Why does insurance require physician supervised diet ?

Hi, this is my first post to this forum.  I've been lurking for a week or 2.

I have had orientation for the Sleeve and have my initial consult with the surgeon tomorrow.  Psych and nutrition not until Sept 28th.  Hopefully surgery in November.

So, I am on month 4 of my required physician supervised diet and I have lost 3 pounds.  Admittedly I am not doing as well as I could.  I know what I'm supposed to do and I know what I'm not doing, but I am having a hard time summoning the motivation.  I know I should be using this time to learn different habits but it seems like such a Catch-22: if I had been able to change my habits, I wouldn't need surgery in the first place.

I am not one of those people who have lost 100+ pounds several times over but gain it back.  I've never been able to lose more than 20-25 pounds at a time.

I will say that I have been doing well at most meals, as far as no bread/rice/potatoes, nothing fried etc.  But my issue is sweets, especially frappucinos and the like.  I did journal my foods for about a week and aimed to stay around 100-120 carbs a day (which I know is higher than I need to be) but nowhere near where my PCP wants me to be (under 50).  Its amazing how many carbs a serving bread has so I only eat protein for meals; yet I'll spend 60+ carbs on a coffee drink that is gone in 30 minutes.

I'm frustrated with myself and deep down I'm so worried I am going to fail this surgery.  I feel like the restriction is what I need, as I definitely overeat.  Having consequences to doing that is what I need.  But I know that it is just as much about the kinds of food you eat post op as the quantity. 

I know everyone has challenges in their life that make it harder--mine is that my husband is going through the process as well, but has made zero efforts at changing his habits.  He is a total carb addict.  I know only I am in control of what I put in my mouth, but it does make it harder.

So I have a couple questions and am interested in hearing of your experiences.

1. Why does insurance require this diet and what are they looking for?  Like I said earlier in my post, if I could lose the weight, I wouldn't need the surgery, so what is the point from their view? 

2. Any former carb addicts out there who could never lose more than 10-20 pounds at a time and ended up falling off the wagon after just a couple months?  How did you overcome that?

3. Post-op, do your tastes change from wanting carbs to not wanting them?  This is probably one of those things that is dependent on the person, but I'm hoping this might change the horrible food cravings I have.

I am going to try to get in with the psych who works with my surgeon to actually start therapy now, or at least get some referrals from him.  My goal is to get that sorted out this week.

My PCP is against the surgery and gave me a butt kicking last month when I gained back 2 of the 5 pounds I lost initially.  But I needed the butt kicking and it motivated me for a week.  Then there were two potlucks that weekend with pretty much all carby stuff and I have been off the rails since.  I see him again in a week and am not looking forward to it.

I know what is working against me the most and that is self-sabotage and not believing in myself.  Growing up, my mom was convinced the end of the world was imminent.  I was scared all the time and never followed through on anything and didn't achieve anything because I thought the end of the world was near, so nothing mattered.  Even today, I can't shake that inability of planning anything for the future, because I can't picture it.  I can't picture getting approved for the surgery, so I'm not getting serious about it.

I know above all, I need to get into therapy, but I would really like to hear from anyone who may have had a similar experience.

Thank you so much and thanks for reading,

Becky

Welcome to the forum.  I'm so glad you posted. 

I would like to address the carb addiction because I had a serious problem with carbs.  I could eat a box of cookies in an evening and want more.  The thing about the carb addiction is that you have to break the cycle.  Its tough for the first few days and then it gets easier.  Once you break the cravings, you can vary the amount of carbs and see how many you can consume before the cravings start again. Then you have to stay below that limit.

You do need to get the carb addiction under control or you will defeat yourself whether you have the surgery or not.  Carbs are slider foods - meaning that they go right thru your stomach and the stomach restriction won't help. 

You can do this.  It means white-knuckling it for a few days.  Cut your carbs to a very few - only carbs from healthy veggies and dairy. No breads, potatoes, pasta, sweets, etc.  Try to get it below 25 grams of carbs a day for a few days.  By day 3 or 4, the cravings will pass, and it'll become manageable. 

I know how hard it is, but its the only way to succeed.  You can do it!

best wishes,

Carol

On June 30, 2015 at 7:32 AM Pacific Time, yesican2 wrote:

Hi, this is my first post to this forum.  I've been lurking for a week or 2.

