Friday, March 16, 2012

Here, Have a Diet Pill.

Let me preface this post by saying I have been through quite a few doctors in my life. Every time I switched insurance or moved or had a bad experience with my primary care doctor, I was out looking for a new one. As I progressed along this weight loss journey, I got pickier about my doctor. I wanted someone who would spend time with me, listen to me, actually look in my eyes when I am speaking, hear what I had to say and address my concerns. While I am not a doctor, I do have a science degree and don't like being talked down to. I don't like being treated like I am stupid, and I don't like a doctor brushing me off, staring at his chart or his watch, and rushing out the door. So I was absolutely thrilled when I found my current doctor about 2 years ago.

I must have weighed in the low 200's when I first went in there for a checkup. I know I weighed in the low 230's when I went to him with the Medifast materials and asked him for his opinion. He did a bunch of tests on me, told me it was a good plan but I'd need to come in for checkups every so often, and gave me the thumbs up. He was thrilled when I came back and all of my blood work had improved and I had lost weight. We sat and talked about nutrition and exercise and he gave me a referral for physical therapy for my knees. When I was 175 pounds he was so happy for me. He told me he was excited to see my success because almost everyone who came in there obese was complaining how they only eat salad and chicken and "couldn't" lose weight. He said they never wanted to take his advice, never actually stuck with any plan long enough to see results, always asked for weight loss surgery or magic diet pills and pretty much always stayed fat. He said it was refreshing to see someone actively taking charge of their health and changing their life. "That is rare," he said. He always seemed interested in what I had to say about the subject. He always looked in my eyes and listened intently. He always smiled.

I searched so long to find a doctor like this. I trust him. He has done right by me in every circumstance when I have been sick. So this week when I went in to see him, I was saddened at his change of attitude.

I went in because I had an infection. He prescribed the antibiotics. But I also wanted to ask him about my regained weight, my struggles to get it back off and lose more, and if he had any suggestions... like maybe a dietitian or more PT or maybe he would find something wrong like a thyroid problem and could fix it. It was obvious I'd regained some weight; last time I saw him I was probably 20 pounds lighter. I am the one who brought it up, after he noted my raised blood pressure (140/90).

"I have had a really hard time losing anymore weight," I said. "You know, I lost over 100 pounds and then I got stuck, and I felt like I couldn't stick to my plan very well. And I've gained some weight back and I keep going up and down and I really want to get losing weight again." We talked about Medifast and that it was a good time to stop and make some changes, but I noticed he wasn't looking at me. He was looking at his chart, seemed disinterested a bit. Suddenly as I was sitting there feeling and looking rather fat and complaining that "I am trying, but I have no energy. I am tired most of the time, and get hungry a lot, and get these cravings and want to eat..." and in a split second it was like I was hovering over myself in the room, seeing a very different scene than I had imagined.

It was a fat woman sitting in the room with her thighs spilling out of her chair, whining about not being able to lose weight, and her doctor was busily noting things in her chart, and he was disconnected, checked out, thinking, "I am so tired of these fat people who won't just DO it..."

I don't know if he was thinking that, but he was definitely different. I almost wondered if he was rolling his eyes as he turned away, because I was just like every other fat person who came in there complaining and staying fat. Well, most likely that was all in my head. But I felt it anyway.

And then, instead of a dietitian or a meal plan or a PT referral or a "how about you get off your ass and burn some calories?", I got a suggestion I didn't expect.

Adipex. Adipex? What the heck was that? I had no idea. He said that if my blood work came back okay, and there was no underlying reason for my weight issue, he would be willing to write me a prescription for Adipex. It is only for short term use, he said, and it basically is an appetite suppressant. Okay, then... I said I would think about it.

I came home and looked it up. Adipex is phentermine. You know, the phentermine that is one half of the Fen-Phen debacle of the 90's. Remember that? I do. Because I took it. Yep, I took Fen-Phen back in 1996 because I weighed a whopping 180 pounds and my doctor (different doctor) told me to take it. I lost 6 pounds on it and had some really awful side effects. Of course, it is the *combination* of phentermine and fenfluramine that causes potentially fatal side effects; the FDA says phentermine alone is "safe." Except when it isn't. Surely the side effects must be rare, I suppose, but when I saw irregular heartbeat and heart palpitations on the list, I decided to opt out. I've had issues with these before that have sent me to both the ER and a cardiologist. It turned out to be remedied by, of all things, avoiding sugar (and stress), but who knows if this drug could be a trigger? And the other, "more common" side effect? Increased blood pressure. Nice.

