ValerieKGorman

Requirement to participate in diet+exercise program

Recommended Posts

I'm 100 lbs overweight.  I'm 47 years old. I've been overweight for many years (20?).  I'm so excited to move towards bariatric surgery to help me get in control of an area that is very out of control.  

I'm interested in whether anybody understands what I read in my insurance company's definition of my bariatric surgery being medically necessary.  Besides the BMI and co-morbid conditions, it also requires: "Participation in a diet, nutrition, and exercise counseling regimen as recommended and documented by the bariatric surgical preparatory team".  What I'm wondering is this.  Is my participation in this regimen an attempt to help me lose the weight and eliminate the need for surgery?  I've dieted and lost weight, only to regain it all and then some 3 times in my adult life so far.  I KNOW that if I grit my teeth and stay super focused I can follow their plan to the letter and the weight will (probably) all come off...it has in the past.  But I know me, I need more help than white knuckled adherance to a "diet plan" to see any permanent weight loss.  It ALWAYS comes back.  Usually starts to creep back up a week or two after my diet.  Because I am a sugar addict and an emotional eater.  So.  If I am required to do a "physician supervised program" to qualify for bariatric surgery, and I really actually force myself to do the program I will succeed temporarily and disqualify myself. Because I am 100 lbs overweight, It will take me a whole year of this to get the weight off.  Then it will take a year for it to pile back on...or maybe 2.  So then I'm 3 years away from today, and beginning again to apply what I know I need: surgery.   If the diet&exercise regimen is there to disqualify those who can lose weight, then I would like to go through the humiliation of sabotaging the program just so I can get on with surgery and get on with the life I want to live. 

Or is the participation not designed to disqualify me but to prepare me for my future life?

Any knowledge of this part of the eligibility requirement? Any advice on how to sabotage it without being obvious (I don't want to be disqualified because of unwillingness to do the program either).  

Sorry if I sound ridiculous.  I've just had it with my eating and my body.  I'm ready.

Share this post


Link to post
Share on other sites

The point of the diet program is to prove you are ready to change your lifestyle.  The surgery is a tool,  It won't magically make you thin forever.  You still have to learn how to eat and exercise.

Share this post


Link to post
Share on other sites

They just want you to try something before going under the knife.  It is a drastic step, one you know you need. But if there is another way, they want you to investigate that first.  f you have enough information on your previous weight loss attempts, that may be sufficient for your doctors.  Did you see a doctor? Enroll in Weight Watchers? Have NutriSystem delivered? If you can recall how much you lost and then regained, it might just be enough.

Share this post


Link to post
Share on other sites

Jstire-i figured someone would jump on me with a remark like that. I know it won't "magically make me thin". I'm sorry but that sounds condescending. As I stated I have faithfully followed and achieved weight loss in the past via diet and exercise...but it always comes back and brings friends. I need more help than that. I'm brand new here sorry if I'm not using the right words. 

Share this post


Link to post
Share on other sites
1 hour ago, Jenny G said:

They just want you to try something before going under the knife.  It is a drastic step, one you know you need. But if there is another way, they want you to investigate that first.  f you have enough information on your previous weight loss attempts, that may be sufficient for your doctors.  Did you see a doctor? Enroll in Weight Watchers? Have NutriSystem delivered? If you can recall how much you lost and then regained, it might just be enough.

I have done weight watchers but it was many years ago and I'm not sure if I fit under the obese category at that point. All other attempts I have done on my own. I'm thinking I'll have to do their program and I don't want to succeed and delay the inevitable, regaining all the weight. But at the same time I don't want to be disqualified because I'm not trying because I want to hurry along the approval process. Just wondering if anybody has knowledge of what exactly their expectations are during the program. 

Edited by ValerieKGorman
Typo

Share this post


Link to post
Share on other sites

Valerie, it's fine. You will not be disqualified for being able to lose weight. The reason for nutritional counseling, etc. is to be sure you're prepared and armed with the information you need to maintain a healthy lifestyle for the long haul.

Eating after bariatric surgery is a little different than what you've done before, especially early post-op. You need new information, and your insurance company wants to be sure that you get it. I lost 55# between my initial consultation with the bariatric practice and the day of surgery. When I had my psych evaluation, the psychologist said my history of being able to lose all of my excess weight combined with my inability to keep it off coupled with my understanding of and willingness to make the necessary behavioral changes made me an ideal candidate.

