Seeing the doctor for weight loss advice

Hi, this is my first time posting. I would like to have some advice on a situation that happened today.

I have a BMI of 28 - but I carry it well. I've been concerned about my weight for a long time, and today I had an appointment with the GP about something else entirely (I've got a bulging disc that flared up). It took a week to get the appointment and in the meantime my issue cleared up on its own. Anyway, I figured that while I was there I would get some help with my weight.

The GP gave no help at all. I was floored at how little she cared. She asked about my family history of weight problems - and that was it. She didn't ask me to step on the scales, measure my waist... nothing. She didn't ask about the food I eat, or the exercise I do. She just said that some people maintain around certain weights, and I'm not large enough to go on the NHS weight loss program.

I was hoping to get my thyroid levels checked - because I'm a molecular biologist and I think there is something wrong with me, and there is a family history of thyroid problems. I hoped to get at least something more than a disinterested smile. I've not dealt with GPs about weight issues before, and I had expected something totally different than what I got. Now, I'm not sure what to do.

Is this normal behaviour for a GP?

I'm not obese, so, I don't matter?

Should I try to see a different GP, or will I be subjected to the same kine of treatment all over again?

19 Replies

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  • I'm around the same level of overweight as you, and have had a range of reactions to my weight gain. Some like you describe, others following a kind of rote method, that any BMI above 25 needs urgent action (this response usually from nurses). Regarding having a thyroid test, I've had one of these in the past and it's quite straightforward, I was offered it to rule it out because of other health problems, not directly in relation to any weight issues. But it should be possible to get it checked if you have a family history, so I think you need to ask again. For example I have a family history of diabetes, but no symptoms, but I can ask for a diabetes test any time.

    Regarding support from the NHS to lose weight, I really recommend following the NHS weight loss plan (link below). If you are able to lose weight by following this, you may find your other health fears are either A. allayed or B. brought into sharper relief. Doing something about your weight yourself should surely get a positive reaction from your GP? You could also just consider seeing a different GP next time...

    nhs.uk/Livewell/weight-loss...

  • Hi, unfortunately this isn't unusual. I work in the nhs and due to underfunding and understaffing we have waiting lists that make us as clinicians feel dreadful, and we have no choice but to prioritise. So I do understand from a gps point of view that when they are faced with a relatively fit and healthy person compared to the large number of very sick people they may seem the same day they also have to choose priorities. Im also similar to you though in that I'm frustrated by difficulty getting results and answers. I've recently had quite a lot of tests for symptoms which are not individually terrible but added together can be debilitating at times.it seems that if the most straightforward tests come back negative it's a case of well you don't have x,y or z problem so just forget about it however when you learn more, you find the most straightforward tests are only the first step, and not 100% reliable at diagnosing but unless you have very severe or classic symptoms Drs are reluctant to do further testing. I actually wouldn't mind so much if they said look we have limited funding and there are people worse off, here's how you can get the test done privately if you want and can afford, that I can understand, but I'm left feeling that they think im just making a fuss about nothing . I don't think your gps attitude was very helpful, and it would be better if you saw another one next time as you're not going to feel very confident with this one now anyway. From my experience and from reading countless posts on various autoimmune forums it would probably help if you went back with concrete symptoms such as tried to loose weight with calorie counting (they tend to see this as the only evidence based weight loss method) and it didn't work, or any other thyroid symptoms you may have. I have an idea that you can have thyroid tests done privately for not too much money, which may be worth investigating as you would be given your actual results rather than the nhs tests where sub clinical results (showing a problem but not bad enough yet to need active medication treatment) would just be reported as "normal". Good luck. X

  • Hello

    Sorry your having such a frustrating time !

    Last year I went through the the same thing with my doctors .i felt so unwell .I felt so tired all the time and started putting on weight like it was out of control but I was eating less but still as active .My asthma started to get worse and I got a horrible cough which I still have since September last year (was rushed to hospital a couple of times because of my ashma ) and my Ibs was horrible .Also my hips and back were in so much pain I could hardly walk after a day at work .

