Question:
I wanted to know if anyone had a PCP that was not supportive of WLS?
My PCP is not supportive of my descision to have WLS. I originally spoke to her last year about it and she scared me away from it with horror stories. I have done some more research and found that not to be the case. I have decided to go ahead and have WLS. I wanted to know if any of you had a PCP that was non-supportive and did that effect your approval for the surgery? I am in the process of switching doctors, but I don't wanna wait for the surgery. Any insight would be appreciated. — Malika R. (posted on July 17, 2000)
July 17, 2000
My first PCP was not supportive. He said he had never had anyone approved
that did not have comorbidities (and I had a BMI well over 40) and the
arthritis in my right hip did not count as a comorbidity. I could see I
was going to get nowhere with hime. So, what I did was find the surgeon I
wanted, saw that he accepted my insurance. Then what I did was ask the
surgeon's office who they would recommend for a PCP with my insurance. I
switched to that PCP and it was smooth sailing! After going through all
this I realized that it was not my insurance that was going to deny the
surgery, but the physician's group that my first PCP belonged to. So, my
advice is to not waste time with an unsupportive PCP, switch PCP's!
— Gina E.
July 17, 2000
Hi Malika, I agree with Gina. Don't waste your time on a
Doctor who isnt supportive of your decision. I too had a PCP
who was not only not supportive but acted like a real jerk.
I really respected this guy until that day. He told my husband
that I didnt need WLS but rather for him to lock me in a
closet with 600 calories a day and an exercise bike! I held
back the tears til after we left his office that day, I
havent been back since. I contacted my surgeon who recommended
a Dr. who was supportive of WLS. As it turned out I couldnt
get in to see him for over a month. So instead of waiting, I
contacted a previous PCP who was more than happy to help me
out with a letter of support. Whatever you do, dont stay with
a Dr. who doesnt support you. There are too many others out
there who will. Thanks to my previous PCP, I'll be having
surgery Friday of next week! Hope this helps you. Take Care,
Rooting for you in KY......
— Cheryl S.
July 17, 2000
Hi Malika, I had been going to my PCP for 9 yrs. Also my hubby,3 kids and
now their spouses and 4 of my grandchildren. My PCP does not believe in
WLS. He believes that weight loss,smoking and alcoholics could quit if they
really wanted to. Thankfully we have PPO insurance which would allow me to
seek another PCP of my choice but, by me seeing his assistant for most of
my visits,,we had managed to have a very respected relationship. She did
not hesitate to say that she would write me a referral for weight loss and
detail all my efforts as well as my comorbidies,,however she could not
specify that I have WLS. I do not need a referral from my PCP because our
insurance is PPO,not HMO..etc. But if by chance I am denied approval this
first time,,her letter would be of use in my resubmitting to my insurance
in my fight for WLS~~`hope this helps~~
— Violet K.
July 17, 2000
Hi...I was up against a real witch of a pcp, but I asked for the referral
for the wls, because that is the process! They HAVE to submit it! You will
probably be denied like I was, but that is what you need for an appeal, and
I did the appeal right over the phone it was EASY! Then I had to wait up
to 30 days for the appeal to go through and then I was approved for a
CONSULTATION so...I see him tomorrow! I know that I could have changed
pcp's until I finally found one who would be supportive but who knows how
long that would take!
Call your insurance co. they really helped me. I asked them a lot of
questions, and they were wonderful.
Good wishes to you and be a little tough with your pcp, remember...you
need the referral to get the denial and then appeal to get consultation!
— [Anonymous]
July 17, 2000
PCP...Gate Keeper...Goal, to try to save the insurance companies money! I
was told by 4 doctors that my insurance would never pay for my surgery! I
had to fire my first PCP. My 2nd PCP was not really supportive. I fought!
I fought very hard. After 3 denials, I was approved! The PCP was
probably the most infuriating, degrading, negative experience that I have
ever had to tolerate.
