How to Get a Gastric Sleeve with Low BMI - Where to Go, How to Convince Doctors I Need It

[Salazar 2]

Hi Folks,

I am new to the forum, but have gotten a lot of good information over the years from you folks, so thank you! A bit about me, I am a corporate attorney in the D.C. market (I live in northern VA), an author, an avid outdoorsman, a husband in about as perfect a marriage as I could dream existed (I got together with my wife when we were teenagers), and the dad of an adorable toddler. I have finally settled on a gastric sleeve as the right surgery for me, but I have been quite disappointed to learn that insurance will not likely pay for the procedure, and at least at the first level of contact at different institutions that perform such surgeries tell me that they will not likely even consider me, even if I pay out of pocket, which I am quite prepared to do.

My BMI is right now at 30, and although I know this is not as high as is generally the case for bariatric surgery, I have made Herculean efforts to lose and maintain a good weight for the past 14 years (since I was 16), and no matter how hard I tried, nothing worked. I was a high school athlete (football, lacrosse, daily weightlifting), and am used to pursuing physical goals in a very disciplined way. Some examples of ways I have tried to lose weight have been running 28 miles per week, extreme dieting, even bulimia, and basically my body just seems to want to be between 210 and 230lbs, regardless of what I do. I still lift freeweights every day, hike, fish, and do lots of physical activities. My mind boggles that I have such high physical endurance and strength - I am, if anything, more athletically able now than I was as a high school tight end/linebacker - and still cannot get down to what is considered a health weight. I know that my BMI is partly artificially elevated by the fact that I have been lifting weights since I was 12 and have a very large amount of muscle mass, but I still have a noticeable gut and I know that I will have a healthier future if I can drop about 70lbs.

My goal for weight loss is not to look great like I did at 15 again - my awesome wife is very supportive of me and met and fell in love with me when I was 19, so she has never seen me at my trim, 6'1 165 figure from high school football - but to decrease my risk of obesity-related illnesses. For that reason, I want to get moving on this as quickly as possible. I have researched and tried weight loss procedures, including reading all the scholarly articles I could find on bariatric surgery since I was 24, and I think that now, while my blood pressure, cholesterol, and heart rate are all excellent, is the best time to slim down, as it is harder to correct these health problems once they start than it is to head them off.

I am particularly hoping to hear from folks on where they went and how they went about getting a gastric sleeve done when they were below the 35-required BMI. I do have sleep apnea (I've had it since I had a BMI of 22, so it is not obesity-related), so I would be able to get insurance coverage if I got to 35, but I do not feel like gaining 40 pounds in order to qualify for a surgery I can easily afford out of pocket. I know that Mexico and Brazil are options a lot of people use due to their low cost, but my wife really wants me to spend the extra money and get it done in-country.

For those of you that have gone the foreign route, what were your experiences with it, and is there anyone in particular you would recommend? For those who have had it done in this country, are their doctors or clinics around that are willing to hear you out and accept that you have made the decision that you need it? I understand that doctors have to be gatekeepers for people who want this kind of thing for a vanity goal on a whim, but I have been dieting, exercising, meeting doctors and nutritionists, and researching all possible weight loss methods for 14 years, and now that I have decided on a gastric sleeve, I do not want someone to patronize me or condescend to me. I hope to find a doctor who will listen to me, then take my money, and cut off part of my stomach!

Thanks again, and I look forward to hearing your thoughts.

[kakatlady612 1,053]

Welcome Salazar. I flatter myself that I have all the answers since I'm probably the oldest chronologically on Bariatric Pal. I am actually 72, nearly old enough to date Methuselah. Now there has got to be someone in the whole Delmarva that would take your case. Let's take it out a little bit, i know you're in Northern Va, try maybe the Maryland suburbs. I know there's someone in Prince George county on here. If I remember her name I'll let you know. Golly,most,of us worry about insurance. comorbities, here you are money in hand and still having trouble., it does boggle the mind.Hey I noticed on my tablet one of the highlighted surgeons today was Dr Masoud Resvani in W oodbridge Va. Did you try him? Just wondering. I will be having a RnY in early-mid March , date is still labile at this time. All my prerequirements are done just waiting for a date from my surgeon. I will,have,my surgery at Mount Carmel in Columbus Ohio. I'm so grateful,they don't think I'm too old, many programs won't touch anyone over 60. I have low bp, no diabetes,,no cholesterol and a proper motivation. I am in it to win it just like all the younger people.

