Beginner: my story and the issues I am having

[J.lynn 50]

Sorry for the long post in advance, I hope I am posting this in the correct section.

I am 23 years old. I have struggled with obesity and emotional binge eating since the age of 10. I had an extremely dysfunctional home life and turned to food for comfort because it was the one thing I could seemingly control. I am currently 256 lbs, and I am 5'5". This puts me at a BMI of about 43. My highest known weight was 280 about 2-3 years ago. I was having severe abdominal pains (I think I had a fatty liver but never confirmed this with my PCP) because of the excess weight so I decided to try the Atkins diet. I was pretty successful, lost about 60 lbs over the course of a year and a half. I was so bored with preparing the same food all of the time and the extreme restriction, high fat/protein and absolutely no carbs or refined sugar. I ended up going off of the diet, and gained 40 lbs back the following year. Over the course of my adult life, I have tried other countless diets, pills, and exercises: Weight watchers, Insanity, the Makers diet (very similar to paleo), heavy cardio and resistance training daily, prescription phentermine, etc. I tend to put my all -so to speak- into losing weight and then fairly quickly get burned out and stop altogether. Often times, gaining more than I originally lost on the upswing. I am not diagnosed with depression though I recognize the symptoms and I know that it is something that I deal with as do a lot of other obese people.

I had a very close friend of mine get the VSG surgery back in 2011. At the time, we were similar in size. I watched her quickly lose all of her weight with what seemed to be little effort. She has managed to keep all of the weight off without "dieting" or extreme exercise - just healthy eating and moderate exercise. Since then, I have had a few other friends have the surgery and also be successful.

A couple of weeks ago, I decided I would look into getting this surgery myself. I have spent hours researching, watching YouTube videos, reading forums, and just generally absorbing as much information as possible. I met with my PCP 2 weeks ago to see what he thought on bariatric surgery. He basically told me that I didn't need it. He only recommended it for patients that were house-bound due to their weight. He told me that it's a marketing ploy and that it doesn't treat the root cause of obesity which causes most patients to gain 80-100% of the weight back after 5+ years. He gave me a fitness and diet regimen to follow and sent me on my way. Obviously, I was not satisfied with this answer because I have been dieting for years and I am still freaking obese!

I have only discussed the idea of surgery with my parents and one friend who has had the surgery. My mom is supportive of whatever decision I make, but my stepdad says that I just need to eat healthy and exercise. I don't think I will be telling anyone else because people who have not had weight issues don't seem to understand what it is like and view surgery as an easy way out. I am in no way expecting to lose and/or maintain the loss without some form of exercise and healthy eating and I am fully prepared to do so. It is just so devastatingly difficult to get to that point of maintenance.

So today, I contacted the surgeon that performed one of my friends surgeries for an initial consult on 9/21. I called my insurance provider (Anthem BCBS of TX) and they gave me the expected requirements for "approval" which includes a 6 month supervised diet and fitness regimen and I must have a minimum BMI of 40. Over the course of these 6 months, if I lose more than 14 lbs, I will be ineligible for the surgery. My deductible is $2600 and then I am responsible for 20% of the cost of the surgery.

I am not really considering going to Mexico because I don't want to be in a situation where I cannot follow up with my surgeon if any issues arise, God forbid. I realize that it will be slightly cheaper out of pocket and I won't have to wait as long or jump through as many hoops, but the risk doesn't seem worth it to me.

Thanks for reading would appreciate any advice on what to do regarding my insurance.

[Thinside 155]

@@J.lynn My insurance also required a 6-month supervised weight loss program. Then realized that I had been on phentermine under my doctor's supervision for more than 6 months. I was able to document that with a letter from the doctor's office and copies of my prescription records from Walgreens (which will give you a print out on written request). In addition, I submitted two years' of food logs and weight records from Sparkpeople, a letter from a weight loss residency program I attended for two weeks, and Jenny Craig and Weight Watcher's receipts from my credit cards. I was approved without the 6 months supervised diet.

[Nurse_Lenora 903]

First off, welcome to the journey!

this is a decision you must make for yourself regardless of who is or is not suportive.

As for insurance, follow their requirements to the letter and you should have no problems getting approved! Your surgeons office will be a huge help in that arena so dont forget to ask for their help.

Good luck! Im in the process of doing my 6 months of supervised now and altthough it seems like forever its going quickly! Also, after you see the surgeon try to schedule any other appointments or tests required ASAP so you are not scrambling right before surgery to make an appointment for say Cardiology that may take a month for you to get an appointment and it delays surgery.

[J.lynn 50]

Thanks for responding Thinside. I wasn't taking phentermine for very long. I was on it for 2 months straight, stopped during the 3rd month. I was having Migraines and issues sleeping on that drug. I was experiencing difficulty formulating sentences, often times I would mix up words and not make any sense. Also, I drink a ton of Water and only occasionally drink a diet soda (maybe 2-3 per week). That is one thing I have learned from yo-yo dieting - don't drink your calories!! That said, no amount of Water could satiate the thirst and dry mouth I had. It was horrible. Needless to say, I flushed the remaining pills and never went back to that clinic. In hindsight, I think the dosage was too high. Other than that, I don't have any kind of medically documented record of my dieting.

My concern is that I will spend the next 6 months trying not to gain weight but also not lose because then I would be ineligible. I am going to pull up a copy of the requirements on the Internet to make sure I have everything correct because my case worker covered everything in about 20 minutes and I certainly do not want to miss anything. I am hoping that there is no provision that you must lose a certain amount of weight during the 6 month non-surgical fitness program. If it is just a matter of maintaining my weight, I should be ok!

Good luck to you nurse_lenora thanks for the info. I am so glad that this website exists.

Edited September 9, 2015 by J.lynn

[Thinside 155]

I hated Phentermine too. I took only half a dose, every other day. But nevertheless I had sufficient records to get approved, so in the end it was worth it.

I was also worried about falling below the qualifying BMI/weight, which was borderline. I didn't lose much before the approval came through -- my insurance coordinator told me not to. I sweated all of this stuff, but it all worked out, and I'm sure it will for you, too!

[J.lynn 50]

Thanks for the positivity! It means a lot. I tend to worry about things too much and psych myself out. I still have a while to go and if it is meant to happen, it will.

[newmebithebypass 713]

im on the 6 month diet program as well although i have a bmi of 50 with 3 comorbities so i qualify overwhelmingly i know it seems daunting all the hoops you have to jump through but it will be worth it