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Recently, the U.S. Preventative Services Task Force recommended that doctors refer all patients with a body mass index of 30 or more to a program designed to promote weight loss. A successful program, according to the panel, combines counseling sessions with concrete weight-loss goals, nutrition advice, and education on setting limits and recognizing barriers to change.  The recommendation was met with mixed reviews from doctors and politicians involved in the healthcare debate. Some cited it as a “long-overdue” prod to physicians while others acknowledged the additional responsibility it would place on doctors who are already facing time and resource constraints.

What the debate skims over, however, and what may be the most important point is not a single study demonstrates the long-term benefits of an intensive weight loss program for health. This oversight is at the crux of the war on obesity and America’s obsession with weight loss.

One of the central misconceptions fueling the task force’s recommendation is that body weight alone is indicative of health. Many studies have indicated that weight, when viewed in conjunction with other lifestyle habits like exercise, is not related to disease or early death except in the morbidly obese. Other studies point out that equal numbers of thin and fat people exhibit unhealthy eating habits and whether or not those habits become externally apparent is largely determined by genetics. To assume all fat people are unhealthy and all thin people are healthy is prejudicial and does a disservice to both groups.

Another misconception is that everyone who is fat must suffer from some form of disordered eating. In reality many people with a BMI above 30 are healthy adults who exhibit moderate eating and exercise habits. Likewise, many people at a “normal” BMI of 18.5 to 24.9 do display maladaptive eating habits. Using BMI alone as the criteria for admission into a free counseling program both sets the stage for further discrimination against fat people and excludes many “normal” weight individuals who might benefit. In short, It is a grave mistake to assume everyone at a “normal” BMI is making healthy choices and everyone above a “normal” BMI is not.

As part of the initiative, doctors are urged to refer obese individuals to programs where weight loss is the primary goal and benchmark for success. There are many problems with this. First, weight loss programs fail for about 95% of dieters and ultimately cause more health problems from the resulting weight cycles. Second, there is not sufficient evidence linking weight loss with improved health outcomes in the long run, which the task force openly admits but appears to dismiss in another classic case of succumbing to popular culture rhetoric about dieting. The task force states that in some cases, programs include exercise sessions. From an evidence-based perspective, this should be priority number one. Research has shown dramatic improvements in health from exercise alone, and obese but fit people are as healthy as fit people falling within the normal BMI criteria. A focus on weight loss over increased physical activity gives people an inaccurate tool for gauging health.

Dr. Jack Der-Sarkissian notes that more than half of all obese patients are never told they need to lose weight, and that’s just “not fair to the patient.” Hmmm…. Let’s talk about what’s really not fair. It’s not fair that doctors assume all fat people have homogenous eating habits and weight loss is the lifesaving miracle panacea. It’s not fair that doctors assume a fat person is automatically unhealthy and on the flip side, a thin person is healthy. It’s not fair that so many medical problems a fat person encounters are attributed to weight with no further investigation. It’s not fair that people at “normal” weights are rarely offered nutritional advice, diagnostic testing, or counseling because they are assumed to be healthy. It’s not fair that so many people with diagnosable eating disorders do not get the treatment they need because they don’t meet certain weight criteria, while the government wants to the foot the bill for every fat person to a enter a weight loss program.

When will health officials come to realize that both physical and mental health are independent of body size and the people who could actually benefit from counseling fall all along the weight continuum.

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DIET: that dirty four-lettered word that is so ingrained in our national vocabulary that it’s mention is akin to discussing the weather.

“What’s the forecast for tomorrow?” you ask.

“A high of 1200 calories with a slight chance of deprivation.” How gloomy.

Dieting has become as American as baseball and apple pie, that is, as long as you make it a slice of sugar free, fat free pie.

Yet despite how often we talk about dieting, very few actually succeed in losing weight and keeping it off. So why do we persist? Are we all insane, as a popular quote would suggest?

“The definition of insanity is doing the same thing over and over again and expecting different results.”

Or maybe we’ve been bamboozled by an industry that profits off of our failures, an industry that designs a faulty product and then places the blame on the buyer? Today I challenge you all to embark on a different kind of diet: the anti-diet.  Let go of all your complicated food rules and beliefs about “good” and “bad” foods and begin to trust your body to tell you what it wants and needs.

To provide you with some motivation, I’m counting down the top ten reasons to ditch dieting for good.

10. Dieting wrecks havoc on your metabolism.

Dieting slows the metabolism down tremendously, as the body enters what it assumes to be a period of famine. And while fat people who lose large amounts of weight may look similar to a naturally thin person, their bodies are actually behaving more like that of a starving person. In other words, a fat person who loses weight will not acquire the health characteristics of a naturally thin person. On average, the metabolism slows so that a formerly fat person burns about 24% fewer calories per square meter of their body’s surface area than a naturally thin person. By avoiding diets, you can ensure your metabolism is functioning at its optimal level.

9. Your body produces hormones that fight against weight change.

Your body has a natural set point for weight, largely determined by genetics, at which it feels most comfortable. Deviating much beyond this point triggers a cascade of hormones designed to resist further weight fluctuations. These hormones can stimulate or suppress appetite, decrease or increase metabolism, and encourage or discourage activity. Dieting interferes with the mechanisms that regulate set point and makes it difficult to respond to hormonal cues. Much like a broken gas gauge on a car, dieting makes it difficult to tell when the tank is full or running on empty.

