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Old 09-14-2009, 10:27 PM   #1
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Start weight loss meds or find new doc?

I am hoping for some opinions and advice.....thanks in advance.

Over the last 1.5 years, I have gained a lot of weight, and I really don't know the root cause of it. I have been going to the same nurse practitioner because she participates in my work's insurance program and I got assigned to her when I signed up. I am a 32 year old white male in good health, except for the weight gain.

My first visit, in April 2008, was for a physical. She weighed me at 188 and measured me at 5'11". I went back in January, 2009 for a sore throat and was surprised to find out that I was all the way up to 201. In May, I was up to 208 and she said something along the lines of "you've gained quite a bit of weight since last year," but she didn't run any tests. Instead, she said she wanted me to come back in a few months just to get checked out.

Last week I finally got around to going back. My pants were fitting a little tighter, so I knew this might not be good. It was bad. 218. Yes, 218. I had gained another 10 pounds in less than 4 months. As she was writing my new, ugly weight down on my chart, all she said was, "Ay, Ay, Ay, CHRISSSSSSS....." while shaking her head and letting out a little bit of a chuckle, which made it sound like it's all my fault, or maybe it was meant out of sympathy. I'm not sure.

Most of my friends told me that, at a minimum, my thyroid and cholesterol should have been checked when she started noticing the weight gain. So I waited to see what she did this time. When we got back to the exam room, she did her normal thing (which consists of taking my temperature, blood pressure, pulse, and listening to my chest). Just as I was about to ask her why we weren't doing any tests, she announced that she was starting me on Xenical because I am now officially "obese" by the body mass index standard, and that she wants me to lose 35 pounds, to get back to 180-185. That was it! She asked me to sign my chart and then was on her way out the door. So then I asked her about tests to find the root cause, and she just looked at me and said something about it probably being genetical or a function of poor diet, work stress, and lack of exercise, and that she wanted to prescribe something when I went over 200, but couldn't because I wasn't officially obese. Then she turned and left.

I realize I should have been more proactive about this, but it sure doesn't feel like I've gained 30 pounds....more like 10 or 15. Although a few late nights at the office have caused me to skip a few workouts in favor of ordering pizza, it hasn't happened all that often. Not 30 pounds worth, that's for sure.

So now I am worried. My question is, should I just start the medication and see what happens, or should I go to another doctor? This nurse practitioner is very young (probably 27 or 28) and seems more interested in just taking my vital signs and getting me out of there (at a cost of $110 per visit) than with figuring out if I have an underlying problem (which seems likely at this point). And then I got to thinking that maybe she can't relate to men's weight problems or just looks down on overweight folks with disdain. I'm guessing she's about my same height since she's a few inches taller than me in her heels, but she is skinny.....I'll bet she doesn't weigh any more than 125 or 130. Sorry to digress, but there might be something to it.

But going to another a new doctor isn't easy, because my work's program basically forces me to choose one primary care physician. If I change before February, I have to pay a big enrollment fee.

I am kind of scared of going on this medication, I don't know much about it. Sorry this post is so very long, I just wanted to share all the pertinent details and hopefully get some good suggestions from members here.

Thank you very much.

 
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Old 09-14-2009, 11:02 PM   #2
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Re: Start weight loss meds or find new doc?

Was there a period before 1.5 years ago when you were not getting heavier? If so, can you think of any change in your eating, drinking, and exercise habits that may explain? Be sure to consider changes in activity that you might not think of as formal exercise, such as a change in work location or work duties that may cause you to be less active during work or commuting.

If there is no explanation from changes in eating, drinking, and exercise, another possibility is that if you are inactive, your muscle mass slowly declines, reducing your metabolism, so the same amount of calorie intake and activity will eventually result in fat gain.

Also note that weight gain is not necessarily fat; if you exercise a lot, you can gain significant amounts of muscle, which is healthy and desirable. However, if the weight gain is accompanied by a growing waistline, and you are getting softer and flabbier, than the gain is likely to be mostly fat, which is undesirable.

If none of the above explanations fits, you may want to get checked for hormonal irregularities to see if that explains the problem.

Due to (presumed) obesity, it is possible that screening for high blood pressure, high blood cholesterol, and diabetes may be indicated. See http://www.ahrq.gov/CLINIC/cps3dix.htm . If you are not satisfied with your primary care NP, you may want to change to a different one when you can.

Xenical is a fat absorption blocker. Due to unpleasant digestive side effects if you eat a high fat diet while using it, using it will likely deter you from eating a high fat diet (although if you consume a lot of sugar or other carbohydrate calories, you could still be consuming too many calories even on a low fat diet).

But regardless of any of the above, cutting back on calorie intake and increasing exercise would be something to try to stop or reverse unwanted fat gain.

 
Old 09-15-2009, 08:38 AM   #3
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Re: Start weight loss meds or find new doc?

I guess she figured you weren't going to lose it on your own because you had gained even more since the first visit. So, I'd say to straighten out your eating habits and get back to exercising. I don't know what blood work could have shown vis-a-vis weight gain since you've admited that you have changed oyur eating habits and dropped your exercise. I can tell you for myself, if I were to stop exercising, I would pile it on in a couple of months. It's very easy for me to do that...so I really have to make sure I get my jogs done very week and hit the weights at least once per week. Otherwise, my middle grows...

 
Old 09-15-2009, 10:12 AM   #4
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Re: Start weight loss meds or find new doc?

Due to inactivity (feet problems) I gained a lot of weight. Now that I can walk the treadmill again and have reduced calories my weight is gradually going downward instead of up. It is a very slow loss but happy scales are going the other way.

For several months I had a problem stopping the gain even tho I knew about food choices and portion control. Believe I have now reversed the direction and hopefully will be able to lose what I have gained by reducing calories and walking treadmill.

Personally I would not take the blocker, better to do weight loss on your own rather than messing up your digestive system. I asked my internist regarding blockers and he advised against them. I am 5'2" and weigh 196. You can see I am much more overweight than you are.

I am diabetic and hypothyroid. I try to stick to very little starches or sweets and small portions of other vegetables and lean meat. Pizza is very high carb and fat, might cost you a few extra pounds each time you enjoy it.

Wearing an invisible zipper in closed position over mouth all the time except when having a scheduled meal has helped a lot, keeps extra calories out of my tummy. Does need a conscious effort to keep zipper closed!!LOL!! It does work!

In the past years I lost 65 lbs by eating only 3 oz. lean meat and two green veggies for lunch/dinner and 1/4 c. old fashion oatmeal cooked in water for breakfast. Wore invisible zipper too!! Walked treadmill 1-3 miles per day. I did not lose weight fast, took a while. Weight stayed off until my feet bit the dust and could not walk treadmill. Had to make change in diabetic diet after 8 years which lead to weight gain.

It is difficult to belive a doctor would intentionally wait until you were classed as obese. Best to keep weight below that amount. Being overweight increases your chances of becoming diabetic.

 
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