Medical professionals advice: "be realistic"

lacyphacelia · October 2017

I've been to the doctor and talked to them about losing weight. Needless to say, a lot of the "advice" hasn't been helpful, but there was a visit that made me pause. At one visit, the nurse practitioner (who was seeing me for a semi-related issue) said "I think you need to be realistic about how much weight you can lose." I'm 166 lbs, 5'4" (and YES I know I'm fat)-- and said I'd like to lose 35-40.

Now to the pausing part. If medical practitioners are telling me to "be realistic" and my general practitioner said to "avoid dieting," what should I do? Half of me says screw this and be happy and eat how I want, and the other half is telling me the extra weight is bad for my knees and prediabetes. That's why I went to the doctor and asked for help-- and wasn't given any. Maybe I need to be "realistic," whatever that means? What, 10-15 lbs max? It's still overweight and I'll still have a lot of extra fat.

MsChewMe · October 2017

What is not realistic? Losing 35 or 40 pounds? You can do this.

Unknown · October 2017

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davidylin · October 2017

Start with ten and see where you go from there? I wouldn't worry about it too much.

timtam163 · October 2017

It's unrealistic from a medical practitioner's standpoint because they've seen lots of patients come back year after year not having changed a single habit. Or maybe they "diet" and then revert to their old ways and gain the weight back and then some. That's probably where she's coming from.

People have lost literally hundreds of pounds... and kept it off. I've lost 20 lbs and I started at 140 (I'm very short); is that unrealistic? I say start with familiarizing yourself with food logging and CICO, set a goal weight that's healthy for your height, and use MFP's tools to come up with a calorie goal that isn't too drastic but that will get you there. That isn't "dieting" as much as it is slightly shifting your habits to move you closer to your goals.

Look around the "success stories" forum, it'll give you an idea of what is and isn't "realistic". Good luck to you!

P.S. it's messed up that the doctor has no advice for you other than "don't try". I think this is at the limits of their training: weight loss can sometimes involve counseling and lifestyle assessments and most doctors don't have that kind of time. The good news is you can empower yourself to figure it out.

jo_nz · October 2017

Maybe they didn't mean it quite like that.

I would bet they see a lot of people wanting to lose weight who change their diet or exercise and then get discouraged that they are not at their goal weight when they are doing everything "right".
Maybe they see better success if people have smaller goals??
I tend to prefer smaller goals myself, but just because I reach it, doesn't mean I stop - I just set a new goal.

lorrpb · October 2017

Doctors have told me it is very rare to have a patient that loses much weight let alone keep it off. By don't diet I think they mean don't do any fad diets. Definitely lose the weight, but do so in a reasonable way you can sustain long term.

counting_kilojoules · October 2017

When they say "avoid dieting" they might mean more the diets where you don't change habits you "go on a diet" then when you've lost the weight you start eating normally and gain it all back plus a bit extra. That's more unhealthy than being a little bit overweight.

Doctors really aren't given much training in nutrition at school so if you want advice that you can't get here I'd go to a registered dietitian. Otherwise, what worked for me, was logging without changing anything for a few weeks which meant I could see where I could make small changes that weren't too difficult. (Some things just weren't worth the calories and I don't miss them, others I save for the occasional treat and others I just have smaller portions but it's working pretty well.)

goldthistime · October 2017

To paraphrase someone who worked was a published author in diet research, "the best way to gain weight is to start with a period of deprivation". I can completely understand why your medical professionals wanted to caution you against losing weight. Statistically speaking, it's far more likely that you'll regain the weight than that you'll keep it off. But I think places like MFP, that put the emphasis on changing habits for life rather than quick weight loss, are going to improve those stats. Take to heart the advice to go slow and not adopt any unsustainable methods to lose the weight. Help change the stats and the advice those medical professionals will dispense in the future.

amusedmonkey · October 2017

I think something is lost in interpretation here. "Be realistic" is sound advice. Losing 15 pounds and being able to keep them off makes you healthier than losing 40 then regaining them all plus some. "Be realistic" is a very individual advice. If you manage to find an enjoyable and sustainable way that allows you to lose 40 pounds and keep them off without pouring so much effort into it you eventually break, then that's your "realistic". If you're struggling and white knuckling to maintain that weight, then that may not be your realistic. You may be better off regaining some and maintaining at a 30,20, or even 10 pounds lost while you work on continually learning how to improve that outcome sustainably. Being slightly overweight is much better than being more overweight from a health standpoint, so their advice makes sense given their profession and the current statistics.