Now, to my doctor's credit, he did have his nurse call me after I got home to tell me that he would want me to come in regularly for walk-in blood pressure checks if I take this drug, and would not prescribe more after 30 days if it was elevated. But still. Hello? WHY?? Why.

It makes me sad. Even the good doctors are jaded. Here, take a drug, maybe this will give the fattie some hope. Maybe this will work, or at least make her stop whining about being fat. That's how I feel. I feel like doctors just sigh and look at us (us, the fat ones) and think we are kind of pathetic. Maybe they don't, I dunno, but he was so excited when I was actually losing weight and keeping it off that I now feel like a great big disappointment. Just another fat person, staying fat.

I won't be staying fat, but I won't be taking Adipex either.


Forty Pound Sack said...

I'm not sure what your doctor was thinking, but maybe you should just ask him. You never know what happens outside the office. Maybe he was disconnected because he has a sick child or is going through a divorce or one of a million other things. If it really bothers you, you can always tell him you don't feel comfortable with the side effects of Adipex and could he write you a referral to a nutritionist. Don't take it personally, Lyn.

Theresa said...

I really hope you doctor was just having an off day..... I know I've been disappointed in my doc on occasion. Maybe he thought that is the a ensue you were looking at? "I've tried everything....." he might have thought you were ready for a boost like this. If you had asked for those options he likely would have said yes, let's try it. I'm glad you're not going to take that drug. Allow yourself to just enjoy your life for a day with no strings, guilt, fears or judgement. You deserve a holiday. :)

Jane Cartelli said...

Good for you. You don't need it. Remember this: It is not about staying on the balance beam no matter what. It is about picking yourself up off the mat and getting back on the beam no matter what. You can get back to it. Keep peeling away the layers of the onion, Lynn. Hang in there and do not trade yourself in for someone else's model of you.

Anonymous said...

just thoughts here. I wonder if you are having troubles staying on a plan and having cravings because of the combination of a low calorie diet which pushed you into starvation mode, stress and not addressing some of the issues that cause you to want to zone out? When you were actively losing, you wrote alot about your emotions and your insights regading those were really great. You were practicing self care. When you stop doing those things is when things get slippery, I think, from being an observer. Something else to think about is that all those fat cells are STILL THERE!! They are screaming 24//7 to be FED! It is much harder to lose once you have been obese and much easier to gain. That is why the self care is sooo important. The second I think this is a REWARD, or its too hard, etc. I know im in a slide. Feeling the feelings and coming out the other side I think is really the only way to lose weight and keep it off. The lifestyle change has to be emotional first. ACK! Easier said than done, but what is the alternative?? The only way out is THROUGH.

Marilyn said...

Forty Pound Sack makes a very good point: your lack of a sensed connection this time with your doctor could just be about HIM and have NOTHING to do with YOU! I've had to change doctors and dentists who started out giving me excellent service but got waylaid by insurance problems, taking on too many new patients, personal breakdowns, etc. And it's discombobulating, especially when you've come to rely on them treating your right - but it happens, and a lot more frequently than you might think!

That said, keep the faith, Lyn! You've accomplished so much already and just because you can't see the path clearly from here doesn't mean that it doesn't exist or that you'll NEVER find it! Adipex doesn't sound like your answer (or MY answer, for that matter!) but your doctor is probably having trouble coming to terms with HIS OWN limitations and, lacking anything else new to offer you, is trying to inspire you with the latest that Big Pharma has. (plus there may be some kind of a "bonus" in it for the doc to recommend it!? Some of my doctors sure tried that on me in the past!!) Stay the course and you will find what you need... it's only when we stop searching and throw in the towel that we fail!

Anonymous said...

