Question:
By BMI is 30. What to say so I can get approved for surgery since I got denied?
My BMI is 30 and I got denied surgery b/c I don't meet my health plan's criteria. My health care is Universal-based in Southern California. I'm 5 9" @ 200 lbs and really depressed. Someone please advise what else I can do, say, write, etc. so I can get approved for this surgery. Both my mother & sister had the surgery and were very successful with their weight loss. — robyn B. (posted on January 23, 2003)
January 23, 2003
At a BMI of 30 you are not going to get approved anywhere. Your BMI has to
be atleast 35. I am a light weight myself. You might consider gaining
weight for the surgery, but at your height you would have to gain about
40-50 pounds. Are you sure that you are 5ft 9in tall??? This is one time
that you could definately stand to be a bit shorter. Have your dr's office
measure you .. Maybe you can squeeze out a couple of inches. Drink high
cal. shakes and eat like there is no tomorrow.. But whew, 50 pounds or so
is quite a lot to gain.... Have you checked out a lap band, there are other
methods that you may qualify for..
— Nickie C.
January 23, 2003
I'm just curious as to WHY you even want this surgery? I am 5'9" as
well and now weigh 230lbs. I started at 382. I can't wait to get to weight
you are at and feel like "normal" weight. This surgery is no
joke. It's a complete life change. Don't put yourself at risk for death (as
with any surgery) because you need to loose 50 lbs. This is NOT the easy
way to do it. For most of us here it was the last resort. Please don't that
anything I said as being an assult on you. Think long and hard before you
gain 50lbs and have a major surgery to loose it. I hope you find the answer
to what you need. Be blessed.
— Sandra C.
January 23, 2003
This surgery is the last resort for morbidly obese people. You're not
morbidly obese, so no insurance company would approve this type of surgery
for you. You probably want to lose about 50 lbs. right? Best bet is to
get on a good eating/exercise plan to lose that weight. You're beating
your head against the wall if you're trying for insurance coverage. I even
see people with BMIs of 40 and higher being denied who desperately need
this surgery to live. So someone with a BMI of 30 will be dismissed out of
hand. Sorry to be the bearer of this kind of info...you say you're
depressed, and I'm sure this doesn't help. Hugs, Joy
— [Deactivated Member]
January 23, 2003
I can't believe that you want to have this surgery for 50 lbs. This is a
major surgery with very serious and high risks. I think you should really
think hard about this and what other solutions there may be for you.
— S W.
January 23, 2003
I agree with everyone else. No insurance will pay and no doctor will do
it. I am only 16 days postop and this was truly my last resort even though
my BMI was "only" 40. If I were you I would thank your lucky
stars you don't qualify and just find a good plan to follow.
— susanje
January 23, 2003
maybe the lap band is a better choice for you. :) You might have to pay
this cash though. The NIH doesn't believe you're a candidate, but I think
the LAP BAND might be better cuz you can just do it and lose a smaller
amount of weight. Good luck either way. My sisters are on Weight Watchers
and doing pretty well, you might try that out as well!
— Iris B.
January 23, 2003
I would never!!!! advise anyone to gain weight to get surgery!! what if
someone gained the 40 or 50 pounds and still did notget covered for
surgery, theor life would be even more difficult and their health impaired
or endangered. By the way, if weight watchers, or diet & exercise
worked more than 5% of the time, none of us would have had surgery.
— **willow**
January 23, 2003
I would never!!!! advise anyone to gain weight to get surgery!! what if
someone gained the 40 or 50 pounds and still did notget covered for
surgery, theor life would be even more difficult and their health impaired
or endangered. By the way, if weight watchers, or diet & exercise
worked more than 5% of the time, none of us would have had surgery.
— **willow**
January 23, 2003
If you're 5'9" and 200 pounds, gimme a break! If that's a typo, let
us know!