— Janice K.
July 17, 2000
I also had a non supportive PCP and she was not happy that I was choosing
the surgery over her chose of do it through diet. We went round and round
but in the end she gave me what was needed and I had my surgery on July
5th. I don't believe that I will be staying with her after this she is a
great doctor but in the future I don't want any road blocks that will stop
me from anything needed medically.
— Catherine P.
July 17, 2000
Yes my pcp was not happy with it at all. She wanted me to try her diets
first, which I did. Before the next appointment I printed a lot of what I
had researched and dropped it off to her. The next time I went she was
better about it. When I went last week she asked me if I had a surgery date
yet, I told her yes and she was very supportive, she asked if I needed
anything else from her. I told her no, she gave me a appointment for 3
weeks after surgery and also her blessings. So just go armed with good
information I'm sure your doctor will come around. Good Luck
— smul3
July 18, 2000
My PCP was unsupportive. In fact I went to her last year about having the
surgery. She said she had patience that didn't do well or the surgery
didn't work. So I put it off. Everytime I would go into her office she said
I needed to lose some weight. Duh!! That is what I was trying to do. Then
in January I got fed up of being big so I told her to give me the
referreral and I want to see what this doctor had to say. I went and I
liked what he had to say. So I told her I was going to have the surgery,
but she had to do the pre op testing. She waited three days before to do
the testing. They gave me some of my results and was suppose to send the
rest to the doctor but didn't. It didn't stop me from having the surgery.
— [Anonymous]
July 18, 2000
My PCP was new to me. He had taken over my regular PCP's practice after he
had a medical disablilty and had to stop practicing. The new PCP was not at
first very interested.
I asked him to please give me ten minutes of his valuable time and close
the door so I could talk to him. I told him this was what I wanted and
since I was a new patient to him it didn't matter to me if I used him or
found a new PCP. If he would be supportive of me, I would stay with his
office.
Guess What? He chose to not only support me in the decision, but to even
get interested and is anxious to see how it goes with me. Bottom line, he
is a nice guy and concerned about HIS bottom line also!
Find a new PCP if necessary. Never stay with one that thinks they are the
law and ignore your requests.
— [Anonymous]
July 18, 2000
Many PCP's and other medical professionals are very unsupportive of WLS.
It's no surprise. Unfortunately, ignorance about WLS and obesity is not
just commonplace to the general public. Attempt to educate your PCP, but
don't waste a lot of time with it. Move on to another physician. And
bravo on your decision to move beyond her ignorance!
— Paula G.
July 18, 2000
PRINT THIS FOR YOUR DOCTOR: (NOTE THE PARAGRAPH ON WLS)
First Federal Obesity Clinical Guidelines Released
By The National Heart, Lung, and Blood Institute
The National Heart, Lung, and Blood Institute
The first Federal guidelines on the identification, evaluation, and
treatment of overweight and obesity in adults were released today by the
National Heart, Lung, and Blood Institute (NHLBI), in cooperation with the
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
These clinical practice guidelines are designed to help physicians in their
care of overweight and obesity, a growing public health problem that
affects 97 million American adults -- 55 percent of the population.
These individuals are at increased risk of illness from hypertension, lipid
disorders, type 2 diabetes, coronary heart disease, stroke, gallbladder
disease, osteoarthritis, sleep apnea and respiratory problems, and certain
cancers. The total costs attributable to obesity-related disease approaches
$100 billion annually.
"Overweight and obesity pose a major public health challenge. The
development of these guidelines was a pioneering achievement since they
were the first ever developed by the Institute using an evidence-based
model and methodology," said NHLBI Director Dr. Claude Lenfant.
"This report will be an invaluable clinical tool for any health care
professional who works with overweight or obese patients," he added.
