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"We don't think you're a good candidate for WLS at this time" ....Should I seek a 2nd opinion?



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So I had my first consultation today with the weight loss center I was planning on going through. My insurance has already approved getting surgery, for what its worth. During the meeting, the lady asked a ton of questions, and inquired about my relationship with food. She somehow got the impression that I stress eat, even after I tried to clarify that I do not. Things at home have been a bit rocky, and my stress level has been high, so you can see where this is going. After the hour long consultation, she told me that due to stress being high, financial issues being a factor, and the fact that we moved 2 years ago and have no family or friends here (No local support group), that I was not a good fit for surgery.
I was a little floored, but took it like a champ. I had an appointment already scheduled following that one, with a physician, and she encouraged me to see him regardless because ultimately he'd be working along with the surgeons and may have a different opinion. We met for a little over 40 minutes, and he questioned me about the traumas I'd experienced as a child, and followed up asking about how often I turn to food for comfort. I don't feel I do (And neither does my husband, nor my best friend of 20+ years), and told him rarely, if ever. He said, and I quote: "Mmm.. I disagree with you there!" Uh? Okay..? I figured I'd humor him and asked why he came to that conclusion. He went on to elaborate that because I was abused as a child that I surely turned to food as a form or comfort, or affection, even if I didn't realize I was doing so. Huh. Okay. I mean, I literally brought you my food log, and am telling you otherwise, but alright. The rest of the meeting he spent explaining that I was a better candidate for medical weight loss, but not so much surgical. I'm 32 years old, 397lbs. I have pcos, am pre-diabetic, and am pursuing WLS to not only better my health as conventional methods have failed, but also to start a family in a few years with my husband.
This whole experience has left me incredibly disheartened, and I genuinely feel like every step I've made on this journey has been an uphill battle. Do you guys think I should pursue another opinion with a different clinic? I'm not exactly thrilled at the thought of taking 'weight loss pills' so medical weight loss isn't very appealing to me. I'm super conflicted and confused as to what to do going forward. Any advice would be welcomed! Thank you!

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Me, personally, I would go to a different clinic. My history as an abused child also came up during my psych eval, but the psychiatrist never once leapt to the conclusion that I turned to food as comfort. To be be fair, she did immediately ask if I had been through counseling for it, which I had as an adult, so maybe that's why it wasn't a flag?? (FYI, pregnancy hormones and motherhood can really stir up childhood traumas, so be prepared if/when you start a family...counseling will be your friend!!)

All the same, find another provider through your insurance and get a second opinion.

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Yes, seek another opinion , especially if you are approved by insurance, but also consider mental health services/counseling to manage or to prove that past trauma has no affect on your eating habits. Be brutally honest with yourself here.

You will want to put to bed all problems you can recognize before surgery so you can focus for a while in just the mechanics of the new lifestyle.

The doctor may have a point or think he's correct in his assessment , but so what. These things can be worked on, you shouldn't be counted out forever. And now you know to proceed cautiously against giving out too much information.

Safe Journey 🎈

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Undoubtedly I'd go to another clinic, if for no other reason than the fact that you're not being heard.

I started the process with one group in my city and I just felt so alone and supported. Any time I had a question, I felt ignored (had to reach out multiple times) or that it was turned back on me to answer. Even though I could have had surgery about a year earlier, I chose to switch practices because I felt that I had better resources and more support with their program. Best decision I made.

I come from a family full of physicians, and I gotta tell you I am a huge proponent of having your physician/ team be a PARTNER to your medical needs. Docs and their staff are humans who have opinions (that may not be accurate) who make mistakes, and who do not have all the answers. Medical care is a partnership- get you a partner who listens to you!! You deserve it!!

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You might consider giving medical weight loss a try just to demonstrate to them that you are able to follow recommendations and lose some weight without surgery. pills are only one option and you do not have to take them. Get active in a local bariatric support group even if you are pre op. Commit to whatever level of daily exercise you are able to do. Suppose you can lose 50# on your own in the next 6 months. That might go a long way to getting approval from the surgeon.