8. Dieting can lead to many psychiatric problems.

Here’s a novel idea: your body, as adept as it is at carefully regulating all your bodily systems, cannot tell the difference between a diet and unintentional starvation. And starvation has been shown to cause a lot of psychological problems. In the classic Minnesota Starvation Study, healthy men were put on 1,600 calorie diets with the intention of losing 25% of their body weight. Over the course of the experiment, the men experienced what head researcher Dr. Ancel Keys came to call “semistarvation neurosis.” They became nervous, anxious, withdrawn and overly critical of their appearance and weight. Many exhibited signs of depression, losing their ambitions, interests, sense of humor, and desire for social interaction. They became obsessed with food and many developed odd food rituals. And to think this all happened on 1,600 calories per day. Many popular diets today prescribe much less!

7. Dieting wastes a lot of time and energy.

As noted by a participant in the Minnesota Starvation Study the act of restricting food “made food the most important thing in one’s life.” Whether your counting calories, weighing out just right portions, or dreaming about all the food you wish you could be eating, dieting can quickly become an all-consuming undertaking, often at the expense of other areas of your life. When we deny ourselves food we enjoy in favor of “healthy” foods we dislike, a lot of time gets spent fantasizing about that forbidden food.

6. Dieting robs a lot of the pleasure from eating and can make for more complicated social situations.

Despite what many popular diets lead you to believe, getting pleasure from food does not make you a hedonistic, weak-willed person. Eating can and should be a pleasurable experience. Think about digging into a big stack of fluffy pancakes on a lazy Sunday morning, eating a slice of cake on your Birthday, or clinking champagne glasses with friends and family on New Years Eve. Food is a part of many of social situations, and when your web of complex food rules keeps you sidelined from digging in with everyone else it can be an isolating experience.

5. 95% of dieters regain the weight and then develop a higher weight set point.

Because of the numerous regulatory checks that your body employs, in the end, dieting is more synonymous with weight gain than weight loss. It slows metabolism, increases the body’s efficiency at getting calories from food, increases appetite, decreases activity levels, lowers your body temperature, breaks down muscle tissue, and increases fat storing enzymes. All these checks ensure you are on the fast track to gaining back any lost weight. And because our bodies are programmed to protect us from weight loss but aren’t too concerned with weight gain, they settle at a slightly higher set point than they were previously at. In other words, the same amount of calories you were once eating to maintain weight X are now how many you need to eat to maintain X+10lbs.

4. Dieting and weight cycling causes a lot of the problems that excess weight is blamed for like heart disease, high blood pressure, high cholesterol, and liver damage.

It’s a classic case of what came first, the chicken or the egg? Many people see a correlation between excess weight and disease and assume weight is the cause, when in reality the relationship isn’t so straightforward. What often underlies conditions like heart disease is the damage done to the body by losing and regaining the same weight over and over again, the same cycling that leads to higher set point weights.

3. You don’t need to diet to maintain your body’s healthy weight.

Too many people are under the impression that without constant vigilance the pounds will keep piling on, when in fact, this is far from the truth. A scientist at the University of Vermont, Ethan Sims, conducted an experiment that was the mirror image of the Minnesota Starvation Study. Instead of looking at the effects of calorie restriction, Sims put men on a calorie dense diet. In order increase their weight by 20% above their natural set point the men had to eat as much as 10,000 calories for up to six months time. Sims discovered that the amount of weight the men should have gained based on a simple calories in versus calories out equation was much more than they actually gained. Their bodies fought hard to maintain their natural set point, and at the conclusion of the study they returned to these weight without effort. Your body knows the weight it is healthiest at and will fight you to maintain that weight. Ironically, you have to diet to NOT maintain your healthy weight. Watch a documentary that puts participants through a similar weight gain experiment here.

2. Being thin does not necessarily make you healthier. Moderate activity and healthy, moderate food choices make you healthier.

Fit, active people are much healthier than sedentary individuals, regardless of weight. In fact, fit obese people are healthier than thin sedentary individuals and just as healthy and thin active individuals. When fat people exercise, they reap all the benefits even without an accompanying weight loss. In other words, losing weight will not make one healthy but exercising will. Several studies also indicate that fostering an active lifestyle increases self-confidence and acceptance while dieting often has the opposite effect. Read more.

1. Dieting is NOT about loving and respecting your body.

How many times have your heard someone say (or said yourself) “I’m trying to lose weight because I want to take care of myself?” While the intention is good, dieting is a misguided attempt at promoting health and well-being. Choosing a healthy, varied diet, staying active, and accepting your body in its present state sends a lot more powerful message if you ask me. You wouldn’t tell your partner or your best friend, “I’d love you more if only you were….(fill in the blanks).” So why do we repeatedly tell ourselves this message by trying to lose weight? Love and respect come from an understanding that I am a complete, whole person as I am.

For a great resource on the research behind these reasons check out Big Liberty’s blog. Or pick up a copy of the book Health at Every Size by Linda Bacon, The Obesity Myth by Paul Campos or Rethinking Thin by Gina Kolata.

My 26 week pregnant belly demands food! Lots of food! Okay, so more like an extra 300 calories or so per day, but it sure grumbles loudly with disapproval when it’s been too long in between meals.

