I been denied surgery by my insurance and can't lose weight normally.

awner81
on 9/9/18 7:22 pm

I am obese and around 480, a few months ago I was about 430 a few months before that I was about 460 my weight goes up and down. I am on thyroid meds, they don't seem to help. I have low thyroid issues. I been denied 7 times by my insurance. They demand i have diabetes or history with gout or sleep apnea or high blood pressure that I need to be on 10 or more meds and none work or I need to have a fatty liver.

I actually have none of these issues. I also try to eat right and try to not eat more than I am supposed to. for example yesterday I had two slices of toast no butter for breakfast and for lunch/dinner mix I had two chicken legs baked in the oven with some rice and corn. This is how my eating kind of is. my cousin eats the same way and has lost over 50 lbs.

I was even working out in a gym for a few months and gained about 20 lbs in 2 months, that is not muscle. I was walking 6 miles a day 5 days a week for 2 years and eating a can of tuna fish and some toast for breakfast and had a salad for dinner and still was unable to lose weight.

I am basically giving up in trying. I also been in the dating scene for over 9 years and all I get is rejected, mocked at, laughed at, made fun of and humiliated and ghosted by women because of my weight. I am just sick of it all and don't know what to do anymore. My dr gave me some weight loss meds I lost about 25 lbs in 3 months of being on them but I can't afford to be on them. after insurance I have a copay of 180 dollars for them. They are the phentermine. which was part of the fen phen in the 90s that killed many and made others very sick.

peachpie
on 9/10/18 2:25 am - Philadelphia, PA
RNY on 04/28/15

I'm sorry you were denied surgery. Every insurance writes thier requirements differently, but yours does sound very stringent. Did you appeal? I've seen many get approved on appeal.

Re: thyroid- the meds are not designed to help you lose weight. (I had my thyroid removed and am on meds too). If your TSH is in the optimal range for you the thyroid is not the issue. Get the dosage right then forget about any effect you think they may be having on your ability to lose weight.

What is affecting your ability to lose: your diet. I don't think you are telling the whole story of what you eat. You tell us what you try to eat when you want to lose- but how do you eat when you just don't care? (And we've ALL been there- I could have easily ate 3,000 calories at breakfast alone in my hay day). To sustain a weight of 480- you are eating far more than you suggest. The weight loss drugs will allow you to lose short term- but you won't keep it off. Not worth the risk/reward trade off in my book.

And from what you do eat when you want to lose- they are not very good choices. Toast, rice and corn are carbs that's you would need to avoid like the plague if you had surgery. Same holds true without surgery- they aren't nutritious. What are you drinking? Do you set a calorie goal? Do you track what you eat and weigh and measure portions? These are all part of the life post wls- and things you could do now. Consistency is key.

Know that losing weight may not make dating any easier. It unlocks a door to health, but too many people believe excess weight is the thing holding back from totall happiness. Then they lose it and still aren't happy and can't use food to cope. This is where transfer addictions come into play. Therapy is so very important for us to understand why we eat the way we do.

There is much you can do, and are in control of- you need to truly believe that to be successful in any regard.

5'6.5" High weight:337 Lowest weight:193/31 BMI: Goal: 195-205/31-32 BMI

MarinaGirl
on 9/10/18 7:12 am
Revision with

If your employer-sponsored health insurance won't cover your WLS than 2 other options are to get a job at a company that offers bariatric surgery with requirements you can qualify for or self-pay. Many of us (myself included) have gone to Mexico for surgery as it is more affordable than other countries. I recommend Mexicali Bariatric Center.

Haley_Martinez
on 9/10/18 9:53 am
RNY on 05/03/18

I'll second this, you do still have options, and I would seriously look into them.

