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6 month Weight Management requirement



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I had a lapband from 2008 until earlier this year. I loved my band but due to some recent complications it had to be removed. My surgeon encouraged me to consider either the sleeve or RNY after the band removal. I didn’t think I would need one because I felt like I had maintained my weight well with the band, so I should be able to do it on my own. Boy was I wrong. I have gained 40 lbs since they removed the Fluid back in October. So in February, I decided to move forward with RNY. My insurance required a 6 month weight management program. I completed my dr visits, but I gained 8 lbs during that 6 months instead of losing. I seem to have plateaued but it seems that nothing I do is working to lose weight. Neither my dr nor the insurance coordinator know if my surgery will be approved since I didn’t lose during this 6 months. Has anyone had this happen and still get approved?

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Everyone's insurance requirements is different, but there was a woman who was having the same surgery as me and was going through the six month requirement just as I did. We were both there for our pre-op appointment and were discussing our weight loss. I said I'd lost a total of 64 pounds in that time and she said she GAINED 15. However, we were both approved for surgery. The six months is mostly to prove to your insurance that surgical intervention is needed. I was actually worried that my insurance wouldn't approve my surgery because I'd lost so much on my own, but I was still 321 pounds on the day of my surgery which is still in the super morbidly obese category (BMI over 50) so the surgeon had assured me I wouldn't have any issues. I honestly don't know how your insurance works, but I don't think they'll pass on you.

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I've been working on the 6 month approval and during Covid WFH have absolutely gained 15 lbs. before meeting with the surgeon and the ppw was submitted to insurance - i lost 6 lbs of that. i was approved in less than a week though the surgeon had warned that they may require that i get back to the original weight. surgery is in 8 days!

i would think that your previous success with lapband would help them see that you'll be successful!! good luck!!

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I think it totally depends on your program. My insurance is through Kaiser, and their only requirement is that you NOT gain any weight during the six month bariatric program. If you gain weight, they just won’t give you a surgery date... until you get down even 1lb below you’re starting weight.

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Thanks for all the answers! I am going to check with my insurance and see what they say. Fingers crossed!

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    • Prdgrdma

      So I guess after gastric bypass surgery, I cant eat flock chips because they are fried???  They sell them on here so I thought I could have them. So high in protein and no carbs.  They don't bother me at all.  Help. 
      · 1 reply
      1. NickelChip

        It's possible for a very high fat meal to cause dumping in some (30% or so) gastric bypass patients, although it's more likely to be triggered by high sugar, or by the high fat/high sugar combo (think ice cream, donuts). Dietitians will tell you to never do anything that isn't 100% healthy ever again. Realistically, you should aim for a good balance of protein, carbs, and fat each day. Should you eat fried foods every day? No. Is it possible they will make you sick? Maybe. Is it okay to eat some to see what happens and have them for a treat every now and again? Yes.

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      · 1 reply
      1. NickelChip

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    • Clueless_girl

      How do you figure out what your ideal weight should be? I've had a figure in my head for years, but after 3 mths of recovery I'm already almost there. So maybe my goal should be lower?
      · 3 replies
      1. NickelChip

        Well, there is actually a formula for "Ideal Body Weight" and you can use a calculator to figure it out for you. This one also does an adjusted weight for a person who starts out overweight or obese. https://www.mdcalc.com/calc/68/ideal-body-weight-adjusted-body-weight

        I would use that as a starting point, and then just see how you feel as you lose. How you look and feel is more important than a number.

      2. Clueless_girl

        I did find different calculators but I couldn't find any that accounted for body frame. But you're right, it is just a number. It was just disheartening to see that although I lost 60% of my excess weight, it's still not in the "normal/healthy" range..

      3. NickelChip

        I think it's important to remember that the weight charts and BMI ranges were developed a very long time ago and only intended to be applied to people who have never been overweight or obese. Those numbers aren't for us. When you are larger, especially for a long time, your body develops extra bone to support the weight. Your organs get a little bigger to handle the extra mass. Your entire infrastructure increases so you can support and function with the extra weight. That doesn't all go away just because you burn off the excess fat. If you still had a pair of jeans from your skinniest point in life and then lost weight to get to the exact number on the scale you were when those jeans fit you, chances are they would be a little baggy now because you would actually be thinner than you were, even though the scale and the BMI chart disagree. When in doubt, listen to the jeans, not the scale!

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      · 0 replies
      1. This update has no replies.
    • BeanitoDiego

      Now that I'm in maintenance mode, I'm getting a into a routine for my meals. Every day, I start out with 8-16 ounces of water, and then a proffee, which I have come to look forward to even the night before. My proffees are simply a black coffee with a protein powder added. There are three products that I cycle through: Premier Vanilla, Orgain Vanilla, and Dymatize Vanilla.
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      · 0 replies
      1. This update has no replies.
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