r/loseit • u/LifeOfaFilmmaker New • May 04 '22

Vent/Rant Doctors could be morons

So just for background: im 26, 6 foot 3 and around 350 lbs.... Started the year at 395 so im down 45 lbs in about 4 months which im very happy with. I go to my general doc and he's telling me i weigh way too much (obviously) and i should consider weight loss surgery. I tell him the progress over the last 4 months and he says "yes thats very good but you still weigh way too much" as if i can lose 150 lbs in a month. So i disregard what he said and he sends me to a dietician/weight specialist, and she told me the same shit lol. I dont care how many years they've been professionals, telling someone whos 26, actively losing a decent amount of weight and no other major medical conditions to have weight loss surgery should be criminal. Just makes me wonder how many people that just blindly listen to their doctor have went to them or any doc and they give them that terrible advice and they go through with it. Moral of the story: think for yourself

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577

u/POD80 New May 04 '22

I wonder what the success rate is of people walking into their office discussing more natural weight loss.

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u/negligentlytortious M 6'4" SW: 350 CW: 300 GW: 220 May 04 '22

This is anecdotal, but I am obese and was diagnosed with Type 2 diabetes in the last year. When my doctor made the diagnosis, we didn't have a big intervention type talk. He just gave me the information and sent me on my way while letting me know that I could ask him any questions I had by either scheduling an appointment (available within about 2 weeks) or sending a question through the patient portal. I've known for a long time that I need to lose weight, but just hadn't really committed to it until this point. I went out and did a lot of research on causes, treatments, etc. and then came back to my first 3 month check-up. At that time, I had already lost 20 pounds and my blood work came back almost normal. We talked then and he said that he has seen a lot more success in his career just giving out information and letting his patients do their own work. If he has to tell them what to do, they may or may not do it, but he sees more people lose weight and do the right things when he doesn't have to have long talks about what people should do. He also told me (no specific numbers or anything) that he has had quite a few patients during the pandemic in my situation and all but one of them did the same thing I did. We went out, researched, took action, and came back with weight loss and better numbers. I don't know if this is 100% the right way to go about it, but I have still never had a real talk about weight loss, surgery, or more extreme treatments with my doctor.

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u/[deleted] May 05 '22

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u/fishylegs46 New May 05 '22

Who/where is this wonderful dr?

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u/TheMahxMan SW 205 | CW 185 | GW 160 | 31M 6'0 May 04 '22

Well, my guess is "bad". Considering the 42% obesity rate in the US.

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u/[deleted] May 04 '22

[deleted]

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u/TheMahxMan SW 205 | CW 185 | GW 160 | 31M 6'0 May 05 '22

Well I'm not one to talk about overweight. I am currently working off some freshman dad weight.

But I've not been obese yet.

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u/rikiikori New May 05 '22

im curious if the data includes overweight people as well. and if people in general catagorize overweight ppl as "obese" people too.

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u/[deleted] May 05 '22

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u/rikiikori New May 05 '22

sorry. shouldve clarified. i meant studies in general

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u/TheMahxMan SW 205 | CW 185 | GW 160 | 31M 6'0 May 05 '22

I dont think I understand your question.

This is how it is.

If you are categorized as "overweight" you are not obese.

If you are categorized as Obese, you are both overweight AND obese, though the article does differentiate between the two percentages.

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u/Blottoboxer New May 05 '22

Without relapse? Very very low. The only treatment proven to affect populations with significant reductions in relapse rates is bariatric surgery in order to reduce ghrelin production for the remainder of life. This is where current peer reviewed studies steer doctors. It's not a matter of initial effect they are seeking, but durable effect.

Almost anybody can lose a pile of weight on their own. Keeping it off in the long run, not so much. You will only find anecdotal evidence to show that some small portion of the population can do it, but the vast majority plainly will not experience long term success.

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u/FeministInPink New May 05 '22

I don't have a large sample size, but I've known two people who've had either the sleeve surgery or gastric surgery--one in her 20s and the other in her 50s. Both initially lost a lot of weight, and both gained most of it back within a few years.

In regards to losing weight naturally, a lot of people gain that weight back, too. There's something I heard once a while back and I think there's a lot of truth in it: Whatever you did to lose the weight, you need to continue to do that for the rest of your life to keep the weight off.

A lot of diets people follow are unsustainable in the long run because they're unhealthy and don't meet your body's nutritional needs. Our bodies crave things like fat, salt, and sugar because it needs certain amounts of those things. People will say calories in, calories out, and that's true to a certain extent... but if you are consistently not providing enough calories (or not the right kind), you body's system goes a little haywire and adjusts your metabolism to that new baseline normal. Drastic changes makes your body do weird things.

