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?

  • gilokee@lemmy.world
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    2 days ago

    This sucks, and I’m sorry, but you missed one crucial thing.

    Eat healthier, eat more fruits and veggies, cut out excess sugar, walk more, exercise more

    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.

      • Pommes_für_dein_Balg@feddit.org
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        2 days ago

        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.

          • Pommes_für_dein_Balg@feddit.org
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            2 days ago

            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?”

            • gilokee@lemmy.world
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              2 days ago

              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.

              • s38b35M5@lemmy.world
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                2 days ago

                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.

                • communism@lemmy.ml
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                  2 days ago

                  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.

                  • s38b35M5@lemmy.world
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                    2 days ago

                    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.

      • gilokee@lemmy.world
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        2 days ago

        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.

        • Pommes_für_dein_Balg@feddit.org
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          2 days ago

          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.

        • starlinguk@lemmy.world
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          2 days ago

          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.

          • gilokee@lemmy.world
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            2 days ago

            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.