Should I be skeptical of a doctor prescribing weight loss pills?

September 12, 2015 8:08 PM

My doctor wants to discuss taking weight loss drugs even though I have a normal BMI. Am I right to find this sketchy?

The pertinent details: I'm female and in my early 30s, 5'-1" and 120 pounds. I have a normal BMI and my clothing size is in the 2-6 range. I feel like I'm pretty healthy. I jog about 5 miles 5 times a week and walk quite a bit on top of that. My blood pressure, heart rate, and cholesterol are excellent, I eat pretty well and drink moderately. I don't smoke or take drugs.

I used to be very skinny but over the past year I've been undergoing hormone replacement therapy for an autoimmune disorder that caused early menopause. In high school, I was about 100 lbs, in college more like 110. My weight crept up again to 120 when I started treating my autoimmune disorder, but it seems stable now.

I have to check in pretty often to get my hormone levels tested and my last check-in was over the phone. I mentioned that I was trying to lose that 10lbs that crept up on me and my doctor immediately suggested coming in to talk about weight loss drugs. As soon as I got off the phone, I felt crappy-- like a big fat failure. But the more I thought about it, the more this felt weird to me. Is it normal for a doctor to offer weight loss drugs for someone in my situation? Am I completely out of line for thinking about finding a new doctor?

posted by anonymous to Health & Fitness (25 answers total)

Even when fen/phen was considered a reasonably sensible choice for normal doctors to prescribe, I rarely heard of it being prescribed except to heavily overweight patients by doctors who were specifically consulted for help with bariatric issues.

Which is to say that ANY doctor suggesting you take weight loss drugs should be considered HIGHLY suspect. Even if there were some weird off-label reason to use weight loss drugs for other conditions you're dealing with, the doctor should have explained and -- this is crucial -- gained your express consideration for moving forward with that treatment.
posted by St. Hubbins at 8:16 PM on September 12, 2015 [5 favorites]

Yes, for your height and weight, that is very sketchy. My first suspicion is the doctor has a stake in the pharma company, but in any case, it's very suspect.
posted by atinna at 8:20 PM on September 12, 2015 [2 favorites]

Get a second opinion on the weight loss from a new doctor.
posted by nologo at 8:21 PM on September 12, 2015 [5 favorites]

No, you're right, it seems supremely sketchy for a doctor to suggest this for someone with your height/weight and other health stats (exercise, normal cholesterol, etc). I wouldn't bother getting a second opinion about weight loss but in your position I would seriously consider a new doctor.

My first thought was that he might be selling some high priced weight loss supplements (the kind that squeak by under the FDA's radar since they're "alternative medicine"), but on preview, I could also see this having something to do with ties to big pharma, as atinna mentions.

Or heck, maybe this is plain old fashioned bad medical practice, but whatever the explanation, I would start looking for a new doctor.
posted by litera scripta manet at 8:36 PM on September 12, 2015 [7 favorites]

This is a red flag, but you know your doctor better than we do. If there are other signs that he's sketchy, then I'd say he's almost surely sketchy.

But it doesn't sound like he said "I want to get you on weight loss drugs right away!" He said he wanted to discuss it. If you have never had any other reason to distrust him, then I would go in and say "Hey, you know, I don't understand why you think I should even consider weight loss drugs when my BMI is normal and stable. Can you explain what you're basing that on or if there are reasons why you think I should be concerned enough to do something so drastic?"

It's possible there's some logic or factor you haven't considered. It's possible he has some conflict of interest. It's also possible that he's just an err-on-the-side-of-medicate sort of doctor and you're a stay-off-anything-that-isn't-absolutely-necessary kind of patient. If you're incompatible on that front, then you might consider switching doctors.

Also, obviously if you decide this is probably about a conflict of interest of some sort, that would be a huge red flag that would point towards switching doctors. You can search for your doctor here and find out what they've received from different drug companies.
posted by If only I had a penguin... at 9:11 PM on September 12, 2015 [8 favorites]

I find that really sketchy, especially as being 20 pounds above your high school weight is quite normal as your body fully matures. It's rare to get back to high school skinny again.