I’d like to take you on a culinary adventure, aka, what did Dana eat today. The first thing my refined pregnant pallet got to enjoy today was 75g of pure, orange-flavored glucose. Yummy!

Between weeks 24-28, it is recommended that women take a glucose tolerance test to screen for gestational diabetes. Similar to snorting pixie stixs for breakfast, this test requires you to down 75 grams of sugar on an empty stomach and then just quietly sit around for an hour while you wait for your pancreas to explode release insulin and remove it from your bloodstream.

After that nutritious start to my day, I came home craving protein and promptly consume scrambled eggs with spinach, bell peppers, fresh Parmesan cheese, and a drizzle of olive oil. Protein is of particular importance when pregnant because the amino acids in protein form every cell in your growing baby’s body. Guidelines suggest consuming about 70 grams/day, especially during your second and third trimester when the baby grows the fastest.

My mid-morning snack of choice was a tall nonfat late from Starbucks and a petite vanilla scone. Coming in at 75mg of caffeine it fits nicely within the 200mg of caffeine permitted per a day during pregnancy and is a good start toward getting the recommended 1000-1300mg of calcium. And the scone…I swear I can’t go into Starbucks without getting one, 75 grams of glucose for breakfast or not.

Lunch consisted of whatever I could throw together quickly. A bowl of Trader Joe’s roasted red pepper and tomato soup, a broccoli cheddar lean pocket (because sometimes convenience takes precedence), and some dried mango slices.

Oh yea, and my favorite accompaniment to any meal: prenatal vitamins, DHA/fish oil, and calcium chews. When selecting a prenatal vitamin the two most important ingredients to look for are folic acid (at least 800mcg) for the prevention of neural tube defects and iron (at least 17mg)  for the production of red blood cells and subsequent transport of oxygen. Fish oil, specifically DHA and EPA, is crucial for the neurological development of the baby.

And what goes great with oodles of pills?

Water! Drinking enough water during pregnancy is very important. Besides preventing premature uterine contractions, a nasty side-effect of dehydration, it is needed to replenish your blood, which increases in volume by as much as 40% in some women. Additionally, it helps maintain adequate amounts of amniotic fluid for your baby to splash around in.

My post-workout out mid-afternoon snack for the day consisted of a yogurt and a handful of pistachio nuts. Normally I go for Greek yogurt, but with my digestive system faltering, I was hoping Activia would give it the jump start it needs. Results on that one are pending.

For my husband and me, dinners are always the most elaborate meal of the day. On tonight’s menu was salmon roasted with a dijon and horseradish topping (a recipe I had been wanting to try for awhile), garlic pea pods, red peppers, and potatoes, and a large spinach salad with peanut dressing. My husband isn’t much of a fish guy so whenever I cook salmon I make him an 8oz New York strip steak.

We finished off the meal with fresh, delicious kiwi fruit!

And because this pregnant girl can’t make it through the night without a bedtime snack… I chowed down on some graham crackers and Justins’s chocolate almond butter. Fair warning, Justin’s chocolate almond butter is addictive, and I dare you to try it without ending up spooning it directly from the jar to your mouth.

The key to my pregnancy diet: VARIETY! I try to not eat the same thing two days in a row. Also, eating smaller mini meals more frequently throughout the day has been very helpful in warding off hunger and fatigue and preventing first trimester morning sickness. Have any foods you really craved during pregnancy? Please share!

Worried your pregnancy eating habits are packing on more or less pounds than is considered normal? Here is a great tool from babycenter.com to ensure you are on track: http://www.babycenter.com/pregnancy-weight-gain-estimator. In the end, always talk with your doctor. Every woman’s body is different, as is every pregnancy.

I hate to admit it, but I was wrong.

Back in April of 2010 I wrote a blog entitled “Life, Liberty, and the Pursuit of Fatness” discussing the fat acceptance movement. I questioned its motives, pointed the finger at what I thought were its unreasonable claims, and flat out refused to believe that being fat could be healthy. You see, like most people who have grown up in the “fat is bad” era, when I heard news reports claiming we are drowning in a nationwide obesity crisis (talk about a loaded expression), I jumped on the lifeboat.


It took a good amount of critical research, reading between the lines, and turning a deaf ear to the popular media fat-bashing machine before I would be willing accept the possibility that all my nutritional indoctrination might be wrong. But wrong I was.

A lot of current claims about the obesity crisis are based on misinformation. In 2002, Richard Carmona, the former surgeon general described obesity as “the terror within, a threat that is every bit as real to America as the weapons of mass destruction.” And how could it not be when the Center for Disease Control reported that more than 400,000 Americans die from being overweight or obese? This shocking statistic became the headline for thousands of popular media articles and pumped millions of dollars into scientific research aimed at curing obesity.

But in 2005, an updated report from the CDC acknowledged that the previous analysis suffered from computation errors and reduced the estimate fifteen-fold, taking the 400,000 deaths down to 26,000. Further separating “overweight” and “obese” individuals from “extremely obese” individuals (BMI over 35) decreases the number even more, as most deaths are clustered in the BMI over 35 category. When “overweight” individuals (BMI 25-30) are compared to “normal” weight individuals (BMI 18.5-24) an even more interesting statistic surfaces. Overweight individuals actually live longer than normal weight people.

