BMI is 31, but wls would improve the quality of my life

I recently discovered that I could potentially improve the quality of my life by undergoing gastric bypass surgery.  I began my weight loss journey 33 years ago.  Currently my BMI is 31, and due to chronic fatigue and other issues stemming from poor health, I have never been able to get below 29.  I have 5 co-morbidities: hypertension (21 yrs), congestive heart failure (18 years), high cholesterol (10 years), type 2 diabetes (15 years) and obstructive sleep apnea (4 years diagnosed).

Hopefully, Blue Cross FEP will cover the cost of surgery despite my low BMI when they examine my extensive medical history.  Has anyone been in a similar situation regarding BMI?  Should you respond to this post, fyi: I've been athletic my entire life, so I know how and what to do to lose weight; my health problems severely limits my ability to consistently exercise.  Heart failure and sleep apnea inhibits the flow of oxygen throughout my body, etc, etc, etc.

My BMI was around 40 so I qualified anyway but had some of your same comorditites:  hypertension, sleep apnea, cholesterol, arhtritus, gerd.  Between the weight and my arthritis, I was severly limited in what I could do.  No more.  I did end up with a new knee but I am healthier and more active than I have been in 20 yrs.  The only med I am still on is prilosec and it is because of the WLS, not gerd like before.  Maintainance isn't easy but I have a tool to help and I with being able to be more active, I have been in the same size clothes for multiple seasons now. 

Surgery isn't something to be taken lightly but it is the best thing I ever did for myself and I wish I had done it sooner. 

I would be very surprised if you were able to have insurance pay for WLS.  I have never heard of anyone with a BMI that low having insurance pay for it.  That isn't to say that you couldn't self pay but insurance is pretty strict.  It doesn't hurt to try.  The only place I have heard of people having WLS at that low of a BMI is Mexico, where they aren't as concerned about malpractice as they are here.  I recall hearing something about lowering the BMI requirements for the lap band but I'm not sure if they have done that yet.  I wouldn't recommend that, anyway.  The quality of life is pretty poor after the lap band from what I've heard.

It may help if your doctor is on board and can convince the insurance that WLS is medically necessary for you.  Also, have you considered a sleeve?  That may work better for you since there is restriction without malabsorption.  Again, getting approval from insurance will be an obstacle, no doubt.  Are you able to self pay?  That may be your best option.

 

I agree with LadyTazz that it's unlikely that insurance in the US will pay for bypass surgery with a BMI under 35. However, I don't agree that it's not done in the US as a self-pay with a BMI under 35. It's done *all the time* and many surgeons in the US will do it if you are willing to pay for it. Many. Mine does and so do most of the top surgeons. They are just QUIET about it.

That is probably because most countries have a protocol to do it if your BMI is 30-40 and you have co-morbidities while in the US, the protocol is 35-40. But a BMI of 30 is OBESE. That's a lot of weight and studies show that it's unlikely to come off and stay off with diet and exercise. (In case you can't tell, I think the US standards are lame and agree with the rest of the world that it should be 30 and not 35.) So it seems like the surgeons will do it but they are quiet about it since that's not the official standard.

 

And, yes, the standard was lowered for the lapband so that insurance might pay for that with a BMI between 30-35. However, just because the FDA gave approval for lapband use in that BMI range doesn't mean insurance companies have changed their policies.

There are definitely some people who frequent this Board who had WLS with a BMI lower than 35. Hopefully they'll see this message and chime in.

If you have diabetes you may want to consult with Dr Marchesini in Brazil. In Europe and South America they do the switch only portion of the Duodenal Switch as a cure for diabetes. They don't reduce the stomach to a sleeve but the side benefit of having just the switch portion is a loss of weight. I think I read one time of about 30% of your excess weight. You should be able to find Dr Marchesini's contact info on www.dsfacts.com.

--gina