    I went to the doctor and was tested for my thyroid but tests came back ok which was good .But that was it I was sent away with no reason as to why I was feeling like this and the weight gain .I had to give up work in end as I was so unwell .I have never felt so unwell or miserable .

    Anyway I did go back to doctor and seen an amazing lady .Staight away she sorted me out .Turned out I was going through early menopause .But the stress of being in crap job and feeling so unwell just got too much .Thanks to her I'm back on track feeling a lot better but may have ostiarthritis in my hips which explains hip pain .i have a great job now as a nanny which I love .

    I would go back and see another doctor and keep at them .Good luck 😃🌻🌺🐝

  • I find it disappointing that GPs and nurses do not know about the NHS weight loss and couch 2 5k programmes on these websites. They are such a good resource.

    I have never needed to discuss weight with a doctor as it is usually checked by a nurse at annual 'well woman' checks.

    I would definitely go back for thyroid check.

  • Regarding thyroid function tests -

    You don't have to pay privately in order to see the actual numerical results rather than a comment like "normal" or "fine". You are legally entitled to see the results. Ask for a print-out from your GP practice.

    Armed with the test results (including the range they consider normal, given in brackets after the person's own number) you could go over to the Thyroid community on HealthUnlocked and ask for their views, even if the GP says everything is normal.

  • Not suggesting anyone should have to go private, I certainly couldn't afford to just something I'd seen suggested in the thyroid uk forum and thought it worth mentioning. I requested printouts of tests done two weeks ago (from the hospital not the gp) and still waiting. Don't want to ask again as I hate causing a fuss.

  • Hi Vetticus,

    If you had seen me, I hope I would have been a bit more helpful. Sadly GPs are overstretched at the minute but this is not an excuse. This would have been a good opportunity for me to suggest that losing some weight could help your back problem! If you have a family history of thyroid problems then you have a slightly increased risk of having this yourself, but to be honest we rarely find thyroid problems to be the cause of being overweight. Check this to see if you have any other symptoms;

    patient.info/health/hypothy...

    and if you do have any of these go back and see your GP, mention that there is a family history of thyroid problems, and that you were wondering if it might be worth checking your TFT's.

    As you are not obese you would not 'qualify' for an intense lifestyle intervention on the NHS (nor the only remaining drug treatment available), but where I work in Sheffield there is a weight management programme that patients can self-refer to; whyweightsheffield.co.uk/ and also an exercise programme that patients can self-refer to; movemoresheffield.com/mirac... - check out if there is anything similar in your area.

    The standard advice I give is;

    1. Weight creeps up on almost all of us slowly over the years as we seem to burn off less energy as we get older

    2. It sounds simple: less energy in, more energy out - but it is hard work, and it's work that you will have to keep doing!

    3. The only surefire way of losing weight is to make sure you burn more energy than you consume. To do this you need to work out your calorie intake and compare this to what it needs to be for you to lose weight. Then you need to monitor your calorie intake honestly for a while, and think about how you are realistically going to reduce it in a way that is sustainable.

    4. There are some little tips that may help such as: replacing unhealthy snacks (biscuits, cakes, crisps) with healthier alternatives (fruit, raw vegetables), eating smaller portions (it may help to get some smaller plates), not buying unhealthy foods in the first place, cutting down on processed food (ready meals), replacing 'white carbs' like white bread, white pasta, white rice etc with 'brown carbs' - wholemeal bread, wholemeal pasta, brown rice etc., still letting yourself have the occasional little treat, but smaller versions - so instead of having a bar of Dairy Milk when you fancy some chocolate, have a Freddo instead - but only one, and be sure you count it as part of your calorie intake.

    5. Things that can help with exercising more include building it into your daily routine - doing little things like taking the stairs instead of the lift, getting off the bus a few stops earlier or cycling to work instead, walking instead of driving to the shop. The amount of exercise you have to do to burn off calories is quite a lot. Jogging for 15 minutes burns off about 100 calories, but a Mars Bar contains 450 calories. Best avoiding the Mars bar in the first place. I have taken up Parkrun (http://www.parkrun.com/) - this motivates me to get out of bed every saturday morning and go for a run - it also means I'm less likely to down 5 pints and a curry the night before! Maybe see if you can get a friend to start doing some sort of exercise with you every week?