Research from a Canadian national health survey following more than 11,000 adults looked at the relationship between BMI and longevity. Compared to people who fell into the normal-weight category:

– Those classified as underweight were 73% MORE likely to die
– Those classified as extremely obese were 36% MORE likely to die
– Those classified as obese had about the SAME risk of death
– Those classified as overweight were 17% LESS likely to die

Eric Oliver, a political scientist at the University of Chicago says the obesity epidemic is really “a relatively small group of scientists and doctors, many directly funded by the weight loss industry, (who) have created an arbitrary and unscientific definition of overweight and obesity. They have inflated claims and distorted statistics on the consequences of our growing weights, and they have largely ignored the complicated health realities associated with being fat.”

“So what?” you may be thinking. “Just because people are living longer doesn’t mean they are living healthier lives. Everyone knows fat people are unhealthy.”


While weight is a causal factor in a couple diseases, say osteoarthritis or sleep apnea, there isn’t much evidence that excess body fat itself causes disease. Instead other variables might be at play. For example, most overweight individuals report weight cycling at some point during their lives. A single weight cycle, think a failed crash diet, has been shown to damage blood vessels and increase the risk for cardiovascular disease. Rat studies indicate that obese rats that have weight cycled have very high blood pressures compared to rats that have maintained a consistent weight.

Additionally, there is a weak association among obesity and hypertension in cultures where dieting is uncommon. Could the “cure” for hypertension actually be the “cause?”

Research also finds that overweight people report feeling more stress and anxiety, both of which are a risk factor for diabetes and cardiovascular disease. In countries where there is less stigma attached to weight, overweight individuals are not prone to the same diseases associated with obesity in the United States. Additionally, when researchers looked at a group of more than 170,000 U.S. adults, they found the differences between actual weight and perceived ideal weight was a better indicator of mental and physical health than BMI. In other words, feeling fat has a stronger implication for health than being fat.

Research indicates that activity level, combined with other lifestyle choices like sleep and social habits, are more related to health than body fat percentage. For example, one study found that obese men classified as “fit” based on a treadmill test have similar death rates as lean men classified as “fit.” The obese fit men actually had death rates one-half those of the lean but unfit men.

What about type 2 diabetes? This disease, characterized by a reduced sensitivity to insulin, is much more common among obese individuals, and thus, obesity is often blamed for its emergence. But is it possible that insulin resistance causes obesity? In this classic which came first scenario, research suggests that high levels of insulin appear before weight gain in future diabetics.  This finding is consistent with the “thrifty genotype” theory, which views insulin resistance as a helpful adaptation for storing more fat during times of famine. Because fat cells do not develop insulin resistance as readily as other cells, they allow glucose and nutrients to enter, promoting excess fat storage and weight gain. The added weight gain further increases insulin resistance and the cycle continues. So is weight loss the answer?

I’ll give you a second to guess what my answer is going to be (cue the Jeopardy music).

What is a resounding NO!?! A review of controlled weight loss studies for type 2 diabetes shows that initial improvements were short-lived, and study participants returned to their starting values within eighteen months, even when they maintained their weight loss. In another study, women who underwent liposuction resulting in an average loss of twenty pounds of body fat did not show improvements in insulin sensitivity. What have been shown to improve diabetes time and time again are changes in nutrition and increased activity, even without any resulting weight loss.

What’s most unfortunate about our culture’s association between body size and health is that it paves the way for fat bashing, prejudice, and discrimination. We demonize fat, and as a result, view the people carrying it around as vessels for evil. In our quest to cure obesity, we ostracize a segment of the population. We confer them with labels like lazy, sick, bad, stupid, and unhealthy. We spend so much time trying to rid the world of “fatties” that we lose sight of what is really important: health. If we could refocus our attention on finding health at any and every size, and let go of the notion that only “average” or “normal” weight people can be healthy we could start to see actual improvements in blood pressure, cholesterol, diabetes, and a slew of other conditions previously linked primarily with weight.

In the end, by focusing so much on weight, we are preventing people from finding what every weight-loss venture promises to deliver: a long, happy, and healthy life.

Note: For further reading please check out the book Health and Every Size by Linda Bacon or refer to her blog at www.healthateverysizeblog.wordpress.com. Another great resource that promotes health and every size is thefatnutritionist.com. If you would like more information on the research I am referencing please comment or send me a message.

I’m minding my own business at the gym the other day, happily meandering around the weight room when one of the “fitness consultants” approaches.

(How bad-ass I imagine I look) Source

“Hey, you’ve been working out here for awhile now, but I don’t think I’ve ever learned your name,” he says casually. Hmmmm, I think to myself, it’s probably because I have no desire for you to know my name. My antisocial, just leave me alone and let me work out in peace attitude starts to surface.

“I’m Dana,” I politely respond stifling my inner bitchiness.

“Hi Dana, I’m Jeff**.” He extends his hand. You really want to shake my hand right now? Can you not see how sweaty I am? I politely shake his hand, intending to end our little exchange and get back to lifting. But Jeff persists, “I can’t help but notice you look like you’re losing some of the definition in your stomach. If you want to set up a session with me I can show you a great workout to tighten that area up.”

I glare at Jeff with my “I can’t believe you just said that, I’m ready to go all psycho on you and rip your head off” eyes. He doesn’t seem phased. I muster up the gumption to interject but Jeff continues.