25 years old - 5'5" tall - HW: 260 - SW: 255 - CW: 161.8

Pre Op - 5.0, M1 - 25.6, M2 - 15.6, M3 - 14.0, M4 - 13.4, M5 - 10.8, M6 - 13.8, M7 - ?

jenorama
on 9/10/18 10:15 am - CA
RNY on 10/07/13

Peach hit it head on. You need to do a serious evaluation of your diet, including your drinks. I bet you'll find that you may not be "eating" much, but you're taking in way more calories than you should via liquids. Soda, coffee with cream, frappucinos--those all add up faster than you think they do. For example, I saw an infographic just yesterday about how much sugar was in various drinks. A 14 oz frozen coffee from Dunkin Donuts has 145g of sugar. That's 870 calories worth of sugar alone. That's more than a lot of post-surgery people eat in a whole day for the first six months or so out of surgery.

For reference, most people need about 10 calories per pound of bodyweight to maintain their weight. This means that in order to maintain your current weight, you're consuming around 4000 calories a day. To lose 2 lbs per week, you can cut 1000 calories per day off of that and still be eating more than your average person.

Get yourself a calorie tracker and be honest. Log what you eat and drink in a day without making any major changes just to see where you're at with your consumption. I imagine you'll find some surprises in there that you can cut out for an easy win. Before you know it, you'll be losing weight.

As Peach said, drop the carbs and load up on protein and non-starchy veggies. You want to focus on foods that will satisfy you and keep you satisfied for a long time. Meats cooked in the crock pot are great for this. Don't be afraid of fat--fat is satiating and will keep you feeling fuller longer, just make sure you account for it in your calories. If you're drinking sugary things, cut them out. A single 20 oz bottle of soda has around 300 calories. Is it worth it? Not really.

Don't worry about trying to get out there and exercise. Right now at rest you burn more calories staying alive than most of us do being out and walking around. A lot of times, people will exercise, overestimate how many calories they burned and then think, "I deserve a treat!" and in five minutes completely undo all of the work they just did. Do not fall into this trap.

You are extremely fortunate that you haven't developed high blood pressure, diabetes or sleep apnea yet. I used to think I was one of the lucky ones, but at 40 years old and 350 lbs, I had sleep apnea and all of my health markers were on the way up, so make no mistake--it's coming for you.

Do not feel helpless. Your weight is in your control--it's up to you to take that control. It's going to be hard and frustrating, but you can do it. Every single one of us have been where you are and we totally understand where you're coming from. Come here for support, recipe ideas, victory sharing or even just to vent. Don't just sit and give up--you're worth so much more!

Jen

Mary Gee
on 9/10/18 11:53 am - AZ
VSG on 05/14/14

What insurance do you have?

Most insurers have the same basic requirements: (1) BMI of 35 with co-morbidity, of (2) BMI of 40, no co-morbidity required.

Do you have an insurance policy that simply does not cover the surgery?

If you don't have coverage, you would have to do self-pay. Most go to Mexico and you can visit that board for more info.

If you can't go the surgery route, then I would suggest Weigh****chers for a more structured program.

       

 HW: 380 SW: 324 GW: 175  

 

 

 

 

 

 

 

Sparklekitty, Hag of Science
on 9/10/18 12:19 pm
VSG on 12/10/13

You say you "try to eat right," but it's not WHAT you eat so much as HOW MUCH you eat.

How much is "some" rice and corn? 1/4 cup? 2 cups? That's a major difference in calories. How much is "some" toast with your tuna? One small slice? Four slices from a jumbo loaf?

What's in your dinner salad besides lettuce? Dressings and toppings can have tons of calories, and it's not at all difficult to have a salad that tops 2000 calories.

Did you change your eating when you went to the gym? Calorie-burn estimates tend to be WAY off. If you thought you burned 2000 calories at the gym, then gave yourself permission to eat another 1000, it's very likely why you gained weight.

Do you have your insurance requirements in writing? Your requirements sound very unusual; after being on the boards here for over 6 years, I have not heard this specific situation. Have you actually been tested for sleep apnea or fatty liver? At your weight, I would be very surprised if you did not.

I understand that you're ready to give up, but from your posts, it doesn't seem like you've made a full effort to fully measure and track your intake; you have no idea if you've been doing enough to lose weight. That's something you'll still need to do after surgery, because it isn't magic.

