Conflicting info - losing/gaining weight before surgery

[WitchySar 244]

I've heard some conflicting info and would like to hear from some people who have maybe gone through this. I know that some (most?) insurances require a medically supervised diet before surgery, usually about 6 months. I know mine does. The conflicting info I've heard though is regarding losing or gaining weight during that time. Some people I've heard from said they were told they couldn't get the surgery unless they lost weight on the diet, but I've also heard that if you gained weight on the diet it would make it more likely to get the surgery approved since it shows that regular diets don't work. I can see it both ways... one way they want to see proof that you can make changes and losing weight shows that, but the other way proves that regular diets don't work and the surgery is your best option. Maybe it depends on the insurance? I'm just concerned because I don't know what kind of diet the nutritionist is going to want to put me on. My primary is a strong advocate for going vegetarian but that makes me gain weight. The only way I've ever had luck losing weight is when I followed very strict low carb but I don't know if the nutritionist will agree to a low carb diet for me. Last time I saw a nutritionist was, oh god, almost 20 years ago and of course low fat low calorie was the suggestion. I've tried so many diets over the years, I gain weight on nearly all of them, even when following perfectly. Needless to say, I'm nervous about this.

I talk to my primary tomorrow to start the ball rolling so I haven't seen a surgeon or nutritionist yet. Just was thinking about that tonight and figured I'd ask.

[Shaydi.Laine 237]

Most are on a low carb, high Protein plan after surgery, so I doubt anyone will tell you not to go low carb. My program required a 10% loss of excess body weight, no one told me how I HAD to get there. I just told my nut what i was doing and she wrote it down. Low carb for me ☺ all the way.

[WitchySar 244]

Would your surgery have been denied if you weren't able to lose that much weight? At my weight a 10% loss is significant. I'm worried what will happen if I don't lose. I'm on Medicaid and the requirements just say a supervised weight loss program is required for 6 months, it doesn't say what will happen if you don't lose.

[Harsha 168]

My insurance didn't require weight loss pre-surgery. I just made a few changes though to help me, for example I started drinking my Protein shakes months earlier for Breakfast.

Sent from my SM-G925V using the BariatricPal App

[James Marusek 5,244]

My insurance required that I enter a 6 month medically supervised weight loss and exercise program. In the program I kept a journal of what I ate and met with a nutritionist/doctor once per month and went over my diet and exercise. Monthly weigh-ins. I was also advised to go to monthly Bariatric Surgery group meetings. I received a signed form at each of these that showed I attended. I lost 20 pounds during the process, primarily by giving up my 6 diet coke a day habit. My nutritionist/doctor then wrote a letter stating my progress and this went to the surgeon's office who then wrote a letter recommending my surgery.

I did not have a set weight loss requirement to qualify for insurance. Obviously gaining weight during this period would set off some alarm bells. Watching "My 600 pound life" which is a TV series about individuals undergoing bariatric surgery, those that are very heavy seem to have a set weight loss amount pre-surgery by THEIR SURGEON. I think this is because they need to prove to the surgeon that they have the capacity to lose the weight and maintain the weight loss after surgery. It may also have to do with the fact that too much fat may make it difficult to perform the operation (no working room). Some individuals who do not need this 6 month diet and exercise program to qualify for insurance undergo a liver shrink diet for the same reason.

[Bufflehead 6,358]

You need to get the requirements directly from your insurance company. My insurance plan required that I be on a supervised weight loss program for six months pre-op and that I FAIL in my weight loss attempts. If I lost more than 10% of my excess weight I would have been denied. But other insurance plans require that you succeed in losing weight. So no one here can really tell you what your insurance says -- check with yours and be sure to get their answer in writing. Good luck!

[KristenLe 5,979]

It also depends on your BMI and the surgeon too. Many surgeon's require weight loss before surgery (often 10%). You need to ask the Bariatric Team what the goal of the medically supervised program is. Some plans will waive it with a high BMI.

