from KuromiGirl04@lemmy.world to nostupidquestions@lemmy.world on 05 Mar 01:16
https://lemmy.world/post/43865952
Let me explain with my current situation. I am 22 F and I currently weigh 305lbs.
I am obese. Morbidly obese.
Even though I have been trying for 5 years at this point to lose the weight on my own. Eat healthier, eat more fruits and veggies, cut out excess sugar, walk more, exercise more, the whole kit and caboodle.
But I still am not losing the weight. I am still very fat. And I am worried that it will cause very serious health problems.
So I talked with my doctor and she told me “We need to get you on a weight loss medication. Let’s try Ozempic”.
But my insurance told us that they don’t think I need the Ozempic so they won’t pay for it.
So we tried Wegovy and Mounjaro. But my insurance still rejected our requests.
They’re saying because I am young, and I am a diabetic with good numbers, I dont need the weight loss meds and I can just lose the weight naturally.
But ive been trying to and it hasn’t been working. So that’s why my doctor prescribed me the weight loss med.
Why is this allowed? Why is it that your insurance can deny you a medication, even if your doctor says you need it?
#nostupidquestions
threaded - newest
It’s quite simple:
They are money-grubbing assholes in an unregulated industry. Their goal is to make as much money as possible while hurting as many people as possible. Because if they hurt people, they can take their money and provide no service.
It’s legal because the government won’t make it illegal.
They argue that they are preventing waste and fraud by holding doctors accountable. Like “oh if we didn’t have this power then doctors would order so many unnecessary tests and prescriptions”
(Not defending them, just sharing what they say)
Yeah, and what they say is bullshit. Doctors prescribe the medicine people need.
They don’t care about fraud. They care about their profits. We shouldn’t repeat their excuses like that.
If that was the case we’d have one of the most efficient medical systems in the world instead of one of the least
They can’t, they can only deny coverage for it. You can still get it paying for it yourself.
Yeah, paying $200+ a week for a shot. In this economy?
I don’t know anyone who has that kind of money
I just went through this battle myself. And my insurance even approved it, but I’m traveling overseas for two months and even though they tell me my benefit covers a “vacation override” they wouldn’t approve it.
I asked the pharmacy how much it would cost to pay out of pocket. $1300 for 4 weeks, so $2600 to cover my trip.
Luckily my Dr was able to give me “samples” to get me through my trip.
Also, another thing that I learned in the past year. What your insurance will cover and how much they’ll cover changes depending on your history.
Spend a three day weekend in the ER/ICU and suddenly I DO need Ozempic and they’re giving me thousands of dollars worth of CGMs for free.
It’s all a cost/benefit analysis for them.
Health Insurance CEO
The intended goal of conservative voters is to ignore your plight and they’d like you to die off screen.
Here in NZ it’s less than usd $300 a month full cost, but usually funded by the govt.
I’m not saying it’s right, I’m just saying it’s so.
imagine trying to get approval for biologics, which can thousands a month.
Not always. Sometimes, companies won’t sell it to you if your insurance has denied it. They may say it’s because they don’t believe you can afford it.
<img alt="" src="https://lazysoci.al/pictrs/image/d7937678-d49e-4980-8b88-035a1fa2f1e9.jpeg">
Monied interests have crafted a legal system that benefits them, not you.
I hate that this is happening to you.
Darknet Markets are booming with semaglutides because of capitalism’s greed.
This guy is so photogenic, it’s insane
he bulked up in jail apparently too.
My wife was prescribed one of those for her diabetes, and the insurance company STILL wouldn’t cover a dime. She was able to find a coupon for a three month supply for $350.
And see, that’s what my problem was
Yes, I am technically a type-2 diabetic, but i am a diabetic with good numbers, so my insurance is saying "oh we wont pay for those meds. You don’t need it."🙄😒
Unfortunately, the answer is to move to a country that’s not a shit hole and has universal healthcare. The next best is to do what you can to survive while you try to convince people to vote with you for a gov’t that will give you universal healthcare.
Right now? I can’t imagine what you’re going through and I really am sorry I can’t help directly. Your system is broken. Your gov’t has failed you. I really, truly and honestly, wish you the best and hope you find the help you need.
Then you gotta pump those numbers up, those are rookie numbers!
(pls don’t)
Three months for 350 is pretty good, here it’s 500 a month.
Because the humans making money off health insurance don’t care that we suffer. Our wellbeing is absolutely irrelevant. That is why the Luigi is a folk hero right now. Get Saint Luigi a meeting with your health insurance CEO.
Capitalism and actuarial science. Their models likely show that you are still young enough for them to keep you fat for a few years while the cost of GLP1s go down.
