To think this is not just because I’m fat?

[exercisewoe]

I’m permanently exhausted . I weigh 21 stone, I’m aware I’m morbidly obese and I’m trying to fix it .

I take a beta blocker twice a day for anxiety . I take mirtazapine before bed .

I’m absolutely fucking exhausted . I’m wearing a sports watch and can see even if I’m out of breath and sweating (walking briskly) my HR rarely gets above 80, it’s hire often just 65 when walking quickly - it usually sits at 50 when relaxing . God knows what’s happening when I’m asleep .

I’ve started blacking out when standing for prolonged periods, so GP did an ECG, fine.

Severe postural hypotension though - BP drops by 45 on standing up . I know that’s happening as I can feel my heart pounding in my head when I stand up or move quickly . The nurse I saw on Friday said she thinks I need a GP review so asked me to organise .

GP did online review via email - said it’s definitely because I’m overweight and suggested I start running - said if my HR isn’t going above 90 I’m not exercising hard enough .

I cannot physically get my HR that high .

I’ve also been advised by cardiology specifically not to run - or do intensive exercise - as there’s a small chance of me having an inherited condition, get screened for it yearly .

I’m feeling very miserable with it all and so bewildered about being told it’s just because I’m fat, with no advice other than that !

Worth asking to come off the sodding beta blockers all together?

This doesn't constitute medical advice BUT I just asked my DH (a GP) and he said instantly: it's the beta blocker (re: the hypotension) and mirtazapine (re: impaired proprioception, sedation & potential increased appetite).

Were these prescribed in primary care or by a psychiatrist?

I don't often advocate this but I think the advice you were given is a bit (!) crap and you need to talk to a different doctor because, assuming you're taking them regularly, these drugs are probably why you feel so awful.

And yes, the sleep apnoea needs attention too.

I'm sorry everything was blamed on your weight. That is particularly ludicrous!

Wait...you were prescribed popawotsit for panic attacks?

They even tried to push that on me and I have low blood pressure. i resisted.

I am on fluoxetine and take diazepam when needed. It was a battle, I won't lie.

I switched from citalopram to fluoxetine because the weight gain was extraordinary and very fast.

Mitripizine is the worst for weight gain isn't it? I've known people not jut gain weight but able to sleep all day and all night on it.

I'm sorry but it sounds like you need a doctor with a different approach.

I really think you've been given very poor treatment, based on what you have said. If you lose weight and continued these medications, you'd still feel like shit.

Actually the way you have been treated makes me feel quite angry. Mum had a friend in her 50s who was treated in a similar way. She even ended up losing hair as well as gaining weight. I don't know what she is on now but she is losing weight and her hair is growing back, she feels much better.

She had a battle with the doctor too. I'm sorry, it should not take a battle.

It more than likely plays a huge part in it, my partner is 19.5 stone his energy levels are dire, it is a lot to carry and plus the interference of sleep the extra weight causes to your organs when you're lying down.

I take beta blockers. Firstly, although it's true obviously that you'll struggle to maintain the sort of heart rate that is ordinarily associated with weightloss when you exercise, that doesn't mean you can't lose weight. When you aim for a certain heart rate all you are doing is using it as an indicator of a certain amount of effort and therefore energy expended. If you are making that effort, you will still expend the energy and lose weight, even though your HR won't be as high as the next person's. The idea that beta blockers of themselves make losing weight harder is a myth. However, regardless of all that, it may well be that a different drug regime would be better for you and your GP shouldn't fob you off just because you're obese and have to expect to feel awful.

Secondly, if you are 21 stone, running is not a realistic place to start. You would be better off walking. If you can afford it, buy some decent, supportive walking shoes so that your knee and hip joints are optimally supported, as they'll be shifting a lot of weight around. Walk as much as you can as an alternative to driving/transport/lifts/escalators but also learn to love going for proper walks in the great outdoors because you have a lot of weight to lose and need to make a sustainable habit here. Swimming and aqua aerobics are also really excellent for very overweight people, but not possible just for the moment obviously.

Thirdly, you need to get on top of the blood results. Elevated CRP is probably an artefact of your weight, which will be causing an abnormal inflammatory response, but there's no reason why obesity would cause abnormal B12, folate or iron, etc, so you need to find out what your values are and whether you need supplements or injections. If your GP says you can 'forget about them', he needs to be prepared to justify that with some numbers. Deficiency in any of those could definitely be what's making you feel awful.

However, assuming your bloods are basically normal, then, genuinely, being 21 stone could certainly be making you feel exhausted. It's a lot of weight to be hauling around. Not to be unkind - and I say this as a fellow fatty - but if you were a normal weight and had to do all your daily tasks carrying another person on your back, you'd expect to feel exhausted, wouldn't you - and that is basically what you're trying to do.

Losing a lot of weight is really hard and takes stubborn commitment, but regardless of whether you have some deficiencies to address and/or whether your drug regime is optimal, you will definitely feel much, much, much better if you can shed some of it. I wish you luck and urge you to start from tomorrow.

I put on 2 stone on mirtaz. It took me ages to get it off as I'm in my 50s. It was the first time I've ever been overweight. The GP completely blew it off, told me point blank it didn't cause weight gain.

They should offer you a medication review and some blood tests. In honesty your weight probably doesn't help, but they have a duty of care, and if you have those symptoms now, it needs to be investigated.

It could be POTS? Do you have PCOS? If so balancing your blood sugars throughout the day will be key for energy. Also Intermittent fasting can work well for weight loss in PCOS (I’m a nutritionist).

My anxiety meds make me really tired, and also your weight will absolutely definitely be having a huge impact.

Haven't read every post but the GPs advice to take up running when you are morbidly obese is positively reckless - your poor joints!

