Thursday, September 4

Fat Forever?

You know, things in the lowcarb and weightloss categories have been coming up with me, that I haven't known how to blog about. In part because they are not those happy-joy encouraging, positive things. And in part because I don't really have an answer to anything, I'm just speculating. Let me go ahead and speculate on-blog-paper. Maybe other people have thought about similar issues. Feel welcome to comment because I'd really like other peoples' input on this difficult subject.

I have observed the last few months that I can eat really well, and I'm not losing weight. Or when I do, it's a very small amount over a rather long period of time. I can eat badly, and gain water weight, or actually lose weight on the scale, which is unintuitive, seems quite unfair, is even maddening. Long-term, yes, eating too many carbs drives my weight up, through the water/glycol storage if nothing else. But short term, it often drops the weight several pounds. Maybe because less protein means degraded LBM? God only knows. I can only tell you that the scale does not seem to adequately reflect my eating behavior in the short term. This is the case for other people I know who are about the same size as me, coming from a similar high weight as me.

And for the long term, eating badly will see the numbers rise, but eating well is not seeing them fall. Low calorie. High calorie. Moderate calorie. Low carb. High carb. Moderate carb. Vegetables. No vegetables. High fat. Low fat. With Gluten. Without it. With dairy. Without it. I admit I have not obsessively pursued every one of these, but there should be some vicarious experience here: I have friends online who have pursued many things I haven't, are about the same size with the same history, and facing the same issues.

Now, as a friend recently pointed out, lowcarb has its own near-religious devotion. People will insist that since lowcarb is The Answer™, surely you must be doing something "wrong". You must be having too many carbs... too many calories... you should be doing Intermittant Fasting (IF)... you should be doing High-Fat... you should be doing Low-Fat... you should be adding in Coconut Oil... you should be avoiding dairy... the list goes on.

When I see someone suggest that gosh, maybe "carbs are creeping," I swear I want to punch them in the head. What kind of arrogant denial-of-my-reality crap is that? Put this in the category of "you're fat so you must be retarded." YES it's one of MANY possibilities for people not paying attention, but if I were not paying attention to what the hell I was eating, why would I be complaining that I'm living on X or Z and not losing weight? Or not at any speed that verges on 'reasonable' given the levels of restriction on food intake?

I think this is denying reality. The reality is that there is not much research on morbidly obese people who lose weight via lowcarb. We don't actually KNOW what is "supposed" to happen, what can, what should, what will, or what factors might affect bodies with this history much moreso than bodies which have had "lesser degrees" of it.

It is entirely possible that peoples' bodies vary in terms of what amount of weight they are willing to lose -- or at what rate, with what 'rest for homeostasis' periods in between -- just like metabolism varies. And it is entirely possible that when you start out 500 pounds, you are never going to be thin. BUT: most of us already accept this. "Maybe I'll never be thin again," but most of us do NOT accept that the weight we WILL be, will be 350 pounds. I mean that sounds completely unreasonable right? How could that possibly be a 'proper' weight?

Surely if you just did X, or Y, or Z, the weight would come off until some number we "like better" arrives, e.g., ok maybe you'll never be thin but you might be 30-40 lbs above your ideal weight. What if that is Just. Not. True. ?? What if the body EVER getting to 500# means that it is going to willingly go to around 350-380 and then "sit there" in homeostasis for eons, no matter WHAT you do, and then gradually get a LITTLE bit lower later? What if 300# is your 'thin weight'?

My point is, nobody knows! We act like it's a known, but it's not. There just isn't really research on this stuff. Most the people who've lost "a lot" of weight have lost like 100-150#. We know people can do this and at the end of that be a 'reasonable' weight, but they still have a lot of issues related to their former obesity, from vastly lower metabolism, lower leptin levels, higher hunger compared to people the same weight, need to eat fewer calories to stay the same weight as other people who didn't used to be fat, and so on.

