pre surgery weight-loss?

Does everyone have to do a pre surgery weight-loss and how do they determine how much you need to loose before surgery?

Short answer:  it depends. You are going to have to check with your insurance policy if you are not self pay and with whatever surgeon you choose.   Some surgeons don't require it.  Some do.

From what I read on the boards, I think it really depends on 1) your insurance company requirements or 2) your surgeon's requirements.  I am presently pre-op , my insurance doesn't require me to lose weight before approval but the surgeon strongly suggested I lose weight to make the surgery easier.  [I had my initial surgery consult on 10/31 and found myself eating far too many "last meals" I knew if I didn't go on a diet  I would actually gain weight before surgery - I've heard of some surgeons who postphone surgeries due to weight gain]

I have read of all different kinds of requirements.  Some had to lose 10% of the their body weight, some 5% - some had to lose some amount determined by the surgeon, some had to lose in order to have their procedure laproscopically.

Hope this helps

My insurance required a six-month Dr. supervised weight loss trial.  I did it and lost about 40 pounds.  In the time that I started the supervision and going for approval, my insurance wrote in an exclusion for the surgery so I was screwed.  My husband went in the AF reserves (was planning on doing it after my son graduated) and Tricare covered it with no supervision only the required BMI and co -morbidities.

I did have 5-day liquid diet to shrink my liver which seems to be pretty consistently required from many doctors since the liver overlaps the stomach and makes the laparoscopic surgery more difficult with a large, fatty liver. 

 ~Namaste~

I think that virtually every surgeon and/or insurance company requires either pre-op weight loss or pre-op weight loss attempts.  I don't think that insurance companies are looking for a specific amount of weight loss; they are concerned only with whether or not you've tried non-surgical treatment for obesity for a specific period of time that can be or has been documented by your PCP. And, it’s important to remember that even if you do fabulously well during your insurance-imposed non-surgical weight loss attempts, you can’t disqualify yourself from eligibility because they will use your starting weight to determine eligibility.  So far as I know, even with surgeons, there's no magic number (in pounds, percentage, or BMI points).  The figure most often heard is 10%, which is significant for people starting with BMI's over 50.  To confuse matters further, you need to know if 10% means 10% of your current weight or 10% of your excess weight.  For example, my high weight was 404 pounds.  Losing 10% of my total weight pre-op would translate into a loss of 40 pounds.  My "ideal" (don’t get me started on those ludicrous charts) weight as a 5'6" woman is 142 pounds which means that my starting excess weight was 262 pounds.  Losing 10% of my excess weight pre-op would translate into a loss of 26 pounds.  Either way, considering that I was self-pay because of an employer imposed insurance exclusion for all obesity treatment regardless of BMI, co-morbidities, etc, I had exactly 49 days from seminar to surgery (32 days from first surgical consult to surgery – the only plus to being self-pay is the significantly decreased time-frame between your decision to have WLS and actually having WLS) to lose 26-40 pounds. 

Your surgeon will tell you how much weight they want you to lose pre-op.  Keep in mind that this pre-op weight loss serves a purpose; it’s meant to shrink your liver so that your surgeon has increased access and mobility in your abdominal cavity for laparoscopic procedures.  Additionally, the pre-op diet also help *you* to prepare for the changes to your eating habits that will be required for life regardless of chosen procedure.  Most surgeons have specific diets that want patients to follow pre-op.  Almost all have a liquid diet that they impose anywhere between 14-3 days pre-op.  Many will have you follow a modified Atkins diet (high protein, extremely low carb & fat) to deliberately put you into ketosis so that your body is forced to use fat for fuel.

Now that I’ve probably confused you, I can tell you that I did lose 40 pounds between 10/01/2008 and 11/19/2008.  From 10/01 to my consult on 10/18, I put myself on a modified Atkins diet that included two meal replacement shakes daily.  After my consult, per my surgeon’s advice, I did 10 days of clear liquids plus 3 30 gram protein shakes daily, 10 days of a modified Atkins diet, and finally his required pre-op diet of 10 days clear liquids plus 3 30 gram protein shakes daily.

I wish you much success on your journey towards a healthier, happier, and longer life!

Amy

Some programs have BMI restrictions.  My operation was done laproscopically and they required me to have a below 60 BMI.  It took me ten months on South Beach to get there, but I made it. 

They are strict...they have never had a death. 

Thank You all that replied. I am just starting the process my 1st appointment is Feb. 26th I have to go to a siminar the day before just to get seen. I am looking to get either DS or the RNY?  I have wanted the surgery sence I was 18 and 100 pounds over but at that time not many doctors were doing it around where I lived.  I am on State Aid for medical so I am not even sure if there is certain hoops I need to jump through or what. My BMI is 64.  I am interested in learning all anyone wants to share.  I do not want the band my cousin had a bad problem with hers a couple of years ago and went into a coma when she was having it put in so I do not want that. 
Our doctors don't do much of anything here so my weight loss attempts are not really documented really that's why I am traveling 6 hours away for better care.

The more you can lose pre-surgery the better. You are not only less of a surgical risk, but there is also more room to "maneuver" of the surgery is LAP.

I also encourage you to start exercise beforehand, even if just chair exercises.

My surgery is covered by medicare. They require a 6-month supervised diet. After that, my doctor asked me to drop enough to have my BMI below 60 (about 25 more lbs.). I have a lung condition and he doesn't want any problems getting me off the respirator after surgery. I am on 2 high protien meal replacement shakes and one low cal, low carb, low fat meal daily. I will have been on an all liquid diet for 1 1/2 weeks when I see my surgeon again in mid February. I am hoping to have the surgery in late February. Good luck to you!        

Thanks to all who has responded. These forums have helped a lot.  I am on medicaid so I am not sure what my state will make me do.  Exercising isn't much of an problem I am an EMT and a Firefighter for our small community.  Most of the last weight gain is from eating once a day but a full dinner at 9:00 at night right before bed. My other problem is my husband thinks this is a unnecessary surgery because he loves me the way I am and doesn't want something to happen to me during the surgery.  I explained to him that I need this and have wanted it for years.  Tomorrow can't be soon enough.  He is getting better with it.  I have a few female EMT's and Firefighters talking to him explaining how healthy I will be when it's done. I go Friday to see if I need a hysterectomy. Thanks again!!

hello i am well on my way to having my surgery and my medical dr. said that the reason for pre op weightloss (10%) will help shrink your liver and to make more room for the surgions to perform there work  good luck and best wishes to all  Dennis