Kaiser Sacramento PCP won't consider referring me for WLS

[khoktzen 2]

Greetings everyone!

I have been tirelessly researching forums regarding Kaiser Northern CA and finally decided to write a post and ask for advice. I have been pretty overweight for the last 10-12 years. I have hovered between 190-200 and am 5'2". My BMI has consistently been just above 35. In 2013 I asked my PCP provider about weight loss surgery. She said that I didn't qualify as I don't weigh enough or have enough comorbities. She then said that I could consider the medical weight loss program but if I was planning on having children any time soon there "was no point." Being that I wanted to get to a a healthier weight prior to having children I ignored her advice and tried the Kaiser medical weight loss program anyways. I got down to about 182, got pregnant, was very careful during pregnancy and didn't gain a lot of weight at all. My daughter is now two and my weight has slowly crept back up to about 195. I asked my dr again about weight loss surgery and if there were any possible comorbities I might have that coupled with my 35 bmi might make be eligible for surgery. Again she said no and that I just need to diet and excercise. I explained that I follow a very strict 1200-1400 cal diet that is very well balanced, walk 13k-15k steps a day and do cardio/swimming 3 times a week. I am very frustrated and truly believe I have adopted a much more healthy and active lifestyle and feel weight loss surgery would be a valuable extra tool to help with weight loss. I filed a grievance last December and Kaiser sided with my PCP and reiterated that I'm not eligible. So, my question is, should I contact my dr again and ask to have a sleep evaluation done? My husband has mentioned that my snoring is getting worse and I always feel very tired when I wake up and a lot of the time I gave headaches. OR should I try to get a different PCP at Kaiser in Sacramento? I'm just not sure what to do. Does anyone have a recommendation for a Sacramento area PCP that is more supportive of obese patients trying to utilize weight loss surgery as a helpful tool to be healthy?? Or should I drop Kaiser altogether and switch to a different plan like Sutter in Sacramento? (I work for the state of CA and have callers health insurance) help!!!

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Edited September 24, 2016 by khoktzen

[laceemouse 631]

If one co-morbidity would get you approved then go ahead and ask for the sleep study.

Do you plan to have more children? I hate to say it but honestly I would probably get done with having kids before WLS if it were me, unless my weight was making it impossible for me to conceive or have a healthy pregnancy but they doesn't seem like the case with you.

I had 4 kids in 6 years back in the '90's. I was normal weight when I started, I gained a lot the first pregnancy but not nearly as much the other 3 times. Every time I was a higher starting weight and never got all the pregnancy weight off. I was starving when I was pregnant and starving when I was nursing (basically, I was starving the entire decade!)

I was never heavy enough in those days, or had any other health problems, so I didn't even consider WLS. I was mildly successful with Weight Watchers a couple of times but always gained it back.

I know many people go on to have healthy pregnancies after WLS but I would be so concerned about getting enough nutrition without gaining too much. I know someone pregnant with twins after WLS and she is struggling to get enough calories in to ensure a healthy pregnancy. Just something to think about.

Also, when I was born my brothers were teens and my sister was 9. I love them but honestly feel like we aren't even in the same family. My kids are all close in age and best friends with each other. I wouldn't have it any other way personally! After WLS you should wait at least a year to get pregnant, keep that in mind as well. How much of a gap in age do you want between your kids (assuming you want more)?

I do have to say my PCP is not in favor of me having WLS. Thankfully with BCBS Texas she doesn't have to be! If I don't get approved for some reason I will consider self pay, maybe even Mexico. Have you looked into other options?

Anyway, just my two cents.

[gowalking 10,790]

I can't help you with a recommendation as I am no where near your area...but I can say that you need a supportive PCP immediately. This doctor is wrong wrong wrong about WLS.

Telling you to 'eat right and exercise' is the same as having someone tell you to just 'walk away' from the table. That's so NOT helpful and it's more than that. At best, it's condescending and to me, I'd say she is potentially doing you harm by not having your best interests at heart and instead is showing her own ignorance and prejudice.

Stupid doctor....

[khoktzen 2]

Update: I requested a sleep study because I let my PCP know I have concerns about sleep apnea and she referred me right away. I'm doing the study tonight at home and hopefully I'll get the results rather quickly. I just assume that I have mild sleep apnea and Kaiser will said it needs to be severe for it to be a comorbity. It's sad I'm hoping I have it so I qualify!!

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[erp 2,016]

If you do not end up having apnea, you need to read what Sutter's requirements are or you may not qualify with them either. My program required a BMI of 40.

[EventHorizon 4]

I had the same issue with Kaiser, I've decided to self pay.

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