Nerdy Little Secret (#42) - Tucson Roller Derby

H.A.L.A B.
on 9/10/18 7:20 pm, edited 9/10/18 12:20 pm

Right there with you. Even 10 year post op - I can have 1 oz of rice, as long as it is with proteins and fats. But more than that that may cause a significant insulin response and RH.

There are some items that I no longer "measure", but anything with sugas or starchy carbs - I make sure i don't get more than 1/2 servings or even less than that.

I make mash potatoes for my BF, but I almost never taste it. Small amounts of mashed potatoes can trigger a RH episode in me. I hate dumping, but I take dumping over an RH episode any time.

eddited to fix spelling and autocorrect issues.

Hala. RNY 5/14/2008; Happy At Goal =HAG

"I can eat or do anything I want to - as long as I am willing to deal with the consequences"

"Failure is not falling down, It is not getting up once you fell... So pick yourself up, dust yourself off, and start all over again...."

sweetpotato1959
on 9/14/18 11:40 am

Sparklekitty and awner81,

I'm inserting this here- because seems like most reasonable place to insert.

Awner81- I know these questions may not seem "nice" or "reasonable" to you...they may even sound snippety.

Just know that each of us are thinking from different perspectives and experiences. This is one thing that makes this forum so effective. By us having different perspectives we can help you to find things you will be able to apply.

We do not know you or your abilities to accurately measure, to judge portion sizes...just to name 2 things. We are not in your head... Those are ALL your jobs... to get in your own head., Build your skills. Use measuring containers> Make your measuring of each food conform to the ADA serving size of that vegetable/food/fruit. Go to non processed foods as much as possible...ie no boxed meals, no fast food. prepare hamburger from best quality beef you can get. You are worth it.With modified diets GOOD quality food is more important thatn quanity. Lemon juice added to filtered water or apple cider vinegar may help with your digestion and your actual fat loss/as opposed to weight loss.

You need to do measurements...to know where you are beginning today. start with true chest measurment across nipples, and around body. actual waist measurment,(at bottom of rib cage) widest hip measurment.. biggest part of each thigh and biggest part of each upper arm and calf measurments. as the muscle builds and you do not see weight loss ..you will be able to document actual fat loss.

Each of us are here to share what we can that may help others. I had an open wls that is no longer done- 23 years ago. it did include an RNY.It was a permanent solution to a permanent problem.

The important thing is for you to learn from the questions that are being asked, evaluate and make the changes that are necessary. I have a family member who rivals you weight. It is truly a life long sruggle for people who do not have surgical modifications. I was a small part of a study done thru University of Tn,/ under Obesity Wellness Center.....Both My Mom(who passsed from this life at 140 lbs) and I were part of this study,..as were other familial sets of other patients....ie. some were mother/son, some were father daughter, many were mom and dau.... of this Obesity specialist surgeon. The study itself was peformed by UT professors as they evaluated genetic components that they deemed ..to be morrbid obesidy influencers. In short in a follow up visit past year one...Dr George Cowan told us "they did find an obesity gene. It sets up the tendancy to be obese." That would be the hormonal components that control use and storage of carbohydrates.

Who is this doctor, ? some may ask. He and another Dr literally wrote the book on supplying nutritional needs, to those unable to take foods by mouth, with IV solutions... the solution is called "TPN". This book is still used in medical colleges today.

Is MO and the genetic tendency to be overweight something that can be over-come ?, yes!

Is it hard? Yes!

Can you do it? Yes.!

... you will have to be consistent with diet and application of all forms of weight control. training your brain is the hardest. first 3 days are really hard...then it gets easier to maintain . You will not always be able to stay on track. Just do not beat yourself up(plenty others will do that for you). get back oon the horse and try it again. try to learn from your failures. each of us has different challenges to remain on track .avoidance of those is wise.

PCBR
on 9/10/18 7:15 pm

Have you actually been tested for sleep apnea? Like, you did a sleep study?

HW: 260 - SW: 250

GW (Surgeon): 170 - GW (Me): 150

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