Wednesday, September 9, 2009

Being Fat is Hard, Losing weight is Hard...

Choose your Hard!
I am probably going to ruffle some feathers with this post but this is MY blog and I guess it is a form of therapy for me.
I was asked yet again over the weekend if I had weight loss surgery. I didn't and I will scream it from the roof tops. In my mind there are a few reasons to get the procedure and laziness or lack of will should not be one of those reasons. Maybe you have tried and failed a few times and there are medical reasons that you need the weight is then an option but I think it needs to be combined with therapy and exercise to be successful. In the past 2 months I have seen at least 3 people I know jump into surgery. No pre-op obligations to meet at all. Really it is just a lack of authority on the insurance company's part and a whole lot of greed on the doctors part. I have seen appointment to surgery progress in as little as 4 weeks with no diet history, no medical problems and a need to only lose 75 pounds. This just lights a fire under my ass.
I will be the first to admit that I went to the orientation and really looked into surgery. Because of financial reasons and fear I backed out and have been on the track to lose the weight myself. I understand that some people cannot do it. I really do because I was a yo-yo dieter for years but don't the doctors have some sort of responsibility to stop these over night surgery fans. I mean it has become the social norm to have your mouth surgically routed to your ass for weight loss. Years ago people would whisper with suspicion behind your back if you have weight loss surgery and now they treat it like a prize. Smiling and congratulating the woman that went to Mexico because she had so little to lose an American doctor wouldn't touch her but she just had to lose that 50 pounds somehow.I have loose skin and I will have to pay for removal or live with it because my insurance company will only pay for it IF I have had WLS. Seriously?
I am sore everyday, I push myself everyday. Sometimes I am so tired I just want to break down in tears. I push myself to my physical limit all of the time. I eat clean and I struggle. I look in the mirror and still see how far I have to go. I should be proud. I should be thrilled to show my old ID at the store. The truth is sometimes I lie and say I don't have it just so I don't have to get into the great weight loss debate with the nosey cashier. It's never easy. It's hard but at the end of the day I am happy with the path I chose.


Cyclin' Missy said...

Good for you! Natural weight loss is hard work, but it is the healthiest, safest way to do it. It's a change in lifestyle that will last...not an overnight procedure with no long term commitment. Lots of respect to you for all the work and will power you've invested in yourself. It's already paying off! Congratulations on your progress so far, and keep it up! You're doing amazing.

Cyclin' Missy said...

By the way...we don't live that far apart. We should meet at the White Pine Trail or the Musketawa Trail some time for a ride!

ShellyD said...

Hi there, I agree with you, if anything surgery should be a last resort. Here in SA our medical aids will not pay for any cosmetic surgery, surgery related to obesity, etc etc. Those who want to do it have to pay for it out of their own pockets.

Lately we have an ad on the radio for a slimming product - 'lose weight without dieting or training' Great huh!! There was a time that would have grabbed my attention - now I scream 'yeah right, if only it was that easy'.

Losing weight is a daily battle. I hear you on the exhaustion. Yesterday I was completely flattened and frustrated because of it. I'm at the point of seeing a dietician - I don't think I'm eating enough - I need guidance especially with all the cycling.

I'd rather go this route any day than the quick one.

With you all the way.


Anonymous said...

WRONG! Every person that I know of who has had weight loss surgery has done so after going through rigorous medical and psychological testing. Why would doctors risk their license and practice should the least little complication arise? Insurance companies will not pay if people do not meet the criteria and go through the medical clearance and psychological testing. I know what I am taling about and I think the people you know are lying. To qualify for weight loss surgery one needs to be a minumim of 100lbs overweight and considered obese. 75lbs is not enough to get weight loss surgery in the states, but they can get a lapband. Excess skin surgery is considered cosmetic.

Why wouldn't you want to show your old I.D. to the cashier and scream that you did not have weight loss surgery when you claim you will scream it from the rooftop? Be proud by saying I did it on my own and don't see it as an inconvenience or nuisance, educate people!

Tiffany said...

