[Fishbowl]

My current BMI is 35 and I have high blood pressure and gout because of the excessive weight. I believe WLS surgery is the right course of action and my insurance plan will cover most of the cost. However, there is a precondition in the plan that I have to go through a physician monitored diet. It's not clear to me what this is and I have some other nagging questions that I hope the community will help me answer.

1. What does the physician monitored diet entail and what is the purpose?

2. Do most general practitioners (family doctors) agree to WLS for the morbidly obese? Keep in mind this is a new doctor, I've recently relocated to a different state.

3. What is the typical time frame between a doctor consenting to WLS then to the point of surgery?

[duckyyellowfeet]

Welcome

So if there is anything I've learned from WLS, its that different surgeons and surgery centers do things differently... and I think answers will really vary person by person. But here is my experience:

1) I had to lose 20 lbs before surgery. My surgery center gave me a "suggested diet" list, but it boiled down to 60 grams of protein, 1200 calories a day. I think other people have had to do programs like Medifast or Optifast before hand, which is much more restrictive and medically supervised.

2) My GP send me right over to surgery. I went through two very quickly-- I choose a new one to get my referral and by the time I wanted to move forward in the process, the original one had left. Both doctors referred me to surgery without much discussion.

3) I started in August of 2013. I went to a pre-surgery informational session. Then, I halted the process until early March 2014 because I wanted to be completely sure I was ready. My GP sent the referral to the surgery center, they called me within 24 hours and I went to the second surgery session 2 days later. From there, getting through psych, nutrition and a one-on-one meeting with my surgeon took about a month-- and I had surgery on June 10th. It could have gone faster, but I teach, so getting time off is difficult and I had to wait until summer to have surgery. It can also take longer depending on how fast you can lose weight and how quickly you can schedule appointments. I was told 3 months to a year was common.

The best advice I can give is to ask lots of questions, get a lot of information and make the best choice you can for yourself.

[jiffypop]

Some of our Canadian members can give you insight to the differences from one province to another, but in general, that supervised physician diet is also a 'test' to see if you can stick to something and can follow directions. It doesn't really matter how much you lose on the plan. But, as ducky pointed out, you have to lose SOMETHING because it makes the surgery easier, and reduces the fatty liver in case you have one.

most of us want to have the surgery NOW, as soon as we've jumped through the insurance hoops. but consider this: in order to make surgery work for you over your lifetime, you'll need to make major changes in how you look at food and in how you deal with your emotions. If you use the waiting time and hoop-jumping time to work on this, you'll be that much farther ahead when you get your surgery.

And the amount of time between the surgeon saying you're ready and the actual surgery also depends on your insurance company and the doc's schedule. Up to a year is possible, but some have had surgery within a couple of weeks. All excellent questions to discuss with your surgeon.

keep asking Qs. And which form of surgery are you considering? your surgeon will chime in here as well -

[Fishbowl]

Thanks guys for the great advice. I'm favoring the sleeve gastrectomy at the moment as it seems to be safer than WLS involving the removal of the small intestine. The recovery time is faster also which is important to me.

The one nagging concern that I have is that I may not be technically morbidly obese at a BMI of 35. The insurance defines morbid obesity at 40. But I do have some major problems related to my obesity such as gout and high blood pressure. I'll see the doctor and find out I guess.

[seabiscuit]

Hi Fishbowl,

I recently went to a WLS info session and it was very informative. For this particular center, they say that insurance requires a BMI of 40 or above, or if you have a co existing condition such as high blood pressure, your BMI requirement for the surgery may be 35 or above??? Don't quote me, I'm not sure. Good luck and I say go to the info session, you may get a lot of your questions answered.

Take care!

Amy

[Fishbowl]

Thanks seabiscuit for the info!

[Iwanawurkit]

sleep apnea is also considered life threatening here in the states and they said I may have to tested since I was one of those with under 40 BMI. I didn't have to be tested so I guess other medical conditions pushed me forward.

[Fishbowl]

Does anyone know why depression is considered a comorbidity and yet the insurance may count that AGAINST as a candidate for bariatric surgery?

I weight causes social stigma that has led to depression for me. I wonder why this would make me a bad candidate for surgery.

[jiffypop]

Is that what happened to you? I'm not sure AT ALL what's going on with this, but here are a few ideas -

because depression is often considered treatable without WLS, the insurance company might want to see it as being under control before surgery.

people who are depressed MIGHT [and i'm not saying this applies to everyone] have trouble managing post-op life.

people who have depression might perhaps look at the WLS as the cure-all for their depression, and it's not - not really. trust me, it helps A LOT, but depression is not only a reaction to outside forces, but also a neurochemical glitch that's not necessarily related to those outside forces.

for your particular case, perhaps a chat with your doc, and maybe even with the insurance company, might be in order.