Well, me and friends have lost that much weight, but some of us at the other end of that are still fat. And the 'additional' weight, unlike the first 100-150 lbs, is simply not coming off in any mathematically reasonable way. Not that any of it is mathematically reasonable--because metabolism is chemistry, not math--but it's really quite unreasonable according to our belief systems.

In a previous blog post I quoted Dr. Jeffrey M. Friedman, head of the Laboratory of Molecular Genetics at Rockefeller University. Here's a couple of 'reminder' quotes:

So let me put a finer point on this. Imagine you’re 250 pounds. and you lose 100 lbs. to 150 lbs. Now you ask how many calories does that person burn compared to someone who started out at 150 pounds.They burn like 300 or 400 calories fewer per day when they’re at that reduced weight. Now think about it. That person is hungry and now can only eat fewer calories than the equal weight person to maintain that weight, despite the fact that they weigh the same amount.


Dr. Jeffrey Friedman (regarding post-weight loss surgery): …there’s another feature of this surgery that people, I think, ignore, and it’s this: when you do this procedure you limit the intake of a person to about 700 calories a day. Just so you know, none of you could consume 700 calories a day for very long; it is a very small number of calories. Despite that fact, these people still end up being clinically obese at the other end of the procedure. They lose a lot of weight but they would still on average be definable as significantly obese on average after the procedure.

Now think about it, they’re eating 700 calories a day and they’re still obese. I mean if that doesn’t say that there’s something metabolically different about the obese than the lean, I don’t know what does.

Maybe the reality is that I need to live on green veggies and meat and nothing else for about 3 months, for every 1-5 lbs of weight I want to lose. Maybe this is just the way it is. Do I want to lose 1-5 lbs? Sure. Do I think that losing 12-60# in a year would still be worth it? I sure do. Do I think that I can live on an insanely restrictive eating plan for the next several years in the hope that I might someday, and this even assumes the current trend doesn't get worse, I might someday get somewhere NEAR a normal weight? Or maybe only get 100# lower, which would be awesome, but I'd still be morbidly obese?

I'm not sure. In all honesty, I am not sure. I am sure that I can eat generally low-carb -- if we consider ~100 or less carbs a day to be lowcarb, no problem. I can eat gluten-free, that's a bigger problem but do-able. I can avoid junkfood, processed foods, for the most part, that's not that big a deal. But I am not sure that I can avoid every molecule of less than perfect food forever while "waiting for" my body to decide to lose a little more weight.

It is ticking me off that when I eat well, the scale isn't really moving. One reason is because some people look at me as an example, since I'm a blogger so in public. They might be obese too, and see my success so far with weight loss as inspiration. So what the hell do I say now? Why have I stayed in the 350-380 zone (varying) for so long? Why does eating well not seem to drop my weight? When I began lowcarb, even accounting for water/glycol loss, merely keeping my carbs fairly low resulted in super rapid weight loss. Now it seems like very little works to bring about weight loss at ANY speed let alone 'rapidly'.

Now as a caveat to all this I will make one admission: I have not eaten, for "the long term" (meaning a solid 40+ days), according to the "nutritionally complete" eating plan that Regina Wilshire would recommend. In other words I have not gone greatly out of my way to get every vitamin and mineral and nutrient that the body probably thinks it needs, as part of my eating plan. It IS possible that the body is refusing to lose weight that it might agree to, with a more nutritionally complete eating plan.

So far, I have simply been incompetent on this issue. My eating habits have changed so radically the last two years it's absolutely amazing. I eat better than most of planet earth, most of the time anyway. I am on the verge of being a 'whole foods' person (not raw, not vegetarian, but not processed either), with a couple of condiment/sauce exceptions. I eat fewer carbs AND calories than people 1/3 my size. I don't lose weight.

If I up my calories and make SURE I am getting at least 2000 per day, I may lose weight verrrrrrrrry slowly. If I up my protein, I can stay with that. If my protein is not at least 100+g per day, I will eventually be driven by biology to eat higher carbs because my body isn't getting enough protein/amino. So that makes eating ~120g protein/2000cal per day absolutely required. Yet even when I succeed at that (I chronically fall short; I seldom go over--it's just not easy to eat that much protein and still be high-calorie frankly), the weight loss is amazingly slow.