Obviously you have never met a crooked doctor in your life. Start doing some internet searches. You will find a ton of people that have had surgery and only needed to lose roughly 75 pounds. It is your BMI that gets you approved but if it isn't high enough doctors will fudge things if they have to. AND insurance companies will pay for skin removal if you have had WLS and the skin is a "problem" again another little loophole that can be gotten around. It all depends on the insurance plan. Some pay with no medical reason needed just a high enough BMI. When I was looking into surgery you have no idea how many times I heard the phrase "there are ways around that" And I don't like to show my ID because I am sick of having the WLS questioin asked and then when I tell them no they debate with me about how it is not possible to lose weight without it. Like it is unheard of to do it on your own anymore.
It would be nice if it was all legit like you say but it is not..I know for a fact.

Sara said...

The interesting thing about the great WLS debate is just how much of it is rooted in emotional assertions, and just how much fact is ignored.

I have chosen, at this point in my life, not to have surgery. I have also chosen not to feel overly confident about that choice and it's relative worth over those who do choose surgical intervention. While the behavioral modification route is the ideal choice, the statistics for long term success are downright dismal. There is a reason that every great WL story is followed with an asterisk and the phrase "results not typical". Typically, some 95-97% of people will never be able to maintain ANY loss long term, much less get to and stay at goal weight. WLS is statistically the most successful weight loss method around at present, and I don't begrudge anyone making that choice. It's not a cure all, but when it's combined with lifelong commitment it has fantastic results...just like any other weight loss problem. It's that whole 'lifetime commitment" that trips people up.

I believe that until we stop viewing obesity as the last of the bonafide medical conditions to be viewed as mainly a character flaw we will NEVER have a hope of beating it. What if we didn't have to pick our route to getting healthier based on how "weak" we are or didn't have to hate ourselves for our "failures"? What if we could approach our choices with the knowledge that NONE of them are 'easy' and that one size rarely fits all?

I don't have all the answers, but I sure wish it was easier to talk to eachother about all the possible answers out there...

Tiffany said...

I agree that the medical community as a whole needs to open up to the idea that obesity it a medical problem but in the same respect it is more often than not a mental problem. There is usually an addiction to food involved. Same as you have not written off surgery, neither have I. I only have 50 pounds left to lose and have already lost 150 but it has been a long emotional road. If something were to happen and I gained it all back and just couldn't do it on my own I would get surgery. The point of the blog is that it is getting far too easy to get surgery. I ran into a woman at JCPenny and she had the surgery and had exactly 75 pounds to lose according to her BMI. She lost it all and gained it all back. She never worked out, she never went to any support groups. The surgery is a tool and in my opinion should be used as such instead of a quick fix. There are people that truly need it and have worked for the surgery that are not approved and then people that have only been obese since having a child and just don't want to "work at it". It just seems to me like society is getting WLS brainwashed.

Anonymous said...

A response from a fellow WLS patient:

