Question:
38 yr old female-5'5" 235lbs, no major comorbities- Will I qualify for WLS?

I am a 38 yr old female-5'5" 235lb. My weight flucuates from 235 to 240 placing my BMI anywhere from 38 to 41. My PCP does not support my decision because he believes that I should diet and exercise more. I have no major comorbities. I do have arthritis in my right knee, Reflux and a hernia. I'm afraid I won't qualify or have a justified reason other than not wanting to be fat anymore. Any input would be helpful    — tigerpaws (posted on May 11, 2003)

May 11, 2003
Hi, I t just depends on the consult with the surgeon that would be doing the surgery. My surgeon does it only with a bmi 4o or more but since you are close to that range then they probably would and since you have reflux, that's is considered a medical problem to have the surgery. i would go ahead and check with a surgeon in your area if you want to have this done. i am now 3 mths. post-op and am very glad to have this done, I heard that it helps with reflux. good luck to you, hope this info helps.
   — Melodee S.

May 11, 2003
Let me be your biggest supporter. Arthritis is a comorbidity, reflux, hernia... I would recommend finding a new PCP. If diet and exercise worked alone, this surgery would never have been done. As far as qualifying, you need to look to your insurance policy on what their requirements are. I am assuming you have to have a referal from your PCP like I did. I met my insurance qualifications, even though I did not have the support of my PCP. Arm yourself with information, on what your insurance policy is and educate your PCP on the surgery and benefits. If he/she does not support you, get a new one. You pay for your insurance, these docs work with you, not against you.
   — dimpkd

May 11, 2003
Lisa - Our 'stats' are similar and I was approved for LAP RNY. If your PCP is not supportive at all, maybe you should find a WLS friendly PCP. My PCP was anti-sugery, anti-diet pill and told me, "Kim, some people are doomed to be chubby for life and you are likely one of them.' " So I went home (with my feelings hurt) and I did a lot of home work on the topic of WLS THEN I went back to my PCP (months later) with a lot of WLS information for him to review. He became supportive quicker than I thought. He told me that he would write a letter of support but doubted I'd ever qualify. Now, that was my PCP! Real cheerful and positive, LOL!! Also I have arthritis in my knees and my surgeon told me that after the weight loss, the pain should dissipate along with other problems that go along with being obese. Good luck to you. E-mail me if I can help you!
   — Kim W.

May 11, 2003
Lisa, I was in your exact shoes 6 months ago. Although I have GERD, which is the same as acid reflux, and is a high co-morbidity by the way. Make sure you are on a prescription medication for that, and that will help your chances of approval. I thought I weighed 237, but really was 240, and now weigh 243, since I had all that time to wait to see my surgeon, which is this Tuesday. I also had a sleep study done on my own to SEE if I had sleep apnea, and it turns out I have SEVERE sleep apnea, which is a high co-morbidity as well. So, have that test done and maybe you will shock yourself. Research the various co-morbidities on this website and you may have more than you thought, such as irregular menses, or infertility, etc. Also, you need to find a PCP that supports WLS. If yours does not, call your surgeon and ask them to recommend a few in your area, they should have a list of them, and that will make your journey SO MUCH EASIER. everything will work out, just keep positive. You qualify, it wouldn't hurt not dieting for a while to gain a few extra ounds. I know MANY people that have gotten approved with our height and a BMI of 40, and no co-morbidities, just make sure your BMI is 40 and you will be okay. Hugs Michele
   — Michele B.

May 11, 2003
I didn't know irregular menses and fertility were considered co-morbs. I would check on that one if I were you. From what I understand most insurances that do approve wls with the condition of being "medically necessary" defines it as having a BMI of 40 or higher OR a BMI of 35 with 2 co-morbs. I think the suggestion of having a sleep study makes sense. Good luck!
   — TheresaC

May 11, 2003
HI! First find a new doctor who will support you for surgery:) And GAIN 2 lbs to have a 40.2 BMI.good luck:) ~~~muffy~~~~~~~
   — leslie M.

May 12, 2003
Thanks for everyone's input. Let me add, even though he does not support my decision, he did give me a referral. And I guess I haven't checked out what comorbities might be considered. I do have PCOS, a previous heart surgery, and infertility before having my tubes tied. Best of all, I weighed in at 239.5 today without extra clothing. Now if only I can find a doctor in my preferred plan that doesn't require a BMI of 50+.
   — tigerpaws

January 10, 2010
HI IM CINDY AND IM ALSO MORE OR LESS IN THE SAME POSITION. IM 22 YRS OLD Im 5'1 WEIGHT 248-255 WITH A BMI OF 45-47 BUT WITH NO COMORBIDITIES.WELL I DO HAVE ASTHMA AND ACID REFLUX BUT THAT DOESNT SEEM MAJOR. MY PAPER WORK ALREADY WENT OUT TO MY INSURANCE COMPANY.SO IM JUST WAITING IMPATIENTLY!! MOST LIKELY YOU'LL GET APPROVED FOR THE LAP BAND IF U DONT HAVE 100 POUNDS OF EXCESS WEIGHT
   — Cindy18