More than one person alerted me to this article by Gina Kolata that appeared in the New York Times over the weekend. Check it out: "After 'The Biggest Loser,' Their Bodies Fought to Regain Weight:"
I read the article with interest as a formerly obese (but not morbidly obese) person. I once lost a lot of weight, and... this is the place where I have trouble answering pithily. I didn't quite "keep it off," because I have had two pregnancies since. I didn't maintain my lowest weight, because I decided I looked gaunt, and settled on a larger target. Nor have I quite maintained that, because after the more recent pregnancy I didn't come quite all the way down. I'll tell the story in jeans sizes instead of scale numbers: from 14 to 2 to, now, 4. The 4 puts me on the border between normal and overweight, but it is fairly easy to maintain and so I have parked there for a while.
And seriously, I can't get too worked up about wearing a size 4 instead of a 2. I am 41 and a half years old and have given birth five times. This is not so bad, I keep telling myself. It could be worse.
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The gist of the article is that post-weight loss, a person experiences at least three separate mechanisms that tend to drive weight back up, even past the starting point.
First, weight loss measurably drops resting metabolism -- the energy that one's body burns steadily in the background just to operate basic life processes, not the extra that it burns to fuel spurts of exercise and exertion. "Just about anyone... has a slower metabolism" after losing weight; if there is less of you to run, less fuel is needed. That is the well-understood part, I believe. The not-so-well-understood part is that, apparently, if you begin gaining weight again, the metabolism stays low. Some kind of check has been lost forever, and you might not even be able to get back to where you were before.
Second, a drop in the hormone leptin increases feelings of hunger. Not everyone realizes that the gnawing feelings of hunger that normal people associate with "empty stomach feelings" are not really us feeling our emptiness -- they are hormonal signals, and have more to do with what is in our bloodstream and gut than with what is in our stomachs. Some of the contestants, according to the article, had such low levels of leptin that the doctors presumed them to feel hungry most of the time.
Third, persistent cravings -- desires to eat, not associated with hunger. Those seem to be an unknowable mixture of habitual behavior (conditioned responses to external cues) and of additional, even less well-understood hormonal signals.
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I really, really hate the "hopeless" narrative of obesity reversal: the idea that there is nothing we can do to get rid of excess fat and keep it off. Very hard work and obsessive attention can make it happen under some circumstances. We know this because a few people succeed, and none call it easy.
But I also really hate its opposite, the "slacker" narrative of obesity reversal: the idea that, because weight loss is possible, those who stay obese must be greedy, lazy, or stupid.
I prefer a "heroic" narrative of obesity reversal. Every piece of evidence points to the conclusion that it is massively difficult to reverse obesity long-term. Failing to lose a great deal of weight is no more proof of a person's sloth and greed and self-indulgence, than his failing to run the Ironman would be.
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So, I didn't have to lose a three-digit number. My body didn't have to take quite as large a hit as the "Biggest Loser" contestants who were followed in the study.
Did I experience a diminished metabolism after coming down 40 pounds, the first time? I must have, because I ate, to maintain that low weight, between 1/3 and 1/2 of my previous intake -- and while getting more exercise. But I doubt I experienced the subjects' permanent metabolic depression. I'm pretty sure that my current habits have me eating more calories than prior to my first post-loss pregnancy; even so, my weight is apparently stable (although 15 pounds heavier).
How about "constant feelings of hunger?" No -- I haven't experienced that at all. I get a growly stomach before meals, faster if I have been swimming or running. After eating I feel satisfied. If I have a supper that's later or larger than usual, I don't wake up hungry for breakfast right away. Also, I can live with hunger for a couple of hours without feeling compelled to fix it. I have learned to enjoy the "hunger is the best sauce" phenomenon, and to wait for the next meal.
(Despite that, I do take people at their word if they say they struggle because they feel unpleasantly hungry all the time. Not fun, and a hard signal to learn to be patient with.)
What I do get is "head-hungry" -- the vague feeling of fuzziness and sluggish mental power that I associate with low blood sugar. It mostly strikes when I've put off breakfast too long, and sometimes in the late afternoon.
Sometimes, to be honest, I think my body creates the feeling on purpose to reverse any weight loss I may have managed. But it is very difficult to resist -- there's this general feeling that I can't think, and I will be able to think if I just have a sandwich. Maybe that is what I get instead of the constant hunger thing, now that I have learned that a growly stomach won't kill me and I can wait a couple of hours to silence it. A new tactic, and a more effective one, since I hate the "can't think" feeling.
And then there are still cravings: the desire to eat when not hungry, or to have seconds and thirds after an already-satisfying plate. It's moderately hard to resist these; I can do it, usually without a great deal of effort, but not effortlessly. And all those little efforts add up to fatigue.
This is the part about working on weight maintenance that has been so frustrating, if not entirely unexpected. It costs. I feel permanently, or at least periodically, diminished. Fuzzy in the head, fatigued from saying "no thank you" to every impulse, chilly enough to put on a sweater, wanting a nap, irritable. I drink more coffee and snap at children. I have to spend some of the time and motivation that could have gone to create, or write, or analyze, or plan -- instead on getting from meal to meal. I feel that weight maintenance has made me slightly stupider.
So, I don't know. Is it worth it?
Probably. I will be more likely to live longer. I can do more things. I look better, and that privileges me in a society that judges people harshly by appearances. But I want to acknowledge the cost. It really does feel like having a medical condition -- a manageable medical condition, but (as anyone with a manageable medical condition knows) just the fact that it must be managed creates a mild disability, diverts resources. The question is, do the benefits outweigh the cost.
The answer to that is not actually obvious. I guess it must be worth it, because that is what I choose to do; even if it isn't a conscious calculation. But by that measure, maybe those who don't keep it off are making the same calculation. Maybe nobody appreciates that in their current condition, maintenance simply costs too much -- too much effort, too much suffering, too much attention, too much time, too much diversion of resources. They have lives, and life itself costs a lot; and when you work all the time, there are joys you miss out on.
I mean, it's also possible that they, and I, are just doing it wrong. Give it time and someone will step up to let me know.
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This was a very interesting read. I've come back to your weight series periodically over several years (although without any implementation on my part). Your systematic approach and discussion on gluttony have both been sobering for me, but I especially trust your writing because of how much emphasis you place on contextualising health and body image concerns within a framework of human dignity and flourishing.
Posted by: Kathgreenwood | 08 May 2016 at 03:13 AM