degree of malabsorption Because of the high incidence of cholelithiasis associated with the procedure, patients typically undergo an associated cholecystectomy. Many potential metabolic complications are related to biliopancreatic bypass, including most prominently iron deficiency anemia, protein malnutrition, hypocalcemia, and bone demineralization. Protein malnutrition may require treatment with total parenteral nutrition (TPN). In addition, there have been several case reports of liver failure resulting in death or liver transplant. Mini-Gastric Bypass (no specific CPT code) Recently, a variant of the gastric bypass, called the “mini-gastric bypass” has been popularized. Using a laparoscopic approach, the stomach is segmented, similar to a traditional gastric bypass, but instead of creating a Roux-en-Y anastomosis, the jejunum is anastomosed directly to the stomach, similar to a Billroth II procedure. This unique aspect of this procedure is not based on its laparoscopic approach, but rather the type of anastomosis used. NOTE: CPT code 43846 does not accurately describe the mini-gastric bypass, since this CPT code explicitly describes a Roux-en-Y gastroenterostomy, which is not used in the mini-gastric bypass. The following procedures reported as gastric bypass or gastroplasty are also considered investigational due to the lack of clinical studies to support effects on health outcomes: <LI class=bulletedList-1>jejunoileal bypass <LI class=bulletedList-1>gastric wrapping Garren-Edwards gastric bubble. BILLING/CODING INFORMATION: CPT Coding: 43644 Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (Roux limb 150 cm or less) 43645 Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption (investigational) 43770 Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric band (gastric band and subcutaneous port components) 43771 Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric band component only 43772 Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric band component only 43773 Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric band component only 43774 Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric band and subcutaneous port components 43842 Gastric restrictive procedure, without gastric bypass, for morbid obesity; vertical-banded gastroplasty 43843 Gastric restrictive procedure, without gastric bypass, for morbid obesity; other than vertical-banded gastroplasty (investigational) 43845 Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch) 43846 Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (150 cm or less) Roux-en-Y gastroenterostomy (may be done laparoscopically) 43847 Gastric restrictive procedure, with gastric bypass for morbid obesity; with small intestine reconstruction to limit absorption (may be done laparoscopically) There is no specific CPT or HCPCS code to report mini gastric bypass. A laparoscopic approach is used with the mini-gastric bypass. The stomach is segmented similar to a traditional gastric bypass; the jejunum is anastomosed directly to the stomach, similar to a Billroth II procedure. The mini gastric bypass is not based on its laparoscopic approach, but rather the type of anastomosis used. HCPCS Coding S2083 Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline ICD-9 Diagnoses Codes That Support Medical Necessity: 278.01 Morbid obesity REIMBURSEMENT INFORMATION: Bariatric surgical procedures are limited to individuals 18 years and older and are reimbursed based on the procedure performed and not the surgical technique used (e.g., microsurgical, laser, laparoscopic). PROGRAM EXCEPTIONS: Federal Employee Program (FEP): Follow FEP guidelines. State Account Organization (SAO): Follow SAO guidelines. DEFINITIONS: Biliopancreatic bypass: gastric restriction rerouting bile and pancreatic juice to the distal ileum. Garren-Edwards gastric bubble: a free-floating intragastric device made of elastomeric plastic is placed in the stomach via a gastroscope, used for reducing stomach capacity. Gastric wrapping: the stomach is folded over on itself and a full stomach wrap, i.e. polypropylene mesh, is applied to limit gastric volume. Gastric banding: a synthetic band rather than staples is used to divide the stomach into a small upper pouch and a lower portion). Gastric bubble: see definition of Garren-Edwards gastric bubble. Jejunoileal bypass: shunts food from the jejunum into the ileum, bypassing the small intestine. Morbid obesity: defined as a body mass index (BMI) of 40 kg/m2 or greater. Satiety: the quality or state of being fed or gratified to or beyond capacity. RELATED GUIDELINES: Gastric Bypass