General Question - Why Do Doctors Push for Surgery?

I'll try to keep this short and on point.

I'm 60, been overweight most of my life; in later years extremely so for one reason or another. Not worth giving my whole life story for this question. I'm 5'0 currently 198 pounds, but, started out at 232 in October 2018 so I've lost 34 over the last 9 months by changing my diet completely - usual calories in/calories out, eating better more wholesome foods overall, weighing my food and myself and logging intake consistently. I eat approximately 1250 - 1350 calories daily, give or take.

I also had seen a nutritionist prior to beginning to be serious about the weight loss - and had lost 10 before that so my high was actually 242 (I'd been more or less bedridden for a few months due to a broken foot - one of the reasons I finally had enough of being the weight I was at) for a total loss in the past year of about 45 pounds.

I'm pleased with my progress - I average about 0.5 lbs lost each week. Have never gained other than one week on vacation but, the last vacation I actually didn't gain at all so that was a victory for me. I'm not particularly active and never will be although I do quite a bit of walking so that's my basic form of exercise.

At this continued rate, I'm assuming by the 1 year mark I'll be down another few pounds. FYI - the lowest weight I've been as an adult for decades was 169. I never was able to get below that so that is my ultimate goal. Still quite overweight for a 5' women but a LOT better than 242!

To add to all of this, my husband was diagnosed as Type II diabetic some months back so now it's 2 of us who are in this together eating better. That helps a lot too.

Anyway, doctor is happy with the amount I lost but...for the 2nd time has brought up bariatric surgery. Like, WTF? The first time he said it I was very clear that I'm not interested. This time, I kind of got angry with him about it and again, said that this is not ever going to be an option for me. I'm not even a candidate at this point. I have NO underlying medical conditions. I'm healthy other than the weight. I'm losing consistently, he sees I'm able to achieve it. It's been 9 months of him monitoring me every 3 months and each time I come in we have real discussions - it isn't like a "hey how are you ok you can go now" talk.

So, I'm curious if there's some kind of agenda/bias here? I remember at the beginning him telling me to be realistic about my expectations of weight loss and yet here we are with him telling me to think about surgery with me having lost 45 freaking pounds! It kind of makes me feel like his expectations are not realistic now, and I keep reading that even losing 10% of your weight will make a big impact on your health and so far, I've lost nearly 20% and I'm still losing.

Ugh. Anyway, mostly venting. I like him as a doctor overall, in fact, he's probably the best one I've had in many years. Just not sure how to handle this one specific situation, and hoping this time I made it clear enough to him to back off from that conversation.


  • collectingblues
    collectingblues Posts: 2,539 Member
    PAV8888 wrote: »
    PAV8888 wrote: »
    I'm going to give you the answer you probably don't want to hear.
    At your almost-high weight, your BMI was 45. At your highest weight it was 47.3. It's currently 38.7.
    You're not just overweight. You went from the highest level of obesity risk -- they don't even break down the categories over 40 -- to now being at the second highest level. At your goal weight, you're still at that second level of risk.
    Being that level of obese isn't healthy. No one recommends surgery just for funsies.
    Your doctor doesn't think you can lose weight -- and he might be on to something, considering that a person of your weight can safely lose 2 pounds a week, and you're doing a quarter of that. And you're *certainly* not logging accurately considering how little you're losing.
    Prove to him that you're not just coasting along if you don't want to keep hearing his recommendations.

    I usually don't disagree with you @collectingblues .

    But I will disagree with your above suggestion, though your take as to why the doctor may be continuing to offer surgery may be correct.

    But, for the OP, I would argue that-barring an imminent medical necessity--CONTINUING TO LOSE *as she has been doing* is much more valuable to her than trying to ACCELERATE the loss at the cost of potentially increasing the risk of failure.

    Primarily because she has stated that she is not very active and she is relatively speaking short, therefore these deficits represent a large percentage of her TDEE.

    I do AGREE with you that the OP has no reason to be placing limits to her ultimate goals. After proving to herself that this IS possible... continuing on the same path towards a healthier level of energy reserves would make a lot of sense to me!

    And you know I love you, Pav. But unless she's got significant AT at play, her TDEE at sedentary *should* be almost 2100 calories -- using her provided height/weight and a sedentary factor. if she were truly eating what she says she is, she'd be losing on average almost 1.5 pounds a week at her high level, and almost 1.7 at the lower intake. Which is why I can understand the doc side-eyeing and suggesting surgery again.

    Maybe 2 pounds a week isn't safe for her if it presents a high deficit. That's probably true. Sure, half a pound a week is better than nothing. But if she's not being honest to herself about what she's eating, she's not helping herself -- and she's not helping herself by thinking that being obese is still healthy.

    Hmm.... I think you got side-suckered by some of the numbers :wink:

    BMR @ 198lbs age 60 F 5ft0" is 1390
    TDEE @ MFP sedentary is 1737.5
    <and don't forget that Mifflin, which MFP uses, slightly over-estimates BMR for obese, so real TDEE might be a bit less. Mind you walking more than 5K steps would argue for a higher TDEE so there's that!>

    1737.5 - 1350 is about 400 Cal a day on average with weight loss corresponding to 250.

    Not supreme; but not terrible! And I will admit that 250 / 1750 is about 15% not 20 to 25%

    So definitely worthwhile to make sure that food is getting accurately measured if things slow down more.

    Ah. I was running SailRabbit, not MFP. ;)
  • 150poundsofme
    150poundsofme Posts: 523 Member
    I had a doctor visit, first time I went to him, and he told me that I should have surgery and that he knows someone who could do it. Never even asked me about any previous diets, weight loss etc. I think you need to ask him if he suggests again that you have surgery as to why he thinks that. You sound very motivated and know that you will keep on losing weight. I am proud of you and your weight loss thus far. Hugs