The road to being approved by your insurance company (and your surgeon) for weight loss surgery has a lot of components. For my husband and I, first, we had to lose 10% of our body weight over the course of 6 months prior to surgery, documented monthly in your primary care physician's office. At the time I remember thinking, "Dude, if I could lose weight on my own, I wouldn't need the surgery!" But we went on a crazy low calorie diet (like 500 calories a day crazy low) and made it happen.
In addition, we had to undergo a psychological exam and get a letter of approval from the psychologist basically stating that we weren't nuts. I guess we both fooled him. lol It was an odd process. We had to take a quiz and then spend an hour in discussion about the weight loss journey, familial support, etc. The quiz was a really weird assortment of true/false questions. I asked the psychologist about it, and they essentially use it to weed out people who lie (by making things seem overly good, or overly bad).
We also had to see a nutritionist/dietitian. It was a little over an hour of this woman telling us what a normal and balanced diet looks like. We each paid nearly $200 for her to tell us how we should have been eating all along to not be obese in the first place. What she did *not* tell us was what we needed to eat after surgery. I mean, I guess it's fine and dandy to have the information, but literally in a few weeks time, it would be meaningless. What is the point in telling me that I need 46 grams of protein per day, if my surgeon is going to immediately rebuke that as being too much?
Which is exactly what he did. He asked if I thought I was prepared for eating post-op and I said I was confused because the amount of food the nutritionist told us we needed to eat seemed like too much. Then he yelled at me for not realizing I needed to follow his post-op diet in the workbook he gave me. The post-op diet is very specific for the first couple of months after surgery (pretty much so you won't blow your stitches, explode your stomach, and die). However, there wasn't a whole lot of guidance for what to do with the rest of my life after the surgical recovery was over. And the nutritionist I had just seen made that more convoluted for me rather than less so.
So, my husband and I have muddled through for the last 4+ years. For the most part, the restriction in the quantity of food we can eat has continued to keep our weights in check. But it never was really because we had moved on to a phase of our lives where we were necessarily eating the "right" things. The year I spent at home binging on chips and gaining weight was a testament to that. Because although we cannot consume a large quantity of food at one time, snacking every hour is absolutely possible particularly with "slider foods" like chips that process quickly and (in general) don't fill you up (like protein would).
So, here I am 4.5 years after having gastric sleeve, back to maintaining the 100-pound weight loss, still not really sure what I should be eating. Add in the layer that in the last year or so I have been diagnosed with binge eating disorder, and this gets pretty messy. Working with my therapist is helping me with getting to the core issues of why I am binging in the first place, but it doesn't really address the dietary piece of the puzzle, which is why she recommended that I see a dietitian to get me on a better eating plan.
I have been maintaining a keto lifestyle for most of this year and thought I had finally found an eating plan I could stick with. I am definitely addicted to carbs and they are 100% my favorite binge foods if I had to choose. So, mostly eliminating sugar and carbs from my diet helps me two-fold. Not only did I lose the weight I gained in 2017 and have been maintaining that, but I also don't really even have any of my favorite sugary binge foods on hand when I get overwhelmed. Of course, I was still binging on other things, just things within the keto-friendly world.
You can imagine my disappointment when I visited my endocrinologist earlier this week and learned that 8 months of keto increased my cholesterol by 36 from just below the high limit of within range, to the high cholesterol range. My doctor asked me if I had been doing the keto diet (she knew!). She prescribed me a statin drug to take and advised me to change my diet. So, I asked if I should continue doing low carb since it has been a good thing for my progress with my eating disorder, maintaining the weight loss, and keeping my hyperinsulinemia in check. "Yes, you should continue doing low carb, and do low fat as well." Really the only staying power with the fact that I gave up sugar and carbs was that I could still have cheese and bacon.
I decided that I should probably consult a dietitian after all, because information about food and what you should be eating is really confusing (all things considered). I looked in the online directory for my insurance company to see if there were any covered providers and there was a list of 18 (2 of which were not even in Tennessee - West Memphis and Southaven). The first group of 6 or so were all at the office of the same dietitian I had seen prior to my weight loss surgery. "Great!" I thought. I figured they would be the most qualified since they had already seen me and they consult with bariatric patients regularly.
Apparently not. They told me they couldn't treat someone with binge eating disorder and gave me the number to the local in-patient facility for eating disorders. WTF. I don't need to be hospitalized, or my therapist would have recommended that. And so I proceeded calling down the list of providers, only to find that they either worked within a hospital and only treated patients of the hospital, or they worked in an endocrinologist's office and only treated patients of the doctor at that office, or they worked in a diabetes treatment program and only treated patients who were in the (year-long) program. There was one (1!) dietitian covered by my insurance who was even willing to make an appointment with me.
I will concede that there are a lot of dietitians in Memphis that are not covered by my insurance plan. The group that was recommended by my therapist does not even bill to insurance, you can just try to be reimbursed after the fact. It is $185 for the initial visit (1 hour and 15 minutes), $95 for each follow up visit (45 minutes). Alternatively, you can sign up for a basic coaching package including 4 visits for $425, or a solid nutrition coaching package including 7 visits for $650.
And the powers that be wonder why this country has a problem with obesity.
Seeing a dietitian isn't even covered by a lot of insurance companies. And the ones that are all seem to be affiliated with diabetes treatment in some way. Here's a novel idea... perhaps if we had access to see a dietitian for coaching BEFORE we are diagnosed with diabetes, it may actually save everyone a lot of time and money in the long run (and lives). I managed to get my appointment set up. But I know that there are a lot of people who would not have access to this via insurance in the first place, and definitely wouldn't be able to afford to pay for something like that out of pocket.
But, Mary, you can find all of this information online or in a book anyhow. It isn't like you have to see a professional to tell you how to eat!
Sure. Right. I spent the better portion of this week researching what I needed to be eating that is both low carb and low fat. You know what I found? That "food experts" argue over whether you should eat fat or not, and which fats are bad vs. good. Some say to avoid all fats. Some say just healthy fats (then define that however they see fit). Some say avoid saturated fats only, or trans fats only, etc. That's just fats. Let's not even try to talk about whether the cholesterol in an egg is good or bad or if it matters at all. The only conclusion I arrived at was going vegan and eating uncooked organic fruits and veggies for the rest of my life - but not any that are high in carbs! Doing something like that is absolutely not sustainable for me.
I apologize that this turned into kind of a rant. I'm mad because I can't do keto (when doing it seemed like the only thing that has ever really worked for me). I'm frustrated with everything I have gone through this week to get the appointment with the dietitian. I'm pissed off that I am probably going to have to eliminate cheese and bacon.
Honestly, I'm mostly upset about the cheese.
TL/DR: The healthcare system sucks. Not eating sugar sucks. Not eating cheese sucks the most.
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