Revision, 02-40000-11 OTHER: Other index terms for gastric surgery: Adjustable gastric banding Bariatric surgery Gastric bypass surgery Lap-Band System Mini gastric bypass Billroth II Long limb gastric bypass Roux-en-Y Scopinaro Vertical banding REFERENCES: <LI value=1>All-plan survey (Blue Cross Blue Shield plans) <LI value=2>American Academy of Medicine CPT Coding (current edition) <LI value=3>Blue Cross Blue Shield Association TEC Evaluation (12/88), 2003 <LI value=4>Blue Cross Blue Shield Association TEC Special Report: The relationship between weight loss and changes in morbidity following bariatric surgery for morbid obesity. BCBSA TEC Assessment Program, 2003; 18:1-25 <LI value=5>Blue Cross Blue Shield Association-Surgery for Morbid Obesity (7.01.47), 12/14/05 <LI value=6>DeMaria, E J, Sugerman, H J, Meador, J G, et al. High Failure Rate After Laparoscopic Adjustable Silicone Gastric Banding for Treatment of Morbid Obesity. Annals of Surgery 2001:233:809-818 <LI value=7>First Coast Service Options (FCSO) Medical Policy - surgical Management of Morbid Obesity, LCD #L14600 (01/01/06) <LI value=8>Guidance for Treatment of Adult Obesity, American Obesity Assoc., 1998 <LI value=9>Hayes Medical Technology Directory - Laproscopic Bariatric Surgery - us.lapa0008.2005 (11/03; Update report 12/05) <LI value=10>Hayes Medical Technology Directory - Obesity Management, Surgical Approaches OBES0802.03 (10/99; updated 07/27/02; updated 04/04/03) <LI value=11>InterQual Care Planning Criteria: General Surgery; Weight Loss Surgery GS-23 (2003) <LI value=12>National Institutes of Health Consensus Development Conference on Gastrointestinal Surgery for Severe Obesity Statement (March 25-27, 1991) <LI value=13>Rutledge MD, Robert. “The Mini-Gastric Bypass: Experience with the First 1,274 Cases”; Obesity Surgery 2001; 11:276-280 <LI value=14>St. Anthony’s ICD-9-CM code book (current edition) U.S. Food and Administration (FDA) Talk Paper, FDA Approves Implanted Stomach Band To Treat Severe Obesity, T01-26, 06/05/01 COMMITTEE APPROVAL: This Medical Coverage Guideline (MCG) was approved by the BCBSF Medical Policy & Coverage Committee on 04/27/06. GUIDELINE UPDATE INFORMATION: 10/15/99 Medical Coverage Guideline developed. 09/15/01 Various revisions. 01/01/02 Coding changes. 10/15/02 Annual review. Added Roux-enY anastomosis or vertical-banded as covered services. Added biliopancreatic bypass with duodenal switch and very long limb gastric bypass procedure (e.g., greater than 100 cm) as non-covered services. 05/15/03 Revised to clarify coding of the various procedures; criteria revised and is consistent with Inter-Qual criteria. 09/15/03 Coverage criteria for psychological testing/counseling revised. 10/15/03 Reversed investigational status for CPT code 43847 and provided coverage criteria for long-limb Roux-en-Y procedures up to 150 cm. 01/01/04 Annual HCPCS coding update. 04/01/04 2nd Quarter HCPCS coding update; added S2082 and S2083. 07/15/04 Scheduled review; no changes. 01/01/05 HCPCS coding update. Added 43644, 43645, 43845, S2082, and S2083. Revised descriptor for 43846, and deleted S2085. 05/15/05 Unscheduled review of the non-covered statement for laparoscopic adjustable gastric banding (Lap-Band); coverage statement unchanged. 01/01/06 Annual HCPCS coding update (added 43770-43774; deleted S2082). 04/15/06 Scheduled review; removed investigational statement for laparoscopic adjustable gastric banding and biliopancreatic diversion with duodenal switch; updated coding, index terms, and references. 05/15/06 Scheduled review; removed investigational statement for laparoscopic adjustable gastric banding and biliopancreatic diversion with duodenal switch; updated coding, index terms, and references; added age limitation of 18 years and older. Private Property of Blue Cross and Blue Shield of Florida. This medical coverage guideline is Copyright 2006, Blue Cross and Blue Shield of Florida (BCBSF). All Rights Reserved. You may not copy or use this document or disclose its contents without the express written permission of BCBSF. The medical codes referenced in this document may be proprietary and owned by others. BCBSF makes no claim of ownership of such codes. Our use of such codes in this document is for explanation and guidance and should not be construed as a license for their use by you. Before utilizing the codes, please be sure that to the extent required, you have secured any appropriate licenses for such use. Current Procedural Terminology (CPT) is copyright 2006 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT® is a trademark of the American Medical Association.

