I'm new here and researching my options

Hi, I'm Karen. I have been researching a lot and am curious about some things. Right now my BMI seems to be borderline to qualify with a co-morbidity. At 5'4.5 and 205 lbs I am under but my highest weight was 211 no that long ago. Over the summer I did the whole 30 diet and lost 6 lbs which have stayed off. That loss apparently cured my foot pain which was becoming unbearable. I do not know if I have any comorbidities. I have seen a bariatrician off and on for years, who prescribed Phentermine and a low carb diet designed to treat insulin resistance. I stopped going 2 years ago. My PCP told me to stop taking the Phentermine, sent me to a cardiologist because my heart skips a beat and sometimes it races. The phentermine use kept my weight under control for about 20 years. I can go back and start again and I will probably be able to lose weight but I hate the side effects. I already have terrible insomnia and the phentermine makes it even harder to get to sleep.

As for co-morbidities I am going to ask my PCP to test me for sleep apnea because of my insomnia and my husband says I snore.

My father and aunt both have type 2 diabetes and I am concerned that I am on my way if I don't get off this yo-yo diet syndrome. I haven't had my bloodwork done since I put on these extra lbs (I think my last weigh in 2 years ago I was around 190)

My husband has a health and wellness certification and is an excellent trainer but after working out with me for 6 months, 4 days a week doing cardio and weights I got strong but didn't lose any weight. He is baffled and thinks it may be hormonal.

I generally eat healthy, organic and home cooked food but I do have a large appetite and can eat as much as my husband (who is very fit)

One serious medical issue I have is an old injury where my ankle was shattered in a car accident. I have lost quite a bit of mobility and if I overdo it physically It swells and stiffens and I cannot walk without a limp. This means that If I work, on my feet for 8 hours I am somewhat laid up for the rest of the day or longer.  My doctor said I would need to have my ankle fused and walk with a cane by the time I was 40 but thank goodness I am almost 52 and that has not happened but I do feel it is holding my back from being active enough to control my weight as I cannot run or do jumping. Which of course worsen's as I gain weight and then of course there is the incontinence and my breasts are getting so big I have divets in my shoulders and back and neck pain and headaches. 

So that is basically my physical state and my mental state is getting pretty depressed because I feel helpless to change. I don't want to gain more weight but the pattern of gaining 5-10 lbs a year is the reality I am looking at. I really want to have the gastric sleeve so that I can control my portion sizes without ever using the diet pills again. 

What do you all think? Do I have a chance? My insurance is Aetna choice POS 2

Do you weigh 105 now? If so, no insurance is going to pay for bariatric surgery.

Oh gosh NO, that was a typo, I am 205!!! 

205, sorry :)

Well 205 is different! I had a BMI of 39 when I started, had high BP, was pre-diabetic and had sleep apnea.  The surgeons offices know exactly what it takes to qualify for insurance  - I was afraid I wouldn't with a BMI under 40, but they were quite confident that I was eligible (and they were right).  For most insurance, if WLS is covered, you have to have BMI over 35 with co-morbitities or over 40 without.  If you've been over 35 for a while and not super young, it seems like there are usually co-morbities.

In all likelihood, the surgeons office will use 5'4" as your height (I am a bit over 5'3", but mine rounded it down to calculate BMI).  The qualifying BMI is usually the one that the surgeons office weighs you at on the first appointment.  At 205, 5'4", your BMI is 35.18.  You might want to wear heavy clothes and/or eat some big meals prior to consulting with a surgeon.

I wasn't on the line but I was older, 62 and had a few co-morbidities.  Basically, I wanted my life back. 

Go to one of your surgeons introduction nights and see what they are saying.  They will know exactly what will qualify and what won't.  You probably do have sleep apnea, it is very common. 

I will add that I have heart damage from diet pills.  Please be careful with those.

Good luck.  Also check out the RNY.  I love mine and have seen more folks loose all their weight and keep it off with RNY.

Thank you for your reply :) Hearing from others is really helpful!

I found a copy of my insurance companies guidelines, it turns out it was on my providers website to download. I didn't find anything unusual in it until I read the part about having to have all of the qualifications for at least 5 years. 2 years ago, the last time I was weighed by a doctor, I was at 190 and on the phentermine years prior to that I was struggling in the 180"s. Going off of it lead to the gain and most attempts since then to lose weight have been unsuccessful. I seem to be able to lose 5-6 lbs and then I fizzle out. 

So, do you think I should speak to the Surgeons office anyway? I imagine the insurance company will want proof of my problem for the whole 5 years and I haven't even been diagnosed with a secondary morbidity yet. I sure don't want to wait another 5 years, I would rather prevent further complications.

I am in the process of seeing about going to Mexico to have it done as there is financing available, but it looks like doing it this way happens really fast! 

Welcome to our Board!   Have you ever joined Weigh****chers or another weight group?  Years of WW showed that I had been trying and wasn't successful.  Think of anything that you have used over the last 5 years...like the program that your husband worked with you on.  One of my comorbidities was my legs ached when I walked. 

Like the others said.  Your PCP and Surgeons office should be able to point you in the right directions to get approved.

Hi Karen!

My insurance plan coverage for bariatric surgery is a joke. They require BMI 40 with two co-morbidities for 5 years or no co-morbidities and BMI of 50 (!!) My primary care doctor was shocked by how restrictive my plan is, one of the most restrictive she's seen. It's eye-opening to see the gap between criteria for qualifying for bariatric surgery put out by the ASBMS.org (the bariatric/metabolic specialists) and what insurance plans approve.  Some of them are still calling VSG "experimental". Ludicrous. After yo-yo-ing for decades and reaching an all time high BMI of 37/38 (and succeeding, then regaining on every diet plan ever invented including 500 cal/day physician supervised fasts) adding sleep apnea and pre-diabetes to the mix, I decided to self-pay my VSG. .So, in a few weeks I'm going to a Bariatric Center of Excellence in Mexico to self-pay (at a very reasonable price, about half US self-pay cost). The physician I chose is US trained, board certified and does the surgery at a site that meets JCI standards. It still irks me that I pay all this money for insurance and they won't cover what bariatric guidelines recommend until I'm a helluva lot sicker or fatter. So shortsighted. My primary care doc fully supports my decision, will help manage my care after surgery along with a nutritionist and a local support group and I can follow up with my surgeon without air travel. 

As far as which surgery to have, metabolic syndrome runs rampant in my family. VSG made the most sense to me after I read this article. http://healthnews.uc.edu/news/?/24172/