— cddgo
January 23, 2003
Sounds like you're feeling desperate. I hear you. At 5'9", I think
150lbs is the normal range. I'm sorry you're getting all sorts of negative
responses, the reality is that it can be hard or impossible to get rid of
the weight with or without surgery, but the emotions are the same.
Desperation. I don't know your history but I'd suggest the whole exercise
& cutting calories, or whatever. But if you are set on having surgery,
the lap band would be better for you. If you're binging, maybe going to OA
or EDA would help? If you've already tried all this, then follow your
heart. One doesn't HAVE to get surgery in the US. There are other options.
Take care of you.
— LionGirl2k
January 24, 2003
I hope you will stop considering a RNY for only 50 lbs. It just is'nt worth
it. I needed to lose 190 lbs (lost only but thankfully 160 lbs). I had to
get my gallbladder out 10 months post op. Plus I'm still having intermitant
severe pains that feel like gallbladder attacks. No one knows what is going
on. I'm having potassium, B-12, iron (anemia), and osteroporosis problems.
Oh and now LOW blood pressure (88/44) and frequent bouts of feeling as if
I'm going to pass out. And there are other problems such as my athritus is
much more painful and spreading. I don't regret the RNY as it was the last
resort for me. And I just could'nt go on at 319 and 5' 2 1/2. But there are
so many life long changes that just would'nt be worth it for only 50 lbs.
As someone suggested, the Lap Band may be the way to go for you. But please
don't consider gaining weight or haveing the RNY. I think you would highly
regret ether. I was emotional prepaired for the changes, and for the most
part can handle them. But even so, it is still very hard. WLS is not the
easy way out. With surgery comes pain and possible complications and/or
death. And once your guts are cut and rearranged you will NEVER, I repeat,
NEVER BE THE SAME. You can NEVER go back to what you were. Yes, it some
cases it can be reversed, but your insides will NEVER be the same. (Believe
me, I know about bad surgeries and trying to put things back the way they
were. You never can). I'm happy with my WLS... but I'm paying for it with
nutricianal problems and more problems that keep cropping up. I sure don't
know where it is going to end. The risk, for me, was worth it. But that is
not to say, I like the problems I have. But it is'nt worth it for 50 lbs!
Consider the Lap Band. It is my understanding that CAN BE REVERSED!
Actually that is what I wanted to have done as I did'nt want my guts all
cut up and rearranged. However I was to late to get into the trials... and
by the time they approved the LAP BAND I already was approved for the RNY.
I fought my insurance for 9 months to get approval for RNY and I was'nt
going to fight to get it changed to the Band at that point. I wish I could
have had it done. Please, consider it. It just is'nt worth all the pain and
potential problems for 50 lbs. Best of luck to you.
— Danmark
January 24, 2003
I too feel that the effort she would have to put in to GAIN 50 pounds to
qualify for this surgery is the same amount of effort she's have to put in
to LOSE the 50lbs- just not as "fun" (I say that term loosely as
over eating should not ever be considered fun!). However losing weight
would not affect your health negatively as gaining that much would. So in
my opinion, do not GAIN just to get this surgery, do not risk your health
by over eating, and then having this life risking surgery. I would suggest
the WW program; or the band if you can afford it.
— Karen R.
January 24, 2003
Robyn, I have to agree with the others than this surgery is not worth 50
pounds. I doubt you will find an insurance company or for that matter a
surgeon even if self-pay to do the surgery on you. You don't say if you
have alot of health problems at 200 pounds. Usually you have to have a BMI
of 40 or over to qualify or 35 -40 with co-morbidities (health problesms as
a result of the weight, like diabetes). I'm sorry you are depressed,
perhaps getting on some medication to help with that? Did your mom and
sister have BMI's over 40? What have they said to you?
— Cindy R.
