Yesterday I saw my gynecologist for my annual checkup. We had an odd, at least for me, discussion afterward. He told me that I had achieved an unusual accomplishment and was to be commended. Then there was the really strange part. He asked me if I would mind taking the time for a discussion with him about my weight loss because he has so many patients with weight problems and he was struggling with how to help them. We had a long discussion where I felt like he was really trying to learn from me. He asked me many questions, not only about how I am losing weight but what motivated me, how I started, how my loss has affected how I feel, etc... He asked about my mobility. He is slender and said that he could not imagine strapping 100 pounds on his body and then being able to move around.
He asked one question that I am still considering and wonder if I gave a good answer. How can he, as a doctor, inspire his morbidly obese patients to lose weight? I told him that I didn't think that he could. IMO, that he should tell them the possible consequences of being morbidly obese without it being a lecture. One reason I stayed with him for 28 years is because he did not lecture me and make me afraid to go see him.
One suggestion I made was that he could encourage them to lose even small amounts. My family practice doctor had promised me that even a 10 or 20 pound loss would help. That 10 or 20 pounds seemed doable, so that encouraged me to start. However, I did not think he could inspire his patients to lose weight. Losing a large amount of weight is an individual's decision. I was like an alcoholic and did not get serious about weight loss until I hit rock bottom.
I told him that I think that
1- the pain of the excess weight has to be greater than the perceived pain of losing the weight
2 - that someone has to believe that it is possible to lose large amounts of weight.
Actually, he appeared to be sad about that. I have always thought that he is a caring doctor and our discussion confirmed that with me.
What do you think? Can a doctor inspire morbidly obese patients to lose weight?
08-03-2010, 10:30 AM
I think you're right on target, the only person who can decide what to do when it comes to losing a large amount of weight is you. What a great accomplishment you have acheived, 100lbs lost is fantastic!!! I'm fairly young and haven't had any health problems requiring me to seek medical attention. I hated the doctor because any time I did go, my weight was always brought up and I never returned to that doctor again...once my weight makes me feel uncomfortable it's hard going back for the same punishment every year.
My motivation to get started was my own rock bottom too...and now I'm determined to be at a healthy weight and I WILL get there! No doctor would have gotten me their...only myself. He could have given me a list of things that were wrong or could go wrong and that would have never motivated me...my own mind got me to that point. If his patients aren't ready to lose weight, they won't...bottom line.
08-03-2010, 10:33 AM
First of all, that's awesome that he asked you these questions! Congrats!
About your question--I agree with you, a doctor can't inspire someone to lose weight. The person has to want to do it on their own. However, I think that a doctor (one that isn't like yours) can make an obese person shut down about weight loss if they don't approach the subject appropriately.
So it sounds like he's doing the best he can. It's important for obese people to have mds they feel comfrotable with, because we as a group do tend to avoid going to the doctor for fear of a lecture. His not doing that is helpful in other ways and allows for his patients to be healither just because he makes them feel comfortable going to see him for other issues. Preventative care is so important!
08-03-2010, 10:40 AM
I don't know that he can inspire someone to decide to lose weight, but letting them know that a huge undertaking like losing 100 pounds is taken a small step at a time. I always believed that there was no way to lose weight for me because I didn't see that it was a series of steps. I always thought that to lose weight I would have to starve myself and I wasn't willing to do that. As soon as I recognized that the smallest of changes would make a difference, it became doable.
To someone who has never been successful at losing weight it seems impossible. I had advice to "count calories", but that at the time seemed like a huge undertaking because I didn't realize that there are so many online tools to make it easy.
So instead of attempting to inspire his patients, maybe he should do some research, make a list of online sites which he thinks would be helpful for his patients, and include it in his office literature? Of course 3FC would top the list. Maybe a couple of the calorie counting sites. A site with an explanation of BMR and how to calculate it. Concrete directions on HOW to lose weight was the only thing that helped me. Until then it was just a concept to me with no real directions on how to actually do it.
