The belated twice-yearly post on weight maintenance.

Usually I write this post in May (around the anniversary of the "click" in my head that changed things) and November (around the anniversary of reaching my goal weight, around six months later).   I'm writing the November post late this year, in January, not because I want to cash in on all the New Year's resolution stuff, but just because I've been a delinquent blogger.

Let's grab something as it flies by and slap it up on the page to make things look current.  Here's a year-old article that has been going around on FB the last few days, it being January:  Diet and exercise alone are no cure for obesity, experts say.  Here is an extended excerpt from the  newspaper's summary of the information:

Take note, glib-talking doctors and legislators, rail-thin commentators, and fat-haters of all stripes: For most of the nation's 79 million adults and 13 million kids who are obese, the "eat less, move more" treatment, as currently practiced, is a prescription for failure, these experts say.

In a commentary published  [ed: in the May 2015 issue] in the journal Lancet Diabetes and Endocrinology, four weight-loss specialists set out to correct what they view as the widespread misimpression that people who have become and stayed obese for more than a couple of years can, by diet and exercise alone, return to a normal, healthy weight and stay that way.

"Once obesity is established, however, body weight seems to become biologically 'stamped in' and defended," wrote Mt. Sinai Hospital weight management expert Christopher N. Ochner and colleagues from the medical faculties of the University of Colorado, Northwestern University and the University of Pennsylvania.  

The human body, evolved to endure through periods of food scarcity, has adapted a host of methods to ensure that lost weight will be restored, the authors say. It will respond to weight loss by powering down its use of calories as fuel, pumping out hormones to increase hunger, boosting fat storage capacity, and tricking the brain to demand overconsumption.

"Few individuals ever truly recover from obesity," the authors wrote. Those that do, they add, "still have 'obesity in remission,' and are biologically very different from individuals of the same age, sex and body weight who never had obesity." They are constantly at war with their bodies' efforts to return to their highest sustained weight.

...Why would an influential foursome see the value in recapitulating these ideas in a respected medical journal?

"It's not just that most people still stigmatize obesity--as they say, it's the last acceptable form of stigma," said Ochner. "What really bothers me working around and with clinicians, is that some of them--a disturbing percentage--still believe it's all about personal choice: that if the patient just tries hard enough, and if we can just figure out how to get them a little more motivated, then we'd be successful. And that's just not right."

Lifestyle changes are undoubtedly a necessary condition for enduring weight loss, Ochner said. But they're far from sufficient, and when physicians believe they are--when they say "you already know what to do, I told you what to do," he said--"that's certainly cruel, and it's harmful: It prevents them getting the care they need."

Physicians, he said, should be doing more than exhort patients to eat less and move more. They should[:]

• "intervene more quickly to encourage weight loss in overweight patients before they become obese."
•  "discuss with obese patients ... medications, surgery and device-based treatments...to supplement diet and exercise..."
• "make weight-loss maintenance--an aspect of obesity treatment that is neglected--a part of their treatment plan."

 + + + 

I'm one of the odd people that did manage to correct long-term obesity through diet and exercise.  It required a level of focus that bordered on the obsessive; I paid a price in mental health.  I'm not saying it was the wrong choice to make; the sacrifice was temporary, and it worked.  

 I think I'm mentally more balanced now, but it's also been harder to maintain the habits that seem to correspond with keeping my weight off.  It could just be because I'm under a lot of demands in this season of my life; but sometimes I wonder if I will always have to choose between staying thin and staying relatively sane.

+ + +

Maintenance?

It really is very difficult.  I understand intimately what they mean by "obesity in remission."  I was obese for about 25 years, and I've only been not-obese for 7.5 years, and I feel -- deeply -- that the lifestyle which maintains it is something I put on, not something that's really sunk in fully.  