January 24, 2003
I totally understand your feelings. HOWEVER, I think it would be in your
best interest to think of a 3 prong approach to this problem. #1:
counselling. Talking through issues that you may have will help to ease
your stress so the desire to eat will be lessened. #2: Exercise. For the
same reason as #1. It helps to ease stress as well as helping to lose
weight. #3: A support group of others who are trying to lose weight, I
believe Ediets.com has one. You need to focus on a way to lose the weight
without considering this drastic measure. Also, as far as antidepressants
go, they can make you gin weight. Ask your doctor about ones that don't.
Good luck, Carol
— daisymae
January 24, 2003
I totally understand your feelings. HOWEVER, I think it would be in your
best interest to think of a 3 prong approach to this problem. #1:
counselling. Talking through issues that you may have will help to ease
your stress so the desire to eat will be lessened. #2: Exercise. For the
same reason as #1. It helps to ease stress as well as helping to lose
weight. #3: A support group of others who are trying to lose weight, I
believe Ediets.com has one. You need to focus on a way to lose the weight
without considering this drastic measure. Also, as far as antidepressants
go, they can make you gin weight. Ask your doctor about ones that don't.
Good luck, Carol
— daisymae
January 24, 2003
Since I had my surgery I have been approacjhed by several people who are at
a similar weight as you, Theey are also upset that they cannot have
surgery. As one person said "why should I have to be near death to get
a surgery to improve my health? " Just because one is
"only" 50 pounds overweight doesn't mean that they are not
suffering and struggling just like those who are more overweight. It is all
reletive to each ones own situation. I know many in the 50 # over who have
done WW, atkins, slimfast, Jenny Craig, etc, etc , etc, to lose a little ,
gain it back as we all know the yo you sundrome. In 10 years they will
have dieted up to the weight required for surgery, but will be older,
sadder, unhealthier, and have wasted all those years of their lives
struggling.
— **willow**
January 24, 2003
I understand your frustration at being 50 pounds overweight. I know it
seems like a lot but if you added another 50 pounds on top of that you
could have a heart attack and die! Do not strive to gain the weight that
will be bad for you. Don't look at it like you have to lose 50 pounds.
Start with a smaller goal. I know that if you just lost 25 pounds you'd
feel so much better about yourself honey. I imagine losing 50 pounds seems
far out of reach, maybe a bit overwhelming but you know what? I bet 25
pounds doesn't seem so far out of reach, then once you lose that 25 pounds,
you're looking great, feeling great, then you'll be in the good habits and
lose the rest that you want to lose. Get your mind off of having surgery.
It's not meant for you love, don't put your health at risk by having
surgery.
God Bless,
Rachel
— Rachel O.
January 24, 2003
There's another consideration here: If you had the RNY, you might well
find yourself losing weight down to an uncontrollably low and unhealthy
level. I agree with the previous poster who said that, unfortunately, lots
of people with 50 pounds to lose will keep yo-yo dieting, and struggling,
until they wind up joining those of us who eventually became M.O. or Super
M.O. So it's understandable why you *don't* want to put yourself through
that. But I think it's likely that if folks in the 50-pound loss range
started having the RNY, significant numbers of them would wind up grossly
underweight and sick from it because they're just not big enough for that
kind of procedure to begin with. Maybe some interim solution (another
procedure -- dunno about the band? -- or decent medication) will come along
to help you before you join the ranks of the M.O. I remember being in your
shoes, and dieting and dieting and dieting, and it's no fun. :(
— Suzy C.
January 24, 2003
Robyn:
May I make a few suggestions? You haven't listed your other attempts at
weight loss, so forgive me if I tell you something you've tried already.
First of all, dealing with depression; many of us overeat when we're
depressed, and who isn't depressed when they're overweight at sometime or
another? Not all antidepressants cause weight gain! I was prescribed one
specifically so that I could curb my appetite-I was unfortuately allergic
to it, but did notice a difference in my appetite before I had to stop it.
SO, check it out with your doctor- you could feel better, and eat less.
