Questions for a dopey doctor

Especially an endocrinologist

Mrs Cad was skinny until her first pregnancy (with her first husband). After that, she steadily put on weight and was shall we say Rubanesque when we met.

During her two pregnancies with our children, she lost weight drastically. In fact, both times she was 50 lbs LIGHTER when 9 months pregnant than when she started gestating. Despite eating healthfully and exercising, the weight was back within 6 months.

Over 8 years, her weight got to 300 lbs. She went to weight watchers and lost 50 and has been there ever since. That’s over a year now. We started an exercise program (5 days a week/1 hour a day) three months ago - I’ve lost 20 pounds and she has lost nothing.

We’ve heard all about plateaus and eating healthy and “it takes time” but something is seriously wrong. I know its hormonal - just look at her history. Her endocrinologist at Kaiser says the problem is she is not on the Kaiser food plan and that is why she is not losing weight. Of course that ignores the fact that the pounds fly off when she is knocked up or that exercise has no impact on her weight loss. They did do some test and came up with mild hypothyroid and she has been on low doses of levothyroid for a year with no weight impact. She is 43 and has not hit menopause. I half jokingly tell her she should go on the pill to lose weight.

Emperically, I know it’s hormonal but the HMO doesn’t want to listen. Have you heard of this in your experience? Is there a test she can request that an HMO normally would not do? Is there a doctor in Los Angeles (not necessarily Kaiser) that specializes in this sort of problem? How can we get someone at Kaiser to listen to her and not go “by the book”?

Since the OP is requesting personal experiences, I think this is better suited for IMHO.

General Questions Moderator

IANAD, but I do endocrinology/diabetes research. It honestly doesn’t sound hormonal to me. Did she have good prenatal care with your kids? The weight loss might have been due to gestational diabetes, but good prenatal care should of caught that. Also, GD doesn’t explain the subsequent weight gain. I would actually focus more on her diet/exercise plan. Losing weight (even excess weight) is harder for women than for men, because women have lower lean muscle mass (= less calorie burning cells). What makes you lose 20 lbs might not budge her. See if she’s willing to do weight-lifting to build her muscle mass. Finally, there’s an adage among the doctors/PhDs here: “As long as it took to gain it, it will take as long to lose it.” Basically, if the weight has crept up over the years, it will take as many years of careful diet and exercise to bring it back down. Your body really works against the weight loss.

Good Luck!

If not hormonal, then how does a woman weigh 50 pound lighter when 9 mos pregnant? How come a 1800 cal/day diet with 1hr/day 5dys/wk workouts not impact her weight? She has been working out a few months, so it’s not new

Do you monitor her diet? Does she work a full time job? It may be that she has “cravings” while you are not around and doesn’t want to admit it to your nor the doctor.

I know that’s not what you want to hear, but I dealt with a bulimic fiancee for a year. She’d go to the store, pound a pint of Ben n’ Jerry’s ice cream (or two) and then eat normally around me. It took me catching her at the store, eating it in the car, for me to find out.

No experience with endocrinologists. Lots of experience with doctors not listening.

You may have to go outside Kaiser and get a second opinion out of network. If you know anyone who works in health care, start networking and ask for referrals.
I also know, anecdotally, someone who had good luck with this kind of thing by going outside traditional medicine–I’m skeptical, but it worked for her (nutritionist & naturopath, I think).

The doctors may be right about what’s happening/not happening, but it is frustrating when they seem not to be paying attention.

It may not be hormonal, but empirically I know something is wrong that just cannot be answered by dieting or lack thereof.

Lets say she weight 250 lbs when getting pregnant. About to go into labor she’s at 200 lbs - and that’s with the baby still inside. 6 months to a year later she’s back at 250 lbs.
How is that what she eats?

For a year she has been journaling her food and she has no reason to lie about it and she is always within her WW points. On top of this, for 3 months she has been moderately working out. No weight loss and even a slight gain.
How is that what she eats?

I may not know what it is, but I do know it’s not an issue of “take the fork out of your mouth and start jogging”, but that’s the only answer we get.

Many women eat very little when they’re pregnant due to morning sickness and gain weight afterward because they get their appetites back. How were her pregnancies? Was she vomiting a lot or did she have the trots? If so, that could explain the weight loss - many women lose weight during pregnancy, particularly during the first part (though, admittedly, I’ve never heard of a 50-pound weight loss throughout) only to have it come right back with extra once they’ve had the baby.

Additionally, it is possible that she’s not being 100% truthful about what food she’s eating. This is something I’m working on right now. I’ve got no reason to lie about how much or what I eat, either, but as a moderately overweight person, I feel guilty and conspicuous when I eat anything other than a carrot stick even around my husband. It’s completely self imposed and I’ve managed to lose 25 pounds by being extremely disciplined, but I do find myself slipping or not counting things that should be counted, like the little bites of food I take when I cook to taste it. Or the handful of chocolate chips I grab when I’m baking for an event. If your wife is self-conscious enough, she could be eating on the sly. It sounds stupid, but it’s certainly possible.

That said, I agree that you should seek alternative opinions. Weight loss is much, much more than just “eat less, exercise more.” Well, for me it isn’t but for your wife it might well be.

