Mar 13

You Have to Stop Losing Weight, NOW

“You have to stop losing weight,” my nurse said. “If you lose any more your insurance may not approve your surgery.”

The date was my four-month visit, of my six-month pre-gastric-bypass-surgery program. The problem was my BMI (body mass index) and the success I was having with my supervised pre-op program.

I’d lost weight, which was necessary for surgery insurance approval. However, suddenly my hard work was my enemy. My BMI had dropped dangerously close to the line that could deem my surgery not coverable.

How screwed up is this whole weight-loss surgery and insurance approval process? I was doing what the insurance demanded. I was still obese. I still needed the surgery. But a few more pounds eliminated and my surgery ship might sink.

Not Obese Enough for Weight-Loss Surgery But Obese Enough to Die

About a year before, when I weighed 215 pounds (at 5-foot 3-inches), had high blood pressure, couldn’t breath or do normal activities, and was threatened with diabetes, I wasn’t fat enough (didn’t have a high enough BMI) to get into the program. I could still join the program and have surgery. I would just have to self-pay the $24,000, which I didn’t have on hand. So, I just kept on living — sort of.

obesity grim reaper

Obesity and heart disease paint a frightening picture.

A few months later, I found myself in a hospital in northern Mississippi, alone and 1,500 miles from home. I was having a heart cath and subsequently a stent placed in my LAD artery, the widow maker artery. I was also over 230 pounds.

The Catch 22 for Borderline Obese People

The good news, which also helped cause the heart problem, was my BMI was now high enough to get into the fabulous weight-management program at my home hospital, Conemaugh Memorial Medical Center. I:

  1. Had to wait a few months to get into the program
  2. Worked hard once in the program
  3. Learned from my medical team and studied how to succeed
  4. Was so excited about changing my life

Then BAM, everything I worked for, and my new healthy life, was in jeopardy. I had to stop losing.

After four months of learning how to live healthy and lose weight — I had to do a 180, jump ship. Insanity.

Insurance Insanity and Walking the Obesity Tight Rope

For two months I had to:

  1. Walk a tight rope
  2. Live with the fear of losing weight and not getting approved
  3. Face the terror of regaining weight and reversing my new lifestyle and way of thinking

I managed to find a middle ground where I could still eat healthy but quit losing, but I was depressed. I didn’t want to quit. I wanted to keep conquering my decades-old life of obesity. Thus, another health issue (depression) forced on be by the insurance industry.

Thank God for my amazing medical team. They kept me focused. But, I worry about folks who might not have the support system I had.

Slowing the Weight Loss Train

  • Check with your insurance program. Some say if you start with your BMI at a certain point they’ll cover you no matter how much you lose, and encourage you to lose
  • Talk with your nutritionist about how to handle the situation, and
  • Keep a positive frame of mind and
  • Stay focused on healthy eating and living

Medical Opposition to the Reqirement by Insurance to Lose Weight Pre-Op

The American Society of Metabolic and Bariatric Surgeons (asmbs.org) has taken a stance against prolonged dieting before surgery. Don’t, however, misconstrue the organization’s stance with opposition for following a pre-op program of education and involvement with your medical team.

“It is the position of the ASMBS that the requirement for documentation of prolonged preoperative diet efforts before health insurance carrier approval of bariatric surgery services is inappropriate, capricious, and counter-productive given the complete absence of a reasonable level of medical evidence to support this practice. Policies such as these that delay, impede or otherwise interfere with life-saving and cost-effective treatment, as have been proven to be true for bariatric surgery to treat morbid obesity, are unacceptable without supporting evidence. Individual surgeons and programs should be free to recommend preoperative weight loss based on the specific needs and circumstances of the patient.”

Read more about the organization’s reasoning, Preoperative Supervised Weight Loss Requirements



About the author

Laurie Lee Dovey

LLD is a writer, photographer, marketing and media consultant, hunter, angler, RVer, sports nut, poker player, and wife.

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