The reason is that doctors and pharmaceutical companies are also for profit, meaning they make money selling you treatments. This puts them in a position to use your condition to exploit both you and the company. The insurance company is balancing the cost of your preferred treatment versus the cost of other treatment and the benefits. You can work with your doctor to build a documented record of attempting to lose weight- see a nutritionist, start seeing a therapist for your food addiction, start going to weight loss meetings, exercise therapy for the morbidly obese, etc. These will also be helpful by themselves, because those drugs are only temporary. Like weight loss surgery, people regain the weight when they don’t do the work to address the underlying issue.
This is what pushed Luigi to allegedly merc one of them
What do you mean, Luigi was at my place playing xbox games when that guy got killed.
Can confirm. I was playing with both of them online, and Luigi and I were making lewd comments about lemmyng’s mom.
That was so rude, but also hilarious. It was a big lobby that night, but Luigi was really keeping everyone chill.
yep, I was there too.
Allegedly ☝️
Because the filthy rich don’t care if anyone dies.
They care if a rich person dies. My friend Luigi proved that.
Allegedly. Could have been anyone. More people had a motive than would fit into a police database.
You can get wegovy 28-day of the auto injectors through Amazon pharmacy for $200 a month without insurance. It still requires a prescription, but it sounds like you have that.
Obviously it would be better if your insurance would cover it, but $200 a month is better than the $600 a month some people are paying for ozempic/etc.
When signing up for insurance, you’ll want to check their approved medications. My wife was prescribed mounjaro for her diabetes, but most of the insurance plans we looked at didn’t have it listed as one of their approved medicines. It was one of the largest factors in deciding which insurance we needed to go with.
apparently you can use coupons for the pharmacy in amazon to lower the price evenmore. i wonder of goodrx works on it.
Clown ass country where we need coupons for medicine
Tgis article has some helpful tips if you haven’t tried what the article entails.
healthline.com/…/how-to-appeal-insurance-claim-de…
Also assuming you’re American look to see if your state has a Department of Insurance. I had a positive experience with mine when Geico was trying to pay me half what my car was worth.
Oh, I know the answer to this one. It’s because we don’t have single-payer healthcare, which Republicans don’t want because they don’t want bureaucratic death panels of disconnected doctors denying people access to medication.
They’d much prefer to have bureaucratic death panels entirely disconnected from any medical expertise denying people access to their medication and for spurious reasons.
Had the same experience. I ended up having my doctor write a prescription for wegovy pills and am just paying $200 out of pocket. I figure I’m at least breaking even by eating less. Only been a month so far.
The insurance company is going to have a doctor who said you don’t need it. They will try to hide who that doctor is, specifically what their NPI is, which can be used to personally identify the doctor who made the medical judgement against your doctor’s without having to provide further explanation than they’ve already given. Depending where you are they may have to provide more information when directly asked for specific evidences, or will suddenly change their rejection on the claim with a letter from an attorney asking for specific details in writing. They know hiring an attorney is expensive and bank on people not advocating for their rights & people with severe medical issues not being able to afford to.
<img alt="a list of things to request from your insurer that may cause them to charge their determination" src="https://lemmy.dbzer0.com/pictrs/image/43cc8666-b83f-49cd-8d00-76e17e85f936.webp">
And lastly a video of a surgeon being denied the NPI of the insurance’s doctors who are likely breaking the law hiding behind the idea that insurance doctors are so hated they need to hide their identity even from other doctors to prevent reprisal. She was blacklisted from United claims for this video and others like it.
youtu.be/AZhCYisIQB8
This is the lore. I haven’t heard from anybody trying it, I hope OP will make the attempt and report back.
To add on to this, my psychologist told me that he’s had antipsychotic meds denied by a urologist before, because the insurance companies often don’t actually care what field the doctor is in. All they care about is getting to say “a doctor” reviewed it.
then they have teams to review the first insurance agent approved your medications, and sometimes a team to review that teams decision of said medication. they will do this til you give up.
And you can leverage that in your appeal letter.
Especially when you have a pissy provider who doesn’t like being told “no.”
I have a relative who is a doctor. Had a claim denied once from someone that was not a doctor. Next: denied by someone not actively practicing in the field. Then denied by a doctor with no experience in that specialty. Only after all of that was it approved. They’ve also been picky about order of operations, such as not covering an MRI because there wasn’t also an order for a CT.
Isn’t the insurance approving the medication/procedure only after being asked for proof the denial was legally obtained evidence that the denial was illegal, and reason enough for a lawsuit?
I have no idea, it might be worth checking with a couple attorneys who specialize in healthcare to see if you have a case worth pursuing as many will at least do a quick consult to see if you have a case without charging. The legal system is setup for wealthy people and organizations though so I wouldn’t expect much without something like practicing completely outside of their area or pretending to be from another state or something more than a lapsed certification or making judgements from a kinda similar but not really the same specialty.
Because Fuck You, that’s why.
Mounjaro and Ozempic both have savings cards you can sign up for on their respective websites, as long as you aren’t on government insurance.
I had the same issue last year, my A1C was 6.9 and insurance denied coverage. I got the savings card from Lilly, had my doctor call in the script and BAM! 25USD for 12 weeks of Mounjaro.
