I just got back from the doctors, and while I showed a weight loss, he is still being 'assertive' with me that if I just ate 1500 cals a day, I would lose more. As I am one of the notorious one meal a day eaters, I think this is an unfair assessment. I have worked very hard since my hyster surgery in Dec to start eating regularly, and have been thrilled with the fact that I have started losing weight at all.

My main focus has been identifying the signs of hunger, trying to chew slowly and completely (for practice), and to make sure I don't skip any meals. I am also making better choices with my meals, and trying to eat low carb Snacks and no-sugar Desserts. As my dietician told me to eat a MINIMUM of 1500 cals a day, and now the doctor says a MAX of 1500, I don't know what to think. I'm trying to change a decade of not eating, and feel caught between two very different views on weight loss.

I know that my doctor will be the final say on the surgery due to the insurance company, so I need to keep him happy, but I'm struggling. I just got back from vacation and had the best time of my life, but there was NO way I was going to try to count calories on a whitewater rafting trip, climbing cliffs and caving. I was very happy with the fact that I had made good enough choices during my time away that I didn't gain an ounce, but it seems the doctor is not of the same opinion, and chastised me on not losing more.

Has anyone switched doctors mid-stream during their six months of supervised weight loss? Does it have to be a doctor? Can it be a dietician? I love this doctor for the family, but I'm having a hard time being patient with him when he admitted today that he just doesn't have the time to read the reports from my specialists to get up to date on my treatments. If he hasn't takent the time to read their recommendations, how is he supposed to understand I've been struggling with this weight issue for so long?

I did not have to do the six month diet before the surgery, so I can't give any advice for that or changing doctors midstream. But here is what I can advise you:

CHANGE DOCTORS!!

1. Any doctor who "can't be bothered to read the reports from other specialists" is NOT someone that is focusing on your health and your best interests!!! A doctor should not only try to gather as much information about you and your health, but definitely should READ the information he does get!

2. He is your doctor - which means that the specialists are giving their reports to him with the idea that there is one person who is reviewing the info and able to create a complete picture of your health. There are many diseases, disorders, syndromes, etc that can cause weight gain. That can prevent weight loss. That can cause other irregularities in various way. So one specialist might only have 2 pieces of a ten piece puzzle. They will never know if there is a piece missing. Only the main doctor having all the pieces will know right away that there are only 9 pieces or there are 11! That is his job!!

3. Weight loss is a very complicated science and they are discovering more and more that there is so much more to weight gain/loss than simply calories in vs. calories burned. The idea that if you "simply eat only 1500 calories" it is guaranteed that you will lose weight is NOT true. And a good doctor should be working with you on that. Helping you, not berating you! The fact that you are seeing a nutritionist - someone whose only job is diet and nutrition - and the doctor is contradicting their advice should be a huge warning light in your head!

4. If the s**t hits the fan, you are going to have to rely on this man to help you and your family through an incredibly difficult time. Is this the man that you really want to hold your hand through the rough stuff? You don't have to be best friends or anything, but you sure as heck better feel that your health and welfare are of the upmost importance to him. He has already shown that isn't true with him by not reading those reports.

5. You and your doctor are supposed to be a team! He has extra knowledge and you are paying him for that expertise. He works for YOU!! Together, he and you are supposed to be trying to get you in the best health possible. He is no different than any other service industry employee. Would you buy a burger at BK and allow the guy behind the counter to belittle you? And when the order came over and it was wrong, would you just take it if he said, well I just couldn't be bothered to actually listen to your order! That would never fly! And you have to try and think that way. You have a right to be treated well.

I'm not sure what the deal is with switching doctors now, and I do realize that the last thing you want to do is start from square one again, but I really have to say that you need to switch doctors. I just can't get over that he didn't read those reports. Keep looking until you find a doctor you are comfortable with. There are tons of doctors out there and at least a few must be covered by your insurance, right? Find a GOOD one!! :cursing:

If the doctor is not reading your reports, that is inappropriate and you will want a new doctor down the road. However, there may be risk in changing the doctor right now if you have to go back to square one with a new one. I doubt that they would accept 3 months of one and 3 months of another, however you can always check with your insurance to see. It may be worth toughing out a few more visits and then swapping out doctors.

If you are on a doctors supervised diet and the doctor says 1500 calories is the maximum amount of what he would prefer for you to eat daily, why do you feel that this is such an unreasonable request? I understand that you are making other healthy changes in your diet, but it seems like the calorie requirement is a straightforward request.

If you are banded, you will need to follow your doctors instructions. If you don't follow them now and then choose not to follow them post banding, you may not be successful with banding. It is important to consider that surgery may not be the best option for you if the requirements are too strict for you to follow.