Another option is xenical, a perscription medication that inhibits fat
absorbtion... it has some unpleasant side effects, such as gas and
diahreah, but hey, so does RNY, so if you were willing to take that chance
with surgery, why not try the meds? You are good to start working on your
weight NOW, before you get to the morbid obesity point, but as hard as it
is to lose, your best bet is non-surgical at this stage. And please, don't
TRY to gain, not only for the health reasons, but what might only be mild
depression at 200lbs, could become much more severe at 250+, and in many
cases, insurance companies will require you to have been morbidly obese for
FIVE years or longer... that's a very long time!!!! Keep seeking the
support of others with weight issues... it helps to talk! and Best of luck
to you... hopefully by addressing your problems now, you'll never get to
where we are. Good luck.
— Kelly B.
January 25, 2003
Robyn, I know it hurts to hear that you should not have surgery when you
are seeing your family members having quick results with surgery. There are
so many things that I'd like to know about you like your age? any kids? Not
that it makes a difference but it helps me to understand where you are at
in life. I am about 135 pounds over weight. When I was at 50 lbs over if
I would have ever thought that this is where I'd be years later, I would
have done every thing in my power to lose. I have 2 kids that really
contributed to my weight gain. I feel so over the edge that I can not get
back to a near normal weight with out surgery. However, I remember being
200 and @ 5'6.5", I really didn't look that bad. At 5'9" you
probably really look great. We are usually are own worst critic. Please
try not to judge yourself by your mom and sisters weight loss. Especially
if you have always been the thinnest and are secretly afaid of being bigger
than they are. I can relate to that. Please do consider some thing like
weight watchers where you can get support from people who are going through
it too. I have tried and lost weight with them but I am now at a point
where I hurt so much from the excess weight that I can hardly walk let
alone exercise. Unfortunately you will probably not get approved for this.
I feel that you have not exhausted all of your options. Feel free to send
me an email. Hang in there!
— kcarie
January 25, 2003
Why would any of you want to add to this person's emotional pain? You have
no idea what personal struggles she is facing. She could have a husband,
family member or anyone else that has been so critical that her self-esteem
is severely damaged. This is supposed to be the Association for Morbid
Obesity Support. None of us know what she has faced on a daily basis.
Obviously, by her own admission she is depressed. Obese AND OVERWEIGHT
people face terrible prejudices in our society. Aren't we all painfully
aware of this sad fact? AMOS should be an island of refuge away from
emotional abuse.
Thank God for the members that gave her a compassionate answer - shame on
you that slammed her for asking on open and honest question. Some of you
owe her an apology.
— jnc
January 25, 2003
I meant my answer to be light-hearted and indicative that she wasn't
overweight at all in my eyes - an effort to cheer her up. (and I don't
appreciate personal emails to my home causing me more hurt than my answer
could possibly have given her)
— cddgo
January 25, 2003
Robyn, keep your chin up. There are a lot of good research in non surgical
weight control on the horizon. They've discovered a hormone (Ghrelin)
secreted by the stomache that is responsible for increased appetite.
Ghrelin also is responsible for the direct storage of fat you consume.
Although they've discovered this hormone and it's connection to appetite,
they do not yet know how to inhibit its production. They have found that
in Post-op Gastric Bypass patients their Ghrelin levels have dropped by
70%. Perhaps this is the result of the stomache being transect and thus
not providing stimulus to the Gherlin trigger mechanism in the stomache.
In time they may be able to stimulate this effect with drugs or some other
method.
<p>As for most of us pre-ops here in AMOS we can't afford to wait for
that research to bear fruit. Being Super Obese with sleep apnea, I can go
any day. Tonight, there could be a Power outage and my CPAP machine cuts
off... I stop breathing... my blood pressure skyrockets placing an
incredible burden on my oxygen deprived heart... cardiac arrest at the
absolutly worse time - at night alone and asleep. I'm not absolutely
garunteed to survive the surgery but I am absolutely garunteed to have a
power outage at night at some point.
<p>Take Care, Be Well, and Be Happy!