Originally Posted by Lap_dancer From BCBS Association (corporate) . 5. The improvement must be attainable outside the investigational settings. The improvement in health outcomes for laparoscopic gastric bypass can be attained outside the investigational setting, if the training of surgeons and the programmatic elements are similar to programs in the published literature, and if performed at a hospital with sufficient surgical volume. However, there may be considerable variation in capabilities and resources among different bariatric surgery programs. To address this concern, Blue Cross and Blue Shield Association and the American College of Surgeons have developed criteria for credentialing and tracking outcomes from bariatric surgery programs. Based on the above, laparoscopic gastric bypass meets the TEC criteria, when performed in appropriately selected patients, by surgeons who are adequately trained and experienced in the specific techniques used, and in institutions that support a comprehensive bariatric surgery program, including long-term monitoring and follow-up post-surgery. http://www.bcbs.com/betterknowledge/.../20/20_15.html Source found at above website. Yeah, but isn't this just for gastric bypass? I couldn't find anything about gastric banding in this document. JB .................................................................................................. Airman, think of doing searches on this subject like a crossword puzzle. Just because you have a th_ _ K doesn't mean the word is think. You won't find some of the information easily. You should keep track of your searches via your search engine history. Book mark things, reduce the screen and open up another window to continue a new search. Open WORD and copy and paste links and language from documents. ( I do this all the time when I am researching). I'm not an insurance agent but here is what I have learned about Blue Cross and Blue Shield. Blue Cross and Blue Shield (BCBS) is like a mall. Inside the mall you have different stores that you can shop from. So you get Blue Cross, Blue Shield, Blue, Blue Options, ... Google is a good friend. Please utilize this in your efforts to gain information available to you. Google entry from me was: BCBS South Carolina weight loss surgery HITS: Suburban Surgical Care Specialists, S.C. - Bariatric Surgery Vanderbilt Center for Surgical Weight Loss, Exclusion List The Next Step for Weight-Loss Surgery Blue Distinction Centers for Bariatric Surgery That one sounds good, I think I'll try it......... (thinking, if BCBS doesn't cover it and thinks Lap Band is experimental, I won't find a hit on my search ) Inside this HIT I see it is the BCBS site, I'l go to SEARCH and type in GASTRIC HIT: Displaying results 1 - 5 of 5 items found. 1. TEC in Press - Laparoscopic Adjustable Gastric Banding for Morbid Obesity (Web Page; Thu Jan 25 15:43:00 EST 2007) EXECUTIVE SUMMARY Background: Bariatric surgery leads to substantial amounts of weight loss in morbidly obese patients, and this weight loss leads to net improvements in health outcomes. Among different surgical procedures,... Description: Laparoscopic Adjustable Gastric Banding for Morbid Obesity 2. Laparoscopic Gastric Bypass Surgery for Morbid Obesity (Web Page; Mon Oct 30 15:26:00 EST 2006) Assessment ProgramVolume 20, No. 15 February 2006Executive Summary Background Bariatric surgery leads to substantial amounts of weight loss in morbidly obese patients, and evidence exists that this weight loss leads to net... Description: Bariatric surgery leads to substantial amounts of weight loss in morbidly obese patients, and evidence exists that this weight loss leads to net improvements in health outcomes. 3. Newer Techniques in Bariatric Surgery for Morbid Obesity: Laparoscopic Adjustable Gastric Banding, Biliopancreatic Diversion, and Long-Limb Gastric Bypass (Web Page; Mon Oct 30 15:27:00 EST 2006) Assessment ProgramVolume 20, No. 5 August 2005Executive Summary Morbid obesity, generally defined as a body-mass index (BMI) of 40 kg/m2 or greater, is associated with excess mortality and a high burden of obesity-related morbidities.... Description: Morbid obesity, generally defined as a body-mass index (BMI) of 40 kg/m2 or greater, is associated with excess mortality and a high burden of obesity-related morbidities. HIT: TEC in Press - Laparoscopic Adjustable Gastric Banding for Morbid Obesity EXECUTIVE SUMMARY Background: Bariatric surgery leads to substantial amounts of weight loss in morbidly obese patients, and this weight loss leads to net improvements in health outcomes. Among different surgical procedures, gastric bypass is the most common procedure performed in the U.S., and offers the most favorable benefit/risk ratio among established procedures. Laparoscopic adjustable gastric banding (LAGB) is an alternative technique that has the potential advantages of being less invasive and reversible. Prior