Dear Dr. Roach: I have been trying to lose weight, with no results. I have cut back on carbs and sugar. In general, I watch what I eat. I also work out — in the water mostly, because my legs hurt so much. I weigh 286 pounds. I’d love to lose 100 pounds, but I can’t seem to.

When I go to my primary-care doctor, he tells me that I need to lose weight. When I tell him what I have been doing to try to lose weight, he doesn’t believe me.

My husband tells him I’m trying. I think I need more help.


Dear J.S.: I have heard variations of this story so many times from my own patients that I am sure you are trying. However, losing weight is a very difficult thing to do. Once your body has reached a certain weight, it is incredibly hard to get things turned around. Fortunately, it is possible for everyone to lose weight. But you certainly do need some help. So does your primary-care doctor. As an alternative to getting a new one, I think it might be worthwhile to see an expert in weight loss, since this is a field requiring knowledge of new medications, as well as potentially using medications approved for other conditions in an “off label” way to help you lose weight.

One of the first things to look at is the medicines you already take. Most primary-care doctors don’t know how many medications for blood pressure, depression, epilepsy and diabetes (among others) can cause weight gain as a side effect. Sometimes switching medications can help a great deal. Most primary-care doctors are uncomfortable prescribing medications for weight loss, especially after the disaster caused by the combination of dexfenfluramine and phentermine (fen-phen). There are newer and safer medications now.

Metabolic conditions such as Cushing’s disease and hypothyroidism need to be looked for.

Careful evaluation of the diet, using food diaries and enlisting the expertise of a registered dietician nutritionist, is of paramount importance. Since there is so much misinformation, I almost always find people eating unhealthy foods and avoiding healthy ones, to their detriment.

You should be congratulated on finding an exercise that you can do, and be encouraged to do so every day.

Finally, since you are 100 pounds or so overweight, your doctor also should consider the risks and benefits of bariatric surgery, the most effective way (and only reliable one for most) of losing that much weight.

Dr. Roach writes: Several people have asked me about who should not get the shingles vaccine. They are those with immune system problems. This includes people with HIV or AIDS, people on chronic steroids with doses greater than 20 mg per day, people with cancer who are undergoing chemotherapy or radiation, or people with bone marrow cancer such as leukemia. However, the vaccine is safe for people with an egg allergy. As always, your doctor knows you better than I do.

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