Question:
Has anyone ever gained an extra 20 lbs so they qualify for the surgery?
I had my first visit with the Dr. today and he said I could not have the surgery unless I weighed 220 lbs. I weigh 196 and have sleep apnea ( I have a CPap) and about five other conditions that I take medications for. I have been over weight my entire life. And I am miserable. I have spent nearly $20,000.00 in the last 20 yrs on diets, weight equipment, and gyms and never have lost more then a few pounds. I was so depressed when I left the Dr.'s office today. I feel like a failure. Does any have any advise? Should I gain the extra weight or stay fat the rest of my life? — Deberah V. (posted on September 12, 2003)
September 12, 2003
What is your current BMI? I've always understood the criteria to be 40 or
more, but they will approve between 35-40 if you have comorbidities, which
you appear to have.... Don't take your own physician's word for this...
contact a surgeon's office and/or your insurance company before getting
worried about gaining weight.
— Kelly B.
September 12, 2003
I don't mean to sound unkind, but there are reasons that the guidelines
exist. Your profile has very little information, but your BMI is ony 32.
There are some seriously obese people who have to lose 150 or 200 pounds to
get down to a goal of where you are. The post-op life is not easy, and
this surgery should not be done except as a health-saving last resort. I
don't know why you have been unable to lose enough weight by dieting and
exercise, but if you have to gain 24 pounds just to become eligible for the
surgery, that should raise major red flags that this is not an appropriate
solution for you. I'm sorry that you have health problems and are unhappy
with your weight, but I truly think you should explore other avenues first,
such as a medically supervised diet and exercise program that you commit to
for a minimum of six months, for example. If you truly stick to it, and
that's not successful, then consider something more drastic. If you are
unable to stick to a strict diet and exercise regimen for six months, then
WLS is not likely to be your answer, either. My best wishes to you.
— Vespa R.
September 12, 2003
I wouldn't recommend gaining weight for this surgery. It is a painful,
major surgery. And, not being able to eat hardly anything is no fun. I
throw up several times per week and can only eat about 1 1/2 oz. of food at
a time eventhough I was supposed to eat 3 oz. by now. This is so difficult
and painful and I would not recommend it to someone who was not just obese,
but morbidly obese.
— Wendy T.
September 12, 2003
Vespa: I usually really like your answers to questions, but I have to say
I think you were off the mark on this one. If losing weight was so easy
just because we were in the low 30s BMI, then why in the world did we all
get to the 40s and above? This woman has probably experienced all the same
things as us with higher BMIs but maybe she was just slightly more
successful at keeping her weight down. Should she be penalized or treated
as less worthy of the surgery because she worked a little harder or
genetically was proned to be a little more successful? I was kind of a
light weight when I looked into the surgery, but I had co-mobidities, and I
knew things were just going to get worse, so I felt I had to have the
surgery too. That being said, there is a reason for a weight limit, and I
think it's because people who have less to lose don't lose enough to
warrant the dangers of the surgery. Maybe that is what you were saying
Vespa, and it just didn't sound that way to me? I admit I'm a bit touchy
about people being hard on the "lightweights." Someone had a
similar question as this shortly after I had my surgery 2 years ago, and I
was having so many problems, so I wrote and begged her not to do the
surgery because of how hard it was. Well, now in retrospect I realize that
those initial problems weren't really as awful as they seemed in the big
scheme of things. My second and third months post op were hard, but things
got pretty easy after that. However, after month 13th things got hard
again in terms of keeping the weight off. So here's another problem with
being a lighter weight: I didn't have to gain all that much back (41 lbs)
to have gained back 1/2 of my initial loss. My blood work shows low
calcium and low iron even though I'm taking the vitamins and supplements,
so I am malabsorbing, just not enough to keep from gaining weight. Poster,
you need to ask yourself if it's worth losing as little as 45 to 55 pounds
but still have all the disadvantages of the surgery? If you do have some
serious co-morbidities maybe curing those, or making those better, would be
worth it. I do think the surgery is too drastic to just do it to be able
to get down, or close, to goal weight if you have less than 100 pounds to
lose. But that's not the case for this poster. So I say think really long
and hard, and know that this surgery does have a better chance of helping
you improve your health through weight loss, but it isn't a guarantee
either. There can be some really unpleasant side effects, and you have to
weigh the risks, to the possible benefits. It's horrible to be overweight
your whole life. Just because it's 75 pounds over weight instead of a 100
plus doesn't mean it still doesn't suck. I honestly don't have any advice
for you poster other than really know whether or not you're ready to have
the surgery. If you're honest with yourself, and know your situation
warrants it, then go for it, and do what you have to do. Also, really
consider all the surgery possibilities. I was in such a rush when I first
looked into having surgery, I didn't hear about the DS until I was already
pretty committed to the RNY. You might also consider being banded as
that's less risky, and might be good enough for you since you don't have
quite as much weight to lose. If you want to email and talk more, feel
free. I wish you luck in whatever you decide. Sherry
— sherry hedgecock
September 12, 2003
Sherry: Thanks for the opportunity to clarify. I was by no means slamming
lightweights. I am very sympathetic to the poster's situation. You're
right that we were all at some point on the lower end of the obesity scale,
and I applaud people who recognize a problem and work towards solving it.
