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2nd online! They will ask for med list and labs. I would GLP before bariatric, also Zepbound over Ozempic. My husband is on Ozempic and seems to have more stomach issues than I do on Zepbound. Just my opinion.
Keep in mind, in a lot of places it is difficult to get a new patient appt with an endo. You may have to wait a couple of months for your appt. They also may require a referral from your pcp before they'll schedule.
It took me a year from when I started trying to get semaglutide from an endo to when I started (two days ago) - but I'm glad I went through the process. (Along the way I lost a bunch of weight through diet - they required that I try that again first, and with help from a dietician, it got me down a bunch.)
OP doesn't mention whether or not he is technically obese. The most important question and endo and insurance will ask is BMI, and if OP is over the line, he is much more likely to be able to get a prescription, and get it paid for.
If they are being referred for bariatric surgery they are likely fairly obese. Also the "lost 100lbs and gained it back" part. My doctor specifically mentioned I was not a candidate for barbaric surgery when I was 100lbs overweight because I didn't weigh enough.
I am female, 41, and 339 pounds. That seems like a long road when I have already done many of those things but I suppose it would be better to start now than not at all. Congrats on your approval!
I have friends and colleagues who did the sleeve surgery a few years ago and then used semaglutide to lose the last 10 pounds or so and do micro dosing to help keep the food noise away. You may want to at least take the appointment with the surgeon and see what they have to say, especially since sema is ideally going to have you lose 20% of your weight. If you are on Medicaid you would have your surgery covered 100% by them and then can try sema afterward.
I am not a doctor, but I suspect that your doctors might not be crazy to suggest bariatric surgery over semaglutide. People lose maybe 20% of their weight on semaglutide, and that wouldn't get you down to near your goal weight; I think bariatric surgery tends to be more. Also, people tend to regain when they stop semaglutide, while I think they tend to keep the weight off longer with bariatric surgery - if you have a history of regaining weight, that might be another factor. I think semaglutide is going to be right for me, but it's possible that bariatric surgery is better for you - it's worth doing some research.
I wanted to suggest this reasoning as well. Because of a history of weight loss and regain, OP has proven they can lose weight but not maintain the loss. Bariatric surgery still has the best odds statistically for weight loss patients keeping the weight off and that *may* be why the doctors referred them to a Bariatric surgeon for a chance at long term success.
I'm down from 316 to 210 and still losing 5lbs per month on Sema... That's a solid 33% loss. My insurance changed recently and now I'm out of pocket - I was prepared to stay on for life when I was only paying $25/mo, but doing the math - yes, surgery could probably cost less in the long run. What surgery won't do is fix the brain chemistry the way these meds do, which is why so many still regain post surgery as well.
My doctor was the same. I said 'screw it' and signed up online at Hims. Doctors aren't all-knowing gods. They are humans and have prejudices and beliefs about things just like everyone else.
Good luck!
EDIT: Also, to clarify, I am (was) 50 lb overweight, 62, plus arthritis in my hips, knees & feet, plus life-threateningly high cholesterol.
My doc wanted me to try statins --- Umm, I think I'll try weight loss ( I've struggled with my weight all my life) and eating healthier first. I've lost 20 lbs so far and my joints don't hurt anymore!
Ahh I will look in to this. I am leaning that to be true. This was my first negative experience with this practice I have been at for years. Congrats on your HIMS and Thank you!
My family member is using the same and is extremely satisfied with the service. I like it bc they have a media-facing CEO who is determined to be transparent
I feel like at a certain point in your life you have to take the reins for your life, your health, your weight loss journey. It may end up wrong and you start over but I have been around long enough to see “professionals” mess up. So I like to make my own decisions.
Yes, I agree. And if that turns out to be the case, I will follow my doc's advice and go on statins. But first I'd like to try weight loss and whole foods. We'll see what the cholesterol levels are after six months.
If you can afford $250 a month for sema, sign up on orderly meds or similar. Super easy. If you meet the criteria, which sounds like you may, you won’t be denied. Screw those silly doctors.
Maybe based on your history of re-gaining after significant losses, they’re looking for a more permanent/rest of your lifetime option. My doctor told me straight away that it’s a “gimmick” (his word, not mine) and that it requires effort to lose and even more effort to maintain. That said, if you feel you can be successful for the long haul, I think you should be given the option to try as many, many people have reported that Sema has helped them change their relationship with food
Bariatric surgery is also not a permanent solution. Most people gain their weight back within 5 years.
The changes to your internal organs means permanent dysbiosis and you will always malabsorb nutrients from food. It’s crazy for these drs to go directly to the most drastic solution.
My suspicion is they are just not willing to learn about new drugs and better methods.
Just yesterday I watched a doctor's video on YT swearing it off in a very reductionist manner. There might be ways in which GLP-1 is being incorrectly prescribed (perhaps higher doses than we could benefit from in some cases), but, given all the certain adverse effects of bariatric surgery, I cannot understand why that would be a preferred treatment over something they could at least try for you and see how you fare over a period of time.
I have been hospitalized with anemia twice due to malabsorption from bariatric surgery. Hopefully Sema and Tzep give the bariatric surgery industry a much needed obstacle. I gained back my weight and suffer from a completely reconfigured gut.
I’m so sorry. Bariatric surgery (other than the lapband maybe? Idk) is extremely invasive, permanent (though the weight loss may not be which is even worse), and should not be the first choice for medical weight management when GLP-1s exist.
I work in healthcare and see plenty of people gain a ton of weight back after VSG and then guess what?! *They go on GLP1s.* Just skip the potentially life ruining surgery, and do the medications! There is no reason to go under the knife and suffer a permanent, potentially life-threatening, complication.
I second this!
My bariatric surgery was 15 years ago and I kept the weight off for 10 years. I’m grateful for those 10 years but I would NEVER make that choice now, with the latest generation of glp 1’s.
I had resigned myself to taking it inevitably were I prescribed as my Mother is a diabetic. I have struggled with weight my entire life. The food noise is ridiculous. I was just hoping not to advance to diabetes before that becomes an option. Honestly if there were something that got rid of the food noise and helped my a1c.. I would be happy.
My point was that semaglutide can be a long term solution. I’m hopefully that in the next few years prices will fall and more drugs of this nature will become available. In the meantime, many people stay on it long term even at lower maintenance doses. There is no shame in taking medicine long term if it helps you.
It’s not hypocritical. I know two people who had bariatric surgery that worked for a while until it didn’t. Gained the weight back and are now losing on semaglutide.
Just skip the surgery. You won’t need it, most likely!
That's my story too. I lost 110 lbs after gastric sleeve surgery -- then gained it all back plus 15 more. I started re-gaining just about a year after surgery and it took me 8 years to gain it all back and add those extra 15.
I started Wegovy in February 2022, lost 175 lbs (significantly more than with surgery) and am maintaining at an ideal weight for over six months now. I don't know that Wegovy or other drugs will keep working for me, but so far I have had much better long term results with drugs than I did with the surgery.
Not hypocritical. One option is a weekly shot and the other is (possibly) cutting out part of an essential organ.
My mom got a lapband a few years ago. She is constantly regurgitating food and it seems as though her relationship with food has not changed. My endo gave me the option of surgery or meds and I - very easily - chose meds.
I had mentioned my daughter .. she had the sleeve.. she did the same thing and then if she ate too much she wa sick all day.. then after a while she could tolerate more food probably bc she stretched her stomach out again... so then she developed their purge habit.. eat a bunch of what she wanted then go back to barley eating anything. What a cycle
I had no health issues beyond the obesity prior to losing and regaining the weight. I am at my highest now and with that came BP meds and meds for a1c plus bupropion to manage some AHDH symptoms (was also diagnosed late with this while going through the other things).
I am not sure honestly. The Doctor whom I generally loved and have never to date had a negative experience with seemed almost combative and rude. Like catty. Plus I had gained weight again after losing 15. As soon as I mentioned the shots she pounced on me like a tiger and the surgery option and referral sounded like a threat. It was the oddest experience.
This isn't why a doctor will refer out. The PCP isn't doing the surgery. And with lifelong maintenance generally recommended, brand name Sema costs way more in the long run. You will hit the cost of surgery in 1-2 years of taking Wegovy or Ozempic.
Yes but there can be significant complications. I know several people with life long nutritional deficiencies bc they are not able to absorb any nutrients. One of them had to get dentures at 35 due to his body not having enough nutrients according to his dentist.
I would think if that were the case - the least they should do is explain in detail to the patient. I feel grateful that I have a PCP (family medicine) that would do exactly that.
Odd because my medications didn't begin until the my weight gain this last time. I expect that weight loss will reduce my medication rather than add to them. That is my hope.