Just get started, and if you are a medically appropriate candidate (that is if you have qualifying comorbidities given that your BMI is below 40), things should fall into place. I would caution you not to try to lose weight before your first bariatric appointment. If your BMI drops below 35 before your first weigh-in there, your insurance company will most likely deny your request for approval for the surgery.

Share this post


Link to post
Share on other sites
10 minutes ago, WendyH said:

Valerie, it's fine. You will not be disqualified for being able to lose weight. The reason for nutritional counseling, etc. is to be sure you're prepared and armed with the information you need to maintain a healthy lifestyle for the long haul.

Eating after bariatric surgery is a little different than what you've done before, especially early post-op. You need new information, and your insurance company wants to be sure that you get it. I lost 55# between my initial consultation with the bariatric practice and the day of surgery. When I had my psych evaluation, the psychologist said my history of being able to lose all of my excess weight combined with my inability to keep it off coupled with my understanding of and willingness to make the necessary behavioral changes made me an ideal candidate.

Just get started, and if you are a medically appropriate candidate (that is if you have qualifying comorbidities given that your BMI is below 40), things should fall into place. I would caution you not to try to lose weight before your first bariatric appointment. If your BMI drops below 35 before your first weigh-in there, your insurance company will most likely deny your request for approval for the surgery.

Thank you so much Wendy.  That is very helpful and encouraging.  You sound like you were aimolar to me! May I ask which procedure you chose and how it's going for you?

It sounds like I can at least ask them straight out what their goal is for me right? If they're doing it to prepare me and no amount of weight loss will disqualify me then I know I can just relax and do my best. If they are doing it to see if I can lose enough weight to not need surgery I guess then I will just not follow the program very well. 

Share this post


Link to post
Share on other sites

Your insurance company wants you to succeed, I just like you and your medical professionals. There's a good chance that the only weight your practice will provide to your insurance company is the one from your initial weigh-in. 

As for my history, I lost 160# on three prior occasions and kept it off for a year the last time around. I also had several 70-100# losses along the way. As for which procedure and why, I chose the sleeve. There are pros and cons to both procedures, and at the moment I'm too tired to make a detailed post of my thought process. I am thrilled with my decision. It is going great. Time will tell how I do long-term. Take your time, and do your research looking at those pros and cons before deciding which one is right for you.

Share this post


Link to post
Share on other sites

I wasn't trying to come off rude. I apologize. I was just letting you know its not a fix all.  

Share this post


Link to post
Share on other sites

I'm with you pretty much exactly. 100lbs overweight and I've tried many diets and always regained it and then some. My Dr and I both think the sleeve is for me. Everyone iis different. My insurance is still making me do the 6 month diet program, A psych evaluation and sleep study. Make sure to call your Insurance to make sure of everything you need to do. I have united healthcare and had to go through the bariatic program with optum to get started before going to my first appointment. 

Share this post


Link to post
Share on other sites

Valarie - I like your questions; I think we are in the same boat. One problem I'm thinking about is that my insurance company says something providing with documentation that you have lost weight; my weight watchers and atkins were years ago (I can't even remember that or even how much I lost!).

Share this post


Link to post
Share on other sites
8 hours ago, jstire said:

I'm with you pretty much exactly. 100lbs overweight and I've tried many diets and always regained it and then some. My Dr and I both think the sleeve is for me. Everyone iis different. My insurance is still making me do the 6 month diet program, A psych evaluation and sleep study. Make sure to call your Insurance to make sure of everything you need to do. I have united healthcare and had to go through the bariatic program with optum to get started before going to my first appointment. 

Jstire: Were you told if the 6 month program is designed to get the weight off without surgery or to train you for future success? 

Share this post


Link to post
Share on other sites
5 minutes ago, Jumping Jo said:

Valarie - I like your questions; I think we are in the same boat. One problem I'm thinking about is that my insurance company says something providing with documentation that you have lost weight; my weight watchers and atkins were years ago (I can't even remember that or even how much I lost!).

Yeah that's tricky because my low income has meant I've done all my previous attempts on my own...not with an expensive diet program...!

Share this post


Link to post
Share on other sites

I had the 6 mo supervised diet/NUT visits.  I was told just not to gain weight.  It's basically to start preparing you for life post op.  

Share this post


Link to post
Share on other sites

Join the conversation

You can post now and register later. If you have an account, sign in now to post with your account.

Guest
Reply to this topic...

×   Pasted as rich text.   Paste as plain text instead

  Only 75 emoji are allowed.

×   Your link has been automatically embedded.   Display as a link instead

×   Your previous content has been restored.   Clear editor

×   You cannot paste images directly. Upload or insert images from URL.

Loading...