Managing Significant Weight Loss: When to Seek Medical Advice?

Please consult the outpatient clinic for significant weight loss evaluation?

Hello, doctor.
In February of this year, I weighed 116 kg, and I currently weigh 87 kg (I have lost 30 kg over 8 months).
My current BMI is 25.9.
During my weight loss journey, I have made the following changes: (1) I originally had sleep apnea and poor sleep quality, but after using a CPAP machine, I now feel well-rested (my energy levels have significantly improved).
(2) I reduced my carbohydrate intake; I used to consume a large amount of starch (up to two bowls of rice per meal), but now I limit it to one and a half bowls per meal.
(3) I switched to eating steamed vegetables (boiled/2-3 types of vegetables per meal), and I steam lean meats or fish in a rice cooker.
Occasionally, I have nuts in the morning.
(4) I avoid sugary foods, fried items, and pastries.
(5) Before the pandemic (in March-April), I went to the gym for running and strength training, which contributed to my weight loss.
Initially, I lost about 5 kg per month for the first two months, but then it decreased to about 3 kg per month.
Recently, I doubled my starch intake and noticed that I am still losing weight.
I have read many articles online stating that rapid weight loss is not advisable, so I would like to ask the following questions: (1) Will my weight continue to decrease? I want to maintain my current weight and not lose more (even though my BMI is still 25.9).
(2) Given the significant weight loss, should I consult a metabolic or endocrinology specialist? What tests should I undergo (such as thyroid function tests or hormone levels)? Thank you.

Rui Rui, 40~49 year old female. Ask Date: 2021/10/02

Dr. Li Jian reply Internal Medicine

1.
It is better to reduce the BMI to below 24 and the waist circumference to below 90 centimeters.
2.
Rapid weight loss may lead to decreased thyroid function.

Reply Date: 2021/10/02

More Info

Managing significant weight loss is a commendable achievement, and it’s essential to approach this journey with a balanced perspective on health and wellness. Based on your situation, where you have successfully lost 30 kilograms over eight months, it’s crucial to consider both the physical and psychological aspects of weight management.

1. Will My Weight Continue to Decrease?
Weight loss can be influenced by several factors, including dietary changes, physical activity, and metabolic adaptations. Initially, you experienced a rapid weight loss, which is common when making significant changes to your diet and exercise routine. As your body adjusts to a new weight and lifestyle, the rate of weight loss may slow down, which is entirely normal.
To maintain your current weight, focus on establishing a sustainable routine that includes a balanced diet and regular exercise. Since you mentioned that you have increased your starch intake recently, it’s essential to monitor how your body responds. If you find that your weight continues to decrease despite this increase, it may be worth reassessing your overall caloric intake and expenditure.

2. Should I Consult a Specialist?
Given your history of significant weight loss and previous health issues, such as sleep apnea, it is wise to consult a healthcare professional, particularly an endocrinologist or a metabolic specialist. They can help assess whether your current weight is appropriate for your body and whether any underlying metabolic issues may be contributing to your weight loss.

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Recommended Tests:
- Thyroid Function Tests: These tests measure levels of thyroid hormones (TSH, T3, T4) to determine if your thyroid is functioning properly. An underactive thyroid (hypothyroidism) can lead to weight gain, while an overactive thyroid (hyperthyroidism) can cause weight loss.

- Hormonal Assessments: Hormones play a significant role in weight regulation. Tests may include checking levels of cortisol, insulin, and sex hormones, which can provide insight into your metabolic health.

- Nutritional Assessment: A registered dietitian can help evaluate your dietary habits and ensure you are meeting your nutritional needs while maintaining your weight.

Additional Considerations
- Sleep Quality: Since you mentioned improvements in your sleep quality with the use of a CPAP machine, continue to prioritize good sleep hygiene. Quality sleep is crucial for weight management and overall health.

- Physical Activity: Maintaining a regular exercise routine, including both cardiovascular and strength training, is vital. This not only helps in weight maintenance but also improves muscle mass and metabolic rate.

- Mental Health: Weight loss can sometimes lead to emotional challenges. It’s essential to address any psychological aspects of your weight loss journey. Consider speaking with a mental health professional if you experience anxiety or stress related to your weight or body image.

- Regular Monitoring: Keep track of your weight, dietary intake, and physical activity. Regular check-ins with your healthcare provider can help you stay on track and make necessary adjustments to your plan.

In conclusion, while your weight loss journey is impressive, it’s essential to maintain a holistic approach to your health. Consulting with healthcare professionals can provide you with the guidance needed to ensure that your weight remains stable and that you continue to thrive physically and mentally. Remember, the goal is not just to lose weight but to achieve a healthier lifestyle that you can sustain in the long run.

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