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For me, my family was part of the reason I was obese. So I found it quite empowering to make the decision by myself to go for bariatric surgery. That being said, I wouldn't be where I am today without the support I have from people around me. However ultimately it's me that has to deal with the pains from overeating. Me that has to deal with the dumping and hypos. But it's also me who can say how incredibly proud I am to have achieved what I have to date (-150lbs). You are never alone, even with yourself Sent from my GT-I9505 using BariatricPal mobile app

The reason hyper vs. hypo confuses me is because nearsighted vs. farsighted sounds backwards to me. I also have a problem with astigmatism. Do you have a stigmatism, or an astigmatism? They should drop the "a" and call it a stigmatism! People also get "fortunately and unfortunately" backwards all the time. Therefore I have a slow thyroid, no confusion! Now I have to read up about how soy will affect my already slow 'roid.

In deferse of we men, may I say that we tend to be proactive rather than reactive and analytical rather than emotionanl. I don't say this to offend you, rather, just to let you know where we are coming from. He just wants to be certain that you have all the data you need to make in informed decision. Tolerate him.:grouphug:

I was banded April 23, 2008. I haven't lost or gained anything since. I lost 24 lbs the weeks prior to surgery during prep time but nothing since. My doc said I may not lose during the healing period, and I might even gain after starting to eat again. I haven't been exercising very much. I have reactive arthritis and am having alot of foot and ankle pain. But I also don't eat very much at all. Ive thought that maybe Im not eating enough? What do you think? Is it common not to lose before your first fill. My first fill is tomorrow.

Apologizing in advance for the length of this post but here goes my 'deleting my online profile' story: So...I met a guy on Zoosk in the spring of 2015. No attraction on my part, and every time we went out, I said to myself that I would end it. Problem was...I really enjoyed spending time with him. Eventually we did become a couple and I hid my profile rather than delete it. Glad I did because after nine months of dating, he blindsided me and dumped me. We were not in love and I'm fairly certain in time, the relationship would have limped along till one of us made the move to end it. But because I wasn't prepared, it hit me like a ton of bricks and brought up all kinds of rejection issues for me and well.....you ladies know how this part goes...what did I do wrong?, why was I not good enough?, yada yada yada. What I did know when the relationship was over, was that I wanted to be with someone so crying hysterically, I resubscribed back onto Zoosk and JDate, which I had also shut down but not deleted my profile from. To my complete surprise, I met a man on JDate in June and we have been having a great time together. This relationship is nothing like with the other guy. This new one and I have so much in common and we enjoy talking about all kinds of things and doing so many of the same things. I wrote on another thread that he might be the lid to my pot and so far, it's going gangbusters. I know he deleted his profile from both Match and JDate a few weeks ago and knew that I had not. It wasn't that I was dating anyone else...I just wasn't ready to shut it down again. Last night I went onto Zoosk because I was getting email notifications from them and on a whim, went onto the site. Just for the heck of it, I looked up former boyfriend's profile...which he had not reactivated when I first went back onto Zoosk..and sure enough, he popped up this time. I looked at his profile..his new profile by the way...and the updated pictures on it. And that's when I knew...time to shut down my profile. It's not that I don't hope he finds someone...I'm not that petty. I just know more than ever now, that he's my past, and it's time to focus on my future..and with this new man in particular. Now...if I could just figure out how I managed to send old boyfriend a friggin' friend request on FB, it would be great. I swear I have no idea how I did that, but I did. I can't unfriend him now...not after sending that request...even by accident. Oh..and why he accepted that request is beyond me. But if I'm lucky, he'll see the pictures of me and the new guy, and delete me from his feed...

