How would you like your doctor/GP/family physician to help you lose weight?
Replies
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Lobsterboxtops wrote: »cmriverside wrote: »Lobsterboxtops wrote: »I think PCPs can’t win in this situation. Either they mention the weight as a possible cause for issues and are told they are focusing on the wrong thing, or they don’t mention it and they are not helping.
I can understand why they either get stuck in the loop of blaming everything on weight or just ignoring it.
I never even had a doctor MENTION my weight, though.
I'm one of these people who got up to a size 18 and thought I didn't look that bad and that I was healthy.
Someone needed to sit me down...
Understood, but for every person like you there is one who would react the total opposite “OMG, the first thing my doctor said was that I’m overweight don’t they think I know that! “ and then shut down to anything else they said.
Like I said..can’t win.
Those are not the only two options. It IS possible for doctors to both properly educate their patients about the risks of obesity while also doing proper diagnostics and investigation into the causes of health issues and not simply assume it's from obesity.
ITA. This is just my vaguely educated opinion, but it seems like a lack of education in nutrition, exercise science, and weight maintenance leaves PCPs unprepared for these issues, and in the day to day rush they either ignore weight issues to avoid conversational awkwardness, or harp incessantly on weight issues to avoid "wasting time" (sarcasm quotes) on diagnosing something that might be weight related. Or they latch onto a fad that they don't have the education to see through, but give it credence because of their title
It also doesn't help that at least here in the US many people are forced to play musical chairs with their health insurance so often have to switch doctors or go to offices where you see whoever is free. So you don't develop that relationship that fosters more than a hit and run dynamic.
I think a PCP should mention if a patient's weight is a health concern while still treating them as a complex human being with other concerns, and be ready to refer them to an RD or an obesity specialist if they are open to dealing with their weight.8 -
I can vouch for a lot of people who say that nutrition isn't part of medical education...I'm a first year medical student, and though we've had several lectures on nutrition with respect to metabolism and biochemistry, nutrition as a whole isn't integrated into medical curriculum very well. To exacerbate this issue, most doctors forget the biochemistry they learned during first year - practicing physicians are pretty far removed from the world of diet and exercise, even though we are taught to ask about this with each patient. I will say though, that it's out of respect and concern that doctors ask patients about their health goals; it seems like people get offended when asked about this, but we mean no harm or malice in any capacity. We ask because metabolism is a) different in every person, b) a major contributor to microscopic health (not just macroscopically - i.e. BMI), and c) changes quickly and sometimes for unknown reasons. If I wanted nutrition advice, I would not ask my PCP - at the same time, I (and hopefully my peers) recognize that nutrition is out of our scope of practice unless we're certified in some way. Ask your PCP for a nutritionist or dietician consult and see what they say; if they gladly oblige, they're doing their job. If they brush the request off, they are not fulfilling their role as a provider of care and as a patient advocate. A good physician will get to the root of the problem and give you access to as many resources as possible.15
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I have never had a doctor mention my weight to me. I mentioned it one time to a neurologist (we were trying to figure out why I have syncope). I said something like, “I know I’m overweight,” and he literally told me that my weight was fine. Now I was literally on the low end of obese by the BMI chart, and he literally gave me a hand sweeping motion while brushing off my comment. I expected more of a “yeah, it would be a good idea to get to a more normal weight,” but that never came.
Granted my weight doesn’t cause me any health issues. I have low blood pressure (which causes the syncope) and weight doesn’t affect that at all. I remember that vividly bc that was the day I paid $45 to be told “to eat more salt.” 😒🥴😑0 -
@j_eanie fantastic topic.
Unfortunately, I agree its lack of education, Many medical facility's don't have the money or staff to put together real treatment options. How would I like a DR/GP/FP help me to lose weight? A simple referral to a program offered by my local hospital (My Dr, had no clue this program existed)
Drs diagnose medical issues and give advice on the best route to address weight and nutrition.