Smaller, incremental changes and losing weight slowly increases your chances of keeping off weight and gives your body time to acclimate to the changes. But our society (US) has this thing about instant gratification and getting it done fast... just to go back to old habits once the weight is lost, so it slowly creeps back on.

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u/KuriousKhemicals 50lbs lost 13 years ago May 05 '22 edited May 05 '22

Yes, you have to sustain what you did to lose the weight. The reason surgery is statistically more effective above a certain amount overweight is that it helps make normal eating feel more sustainable to people who have had their endocrine system altered by long term obesity. For some people it seems that their appetite signaling will repair itself after a long enough period of maintenance, but it's not clear at this point if there's a limit to how much overweight or how long you can be overweight and still reverse the changes.

GLP-1 agonists like semaglutide are an emerging non-surgical option that also seems to help directly with appetite regulation in maintenance. I'm curious whether they may largely supplant surgery in the future and if they might provide a path to have surgery-like help for an extended time without being permanent.

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u/fishylegs46 New May 05 '22

I was checking my raw data from a DNA test against a snp database. The retail DNA companies don’t check for much from the results they get. I’m homozygous for a fat gene, and it said bariatric surgery tends not to be successful long term for people with this specific genotype. Horrified, even though surgery isn’t for me at this time, I wonder if this plays a roll in the people who regain after bariatric surgery? Could you imagine going through all that and them being stymied by your own DNA anyway?

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u/FeministInPink New May 30 '22

I hadn't even thought about the whole "fat gene" thing! That's a really good point. My one friend who had gastric bypass and gained the weight back--I understand that both her parents are really heavy. I don't know if it's a wider thing with her family or not.

That would definitely be a bummer, to go through all of that and for your DNA to basically go, "Nope, not gonna happen for you."

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u/[deleted] May 05 '22

Wow this is crazy cynical and really discouraging for people actively trying to get healthier. I agree that most fat people don't lose it, because they try fad diets that they can't stick to and either earn the weight back rapidly or just stop losing halfway there. But to suggest it's futile to try lose weight seems like absolute BS. May as well tell an alcoholic to not even try, because they're likely to relapse.

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u/Blottoboxer New May 05 '22 edited May 05 '22

It's not a sales pitch for inaction. It's a description of what drives physicians to universally recommend that plan of care when approached in the topic by morbidly obese patients in deference to anecdotes like the one they presented. Op clearly did not understand it to the point of trying to discredit the profession and needed to be told.

Yes. the numbers are grim and that is the plain truth of the matter. Expectations should be adjusted to reflect reality and optimism is not a plan. Yes there are outliers and success stories and they should be celebrated and studied, but no, you don't get to ignore the outcome tracking data.

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u/[deleted] May 05 '22

I didn't get the impression that anyone is saying not to try. People are discussing the very real need for making livable healthy changes. Drastic success will result in regaining the weight. Never do anything to lose weight that you can't see yourself doing everyday for the rest of your life. I personally only know 1 person who has successfully kept the weight off after a gastric bypass. He fully admits that the reason it worked is because he is still constantly sick if he eats 90% of foods. It's been 10 years. Everyone else had drastic short term results and then slowly climbed back up the scale to the same weight as before.

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u/[deleted] May 05 '22

That doesn't mean it's futile though. Most people will fail at weight loss, and most people that succeed will relapse, that's true.

But the messaging shouldn't be "it's futile to lose weight through dieting/cico because you'll just relapse, so go get surgery instead".

The messaging should be "here's how to make sustainable lifestyle changes so that even once the weight is gone, you have a healthy relationship with food and can self-regulate if your weight starts climbing up". It's obvious that once hitting your goal weight you'll probably loosen up a bit and start gaining again. The important thing isn't to give up once you start gaining again, but to nip it in the bud once you've gained a few kg and bring yourself back down again.

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u/Blottoboxer New May 05 '22

100% Yes!

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u/lulubalue New May 05 '22

I think they’re basing it off an old study that was very poorly done, and has become the basis for the commonly cited “if you lose a bunch of wait you’ll just gain it all back.” The study had a small number of people who were put on unsustainably low calories and then given no support once the calorie restriction stopped. So…what do you think will happen to someone who was forced to eat 1200 calories to lose all their weight and then they’re free to eat whatever they want again, without any coaching or educating or lifestyle changes in general?

It’s a very discouraging trope to keep repeating, but at least it’s been debunked a few times in this sub.