Hello new friends. I had a lapband 4 years ago and it has given me trouble from day one. It simply wasn't the best tool for me. My sister had full gastric by-pass the same day. Shes down 100 pounds. (she made the right choice for her). Four years ago I thought lapband would be best for me. My body has not responded regardless of amount of Fluid in I have had port pain- side pain- and choking and vomiting. I recently decided to go forward in my life and after prayer, research and counsel I have decided to have the sleeve. My doctors feel that I will be successful. I also feel that I will be successful, but I have to share that I am not willing to share with friends and co-workers. I don't want to continue to be the person they always greet with A. How you feeling? B. Have you lost weight? C. Wow Your looking great!. The only loss I had before was during the pre-op. After that I started gaining off and on throughout the years due to not able to get meat down (protein) and choking even on the smallest bites and frothing. Ugly story. My doctor shared that when you can't get Protein down, you live on carbs therefore- your body thinks its going to starve so you hold on to all the carbs and the carb results. Needless to say- I went up 25 pounds in 4 years. I just did'nt want to give up on the band. I wanted to be successful so bad. Now, things are different, I am tired of being tired, chaffed, taking blood pressure meds, the arthritis, swelling and uncomfortable in clothes, uncomfortable sitting, standing and walking. I want to be healthy. The same thing I wanted 4 years ago. I am ready to be bandless and to be sleeveful. :wub: MollyBsleeve wants to be sleeve- full very much. I do have a question and hope someone will have the answer for me. If you have Hypo-glycemia how do you keep from having sugar drops when you are so limited on getting nutrition in at the beginning. I had very few sugar drops after surgery but I know when I am weak and can't eat due to stomach virus or such I get sugar drops and it usually takes Peanut Butter - (small spoons at a time to get me back up). Blessing for a new journey for all.

I was diagnosed with Hypothyroidism about ten years ago. My levothyroxine has been decreased since surgery also. I can't say I've been a slow loser but. I am a very happy loser either way you look at it. My stats: HW 289lbs SW 251lbs CW 183lbs Highest BMI 43 Current BMI 28 I am 5'8" and feeling healthier that I have in many, many years. I try to exercise daily, Walking for 5+ miles is my new freedom. I am now 9 months post-op. My weight-loss has slowed considerably in the last 2 months but I expected that as I get closer to my goal of 160lbs. The main thing is......I am still losing. My Dr's goal for me was to lose 70% of my excess weight. I've met and exceeded that goal by 17lbs. My personal goal is to hit 160lbs. That will put me just under 25 for a BMI. Woohoo! Only 23 more lbs to go! Good Luck to all of my fellow Hypo's.

I got dizzy too for about two weeks. I also had some nausea with it. For me it was around week 10 and 30 lbs down. The doc thought it was vertigo and said sometimes people loose the fat pad in their inner ear with rapid weight loss. I wore a scopolamine (sp?) patch for about 10 days and it helped. (I even went to Disneyland.) warning this did make my vision blurry and I had to make the font really big on my computer for a while. Another poster mentioned hypoglycemia. My doc suspected that and had me test 30 min after eating. Apparently there's a phenomenon card reactive hypoglycemia where you overproduce insulin.) Hang in there!

I actually have experienced a kind of dumping syndrome both within the week after surgery and now. When I went on to full liquids (milk/soy base Protein shakes), it caused me to shake a bit, sweat, and run for the toilet. My body held nothing and I had to slow down my Protein Shake intake from 8 oz in 30 mins to 2 hrs to help me retain it. This is using low sugar, low fat, bariatric Protein shakes. Now, I have a strong sensitivity to carbs. If I have a meal w/ 20 g total carbs (including fiber), my heart starts to race. I had 1/2 slice of pizza from a small pie, this triggers the same effect. I'm netting around 25-40 g carb per day, which is extremely low. My doctor says its likely reactive hypoglycemia, when my body produces too much insulin in response to a relatively high blood sugar load. Some patients experience thing after surgery, but you'll want to consult with your doctor to rule out anything else.