.

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[Apple203 1,314]

Is 165 a reasonable goal with your height and muscle mass? I know how maddening the struggle is to lose weight, but you are very close to an ideal weight now. My husband (also 6'1") has a very lean frame and 190 sits well on him.

Edited February 6, 2018 by Apple203

[KimTriesRNY 1,853]

In some people that are very muscular BMI is not the best indicator of a healthy body weight.

You may have to really shop around to look for a surgeon willing to operate because if something were to happen to you, would he or she perhaps be scrutinized as to why they were performing a bariatric procedure on a non bariatric patient? Is it ethically frowned upon by other surgeons to do this? I do not know the answer to this.

I hope you find the solution you are looking for and let us know. We all know how frustrating it is to battle our weight.

[Msdooloo 102]

I can't get over 28 miles a week and also an attorney. When do you have the time??? From a psychologist view I think part of your eating disorder is playing the part but to each their own struggle. I don't even know if MX will approve you but it's worth a shot?

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[PrupleSleeve 15]

Good Evening.

I was looking at/working with Virginia Bariatric in Reston with a BMI of about 35. They were willing to do mine as I was "self pay". They hinted at appx $18,000. I opted out and am scheduled in March in Tijuana with Dr. Illan.

Like you, I didn't want to gain weight just to be approved.

There is a form on Bariatric Pal website you can fill out to see if you would be approved, if interested.

[Apple203 1,314]

@Salazar Since you are in the region, Johns Hopkins offers a concierge ESG for lower BMI patients that you could consider.

[GassyGurl 428]

Here is my experience. I was borderline 35 bmi, for the past 5 years. Most Dr's required an online questionnaire about medical history, so I used my highest weight. No one requested medical records as proof. Once I started the process, I started doing shakes, and was 32.7 Bmi the day of surgery.

I did need medical clearance from my PCP for surgery. I don't know if she would have supported me had I not been obese. Out of the 4 surgeons I had consults with, no one had any issues with my 32/33 Bmi.

there are folks have struggled with bmi in the 32 to 35 range that have surgery and do very well. I think having the history of obesity is part of the key.

If you search for lightweight you might find some more info. Or low bmi.

I used Dr Taggar in Coral Springs, FL and was thrilled with the experience. If you can't get clearance from your PCP, I think Mexico is your best bet.

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[elforman 234]

My question is how you settled on the sleeve as the best option for you. Have you consulted any doctors for their advice on how you can reach your goals other than sleeve surgery? There are many reasons it's normally only approved for people with a much higher BMI. It certainly doesn't sound like your health is in danger so I really get the idea that the sleeve is not for you and that you should be exploring other avenues with a professional.

[KatFight 207]

Hi Salazar. You clearly have made attempts at weight loss and aren't where you'd prefer to be. I can relate with you there.

You may know that a nutritional plan is followed as part of the Bariatric (autocorrect keeps capitalizing) process. Many patients who could not lose weight with other attempts do lose on this plan. It's going to sound super-obvious...for me, the goal was to get 80-90 grams of Protein, 64 oz. or more Fluid, 1/2 c. whole grain, 1/2 c. veg/fruit (veg preferable to fruit), and no sugar. Even when I've followed high protein/low carb, my protein goals were not THAT high (and I didn't know that they "should" be). I did lose some weight - in 2 1/2 months I lost 16 pounds.

Perhaps it's worth trying a Bariatric food plan?

Like you, my husband is 6'1" but he weighs 256 lbs. He is currently trying to lose weight as well. His goal: 210 lbs. Everyone has different goals but his happens to be the lower end of your current weight. Doctors have said no to you for a reason. There's nothing you can do to "convince" most doctors to do surgery on you. You simply are not obese.

I applaud your thought regarding not gaining so that a doctor may be compelled to perform your surgery. Many doctors, even most, are not likely to perform your surgery since you have no co-morbities and will still have a relatively low BMI.

A few of the responses you rec'd gave suggestions of where to go to seek surgery. Wherever your next step leads, I wish you great success. [emoji458]

[KatFight 207]

Hi Salazar. You clearly have made attempts at weight loss and aren't where you'd prefer to be. I can relate with you there.

