Now that I've made the decision to have WLS & am waiting for my appt with my PCP my mind won't shut up! I know my insurance requires a 6 month supervised diet, but what if I lose weight on the diet and my insurance decides that I don't NEED to have WLS to lose weight since I was (theoretically) able to lose weight for this requirement? I was told after a colonoscopy that I have sleep apnea and need to have a sleep study done & that I should really be on a cpap, but what if sleep apnea is a reason to deny me the surgery? I take omeprazole for acid reflux because I have a hiatal hernia. What if that prevents me from having the surgery?

What if they just say NO? After making up my mind to do this, I just don't think I could take it. I'll be 60 in Oct & I'm 5' 8" - used to be 5' 9" - & I weigh 338 lbs. On my own I have fooled with hCG diet, keto, low carb, etc, etc, etc for sooooo many years. I lose weight & gain it back. I know what I'm supposed to do, but can't stick with it. I need this. Period.

I don't know how other programs do it, but my 6 months of supervised diet was basically just a logbook of what I was eating, when, how much. My team didn't have me on any restrictions until 2 weeks before the scheduled surgery. They certainly followed up with me consistently, but it was more to suggest how I could adjust my food after the surgery -- ie, "I see you had 2 cups oatmeal for breakfast! After the surgery, you'll probably start at half a cup and go from there, you'll want to make it with either a higher protein milk like fairlife or even a protein shake, you'll want to use thicker oats rather than instant or minute-oats," etc

I did lose about 20 lbs total pre-op -- just because having to measure my food made me more aware of how much I was eating.

I don't want this to come off the wrong way, but I don't think losing too much weight before the surgery will be an issue for you -- or for most people approaching it as an option. If your BMI is high enough to qualify you starting the program, it's highly unlikely you'll be able to lose enough on your own to drop your BMI to a point that it would disqualify you.

(I'm not saying it's impossible! But most people turn to WLS as a last resort after so many other methods have failed -- if we could successfully lose a big chunk of weight by ourselves just by being on a supervised diet, we would have done it without turning to WLS.)

Thanks JennyBeez, I guess my concern is not so much my BMI dropping too low, as it is that the insurance will say, "See?? You can lose weight on a diet! Just keep doing what you're doing!"

1 hour ago, alisasings said:

Thanks JennyBeez, I guess my concern is not so much my BMI dropping too low, as it is that the insurance will say, "See?? You can lose weight on a diet! Just keep doing what you're doing!"

I was worried about losing too much weight too The thing is that they can suggest changes all they want but we already know how we are supposed to eat. If we could do it we wouldn’t be where we are now. Chances are you are not going to be able to stick to any diet for a full six months. I know I couldn’t. Also, the surgeries are known to help with sleep apnea and GERD depending on which one the dr feels is appropriate for you. I can’t imagine that being a reason to disqualify you. I have heard of a lot of people getting a hernia repair done at the same time as their surgery.

Edited July 12, 20242 yr by ShoppGirl

that's not why some insurance policies require a six-month supervised diet. They require it because they want to see if you're able to stick to a diet long-term, because they don't want to fork over thousands of dollars for patients to have an elective surgery only to blow it big time by not following their clinic's plan. On top of that, some surgeons require that you lose a certain number of pounds before they'll let you have surgery.

I lost 56 lbs on my six-month supervised diet, and no way were they going to tell me I couldn't have surgery because I could obviously "do it on my own" (and honestly, fewer than 5% of people who lose a lot of weight can maintain it for more than a few months. Bariatric surgeons are well aware of this fact)

by the way, since you have acid reflux, did your surgeon suggest gastric bypass (RNY) instead? That's often recommended for patients who have reflux issues (I was one of them...). RNY usually improves if not outright cures reflux. With sleeve there's about a 30% chance of it getting worse. Some people are comfortable with those odds and have gone ahead with sleeve and lucked out. I wasn't comfortable with the odds.

35 minutes ago, catwoman7 said:

by the way, since you have acid reflux, did your surgeon suggest gastric bypass (RNY) instead? That's often recommended for patients who have reflux issues (I was one of them...). RNY usually improves if not outright cures reflux. With sleeve there's about a 30% chance of it getting worse. Some people are comfortable with those odds and have gone ahead with sleeve and lucked out. I wasn't comfortable with the odds.

I have not talked to a surgeon yet. I have one picked out, but figured I would see my PCP first on 07/19. I'm hoping they will just repair the hiatal hernia. I'd much prefer the sleeve over the bypass.

29 minutes ago, alisasings said:

I have not talked to a surgeon yet. I have one picked out, but figured I would see my PCP first on 07/19. I'm hoping they will just repair the hiatal hernia. I'd much prefer the sleeve over the bypass.

They may still consider you for the sleeve even with GERD. It’s gets super complicated and I don’t understand how he knew exactly what was causing what but I have MILD GERD post sleeve and I take only 20mg Omeprazole which controls it.

The surgeon said if I wanted to revise to bypass I was good to go but if I wanted to revise to SADI that he had to do some tests first. He did a Endoscopy which found a hiatal hernia but because of my sleeved stomach he wasn’t able to turn the camera to get a good angle to determine the exact size of it.