This is going to be long, so I apologize. I'm just frustrated. I'm almost 2 years post VSG and have developed a significant case of GERD. It's so severe, and not controlled by medication, that my surgeon feels we can't just let it go. He has recommended that I undergo a procedure called stretta, which seems promising. We submitted for approval to my insurance company which promptly rejected the request (took them all of 3 business days) on the grounds that the procedure is experimental and there are well accepted alternatives, including pharmaceutical therapy and Nissen Fundoplication. Well, I'm not controlled by medication and the only combination that provides any relief Protonix/Dexilant was already rejected by the Company (they won't pay for the Dexilant and at almost $400 a month, the cost is almost prohibitive). Also, given that I no longer have a fundus, a fundoplication isn't available to me (nice going insurance co . . . way to review my medical records). My final option is conversion to bypass, which I really don't want to do. Other than my GERD, I LOVE my sleeve. It's allowed me to lose 130lbs and live an active lifestyle I've only dreamed about. I like having my pyloric valve and not having to worry about dumping, reactive hypoglycemia, etc. Also, the thought of another major surgery is not thrilling me. Anyway, my surgeon gave me the cost for both Stretta ($5,000) and conversion ($100,000). We decided to seek approval for conversion just to have it in our back pocket while we appeal the denial to my state Department of Insurance. Wouldn't you know it, they approved the $100,000 surgery. This is a prime example of what's wrong with the insurance industry. Why would you approve a $100,000 solution to a $5,000 problem???? Just frustrated beyond belief and knew this was a good place to get out my aggression . . . here and in my kickboxing class where I visualize the Ins. co's medical director's face as my target!

One of the major reasons I had VSG was to get off my diabetes meds. I haven't taken any since immediately post-op. Yay! Now I have the opposite problem. My fasting glucose yesterday was 71, which is approaching the danger zone. I'm shaky every morning and I can't exercise or I feel like absolute garbage. Three "meals" per day isn't an option - I have to snack or my levels tank. At only 6 weeks out, I'm not eating any carb-heavy foods or anything not on my plan, and I take in the appropriate number of calories for this stage. All water and protein goals met 99% of the time. It's too early to have "reactive hypoglycemia," so they're sending me to an endocrinologist to figure out why this is happening. They also suggested I eat some yogurt before bed and before exercising (I'm only taking the dogs for walks around the neighborhood at this point) and that actually seemed to help. Their reasoning is that it contains both protein and carbs. Anyone else have this issue? Is it our bodies trying to adjust to the new normal? Is it too few calories for too long a period? I had grand plans of taking up hiking with my Life Scout son, but at this rate I'll never be able to go anywhere I can't get medical attention.

Hello John, Did I read right? Your surgery has been delayed by 2 weeks? I'm on the home run, surgery on Tuesday,11th July. As I'm diabetic I'm the 1st patient on the day,I resent the 7am show up, but then its better this way isn't it? I won't be stressing the whole day waiting for my time I've been given. Good luck with the diet they've given you as you have another 2 week wait. Incidentally,what are you consuming on your diet ? I suffer from diabetes and hypertension's,thats why I want gastric bypass surgery, i have 6 brothers,4 of them have had heart attacks, my father died from a heart attack thats why I want the op. Its a shame I'm vegetarian, easier way to get protein if you're a meat eater. Im feeling better then I was last Saturday when I started the preop diet. Last night wasn't good as I got a hypo. My diabetic meds will definitely have to change after the op. Yes I'm set for Tuesday,ive bought my M&S cotton dressing gown ;-)''.

I have been hypo for seven years now. As long as you have your levels under control with meds, there is no reason why being hypo would keep the band from working. I did have to lower my Synthroid dosage after losing about 65 pounds.

I understand your thinking, but dropsets are actually a very bad way to build strength. Yes, you will feel a pump from the muscle being engorged from increased blood flow, but that is not the same as building strength. Let's use squats as an example. You might be able to do 12 reps on the first set of the bench press but you should stop at 9 or 10. Stopping before muscle and nervous system fatigue will allow you to complete the full set. So lets say that you squatted 100 lbs for 12 reps, then 8, 6, and 4 for a total of 30 reps. That would give you a total volume of 3,000 lbs. However, if you dropped that to 8 reps for the entire set, you would have 32 reps for a total volume of 3,200 lbs. As you get further and further into your strength training, the disparity become even greater. All that being said, I don't do that many reps in any of my sets. Sure, I could probably do 12 reps at 185 lbs, but 3 sets of 5 reps at 245 lbs provides me with 3,675 lbs of volume work. As for the OP's question, 2 weeks post op I would focus on just walking. Your stamina is going to be very, very low. The threat of reactive hypoglycemia is very real, as is low blood pressure. Getting dizzy is common and fainting is not unheard of (as me how I know!). There is no time in your life when the weight will come off faster and easier than this point of your recovery. Capitalize on it. Once you are hitting your fluid and protein goals or more for the week, then start Pilates or resistance training. I actually liked Pilates in the beginning. Once that is no longer kicking your butt, start real weights. Squats and deadlifts are the two must important movements the we as humans need to do properly. If you are picking up small children or heavy bags, moving furniture, etc... you are using the same muscles, so start training them when you are able.