I didn’t even need a prior authorization anymore. Apparently results may vary, but I got lucky. Try them both if needed. Stay vigilant!
I am on government insurance.
they recently stopped covering glp-1 and similar for state subsidized healthcare, seems to coincide with it being lobbied against recently in congress.
The insurance companies want to make money.
There are no (enforced) laws prohibiting this behavior.
Very few insurance company decision makers are murdered in the street.
Change one or more of these, and you’ll get better results.
Not to say you should be denied prescription coverage, but that is not the whole kit and caboodle. Weight loss results from consuming less calories; specifically, less than you are burning. You can lose weight on a completely unhealthy diet and without any extra effort to exercise.
What a pointless post.
If my alternative would be 200$ per week, I’d take eating less as a solution.
And depressed people can save money by just smiling more!
My first reaction would be to say not the same thing, but then I remembered we’ve had studies recently that have confirmed that depression can genuinely be helped by leaving the house and touching grass.
But still not the same thing compared to depression, unless you have some eating related disorder or medical issue, the vast majority don’t and historically never have. The obseity epidemic is caused by caloric density creeping up in ultra processed foods, which already tells you everything you need to know, tricking people into thinking they eat a normal amount when they most definitely don’t.
The fact that this food is almost like a drug for some brains combined with the fact that some bodies struggle more than others with burning calories can make it more difficult at first for people but given difficult circumstances like having to pay 200$ per week to do something about it, there is always the free alternative. The difficulty in this case is more akin to quitting smoking or coffee. No one said it’s easy, but most could do it if they set their minds on it.
On a less brute force but not free path I would spend a fraction of that money on a dietician that can monitor my intake and make recommendations. At least that way there’s external support and motivation. I found they are like 100-200$ per month so an 8th to a quarter of the ozempic price.
What I’m hearing here is the reason her medication was denied is because people like you are more than willing to jump between a patient and their doctor to take the bullet.
There are many who had all these resources and the only thing that worked was this medication.
You clearly do not have the medical knowledge to back any of this up since your take away from those articles on excersing for depression is that it’s is a replacement for medicine. That’s the pop-science understanding of the topic.
You are leaking Dunning-Krugerall over this thread and you inability to absorb new knowledge here is telling.
Yep, this. I’m like 130 lbs and I literally sit around all day and I eat garbage. But just a little garbage.
Sadly there are some people i know who gain enough to look unhealthy if they dont eat a strict healthy vegan diet. And its easily to see in some cases. A friend of mine was very annoyed when she only got compliments after such rigorous effort. At that time her unhealtiest snack was dried strawberries.
On the other spectrum is me who cant gain any weight how matter what and how much i eat (cant even donate blood ;.;)
Bodies are VERY different and there are extremes where only meds can help and i think OP is one of them
True, and it could be easier for them to keep weight on, but CICO is a very basic science and will work if one keeps to it.
she must be dehydrated if she eats “freeze dried strawberries”
She definetly hydrated helself properly with those 2L/Day bottles
While CICO is universally true, it doesn’t account for a few other factors. For instance, gut microbiome. Gut flora has a strong affect on cravings. Also mental and emotional health also affect self control and regulation. Food “science” has created craving
monstrositiessnacks that are as addictive as cigarettes. Personal health issues like PCOS and thyroid dysfunction will affect how many calories are consumed by the body and how those calories are used within the body.So yes, eat less and lose weight. Sure. Some people can lose weight eating junk. For others it creates a reward cascade in the brain that leads to overeating. Just eat less. For some that’s as practical as telling a lifelong smoker to give up the habit. And that’s why medical alternatives to self control exist, but aren’t successful without addressing the root cause of the obesity.
All those behavior cycles and feedback mechanisms are also literally what these GPL drugs suppress.
It’s like anxiety meds for someone who has diabilitating anxiety to just relax. Or more commonly telling the clinically depressed to just smile more.
Telling someone it’s a personal failing only fuels the feedback mechanism.
Medications exist because they stop the biological feedback loops.
Exactly!
Money and the power of “fuck you”.
:(
This sucks, and I’m sorry, but you missed one crucial thing.
Have you tried eating less? Fruits and veggies give you good nutrition, working out builds muscle, but the only thing you can do to actually lose weight is to eat less.
Yes, i have in fact tried eating less
LMAO @ “You missed one crucial thing: Have you tried eating less?”
What a ridiculous question.
Stay strong and I hope you can get the medication you need.
I mean it is pretty crucial.
Assuming that someone who’s been trying to lose weight for 5 years never considered eating less is laughable and condescending.
It’s like telling someone with a severe substance addiction “You missed one crucial thing: Have you tried not doing drugs?”
True lol. It’s just that that’s usually the culprit. Eating less is really hard, and tons of people are addicted to food. I’m not trying to be the enemy here, despite what it seems. It’s the fact that OP didn’t say they tried eating less in their post, so that was what first came to mind.