For a while, between my last two pregnancies, I thought it really had sunk in.  Post-weight-loss, I'd maintained for several months, gotten pregnant, had an amazingly healthy pregnancy and an easy delivery, and then I picked up my old, good habits where I left off.  I returned to my desired weight range and maintained that for three years or so before my fifth pregnancy.  

But after my youngest child was born I was much more sluggish.  He is two now, and I have never quite gotten back to where I was.  I'm about ten pounds and one clothing size over my desired weight.  I'd be okay with it, I think, if it weren't for the frustration and fear that's all wrapped around the knowledge that I've simply not been able to hold myself tightly enough to a plan.

Again, I have a lot of demands on me right now, and I well remember the level of obsession that it required for me to lose the weight the first time.  Maybe there simply isn't enough of my attention to go around, and maybe I could do it if I could only clear my schedule and clear my head.  But it's all hypothetical.  I can't seem to stick to anything very long.  And that "can't" is very scary to me.  

I wonder all the time:  Am I out of remission?

+ + +

Let's take a look at these words again:

The human body, evolved to endure through periods of food scarcity, has adapted a host of methods to ensure that lost weight will be restored, the authors say. It will respond to weight loss by powering down its use of calories as fuel, pumping out hormones to increase hunger, boosting fat storage capacity, and tricking the brain to demand overconsumption.

 

I don't know if the three other response mechanisms are active, but the last one?  Tricking the brain to demand overconsumption?

It is so very, very real.

My brain is a traitor.  It has completely gone over to the side of the body in this one.  How to explain it?  My brain doesn't try to get me to break my resolutions, to foil my plans, anymore.  It's learned that this does not work.  

I don't do the emotional-eating thing.  I don't get tempted to break my resolutions.  If I am conscious of a plan I have made (say "Don't eat dessert tonight") you can wave a chocolate cake in front of me all evening and I will not take that first fatal bite.   My brain has given up trying to tempt me away from my plans.

Instead my brain has learned a better way:  it causes me to forget I had a plan in the first place.  "Ha ha!" the brain says.  "If I refuse to do my job of remembering important things, there's nothing that the rest of you can do about it!" And when dinnertime comes it's all like "Plan?  What plan?  Pass the potatoes."

I realize that this sounds absolutely insane.

I can't think of a better way to describe it.

I make plans.  I literally forget them, or at least forget that they matter, when I sit down at the table.  And then immediately after we are all done eating, I seem to remember them again.  Shit.  And then the remorse.

This is not a good mental situation.  I really have to do something about it, because it is the kind of mental situation that eating disorders are made of:  a cycle of self-recrimination that begins immediately after a meal.  It's bad.

+ + +

There are definitely things I could do about this.   I think that the best course is probably to pick one good habit, one tried and proven one from my old life, and concentrate on that until it's second nature again.   But panic overtakes me.  "Just one habit" is too scary; I fear I'll let all the others go.   For example:  If I concentrate only on not snacking between meals (a worthy goal, part of the way I want to live my life), I fear, I'll destroy all the practice I've made at having reasonably-sized meals.  And so on.  I keep starting off with single habits, but eventually I try to do all the habits at once, get overwhelmed, and start forgetting them again.  

+ + +

And make no mistake:  while I might be able to develop and reinforce habits that maintain my weight where it is, I really have to be conscious at every meal if I am going to run a calorie deficit and live off my stores even for a few weeks.  I am under five feet tall.  Maintaining my weight as it is  requires, roughly, only 1850 calories per day.   Losing it at a noticeable pace means going down to something like 1400-1500.  This is not that much food, people!  Unless you are the sort of person who forgets to eat under stress, it takes attention to maintain that for more than a couple of days, and it is shockingly easy to make up several days' deficit in only one meal.  