I agree 100% that WLS is becoming a societal norm but it is not completely accepted by the population. As a previous bariatric RN, I worked side by side with patients who underwent this surgery. Initially, I thought "WOW, this is too good to be true!" but then I started noticing how many of the patients could not keep the weight off. I spoke with one of the surgeons and asked him what would be the best route for me. With 130-140 pounds to lose, he showed me research based evidence that suggested that only 5% of people who are overweight and lose enough weight to be a "normal" BMI will keep the weight off for 5 years or more. Only 5%. I was approved for WLS in 2003 and then my insurance changed the coverage for WLS. I attended my second consult in 2007 and then chickened out. Finally, I pursued the surgery in March of 2009 and had the full gastric bypass (RNY) in May 2009. Should the surgeons be held accountable for pushing patients through? Should insurance companies? What about the patients? I think all three are fairly guilty. Many insurances do NOT cover will see patients going to Mexico because there are no real exclusions...these people are self-pay. Surgeons in the US will still push people through quite quickly (and YES, you don't have to have a psychiatric evaluation if you are self-pay) because they are money hungry. For myself, BCBS required several things: A) BMI. >50: no medically supervised diet needed, no co-morbidities. >40 6 months of a supervised diet and co-morbidities. B) Psychiatric Evaluation C) Letter from doctor stating medical necessity. I have always had issues with my weight but it got much worse after a softball injury that resulted in a major back surgery. I became depressed and used food to cope. After 10 years of being morbidly obese, I became pregnant and my health worsened. I had a tough pregnancy complicated by borderline gestational diabetes and pre-eclampsia. After delivering via c-section, I had rebound hypertension and went on medications. Prior to becoming pregnant, I faithfully followed a Weight Watchers lifestyle change and worked out every single night. After having my child, I didn't want a quick fix, but I wanted a tool to help me with steady weight loss. Has it been easy? Hell no. I think it's much harder than MY previous attempts at weight loss. It's 99% psychological/behavioral and 1% following the guidelines. I have to eat 78 gms of protein daily, limit my fats and sugar and yes, I do some form of exercise every single day. I definitely don't do as much as Tiffany but I do walk, use the elliptical, or total gym on a routine basis. I maintain strict adherence to my surgeon's regimen for post-op appointments and lab work. I take my vitamins and conduct literature reviews on how to be SUCCESSFUL with my choice. Recently, I have started going to counseling for two main reasons: A) Learning how to deal with my new body and the attention (something I've never been comfortable with) and B) Understanding that I had an addiction to food and eating is not a method of coping. I eat to live, not live to eat. I went through a very rough time for 2-3 weeks after surgery. I asked, "What in the hell did I do to myself?" Nobody can prepare you for the emotional rollercoaster you are about to be on. I am now 17 weeks post op and have lost 73 pounds. I have busted my butt to lose every single one of those 73 pounds and now I can confidently say that I am happy I had surgery because it was right for ME. Is it right for everyone? Nope, and until obesity is treated like a multifaceted disease that needs treatment from all ends of the spectrum (behavioral, diet modification, exercise, etc), people are still going to think surgery is the quick fix and route to go.

Sara said...

Tiffany--I totally agree with you that obesity is more often a mental problem than a physical one. I also think that mental problem = medical problem.

Anorexia is a mental problem,so is schizophrenia, and alcholism, and heroin addiction etc....and there continues to be intense research into those conditions and equally intense treatment options available that combine behavioral therapy and medical intervention. I want the same kind of status for obesity, more "let's get to the bottom of this with every option available" and less "buck up and get on the treadmill, fat ass". Does that make sense?

I too know a person or two that I cannot believe jumped so quickly (or were allowed to!) into WLS. One of them lost 88 pounds to get to goal, and has slowly been gaining it all back. I think she thought that there'd be a time when the work was over and she'd be normal. Everything I know and have learned tells me the hard work is NEVER over. Bummer.

Tiffany said...

Well said ladies and Sarah what you said makes perfect sense. Someday hopefully it will get more attention but until then I guess I will buck up and get my fat ass on the treadmill...LOL.
Aimee, you know I love you and fully supported your choice and this was in no way directed at you because there was not one tiny part of your choice that has been the quick fix.

Anonymous said...

Tiffany, I know it wasn't directed towards me. One thing that makes obesity harder to deal with is the addiction to food. People need to eat to it's the fine art of balancing how much they should be eating with other aspects such as exercise. With smoking and alcoholism, you cut that stuff out completely...for fat people, you can't remove food completely and THAT is the challenge!

Deanna said...

I agree that WLS is not something that should be handed out so easily. I've known three people who have done it. One started at 350 and dropped to about 160; three years later she was well over 250 again. The other two, a husband and wife, had it when they were both about 100 lbs. overweight. The husband looked fantastic for a while, but he gained it all back in less than 2 years. The wife has gained a good 40 or 50 back and tends to eat mostly potato chips and snack cakes at work, so I clearly she is struggling.

In all three cases, they people were told they had to go on a diet for 6 months. If they didn't lose much, they'd get the surgery. The diets they were given were just printed on a sheet of paper, and there was no supervision. After 6 months, they signed a statement saying they had followed the diet--although I know for certain two of them didn't since I ate with them regularly. So much for the medical establishment doing it's part to encourage them to take the healthiest route.

On another note, my doctor told me that she didn't think surgery was the best option when I approached her about it. She's a bit overweight herself, and she had looked into for personal reasons. However, she felt the risks involved were too high for a woman with young children. I am the sole breadwinner for my family--my husband takes care of the home--so it would have a devasting impact if I were to die in surgery. And that is a risk that I can't take now. So I'm going the natural route. It's slow going. In four months I've lost 45 pounds. With surgery, it could be so much more than that. But what I've found is that my relationship with food has changed in a way that surgery could not do for me, and that is what I must do in order to succeed.