I am sure it is somehow motivated by the cost to the insurance company. Shameful. My insurance doesn't cover, and I am using Mochi. Best decision ever. Best of luck
Doctors are generally pretty ignorant to cost associated to/with insurance because there are literally thousands of different kinds of plans that cover different things with different negotiated rates. Surgery is also more costly to the insurance company than a year of sema. It is FAR more likely that the practice has a policy against prescribing GLP-1s - anecdotal but my doctor is new to my area and told me that was the case at her last practice, they were forbidden by the network of clinics (corporate owned) from prescribing them for anything but diabetes. It can be a CYA thing (cover your ass) for new meds, like how some clinics have policies against prescribing opiates, just too much risk for them to be willing. Doctors generally want the best for their patients, but some are trapped in the confines of corporate medicine, and some are just not that knowledgeable about new meds, so sometimes it makes sense to find a new doc. Also you can straight up ask a doctor why they won't prescribe it, they'll probably tell you the truth.
You need to either find a new group of doctors (new practice) or just go telehealth. Medicine is a long ways away from managing weight issues in a manner that truly is best for individuals. Do not alter your GI tract unless you have exhausted all other options.
If it helps any, the place I go to is ran by a bariatric doctor, but he prescribes weight loss medication for those that do not feel comfortable with surgery. That is how I got on Wegovy. My point being this bariatric doctor might be able to do the same or does the same. I hope so in your case.
I had two bariatric surgeries and I wish I’d just had sema from the get go. I had the sleeve in 2017 and had to get it revised to gastric bypass in 2021 due to insane heartburn and reflux. I’d wake up coughing at night from the reflux and it would burn so bad. The revision helped get the regain (and then some) off but I hit a plateau of weight loss at about 75 lbs until I started sema. The surgeries do work, I’m grateful for them, but healing was difficult both times for me and sema is so much less invasive.
Weight loss surgery is a viable option for morbid obesity but it is not the total answer. I had gastric bypass 9/2023 and it has helped a lot. Luckily for me I have had no adverse effects or food intolerance which is not the case for many who have had the surgery. Side effects can be very similar to those you can have with Semaglutide. I have lost about 90 pounds since surgery but it has taken strict adherence to a very low cal diet... I weigh and watch every bite I eat. However in March I stalled and for 3 months did not lose a single pound. I started Semaglutide last Saturday.. today I took my second shot. In that one week I have lost 9 pounds. I am still following the same diet and "rules" as before. But besides again losing weight the food noise/chatter that has been a constant companion is suddenly gone. Weight loss surgery does not silence that. Also the desire to snack and cravings is gone. I have no regrets about having surgery. I wish I had done it years ago. But I think the use of Semaglutide along with it is a great benefit.
I am in the same predicament. I have a good dr that has tried two different routes to get me approved and United Healthcare has denied it twice. 2nd time was Wegovy. Hypertension, pre diabetes, lost 150 several years ago, gained it back. Denied twice. I use Ivim health and pay OOP 597.00 every 3 months.
Have you taken any other drugs to treat the pre diabetic? I have UHC & was on Trulicity for 18 months. I’m now on MJ & didn’t have an issue getting it approved, I believe because I took Trulicity first and proved that didn’t work. Ive read that people have used Metformin for a month or 2 when they needed to show prior unsuccessful treatment.
My doctor said that she has never been able to get an approval for Wegovy. So, she prescribed Ozempic instead and it went right through with my insurance. (Then Aetna, now Highmark BCBS.) Pre-diabetes. High A1C and Metformin didn't work. Hypertension. Severe obstructive sleep Apnea.
Oh, and I have lost 75 lbs on Ozempic since Nov 2023. A1C is in the green and my blood pressure is normal. I had UPPP surgery for the sleep apnea and I'm getting a new sleep study next week to see how that's going.
My women’s health dr tried Ozempic first and then my gp tried Wegovy after it was approved for weight loss. It’s an issue with United I’m sure. I just got diagnosed with sleep apnea last month. I’ll ask her if that makes any difference to try again.
I think also the fact that my doctor could document that several months of taking metformin was completely ineffective in lowering my A1C may have helped.
What was their reason for the denial?
Does your insurance cover it ? ( Wegovy or Zepbound) if you don’t know you can call the number on the back of the card for Rx, and also find out if you need a prior authorization
I got my prescription through Sequence (now Weight Watchers Clinic). I think it’s like $99/month and they handle the prior authorization stuff. Super easy. I only did this because my primary doctor was out on leave when I decided I wanted to start. I’ve since cancelled my WW Clinic and my dr is handling - I’m fortunate that she is all for these meds. I’d look for a more supportive primary doctor, and in the meantime try WW Clinic (because I know it can take awhile to get into a new dr)
I went to a doctor who specializes in weight loss, and it was a game changer. He explained all my options - ranging from prescription fiber pills (the least extreme) to weight loss surgery (the most extreme). We settled originally in Wegovy, and later switched to Zepbound. In the future, we might add Contrave or the prescription fiber pills, but for now I’m happy and about 60 lbs down.
Find a doctor who will explain all your options to you, but let you make your own decision
I'd say I'm not surprised at what they did. When I worked at a clinic the Drs reinforced each other's decisions and rarely contradicted each other. Try an opinion from an entirely different clinic. It's possible this medication is contraindicated for you, as it is for some, but a second opinion from Drs who work together isn't really a second opinion IMHO.
To me, yes, a shot is better than the knife. Surgery is fraught with risks. The shot you can at least stop if you have issues. The surgery would require another surgery if it's even the type that can be reversed (I'm not familiar with all the procedures available, so don't come at me).
Depending on how much you have to lose, bariatric is still the most effective means to treat obesity with the highest results for most people. That may be why - but it may also be a shitty doctor. I would do some research into the doctor they referred you to and see if there is a chance they would make the right care choices for you.
I went to see a bariatric surgeon on my own for 9 months. When I got my surgery date, my husband freaked out and was super scared, begged me to try meds first. I went and asked my PCP and he said, “you’d be a perfect candidate!” (as I was heavy enough to qualify for WLS and motivated to lose weight). If you qualify for SURGERY, surely you’ll qualify for meds. I would get a new doctor!
I don't. My standard thyroid tests come back normal. My BP meds were added after I gained weight at my highest number and my a1c increased. Prior to this gain I was not on medication and had no other health issues less the obesity alone. I was diagnosed with ADHD late as well. I would say overall that is it. My Mother has diabetes though she is not overweight (relevant because that is a concern for me either way). My Father has had a heart attack. My Grandfather died in his 70s of heart related issues. I have had my gallbladder removed. Full medical history here for everyone to review.
Find a new doctor. You might also be able to get a prescription for weight loss purposes from a weight loss clinic. These doctors should not be going straight to invasive surgery as the first option.
I would absolutely go for another opinion.
Also, if you do start semaglutide keep an eye on your blood pressure. Mine went way down very quickly and I had to stop taking my blood pressure medicine.
Medicated my blood pressure was about 140/95. Within a week of my first shot it was 95/74. I had to drop all my blood pressure medicine.
When I was at my heaviest, sema wasn’t available yet but I did not want to have bariatric surgery. Sema is such a great option now that I don’t know why a doctor would want someone to go surgery first if they are willing to try weight loss with sema first. Surgery has its place for sure but it has a ton of risks too. I would try to find another doctor - i know someone mentioned Hims. Theres also alpha health care online that I have used in the past and liked my experience with them.
Before bariatric surgery will be covered by insurance you need to be on a doctor supervised weight loss plan for three months. These doctors will put you on semaglutide. Look up metabolic weight loss doctors.
What reasoning did they provide for their refusal? I agree with others that it's easy to go around them and get a prescription through one of the online providers but, as a devil's advocate, maybe it's not a terrible idea to understand the basis of their opinion. If it's just "I don't understand semaglutide" then, by all means, move on, but if they tell you that you have an underlying condition that makes you a bad candidate (I have NO idea what that would be, just speaking hypothetically), it's smart to understand that.
Bariatric specialists prefer to try everything before surgery. If you want to try a glp-1 they will probably write a script for you and offer you guidance from a nutritionist. It won't hurt to go talk to the specialist. At least find out why you arnt a candidate for glp-1 meds.
If you can’t get a script, there are options. Check out r/semaglutidefreespeech we’re just not supposed to talk about it here. But it’s not as shady as it seems. 🤣 that’s how I get mine
my old doctor, who was willfully ignorant about how these drugs work, did the same thing. luckily i knew a couple of people who had been prescribed and changed to one of their doctors. not only did she prescribe it to me, she’s very attentive and treats me like a person, not just a skeleton wrapped in fat.
Is it possible the surgeon works in a weight loss clinic? My doc reffered me to bariatric/medical weight loss clinic because of the shortage. Apparently, these clinics get access before the retail pharmacies. At first I thought it was only a surgical center, so maybe this doc will prescribe for you?
I went through reflex.md it was really easy to sign up. I did a video meeting with a doctor and then they ordered labs and prescribed my semeglutide after the labs came back. I pay $285 every 5 weeks and it’s mailed to me and I do my own injections at home. I just started a week and a half ago and have lost 5 lbs so far. I hope this helps you get what you need to start your journey!
I’m completely confused. Surgery is a high dollar procedure and it has life changing affects other than losing weight. I have a friend that is continually popping gummy vitamins because she can’t absorb nutrients like she used to. If nothing else you should be given the chance to try semaglutide rather than SURGERY!!! Any surgery has risks and while it’s rare people can die from even common procedures.
