Good Morning:

I just wanted to get some feedback in case anyone else has experienced this (I'm quite sure some have). My last bariatric follow-up was fine. He told me my numbers were good and to keep it up. This week, I had a visit with my new primary care doctor. My previous PCP retired after 15 years (which I was very sad about-her retirement was unexpected). I was with her before & after my RNY, and she was very knowledgeable about everything related to the surgery.

When I went to the new PCP this week, after he reviewed my numbers (BP was a little high-I was told to stop taking my birth control because it can cause high blood pressure for woman over 35), he looked at my weight and advised me to lose more weight, which could help with my BP. I wanted to go on the defensive but did not. My BMI stays around 28-29, and that is after having skin removal on my entire body. I wear size 6-8 jeans and small to medium in pants. I honestly don't know where the additional weight could be lost lol.

My question is: how does everyone else handle this with a medical provider when it's encountered? I wanted to tell him that I used to weigh 311 pounds, so my weight now is considerably better.

Edited December 30, 20223 yr by BAA624

I would have told him how much I used to weigh! Impress him. Tell him your BMI used to be morbidly obese. So you will take a few points over normal any day!
When I go to the doctor if mine is 1 point higher then it should be, I get sent home with a paper about weight loss & I healthy diet?

Does he have your records. He must not have reviewed them too closely if he didn’t know that you had a major surgery and that your weight is way down. Honestly I wouldn’t care much about his opinion of my weight but I may take that as a hint that he isn’t paying enough attention to your history.

I swear it's never enough for some of these doctors. Not everyone is capable of reaching the arbitrary number they consider to be "normal", and if you're healthy and happy it shouldn't matter anyway.

The BMI is a flawed guide, with "guide" being the operative word. I'm *JUST* in the "normal BMI" range now, and I'm a US6-8/AU10-12, at 5 foot 7 inches. My collarbone, neck tendons, chest bones all stick out, I can see my ribs, my muscles and tendons in my arms etc. I can even see my hip bones through the loose skin. I look skinny - I know I do, because I get a shock every time I see my full-body reflection, and I've been called skinny by others. But my BMI and the Hip/Waist ratio markers all suggest I'm not. My Hip/Waist ratio tells me I'm still quite overweight! It really doesn't take body shape into account as I've never had an hourglass figure - I joke that I'm shaped like a plank with tits. Straight up and down.

So don't take the BMI to heart, and I think it would be a good idea to tell this doctor your history. Some doctors don't think beyond their charts, unfortunately.

Edited December 30, 20223 yr by Smanky

I would be finding another doctor. If he didnt even review your record what else did he not see? Honestly, there are many things that you could do to get your BP down including just cutting down on salt a little and it could be that your BP was just high that particular day. Mine is always higher at the dr office. Did he have any ideas on other kinds of birth control for you if you stopped the pills? If you are a size 6-8 you do not need to lose more weight!

Thank you everyone. That’s a really good point that was made, whether or not he even looked at my records. It is certainly frustrating that doctors just seem hyper focused on one measure. I am giving thought to moseying on down the road to another doctor. And, my husband had the snip, so I was able to stop the pill and hopefully my BP continues to go back to normal. He also reminds me that BMI is not an accurate measure of total body composition. ?

1 hour ago, BAA624 said:

Thank you everyone. That’s a really good point that was made, whether or not he even looked at my records. It is certainly frustrating that doctors just seem hyper focused on one measure. I am giving thought to moseying on down the road to another doctor. And, my husband had the snip, so I was able to stop the pill and hopefully my BP continues to go back to normal. He also reminds me that BMI is not an accurate measure of total body composition. ?

I would seriously consider another doc. There are medications that are no longer appropriate for you and I assume other things that will only make sense in the context that you had surgery. Thats something that the doctor needs to know. Of course you can just remind them with every rx that you had the sleeve and make sure it’s okay but if they are missing that, what else are they missing.

I meant to say bypass (I had sleeve and I remind them with every rx just in case but we shouldn’t have to).

