ASMBS: Open Letter to Insurance Companies, Regarding Mandatory Pre-bariatric Surgery Diet Regimens

@swimbikerun: Ad hominem - attacking the person rather than the ideas. I see no ad hominem or personal attacks above, only criticism of your ideas and point of view.

Your posts suggest that you are struggling with your health and/or weight with your VSG. I'm sure it feels more empowering to believe that you are in control of your destiny, if ONLY you could again exercise the "willpower" you had meeting your pre-op requirements. Your short-term success in that venture seems to have given you the idea that you could control your weight by exerting that willpower - which makes me wonder, if you were so successful during that pre-op diet, why did you go ahead with the VSG, which is restriction-only? Are you struggling with your weight now, and trying to talk yourself out of the need to revise to a DS? Are you projecting your problems onto non-compliant DSers?

By the way, do you think that lung cancer patients who smoke should be required to prove that they have quit smoking for an extended period of time before they get surgery or medication? Do you think that diabetics should be forced to wait to get treatment until they can prove they can make the optimal dietary changes over an extended period of time? How about people with cardiac artery blockages? Under your theory, shouldn't they be required to prove their ability to exercise "willpower" to prevent recurrence of their diseases?

You have been told here by people who are reasonably reliable reporters that their success was not a matter of willpower, which they had a-plenty prior to surgery, but rather was due to their metabolisms CHANGING, and the vast improvement in their painful lack of satiety driving them to eat. Maybe you should read about the experience of people with Prader-Willi syndrome, which is likely an extreme version of what many of us experience pre-op, and consider how "willpower" could possibly overcome this primal, primitive drive to eat, regardless of true "hunger."

I have an Ivy League undergraduate degree in biology, a PhD in biological chemistry and molecular biology, and a law degree (and did law school at night while working full time in a law firm, much of the time as a single parent of two small children). I have a reasonably well-regulated and balanced personality in terms of OCD or other behavioral issues. My mother was morbidly obese, and worked pretty hard to try to avoid her children developing morbid obesity - yet my sister and I both became MO, my sister having a weight problem essentially from infancy (I yoyoed between obese to severely obese from age 16 to 45, when my weight finally got away from me entirely for the minimum 5 years to qualify for bariatric surgery).

I successfully lost 60-80 lbs a few times as a young to middle-aged adult (last time in my early 40s), which took me in each case well over six months of essentially starving myself on 500-700 cal/day, including taking HCG shots, mazindol and Phen-Fen. The minute I stopped starving myself, the weight came right back. My body CLEARLY did not process food the way naturally slim people's bodies do, and my hunger was clearly unreasonable. I did NOT have a psychological eating disorder - I had inappropriate and insatiable hunger, and a damaged metabolism. Yet I never developed a binge eating disorder, despite never feeling satiated - because I had "willpower." But I could NOT live on 500-700 cal/day indefinitely - it is simply impossible UNLESS you have an anorexia-type eating disorder.

I don't know why you are victim-blaming the unfortunate people who are getting the DS without adequate or even remotely appropriate education - some of them clearly are hoping for a magical cure (how many of us have not wished to lose weight when blowing out their birthday candles?), but most simply have been misled, which I put squarely at the feet of their surgeons. However, it doesn't take 6 months of being subjected to pointless pre-op diet and exercise (for which there is NO evidence based medical justification) to "learn to have willpower" - it requires a few hours of education, perhaps being subjected to a test of knowledge, and appropriate follow-up care - which can be very difficult for the majority of people who have to travel to get the DS.

Yes, people have to take personal responsibility for their post-op needs - but that is not the same as having or exercising "willpower." That is just nonsense.
 
DS changed me physiologically. I am not sure in how many ways, but I know I am not feeding the "hunger monster" who lived with me since childhood. I am not failing at maintaining weight loss for the first time in my life. I have a healthy relationship with food. I can savor it, enjoy it, splurge occasionally, eat what I want and what I need. I haven't spent $1 in the past 12 years on a book, program, potion, or drug that was supposed to help me lose or maintain weight loss. And I have the same willpower I had as a fat person.

Love this! Thanks for articulating how I feel.
 
@swimbikerun: Ad hominem - attacking the person rather than the ideas. I see no ad hominem or personal attacks above, only criticism of your ideas and point of view.

