By Dr. Michael Roizen
Q: I gained about 25 pounds during the pandemic and it’s affecting my health, but when I went to my doctor for an annual checkup (finally), she didn’t say a word about what to do to lose weight — so I didn’t either. Should I make another appointment and insist we discuss it? — Janna R., Portland, Oregon
A: That’s a great — and very complex — question. Those who advocate for people with eating disorders believe most health conditions can be addressed without focusing on weight or weighing patients at every doctor appointment. Cards that say, “Please Don’t Weigh Me Unless It’s (Really) Medically Necessary. If you really need my weight, please tell me why so I can give you my informed consent,” have been created by a Los Angeles-based eating disorder coach and are welcomed by some doctors as a way to actually start a tough conversation more effectively. On the other hand, some doctors find talking about weight difficult and dodge the topic altogether. Still others believe that weight, like blood pressure and LDL cholesterol levels, is a data point that must be included in every evaluation of a person’s health.
Researchers at the University of Buffalo recently published a paper that suggests a compromise. They say obesity and weight should be addressed in a health-focused way that eliminates weight stigma and the pervasive diet culture. That’s also the perspective in another new study in the journal Obesity. The researchers heard from patients with obesity who lost and kept off 50 pounds or more; they said being motivated by health concerns was effective and helped them feel more at ease and comfortable mentally and physically.
The bottom line: It’s smart to make another doctor appointment to talk about improving your health by upgrading your nutrition and making better food choices, controlling portion size and changing the timing of your meals. You also want to discuss ways to improve your stress management and increase your physical activity. The wide-ranging regimen the two of you develop will be able to improve your well-being — and you’ll lose weight.
Q: I take Xanax several nights a week to ease anxiety and help me sleep. In two months, I am getting a total knee replacement, and my doctor says he will prescribe an opioid for post-op pain management. That combo worries me. Should I try to wean myself off the sedative before the surgery? What do you think? — David Y., Erie, Pennsylvania
A: Your instincts are right on. The combination of a benzodiazepine like Valium or Xanax with an opioid is potentially deadly. The main risk, according to a Food and Drug Administration Drug Safety Communication, is that the duo depresses the central nervous system, and that results in slowed or difficult breathing and deaths.
Despite that, 2.6 million Americans are prescribed opioids and a benzodiazepine or another sedative at the same time, according to a new study in Regional Anesthesia & Pain Medicine. And it isn’t just occasionally. The researchers found that the annual average number of prescriptions these folks had filled for opioids, benzodiazepines and other types of sedatives was nearly 25 per person.
There has been some interesting research that shows even for severe post-op pain that naproxen, as well as acetaminophen, is effective, and they both can reduce or eliminate the need for opioids. Talk to your doctor about whether that approach will work for you.
As for remaining on your Xanax up to, during and after your surgery? There are studies indicating that these types of drugs can interfere with the outcome of knee surgery and increase rates of revision, resection, femur fracture fixation, and even delirium.
So, talk with your surgeon about all this. Ask for help in coming off the Xanax if that is what you decide to do, and explore pain control alternatives to opioids. If you want more information, the American College of Surgeons has safe pain control information at facs.org.
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