The guidelines are based on the most extensive review of the scientific
evidence on overweight and obesity conducted to date. The review involved a
systematic analysis of the published scientific literature to address 35
key clinical questions on how different treatment strategies affect weight
loss and how weight control affects the major risk factors for heart
disease and stroke as well as other chronic diseases and conditions.
The guidelines present a new approach for the assessment of overweight and
obesity and establish principles of safe and effective weight loss.
According to the guidelines, assessment of overweight involves evaluation
of three key measures -- body mass index (BMI), waist circumference, and a
patient's risk factors for diseases and conditions associated with
obesity.
The guidelines' definition of overweight is based on research which relates
body mass index to risk of death and illness. The 24-member expert panel
that developed the guidelines identified overweight as a BMI of 25 to 29.9
and obesity as a BMI of 30 and above, which is consistent with the
definitions used in many other countries, and supports the Dietary
Guidelines for Americans issued in 1995. BMI describes body weight relative
to height and is strongly correlated with total body fat content in adults.
According to the guidelines, a BMI of 30 is about 30 pounds overweight and
is equivalent to 221 pounds in a 6' person and to 186 pounds in someone who
is 5'6". The BMI numbers apply to both men and women. Some very
muscular people may have a high BMI without health risks.
The panel recommends that BMI be determined in all adults. People of normal
weight should have their BMI reassessed in 2 years.
"The evidence is solid that the risk for various cardiovascular and
other diseases rises significantly when someone's BMI is over 25 and that
risk of death increases as the body mass index reaches and surpasses
30," said Dr. F. Xavier Pi Sunyer, chairman of the expert panel and
director of the Obesity Research Center, St. Luke's/Roosevelt Hospital
Center in New York City.
"The guidelines tell the truth about the risks associated with
unhealthy weight. We hope that physicians and the public will take the
message seriously and use the guidelines to begin to deal effectively with
a difficult problem," asserted Dr. Pi-Sunyer.
According to a new analysis of the National Health and Nutrition
Examination Survey (NHANES III), as BMI levels rise, average blood pressure
and total cholesterol levels increase and average HDL or good cholesterol
levels decrease. Men in the highest obesity category have more than twice
the risk of hypertension, high blood cholesterol, or both compared to men
of normal weight. Women in the highest obesity category have four times the
risk of either or both of these risk factors.
The guidelines recommend weight loss to lower high blood pressure, to lower
high total cholesterol and to raise low levels of HDL or good cholesterol,
and to lower elevated blood glucose in overweight persons with two or more
risk factors and in obese persons. Overweight patients without risk factors
should prevent further weight gain, advise the guidelines.
In addition to measuring BMI, health care professionals should evaluate a
patient's risk factors, such as elevations in blood pressure or blood
cholesterol, or family history of obesity-related disease. At a given level
of overweight or obesity, patients with additional risk factors are
considered to be at higher risk for health problems, requiring more
intensive therapy and modification of any risk factors.
Physicians are also advised to determine waist circumference, which is
strongly associated with abdominal fat. Excess abdominal fat is an
independent predictor of disease risk. A waist circumference of over 40
inches in men and over 35 inches in women signifies increased risk in those
who have a BMI of 25 to 34.9.
According to the guidelines, the most successful strategies for weight loss
include calorie reduction, increased physical activity, and behavior
therapy designed to improve eating and physical activity habits. Other
recommendations include:
Patients should engage in moderate physical activity, progressing to 30
minutes or more on most or preferably all days of the week.
Reducing dietary fat alone -- without reducing calories -- will not produce
weight loss. Cutting back on dietary fat can help reduce calories and is
heart-healthy.
The initial goal of treatment should be to reduce body weight by about 10
percent from baseline, an amount that reduces obesity-related risk factors.
With success, and if warranted, further weight loss can be attempted.
A reasonable time line for a 10 percent reduction in body weight is six
months of treatment, with a weight loss of 1 to 2 pounds per week.
Weight-maintenance should be a priority after the first 6 months of
weight-loss therapy.