“A lot of women notice that has they get older (excuse me, when has 27 ever been classified as old?) it’s easier to accumulate fat around the midsection. But if we go over your diet and exercise plan I’m guessing there are some simple changes we can make to keep that from happening.”

Can your diet and exercise plan remove this baby from my midsection? I’m sure that would tighten things up quite a bit you ass. I almost say this out loud, but I decide to let him continue knowing that once I do reveal I am pregnant, not just the fatty he is implying I am, he will feel like an even bigger ass. Sometimes I can be a little evil.

Jeff continues on about the importance of high intensity interval training for fat burning and avoiding sugar because it turns to fat. “Do you want to go downstairs with me for a consultation?” he asks. “We can get some baseline measurements for weight and waist size. Give me four sessions and I’ll bet we can knock a whole inch off your waist and 5lbs off the scale.” Do these aggressive, make you feel like shit tactics really work on most women?

Source

I finally decide to spare Jeff any further humiliation, plus he set himself with that last statement. “Well Jeff,” I say “I don’t think my doctor would approve of me losing 5lbs right now, but if you want to wait until mid July, I’d be more than happy to drop say 6-8lbs all in one day and you can take full credit, although my husband might not like that.” I’m relishing in the confused look on his face. I wait long enough for there be that cinematic, dramatic pause. “Yea, I’m 19 weeks pregnant.”

A flash of understanding crosses his eyes, and I’m expecting him to apologize and wander off to find some other girl with an expanding midsection to torture. But instead Jeff surprises me. “Oh, you didn’t really look pregnant.” He laughs a little too confidently. “In that case, definitely look me up later in the summer and I can help you get off all that baby weight.” I cannot believe this guy. Oh Jeff, yes of course the first thing my former anorexic midsection wants to do after giving birth is come find you to be ridiculed and shamed. It would be the start of such a beautiful relationship.

I desperately search for something snarky to say, but in the end all I can think of is “no thanks,” and I walk away.

The world is full of people like Jeff: well intended but clueless. They make comments that lead you to question your self-worth, your beliefs, and your inherent goodness and beauty. They’re ready with a snap judgment or inappropriate remark that can bring you down even when you’re feeling on top of the world. You can’t avoid them because they’re everywhere. And unfortunately, despite my desire to mark this Jeff with a big, flashing neon sign that read Unintentional Jerk, they don’t come with any warning label or exterior sign of inner thoughtlessness.

The best remedy for a Jeff is to educate and move on. If you’re feeling brazen enough (which I was not at the time) tell him or her that, while you’re too confident to be brought down by their comment, other people not as tough as yourself might find it hurtful. Your advice might register with them, but since I don’t call them “clueless” without reason, it probably won’t. In that case, just walk away. Everyone views the world and the people in it through a unique lens. The way one person sees you does not truthfully reflect who you are as a person. It only reflects who you are through the personal experiences and biases of the person looking. Work on creating the most favorable, forgiving, and loving lens through which to view yourself. In the end, that’s the only perspective that really matters.

In the meantime, if anyone does come up with a good “jerk tagging” system, please let me know. I’ll spearhead the campaign!

**Name has been changed to protect the identity of said fitness consultant (you’ll see why he needs protection in a moment).

The shirt I contemplated buying but decided it wasn’t worth spending $20 to flaunt my insecurity:

Source

In the classic tale of the tortoise and the hare, the slow-going tortoise crosses the finish line ahead of the speedy but arrogant hare. “Slow but steady,” the tortoise says. By adopting that mantra in the race to lose weight, you are not only guaranteeing that you cross the finish with energy to spare and your vital organs in tact (more on that later), you are preventing yourself from having to rerun the same course over and over again.  Approaching weight loss more like a marathon instead of a sprint to one’s goal weight is the ideal way to ensure your body maintains optimal functioning.

One of the prime examples that comes to mind when I think of fast weight loss is the NBC reality show The Biggest Loser. Contestants vie for a chance to win $250,000 by adopting very low calorie diets and engaging in grueling 6-8 hour long workouts (all under doctor supervision of course), all in the hopes of dropping the largest percentage of their body weight and being crowned the Biggest Loser. What the viewing audience doesn’t see is that in addition to the money, every contestant walks away with another prize: a significantly slower metabolism. Maybe they should rename the show the Biggest Metabolic Loser?

In an abstract presented at the most recent Obesity Society Annual Scientific Assembly, Darcy Johannsen and friends reported that by week 6 Biggest Loser participants had lost 13% of their body weight and by week 30, 39%. More interestingly they reported that by week 6 participants metabolisms had slowed by 244 more calories per day than would have been expected by their weight loss and by week 30, by 504 more calories. (Source: WeightyMatters)

The term for what is happening is called metabolic adaptation, and under normal circumstances, it’s a great survival mechanism. Back when our ancestors had to go prolonged periods of time without substantial amounts of food, a slowed metabolism ensured survival. Today, when food is bountiful, it’s not quite as useful. What’s interesting to note is that this phenomenon does not occur when weight loss occurs at a rate of 1-2 lbs per a week, the amount recommended by MayoClinic.com medicine specialist Dr. Donald Hensrud.