I am hypo and have lost nearly 75 pounds. I'm 16 months out. At my one year mark I had lost enought that my thyroid levels were a high, so my doctor reduced my dosage of synthroid. He checks it now every 4 months and said as I continue to lose I will continue to have it adjusted. So far I reduced my synthroid medication, I've cut my blood pressure meds in half and completely got off my bladder control medication. The band is wonderful and I feel great! Before surgery, I was convinced I would never lose with the band. I thought with hypothyroidism I was sentenced to a life of obesity. I was wrong. I've been pleasantly surprised.

Off to an interesting start for 2005 Please forgive the length of this post, but I really need to vent. Since the first of the year, I’ve been admitted to the hospital twice. Not so good when you notice we are just now on day 7 into the New Year. The official diagnosis is “reactive airway disease with restrictive ventilatory defect due to obesity.” The treatment: loose weight while taking massive doses of steroids. I’m so tired of them not knowing what is wrong, so they use my weight as the scapegoat. “Because you are fat, we will say that is what is wrong. While we’ve never actually been able to prove that your extra weight is the cause of you not being able to breathe, we heard about another doctor that saw someone who couldn’t breathe because they were fat. And since you are fat, that must be why you can’t breathe. That, or you are just faking it. … If only you had the strength of will-power, you should loose weight. Oh, and those steroids, well, yes, you will probably gain another 20 pounds, but don’t worry, you just need to be stronger…. What? You say you are currently on 1500 calories? Well, that doesn’t make sense, you should be losing weight. Why don’t you try running and see if that helps you lose weight? I got the flu for Thanksgiving, and have been sick since. I didn’t qualify for the flu shot in ID, since it was really scarce there. Not sure why they didn’t give me a flu shot while I was in the hospital. I’m tired of being tired. I’m tired of not being able to breathe. I’m tired of doctors scapegoating instead of finding the true cause.

I'm hypo too, but I haven't had a problem so far losing. As a matter of fact, I even had to change thyroid meds right after my surgery, because they are no longer making Armour thryoid. It did cause a change in my energy level and caused me to be slightly depressed., but did not seem to affect my weight loss.

Well, Here I am! New to all of this and hoping I can meet new friends and different opinions on this whole new life! My life changes started when I learned that I had developed Diabetes, along with already having High blood Pressure and hypo thyroid. Along with my mother getting sick and having to go to the hospital and when I rode in the ambulance with her, I couldnt even buckle the seat belt! I was soooo embarrased! I made an appointment with Dr. Shroder and went in January of 2013. As required, I had to get a nutrionionist consult, a psychaitric evaluation, and letter of support from my Family Practice Doctor. I completed all of this by the end of April this year. All information was submitted to my insurance company, and within several weeks I was approved for surgery! No problems! The insurance company covered it 100% other than the 250$ a night I had to pay out of pocket. My surgery was scheduled for August 12, and was I excited! I had preop work done the end of July. Surgery date came and I was at the hospital by 7am. Of course I had bad veins and it took a few sticks, but finally got the IV started. I was wheeled into the OR at 9am. By 1pm I was out of surgery and back to my room. I do remember being in some pain in Recovery room, but hey, they were well equipped with drugs to keep me happy. I never had any extensive pain while I was in, just being a little uncomfortable. My doctor has his patients in the step down unit to ICU, so there for I was under constant nursing supervision the whole time. I had the BEST care at my hospital and dont regret a thing. I stayed a total of 2 days, and then went home with my JP drain. Yes, not too pretty, but hey, it was only in for a week. Totally painless to remove. I have 4 incision sites, that are just a light red now, 2 months post surgery! So, Please, take this step for surgery if you are considering it! Totally worth it!