Your posts suggest that you are struggling with your health and/or weight with your VSG. I'm sure it feels more empowering to believe that you are in control of your destiny, if ONLY you could again exercise the "willpower" you had meeting your pre-op requirements. Your short-term success in that venture seems to have given you the idea that you could control your weight by exerting that willpower - which makes me wonder, if you were so successful during that pre-op diet, why did you go ahead with the VSG, which is restriction-only? Are you struggling with your weight now, and trying to talk yourself out of the need to revise to a DS? Are you projecting your problems onto non-compliant DSers?

By the way, do you think that lung cancer patients who smoke should be required to prove that they have quit smoking for an extended period of time before they get surgery or medication? Do you think that diabetics should be forced to wait to get treatment until they can prove they can make the optimal dietary changes over an extended period of time? How about people with cardiac artery blockages? Under your theory, shouldn't they be required to prove their ability to exercise "willpower" to prevent recurrence of their diseases?

You have been told here by people who are reasonably reliable reporters that their success was not a matter of willpower, which they had a-plenty prior to surgery, but rather was due to their metabolisms CHANGING, and the vast improvement in their painful lack of satiety driving them to eat. Maybe you should read about the experience of people with Prader-Willi syndrome, which is likely an extreme version of what many of us experience pre-op, and consider how "willpower" could possibly overcome this primal, primitive drive to eat, regardless of true "hunger."

I have an Ivy League undergraduate degree in biology, a PhD in biological chemistry and molecular biology, and a law degree (and did law school at night while working full time in a law firm, much of the time as a single parent of two small children). I have a reasonably well-regulated and balanced personality in terms of OCD or other behavioral issues. My mother was morbidly obese, and worked pretty hard to try to avoid her children developing morbid obesity - yet my sister and I both became MO, my sister having a weight problem essentially from infancy (I yoyoed between obese to severely obese from age 16 to 45, when my weight finally got away from me entirely for the minimum 5 years to qualify for bariatric surgery).

I successfully lost 60-80 lbs a few times as a young to middle-aged adult (last time in my early 40s), which took me in each case well over six months of essentially starving myself on 500-700 cal/day, including taking HCG shots, mazindol and Phen-Fen. The minute I stopped starving myself, the weight came right back. My body CLEARLY did not process food the way naturally slim people's bodies do, and my hunger was clearly unreasonable. I did NOT have a psychological eating disorder - I had inappropriate and insatiable hunger, and a damaged metabolism. Yet I never developed a binge eating disorder, despite never feeling satiated - because I had "willpower." But I could NOT live on 500-700 cal/day indefinitely - it is simply impossible UNLESS you have an anorexia-type eating disorder.

I don't know why you are victim-blaming the unfortunate people who are getting the DS without adequate or even remotely appropriate education - some of them clearly are hoping for a magical cure (how many of us have not wished to lose weight when blowing out their birthday candles?), but most simply have been misled, which I put squarely at the feet of their surgeons. However, it doesn't take 6 months of being subjected to pointless pre-op diet and exercise (for which there is NO evidence based medical justification) to "learn to have willpower" - it requires a few hours of education, perhaps being subjected to a test of knowledge, and appropriate follow-up care - which can be very difficult for the majority of people who have to travel to get the DS.

Yes, people have to take personal responsibility for their post-op needs - but that is not the same as having or exercising "willpower." That is just nonsense.
Diana, you have such a spot on way of stating this! Thank you so much.
 
Oh, and I left one thing out - I talked to Dr. Rabkin about this a long time ago. I asked him whether it was better to learn how to eat like a DSer first, before surgery, especially if the person had a diagnosed eating disorder. His response was that therapy for a so-called eating disorder, much less learning to eat like a DSer, is FAR easier when the patient has the DS and is NOT driven by inappropriate hunger.

A little pre-op education, and significant concurrent and ongoing post-op counseling, is probably a FAR better recipe for success.
 
Oh, and I left one thing out - I talked to Dr. Rabkin about this a long time ago. I asked him whether it was better to learn how to eat like a DSer first, before surgery, especially if the person had a diagnosed eating disorder. His response was that therapy for a so-called eating disorder, much less learning to eat like a DSer, is FAR easier when the patient has the DS and is NOT driven by inappropriate hunger.

A little pre-op education, and significant concurrent and ongoing post-op counseling, is probably a FAR better recipe for success.
While I agree, dh and I had already spent over a decade learning to eat like a DSer, long before we even knew what it was as it's also the BEST way for a diabetic on insulin to eat to control blood sugars.
 

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