These results have been replicated in studies with rats. In a laboratory study using rats that are prone to gaining weight (think your average person with a genetic predisposition to obesity), rats on a severely calorie restricted diet showed significant reductions in metabolic rate, measured as both 24-hour energy expenditure and sleeping metabolic rate. Eight weeks after returning to a normal feeding schedule, the metabolic slow-down persisted, thus setting the rats up to regain much of the lost weight. Sound familiar?

In addition to a damaged metabolism, side effects of extreme dieting include dizziness, fatigue, irritability, hair loss, malnutrition, muscle loss, and even in some cases diabetes. On a sufficient number of calories, most adults can get the recommended daily allowance of vitamins and minerals assuming they are choosing carrots over candy 90% of the time. With a sever calorie restriction, however, it is very difficult to get all of the essential nutrients, snowballing into many of the other accompanying problems. Take hair loss for example. Without adequate amounts of protein a condition know as Telogen effluvium, or the loss of more than half the hair on your head, can occur.

Who’s up for skinny and bald? I suppose Brittany Spears pulled it off.

Rapid weight loss can cause major fluctuations in blood sugar levels. A 1996 study in the “Journal of Diabetes and Its Complications” indicates that patients who lost weight very quickly developed diabetes most likely as a result of swings in blood sugar levels and stress hormones.** Additionally, when the body depletes its glycogen (blood sugar) stores it begins to fuel itself by breaking down muscle tissue, not fat. Dr. Linda Bacon points out that yo-yo crash dieting can eventually lead to heart muscle loss. It damages your blood vessels and causes micro tears that create a setup for atherosclerosis and other types of heart disease.

If you are in need of losing weight please consult your doctor or a nutritionist to learn the proper way to go about doing it. Become the tortoise in the race to lose weight and go about it slow and steady. Because in the end, even if you don’t win the race to fit into your bikini come this summer, you’ll win a much better prize: long term health.

**Small sample size and in need of replication. If you find another study that shows similar results I would be interested in hearing about it.

“Expect to gain 25-30 lbs over the next 30 weeks,” the doctor said. “Really,” she paused to chuckle “after week 20 it’s going to be hard not to gain a pound a week.”

Those words sound eerily familiar. Almost eleven years ago, I was sitting inside another doctor’s office, albeit one filled with a plush “tell me all your problems” couch and a box of tissues instead of an exam table and lubricating gel, but the message was the same. “Our goal is for you to gain about 30 lbs over the next 3 months, say about 2 pounds a week.” My reaction eleven years ago: I burst into tears, hide my face in an oversized sweatshirt, and silently promise to myself that I will do no such thing. My reaction one week ago: the most nonchalant “okay, sounds good” you can imagine. My how far I’ve come.

Before my husband and I even discussed children, long before I even knew if I wanted kids at all, I was convinced I could not have them. With the slightest mention of babies or grandkids, I would ardently declare, much to mother’s dismay, “I’m never having children…EVER!” Even though I knew it was something I wanted, my fear that I would not be able to have them overtook any optimism and faith I could muster. After years of damaging my body and depriving it of the essentials it needed to develop, how would it have the energy or vitality to create another life? I viewed myself as damaged goods, as irreparable. I labeled my body as defective, and decided I deserved whatever was coming to me. My mind was ready to accept defeat; my body on the other hand, was not.

When I begrudgingly took the first home pregnancy test, I thought I was being paranoid. When the test came back positive I assumed it was defective. When the second came back positive, I believed the whole box to be defective. When, two months later, I looked at the ultrasound monitor and saw our baby for the first time, I was still in disbelief. I was convinced that the image on the screen would display an empty nothingness, but instead, I saw wiggling arms and legs, a defined head, a body, and a heart that was beating despite all my fears and doubts.

Now, I feel like the ambassador, like the protector of this new life growing inside me. I can’t officially claim the title of “mother” yet, but my maternal instincts have kicked into high gear. “What’s that ghost of an eating disorder? You don’t like the idea of gaining weight, of putting someone else’s health and well being above your desire to restrict, to binge, to purge? Well guess what, I don’t care.” It’s interesting how easy it is now to shut off the voices in my head that belittle and try to convince me my worth is only skin-deep. It was so difficult when I was only standing up for myself, but now I’m standing up for two, and like the saying goes, strength comes in numbers.

I’m not going to lie; I am terrified of becoming a mom. I’m terrified of the power I will soon wield over another person’s life. I’m terrified of the responsibility to nurture, strengthen, inspire, teach, motivate, and love and on the flip-side, the potential to destroy, letdown, scar, and demoralize. I instantly want to protect this baby from every future hardship, from scraped knees to broken hearts, but I know that those are the trials I can’t control once he or she enters the world. But right now, while he’s still just a small fig-sized** baby inside me, I do have the power to protect him. And protecting him from the backlash of my neglected, kicked-to-the-curb eating disorder voice is the least I can do.

Today, at eleven weeks 2 days pregnant, when I look at the small image of the baby hanging on our refrigerator, I’m truly amazed. My body has done what my mind perceived to be impossible: it has healed.

**Thank you babycenter.com for all your fruit and vegetable references. Although, I had to wait until week 11 to post this because normal people don’t know what your week 10 fruit, a kumquat, looks like.