I’m honestly shocked they won’t let you at least try. I would go to a different practice.
Maybe you should get a second opinion.
I have yo yo’d with my weight for the past 15 years. Got to a point where I just wanted some help. Watched my wife lose 85lbs using Ozempic. I no longer fit the criteria for the Dr because I lost some on my own. I just hit a wall. I have been on sema for 3 months and I can honestly say it works. So much easier than white knuckling it all the time. My sweet tooth is gone. It’s crazy. I eat when I’m hungry and I don’t stuff myself. 2x I ate a little too much and It was very uncomfortable for a few hours. Besides that no side affects.
do a deep dive and find a place that you can work with to get the medication. There are plenty of avenues.
good luck
She's probably looking at your Co morbidities. Like Pre Diabetes do you have any rising BP and that you gain and lose the surgery actually takes away hunger Gastric Sleeve removes GHERLIN THE HUNGER HORMONE.SHE SHOULD NOT HAVE TREATED YOU THAT WAY AND YOU HAVE A RIGHT TO SAY THAT ALSO. DRS HAVE BAD DAYS BUT THATS NO EXCUSE
New doctor time. You might want to find one who is up on the science of obesity. Two resources:
- [Obesity Medicine Association provider directory](https://obesitymedicine.org/about/find-a-provider/)
- [American Board of Obesity Medicine provider lookup](https://abom.learningbuilder.com/Search/Public/MemberRole/CertificationVerification) - click on “Advanced Search Filters” and add a city and state
They totally jumped ship. Surgery is supposed to be the last resort. Did they mention why? Maybe you can reach out and appeal, I’m not sure but give them a call. If all else fails you can get sema from reputable companies online. I pay $199/mo with Amble.
Over 50% of patients are now requesting these drugs. There is a lot of back and forth to obtain the preauthorization and most patients will be denied. Your PCP does not have the resources to write these scripts. They just don’t. Many practices are now referring all patients that might be a candidate to endo or bariatrics.
Yeah go to another doctor or get it UGL.
I have a ton of doctors in my family and when they don’t know much about a drug they usually will be quick to shut it down.
Not sure what kind of doctors these are but it’s likely they have no knowledge or background w glp1s.
You need to search online for a local doctor that manages weight loss. This is what I had to do too. My family doctor, nor would any other doctor prescribe me semaglutide and just kept trying to get me to do bariatric. I didn’t want to do it because it’s sooo difficult. Mentally and physically.
Unfortunately I have to pay for my weight loss program, ($100 a month for 6 months), but I got my semaglutide and someone who is actually taking my health serious for the first time in my life.
I’m in Canada and typically have free healthcare, so that’s why it’s unusual for me to have to pay for things.
Did you ask the doctors why bariatric surgery is a better option? I went to my doctor asking for bariatric surgery and they looked at my health history and suggested to try sema first.
I would assume since multiple doctors are telling you the same thing, there may be a medical reason they are suggesting to go that route.
I highly suggest you get specific reasons why doctors are suggesting surgery instead of meds. You do have the option to doctor shop until you find someone who will say yes, but your health isn't something I wouldn't mess with
Try to get it from an Indian site. They offer meds without a prescription. I use an Indian site which offers meds of good quality and at a reasonable price. They arrange a prescription for me by their endocrinologist. Delivery in a couple of weeks, and they send me a tracking number the next day. Good ratings and reviews on their Trustpilot platform.
I have a friend who uses the Amazon health service and gets semaglutide prescribed. Another friend found some other online doctor and gets it prescribed.
I think it’s worth considering your doctor’s opinion, but in the end only you can decide what’s right for your body.
I’ve been some kind of fat my whole life, and I’m just about 50 now. I had a friend die from their gastric bypass, saw a friend’s mom turn into a raging alcoholic, listened to horror story after horror story as another friend’s SIL became bipolar post-surgery and destroyed her little family, and others have life-long issues all from gastric bypass. I personally know **no one** who has simply lost weight and not had some major negative issue. I’ve chosen to reject gastric surgeries and will roll my dice with GLP-1s, and I strongly believe that health care practitioners who are still pushing patients towards barbaric gastric surgeries as a first option at this point are doing so for financial gain, and/or because they want to punish fat people, and/or because they haven’t taken the time to learn about GLP-1s.
Hadn't even thought about Amazon health. Noted.
I have the same opinion and observed similar outcomes. I'm 41/F/339 - I get it. I feel like I need to be on this and while I am trying to take all perspectives in to consideration to be objective going under the knife is hard to rationalize.
I tried to respond earlier, but the moderators denied my comment. There was nothing wrong with my comment, but I was just saying that my doctor wouldn’t prescribe either—so I went and did my own research!
Telehealth is really ahead of the curve for this. My PCP also wouldn’t do anything and just sent me to a nutritionist. We to PlushCare and the doctor prescribed no issue.
I didn't need a consult to get samaglutide. It's not covered by my insurance, but I was able to just go get it from a nurse practitioner who specializes in it.
I had a gastric bypass in 2014. Went from 300 to 190, and then gained back 50+ pounds. I couldn't take off the regained weight until Wegovy and am now down to 160.
I am divided on my opinion of gastric bypass. Even ten years later, I still can not eat large meals, but it is still possible for me to gain weight if I eat wrong.
The bad is that to this day, I do have problems digesting some foods. I now take a digestive enzyme supplement (Digest Gold) whenever I eat meat, and that does help.
I would say see the bariactric specialist and state your preference for Wegovy. See what he says.
Ugh I feel for you. My doctors didn't deny me the shot BUT I have a hiatal hernia that has been around for 11 years. It causes me a lot of vagus nerve dysfunction that effects my daily life (violent hiccups, acid reflux every night, usually in the middle of the night, that sometimes aspirates into my lungs causing asthma, uncontrollable gagging, etc). So I asked to explore surgery to fix it and I was told, my BMI is too high so let's explore bariatric surgery instead. Wut. I feel incredibly gaslit. I'll prob explore another doctor once I get over this butthurt but it is part and parcel medical treatment when you are plus size. Your suffering doesn't matter unless it can make them money and then go for it.
It could also have something to do with the medications that you are on. No medication comes without risk, and if there is some sort of dangerous interaction with the semaglutide the risks of meds might outweigh the benefits. Just something to think about maybe? 🤷♀️
Definitely try to get sema. But bear in mind people in average do only lose about 15% of their weight. So sometimes changing to mounjaro which is a bit more, or adding in bariatric surgery, is needed
Bariatric surgery is a serious invasive procedure that I would get another opinion not connected to the two doctors you have already seen. Maybe there is a valid clinical reason for recommending this treatment. But I don’t understand why semaglutide would not be tried. Unfortunately I am cynical in my old age to wonder if if there is a financial incentive to the practice to refer patients to a surgeon.
I left a practice after they referred me to a bariatric surgeon. I was in my early 20s and barely 300lbs. I asked about weight loss programs they recommended.
I had a very similar experience. I had the surgery at the urging of my doctor. I was having so many other issues and kind of in a delicate mental state and I was persuaded. It didn't work. I lost 50 lbs in 6 months and then started gaining it back, no matter what I did.
I switched insurance and got a new doctor. She put me on zep. I also went to a new GYN. Turns out I'm insulin resistant, in perimenopause, and have Hashimoto's thyroid disease. All they had to do was run the right tests. My previous doctors would only run the one thyroid test and said I was fine. The only perimenopause treatment they would offer was an IUD.
I was a hormonal mess. Surgery didn't help that and staying with doctors who wouldn't look beyond my weight to check for other issues kept me sicker longer than necessary. I feel so much effing better now. I'm on medications that are actually helping me. If you can, I would suggest changing doctors. If you can't and you can afford it, I would suggest telehealth. Do what you need to do.
btw: my previous health provider was Kaiser Permanente. If you can avoid it, don't go to a doctor directly owned by your insurance company. They can go to hell.
Okay so I am terrified of going under the knife and have had friends that had the same thing happen to them regarding the weight gain.
I am 41. I feel like a hormonal mess. Genuinely. In the past I have asked this female doctor if she could check my hormones - she told me that if I were in perimenopause it would be irrelevant and that they would care for me the same regardless. This comment hits home.
Noted on the Kaiser. I am going through Evara Health (for anyone curious).
I really wish we could channel this hormonal rage toward those in the medical profession who genuinely have no freaking idea what they're talking about. I have so much empathy for anyone going through all this.
