The Diabetes Cure That Most Insurance Companies Won't Pay For(gizmodo.com)
gizmodo.com
The Diabetes Cure That Most Insurance Companies Won't Pay For
https://gizmodo.com/the-diabetes-cure-that-most-insurance-companies-wont-pa-1826946364
58 comments
From the article:
"For over a decade, Cummings and others have tried to reframe the very concept of bariatric surgery (they prefer “metabolic surgery”). Their work has shown these procedures just don’t change how much food the stomach can fit; they trigger a cascade of metabolic and bodily changes, many of which help people with type 2 diabetes naturally get their blood sugar under control. Some changes even start happening before a patient loses weight, such as higher levels of peptide production in the gut that seem to restore a patient’s sensitivity to insulin."
"For over a decade, Cummings and others have tried to reframe the very concept of bariatric surgery (they prefer “metabolic surgery”). Their work has shown these procedures just don’t change how much food the stomach can fit; they trigger a cascade of metabolic and bodily changes, many of which help people with type 2 diabetes naturally get their blood sugar under control. Some changes even start happening before a patient loses weight, such as higher levels of peptide production in the gut that seem to restore a patient’s sensitivity to insulin."
I have never heard of an association of obesity with autism. Claiming the converse wouldn't startle me as much, but surely the incidence of obesity and type 2 diabetes are far, far greater than autism.
Do you have any particular reason for your statement? Lately, I've been noticing frequent mentions of autism on the internet in weird and novel (to me) contexts.
Do you have any particular reason for your statement? Lately, I've been noticing frequent mentions of autism on the internet in weird and novel (to me) contexts.
> Part of the reason nobody wants to pay for it is it costs as much as a Model 3
That's a bargain compared to paying for a diabetic!
http://www.diabetes.org/advocacy/news-events/cost-of-diabete...
> People with diagnosed diabetes incur average medical expenditures of $16,752 per year, of which about $9,601is attributed to diabetes. People with diagnosed diabetes, on average, have medical expenditures approximately 2.3 times higher than what expenditures would be in the absence of diabetes.
That's a bargain compared to paying for a diabetic!
http://www.diabetes.org/advocacy/news-events/cost-of-diabete...
> People with diagnosed diabetes incur average medical expenditures of $16,752 per year, of which about $9,601is attributed to diabetes. People with diagnosed diabetes, on average, have medical expenditures approximately 2.3 times higher than what expenditures would be in the absence of diabetes.
Nope it really is a cure. I know people involved with diabetes research, and it really is a cure, and they dont know why. Its not because of the weight loss, because it is instant! They day the get the surgery, the loose the Diabetes II. (The people I know, work at Novo Nordisk, i would think its the world leader in diabetes and diabetes related research.)
As someone rather interested in the subject that has been my general understanding. The refusal for people to look beyond "eat less and fast etc" is rather disheartening.
What if they gain weight again, months or years after surgery? Does diabetes come back?
Im not doing the research, so I cant answer, but it dosent seem to be weight related, as they loose the diabetes on same day as surgery. They loose none of the weight on surgery,
Could it be a side effect of some part of the surgery procedure? Anesthesia perhaps?
> “My diabetes went into remission basically immediately, almost that same day. And I’ve been off insulin for about 8 months now,”
That's not because of the surgery. It's because he was forced into an extended fast before (and after) the surgery. Type 2 diabetes reverses almost immediately with fasting.
I have no personal involvement with Dr. Jason Fung's clinic in Canada, but he claims to reverse type 2 diabetes in virtually every case. https://idmprogram.com/
That's not because of the surgery. It's because he was forced into an extended fast before (and after) the surgery. Type 2 diabetes reverses almost immediately with fasting.
I have no personal involvement with Dr. Jason Fung's clinic in Canada, but he claims to reverse type 2 diabetes in virtually every case. https://idmprogram.com/
Similar is true for a Ketogenic diet. Virta Health(https://www.virtahealth.com/) founded by
Sami Inkinen(Trulia) and some well known doctors in the field, is using Ketogenic diet approach for Diabtetes type 2 treatment.
