Medical professionals advice: "be realistic"
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Hmmmm.... Maybe they meant to be realistic and not have expectations of getting the weight off in a couple months or something?
You can certainly do whatever you put your mind to though. I’m 5’4 and started off here at 160lbs. Ive lost 45 simply by counting calories.5 -
lacyphacelia wrote: »
It's not necessarily "dieting"...I know people with PCOS and I know people with diabetes and in both cases, they eat diets lower in carbs...not super low carb or anything, but less than someone without medical issues would take in. PCOS is associated with insulin resistance which is generally where lowering carbohydrates is subscribed.
My dad had type II and had to watch his carbs and make better choices in regards to the carbs he was eating. He typically only ate grains and starches and the like at breakfast and lunch and he at them in amounts that kept him under some number per meal...his evening meal was typically vegetables and a protein. This wasn't a weight loss diet (though he did lose weight)...this was how he ate to control his blood sugar.
In regards to "be realistic", that can mean any number of things. Five years ago I went in for my 38 year checkup and came out with a bunch of nasty blood work and my doctor wanted me on meds right away...I told him I really wanted to work on cleaning up my diet and exercise and losing weight before I went to the meds...he said, "ok...but we have to be realistic here." I asked him what he meant by that and he told me that he rarely sees his patients have success with diet and exercise because they just don't stick with it...not just for the handful of months necessary to lose weight, but forever to necessarily control these conditions.
Five years later I have very much been the exception and he tells me that every time I visit.8 -
lacyphacelia wrote: »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?
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.
In context of that complete sentence sounds like he/she meant not to diet in terms of doing fad going on a diet thiings - but do long term changes such as WW (or here)
Which woudl in fact be good advice.
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I'm 5'5 and started out at 165.5. I weighed in at 125 this morning. So what's not realistic about your goal?3
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I started at 5'5"/183lbs at age 59, and was in the 120s just less than a year later, by making sustainable, healthy changes in eating - mostly portion control and reduced treats, as I already ate lots of healthy foods. I didn't even change exercise materially, since i was already quite active.
I've stayed in the same weight range for nearly two years since, and will be 62 next month.
If that's not a realistic thing to do, does that mean I have to go back?
I sure hope not - I feel so much better!
(I don't have PCOS, but others here on MFP who've been successful do. I only have hypothyroidism.)
Best wishes - I think you can achieve your goals, if you commit to them, and take sensible steps toward them.2 -
Timtam summed it up really.
Your doctor is right, most people never make a long term progress. This is my advise: fat loss is not linear but logarithmic, your average kcal intake supports a certain mass. Start by slowly changing your habits and start exercising. Never diet or continue what is difficult, it is quite possible to eat between 1700-2000 kcal per day and feel satisfied.0 -
NorthernLights1985 wrote: »This is my advise: fat loss is not linear but logarithmic, your average kcal intake supports a certain mass
That's a really good of putting it! I know there can be weeks of no weight loss, and then BAM people lose 5 pounds.
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MsMaeFlowers wrote: »I'm 5'5 and started out at 165.5. I weighed in at 125 this morning. So what's not realistic about your goal?
I think the doctor doesn't think I can do is successfully and keep it off. She's probably gotten used to seeing me heavy, as I've been seeing her since my late 20's and have been within the same 10 pound range.0 -
lacyphacelia wrote: »NorthernLights1985 wrote: »This is my advise: fat loss is not linear but logarithmic, your average kcal intake supports a certain mass
That's a really good of putting it! I know there can be weeks of no weight loss, and then BAM people lose 5 pounds.
Yes! I lost a lot of weight about five years ago, two years ago I started to gain some of it back because I was slipping back to old habits. For the past 6 months I have been working on changing them again but this time without any kind of dieting. It´s been going well but much slower than I was used to from before but that is the trick to a life time change, do it slowly and in a way that you can keep doing forever.
You should start to look into your mental side as well, are there emotional issues that cause you to over eat? Because you will need to learn to tell the difference between real hunger and emotional hunger.0 -
oh oh oh! I´m getting excited for you! Just one tip that really makes a difference for me, make a nice tasting salat at least with one meal per day, twice is even better. For me it works best to have fruit in it as well. One of my fave is half a mango diced with diced selleri, just about 50/50 of each. That really helps keeping me satisfied. 0
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Just curious if the practitioner is overweight/obese? This may be affecting her reaction to your goals. She should be optimistic rather than discourage what may be an achievable goal. My recommendation for you is to prove her wrong.0
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Most medical professionals don't know the first thing about weight management and only basing this off of experience. Also noting that the vast majority of patients are overweight or obese, have tried diets and failed, so what you're getting is a lifetime of confirmation bias.