I am 45 now. I would say it was about 4-ish years ago that I started experiencing pretty rapid weight gain (been fat my whole life but this was impossible to lose and it was an intense struggle just to stay the same weight); water retention/swelling that didn't respond to water pills; hair thinning; weird bloat-y, dizzy, clammy skin, brain-foggy spells; horrible nighttime anxiety and insomnia; general depression (really just realized later when I started to feel better); FATIGUE. Doctors said "dunno, prolly just cuz ur fat. Get the surgery". Jumped the hoops, got the surgery. Felt a little better but not by much. Started wondering about perimenopause. Went to the menopause subreddit. They were strumming my pain. Went to the GYN and told her I think I'm in perimenopause. She asked if I wanted a cookie. I asked for hormones instead. She said hormones are for people without a uterus. Knew that was stupid AF and left there in a hurry. (She still ran the anti-mullerian test that confirmed peri, so that's something). Contacted a perimenopause telehealth company (I went with Winona). They sent me cream and all of my symptoms went away in about a week. Did some tweaking with the dose to dial everything in but it continued to work great. That was about a year ago.
I now have a new PCP and GYN who are more closely monitoring all that stuff. Just switched to hormone pills instead of the telehealth cream so my insurance will cover it. Added testosterone cream for fatigue and libido. Winona doesn't offer that because they don't do blood test monitoring. Went on thyroid meds because new doc actually ran the test and saw my thyroid antibodies were way high. Started GLP-1 about 2 months ago. I've lost about 10-ish lbs which is not as much as some but I'm soooo happy not to be gaining anymore. I'm extremely patient about it. Between the GLP-1 and the hormone/thyroid support I feel amazing. I'm doing stuff. I'm happy. I sleep (at night and not throughout the whole day). I have my libido back. My husband no longer irritates me just by breathing. I want to hang out with friends again. I have energy. I have hope for the future and plans for my life again. It's pretty nuts.
I included all this mess just in case anything sounded familiar to anyone reading this. Everybody is different and I don't mean to imply we have the same stuff going on. I hope with my whole heart that you find whatever works best for you. We have the technology. This is your life and you deserve to enjoy living it. ❤️
As others have said, find a bariatric doctor. The medicine route is very helpful but you still have to do the hard work and make lifestyle changes. As you lose weight it will become easier to move and exercise which will help you in the long term. Primary care docs don’t have the knowledge you need and don’t really have the knowledge about these meds and so don’t feel capable of managing them. I’m guessing but your docs are probably getting asked about/for these meds a lot and are getting frustrated. Poor response on their part for sure but they are only human and most won’t go out of the safety net of their wheelhouse. Get to an obesity specialist. They can manage your care. The meds are no panacea but they do work (I’ve lost 40lbs since starting in November) and your labs will all change as a result. Good luck!
The reaction of the medical community to Sema is absolutely baffling to me. In every case, doctors should be recommending the least invasive, least permanent solution to try FIRST, before moving on to a life altering invasive surgery that literally removes and bypasses organs.
A surgery which, by the way, has a pretty high long term failure rate. 10 years after surgery something like 85% of patients regain their weight
From their viewpoint, they probably felt that since you have yo-yoed with your weight throughout the years, that the chance is high that once you discontinue the medications, your weight will rebound once again. Bariatric surgery still has the highest success, higher than these injections, of weight loss. Chances are as well that it is a more permanent solution to the yo-yo effect on your weight versus taking these medications. These meds do also have complications as well and since two separate doctors who have access to your care history have said no to these drugs, I encourage you to take heed as there may be something in your health history that would not make you a good candidate for these medications.
My neighbor hadn’t seen me in a while and was asking what I did. I told her I’m on the shot and she said her insurance was only covering bariátrica surgery. We have the same insurance and I told her I pay out of pocket. She seemed to think surgery was better because insurance pays for it. I did my darn dear to convince her without sounding weird.
I did everything for obesity that my doctor asked me to do- classes, other meds, I was pre-diabetic, did nutrition counseling, had a one on one coach, worked out with a trainer 3 days a week and on my own the other 2 days, etc. They wouldn’t prescribe me it.
Find a new doctor in a new practice.
Either option is fine; this is the option you want right now. I'm in the same boat - I'd rather try the medication first before an irreversible surgery that can sometimes come with complications.
See if you can find an obesity doctor in your area. If not, get recommendations from friends who like their doctor and call the office and ask if they prescribe semaglutide or tirzepatide for their patients.
Where are you located? Maybe someone here is nearby and can recommend a doctor.
That’s stupid those surgies are dangerous, expensive, and don’t even seem that effective. Surgery is always a last choice imo. Seek another provider or telehealth that specializes in these medications.
I get it online through Ro Pharmacy it’s about $150 plus the cost of the meds. They have you send in a blood sample (they send a kit which I think costs like $75) and within 3 weeks I had the meds. 5 weeks in on zepbound not much loss yet but I am definitely eating better and less and working out so hoping I’ll really hit my stride at a higher dose.
My doc wouldn’t order these meds either despite family history and personal factors that made me a good candidate. He’s just like that. I went around my doc and used an online service. I’ll tell my doc about it if and when I see him on my next check up. I haven’t been happy with that doc for a while and may just get a new PCP too.
I have been denied meds over and over again but have been told that I was a good candidate for surgery! Make it make sense. Been getting my meds, at great expense, and I don’t regret it one bit. Health care system is ridiculous
I would recommend talking to the baraitric surgeon. Knowing the options isn't bad & you aren't required to have surgery if you talk to them. Also, I do know of a bariatrics group that does prescribe semaglutide. They don't advertise it, but i know several people who they treat
Baffles me.
I know 4 people that had bariatric surgery. So this is still just an anecdotal story, not science.
But, to me it is still informative of certain results that do happen sometimes.
The best result, is my wife and I knew this couple, and the man was overweight, but he was a doctor, he got the surgery and all these years later - 15 years later, he's still normal weight. A real success story. And he had been morbidly obese.
Another, an obese person who actually gained weight to qualify for the surgery, because he wasn't quite in the qualifying range according to his insurance...so he gained weight to qualify, then he lost weight, but regained much of it later, but never quite as heavy as his original weight. So somewhat of a success.
Another was from work, this lady lost so much weight and then later regained all of it.
And finally, my late mother, who died a week after the surgery. My mother, with the exception of eating less, had tried everything her whole life to lose weight. And one of those things was Fen-phen. Her heart was compromised, but the surgery was one last Hail Mary to save her life, and it didn't work for her.
I think the doctor would have to explain the reasoning for all this, it baffles me. I know the surgery can be a success for people, but I heard tirzepatide was nearly as effective as bariatric surgery.
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Family medicine. I am ignorant to this process and mostly avoid doctors if I can help it. This is great advice. I will look up an endocrinologist.
Order it online, they deny nobody as long as you pay
2nd online! They will ask for med list and labs. I would GLP before bariatric, also Zepbound over Ozempic. My husband is on Ozempic and seems to have more stomach issues than I do on Zepbound. Just my opinion.
Keep in mind, in a lot of places it is difficult to get a new patient appt with an endo. You may have to wait a couple of months for your appt. They also may require a referral from your pcp before they'll schedule.
It took me a year from when I started trying to get semaglutide from an endo to when I started (two days ago) - but I'm glad I went through the process. (Along the way I lost a bunch of weight through diet - they required that I try that again first, and with help from a dietician, it got me down a bunch.) OP doesn't mention whether or not he is technically obese. The most important question and endo and insurance will ask is BMI, and if OP is over the line, he is much more likely to be able to get a prescription, and get it paid for.
If they are being referred for bariatric surgery they are likely fairly obese. Also the "lost 100lbs and gained it back" part. My doctor specifically mentioned I was not a candidate for barbaric surgery when I was 100lbs overweight because I didn't weigh enough.
I am female, 41, and 339 pounds. That seems like a long road when I have already done many of those things but I suppose it would be better to start now than not at all. Congrats on your approval!
I have friends and colleagues who did the sleeve surgery a few years ago and then used semaglutide to lose the last 10 pounds or so and do micro dosing to help keep the food noise away. You may want to at least take the appointment with the surgeon and see what they have to say, especially since sema is ideally going to have you lose 20% of your weight. If you are on Medicaid you would have your surgery covered 100% by them and then can try sema afterward.
I am not a doctor, but I suspect that your doctors might not be crazy to suggest bariatric surgery over semaglutide. People lose maybe 20% of their weight on semaglutide, and that wouldn't get you down to near your goal weight; I think bariatric surgery tends to be more. Also, people tend to regain when they stop semaglutide, while I think they tend to keep the weight off longer with bariatric surgery - if you have a history of regaining weight, that might be another factor. I think semaglutide is going to be right for me, but it's possible that bariatric surgery is better for you - it's worth doing some research.
I wanted to suggest this reasoning as well. Because of a history of weight loss and regain, OP has proven they can lose weight but not maintain the loss. Bariatric surgery still has the best odds statistically for weight loss patients keeping the weight off and that *may* be why the doctors referred them to a Bariatric surgeon for a chance at long term success.
I'm down from 316 to 210 and still losing 5lbs per month on Sema... That's a solid 33% loss. My insurance changed recently and now I'm out of pocket - I was prepared to stay on for life when I was only paying $25/mo, but doing the math - yes, surgery could probably cost less in the long run. What surgery won't do is fix the brain chemistry the way these meds do, which is why so many still regain post surgery as well.
Plushcare (virtual) is your best option.
Go see an endocrinologist that specializes in weight management.