You may or may not at some point accumulate some new skills that allow you to maintain relatively comfortably at a lower weight. Not what I'm saying doesn't mean dieting and maintenance should be effortless, it simply means it shouldn't be soul-breaking because that wouldn't last. Think of it as the closest weight to the goal weight you have in your head that is sustainably maintainable.

As for "avoid dieting", that's one of the best advice you'll ever get for weight loss. They may not have worded it well, but it simply means diet in a way that is pleasant and feels like something you'll be able to do for a very very long time. The "lifestyle change" cliché, if you will. I personally don't like that phrase because it implies you decide to change your lifestyle, you change it, and you diet happily ever after. The best explanation would be to actively work on accumulating lower effort skills and strategies while dieting that would make weight maintenance easier in the future and build long term habits so you eventually find it possible to maintain the weight you realistically can (which may as well be 40 pounds lower).

TL;DNR: work smart with an eye on maintenance.

Unknown · October 2017

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jemhh · October 2017

166 isn't as big as you seem to think it is. Yes you have extra weight but your attitude about it seems extreme. Perhaps the nurse was pointing that out based on however you were acting in the office.

VintageFeline · October 2017

Is there more context to this? Why were you told to avoid dieting? Did they mean extreme diets or that there's some medical issue and you'd be ill advised?

tinkerbellang83 · October 2017

I also take the way they mean to it as don't temporarily diet, make sustainable lifestyle changes that you can realistically achieve.

kbmnurse · October 2017

Here's the deal realistic goals are key to any weight lose plan. Don't set yourself up for failure. Start with losing 5 lbs and then go from there. Lose the word diet-such a horrible word.

mitch16 · October 2017

I don't think 35-40 pounds is unrealistic... Maybe they meant to manage your expectations about how quickly it happens? It may take a year or longer. As someone else said, make sustainable lifestyle changes that will help you become healthier. You'll get there. Or maybe not--but even if you only lose 10 pounds you're still better off than you are today.

RoxieDawn · October 2017

Never leave a doctors office with assumptions. If what a doctor or GP gives you for advice or recommendations or anything you should be doing to feel better or improve your health, ask questions! You should be able to walk out of your appointment with confidence, and if you have questions later, call them.

sijomial · October 2017

It's totally realistic for you to get down to a healthy weight. Unfortunately many (most) fail to either get there or stay there - which is where I'm guessing the less than helpful soundbite "avoid dieting" comes from.
Extreme deficit or exclusion of enjoyment of your food or a hateful and unsustainable exercise routine can all make the process harder.

Personally I'm probably an exception in that "dieting" was all I needed to do for a while as maintenance for me is neither difficult or unusual (I just maintained too fat for too long sadly). The majority much more likely do need to make sustainable changes to how much they eat, how much activity is part of their lives and how much exercise they get.

Yes your weight is bad for your health now and will only get worse if you fail to address it. Health and happiness have a very strong link, the simple feeling of well-being really does give you a boost.

Realistic also applies to how you diet especially the timescale. "Get ready for the beach in 8 weeks" only works if you are already almost ready for the beach now.

Have a real think about what is realistic for you. There's loads of techniques to achieve a calorie deficit so pick the one that appeals to you, or even the least worst.

In the end support is nice but really it's all down to you. Every forkful is your choice.

Irishm72 · October 2017

I agree to a point about the being realistic, I am 45 and I know I will not have my "20's body" back but I would like to be smaller and healthier than I am now. It's a daily battle for me. My doctor told me portion was key. To eat more fresh veggies and lean protein and drink lots of water. She also told me to keep my bread, pasta, starches to a minimum and walk at least 30 minutes a day. She could not stress the fresh veggies, protein and walking enough. It helps. She said if I crave something eat it.. but in a small portion and maybe get a little extra exercise in that day. She never uses the word "diet" Its healthy options and exercise with her. It works when I stick to it but I fell off the wagon and now trying to get off the extra pounds I gained back so I can keep on moving forward.

kenyonhaff · October 2017

I think "be realistic" unfortunately was not followed up by what to be realistic about. And ideally, you would have asked, "what do you mean exactly by that?" (Not criticising you - what was likely a bit of an offhand remark could have been more helpful if clarified by either of you).

