Hello everyone. I have started my journey on a new life. The surgeon in my area requires a BMI of 60 or under. My BMI is 74. I have to lose 80 pounds to get to a BMI of 60. Upon being successful at losing that weight, I’m wondering if my insurance will see that as too successful and not approve my surgery. Anyone else have this issue?

I don’t have personal experience with this but the doctors are pretty keyed in to what the insurance companies tend to do. I would say if they told you to lose it to trust them. Plus, it’s much easier to lose some weight than to lose all your weight and to keep it off.

Most bariatric surgeons require some amount of weight loss or compliance with a pre-op program before surgery. That is very, very common. Its highly unlikely though that insurance would use that as the basis to deny surgery, given that even after the weight loss, your BMI would still qualify you. Additionally, if you have any obesity related health issues (diabetes, sleep apnea, high blood pressure, etc.) than it would further justify the need for surgery. I would say go for it and use the pre-op process to prepare your heart and mind for the life long changes that will come post-op. You're going to do great!

Most insurance companies require that your BMI be higher than 40, or 35 with co-morbidities like diabetes or sleep apnea ... and you often have to be able to show you can lose some weight, so losing weight to get to a BMI of 60 wouldn't disqualify you at all. Also, the surgery center probably has an insurance specialist who knows what your particular insurance company requires and can help you set up all the appointments and everything else.

I had 4 months of nutrition classes required by insurance, so I decided to live a bit like I would live after surgery during that time. I did lower carb and higher protein and lost about 50 lbs prior to surgery. Of course, my problem was that I got to the point where my BMI was going to be too low for surgery, so I started eating junk again (throwing food funerals!) when I got closer to the pre-op "shrink the liver" diet. My BMI was about 40 or 41 day of surgery, down from 49 when I called the surgeon and started the program.

Any weight you can lose now is weight you will not have to lose after surgery. I found that will higher protein, lower carbs, and low added sugars (I still ate fruit and occasionally small amounts of ice cream), I was less hungry and had fewer cravings. I'm actually more hungry now after surgery, which sucks because I can barely eat anything (although I'm only 3 weeks out and most people say they are not hungry).

I wouldn't worry too much about it. If you are, say, 5'5", getting from a BMI of 60 to a non-obese BMI of 30 would mean an additional weight loss of 180 lbs. (on top of the other 80 lbs.) which even the most hardened insurance company would see requires surgery.

But definitely ask your bariatric center for guidance and access to a nutritionist/dietitian to help you get those 80 lbs. down.

no - this is the surgeon's requirement. There are surgeons who won't operate on patients who have BMI's over 60 because that's considered "high risk". The insurance company isn't going to consider that particular piece when deciding whether or not to approve your surgery. In fact, they'd probably prefer you get under a 60 BMI as well so your risk of complications is lower.

I was initially worried that if I was too successful in my six-month supervised diet that was required by my insurance company that they wouldn't approve the surgery. But that's not what they're looking for. They're looking to see if you're capable of following a plan long-term, since that's what you'll need to do AFTER the surgery. They don't want to fork over thousands of dollars for someone who's likely to not follow rules and just gain all the weight back. So if anything, this 80-lb required weight loss is likely to improve your chances of being approved -- not disqualify you for being too successful.

I lost 57 lbs before surgery by working with a dietitian and gradually improving and shaping my eating habits to align with what I'd be eating after surgery (gradually increasing my protein intake, gradually weaning myself off caffeine and simple carbs, gradually reducing my calorie intake, etc). If you don't think you'll be able to do this on your own, then find a dietitian who's had some experience working with bariatric patients. I was really surprised I was able to lose all that weight pre-surgery - but I think it was a combo of wanting to do whatever I could do get the surgery -- and the accountability of working with a dietitian (i.e, knowing I'd have to report to someone every month on my progress).