sounds like it might be reactive hypoglycemia (RH), which some people refer to as "late dumping". I used to get it about an hour or so after I ate too much sugar. It's not all that uncommon in RNY patients - and it usually starts a year or two after surgery. You can control it by limiting (or avoiding) sugar - and my PCP also suggested I try to eat something every 3-4 hours. It's helped a lot - I rarely get those episodes anymore. P.S. admittedly I'm not a healthcare worker, so I don't know for sure - but it does sound a lot like what I had/have. And again, it's not uncommon in bypass patients.

If you don't want to read the whole post, skip to the end for the questions. Thanks! Does anyone have tachycardia or did you have it before your surgery? I am so frustrated. I have been on a beta blocker for tachycardia for a few years now. I have had all the tests (echo, stress, ekg, nuclear imaging) and my heart is healthy. However, my tachycardia seems to be getting worse. I went to my cardiologist a few weeks ago for cardiac clearance for surgery and my resting heart rate was 112....he put a holter monitor on me and it got up to 150 at some times over the next 24 hours. He belives some type of hormonal problem is causing this so he tested my thyriod (which the levels were a bit off, some indicating hypo, some indicating hyper....I have symptoms of both...go figure), my cortisol was a little high but not high enough to indicate Cushings and he has referred me back to my regular dr for a catecholemine test (these are the levels of adrenaline, epinephrine and norepinephrine). I'm so frustrated. I feel that if I could just have the surgery and get some weight off, a lot of my health problems would start to diminish. I know there are people on here who have had surgery who were in worse shape than me. I know that I can't go into surgery with 110-150 beats/minute heart rate because they won't put me under but I'm just so irritated about having to wait. He has increased my beta blocker which has helped some but probably not enough. Sorry this is so long. My question is basically did anyone have tachycardia before your surgery? Did it cause a delay or did it cause problems in your surgery? What did your surgeon or anesthesiologist say about it? Thanks.

Oh, thank you, for mentioning the Facebook thing. I'll be careful not to do that since I have decided, for now, not to tell anyone, except my husband. I am pretty sure I will share with friends and family, eventually. I just don't want to have to deal with any commentary/opinions for now. My side of the family is a little too honest at times. I remember, I hadn't seen my brother for about a year. I had had a baby, and when I saw him next his first statement to me was not even hello but a straight up "Boy, you have put on a lot of weight." Rude! When my children say something reactive like that, I always reming them; 1) You can have a whole thought process in your head but the world doesn't need to know about it and 2) If you have nothing good to say, say nothing at all. Hope your hip recovers soon. How did you get hurt?