08-03-2010, 10:47 AM
It sounds like you have a wonderful, caring doctor. And I agree that motivation has to come from within, but I also believe that if someone had helped me to understand that it *is* possible to lose weight and keep it off, I would have tried sooner. I honestly didn't know any women in my real life who had lost more than a few pounds through healthy methods and kept it off. So until I stumbled across 3FC, it just seemed like a huge, impossible undertaking to me. I did have one health-care professional mention that I would probably lose weight just but stopping going out to lunch every day, but that didn't seem likely to me so I didn't do it. (She was right; it did help when I finally started packing my lunch).
So as others have said, even if doctors mention that losing 10-20 pounds will bring health benefits, that is at least something they can do. It seems like docs walk a fine line; I've heard people say here, "Why didn't my doctor SAY anything???" and then others say that they won't go back to a doctor who even broaches the subject of weight. So it seems that doctors are in a pickle; they want to help and encourage their patients to lose weight, but they know that if they say anything (or say it wrong), they risk having their patient leave and never come back.
Kudos to your doc for asking for your help. :)
08-03-2010, 11:37 AM
You know what popped into my head? A bulletin board of before/after and maybe "during' pictures. Under each picture could list how much was lost and through what method: calories/exercise; South Beach; atkins...the wide variety of methods out there. Eventually the doctor could have enough pictures to post a different bulletin board in each exam room.
I remember my OB/GYN did this with baby pictures and I'd sit forever in that exam room staring at the babies.
I'd find that very motivational. And the doctor wouldn't need to say anything but would be available for questions if asked.
08-03-2010, 11:56 AM
This is slightly off topic, but I will never forget my internist, who I dropped like yesterday's news. I could tell he had a real fat phobia by everything he said. The final straw was once I went in because I could not stop wheezing and coughing. He said to me "don't you always wheeze"??? I went to another doctor and found out I had bronchitis. He couldn't even be bothered to find a diagnosis cause a fat person gets what they have coming to them I guess.
This doctor of yours sounds like a real gem, you are lucky. The before and after pictures sounds like it could be inspiring! To just hear a story is not the same as seeing the evidence in pictures.
08-03-2010, 12:04 PM
I just knew that you all would have good ideas! You always do.
I really like the idea of the before and after pictures. Do you think that I should send him a composite one and give him the idea and permission to use mine? Does it sound too attention grabbing? Of course, if I send him one now, he would have to update it in a few months after I have lost more. :)
I also like the idea of a brochure in the waiting room. I bet a lot of people would take that.
Paula, I am sorry about that internist. I have seen specialists before that I would not go back to because of similar experiences.
08-03-2010, 12:06 PM
I think you should definitely send him something! Maybe include a little blurb about your success. I'd keep it short because people are going to be browsing the board. Some people will want to know more and for others, just the picture would be enough.
And, I think "not quite at goal" pictures are awesome because a lot of people would see that perfection is not the goal. I'd love to see some real life success stories and not some modeled up air brushed toned abs pictures.
08-03-2010, 12:52 PM
I think that if you help him do a before/after board, you might also ask him to solicit from the participants "what one piece of advice would you give someone just starting out losing weight?"
I've gotten SO much from threads like that online -- from the idea of breaking it down into 10-lbs do-able chunks, to small changes make big differences, to one pound a week adds up to over 50 in a year, to just a 10% loss makes a huge difference in health and mobility, etc. etc.
08-03-2010, 01:00 PM
The photos of before and after weight loss on this site is one of the things that keeps me motivated. When I'm feeling like this is impossible I'll go look at the photos and see that even 10 lbs makes a difference on someone. Seeing 10 lbs is helpful to me right now because that is what I have lost in the last month. If I saw something in the doctors office that showed before & after photos, I would definitely want to know more information about it. It seems like when I do see something like that (not in a doctors office) it's about some weight loss diet scam and the photos are photoshopped. But, if I saw something about someone losing weight that didn't involve spending lots of money on a diet, buying diet pills, drinking magical weight loss juice or some other crazy diet thing I would be inclined to ask about it.
