A doctor's take on weight loss

Peter470

New member
This will probably be be a slightly unusual post because I have 2 confessions to make:
1. I'm a doctor (GP) and see overweight people all day, and do my best to help them; and
2. I've never been overweight (as measured by BMI) but I tried following my own advice and dieting for the first time in my life in the last few months, with mixed results.

First the back story: I have seen more overweight people than I can count in my medical office, and several thousand times I have had a conversation like this:

OWP (overweight patient): How do I lose weight?
Me: You need to eat less, and maybe exercise more, but with the emphasis on the eating less.
OWP: But I hardly eat anything doctor (then OWP lists all the things which s/he does NOT eat, which takes a long time because there are seemingly an infinite number of them)
Me: Logically, all your weight has come from what you have eaten. Therefore, it logically follows that if you eat less than you are eating now, you must eventually start losing weight.

Fast forward a few decades, and I find for the first time in my life that my trousers are getting too tight and my kids are joking that I am developing a double chin. This is not good. I assess the situation. I am not overweight - my BMI is a theoretically healthy 23.2 - but all my life I have been on the light side of average, and now I am on the heavy side of average. This is definitely not good and I need to do something about it.

So I follow the advice which I have been giving to my patients for many years and put myself on what seems like a reasonable diet. I cut out my weekly visit to KFC, get diet pepsi instead of regular pepsi, cut down the snacks and use the stairs every day instead of the elevator in my apartment building. This should do the trick.

I do this for a few weeks and weigh myself every week. Nothing happens. I don't gain any more weight - that's good - but I don't lose any weight either.

So more action is called for. I cut out the hot chocolate which I normally drink at work, and drink 1% milk instead. I put myself on what seems like a near starvation diet which is little more than a bowl of cornflakes in the morning, a boiled egg at lunchtime and a small tin of salmon in the evening. If I have a snack, I compensate for that by missing out a whole meal (if you can call a boiled egg a "meal"). And at last, I start to lose weight at a rate of about a pound a week. So far I have lost 9 pounds and got down to a BMI of 21.9 which is pretty close to where I want to be.

I think there are four lessons to be learned from this:
1. My OWPs are correct when they tell me they hardly eat anything
2. I am correct when I tell my OWPs that if they keep cutting down what they eat, they will eventually start to lose weight
3. The amount of food actually needed to keep the human body going is astonishingly tiny. Our bodies have evolved to be very efficient, which was a good thing in days gone by, but works against us in today's society.
4. The key to losing weight is to weigh yourself weekly so you get real-time feedback about whether what you are doing is working or not. If you are a pound lighter this week than you were last week, that's great, keep doing what you are doing. If you are the same or heavier, what you are doing is not working and you need to do something different. I have very little patience with OWPs who say they want to do something about their weight, come to my office once every three months to be weighed, but don't weigh themselves in between times. This seems to me to be a sure-fire recipe for failure, and suggests that they are not really trying / not really interested.

Good luck, and I'd be interested to hear what people think about all this!
 
BMI is a joke. My friends is a volleyball, soccer, and softball player. She is 5'9 and is ate a healthy 140 pounds. But when she calculates her BMI It says she is obese.
 
And their is barely a difference between diet soda and regular soda. Soda companies put the whole "Diet" thing on the bottle because the soda has a reduced to zero amount of calories. But it can still cause just as much weight gain as regular soda can.
 
Whole milk and skim milks arent very diffent from eachother. Yeah whole milk has a bit more calories and more fat but it has a better nutritional value. Sadly I dont like whole milk because it tastes like I am drinking butter.
 
Also you are most certainly correct when you say you will lose weight if you eat less. But keep in mind it is very hard for some people to actually cut down calories. When I eat 1,500 calories a day I feel like I am going to pass out all day long. And I only lost about 5 pounds in a month. But I am happy you got to where you want to be!!!!
 
BMI is a joke. My friends is a volleyball, soccer, and softball player. She is 5'9 and is ate a healthy 140 pounds. But when she calculates her BMI It says she is obese.
No it doesn't - it says she is a lean and healthy 20.7!
http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm

But I think the thing about physical fitness and BMI is: yes, if your BMI is borderline, say 26 or 27, it may be true that you are a healthy weight if you have a high proportion of muscle to fat. But a lot of my patients have BMIs in the 30's, 40's and even 50's, and with those sorts of BMIs you just can't swing it like that: the numbers are telling you that you are fat.
 
No it doesn't - it says she is a lean and healthy 20.7!
http://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm

But I think the thing about physical fitness and BMI is: yes, if your BMI is borderline, say 26 or 27, it may be true that you are a healthy weight if you have a high proportion of muscle to fat. But a lot of my patients have BMIs in the 30's, 40's and even 50's, and with those sorts of BMIs you just can't swing it like that: the numbers are telling you that you are fat.

To some degree, I see your point, Peter, since many of those whom you see no doubt have a poorer proportion of muscle to fat, largely due to their unhealthy and sedentary lifestyles. However, there are many who are incredibly active, possessing high proportions of active muscle to low levels of body fat.

As such, the methods and calculations employed by the scale, to determine whether active individuals happen to be of a healthy weight, are wholly antiquated, largely since they fail to take into account levels of muscle mass and bone density, for example.
 
I think the value of BMI, for me, is it gives me an objective measure which I can discuss with the patient, many of whom are surprisingly resistant to being told what they need to hear. For example: patient walks in with a belly-roll of fat hanging down over the waistband of his pants, I check his blood sugar, and it's 6.5, which is pre-diabetes. I don't need to weigh him or calculate his BMI - I can see all I need to see as soon as he walks in the door. I have an obligation to tell this patient the facts of life, which are that he is overweight, there is a link between his weight and his pre-diabetes, and if he loses weight he can slow down the progression to full blown diabetes. So I tell him this. He looks at me in astonishment and says "I'm not overweight doctor, because I have always been this weight / my parents are this weight / all my friends are this weight / I have big bones" / whatever, pick your favorite excuse. So I could just leave it there, let him go on his happy way in blissful ignorance, and treat his diabetes when it occurs. But calculating his BMI is an extra thing I can do to try to orientate him towards reality because I can say, look, your weight and height are this, your BMI is this, and according to this chart you are obese and you need to address this. And maybe, in a small percentage of patients, this might get through to them.
 
Again, I do see your point, Peter, not least when it comes to addressing patients at risk from developing such a condition (diabetes), in addition to the host of other illnesses that can arise from being excessively overweight.

I also accept that the BMI scale isn’t required to inform those, who happen to be excessively overweight, that they risk developing such diseases (since it’s pretty evident).

Although it may provide you with a point of reference with which to begin such a discussion with over-weight/obese patients, the BMI scale isn’t fully representative, as it fails to take into account the composition of those who possess high levels of lean muscle mass and low levels of body fat, hence why I’ve long considered it an antiquated method of determining overall health.

Granted, as a GP, you do have a duty to explain the importance of the link between excess weight and diabetes, although I do feel that there are more informative methods than that of the BMI scale.

For example, by explaining how detrimental excess glucose in the bloodstream can prove to be, in addition to placing heavy emphasis upon how regular exercise can help lower it (thus improving insulin sensitivity), I believe that there are for more informative ways of encouraging those who are over-weight/obese to reverse errors of their ways, rather than compounding something that they're already in denial over.
 
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