I admire the poster's desire to get her weight problem under control. I,
however (like you), don't know that the inherent risks of the surgery weigh
out ahead of the poster's current weight issues. I'm not suggesting that
she hasn't tried hard enough, or doesn't have a sincere problem, and a
sincere desire to solve that problem. However, she provided very little
information in her profile, and I do believe that one last, long, sincere
attempt at a supervised diet and exercise program is an appropriate next
step. If surgery ends up being the answer in the end, then a six month
comittment to lifestyle changes is good practice. If she's successfully
able to lose 50 pounds without the surgery, she is definitely better off.
This is a serious, life-long, life-changing event, and I think that trying
to gain 25% of the excess weight required for this treatment is not
something that should be undertaken until and unless it's a last resort.
Adding 24 extra pounds carries its own health risks. I don't think it
makes sense to gain 25 pounds to ultimately lose about 75 (and put your
health at risk during the gain, and through the risks of the surgery)
putting you just 50 pounds lower than you started out. I'm suggesting
there is a third alternative to "Should I gain the extra weight or
stay fat the rest of my life?", and until she's sure that third
alternative is not viable, and is sure that she can commit to what it takes
to be successful and healthy with the surgery, that she shouldn't do
anything as dangerous as she's proposing. That's all.
— Vespa R.
September 12, 2003
It is very unfortunte that some people regard this surgery so lightly.
It's not a cake walk. As sooooo many posters have said soooooo many times,
this surgery is only a tool. It is no way a magical cure! The risks are
real and the healing can be difficult. And then if you are not realllllll
careful, you could gain the weight back. Also this surgery does not cure
eating disorders. If there are some psychological reasons for obesity in
the first place, WLS won't fix those. WLS is not something to be taken
lightly and there really are some who think you just waltz in, have the
surgery, waltz back out and all your eating problems are gone. It is
because of the big time risks that it is require you be the 100 lbs over
weight. I know it's hard for most people to diet successfully. And I know
that the success rate of keeping the weight off is dismally low! I think,
hopefully soon, we will see some other ways to help those morbidly obese
lose weight and keep it off that won't require such a dangerous surgery.
The bottom line, it STILL takes will power, self control, and hard work.
Again, WLS does not provide you with those things.
— Ginger M.
September 12, 2003
find a new doctor!!
— smmeow
September 12, 2003
Even people with normal weight suffer from sleep apnea and other conditions
that most people think are just because of their weight. This surgery will
may help you lose weight but will not solve every problem in your life,
medical or emotional. Another thing we have all heard before, we must fix
our minds before our bodies. Also I believe sometimes you have to show
that you have been at a high BMI for a certain period of time.
— Sarahlicious
September 12, 2003
This surgery isn't for people who are overweight and unhappy about it; it's
for people who are morbidly obese. There's a reason those limits are set.
It's a very serious and risky surgery so it's only done on people as a last
resort, as a drastic measure.
I think it would be foolish to gain over 24 pounds when your goal is to
lose weight. If 196 is intolerable to you, how happy do you think you'd be
at 220? Gaining weight would not be helping your health and you still
might not be approved. There's no guarantee that the surgery would cure
your sleep apnea or any other co-morbidities.
I admit I have my own bias in this situation; I'm 198 now after losing 161
pounds after WLS, so it's hard for me to relate to 196 being such an awful
thing. And to be honest, I worry that as more and more
"lightweights" look to WLS as just an alternative to dieting, and
don't take the surgery as seriously as they should, sooner or later the
boom is going to drop, and we could see a backlash against the surgery
being covered at all if people whose health is not seriously threatened to
begin with start having serious complications or, God forbid, dying on the
table. I'm sorry if that sounds harsh, but it's a real concern of mine.
You said you've been overweight for 20 years yet you've still managed to
maintain a weight under 200. I think it would be pretty difficult to gain
the 25 pounds for the surgery and even more difficult to lose it if you
didn't get approved.