Glad to hear that you are prioritizing health over losing weight at any cost. If you're having blood pressure problems, phentermine doesn't sound like a good idea (and even if you weren't... at the end of those 30 days you'd be on your own again... so why not get there doing things you know you can keep up?). I know you've been struggling lately, but there must be a better way. Stay the course with stuff that you know is good for you, not pills of dubious effect.

Neesha said...

A lot of my graduate research focuses on the doctor-patient relationship and obesity (surprise, surprise, I used to be obese so it's particularly interesting to me). Your experience sounds very familiar...and sad. But what if you knew that doctors get little to NO obesity training? That research shows that doctors do not feel they are equipped by their training to deal with obesity? That it is really the domain of a nutritionist or a counselor/psychologist/psychiatrist? If you want to read the research, I will send you several articles that back this up. Doctors are frustrated because patients come in very clearly needing to lose weight...but they don't actually know what to do besides prescribe diet, exercise, and drugs.

PaulaMP said...

I'm glad you already decided no. I have a good friend who took Fen Phen, she started out around 130 and got down to 110 BUT she now has a leaky heart valve when before it was perfect. I don't trust any of these diet pills.

Anna Down Under said...

Isn't that something, so it IS the same drug! My doctor told me Phentermine had been banned in all countries but Australia and New Zealand, but apparently that's not true if he offered it to you.

My doctor plans to keep me on it for 12 weeks, and I go back next week to have the dosage increased as she started me at the lowest one. I'm hoping it gives me the kickstart I need, and that I can continue on once I come off the drug, because I don't need it to become just one more thing I fail at.

And I hear you about doctors - I often feel that way. I didn't with this one, she was very kind and sympathised with me when I said I'd already tried everything else. That's why she suggested surgery. I don't know that I'd do that even if I could afford the $18,000 it would cost me, so I decided to try the drug. But I understand why you didn't.

Tammy said...

I do not advocate diet pills or weight loss surgery any more than I think the rest of you and Lyn do either. HOWEVER, why is it okay to prescribe drugs for other health issues ie. high blood pressure, cholesterol, etc. and we don't think anything about that? But anyone mention an appetite suppressant and and we look at them like they're monsters? If we could control our weight we wouldn't have to take the majority of meds that are out there. There are times I think we've got it backwards. Yes we must make lifestyle changes but is it wrong to have help doing it? I don't necessarily think so all the time. Just a thought!

Anonymous said...

I suspect that what you sensed in that office, and described so beautifully, is exactly what was going on. Trust your own radar.

If you remember, in a recent comment on this blog, I mentioned getting a lecture from a doctor about how easy it is to ignore diabetes and just bother about it.

He hadn't asked me one question about what I was or was not doing. Not one. He took one look at me, a 210 pound woman with diabetic complications, and assumed I hadn't done any of the things I had, indeed, done.

He would not have treated me like that if I sat there with the same complications, but weighting 150 pounds. I would have been told that doctor's can't predict who will get which complications. That even with good control, complications happen.

I know that, because I had that second response twice when I weighed 175 two years ago...not even 150. It seems that my perceived IQ goes down as my weight goes up, too.

Uh-hmmm. Listen to brakes squealing as I bring rant to a premature halt.

Hugs, Lyn.

We will do this thing.


Anonymous said...

Good for you for not considering the pills.
You have to remember that your doctor is only a human. Maybe if you asked for the nurtitionist, he would recommend it. And the PT too.
Working with weight issues is very difficult for doctors. Not many have enough education for that. it is frustrating with not enough education and experience.
I hope you find your way. You are a strong woman.

Anonymous said...

What is it that you want? I truly do not mean this to be disrespectful, nor do I think you ought to take the drug. This isn't meant to be rude or condescending or obnoxious. It is offered with respect and support for clarity, to get to the heart of the issue. No excuses, no disclaimers, no explanations, no 'just because', no alibis, no rationalizations. Just complete honesty.

Ask yourself 'what is it that I want, and what am I willing to do to achieve that?'

Diandra said...

Maybe your doctor had a tough day. Maybe he is getting paid for prescribing this drug. It is hard to tell from over here.

I would strongly advise against taking any diet pills, mostly because we learn nothing from it. The stuff being dangerous would be another good reason.