I guess I didn't make myself clear enough the first time around. My dietician's (over the last three years) did not want me eating less than 1500 cals, as it was hard to keep my blood sugar on an even keel. I have a tendancy to be hypoglycemic, and get shaking and sweaty when my sugar is dropping. This has been happening on the 1500 max diet, which is what I tried to tell him today.

I always eat my Protein first as to give it the max amount of time to work before the carbs are added, but it doesn't seem to help on this program. I was having much better luck controlling my diabetes when I was eating a min of 1500, with at least three meals and trying to get at least two Snacks in too.

I don't think the 1500 max would be a problem for another patient, but that shipped sailed long ago. My metabolism was wrecked years ago, and have been trying to get it burning again for two years. Like I said, I was thrilled to see the scale going back down instead of up!

Sometimes I think doctors forget each of us has our own unique body, and history that can't be made equal to another person. I am the ONLY large person in a large family of thin people (I'm the tallest female though) - mainly because my metabolism is burnt out. I started looking at Lapband as a way to keep small meals in my body consistently in order to get it burning correctly again. I don't want to ruin the progress I worked so hard to achieve. Quoting one of the thousands of studies on weight loss does not mean it will work for me - especially if its the program he uses for himself. Men and women are not the same creatures.

I'm not looking for excuses, but solutions. I don't think this physician is looking to help a patient recovering from what is essentially anorexia (one meal a day) overcome their struggle, but to neatly fit me into their profile. He clearly stated that he doesn't have the time to read my reports from my endo, obgyn, dermatologis or neurologist, and thinks that my PCOS, migraines and diabetes were caused from my weight - not as a result of it. My endo and I have clearly marked the illness I had that resulted in 30 lbs lost in 30 days in my late teens, and weight gain/complications that resulted every year since. It clearly shows the progression of my diabetes, along with the increased symptoms of PCOS. This history will not be solved with a diet that isn't tailored to my individual needs - like the ones my dieticians have given me.

Wow, it is much more complicated then I thought. I didn't realize you couldn't go under 1500 without suffering physical consequences from it.

Is there a chance that after being banded that you may start having symptoms again and feel like you did before when you were having a hypoglycemic episode? Did the doctor explain how this surgery might affect your diabetes as well?

I talked this over with my endo, and she is as supportive as I expected. She understands that I feel this may be my last resort for losing any significant weight, and that at this point, I need help to make sure I break the cycle of eating once a day permanently.

I know it sounds ridiculous, but I truly am NOT hungry, except at night when I haven't eaten all day. My body has been in starvation mode for soooo long that I can eat one meal a day and be perfectly happy - except I cannot lose an ounce! I know my PCP doesn't understand my struggle, because he directly told me that he didn't care if i ate all 1500 in one meal, I would still lose weight. He absolutely did not believe that I had been trying to break that exact cyle for years.

I cannot be the only person out there on this board with this problem, as my endo thinks it is far more common in busy women than people think. She has several women like myself that are trying to kick start their metabolism again, and actually asks me to forward any information I find on increasing metabolism on to her so she can review it for everyone. My family doesn't understand the issue at all, and thinks I'm a closet eater, which I feel like at times when I'm stuffing my only meal in my face at 8pm because I'm suddenly ravenous.

I understand the post-band diet perfectly, and it fits neatly with the program my dietician designed, and I was trying to implement one step at a time. A decade of habit cannot be changed overnight, and adding one small thing to my pattern seemed to be finallly making progress, as seen in my now slow weight loss success. The dietician explained I'd gain before I'd lose, as my body would need to adapt to the continued food additions through the day, and I gained 10 lbs before the losses started. I still have 3 lbs to go before I'm back at my 'start' weight.

Now that I have to restrict the calories even farther, it seems like my body is protesting yet again, and can't keep the blood sugar even. As it took me months to be able to eat Breakfast without gagging it up, I know 6 months isn't long enough to get used to a lot more carbs just to be able to stay under the 1500 max. Good Protein is 'expensive' in terms of calories, especially after I had been told to count carbs per meal/snack and take in a minimum of cals to get the fire burning. I know many of you drink the slimfast and others, but the sugar count in those would send me into hypogylcemia in an hour with the reaction to too many carbs at once. It would be a great option if my system could handle it, but real food seems to keep me level for now.

I am going to continue on for the remainder, but it looks like for now I will have to try and find some of those pre-packaged meal supplements to try and kick out at least two more additional lost pounds next month. I thought approx 3 lbs a month was good progress, as I could potentially lose 18 instead of the required 15 for that practice, but I guess that isn't fast enough for my PCP. I hope I am able to find some things that I can physically get down that have enough grams of protein in them to keep me even, or I get the impression he will not be willing to write up a referral letter for me.