— John T.
January 25, 2003
I know what you are going through, most of us have been there at some
point. Please do not try to gain weight for this surgery, because it is
true that most insurance companies or surgeons require you to be 100 lbs.
or more overweight for more than 3 years to qualify. Please do not have
the surgery at your current weight!!! I was considered a light-weight at
243 lbs. and a 45 BMI with co-morbs. I am one year post-op and doing
everything I can to stop the weightloss. I only have 6 pounds to lose
before I am officially underweight. Being underweight would have sounded
great to me when I was heavy, now it's a fight not to die. I almost
slipped into my very first coma, due to almost non-existent blood sugar
levels just last week. I can get around a little easier, but I have no
muscle mass left. I would like to exercise, but I get so weak and tired
that I have to stop. I still would have had the surgery at my weight then,
but there is no way I would go through this for an extra 50 pounds, and if
I did, I might not be alive to tell about it a year later. I don't know
what makes you happy in your life, but my husband and son are my
everything. I still live with the guilt of what I have put them through
this past year, the pain and suffering that they endure every time
something else happens to me. My husband and son got to watch me almost
die several times in one year. I am 26 years old, and I did this for all
the right reasons and some of the stupid ones, I am not attacking you, I am
just very concerned. I don't have any great advice for weightloss, I
wouldn't have risked everything if I had found something that worked. I do
advise talking to someone that can help you evaluate your life, your
weight, and your self-worth. I found that you can love yourself alot more
at 243 lbs. than 115 lbs., sometimes. It is easier on you emotionally, to
be thin in society, but it's alot harder to accept the first time you see
your loved one crying at your side wishing it was them instead of you. You
are going to have to do alot of soul searching. I wish you the very, very
best.
— Karen E.
January 25, 2003
I'm 5' 9" and my GOAL is a little under 200. I don't know of any
doctor anywhere in the world who will approve you for surgery!
Hey our recommended weight for our height is somewhere between 169 and 180.
So you're 20-40 pounds overweight!!! ANY surgery is not for people who are
20-40 pounds overweight!!!
— M. B.
January 25, 2003
Hi Robyn, I will probably get blasted for my thoughts as well but I will do
my best to put it gently. I think what bothers most of us who have been or
are, morbidly obese, is that we all battle serious health complications and
fight insurance or even go into debt to have this surgery -- AFTER years of
self-loathing and/or depression and discrimination have taken a toll. While
your pain is valid and genuine for you, it is harder for some of us to
relate to. I wish I had done something when I only had about 50 pounds to
lose. It was the last 50 pounds I gained that really made my health go
downhill...that's when I developed sleep apnea and high blood pressure, as
well as acid reflux disease. Please don't take this the wrong way. Is it
possible you have always been the thinner one and now that your mom and
sister are doing so well after surgery you feel slightly out of place? I
say this from experience, truly. My sister has always been the active thin
one, the one who was popular with the boys all the time we were growing up.
It bothers her now that I wear smaller jeans than her. One of my dearest
friends and I went Christmas shopping last month. She asked me how much I
weigh now. When I told her she said "You weigh less than I do."
She was then totally bummed for the rest of the day. I love both of these
women dearly but the fact that I am now thinner than them doesn't make me
think I am better than they are, or that they are less lovable. If they
feel threatened it is their issue, not mine. Perhaps the best option right
now might be for you to follow an Atkins-type diet, similar to what your
mom & sister are eating and to get some exercise with them. You can let
their renewed motivation and enthusiasm rub off on you. Talk to them openly
and I'm sure they would love to support you in whatever you do! - Anna LAP
RNY 7/3/02 -109lbs.
— Anna L.