style="margin:0;padding:0;background-color:#d8dde8;color:#5a5a5a;font:normal 13px helvetica, arial, sans-serif;position:relative;"> Hey BariatricPal Members! Merry Christmas, and Happy Hanukah to our Jewish friends! Season’s Greetings for those of you who are not celebrating a holiday now – it’s still a festive time when everyone can enjoy the uplifting spirit around town. As we near the end of a long season of tempting food, you may need a little help getting back on track or staying on track. Here are our offerings. Weight Loss on Christmas? A Personal Challenge Breaking the Slump: Make a Healthy Choice Now! The Holidays, Your Family, and Weight Loss Surgery Hopefully this newsletter can help you keep your weight loss goals in mind and give you a little push to inch closer to hitting them. After reading the newsletter and spending some quality time with your loved ones, don’t forget to head on over to the BariatricPal Forums so you can share your tips and ideas with all of the BariatricPal members! Merry Christmas! Sincerely, Alex Brecher Founder, BariatricPal Weight Loss on Christmas? A Personal Challenge The weight loss surgery journey itself is a bumpy road, and recent weeks may have been even tougher as the holiday spirit has taken over. High-calorie, fatty, sugary foods have been everywhere, and gift shopping, family obligations, and holiday parties may have been eating into the time you might otherwise have spent exercising or planning healthy meals. So, what do you say to a challenge to lose weight this Christmas? The idea may sound crazy, but it is actually possible if you try hard. Here are our suggestions for a weight loss Christmas Day. Christmas dinner the WLS Way The totals for a full-blown Christmas dinner can be somewhere between staggering and horrifying. You yourself may have indulged in a few such dinners in the past. Between the ham or turkey, stuffing, mashed potatoes, casseroles, and Desserts, plus some alcohol and a bit of nibbling on appetizers and nuts, you can have 5,000 or more calories on this single day. Yuck – that’s 1.5 pounds of fat! Here is a more reasonable Christmas Day scenario to consider. Breakfast: Festive Protein pancakes with 1 cup sliced strawberries (150 calories) Meet ‘n’ Greet Appetizers 1 cup fresh cut vegetables with yogurt-based dip (100 calories) Red, white, and green Christmas skewers with cherries, peeled apples or pears, and green grapes. (100 calories) chocolate Coated Protein Puffs Soy Snacks (150 calories) Christmas Dinner 3 ounces of ham or skinless turkey or duck breast with mustard (150 calories) Green bean frittata – a high-protein, low-calorie substitute for green bean casserole (100 calories) Green salad with Light Dressing ½ cup pureed sweet potatoes sprinkled lightly with crushed pecans and sugar (or honey or low-calorie sugar substitute) (200 calories) 1 medium baked apple with cinnamon, served with light or sugar-free whipped topping (150 calories) Later Snacks Protein Cocoa or Mocha (100 calories) 1/2 ounce mixed nuts (100 calories) (Don’t forget to use coupon code BPNEWSLETTER10 for a 10% discount of your first order!) Savor Your Treat Don’t forget to leave room for a treat. That’s right, even WLS patients deserve a treat. Just make sure: It’s one that you really, really want. You can tolerate it (some treats are too sugary or fatty for your post-op digestive system, and even a small serving can make you feel sick). You take only a small amount and count the calories. In the sample Christmas Day menu shown above, there is room for another 200 to 400 calories from your treat while still staying under 1,500 to 1,800 for the day. Those calories can get you any two of the following: A half-cup of mashed potatoes with gravy. A half-cup of bread or rice-based stuffing. A 1-inch sliver of pecan, pumpkin, or another kind of pie. A small square of fudge. A small dinner roll with a pat