Who cares what others say? You decide your fate.
Set a goal to lose 1 lb/week for the next 10 weeks - if you hit or exceed your goal - great! If you miss the mark take a look at your diary and find out what went wrong with your plan, readjust and set a new goal.1 -
Perhaps it's because the ideal weight for a woman in their 20s at your height is 120lbs. When you are 40 with metabolic issues, it may not be realistic to set your goal at the ideal weight for an average, healthy 20-something. Yes, losing weight will help with issues, but we also have to recognize that at a certain age, the ache in our knees or our pre-diabetic issues, blood pressure and other items, are not going to be always weight related, and are going to be more age related.
They may be giving you this particular advice because once you're into your 40s and higher, metabolic rates slow down, other health issues go up, and the focus for not exceptionally obese people should be on health far more than weight loss, IMO anyway. You're certainly not super fat at 40lbs overweight. Reducing that even by half is going to have a major impact on any health issues that are actually related to the weight.
PCOS is also well-known to impact a person's metabolic rates. Perhaps the conceptualization of "being real" has to do with the time frame that you're talking about.
Theoretically, I was supposed to lose 300lbs in about 2.5 years. It's now almost 6 years later, and I'm down 250lbs, and that's after many different treatments, changes, and eventually weight loss surgery. My PCOS has definitely not gotten better with weight loss... it actually manifested AFTER I started losing significant amounts of weight. It really depends on your medical history and situation, and if you told your NP that you expected to lose 40lbs in less than a year, she may have simply been trying to make sure you had a realistic understanding of how age and PCOS among other things can seriously impact the ability to actually lose weight.3 -
Flipping this around - would it be responsible for medical professionals to tell you to set unreasonable goals?2
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Not a doctor, but here are some helpful links from reputable websites:
https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome
https://www.nichd.nih.gov/health/topics/pcos/conditioninfo/Pages/causes.aspx
What I like about BOTH of these government websites is that they link losing weight with feeling better!
Secondly, PCOS is related to rapid rises in insulin, which by the way, can in some cases be controlled both by medication and modifying your diet.
There are nay-sayers here on MFP that will say that Atkins / Paleo / Ketogenic diets don't work. But, then others swear that by eating very low sugar / carbs and increasing healthy fats and protein that they were better able to control their sugar cravings and even out their bool sugar (and, they lost weight by maintaining a calorie deficit but weren't that hungry).
(Note: it's easy to avoid the "keto flu" if you glide into this way of eating gradually. Change out breakfast during week 1; lunch (and breakfast) during week 2; and dinner along with lunch and breakfast during week 3. I generally try to have a cheat meal on the weekends so that I don't feel so deprived. I also eat a lot of peanut butter, which you may not be able to eat, but, you need to find a satisfying fat to snack on. I also like Epic bars.)
See this website as an example of one where women have reported that it worked for them:
http://soulcysters.com/dr-atkins-diet-and-polycystic-ovaries/#
And another one where the OP describes PCOS and celiac / thyroid:
https://www.paleohacks.com/weight-loss/hack-my-non-weight-loss-i-have-celiac-pcos-and-possible-thyroid-problems-and-possible-ms-13239
Finally, PCOS and thyroid issues seem to go hand in hand:
https://stopthethyroidmadness.com/2012/05/30/hypothyroidism-insulin-resistance-and-metformin/1 -
Be realistic is great advice and there's something powerful in taking a pause. You won't lose the weight and keep it off overnight without starving yourself. I know some others have commented with similar answers. That said, have you thought about getting a body fat analysis done? I'm 5'3'' and doctor approved "healthy" at 140-155 if my muscle mass is high (even though the BMI says I should be closer to 115). I like to use multiple measures to check my progress because when I get too low, it's not sustainable (realistic) and I usually gain the weight back. Be kind to yourself and your body. You may have extra fat/body weight but it doesn't make you a bad person. What things can you do and have you already changed to be a healthier person? Good luck on your journey!0
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And with all of that said...35-40 lbs may be perfectly realistic for you!
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Perhaps it's because the ideal weight for a woman in their 20s at your height is 120lbs. When you are 40 with metabolic issues, it may not be realistic to set your goal at the ideal weight for an average, healthy 20-something. Yes, losing weight will help with issues, but we also have to recognize that at a certain age, the ache in our knees or our pre-diabetic issues, blood pressure and other items, are not going to be always weight related, and are going to be more age related.
They may be giving you this particular advice because once you're into your 40s and higher, metabolic rates slow down, other health issues go up, and the focus for not exceptionally obese people should be on health far more than weight loss, IMO anyway. You're certainly not super fat at 40lbs overweight. Reducing that even by half is going to have a major impact on any health issues that are actually related to the weight.