[Jorge Mope 1]

I've heard some conflicting info and would like to hear from some people who have maybe gone through this. I know that some (most?) insurances require a medically supervised diet before surgery, usually about 6 months. I know mine does. The conflicting info I've heard though is regarding losing or gaining weight during that time. Some people I've heard from said they were told they couldn't get the surgery unless they lost weight on the diet, but I've also heard that if you gained weight on the diet it would make it more likely to get the surgery approved since it shows that regular diets don't work. I can see it both ways... one way they want to see proof that you can make changes and losing weight shows that, but the other way proves that regular diets don't work and the surgery is your best option. Maybe it depends on the insurance? I'm just concerned because I don't know what kind of diet the nutritionist is going to want to put me on. My primary is a strong advocate for going vegetarian but that makes me gain weight. The only way I've ever had luck losing weight is when I followed very strict low carb but I don't know if the nutritionist will agree to a low carb diet for me. Last time I saw a nutritionist was, oh god, almost 20 years ago and of course low fat low calorie was the suggestion. I've tried so many diets over the years, I gain weight on nearly all of them, even when following perfectly. Needless to say, I'm nervous about this.

I talk to my primary tomorrow to start the ball rolling so I haven't seen a surgeon or nutritionist yet. Just was thinking about that tonight and figured I'd ask.

Edited June 8, 2016 by Kim Sampsill

[Jorge Mope 1]

My diets were Atkins x 2 HGC and the dr prescribed belviq for me once. all failed since 2012. I was approved.

[WitchySar 244]

Thanks for the info. It's really frustrating how different it can be from insurance to insurance and surgeon to surgeon. My insurance doesn't seem to list a requirement to gain or lose, just have to be on the medically supervised diet for 6 months. If they have a preference beyond that they don't make that info available. Hopefully my doctor will know.

[WLSResources/ClothingExch 3,444]

I've heard... I've heard though...Some people I've heard from...I've also heard... Maybe it depends on the insurance? I'm just concerned because I don't know what kind of diet the nutritionist is going to want to put me on. My primary is a strong advocate for going vegetarian but that makes me gain weight.... Needless to say, I'm nervous about this...figured I'd ask

Do you see a pattern here? Maybe it does depend on the insurance and, if so, it may be your own plan's requirements upon whicith it depends. It may be the RD (I hope not a nutritionist) at your chosen bariatric practice who will inform you of the prescribed food plan(s) and with whom you can bargain for something more to your liking.

Based on the information you provide, you may do well to have broad discussions with the RD, as you suggest knowing almost nothing about nutrition and weight loss. To gain weight as a vegetarian is possible, especially if you coat and fry everything, pile on pounds of cheese and lean toward the starches.

You'll save a lot of nervousness -- and time -- if you present the questions to the proper sources. Compiling a list of requirements of 10 other insurance companies, for example, may very well shed no light on yours.

When I feel overwhelmed by a large project, I regain my confidence and capability when I compile a list of tasks and questions all in logical sequence.

P.S. My own insurance company is staffed by idiots on the front line and, as it's worsened in the past couple of years, it becomes clear that this is deliberate on the part of management. The person in your bariatric practice who handles insurance applications will/should be a reliable resource.

Edited June 8, 2016 by WLSResources/ClothingExch

[beggingtobehealthy 97]

Mine was i just couldn't weigh more than when I started

Sent from my XT1585 using the BariatricPal App

[jennmonterrozo 139]

My insurance requires either 6 month medically supervised diet (no specified amount of loss) or 3 months with an RD. Of course I chose the 3 month option. Both options require no net gain.

Sent from my iPhone using the BariatricPal App

[Jorge Mope 1]

Thanks for the info. It's really frustrating how different it can be from insurance to insurance and surgeon to surgeon. My insurance doesn't seem to list a requirement to gain or lose, just have to be on the medically supervised diet for 6 months. If they have a preference beyond that they don't make that info available. Hopefully my doctor will know.

Belviq is great. I don't know if you have seen the commercials on TV. I did loose a lot of weight on it. About 20 lbs in 2 months. Then I couldnt afford it anymore. My insurance wouldn't pay for it.

[HanSolo1977 261]

Mine was i just couldn't weigh more than when I started

Sent from my XT1585 using the BariatricPal App

This is the same in my program. They also require regular dietician visits, a psych eval, and attend the support group at least once. My insurance company required I get 15 minute phone calls every two weeks.