You’re fat…but not fat enough

[lauren8486 48]

Insane, right? My husband and I went to a consultation appointment last Saturday (1/31) and I was told that while I’m overweight, I’m not overweight ENOUGH to have my insurance cover the procedure – I can not afford to do this procedure out of pocket. Never, in a million years, would I have thought I’d hear that I need to GAIN weight (no my doctor didn’t utter the words “you need to gain weight” but he said “read between the lines”). The doctors asked that I come back in a few weeks (this upcoming Saturday) and weigh in again. They noted that since I had just completed my menstrual cycle it’s very possible that I would register a lower weight on 1/31 and that the bloating I normally experience might influence a higher weight. They also said if I weigh in again and I don’t meet the goal, I can drink Water to get myself there. Has anyone else experienced this? Being told you need to actually gain a few pounds?

I stand at 5’7.75” with a weight of 252 and a BMI of 39.5. I’ve been on diets for about 20 years (I’m 28) and I’m finally allowing myself access to this tool after years of contemplating it. I’ve been on every diet known to man: Weight Watchers, Atkins, South Beach, Master Cleanse, Cabbage Soup, eat nothing after 7pm, eat only once for 2 hours, don’t eat anything white, drink two full glasses of water before meals, drink nothing before meals, carb cycle, Protein binge – you name it, I’ve done it. I’ve joined countless gyms, signed up for spin classes, yoga, pilates, yoga-lates, I’ve run a few 5ks, I used to get up at 6am (blerg!) to work out, I’d work out after work, I’d walk around the parking lot during lunch. I suffer from Hashimoto’s Thyroiditus AND PCOS – both make weight gain incredibly easy and weight loss nearly impossible. I am doing this as a last resort, I don’t like the idea that I’ve gotten so overweight that I need to have 3/4 of my stomach ripped out through my belly button in order to lose weight BUT I understand that I have done everything I can do and I deserve this. I deserve to walk into a store and not worry that they won’t have my size, I deserve to join CrossFit (as I’ve wanted to for years) and actually be able to complete the work out, I deserve to go into various yoga poses and not be literally suffocated by my weight. I deserve this and I’m ready.

With that being said I’m struggling with the weight gain (“oh shut up!” I know, I’m sorry) and the mental anguish that goes with it. I genuinely enjoy eating healthy, I’ve played with Whole30 and the Paleo diet for over a year now and I love it. I feel amazing when I eat clean, I love all the different veggies that I’ve been exposed to (beets! rutabaga!) and it’s something I enjoy. Having a 3-4 pound weight gain to qualify for surgery looming over my head is more difficult than I thought it would be. I feel like shit…I eat shit and I feel like shit. I snack more and I eat more high calorie foods but I’m finding it very difficult to allow myself the sugar and dairy that I so carefully took out of my diet. I’m genuinely terrified that I’m going to step on the scale on Saturday (2/14) and not weigh enough. I can’t continue to eat like this. My clothing is starting to not fit correctly. I just need to make this weight and then I can go back to my healthy eating.

Please offer some encouragement…something. Tell me I’m not alone. I’m freaking out.

[mis4may 35]

I had the same thing happen to me. As crazy as it may seem I had to actually gain 2 lbs and keep that weight on throughout the whole process in order for them to submit it to the insurance. I'm waiting to hear back from them now so hopefully it was all worth it!

[SimplySam2015 0]

Although I cannot relate, I'm positive you are not alone. I know someone your size who was approved. Maybe you need to look for different insurance. No you shouldn't have to gain weight, that's ridiculous. I hope you get more feedback. Take care

[Soozzzee 12]

I've been eating to the point of exploding this past week to get my weight up. I know... it feels stupid. I guess all I can say is you are not alone. Bon Appetite!

[BLERDgirl 6,417]

@@lauren8486 - I would have tried another program. While you may not have 40% BMI you have other health factors that should have justified your needing surgery.

I ALWAYS recommend people look at more than one bariatric program before deciding. I went to 2 different programs before choosing my surgeon. I wanted to make sure I choose one that best suited my needs.

[SeahawksFan 444]

I can relate. I would have had to gain 20 lbs in order for my insurance to pay for it. I ended up paying for it myself and using money I had in my Health Savings Account but if I only had to gain 3 or 4 lbs I would have Have some creamy high fat sauces because you won't be able to after surgery.