And our bodies are just machines. We can’t create fat if were using the calories we consume. I don’t really get anyone who “tries” to lose weight for years. If you keep putting more food in your body than you need, your body converts it to fat. The idea of since “strange reason” that a body won’t lose weight is silly. There’s just no way for a body to keep weight on unless they are taking in more calories than they are using. So if OP can’t bear to eat less, they need to get really active. There really isn’t a mystery here. Its math. If you only add to the equation, the figure only increases. This is a willpower issue. … Or maybe we found the one obese American whose body defies caloric mathematics.
My weight varies around 50kg and there was a stretch of a few years where I tried bulking up to put on muscle. I found it very difficult and only got up to about 65kg where I plateaued (and it was damn difficult to get to that point—required an annoying amount of calorie-counting). I think my body is just naturally averse to putting on weight. It naturally follows that there are some people with the inverse problem, where their bodies naturally want to keep fat. I have friends who say they have this problem, and I have no reason to believe they’re lying; they know I wouldn’t judge if they just said they like eating and don’t feel like changing. There’s 8 billion people on Earth and plenty of genetic diversity among us. Of all the fat people in the world, you really think every single one of them is incapable of simply eating less? Or do you think I’m too stupid to decide to eat more food? Come on.
Just because a rock falls down doesn’t mean it “naturally follows” that some rocks fall upward too. There is no way to invoke a system that stores excess energy as fat if there is no excess. Could some energy that is actually needed get stored as fat? Okay, but… Not for long, as the body would need energy, since it isn’t getting calories. Unless it is getting calories from food.
I went from 175lbs to 125lbs in four months during divorce proceedings. My metabolism didn’t change. I wasn’t on a new miracle drug. I was depressed and didn’t eat, and I took up running a 3.2mi circuit around the bay where I live.
To your point, I bet OP’s diet would help you bulk up, just not likely with muscle. Chow a few gallons of ice cream each week. Eat American fast food three to ten times a week. Put cheese on everything. Ignore the “added sugars” part of the nutrition label. My weekly intake fits in a single shopping bag. I doubt OP can say the same. They weigh 2.5 times my weight.
Willpower is much harder to muster for a whole year, and its exceedingly difficult to avoid bad calories in this country.
ETA: Ozempic isn’t prescribed because doctors found patients whose bodies are non-conformant to the basic principles of caloric intake. It’s because doctors know patients have no willpower, and its likely the only way they will accept to lose weight.
Nobody can defy the laws of thermodynamics, but some people can be genetically predisposed to being fatter, just as some people are genetically predisposed to being taller. Plenty of skinny people (myself included) can eat through loads of fatty fried foods and not put on a single kg. Meanwhile you see a fat person eating all salads and they get told maybe they should eat fewer salads.
And even if it were entirely down to what you eat, calling it an issue of willpower is just insulting. Do you think people struggling with drug addiction just have a willpower issue? If OP is in the US (which I’m assuming she is from the described healthcare system), the food there is designed to be practically addictive and unhealthy. I doubt OP has a diet of cheeseburgers and doritos—it wouldn’t make sense for someone trying to lose weight to eat like that—but if she did, that’s clearly a social issue of both fast food companies under capitalism, availability of healthy food, and a US food culture centred around destroying your arteries. Sure, a drug addict could simply physically not pick up the needle, but they can hardly be blamed for doing so when there is an obvious material reason for them doing so, ie a chemical addiction.
Do you keep your calories under a certain amount every day? Myfitnesspal used to be good for tracking that. Now I use cronometer!
y’all are so salty and hate facts lol.
For some people that “eating fewer calories” part might be only eating a few hundred calories a day because of insulin resistance (hello?), certain medications they’re taking (like beta blockers) or plain old stupid genes.
The average resting human body burns like 1200-1800 calories a day. So no, not a few hundred lol. If OP ate around 2000 they’d probably start to lose weight.
Also: both of my parents have diabetes and they’re both relatively thin. It’s not that complicated.
Has it occurred to you that OP has heard advice like yours with varying levels of condescension literally all their life?
And they haven’t asked for weight loss advice in this thread. They asked for advice on accessing healthcare their doctor has deemed necessary.
Sorry. I can only afford liver and roadkill.
I’m sure you think the whole world revolves around you, but without giving your country, how can anyone answer this?
I’ll assume you’re in the UK, and suggest you use the NHS.
I do not “think that the whole world revolves around me”
Then how would you expect anyone to answer about a country specific think like health insurance without saying what country you’re in? Are you Japanese?
No, I am not Japanese
It is indeed curious that a place called “no stupid questions” is rampant with US defaultism.
The NHS will prescribe both. Germany too because they have diabetes. If they don’t have diabetes the latter won’t, even though the medications have been approved by STILO for weight loss (that is, if you have a gesetzliche Versicherung, private insurance will prescribe them).
