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Dr. Avoiding Treatment for Obesity - Where to Go Now?
Sep 11, 2001

When I asked my Infectious Disease Dr. for a BIA and inquired about Human Growth Hormone, he referred me to a nutritionist and asked me to seek a psychologist instead. Im 27, 56 and 220#, and although Im a husky and stocky guy, Ive got nasty back-fat, a fat face and a 40 waist. 4 years ago I used to have great pecs, a 29 waist and weighed 145#. I have a history of depression, which my doc believes is the cause of my weight gain. He also believes the therapy will help me to help him treat me for HIV. Okay, the therapy and a nutritionist isnt such a bad idea, but Ive gotten to a point where I want and feel that I need to do more. Whats wrong with what I asked for? If it wont help, then what else can I ask him to help me with? Im afraid my obesity will further complicate my HIV/AIDS, so why have we stopped there? I feel like my body has been slowly disintegrating into fat when I eat the same and exercise as much as I ever have before. Could this have anything to do with my HIV status (poz for 9 years), is it really depression, or should I be talking about this to a physical trainer without consulting with my ID Dr.?

Response from Ms. Fields-Gardner

It does make sense to evaluate what is going on that may contribute to unwanted weight gain and the nature of weight gain you have experienced. Because you mention weight gain as fat gain, you may want more than a BIA and many dietitians are well-trained in anthropometry (body dimension measures) that will help to characterize those changes. By evaluating the changes you, personally, have experienced you can get a better idea of the best treatment options.

Depression can often lead to a change in eating and exercise habits and, in those cases, treatment for depression along with counseling on appropriate diet and exercise makes sense.

Obesity does complicate health and pretty much any chronic disease. It is worth paying attention to and you should be congratulated for looking for solutions.

There are many reasons why such changes occur and often there are many types of treatments that can counter the problem. HIV disease and duration of disease, because it is a chronic inflammatory disease, is likely to contribute to changes in metabolism of body tissues. Hormonal alterations, drug-induced changes, and non-disease-related risk factors (such as diet, exercise, smoking, drinking, family history of disease, and others) are all candidates for causing metabolic and body composition changes.

Exercise is important, but there may be a higher risk of complication with long-term HIV infection, drug therapy, and weight loss history. If your ID doc is your primary care, ask for an exercise release and a referral for an evaluation and exercise prescription from a physical therapist.

Your dietitian and exercise physiologist or physical therapist can work together to help you shape up while your physician (ID, endocrinologist, and/or others) work with you on any medical limitations to achieving your goals. Best wishes on your efforts!


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