January 26, 2003
Some really excellent feedback on the last couple of posts. This is
definitely a 'hot' topic. Robin, we would venture to guess that everyone
here feels that your biggest hurdle would be to find a compassionate
therapist. You can learn to love yourself at any weight! It's the health
problems associated with MO that make it medically necessary. I was at my
very thinnest when I was 27 years old - 123 lbs. - and in a terrible
marriage (NOT to my sweet husband, Thomas). I have never been so
miserable, lonely and unhappy as then. Now I'm MO, have some significant
health problems but can honestly say I am HAPPY.
I posted an interesting question for debate on the Q&A's last night and
hopefully it will post sometime. The topic of discussion had to do with
why we (or maybe the insurance companies) limit this surgery to the MO.
— jnc
January 26, 2003
I don't want to add to the controversy, but I am 17 months post op and have
a higher BMI that you!!!!. I want to lose another 50 lbs, and I understand
that you are depressed, but surgery isn't the answer for you in my
oponion. Any wls surgery has real risk and complications, and like alot of
other post have said no Dr. would approve you for surgery!!!! My Dr.
considers the surgery a success if you reach a BMI of 30, your a little
under 30. Please don't think that we are not supporting you, because we
do. We all know how it feels to be overweight. The best of luck and
please find someone you can talk to that will help you deal with your
depression. Depression is curable, it just takes time and effort. Again
the best of luck!!!!
— Jody Diou
January 26, 2003
Robyn, My goal is right where you're at and I'm not as tall as you. I'm
30 now, my lowest adult/teenage weight was just over 200lbs. I know when I
was at that lowest weight that I compared myself to my peers who were very
thin teenagers of 17,18, 19 years old and felt horribly fat. I had tons of
things going for me and just couldn't see it. VP my senior year of high
school, boyfriend who was in college, things that not everyone else really
had. Yet I just felt "different" I guess. I can NOW look back
and see that I looked wonderful. I just wasn't able to see it. I also was
at the point you are now. I just couldn't seem to lose anymore no matter
what. I gave up on my weight loss for a while and then yo-yo dieted my way
up to over 300 lbs and being 100% miserable. When I was looking at my
weight when 200 lbs I thought I had almost a hundred to lose to be
"normal". I was waaaay off on that. And it IS depressing to
think of yourself as so very far from normal. Now I look at things
differently. Obviously how each of us see things makes a huge difference.
For me, I now feel that I was never meant to way much below 200. And its
true, officially my goal should be about 170 with WLS. Looking back at
myself at that 200 pounds, besides wishing I could have saw myself as I was
and accepted it, I wish I had realized that I could have had a tummy tuck
back then. That was one of my hugest issues with my body and I thought
that losing weight was the only way. The truth is though that my stomach
was where I stored most of my fat, it was the last place I'd ever lose, and
even at goal I would have problems with it and have needed it done. For me
I had to have it done while still heavy for medical reasons. But its made
a huge difference in my look and how I feel about myself. I wished I
realized back then that I had options besides yo-yo dieting. If I were
there as a friend I'd throw away the scales and help you find help to deal
with body image. Until you can really see yourself, the scale is more of
an enemy than a tool. And I can guarantee if you were to gain 50 + pounds
to have surgery you'd look back at yourself and see things a lot
differently than you do now. I hope I've made some sense. If you want to
talk you can email me.
— Shelly S.
November 15, 2005
Hi,
It is not necessarily true that one has to have a BMI of 35 or more. My
BMI was not as high as that and I was still approved by Medicare because of
the number and severity of co-morbidities. You hadn't mentioned, do you
have co-morbidities, i.e. significant health probems which are seriously
affected by your weight? It does appear that you would have difficulty
with your particular height and weight though. I understand that you would
rather have WLS than use diet and exercise out of fear that this doesn't
seem initially to work as well. However, remember, that, a year or so
after WLS, you will still having to be watching your food intake and being
certain to exercise. WLS is not a magic bullet. There are folks who have
WLS who do not dump from sugar or fats so it becomes a matter of willpower
anyway to maintain your weight loss.
— cokijan2
March 6, 2009
what is mbi?
— trinity P.
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