If things are "rocky" at home you need to assess if you will have any support from family or friends if you do decide to have surgery. Do everything you can to reduce/eliminate stress and focus on your health. This is hard enough even with support.

And, in the future, get another opinion about WLS. It is not magic and only fixes part of the problem with morbid obesity. Good luck to you.

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So I had my first consultation today with the weight loss center I was planning on going through. My insurance has already approved getting surgery, for what its worth. During the meeting, the lady asked a ton of questions, and inquired about my relationship with food. She somehow got the impression that I stress eat, even after I tried to clarify that I do not. Things at home have been a bit rocky, and my stress level has been high, so you can see where this is going. After the hour long consultation, she told me that due to stress being high, financial issues being a factor, and the fact that we moved 2 years ago and have no family or friends here (No local support group), that I was not a good fit for surgery.
I was a little floored, but took it like a champ. I had an appointment already scheduled following that one, with a physician, and she encouraged me to see him regardless because ultimately he'd be working along with the surgeons and may have a different opinion. We met for a little over 40 minutes, and he questioned me about the traumas I'd experienced as a child, and followed up asking about how often I turn to food for comfort. I don't feel I do (And neither does my husband, nor my best friend of 20+ years), and told him rarely, if ever. He said, and I quote: "Mmm.. I disagree with you there!" Uh? Okay..? I figured I'd humor him and asked why he came to that conclusion. He went on to elaborate that because I was abused as a child that I surely turned to food as a form or comfort, or affection, even if I didn't realize I was doing so. Huh. Okay. I mean, I literally brought you my food log, and am telling you otherwise, but alright. The rest of the meeting he spent explaining that I was a better candidate for medical weight loss, but not so much surgical. I'm 32 years old, 397lbs. I have pcos, am pre-diabetic, and am pursuing WLS to not only better my health as conventional methods have failed, but also to start a family in a few years with my husband.
This whole experience has left me incredibly disheartened, and I genuinely feel like every step I've made on this journey has been an uphill battle. Do you guys think I should pursue another opinion with a different clinic? I'm not exactly thrilled at the thought of taking 'weight loss pills' so medical weight loss isn't very appealing to me. I'm super conflicted and confused as to what to do going forward. Any advice would be welcomed! Thank you!
Therapist here, 14 years post RNY. [emoji1327]‍♀️

Definitely see a different clinic AND start seeing a therapist (preferably see the therapist at least once so you can tell the new clinic you are going).

Based on your post, nothing stands out that would indicate that you couldn't have surgery.

1) even if you were stress eating - not something that can't be dealt with in therapy (e.g. I think most of us stress eat at some point, TBH)
2) My original doctor said I "wasn't bog enough" for surgery (278lbs, 26 years old, arthritis in knees and high blood pressure) - so I fired him and went to another doc. She saw and heard me, so she agreed that I could have surgery
3) if all else fails, go ahead and see a psychologist for an evaluation. Find one in network with your insurance AND that is approved by the surgery group, if they have a list). Nothing like having a step out of the way AND validation that you are ready.

Hope that helps!

~SW: 278 CW: 165~
RNY 1/5/2005
"What got you here won't get you there."

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Thank you everyone for your kind words and tips! I feel I should mention that I currently am (And have been at several times in my life!) seeing a wonderful therapist! She's been a great help at helping deal with my stress levels, and I made sure to mention that to both people I saw yesterday! To go a little bit further into detail, my husband had been struggling to adjust to all of the major life changes we've had in the last few years, and is currently on FMLA while we find the proper medication dosage for him with our psychiatrist. He leans on me heavily for emotional support, which I am more than happy to provide! All of that aside, I am very dedicated and serious about taking my weight and health into my hands, and tried to emphasize that to them. I'll be honest, after all was said and done, I wanted nothing more than to wallow in my pity party with a mountain of junk food just to spite them for their assumptions. But I didn't. Because I don't use food as comfort (You presumptuous jerks! I might still be a little salty at them- ha)

Thank you all again for your help. Its helped lift my spirits a bit that this isn't the end of the road, just a small Detour.

