Question:
I am between 5'10 and 5'11 with a weight of 245. If I go with 5'10, my BMI is 35.2,
just high enough to qualify. I'm not certain on the com-morbidies though. I do have depression (thanks to being "fat"), though it's never been diagnosed and I was diagnosed with mild sleep apnea YEARS ago. (I'm 20 now, I was like 12 then)I also have very heavy and irregular periods. Would this be enough to qualify me? I NEED to lose 75 pounds, but would like to lose 85. Any help will be appreciated. I have tried nearly everything, counting calories, low-fat, lots of exercise. It just won't go away. — Ginger F. (posted on March 24, 2004)
March 23, 2004
Hi Ginger, approval rests solely with your ins. company and employer (if it
is a group policy thru work). If your employer has chosen not to provide
this benefit, even if your ins. company offers it, it will not be covered.
But if all you need is medical necessity, the ins. company will usually
have a list of requirements you have to meet in order to be approved. You
need to call them and see what they require. Some are pretty hard-nosed,
they want definite life-threatening co-morbids, such as diabetes, high
blood pressure, sleep apnea, etc... Any advice we give may or may not be
true to you in your case, because we do not know what is required to be
approved. Good Luck.
— Ali M
March 23, 2004
Hi there. I had a MGB with a BMI of 34.4. But I did have some co-morbs
including pre-diabetic, blood pressure problems, joint problems, and
serious back problems including having to have a spinal fushion and
degenerative disc disease. All I can say is it does not hurt to try.
— Mini Gadget
March 23, 2004
There is a lot of variation among the different insurance companies. Some
insist on 40+ BMI, and 100 pounds overweight. Some say twice ideal weight.
Mine (Highmark BC/BS) said BMI 35 or over, and body weight twice the
ideal. Which is kind of hard to do with a 35 BMI. Anyway, they (as far as
I know) did not require any co-morbidities, although mine were included on
my pre-approval by the doctor's office (mild sleep apnea, back and feet
pain). I would check with your insurance company to see what your policy
says about WLS.
— Carlita
March 23, 2004
Ok, this is gonna sound like a gripe. Ironically your weight is where my
weight has settled after WLS. I started out at 368 and I am 5'11/6'
depending on if I slouch or not. I had WLS 2 years ago and I stopped
losing at about 247 lbs I go up and down a few lbs. My primary care dr
tells me I should be happy at this weight, it is much better than where I
started and my BMI is no longer over 40. PLus my health problems are
improved. I think I'llprint your question out and take it to him, see
folks want to have the surgery at the weight I am now at. <heavy
sigh>
— SARose61
March 23, 2004
You may find a surgeon willing to do the surgery, but your insurance
company may not pay. If you are willing to become self-pay (like many of
us have to do), then you may want to look at all your options, like getting
the lapband instead of the bypass, going to Mexico or Europe (excellent and
experienced surgeons at a reduced cost), etc. You have many options, so do
your research as much as possible...
— Sheryl W.
March 23, 2004
OK, I know this won't be a popular answer, but at 20 years old with that
low of a BMI, are you SURE that you've investigated every other alternative
first? RNY will change your insides forever, and you have a long life in
front of you that you may need to deal with malabsorption issues. RNY is a
better alternative than being MO w/ multiple health problems, but it should
be a last resort based on health issues. Just something to think about.
Have you tried working with your doctor on using meds in conjunction with
South Beach? Low cal and low fat don't work. South Beach can, and maybe
you could be one of those that can stay on it with some help from your doc?
It may be worth a shot before you take more drastic measures. I'm not
saying you won't need surgery, I'm just saying that at your age, health and
weight, you may have other alternatives to consider first. (PS...I don't
know what surgery you're considering, but I would have lap band before RNY
if I were you)
— mom2jtx3
March 24, 2004
My recommendation is to learn moderation as you are so borderline in so
many ways (weight, BMI, age, co-morbs). WLs is not going to make the
depression go away, I speak from experience!
<p>If in a few years things are not improving I would consider the
LapBand in your case as it's totally reversable. My surgeon has started
using this on younger people as he truly feels there will be a cure for
obesity in your lifetime. Any RNY would be very drastic for your situation
in my opinion.
<p>All I can tell you us 5'11 and 160 lbs will likely make you the
poster child for anorexia. I'm 5'9 and am at 200 and other than I have
thunder thighs and heavier legs, I am a skeleton on the upper half.
Granted I carry a lot of muscle but it still doesn't make me look any less
bony on top.
<pPersonally I think there is way more factoring in here and until you
work through those things WLS is not going to solve anything. Read my
profile, the early pre-op stuff and see what I have gone through related to
WL and depression. Maybe it will give you a little insight into your
situation.
<p>I sincerely doubt you would qualify at your present BMI and lack
of serious co-morbs. Please consider some counseling before going down
this road to be ablsolutely sure it is the right thing and you are willing
to make the changes required. I started at 442 so it was a slam dunk I
needed it, but now that I am at goal and almost 14 months PO it is so easy
to slide back into old habits, however I amble to remember what 442 was
like and keep things reasonable. At 5'9 and 245 I would never considered
having an RNY and not even sure if I would have considered surgery and I
had serious enough co-morbs that I might have qualified under a 40 BMI.
<p>Please do some serious soul searching!
— zoedogcbr
March 24, 2004
I guess I should have specified what I am looking into. I'm looking into
LapBand as a last resort to help with my weight problem. I'm not saying I
don't want to work for it, but I just think I need help doing so. I've
been dieting since I was 12 and nothing had produced any lasting results.
At my height, I am wearing a size 18/20 and I have heard many success
stories of people at or near my height and weight who have had LapBand fill
in the gap where they couldn't lose weight. I am telling you, this stuff
is glued to me.
— Ginger F.
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