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.

It absolutely will. There's a huge amount of evidence that dieting is one of the biggest determinants of obesity. (And it is dieting, whatever you choose to call it. Modifying your food intake in order to lose weight is a weight loss diet).

That's one of the biggest things that obese people wish they could make people understand. That the harder they work at weight loss the fatter they get. All to do with set point theory, leptin / ghrelin etc.

I am Asian. I have a BMI of around 24 in my fifties. I have diabetes in the family, as do most Asians. I was advised by my GP to get my BMI below 23 if possible. This is very, very hard, especially as my natural Asian diet has a lot of carbs though zero UPF. The GP did direct me towards diabetes information, but I am doing it mostly on my own.

I am not offended, patronised or humiliated. I am grateful the GP cautioned me. It's unfair that I have to stay below 23, but it is what it is and nobody's fault or problem. It's my own problem to solve.

But as the OP says, they know how to lose weight. Knowledge/ignorance is not the issue.
The issue is far bigger than can ever be handled but a HCP in a 5 minute chat. all they can do is lay out the basics of weight loss.

@missmollygreen - but what are the basics of weight loss? On this thread alone there have been so many conflicting theories. Many people insist that carbs are the devil, yet the NHS website says, "Starchy food should make up just over a third of the food we eat." Equally, I have always thought that dried fruit and fruit juice were full of sugar, and to be avoided, yet the NHS website says, "Aim to eat at least 5 portions of a variety of fruit and veg each day. Choose from fresh, frozen, tinned, dried or juiced."

There is so much conflicting information out there, and it's difficult for ordinary people, who don't have a nutrition degree, to know what is best for your health, and what works for weight loss. Eat less and exercise more is another (although I admit that works for me!) - I have a friend undergoing chemo - she is putting on weight every week, yet is eating less and less. If only there were clear "basics".

I can still only laugh at the people here saying to eat less is decent advice. Say this to an alcoholic or drug addict. 'well, don't drink then and you'll no longer be an alcoholic'. It doesn't work like that.

I dont know what some people are expecting TBH...obesity is such a complicated issue with so many causes and most HCPs get minimal training in diet and nutrition.
Of course they are going to give you a very basic spiel. Maybe most people will already know everything but it could help somebody who isnt so sure about what to do.
At least it never bothered me when I sat in the Drs at 17st listening to a nurse explain to me how I was prediabetic and how to eat healthy. I also didnt feel the need to point out that as a gastroenterology nurse with 25 yrs experience I kinda knew what I should be doing!!LOL😆

If you eat less calories than you consume, consistently, you will lose weight. Psychological, hormonal and other factors may make this harder to stick to, but if you consume less than you use, the weight will come off. You don’t see overweight people in starving populations, being protected by their hormones, or by being perimenopausal etc.

I read that one of the difficulties was accurately recording what is consumed and what is used (devices are inaccurate and the body can burn differing amounts of cals depending on certain situations). Sorry, I don’t have time to look for citations now.

Having lost a lot of weight via intermittent fasting, and endless walking, I believe it to be true that weight loss is, for most people, theoretically ‘simple’. It’s just boring, sometimes miserable, and bloody hard to stick to (which is why I didn’t successfully lose weight for a long time, as I didn’t stay at it consistently).

If an overweight person refuses to eat less, how are they going to lose weight?

If an alcoholic refuses to stop drinking alcohol, how are they going to get sober?

No-one's saying it's simple but it has to be done and if the person refuses, they'll always remain the same.

Why do we have specialists if GPs know it all?

And that wasn't the solution for me as advised by my dietician.

Are you serious?? 🤯

I have been given advice by my dietician which has enabled me to lose weight. No part of that advice was 'eat less.'

@missmollygreen @OhBumBags (this isn't for mollygreem but I can't delete it on my phone) is that how you think it is? I don't believe many obese people refuse to eat less. I believe they fight this battle at every single meal and their mental health suffers greatly every time they don't manage or undo a days 'good eating' at night or even the next day.

