I am now 9 days out on my insurance required 6-month diet.  If the insurance wants to be picky, they will stamp me with an F for Fail if I don't get it together.  I am incorporating protein shakes and vitamins so that I get used to the idea of those things being necessary, but I cannot leave sugar alone, please tell me that the DS will help get this sugar monkey off my back.  I can't express how much sugar is truly ruling my life, it's unbelievable really.  Also, for those who had to do it, how closely does the insurance company scrutinize what you did and how well you did on the 6 month diet? I'm not even following a specific diet per se, but just trying to adjust to lower carbs than say the billion I have been consuming for years and of course adding more protein.  God help me, I'm a sugar factory!  Did any of you feel this way before surgery? Right now I feel like I may not even be a candidate for surgery if I can't demonstrate compliance now.  I hate the word "compliance" in this situation because I am struggling here with this sugar thing in a bad way--my body wants sugar!  Major major frustration here.

The DS will not make your desire for sugar go away.  You're going to need to accept that a heavy-sugar diet is toxic for a DS'er for a number of reasons.  It makes your poo stink (worse), it makes you gasy, it gives some people the runs, and we absorb 100% of the calories we consume from sugar, so if you eat high sugar, you will be eating high calorie.

Moderation, sweetheart.  You have to try.  Took me quite a few times getting my wrist slapped by MajorMom and BeemerBeeper before I was capable of switching over to low carb.  It's inevitable.  You just have to do it.

Oh, I would absolutely NOT have the surgery if this sugar "problem" were not under control.  No way, no how, bottom line.  I've learned how not to be reckless and dumb if I've learned anything on here so far, and lord knows, there's more to learn.

I completely understand...I had the same problem before I had my RNY, although when I went on a high protein diet 30 days before my surgery, my cravings went way down, it will take time to adjust to it, is just like any other addiction, you have to get through it for a bit, but each day gets better.

When you are craving something sweet, i have found sugarfree popsicles really help, or if it is chocolate sugar free fudgecicles.

Hope that helps

First of all, you are going to HAVE to get the carb situation under control - one way or another.  However, it will be MUCH easier post op.

Having said that:

There are a ****LOAD of studies and a policy statement from the ASMBS that pre-op diets are not only WORTHLESS but counterproductive.  I would STAY on the diet and immediately appeal to have the requirement waived.  That could get you out of it in 2-3 months.

You need to find out what their requirements are for weight loss, if any.  Many programs just require you to go to the doctor/nutritionist once a month for 6 months, nod your head and say you are sticking to the program, but not losing weight.  It is just a game they play to hope you will give up, change insurance, or DIE before they have to pay for surgery.  But you need to call and find out if they have a SPECIFIC requirement - while you appeal to have it waived.

Diana-

That's interesting because like a little sheep that I can be at times (becoming more of a wolf everyday now though) I just thought I'd get through it the best way I could and I had no idea you could ask for an for appeal that requirement! Have others had success in doing that? Let me do a DS forum search! Thanks again! 

Let me say that in all honesty I don't mind the diet that much, I mean it's giving me a specific time line where I can do my research on surgery and not have to worry about getting ahead of myself.

Diana, I've only ever heard of people being able to appeal and win the right to get out of the diet by people who live in California, or have an insurance that is based in California, and subject to the rulings of the California Dept. of Managed Care.  Do you know of it ever working outside of California?

No, but SOMEONE needs to be the first one to try - she could Pay it Forward before she even has surgery.  There is a ****TON of publications, and the ASMBS has come out against pre-op diets (citing 26 references), so she could do herself and everyone who comes afterwards a huge favor.  It would require submitting the appeal to the insurance company, likely twice, and then requesting Independent Medical Review.  If enough people do it, they may change their policy (or, perhaps if the media gets involved, hint hint ...).

I said it COULD work, not that it WOULD work, and I told her to stay on the diet while appealing.

ASMBS Position Statement: http://www.asmbs.org/Newsite07/resources/ASMBS%20Position%20 Statement%20on%20Preoperative%20Supervised%20Weight%20Loss%2 0Requirements.pdf

It is the position of the ASMBS that the requirement for documentation of prolonged preoperative diet efforts before health insurance carrier approval of bariatric surgery services is inappropriate, capricious, and counter-productive given the complete absence of a reasonable level of medical evidence to support this practice. Policies such as these that delay, impede or otherwise interfere with life-saving and cost-effective treatment, as have been proven to be true for bariatric surgery to treat morbid obesity, are unacceptable without supporting evidence. Individual surgeons and programs should be free to recommend preoperative weight loss based on the specific needs and cir****tances of the patient.

Papers:
http://www.nature.com/oby/journal/v18/n2/full/oby2009230a.ht ml (full paper)
Obesity (Silver Spring). 2010 Feb;18(2):287-92. Epub 2009 Aug 6.

Effectiveness of a prebariatric surgery insurance-required weight loss regimen and relation to postsurgical weight loss.

Ochner CN, Puma LM, Raevuori A, Teixeira J, Geliebter A.