They have their weight in lbs and talk about health insurance and for some reason you think the UK?
The UK still uses imperial measurements for things like height and weight.
Because only 'Muricas:
Because there aren’t enough Nintendo video game characters advocating for a change.
Nurse here. Because in America our healthcare priorities are FUCKED that way. Getting worse every year too
isnt also because alcohol industry is lobbying against it, because omezpic also reduces your “desire” for drugs.
and McDonalds.
no way this skinny CEO eats that shit.
<img alt="" src="https://lemmy.ca/pictrs/image/a5918d7d-e1dd-469a-8e13-34696eca1db0.png">
He swallowed some of the juice, he’ll taste that for weeks.
You gotta love the wince developing on the left side of his face as he chokes down his promo nibble.
I think “Super Size Me” touched on this. Calories in the burger aren’t as impactful as calories in the fries and drink.
it simple, they wont pay for expensive ones at all. brand names, they prefer you to take generics over it, even if its a different type of generic.
they dont like paying for expensive services.
Also insurance may have tiered system for certain drugs, the lowest being generics, the 2nd one being brand name of generics, and then expensive generics would be the next tier, or brand names that dont have generics.
its when you get to things like biologics, or speciality drugs things get super expensive. think drugs for psorisis, chrons disease, or severe eczema.
Ozempic addicts ruined it for people who need the drugs.
The answer is evil greed.
Sadly that’s only (or mostly) in America. Here we get whatever meds the dr says. Most common ones are subsidized by the government (via taxes yes).
My idea of Ameroca was already wild but finding out you gotta convince an insurance company you pay that you need medicine a dr prescribes is crazy.
Oh and we get pretty much all blood tests and stays for free. GP one day, scan/test the same day (different location but some have them next door) then back at the GP by the end of the week with results and get your meds. Done.
Sorry OP.
Luigi…
Because “business” and “dollar amounts” are more important than human life (some human life anyway).
These drugs were originally diabetes drugs, that had the side effects of weight loss, but that wasn’t their original use that they got FDA approval for.
So they are going back and getting them approved for different uses, and maybe one of those will get by the insurance company. I saw one being advertised for Sleep Apnia, which is common in obese people. It works because when you lose weight, your Apnia usually improves, so while they aren’t selling it specifically for weight loss, that’s the mechanism that improves the Apnia. Maybe your doctor can get it approved for that reason, or another one.
I was 350, and I’ve lost 100 pounds, without the drugs. I quit all sugary beverages, and only drink ice water or unsweet tea. I only eat when I’m hungry, and only until I’m not hungry. It allows me to eat whatever I want, but in strict moderation. It doesn’t feel like a diet, though, because when I’m hungry I eat, but only until I’m not. I never eat more than a half sandwich. I will eat cookies, but only two, not half a package. When I have craving for chocolate, I’ll eat 4 or 5 chocolate chips, one at a time, and let them melt on my tongue, so my chocolate craving gets fulfilled, without an entire candy bar.
And importantly, I developed a distraction. My Dad quit smoking years ago, by doing a Rubik’s Cube whenever he got a craving. I took up the guitar. I keep an acoustic guitar next to my chair, and if I get a craving, instead of heading to the fridge, I pick up my guitar.
I didn’t even increase my exercise, although I have a pretty physically active job. I’ve plateaued now, so I think it’s time to increase my exercise for the last 50 I’d like to lose.
Keep at it, don’t give up. It is far easier to lose weight at your age than after about 30, so do it now. Keep making adjustments in your diet and exercise, and eventually your metabolism will shift and start working with you.
I’ll add that one huge thing is establishing a realistic plan that accepts weakness and failures without derailing. When I was actively losing weight I did the following cico based plan.
I started with a week of just counting calories, all diet changes were because I was aware of how much I was eating. While doing that I found out what my maintenance calories were and what the maintenance calories of my goal weight were.
I then did a week at my maintainance calories, though the goal is to keep doing it until it’s comfortable. While doing that I figured out general meal plans (ie how much I wanted to budget for breakfast/lunch/dinner/snacks). This stage is important because a) you’re probably used to overeating so this is you stopping gaining weight, b) you’re learning where you’re most comfortable cutting calories in your day, and c) relearning your relationship with hunger. For that last part, I was teaching myself to associate a mild hunger with losing weight and to stop seeing it as such a problem.
Then once I was comfortable at maintenance I began with a 500 calorie deficit. That’s a generally safe number that’s largely achievable and results in a pound a week loss. When I was comfortable there I moved up to 1000 a week, which is about the limit of what is safe/wise for the average person to sustain over an extended period without medical supervision. Either as the ultimate deficit is fine.