I do think it's about hitting bottom though. During my bottom, I was looking for something that actually works and I could live with long term. I was tired of all the crazy diets and still am. I had heard my doctor tell me tons of times that I needed to lose weight but I would just think that he must think I'm blind or something, of course I know I need to lose weight. And my doctor is very compassionate and a wonderful doctor. The only thing that worked was being in pain, in so much pain physically, emotionally and spiritually that I had to change.
08-03-2010, 01:00 PM
First off, KUDOS to your doctor for wanting to help his patients in that way. In today's healthcare climate, at least in my experience, that attitude is very unusual. I hope you go back and tell him how much we liked hearing about him. :D
But, did you tell him it's really not that unusual? If he could look on this site and see how many people have worked hard and lost the weight, with and without surgery, and kept it off, he might be suprised. I know I was when I came to this sight. It's just not out there for the public to see. If you aren't actively looking for this good news, it's not necessarily obvious. And let's not talk about how many doctors say it's not possible without surgery. I mean some of them actually say that to their patients.
I think the pictures are a great idea. No nagging, no pressure. Just proof that it can be done placed where it can be seen by everybody.
Now if he could bottle his concern and approach then prescribe it to all doctors!
08-03-2010, 01:44 PM
A doctor that's willing to learn from a patient is an amazing thing.
I think doctors CAN inspire patients. I think anyone can. Inspiration isn't a magic wand that makes people do what you want them to - it's a spark of a good idea that you pass along.
When I come to 3FC, I find a lot of inspiration, yet that inspiration doesn't "make" me do anything. I can leave totally inspired, and yet not follow through on that inspiration. Inspiration is just a small early step on the journey.
Doctors are potentially an important source of inspiration (and the opposite of inspiration - discouragement as well). If a doctor tells you that your weight loss efforts are futile, that's pretty much the opposite of inspiration. I had such a doctor - who told me that weight loss without weight loss surgery was essentially impossible.
Luckily I chose not to be discouraged by the statement.
But if a doctor can discourage, a doctor can also encourage and inspire.
It's not the big pushes that I've found inspiring. My current doctor is the most inspiring doctor I've ever had. He has had a small weight problem himself and isn't afraid of using himself or members of his family as examples (not just in weight loss). He asks for small, modest changes and celebrates them with me. He reminds me that weight loss is difficult, but possible, and that whenever I feel like I'm failing, he points out how unusual even my small successes are - I'm not failing I'm succeeding (and while I'm succeeding slower than I'd like to, my sucess isn't "slow" when you compare it to the fact that most people don't succeed at all, because they give up when the challenge seems too big).
If my doctor were my only source of inspiration and encouragement, I would fail. I only see him 3 times a year - so he'll never be my primary motivator, but he definitely is part of the "team" I am building.
My doctor did inspire me, with his understanding, encouragement, and praise. It was only a small inspiration, but sometimes a small inspiration is a start.
08-03-2010, 01:55 PM
I like the idea of the before & after pictures on a board; plus a brochure that reads something like this -- "Could you use some help to lose weight?" I agree about the small steps (as you can see in my signature); focusing on losing 10-30 pounds will sound much more doable for people and get them started. If a patient brings the subject up themselves, then he could offer that advice -- that just losing 10-30 lbs could make a huge difference to their health and how they feel. I read that on a site somewhere and that stuck with me ...
BTW, I have a new doctor and every time I went to see him he was hounding me about getting Weightloss Surgery; I told him that I didn't like the idea becuz I had researched it and didn't like what I found out. He asked me to research it again becuz they have made huge strides in the process. Then the next time I told him again that I already had researched it recently ... but it fell on deaf ears. By that point I started to consider transferring to another doctor (which isn't easy here becuz we have a shortage of doctors); but the last time I saw him, he didn't mention it to me at all. I informed him that I am going to lose the weight my own way; and he didn't say anything in response ... He is a caring doctor in every respect; but he seemed convinced that WLS was the only option for weightloss these days.
08-03-2010, 03:12 PM
Congratulations on the great compliment.
I think the composite picture is a great idea: just before and after shots is too daunting imho: all they do is show a person who might already be desperate about their weight, that someone has 'magically' succeeded. If you have shots that show that yes, you'd lost some weight but not so dramatically as to be 'impossible' to someone who's struggling, and then another and another, so that they can see the little by little stages, that would be very encouraging.
