Expert: John Pilcher, MD - 9/13/2008

Question
I have been more then 100 lbs overweight for 17 years. Sometimes I lose a little, but I have never been able to maintain the loss. I think I would be able to maintain it if I could ever get down to my goal...just getting there would make me feel so good I think I would be able to keep it off. I am 5'10" and weigh 285 presently. I am 46 years old. I don't have any medical problems other than hypothyroid and GERD. I have been told that I am prediabetic though.

I have been considering Lap Band surgery. I have signed up for a seminar on October 7. But I really feel like I owe myself one last shot at doing it without surgery, but I am afraid that if I try to diet and lose some of this weight, I will lower my BMI enough that I will no longer qualify. Then I will be in the position of needing it but not being able to get it.

Generally speaking, what is the lowest BMI that doctors usually do the surgery for? Because if I manage to lose 50 lbs but can't seem to lose the rest (85), I really want the option to do the surgery. Thanks for your help.

Answer
Kathleen,
You are asking a sensible question, and one thing I want to reinforce is that a person must have a strong sense of conviction about the need for surgery before they go into it.  As long as you have the feeling you ought to try some dieting further or something else, then you should do that before you actually go into surgery.

Partially successful weight loss does not need to interfere with potential surgery - I think you'll understand as you read below.  I recommend the following:

1) Attend the seminar, and learn about surgery.  Information is almost always helpful.

2) Learn about whether your insurance plan requires a timed and monitored diet.  It is very common that insurance requires at least 6 months of dieting, and the monitoring requirements are very strict.  If your insurance does require such a diet, the surgical team can usually help you do that in a way that it meets insurance requirements.

3) Do the diet as best you can, and lose as much weight as you can.  You will be giving yourself a final really good try at losing weight without surgery.  If you find that surgery is not needed then that's great.  If you do need surgery in the end, then the more weight you lose, the better it is for surgical preparation.  Because your starting weight was correctly documented at the beginning, you should have no trouble "qualifying" for surgery even after weight loss.

Best of luck to you!
Dr JP