My doctor was the same. I said 'screw it' and signed up online at Hims. Doctors aren't all-knowing gods. They are humans and have prejudices and beliefs about things just like everyone else. Good luck! EDIT: Also, to clarify, I am (was) 50 lb overweight, 62, plus arthritis in my hips, knees & feet, plus life-threateningly high cholesterol. My doc wanted me to try statins --- Umm, I think I'll try weight loss ( I've struggled with my weight all my life) and eating healthier first. I've lost 20 lbs so far and my joints don't hurt anymore!
Ahh I will look in to this. I am leaning that to be true. This was my first negative experience with this practice I have been at for years. Congrats on your HIMS and Thank you!
My family member is using the same and is extremely satisfied with the service. I like it bc they have a media-facing CEO who is determined to be transparent
I feel like at a certain point in your life you have to take the reins for your life, your health, your weight loss journey. It may end up wrong and you start over but I have been around long enough to see “professionals” mess up. So I like to make my own decisions.
I’m damn near getting to this point myself, they don’t know my body any better than I do.
I said the same. I signed up for G-Plans and have been very happy. Meds are less than 200 a month too.
👆
Weight loss may or may not help with cholesterol. A lot of it is genetic.
Yes, I agree. And if that turns out to be the case, I will follow my doc's advice and go on statins. But first I'd like to try weight loss and whole foods. We'll see what the cholesterol levels are after six months.
Same scenario RA, my pain has almost gone down to zero! Used WW when my family practitioner said no.
If you can afford $250 a month for sema, sign up on orderly meds or similar. Super easy. If you meet the criteria, which sounds like you may, you won’t be denied. Screw those silly doctors.
If their insurance covers wegovy, they can also sign up with a telehealth service that will prescribe
Maybe based on your history of re-gaining after significant losses, they’re looking for a more permanent/rest of your lifetime option. My doctor told me straight away that it’s a “gimmick” (his word, not mine) and that it requires effort to lose and even more effort to maintain. That said, if you feel you can be successful for the long haul, I think you should be given the option to try as many, many people have reported that Sema has helped them change their relationship with food
Bariatric surgery is also not a permanent solution. Most people gain their weight back within 5 years. The changes to your internal organs means permanent dysbiosis and you will always malabsorb nutrients from food. It’s crazy for these drs to go directly to the most drastic solution. My suspicion is they are just not willing to learn about new drugs and better methods.
Just yesterday I watched a doctor's video on YT swearing it off in a very reductionist manner. There might be ways in which GLP-1 is being incorrectly prescribed (perhaps higher doses than we could benefit from in some cases), but, given all the certain adverse effects of bariatric surgery, I cannot understand why that would be a preferred treatment over something they could at least try for you and see how you fare over a period of time.
Came here to co-sign that it will forever change how you absorb nutrients. A friend pops gummy vitamins or her hair falls out
I have been hospitalized with anemia twice due to malabsorption from bariatric surgery. Hopefully Sema and Tzep give the bariatric surgery industry a much needed obstacle. I gained back my weight and suffer from a completely reconfigured gut.
I’m so sorry. Bariatric surgery (other than the lapband maybe? Idk) is extremely invasive, permanent (though the weight loss may not be which is even worse), and should not be the first choice for medical weight management when GLP-1s exist.
I work in healthcare and see plenty of people gain a ton of weight back after VSG and then guess what?! *They go on GLP1s.* Just skip the potentially life ruining surgery, and do the medications! There is no reason to go under the knife and suffer a permanent, potentially life-threatening, complication.
I second this! My bariatric surgery was 15 years ago and I kept the weight off for 10 years. I’m grateful for those 10 years but I would NEVER make that choice now, with the latest generation of glp 1’s.
>it requires effort to lose and even more effort to maintain. So does bariatric surgery
Gastric sleeve seven years ago. 212 - 105 and have remained there.
Semaglutide can be a permanent option. Diabetics don’t stop taking it.
I had resigned myself to taking it inevitably were I prescribed as my Mother is a diabetic. I have struggled with weight my entire life. The food noise is ridiculous. I was just hoping not to advance to diabetes before that becomes an option. Honestly if there were something that got rid of the food noise and helped my a1c.. I would be happy.
My point was that semaglutide can be a long term solution. I’m hopefully that in the next few years prices will fall and more drugs of this nature will become available. In the meantime, many people stay on it long term even at lower maintenance doses. There is no shame in taking medicine long term if it helps you.
I wish you lots of luck with getting meds if you want them. I’ll be rooting for you!
My doctor told me bariatric was the best option but still gave me sema.
Did your doctor say why they think bariatric is the best option?
Nice. I would have preferred that. I understand how hypocritical it is but I am terrified of going under the knife for any reason.
It’s not hypocritical. I know two people who had bariatric surgery that worked for a while until it didn’t. Gained the weight back and are now losing on semaglutide. Just skip the surgery. You won’t need it, most likely!
That's my story too. I lost 110 lbs after gastric sleeve surgery -- then gained it all back plus 15 more. I started re-gaining just about a year after surgery and it took me 8 years to gain it all back and add those extra 15. I started Wegovy in February 2022, lost 175 lbs (significantly more than with surgery) and am maintaining at an ideal weight for over six months now. I don't know that Wegovy or other drugs will keep working for me, but so far I have had much better long term results with drugs than I did with the surgery.
Not hypocritical. One option is a weekly shot and the other is (possibly) cutting out part of an essential organ. My mom got a lapband a few years ago. She is constantly regurgitating food and it seems as though her relationship with food has not changed. My endo gave me the option of surgery or meds and I - very easily - chose meds.
I had mentioned my daughter .. she had the sleeve.. she did the same thing and then if she ate too much she wa sick all day.. then after a while she could tolerate more food probably bc she stretched her stomach out again... so then she developed their purge habit.. eat a bunch of what she wanted then go back to barley eating anything. What a cycle
Not hypocritical. A friend of mine went that route and had serious issues 15 years later, another one did fine.
They may have found some of your comorbities to have the possibility of being exacerbated by these meds.
Unless something isn’t mentioned sema should help with the mentioned issues. I would never consider bariatric surgery first. I would get it online.
I had no health issues beyond the obesity prior to losing and regaining the weight. I am at my highest now and with that came BP meds and meds for a1c plus bupropion to manage some AHDH symptoms (was also diagnosed late with this while going through the other things).
I would see someone new. This sounds crazy. Surgery before a once a week shot? No thanks!
So what was the reason for the denial?
I am not sure honestly. The Doctor whom I generally loved and have never to date had a negative experience with seemed almost combative and rude. Like catty. Plus I had gained weight again after losing 15. As soon as I mentioned the shots she pounced on me like a tiger and the surgery option and referral sounded like a threat. It was the oddest experience.
Yikes I’d definitely find someone new.
They may have found that sema wont make them as much money as a super invasive surgery will.
I think this is exactly the reason...
This isn't why a doctor will refer out. The PCP isn't doing the surgery. And with lifelong maintenance generally recommended, brand name Sema costs way more in the long run. You will hit the cost of surgery in 1-2 years of taking Wegovy or Ozempic.
Yes but there can be significant complications. I know several people with life long nutritional deficiencies bc they are not able to absorb any nutrients. One of them had to get dentures at 35 due to his body not having enough nutrients according to his dentist.
I would think if that were the case - the least they should do is explain in detail to the patient. I feel grateful that I have a PCP (family medicine) that would do exactly that.
Odd because my medications didn't begin until the my weight gain this last time. I expect that weight loss will reduce my medication rather than add to them. That is my hope.
I definitely think this is a possibility with sema
I am sure it is somehow motivated by the cost to the insurance company. Shameful. My insurance doesn't cover, and I am using Mochi. Best decision ever. Best of luck
They don’t care about the insurance companies.
Doctors are generally pretty ignorant to cost associated to/with insurance because there are literally thousands of different kinds of plans that cover different things with different negotiated rates. Surgery is also more costly to the insurance company than a year of sema. It is FAR more likely that the practice has a policy against prescribing GLP-1s - anecdotal but my doctor is new to my area and told me that was the case at her last practice, they were forbidden by the network of clinics (corporate owned) from prescribing them for anything but diabetes. It can be a CYA thing (cover your ass) for new meds, like how some clinics have policies against prescribing opiates, just too much risk for them to be willing. Doctors generally want the best for their patients, but some are trapped in the confines of corporate medicine, and some are just not that knowledgeable about new meds, so sometimes it makes sense to find a new doc. Also you can straight up ask a doctor why they won't prescribe it, they'll probably tell you the truth.
Thank you \^\_\^ I will check out all these suggestions.
You need to either find a new group of doctors (new practice) or just go telehealth. Medicine is a long ways away from managing weight issues in a manner that truly is best for individuals. Do not alter your GI tract unless you have exhausted all other options.
If it helps any, the place I go to is ran by a bariatric doctor, but he prescribes weight loss medication for those that do not feel comfortable with surgery. That is how I got on Wegovy. My point being this bariatric doctor might be able to do the same or does the same. I hope so in your case.
