Type 2 db, apnea, high cholesterol - BMI 28 - is surgery an option?

[dandwms 0]

I was recently diagnosed with type 2 diabetes and recently have been having sleep apnea issues. I've had above-normal cholesterol for a few years. My BMI is 28, I am 56 years old. I've tried many many times to lose weight. Are there any weight loss surgery options for me since I do not have a BMI over 30?

Thanks in advance for the advice.

[SpartanMaker 676]

Most insurance won't pay since typically they use a BMI of 35 with comorbidities, or 40 with no comorbidities as their cut-off.

If you're self pay, there should be more options open to you. I do think a lot of those tend to use a BMI of 30 as their cut off, but I'm no expert there. Your best option might be to talk to a few different clinics about what they can do for you.

Edited October 20, 2022 by SpartanMaker

[kcuster83 1,502]

I would agree with @SpartanMaker your insurance likely will not cover it. You may have to pay out of pocket.

Good luck

[ShoppGirl 3,397]

If I were you I would consider trying the nutritionist and bariatric therapist first. Those two things are often a huge part of why the surgery is successful and they very well could just be enough to get you there without surgery. I understand that you have tried everything and can’t lose and I get it that you need to do something. I was lower BMI as well (35). But, I had the sleeve a year and a half ago and I still didn’t get to my dream weight. This surgery is a great option for many people but it is still major surgery. Post surgery you cannot take NSAIDS for pain and you may struggle with Constipation plus have to take Vitamins all for the rest of your life. These are all things that you can live with and of course if you still can’t lose the weight they may be things you have to live with but I wish someone had told me to give it one last try with the nutritionist and therapy before I committed to all this. I may still be exactly where I am by now but at least I wouldn’t have to wonder if I could’ve done it on my own. Having said that, ask your doctors of course because you do have medical issues that I did not have and maybe losing the weight asap is really important and the surgery is definitely a faster way to lose it.

Also, IF your insurance will cover you can kill two birds with one stone if you get the process started while trying to lose. For many insurance companies you have to do 6 months of physician managed weight loss attempt anyways so you can do all that while you see if the nutritionist can help and maybe even talk to a bariatric therapist to see if you have any disordered eating behaviors that they can help you with.

In terms of getting the surgery if that’s what you choose you may have to wait until you get to a BMI of 30 to qualify, BUT. If you haven’t been measured in a while your height may be shorter than you think because we shrink as we age and your BMI will be higher than you think. (BMI goes up almost an entire point just because of one inch). Also, I would still call around because I believe anything under 35 you will have to be self pay so maybe with your medical issues they would consider doing it just under 30. I’m pretty sure it’s up to the doctor.

Edited October 21, 2022 by ShoppGirl

[Sleeve_Me_Alone 654]

Agree with others that surgery options may be limited. Have you talked to your PCP about the GLP-1 medications? Mounjaro is newest to market, specifically for diabetics, and has pretty significant results. Wegovy/Ozempic are similar but a little older and easier to get insurance approved.

[ShoppGirl 3,397]

5 minutes ago, Sleeve_Me_Alone said:

Agree with others that surgery options may be limited. Have you talked to your PCP about the GLP-1 medications? Mounjaro is newest to market, specifically for diabetics, and has pretty significant results. Wegovy/Ozempic are similar but a little older and easier to get insurance approved.

Great suggestion. Dr Weiner just made an instagram post about the GLP-1 the other day for weight loss. It’s hard to get insurance to cover it though if your not diabetic but since you are this may be a really good option for you, OP. Also his book, a pound of cure was really informative.

Edited October 21, 2022 by ShoppGirl

[SpartanMaker 676]

12 minutes ago, Sleeve_Me_Alone said:

Agree with others that surgery options may be limited. Have you talked to your PCP about the GLP-1 medications? Mounjaro is newest to market, specifically for diabetics, and has pretty significant results. Wegovy/Ozempic are similar but a little older and easier to get insurance approved.

I tried both Ozempic and Saxenda (both GLP-1 agonists), pre-op and they do work for some, but at least for me, neither was the miracle drug some claim them to be. The idea is they curb hunger, but hunger is not why I was obese, so overall these had little impact on me. They are also quite expensive (~$1,200 a month sans insurance coverage), so depending on your budget it may be cost prohibitive.

As I understand it, this class of drugs have also become trendy among the wealthy that don't really need them, but can afford the monthly cost to help them stay slim. As a result, there are significant shortages right now.

[Recidivist 1,141]

I have an acquaintance who had type 2 diabetes that resulted in extreme swings in blood sugar levels, making her almost incoherent at times. She qualified for surgery based on that alone, although she was not hugely overweight. (I'm guessing her BMI was similar to yours.) I don't know the science behind it, but the surgery did address her diabetes. It's worth consulting a doctor.

Edited October 21, 2022 by Recidivist

[SpartanMaker 676]

1 hour ago, ShoppGirl said:

If I were you I would consider trying the nutritionist and bariatric therapist first. Those two things are often a huge part of why the surgery is successful and they very well could just be enough to get you there without surgery.

This is a fantastic point!

The surgery is just a tool, and plenty of people have surgery and fail. Those that are successful have made fundamental changes to the way they eat.

OP: either way, if you want to be successful with or without surgery, you'll need to change your relationship with food. For you at your low BMI, that may be enough even without surgery.

[dandwms 0]

On 10/20/2022 at 6:25 PM, SpartanMaker said:

Most insurance won't pay since typically they use a BMI of 35 with comorbidities, or 40 with no comorbidities as their cut-off.

If you're self pay, there should be more options open to you. I do think a lot of those tend to use a BMI of 30 as their cut off, but I'm no expert there. Your best option might be to talk to a few different clinics about what they can do for you.

Thank you. I will reach out to clinics to see what they see.

[dandwms 0]

On 10/21/2022 at 7:22 AM, ShoppGirl said:

If I were you I would consider trying the nutritionist and bariatric therapist first. Those two things are often a huge part of why the surgery is successful and they very well could just be enough to get you there without surgery. I understand that you have tried everything and can’t lose and I get it that you need to do something. I was lower BMI as well (35). But, I had the sleeve a year and a half ago and I still didn’t get to my dream weight. This surgery is a great option for many people but it is still major surgery. Post surgery you cannot take NSAIDS for pain and you may struggle with constipation plus have to take Vitamins all for the rest of your life. These are all things that you can live with and of course if you still can’t lose the weight they may be things you have to live with but I wish someone had told me to give it one last try with the nutritionist and therapy before I committed to all this. I may still be exactly where I am by now but at least I wouldn’t have to wonder if I could’ve done it on my own. Having said that, ask your doctors of course because you do have medical issues that I did not have and maybe losing the weight asap is really important and the surgery is definitely a faster way to lose it.

Also, IF your insurance will cover you can kill two birds with one stone if you get the process started while trying to lose. For many insurance companies you have to do 6 months of physician managed weight loss attempt anyways so you can do all that while you see if the nutritionist can help and maybe even talk to a bariatric therapist to see if you have any disordered eating behaviors that they can help you with.

In terms of getting the surgery if that’s what you choose you may have to wait until you get to a BMI of 30 to qualify, BUT. If you haven’t been measured in a while your height may be shorter than you think because we shrink as we age and your BMI will be higher than you think. (BMI goes up almost an entire point just because of one inch). Also, I would still call around because I believe anything under 35 you will have to be self pay so maybe with your medical issues they would consider doing it just under 30. I’m pretty sure it’s up to the doctor.

Great advice. I actually measure myself and I am an inch shorter so BMI is closer to 30 now. I really appreciate the advice.