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44 minutes ago, Dryad said:

I'll be honest, after all was said and done, I wanted nothing more than to wallow in my pity party with a mountain of junk food just to spite them for their assumptions. But I didn't. Because I don't use food as comfort (You presumptuous jerks! I might still be a little salty at them- ha)

Important to acknowledge this... But I personally wouldn't tell this to a surgeon if I was trying to get approved

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Maybe it would help to think of these doctor interviews like a job interview...you want to be strategically honest. Never lie, but maybe don't volunteer the whole truth?

Good luck with your next doctor!

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On 19. Januar 2019 at 10:04 PM, Sigi42 said:

Maybe it would help to think of these doctor interviews like a job interview...you want to be strategically honest. Never lie, but maybe don't volunteer the whole truth?

This.

And I'm honestly surprised (again and again) that an eating disorder and/or stress eating or whatever eating has to be ruled out because... well... if all of these things weren't a problem: how did the weight came on after all?

I somehow doubt that the majority of people that qualify for WLS is on a drug regime that caused a 100 lbs+ weight gain and the prolonged maintenance of that weight gain.

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This is so odd...I used food as comfort, and I was honest about it. I didn't get to almost 300 lbs by accident.

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On 1/24/2019 at 12:31 PM, NYJenn said:

This is so odd...I used food as comfort, and I was honest about it. I didn't get to almost 300 lbs by accident.

I discussed stress eating during my psych eval. That psychologist recommended individual counseling to work on managing stress but did not consider it a surgery disqualifier. After the psych eval, I voluntarily stopped eating most carbs to get in line with the post surgery expectations (about 10-15% of my intake now is carbs from nuts and veggies). I found that I was not really stress eating, I was craving carbs, the stress just allowed me to say that eating sugar laden foods was comfortable and acceptable because stress was 'painful'.

Hopefully you have other options for surgery groups, mostly because it seems kind of disrespectful to say 'yeah you are wrong' about your own life. Most surgeons have seen so many patients who lie to themselves about quantity and types of food that the doctor may feel like you just don't want to admit truths (even if that is not the case). There can be jaded individuals in any profession that has "seen it all" and may say something based on their experiences that do not apply to you.

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I'm not qualified to o evaluate anyone but last week I took my psych eval and while admit to overeating, and being hungry all the flipping time I was adiment I was not a stess eater. Well I had to wait a week for my follow up on my psych eval before being cleared to go proceed with my surgery. I was so nervous nervous about this psych eval! I really want this surgery. One day I found myself rummaging through the fridge.... Then the cupboards.... Not finding anything suitable aka: sweet stuff and then I stopped and had an epiphany.....oh my God!!!! I AM a stress eater!!! I just caught myself with my hand in the cookie jar!!!! I was SO SURE I wasn't! Its possible others can see things in us that we don't and I'm so glad I had that week to stress out and see myself for what I am. It's important for us to at least be open to the idea that maybe we could be wrong and they could be right. I'm saying just be open to the possibility and therapy can help you explore that possibility and put it to rest one way or the other.

Sent from my moto e5 (XT1920DL) using BariatricPal mobile app

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On 1/19/2019 at 3:03 PM, Dryad said:

I currently am (And have been at several times in my life!) seeing a wonderful therapist!

I think its odd they didn't let you use your current therapist for your eval. S/he knows you and your capabilities best. My therapist (who, granted, specializes in weight management/bariatric issues) was able to do my eval and write my letter. I saw three docs before I chose who I'd ultimately use and all 3 said my current therapist could write the letter.

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I think its odd they didn't let you use your current therapist for your eval. S/he knows you and your capabilities best. My therapist (who, granted, specializes in weight management/bariatric issues) was able to do my eval and write my letter. I saw three docs before I chose who I'd ultimately use and all 3 said my current therapist could write the letter.
I've found out (as a therapist myself) that some insurance companies are the ones that won't let a therapist write the letter, not necessarily the doc. That may not be the case here, but just my own experience. It sucks. I figure I could help better than someone who hasn't had the surgery, but the damn insurance companies know better, I guess (insert eye roll - LoL).

~SW: 278 CW: 165~
RNY 1/5/2005
"What got you here won't get you there."

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