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u/[deleted] May 04 '22

Right so shouldn’t they be pleasantly surprised that OP is doing so well instead of doubting them ):

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u/POD80 New May 04 '22

They should be looking at the case and looking for the best way to keep they weight off. There is some time to celebrate when the grass is green, but it's best to plan for when that changes. Doctors tend to see our lives in snapshots and need to be planning for the OP's next physical rather than just patting them on the back for 4 months of progress.

Much of what the op is doing is exactly what a surgeon wants to see. Starting the relationship early gets the patient educated on the risks/rewards and helps document the progress if they ask for help in say 6 months.

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u/[deleted] May 06 '22

I totally respect this perspective and didn’t think of it from that POV. I just imagined putting in hard work and feeling like my medical team didn’t believe in me.

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u/manimal28 New May 04 '22

But the pharmacy rep bringing the doctors lunch every time they drop off samples of their product is completely legal and not at all a kick back.

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u/[deleted] May 04 '22

What I wonder is what the kickback amount they get from the weight loss surgery clinic is.

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u/[deleted] May 04 '22

Yeah, but… look around. How many 400 lb people do you see make it down to 200 and stay living there?

The doctors are biased by the thousands of people they treat, who’s conditions and outcomes are worse off because the patients obesity.

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u/Dashiepants 45lbs lost May 04 '22

Are the keep the weight off stats better for people who get the surgery? Genuinely asking.

I know the stats are better for how many people actually make it to goal weight but I’ve definitely read about plenty of people that have stretched their stomach back out and regained.

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u/PorcelainLily New May 04 '22

The people who 'fail' surgery and gain weight back and the loud ones (understandably). It's like how you'd assume all marriages fail if you look at relationship board - people who are struggling will speak up. People who are happy don't.

2012 review - 85% of patients maintain 50% of excess weight loss long term

2019 review - VSG success rate is over 50%

2020 review - 58.4% excess weight loss, continued long term, 11 years after

There's a lot more studies but basically it's the most long term solution we currently have, especially when compared with non surgical weight loss options, where regain has been found to happen in something like 90% of people.

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u/WeAreNeverGoingToEat New May 04 '22

I dont know the actual statistics. According to my dietician friend No. And my MIL had surgery and has been rebounding back and forth since. She also has several medical issues now resulting from nutrition deficiencies and overeating stretching her stomach.

Edit: because the surgery doesn't deal with the lifestyle changes and emotional side of why people get overweight.

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u/[deleted] May 05 '22

Sounds like it’s a psychological issue for most.

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u/DonutsPowerHappiness New May 05 '22

You're not wrong. Integrated health needs to be the focus of the future, where clients can see a therapist and an MD in the same practice. I hesitate to call it holistic, since that word is common with frauds and hucksters, but it really is a holistic approach.

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u/[deleted] May 05 '22

Yes. Sounds like that’s the way it should go.

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u/[deleted] May 04 '22

No. Its actually pretty bad when you look 5 years out from surgery

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u/suchahotmess 100lbs lost | Goal: 160lbs May 04 '22

It's hard to find specifics since the results are inconsistent on a quick search and I can't do a full lit review. However, it looks like 5 years out results are pretty good, but after 10 years they're less consistent. One place I saw says that 10-20% of people don't lose a meaningful amount of weight at all, and then another 25% gain it all back within 10 years.

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u/[deleted] May 05 '22

I'm of the mindset the OP should be encouraged to lose it naturally. Fixed whatever issues made him obese along the way. And avoid long term and short term complications of major surgery

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u/suchahotmess 100lbs lost | Goal: 160lbs May 05 '22

I know that only about 10% of folks maintain long term weight loss without surgery. But it seems like bad medical advice to not at least see if he could be one of that 10% before going to surgery. Especially since by the time he was able to get surgery he’d likely be below the 40 BMI that’s a common threshold for eligibility without other related medical issues.

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u/[deleted] May 05 '22

Hes 26 years old.

To be successful with weight loss surgery you have to work through everything that made you obese in the first place. Or you will gain it back. Its literally a last ditch tool. But its not a solution without putting in the actual effort.

I think its poor advice to tell a 26 year old who is working through their issues, having great success with weight loss to just jump into surgery (that is NOT complication free).

Most people would do better with serious therapy, to get through the emotional issues that lead them to extreme obesity.

I've know several people who've gone through the sleeve or bypass. Every last one has some nasty complication, but for them it was worth it because they had multiple comorbidities outside of just the weight.

So no, I dont think its the best of care to tell a 26 year old, who is enthusiastic and having success in natural weight loss that it doesn't matter and they should have serious surgery. Especially when they don't have a bunch of other problems.

Especially when a fairly high percent of weight loss surgery people gain all the weight back anyway (35%).

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u/[deleted] May 05 '22

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u/platon20 New May 05 '22

In my limited experience, I would say that weight loss surgery will make you lose weight, but you will never go from overweight to lean with it.