of butter. A half-cup of eggnog. Get Moving, for So Many Reasons It’s a busy day, but surely you can find a few minutes to get in a short walk or workout. There are so many reasons to get moving in the morning or during the day. Burn calories and boost metabolism. Keep yourself motivated as you notice how good it feels to get moving rather than eat. Take time away from the food because when you are walking, you are not eating. Bond with your children, nieces, or nephews; with your out of town relatives; or with your significant other. Breaking the Slump: Make a Healthy Choice Now! One bad day of eating does not make a habit, but a six-week period does. A skipped workout or two doesn’t get you out of shape, but a month of inactivity makes you sluggish. A single bad weigh-in is no cause for alarm, but a few weeks of climbing numbers is reason to take heed. The time between Thanksgiving and Christmas can put you in a weight loss slump. Over time, your can get weaker and those poor decisions can get easier. While a bite of a cookie might have made you feel guilty in early November, the whole cookie and a second one may be par for the course now. Snap out of it! It is time to get out your slump. If the thought of reversing all those bad habits at once is too much, take heart. You can put yourself on the right path with a single decision. One good decision can increase your confidence and lead to more good decisions. You could: Make your own 200-calorie Breakfast sandwich with Protein Pancakes, a fat-free slice of cheese, and egg whites instead of hitting the drive-through for a 500-calorie breakfast biscuit. Schedule a short walk with a neighbor – no backing out! Log your food for a day, no matter how bad you know the numbers will be. Step on the scale if you’ve been avoiding it. How will you break your slump? The Holidays, Your Family, and Weight Loss Surgery As hard as the food and lifestyle around the holidays may be for you as a weight loss surgery patient, your family can make things even harder. You can prevent them from knocking you off your game by being prepared for what to expect and how to handle it. Problem: Pressure to Go Off Your Diet Saying no is just one of those things you have to learn how to do in life. Refusing your relatives’ offer of freshly baked Christmas bread or Christmas Cookies made “just for you” is difficult. They may feel that you are rejecting them. Practicing ahead of time can help. A simple, “No, thanks” can do wonders, and it leaves no room for argument. You could elaborate with variations such as “No, thanks, I’m not hungry,” “No, thanks, my doctor says I can’t eat that anymore,” or, “Not right now, thanks. It’s already great to get to see you!” Problem: Unwanted Comments on Your Weight or Weight Loss If you got your WLS in the past year, you may have dropped several pounds since relatives from out of town saw you. They may be overly reactive to your weight loss. Or, they could have the opposite reaction and say something discouraging about how they expected you to lose more weight by now. Whatever they say, do not let them throw you off your game. Problem: Lack of Acceptance of Your WLS They are not living your life, and they do not know exactly what you have gone through. A lack of understanding about what WLS is and how a WLS lives can inspire negative comments. You can choose to ignore them, or try to explain your WLS to them. You can also try to include them in your routine, such as inviting them on a walk or asking for their help in your kitchen while they’re in town. You can grow closer and develop a better understanding. Again, Happy Holidays! Enjoy this special time with family and friends, and make it a safe and healthy time for yourself and your loved ones. Thanks for spending some time with the newsletter, and we look forward to seeing you on the forums! · Unsubscribe from all BariatricPal E-Mail.

