Disheartened after GP consultation re. Weight

[Lavenderbythefrontdoor]

Booked GP consultation due to low mood and weight gain. Blood tests have come back all clear.

GP said this morning that she will refer me to Weight Management Clinic. "Because your BMI is above 40, you can get in right away, so that's good" 🙄

I asked if that effectively means I will be asked to join Slimming World, she said yes, most likely. You need to start there and then if it doesnt work they look at other options such as injections etc (assuming Saxenda) but they dont "skip stages". God knows how long Id be expected to attend Slimming World until they moved a step?

I have explained to my GP numerous times that I pay a bloody nutritionist a large sum each month and follow a calorie deficit food plan. I lift weights 5 times a week and get my 10k steps a day, minimum. I also do some fitness classes, swim and climb hills at the weekend! On paper, I should not be as fat as I am. I am pro-active about my weight gain, Ive been working hard to lose weight for 18+ months. I've got nowhere with it, couple pounds here and there but then I get a bad menstrual period and it all goes back on.
I hold hormonal contraception to blame for the weight gain but just pointed to my ok blood work and told me thats not it.

Feels like a right kick in the face that, when Im at my lowest and finally decide to seek actual medical advice, Im being told to go back to the beginning and prove I dont sit on my arse eating Maltesers all day.

Oh, and my low mood is "probably because of your excess of fatty tissue playing havoc with your estrogen levels".

Righto.

Yep.

Rather than spending that money on a nutritionist why don't you do the Cambridge diet or something.
That would be too much food for me.. I eat once a day and have a big meal.. If lightheaded in the day I have a small snack like a slice of toast or something, but if I ate throughout the day I wouldn't lose anything.
I recommend intermittent fasting as you might see more results.
Also leave alcohol for weekends only, and sugary drinks are a no go on the regular, switch to diet.

Gosh, I just don't know what could be going on with you.
You are pretty active (though maybe more cardio would be beneficial?).
20 stone, all that activity and eating less than 2000 cals - there's obviously something going on. What does your nutritionist say?

Why not

eggs or oats for breakfast
Cheese salad for lunch
something low carb for dinner

boiled eggs are good filling snacks too!

I think your GP can see the real issue here and that’s why they’ve sent you to SW. The issue is that you’ve been sold a stupid diet that won’t work (not your fault!)

Sorry op that is not a great diet.
3 bagels a day is 21 bagels a week. I know the bagels you mean and I couldn’t eat one a day as they are not good for digestion as much as anything else.

There’s nothing wrong with carbs in moderation, no. But the type of carbs - skinny bagels and packet rice - the OP’s “nutritionist” has suggested are not the good kind of carbs. Sweet potatoes, brown rice, couscous, bulgar, pearl barley and, if OP wants bread, whole meal or brown sourdough would all be far better options.

Agree with others. I’m angry for the OP and appalled that somebody calling themselves a “licensed nutritionist” is charging money to tell her she needs to eat skinny bagels, energy bars and meal replacement / protein shakes, virtually no vegetables, and throwing in words like “macros” to make her think it’s all scientific.

I did a low carb diet while running 20k a week and doing weights and lost 2 stone quite quickly!

I also have a rheumatologist and a neurologist - I’m not a well person but the low carb thing really helped (especially with my fatigue and fogginess!)

You can do it OP x

Why are you paying £80 per month? What are they actually doing for that amount of money? Because if it's just giving you that meal plan I'm sorry but you are being severely ripped off.
So you've been eating the exact same diet for over a year, with no result, yet you are still paying £80 a month? Do you not think after such a long time they should have tried a different plan? You are staunchly defending them, but why? They aren't helping you, and for £1000 a year they really should be. After 3 months of eating the same food with no loss, it would be time to change it, not carry on. There's a saying "the definition of insanity is doing the same thing repeatedly and expecting a different outcome"
You could get rid of the "nutritionist", buy saxenda and actually save money.

around 1800 calories per day. Around 1600 per day on a rest day. Perfectly normal range

It is. For someone who has a stubborn half stone they want to shift. 1800 calories a day for someone with a BMI of 40+ (plus extra occasional treats) is quite frankly bonkers and it's hardly a mystery why you're not losing weight.

Stop paying £80 a month for a diet that clearly doesn't work, your 'nutritionist' is clearly inept.

In your position I would try Exante or Fast 800 or similar.

Sorry, I’ve not read the full thread. I’m a GP.

The way weight management clinics work is that the GP refers to the clinic but has no say at all over which of the clinic’s range of interventions will be offered to the patient. Therefore most GPs will warn you that you may have to start on the lowest level intervention (Slimming world vouchers or similar), as anything further is simply not within their gift to promise.