    I hope that has been of some use. We're not all disinterested!

  • Ah, see that's just it, and its why I wanted more of a conversation with my GP. I don't eat junk, I count my calories (very rarely do I go over 2000, more likely I naturally eat around 1800), and I exercise.

    I haven't had a mars bar since... high school. I make all my own meals, nothing processed. Chocolates - once in a while I'll buy one of the handmade fancy bonbons (and once in a while I mean, every 3-4 months). I don't eat the chocolate bars in the stores - they taste wrong. I don't drink sodas - diet or otherwise. I'm not a drinker. I don't eat in the middle of the night. And I'm not a big fruit eater... mostly vegetables and salads. The last time I ate white bread was in 2012 on holiday. I don't like bread.

    When I was really cutting back calories - 1200 a day for over 6 months, and an exercise program at the gym... I lost 2 kgs. In 6 months. No inch loss, no looser clothes. The trainer at the gym suggested I go for metabolic testing, but he also suggested some homoeopathy, so I never followed it through. Then I got food poisoning, and the diet got thrown out the window. Eating without the diet, the 2kgs came back very quickly... but nothing else has really changed.

    A typical day will be:

    Breakfast - yoghurt with added psyllium husk.

    Lunch - salad with no dressing, can of tuna or a slice of cheese.

    Dinner - vegetables (either stir fried or boiled) with brown rice and around150g of meat.

    No snacks. No coffee. I drink tea with lemon or almond milk.

    I've run a couple of half marathons and more 10ks that I can count. I do pilates for my back, and I ice skate because it a lot more interesting than pilates and better at maintaining overall core strength. I also walk everywhere.

    I needed someone to explain to me why I have a BMI of 28, but I eat so little. My diet is so freaking clean, it's bordering on sad.

    I told her, that for the amount of food I do eat, people at work have noted that I should be a lot smaller. And she simply said, people hover around a certain weight, and she has no problems maintaining her weight. Followed by a smile that will haunt my dreams.

  • You sound like you are fit and healthy and are eating a healthy diet and are exercising. BMI is not always the best measure of how healthy you are and perhaps you should take heart that your doctor does not think you need to worry.

    If you want to lose weight for cosmetic reasons (like I do) then I'm sure you can find lots of advice on here but you don't really need public funds to help you do that. Why not try a low carb high fat diet or something similar which may help?

    Best of luck!

  • Hi Vetticus. Not sure of your age but is menopause / peri-menopause a factor? I found that was the time I started to gain weight despite there being no obvious changes to food intake/composition or exercise. Certainly there's supposed to be a connection between sleep quality and weight, and for me, sleep quality has been poor ever since the start of menopause. (I am now 58). I have subsequently turned it around (at least got it back to a Bmi similar to yours). Large amounts of swimming and some weight training on top of walking, running, have made a big difference in that I am currently losing around 0.5-0.75k a month. Slowly but surely.

  • Hi Vetticus,

    Before you do anything else, double check your height, get weighed on an accurate set of scales and make sure your BMI is accurate.

    If it is..

    It sounds like you know what you need to do. You have managed to lose 2kg before so you know how to achieve weight loss. And you know what puts the weight back on. Weight loss is very hard work. There is no easy answer. From what you've said, I strongly suspect there is no secret that your GP knows about that you do not. Some people unfortunately find it more difficult to lose weight than others. There are some rare situations where weight gain is a result of a fluid build up - I'll mention these at the end. But I suspect you'd know if you had one of these conditions. Homoeopathy is complete nonsense. There is no scientific evidence for it. Do not waste your money. There are some herbal remedies for some aliments (such as depression) for which there is good scientific evidence - and I have no problem with recommending them. But not for weight loss.

    You said "I needed someone to explain to me why I have a BMI of 28, but I eat so little."

