General Question - Why Do Doctors Push for Surgery?

sivyaleah

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.

nooboots

Is this in america? If so, is he likely to make money out of referrals etc?

If its not about money, is he quite fatalistic as a person perhaps and only sees a quick fix as an option for things (which would be odd for a medical person perhaps but not unheard of)

lorrpb

Congrats on your weight loss! Is he pressuring you or just mentioning it? He is on autopilot to mention all the options.

Keep in mind that doctors RARELY have patients who lose the weight and keep it off, like 3-5 in a 30 year career. So he has a different perspective than you who have made the commitment and life change. Although, I must say, I'm surprized that he has mentioned it again given your success over the past year!

cmriverside

Doctors want to doctor. That's how they put their kids through college, ya know? Referrals, surgery that isn't needed, drugs that aren't needed.

If he doesn't recommend it, then people would complain about THAT.

Medicine is a business, and now that the government is in the insurance racket in the U.S., there is an even bigger profit to be made.

concordancia

Huh. I have never had a doctor recommend weight loss surgery. Plus, my husband and I both have spinal issues that in theory could be addressed with surgery, but our separate doctors have only proposed physical therapy.

You say that you have been to this doctor every 3 months despite not having any other medical issues. Is this specifically a bariatric clinic or doctor? They live with the long term statistics, as mentioned above.

gottswald

I figure doctors are like cops, eventually they just get to looking at everyone a certain way through the lens of their cumulative bad experience? My doctor once told me that I would "probably" only lose the weight with surgery, but never pushed it or surgery. I tried to go to their weight loss clinic (not the surgery part), but my insurance doesn't cover anything (surgery or otherwise) to do with weight loss even though almost every health problem I had was blamed on my weight. Now that I've lost the weight my doctor is happy for me but still reluctant to remove me from meds I no longer need. I think they just get really jaded?

LyndaBSS

Some doctors are pro surgery. Some aren't.

Be a proactive patient and stick to your guns. Sounds like you've got your head on straight and have a game plan.

Good luck!

dbanks80

Sounds like he might be getting a kickback of some sort. You know what you are doing is working keep at it. It is sad that now a lot of doctors are more interested in the money and not the best care of the patient

privy95

The reality is that very few people who have been overweight for an extended length of time actually lose the weight they need and keep it off. You are lucky that you do not have any comorbidities but you will sooner or later if you do not continue to lose the weight. He is being a good dr in making sure you stick to your guns about losing the weight. He is also giving you all the options. I hate drs who just figure you are overweight and give you no help or give you drugs to treat symptoms without addressing the problems.

Keep up the hard work! You have done an amazing job in a year’s time! Be that success that drs rarely see!!!

Diatonic12

@concordancia I'm with you on this one. I've never heard of a doctor recommending WLS before encouraging you to do it on your own with medical/nutritional help. I have about 6 relatives who've opted for WLS and all of them had counseling and instructions before any surgery was done. I will add that all of them have rebounded back with every pound. Not one has maintained their original loss. It didn't fix their relationship with food and it didn't do anything to change the appetite control center which is located in the brain and not the stomach.

I say about 6 relatives because one of them died from complications after surgery.

whoami67

Doctors pretty much have zero training in nutrition, weight loss, diet, etc. It's not what they do and it's not what they know about.

They do know about surgery.

collectingblues

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.

PAV8888

collectingblues 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!

ETA: I would encourage the OP to continue losing, of course. And to pay attention that her logging is correct and food weighed as opposed to loosely measured especially if she finds herself losing much less than expected.

collectingblues

PAV8888 wrote: »

collectingblues 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.

PAV8888

collectingblues wrote: »

PAV8888 wrote: »

collectingblues 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

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.

paperpudding

I think the thread title is inaccurate.

it isnt why do doctors push for surgery? it is why is your one individual doctor pushing for it?

and whether it is appropriate depends on whether it is pushing or just mentioning in his general spiel

I have never been obese (overweight, certainly, but not to obese level that would be a surgery consideration) but I do work in a large medical centre.

It is certainly NOT our practice to push bariatric surgery - or even to mention it, unless the patient brings it up, except in extreme circumstances.
We had a lady with BMI of 75 (not a typo), that was being recomended as an option for her - unfortunately she died of heart attack before getting to see the surgeon.

But I am in Australia - there are not kickbacks for referrals or drugs here.