My sense is:

* Losing weight is hard. Too many people want quick, easy fixes... not realistic.
* Changing habits is hard. Too many people go in thinking it will be easy... not realistic.
* Getting knowledge is hard. Too many people want to just be told what to do... not realistic.

That's my guess, anyway.

It's unfortunately your health practitioner wasn't as helpful as ideal...but you're here... and we can help with all of these.

Fuzzipeg · October 2017

I'm 5'3"/4, my goal ultimately is 140, I was at that level in my late teens/early 20's. I was comfortable in my skin and happy with myself which I expect is what you would like for yourself. I've been plagued by ill health much could have been avoided had the advice in the 1960/70's been more as it is now. I'm on my way down from a much higher level. It would be good to be starting from your starting point now, believe me.

I would look at the foods I was currently eating, see how well balanced my food groups are and take it from there. I'd be looking for the obvious places where I could improve my diet with the benefit of a good over view. May be carbs are too high, fats may also be high but could equally be lower than is advisable as fats are now being seen as helpful for hormone and other essentials production in our bodies, protein could also be out of desirable range too. Possibly MFP to maintain as you are would give the best overview of where any improvements could be made.

I looked to see if your diary is open, its not, mine is not either. Simple things like one less slice of bread a day with associated additions would make a big difference, over a period. Keeping to the foods you enjoy now ensuring your portion size is appropriate would also benefit you. I'd give myself say 6 months doing this and include more walking or even swimming. I'd expect to see great changes in that time.

Expecting to loose too much too quickly does damage. Strict diets compromise nutrition. Best nutrition is something we should all aim for. Meals should be enjoyed, with family and friends where possible, getting overly stressed about it all, could see you on a revolving cycle, loose/gain for life! Please go for small changes. To see big results over a reasonable time scale. I wish I was starting where you are. All the best.

Lounmoun · October 2017

Start with setting a goal of losing 1 lb a week.
Log everything you consume as accurately as you can.
Don't do a restrictive or extreme diet. Eat foods you like so you can sustain and learn how to eat less.
Get enough protein, fats and fiber.
See how things go. You may not get to 126 lbs but 150 is better off than 160.

kenyonhaff · October 2017

I'd also add that unfortunately as a whole general practitioners are not really very good at really helping with weight loss. It's not really their fault...weight loss is really complicated and needs a lot of holistic life changes that the average time-constrained appointment just doesn't have time for.

They are absolutely able to tell you that you're overweight, need to look at diet, exercise, and so on, and give some pointers. But they usually can't figure out specifically that your soda consumption and your online gaming habits specifically need to change.

Specialists, like dietitians, weight loss specialists, and wellness coaches are much better at evaluating and offering more specific and detailed advice. Doctors really do know what needs to be done, but unfortunately are typically constrained by time issues.

lacyphacelia · October 2017

VintageFeline wrote: »

Is there more context to this? Why were you told to avoid dieting? Did they mean extreme diets or that there's some medical issue and you'd be ill advised?

I wasn't expecting the amount of responses, but it's been helpful.

To answer your question-- I was at the doctor's for a visit about PCOS when the nurse told me to be realistic. I had to go to a specialist, because as much as I do like my general practitioner, she seems to have no clue about PCOS and has never addressed it with me.

It was also my general practitioner who told me not to diet, but then in the same conversation told me to use Weight Watchers...LOL.

lacyphacelia · October 2017

jemhh wrote: »

166 isn't as big as you seem to think it is. Yes you have extra weight but your attitude about it seems extreme. Perhaps the nurse was pointing that out based on however you were acting in the office.

No, I wasn't "acting extreme." I asked her if losing weight would help my PCOS symptoms, because I did research on body fat and its influence on hormones. She asked me how much weight I thought I needed to lose, and I mentioned the weight I was at before PCOS (and healthier). That's when she told me to be realistic.

