Consultant told me not to lose more weight but I am still overweight?

[Pedestriancrossing]

Hi all. I had some blood tests earlier this year that showed high cholesterol and triglycerides, high blood pressure and BMI 29.6. Was a big shock and kick up the arse to sort myself out.
Anyhow, I've been on calorie controlled low fat diet plus (a bit of) exercise and lost1.5 stone. BMI now 25.5.
I was referred to clinical pathologist for possible familial Hypercholesterolemia. I saw him this week. Good news is that my cholesterol is now in normal range. BP a bit high but better than it was.
Dr stated probably not familial Hypercholesterolemia which is a relief. So I asked what I should do now.
To my surprise he said don't lose anymore weight, don't bother with Benecol etc. I am still in overweight category, and look it.
I'm feeling really confused and deflated by his advice as he was very dismissive in his approach.
Just wondered what others would make of this?

Maybe he’s wrong.

congrats on your weight loss and blood pressure reduction- sounds like you’ve done really well!

Thanks, it's been hard going at times. I just found his approach really discouraging!

Well done on the loss so far and getting your cholesterol down. Maybe he meant you don’t need to lose more weight- in that what you have done so far has addressed the medical problems, rather than don’t lose more weight?

Well done on changing your lifestyle to get your cholesterol and BP back on track

Consultants can have a terrible manner and tend to only bothered about their specialism - your weight per se is neither here nor there to him given the improvement in other markers.

You are barely overweight according to BMI, any more you want to lose is about how you want to feel and look, rather than massive health benefits.

Did you ask why? I think you need to know if it's for a medical reason or if it's because in his mind you're now a healthy weight. I don't think anyone on here will really have the answer.

I didn't really get the chance to ask as he kept talking! He said mortality risk highest in those BMI below 20 and lowest mortality in BMI 25 to 29 - never heard this before as surely the healthy BMI range must be healthiest? Really confused me!

No it's new research- BMI isn't entirely helpful in predicting mortality. Slightly overweight is potentially protective, whereas slightly underweight is less helpful.

I'm sure I've not expressed it technically correctly but it's true.

Particularly important if you’re elderly to have a bit extra weight in case of illness. Assuming you’re not, it sounds like he thought you’d lost enough to bring your health back on track and effects of additional weight loss would be negligible. My BMI is currently 26.1 and working on bringing it down to 25. It’s up to you if you wish to lose any more.

I'm still technically obese. I'd love to lose more, but have to balance mental health as well.

People are always shocked that I'm obese still.

There is a growing body of evidence that in post menopausal women the lowest mortality is in the technically slightly overweight andin the same age groups BMI of under 20 has greater mortality than morbidly obese. A bit like the late Queen in her late eighties early nineties. I don't know how old you are but your consultant is probably right from health point of view there is nothing to be gained from losing more weight though being fitter at same weight would be a health gain. There is a temptation to think even within healthy range that BMI of 20-21 must be better than 24 but it's not true, unless you are very young or from certain ethnic groups

you are also best to stay at a weight that you can consistently maintain from now on....dropping weight only to end up yoyo dieting is not great for your health either. try to focus on your exercising as that will ultimately benefit your BP ,rather than be led solely by BMI.

I had to have a reset due to poor health. I focus on strength and flexibility these days.

there are also aspects of WHERE you carry your weight...if you are an apple with lots of weight around your middle this can be more of a health issue then if you are a pear shape, even if same weight. Even people of low BMI can have unhealthy levels of body fat around their main organs/middle.....its why keeping an eye on your waist measurements/waist-hip ratio is a good way to check progress.

It's fairly well known. He's telling you what is medically accurate - that you're in the perfect range for the best health outcome. So i think what would be best is to listen to the expert medical advice and follow it.

To what extent is this correlation rather than causation though? i.e the low weight is caused by an external factor which is the cause of the mortality risk rather than the low weight itself being the cause of the mortality risk.

@Bubbles254 With most things there maybe some correlation ie in the already ill but in others it is causative , a thing doesn't have to be either causative or a correlation it can be both.
While an extremely low BMI can be indicative of severe disease or illness that is generally when accompanied by rapid weight loss without explantion ie they did not previously have such a low BMI,
however in older people having a low to very low BMI normally means that there are little to no reserves when illness strikes, as we generally take longer to recover and heal as we age having no reserves makes it just so much harder , hence when it is said being technically a little overweight is protective, it is really talking in the 25-28 BMI; but also that having a BMI under 20 is actually worse that having a BMI so 35-40 in terms or mortality
hence the normal range pre menopause is considered 18.5 - 25 but after menopuase it should be more like 22-28
This is still be researched but it complicates matter and public health like simple messages so having different ranges for different ages, sexes and ethinicites takes away from the simple message under 18 bad, under 25 good, over 25 not so good over 30 bad
There are of course many other factors mentioned above like weight distribution, also in type 2 diabetes a sort of "skinny fat" where people are healthy BMI but too much fat around vital organs the slim person but with unhealthy diet nutritionally, there is family history and genetics, hormonal changes etc
but overall the statistics bear out that all things considered those in the mildly overweight category post 55 women have the best health and live longest, that does mean there will be no outliers the extrmely thin person that lives to a 100 or the mildly overweight that dies early but overall it is true and so OP's doctor is right there is probably no medical benfit to her of losing more weight, the indices that were high are now normal so her weight loss andhealth measures have achieved what is necessary and she just needs to maintain this, that is often the hardest part. because about 90% of all weight loss is put back on again

It's hard to know what the consultant meant without being there but it sounds as if you are seeing this consultant for familial hypercholesterolaemia but you now have a normal cholesterol.

In which case did his advice just apply in terms of your cholesterol?

• losing more weight won't get it lower
• using Benecol won't get it lower
• Congrats on your acheivement

This is just how I am interpreting the comment.

My colleague is donating a kidney to a family member, all being well. Her BMI is 28.1 but the specialist nurse was unconcerned, as was the nephrologist. They both told her not to creep over 30 if possible but advised that there was no medical need to get down to 25. They explained (separately) what has been written above about the 25-29 category.

I found it interesting because I’ve hung around on the Weight topic for a while and haven’t seen mention of it. There are a few medical people and PTs on here but no one has written about this subject (not that I’ve seen anyway!)

For context, my colleague has no health issues and is active, lots of dog walking and weights in the gym.