People suffering from eating disorders, are referred to a specialized mental health program
Diabetic issues are treated and given education and nutrition to meet their needs
They offer supervised with loss. Appointments with a dietitian. Weight loss diet/nutrition is NOT a one size fits all. They go over your medical history, medications, blood work, hormones and any risk factors to develop a individualized weight loss eating plan.
Exercise - Some classes are offered for people with mobility issues. Insurance company's may cover free gym memberships. Support groups have scheduled days for group fitness.
Group behavior change class facilitated by a psychiatrist
Classes on navigating grocery store for healthy eating and ordering healthy at restaurants.
Cooking classes
Support groups facilitated by nursing staff
Education and treatment for the obesity.
Options for bariatric surgery – Referral to an education seminar that go’s over gastric sleeve, Mini by pass, SIPS, Roux -N – Y bypass (many surgeons don’t do band or balloon procedures) Insurance approval, medical and/physiological pre surgery exams. Pre surgery education with one year dietitian support, five years of check ups. cooking classes, behavior change support groups Etc…
Only my opinion,
We can agree weight gain is food choices and eating over your maintenance calories. But, it so much more than that. age, sex, medical issues, genetics/body physiology, medication, mental health. hormones access to healthy food/income.
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When I went to my previous physician and asked her about weight loss she questioned why, stating that I don’t look fat, despite the fact that I was 20 lbs overweight. When I asked for her advice, her suggestion was phentermine and a 1200 calorie diet.
Im a P.A. now and would never give that advice. Tbh, most patients get offended if you mention their excess weight as the probable cause of their disease or pain, no matter how nice and tactful you are. This is probably why so many probably don’t bother to address it. Tbh, most just want an immediate fix, a pill, etc. It is the minority of patients that actually are willing to make a lifestyle change.
If someone asks for my advice about weight loss, I will encourage them to change their diet, move more, and I suggest MFP to help them count calories. If they ask for my advice on what to eat for health, my advice will be different.3 -
In general I don't expect doctors to comment on weight loss unless a patient is obese and then gently. If there are health issues that can be resolved I think it's great to bring it up. For example when I was diagnosed as diabetic I was given medication and a meter, no dietitian or counseling covered by insurance. The majority of my older family members are diabetic including some who work out daily. I started losing for my health, I never thought I'd be able to go off medication with my family history but my A1C is down to 4.5 and I'm slightly hypoglycemic instead when I wake. I found what to eat and do from my own research and n=1. My doctor was happy for me and wanted to know what I'd done.2
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My weight got to the point where I needed to be put on blood pressure meds. I hate having to remember to take pills. My GP is a second-generation Iranian guy who gives no *kitten* and told me flat out, "Lose the weight and you'll be able to get off the pills." He introduced me to MFP - I'm a numbers person and I was motivated. He gave me gentle encouragement and if I had questions he would point me toward an authoritative reference or email me something. I held up my end of the bargain, lost the weight, and he held up his. I've been off the pills for a year.13
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My weight got to the point where I needed to be put on blood pressure meds. I hate having to remember to take pills. My GP is a second-generation Iranian guy who gives no *kitten* and told me flat out, "Lose the weight and you'll be able to get off the pills." He introduced me to MFP - I'm a numbers person and I was motivated. He gave me gentle encouragement and if I had questions he would point me toward an authoritative reference or email me something. I held up my end of the bargain, lost the weight, and he held up his. I've been off the pills for a year.
That’s excellent! It is so motivating and inspiring when patients make positive changes for their health!
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I have EDS and my doctor essentially told me "you're best shot for a healthy life is to get as light and as strong as possible. Do that however you want"0
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When I was a child, our family doctor would not stop talking about my weight. He made me feel like an animal and not a person. He wouldn't look at me or speak to me, but used words like fat and cow (seriously). This began around age 7-8 and continued until I was 13 and my parents finally switched doctors. At one point he sent me to a psychologist AND a dietitian. The psychologist helped with my anxiety but the dietitian basically said I was a healthy preteen and needed to drink more milk. I was around 5'4" and around 140 lb when I was 10 years old...which is strange for an elementary school aged child, certainly very tall and big for that age and on the way to weight issues, but not dangerously obese or anything. I was active, rode bikes & swam and didn't have any other health problems.