Great doctor too, someone who takes fat seriously!
08-03-2010, 03:50 PM
I think the pictures are a great idea!
08-03-2010, 04:01 PM
I think that pictures are a great idea. I wonder if you could also add some info about the people as well, if applicable. Perhaps which patients have reduced their cholesterol, or blood pressure, or were able to reduce their medications, etc. We have a family friend who is quite obese. After losing less than thirty pounds he was able to stop blood pressure medication, and reduce his cholesterol. He still had 80 to go to reach a healthy weight, but the initial amount had a significant effect on his health.
Maybe you should call the board the wall of fame, and encourage patients (and staff!) to list their weight loss and health successes.
I also agree with the idea of pamphlets, something that people can take home and look at when they don't feel like the elephant in the room, so to speak. Include how to calculate BMI, and a healthy range, as well as resources to turn to, and encouragement that small amounts are helpful and easy to attain. Maybe include questions to ask your doctor as well about how to get started.
What an awesome MD- the world needs more!
08-03-2010, 04:55 PM
Perhaps which patients have reduced their cholesterol, or blood pressure, or were able to reduce their medications, etc. We have a family friend who is quite obese. After losing less than thirty pounds he was able to stop blood pressure medication, and reduce his cholesterol. He still had 80 to go to reach a healthy weight, but the initial amount had a significant effect on his health.
What a fantastic idea! Perhaps some people wouldn't want to share a photo but wouldn't mind having a name/info posted like: Eliana brought her BP down from 105/155 to 116/64 after just three months of exercise.
That would be awesome!
08-03-2010, 04:59 PM
Concrete directions on HOW to lose weight was the only thing that helped me. Until then it was just a concept to me with no real directions on how to actually do it.
I agree with this 110%. I've never had a doctor that could discuss weight loss technique with me in any more detail than what you find in a Family Circle article: I'd get really profound advice like "Weight Watchers works for some of my patients" or "Eat more vegetables and fruits, and exercise 30 minutes a day". Both those things are good ideas, but that was all they had. None of them could actually go into any detail. None of them could work out a plan with me that fit me, not some generic woman.
I didn't need inspiration. I wanted to lose weight so bad I'd have probably traded a kidney to be the weight I am now. I needed to know how.
08-03-2010, 05:41 PM
For most of my life, I've had a lot more motivation than I do now. To be quite frank, after nearly 40 years of dieting, I'm entirely burnt out on "gung ho" methods. I'm no longer willing to channel 99% of my life's energy, time and effort into weight loss.
And yet, I'm succeeding almost despite myself. Yes, I'm losing slowly, but that's only because I'm only willing to spend 10% effort. 90% of my effort goes into other areas of my life. If I were willing to double my effort, no doubt I'd double my results.
That doesn't explain why I wasn't succeeding (at least for long) when I was putting 99% effort in. Part of it was devoting too much to weight loss - losing too much of my life to it, so I'd get frustrated and decide it wasn't worth it.
But the bigger part was that I was trying ineffective methods of weight loss. I didn't realize that carbohydrates fueled my hunger to a ridiculous proportion. I lose better with less effort on low-carb. Low-carb is a difficult plan to adhere to. Almost everyone tells you how unhealthy it is. Eating outside the home is an ordeal, and friends and family "push" carbohydrates more intensely than any drug dealer pushes their wares.
Bread and other high carb foods aren't just food, they're cultural institutions - intwined in ethnic identity, family celebrations, cultural identity. Food isn't just fuel, it's celebration, exploration, adventure, love, shared experiences...
Weight loss is a battle that has to be fought on many fronts, and even if you think you have all the information and motivation you need, you can bet there are pitfalls you haven't considered.
There are a lot of people telling us to lose weight, but finding what works can be a lot more challenging than it appears. I think the biggest disservice is the expectation for change to be quick and dramatic. More people quit weight loss attempts because of feelings of failure than true failure. They see modest results as failure instead of success. "I'm only losing a pound or less a week. With such small results, the huge amount of effort I'm putting in just isn't worth it."