Example.  If I am trying to stay at 1500 cal/day, chances are good I'll really manage closer to 1650.  Let's say I do that for 4 days in a row.  Great! I'm running an 800-calorie deficit.  Then on day 5 I go to a restaurant for lunch and in a fit of forgetfulness I order a cheeseburger and a fountain Coke with a vinaigrette side salad (no fries, please).   That's all it takes!  The deficit is gone, and I'm back to square one.  Without ever really departing from reasonable, moderate eating!  We're talking a single, culturally normal-sized meal (too big for my body size, but it isn't an amount of food anyone would call "overeating") after 13 carefully-restricted meals in a row.  If I kept up that pattern (13 restricted meals, one culturally normal meal) over and over, I would never change.  The only thing that would be different is that I would feel very frustrated.  Would you be able to keep that up without going slowly insane or developing an eating disorder?

It requires attention.  I have found that it requires counting.

+ + +

Still, I can point to areas of relatively easy improvement.  Someday I will have the attention available to make a final push through those two-year-old postpartum pounds, and I could concentrate on developing the habits that support the drive, make it a little easier.  Cutting back on alcohol, making easy-to-remember resolutions like eliminating snacking and seconds, making rules like "half sandwiches only," splitting things with Mark at restaurants (and NOT using that as an excuse to go ahead and have dessert).  

I could do these things.  The question is, will I?

A series of older pictures can be found here.

Comments

[Jenny]

I am glad to see you update this topic again. I certainly don't have the history that you do, but I find myself about five pounds heavier than I'd like, with snug pants, and lacking the motivation to do what needs done. I *know* what to do, I've done it before, but sustaining the effort for the required time is more that I care to bother.

Not to complain too bitterly about being short, but my normal, weight-maintenance meals are already small. If I eat to lose, we are talking child-sized portions which is a drag without significant motivation. So I button the snug pants and sigh and wonder if I will ever be motivated to do it again. Of course I could just get pregnant and delay the pain for two or three years. Ha!

[Bearing]

You can complain to me about being short all you want. It's a rather depressing realization to make: child-size portions forever. Or at least until I age into the Senior Menu.

(I mentioned that at my current weight and activity level, it takes 1850 cal/day to maintain, approximately, according to the Mayo Clinic calculator. At my goal weight it is 100 calories less, so I lose access to a caloric load equal ro a quarter of my lunch. I suppose that means if I stick to 1750/day I will get there asymptotically.)

[Jenny]

I've been thinking about you and this recently, wondering how/whether you tried your 6-week period of working with 14-hour fasts.

My #6 baby turns 1 at the end of next month... I turn 39 in May... I'm about 10 pounds away from still-nursing "goal" weight. Not stressing about it yet--just trying to make small choices.

Anyway, I'm interested to read about your experiences.

[bearing]

I didn't keep up with the 14-h fasts as a regular duscipline, but I played around with it for long enough to realize that the world will not end if I don't get to eat breakfast.

Which was actually a very useful thing to have learned.

[entropy]

You look great.

[Bearing]

I wish I *felt* great.

I suspect that part of my difficulty here is my (reasonable) unwillingness to go into the mental space that the effort requires. I mean, I have other things that I want to read more than blogs about eating and not eating.

But I can't seem to just let it go, either, and say to myself, "You know what, it's fine to just stay where you are for now and make the effort later."

And the reason for that is that I am very, very afraid that my weight will creep back up to where I used to be. And that this will prove that I never was as (virtuous? together? smart? self-controlled? competent?) as I let myself believe.

The part that I dislike most about this underlying feeling -- and I hope that by putting it out there in the name of honesty and trying to develop my own right-thinking I don't add to it -- is that it is sheer fat-shaming, something that our society could do with a lot less of. The fact that it is self-directed does not make it any less poisonous. I hate that I have internalized this.

[Jenny]

I went to look up the Mayo Clinic calculator to see my numbers. Man, is that depressing. My current weight and activity level calls for 1750 calories a day and my preferred weight is 1700.

I went with the light activity level because, hey, I don't sit all day anymore and I do walk around the house. Really I should be much more active, but I can't find the mental space to add that in with all the other changes around here.