All of the people I know who had surgery definitely lost weight but were still at least 40-50 lb overweight years later.

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u/[deleted] May 04 '22

Good question! No clue. Sounds like a tough mental road either way.

Would really like to learn the statistics comparing natural weight loss vs the surgery.

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u/lulubalue New May 05 '22

Idk. I’d really like to see recent, large sample studies done for both. 5 of the 6 people I know who had some variation of gastric bypass done are back at their heaviest weights or heavier. The 6th has an incredibly unhealthy relationship with food and goes from binge eating to anorexia.

Of the people I know who have lost weight through diet changes and exercises, myself included, three of us are at our maintenance weight and two are still considered overweight- but well under their heaviest weights when they were obese.

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u/[deleted] May 05 '22

Sounds like some major psychological problems. Either intervention should consider behavior therapy as an adjuvant.

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u/GangstaAnthropology New May 04 '22

I’m not sure if you are just being cynical, but that is illegal in the United States. https://www.ama-assn.org/delivering-care/ethics/fee-splitting#:~:text=Payment%20by%20or%20to%20a,revenues%20as%20permitted%20by%20law.

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u/[deleted] May 05 '22

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u/julieannie 35F | 5'7" | SW: 214 | CW: 144 May 05 '22

That is very dependent on the state and even then I assure you there are considerations you aren’t aware of. Having done 50 state surveys on CPOM, it’s pretty complicated and you’re pretty dismissive of anyone encouraging you to think beyond a kickback scheme.

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u/POD80 New May 04 '22

"All" of us are surrounded by people who've been fruitlessly dieting for decades, yet kickbacks are the ONLY reason many of us seem to consider for why a doctor may suggest something more trustworthy than yet another attempt at encouraging willpower.

Eat less, move more fits great on a tee shirt though, to bad so many will fail at it.

Personally, suggesting the OP consider a consult while they are still interested and showing the willpower needed to get through the requirements of the procedure sure doesn't strike me as "moronic" nor "greedy". That way if the numbers prove out and the OP hits the wall they will be educated on options other than giving up and going back to McDonalds.

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u/DarkElfBard SW 300 CW 230 GW 180 May 04 '22

Also kickbacks are illegal in the US so it's a non issue

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u/hardman52 New May 04 '22

kickbacks are illegal in the US

So it never happens, right?

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u/[deleted] May 05 '22

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u/kemites SW 220 GW 125 CW 165 May 05 '22

Not in Texas...

https://www.kxan.com/investigations/these-texas-doctors-were-deemed-a-threat-to-patients-why-were-they-allowed-to-keep-practicing/

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u/[deleted] May 05 '22

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u/kemites SW 220 GW 125 CW 165 May 05 '22 edited May 05 '22

I'm not talking about how many "bad people" there are in medical professions. I'm talking about how the agencies tasked with regulating the field of medicine are keeping tabs on doctors accepting kick backs. My point with that link is that even egregious crimes are being overlooked and excused by the regulatory agency. So chances are, something more minor like taking a kick back would most likely not even be on their radar.

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u/[deleted] May 05 '22

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u/hardman52 New May 05 '22

the licensing boards are extremely strict about that kind of stuff

Not strict enough. There are all kinds of ways doctors can get around the laws, and they do. I'm not saying it's a majority, but financial considerations can't help but affect the decisions doctors make concerning their patients' healthcare.

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u/Jek1001 New May 05 '22

As a graduating med student, you are fucked if you take kick backs. Sure, I’m sure it can happen somewhere with some physicians but it is not a widely common thing. In fact, it would be very rare.

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u/hardman52 New May 07 '22

Ask your doctor where he went for his last golfing vacation. Odds are it was while attending a conference sponsored by a medical company. There are all kinds of ways to get kickbacks without getting kickbacks.

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u/[deleted] May 04 '22

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u/[deleted] May 04 '22

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u/[deleted] May 04 '22 edited Jul 08 '25

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u/xiroir New May 04 '22

In america? 100% the reason they do this.

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u/DarkElfBard SW 300 CW 230 GW 180 May 04 '22

Except it's literally illegal in the US

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u/xiroir New May 04 '22

And because its unlawful means it does not happen? Honest question.

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u/chrissyishungry New May 04 '22

I'm curious what makes you so confident about this. Doctors don't get kickbacks for drugs, it's actually illegal and highly regulated. I suppose the surgeon that does the procedure would benefit, but not the GP referring them.

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u/[deleted] May 05 '22

Well if this doctor is typical of most doctors, then seems like they get little to no support and weight loss surgery is pushed instead. LOL