From there, don’t check the scale more than once a week, and if you hit a plateau for a few weeks reevaluate your maintenance calories and double check you aren’t missing some in your counts. I also recommend smaller portion sizes over a longer time. Keep food out of sight when it’s not eating time. Try a glass of water and a walk instead of a snack. You may need a multivitamin or to plan around your micronutrients. Fiber helps with satistion, refined sugar hurts with it, though you’ll figure out what foods leave you full and what foods just aren’t worth the calorie/fullness ratio pretty quickly. Some days you will fail, that’s ok, keep them spread out and don’t try to make up for them. You can have cheat days, but those calories do still count so keep them few and far between. Also home cooked is usually a better value for calories than premade.
Once you hit your goal keep counting while eating at maintenance for a while to ensure you’re sticking with stable maintenance habits. This isn’t supposed to be a yo yo (though if you’re active dirty bulk/cut cycles), instead it’s about building a healthy relationship with food portioning.
Exercise doesn’t make you lose weight outside maybe a hundred or two calories a day, but it does lead to a healthier lifestyle and creates reinforcement of the health and ability gains from weight loss. It also can raise your resting calorie burn (don’t calculate for changes from it until you’re done). The important thing is just like with diet, finding a way to sustain it. This means finding something involving cardio that you enjoy that you can do regularly like a sport, running, or biking. If you’re interested in strength building, bodyweight exercises are great. Slowly build up with exercise, until you’re at an activity level that you want.
Anyways yeah, I figure it’s worth putting all this out there since a lot of people out there love to act like it’s either all about willpower or all about finding tricks to not need any willpower, when really it’s all about building better habits and accepting that it took time to gain it, it’ll take time to lose it, but you lose it bit by bit with actual changes. I was never huge, but I lost 30 pounds in about half a year when I was OPs age and developed a healthy lifestyle for years out of it despite a family riddled with obesity, heart disease, and anorexia. This doesn’t take from the shittiness of what OP is going through and if her doctor feels the medical benefits outweigh the risks the insurance company needs to shut up and pay.
Losing weight is just math: Calories In vs Calories Out. Which one is bigger determines whether you gain or lose weight.
This is huge, and one of the first things that you have to overcome. Heavy people have been conditioned to not just eat when they feel the slightest hunger, but to stuff themselves. Making that psychological shift that a little hunger is not only acceptable, but it’s a signal that you are losing weight, is a sign that your diet is working. After a while, instead of motivating you to go to the refrigerator for something to eat, that hunger reminds you of your weight mission, and motivates you to stay the course.
It’s just math in the same way basketball is just a bunch of physics 101 problems. Yes, but the hard part is taking it from paper to doing it with biology. Your brain is struggling to get you to have an excess when there’s more than enough because animals whose brains didn’t do that were less likely to survive lean times. Add in complications like hypothyroidism and other endocrine and metabolic issues, some people are going to really struggle in ways others might not. For some the cravings will be far more intense than they can bear, and that’s why going in steps and waiting until that step is comfortable and sustainable before the next step is so useful.
Food can serve in many roles, some of which are healthy, such as a bonding exercise, cultural expression, and nutrition, others are unhealthy like stimulation and emotional comfort. One of the important things about my method is that the maintenance and early loss steps are going to challenge your negative relationships with food and find more healthy forms of stimulation and emotional comfort if those are reasons you overeat. A small weight is a great replacement for stimulation as is a glass of water or a walk. And learning to handle emotional distress without destructive coping mechanisms such as overeating is vital, here too I’ve found exercise to be a magnificent replacement. (Yeah basically any time anything happens or I feel anything I take a walk or bike ride)
Oh also I totally forgot to mention the self esteem elements. I’m not going to say nobody can hate themselves skinny, I’ve seen it, but the people who do it are rarely the sorts one should emulate. Much easier is to love yourself and your body enough to do this for yourself. “I deserve to have a body that I am physically and emotionally comfortable with” is just so much better of a mantra for when you’re hungry or struggling to exercise than something about hating how fat you are. You want to learn to look in the mirror with love and kindness and as time goes on with pride. Firstly because it’s not like fat people are less deserving of love and kindness. But also because you’re doing this for you, and it’s a hell of a lot easier to do something difficult for someone you love than out of spite. And that spite will fade as you lose weight anyways, and it may coincide with sagging skin.
But also, hugely important is that hating yourself is a fast track to disordered eating and overshooting weight loss as well as developing weight focused body dysmorphia (ie inability to see your healthy weight as healthy). I have a loved one who wound up hospitalized for anorexia, so it’s something I feel is important to acknowledge and avert the risks of. It’s better to be overweight and living an active and happy lifestyle than to be anorexic. General rule is a little over is better than a little under, but a lot over can be worse than a little under.
Money.
Nunber 1: Ozempic is NOT a weight loss drug.
Ozempic is a diabetes management drug that has a potential side-effect of weight loss.
The reason that you are likely being denied for Ozempic by your insurance is because you likely lack the diabetes with the additional comorbidities. You shared that you are diabetic with good numbers.
