Help! What needs to be accomplished in 6 month pre-op plan?

[timmytommy 9]

I currently have a BMI of 36.5 with comorbidities. I have to follow the 6 month pre-op diet as part of the bariatric program. My question is: what if I lose too much weight during this phase and fall below 35 BMI? Will this exclude me from surgery? I know I can be successful at a 6 month diet, but past experience has proven that I will gain that weight back. Any feedback is welcome!

[ColieCallwell 129]

I'm in the same boat as you. My BMI is 35.5 with a comorbidity (sleep apnea). I met with my surgeon last week. My insurance requires about 4 months of classes, etc. My surgeon told me not to lose any weight during that time or I could un-qualify myself. She told me not to go and lose 10 lbs on her during this time. I'm considering self pay just so I don't have to worry about it AND not lose weight for the next 4 months. I'm ready to get my life back. Of course since I'm not supposed to lose weight, I've lost 3 lbs. [emoji52]

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[timmytommy 9]

7 hours ago, ColieCallwell said:

I'm ready to get my life back. Of course since I'm not supposed to lose weight, I've lost 3 lbs.

Oh, the irony.

[DoodlesMom 98]

timmytommy, ColieCallwell, I'm surprised you wouldn't be approved if you lost too much weight durring the process. I thought insurance used your starting weight for approval. This just proves how everyone's path to surgery and requirements are different.

timmytommy, what you'll need to accomplish during your six-month pre-op depends on what your insurance requires and what your doctor/ surgeon wants/needs to prove that you're physically and mentally ready for surgery. You may be required to do the following:

• Begin a medical weight loss program
• Lose weight
• Have psychological evaluation
• See a registered dietician (RD)
• See an exercise therapist or get on an exercise plan
• Attend a support group for bariatric patients
• Reduce soda/ alcohol
• Stop smoking/ using tobacco products
• Make dietary changes
• Increase Protein
• Start a vitamin/ Supplement routine
• sleep studies/ Maintain CPAP/BiPAP compliance
• Labs/ Tests: blood panel for CBC, thyroid function, B12, HgbA1--for prediabetes/diabetes, other Vitamins
• EKG/ cardiac stress test
• EDG (esophagogastroduodenoscopy)

Good luck!

Edited July 11, 2021 by DoodlesMom

[ColieCallwell 129]

Yep. You can contact your insurance company and they should be able to tell you the requirements for the surgery. My husband had RNY in December 2020, and he was recommended this surgeon by the insurance company. I'm using the same surgeon, but having the sleeve. For my insurance (BCBS) I have to:

- Attend a WLS informational seminar before I could schedule an appointment with the surgeon. This was put on by the surgeon via Zoom. They scheduled this for me when I called to start the process. I think they do these once a month at her office.

-Meet with the surgeon, (I ate a huge lunch before I went in hopes of ensuring my BMI was high enough to qualify, lol. It worked).

-Attend a diet and nutrition class led by the surgeon, (this was 1 hour by Zoom). She explained the post op diets and what was allowed/not allowed after surgery. She mostly does not require the pre-op liquid diet...only for those with tight abdomens who need to shrink their liver so she can more easily access the stomach.

-Attend 1x per month for 3 months meeting with a nutritionist where I show *some* weight loss at each meeting. I didn't ask what happens if I gain. My husband did this during 2020 and said it was all via Zoom - they just asked him what his weight was, and he told them he lost a pound or two. He didn't get on a scale, but he ultimately lost weight between his 1st appointment and surgery date.

-Psychological evaluation, (my surgeon's office uses a service where you can schedule this via telehealth for anytime of day).

-Lab work

-Chest xray

They scheduled me for all these appointments in my first meeting with the surgeon. So far, my pre-op appointment is scheduled for 9/29, so hopefully my surgery will be sometime in October. I can only know what my surgeon told me, which specifically was not to lose too much weight, (even 10 lbs) or I could disqualify myself for surgery. I'm just going to be as healthy as possible and if I lose too much weight and get disqualified, I'll self pay.

I hope this is more informational than my last response. Good luck to you!


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[lizonaplane 1,612]

What you will have to do will vary based on surgery center, insurance, and starting BMI, as well as any co-morbidities.

I started in January with a BMI of almost 50 and no co-morbidities, so I have been trying to lose weight, although now that I have had to wait so long (insurance required 4 months of monthly nutrition classes, and now there are delays due to staffing issues and backlogs due to COVID), I've lost 42 Lbs and my BMI is getting to the point where I'll have to stop losing weight.

However, I don't have to have EGD or EKG or sleep study.

I did have to meet with the psychologist and nutritionist a few times and have their sign-off.

[alf17 9]

My insurance required 6 months in a medical weight loss program. I met with the PA and dietician alternating months. I had to have the psych eval and some bloodwork and when the PA felt I was ready I met with the surgeon. I actually met with the surgeon last week Thursday, they sent everything to the insurance for approval, I got an approval letter in the mail on Monday and scheduled my surgery on Tuesday. The whole process was actually pretty easy and seemed to go really fast!

[ShoppGirl 4,799]

It seems to vary by insurance but also by doctor. I didn’t have to do any tests or procedures other than the pre op labs and I had psyc eval and nutritionist meeting but that was all and I had 5 months to do it between my 6 mandatory meetings with the PA at my clinic which satisfied my supervised diet appointments.