I'm like twice your weight and have a bunch of doctors and none have ever said anything about weightloss drugs because, as my own research confirms, big pharma are yet to come up with anything effective and safe.

Maybe he mixed you up with someone else since it was over the phone?
posted by kitten magic at 9:26 PM on September 12, 2015 [2 favorites]

Maybe your doctor assumed you were hinting around that you'd like weight loss drugs, given you mentioned you were trying to drop 10 lbs, and what he said was along the lines of "Well, if you're interested in weight loss drugs, I'm not going to prescribe over the phone, I'll need you to come in" rather than "Let's get you on this right away"?

All of which is to say, I've definitely gone to doctors who seemed to think that an interaction had gone poorly if I didn't walk away with a prescription for something. That wasn't MY cup of tea but I definitely know people who feel that dispensing scrips is a doctor's raison d'etre. If your doctor operates that way he may well have felt you were circumspectly asking for his pharmaceutical help in weight loss and answered accordingly. And it would be drastically irresponsible to prescribe weight loss drugs over the phone, so...
posted by town of cats at 9:43 PM on September 12, 2015 [10 favorites]

And it may ALSO be the case that he's had previous patients on your same HRT who couldn't lose weight no matter what they did and drugs were the only thing that worked. In short I don't think this is *obviously* sketchy as you told the story. But I do agree that it's *possibly* sketchy.
posted by town of cats at 10:12 PM on September 12, 2015 [4 favorites]

If you are curious, you can see what your doctor has accepted from various drug companies at https://projects.propublica.org/docdollars/.
posted by _DB_ at 10:48 PM on September 12, 2015 [6 favorites]

Second options are a thing for a reason.
posted by Cool Papa Bell at 11:19 PM on September 12, 2015

I agree with town of cats the answers so far are being very quick to jump to "sketchy." Specific HRT regimes can make weight loss difficult. I don't think there's any issue with discussing the options, and you don't even know what your doctor is planning to say at this point.

Even when fen/phen was considered a reasonably sensible choice for normal doctors to prescribe, I rarely heard of it being prescribed except to heavily overweight patients by doctors who were specifically consulted for help with bariatric issues.

This was never my experience. YMMV.
posted by DarlingBri at 12:18 AM on September 13, 2015

I felt crappy-- like a big fat failure

no, you are a small totally normal person. pretty much everyone gets a bit heavier as they get older. Partly from carrying around some more fat, but also from gaining muscle mass, which you have no doubt done with all the running. go you!
posted by 5_13_23_42_69_666 at 12:18 AM on September 13, 2015 [1 favorite]

Get a new doctor. Your weight is fine, and you do not want to be told in 5 years that the weight loss drug has dire side effects long term, like the stuff that was prescribed all over in the 80s and 90s and then turned out to be bad. You sound very healthy. Keep up your exercise, maybe cut carbs for a while to lose that ten pounds and do get another doctor. You are in good shape, the doctor is out of line.
posted by mermayd at 4:19 AM on September 13, 2015

I don't think you need to get a new doctor. You could have misunderstood him-- for example, some hormonal imbalances, especially ones that cause premature menopause, can make it very difficult to lose weight. Your doctor might have meant that he could give you some medication (HRT or something like that) to make weight loss easier or possible for you.
posted by gemutlichkeit at 5:47 AM on September 13, 2015 [1 favorite]

The doctor may have been trying to prevent your doing some other, more extreme form of weight loss. Maybe he's worried that if you change your diet radically, for example, it could interfere with your health in other ways. (I don't know about these things, just trying to find an alternative explanation for your doctor's behavior).
posted by amtho at 6:42 AM on September 13, 2015

Yeah, I was thinking something like amtho. You doctor thinks "Hmm, anonymous is talking about weight loss when she really doesn't need to worry about it, but this is a discussion we should really have in person. If I tell her to come in to the office so I can tell her that she doesn't need to lose weight, she won't come in, but if I tell her we can talk about weight loss drugs, she might."

