To think that most health care professionals are hopeless at advising on weight

[Hellostrawberries]

I had a hospital appointment today and the doctor, as expected, advised me to lose some weight. (My BMI is 39). He then spent around 30 seconds explaining how to do it, basically by eating less processed foods and more fruit and veg, lean protein, whole grains etc.

I couldn't be bothered to say what I was thinking so I just thanked him, assured him I'd try and went on my way. What I was thinking was more along the lines of 'FFS do you honestly think I don't know that! I've spent the last 30 years trying to do just that. I succeed for a few weeks and then the hunger and cravings overwhelm me and I abandon the diet yet again. Each time it happens I hate myself a bit more. I've also got a history of ED and had a year of therapy for bulimia in my teens. My weight and my disordered eating are the biggest struggle of my life. And you reckon you can wipe it all out by trotting out a line about how I should eat more vegetables and less cake! Fuck off!'

So AIBU to think that HCPs are hopeless at advising on weight? I'm happy for it to be mentioned. I'd just like it to come from a place of understanding, of assuming my weight history is long and complex, of crediting me with knowing what healthy eating is.

I agree with this. There is nothing he can say is there? You know you need to lose weight and how to do it, he knows you need to lose weight and know how to do it but don't. It had to be said though because your weight is impacting your health. As far as he is concerned now he has told you what to do and it's up to you whether or not you do it. He can't really do much else, lifestyle choices are something that HCPs can't change for you.

@Riversideandrelax what would you have liked the HCP to say in this situation?

@Riversideandrelax ...there are HCPs appropriately trained to help people with complex obesity, however it's unreasonable to expect a doctor from a different specialty to have this in depth knowledge.
If you are going to argue that being overweight is a complex medical issue then surely you want people being seen by the doctors and nurses who are specialist in that field ?
Because if you think every doctor should be able to give "better" advice despite that not being their speciality then we are effectively saying it's not complex or a medically complex problem because any doctor can dish out the right advice

Errr this.

Your BMI is 39 so that is a risk factor and he had a duty of care to mention it. There are some procedures that they won’t do over a certain BMI e.g. IVF is 30

They can be expected to know that complexities exist without being experts in the solution. Any HCP can direct patients to smoking cessation support. They don't just tell their patients who are smokers to stop putting cigarettes in their mouth and lighting them.

I just think it's a checklist they run through, eat well, less alcohol, no smoking, more sleep.... Etc there isn't much more they can say in a short amount of time. I do wonder sometimes if things are missed in patients over a certain bmi as any symptoms are attributed to weight but I'm just spectating.

also to add, I think you get this nonsense obvious advice in loads of context, my friend has chronic insomnia and the doctor asked if she had considered lavender pillow spray. I had chronic back pain for years, and repeatedly was asked by Doctors if I tried Pilates, I had done it for absolutely years and could plank for minutes... It's just autopilot I think.

@Hellostrawberries What do you think the HCP could have said in this situation? I mean this as I’m genuinely interested.

So why do dieticians have to study then? I mean after all all they need to know is 'eat and drink less crap'??

Do you not understand there are many reasons people are overweight? For example due to medication?

And clearly you have no clue about being preventative? Then we have less people to scan etc.

Good questions for HCPs to start with
what are you currently doing?
what have you tried in the past?
Is there anything that has worked before?

with those three questions they can get a good idea of the knowledge someone has, the level of wanting to change and what barriers there are to change.

Incidentally my weight isn't impacting my health. I'm up to date with all my screenings and have recently had an NHS health check that's offered to everyone over 40. I'm not diabetic or pre diabetic, my cholesterol is normal, my BP is normal. Maybe I'm just lucky, maybe it's due to the effort I make with my lifestyle choices. I don't smoke, don't drink excessively, eat my 5 a day, limit saturated fat, get enough sleep, avoid stress. Health is multi faceted. I could well be at less risk than someone 5 stone lighter who eats less calories than me but binge drinks every Saturday night and lives on bacon sandwiches.

I would have signposted them to a service that may be able to help.

They don't need in depth knowledge, they just need to signpost instead of trying to do a job they're not trained in.

Yes it obviously isn’t going to help, fair enough if they need to bring it up, but trite obvious advice is just disheartening. It reminds me of going to see a male dr with the latest in a neverending succession of UTIs that had nearly landed me in hospital, gone on for years, caused me huge amounts of pain, upset, lost nights of sleep and days of work. And he told me to ‘wipe front to back’ and I really had to just clench my fists and jaw to not scream at him, I have never wanted to hit someone so much!

At a certain point in a nation's overstretched health system your life, you have to take responsibility for yourself. We are at that point. Not the HCPs fault.

This is what I think about the vast majority of threads on MN.

Incidentally my weight isn't impacting my health

Not yet, but I'm guessing he's advising you that it probably will catch up sooner or later.

Have you had an ultrasound of your liver to rule out non alcoholic fatty liver disease?

How do you think things will look in 5, 10, 15 years?

What do you want HCPs to do? Do you think you need therapy to suppprt your weight loss journey?

A good starting place is to give up:
Flour
Refined carbs
Refined sugars
Saturated fat
Red meat

Up fruit, veg, lean protein, avocado, nuts, olive oil, oily fish. All things that will full you up and once the carbs have gone, the spikes will go. Sensibly, you will.probably lose two to three stone a year.

It isn't a diet, it's eating differently. You have to want it and to follow through.

Weight is complex. There are many reasons why people overeat and are compelled to eat more calorific food than others. However, most things can be overcome. But no one can do it for you.

In this situation - nothing. Because it was just tickbox advice, I wasn't seeing him about anything directly weight related. In general, as others have said. 'I'm sure you know that losing weight would be beneficial. There are a few more avenues of support these days, would you like me to direct you to anything in particular?'

My BMI hovers around 29/30 - yes, higher than I'd like it to be, but the diabetes nurse is way larger than I am.
I mentioned the UCL research that was published last week on the impact of semaglutide - she denied that there was any research on the subject.
She suggested I take statins to reduce my cholesterol - my cholesterol is well within the normal range.
She then asked me to check my prescription on my phone - she was sitting in front of her screen with my medical records open.

Thick in more ways than one.

I think that your anger is misdirected. He’s doing his job, which is giving you some basic advice about a good diet. How is he to know your 30 year attempts at weight loss history? It sounds like you (and I mean it nicely) need a therapist.

Right but that's a low bar isn't it? Being healthier than a slim binge drinker who lives off bacon sandwiches? That isn't someone most people would hold up as any kind of health standard and I would imagine the Dr would also talk to them about diet and their drinking. If you are carrying around an extra 5 stones that will be taking a huge toll on your body whether you can see that right now or not, to say it isn't impacting your health because you can't see it on tests just yet isn't really reality.

Off MN many ( most?) people don't know they should avoid UPF or even what UPF is.

How hard is it to say: this is my situation - can you signpost me to something that might help?

It's just ticking a box.. sadly the gov make them do it and think it will help, which is rubbish.

No one believes it takes a health professional to point out the obvious