Physicians should have their patients try lifestyle therapy for at least 6
months before embarking on physician-prescribed drug therapy. Weight loss
drugs approved by the FDA for long-term use may be tried as part of a
comprehensive weight loss program that includes dietary therapy and
physical activity in carefully selected patients (BMI 30 without additional
risk factors, BMI 27 with two or more risk factors) who have been unable to
lose weight or maintain weight loss with conventional nondrug therapies.
Drug therapy may also be used during the weight maintenance phase of
treatment. However, drug safety and effectiveness beyond one year of total
treatment have not been established.
Weight loss surgery is an option for carefully selected patients with
clinically severe obesity -- BMI of 40 or BMI of 35 with coexisting
conditions when less invasive methods have failed and the patient is at
high risk for obesity-associated illness. Lifelong medical surveillance
after surgery is a necessity.
Overweight and obese patients who do not wish to lose weight, or are
otherwise not candidates for weight loss treatment, should be counseled on
strategies to avoid further weight gain.
Age alone should not preclude weight loss treatment in older adults. A
careful evaluation of potential risks and benefits in the individual
patient should guide management.
According to NHANES III, the trend in the prevalence of overweight and
obesity is upward. The guidelines note that from 1960 to 1994, the
prevalence of obesity in adults (BMI 30) increased from nearly 13 percent
to 22.5 percent of the U.S. population, with most of the increase occurring
in the 1990s.
"There are several possible reasons for the increase," asserted
Karen Donato, coordinator of the Obesity Education Initiative. "When
people read labels, they're more likely to notice what's 'lowfat and
healthy' but may not be looking at calories. Also, more people are eating
out and portion sizes have increased. Another issue is decreased physical
activity. So people are consuming more calories and are less active. It
doesn't take much to tip the energy balance," she said.
The upward trend in adult obesity has also been observed in children, notes
the report. Since treatment issues surrounding overweight children and
adolescents are quite different from the treatment of adults, the panel
called for a separate guideline for youth as soon as possible. However, a
healthy eating plan and increased physical activity is an important goal
for all family members.
With that in mind, the guidelines contain practical information on healthy
eating. Based on this material, the NHLBI has developed consumer tips on
shopping, eating, and dining out.
The guidelines have been reviewed by 115 health experts at major medical
and professional societies. They have been endorsed by the coordinating
committees of the National Cholesterol Education Program and the National
High Blood Pressure Education Program, the North American Association for
the Study of Obesity, the NIDDK Task force on the Prevention and Treatment
of Obesity, and the American Heart Association. These groups represent 54
professional societies, government agencies, and consumer organizations.
Clinical Guidelines on the Identification, Evaluation, and Treatment of
Overweight and Obesity in Adults will be distributed to primary care
physicians in the U.S. as well as to other interested health care
practitioners. It is available on the NHLBI Website. Single free copies of
the consumer tips referred to above are available by writing to the NHLBI
Information Center, P.O. Box 30105, Bethesda, MD 20824-0105.
The National Heart, Lung, and Blood Institute of The National Institutes of
Health. Press Release: First Federal Obesity Clinical Guidelines Released.
June 17, 1998. (Online) http://www.nih.gov/news/pr/jun98/nhlbi-17.htm
— merri B.
July 18, 2000
My PCP is very much against WLS. Before I tried looking into WLS, she
wouldn't even help with diet pills so I had to go to an outside Dr. She did
ask for a referral knowing it would be turned down. So I file a grievence
that was denied, Yesterday I had a hearing in front of a reconsideration
board. I think it went well except I have to get pass the Medical Director,
not a covered benefit was all she would say. To top this off she and my PCP
were in the same practice back when she was practicing medicine some years
ago. Waiting to hear about their decision. Wish me LUCK. If not on to the
next step.
— Colleen K.
July 18, 2000
Please read my post on the "Bulletin Board". hope it helps~~~
— Violet K.
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