Reader question.

I had an email exchange from a new reader this week who had a couple of weight loss questions, both of which I thought were good jumping-off points for the blog.

I am  5'7"in height, and 217 lbs. (obese) and unhealty and a glutton. I'm 92 lbs overweight.   I'm 125 lean body mass and 92 lbs. of fat(!) according to my recent testing in this area.

I answered:  You are *not* 92 pounds overweight. Everybody is supposed to have some fat on their lean body mass. Nobody is supposed to be 0% fat! If you go by BMI, you would reach the top end of the "normal" weight range at 159 pounds. So. 58 lbs probably seems like a big number, but I hope it does not
feel as big as 92.  

"BMI-normal" is a pretty wide range, and maybe she would be better off losing more weight than that, but at 159 pounds she would technically be within "normal."  At 190 pounds she would go from "obese" to "overweight."

Another way, maybe an even better way, to find a definition of "normal" with this data would be by percent-body-fat (the weight of your body fat divided by your total body weight).  If your body fat measurement is accurate (which it probably isn't) you'd be at a body fat percentage of 31% (top end of "average") at 181 pounds.  That's only 36 pounds away.  To get into the "fit" range at 24% body fat for women, if this data were accurate, she'd have to reach 164 lbs.  But I suspect the body fat percentage is not accurately calculated to begin with.  All these numbers are just starting points.  Anyway:  it's not that bad.  You don't have to lose 92 pounds.  Please don't.

I note on your blog that you mention both calories and hunger fullness.  What do you recommend for one as me starting out?   I know I'd love to eventually manage my weight with hunger/fullness, but for now it seems so subjective/hard to find. 

I've been trying to eat only when hungry but find that my body doesn't ask for food but maybe twice a day... I had been obsessive about the waiting for hunger growl and I felt like I was gluttonous if I ate at any other time (schedule)....and if I stop when politely full on these occasions my stomach holds only 2 cups of food/liquid.  2 cups of food twice daily = 4 cups of food.     I find it's hard to get the NUTRIENTS I need in 4 cups of food (I'm not worried about energy/calories/fat as that's stuck all over my body), but I am finding it hard not to binge once I've tried this pattern a few days as the urge becomes overwhelming.

I noted:  I am suspicious about "waiting for the stomach to growl" as the only legitimate sign of hunger.  And I definitely don't think that it's automatically "gluttonous" to eat when your stomach isn't growling! Our bodies give us a number of different cues to eat, and a growling stomach is only one of them; and as far as I can tell, different people feel different hunger cues to different degrees.  Hunger signals aren't caused (just) by physical lack of food in the stomach -- they travel around the body in the bloodstream via at least three different hormones, all of which respond to the levels of available fuel (sugar and fat) for cells.  So -- the stomach growl might be a good cue for one person but a terrible one for another.

I believe that my hunger signals were messed up, so I quit trying to eat when I was hungry and stop when I was full. I had been trying to do that a lot of my life, and it wasn't working, partly because (as I figured out 
later) I was interpreting "not yet painfully stuffed" as "still hungry." I had to learn what hungry really felt like and get to know it. 

I also think that eating every time one feels hungry is a recipe for staying the same weight, not for losing it. My experience is that to lose weight, and even now to maintain it, I had to spend time feeling hungry every day. Not all day; I wasn't hungry right after meals. But I had to spend some time feeling hungry in the hour or so leading up to a meal. If I never let myself get hungry and stay hungry for a little while, then that was always a sign that I was eating enough to keep up with my energy intake.

To stay motivated, I would tell myself that hunger was a sign that my body was consuming itself.  But I always knew another meal was coming, I just had to wait for it a bit. 

 Do you recommend beginning to tracking calories/points (something more objective) in the beginning or will you continue to count calories?