Weight loss is 80% diet and 20% exercise, so other than increasing activity with perhaps more walking, you really don't need to be doing high impact exercise at this stage - its diet you need to focus on (incredibly hard, I know)

I agree that you probably have sleep apnoea and this is probably tiring you out. Your diet might also be at fault with peaks and troughs in your blood sugar, you might have metabolic syndrome. When I eat too many carbs I have to have an afternoon nap. When I cut carbs and processed foods right down - that doesn't happen so much

I empathise - I am at my heaviest with a BMI of 36, partly due to depression (now better) and partly due to a problem with my feet which meant that I spent 6 months sitting on my arse (also now 90% better now). I have been dieting for 5 weeks and have lost 12 lbs (slow and steady) - following the 5:2 diet, but you have to find what works for you

This could be the beta blocker. I can't take them. They absolutely floor me. It's a common side effect in people who metabolise them poorly.

Mirtaz can be combined with bupropion to quite successfully mitigate the weight gain but you'll need to see a consultant for this. There's a mistaken belief that these two are not licensed to be used in combination to treat depression but it's not true, but it does require a consultant.

@BuggerBognor

Mirtazipine made me fat, floppy and constantly exhausted (and did fuck all for my depression).I was told by a GP that it was developed to stimulate appetite in the elderly - no idea if that’s true, but I certainly found it stultifying. Try a different AD?

It's used as an appetite stimulant, yes. It was great for my depression but did not help my sleep and made me pile on weight. It's shockingly popular, however, with the user then plowed into for gaining weight and some flat out lying and saying it doesn't cause weight gain.

Could this be POTS?

OP I sound similar to you - constantly exhausted but not losing weight/putting on weight even though I’m exercising and dieting. I took a private blood test which checked my thyroid and showed that my blood tests were abnormal and could be a sign of hypothyroidism. But the doctors have said I need to wait almost 6 months to take another one to see if my levels have changed - I looked into it more and apparently getting treatment for thyroid issues is almost impossible in the UK.

The only advice I have is what I’m doing - write down everything you’re eating and get a Fitbit to track your steps. If you can afford it get a proper private thyroid test done (about £70) not just a cheap basic one. Then take all of this information to the doctors.

I was prescribed mirtazapine to help me sleep after a traumatic event. It was really difficult to function the day after taking it. I could only take them at the weekend,

It could well be the weight. I'm about 12 stone. I started running about 1 month ago and starting to shed a few pounds here and there. I am feeling about 10 years younger. I would try some jeffing or brisk walking if you can. Sustained over a period of time. It will make a difference.

OP, I am 18st (eurgh) and have no energy issues, my HR runs higher rather than lower. We’re all different but I wouldn’t just assume your symptoms are down to weight alone, and I think your meds need to be looked at. As others have said they’re known for those side effects. Do look at supplements as well, are you getting enough B12 and iron for example?

Frankly your GP sounds disinterested at best. Unfortunately once you’re obese you will struggle to be treated for anything without that thrown back in your face, unless you get lucky with your GP. And that’s not to say they are always wrong, of course sometimes an ailment or condition has a direct correlation to my weight, but I’ve had GPs in the past who would blame my weight if I walked in with my arm hanging off. I have finally found 3 GPs at my practice who listen and who I trust.

You deserve better. In your shoes I would now be asking to see another GP at the practice. I sympathise with the weight loss support you’ve received; I was sent on a 10 week course with a dietician when I was TTC. I only made it to week 4 because I got so pissed off at people in the group complaining that they would die if they only had the correct portion of cornflakes for breakfast. It was psychological support I needed, I understood food groups, calories and portion control. I’ve now requested to be referred to the tier 3 weight loss programme, have a google and see what you think and if you think it might be beneficial. I haven’t started yet so can’t comment really, but I’m so desperate I’ll try anything now - except surgery!

I do hope you get to the bottom of it all. x

I'm fat, I have a bmi of around 39. I weigh less than you and have an underactive thyroid and some other health issues including anxiety which I take medication for and some gyne stuff.

I'm on a pathway to have barriatric surgery. I do worry about my health right now. But a significant motivation for me is I'm suck of how hard you have to fight as a fat person to be take seriously by doctors. They just think everything is fatness. This worries me particularly for going through the menopause. As I think women have enough of a challenge getting proper medical support without being fat and any symptoms being blamed on this.

So I'm just sympathising really.

Probably not just because you are fat.
But that will contribute hugely.

However , losing weight is so bloody hard.
I feel your pain x

Mirzapine made me tireder than I've ever felt before, and I gained SO much weight. I bet switching from those if possible for you would make a massive difference.

They did think sleep aponea in hospital 2019 but said wouldn’t treat that either

Did they actually do the sleep study and did you see a specialist for this? Or was it just a passing comment by a non specialist?

I'm struggling to understand why, with your health issues, they wouldn't tackle the sleep apnoea first. Its so very treatable and can transform life to a position where you can address any other issues. Ask for a second opinion at the GP but also pursue the sleep clinic/study.

@LunaHeather was it citalopram you gained weight on? I really feel its been a significant factor for me. But I don't want to stop my ssri in the middle of a pandemic!

And don't allow them to tell you it doesn't cause weight gain. I've been more or less the same weight since I was about 17 (just nature I think I because I eat plenty). I gained over a stone in 2 weeks with mirzapine and lost it within a month of stopping. When on it I was going to bed planning my breakfast and planning the next meal as I was eating the current one. Never felt that level of ravenous hunger before or since!

A serious diet plan seems to be needed here, and will take a while for some weight loss, but has to be done, Running would be harmful for you right now, walking is better when you feel able to move around more.

I cant believe how all these medications are dished out, people come to rely on them, and I can't imagine what they will do to your mind and body in the long run.