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Paul, thanks so much for explaining the rationales. I need to lose 10 pounds. My doctor says my insurer requires it, but my insurer's weight loss surgery medical policy doesn't say so.  In fact, it says only that "the patient must have actively participated in non-surgical methods of weight reduction; these efforts must be fully appraised by the physician requesting authorization for surgery..."The patient's treatment plan includes pre- and post-operative dietary evaluations and nutritional counseling." I'm planning to ask my surgeon in writing whether the 10 pound weight loss is still required under the cir****tances. If he says yes, then I know it isn't the insurance company who wants proof I can handle the program, it's the surgeons themselves.