General Question - Why Do Doctors Push for Surgery?
Replies
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Clarifying one point:
When I wrote I average 0.5 pounds a week what that means is over this 9 month period, taking my weight loss in total and dividing it by 9 months it equals 0.5 a week.
However, that does not mean I only lose 0.5 a week. Some weeks I don't lose like on our 2 week vacation for our anniversary (but at least there was no gain). Some, I've lost a pound or a bit more.
So, the weight loss is not a static number. It fluctuates based on calories in/out and activity - just like everyone else - it just has average to 0.5 a week over time.8 -
Clarifying one point:
When I wrote I average 0.5 pounds a week what that means is over this 9 month period, taking my weight loss in total and dividing it by 9 months it equals 0.5 a week.
However, that does not mean I only lose 0.5 a week. Some weeks I don't lose like on our 2 week vacation for our anniversary (but at least there was no gain). Some, I've lost a pound or a bit more.
So, the weight loss is not a static number. It fluctuates based on calories in/out and activity - just like everyone else - it just has average to 0.5 a week over time.
You've done really well and should be proud of yourself. There is nothing wrong with your progress, however I worked out your average loss to be more than 0.5 lb a week, but even if it is, its great2 -
lovelylosses 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.
Not everyone gains weight because of some kind of "issue." I put on about 40 Lbs very slowly over the course of about 8 years...I didn't have some big issue to deal with causing me to overeat. I went from being a very active college student who walked or road my bike everywhere to sitting behind a desk 10-12 hours per day and commuting by car.
I lost the weight years ago and have been in maintenance for over 6 years.9 -
Clarifying one point:
When I wrote I average 0.5 pounds a week what that means is over this 9 month period, taking my weight loss in total and dividing it by 9 months it equals 0.5 a week.
However, that does not mean I only lose 0.5 a week. Some weeks I don't lose like on our 2 week vacation for our anniversary (but at least there was no gain). Some, I've lost a pound or a bit more.
So, the weight loss is not a static number. It fluctuates based on calories in/out and activity - just like everyone else - it just has average to 0.5 a week over time.
You've done really well and should be proud of yourself. There is nothing wrong with your progress, however I worked out your average loss to be more than 0.5 lb a week, but even if it is, its great
OP, I agree with nooboots.
You are doing great and should be proud of how well you are doing!🌸3 -
First, a huge congrats on your loss, especially in such a short period of time! Second, I didn't read everyone else's replies, so this is just my take on it. If I were you and my doc pushed for surgery that I already told him I don't need, and that you obviously don't need (you don't weigh enough to warrant surgery) I'd simply find another doctor. I don't know what his personal agenda is, but it sounds like he gets a kick back for every surgery candidate he sends the surgeon's way. And yes, even here in the States, sad as it is to think about it, this DOES happen, and quite often. So yeah, my first move would be to check for a new doctor.3
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Clarifying one point:
When I wrote I average 0.5 pounds a week what that means is over this 9 month period, taking my weight loss in total and dividing it by 9 months it equals 0.5 a week.
However, that does not mean I only lose 0.5 a week. Some weeks I don't lose like on our 2 week vacation for our anniversary (but at least there was no gain). Some, I've lost a pound or a bit more.
So, the weight loss is not a static number. It fluctuates based on calories in/out and activity - just like everyone else - it just has average to 0.5 a week over time.
That’s what I was going to point out too! I agree you are doing great and there’s no reason for surgery that could potentially mess up your body forever.
1/2 lb is a 1/2 lb and as someone who has backslid and gained 18 lbs after losing 98, I wish I was back to losing 1/2 lb a week.
As Dr Now says - if you’re not losing, you’re gaining and he’s absolutely right!
PS I’m 60 also
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paperpudding 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.
I think there is probably a fair bit of difference between Australia and the US in this regard. In the US, there is a lot of financial pressure on doctors, and billions in marketing spent to encourage doctors to prescribe specific medicines and procedures. What the pharmaceutical industry in the US does with marketing to doctors ranges between highly unethical and flat out illegal. It's a big reason the opioid epidemic is as big as it is in the US.