— sandsonik
September 12, 2003
I have two points to make. The first is that I have lost 192 pounds since
the surgery (205 pounds overall) and I still have sleep apnea. The
severity of it has been reduced, but as of my last sleep study in March, I
still had it. The second point is that there are other causes of sleep
apnea other than obesity and if one of those is the cause of your apnea,
then losing weight wouldn't help. It's hard to comment on the other
conditions because you don't disclose what they are.
<p>
I wouldn't deliberately gain the weight just to qualify for the surgery
because a) it's unhealthy, b) you still may not be approved and c) most
insurance companies require you to be morbidly obese for a period of time
(some as long as 5 years) before you can qualify for this surgery. I'd
find a surgeon that is willing to perform the lapband surgery on you as a
self-pay patient if you are that gung-ho about having the surgery...JR
(open RNY 07/17/02, -205# since initial consult, -192# since surgery)
— John Rushton
September 12, 2003
I know people who have done this. Post ops now they dont regret gaining the
weight to qualify. I remember TRYING to loose weight when I wasnt a bmi of
over 40. It wasnt easy and I failed. The qualify numbers are mere data
points picked by insurance wanting to save money:( No doubt for fear of a
even larger flood of people wanting surgery and costing them big bucks. My
PERSONAL belief. Each one of us must do whats best for themselves. If
eating Ben and Jerrys helps you to get to goal then thats ok. But make
CERTAIN theres not a must be MO over X years to qualify. Wouldnt want to
see you put on the weight and not be able to have the surgery. <P>
With my MOD hat on lets try to treat EVERYONE nice and be understanding of
the desperation involved when you cant successfully loose weight. We have
ALL been thru that, and no matter the number its the pits
— bob-haller
September 13, 2003
If you're not 100 pounds overweight then you probably don't need the
surgery. But if you have co-morbids besides sleep apnea, they might
consider you for surgery at 35 BMI. I guess you can call different
surgeons. Why gain weight though? Strap 25 pounds of bricks to your back
and carry them around for a day. That's how you'll feel for the 3 months
pre-op (if everything w/ insurance goes smoothly) if you gain weight on
purpose.
— mrsmyranow
September 13, 2003
My thought on this is that it is those people out there who are GAINING
weight to have this surgery that are making it VERY DIFFICULT for those of
us who weigh A LOT (in excess of 150 pounds overweight) to get insurance
approval!! I find it very disturbing and quite pathological. My response
may not be popular - but it's how I feel. I have had to fight for a year
for insurance approval- weighing 366 pounds!!!! INSANE!!! I am sorry, but I
have very little empathy for those who would willingly GAIN weight to
defraud their insurance company! I understand the feelings of being
overweight - but since I would kill to weigh under 200 pounds - I just dont
get it!
— MissKimberly
September 13, 2003
Bob Haller: I'm not trying to pick a fight here, but the requirements are
not mere number selected by the insurance companies to avoid paying for
surgery. The 40 BMI (or 35 with significant co-morbidities) guideline was
set up by the medical profession: The National Institutes of Health set
these criteria following a conference on obesity attended and contributed
to by the best medical folks in the obesity field. These requirements were
later backed up by other segments of the medical community, including the
National Institute of Digestive Disorders and Kidney Disease, and the
American Society of Bariatric Surgeons, among others. The requirements are
not arbitrary; they are based on medical science, not insurance risk
concerns. They therefore bear serious consideration.
— Vespa R.
September 13, 2003
Deberah-
I am in no means disking you because you are a 'lightweight" but I am
only 22 years old and I weigh 445lbs. I would do anything to be under
250lbs. I was able to work until November of last year when I started
having severe back problems. Everyone in my family kept telling me that I
needed to apply to have the surgery but it wasn't even a thought for me.
This is a major surgery that can have major complications and God knows I
would never have even considered this surgery if it wasn't a must to save
my life. I understand that being overweight is very depressing and anyone
would do just about anything to fix the problem but making a bigger problem
could be the biggest mistake of your life. I take this surgery very
seriously considering I have two family members that have almost died from
it and a family friend that is bigger now than before her surgery. What if
you were to gain the weight and the surgery was not a success for you?
Sleep Apnea can be controlled with a C-Pap (not cured) but if you were to
gain more weight and were not able to lose it back your sleep apnea could
get worse. I do not know what type of weight loss procedures you have
tried and I know none of them work for me and I slowly got to the weight I
am now, but if I were you I would try dieting and if you still cant lose,
your body should eventually start gaining and then as a last resort to save
your life you should consider the surgery. I hope I have in no way
offended anyone but surgery is not always the answer especially something
as serious as this. If you would like to contact me my e-mail is
[email protected]. I hope to hear from you. Good Luck! Anna Payne
— Anna P.