Source

New York Obesity Research Center, St Luke's Roosevelt Hospital, Columbia University College of Physicians and Surgeons, New York, New York, USA. [email protected]

Abstract

Most US insurance companies require patients to participate in a medically supervised weight loss regimen prior to bariatric surgery. However, the utility of this requirement has not been documented. Data was collected from 94 bariatric surgery patients who were required, and 59 patients who were not required, by their insurance company to participate in a presurgical weight loss regimen. Weight change in the required group, as well as group differences in weight change, was examined from 3 and 6 months presurgery to 1 week presurgery, and from 1 week presurgery to 3 months postsurgery. Weight change presurgery was then used to predict weight loss postsurgery. In the 6 months prior to surgery, required patients gained 3.7 kg +/- 5.9 (s.d.) (P < 0.0005), which did not differ from nonrequired patients. From surgery to 3 months postsurgery, required patients lost 23.6 +/- 8 kg (P < 0.0005), also without differing from nonrequired patients. Patients who gained more weight prior to surgery, lost more weight postsurgery (P = 0.001), while controlling for initial weight. Findings suggest that the common weight loss regimen requirements of US insurance carriers were ineffective in producing presurgical weight loss in this sample. Most patients (>70%) in this sample gained weight prior to surgery, potentially taking advantage of final opportunities to overindulge in preferred foods. Required patients fared no better in terms of weight change postsurgically and, surprisingly, presurgical weight gain predicted better postsurgical weight loss outcome. Several potential explanations for this finding are offered.

http://www.ncbi.nlm.nih.gov/pubmed/16925335
 

Surg Obes Relat Dis. 2006 Mar-Apr;2(2):122-7.

Insurance-mandated preoperative dietary counseling does not improve outcome and increases dropout rates in patients considering gastric bypass surgery for morbid obesity.

Jamal MK, DeMaria EJ, Johnson JM, Carmody BJ, Wolfe LG, Kellum JM, Meador JG.

Source

Department of Surgery, Division of Minimally Invasive Surgery, Virginia Commonwealth University Health System, Richmond, Virginia, USA. [email protected]

Abstract

BACKGROUND:

Preoperative dietary counseling (PDC) before bariatric surgery is mandated by a growing number of insurance payers. Their claim is that PDC improves outcomes and postoperative compliance. We compared outcomes of GBP patients undergoing a mandatory 13 weeks of PDC (n = 72) to a contemporaneous group of patients with no such requirement (no-PDC; n = 252) who underwent operation between January 2000 and December 2002.

METHODS:

The PDC and no-PDC groups were characterized by similar male:female ratios (1:4 vs 1:4.6), mean age (42 years), mean body weight (324 lb vs 309 lb), and mean body mass index (BMI) (52 kg/m2 vs 50 kg/m2). The PDC group had a higher incidence of obstructive sleep apnea compared with the no-PDC group (41% vs 28%; P < .04) but otherwise the two groups had similar incidences of obesity-related comorbidities. The presurgery dropout rate was 50% higher in the PDC group than in the no-PDC group (28% vs 19%; P < .05).

RESULTS:

At 1 year follow-up, the no-PDC patients had a statistically greater percentage excess weight loss (67% vs 60%; P < .0001), lower BMI (32 vs 35; P < .015), and lower body weight (197 vs 218; P < .01). Resolution of major comorbidities, complication rates, 30-day postoperative mortality, and postoperative compliance with follow-up were similar in the two groups.

CONCLUSIONS:

The data demonstrate that insurance-mandated PDC is an obstacle to patient access for surgical treatment of severe obesity and has no impact on weight loss outcome or postsurgical compliance. PDC should be abandoned by the insurance industry.

http://www.nature.com/oby/journal/v14/n3s/full/oby2006285a.h tml (full paper)
Obesity (Silver Spring). 2006 Mar;14 Suppl 2:70S-76S.

Previous weight loss experiences of bariatric surgery candidates: how much have patients dieted prior to surgery?

Gibbons LM, Sarwer DB, Crerand CE, Fabricatore AN, Kuehnel RH, Lipschutz PE, Raper SE, Williams NN, Wadden TA.

Source

Department of Psychiatry, Weight and Eating Disorders Program, University of Pennsylvania School of Medicine, 3535 Market Street, Suite 3029, Philadelphia, PA 19104, USA.

Abstract

OBJECTIVE:

To describe the dieting histories of bariatric surgery candidates.

RESEARCH METHODS AND PROCEDURES:

One hundred seventy-seven individuals with extreme obesity who sought bariatric surgery completed the Weight and Lifestyle Inventory, a self-report instrument that assesses several variables, including weight and dieting history. Patients' dieting histories were further explored with an aided recall during a preoperative behavioral/psychological evaluation performed by a mental health professional.

RESULTS:

Participants who completed the Weight and Lifestyle Inventory reported an average of 4.7 +/- 2.9 successful dieting attempts, defined as those that resulted in a loss of 10 lbs (4.5 kg) or more. These individuals reported a mean total lifetime weight loss of 61.1 +/- 41.3 kg. Despite these efforts, their weight increased from 89.4 +/- 27.4 kg at the time of their first diet (age 21.2 +/- 10.1 years) to 144.5 +/- 30.8 kg at the time they underwent their behavioral/psychological evaluation (age 43.0 +/- 11.0 years). Results of the aided recall revealed that participants had made numerous other efforts to lose weight that were unsuccessful. Self-directed diets and commercial programs were used more frequently.

DISCUSSION:

Individuals who sought bariatric surgery reported an extensive history of dieting, beginning in adolescence, that was not successful in halting progressive weight gain. Thus, the recommendation often made by insurance companies that patients delay surgery to attempt more conservative treatment options may be unwarranted, particularly in the presence of significant obesity-related comorbidities. Weight loss histories should be routinely examined during a behavioral evaluation to determine whether additional attempts at non-surgical weight loss are advisable. Future studies also are needed to explore the potential relationship between dieting history and postoperative outcome.

 

Diana, you have such mad skills and knowledge -- thank you for all you do to pay it forward!

Diana-

I did pull some of these studies to read.  Thanks so much for planting that bug in my ear that these studies even existed.  You are the researching machine!