Because of that (and other issues with same physician) I developed a fear & mistrust of doctors that lasted well into my thirties.
When I finally went to a doctor in my 30s, he told me I really needed to lose about 10% of my body weight to avoid becoming prediabetic and other issues. I was morbidly obese at the time and needed lose much more than 10%. BUT...that worked for me...I took his concerns very seriously and I liked and trusted him much more because he didn't seem to write me off for being too fat. I knew a lot of other people around my size who were basically told that any health issue they had was due to weight and they needed to get various surgeries such as the sleeve, lap band, etc. That doctor wound up retiring but I liked and trusted him all the more due to his realistic suggestion. It felt doable and I got serious about exercising more and eating less.
Now that I'm at a healthy weight or technically about 12-15 lb overweight (on the charts) as a 5'8", 43 year old...my doctor thinks I'm at a great weight and it's amazing that I've maintained a major loss for 6.5 years.
I would be 100% open to any suggestions if I began to have any type of health problem that could be exacerbated by excess weight.
I think PCPs need to be frank about weight affecting certain body systems and making certain conditions worse. But shaming and berating patients is usually not effective.
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@seltzermint555 I am saddened to hear of your experience. I can not for the life of me imagine any doctor speaking to one of their patients like that, but can appreciate the lasting impact it had on you. If any of my doctors spoke to my children like that there is no way I'd ever set foot inside their door again. Those sorts of comments are more likely to bring about eating disorders instead of healthy weight loss. It is such a positive ending though to read that you found a doctor that helped you achieve and maintain a healthy weight.
What I would look for in a doctor? One that is honest that I can easily relate. One who accepts his limitations and will refer me on when necessary. This would include a dietitian if necessary as I wouldn't expect him to be an expert in weight loss. One that is holistic, looking at the physical, psychological, social and cultural aspects of my life. Fortunately, the doctor I have been seeing for over 20 years fits the criteria well.4 -
My Dr helped me by telling my A1C test came back as pre-diabetic. That's all I needed to start my WLJ. She was shocked when I came back for 6 month labs and was down 75 lbs. I completely turned all my bad numbers around and A1C went from 6.1 to 5.2. Currently down 90 lbs from April.6
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i love my PCP - she is a PA that i've been seeing for 4 years now - she's seen me at my lowest weight in 4 years and my highest - which while obese on BMI scale, i'm still at 22% BF (so she isn't too worried about me)
i do wish in general getting help was easier - for example, I can't use my flex spending for a dietician unless i get a refer and typically then that is when its too late and you are already overweight - so reactive rather than proactive1 -
I would want my PCP to be able to refer me to a reputable registered dietitian that would help me create a healthy deficit.3
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My mother's GP; when she mentioned that she felt her weight was not under control and that she needed help; GP wrote out a referral to a registered and licensed dietician with a proper education. Not only that, but at the next visit for her medication the GP actually followed up with her, whether she went and what progress had been made.
Three years on. Mum (75) has lost 25 Kg She is still overweight borderline obese. She feels it is OK now, and her GP is monitoring how she is doing. If she regains anything I am sure it will get mentioned.3 -
SuzySunshine99 wrote: »I have a great doctor who brought it up by asking me questions about it...the conversation went something like this...
DOC: How do you feel about where your weight is right now?
ME: I know I've gained some, and I'm not too happy about it.
DOC: What do you think would be a good weight goal for you?
ME: I think around 140?
DOC: That sounds good. How do you want to go about getting there?
Etc...etc...it was all questions from her.
She made me come to my own conclusions about it, and just affirmed that I had a good plan. She said to let her know if I wanted a referral to a dietician or any other resources. It wasn't a lecture, which I think can turn people off.
A year later, when I came back below the goal I had set, she just said "Yay!", confirmed that I was now at a healthy weight, and encouraged me to maintain.