Now I'm guessing people will be along to say they just need to strengthen their willpower. I believe many would benefit from therapy to assess the why and then establish different coping mechanisms. Often it means damage done in childhood needs to be undone and it takes a long time. Some cycles may in fact never be broken and I just find the ignorance on this thread sad by people who don't have the depth to look at this issue properly. I want to know how many of them have actually broken bad habits that were set in childhood for things they cannot just stop but have to manage every day, like eating.

People in starving populations aren't usually taking medication that causes weight gain or yo-yo dieting just as 2 examples.

It is much more complex than calories in, calories out according to my dietician. Even you have said 'the body can burn differing amounts of cals depending on certain situations.'

you're presuming that obese people don't exercise by saying do even the minimum of physical activity
We do exercise!

@Riversideandrelax if food isn't available as a coping mechanism, like it isn't in starving populations, there will be other unhealthy coping mechanisms.

It's in such poor taste to compare obesity with starving populations. I guess they also don't treat depression there or cancer because who's going to pay for it and so nobody can complain that their tax money is being used for people who have self inflicted illnesses.

It's in such poor taste to compare obesity with starving populations
Why? It literally demonstrates that over eating causes obesity, however much you insist that there are other factors that keep people eating within normal limits overweight.

Not being obese- as a PP characterised some of us posters- is not some kind of unachievable, distant, high faluting privilege reserved exclusively for some. It is achievable for most people. Maybe not all. But certainly the majority. The UK has far, far better health provision than most countries. And not starving populations. There are many countries which are neither starving nor obese. Japan. Korea. Malaysia. Vietnam. Singapore.

I am tired of this " I can't do anything about it so no one should give me medical advice" narrative, frankly. And I am menopausal so not that easy for me either.

So people in starving populations are on medication that causes weight gain?

Are you suggesting that dieticians have no idea what they are talking about? That my dietician just made up some rubbish and it just magically helped me to lose weight?

I was never overweight before I started on my medication. Like everyone I know on the same I put on weight. But with my dietitian's plan I've managed to lose it. I think that proves that there are other factors.

What people need is the correct advice. As soon as I had that I started losing the weight.

The rubbish advice I got from the 'health coach' and the weight loss medications did nothing for me!

I was a binge eater and at my heaviest was 138kg with a BMI of almost 50. I didn't need telling to eat more cucumber and less mars bars, because I knew that.

I went to see the practice nurse about something unrelated and we had the conversation about weight. She asked if I'd considered a referral to weight management services and that was the changer for me. I benefitted massively from the therapy provided as part of the service and ultimately decided to have surgery. Eating all the lettuce in the world wouldn't have worked for me without those things.

Would you mind sharing some of your dietician's advice, please?

@Riversideandrelax - exactly. This was my point above to @missmollygreen - it's all very well saying that people should follow the "basics" of weight loss - what exactly are these basics?

”basics" of weight loss - what exactly are these basics?
Eat less, move more…

Eat better too.This works for the majority of people across the world. No point posting saying it doesn't work for you because you have certain specific conditions or meds. It works for the majority. And that's what the HCP is saying.
I have been unpleasantly surprised by how few calories I can eat in menopause. But it is what it is. I can't eat like I used to and I have to move much more than I used to.

'What people need is the correctadvice. As soon as I had that I started losing the weight'

It doesn't matter whether its a stranger online telling you, or a gp or your seemingly wand waving dietician. The advice is the same. Stop calling it a diet, start calling it eating the correct amount to match energy used and just eat smaller portions.

Mostly, take responsibility. Stop blaming meds, stress and everything else. I can't understand why there is so much excusing going on. I fancy a massive slice of cake right now, it isn’t as if people with healthy weights and bodies don't get cravings but I won't overeat because newsflash I'd soon be overweight. I have a an averagely stressful life but I can still control myself.

I don’t know. I mean I suppose it’s similar to the number of times I was told over the years by Drs and HCPs that I should stop smoking. Sometimes they would recommend nicotine replacement products or books or hypnotherapy, but mostly they just told me I should stop. I would smile and nod and then light up a fag on the way home. I did stop eventually, but I had to make that decision myself and try multiple ways of doing it before I found what worked for me.