TEC Assessments have concluded that LAGB does not meet the TEC criteria. Objective: To review the available evidence on whether LAGB results in similar improvements in health outcomes as does open or laparoscopic gastric bypass (GBY). Search strategy: MEDLINE search for the period of 1980 through September 2006, supplemented by hand search of bibliographies and search of Cochrane database. This goes on but it tells me that they are NOT calling it "investigational." PRINT AND SAVE 1. The technology must have final approval from the appropriate governmental regulatory bodies. Bariatric surgery itself is a procedure and is not subject to U.S. food and Drug Administration (FDA) regulations. However, certain devices that may be used as part of the procedure may be subject to FDA approval. The Lap-Band® system received premarket application (PMA) approval by the FDA in June 2001 for use in morbidly obese patients. 2. The scientific evidence must permit conclusions concerning the effect of the technology on health outcomes. The evidence is sufficient to permit conclusions concerning the short-term safety and efficacy of LAGB in comparison with GBY. Weight loss at 1 year following LAGB is substantial, in the range of 40% EWL, although less than that seen following GBY. The short-term complications of LAGB are very low, with serious short-term complications being uncommon, and mortality exceedingly rare. Rates of short-term adverse events, including serious procedural complications and mortality, are lower for LAGB compared with GBY. Same page, further on down the page. Airwayman, I could truthfully sit here for the next span of time and do this research for you but in the end, it teaches you nothing on perserverance. I am a teacher. I teach my students that perserverance pays off. In the frustration of learning, there is victory in the end. *I began my own Quest knowing NOTHING about the surgery, my own insurance plan nor how the process works. After six months, I can answer pretty much any question thrown my way. Tomorrow I will get my chance to educate the insurance committee at work. They were told "gastric surgery is not covered by Blue Cross", I beg to differ. http://mcgs.bcbsfl.com/ Search: Medical Coverage Guidelines BCBS HIT: 1.(61.06% Relevant)Gastric Electrical Stimulation... peripheral or gastric neurostimulator pulse generator or receiver, direct or inductive coupling 64595 Revision or removal of peripheral or gastric neurostimulator pulse generator or receiver 0155T Laparoscopy, surgical, implantation or replacement of gastric stimulation electrodes, lesser curvature ...2.(59.05% Relevant)Gastric Bypass Revision... gastrectomy or intestine resection; with vagotomy 43886 Gastric restrictive procedure, open; revision of subcutaneous port component only 43887 Gastric restrictive procedure, open; removal of subcutaneous port component only 43888 Gastric restrictive procedure, open; removal and replacement of ...>>3.(58.83% Relevant)Surgery for Clinically Severe Obesity... or stapling along the horizontal or vertical axis). Unlike the traditional gastric bypass, which is essentially a gastric restrictive procedure, these very long limb Roux-en-Y gastric bypasses combine gastric restriction with some element of malabsorptive procedure, depending on the location of the ... 02-40000-10 Original Effective Date: 10/15/99 Reviewed: 04/27/06 Revised: 05/15/06 Next Review: 04/26/07 Subject: Surgery for Clinically Severe Obesity (Bariatric Surgery; Gastric Bypass Surgery) THIS MEDICAL COVERAGE GUIDELINE IS NOT AN AUTHORIZATION, CERTIFICATION, EXPLANATION OF BENEFITS, OR A GUARANTEE OF PAYMENT, NOR DOES IT SUBSTITUTE FOR OR CONSTITUTE MEDICAL ADVICE. ALL MEDICAL DECISIONS ARE SOLELY THE RESPONSIBILITY OF THE PATIENT AND PHYSICIAN. BENEFITS ARE DETERMINED BY THE GROUP CONTRACT, MEMBER BENEFIT BOOKLET, AND/OR INDIVIDUAL SUBSCRIBER CERTIFICATE IN EFFECT AT THE TIME SERVICES WERE RENDERED. THIS MEDICAL COVERAGE GUIDELINE APPLIES TO ALL LINES OF BUSINESS UNLESS OTHERWISE NOTED IN THE PROGRAM EXCEPTIONS SECTION. Non-Covered Billing/Coding Reimbursement Program Exceptions Definitions Related Guidelines Other References Updates DESCRIPTION: Clinically severe obesity is a result of persistent and uncontrollable weight gain that constitutes a present or potential threat to life. For purposes of this medical coverage guideline, clinically severe obesity is defined as a body mass index (BMI) of 35 kg/m2 or greater. See the height and weight tables for Men and Woman, BMI tables (100-195, 200-295, 300-400, and formula for calculating a BMI. Several surgical (bariatric) procedures are used for the treatment of clinically severe obesity. These procedures can be categorized as follows:

Nance not to be too personal but the protein drinks can be very constipating which can cause weight gain. My doc cut me down to 40 grams of protein a day because of that problem. Good Luck!!!!!!!