I think more doctors need to take the time to discuss the risks, but unfortunately the clinics push them to rush through their patients so we're lucky if we get much attention for our questions. Maybe someday we'll get this all to change and obesity can be treated as the medical condition it is.

Anonymous said...

Okay, one more comment. Yes, many factors of obesity can be related to mental issues. What's the problem with this? The lack of mental health parity laws in the U.S. Many mental health conditions are not treated like normal medical conditions (hypertension, diabetes, gastric reflux) and this creates large out-of-pocket expenses for patients. Many people cannot afford psychiatric visits 2x a month (my insurance made me pay $150 per visit after the initial consult cost of $275) and not very many psych meds (for me, anti-depressants) were covered...which left me with huge bills. This issue also needs to be addressed because it affects many other conditions besides obesity...some people cannot be labeled "non-compliant" because the circumstances are not always black or white.

Jessie said...

A patient where I work at a plastic surgeons office located in Grand Rapids told me about this blog. I am here to set the record straight and tell you all that it is absolutely untrue true that insurance will pay for skin removal surgery after WLS. WLS is not always covered by insurance and for certain skin removal is never ever covered by insurance.

Tiffany said...

Ignorance must be bliss.
Do your research.
According to the American Society of Plastic Surgeons, approximately 6.6 million Americans had plastic surgery in 2002. That comes out to a lot of money in doctor fees, so who is paying for plastic surgery costs? Well, that depends.

Who pays for plastic surgery costs depends entirely on your insurance company. Although insurance policies can be very different on what is considered a covered procedure, there are some guidelines most insurance companies adhere to when it comes to definitions of what is considered reconstructive and what is considered cosmetic. Most insurance companies follow the definitions given by the AMA (American Medical Association) and the ASPS (American Society of Plastic Surgeons) which state:

•Reconstructive surgery refers to surgery performed on abnormal structures caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease. This can include surgery to improve function or to give a normal appearance.
•Cosmetic surgery is the reshaping of normal structures on the body to improve the self-esteem or appearance of a patient.
Insurance companies are the interpreters of the above definitions. Take for example the procedure of circumcision on infant boys. In the past all insurance companies paid for this procedure, but it is now becoming more common that insurance companies will not pay for the procedure because is considered cosmetic. What is considered cosmetic is entirely up to what insurance company holds your policy.

Accordingly, this could mean that the nose job you have been seeking or the droopy eyelid you have been wanting to get rid of could now be covered. Here is more about plastic surgery costs and a list of common procedures that may now be covered by your insurance.

And this is directly from a plastic surgeons website :
"This is a very difficult facet of skin reduction surgery. Dr. Shah feels that this is not cosmetic surgery, but rather reconstructive surgery that you absolutely need to prevent rashes and to help you look more “normal.” The insurance companies do not always understand your situation. One of our nurses will take pictures of the various parts of you body and submit a letter and your pictures to the insurance company. They will then look at all of the information and make a decision as to whether they will pay for the surgery. Unfortunately, the trend is for insurance companies to pay less and less for this type of surgery."
Why don't you post the office you work for? Or maybe you don't work for an office at all but maybe for an insurance company..hmmm?

Anonymous said...

Tiffany - what a great discussion you have going here! Rock on, woman!

Anonymous said...

Not all insurances will pay for plastic surgery but yes, BCBS PPO of Michigan will (my insurance). Would you like to confirm this, Jessie? I know that the plastic surgeons through Barix Clinics (where I had my RNY done) do the surgery and many of their patients do NOT pay out of pocket. It must be documented that you have rashes/interferes with activities of daily living and you must have lost 100 pounds and have kept it off for 6 months. Most bariatric surgeons will work with you and help you provide the necessary documentation to have plastic surgery done. I know this because I'm a nurse (I've been the patient and I've been the advocate).

I do think it's unfair that insurances will pay for this procedure (a simple tummy tuck, not a lower body lift and not a breast lift or augmentation) only for those who have WLS. What about ALL people who lose weight, regardless of the method chosen?

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