They've also published results from their clinical trials:
https://link.springer.com/article/10.1007%2Fs13300-018-0373-... http://diabetes.jmir.org/2017/1/e5/
They've also published results from their clinical trials:
https://link.springer.com/article/10.1007%2Fs13300-018-0373-... http://diabetes.jmir.org/2017/1/e5/
As someone who has recently gotten into fasting for health and aesthetic reasons, I wonder about the best place to learn more about it in depth. It seems like it could be a very powerful asset in one's health toolbox, but I also don't want to accidentally screw myself up by doing it the wrong way. Please advise.
Sorry, I should have been more specific. That's specifically intermittent fasting, I've done that for a year, it was ok and didn't do much for me.
I'm mostly interesting in longer water fasts, anywhere between 1 and 7 days.
I'm mostly interesting in longer water fasts, anywhere between 1 and 7 days.
> reverses almost immediately with fasting.
And this effect lasts for eight months?
And this effect lasts for eight months?
Type II Diabetes has insulin resistance as an underpinning. This resistance can be reversed with fasting. Eating healthy is easier once fasting has been reversed, and it is necessary to sustain the results.
Exactly. Fasting cures diabetes as well as a host of many other "incurable" "diseases". But there is no money in fasting, so our messed up world continues to reject it as a valid solution.
Let's not go too far.
The science on fasting as a diabetes treatment seems legitimate (even if early/still evolving), but claiming it cures other "incurable diseases" seems unsupported (particularly if you don't specify WHAT diseases).
Weight loss in general helps combat some other illnesses like high blood pressure, and while fasting might be a means to that end (i.e. weight loss) I've not read studies that looked at if fasting is more beneficial than other forms of weight loss.
Heck, even the fasting diabetes thing is very young science, I wouldn't call even that conclusive yet.
The science on fasting as a diabetes treatment seems legitimate (even if early/still evolving), but claiming it cures other "incurable diseases" seems unsupported (particularly if you don't specify WHAT diseases).
Weight loss in general helps combat some other illnesses like high blood pressure, and while fasting might be a means to that end (i.e. weight loss) I've not read studies that looked at if fasting is more beneficial than other forms of weight loss.
Heck, even the fasting diabetes thing is very young science, I wouldn't call even that conclusive yet.
You can call it what you want. I've been in the field for 20 years and have seen many hundreds of people cure so-called lifelong diseases. But sure, wait on the medical world to admit it, because they have all the incentive in the world NOT to do it if they want to keep the money flowing.
Call what what I want? You haven't even said what diseases...
Plus I'm a little confused by your terminology, you say you've been "in the field" for 20 years but then refer to the medical world like it is a third party. Which field is that you've been in?
Plus I'm a little confused by your terminology, you say you've been "in the field" for 20 years but then refer to the medical world like it is a third party. Which field is that you've been in?
There's actually money in exercise, and it has huge health benefits, but similarly dismal uptake rates. I wouldn't blame the illuminati just yet.
Nope. There is very little money in true exercise. The profits come from unhealthy things such as protein supplements, harmful body building, gyms that promote unhealthy exercise routine, etc.
Protein powder is just protein - it's a specialized food source. Are there bad supplements? Totally - but dodgy salad will give you salmonella.
Bodybuilders actually use intermittent fasting - the unhealthy bits is the supplement abuse, but that's the sort of thing that happens with any extreme lifestyle. That's also a super limited view of the strength world.
What's an "unhealthy exercise routine"? Literally anything is better than doing nothing. Is it optimal? No, but if it gets you moving it helps. Are you talking injury or things that actively make you less "healthy"? I could see an argument from injury, but I'd rather someone have a ruptured ACL now than heart disease later.
I feel like we're about to enter "No True Scotsman" territory here.
Bodybuilders actually use intermittent fasting - the unhealthy bits is the supplement abuse, but that's the sort of thing that happens with any extreme lifestyle. That's also a super limited view of the strength world.
What's an "unhealthy exercise routine"? Literally anything is better than doing nothing. Is it optimal? No, but if it gets you moving it helps. Are you talking injury or things that actively make you less "healthy"? I could see an argument from injury, but I'd rather someone have a ruptured ACL now than heart disease later.
I feel like we're about to enter "No True Scotsman" territory here.
Sad that people are already downvoting you, and sad that more people don't know about other options than medication/surgery.
Here's a link to Dr. Fung's article specifically on reversing type 2 diabetes (https://idmprogram.com/reverse-type-2-diabetes-the-quick-sta...).
Keep downvoting me too, Big Pharma.