Your countries medical system may be different.

collectingblues

PAV8888 wrote: »

collectingblues wrote: »

PAV8888 wrote: »

collectingblues 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

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.

sxekev

Most doctors are unhealthy themselves. They're trained textbook style, and don't know the real reason why people gain weight. Gaining weight is usually a spiritual, psychological, emotional, or mental issue (or a combination of all of them). Knowing how to tackle that requires a specialized coach. A holistic health practitioner or a qualified therapist.

150poundsofme

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

Azdak

I don’t like to go straight to financial conspiracy theories, although I know they exist.

My experience is that there is growing momentum for bariatric surgery, esp as the techniques have become more refined and varied.

First of all, some who practices surgery has a sincere belief that surgical intervention is beneficial. It’s not just about the money. Just like believe in the medical benefits of exercise. Surgeons prescribe surgery, I prescribe squats. We both believe in our tools.

Second: there has been tons of research in the past few years demonstrating the short-term efficacy of bariatric surgery. From the standpoint of how our healthcare system works, it is compelling evidence (again, for the short term, eg 12 mos).

Third: bariatric surgery represents a discrete, easily analyzed and quantified medical procedure (as opposed to diet and exercise). It is something that is much easier for insurance companies to understand and reimburse.

I work for a hospital system and have listened to a number of presentations about bariatric surgery. There was absolutely nothing unprofessional or underhanded—but the surgeons were very enthusiastic about the procedures and had a lot of studies to back them up.

I do not agree, but that’s how the American system works and there is a lot of momentum right now in favor of surgery.

apullum

sxekev wrote: »

Most doctors are unhealthy themselves. They're trained textbook style, and don't know the real reason why people gain weight. Gaining weight is usually a spiritual, psychological, emotional, or mental issue (or a combination of all of them). Knowing how to tackle that requires a specialized coach. A holistic health practitioner or a qualified therapist.

Gaining weight is caused by consistently being in a calorie surplus.

Knowing how to tackle that requires understanding how to consistently create a calorie deficit.

sugarcakes38

I understand you’re just venting. But I encourage you to consider trying to get a better understanding from your doctor, I think it would eliminate a lot of your frustration.

One reason he may be offering this to you now instead of before is that you have almost lost the minimum lbs required in order to be an eligible bariatric candidate. Many clinics, surgeons will not touch an obese patient until they’ve met a 30-40-50lb milestone with diet and exercise.

Not saying you should or you shouldn’t consider it, but I do think it is likely he’s not being unreasonable in trying to at least inform you in just one more matter related to your health.
I’m glad now this option wasn’t offered to me, I’d have taken it. Great job on your weight loss, by the way.

NovusDies

My doctor was super impressed with a style of dieting because he had a patient lose a bunch of weight doing it. When I first visited him I had lost over 70 pounds on my own and he completely ignored my progress and how I said I was doing it and recommended that I read a book. It was surreal because I had just told him I seem to thrive on a moderate carb diet and the book was a high carb diet. He hadn't even been really paying attention because he was fixated on the other results.

Now I am the jewel of weight loss in his crown he is pushing what I do on others. He pays very close attention to everything I say. Since my plan is pretty much do whatever is easiest to stay in a calorie deficit I suppose it is a good thing.

Your doctor probably has a patient or two that has done very well using WLS and he is impressed with the results so he probably annoys all of his overweight patients with it like mine was doing.

paperpudding

sxekev wrote: »

Most doctors are unhealthy themselves. They're trained textbook style, and don't know the real reason why people gain weight. Gaining weight is usually a spiritual, psychological, emotional, or mental issue (or a combination of all of them). Knowing how to tackle that requires a specialized coach. A holistic health practitioner or a qualified therapist.

That's a rather sweeping statement - and not my experience of doctors at all after working with many of them for over 3 decades.

Most are healthier than the general population and I certainly wouldnt say most are unhealthy.

and yes of course they know the real reason why people gain weight - just like anyone with any basic knowledge knows the real reason - they eat too much , they move too little ie they eat more than they burn.
Cannot imagine any doctors not knowing that.

Yes of course there are various backgrounds to why people do this - but for most people knowing how to tackle it does not require a specialized couch.

Way to make something seem far more complicated and specialised than it is.

fdhunt1

Don't be fooled by ANY doctor. Whether it's surgery, medications, or regular "routine" visits, ITS ALL ABOUT THE MONEY - PLAIN & SIMPLE. Even if the doc appears to be a good person, they still have to tote the corporate line.

lovelylosses

apullum wrote: »

sxekev wrote: »

Most doctors are unhealthy themselves. They're trained textbook style, and don't know the real reason why people gain weight. Gaining weight is usually a spiritual, psychological, emotional, or mental issue (or a combination of all of them). Knowing how to tackle that requires a specialized coach. A holistic health practitioner or a qualified therapist.

