His PCP is talking entirely out of his ass by pushing the surgery as the immediate solution and not flat referring the clinic as a whole. No surgeon in their right mind is going to operate immediately. It’s at least six months of hard work on the part of the patient before surgery is even an option, and depending, a minimum of 50 lbs of weight lost.
Each individual insurance has their own criteria for approval, and you can literally jump through those hoops with the bariatric clinic on the road to surgery. They include: x months of dieting and exercise, documentation that past diets have failed (things like MyFitnessPal help a lot here), psych evaluation for dietary compliance post-surgery (the carb temptation is STRONG), upper endoscopy pre-surgery, and other things as required.
Lou will fail the psych evaluation. He can’t commit to a diet, and he doesn’t have the financial stability to support the necessary dietary changes needed to maintain the appropriate lifestyle after surgery. He likely wouldn’t be able to manage the liquid diet, pre-op or post-op, and he’d go way too crazy on high sugar liquids if he did.
And the liquid diet makes you SUPER HANGRY for like three weeks. There would likely be a murder at the Gagliardi house.