I have had orientation for the Sleeve and have my initial consult with the surgeon tomorrow.  Psych and nutrition not until Sept 28th.  Hopefully surgery in November.

So, I am on month 4 of my required physician supervised diet and I have lost 3 pounds.  Admittedly I am not doing as well as I could.  I know what I'm supposed to do and I know what I'm not doing, but I am having a hard time summoning the motivation.  I know I should be using this time to learn different habits but it seems like such a Catch-22: if I had been able to change my habits, I wouldn't need surgery in the first place.

I am not one of those people who have lost 100+ pounds several times over but gain it back.  I've never been able to lose more than 20-25 pounds at a time.

I will say that I have been doing well at most meals, as far as no bread/rice/potatoes, nothing fried etc.  But my issue is sweets, especially frappucinos and the like.  I did journal my foods for about a week and aimed to stay around 100-120 carbs a day (which I know is higher than I need to be) but nowhere near where my PCP wants me to be (under 50).  Its amazing how many carbs a serving bread has so I only eat protein for meals; yet I'll spend 60+ carbs on a coffee drink that is gone in 30 minutes.

I'm frustrated with myself and deep down I'm so worried I am going to fail this surgery.  I feel like the restriction is what I need, as I definitely overeat.  Having consequences to doing that is what I need.  But I know that it is just as much about the kinds of food you eat post op as the quantity. 

I know everyone has challenges in their life that make it harder--mine is that my husband is going through the process as well, but has made zero efforts at changing his habits.  He is a total carb addict.  I know only I am in control of what I put in my mouth, but it does make it harder.

So I have a couple questions and am interested in hearing of your experiences.

1. Why does insurance require this diet and what are they looking for?  Like I said earlier in my post, if I could lose the weight, I wouldn't need the surgery, so what is the point from their view? 

2. Any former carb addicts out there who could never lose more than 10-20 pounds at a time and ended up falling off the wagon after just a couple months?  How did you overcome that?

3. Post-op, do your tastes change from wanting carbs to not wanting them?  This is probably one of those things that is dependent on the person, but I'm hoping this might change the horrible food cravings I have.

I am going to try to get in with the psych who works with my surgeon to actually start therapy now, or at least get some referrals from him.  My goal is to get that sorted out this week.

My PCP is against the surgery and gave me a butt kicking last month when I gained back 2 of the 5 pounds I lost initially.  But I needed the butt kicking and it motivated me for a week.  Then there were two potlucks that weekend with pretty much all carby stuff and I have been off the rails since.  I see him again in a week and am not looking forward to it.

I know what is working against me the most and that is self-sabotage and not believing in myself.  Growing up, my mom was convinced the end of the world was imminent.  I was scared all the time and never followed through on anything and didn't achieve anything because I thought the end of the world was near, so nothing mattered.  Even today, I can't shake that inability of planning anything for the future, because I can't picture it.  I can't picture getting approved for the surgery, so I'm not getting serious about it.

I know above all, I need to get into therapy, but I would really like to hear from anyone who may have had a similar experience.

Thank you so much and thanks for reading,

Becky

Wow, for a new poster you ask terrific questions! Welcome aboard!  Here are my best answers, but please do not confuse this with it being the "right answers". Mostly they are my opinions and sharing what worked for me type thing. 

1, My guess on this question is that they do not want someone just running in without working on changing habits or making an impulsive decision. Additionally, a supervised doctor diet does work for some- my mother-in-law lost half her body weight once via this route and a gazillion failed previous diets. She put it back on though throughout the years. Or, it could just be to make it harder to get the surgery and then they don't have to pay out. This doesn't make sense IMHO though because morbidly obese folks tend to run up medical bills long term, versus getting healthier from the surgery.

2.Wish I could say I was a former carb addict. Pre surgery the longest I could ever hold out was 2 months, but usually a month or so. I would always end up putting it all back on and then some. The surgery levels the playing field in a manner that is hard to describe, but you will recognize it once you have the procedure. You eat less. You crave healthier foods due to the mandated 6 weeks or so of restricted diet to heal your stomach, and in general it just resets your system to provide a much easier pathway to healthy eating.