I would consider another PCP as well. This one is obviously not knowledgeable about WLS. People who've lost large amounts of weight often have heavier bones and muscles than those folks who've never been obese. You needed that extra infrastructure to hold up all that weight. You do lose some of it as you lose weight (along with the fat), but you're going to have more of it than someone who's always been normal weight (excess skin is also extra weight (maybe five lbs or so), but you've had that removed). The PA at my bariatric clinic said you'll probably look about 10 lbs lighter than what the scale says, because of the extra bone and muscle weight you have.

plus as others have said, why in the h*ll is this PCP complaining about you having a 28 or 29 BMI, when you've lost a ton of weight? They should be overjoyed. They must not be aware of your past medical records (??)

Edited December 31, 20223 yr by catwoman7

P.S. Just wanted to add that when I weighed 146 lbs (at the high end of the BMI range for my height), I had a DEXA scan to see how much more weight I should aim on losing. Turns out my body fat was 21%, which is lean for a female. The technician, as well as my PCP, said it was time for me to stop losing. I was shocked. I figured I could lose at least another 10 lbs. Nope. Again, bone and muscle... (normal body fat range for older women (i.e., me!) is 23-33%. So yea - I was pretty low, even though my weight was at the high end of my BMI range)

Edited December 31, 20223 yr by catwoman7

I agree with those who recommend you find another PCP. I would be concerned about this doctor's fixation on your BMI. First of all, as a bariatric patient, you might not need to have a BMI within the "normal" range. I saw a video on YouTube a while back (someone linked to it on this forum) by a bariatric surgeon talking about the best weight for bariatric patients and he suggested that a "normal" BMI may actually be too low. So the first problem with this doctor is that his advice for you to lose weight might not even be correct.

The other thing that bothers me here is that I have a dear friend who went to her PCP complaining of malaise, and the doctor dismissed her symptoms and told her she would probably feel better if she dropped 10 pounds (and this is someone I have always envied because she has always been in great shape;). Turns out she had cancer. I would be wary about a doctor who jumps straight to losing weight as the cure for everything.

Something I appreciate about my PCP is that she never commented on my weight. She suggested I change my diet and be more active to lower my blood pressure and blood glucose, which are obviously associated with weight loss, but she recommended actual actions and not just, "lose weight." Likewise, she didn't praise me for losing weight, only for improving my health. I wish more doctors would take that approach instead of just using BMI as an all-purpose measure of health.

Another vote in favor of a new doctor. He seems like the type who's going to default to "lose weight" as the answer to anything and you don't want to find yourself six months into fighting him to get him to take some seriously while he's insisting you just need to lose weight to fix your compound fracture.

If you've never seen this video, I found it to be a really great explanation for why the best weight for a bariatric patient will almost never be the "ideal" weight according to the BMI chart:

57 minutes ago, kbsleeved said:

Another vote in favor of a new doctor. He seems like the type who's going to default to "lose weight" as the answer to anything and you don't want to find yourself six months into fighting him to get him to take some seriously while he's insisting you just need to lose weight to fix your compound fracture.

If you've never seen this video, I found it to be a really great explanation for why the best weight for a bariatric patient will almost never be the "ideal" weight according to the BMI c

this is a terrific video! Thanks so much for posting it!

2 hours ago, kbsleeved said:

If you've never seen this video, I found it to be a really great explanation for why the best weight for a bariatric patient will almost never be the "ideal" weight according to the BMI chart

Yes! This is the video I was referring to. Thanks for posting it -- I hadn't been able to find it again on YouTube (it's not in my YouTube history because I watched it embedded on this forum). This is great info.

On 12/31/2022 at 12:07 PM, BAA624 said:

He also reminds me that BMI is not an accurate measure of total body composition. ?

This is true. A weight lifter (or those with similar muscular builds may well show as being overweight by scales and BMI but in fact have a very low body fat percentage.

A DEXA scan is a one of the more accurate measures to determine body fat percentage vs lean body mass.

Your high blood pressure may well be related to genetics.