This week I saw the nicest guy in my office. Problem is, he weighs about 400 pounds, even after having bariatric surgery, which is a procedure that reduces the size of the stomach and usually produces significant weight loss.
But this guy didn’t come to me about his weight. He was seeing some blood in his urine and was worried about it. Blood in the urine isn’t usually serious, though it should always be checked out. And it’s unrelated to weight or weight loss. The most common cause of blood in the urine is an infection of the urinary tract or prostate, and I said I’d test him for that and treat him. But I also was concerned that he hadn’t lost much weight after the surgery. He said he wasn’t eating much at all, so something didn’t add up. I suggested he get a full panel of hormone tests.
When the results came back I saw he had an elevated level of prolactin, a hormone secreted by the pituitary gland. High prolactin levels can mean a pituitary tumor, which can be very serious. The high levels were also radically depressing his testosterone level, which was only 40, one of the lowest I’ve ever seen in a man.
I started him on a medication called bromocriptin, which can help treat a pituitary tumor and lower the prolactin levels. I also put him on testosterone replacement therapy, which restored his sex drive and gave him more energy. That, in turn, helped him exercise more, which helped him burn more calories and gain strength.
The reason I bring this up is because not everybody gains weight just because they’re overeating. Sure, if you’re dumping the contents of your refrigerator into your stomach every night, then the reason you’re overweight is obvious. But that wasn’t the case for this guy—and there are plenty of other people out there who are obese but who don’t over-eat.
Also, this is a reminder that, as good as it can be, bariatric surgery isn’t a cure-all. It actually takes a lot of work to un-learn old habits, exercise, and change the way you eat to accommodate your altered digestive tract. And if you’re not seeing clear weight loss after the surgery, then you need to suspect another cause—with a check of your hormone levels being the first place to look.
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