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

Ohhhh I don't like him already. He seems like the type that tells everyone to just lose weight as a solution for anything. He clearly didn't spend the 5mins to look over your medical history too. Wow

Thanks for posting that video - most interesting!

On 12/31/2022 at 10:53 AM, catwoman7 said:

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 (??)

you have no idea how comforting this is for me. I do look much smaller than the scale says I should be (I have a BMI of 22 and keep getting these "you're too thin" comments from family members and even my husband at times). This actually makes it make more sense and helps a lot with some of the dysmorphic feelings I've had.

On 12/31/2022 at 2:26 PM, 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 chart:

Thank you so much for posting this! Wow. What a knowledgeable bariatric surgeon. He even said 27-29 for BMI. I really appreciated hearing him explain that ‘ideal weight’ is sometimes just not the goal for us bariatric folks. At a BMI of under 25, I think personally I would look sickly.

On 12/30/2022 at 3:57 PM, Smanky said:

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.

There are a lot of variables to consider. IMO, BMI is flawed....the formula is based on an average body composition. It does not take in consideration frame size, bone mass, muscle mass, large breasted vs small breasted (boobs are heavy!), body shape (ectomorph, mesomorph & endomorph). If you were overweight in your youth and/or the majority of your life, your bones had to accommodate more weight so therefore are most likely larger and heavier than someone who has been slim most of their lives.

Thirty years ago, the general rule for women was a baseline of 100 pounds for a 5 foot woman and 5 pounds for each additional inch. That is an average, but for me at 5'5", I am chubby at 125, where as; my daughter at 2 inches shorter, looks amazing at 135. Before the weight gain in 2012, my natural shape was hourglass (metomorph) with broad shoulders, heavy chested, small waist and slim legs on a small/medium frame. My daughter is rectangular (ectomorph) with broad shoulders, heavy chested, thick waisted, narrow hipped and thicker legs on a medium/large frame. My best weight is 112 to 117 but my daughter, even though she is 2 inches shorter, looks best at 132 to 138. "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." YES, YES, YES! The variations in the natural body composition of ectomorph, mesomorph or endomorph is not considered when computing BMI. An hourglass shape will carry more fat than a plank shape at the same weight!

Weight is a personal matter. You have to find where you are comfortable and a weight that can be easily maintained. Listen to your body and listen to your doctor but don't let others get into your head.

On 12/30/2022 at 8:51 AM, BAA624 said:

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.

I would go ahead and see if you can get a second opinion and I would seriously tell him what you did weigh, and keep it up