I believe ultimately, most doctors are good people and got into medicine with the right intentions. Most still probably have those intentions. Without knowing more about OP's specific doctor, I wouldn't ascribe any particular ulterior motive to him. The likely answer is that he thinks weight loss surgery would be the most effective option for her, and is making his best recommendation for her. That doesn't mean that he's not wrong, but I wouldn't assign any bad faith to him without evidence, of which we don't have any.
But there is significant financial pressure on doctors in the US that there aren't in other countries, and it's not unreasonable that sometimes those pressures inform their decision making more than they would like to admit in certain situations.9 -
lovelylosses 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.
People gain weight when they take in more calories than they burn, on average.
You stated that "gaining weight is usually a spiritual, psychological, emotional, or mental issue (or a combination of all of them)." However, being overweight does not mean you have any of these "issues." It simply means you overate. Some people have emotional or psychological reasons for overeating. Some do not.7 -
lovelylosses 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.
People gain weight when they take in more calories than they burn, on average.
You stated that "gaining weight is usually a spiritual, psychological, emotional, or mental issue (or a combination of all of them)." However, being overweight does not mean you have any of these "issues." It simply means you overate. Some people have emotional or psychological reasons for overeating. Some do not.
No I didn’t. You’re replying to the OP I think (I replied to your comment but I’m not the original person who said the above).0 -
lovelylosses wrote: »lovelylosses 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.
People gain weight when they take in more calories than they burn, on average.
You stated that "gaining weight is usually a spiritual, psychological, emotional, or mental issue (or a combination of all of them)." However, being overweight does not mean you have any of these "issues." It simply means you overate. Some people have emotional or psychological reasons for overeating. Some do not.
No I didn’t. You’re replying to the OP I think (I replied to your comment but I’m not the original person who said the above).
Sorry, you did not say the quoted text.
It is still true that some people, but not all people, overeat due to psychological or emotional issues. It is not correct to claim that all or most people have psychological or emotional reasons for overeating.0 -
Instead of guessing, or people online with their biases guessing, I recommend you ask your doctor at the next appointment. You can do that, you know.
It may be uncomfortable for you, but I promise; the discomfort only lasts as long as it takes to get the question out of past your lips. I recommend practicing it at home until you are satisfied with the wording, tone, etc, and it is slips out easily.11 -
Referral kickbacks. It’s a real thing, and seems to be pushed quite strongly in Florida where I live. I have to fight the feeling that ALL referrals are nefarious. I’m sure some are good and necessary, but I have had several referrals that I didn’t follow up on cause it just didn’t feel right. Many doctors in my area are all a part of the same medical group, so you know there’s money or at least clients being exchanged.8
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paperpudding 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.
I think there is probably a fair bit of difference between Australia and the US in this regard. In the US, there is a lot of financial pressure on doctors, and billions in marketing spent to encourage doctors to prescribe specific medicines and procedures. What the pharmaceutical industry in the US does with marketing to doctors ranges between highly unethical and flat out illegal. It's a big reason the opioid epidemic is as big as it is in the US.
I believe ultimately, most doctors are good people and got into medicine with the right intentions. Most still probably have those intentions. Without knowing more about OP's specific doctor, I wouldn't ascribe any particular ulterior motive to him. The likely answer is that he thinks weight loss surgery would be the most effective option for her, and is making his best recommendation for her. That doesn't mean that he's not wrong, but I wouldn't assign any bad faith to him without evidence, of which we don't have any.
But there is significant financial pressure on doctors in the US that there aren't in other countries, and it's not unreasonable that sometimes those pressures inform their decision making more than they would like to admit in certain situations.
That may be so - can only speak for situation here - where sure, med reps do recomend and promote their products - but there are very strict guidelines about how this must be transparent and Drs do not financially benifit from any referals, prescriptions etc
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paperpudding wrote: »paperpudding 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.
I think there is probably a fair bit of difference between Australia and the US in this regard. In the US, there is a lot of financial pressure on doctors, and billions in marketing spent to encourage doctors to prescribe specific medicines and procedures. What the pharmaceutical industry in the US does with marketing to doctors ranges between highly unethical and flat out illegal. It's a big reason the opioid epidemic is as big as it is in the US.
