Fady Moustarah, MD

I'm pleased to hear you're "healthy" or aren't suffering with health problems at the moment. With your weight and height, you have a body mass index (BMI) of 45.6. Anytime someone has a BMI over 40, one qualifies for weight loss surgery even without having other health problems. Without doing anything about your weight, you run the risk of a shortened lifespan and developing and living with health problems in the future affecting your heart, breathing, blood pressure, kidneys, diabetes, joint pain, cancer, etc., to name a few areas. If for some reason, your insurance plan doesn't qualify you for surgery and you'd like surgery to be an important early step to help you quickly and effectively get back on track with your weight management, look into changing your insurance plan or look for self-pay programs that will work with you on reaching your health and weight loss goals. Whatever you do, don't ignore addressing your weight, starting now. It's clear you're not and you're thinking about it now, while you're a young adult and losing extra weight can have long term benefits. Congratulations to you! Keep going.

While the reasons for your denials are not clear from your questions, they may be many... some reasonable and some, sometimes, unreasonable. This is where an appeal will help clarify things. You sound committed, so keep at it up. And, you're right, you shouldn't want or have to keep struggling with your weight if its affecting your health and quality of life. You do have other options if your insurance won't approve: You can consider another insurance plan or the self-pay route offered by select practices, with assistance in financing available. Now, Based on your BMI and having comorbidities, as you say, surgery most likely remains the best option for you; and with your surgeon you can discuss which operation would be most suited for you to achieve results, especially as you also stick to that good and committed effort you'll make with lifestyle changes, including diet and exercise. Surgery will help you get ahead early with your weight loss success, and unless you have a clear reason for it not to work, which can be evaluated with your surgeon beforehand, you should see results too. No one can guarantee how much your weight loss will be though. Everyone is different. Again, there are different operations too, with some more powerful and needing different after surgery care than others. Best wishes with your appeal!

Bowel movements usually change after weight loss surgery. After a gastric bypass one can expect more frequent bowel movements. The intestines do adapt over time, but 20 years out, you should not be having "chronic diarrhea." Chronic diarrhea is defined as loose stools that last for at least four weeks. This usually means three or more loose stools per day. Other causes or contributing factors should be considered to help diagnose the reason for your diarrhea if it meets clinical criteria for being worrisome. This symptom should not be ignored as it could make it difficult for you to maintain good nutritional health in the context of your bypass surgery, which alone requires long term follow-up, proper nutrition, and vitamin supplementation. If you have not seen your physician to review your health from a gastric bypass perspective in over 1 year, now is a good time to call your doctor's office or see a bariatric surgeon or physician for an evaluation.

Weight loss surgery can still be very helpful for you, especially since you are still young. At 257lbs, your health and longevity are at risk over time. Keep in mind that surgery is only part of a good management plan for some one like you, and it's not all about what you're eating or how much that is reduced, although that is important too. A good management plan starts with a good evaluation by experts or specialized surgeons that can help identify the causes of your obese condition. Your personal history will be explored for genetic traits among many other things. There are management options to use before and after surgery, if surgery is chosen. At your weight, surgery should be considered seriously since it is expected to help you lose a significant amount of weight and keep it off for a longer time compared to anything else you might try alone. I can tell you've tried hard to address your weight and probably spent much time with diets and exercise only to be frustrated with the results. You're looking for something more to help. Surgery can do that if your surgeon finds you a candidate and you wish to proceed. Besides, there are different operations to consider in your situation, including the sleeve gastrectomy, gastric bypass, and doudenal switch procedure. The sleeve gastrectomy procedure you asked about may still be a very good option since it works by many mechanism, some hormonal and others mechanical, and doesn't just rely on you changing your habits to eat less. All the best to you.

It really depends on a number of factors pertaining to you: Weight alone is one consideration, but it is taken along with your height and how much of your weight is related to healthy lean body mass (or muscle mass) and how much is related to adipose tissue mass (or fat mass). Body mass index or BMI is a number used to guide decisions on who is likely a candidate for weight loss surgery. Once your BMI is greater than 30, then you should consider weight loss, especially if your weight is impairing your health or quality of life. BMI is calculated by dividing your weight in kilograms by the square of your height in meters. There are many calculators online where you can simply put in your height and weight, in metric units (kilograms and meters) or imperial units (pounds and feet), and get your BMI. With you being at 163 lbs, you'd have to be shorter than about 5 feet 1 inches to be considered obese and start thinking about weight loss options. With a BMI less than 30 kg/m2, surgery might be considered in special circumstances, and this should be discussed with your surgeon on an individual basis. Usually surgery is more readily offered for people with a BMI over 35. Your general health is also taken into consideration when deciding if surgery is right or helpful for you. People who struggle with diabetes, sleep apnea, high blood pressure, cholesterol, joint pain, special kinds of headaches, and many other conditions along with their obesity often find weight loss surgery effective in improving both their health and quality of life. Talk to your primary care physician and a surgeon if you're uncertain.