    Weight creeps up on most of us slowly as we get older. Your diet and lifestyle sound very healthy. Are you sure you are tracking your calories accurately? What do you use to track your calorie intake? Do you weigh the portions accurately? Are you sure you are being completely honest with yourself? Do you eat more when you are alone than when others are around? That extra little bit of cheese at the end when you're slicing the cheese? That nibble of cake at the office when someone brings it in? I'm not being nasty - I was overweight for a long time and I used to play mind games with myself.

    Having an underactive thyroid might slow your metabolism down, but nothing will change one of the basic laws of physics - “Energy cannot be created or destroyed, it can only be changed from one form to another.” The only way energy can get into our body is via our mouth, unless someone is hooking us up to a drip while we sleep :-) Unfortunately for us, the energy Einstein spoke of tends to change from food to bodyfat, as human bodies evolved when food was scarce and it made sense back then to lay down a store of energy when we were fortunate enough to find ourselves in a situation where there was an energy surplus. Now we live in an obesogenic enviroment - a society where there is an energy surplus that we are constantly being bombarded by.

    I guess it depends how much it is bothering you. Having a BMI of 28 will increase your risks of a wide range of conditions such as diabetes, heart disease, high blood pressure, stroke etc. What you do with that knowledge is up to you.

    *Rare situations when weight gain may be a result of fluid build up include conditions such as heart failure where your heart is not pumping well enough to return all the blood back to your heart, it leaks out from your veins and you end up with fluid round your ankles (so that they dent when you press on them and take a while to go back to normal) and fluid on your lungs. If you had this there would be no way you'd be capable of running a half marathon. Alcoholics and people with liver cancer can develop a condition called ascites where the liver is unable to process all the blood coming back into it, so in a similar way to heart failure the fluid seeps out and collects in the abdomen. Type ascites into google images and you'll see what it looks like. I think you'd know if you had this. Cushings syndrome is an extremely rare cause of weight gain- and again, I think you'd probably know if you had it, or your doctor would have known just by looking at you.

    There is a good article here on medical causes for weight gain. (Note these are causes of weight gain, rather than inability to lose weight - if your weight has been stable for a long time or increased very gradually these are extremely unlikely to be the reason for this);

    nhs.uk/Livewell/loseweight/...

    If you are over 40 then you should be able to ask for an over 40's health check. The bloods you'd get for this should help rule out any potential medical cause for your problem and would include;

    HbA1c - this will tell you if you are at high risk of diabetes (if it's > 42), in which case weight loss would be even more important. If it's >48, you're diabetic.

    FBC - This will pick up on any blood disorders, including things like anaemia which could make you feel tired.

    U&Es - This will make sure your kidneys are functioning as they should

    LFTs - This would check everything is OK with your liver

    TFTs - This would check everything is OK with your thyroid.

    Lipids - Checks if your cholesterol is too high. Helps calculate your risk of heart attack or stroke in next 10 years.

    You'd also get things like a Blood pressure check - which if raised would be an added incentive to lose weight.

    I hope this is helpful.

  • Your letter matches my experience of visiting the GP. Waste of time, unless you are in severe pain or visit the doc every 5minutes (then they just want to move you on to someone else, or drug you to the eyeballs!

  • Hi, I went to see a dietician (at my own request) and she was just as useless. I took a food diary with me etc and she didn't even ask what I eat. She just showed me a picture of a plate sectioned off into nutritional values - just like you can find online.

    I am very overweight and have very little support from my GP. This site is so much better than any help my GP could give me and so far I have lost over 3st with my own research and the support of this site.