Here's a link to Dr. Fung's article specifically on reversing type 2 diabetes (https://idmprogram.com/reverse-type-2-diabetes-the-quick-sta...).
Keep downvoting me too, Big Pharma.
People are downvoting the parent to your comment because of the "a host of many other "incurable" "diseases" part. It's unsubstantiated and unspecific, and it jumps right to conspiracy theory.
People are downvoting you because you are violating at least 3 site guidelines (commenting about voting, alleging astroturfing/shillage, and being civil). Particularly when you could have made a constructive argument and tried to elaborate what conditions it cured, what studies were behind it (maybe summarizing Dr. Fung's research), or other more valuable contributions.
People are downvoting you because you are violating at least 3 site guidelines (commenting about voting, alleging astroturfing/shillage, and being civil). Particularly when you could have made a constructive argument and tried to elaborate what conditions it cured, what studies were behind it (maybe summarizing Dr. Fung's research), or other more valuable contributions.
These are probably the same people who think CNN is "fake news".
Big Pharma and other such entities have presence in every large online community, HN and Reddit included.
This is clickbait at best, and isn't a cure for Diabetes. Yes it will help a very small fraction of those that suffer from Type 2, but on the whole the article (title especially) is very misleading.
There is a distinct difference between Type 2 diabetes "cure" and "reversal".
Reversal: what is being described here. Symptoms go away, and the longer you pursue the treatment, more difficult it becomes to clinically determine you ever had the metabolic disorder in the first place. However, the latent characteristics that made you first susceptible still exist.
Cure: you not only reverse, but you could stuff your face with pizza and Ho Ho pastries, wash it down with a gallon of Mountain Dew, and your blood sugar hardly budges, like normal people.
We do not have a cure. Short of genetically rewiring in vivo, or similar advancement, we won't see a cure. However, ongoing improvement of our understanding of how our bodies work continue to make it simpler than ever before to reverse Type 2. Simple doesn't mean easy, though.
Reversal: what is being described here. Symptoms go away, and the longer you pursue the treatment, more difficult it becomes to clinically determine you ever had the metabolic disorder in the first place. However, the latent characteristics that made you first susceptible still exist.
Cure: you not only reverse, but you could stuff your face with pizza and Ho Ho pastries, wash it down with a gallon of Mountain Dew, and your blood sugar hardly budges, like normal people.
We do not have a cure. Short of genetically rewiring in vivo, or similar advancement, we won't see a cure. However, ongoing improvement of our understanding of how our bodies work continue to make it simpler than ever before to reverse Type 2. Simple doesn't mean easy, though.
> wash it down with a gallon of Mountain Dew, and your blood sugar hardly budges, like normal people.
If by "normal people" you mean "pre-diabetic", maybe.
Any cure to snake bites requires not getting bitten again.
If by "normal people" you mean "pre-diabetic", maybe.
Any cure to snake bites requires not getting bitten again.
Is drastically restricting the amount you eat equivalent to gastric bypass? Or is there something more?
Put another way: is gastric bypass a way of solving the psychological problem of eating too much, the lack of will to stop eating?
Put another way: is gastric bypass a way of solving the psychological problem of eating too much, the lack of will to stop eating?
There could be more to it. There's a hypothesis that microbiome changes could be a contributing factor[0].
Restricting food intake is similar in that it reduces stomach capacity[1], though almost certainly not as drastically as surgery. Lots of people have already mentioned fasting in this thread; I'll add an anecdote that for a few days after a fast, I get full much more quickly.
[0] https://biodesign.asu.edu/news/dramatic-shift-gut-microbes-a...
[1] https://www.ncbi.nlm.nih.gov/pubmed/8561056?itool=EntrezSyst...
Restricting food intake is similar in that it reduces stomach capacity[1], though almost certainly not as drastically as surgery. Lots of people have already mentioned fasting in this thread; I'll add an anecdote that for a few days after a fast, I get full much more quickly.
[0] https://biodesign.asu.edu/news/dramatic-shift-gut-microbes-a...
[1] https://www.ncbi.nlm.nih.gov/pubmed/8561056?itool=EntrezSyst...
From what I’ve read (https://nyaspubs.onlinelibrary.wiley.com/doi/pdf/10.1111/nya...) it looks like the surgery is associated with dramatic physiological and hormonal changes.
