Patient: I’m 22 years old, 5’3″ tall, weighing at 60 kgs.I have gained 8 kgs within 2 months with absolutely no changes in my diet or routine. The weight does mostly gather in my lower body. My diet is typical Pakistani diet with wholewheat bread as a staple and vegetables and grains making the bulk of my diet. Red meat and fish are rare because I am not a big fan. The only dairy I consume is curd, and that too is occasional. No junk food, pizzas, pasta, burgers, cold drinks (or any drinks for that matter save for water). Every doctor I’ve sought for the matter has discarded my concerns owing to the fact that I’m still in okay BMI range and “too young to worry about such things, just exercise”.I really don’t know where to start and what to do. I don’t know what bloodwork I should have done if any and what changes to make to my diet. I cannot exercise because I have almost debilitating right knee pain (will be seeing a doctor for that in a week). I’m at a loss for what to do. Kindly guide me as to where I should start or look into?
Doctor: HelloThank you for posting your query at ATD for an opinion.I understand your concern and would like to know a l ittle more about yourself before giving any comments or suggestions.What is your gender?You have mentioned about weight gain in lower half of the body- could you please specify the location? Whether it’s waist, hips, or thighs. It determines the weight gain pattern.Can you proportionate your diet into Carbs, protein, and fats?Are you currently on any medication?How many meals you take in a day including snack meals and sneak meals? Do you eat to your hearts desire or just the amount of food to suffice hunger? Include details of time of meals, your waking up and sleeping time?You are just 22 year old, which knee condition are you suffering from?Kindly follow up with answers to these questions for better evaluation of your condition. Feel free to discuss further.Regards
Comments / Follow Ups
Patient: I’m female. My weight goes to my hips and buttocks, followed by thighs. There is considerable bloating in my stomach too but my waist generally doesn’t show any weight gain. My forearms and lower legs are also surprisingly slim and are the same measurement as they were when I used to be 48 kgs.
Unfortunately I’m not very learned in composition of food. I can try to explain my meals instead. For breakfast I have one wholewheat roti/tortilla (the flour comes from our own harvest) (6 inches in diameter) with black tea. For lunch and dinner as well I have one small roti (some days I’ll have a serving of rice instead of bread) each coupled with whatever was cooked for the day, ranging from half a cup of lentils to any number of veggies (cabbage, cauliflower, turnips, bottlegourd etc) or sometimes if it’s chicken then one chicken wing etc. Around 5 pm, I have black tea with powdered milk. Some days I will have a banana or an apple as a snack between meals.
I don’t eat till I feel full because that leaves me feeling bloated and sleepy. I eat VERYYY slow and mindfully, just enough to satiate my hunger.
I wake up around 9:30 am and go to bed around 12 midnight. I don’t have a stressful routine per say.
I’m not sure about the knee, I have had “bad knees” since I was 13 years of age. They hurt and “crack” when I try to bend them or change position of my legs after being in the same position for a while. However since about 2 weeks it’s been different, I have a different kind of pain that I can only describe as excruciating enough that I can’t sleep or even change sides in bed or walk without a limp. It was completely gone the day before yesterday but it’s back again today so I have a feeling that it may be inflammatory in nature (I took Nuberol Forte for it to no relief).
I forgot to add that I also have bowel issues. I alternate between constipation and watery stools and the feeling of not having relieved myself completely. I am not on any medication currently and my doctors have been no help either.
I have had Vitamin D and B12 tests done within this year which were low so I took supplements for those and now they’re back to normal but other than that, nothing. I am however taking a probiotic since one week (S.boulardii I believe?) to help with loose stools and that has been some relief.
Doctor: I too believe like your doctors that both your diet, weight, and BMI is within normal limits. The extra deposition of fat or weight gain in these areas is considered normal for the female individuals. You have a balanced diet and it doesn’t seem you need any dietary modification.
Although there are test to determine the exact amount of fat and muscle in the body but such test are not commercially available.
You have alternating bowel habits but have not mentioned any test or diagnosis.
If you have any other doubts, please write to us. Looking forward to your reply.
Patient: Thankyou. I do have to add however that while I am in the healthy range, 8 kgs within 2 months like that (and still climbing) means that before long I will be overstepping the boundary. It is genuinely disheartening considering I don’t eat unhealthy and yet nothing I own fits me anymore. 4 inches around the hipline is quite a bit of a gain.
That’s because I haven’t had any diagnosis, I had to drop out of college at one point because of my bowel condition but I was ordered no tests by my doctors, just a course of Flagyl as a trial which didn’t work. I have stopped going to doctors now because I don’t want to come across as a hypochondriac and have had no relief following the appointments so there’s that.
Doctor: I understand that sometimes you feel disheartened but if you regard the normal phenomenon or changes as abnormal or altered and continue to believe in it then you will not be able to apprehend the better aspects of life and repeated visits to doctors with same diagnosis will feed your disbelief and dishearten you further.
Regarding your altered bowel habits, it requires evaluation since you are having unresolved bowel issues despite drug trial of flagyl and S. boulardii. Stool examination for occult blood and colonoscopy is usually done.