I'm going to try Plan B.

I have been attempting to do a 6 month physician supervised diet as required by Aetna.  I am finding it difficult.  Firstly, with my relatively low BMI of 38 (with sleep apnea), if I'm too "successful" and lose too much weight during this phase, the surgery becomes less appropriate for me.  Right now I weigh 225 at 5' 6", down 10  lbs. from my initial consultation weight of 235 (the weight insurance companies use to determine approval or not?)  Anyway, I'm unmotivated and can't seem to keep a food log (also required).  I'm more of a "fly-by-the-seat" kind of guy.  I have adult  ADD and attempts to focus on minutia and organization is hard for me.  And doing it for six months seems like an eternity.  Aetna will also accept a a 3 month program supervised by the Bariatric surgeons nutritionist.  If I only took into account the cost of these choises the 6 month is by far cheaper ($10 X 6 monthly visits = $60.  My initial meeting with the nutritionist cost $125.  I guess I'd have to multiply that times 3 visits and that route will cost $375.  I'll call today and try to set it up.  My wife still has yet to totally embrace my decision to have WLS.  She has seen me successfully lose weight during my hair-brained schemes of winning a Lamborghini and others.  I start a diet everyday but it rarely lasts.  I'm a high school gym teacher and coach of our basketball team and am very active.  I've been successful in the war with fat  twice in the last 12 years...for 6 months at a time.  Although I don't really like Dr. Phil, he does pose a great question to his guests when he hears them rationalizing about how they got into the negative situations they find themselves in.  He simply asks, "Well, is it working for you?"  And in my case,  the answer is definately no.  I can only imagine what I would weigh or what my BMI would be if I hadn't lost the weight I did in the past.  I know I need a change and if it costs me a little more money to get there sooner I think I'm going to do it.  Thanks for listening. Sonny 

I understand your troubles. It’s a hard to change your life  (i.e. mental attitude) without a significant scare or motivation event.

Based on your numbers I am assuming that you consider yourself 60-65 pounds over weight. Having RNY WLS would quickly drop those 60 pounds but what then? I stated at a much higher weight, I lost 60 pounds in about 2 months but I am just over losing 160 pounds and still have about 80 pounds to go. At seven months out from WLS I am just getting my head aligned with my new body and my eating choices. I am far better at this now, than I was at 2 months out. I fell I have a long way to go to being at a point that some foods will not trigger a “mental hunger pang”, and since I was more of a volume eater, the smaller pouch keeps me out of danger of being a glutton by way of making me ill and feeling bad. It is a complex issue for me to relearn how and when to eat, and to make smart choices in what I eat. At best I can say I am getting better at it, it takes time, and there are few shortcuts to changing my mental attidude.  The doctor operated on my stomach, not my brain. 

As you mentioned your not great at keeping up with your dieting in the past. Will throwing up help you change your mental attitude toward food and smart food choices? If you lost 60 pounds tomorrow, how would your relationship food change?  I know sticking to a food diary and a smart diet before WLS is hard, and its just as hard after too. It takes discipline. It takes forethought and control. Will having WLS and then having a need to throw up when you break a rule be the motivation you need to gain the disciple you need when it comes to food? Just some thoughts to consider.

I am writing in a different vein than the previous posters.  First, you should see if Aetna will pay part of the fee for the nutrionist.  The nutritionist may be considered a specialist and you may be able to get by with paying a higher copay than you do with the doctor.  I suggest this because I went to see msws for talk therapy (not related to WLS) and that's how Aetna treated it.  That was far cheaper than paying their full rates.  Secondly, if you can't qualify for WLS, you may want to talk to your primary physician about the new medicine that's just come on the market that supposedly increases your metabolism and aids in weight loss.  Your primary doctor can look to see if it may conflict with the meds you take for ADD.  I've also heard that some doctors have some concerns about it.  I don't know the name of the medication but it was recently mentioned on blips for the evening news.  Anyway, don't give up.  I wish I could have had surgery 20 years ago.  However, by the time I got my first RNY in 2000, I weighed 571 and was 50 years old.  You shouldn't want to get older and heavier.  I suspect that may be a problem.  Thinking about a future where you know you will be heavier may end up providing the motivation you need.