I believe ultimately, most doctors are good people and got into medicine with the right intentions. Most still probably have those intentions. Without knowing more about OP's specific doctor, I wouldn't ascribe any particular ulterior motive to him. The likely answer is that he thinks weight loss surgery would be the most effective option for her, and is making his best recommendation for her. That doesn't mean that he's not wrong, but I wouldn't assign any bad faith to him without evidence, of which we don't have any.
But there is significant financial pressure on doctors in the US that there aren't in other countries, and it's not unreasonable that sometimes those pressures inform their decision making more than they would like to admit in certain situations.
That may be so - can only speak for situation here - where sure, med reps do recomend and promote their products - but there are very strict guidelines about how this must be transparent and Drs do not financially benifit from any referals, prescriptions etc
Not in the good old U S of A, perks abound from pharmaceutical companies to doctors here.2 -
grinning_chick wrote: »Instead of guessing, or people online with their biases guessing, I recommend you ask your doctor at the next appointment. You can do that, you know.
It may be uncomfortable for you, but I promise; the discomfort only lasts as long as it takes to get the question out of past your lips. I recommend practicing it at home until you are satisfied with the wording, tone, etc, and it is slips out easily.
This. It sounds like you like your doctor otherwise and it might be really worth resolving this in person, with him!
It might be worth asking if he thinks you are developing a weight-related disease or something (eg pre-diabetic) that is pushing this question.
I’ve learned stats & blood work aren’t always shared in detail until a threshold is met (my iron level was the lowest in the normal range and I wasn’t told until I started losing hair!).
I had similar stats to you now - 5’2 205lbs - and all my doctor recommended was a nutritionist visit. I think at that point I would have just met the minimum requirements for WLS. But yes without underlying medical issues it is an odd recommendation.
Congratulations on your loss!!!
Logging can always be more accurate. I lost most of my weight so far using measuring cups, but I tell ya the food scale has been a game changer. It also generates fewer dishes! And I’m still not totally accurate. (Weighing cooked meat is inaccurate etc). Being honest with yourself about where you can tighten it up a bit - maybe not eating back exercise calories (as a low impact activity person im always skeptical of the estimates for walking etc) is good to know if your loss slows or stalls etc.
I’m also someone who has re-gained and is losing again, (lost 50 gained 20 lost 8) so slow & steady is definitely better!4 -
grinning_chick wrote: »Instead of guessing, or people online with their biases guessing, I recommend you ask your doctor at the next appointment. You can do that, you know.
It may be uncomfortable for you, but I promise; the discomfort only lasts as long as it takes to get the question out of past your lips. I recommend practicing it at home until you are satisfied with the wording, tone, etc, and it is slips out easily.
This. It sounds like you like your doctor otherwise and it might be really worth resolving this in person, with him!
It might be worth asking if he thinks you are developing a weight-related disease or something (eg pre-diabetic) that is pushing this question.
I’ve learned stats & blood work aren’t always shared in detail until a threshold is met (my iron level was the lowest in the normal range and I wasn’t told until I started losing hair!).
I had similar stats to you now - 5’2 205lbs - and all my doctor recommended was a nutritionist visit. I think at that point I would have just met the minimum requirements for WLS. But yes without underlying medical issues it is an odd recommendation.
Congratulations on your loss!!!
Logging can always be more accurate. I lost most of my weight so far using measuring cups, but I tell ya the food scale has been a game changer. It also generates fewer dishes! And I’m still not totally accurate. (Weighing cooked meat is inaccurate etc). Being honest with yourself about where you can tighten it up a bit - maybe not eating back exercise calories (as a low impact activity person im always skeptical of the estimates for walking etc) is good to know if your loss slows or stalls etc.
I’m also someone who has re-gained and is losing again, (lost 50 gained 20 lost 8) so slow & steady is definitely better!
Thank you. I will ask him directly on my next visit. May as well.
My stats/bloodwork are always shared so I'm fully aware of them being normal other than slightly elevated cholesterol, which he didn't feel was necessary to have me on medication for. I have access to an online database which is in a chart that I can reference that goes back since I've been his patient (I'm sort of new to his practice so it's only about 2 years). I was never diagnosed as pre-diabetic either. I did, see a nutritionist for a couple of months at the beginning of changing my diet for guidance - she was extremely helpful for planning meals, portions and getting my head straight about it too. I highly recommend this to anyone.