If you had worse diabetes and additional issues (comorbidities) such as high risk for stroke or heart attack by (very) high unmanaged blood pressure, then you could appeal the insurance company to cover the drug.
Number 2: the struggle is real. I highly recommend you fight this and continue your weight loss journey. Diabetes is unbelievably complicating later in life.
US healthcare will go broke covering $350/mo drugs to counteract lifestyle choices. 15M already on this drug, that’s $5.25B a month.
Oh no! Not the health
careinsurance industry.Damn, so five whole days of the Iran war would cover it for a whole month for everyone?
It doesn’t cost $350/mo/person to produce these drugs. Manufacturers brazenly price gouge knowing no goverment body would retaliate.
This is a problem that can be solved by legislation and cutting out the middle-man(insurance companies) by expanding medicare for all.
Good. Fuck em all and replace the whole thing with a system that works.
Look into compound pharmacies, you can get it for under $50 a month that way and not have to deal with insurance at all.
Sorry you are getting such negaticve responses here, people dont realize ozempic actually helps you to eat less and make the lifestyle changes people insist anyone can do without help. Feel free to dm me if you need additional help.
Im going to go out on a limb and assume you are from the us. us healthcare is nuts. Here is the funny thing. My wife has thyroid issues. Her bloodtests shows it within normal but on the low end. Doctor refuses to raise her cheap thyroid medicine and instead insists on a gpl. Even though she has other symptoms for low thyroid. insurance we had did pay for it. it makes no fucking sense. at times we can’t get stuff we need and at others we are given options we don’t want. A similar thing is there is this pretty cheap procedure called prp where they draw blood and centrifuge it down and dake the serum and inject it in a joint and it seems to relieve pain and does so for awhile. Like she could just get it once a year. They would not cover that but they did at one time. It kinda was based around what medicare was doing. They will pay for surgery that from our experinece may or may not make it better and may make it worse (we have more experience with surgery than anyone would want to have). That surgery is so expensive that if you were to stick the cost into a savings account it would easily make interest enough to do the prp. So even economics wise the insurance company should do the prp. Why don’t they. Because its like a game of chicken. people may get surgery but it does not always go well so many people will not get it. Also prp is done in the doctors office and does not require anything. They will pay for things from drug companies injected into the joint. We have just the worst system. Also you know why your insurance covers some things but not others? Some high muckity muck at your company want something. We had one that did unlimited chiro. Im like 100% the president or one of his family must get chiro adjustments every week or something. Either that or someone between the president and the hr level that decides on what insurance to use.
It’s not allowed, but then again, I’m not in the US.
Because your congressperson is bought and paid for and there aren’t enough people assassinating health insurance CEOs in the street to inspire them to change their ways.
Because capitalism and culture of inequality
It’s a private company operating under a contract that affords representatives ability to deny you payment for care on conditions that favor the company.
Why would it not be allowed?
The health insurance industry is an objectively evil but very profitable business model, that sustains itself directly on human misery.
This is allowed because our government is corrupt, paid off, and broadly dysfunctional, and/or controlled by ideological/religious extremists who hold bigotry of one kind or another as a fundamental principle.
This is allowed because exploiting your suffering makes a small number of people very wealthy.
And that small number of people runs everything by way of paying off nearly everyone involved in potentially regulating them, nearly every elected representative at the level of State government or higher.
You live in a failing, rogue, totalitarian, extremist state, run by pedophile rapist murderers who lie openly and brazenly every day.
You do not live in a well-run, representative democracy, that sees to the needs of its citizens.
You live it’s corpse.
Hey OP, I will copy a point I made somewhere deeper in this thread that you might not see, because I do really believe that there is help to be had. I commend you on your desire to do something about this, since it will increase your quality of life in ways you never even imagined. Other people have also had great points I think and have touched on the tragedy that is the US medical system, I want to touch on the potential alternative solutions that are too often overlooked.
The obesity epidemic is caused by caloric density creeping up in ultra processed foods, tricking people into thinking they eat a normal amount when they most definitely don’t. The fact that these foods are almost like a drug for some brains combined with the fact that some bodies struggle more than others with burning calories can make it more difficult at first for people to loose weight, but you find yourself in the difficult circumstance of having to pay 200$ per week to do something about it, and there are two alternatives.
“Eat healthier, eat more fruits and veggies, cut out excess sugar, walk more, exercise more, the whole kit and caboodle” - as an external observer with no context all I can read from this is that you replaced some unhealthy calories with some healthy calories. So the first proposal is calorie counting by yourself. You have to be anal about it, every little detail, any little snack has to be on your list and fully counted. If you do this properly and have a hard limit of 1500-2000 per day you will absolutely see results without having to do any excercise or eat any specific food. This is proven science at this point and anyone arguing about this is trying to sell you something or someone else sold them something. More colorful trends like intermittent fasting also achieve caloric deficit in a roundabout way, but in the end it doesn’t matter what approach you take, any way that works for you is fine, as long as you don’t go over the caloric limit. Losing weight is not exciting and doesn’t have some funny quirky solution, it’s just simple hard brute force.