Go see him again. Wait what happens. Maybe he is indeed worn out and it is time to find a new doctor. Or maybe it was just a bad day, and next time his behavior will be better once more.

Diandra said...

Another thing I just read... some of the problems you describe... appetite, lack of energy and trouble keeping the weight of... are indicators of a pre-diabetic state, so with your diabetes tests being borderline high, you might even want to take better care of this issue. Normally I would not say that, but it is possible that you might, for example, have to monitor your fruit intake.

Anonymous said...

Deja Vu. I had almost this same scenario play out at a doctor's office once. I had seen her several times but one day she said, out of the blue, "If you don't lose weight, I'm putting you on a diet pill." I was beyond floored. We had never discussed anything weight-related before and I was down 80 pounds from my all time high(although she didn't know this because she never brought the subject up). It's exasperating to say the least. I am pulling for you. I know you will figure this out. It's your journey and only you can find your way.

Jane Cartelli said...

I really think DebWillbefree's comment:
It seems that my perceived IQ goes down as my weight goes up. . . ."
is true. People treat me differently now that I have lost weight, as if IQ points replaced pounds.

timothy said...

sadly regaining is the norm (but it doesn not have to be!) and many drs dont even try to get patients to lose before giving them horrible meds with awful side effects. i say GET mad and channel that energy into motivation to keep going. no one can do it but you and there is no magic pill. do one day and one pound at a time. you'll get there darlin! xoxoxo

Anonymous said...

It's kind of like the alcoholic thing with doctors. After so many tries, the only one responsible or can make a change is the patient himself. What do you want your doctor to say? "Oh my yes, you have a health issue and we can mask it with a pill, but look out for side effects." Basically this is what he said, as his previous tries with you, in his opinion, haven't worked. Isn't this what you feared while waiting for your test results? A health issue that couldn't be fixed? Now there is no health issue except the food addiction and your doctor can't fix that for you. I'm sure he wishes he could fix it for smokers, drug addicts, alcoholics, food addicts and whatever the issue may be, but he's just a doctor trying to do what you want him to do--fix a health issue that doesn't exist but in your mind. He only has so many options. A dietician and counselor also have only so many options and complience is key to success there, as well.

Anonymous said...

I believe, sadly, most doctors today are totally unhelpful in any way. We keep going to them thinking they are going to help. They have nothing. They have spent 8 years learning really complicated stuff but can't use basic common sense.

I have been on Phentermine. I did actually like it and I did lose weight. But, you hit the same problem as always. The plateau. I learned, I didn't need phentermine, because I had the discipline that phentermine helps with. So I didn't need it. I needed something that would help with the plateau.

I remember going to a new OBGYN. Before we did anything she wanted to know about my weight. IMHO totally irrelevant. Which was a decent 190 at the time. I told her about losing to 164 and then hitting the plateau and gaining if I ate anything normal.

She rejected that entire story. She told me I had to exercise hard. I told her that was not a reasonable option for me. Unlike her.. my work hours with commute was from about 7 am to 7 pm. Unlike her, I couldn't mosey on in at 10 am and then scoot out at 4.

She rejected that and said, if I really wanted it, I would find time. BULL! I want it more than anyone. That is utter blame the victim. She had nothing at all to offer me. When I told her my problem.. she ignored it. She had no solution for the plateau, so it was just easier to put it off on me. I suspect strongly that if I had done it, it would not have made any difference at all and likely would have just ended up with a hurt leg / knee etc.

I see so many similar stories. I would actually like to start an advocacy group to send the message to the medical community that they can't hold themselves out as "experts" on health anymore if the don't have any better solutions than anyone else. I also think dieters have to take it all into their own hands. Start a diet program for dieters by dieters. Doctors don't know anything... and frankly they don't have anything that really requires an MD.

Amanda said...

This is the best blog entry I've seen recently about weight loss (and diabetes control, and depression management, and being the parent of a sick kid, failure to hit the baseball... in general, about life) in a long time.

It's not a magic bullet, not for any of the conditions he mentions. Nothing is. But give it a read. He's got an excellent point.

lisa~sunshine said...

