(The Question They Never Ask That We Can’t Answer)

I was 57 years old and retired before a medical professional said to me “So, what’s the deal? Why are you overweight?” I was taken aback by the question, not because I felt insulted, but simply because no medical professional or mental health professional had ever asked me that question before. Later on, it occurred to me how odd that was because I had been struggling with obesity since my teens. I’ve sat in doctor’s offices countless times, yet no medical professional had ever asked me that before. I hastily popped off a quick answer without thinking about it too hard, which turned out to be the most honest answer I’ve ever given about my weight. I even told this medical professional what I needed to do to lose the weight. I’m sure we spoke more about it, but I don’t remember much about the rest of the conversation, even though I have thought about that conversation many times since then.

I should have been excited that I had finally voiced aloud how I had arrived at being obese but I was more intrigued by the fact that I had found someone who wasn’t afraid to speak the truth to me. She wasn’t even a doctor. She was a nurse practitioner that I was seeing for the first and, unfortunately, the last time as we were moving very far away. This made me sad and frustrated because had I met her before, this woman was someone I would have wanted as part of my medical care team. And to this day, I never, forgot that brief conversation. Which brings me to this place I am at two plus years later.

We had moved to another state and I went about the process of setting up primary care doctors and the specialists I needed. I chose a doctor, who, ironically, turned out to have similar weight and build to myself. I did not realize this until I was sitting in front of her. She did not ask me why I was overweight. She referred me to an endocrinologist for my chronic thyroid issues (no that isn’t why I’m overweight. It’s probably why I’m not MORE overweight than I am). The endocrinologist didn’t ask me why I was overweight, either. I’m beginning to think that is going to be one criteria I judge medical professionals by.

You may be thinking “She must not be that overweight if they aren’t mentioning it.” Wrong. At various doctor’s visits I’ve weighed anywhere from 202 to 245 pounds. And I was very happy to be at 202 because I actually looked thin for me.

The answer to why I am overweight has two parts. The scientific part, and the behavioral part. From a scientific perspective, I am overweight because I had been consuming more calories over time than my body was burning. It’s really that simple. The behavioral part is a bit more complicated, because I consume healthy food. For me, it’s not what I eat, it is how much I eat. I was consuming far more food than I needed. It was so easy to rationalize that this was okay because, hey, I was eating healthy. I wasn’t gorging on junk food or snack food. Did I ever notice I was consuming large platefuls? Of course I did, shrugged it off because I was deluding myself it was okay because I was eating ‘healthy’ things. I would look at other people’s plates and notice that mine had significantly more food on it than theirs. And, I ignored this comparison because I was eating healthy… supposedly.

My recent attempt to lose weight evolved from minor medical issues. One medical issue was a fasting blood glucose level that was a point over the high end of the range. Ironically, my endocrinologist was not even remotely worried about that number. The other minor medical issue I had was knee pain that I had been experiencing after spending a few months helping my husband clear brush and trees on land that was basically a hillside.

It had gotten to the point where I could only walk for 15 minutes before I had to sit and rest my knee because after 15 minutes of walking, it was so painful that I wound up limping. A shopping trip to Wal-Mart Supercenter had me leaning heavily on the shopping cart by the time I got to the checkout line. My primary doctor diagnosed an inflamed bursa sac and prescribed oral steroids. That medication didn’t help at all. When I told her I was still in pain, she referred me to a sports medicine orthopedic doctor.

This doctor took x-rays, showed me that I still had “tread” on the tires (his analogy) and prescribed a steroid shot in my knee and physical therapy. The shot helped for a few days. The exercises helped more, and the physical therapist had some theories as to why I was experiencing pain and prescribed exercises to help. Luckily I could do all the PT at home and really didn’t need more PT visits.

A few weeks after my physical therapy visit, I went for my follow up appointment with the orthopedic doctor, and told him I was better but still had pain. He told me the only non-surgical option left was some sort of gel injections to cushion the joint. I was told there would be several and insurance approval was needed. I was not thrilled with that idea and decided that would be a non-surgical last resort. I then asked the most obvious question: would losing weight help my knee? Let’s face it. You and I already know the answer is ‘of course’ but I asked anyway, to confirm what I suspected. The second I asked, my doctor perked right up and said “definitely” and informed me that losing one pound of weight would relieve four pounds of pressure on my knees. That seemed pretty significant to me.

So, I’m wondering, why did I have to be the one to bring this up and why didn’t he bring it up at my initial visit? If that was a viable option to helping to relieve my knee pain, shouldn’t it have been presented to me?

Given the options, I decided that it was time to try again to lose the excess weight. And as I write this, I’m still stymied that I was the one who had to make that determination for my health. None of the three medical professionals I have engaged felt the need to discuss this with me.

Oh, before I forget, there was one other tiny (huge) motivator for trying again. I saw myself in a photograph. In the photo, I’m standing next to people and there is no mistaking how embarrassing large my body is compared to the others.

Just because your doctor has never told you to lose weight doesn’t mean that it isn’t critical that you do it.