A Couple Of Basic Questions

I know that my insurance is going to require a 6 month supervised diet and I have an appointment with my new PCP at the end of next month. She doesn't know me from Adam (or Eve). So if I go on this diet for 6 months and lose, say 40 lbs. and my BMI is now under 40, then I won't qualify for the surgery. And then in another year or so, I'll be back to where I am now plus some. Is this the game I'm expected to play or what?? I guess my real question is - what is the purpose of the 6 month supervised diet? ~Jan

My insurance requires a 26 week diet. Luckily me, my PCP has a person on staff. She approached the diet as changing eating habits, 6 small meals a day, lots of water and exercise. She was not looking for a large weight loss, just to set me on the road to changes in eating habits. One thing she did stress, eat lots of protein. This helps with healing after surgery. I lost 18 lbs, gain a few back and basically about same. But I did change some of my old eating habits. I do shakes 2X per day, and try to do a bit of protein even with my snacks. My PCP is happy with the changes and hopefully so will my insurance company. I have 3 weeks to go!!!!! Marla

According to the National Institutes of Health, which most insurances use their criteria for determining 'medical necessity,' this is their rationale for six-month nutrition and exercise program prior to surgery: "Weight loss surgery should be reserved for patients in whom efforts at medical therapy have failed and who are suffering from the complications of extreme obesity. The initial goal of weight loss therapy is to reduce body weight by approximately 10 percent from baseline. If this goal is achieved, further weight loss can be attempted, if indicated through further evaluation. A reasonable time line for a 10 percent reduction in body weight is six months of therapy. The rationale for this initial goal is that even moderate weight loss can significantly decrease the severity of obesity-associated risk factors. The combination of a reduced calorie diet and increased physical activity can result in substantial improvements in blood pressure, glucose tolerance, lipid profile and cardiorespiratory fitness. The purpose is also to test patient motivation, to reduce peioperative morbidity, to accustom patients to restriction of food intake and to increase total weight loss. For maximum benefit, dieting should occur proximal to the time of surgery, and not in the remote past to reduce surgical risks and improve outcomes. Even if the patient has not been able to keep weight off long-term with prior dieting, the patient may be able to lose significant weight short-term prior to surgery in order to improve the outcome of the surgery. Not all persons who are obese or who consider themselves overweight are candidates for bariatric surgery. These procedures are not for cosmesis but for prevention of the pathological consequences of morbid obesity. Patients must be committed and adequetaly prepared. Screening of the patients to ensure appropriate selection of candidates is a critical responsibility of the surgeon and the health care team." Pardon any typos! This is a print out from my surgeon's office! ~ T. Miami, FL

I think I'm understanding this process a bit more and I guess I'll just take it all as it comes and see how it goes! This is a strange thing, but I went to the dentist today and it wasn't fun at all, and I thought how much more this procedure involves!!! If I'm having a fit because someone is poking my gums with something that feels like a pin, what will it feel like to have big cuts in my stomach! I will take this all one step at a time with much prayer!! Thanks for the responses!! ~Jan

Jan, I dread the semi-annual dentist visit and it puts me in a bad mood for the rest of the day but I tell you this with all honesty. The surgery itself was a breeze for me and the pain was minimal to almost non-existent. Now when I got home and up to today, almost three weeks later, the story is different. It's still not so much the incisional pain, because that was and is nothing, but the complications of recovery of the inside stuff and trying to eat and drink is another story. You can read details in my profile. Mind you, everybody's journey is different. Best of luck and my prayers are with you. Linda

Do you have any health risks and/or family history of CAD or early stroke? For women sometimes you can get approved with a lower BMI if you have health risks. I say that because I was approved by United Healthcare with a BMI of 38.9 and 96 pounds to lose.

I haven't had my blood pressure taken in a while, but it tends to be higher as my weight goes up. I have hip pain and feet pain and I have diabetes and hearts disease in my family history. I'm planning to come armed to my first meeting with my new PCP and if she isn't going to get on board, my plan is to hunt down Dr. Jawad in the hospital sometime and ask him what PCP he would recommend for me to get this process rolling. This board has been very enlightening and I appreciate the responses!! ~Jan

Jan, CHP require you to do 1 years worth of supervised diets. I haven't tried to diet nor want to. However, i haven't gained either. Do the diets to the best of your ability (or not) and the insurance will see that you haven't lost and SHOULD approve your surgery. That is how CHP works. Good luck, amy