PCOS is also well-known to impact a person's metabolic rates. Perhaps the conceptualization of "being real" has to do with the time frame that you're talking about.
Theoretically, I was supposed to lose 300lbs in about 2.5 years. It's now almost 6 years later, and I'm down 250lbs, and that's after many different treatments, changes, and eventually weight loss surgery. My PCOS has definitely not gotten better with weight loss... it actually manifested AFTER I started losing significant amounts of weight. It really depends on your medical history and situation, and if you told your NP that you expected to lose 40lbs in less than a year, she may have simply been trying to make sure you had a realistic understanding of how age and PCOS among other things can seriously impact the ability to actually lose weight.
Overall, I think your advice is sound, and I greatly respect what you've achieved, via strong and persistent effort, in your own life.
Even so, I feel compelled to dispute the passages I've bolded. They may be true for some, but they are not universals. I'd like to see people be open to their own possibilities.
At 46, I was obese - not morbidly obese, but substantially more overweight than OP. I had just completed treatment for stage III breast cancer: Bilateral mastectomy surgery, chemotherapy, radiation, anti-estrogen drugs. I was in very bad physical condition, weakened, just diagnosed hypothyroid, persistent back and knee problems/pain, high cholesterol/triglycerides, prehypertensive blood pressure, and pretty much completely inactive: Sedentary lifestyle, sedentary high-stress job, recently widowed.
Now, 62 in a couple of weeks, I'm strong, athletic, healthy, fitter than most 40 year olds, with solidly normal cholesterol/triglycerides, low normal blood pressure, only minor and occasional knee discomfort from that torn meniscus, no notable back problems, resting heart rate in the high 40s, and at the body weight I was in college.
Age is not synonymous with disability. Yes, decades of poor health practices take a toll, and some of those problems may be sadly irreversible. Luck and genetics play a strong role, as well. But we are not all doomed to steady decline and rapidly increasing disability.
There's ample evidence that the supposed "metabolic slowdown" as we age is in significant measure due to loss of muscle mass and a more inactive daily life: Factors most of us can counter, at least to some extent. Strength and fitness gain has been demonstrated even in people well into their 80s, resulting in improved quality of life.
I'm not unsympathetic to anyone's struggles with any of this, nor do I make the Pollyanna-ish assumption that anything is possible for everyone. We each have our own challenges. It's hard, at best.
But I vehemently disagree that a slow slide into disability and slowed metabolism is inevitable after 40. I don't think we should limit people's reasonable aspirations toward improvement. I like to see people try, see what they can do, find their limitations rather than assume them, and (often) surprise themselves.
End of soapbox speech! 11 -
Keep in mind that doctors have to treat you based on science. Right now there isn't a lot of great science about the best methods of reducing caloric intake.
Most primary care doctors are already incredibly overworked and have gotten sick of spending hours discussing weight loss with patients only to have most patients ignore all the advice. They know that the patients who are truly motivated enough to make the necessary lifestyle changes have already taken the initiative to research methods of weight loss. They don't just ask their doctor for some general advice. If you asked your doctor about a specific diet protocol then you might find them more receptive.
If you want to talk to a doctor about losing weight then you're better off asking for a referral to an obesity specialist. They have the proper training and the time to try and figure out a method that will work for you.0 -
Also: being realistic doesn't mean giving up. People are conflating those two unfairly.
What they aren't saying is this:
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In defense of your doc and NP, if they're under the age of 50, their medical education (either initially or through continuing ed) included science-based nutrition. However, in their practices, they've likely seen 95% of overweight patients 1. never try to lose weight 2. try and give up or 3. try something woo-ish and damage their health. Until they realize you're one of the 5% success stories, they'll give you the same advice they hand out every day, hoping to steer you away from depression and/or gall bladder problems.
Those who say docs don't know nutrition often mean they ask their docs about the latest Dr. Oz gimmick and the docs say, "I wouldn't know about that." Also, docs worth their salt will refer you to a licensed nutritionist if you ask, just as they refer you to any other specialist outside their field of expertise.
When my doc recorded my first 27 pound loss, he was very supportive and asked how I did it. I said "Tracking through MyFitnessPal" and he responded, "Yep, tracking is the only thing that works long-term." Somehow my brain interpreted that as permission to stop tracking and I gained back 17. Here again because tracking CICO works.1 -
lacyphacelia wrote: »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.
I dont care about someone elses opinion of what you are capable of, its completely irrelevant. I care about what your realistic belief is and you already stated its 35-40 pounds. So I say lets see whose belief really was realistic...I got a felling it was yours tbh.0 -
I've never, ever thought that losing a lot of weight in a couple of months is realistic. Nor have I said that, ever. I'm the type of person chastising people who call and complain to me that they didn't lose the 20 pounds they expected after 2 weeks.
