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."
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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.
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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?
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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.
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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.
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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.
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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.
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