For your fear about creeping weight, can you make a deal with yourself? Can you decide on a weight that would trigger your attention and then try not to worry about it until you see it?

For me that weight is 125. I'd prefer to be under 120 even though I'm not, but if the scale hits 125, I start paying much more attention to my food in order to drop a few pounds and then go back to not worrying about it. The trigger weight allows me to keep things in check without *always* worrying about it.

I am right about the age when my mother's weight exploded so I am very wary about letting things get too far gone.

[Bearing]

Well, unfortunately I am currently right at what I would normally call my trigger weight...

[Jenny]

Ah, but is it the old trigger weight when you weighed your preferred weight or is it your temporary-until-I-find-the-mental-space-new-normal-haven't-quite-lost-the-baby-weight trigger?

When I was at my preferred weight, 120 was my trigger weight, which worked until I had too many balls in the air. I readjusted the trigger up to 125 to account for the fact my weight is relatively stable, if not what I prefer, and to give me breathing room to not have to worry about it right now.

Obviously, you can't continuously readjust the trigger point for it to be meaningful, but you have to set the trigger based on your life right now and not the way it was three or four years ago.

[Bearing]

This is a good point. I could probably derive a new trigger based on available data.

[Christy P.]

I am already freezing nearly all of the time and can't imagine limiting calories in winter despite being over a reasonable trigger weight for my height. To everything there is a season.

[Bearing]

I completely understand, Christy, I find I am cold in the summer, too, though, so it isn't much better...

[Sarah]

Would it help to make a different fitness goal that you could feel good about working toward, rather than lowering weight? Like running faster, or lifting more weight, or lowering your resting heart rate? Because I doubt the 10 extra pounds are detrimental health-wise; slightly overweight people even have lower all-cause mortality than normal-weight people, right?

[Christy P.]

Sarah, I like the way you think. Especially since, if I get stronger, I will likely weigh a little bit more.

[bearing]

Definitely, Sarah has a better way to think.

(I want to be clear that I am not holding up my mental processes here as an example of a good attitude to have; just trying to be honest about the attitude I often feel trapped in.)

My resting heart rate is already classified as bradycardia.

Honestly, my fitness goal at this point is to show up to the Y regularly 2-3 times per week instead of irregularly. Which given the demands on my time, these days, means I sometimes have to get up early to do it. Hard when it's freezing out. Am rewarding myself for the showing up by doing things I like when I am there, like swimming.

[Sarah]

Showing up and doing exercise consistently is probably the single most important thing, yes, absolutely, and I bet doing something you enjoy increases the mental health/general well-being benefits, too! Was just trying to think of something that would work with the "I want to have a quantitative fitness/health measure to focus on" idea.

[Wendy]

I've been reading your blog for years, but I'm not sure if I have ever posted a comment. I really appreciate this post as I'm currently losing weight and worry about maintaining. Previously, I lost about 20 pounds and kept it off for several years, but slowly the weight crept back (plus 10) so I'm working on it again...

I'm trying to read weight loss articles and books to keep me focused, and I recently found the book and blog "Refuse to Regain" by Barbara Berkely,MD. http://www.refusetoregain.com/
I really have enjoyed reading her perspective about how much we really don't know about maintenance and how that's what the medical professionals should be focusing on, rather than weight loss. I especially like her perspective that your best guide is yourself - what worked for you in the past, what is working now...

Just thought I'd share. I think you look amazing, and you have inspired me over the years. Thank you!

[bearing]

Yes, I have read Berkely's book. I agree with you (and her) that there isn't nearly enough emphasis on whole-life maintenance. Probably worth noting that Berkely is, more or less, on the paleo bandwagon.

It's seriously difficult work. I might be casting about to blame my circumstances instead of myself, but I really felt derailed by the change in habits forced by my last pregnancy -- it's like I feel a compulsion to eat like a pregnant person.

Could be that the fact I'm still lactating has something to do with it.