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?
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
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.
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 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.
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 not allowed, but then again, I’m not in the US.
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.
Good. Fuck em all and replace the whole thing with a system that works.
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.
Damn, so five whole days of the Iran war would cover it for a whole month for everyone?
Oh no! Not the health
careinsurance industry.
Why is this allowed?
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?
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.
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.
Money.
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.
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
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.
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…