I think the interesting part about this thread is that I’m getting the same feedback here that I get from the doctors - a complete dismissal of the symptoms.
All y’all are convinced she’s cheating on the diet. Y’all are dimissing the weight loss during dieting. No vomiting. Lots of corn and tomatoes with the first one and lots of Hostess Baseballs during the second with the same results. No binge eating afterwards yet a 50 lbs weight gain within a year.

Are there no alternative explanations possible? The only way this could be happening is that I was misreading the scale and she’s a liar about what she eats?

Well, we don’t really Have a clue. You do need to talk to a doctor about it. I hope you find a better one.

On pregnancy and weight gain.

I’m a 140(ish) lb woman. When I was pregnant I gained something like 45 lbs. (High, right?). I gave birth, went home with a seven pound baby and six pounds of extra weight - I went HOME in my pre-pregnancy jeans. Within a few weeks of breastfeeding, I was thinner than I’d been in a decade (with HUGE tatas). Within weeks after breastfeeding, I was back to where I was.

I have no hormonal issues. No thyroid issues. And its a pain in the back end to drop ten pounds like it is for most women - much less 50.

Saint Cad, are you guys seeing a medical endocrinologist or a reproductive endocrinologist (a subspecialty of Ob/Gyn)? My wife is a reproductive endocrinologist who deals with a lot of weight gain/loss issues. We’re in Cincinnati, so probably not all that helpful to you, but you might ask for a referral to an REI (reproductive endocrinologist and infertility) specialist near you. Even though fertility is apparently not a concern for you, an REI doc might approach the problem from a different perspective than a medical endocrinologist. Since your wife has lost weight during pregnancy, maybe an REI will have some other insight.

I don’t want to run afoul of the rules against medical advice, so I’ll just pass on some of the general stuff my wife said when I showed your OP to her. She says that one factor may be the decrease in metabolism that occurs with aging – and 43 is likely when this is occuring. Fitness that would cause weight loss in your 20s won’t necessarily work as well in your 40s. I would presume the same is true of the difference between men and women – the exercise plan that is working for you might not be effective for her. Have you seen someone about designing an exercise plan that is appropriate for each of you? The fact that your wife lost weight during pregnancy did not ring any obvious bells with my wife. This is not to say that there is no hormonal component, just that the description provided in your OP did not cause my wife to go, “Oh, yeah, that’s a sign of X”. My wife said she might run a test for Cushing’s disease if your wife has high blood pressure, but she didn’t seem to think there was a very high chance that would turn up anything.

I hope I’ve successfully trod the line between offering medical advice and being completely unhelpful. Best of luck to you and your wife. If you lived in Cincy, I could recommend a doctor who is brilliant, personable, funny, kind, sweet, beautiful…

Physicians don’t know enough about weight gain/loss, much less folks on a message board. I have been seeing physicians for years about my weight, including two great reproductive endocrinologists. Just recently, my endocrinologist realized I have a lipodystrophy–something no one else realized. It is rare, apparently, but still surprising to me that no one else noticed, given I have always had the signs (the lower arms and legs of a marathoner, chubby everywhere else). Best of luck to your wife, but don’t expect too much from medical science. Bodies are weird.

Hey, I saw a RE in Cincy years ago–Jennifer was her first name. If that rings a bell, PM me. :slight_smile:

Nope. I’ll ask the missus, though. I think right now, my wife is the only female REI in the area, but I’m not sure. I’ll ask her if she knows a Jennifer.

Hey, I said she might be - I didn’t say she was. I simply noted that it was possible she wasn’t being truthful. People don’t need a “good” reason to fudge on certain things - sometimes they just do. I provided you with my reasons. Your wife could be wholly truthful about her intake for all I know. Anyway, did you read this part of my post?

I’m not dismissing your wife’s symptoms at all - I also noted that a 50-pound weight loss during a pregnancy is A LOT of weight. I don’t know your wife - you do. Regardless of whether she’s eating more than stated or not, she should see someone other than who she’s seeing now. Even if all she needs is a different approach, she needs to find someone to help her if she’s unhappy with her current state.

It’s really hard to get good advice on an anonymous messageboard, especially one with as many cynics as this one. Either way, good luck to you and your wife.

This is an article about pregnancy and the thyroid. There seems to be more info out there if you want to google it.

It suggests that some problems that come with hypothyroidism can be alleviated during pregnancy, but doesn’t mention weight loss specifically.

That just jumped out at me, because my wife was having difficulty taking weight off even though she was running 5-6 times a week, and I mean RUNNING. . .sprints, hills, distance, speed.

When they found out – and this is all over the course of a couple years – she had thyroid problems, and she got her amount of synthroid (or whatever) correct, she’s been able to take weight off like she should be able to (and also been less tired, and all that other stuff).

So, I don’t know, but stubborn weight, and changes during pregnancy just smells like thyroid issues, doesn’t it?

My thoughts exactly and they found very slight hypothyroidism (or whatever it’s called) and put her on the lowest dosage of levthyrod which they recently uped to the second lowest dosage.

I love the idea of a reproductive endocrinologist. She’s been having this problem since her late 20’s and it all started with her first pregnancy so maybe they could give us some direction.