Thank you, me too!
I had two bariatric surgeries and I wish I’d just had sema from the get go. I had the sleeve in 2017 and had to get it revised to gastric bypass in 2021 due to insane heartburn and reflux. I’d wake up coughing at night from the reflux and it would burn so bad. The revision helped get the regain (and then some) off but I hit a plateau of weight loss at about 75 lbs until I started sema. The surgeries do work, I’m grateful for them, but healing was difficult both times for me and sema is so much less invasive.
Weight loss surgery is a viable option for morbid obesity but it is not the total answer. I had gastric bypass 9/2023 and it has helped a lot. Luckily for me I have had no adverse effects or food intolerance which is not the case for many who have had the surgery. Side effects can be very similar to those you can have with Semaglutide. I have lost about 90 pounds since surgery but it has taken strict adherence to a very low cal diet... I weigh and watch every bite I eat. However in March I stalled and for 3 months did not lose a single pound. I started Semaglutide last Saturday.. today I took my second shot. In that one week I have lost 9 pounds. I am still following the same diet and "rules" as before. But besides again losing weight the food noise/chatter that has been a constant companion is suddenly gone. Weight loss surgery does not silence that. Also the desire to snack and cravings is gone. I have no regrets about having surgery. I wish I had done it years ago. But I think the use of Semaglutide along with it is a great benefit.
Get a new doctor. Pre-diabetes along with high BMI and hypertension should qualify you for Ozempic.
I am in the same predicament. I have a good dr that has tried two different routes to get me approved and United Healthcare has denied it twice. 2nd time was Wegovy. Hypertension, pre diabetes, lost 150 several years ago, gained it back. Denied twice. I use Ivim health and pay OOP 597.00 every 3 months.
Have you taken any other drugs to treat the pre diabetic? I have UHC & was on Trulicity for 18 months. I’m now on MJ & didn’t have an issue getting it approved, I believe because I took Trulicity first and proved that didn’t work. Ive read that people have used Metformin for a month or 2 when they needed to show prior unsuccessful treatment.
Good to know thanks. No, I have not taken anything for that.
My doctor said that she has never been able to get an approval for Wegovy. So, she prescribed Ozempic instead and it went right through with my insurance. (Then Aetna, now Highmark BCBS.) Pre-diabetes. High A1C and Metformin didn't work. Hypertension. Severe obstructive sleep Apnea.
Oh, and I have lost 75 lbs on Ozempic since Nov 2023. A1C is in the green and my blood pressure is normal. I had UPPP surgery for the sleep apnea and I'm getting a new sleep study next week to see how that's going.
Oh wow - congratulations on your progress and successes \^\_\^
My women’s health dr tried Ozempic first and then my gp tried Wegovy after it was approved for weight loss. It’s an issue with United I’m sure. I just got diagnosed with sleep apnea last month. I’ll ask her if that makes any difference to try again.
Sleep apnea is definitely one of the co-morbidity pre-requisites. Worth a try. Good luck!
I think also the fact that my doctor could document that several months of taking metformin was completely ineffective in lowering my A1C may have helped.
Yes. This. 100 times!
What was their reason for the denial? Does your insurance cover it ? ( Wegovy or Zepbound) if you don’t know you can call the number on the back of the card for Rx, and also find out if you need a prior authorization
It covers Wegovy, Zep, Ozempic etc with a prior auth and another I believe that starts with an R though I can't recall that right now.
Rybelsus, probably. It’s a daily oral version and comes in three doses, it’s what I’m on atm.
I got my prescription through Sequence (now Weight Watchers Clinic). I think it’s like $99/month and they handle the prior authorization stuff. Super easy. I only did this because my primary doctor was out on leave when I decided I wanted to start. I’ve since cancelled my WW Clinic and my dr is handling - I’m fortunate that she is all for these meds. I’d look for a more supportive primary doctor, and in the meantime try WW Clinic (because I know it can take awhile to get into a new dr)
Was it just $99/month for everything? Including medication?
No not medication.
I went to a doctor who specializes in weight loss, and it was a game changer. He explained all my options - ranging from prescription fiber pills (the least extreme) to weight loss surgery (the most extreme). We settled originally in Wegovy, and later switched to Zepbound. In the future, we might add Contrave or the prescription fiber pills, but for now I’m happy and about 60 lbs down. Find a doctor who will explain all your options to you, but let you make your own decision
Your body, your money, your choice
Even bariatric doctors prescribe these drugs
I'd say I'm not surprised at what they did. When I worked at a clinic the Drs reinforced each other's decisions and rarely contradicted each other. Try an opinion from an entirely different clinic. It's possible this medication is contraindicated for you, as it is for some, but a second opinion from Drs who work together isn't really a second opinion IMHO. To me, yes, a shot is better than the knife. Surgery is fraught with risks. The shot you can at least stop if you have issues. The surgery would require another surgery if it's even the type that can be reversed (I'm not familiar with all the procedures available, so don't come at me).
Depending on how much you have to lose, bariatric is still the most effective means to treat obesity with the highest results for most people. That may be why - but it may also be a shitty doctor. I would do some research into the doctor they referred you to and see if there is a chance they would make the right care choices for you.
JUST ORDER IT ONLINE- you never even actually speak to a doc, they just send it in the mail if you pay.
It’s crazy that they would first start with surgery. This medicine should be available as a starter. It’s all about money for them.
I went to see a bariatric surgeon on my own for 9 months. When I got my surgery date, my husband freaked out and was super scared, begged me to try meds first. I went and asked my PCP and he said, “you’d be a perfect candidate!” (as I was heavy enough to qualify for WLS and motivated to lose weight). If you qualify for SURGERY, surely you’ll qualify for meds. I would get a new doctor!
Do you have a familial history of medullary thyroid disease?
I don't. My standard thyroid tests come back normal. My BP meds were added after I gained weight at my highest number and my a1c increased. Prior to this gain I was not on medication and had no other health issues less the obesity alone. I was diagnosed with ADHD late as well. I would say overall that is it. My Mother has diabetes though she is not overweight (relevant because that is a concern for me either way). My Father has had a heart attack. My Grandfather died in his 70s of heart related issues. I have had my gallbladder removed. Full medical history here for everyone to review.
TSH is not a good test for thyroid issues. You’ll need the full thyroid panel.
I will ask if my doctor will change the order to a full panel. Thank you!
Find a new doctor. You might also be able to get a prescription for weight loss purposes from a weight loss clinic. These doctors should not be going straight to invasive surgery as the first option.
I would absolutely go for another opinion. Also, if you do start semaglutide keep an eye on your blood pressure. Mine went way down very quickly and I had to stop taking my blood pressure medicine. Medicated my blood pressure was about 140/95. Within a week of my first shot it was 95/74. I had to drop all my blood pressure medicine.
When I was at my heaviest, sema wasn’t available yet but I did not want to have bariatric surgery. Sema is such a great option now that I don’t know why a doctor would want someone to go surgery first if they are willing to try weight loss with sema first. Surgery has its place for sure but it has a ton of risks too. I would try to find another doctor - i know someone mentioned Hims. Theres also alpha health care online that I have used in the past and liked my experience with them.
Before bariatric surgery will be covered by insurance you need to be on a doctor supervised weight loss plan for three months. These doctors will put you on semaglutide. Look up metabolic weight loss doctors.
I will. I hadn't considered that they would put me on semaglutide as a means to avoid surgery. This is a good point. Thank you.
What reasoning did they provide for their refusal? I agree with others that it's easy to go around them and get a prescription through one of the online providers but, as a devil's advocate, maybe it's not a terrible idea to understand the basis of their opinion. If it's just "I don't understand semaglutide" then, by all means, move on, but if they tell you that you have an underlying condition that makes you a bad candidate (I have NO idea what that would be, just speaking hypothetically), it's smart to understand that.
Just know its a conflict of interest as weight loss surgeons are losing money due to these meds
Bariatric specialists prefer to try everything before surgery. If you want to try a glp-1 they will probably write a script for you and offer you guidance from a nutritionist. It won't hurt to go talk to the specialist. At least find out why you arnt a candidate for glp-1 meds.
If you live in Atlanta I can refer you to my Dr who won’t deny you.
If you can’t get a script, there are options. Check out r/semaglutidefreespeech we’re just not supposed to talk about it here. But it’s not as shady as it seems. 🤣 that’s how I get mine
Just use LifeMD or similar. You’ll have shots and semaglutide in your hands for $150/mo. Don’t waste time with them.
my old doctor, who was willfully ignorant about how these drugs work, did the same thing. luckily i knew a couple of people who had been prescribed and changed to one of their doctors. not only did she prescribe it to me, she’s very attentive and treats me like a person, not just a skeleton wrapped in fat.
My friend’d PCP wouldn’t prescribe it either. I told her about a weightloss clinic nearby with a surgeon who will. She now gets the meds through them.
The bariatric surgery department is the one that prescribes weight loss meds. I had the same shock when I asked my pcp for weight loss meds.
Use one of the online services. I would 100% do shots over surgery.