Perhaps, being that he doesn't know my complete history of weight loss this impacts his viewpoint; he isn't fully aware of previous times I lost weight on my own and kept it off for many years other than what I told him. My records from my prior physician only included diagnostics, not written notations of conversations (that doctor retired). So, it's heresay to him what I relate about my weight loss history and I can see that he may not fully believe me since he has no way of knowing if it's true or not.
I use a scale at home to weigh food, not cups/spoons. Same at work - I keep a small scale at my desk and use that when possible. Most of the food at get at the office is from places that have nutritional info on their websites so I'm fairly confident that it's more or less close to what is stated. I too am skeptical of calories listed so I try to leave some room for plus/minus what is listed. I'm eating fairly low fat (and good fats at that), lower carb (not low carb, I can't manage that), very low sugar (that's easy for me), there's like no trans fats in my diet, very little to no cholesterol unless I eat eggs, good lean proteins, way more vegetable based meals, barely eat dairy at all anymore either. Seriously have completely revamped my eating!5 -
grinning_chick wrote: »Instead of guessing, or people online with their biases guessing, I recommend you ask your doctor at the next appointment. You can do that, you know.
It may be uncomfortable for you, but I promise; the discomfort only lasts as long as it takes to get the question out of past your lips. I recommend practicing it at home until you are satisfied with the wording, tone, etc, and it is slips out easily.
This. It sounds like you like your doctor otherwise and it might be really worth resolving this in person, with him!
It might be worth asking if he thinks you are developing a weight-related disease or something (eg pre-diabetic) that is pushing this question.
I’ve learned stats & blood work aren’t always shared in detail until a threshold is met (my iron level was the lowest in the normal range and I wasn’t told until I started losing hair!).
I had similar stats to you now - 5’2 205lbs - and all my doctor recommended was a nutritionist visit. I think at that point I would have just met the minimum requirements for WLS. But yes without underlying medical issues it is an odd recommendation.
Congratulations on your loss!!!
Logging can always be more accurate. I lost most of my weight so far using measuring cups, but I tell ya the food scale has been a game changer. It also generates fewer dishes! And I’m still not totally accurate. (Weighing cooked meat is inaccurate etc). Being honest with yourself about where you can tighten it up a bit - maybe not eating back exercise calories (as a low impact activity person im always skeptical of the estimates for walking etc) is good to know if your loss slows or stalls etc.
I’m also someone who has re-gained and is losing again, (lost 50 gained 20 lost 8) so slow & steady is definitely better!
Thank you. I will ask him directly on my next visit. May as well.
My stats/bloodwork are always shared so I'm fully aware of them being normal other than slightly elevated cholesterol, which he didn't feel was necessary to have me on medication for. I have access to an online database which is in a chart that I can reference that goes back since I've been his patient (I'm sort of new to his practice so it's only about 2 years). I was never diagnosed as pre-diabetic either. I did, see a nutritionist for a couple of months at the beginning of changing my diet for guidance - she was extremely helpful for planning meals, portions and getting my head straight about it too. I highly recommend this to anyone.
Perhaps, being that he doesn't know my complete history of weight loss this impacts his viewpoint; he isn't fully aware of previous times I lost weight on my own and kept it off for many years other than what I told him. My records from my prior physician only included diagnostics, not written notations of conversations (that doctor retired). So, it's heresay to him what I relate about my weight loss history and I can see that he may not fully believe me since he has no way of knowing if it's true or not.
I use a scale at home to weigh food, not cups/spoons. Same at work - I keep a small scale at my desk and use that when possible. Most of the food at get at the office is from places that have nutritional info on their websites so I'm fairly confident that it's more or less close to what is stated. I too am skeptical of calories listed so I try to leave some room for plus/minus what is listed. I'm eating fairly low fat (and good fats at that), lower carb (not low carb, I can't manage that), very low sugar (that's easy for me), there's like no trans fats in my diet, very little to no cholesterol unless I eat eggs, good lean proteins, way more vegetable based meals, barely eat dairy at all anymore either. Seriously have completely revamped my eating!
Way to go! And good luck with your conversation, hopefully you’ll have a good relationship with your doctor again 🙂2
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