I can't tell you how many times I quit weight loss because of ideas like that. And ironically, I'm now very pleased with results that are smaller than those I once quit over. If only I had felt that every little bit does make a difference.
"If I can't lose it all, what's the use?
I used to believe that too (and I doubt that I was alone). Learning that even small losses can make big differences was a "revelation" (and really only in the last ten years has this attitude truly been mainstream).
Obesity is both a social and a solitary problem. The individual has to do all of the work, but there are so many ways that other people can help. The problem is that most people (even the experts) have no idea how to go about it. We're still in the "dark ages" of weight loss science, and we're all alchemists trying to find the answers by methods that aren't always based on science/logic (we try a lot of ineffective methods before we find effective ones).
That one person's effective is another person's useless doesn't help either.
I think part of the problem is that weight loss expectations are so much higher than the reality. So people think they're failing when they're succeeding. Learning to "keep trying" even in the face of less than epic success is perhaps the hardest lesson to learn.
08-03-2010, 05:45 PM
Kaplods made me think of a misconception I had until this time...
Doctors often, very often, tell patients that losing "1-2 pounds a week" is healthy. That sounded to me like everyone can lose 1-2 pounds per week and most people could lose more if they wanted to...just don't do that. So when I struggled to lose just one pound per week, I thought I was broken. I would rather hear doctors tell patients that an AVERAGE of 4-6 pounds per month is right on par. Because for most of us, that monthly average IS achievable, but that weekly one is not.
08-03-2010, 09:48 PM
Congrats on the doctor asking your advice! I think that is so great. Wow! I am just impressed, most doctors are not like that anymore.
I think you are right, it takes someone hitting rock bottom before they can make a change. That is what it took for me.
08-03-2010, 10:50 PM
I agree that it is wonderful that your doctor asked you and there are so many good ideas here.
I completely agree that one of the biggest obstacles to weight loss is that people do not realize how possible it is.
If you don't know anyone who has ever done it, it seems insurmountable.
08-04-2010, 01:06 AM
The picture board and a pamphlet showing real, regular folks who have lost weight without gimmicks, drugs, or things sold on late night TV would be so valuable. Like so many here, I have never met anyone who lost a HUGE amount of weight and kept it off and it just seemed so impossible.
Also, if even a pound a week is too much then a half a pound is good. Any loss will add up and make a difference. Losing 10 pounds a year is better than gaining 10 pounds (which is much much more common).
08-04-2010, 01:10 AM
I just wanted to say wow, just wow, amazing and cool!! :)
First, congrats to you on all your hard work and amazing accomplishment!! :D
And second, I think it's so amazing that your doctor actually cares enough to want to learn from you and try to share whatever he can with others so they can benefit from improved health too. Very impressive, your weight loss, and his wanting to learn and share with his patients.
There have been some interesting suggestions here about how to potentially help others. Maybe suggesting this place, and possibly being willing to talk with others who are interested in hearing your story, if of course you were comfortable sharing that, would be helpful things. You might find it intersting, kind of like becoming an unofficial (or official if you liked it, maybe he'd want to hire you? I don't know what you do or if you'd be interested in that, but just a thought) nutrition and fitness counselor, someone with the benefit of having been through what the folks you'd be talking with were going through. Just something to consider and/or that you might enjoy. ;)
Again, congrats on your weight loss, and very cool to hear about a doctor that cares!
08-04-2010, 12:07 PM
I forgot to add, I visited a new doctor recently and really liked how she approached the whole thing. It essentially went something like this
"So far everything looks pretty good, though your BMI is higher than I would like to see. A healthy range is x, and currently you are x. We have weightloss information available to you if you're interested, and I am also willing to write a referral to a nutritionist if that would be something you would find helpful. If not, just continue to add acitivity in to your normal life, and remember that even 5 pounds here or there can have a big impact on your overall health"
It made me feel like she was concerned but not judgmental, and that she opened the door for me to discuss my weight with her while giving me the option not to as well. I also appreciate that she offered me resources, but didn't come off as preachy or that I was obligated to take part.