I am going to another seminar this evening (the fourth one....) to investigate yet another practice. I'm going to ask some hard questions of the dietician on staff of their standard practice on the pre-surgery weight loss and see if I can stir up some new ideas. I have read many of you do not have a minimum number of pounds to lose, which would be good in my case, as I am more than happy to keep working hard toward weight loss. I wouldn't consider this surgery if I wasn't willing to make myself eat small meals all day, the fact that it leaves me no other choice was the best part.

I agree about checking into a new Dr. Maybe you could use your nutrionist since you have been with them for a few yrs. Can you do Special K protien Water? I use the individual pks. that you mix in water. it has 30 cal. 6carbs. no sugar and 5g protien. Taste good. Also personal opinion if 1500 isn't enough for you, boost it up to what will keep your blood sugar level and still loose weight. Even if it is slow. Better doing that than ending up in the hospital!

I know I already posted a HUGE message but I just can't shut up - a terrible fault I know! But I have to say again,

GET A NEW DOCTOR

It may not be easy, it may be a difficult route, it will definitely not be fun. BUT any doctor that tells you he doesn't care if you eat 1500 calories all at once only once a day, you will still lose weight is an ASS. There is a big difference between giving a patient calorie restrictions that are reasonable and then listening to the patient whine and having a doctor muffle directions because his head is so far up his butt!!

You are diabetic. Right there, you CAN NOT eat once a day and be healthy. You just can't (as you already stated that you know this and are working toward fixing it). Maybe I can even understand if the doctor had useful instructions for you and was frustrated that you are only implementing them one at a time because it is too slow. But he has no clue! And having a clue is kind of important in a doctor!!

Keep the dietician. Ask her for a recommendation for a good doctor. Tell her what the doctor has been telling you (ie about only eating 1500 calories and you'll lose and that you can take it all at once and still lose weight). If she accepts your insurance she probably works with other people from other doctors with your insurance too. Ask her for a recommendation of a decent doctor.

Seriously, a doctor that would even in jest (but he wasn't kidding!) tell to a diabetic person that eating only one meal a day of 1500 calories would still lose weight is a dangerous person. If he was kidding and wants to be a stand up comedian find a new job. If he was serious, then he is dangerously ignorant. My father is non-compliant diabetic and even he doesn't do that!! Even he knows that you have to keep your blood sugar even and if you screw your sugar that badly you can end up in a coma - which maybe then you would lose weight but I don't think that is the goal to shoot for.

Finally, if you aren't careful, you can convince your body it is starving and then in goes into starvation mode. Which means that your body clings to every calorie and bit of fat it can to try and survive until the next meal. Which is why nutritionists talk about minimum calories and all. If it didn't matter, than why not cut it to 800? Or less? Because everyone is different, because your weight now, your height, your goal weight, your nutritional needs, etc all come into play. If you were ignoring your nutritionist's advice, I'd be less supportive -but this doctor is an ass.

I am so mad for you!! Man, I want to go and kick that doctor's butt!! This is so NOT how this journey should be for you!!! :tongue_smilie:

Have you been able to incoporate physical activity into your life as well? Perhaps a little exercise can help improve the weight loss numbers you are looking for and exercise can really help to kick metabolism back into gear.

You also mentioned that you went up 10 pounds with readjusting your diet but you are back down to only 3 above your start point. Did this increase occur during your physician supervised weight loss period? I was just wondering if your doctor was disregarding the last decrease because there has been a net increase since you began.

Good luck with everything.

Have you been able to incoporate physical activity into your life as well? Perhaps a little exercise can help improve the weight loss numbers you are looking for and exercise can really help to kick metabolism back into gear.

I was wondering this same thing as I was reading this thread. Even a 30 minute walk in the evenings is some progress. Get a pedometer and increase your daily steps by 1000 a month. So if you are walking 4,000 steps a day try to do 5,000 every day for a month, then 6,000 and so on and so on

I agree that you need to find a new PCP as soon as is realistic for this journey.

A couple of things though: with the band, I would expect your diabetes to improve. I am a type 2 diabetic and within months I was able to stop taking both my medications (avandia and metformin) and my blood sugar has been totally normal for at least 7 months now.

However - if you aren't able to physically manage on 1500 calories a day now, I am a little concerned about how you will manage with the band. Many of the things that people use here (protein shakes, etc) would not be ok for you with your diabetes,as you already know. You will need to be extremely careful about not getting too restricted, as it will severely limit the calories of "real" food that you can eat. Many bandsters go to 1000 calories or less per day after banding. I mainly stick to 1000 calories, and I am not sure if I could even eat 1500 quality calories every single day (I am not including junk or treats in that count which I can eat all day and night :embaressed_smile:).

I would really recommend that you have a discussion with your nutritionist and your lap band doc about how to manage your hypoglycemia. The pre and post surgery diets (I don't have a clue what your clinic requires - they are all very different) may need to be much more complicated for you.

Good luck!!!!