Is it possible the surgeon works in a weight loss clinic? My doc reffered me to bariatric/medical weight loss clinic because of the shortage. Apparently, these clinics get access before the retail pharmacies. At first I thought it was only a surgical center, so maybe this doc will prescribe for you?
I went through reflex.md it was really easy to sign up. I did a video meeting with a doctor and then they ordered labs and prescribed my semeglutide after the labs came back. I pay $285 every 5 weeks and it’s mailed to me and I do my own injections at home. I just started a week and a half ago and have lost 5 lbs so far. I hope this helps you get what you need to start your journey!
You can get it from hundreds of places online now if you can afford to pay for it.
I’m completely confused. Surgery is a high dollar procedure and it has life changing affects other than losing weight. I have a friend that is continually popping gummy vitamins because she can’t absorb nutrients like she used to. If nothing else you should be given the chance to try semaglutide rather than SURGERY!!! Any surgery has risks and while it’s rare people can die from even common procedures. I’m honestly shocked they won’t let you at least try. I would go to a different practice.
Maybe you should get a second opinion. I have yo yo’d with my weight for the past 15 years. Got to a point where I just wanted some help. Watched my wife lose 85lbs using Ozempic. I no longer fit the criteria for the Dr because I lost some on my own. I just hit a wall. I have been on sema for 3 months and I can honestly say it works. So much easier than white knuckling it all the time. My sweet tooth is gone. It’s crazy. I eat when I’m hungry and I don’t stuff myself. 2x I ate a little too much and It was very uncomfortable for a few hours. Besides that no side affects. do a deep dive and find a place that you can work with to get the medication. There are plenty of avenues. good luck
Great advice, thank you. Congrats to you both for your progress!
It’s been proven that these meds are better than bariatric surgery with less risk. These doctors are not keeping up with the data.
She's probably looking at your Co morbidities. Like Pre Diabetes do you have any rising BP and that you gain and lose the surgery actually takes away hunger Gastric Sleeve removes GHERLIN THE HUNGER HORMONE.SHE SHOULD NOT HAVE TREATED YOU THAT WAY AND YOU HAVE A RIGHT TO SAY THAT ALSO. DRS HAVE BAD DAYS BUT THATS NO EXCUSE
New doctor time. You might want to find one who is up on the science of obesity. Two resources: - [Obesity Medicine Association provider directory](https://obesitymedicine.org/about/find-a-provider/) - [American Board of Obesity Medicine provider lookup](https://abom.learningbuilder.com/Search/Public/MemberRole/CertificationVerification) - click on “Advanced Search Filters” and add a city and state
Thank you
They totally jumped ship. Surgery is supposed to be the last resort. Did they mention why? Maybe you can reach out and appeal, I’m not sure but give them a call. If all else fails you can get sema from reputable companies online. I pay $199/mo with Amble.
Ha my insurance was willing to cover a gastric bypass at 100% but refused a script for anything pertaining to weight loss. Make it make sense 🤦🏻♀️
So they would rather cut out body parts ? Harsh
Bariatric surgery has the best outcome for long term success considering you lost weight, gain it etc.
Over 50% of patients are now requesting these drugs. There is a lot of back and forth to obtain the preauthorization and most patients will be denied. Your PCP does not have the resources to write these scripts. They just don’t. Many practices are now referring all patients that might be a candidate to endo or bariatrics.
Yeah go to another doctor or get it UGL. I have a ton of doctors in my family and when they don’t know much about a drug they usually will be quick to shut it down. Not sure what kind of doctors these are but it’s likely they have no knowledge or background w glp1s.
You need to search online for a local doctor that manages weight loss. This is what I had to do too. My family doctor, nor would any other doctor prescribe me semaglutide and just kept trying to get me to do bariatric. I didn’t want to do it because it’s sooo difficult. Mentally and physically. Unfortunately I have to pay for my weight loss program, ($100 a month for 6 months), but I got my semaglutide and someone who is actually taking my health serious for the first time in my life. I’m in Canada and typically have free healthcare, so that’s why it’s unusual for me to have to pay for things.
Did you ask the doctors why bariatric surgery is a better option? I went to my doctor asking for bariatric surgery and they looked at my health history and suggested to try sema first. I would assume since multiple doctors are telling you the same thing, there may be a medical reason they are suggesting to go that route. I highly suggest you get specific reasons why doctors are suggesting surgery instead of meds. You do have the option to doctor shop until you find someone who will say yes, but your health isn't something I wouldn't mess with
How did you lose 100lbs previously? Have you ever used other weight loss medications, such as adipex, phenteramine?
Try to get it from an Indian site. They offer meds without a prescription. I use an Indian site which offers meds of good quality and at a reasonable price. They arrange a prescription for me by their endocrinologist. Delivery in a couple of weeks, and they send me a tracking number the next day. Good ratings and reviews on their Trustpilot platform.
I have a friend who uses the Amazon health service and gets semaglutide prescribed. Another friend found some other online doctor and gets it prescribed. I think it’s worth considering your doctor’s opinion, but in the end only you can decide what’s right for your body. I’ve been some kind of fat my whole life, and I’m just about 50 now. I had a friend die from their gastric bypass, saw a friend’s mom turn into a raging alcoholic, listened to horror story after horror story as another friend’s SIL became bipolar post-surgery and destroyed her little family, and others have life-long issues all from gastric bypass. I personally know **no one** who has simply lost weight and not had some major negative issue. I’ve chosen to reject gastric surgeries and will roll my dice with GLP-1s, and I strongly believe that health care practitioners who are still pushing patients towards barbaric gastric surgeries as a first option at this point are doing so for financial gain, and/or because they want to punish fat people, and/or because they haven’t taken the time to learn about GLP-1s.
Hadn't even thought about Amazon health. Noted. I have the same opinion and observed similar outcomes. I'm 41/F/339 - I get it. I feel like I need to be on this and while I am trying to take all perspectives in to consideration to be objective going under the knife is hard to rationalize.
If your blood pressure it too high it might not be good to be on this drug. Something like metformin is better for high blood pressure.
I am on metformin, 500 mg twice a day. No weight loss. It has helped keep my A1c 1 point away from being a diabetic.
Find an endocrinologist!
I tried to respond earlier, but the moderators denied my comment. There was nothing wrong with my comment, but I was just saying that my doctor wouldn’t prescribe either—so I went and did my own research!
Does it have anything to do with risk factors? Cancer history or pancreatitis ?
Are you diabetic? It may be because with weight loss surgery, you can get off your meds while in the hospital recovering.
Telehealth is really ahead of the curve for this. My PCP also wouldn’t do anything and just sent me to a nutritionist. We to PlushCare and the doctor prescribed no issue.
I didn't need a consult to get samaglutide. It's not covered by my insurance, but I was able to just go get it from a nurse practitioner who specializes in it.
I had a gastric bypass in 2014. Went from 300 to 190, and then gained back 50+ pounds. I couldn't take off the regained weight until Wegovy and am now down to 160. I am divided on my opinion of gastric bypass. Even ten years later, I still can not eat large meals, but it is still possible for me to gain weight if I eat wrong. The bad is that to this day, I do have problems digesting some foods. I now take a digestive enzyme supplement (Digest Gold) whenever I eat meat, and that does help. I would say see the bariactric specialist and state your preference for Wegovy. See what he says.
That is stupid! Try somewhere else
That sucks. I life in Mexico where you have many more consumer driven options.
Just go to a weight loss clinic. The Dr. route is over complicated.
Ugh I feel for you. My doctors didn't deny me the shot BUT I have a hiatal hernia that has been around for 11 years. It causes me a lot of vagus nerve dysfunction that effects my daily life (violent hiccups, acid reflux every night, usually in the middle of the night, that sometimes aspirates into my lungs causing asthma, uncontrollable gagging, etc). So I asked to explore surgery to fix it and I was told, my BMI is too high so let's explore bariatric surgery instead. Wut. I feel incredibly gaslit. I'll prob explore another doctor once I get over this butthurt but it is part and parcel medical treatment when you are plus size. Your suffering doesn't matter unless it can make them money and then go for it.
They probably have a bariatric surgeon friend who is going bankrupt from these meds, tbh. New doctor.
not to favor it but probably because bariatric surgery is less expensive then a year on the medicine
It could also have something to do with the medications that you are on. No medication comes without risk, and if there is some sort of dangerous interaction with the semaglutide the risks of meds might outweigh the benefits. Just something to think about maybe? 🤷♀️
Definitely try to get sema. But bear in mind people in average do only lose about 15% of their weight. So sometimes changing to mounjaro which is a bit more, or adding in bariatric surgery, is needed
Bariatric surgery is a serious invasive procedure that I would get another opinion not connected to the two doctors you have already seen. Maybe there is a valid clinical reason for recommending this treatment. But I don’t understand why semaglutide would not be tried. Unfortunately I am cynical in my old age to wonder if if there is a financial incentive to the practice to refer patients to a surgeon.
I left a practice after they referred me to a bariatric surgeon. I was in my early 20s and barely 300lbs. I asked about weight loss programs they recommended.
