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Revision Supervised Weight Loss Question



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Brief background, got lapband about 11 years ago (starting BMI was 43). I did well and kept off 55 pounds (BMI 33)... until I started aspirating at night. I had a barium swallow which showed a distended esophagus and a endoscopy which showed reflux. Doc said band needs to come out. I had band unfilled, and as I expected, I've gained weight. I've gained about 30 lbs in the last 5 months (current BMI 38).

I want to revise to a gastric bypass. I am well aware that I need surgical help to keep at a healthy weight. Prior to banding, and since being unfilled, I'm constantly hungry and never feel full. I finally felt "normal" with the lapband. When I'm not constantly hungry, I can maintain a healthy weight.

But, even with the extra 30 lbs, my BMI is still not over 40, which as I understand it, would make insurance coverage easy. (I have Maryland CareFirst BCBS)

My doctor has me doing all the things needed for insurance approval for the revision, including being on a supervised diet. But I'm gaining weight. This does not surprise me -- there was a reason I needed surgical weight loss in the first place -- but I'm getting mixed messages from my doctor and from my diet supervisor (who works for his office). Diet supervisor tells me that I'm less likely to get insurance approval due to my weight gain since being unfilled and being on the supervised diet. Doctor has made vague statements saying that the reflux found on the endoscopy may be enough to make it go through insurance successfully.

Diet supervisor wants me to lose a significant amount of weight in the coming month, to try to offset my gains, by going on the pre-surgical diet early. Very honestly, I'm hesitant. If I do end up having to get up to a 40 BMI to have the surgery (12 more pounds...), I don't want to yoyo any more than I have to. And if the reflux finding will get me approved, I don't want to starve myself without the benefit of surgical help.

Anybody been in any kind of similar situation? I can use any advice or commiseration available.

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I'm pretty sure I've seen people on here that have had revision due to GERD and were at or close to a normal BMI and I don't think they were self pay. I hope they see this thread and chime in.

Best wishes!

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Are you on medication for your reflux? Reflux can make you feel hungry all the time particularly what they call silent reflux.

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No, I haven't had any reflux issues since being unfilled (Nov). Prior to that, Pepcid was my best friend for at least a year.

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Hi Juniper, I was in about the same situation. I got my band in 2012 and started having significant reflux last summer. I had my band unfilled which helped the reflux but I packed on 40 pounds. I went to Inova Bariatrics and talked about revision to bypass; they said I had to go through the whole program again, which I did. I did not have the supervised diet part and I continued to gain weight until I went on the 2-week liquid diet just before surgery. I had the band removed and the bypass done March 21. I have Federal Blue Cross and they approved as soon as I met the requirements, including cardiac clearance, primary care physician clearance, etc. I don't quite get where your diet supervisor is coming from; I had comorbidities in addition to the high BMI - reflux was one of them (high bp was the other). I think your doctor is right that the reflux should be enough because reflux is one of the signatures of the band. I wish I had known that in 2012 - I would have done the bypass then instead. If you stay with that practice you might be stuck (pardon the lapband pun) doing as the diet supervisor commands. Different practices have different rules. I like my practice very much but they're in Fair Oaks and Woodbridge, likely a huge trip for you. Remember, even though the pre-op diet is very difficult the reward will be worth it. You can do this!

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