Gaining weight is caused by consistently being in a calorie surplus.

Knowing how to tackle that requires understanding how to consistently create a calorie deficit.

Absolutely what you said above makes sense, but how can a person truly lose weight and keep it off, without understanding why they consistently overate to begin with? If it was truly as simple as calories in/calories out without any psychological or emotional work required, many, many more people would be at their goal weight and maintaining without issue.

missysippy930

Generally, I don’t think most doctors push for surgery. From what I have read, surgeons that specialize in WLS require potential patients to lose a certain amount of weight before the surgery is preformed.
I do think that primary care doctors often times don’t know a lot about nutrition and losing weight, but it’s up to us as patients/consumers to ask questions and get satisfactory answers.
I seldom actually see my doctor anymore. The PA, is who actually sees me. I know she suggested cutting carbs for me, when I had already lost a lot of weight through moderation and portion control of all foods. All my labs and BP, are good and I’m on no prescription medication. I ignored her advice.

mburgess458

While money might be involved my first thought was the old adage "to a man with a hammer everything looks like a nail". One of the main things a doctor can offer in terms of weight loss is surgery, so you offer it to everyone who needs to lose weight.

paperpudding

fdhunt1 wrote: »

Don't be fooled by ANY doctor. Whether it's surgery, medications, or regular "routine" visits, ITS ALL ABOUT THE MONEY - PLAIN & SIMPLE. Even if the doc appears to be a good person, they still have to tote the corporate line.

Well, of course they have to make a living, that goes for anybody in any occupation, - but I don't see how it is all about the money or toeing any corporate line or trying to fool anybody.

And certainly here in Australia, it makes no financial difference to the doctor whether they refer you for WLS, refer you to a dietician,prescribe medications, suggest WW or MFP or whatever to you or, conversely, say nothing about your weight at all.

paperpudding

lovelylosses wrote: »

apullum wrote: »

sxekev wrote: »

Most doctors are unhealthy themselves. They're trained textbook style, and don't know the real reason why people gain weight. Gaining weight is usually a spiritual, psychological, emotional, or mental issue (or a combination of all of them). Knowing how to tackle that requires a specialized coach. A holistic health practitioner or a qualified therapist.

Gaining weight is caused by consistently being in a calorie surplus.

Knowing how to tackle that requires understanding how to consistently create a calorie deficit.

Absolutely what you said above makes sense, but how can a person truly lose weight and keep it off, without understanding why they consistently overate to begin with? If it was truly as simple as calories in/calories out without any psychological or emotional work required, many, many more people would be at their goal weight and maintaining without issue.

Whilst I accept that there are some people with dysfunctional relationships to food who benifit from counselling/ therapy, I think the main reason most people don't lose weight and keep it off is our modern lifestyles - high calorie food is abundantly available and modern life ( cars, sedentary jobs, apartment living for example ) leads us to move less.

Speaking for myself - I have lost weight and kept it off for nearly 6 years without any deep understanding or psychological or emotional work.
I eats less, I move more now than when I was overweight - that's all

sivyaleah

OMG I haven't been able to come back to read the responses and am overwhelmed so many took the time to read and write on this.

Thank you to all!

Quick answers to give you an idea of where he's coming from:

First, no this is not a clinic for weight loss - just my regular doctor.

The doctor, is a healthy, youngish guy. Quite fit and thin.

As for me:

I never said my current weight was a healthy range. In fact, I said my goal still put me in the overweight range. Not sure where anyone got that idea from? What I did say was I have no underlying medical issues such as diabetes, high blood pressure, etc. that make me high risk and my understanding is that surgery is typically reserved for those who have other at risk issues along with being way over their recommended weight.

I'm not even going to get into whether or not I'm being accurate or not. There are just some here who will never believe that someone is being truthful about this and that it's just possible that some people lose more slowly than others. Everyone works their plan the way they see appropriate for themselves and as long as one is consistently losing and they are happy with their results, to me, that is all that matters. I wasn't complaining about my rate of loss at all. I'm completely happy with my progress and proud of myself for sticking with it, staying on track, not losing focus at all this past almost year. I feel like for the first time in my entire life, I have my eating under control and am not letting food dictate my life. It's quite remarkable in fact.

Anyway, I do appreciate all the comments and am taking all of them into consideration, even those which sting somewhat. I am sure there is some room for improvement even if it is only a small tweak here and there so thank you all for responding.