Gastric bypass is literally blocking off / cutting out 80% of your stomach. So yes, it is a very extreme solution to the problem - one with a high probability of introducing many other issues into your life.
Dang. I was hoping they perfected pancreatic beta islet transplantation... That is a terribly misleading title and a major click-bait let-down for Type 1s hopeful for an actual cure for diabetes.
As a type 1 diabetic myself I'm highly skeptical of the claims. There is wide consensus that most people with type 2 diabetes could reverse it if they changed eating habits and exercised more. In fact many do! Those that don't could possibly profit from a surgery. But that's admitting defeat really.
I sure hope for people who undergo this surgery do see an improvement. I just hope they got briefed on how they could try without it before having their stomach mutilated. This article does a very bad job of it. As if the surgery were a miracle cure.
I sure hope for people who undergo this surgery do see an improvement. I just hope they got briefed on how they could try without it before having their stomach mutilated. This article does a very bad job of it. As if the surgery were a miracle cure.
"The net result is that less food can fit in the stomach, and there’s much less time for that food to be turned into calories before it exits the body. The vertical sleeve gastrectomy, the most popular surgery in recent years, only tinkers with the stomach, using staples to turn it into a small banana-shaped organ."
Oh, so the "cure" was to make sure his body consumes/processes less calories? And this is considered some novel solution? Is this a joke?
And then there's this technically accurate but misleading sentence - "But Benari, now 44, was a very unusual patient in one clear way: He wasn’t obese." True. He wasn't obese. But he was overweight - "Benari’s BMI before he underwent the surgery hovered around 28, which made him modestly overweight but not obese." Being overweight or obese is a textbook sign of being a diabetic, pre-diabetic, or at-risk for diabetes, as your metabolic functions are most likely comprised to at least some degree which results in the symptom of excess weight. The article tries to mislead the reader to thinking that because he wasn't technically full blown obese by clinical definitions he was somehow an exceptional outlier. Nonsense.
This man was clearly consuming too much food or food other than carbs that also results in blood sugar spikes (excess protein is metabolized in much the same way), which is why the restriction of caloric intake worked for him. The part at the beginning about him being restricted from "most carbs" seems irrelevant in that context, especially when you factor in the knowledge that he was already confirmed to be compromised and a full blown diabetic.
Oh, so the "cure" was to make sure his body consumes/processes less calories? And this is considered some novel solution? Is this a joke?
And then there's this technically accurate but misleading sentence - "But Benari, now 44, was a very unusual patient in one clear way: He wasn’t obese." True. He wasn't obese. But he was overweight - "Benari’s BMI before he underwent the surgery hovered around 28, which made him modestly overweight but not obese." Being overweight or obese is a textbook sign of being a diabetic, pre-diabetic, or at-risk for diabetes, as your metabolic functions are most likely comprised to at least some degree which results in the symptom of excess weight. The article tries to mislead the reader to thinking that because he wasn't technically full blown obese by clinical definitions he was somehow an exceptional outlier. Nonsense.
This man was clearly consuming too much food or food other than carbs that also results in blood sugar spikes (excess protein is metabolized in much the same way), which is why the restriction of caloric intake worked for him. The part at the beginning about him being restricted from "most carbs" seems irrelevant in that context, especially when you factor in the knowledge that he was already confirmed to be compromised and a full blown diabetic.
And then there's this technically accurate but misleading sentence - "But Benari, now 44, was a very unusual patient in one clear way: He wasn’t obese." True. He wasn't obese. But he was overweight - "Benari’s BMI before he underwent the surgery hovered around 28, which made him modestly overweight but not obese."
BMI is a poor measurement for obesity. Especially without knowing his body makeup.
When I was in the best shape of my life - a part time fitness instructor, worked out 10 hours a week between classes and my own workouts, and at one point I was down to a 29 inch waist, my BMI was 29.6 - borderline obese - according to the guidelines. I was muscular, toned, and could pass any of the standard physical fitness tests (military, police, etc.)
Currently according to the BMI guidelines, I’m “obese” with a BMI of 30.72 and I should weigh 35 pounds less than I do now. I wear a size 33 pants (waist). At most, I want to lose about 10 pounds or one waist size.
BMI is a poor measurement for obesity. Especially without knowing his body makeup.