He then ordered an upper GI (I think that’s what he called it, but some call it a barium swallow test) and also a gastric emptying study). Then when he had all the results he said that the hernia is very small and he wouldn’t even repair it.

Anyways, i will still have to be on PPI’S but he thinks they should control the GERD after the SADI. Many people choose the bypass so they don’t have to take the PPI’s again or if it’s so bad that PPI’s don’t always work but being able to take the occasional NSAID and the better weight loss statistics made me choose the SADI over the bypass anyways.

That being said, just be aware going in that there is a percentage of people who need a revision post sleeve because they have inadequate weight loss or regain by like 3 years out. Your surgeon should go over all that with you. I have seen a few people on here say their insurance does not cover revision surgery so that’s something to consider when you make your decision.

I hope I didn’t add to your confusion but it is a big decision and the more info you have the better to know what to ask at that appointment with the surgeon. My surgeon did not make me decide at the first visit either. I got to ask the NP questions every month at my weigh in and then decide which surgery I wanted (for my sleeve, the process for the revision was a little different).

Edited July 12, 20242 yr by ShoppGirl

I have not talked to a surgeon yet. I have one picked out, but figured I would see my PCP first on 07/19. I'm hoping they will just repair the hiatal hernia. I'd much prefer the sleeve over the bypass.

I had severe acid reflux with the sleeve, and had to get a revision to bypass. Before that I had a few instances of GERD but nothing serious. So please seriously think about this because if you have the slightest history of GERD, You're risking having serious acid reflux in the future, and then having to go through a bypass revision just to stop it. Having been through both, it is a very similar recovery period. No side effects, for me at all after revision.

I never had reflux or gerd so I was a fantastic candidate for the sleeve. And after the sleeve, the gerd was so bad I was on 80mg of Nexium TWICE per day PLUS pepcid for break through and TUMS if really needed (and I was always doing all of it, sometimes still with no real relief). I developed so many polyps from the incredibly high amounts of PPI over a long period of time that I needed 4 endoscopies to remove them. I also developed gastritis and esophagitis. I was told I had no choice but to have the revision to bypass. So 13 months after my sleeve, I was back in the hospital having the bypass.

The recovery was SO much faster and easier, the gerd was cured almost immediately, getting my fluids down was so much easier, my only real regret is that I had the sleeve at all. I just wish I had gone straight to the bypass to begin with. If you already have gerd, I STRONGLY advise at least thinking about the bypass instead of the sleeve. The bariatric surgeon may not even give you the sleeve as an option, so maybe start considering the bypass as a viable choice.

1 hour ago, SleeveToBypass2023 said:

I never had reflux or gerd so I was a fantastic candidate for the sleeve. And after the sleeve, the gerd was so bad I was on 80mg of Nexium TWICE per day PLUS pepcid for break through and TUMS if really needed (and I was always doing all of it, sometimes still with no real relief). I developed so many polyps from the incredibly high amounts of PPI over a long period of time that I needed 4 endoscopies to remove them. I also developed gastritis and esophagitis. I was told I had no choice but to have the revision to bypass. So 13 months after my sleeve, I was back in the hospital having the bypass.

The recovery was SO much faster and easier, the gerd was cured almost immediately, getting my fluids down was so much easier, my only real regret is that I had the sleeve at all. I just wish I had gone straight to the bypass to begin with. If you already have gerd, I STRONGLY advise at least thinking about the bypass instead of the sleeve. The bariatric surgeon may not even give you the sleeve as an option, so maybe start considering the bypass as a viable choice.

I'm so sorry you went thru all that! Wow! That's a lot to think about.

Did you have gerd due to a hiatal hernia? I thought that some surgeons repaired that while they are in there and that would take care of the GERD.

Glad to hear you are so much better after the revision.

No. I didn't have gerd at all until I got the sleeve. It was the sleeve that caused my gerd and all the complications.

2 hours ago, SleeveToBypass2023 said:

No. I didn't have gerd at all until I got the sleeve. It was the sleeve that caused my gerd and all the complications.

Oh wow! That sucks! Guess I'll start researching bypass again. I first learned a lot about it probably 15- 20 years ago. Then when the sleeve came out I was all excited.

Hopefully the bypass has improved since I first read about it.

OK - opinion from the other side of the track.

I have had reflux for 20+ years and was always tied to a PPI. When I lost a lot of weight it always receded. When I regained it recurred.

I took the chance and had a sleeve procedure. I wanted to maintain my anatomy as far as possible. I took a gamble that my reflux would not worsen and I won.

The sleeve does work out for some people. Also it doesn't work out for others. I really hope you can weigh up all the experiences we have to share here and find the right path for you.

Edited July 13, 20242 yr by Spinoza

Spinoza I really appreciate your input. I'm much more comfortable with the sleeve. I'd rather not rearrange my intestines.

If you're basing your bypass opinions on 20 years ago, it's come a long way! I chose bypass and have been very happy with the choice. Having said that, I am an avid listener of Dr. Weiner's Pound of Cure podcast and videos, and I found these videos so valuable when making my choice. Ultimately, I went with bypass for the more durable weight loss and avoiding GERD. But there are good reasons to make either choice, and these kind of walk you through some of that.