When to see a doctor

Not everyone needs to see a doctor in order to lose weight, but some people might want to consider this route for two reasons. The first is to get professional guidance. If you haven't been able to lose weight on your own by dieting and exercising, your doctor may be able to help by making specific recommendations. The second reason to see a doctor is to be evaluated for health complications that might be associated with your excess weight. It's important to have a medical evaluation if you are over 40, or if you are younger and have any health problems. Such an assessment can provide you with added motivation to lose weight — to help lower your blood pressure; to reduce your risk of developing heart disease, diabetes, or cancer; or to live a longer, healthier life.

Chances are, your primary care physician can perform this evaluation. Depending on what the doctor finds, he or she may refer you to a nutritionist or dietitian to assess your eating habits, or to a therapist to address any psychological issues that may be interfering with your ability to attain a healthy weight. If you have obesity — or if you are overweight and have obesity-related conditions — your doctor may refer you to a medical group that specializes in weight loss or to a hospital-based weight-loss center.

Medical evaluation for weight loss

Whether you start by seeing your own doctor or a weight-loss specialist, the evaluation will begin with your complete medical history. The doctor will ask you how long you've been overweight. This is an important question because it narrows down the possible causes of your excess weight as well as the effective treatments. If you have been overweight since childhood, you probably have a strong genetic predisposition to be overweight. A lifelong weight problem is usually harder to treat without drugs or surgery than one that developed in adulthood. On the other hand, if you've gained weight recently, a program of dieting, exercise, and behavior modification may be enough to help you lose weight and keep it off.

The doctor will also want to know what you have done on your own to lose weight. What diets have you tried? Did you lose weight on any of these plans? How long did you keep off the weight, and how much did you regain? This information can help your doctor determine strategies that might be more successful.

In addition to your personal history, the doctor will ask you about your family history. Are your biological parents overweight? Does obesity run in at least part of your family? If so, the chances are that genetics plays a large part in your problem. Do you have a family history of disorders that can be caused by obesity, such as type 2 diabetes, high blood pressure, or breast cancer? If so, you, too, are at high risk for these problems. In particular, you will be at higher risk for such conditions than if you were overweight but had no family history of them. Such information can also suggest whether you might need aggressive weight-loss treatments, such as medication or surgery.

As part of your medical history, the doctor will need to know the names of all the medications you have been taking. Several drugs can cause weight gain, increase appetite, or interfere with weight-loss efforts. If your weight gain came on soon after you began taking one of these drugs, it may be the cause of your problem. Depending on your condition, you may not be able to stop taking the drug. But if you can substitute or add another drug, you might be able to lose the extra weight.

Other important information concerns symptoms, both physical and emotional. Do you have any symptoms of obesity-related conditions such as heart disease, stroke, hypertension, or type 2 diabetes? Do you have mood swings or other symptoms of depression, such as insomnia? If so, you may need additional tests to evaluate and diagnose these problems. If you appear to have depression, anxiety, or an eating disorder, your doctor may refer you to a psychologist or psychiatrist.

Screening tests

After the medical history, you will need a physical examination and certain screening tests. Part of the physical exam is to measure your height and weight accurately in order to determine your BMI, which indicates the severity of your weight problem. The doctor may also measure the circumference of your waist and hips (see "What's your body shape?").

Even if you are only mildly overweight, abdominal obesity increases your risk for type 2 diabetes, heart disease, and stroke. Excess fat around the abdomen helps make the body resistant to insulin, the hormone that enables blood sugar to enter the cells where it can be used as fuel. When insulin doesn't act effectively, the pancreas secretes more of it; excess insulin increases blood pressure and triglycerides and lowers the level of HDL ("good") cholesterol.

The doctor will also take your blood pressure to check for hypertension and will draw blood to check for other problems, such as high levels of cholesterol, triglycerides, and glucose. High levels of LDL ("bad") cholesterol and triglycerides are risk factors for heart disease. An abnormally high level of glucose is a sign of type 2 diabetes. Finally, if the doctor suspects a hormonal abnormality, such as hypothyroidism or adrenal gland hyperactivity, he or she will test your levels of thyroid-stimulating hormone and cortisol.

Designing a treatment program

If you have a health problem related to being overweight, the doctor will recommend a treatment for that condition. You may need medication for high blood pressure, high cholesterol, type 2 diabetes, or other complications. If you have depression, your doctor may recommend an antidepressant, psychotherapy, or both before you start a weight-loss program. But treating the health problems associated with overweight cannot help you lose weight. You will need a weight-loss plan not only to reduce your weight, but also to aid in the treatment of any obesity-related problems.

The plan that your doctor recommends will depend on several factors, including your BMI, whether you have obesity-related health problems, and the degree of your past success in losing weight. If you are mildly overweight and in relatively good health, your doctor may be able to provide guidance on diet and exercise — having you come in for regular office visits to monitor your progress and helping you overcome the common weight-loss plateaus. Or your doctor may recommend weight-loss programs offered locally by self-help organizations, companies, registered dietitians, or hospitals. You can find a registered dietitian in your area by calling the American Dietetic Association (see "Resources").

But in some cases — for example, if you are extremely overweight or if you have obesity-related health problems and haven't been able to control your weight on your own — a weight-loss program that involves dieting, exercise, and social support may not be enough. In such cases, your doctor will probably refer you to a weight-disorders specialist or to a hospital-based weight-loss program to consider whether one or more of the medical options, such as a very low-calorie diet, weight-loss medication, or bariatric surgery (see "Weight-loss surgery"), might be appropriate for you.

In discussing the various weight-loss options, your doctor may ask you about your goals and expectations: How much weight do you expect to lose? How much of an improvement in health and emotional well-being do you expect this weight loss to provide? The purpose of these questions is to find out how realistic your expectations are. Don't be surprised or get discouraged if your doctor tells you to set more modest goals. Your doctor will help you set realistic goals about how much weight you need to lose, how much you can expect to lose, and how much you can expect to keep off in the long run — that is, for a year or more.

Such considerations are important because many overweight people begin a weight-loss program expecting to shed many more pounds than will be possible for them. In one study of women with obesity in a weight-loss program, the women said that they wanted to reduce their weight by 32%. That's significantly more than even the best weight-loss programs achieve with weight-loss drugs and diets. Most people who go through weight-loss programs lose 5%–10% of their initial weight. Moreover, the National Institutes of Health (NIH) now defines a successful weight-loss effort as one in which a person loses — and keeps off — 10% or more of his or her initial weight.

Review Date: 2006-09-01

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