When I was in the best shape of my life - a part time fitness instructor, worked out 10 hours a week between classes and my own workouts, and at one point I was down to a 29 inch waist, my BMI was 29.6 - borderline obese - according to the guidelines. I was muscular, toned, and could pass any of the standard physical fitness tests (military, police, etc.)
Currently according to the BMI guidelines, I’m “obese” with a BMI of 30.72 and I should weigh 35 pounds less than I do now. I wear a size 33 pants (waist). At most, I want to lose about 10 pounds or one waist size.
This is a good review of current understanding of the effects for anyone interested in more than some of the comments so far.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2936261/
Abstract
Bariatric surgery is now widely reported to ameliorate or resolve type 2 diabetes mellitus in adults. Some clinical investigators even suggest its use as an early therapeutic intervention for type 2 diabetes in patients not meeting standard criteria for bariatric surgery. However, little is known about the exact mechanisms explaining the metabolic consequences, and much active investigation is underway to identify hormonal changes leading to diabetes resolution. This review includes a detailed description of various bariatric surgical procedures, including the latest less-invasive techniques, and a summary of current data providing insight into the short- and long-term metabolic effects. We outline current hypotheses regarding the mechanisms by which these surgical procedures affect diabetes and report on morbidity and mortality. Finally, we discuss the available data on bariatric surgery in adolescent patients, including special considerations in this potentially vulnerable population.
https://www.sciencedirect.com/science/article/pii/S019697811...
Abstract
Bariatric surgery for obesity has proved to be an extremely effective method of promoting long-term weight reduction with additional beneficial metabolic effects, such as improved glucose tolerance and remission of type 2 diabetes. A range of bariatric procedures are in common use, including gastric banding, sleeve gastrectomy and the Roux-en-Y gastric bypass. Although the mechanisms underlying the efficacy of bariatric surgery are unclear, gastrointestinal and pancreatic peptides are thought to play an important role. The aim of this review is to summarise the effects of different bariatric surgery procedures upon gastrointestinal and pancreatic peptides, including ghrelin, gastrin, cholecystokinin (CCK), glucose-dependent insulinotropic hormone (GIP), glucagon-like peptide 1 (GLP-1), peptide YY (PYY), oxyntomodulin, insulin, glucagon and somatostatin.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2936261/
Abstract
Bariatric surgery is now widely reported to ameliorate or resolve type 2 diabetes mellitus in adults. Some clinical investigators even suggest its use as an early therapeutic intervention for type 2 diabetes in patients not meeting standard criteria for bariatric surgery. However, little is known about the exact mechanisms explaining the metabolic consequences, and much active investigation is underway to identify hormonal changes leading to diabetes resolution. This review includes a detailed description of various bariatric surgical procedures, including the latest less-invasive techniques, and a summary of current data providing insight into the short- and long-term metabolic effects. We outline current hypotheses regarding the mechanisms by which these surgical procedures affect diabetes and report on morbidity and mortality. Finally, we discuss the available data on bariatric surgery in adolescent patients, including special considerations in this potentially vulnerable population.
https://www.sciencedirect.com/science/article/pii/S019697811...
Abstract
Bariatric surgery for obesity has proved to be an extremely effective method of promoting long-term weight reduction with additional beneficial metabolic effects, such as improved glucose tolerance and remission of type 2 diabetes. A range of bariatric procedures are in common use, including gastric banding, sleeve gastrectomy and the Roux-en-Y gastric bypass. Although the mechanisms underlying the efficacy of bariatric surgery are unclear, gastrointestinal and pancreatic peptides are thought to play an important role. The aim of this review is to summarise the effects of different bariatric surgery procedures upon gastrointestinal and pancreatic peptides, including ghrelin, gastrin, cholecystokinin (CCK), glucose-dependent insulinotropic hormone (GIP), glucagon-like peptide 1 (GLP-1), peptide YY (PYY), oxyntomodulin, insulin, glucagon and somatostatin.
I looked into getting it, and the doctor's office was surprised that my insurance didn't cover it. They said that the usual version of my plan normally covers it but my employer had a stipulation that specifically excluded weight loss surgery. $15k out of pocket if I want to do it. I probably should.
This piece has the stench of public-relations ghostwriting all over it. Describing a gastric bypass as a "cure" for anything is fake news if I've ever heard any.
I know many people who have had them, and in every case they'd describe it as having traded one problem for another.
I know many people who have had them, and in every case they'd describe it as having traded one problem for another.