I have a friend who took the phen fen and now has a metal heart valve.. she is on blood thinners and has to do the lovastin shots in her belly when she has too much vit K.. she struggles with her weight because she can't eat anything high in vit K so that outs a lot of low cal veggie sources.. the whole diet pill/magic pill sounds just horrible so I"m so happy you have opted out of it.

I'm going to agree with Forty Pound sack.. I think it was a off day for him.. we all have him.. I too think you should just say what you think to him.. get it out there.. I can't see why he wouldn't give you a referral to a nutritionist at all but then again I think after all these years of dieting.. you are really your own nutritionist too.. I think you just need to pick a plan and commit.. a plan that looks like it's the best fit for you.. commit and give it time.. and walk
Take care.. I know you will figure something out

Dinahsoar said...

What did you expect Lyn. You basically told him bottom line that your inability to succeed was due to "get(tting) hungry a lot, and get these cravings and want to eat", that you were tired all the time and struggling.

What else could he offer? A new diet plan is going require you to deal with hunger and cravings.

You basically expressed you were at the end of your rope.

Why didn't you just ask for referral to a dietician or a PT if that is what you wanted?

My doctor told me that the reason doctor's offer an 'easy' pill is because most people won't comply with any treatment that requires them to do anything hard...they may for the short term, but not for the long term.

Losing weight, keeping it off is a long term struggle. AND you also have to deal with all the rest of the crap of life too along with it.

I was sure when I gained 20 pounds in ten weeks there was something wrong with me. Nope. I was the problem. I was eating an extra thousand calories a day. It is very easy to do when you don't closely monitor what you are eating.

My son always makes this point about weight--the people who survived the concentration camps were skin and bone. Proof positive that if you don't eat much you won't weigh much.

We who struggle eat too many calories. That's the bottom line. And we are the only ones with the power to limit our food intake.

I know you are discouraged and struggling. But what you don't need now is softness and sympathy. You need to do what you've always done. Pick up where you left off, regroup, and get back on track.

If anyone can do it you can. You are smart, you are strong and you are a survivor.

You want it, and I know you can do it.

And that diet pill is a very bad idea. I'm glad you are smart enough to realize it.

Lyn said...

Don't get me wrong. I am not mad at my doctor or planning to switch doctors (unless he doesn't engage/listen to me at my next appointment or two) because I believe he is a GOOD doctor and I know he CAN be what I need from a doctor. I am more disappointed in the whole scenario that culminated in this experience at the doctor's office. I accept responsibility for my part; I don't expect him to "fix" me but I did expect him to take five minutes and talk to me a little about the weight issue. Maybe, "tell me what you've been eating since you stopped Medifast" or "how much exercise are you doing" or "how much sleep are you getting?" But he didn't even ask. I do hope he was just having an off day, or was exceptionally busy or had other things on his mind. I will keep working through it. And once I have rebuilt me lower body strength with the PT I already have, I will go back to him and ask for a referral for upper body PT for my shoulder pain.

Ellen said...

I've never written you before Lyn but I can't help but respond to your recent posts. I completely sympathize with your disappointment in your doctor, but unfortunately not only are doctors all too human, but they're simply not trained in nutrition and diet beyond the most rudimentary knowledge that we all know and read. They can simply rule out certain conditions (like thyroid) that can contribute to a slow metabolislm. It's good that you've covered these tests. I strongly recommend getting a copy of Joel Hyman's Blood Sugar Solution. I know you're probably sick of reading expert opinions, but there is tremendous common sense and knowledge in this book and approach, and may go a long way in helping you right now. Certainly it will address your problem with cravings. Good luck. Thinkning of you and wishing you the best in your jorney.

Anonymous said...

I totally agree with this comment- "It's kind of like the alcoholic thing with doctors. After so many tries, the only one responsible or can make a change is the patient himself. What do you want your doctor to say? "Oh my yes, you have a health issue and we can mask it with a pill, but look out for side effects." Basically this is what he said, as his previous tries with you, in his opinion, haven't worked. Isn't this what you feared while waiting for your test results? A health issue that couldn't be fixed? Now there is no health issue except the food addiction and your doctor can't fix that for you. I'm sure he wishes he could fix it for smokers, drug addicts, alcoholics, food addicts and whatever the issue may be, but he's just a doctor trying to do what you want him to do--fix a health issue that doesn't exist but in your mind. He only has so many options. A dietician and counselor also have only so many options and complience is key to success there, as well."