    Good luck :)

  • Re doing exercise - I think that to lose weight you would need to radically increase the amount you're doing, and perhaps do different types of exercise using lesser used parts of your body. I'm no angel and I agree your calorie intake sounds very low, but I also considered myself, like you, to be fit and active, yet still not shedding pounds. I walked and cycled everywhere and did the couch to 5k programme, lost 3lb, and felt there was little more I could do. It was only by decreasing to 1400 cals a day, thinking about the nutritional content of those calories, and pushing myself to exercise harder, that I started to lose weight. I also really relate to your description of 'carrying it well'. This probably means you have a good base fitness and strong muscular build. Unfortunately this may mean your body's just got used to processing your low calories while doing your current level of exercise. I really recommend following the NHS 12 week plan - looking at it holistically - a journey of learning about nutrition, healthy lifestyle choices, and how you fit into a really interesting community of people on here, all aiming to lose weight too, all finding slightly different strategies that work for them along the way. The plan recommends doing 150mins aerobic exercise and 2 strength sessions a week. See these as goals for exercise to do above and beyond what you do now. It's tough, but combined with further reduced cals and increasing your nutritional awareness, it will all definitely help.

  • I do suffer from hypothyroidism which can slow your metabolism making weight loss more difficult. I have been concerned that despite undertaking 2 hours of serious exercise a day and eating healthily I have been unable to lose weight or get my BMI under 28. My last blood test suggested that my level of medication was correct, but as well as a failure to lose weight I have other symptoms akin to an underactive thyroid unchecked by medication, so I have started the NHS weight loss plan in so far as I am now completing the weekly sheets, and counting calories (which I have never done before). My intention is to take the sheets along to the GP if I continue to struggle to lose weight. I thought that I might get more serious attention with some evidence, as I am sure that without it I shall be told that because the blood tests were okay, I am simply overeating.

  • how long has it taken you to gain this weight if it's fast that would be worrying, my BMI is 25 at the moment but when it was 28 I was 5ft 61/2 size 14 which is okay I was 12.5 stone the amount of time in my 20's they would get me back on the scales at hospital because they thought the scales were wrong, I am always at some medical appt. ( type 1 diabetic) and now the nurse is cross because we are pretty much same height and weight but I am now 10-12 and she is a generous 14 so I guess it all depends on your make up as to how you look and feel!

  • It must be disheartening to have that kind of response. I have been overweight since a period on anti depressants a few years ago. They made me feel hungry all the time but I put my mental health before my physical health. When I stopped needing them I was mortified to find I would now be classed as obese. I returned to my GP for help. He looked at me and said 'you don't look obese!' A few months later I returned again and was given a thyroid test and a cholesterol test. Thyroid came back clear but cholesterol levels are quite high. My GP looked at my postcode and said 'because of where you live I can't give you cholesterol reducing drugs. Go home and make changes to your diet'. It appears that in this area you only get help if you live in a deprived area.

    I would suggest that you return to your GP and insist on a thyroid test so you can rule that out. Good luck.

  • All I wanted was information on whether my doctor's attitude was common... and it is. It was very disheartening.

    I find it strange that GPs will only help when someone is already obese, and reports show that they have a very small chance of returning to a normal size. Doctors aren't very good at preventing health issues.

    But, with that said, I do not want to post more information on my personal issues. I don't want to have random people speculate why I am the size I am, how I got that way, or any other "advice" which is not backed up by having an actual examination or tests. Anyone can be a expert on the internet. Portmoon, I have no idea who or what you are, but if you are actually a GP... I hope you have a better attitude to your patients than what you showed with your last reply.

    It's a forum, should I post my height, weight, age, blood pressure, blood type, and banking details? A forum, which is great for getting a feeling on what is the right direction to head in, but is in no way comparable to having someone actually there to investigate.

    If I want to have meaningful feedback on my health - I simply have to find a GP or health professional who is willing to put in the effort to actually help.

    Hopefully GP #2 will be better.

  • Hi you should be able to have a thyroid test as their is history of this disease in your family,Its interesting when I was diagnosed with thyroid disease it was painful hips that sent me to the drs? you are entitled to a print out of your results.If you are worried about your weight then there must have been changes the medical profession should be glad you are being pro-active I think you would be better seeing another GP sometimes it is better to see the nurse about weight issues I went to the nurse who does weight management interviews she weighed and measured me and told me my BMI score also there was free referrals to weight watchers or slimming world for 12 weeks etc.Good luck.

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