My attitude is realistic, honestly. I'm thinking about things in terms of body fat, and I've noticed to get rid of the fat, I do have to get to a lower weight because I'm apple-shaped.

booksandchocolate12 · October 2017

At 5'3", I weighed 200 lbs and lost 50 lbs with minimal exercise, so I think your nurse practitioner is an idiot.

MissyCHF · October 2017

amusedmonkey wrote: »

I think something is lost in interpretation here. "Be realistic" is sound advice. Losing 15 pounds and being able to keep them off makes you healthier than losing 40 then regaining them all plus some. "Be realistic" is a very individual advice. If you manage to find an enjoyable and sustainable way that allows you to lose 40 pounds and keep them off without pouring so much effort into it you eventually break, then that's your "realistic". If you're struggling and white knuckling to maintain that weight, then that may not be your realistic. You may be better off regaining some and maintaining at a 30,20, or even 10 pounds lost while you work on continually learning how to improve that outcome sustainably. Being slightly overweight is much better than being more overweight from a health standpoint, so their advice makes sense given their profession and the current statistics.

You may or may not at some point accumulate some new skills that allow you to maintain relatively comfortably at a lower weight. Not what I'm saying doesn't mean dieting and maintenance should be effortless, it simply means it shouldn't be soul-breaking because that wouldn't last. Think of it as the closest weight to the goal weight you have in your head that is sustainably maintainable.

As for "avoid dieting", that's one of the best advice you'll ever get for weight loss. They may not have worded it well, but it simply means diet in a way that is pleasant and feels like something you'll be able to do for a very very long time. The "lifestyle change" cliché, if you will. I personally don't like that phrase because it implies you decide to change your lifestyle, you change it, and you diet happily ever after. The best explanation would be to actively work on accumulating lower effort skills and strategies while dieting that would make weight maintenance easier in the future and build long term habits so you eventually find it possible to maintain the weight you realistically can (which may as well be 40 pounds lower).

TL;DNR: work smart with an eye on maintenance.

Excellent post.

Fuzzipeg · October 2017

I'm sorry to read of your PCOS, I think there is a PCOS group on here. I just looked, here in the UK we have support sites/groups. it is probable you will have something in your country too. Many find lowering carbs a great help because PCOS can go hand in hand with insulin resistance and can have hypothyroid aspects. It can come down to nutrition and digestion. If you can be referred to a specialist that would help. I would advise reading round your personal symptoms and PCOS from good medical sites, following your personal symptoms. You may find a list of good people in your area to consult on one of the sites or group, someone could even be in your area. All the very best, many are able to reduce their health issues and have a much better life.

lacyphacelia · October 2017

Fuzzipeg wrote: »

Many find lowering carbs a great help because PCOS can go hand in hand with insulin resistance and can have hypothyroid aspects.

I asked my doctor about lowering carbs, and she said it wasn't sustainable and it was "dieting."

VeryKatie · October 2017

35-40 lbs is realistic. 1 lb a week ish. you can do this!
lowering carbs isn't the same as eliminating them.

Fuzzipeg · October 2017

It seems as if you can't win with your adviser. The doctor might just as well say. Don't try to feel better or make any advantageous changes.

Lowering carbs is sustainable if one has the will and reasons to do it. If MFP suggests 150, 125 could be beneficial, may be even lowering by 10 grams. I agree for most of us going very low 25g or no carb is unsustainable. its what is appropriate to your system, may be. Like I said in my first contribution. Having one less slice of bread with what ever, if you eat it, would have the effect of lowering carbs. Having a smaller portion of potato also, possibly researching portion size, are yours too large? Knowing what carbs are and having fewer need not be dieting. Its eating foods you do now, just fewer/smaller amounts of the starchy veg and things, taking an interest in nutrition.

I've just looked there are at least 6 PCOS groups on here, search groups, I've no idea if many are still active, it could be worth a look. Please try looking for online support sites, they can have a wealth of information on them. You may even find the name of a specialist in your area.

BTW, begging your pardon, I've no time for the dietary advice my doctor, or any doctor over 50 years has given me. Its find out what your body works best on and go with that.

Medical professionals advice: "be realistic"

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