I share the general sentiment of shock in the comments that such a sensational click bait article somehow made it to the front page. A healthy diet with regular exercise might always be the correct answer but this is exactly the kind of problem that would benefit from hacking.
While fasting in various forms may be beneficial and less harmful than hacking out a significant part of your digestive system we must acknowledge the psychological barrier faced in doing so.
As someone who has successfully fasted repeatedly combined with regular exercise solely for weight control, the effort is quite "character building" and simply expecting diabetics and the obese to engage in what amounts to self denial just because it is the correct approach is quite unrealistic.
While fasting in various forms may be beneficial and less harmful than hacking out a significant part of your digestive system we must acknowledge the psychological barrier faced in doing so.
As someone who has successfully fasted repeatedly combined with regular exercise solely for weight control, the effort is quite "character building" and simply expecting diabetics and the obese to engage in what amounts to self denial just because it is the correct approach is quite unrealistic.
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I was totally expecting the cure to be a gym membership. Exercise is still the gold standard of care for managing type 2 diabetes.
Imagine consuming less sugar and less carbohydrates, and food at more infrequent intervals...
Why even bother with the surgery? Real hackers fast intermittently, and eat strict keto otherwise.
Lack of willpower perhaps?
Completely agree. My father is a T2 diabetic. He tried keto with great results but could not sustain it. Recently he tried fasting and started getting similar results. Stopped insulin altogether from his peak of 30 units a day.
Diabetes can already be cured, without the sick concept of a gastric bypass as some sort of a solution. Type 2 diabetes can be completely reversed following a 14 to 40 day water fast or a series of short 4-7 day dry fasts. This is complete insanity that such a simple solution is still not mainstream in 2018.
How do you survive for 40 days with 0 food, and 7 days with 0 water?
Do you know many dead people who suffer from type 2 diabetes? Didn’t think so... :)
https://www.ncl.ac.uk/press/articles/archive/2016/03/profroy...
"In this new study, 30 volunteers with Type 2 diabetes embarked on the same diet of 600 to 700 calories a day. Participants lost on average 14 kilograms - just over 2 stone. Over the next 6 months they did not regain any weight.
The group included many people with longer duration diabetes, defined as more than 8 years and ranging up to 23 years.
Overall, 12 patients who had had diabetes for less than 10 years reversed their condition. 6 months later they remained diabetes free. In fact, after 6 months a thirteenth patient had reversed their diabetes.
Though the volunteers lost weight they remained overweight or obese but they had lost enough weight to remove the fat out of the pancreas and allow normal insulin production."
"In this new study, 30 volunteers with Type 2 diabetes embarked on the same diet of 600 to 700 calories a day. Participants lost on average 14 kilograms - just over 2 stone. Over the next 6 months they did not regain any weight.
The group included many people with longer duration diabetes, defined as more than 8 years and ranging up to 23 years.
Overall, 12 patients who had had diabetes for less than 10 years reversed their condition. 6 months later they remained diabetes free. In fact, after 6 months a thirteenth patient had reversed their diabetes.
Though the volunteers lost weight they remained overweight or obese but they had lost enough weight to remove the fat out of the pancreas and allow normal insulin production."
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The article keeps calling this a "cure" to diabetes. If anything, it's a cure to the "never feeling full" sensation that leads some (usually mildly autistic) people to constantly eat. And this constant overeating is what leads to the diabetes.
Having known people who had gastric bypasses, it's far from a miracle cure. The procedure causes many issues, from intestinal discomfort to life-threatening complications. Treating the procedure with such rose-colored glasses could be considered harmful.
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Part of the reason nobody wants to pay for it is it costs as much as a Model 3:
> The estimated average cost of bariatric surgery is around $15,000, according to a 2017 review. But even these estimates might be underselling it. Benari recalls that his surgery, with expenses before and afterward, was about $35,000 without insurance. The price tag kept him from pursuing the procedure for almost a decade.
And an interesting reaction - the person briefly considered gaining 40 pounds, but instead of considering losing 40 pounds, they guilt-tripped their employer into paying for it.
> “Obviously I couldn’t gain 40 pounds so I could get surgery—that’d be suicidal. I just held off, trying to not think about it,” he said. “Eventually, through a lot of back and forth, nagging and whining, I convinced [Microsoft’s] HR department to overhaul their policy and allow people in my situation to get the surgery done.”