Good luck-

LA

[Queen P 112]

To say the least...my PCP was so good to me...in so many words she said to gain five pounds and you are there...I had a couple of cormorbidities (?) As well... she knew I was tired and needed this chance to get my life back...and she supported me every step of the way!

Edited February 10, 2015 by Queen P

[mae7365 372]

I actually had to gain 16 lbs to qualify for my insurance to pay. But I knew this prior to my first consult, so I packed on 15 lbs in 3 weeks to make sure I met the 35 BMI minimum. I had comorbidities, and ended up at 36.1 BMI the day of surgery. Yes, it's crazy, but I didn't want to end up paying out of pocket if insurance would cover it.

[JamieLogical 8,684]

My insurance would only cover WLS if I had a BMI of 40 or more for 5 years. Well, I had worked VERY hard to lose weight on my own in 2010/2011 and lost 90 pounds. But, of course, I eventually put 80 of those pounds back on. I then didn't qualify for WLS from my insurance, because I had been well under the 40 BMI requirement during and after my weight loss. I felt like I was being punished for having at least TRIED to lose the weight on my own. If I wanted to qualify through my insurance, I would have had to stay fat for at least another 2-3 years. I said "screw that" and self-paid in Mexico. So glad I did that! Now I will be slim and healthy long before I ever could have been if I'd had to wait on my insurance.

[Grateful_Love 114]

I've heard of people using weights in their pockets and wearing the heaviest clothes they could. Not advising this, but I've heard it. I've also heard of people wearing weights even if they did qualify, to ensure they could lose the x pounds in the 6 month period.

Cheaters, I say! But whatever works I guess.

[jayhawkgirl 33]

I'm sorry to hear you're having to deal with this! It's got to be very frustrating! I'm sure these requirements are different depending on insurance companies and bariatric clinics. I'd do just what some of the others have suggested. Drink, eat, wear heavy clothing, and get yourself to the weight they require. You can eat healthy, as you prefer, afterwards and have the satisfaction of knowing you did what you needed to to give yourself a healthier life!

[Lebim 381]

Lol I'm 5'8" and was told I wasn't big enough to qualify either. I was around 10lbs too "thin" to have the BMI required for my insurance [cigna] to cover it. I then proceeded to gain 15-20lbs maxing out at 280lbs and was told I then had to lose it to prove I could control my eating. Fun stuff.

Edited February 10, 2015 by Lebim

[Mrs. Reid 392]

I don't know that it's a good idea to openly discuss insurance fraud on the internet.

[woo woo 872]

How is it fraud if you meet the requirement?

Other than (maybe) wearing weights, I'm not seeing it.

Edited February 10, 2015 by woo woo

[lauren8486 48]

Hi All!

Thank you for the responses and the private messages. I have contacted other surgeons and looked into other options but the restrictions are being set forth by my insurance company and not the bariatric practice. From what I've read I'm actually pretty lucky that I only need 6 months of weight, not 2 years like some other posters. Unfortunately (can't believe I'm saying this) I don't have sleep apnea or diabetes, if I did, I'd be in the clear. By all accounts I'm incredibly healthy, just overweight.

When the doctors told me I didn't qualify because I wasn't "that" overweight, I burst into tears. My husband got watery eyed too. I've struggled for 20 years with weight issues and dieting. I'm doing this as a last resort and not as a quick fix. To those who have commented/messaged that it's "cheating" if you try to flub your weight for qualification, I "understand" where you're coming from but I'd like for you to imagine you've spent 20 years dieting and exercising, losing and gaining weight. You finally spend months researching, planning and speaking to everyone possible about the potential surgery and then you're told "well, you're overweight but because you diet and exercise and don't have sleep apnea or diabetes, you're not THAT overweight so you don't qualify". It's an insurance qualification...a bunch of strangers who know nothing about my past or my continued efforts to get healthy are allowed to judge me based on a weight in a chart. If adding 5 pounds to my pockets to ensure my acceptance into the program is what it takes, then I'll do it. I've already done everything under the sun to try and lose it on my own. Not everyone is "lucky" enough to be accepted right off the bat and seeing as this is an information/support network, your support is appreciated but your judgment is not.