Sadly, it's true. You may be frustrated at his perceived disinterest, or condescension, but the fact remains that he has been seeing you for TWO YEARS, he knows you know what to do, you're telling him "Nothing I'm doing is working, I can't lose weight" but he *saw you* lose weight on Medifast, so he knows it's possible- I mean, really, by your own self reporting and by his history with you really his only option left was to give you a pill.

Just do the Whole 30. Please. You have a lot of food addiction problems still going on and that will break them- it is hard to set off triggers when you can't have dairy, sugar, or grains of any kind. You don't have to count calories, you just eat healthy veggies, meat, some nuts, and some fruit, drink lots of water, and re-set your hormones. You probably desperately need it after two years on Medifast, which is full of soy and fake things.

I know you can do this. But it does come down to *you*- not the doctor, not the pills, not even the plan you decide to do. It all comes down to you.

Colleen said...

Lynn, given that your "calories in, calories out" equation is so abnormal, maybe medication is not such a crazy or offensive idea.

Right now I am in a position where I need to eliminate as many risk factors for stroke as I can before I get cleared to start a new medication. The main risk I have is that I am 20-30 lbs. overweight. I told my doctor that I've maintained a 40 lb. loss but struggled with the last 20 despite diet and exercise. He prescribed me topamax as a weight loss aid.

I am going to try it because I see it as a tool like any other. Eating low carb can give you the "carb flu" at first, working out can make you sore at first, medication can have side effects. All of those tools can be modified or their use scaled back if there are negative effects.

Changing diet and exercise changes our physiology; so do medications.

Really the anti weight loss aid argument is not all that dissimilar to the argument against antidepressants. "Just work harder to lose weight/think positive, you don't need a pill to do that!"

Just some food for thought (har har).

Anonymous said...

Maybe he just registered that you were very emotional about this, worn out about it and he wanted you to take a breather with some chemical help. Like giving someone a sleeping pill when they're strung out from not sleeping. You seem to have a lot of good nutrition information and much experience, so I don't think a dietician would hit the nail on the head as quickly as a food addiction counselor or program. It seems emotional to me; I'd want to talk about it with someone new.

Anonymous said...

Wow. That is disappointing, and surprising. I am the one who left the comment yesterday saying I didn't think your doctor would prescribe phentermine because it is a stimulant and can raise blood pressure.

Since your blood pressure is already borderline, this seems not worth the risk. Especially as you have proven you can lose weight without diet pills.

In addition, you said you have had problems with side effects from this drug in the past. Does this doctor know this? What side effects did you have?

For what it's worth, I have tried phentermine and it didn't do much to suppress my appetite. But I know it does help some people. For me, adhering to my calorie budget and making healthy choices comes down to old fashioned will power. It would be nice if there was a magic pill, but I don't think it exists.

Anonymous said...


Is there a reason you are not going back on to Medifast 5-1? If you were successful it makes sense! It's hard at first but that surge of energy and confidence you get when you lose the weight could do wonders. Then you could start your transition again once you get back down. I just recently started reading your blog so I'm not sure when you started Medifast or transition. I wish you the best of luck....hang in there!!!

Lyn said...


I am not anti-weightloss-drug, but I think this one was a bad idea given my issues. I have heard good things about Topamax but haven't researched it myself. Actually I think one of the specialists I see mentioned it for migraines.

Colleen said...

Lynn, it might be a good option for you to look into, given that it is used to both prevent migraines and promote weight loss.

Here is an article describing a double blind study investigating topamax for binge eating disorder specifically:

I will let you know how it works out for me :).

Anonymous said...

I took Topomax for many years (not for weight loss) and I remained morbidly obese and continued to binge eat. It never did anything for me but maybe you will have better results. I did finally lose all my weight and have been maintaining for a few years.

From what I've read the new obesity drug Qnexa is made up of a combination of Phentermine and Topomax.