I think that a good first step, especially if you haven't tried it for a while, is to begin by eating meals and snacks on a schedule. Mine was like this: breakfast on waking, small snack no earlier than 10:30 (and if I  didn't get it by 11:30 then I had to skip it), lunch no earlier than  12:30, small snack between 3:30 and 4, dinner no earlier than 6. I experimented with having a bedtime snack and not having a bedtime snack and decided I didn't need one to fuel my  sleeping.

The thing about having a schedule is that you are sometimes forced to wait to have your meal. Which means you start getting some practice with feeling hungry and telling yourself, "oh well, it's not time to eat yet, I guess I will survive till then."

A good second step is to restrict yourself to a single not-too-big plate of food, no seconds, at meals (and quite small snacks -- three ounces was big enough for me for a snack most of the time). You can be sure that you will not suffer nutritional  deficiency from that. And if you are worried, you can take a multivitamin, or 
make a larger portion of your plate be nutrient-rich vegetables. I used an  8-and-a-half-inch plate for meals. When it was done, I was done.

By the way, I noticed you wrote that you were not worried about getting enough "energy/calories/fat" but were worried about getting enough "nutrients."  I want to point out that fat is an essential nutrient and you have to keep eating it, even if you are trying to lose weight.  Sufficient fat helps you absorb nutrients, and it plays an important role in satiety, not to mention that it helps your veggies taste really good.  So eat some fat.

The "small plate," "no seconds," "eat on schedule" rules are very simple, but they will get you started without actually having to count anything or even deprive  yourself of any sort of food -- if it fits on your plate, it's cool.  You can save calorie counting (I much prefer calories to WW points as I do not believe in eating low-fat)  for later when you get bored and want something more challenging, or if you hit a plateau, or if you are curious how many calories are on your plate.

Comments

[LeeAnn Balbirona]

I get light-headed long before my stomach ever growls. A sure sign I need some protein to keep me going.

Today I had two cups of coffee for "breakfast" and then got light-headed around noon. I ended up with one of those Starbuck's fruit, nut & cheese trays for lunch --minus the sesame wheat crackers since I'm gluten intolerant (how hard would it be to put rice crackers in there?!). Good for another few hours.

[MelanieB]

For me irritability and anxiety usually show up long before I feel hungry or my stomach growls. When I start snapping at the kids, it usually a sure sign that I need to stop and eat. Funny because when they get whiny and fussy it usually means they need to eat too. So if I lose track of time it usually turns ugly as the kids start fighting with each other and I start yelling and then it hits me that it's snack time or lunch time.

[MelanieB]

And now I just remembered the comment I meant to leave earlier....

I was just wondering about BMI today and realizing that I have no idea how those ranges were established. Bearing, do you know what studies were done, what criteria were used to determine what is a healthy range for BMI?

[bearing]

It's "convenient but inaccurate." Which means that I find it moderately useful. (Remember that my background is in engineering!) (yes, this is meant to be a self-deprecating joke of sorts)

It works better for middling-height people than for short people or tall people, and better if you're not very, very lean, to answer the subjective question "Should I lose weight?"

Body fat percentage is probably a better measure to go by. It's much harder to MEASURE accurately, though, and I can't measure it over the internet at all. (And in the case of my reader who wrote this email, the first thing I wanted to do was clear up the idea that the amount of body fat she has is the amount of weight she has to lose. But from other information she sent me, I suspect her body fat percentage was underestimated.)

Another thing about the BMI, if researcher/author Walter Willett (_Eat, Drink, and Be Healthy_ ) is to believed, is that the BMI cutoff between "normal" and "overweight" should have been revised downward to -- I think I remember it was 22 or something? Because at BMI~22 was where the death rates started to rise with increasing BMI.

An even easier-to-calculate number that correlates with a lot of health markers is simply waist circumference. However, I don't know how to turn "I need to decrease my weight circumference by 4 inches" into "I need to lose about xxx pounds, so I need to drop about xxx calories per week..."

At any rate, BMI strikes me as a decent (because easy to calculate) FIRST approximation for obese people to use to decide about how much weight they should try to lose. It does not give you an accurate number; it gives you a first target. Once you get near there, you can look around and see if it's about what you want to be.