I liked this a lot- asking questions to help a patient think about their own situation and the kinds of changes they might be willing to make. Empowering the person and encouraging them to be invested in their own health, as opposed to giving them a mandate. And then perhaps follow up with encouragement to avoid gimmicks and find a balanced approach. As opposed to my 2 most-hated pieces of advice people seem to be given- go on a 1200 calorie diet and eliminate bread & pasta.
I know the subject is a landmine for doctors, but personally I wish more felt the courage to raise the topic (in the non-judgmental fashion outlined above). When I was at my highest weight, I was having (naturally) several nagging health issues, and my doctor never made a peep and let me undergo several expensive tests that found nothing. Afterward, I determined to see if I could help myself through weight loss, better diet, and exercise. It "cured" everything. When I noted this to my doctor, she enthusiastically said, "I thought that would probably help!", but she had never suggested that to me.
We once had a family doctor that impressed me. I had lost a fair amount of weight before he became our doctor but bemoaned to him that stress and a string of illnesses had caused me to lose my good habits. He asked, "So what kind of plan could you put in place to prevent that from happening in the future?" I was dumbstruck, and it did, in fact, help me appreciate that I wasn't a victim or a failure, I just needed a better plan.
Questions are awesome. 7 -
One of my friends got a thing called a green card from her gp after she got diagnosed with pre-diabetes. It gave her free access to a gym, a velodrome and a swimming pool. I'm not sure what else she got with it. She didn't do very well, however, and went on to get full diabetes so I guess she could have done with a nutritionist or coach.2
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SuzySunshine99 wrote: »I have a great doctor who brought it up by asking me questions about it...the conversation went something like this...
DOC: How do you feel about where your weight is right now?
ME: I know I've gained some, and I'm not too happy about it.
DOC: What do you think would be a good weight goal for you?
ME: I think around 140?
DOC: That sounds good. How do you want to go about getting there?
Etc...etc...it was all questions from her.
She made me come to my own conclusions about it, and just affirmed that I had a good plan. She said to let her know if I wanted a referral to a dietician or any other resources. It wasn't a lecture, which I think can turn people off.
A year later, when I came back below the goal I had set, she just said "Yay!", confirmed that I was now at a healthy weight, and encouraged me to maintain.
I liked this a lot- asking questions to help a patient think about their own situation and the kinds of changes they might be willing to make. Empowering the person and encouraging them to be invested in their own health, as opposed to giving them a mandate. And then perhaps follow up with encouragement to avoid gimmicks and find a balanced approach. As opposed to my 2 most-hated pieces of advice people seem to be given- go on a 1200 calorie diet and eliminate bread & pasta.
I know the subject is a landmine for doctors, but personally I wish more felt the courage to raise the topic (in the non-judgmental fashion outlined above). When I was at my highest weight, I was having (naturally) several nagging health issues, and my doctor never made a peep and let me undergo several expensive tests that found nothing. Afterward, I determined to see if I could help myself through weight loss, better diet, and exercise. It "cured" everything. When I noted this to my doctor, she enthusiastically said, "I thought that would probably help!", but she had never suggested that to me.
We once had a family doctor that impressed me. I had lost a fair amount of weight before he became our doctor but bemoaned to him that stress and a string of illnesses had caused me to lose my good habits. He asked, "So what kind of plan could you put in place to prevent that from happening in the future?" I was dumbstruck, and it did, in fact, help me appreciate that I wasn't a victim or a failure, I just needed a better plan. Questions are awesome.
Empowerment! You have hit the nail on the head there. We all have the resources to achieve the weight-related goals we are after. It is just a matter of realising it and then utilising them in an individual way which works for us. A doctor who knows how to empower is one who will achieve the best outcomes for their patients.2 -
fit_chickx wrote: »@j_eanie fantastic topic.
