Has anyone ever had a PCP stop their pre-op 6 month diet due to not losing enough?

[pg278 1]

I am in the process of doing the six month monitored diet, and I just came from a weigh-in, and I lost 2 pounds. Firstly, when I was told by the nurse that I had lost, I was so happy, but then the doctor came in, and she was very displeased that I had only lost 2 pound, and she was very clear that she wanted me to start losing 10 pounds a month on this diet. I think she might stop my monitored diet, if I don't lose 10 pounds a month. My question is: is there any of you who have had a doctor stop your monitored diet, and if so, why?

[Lannie 135]

Wow! If I could have lost 10 pounds per month pre-op, I would not have needed surgery. (Actually I would still have needed it to keep the weight off). My point is that 10 pounds per month may be unrealistic for pre-op.

Has your PCP consulted with your bariatric doc? Perhaps a conversation could help reorient to a realistic plan. Does your bariatric doc has a specified amount?

My surgeon has a much better understanding of factors impacting weight than my PCP. Can you come up with an alternative plan to ensure you are monitored for 6 months.

[Berry78 4,259]

I was self pay, so didn't do the 6 month diet.

My first PCP probably would have done the same thing. She really didn't like the idea of my having surgery. (I now have a new doc.. but you don't want to switch now or risk having to start all over).

At least she's giving you another chance

10lbs a month is quite a bit, but if you start counting calories religiously, I'm sure you can do this! Aim for 1200-1400/day. (Cutting out sugar and white flour will help too).

[Apple203 1,314]

10 lbs a month is a tough goal -- I'd find another doctor!

[ReadyforChangeChan 35]

What is your current weight-if you dont mind answering.

[shermand 6]

The weight loss clinic that my surgeon is in has dietitian and staff to do the diet in house and are very understanding. My insurance required 4 months and they did it all after my primary doctor referred me to them.

[pg278 1]

@ReadyforChangeChan, I am currently 5 feet 7.5 inches tall, and I weigh 278 pounds.

[pg278 1]

@Apple203, it is a tough goal, and I am scared that if I do start achieving that goal, then my insurance won't cover the surgery, and if I don't start achieving it, then my doctor might not allow me to continue with the 6 month monitored diet. I called the office of my bariatric surgeon to ask them for advice on the matter, and they should be calling me back soon.

[hmills653 365]

I kind of cheated at the end of my pre op. I had a set amount of weight to lose. I did the hcg diet to lose the weight my last month and meet my goal. I've lost significant weight on this diet a few times but it just doesn't stay off. But I feel like do what you have to do to get there. I had changed my eating habits and started walking but it wasn't coming off quickly enough.

[Berry78 4,259]

Insurance companies are funny.. but it might be their policy to just look at your start weight, not the weight you are at the end of 6 months. Check into that.

I was thinking you probably had a higher BMI than you do.. 60lbs loss in 6 months at your weight IS asking too much (especially because typical weight loss is considered 1-2 pounds a week, which means 4-8 pounds a month..).

Are you only a month into the process? If so, then you haven't lost too much if you end up needing to find a new doctor. Remember, you need your family doc on your side throughout the process, and afterwards. So if they are putting unattainable roadblocks in your path, then they are showing that they really don't want to deal with you or the surgery.

Postop, you will have special needs, possibly with complications, but also routine blood draws (vitamin tests), and the like. Bariatric patients require a bit more medical maintenance than the average patient. So make sure your primary doc is on your side.

[Sosewsue61 3,185]

Some questions:

What state are you in? What kind of insurance do you have (work, state, through ACA, etc) What does your insurance require for approval (6 mos supervised diet or actual weight loss, exercise record, etc - read your plan specifics)? Insurance companies have coordinators that can assist you if you have questions about the requirements. Ask very specific questions - am I required to lose weight, will I be rejected if I gain any weight, will I be rejected if I lose weight below the required bmi, etc?

If you can change PCP then do so. Is your PCP connected to the bariatric team? Some bariatric teams require some weight loss but don't demand a specified monthly loss. Ask the bariatric team to recommend a PCP that is in your plan that is on board with the surgery if you can change to a new PCP - your records can be consolidated from one physician to another.

If you can't change PCP, then make an interim appointment with her after you have read all ins specifics and can explain to her those details of what is required, also take literature from the surgeon about the surgery. Let her know that if she persists in a set amount of weight loss you will take it up with whatever medical group administrator monitors the practice (find out who that is) because she seems obviously against the approval for the surgery. I have had physicians that were jerks and have no clue how difficult obesity is.

You have to be your own advocate and sometimes insist on your rights within your ins policy. The PCP is not your 'boss', but is a paid public servant by you.

Keep us posted.

[pg278 1]

@Sosewsue61, I am in Kentucky. I have Anthem through my employer. Also, although my PCP is not part of the bariatric team, I am having the bariatric surgery through the same healthcare system of which she is a part: BaptistHealth in Lexington.

[Sosewsue61 3,185]

Ok.

So what does Anthem require for approval?

Does Anthem only have this healthcare system in its policy or is this the only local system that does baratrics?

And does the surgical team work with other physicians in that healthcare network that are friendlier to bariatrics? I would ask them about their experiences with the supportive physicians.

[pg278 1]

@Sosewsue61 and everyone else, so, I have called the bariatric clinic and the insurance company, and they have both made it clear that if I drop below 260, I will have to pay out of pocket. I have sent an email to my PCP to let her know this. In the email, I ask her to please let me know if she is uncomfortable with me continuing with the monitored diet, so that I can find a different PCP, because I didn't want to be 5 months into this process with her refusing to do month 6. I really hope that she just agrees to continue up until the end, because I am already working on my 3rd month. :/

[Anne15 0]

I am in my 5th month before surgery( hopefully) and have lost 12 pounds. I am try tall and original weight of 262 pounds. My bariatric doctor told me that my weight loss goal pre-surgery was minimum of 5% my original weight. Which is about 14 pounds. My primary has been behind all his requirements. Only suggestion was more Water and exercising, preferably walking. I was also told that the liquid pre-op diet can make you lose up to 10 pounds. The main goal I was told was to set up your routine and learn better habits. And shrink your liver for surgery. Long story short, PvP needs to be more supportive or replaced. Just saying.

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