Has a doctor told you to lose weight?
The first time a doctor told me to lose weight, I was an underweight teenage athlete. Underweight for me anyway.
I had stage 4 osteoarthritis and a post-op follow-up appointment at Alta Orthopedics. A follow-up from what? 3 ACL-related surgeries in the summer of 2006, beginning May 25th and extending through an ICU stay the month of June. During my Cottage Hospital "retreat," I enjoyed intravenous ciprofloxacin & opiates while frustrating the phlebotomists daily. I experienced significant weight loss from my muscular frame. This was not a 'good' kind of weight loss. It was weight loss resulting from an infection increasing my metabolism, repulsive hospital food, and my bedridden 'joie de vivre' waning as the pseudomonas aeruginosa thrived.
Despite the summer of 2006 events, I was happy to be independently crutching my way back into the Pueblo-inspired orthopedic office, with my Razr cell phone falling out of my rear pocket.
Upon arriving at this follow-up ortho appointment, a thoughtful technician approached the front desk to open the door for me. To the right of the front desk was their in-house physical therapy office. However, the technician escorted me to a room on the left before I could sit down. Inside this room was an x-ray machine, height measure, and a scale. New data was collected for my chart. While standing for an X-ray, I made a joke about needing to pay models to pose for pictures. The technician gave me a sympathetic laugh and updated my chart. I weighed less than I had in years, excluding my recent ICU retreat. In fact, I had gained some weight since my ICU weigh-out. After the technician updated my chart, a new doctor came out to talk to me.
This doctor was not my surgeon. He did not know me. He was an older man with a delicate frame, holding my chart of numbers in his hands. He barely looked at me and made no small talk. The doctor stared down at the chart he was speaking to while describing how bad my osteoarthritis was. "Stage 4. Yeah, I know," I thought to myself. He continued to look down at my chart while telling me that my weight gain would wear out my arthritic knee. If I continued on this path (of weight gain), then I'd need a knee replacement 50 years before my peers.
Having existed my entire life as an elite child athlete with enough density to comfortably sit on the bottom of a pool, I had never 'looked' my weight. I have always been much heavier than I look, and had grown accustomed to the shock on others' faces when the number on the scale was unmatched by my physical appearance. However, this doctor continued to tell me that for my 62.5 inches of height (which was not much shorter than his height), my BMI should be less if I wanted to be able to walk in ten years. The new goal I was given was to use my knee as little as possible. Swimming (without kicking) was the only approved form of exercise at that time, and I’d eventually graduate to using a reclined hamster wheel for exercise. It was predicted that I would “never return to my athlete-artist sports.” For me, this was incomprehensibly demoralizing, black-and-white advice. There was frigid apathy towards my mental health. I wasn't seen as a whole person. I was a 2-dimensional outline on a black and white chart that needed to be narrower.
Worse than what was said was what wasn't. He did not talk about my body composition, %SMM (skeletal muscle mass), %BF (body fat), or explain how muscle weighs more than fat. He did not discuss nutrition or offer safe diet advice. How to achieve his goal of not gaining more weight was not outlined for me. He did not acknowledge that my 'weight gain' on that day was technically still a weight loss from my initial surgery date on May 25th. He did not mention that gaining muscle/strength could support my arthritic joint to reduce wear and tear. According to this particular doctor, any weight gain (even in the form of muscle) would further deteriorate my knee. His message was to use my knee/body as little as possible, while simultaneously being as small as possible.
“Eat less. Do less. Be less.”
Now I know that this is how you slow down your basal metabolic rate to nearly nothing, making it even harder to maintain low bodyweight
For the record, I am very pro-doctors and Western medicine. Sharing my story was important for me to point out that just because someone is a doctor, it does not make them a reputable source for nutrition and/or weight-loss advice. It does not make them a strength and conditioning expert, or a sports psychologist. Non-specializing doctors are not trained to recognize or communicate with patients teetering on a tightrope of disordered eating. They don’t know what they don’t know (unconscious incompetence). In fact, many doctors live with disordered eating habits and give nutrition advice that is outside of their scope of practice. It took me too many years to realize this, and I do not wish my experience on anyone.
If you have experienced the gut-dropping feeling when a doctor tells you to drop weight, without being given you the proper tools to support healthy weight-loss, I hope you know that you are not alone. Your health goal should never solely be to have less gravitational pull on this planet.
Body composition is complex. Nutrition is nuanced. You deserve to have your health viewed holistically.