I recently had a blood test and noticed my triglycerides (can't remember exactly what) were higher than normal. Kind of freaked out, contacted the doctor, only to be told "your doctor isn't worried about it because you don't have problems yet." Isn't that point of preventative care to PREVENT problems? Ugh.
This thread has given me some things to think of, but one thing I am now firm in is I can't trust my GP as much as I thought.0 -
lacyphacelia wrote: »I've never, ever thought that losing a lot of weight in a couple of months is realistic. Nor have I said that, ever. I'm the type of person chastising people who call and complain to me that they didn't lose the 20 pounds they expected after 2 weeks.
I recently had a blood test and noticed my triglycerides (can't remember exactly what) were higher than normal. Kind of freaked out, contacted the doctor, only to be told "your doctor isn't worried about it because you don't have problems yet." Isn't that point of preventative care to PREVENT problems? Ugh.
This thread has given me some things to think of, but one thing I am now firm in is I can't trust my GP as much as I thought.
That's the number my doc told me is controlled by diet. It's likely "your doctor isn't worried..." is office staff-speak for "Statistically you don't fall into a risk group that would benefit from counseling and/or medication." That doesn't prevent you from scheduling another appointment to discuss the test results with the doctor.1 -
I'd agree with your GP, it'd also be the first two pieces of advice I'd give someone beginning a weight loss journey.
1. Be realistic about your rate of loss and how low you can/should go.
2. Don't diet, change your eating and activity habits for good. Don't do anything you wouldn't do for the rest of your life. To me, diet implies a temporary effort.3 -
cwolfman13 wrote: »lacyphacelia wrote: »
It's not necessarily "dieting"...I know people with PCOS and I know people with diabetes and in both cases, they eat diets lower in carbs...not super low carb or anything, but less than someone without medical issues would take in. PCOS is associated with insulin resistance which is generally where lowering carbohydrates is subscribed.
My dad had type II and had to watch his carbs and make better choices in regards to the carbs he was eating. He typically only ate grains and starches and the like at breakfast and lunch and he at them in amounts that kept him under some number per meal...his evening meal was typically vegetables and a protein. This wasn't a weight loss diet (though he did lose weight)...this was how he ate to control his blood sugar.
In regards to "be realistic", that can mean any number of things. Five years ago I went in for my 38 year checkup and came out with a bunch of nasty blood work and my doctor wanted me on meds right away...I told him I really wanted to work on cleaning up my diet and exercise and losing weight before I went to the meds...he said, "ok...but we have to be realistic here." I asked him what he meant by that and he told me that he rarely sees his patients have success with diet and exercise because they just don't stick with it...not just for the handful of months necessary to lose weight, but forever to necessarily control these conditions.
Five years later I have very much been the exception and he tells me that every time I visit.
I think it was key that you asked your doctor for clarification. Doctors do have experience and do have interest in helping their patients through lifestyle as well as medication, they just have no idea whether or not the patient is psychologically ready to undertake such a habit overhaul.1 -
At my GP's office, all the rooms have this poster on the door highlighting the point that 95% of people who lose weight eventually gain it back. I seriously don't understand the point of these posters, because it definitely is not very motivating! I have read that doctors are quite hapless at discussing weight loss with their patients.2
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You can do this. Move more. Eat less. I’m 52 and when I was younger my weight ballooned to 185. I decided to change that a few years ago. I have kept 50 lbs off for 3 years. I was down to 125 last year then slowly started to eat more. I have decided to tighten my diet again. I feel so much better when I eat right and exercise. I loved 125 and I think I’ll be elated at 120. At one time, I remember thinking I couldn’t possibly weight less than 150. When I blew by 150, I was astounded. You can do this!!!!4
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lacyphacelia wrote: »I've never, ever thought that losing a lot of weight in a couple of months is realistic. Nor have I said that, ever. I'm the type of person chastising people who call and complain to me that they didn't lose the 20 pounds they expected after 2 weeks.
I recently had a blood test and noticed my triglycerides (can't remember exactly what) were higher than normal. Kind of freaked out, contacted the doctor, only to be told "your doctor isn't worried about it because you don't have problems yet." Isn't that point of preventative care to PREVENT problems? Ugh.
This thread has given me some things to think of, but one thing I am now firm in is I can't trust my GP as much as I thought.
Triglyceride levels tend to be more volatile, IME - to jump around a bit, relatively quickly, with dietary variations. Assuming it's new for them to be high, the doc may just be waiting to see if it's a continuing thing next time, or just a fluke random fluctuation. With this issue, keep in mind that the GP could be doing/thinking something prudent/sensible but the staff is explaining it lamely.0
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