Which is kind of how I used it. I have had a BMI as high as 32.3. When I started to lose weight, I decided I would stop when I got below 22 (picked that number from Walter Willett's book mentioned above). I lived at 21.8 for about six months and decided I felt too thin; after my next pregnancy, I deliberately brought my weight only down to a BMI of about 23. That seems to be a pretty good weight for me -- I feel very comfortable and I don't look gaunt.

So, I found it very useful just for taking a stab at a "goal weight." Mind you, I understood from the beginning that it was only a first approximation of what would be "healthy" for me.

[bearing]

Oh, and as to where it came from, what studies, etc. It's properly a tool for studying populations, not individuals, and as a "simple means of classifying" people (which is really how I used it to decide on my first-guess goal weight).

"While the formula previously called the Quetelet Index for BMI dates to the 19th century, the new term "body mass index" for the ratio and its popularity date to a paper published in the July edition of 1972 in the Journal of Chronic Diseases by Ancel Keys, which found the BMI to be the best proxy for body fat percentage among ratios of weight and height;the interest in measuring body fat being due to obesity becoming a discernible issue in prosperous Western societies.

"BMI was explicitly cited by Keys as being appropriate for population studies, and inappropriate for individual diagnosis.

"Nevertheless, due to its simplicity, it came to be widely used for individual diagnosis, despite its inappropriateness.

BMI provided a simple numeric measure of a person's "fatness" or "thinness", allowing health professionals to discuss over- and under-weight problems more objectively with their patients."

(And an easy way for anyone to write about weight on the internet, I add.)

"However, BMI has become controversial because many people, including physicians, have come to rely on its apparent numerical authority for medical diagnosis, but that was never the BMI's purpose; it is meant to be used as a simple means of classifying sedentary (physically inactive) individuals with an average body composition."

(which is how I use it when I write about it -- I should probably start using a disclaimer)

"For these individuals, the current value settings are as follows: a BMI of 18.5 to 25 may indicate optimal weight;"

(except that some people point out that really "optimal" should only go up to 22)

"a BMI lower than 18.5 suggests the person is underweight while a number above 25 may indicate the person is overweight; a BMI below 17.5 may indicate the person has anorexia nervosa or a related disorder; a number above 30 suggests the person is obese (Al C) (over 40, morbidly obese)."

Or to put it more succinctly, if someone writes me and says "I'm 5 foot 7 and 217 pounds," the BMI lets me do a quick calculation and say "oh, I see, yes, you are probably obese." Otherwise I would be like, "um, 217 pounds... I guess that sounds like a lot, but you're five foot seven..." I've got lots of experience with and intuitive grasp of the varying weights/obesities that a 4-foot-11 person can be, but none with 5-7 people!

[bearing]

(sorry, all that quoted material is just from wikipedia.)

[MelanieB]

Thanks, bearing, that is all really helpful. I suppose I could have gone to wikipedia myself, I do it all the time; but somehow that didn't occur to me for this question.

Having always had a quick metabolism and a tall, skinny frame, weight was never an issue that doctors brought up with me until I started having babies. Then I gained 40 pounds with my first pregnancy and the doctor cautioned me about my weight gain.

Though I always sort of knew my eating habits weren't all that healthy and I even used to joke that at some point bad dietary habits and a sedentary lifestyle would catch up with me. So my first experience of even looking at my BMI was in terms of postpartum weight. I think it was about 25 after Bella was born, 27 after Sophie. Right before this current pregnancy I'd got it to where I was within a pound or two of 24. So definitely above the optimal of 22 but definitely never near obese.

Not being a person who has ever struggled with obesity, I've wondered how concerned I really need to be about carrying a bit more weight as long as I'm still nursing a baby. I've always wondered how applicable it is to use BMI when you are in a situation like mine where for the past five years I've been pregnant then nursing then pregnant again before the previous baby weaned. Is 25 still above optimal for postpartum nursing moms? Is there any specific data for that population and would it be different than the population at large?