You may know that a nutritional plan is followed as part of the Bariatric (autocorrect keeps capitalizing) process. Many patients who could not lose weight with other attempts do lose on this plan. It's going to sound super-obvious...for me, the goal was to get 80-90 grams of Protein, 64 oz. or more Fluid, 1/2 c. whole grain, 1/2 c. veg/fruit (veg preferable to fruit), and no sugar. Even when I've followed high protein/low carb, my protein goals were not THAT high (and I didn't know that they "should" be). I did lose some weight - in 2 1/2 months I lost 16 pounds.

Perhaps it's worth trying a Bariatric food plan?

Like you, my husband is 6'1" but he weighs 256 lbs. He is currently trying to lose weight as well. His goal: 210 lbs. Everyone has different goals but his happens to be the lower end of your current weight. Doctors have said no to you for a reason. There's nothing you can do to "convince" most doctors to do surgery on you. You simply are not obese.

I applaud your thought regarding not gaining so that a doctor may be compelled to perform your surgery. Many doctors, even most, are not likely to perform your surgery since you have no co-morbities and will still have a relatively low BMI.

A few of the responses you rec'd gave suggestions of where to go to seek surgery. Wherever your next step leads, I wish you great success. [emoji458]

[KatFight 207]

Oops. Sent it twice.

[Salazar 2]

Thanks for the great advice, everyone! I figure I can clarify a bit; I don't currently run 28 miles per day (I barely have an hour to myself on an average weekday, and that is part of the problem), and I have tried plenty of diets, ranging from tame to extreme. It has become obvious time and again that when I am on a diet that is strict enough for me to consistently lose weight, I am so miserably hungry all the time that within a few weeks I am quite sure I no longer wish to be alive if I have to feel as starved and miserable as I do on those diets.

Also, I am married into a big, traditional Chinese family (I am a Chinese-speaking white guy, and only my wife in our family speaks English), and it is absolutely impossible to overstate to someone who is not from rural China just how important food is to people there. Where my wife was born and in her family, food is not everything, it is the only thing. To show your family members love and affection, you do not hug them or tell them how much they mean to you, you cook for them and they are obligated to eat it. You do not engage in intellectual discussions of current events or history with your family; you eat with them with the only topic of conversation being how much money you made that day and what you think of the food.

I am able to be part of this culture (I use Chinese at home and basically live a Chinese life outside of work, despite being a country boy from the South) and just eat very small amounts of the food that is so critical to the cultural existence of my wife's family, but it makes it that much more difficult to diet when food is a topic that is given such importance and discussed constantly. Also, it sure does not help that my wife can eat massive amounts of whatever she wants, and yet in the 10 years we've been together, she has stayed between 110 and 120 pounds, with a height of 5' 6". It is obviously very nice to be married to someone so stunningly and effortlessly attractive and thin, but it is maddening that I have to be so careful with what I eat and still be on the overweight-obese borderline, while my wife can stuff her face and still look like a model. Heck, she only gained 15 pounds in her pregnancy, and within a week of giving birth she was 10 pounds lighter than when her pregnancy began!

I have actually never been denied by a doctor, and I do have 1 co-morbidity factor; the pretty severe sleep apnea, although I was diagnosed with that at 14, when I was no-kidding 118lbs at my current height of 6' 1"!

[Megan007 2]

I would strongly suggest Tijuana, Mexico. I had a very successful surgery there, and so have all the people I not only sent there, but those I met while having my surgery there. My BMI was also not overly high (I think it was a 33). The price was affordable and a small fraction of what it would cost in Canada (about 1/5 the cost), not that I would have even been approved.

I wish you much luck!

[KatFight 207]

My apologies for misunderstanding. You mentioned in your earlier post that at thefirst level of contact it was unlikely that the places you contacted would perform your surgery even if it was self-pay. I wrongly assumed you called some Bariatric programs and perhaps saw a doctor(s).

You also mentioned that your sleep apnea is not obesity related - that's why I'm unsure if it would actually be a positive factor. You also mentioned that your BMI may be "artificially elevated" due to lifting weights for so long. Everything considered, I gave you my honest point of view.

Being on the line between overweight/obesity is extremely frustrating and I know how that feels. I was on that train on my way to being severely morbidly obese. I got here in spite of all of my diets and going to the gym. So, obviously you want to get off the train before it reaches its final destination - severe obesity. You'll find a way. Wishing you well. (Oh, and thanks for clarifying. You are very detailed and write well - I assumed you had contacted a Bariatric center/doctor, Sorry. You know what they say about "