Sonny,

in the mens room sometimes we can be hard on each other. we don't sugar coat anything in here and we tell it like it is. so having mentioned that disclaimer i'm going to bust your balls a little but only because i (we) care about you and want you to succeed.

please don't start blaming the cost of treatment as a road block. secondly, don't blame your ADD as a barrier to weight loss. believe me when i tell you, each and everyone of us had roadblocks we had to knock down before we got the surgery and had even more demons to face once we had the surgery. maintaining is the hard part of this journey, hell, surgery is a breeze compared to the temptations out there plus we feel we have all the excuses in the world to feel sorry for ourselves and give in to comforting ourselves with food.

you'll notice by the threads that as soon as one of us freaks out and fears losing our grip we come here and post what's troubling us. we know we'll get slapped around and beat up but never ridiculed for "fessing" up. so we practice tough love here. that's what you need now. you CAN do the diet standing on your head if you want to and you CAN keep a diary if you want to and you CAN find the money to shortcut the waiting period. ***** moan, complain and carry on all you want, that's what we're here for but just do it. we want to see you on the loser's bench and that's going to be a tough road. all of us would be happy to tell you we had to kick our own asses to get there. nobody here just went to the doctor and then sailed through the surgery and then lost 100% of excess weight without some sacrifice or pain along the way.

you are just experiencing bumps in the road. some of these guys here spent years to get to your point but they never gave up. i know you're ready and you can do this. hell yes, cheat if you have to, lie or do whatever it is you feel is needed to cut through the paper chase but get your surgery.

on another note, i was a lightweight too. so don't expect 60 pounds in 60 days. the smaller guys like us lose a lot slower. big guys lose a pound a day but not us so expect some hard work to lose even 60 pounds. ok, enough said. please don't take it personal. i want to see you get your surgery. the only roadblock i see whether you you're going to blast those paper pushers out of the way and stick to your diet and go for it. i'm betting you can. best of luck.....carbonblob

Thanks for taking the time to respond.  I'm not looking for any quick fixes.  I've reasearched WLS for over a year now.  I know the risks and the benefits.  I've questioned the appropriateness of the surgery for me and discussed that with my surgeon.  I asked if my BMI was misleading since I was lean at 170 lbs.  He reassured me that RNY was appropriate for me.   I'm 47 years old and my obesity is starting to affect my health.  I agree, losing the weight will be the easy part.  I've done that before without either a small pouch for a stomach or malabsorption.  I just never had the "tool" to maintain the weightloss.  I don't take the decision to pursue WLS lightly.  I've said many times here that I am inspired by the sucess stories I've read about.  I realize that I'm a lightweight by OH standards and that my all-time highest weight is probably a little above goal-weight for many here.  Please don't make light of my obesity however.   My initial point was simply, I'm going to do the 3 month multidisciplinary surgical preparatory regimen offered by my bariatric surgeon's office rather than a 6 month physician supervised nutrition and exercise program with my PCP.   Fred, you're right about being a lightweight when beginning this journey.  I do frequent the "light-weight" message board too, it gives a very different perspective than all the other message boards. I also appreciate how everyone here "keeps it real."  I'm not looking for anyone to blow smoke up my ass.  If I deserve a beatdown, let 'er rip. Sonny

Sonny, While I wish I had the WLS option years ago when I was slipping over the edge I am glad to have it now in life. Though I can only speak from my experience of coming back to "life" after being over 400 lbs for several years. WLS has given me a great tool and has made me make sacrifices in the right direction towards better health. I wish you well in your journey, and congradualte you on addressing health issues before things get to far out of control, after I read CarbonBlob’s perspective on your goals. I realize that my views need a better perspective of walking in others moccasins. Herb

Sonny, there's a lightweight message board? NO WAY! Really? I'll have to look for it when i finish this.....lol. btw, i can't speak for anyone but myself but i take your obesity seriously. i'm sure the other guys do too. also, you're right on target with your comment about the "tool". that's exactly what i needed to get to where i'm at now. that pouch did it for me. i no longer have that killer hunger that made me stuff myself. what i did learn along the way was to stop when i'm full. sometimes i go overboard and eat too much but for the most part i try to let my pouch do the talking. sounds to me like you totally get it. now jump through those damn hoops and get your surgery! cya on the loser's bench.....carbonblob