I think you are right to be cautious, but I don't think you need to assume bad intentions until you have had the rest of the discussion.
posted by Rock Steady at 8:03 AM on September 13, 2015

It's entirely possible that the doctor believes you were fishing for weight loss drugs, and he might well want you in the office to talk you out of that line of thinking. I'd reserve judgment until you know where he's actually going with all of this.

Then again, in the heyday of fen-phen, half the girls on my office were on it to lose the five pounds they didn't really need to lose. So the over-accommodating prescriber is definitely a real thing, and if he actually does try to get you on a pill in your situation, I'd consider switching doctors.
posted by Andrhia at 8:09 AM on September 13, 2015 [1 favorite]

You mentioned you wanted to lose weight and your doctor offered a possible way to approach that. That doesn't seem sketchy to me. If he had, out of the blue, pressured you to consider weight loss drugs, that would be an entirely different story.
posted by a strong female character at 8:44 AM on September 13, 2015

If the doctor would really consider giving weight loss drugs to a person with your stats, he's a clown or a charlatan. Run away.
If he said what he said to induce you to come in so he could talk you out of weight loss drugs, he's a gamey moron. Run away and find a doctor that will communicate with you in a straight manner.
posted by txmon at 10:32 AM on September 13, 2015

Uh, weight loss drugs and an autoimmune hormonal disorder? No freaking way.

The next time you go in, you can clarify with him to see what he really meant. But you'd also be completely justified in just getting a new doctor.
posted by barnone at 10:36 AM on September 13, 2015

Came here to say what kitten magic said. If there was a "weight loss drug" that wasn't sketchy, I'd have had it suggested to me hundreds of times by now.

If you feel you must consult a medical professional regarding those ten pounds, you might want to consider an endocrinologist and/or a nutritionist, along with that second GP opinion.
posted by gnomeloaf at 10:45 AM on September 13, 2015 [1 favorite]

Depending on how your doctor phrased it, they might just mean "a new drug regime that doesn't make you gain weight as much as this regime does". For example, a steroid-sparing immunosuppressant regime for your autoimmune disorder, or checking for thyrod problems (since autoimmune disorders often go together), or if you are also diabetic there are diabetic drugs that (safely) help with weight loss.

The idea of anyone prescribing you amphetamines or anything like that is so off the wall that I think it has to be a miscommunication. If they actually do offer you speed then obviously do change doctors, but that would be incredibly weird prescribing (to the point of almost being malpractice). Nobody prescribes those drugs these days.
posted by tinkletown at 3:26 PM on September 13, 2015 [1 favorite]

The only reason I might give him the benefit of the doubt, is there may be something specific that treats weight gain/management that is caused by your specific drug regime you are currently on. If it's associated with weight gain there might be medical ways to mitigate that side effect. I have absolutely zero ideas if such medicine actually exists, but it might be worth at least hearing him out.
posted by whoaali at 5:10 PM on September 13, 2015

Weight loss drugs are BAD NEWS. Do not use them.

You sound like someone who is perfectly healthy. If your tests are good, that means you are a healthy person.

Futhermore, overweight is not unhealthy. (If you are skeptical that this is true, I recommend reading some literature from the Health At Every Size movement. This movement is based on strongly supported, peer-reviewed research which has been showing for decades that demonizing fat and attempting to lose weight through dieting have negative effects on health.)

I would find a new doctor who does not try to prescribe healthy people (such as yourself) bullshit drugs that have been shown to have negative health consequences.
posted by switcheroo at 7:46 AM on September 14, 2015

I'm 5'2" and 233 lbs. My weight is negatively impacting my health in a bunch of ways. I have an even dozen doctors. Not one has ever said anything about weight loss pills. Half of them have told me that if I lose some weight, my X will improve, or if I exercise, my Y will feel better, things along those lines. But it's all been healthy diet and reasonable exercise. Never pills.
posted by The Almighty Mommy Goddess at 9:33 AM on September 14, 2015 [1 favorite]