Second, a little less brute force solution, but also not free, spend a fraction of that ozempic money on a registered dietician that can monitor your intake and make recommendations. At least that way there’s external support and motivation, as well as much needed help in case you have a history of eating disorder. I found they are like 100-200$ per month so an 8th to a quarter of the ozempic price. This is still going to be hard work, but with support and help from an expert it will be far easier to establish and maintain.
Both of these solutions will help build good habits and help you build an intuition for food caloric content at a glance. Ozempic, if it works, skips these important aspects, which might make you rebound after finishing the treatment, since you never actually learned how to manage your intake, just had reduced appetite for the duration of the treatment. Any aditional things you do like eating healthier and exercising will be a great bonus to your health, but you should honestly skip if they are overwhelming you and impeding you from achieving your goal. It’s normal to expect failure when the requirements are steep, so keep it a level you can manage. If calorie restriction is all you can do, then stick to that, but don’t compromise it ever because that is the absolute minimum. Everything else may come later.
I wish you good luck with your journey and hope you’ll enjoy the new life when you finally succeed.
Edit: bonus point I forgot to make earlier. Exercise may actually increase your appetite because that’s just how the body is wired. Which will make resticting calories even more difficult from a mental/willpower perspective. So it may be advisable to actually not exersice while you are trying to achieve your goals, because dealing with both changes of exercising and eating less at the same time can be too much and leads to failure of both. If you have to choose, always do the calorie restriction, like I said before, that is the minimum requirement, everything else is a bonus.
This does not refute your bonus point, because this is going to depend on who you are. Everyone is different, so ymmv, but as a systems thinker with VERY pronounced ADHD, counting (while it works on paper) has never actually worked for me past the first few weeks.
In my experience, though, when I am exercising, yes I may eat a bit more to replace what was spent, but I’m put in touch with my body a LOT more, and get clearer signals for what to eat. This often ends up becoming a kind of feedback loop, because I’ll start craving healthier foods that contain more micros, and are less calorically dense whole foods - mostly plants. I’m no longer eating just to get through, but responding to my body intuitively, which significantly reduces the cognitive load of “gotta eat healthy foods”. This is self-reinforcing too. As new microorganisms from specific foods colonize the gut, it pushes the brain to want more of those foods. (Sounds crazy, but it’s true.)
For example, maybe I’ll want a chopped up head of iceberg lettuce with shredded beets/carrots, SMALL portion of chicken/salmon/tofu and a piece of fruit instead of just that dense protein bar or bag of chips to keep me going. Good luck gaining weight on the first one - you would literally not have enough time in the day to prepare, eat and digest an amount that would add any weight.
Exercise doesn’t have to be crazy strenuous either. Just moving at all helps, and low impact movement can help tremendously with the aches and pains that can come with extra weight. OP is very young, and might not be feeling it yet, but she will.
Walking, swimming, cycling, and yoga are all fantastic places to start out, and those activities do have varying levels of accessibility but they’re still all very achievable for the vast majority of people.
CICO is fundamental science at the level of basic physics, but there’s also human psychology and the brain-gut connection to contend with. Layering other things on top of CICO, to that end, could result in compounding effects which accelerate and complement a foundation of rote calorie counting. A whole-system approach that integrates movement, nutrition and food prep skills together with intuitive eating is very much worth trying and is more likely to last long term IMO. With enough practice, this became a new normal. I feel great, keep a healthy stable weight and don’t even think about calories anymore tbh.
Something I’ve noticed is that doctors like to offload saying “no” to insurance companies so they don’t have to do it themselves. That’s at least part of it.
The is healthcare system is clearly a disaster but …. Since those drugs are not approved treatment for a health issue you have (your diabetes is under control), they have. Bit of an excuse. The real reason of course is that most of the population is overweight so they can’t afford to pay for everyone who needs it.
Can I suggest other strategies that may help you lose weight?
When I was planning to have kids I successfully lost over 100 pounds and kept it off for a decade! For me the key factors were doing it with my wife so we kept each other on track and food tracking. We joined weight watchers but it was the food tracking that made the difference for me and there’s many ways to do that. Even when you think you’re doing well you probably consume a lot more calories than you think, and it adds up. Food tracking can highlight this, identify where to make more effort. On the other side of things, losing weight requires following good habits over time: food tracking also helps you stay on track over time but this is also where peer pressure from someone else can really help.
Of course I’ve gained it all back now that my kids are in college but I did pretty well for their entire childhood, which was my motivation. I currently may have better nutritional habits than I did back then but I’m clearly way off in portion size and calories consumed
Because profit margin. There’s no deeper reason than that.
Doctors are concerned with your health.
Health insurance companies are concerned with the stock price.
These are conflicting goals.
Because everything in America is a privatized scam and the regulatory agencies are being completely dismantled