Is this really the best we can do?

Day three of the #DDdailygratitude challenge and already, I’m inspired to share one of my posts in a longer blog form! Unfortunately, the motivation stems from all of the frustration and anger that ultimately turned into my gratitude for the day.

I’m scheduled for a resting metabolic rate test (also known as an oxygen uptake exam, or an indirect calorimetry test) next Friday, but I need to get pre-authorization because many health plans won’t cover the exam. I have been at a weight plateau since April despite working out regularly and monitoring my diet, and so my doctor wants to do this test so that we can better calibrate my nutrition. Basically, we’re checking to see the rate at which my body burns calories while I’m completely at rest, to make sure that my metabolism is behaving the way it should be. The results of this test will help me to make sure that I’m eating enough to support my energy output in my workouts, while still maintaining an appropriate calorie deficit to get my weight down.

The pre-authorization turned into a circus. Aetna couldn’t authorize the test without the appropriate CPT code. The doctor’s office didn’t know it, and billing had to transfer me four times before they could answer my question. Spoiler alert: the Google result for the code was correct and I could have saved myself a whole lot of hold time. When I called Aetna a second time, they gave me a benefit policy code to look up, but basically told me “We won’t cover this, unless your doctor says it’s medically necessary.” However, they couldn’t tell me what “medically necessary” means. Last I checked, the very act of referring me for the test could be considered my doctor deciding this was medically necessary… but I digress.

I looked up the benefit policy to better understand what was going on, and that turned out to be a very, very bad idea. You can find it here in full, if you’re interested. Basically, I would qualify for weight loss medication, no questions asked, but they won’t cover this test because it’s still considered “experimental” or “investigational” for weight loss. Mind you, the benefit goes on to acknowledge that medication works in conjunction with calorie restriction and exercise, and also that weight loss from medication is usually temporary…. but it has the studies to back it up, so it’s all good in their book. However, this test apparently isn’t considered sound science, so Aetna’s having none of it.

A quick PubMed search turned up an article titled “Indirect Calorimetry: A practical guide for clinicians,” which

“Measurement of energy expenditure is the most accurate method to assess energy needs. Indirect calorimetry remains a gold standard in measuring energy expenditure in the clinical settings… To achieve the highest quality of patient care, we should strive for patient-specific nutrition support regiments. Indirect calorimetry offers a scientifically-based approach to customize a patient’s energy needs and nutrient delivery to maximize the benefits of nutrition therapy.” [Nutr Clin Pract. 2007 Aug;22(4):377-88]

Meanwhile, a systematic review of energy expenditure studies, published in Obesity Reviews in 2012, turned up this endorsement of using indirect calorimetry to get more accurate information for patients:

“Today, many health professionals including dietitians typically use prediction equations because of ease of use, low cost and decreased participant burden, but emerging evidence is reflecting great disparities between predicted and measured energy values… The level of inaccuracies of prediction equations that are commonly used in clinical practice may potentially impact patient outcomes… As health professionals seek to improve their quality of service and provide appropriate nutrition care to prevent clinical morbidity and mortality, measuring energy requirements through IC [indirect calorimetry] may be the direction of the future.” [Obesity Reviews, 13: 753–765. doi:10.1111/j.1467-789X.2012.01000.x]

(In case you’re wondering, this is what happens when you’re someone who is naturally curious, who enjoys learning about interesting topics, who believes in doing the research on her own health, AND who also happens to work in academic publishing. Doctors either love me or hate me. There’s no in between.)

So, basically, I was in a really bad place when I called my doctor’s office for the third time today. I had a phone number from Aetna, and I needed my physician to call and make the case for medical necessity, so I’m not on the hook for $200. And that’s when today’s moment of gratitude stepped in.

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The woman I spoke to this third and final time was so kind. She took down all of my information, and she reassured me when she let me know that she processes requests like this all the time. My doctor is at a conference through Monday, so she told me she’d share the message then, and she also promised to follow up with me herself Monday afternoon, even if she didn’t yet have an answer, just so I’d know where things stood at that point. She listened. She cared. It was so unlike every other conversation I had experienced so far today, and I was so grateful to her, I burst into tears. (What can I say? It’s been a long week.)

It’s a sad commentary on the state of our health care in this country that I had to jump through so many hoops today, and an even sadder commentary on human behavior in general that I felt so surprised and relieved to finally experience a little kindness.

We’ll see how this all plays out. I’m probably going to move forward with the test either way, just to know exactly where my metabolism stands, but I’d feel a hell of a lot better if it didn’t set me back $200. More to come!

In the meantime, it’s not too late to jump on this Daily Gratitude plan. Thanks to @thedaydesigner for pulling this together, and for making awesome planners – check out their website here. I love that they offer free printables so you can see how the layout works for you before ordering the full planner. I’ve been using their Daily Planner printable for almost a month and I love it, and I can’t wait to order my 2017 Planner!

Emotional Eating: Why Can’t I Quit You?

Emotional eating has always been my biggest nemesis in the battle to improve my diet. Food has seemingly always been tied to how I’m feeling. Birthday celebrations centered around decadent cakes covered in sugary icing from the local Italian bakery. Stressful periods meant that stopping for fast food could be excused away by my busy schedule. When someone in my family was sick, or after a death, friends and neighbors would come bearing gifts of food – bags of bagels and cream cheese, trays of lasagna, deli platters to feed an army.

Weight Watchers is capitalizing on this right now with their current ad campaign. I have tried their programs in the past and it didn’t work for me, but I know there are a lot of people who swear by the company. Sharing this video is in no way an endorsement of their methods; it is, however, a great piece of advertising and one that hits home with today’s topic.

I’ve mentioned this a few times recently, but my family’s been going through a rough patch lately. My father had surgery last week, and it’s been difficult to keep up with a sense of normalcy with everything that’s been going on. I tend to internalize things like this, which is not to say that there haven’t been incredible displays of support and friendship from the people I care about; I just tend not to talk much about things like this when they’re going on. So, instead, I go to war with the grocery store. Ice cream? Chips? Homemade chocolate chip cookies? All things that were on the patient’s wish list for recovery snacks, and I had zero mental energy to find the willpower to resist adding my own treats to the cart when shopping last week.

So here we are. It’s been a week since the surgery, and I feel gross. I haven’t been eating well, I’ve been drinking way too much wine, and my body is letting me know that it is displeased. My pants are feeling tight, I have no energy, and I can’t find the willpower to get back to my normal healthy eating and exercising routine.

This latest incidence of emotional eating has helped me to see that I need to focus more on the mental side of all of this. I know what I need to do to lose weight and get in better physical shape, and I am totally capable of doing all of those things. What I need to figure out know is how to maintain those habits and not let outside forces shake me to the core. Life happens and I need to learn that turning to comfort foods not only won’t comfort me, but it will make me feel worse in the long run.

I’m making this one of my priorities for the coming year and I’d love suggestions from others who have dealt with this in the past. Any books that particularly worked for you? Techniques to try? Should I just suck it up and try therapy? Advice is welcome, and much appreciated!

Fitnasty for Life
I’m teaming up with Carolyn over at Fitnasty for Life to get #Fit4Fifteen – check out the linkup!

Do you battle with emotional eating? What has worked for you?