Controversies in Coverage for Obesity Treatment and prevention have seldom been emphasized by insurance providers, despite spiraling health care costs attributed to obesity. With more Americans overweight, obesity has become a leading cause of preventable death (65) . Direct costs associated with obesity represent 6% to 7% of the National Health Expenditure (66) (67) ; 99.2 billion dollars were attributed to obesity in 1995, of which 51.6 billion dollars were direct medical costs (67) . A study examining the 25-year health care costs for overweight women over age 40 years using an incidence-based analysis, predicted that 16 billion dollars will be spent in the next 25 years treating overweight middle-aged women alone (68) . Other investigations have suggested a relationship between BMI and health care expenditures. In one study, medical and health care use records of obese women (N = 83) belonging to a health maintenance organization were compared with records of non-obese women (69) . As BMI increased, so did the number of medical diagnoses and the use of health care resources. In another analysis of employees of 298 companies (N = 8822), obesity was directly and significantly related to higher health care costs (an 8% higher cost), even when adjusting for age, sex, and a number of chronic conditions (70) . A longitudinal observational of obese individuals (N = 383) covered by the same insurance plan reported that the probability of health care expenditures increased at BMI extremes (71) . A study of over 17,000 respondents to a 1993 health survey reported a strong association between BMI and total inpatient and outpatient costs (66) . Compared with individuals with a BMI of 20 to 24.9 kg/m2, there was a 25% to 44% increase in annual costs in moderately and severely overweight people, adjusted for age and sex. Wolf and Colditz (67) reported an 88% increase in the number of physician appointments attributed to obesity from 1988 to 1994, and a total of 62.6 million obesity-related physician visits in 1994. A recent review of the scant literature on access to and usage of health care services suggests that obese persons use medical care services more frequently than do non-obese people and that they tend to pay higher prices for these services (72) . Beliefs that obesity treatment is unsuccessful and too costly have been challenged (73) . Weight losses as small as 10% are associated with substantially reduced health care costs, reduced incidence of obesity-related comorbid conditions, and increased lifetime expectancy (73) (74) . Recent research has addressed the cost-effectiveness of drug treatments and surgery for obesity. In 1999 Greenway et al. (75) found that weight losses produced by medications (fenfluramine with mazindol or phentermine) reduced costs more than standard treatment of comorbid conditions. Gastric bypass surgery has demonstrated even more impressive effects, with lower costs and greater long-term weight loss maintenance in comparison to low-calorie diets and behavior modification (76) , as well as significant reductions in BMI, incidence of hypertension, hyperinsulinemia, hypertriglyceridemia, and hypo-high density lipoprotein cholesterolemia, and sick days from work compared with matched controls (77) (78) . Current Coverage Practices Even with some evidence of cost-savings for some weight-loss methods, medical coverage is inconsistent. Surgical treatment is often not reimbursed even though diseases with less supported treatments are compensated (79) . Some have explicitly pointed to prejudice against obesity surgery by insurance providers who are preventing its broader acceptance and use in practices (80) . As Frank (81) concludes, "... no claim to justify the denial of benefits for the treatment of obesity has any validity when held to the standards of health insurance otherwise available in the United States. It should be obvious that such a judgment is ethically unconscionable." It is typical for health insurance plans to explicitly exclude obesity treatment for coverage (82) . Physicians often have difficulties receiving reimbursement for their services (79) . Many reimbursement systems do not categorize obesity as a disease, leading physicians to report comorbid disorders as the reason for their services (79) . In 1998, the Internal Revenue Service excluded weight-loss programs as a medical deduction, even when prescribed by a doctor. In response, several organizations such as the American Obesity Association (83) filed petitions for a ruling to allow the costs of obesity treatment to be included as a medical deduction. As of 2000, the Internal Revenue Service policy changed its criteria, allowing costs for weight-loss treatments to be deducted by taxpayers for certain treatment programs under a physician’s direction to treat a specific disease (84) . The Social Security Administration has eliminated obesity from its list of impairments, which is used to determine eligibility for disability payments (65) . Because individuals who receive social security disability benefits are also eligible for Medicare after 2 years, those who are denied disability also forgo opportunities for medical coverage (65) . Although few studies have addressed this issue, a recent cross-sectional analysis of third-party payer reimbursement for weight management for obese children reported low reimbursement rates (85) . Despite the medical necessity of weight management for obese children in the study, no reimbursement was given to 35% of the children enrolled in weight-management programs, and no association existed between the severity of obesity and the reimbursement rate (85) . Although this article does not intend to examine all of the potential factors that may underlie these coverage policies, one likely contributor are perceptions that obesity is a problem of willful behavior and that treatment is unsuccessful and expensive (81) . Although health insurance typically covers treatment for substance abuse and sexually transmitted diseases, which are also considered to be problems of willful behavior, obese persons may not receive the services they need (81) . Denying obese people access to treatment may have medical consequences, but also denies people an opportunity to lose weight, which itself may reduce exposure to bias and discrimination. For example, Rand and MacGregor (58) assessed perceptions of discrimination among morbidly obese patients (N = 57) before and after weight-loss surgery. Before their operations, 87% of patients reported that their weight prevented them from being hired for a job, 90% reported anti-fat attitudes from co-workers, 84% avoided being in public because of their weight, and 77% felt depressed on a daily basis. Fourteen months after surgery, every patient reported reduced discrimination, 87% to 100% of patients reported that they rarely or never perceived prejudice or discrimination, and 90% reported feeling cheerful and confident almost daily. A further study indicated that 59% of patients requested surgery for social reasons such as embarrassment, and only 10% for medical reasons (86) . After the operation, patients reported improved interpersonal functioning (51%), improved occupational functioning (36%), and more positive changes in leisure activities (64%). Although these studies are based on self-reports from selected samples and, therefore, have limitations, it is interesting to note the dramatic reduction in postsurgical perceptions of prejudice and discrimination, and the power of social perceptions in motivating surgery decisions. Summary and Methodological Limitations A "fat is bad" stereotype exists in the medical field (87) . Further study is needed to test the degree to which this affects practice. It seems that obese persons as a group avoid seeking medical care because of their weight. One barrier to drawing further conclusions, however, is that much of the research relies on self-report measures of variable reliability and validity. There is a need to move beyond reports of attitudes to actual health care practices.

Thyroid meds can be tricky, especially when you don't take them consistently and properly. My thyroid was taken out due to having thyroid cancer. But I've always made sure to take my meds at the same time everyday, on an empty stomach, with nothing to eat for an hour afterwards. I lost 60 pounds prior to surgery following a less than 1200 calorie diet and exercising 4-5xs/week. So while being hypo is a challenge, losing weight is very much doable if you are disciplined and consistent.

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