Unfortunately, I agree its lack of education, Many medical facility's don't have the money or staff to put together real treatment options. How would I like a DR/GP/FP help me to lose weight? A simple referral to a program offered by my local hospital (My Dr, had no clue this program existed)
Drs diagnose medical issues and give advice on the best route to address weight and nutrition.
People suffering from eating disorders, are referred to a specialized mental health program
Diabetic issues are treated and given education and nutrition to meet their needs
They offer supervised with loss. Appointments with a dietitian. Weight loss diet/nutrition is NOT a one size fits all. They go over your medical history, medications, blood work, hormones and any risk factors to develop a individualized weight loss eating plan.
Exercise - Some classes are offered for people with mobility issues. Insurance company's may cover free gym memberships. Support groups have scheduled days for group fitness.
Group behavior change class facilitated by a psychiatrist
Classes on navigating grocery store for healthy eating and ordering healthy at restaurants.
Cooking classes
Support groups facilitated by nursing staff
Education and treatment for the obesity.
Options for bariatric surgery – Referral to an education seminar that go’s over gastric sleeve, Mini by pass, SIPS, Roux -N – Y bypass (many surgeons don’t do band or balloon procedures) Insurance approval, medical and/physiological pre surgery exams. Pre surgery education with one year dietitian support, five years of check ups. cooking classes, behavior change support groups Etc…
Only my opinion,
We can agree weight gain is food choices and eating over your maintenance calories. But, it so much more than that. age, sex, medical issues, genetics/body physiology, medication, mental health. hormones access to healthy food/income.
It's unfortunate that these services are primarily offered to only WLS candidates. I was referred to WW (lost but now the constant program changes don't help), received 1200 calorie chicken/ fish/ and veggie for life handouts, a social worker who suggested more dieting to treat binge eating/ exercise bulimia, and a nutritionist who had an "I can't be bothered, go back to the social worker" attitude. I'm currently paying out of pocket for more in depth intervention from an RD, much of the intervention and follow up similar to that of a bariatric program. I wish my insurance covered this, it's not cheap but worth it. In my experience with many doctors, WLS is the only intervention most doctors believe works, so they can't be bothered to be more thorough. I was even told to gain weight to qualify for surgery. Honestly I wish I had at times, because my insurance won't cover the skin removal I need unless I had WLS.
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I'm through the looking glass on this one; I've had two doctors (a family friend PA and a BIL internist) ask ME about fitness and nutrition.
Despite my -IMO- moderate and practical advice, one still eats most of his meals from vending machines and the other is starting the Red Juice/Green Juice stuff.
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My Drs have either said, "Your weight is good" (and it is) or "Your cholesterol and BP are just slightly high, not enough for me to put you on any medication, but losing 10 kg wouldn't be a bad idea" (and so I have).2
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Was feeling so much frustration over the weekend... my doctor recommended for me to do a keto diet.... did some research on my own and from everything I read my doctor’s recommendation was dead opposite from what I need. While it can work well all research indicated that if you are a female over 40 with severe hormone issues Keto is not the way to go. It has just gotten too complicated for me. I thought I ate incredibly well but can’t seem to stop the weight gain. Need a metabolic reset or something....😕1
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Was feeling so much frustration over the weekend... my doctor recommended for me to do a keto diet.... did some research on my own and from everything I read my doctor’s recommendation was dead opposite from what I need. While it can work well all research indicated that if you are a female over 40 with severe hormone issues Keto is not the way to go. It has just gotten too complicated for me. I thought I ate incredibly well but can’t seem to stop the weight gain. Need a metabolic reset or something....😕
If possible, something like this might be when I'd ask for a referral to a dietitian, who would likely have more individualized and helpful advice than "do keto."
Have you tried logging at MFP?3 -
Going to a doctor in regards to losing weight would be like going to an engineer when I need a carpenter.
Humans have a need to over-complicate issues, especially when their ego is at risk.
I particularly do not want to be billed by a physician to tell me to "eat less and move more" - a colossal waste of both our time.3 -
I don't expect my GP to do much except tell me where I am, where I should be, and maybe suggest resources.1
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