3. Yes and no. I did a great job being super low carb in the first month or so. It caused havoc though due to being hypoglycemia. During this period by the end of 6 weeks or so I can legit say I never craved sweets/carbs... something completly foreign to me. I was able to sustain the low carb thing long enough to not only detox, but change the palate. I had to add carbs back in. I did just fine if it was the "right" type of carbs (green leafy veggies, food low on the glycemic index) but completly started dealing with carb cravings again after adding in crap carbs (processed white stuff- sugar, white flour, etc.) Even now I swing up and down with carb issues. If I start to eat crap carbs it is a slow but highly predicatable slide... at first just a little here and there and it ramps up until I am putting weight on and the majority of the calories from the day are coming from that. Oh, and of course I feel like complete **** when I do it too. When I get as strict as I can with carbs by the 3rd or 4th day or so the cravings are well managed and it becomes far easier to make better choices. 

You recognize the need for therapy- go after it. Be it in the form of a counselor, weight loss support group, whatever. I had the opposite problem as you- I could only see what the future path led to and struggle being more in the moment and mindful. Both have their pitfalls and assets. I highly recommend you start wieghing/logging every bite of your  food on something like myfitnesspal.com. Even if you don't lose anything, you will start to have a clear picture of what your eating habits are so you will be better able to adjust.

I never, ever thought prior to surgery I would make it to a normal bmi. I was diagnosed with cancer and my health was falling apart- I was hoping only to lose enough to be able to move around a little better. What you are feeling "others make it to goal, but how could that possibly be me?" type issues is very typical to experience pre-op. It doesn't mean you won't do well.

My husband and I were both morbidly obese, and this forum actually is what helped me to recognize just how codependent we were- we were both guilty of encouraging the overeating. We finally sat down and agreed on some verbage that we could say to one another and it was established that when we said it, by no means were we trying to hurt feelings and such... just acknowledge that whatever the other was doing was making it terrible hard to eat better choices. It worked brilliantly for quite a while. He also ended up going on the diet with me a couple days post op out of fear I would eat something that would kill me (entirely possible- I was really struggling). He ended up losing more faster and took off a little over 100 pounds. He has since gained back 30. We are both back in that codependent mode, so I just realized I need to sit down and reestablish this again for both our sakes. 

Sorry for the long reply- but know I started out in a very similar position as you and made it to goal, and stayed there a few years out thus far.

Thanks for the response.  It's comforting to know others have been in my position.  I left a message for the psychologist and am waiting to hear back.  He is taking new patients who are pursuing WLS, and he takes my insurance, so that's good.

I also decided to go carb-free tomorrow and see how I do.  I remember doing Phase I of SBD twice and the first couple days were definitely the hardest. 

Part of the pre-op diet is to work on your head. You can still drink all the sugary frappucinos you want after VSG, unfortunately.

Most of us forego carbs entirely-- meals are 90% solid protein with a bite or two of veggies. No bread, rice, or pasta; any carbs you may get will probably come from things like protein shakes or milk. It's rough at first, but it generally seems to do the trick.

Julie,  That's what scares me is that it would be very easy to keep drinking the Frappucinos post-op.  That is the absolute biggest thing I need to get under control.    I know it will ultimately be worth it, but in the short term it is so hard!

Oh I absolutely understand! The good news is that you can start switching things in your diet NOW to get acclimated.

Hydration is SUPER important. Start carrying a water bottle with you everywhere. You don't need plain water, anything sugar-free/calorie-free is O****d tea, SF lemonade, Crystal Ligh****er with lemon or mint or cucumber. When you're hydrated, you're less likely to go for sugary drinks.

You can still do coffee after surgery, especially if you go for something like protein coffee. Skim milk, sugar-free syrup, protein powder if you can, and put it over ice. You can even get a mini-blender and make your own Frappucinos at home! Or just go for black coffee (perhaps decaf, ask your doctor what s/he thinks about caffeine immediately post-op) and start shifting things.

One of the biggest things that's helped me is finding things I can have post-op that are similar to what I ate post-op. My husband and I eat a lot of hot wings, for example, and I found that one of the local wing joints will do "naked chicken tenders" with no breading and hot sauce on the side. Just need to plan, and you can find alternatives!

Just got off the phone with the therapist and he seems really really nice!  Appointment next Tuesday at 1:30...right before my root canal.  What an exciting day it's going to be!

Ewwwww root canals. I've had several and they suck big time. But the therapy stuff is great news, way to go!

first think you should do in my opinion  is to see a therapist that specializes in eating disorders , you need o best the carb and coffee addictions   , or no wls will work

 one of those drinks has more carbs and calories than you should eat  for the whole day

 drink a ice tea instead