Lose 10lbs in 10 days! Drop the weight while eating whatever you want! Watch the fat instantly melt off! Fit into a smaller size by jumping around on one foot, in the rain, while holding a lemon and chanting “I will be skinny!” Okay so I made that last one up, but is it really any more ridiculous than the others when you think about it?

Fad diets promising miraculous (read impossible) weight loss have been around for decades, circulating through popular culture in a fairly cyclical patter. The Master Cleanse diet developed in the 1930s resurfaced in the 2000s, the Cabbage Soup diet from the 1960s came back during the 1990s, and the diet pill trend from the 1970s, well that one we just can’t seem to shake. So why are well-educated, intelligent women still buying into the empty promises advertised by the latest diet craze?

For starters, as consumer-savvy as the modern woman is, the marketing and sales teams behind the most popular diets are just as savvy. They feed off of frustrated dieter’s desperation to lose weight quickly in a society built around instant gratification. They proliferate false scientific information and disguise pseudoscience as infallible evidence in support of their diets. Take the popular grapefruit diet for example. It purports that grapefruits contain an ingredient that promotes fat burning, however, this claim has never been indicated by any scientific research. Can dieters lose weight on the grapefruit diet? Of course, but not for the publicized reason. The grapefruit diet is nothing more than a low calorie, high protein diet, and weight loss will likely result with or without the addition of the magic grapefruit.

This brings up another reason why so many women buy into the diet’s propaganda: they do work, at least initially. Whether it’s the negative calorie diet, the apple cider vinegar diet, or the cabbage soup diet, most fad diets reduce calorie intake enough to cause weight loss, spawning thousands of testimonials and anecdotal evidence for the diet’s validity. Unfortunately, while those who succeed initially are eager to share their triumphs with the world wide web, most disappear into the background once the diet is no longer working.

Because fad diets recommend such a limited calorie intake and a limited variety of food, they are unsustainable in the long run. Whether it’s food boredom or the body’s survival mechanisms kicking in, fad diets take a physical and mental toll on the dieter. Because the diets do not usually meet the recommended levels of micro or macronutrients, they can lead to hormone imbalances, headaches, digestive problems, fatigue, mental confusion, and even cardiac problems in severe cases. Fad diets are not about teaching healthy lifestyle changes or proper nutrition and exercise habits. The focus is on fast weight loss, no matter how unsafe. And unfortunately, when weight loss occurs that quickly it’s mostly lean muscle mass and water that are lost, not fat.

The fact that people don’t stick with fad diets is not news. If a fad diet actually worked, everyone would be doing it and there wouldn’t be the dozens of diets you see on the market. But just how large is that market? According to the FTC, Americans spend close to $34 billion a year on diet products. In order for the industry to grow that large, industry executives depend on dieters jumping on and off the different bandwagons. In other words, the diet industry wants you to fail. Fad diets create what I’m calling the Weight Loss Rollercoaster or the Vicious Cycle of Weight Loss. It goes something like this: (note the high-quality graphics I came up with in PowerPoint)

People are lured into a new diet with high hopes that this time it will be different. Initial weight loss occurs because of calorie reduction, not the advertised magic cure. The diet becomes unsustainable because the body is deprived. People fall off the dieting wagon with a slowed metabolism and binge impulses resulting from severe restriction. Lost weight is regained plus some more. Feelings of guilt and shame surface because  dieters feel responsible for the failure. And then we are back where we started with people being lured into a new diet with high hopes that this time it will be different. But it wont’ be.

So how do dieting veterans break out of this cycle? At some point you have to admit that there is not a quick fix, a magic pill, or a secret recipe for weight loss. If you are overweight, chances are it took you awhile to get that way, and likewise, it will take you awhile to get the weight off in a healthy way. I believe that the first step to adopting a healthy approach to weight loss is to accept the body you are in right now, perceived flaws and all. Learn to love who you are, nurture a deep respect for what your body can do, and then make small sustainable changes that lead you to a healthier life. Don’t focus on weight loss, fixate on a certain number on the scale or a size of clothes you wish to wear. Concentrate your efforts on being healthier all around and likely weight loss will follow. While this is much easier said then done, if you can take that first step to recognize the limitations of fad diets and put the blame for failure where it belongs (on the industry), you will be one step closer to ending the struggle.

Take it from a former dieting expert, there are usually only two ways a fad diet can end: failure and frustration when you give up, or disordered eating when you succeed.

Have you ever tried a fad diet? What was your experience like?

I broke my foot exactly 1 month ago, and with it, all my dreams of losing too much weight, overdoing it at the gym, and once again reclaiming my eating disorder glory. Let me explain.

About 2 months ago, I stumbled upon the website sparkpeople.com. Much like diet and exercise trackers I’ve used in the past, it allows you to set a goal weight and a day at which you would like to achieve said goal weight and POOF…. it pumps out a daily calorie allowance and suggested exercise program.

The fact that I searched out this website to begin with says something about my general mental well-being. I’ve been struggling a lot lately with grieving the end, or death if you want to sound more poetic, of my anorexia. I’ve been struggling to fill the void it’s absence has created. At one point in my life eating disordered behaviors could be the answer to almost any question or problem. Feeling bored? Turn to ED. Feeling stressed? Turn to ED. Feeling overwhelmed? Turn to ED. Feeling angry? Turn to ED. You get the idea. Lately, I’ve had to admit to myself that anorexia is no longer my coping method of choice. I’ve had to admit that even if I wished to develop anorexia again, I don’t think I could. Just as much as I didn’t control its onset the first time around, I can’t magically will it into being now. And all that makes me sad.