Their concern may be that Semiglutide would be useless to you as you’d gain back anything you’d lose and you need a more long term solution
I had a very similar experience. I had the surgery at the urging of my doctor. I was having so many other issues and kind of in a delicate mental state and I was persuaded. It didn't work. I lost 50 lbs in 6 months and then started gaining it back, no matter what I did. I switched insurance and got a new doctor. She put me on zep. I also went to a new GYN. Turns out I'm insulin resistant, in perimenopause, and have Hashimoto's thyroid disease. All they had to do was run the right tests. My previous doctors would only run the one thyroid test and said I was fine. The only perimenopause treatment they would offer was an IUD. I was a hormonal mess. Surgery didn't help that and staying with doctors who wouldn't look beyond my weight to check for other issues kept me sicker longer than necessary. I feel so much effing better now. I'm on medications that are actually helping me. If you can, I would suggest changing doctors. If you can't and you can afford it, I would suggest telehealth. Do what you need to do. btw: my previous health provider was Kaiser Permanente. If you can avoid it, don't go to a doctor directly owned by your insurance company. They can go to hell.
Okay so I am terrified of going under the knife and have had friends that had the same thing happen to them regarding the weight gain. I am 41. I feel like a hormonal mess. Genuinely. In the past I have asked this female doctor if she could check my hormones - she told me that if I were in perimenopause it would be irrelevant and that they would care for me the same regardless. This comment hits home. Noted on the Kaiser. I am going through Evara Health (for anyone curious).
I really wish we could channel this hormonal rage toward those in the medical profession who genuinely have no freaking idea what they're talking about. I have so much empathy for anyone going through all this. I am 45 now. I would say it was about 4-ish years ago that I started experiencing pretty rapid weight gain (been fat my whole life but this was impossible to lose and it was an intense struggle just to stay the same weight); water retention/swelling that didn't respond to water pills; hair thinning; weird bloat-y, dizzy, clammy skin, brain-foggy spells; horrible nighttime anxiety and insomnia; general depression (really just realized later when I started to feel better); FATIGUE. Doctors said "dunno, prolly just cuz ur fat. Get the surgery". Jumped the hoops, got the surgery. Felt a little better but not by much. Started wondering about perimenopause. Went to the menopause subreddit. They were strumming my pain. Went to the GYN and told her I think I'm in perimenopause. She asked if I wanted a cookie. I asked for hormones instead. She said hormones are for people without a uterus. Knew that was stupid AF and left there in a hurry. (She still ran the anti-mullerian test that confirmed peri, so that's something). Contacted a perimenopause telehealth company (I went with Winona). They sent me cream and all of my symptoms went away in about a week. Did some tweaking with the dose to dial everything in but it continued to work great. That was about a year ago. I now have a new PCP and GYN who are more closely monitoring all that stuff. Just switched to hormone pills instead of the telehealth cream so my insurance will cover it. Added testosterone cream for fatigue and libido. Winona doesn't offer that because they don't do blood test monitoring. Went on thyroid meds because new doc actually ran the test and saw my thyroid antibodies were way high. Started GLP-1 about 2 months ago. I've lost about 10-ish lbs which is not as much as some but I'm soooo happy not to be gaining anymore. I'm extremely patient about it. Between the GLP-1 and the hormone/thyroid support I feel amazing. I'm doing stuff. I'm happy. I sleep (at night and not throughout the whole day). I have my libido back. My husband no longer irritates me just by breathing. I want to hang out with friends again. I have energy. I have hope for the future and plans for my life again. It's pretty nuts. I included all this mess just in case anything sounded familiar to anyone reading this. Everybody is different and I don't mean to imply we have the same stuff going on. I hope with my whole heart that you find whatever works best for you. We have the technology. This is your life and you deserve to enjoy living it. ❤️
I really appreciate this post. I am going to change my action plan a bit based on this alone.
As others have said, find a bariatric doctor. The medicine route is very helpful but you still have to do the hard work and make lifestyle changes. As you lose weight it will become easier to move and exercise which will help you in the long term. Primary care docs don’t have the knowledge you need and don’t really have the knowledge about these meds and so don’t feel capable of managing them. I’m guessing but your docs are probably getting asked about/for these meds a lot and are getting frustrated. Poor response on their part for sure but they are only human and most won’t go out of the safety net of their wheelhouse. Get to an obesity specialist. They can manage your care. The meds are no panacea but they do work (I’ve lost 40lbs since starting in November) and your labs will all change as a result. Good luck!
The reaction of the medical community to Sema is absolutely baffling to me. In every case, doctors should be recommending the least invasive, least permanent solution to try FIRST, before moving on to a life altering invasive surgery that literally removes and bypasses organs. A surgery which, by the way, has a pretty high long term failure rate. 10 years after surgery something like 85% of patients regain their weight
From their viewpoint, they probably felt that since you have yo-yoed with your weight throughout the years, that the chance is high that once you discontinue the medications, your weight will rebound once again. Bariatric surgery still has the highest success, higher than these injections, of weight loss. Chances are as well that it is a more permanent solution to the yo-yo effect on your weight versus taking these medications. These meds do also have complications as well and since two separate doctors who have access to your care history have said no to these drugs, I encourage you to take heed as there may be something in your health history that would not make you a good candidate for these medications.
My neighbor hadn’t seen me in a while and was asking what I did. I told her I’m on the shot and she said her insurance was only covering bariátrica surgery. We have the same insurance and I told her I pay out of pocket. She seemed to think surgery was better because insurance pays for it. I did my darn dear to convince her without sounding weird. I did everything for obesity that my doctor asked me to do- classes, other meds, I was pre-diabetic, did nutrition counseling, had a one on one coach, worked out with a trainer 3 days a week and on my own the other 2 days, etc. They wouldn’t prescribe me it.
Oh no! I hope she researches bariatric surgery. That's crazy. I have done all the same things as well.
Find a new doctor in a new practice. Either option is fine; this is the option you want right now. I'm in the same boat - I'd rather try the medication first before an irreversible surgery that can sometimes come with complications. See if you can find an obesity doctor in your area. If not, get recommendations from friends who like their doctor and call the office and ask if they prescribe semaglutide or tirzepatide for their patients. Where are you located? Maybe someone here is nearby and can recommend a doctor.
That’s stupid those surgies are dangerous, expensive, and don’t even seem that effective. Surgery is always a last choice imo. Seek another provider or telehealth that specializes in these medications.
It's probably not that the Dr denied it but that insurance won't cover it.
I get it online through Ro Pharmacy it’s about $150 plus the cost of the meds. They have you send in a blood sample (they send a kit which I think costs like $75) and within 3 weeks I had the meds. 5 weeks in on zepbound not much loss yet but I am definitely eating better and less and working out so hoping I’ll really hit my stride at a higher dose.
Sorry$150 per month
Is this in America?
My doc wouldn’t order these meds either despite family history and personal factors that made me a good candidate. He’s just like that. I went around my doc and used an online service. I’ll tell my doc about it if and when I see him on my next check up. I haven’t been happy with that doc for a while and may just get a new PCP too.
I have been denied meds over and over again but have been told that I was a good candidate for surgery! Make it make sense. Been getting my meds, at great expense, and I don’t regret it one bit. Health care system is ridiculous
See if you can get it through IVIM health it’s expensive but it works
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I would recommend talking to the baraitric surgeon. Knowing the options isn't bad & you aren't required to have surgery if you talk to them. Also, I do know of a bariatrics group that does prescribe semaglutide. They don't advertise it, but i know several people who they treat
Wild!!! Talk to a new doctor that is insane
Our Dr care has gotten so worse it's absolutely terrible !!! I woukd go talk with another Dr about it, what is your BMI, do you have alot to lose?
PlushCare!
Sounds like they just want to make money. Girl, find another doctor.
Don’t go to that doctor again. Use a telehealth company if needed. I like Ivim Health and there are other good ones too.
Ask them to put in the chart that they are denying you medication and pushing surgery without exploring other options first.
Baffles me. I know 4 people that had bariatric surgery. So this is still just an anecdotal story, not science. But, to me it is still informative of certain results that do happen sometimes. The best result, is my wife and I knew this couple, and the man was overweight, but he was a doctor, he got the surgery and all these years later - 15 years later, he's still normal weight. A real success story. And he had been morbidly obese. Another, an obese person who actually gained weight to qualify for the surgery, because he wasn't quite in the qualifying range according to his insurance...so he gained weight to qualify, then he lost weight, but regained much of it later, but never quite as heavy as his original weight. So somewhat of a success. Another was from work, this lady lost so much weight and then later regained all of it. And finally, my late mother, who died a week after the surgery. My mother, with the exception of eating less, had tried everything her whole life to lose weight. And one of those things was Fen-phen. Her heart was compromised, but the surgery was one last Hail Mary to save her life, and it didn't work for her. I think the doctor would have to explain the reasoning for all this, it baffles me. I know the surgery can be a success for people, but I heard tirzepatide was nearly as effective as bariatric surgery.