September 13, 2003
I think another reason why those surgery requirements exist (40 BMI, or 35
BMI + comorbs) is that, if someone who wasn't that large had gastric bypass
surgery, they could possibly wind up being medically underweight. I know
we sometimes kid around about how fun it would be to have *that* problem,
but I don't think it would be fun or healthy at all. I think the original
poster is in a real quandry, one that most of us were in at some point
before we got morbidly obese, and if medical science could come up with an
effective and safe way to nip obesity in the bud before it became morbid
obesity, that'd be a great thing. Clearly there's a need for such
treatment, but there just isn't one yet. I don't know the original
poster's weight patterns over the years, but sadly, it was getting pretty
clear with me that I was heading for morbid obesity years before I got
there, between my family history (female relatives all fighting moderate
weight problems in their youth, then all morbidly obese by their 30s).
Then there were my own, increasingly unhealthy yo-yo dieting patterns,
(lose 20, gain 30, many many times; lose 50, gain 80; lose 80, gain ...
well, 68 and climbing, but at that point, I finally had weight loss
surgery). At no point did I ever sit down and say, I think I'll gain
weight on purpose in order to have surgery, but the thought probably never
occurred to me because I never even thought about the surgery until I was
obese enough to qualify for it. I think you'd want to think long and hard
about how much a deliberate, relatively large weight gain, done just to
have surgery, might mess with your head later on (I know I'd be worried
about that, if it was me -- the head stuff with food is hard enough even
after you've had the surgery). Yep, it just stinks that there are no
decent solutions for the obese or severely obese. Wish there was something
better to be said. Just don't risk your health (physical or mental)
cavalierly ... as pointed out by other posters, what if you gained that
much weight and then got sick or worse from the weight gain alone, or what
if the surgery failed you. You'd be worse off than you are now, and you
really wouldn't want to look back and say, Geez, I really DID do this to
me. Take care.
— Suzy C.
September 13, 2003
I can understand the thought process behind "should I gain weight just
to try and get approved?". I was there at one point. I had Kaiser and
their rules are MUCH stricter than most any other INS that I have seen.
They state that you have to have a BMI of 50 or more with out co-morbities,
and 40-50 with 2 or more co-morbities. I was stuck at being a 49 BMI and
healthy as a horse otherwise. Absolutely nothing wrong with me. So at that
point I DID contemplate gaining the 15-20lbs that it would take to put me
in the 50 range. It was VERY frustrating. Health wise I was in
"good" shape, even though I couldn't do all the things I was used
to doing. I am at 281-283 right now (been stuck in this range for a couple
of weeks now)down from 320 just 3 months ago. I have been doing the lose
before surgery thing. The first 20 were a piece of cake, but that almost
always seemed to be the case for me, it was getting more than that off,
then keeping it off that was hard. I was put on Adipex (Phentermine is the
Generic) which is a perscription appetite suppressant. Maybe this could
help you get off some of that weight. Even being 320lbs, I felt like
compared to others that do this I am not that bad off. But Morbidly obese
is still morbidly obese. I remember being 195-200, and looking back it
wasn't that bad, but It felt AWEFUL at the time. Ultimately this is YOUR
decision, but I would not say go for it, unless you have exhausted EVERY
other possibility. Have they check for thyroid issues? I have heard that
even if the tests look negative that sometimes thyroid medications can
help. Also, don't do this unless you are absolutely positive that your
medical conditions are related to your weight. If they aren't then this
will definitely not solve it.
— Beverly M.
September 13, 2003
I think the best option for you would be to NOT try to gain anymore weight,
and instead look at self-pay surgery with a Mexican Lap-Band doctor. I know
of a few people who were less than 100 pounds overweight that were able to
get lap-band surgery in Mexico. Since lap-band surgery is not as risky as
the RNY is, it's easier to justify doing the lap-band on people who aren't
actualy morbidly obese.
You can learn more about mexican band surgeons at
http://groups.yahoo.com/group/mexicanbandsters/
— K M.
November 30, 2005
I had to gain weight from 196 to 216 I think was my highest weight. but
after I saw the doctor that was going to do my rny he had me go on a deit
befor surgery so I went down to 201 on the day of my surgery. I now weight
between 120 and 125 it go's up and down. helen 2/17/2004 lap rny
— insideout
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