When you have your initial clinic appointment they should take a full history of your weight loss efforts and take those into account. Unfortunately, a lot of clinics do make new patients jump through all the hoops, as lots of people want a quick fix and tend to exaggerate their previous efforts in order to get to the medication.

It would be worth taking along your nutritionist’s plans/ letters when you go to the clinic, or if the initial appointment is telephone, ask if you can send them pictures of your plan.

@pastaandpesto for losing weight it doesn't matter what food she eats though. It really is just calories in and out.

Some foods will fill you up better and so be a better choice but she could eat her entire calorie allowance on bagels and cheese and still lose weight. She'd just not be very healthy and would probably feel hungry a lot.

I pay a licensed nutritionist £80 per month for a plan so I will go with their expert advice.

I know OP has gone but to anyone else reading this who is considering seeing a nutritionist, know that there is no such thing as a licensed nutritionist! Anyone can call themselves a nutritionist but those with higher education / experience, can join the UK Voluntary Register of Nutritionists (UKVRN) & then call themselves a Registered Nutritionist (RNutrs) but they are not regulated by law.

Dietitians are the ONLY nutrition professionals who are governed and regulated by law, and are required to be registered with The Health & Care Professional Council (HCPC).

Definitely do not drop to 800 calories. Jesus Christ!

Are you tracking your exercise effectively op? Just as all foods are not equal, workouts vary quite a bit in the effect that they have on your body. I used to go to various gym sessions and think I’d worked out quite hard until I started tracking my efforts.

I realised that I wasn’t a good enough swimmer to get a decent workout, but I absolutely shed calories running and cycling. I don’t burn nearly as much as I feel like I have doing HIIT or weights but they do have a positive effect on my body shape when combined with lots of cardio.

I went to a weights class recently with a friend who is trying to lose weight. Compared to cardio, we burned very few calories. We also dawdled 15k steps around the shops. My friend spent the day talking about the ‘good’ workout we’d just had and how we deserved the three course meal and cocktails we had in the evening. My fitness tracker did not agree (but I ate and enjoyed it anyway).

I’m not saying you’re doing this op, and I’m certainly not being critical, it’s a mistake that I used to make myself. It is easy to over estimate how hard you’ve worked out and easy to under estimate the treats you are having.

The only thing that helped me to overcome weight issues was some meticulous counting of calories in and calories out.

I think the type of food being eaten is very relevant here though, because whilst the OP started this thread in the weight loss section, she went to her GP for low mood and depression. A diet basically of sugar (which is what skinny bagels and cereal bars are) and virtually no vegetables or fibre, isn’t likely to make anyone feel very good.

That's probably normal range for maintaining your weight, not for losing any.

You know what calories you input, which is a good start, but the facts speak for themselves - your current calorie consumption vs expenditure is not where it needs to be to lose weight.

All of the standard calculations are based on averages for BMR, height weight etc, and even the figures on the packets are averages hence 'typical' on the nutritional information. Height and Weight are easy to adjust for, BMR very difficult unless you sit cycling in a performance lab attached to colorimetry.

I’d love to know where this so called nutritionist trained. The diet they are recommending is awful.

There are good and bad nutritionist training courses. Look for someone trained by the ION. Institute of Optimal Nutrition.

Definitely do not drop to 800 calories. Jesus Christ!

Why?

Such plans are designed for the severely obese. Exante is one of the diet plans that GPs in England suggest when diabetes T2 is a concern (as I image would be the case for anyone with a BMI of 40).

A bmi of 40 would put you just outside the overweight category. That's not so big you'd need to be on a drastic 800 calorie diet.

I think you're misinformed.

"A BMI over 25 suggests you're overweight, while 30-39 indicates you're obese. A BMI of 40+ suggests morbid obesity."

@99ProblemsButAnIncelAintOne no it doesn't, it puts them in the severely obese category!

The fact is that what you are doing isn't working for you. £80 per month is a lot to pay for something which isn't working.

Honestly, in your shoes I'd get over to the low carb bootcamp thread which has just started. It might give your body the kick start it needs. I'd see how coming off the hormonal contraception goes and reassess from there.

Even if the OP is measuring accurately 400 calories per day from cheese seems a bit excessive.

Again, this seems like an awful diet for a qualified nutritionist to have put together. Where are the pulses, the vegetables, the variety? It’s so heavy in cheese and bagels.

I think increasing my your fibre would help. What do you drink (I mean soft drinks for hydration)

Sorry yes, I did mean just outside the obese category. Which technically makes her severely obese but not so big she needs to eat 800 calories. That's a drastic cut.

It's not like once you step into the next category you're automatically the size of a house. She needs to lose weight but eating 800 calories a day is not good for anyone unless it's a life or death situation