I liked having an “easy” answer to all life’s problems. I don’t like having to deal with issues in a mature, adult way. I don’t like having to look for alternative coping mechanisms, or what most often happens, not cope at all. Over the past year I have fallen into quite a depressed state, and without my fixation on weight loss, or the sense of accomplishment I get from sticking to a diet, I’ve been hanging out at the bottom of this dark hole for quite some time.

Enter sparkpeople.com. I became hooked on its community based approach to weight loss and point system very quickly. I loved entering my food for the day and seeing the ticker land right between my designated calorie allowance. I loved watching the calories burned bar far surpass the calories consumed bar. I especially loved watching the slope of the line graph indicating weight steadily become steeper and steeper.

In about 1 month’s time I had lost 7 pounds. The depression was starting to lift, and I was feeling on top of the world. I was feeling like a somebody instead of a nobody. And then in a seemingly innocuous fall while playing tennis I broke the base of my 5th metatarsal (aka: a Jones fracture for all you medically minded people). The moment I heard the doctor say it was broken I knew my weight loss plans were over. The tides had been turned and I was bearing straight toward a sea of home alone binges, uncontrollable crying sessions and irrational, nearly suicidal thoughts.

It’s always been that way with me. The moment my plans are disrupted I can no longer stay on course. In effect, I do a complete 180. It’s my all or nothing mentality at its finest. And sitting on that cold, paper-lined hospital table I knew it all too well. I started to cry, not because my foot was broken, but because I knew that meant I was heading into a period of compulsive overeating, purging, and depression. And despite having complete awareness over what was happening, I had no control.

It’s been one month since that accident, my foot is still cast bound, and my follow-up appointment isn’t until September 6. I’ve completely abandoned my sparkpeople account, except for the rare occasion when I wake up committed to track for the day and make it through lunch. Those half days only make me feel bad when I look back over them…reminders of my failure. I’ve tried telling myself that this broken foot was a relapse intervention; it was some higher power’s way of telling me to cut it out. Or it could have been the universe’s way of showing me just how ill equipped I am at overcoming obstacles, how little drive and perseverance I have.

Despite the cast, I still make it to the gym 3-4 times a week, my weight is “only” up about 2 pounds, and I’m managing to eat a more balanced diet than I normally would were I in a typical binge and purge period. I’m hoping once the cast comes off and I get the go ahead to apply weight I can flip the switch again and get back into tracking and out of this funk. I know I should hope for a future that isn’t centered around any extreme eating and exercise behavior, but frankly, I have a hard time imagining what that would look like.

Because it is the thing that makes me most miserable that I also need to find any joy at all.

October 2011 Update: I am completely managing all eating disorder behaviors and have taken this incident as an opportunity to deal with some of the latent emotions I have surrounding the “death” of my eating disorder.

Back when my eating disorder was the dominant force in my life, I was ready to punch the next person that told me “fat is not a feeling.” I used to get into this debate with my therapist all the time. It went something like this.

Dana: I hate the way I look; none of my clothes fit anymore. I feel so fat.

Therapist: Your weight gain is right on target; no need to worry. And remember Dana, fat is not a feeling. Why don’t you tell me what you really feel: sad, frustrated, scared?

Dana: I feel like I want to punch you (is what I should have said). I don’t know (is more likely what I did say).

Therapist: Fat is a physical state; and you either are or are not fat. You need to ignore your own perception and trust me when I tell you that you are not fat.

Dana: Yes but fat is also a relative term. I feel fat now compared to what I once weighed. Therefore, relatively I feel fat.

Flash forward 10 years, and I weigh in at about 50 pounds heavier than when I previously felt “fat.” The interesting note: I have lots of days when instead of feeling “fat” I feel “normal” or “healthy.” So what’s changed? Most notably it is my perception of what is considered healthy in addition to the fact that I no longer need to use my body nor my weight as a tool for self-expression. I now recognize anorexia for what it is: a disease that distorts perceptions. I recognize extreme thinness as a symptom of the disorder. In the past, I didn’t even recognize my physical condition as a problem that needed correcting. I was healthy I thought, my life was under control and my body reflected that. If I were to gain weight, to give up the disorder, all the calm feelings would leave and my life would be in chaos.

Today I see my body less as a statement of how I am feeling and more as a source of strength, a vehicle to get me to where I am going, and only a small fraction of who I am as a person. With so many more things defining my life, I don’t rely on my body to determine my self-esteem or self-worth or to serve as a temporary fix. Today when I feel “fat” I know it’s because something else in my life is grating on my patience and my body becomes an easy target for expressing my dissatisfaction.

As much as I hate to say it, my therapist was probably right. By calling myself fat and focusing on my appearance I avoided the real issue, which often felt out of my control or too large to tackle. Losing 5 pounds, that I could handle. Resolving the anger and sadness that were building in my head, not quite as easy. Luckily I realize all this now and can act as stand in therapist when the girl I see in the mirror starts to tell me I feel fat. I now look at her and repeat: “fat isn’t a feeling Dana, why not try telling me how you really feel.”

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