Some bodybuilders think that you cannot deprive your body of more than 300-500 calories MAX a day from whatever your BMR--and it might vary per day and depending on nutrients--and lose weight. They think if you go below that number your body shifts into starvation mode instead of weight loss. The exception being some very obese people and only initially. This would suggest that the only way to lose 'additional' per-day would be to add weightlifting, so the body was reducing insulin resistance, and adding lean muscle mass. Of course when you are body building you generally need to add a few more carbs and calories for other reasons.

But I will admit, that along with Regina's nutrient-dense approach, weightlifting with calorie observation has not been something I have seriously done for 40+ days in order to carefully measure the results.

So I haven't tried 'everything'. Maybe this means I have no right to complain.

But you know what--I'm not alone. Lots of people I know are in a similar situation to me. Some are much smaller. Some larger. All have tried a LOT of different options food-wise. And the fact seems to be that eating plan alone, AFTER a certain amount of weight loss, is simply not the 'solution' to obesity.

Maybe it requires hard core nutrition too. Maybe it requires weight lifting too. Maybe it requires prayer and work on 'belief systems'. Who knows.

I only know that what I have been doing IS NOT WORKING.

So until I get to the point of doing one of the two things I have not yet successfully maintained for any length of time, I feel like I have no real point to blogging about progress.

I feel guilty for not losing weight more rapidly. Like I am letting down people who are watching me. Like people might suspect I'm lying about something. Like it might make lowcarb, which I genuinely believe in particularly for my body, look bad.

What I don't know is if maybe I'm wasting my time. Maybe my body is always going to be enormous. Maybe if we had research it would say, "You screwed it up, it is never getting much better." If I knew that, at least I wouldn't feel so guilty about it!



KMG said...

Ugh. You have my sympathies.

I was whining about something similar the other day. I actually DID live on nothing but meat and green veggies for a month. It was agonizing and I hated it, but I did it for the chance of getting well again. It didn't have any significant effect. I sat there crying going "What more can I do? There's nothing left to give up! Am I just destined to be sick all the time?"

All I can say is that in my own experience, a body can be so out-of-whack and flat-out POISONED that it's too exhausted to return to normal levels. It's a Herculean effort that requires food it can't metabolize. Right now, I'm doing all I can to rule out various causes, and if nothing remains, I'll go back to the best I know how. It's not great. In fact, 90% of everyone I know would run screaming. But if that's the best I have, then fuck it, I'll do it and know that I gave my best.

I could sit here and say "Well have you tried this?" (I do have ideas!) but I don't know if that's what you want, particularly from someone who isn't suffering from obesity. There's nothing worse - and I know from experience - than some yokel yammering about how you should see Health Practitioner #902 who Really Helped His Friend, like you've been sitting there twiddling your thumbs for the past 3 years.

You're not wrong for expressing how this makes you feel.

Complex said...

PJ, You say it so well. I don't have the answers but I am asking the same questions. I weight 400# at this time. What is the winning combination? Low carb, Low calorie, this food that exercise? I don't know that either but I do know that I don't want to gain weight and I do want to be as healthy as I can be. So even if losing weight won't happen for me I still have to do the same thing. I have to try but more importantly I have to believe. I have to believe that what I am doing is the right thing for my body. I have to measure my sucess by other criteria. If I only gauge my sucess on the pounds that I lose then I will give up. And "giving up"; What could that mean? That could possibly mean who knows how high of a weight with no hope of anything but disabiliy or death. It is normal to feel discouraged. Just don't quit trying. I love your blog. Keep writing.You are an inspiration to me.

Suzique said...

Great comments, PJ. I wish I had some answers to those questions, too. I started at 340 and am now about 285, but I lose VERY slowly and I think part of it is that I've dieted on and off so many years that my body only grudgingly lets go of the weight. I will lose two or three pounds and then stall for a month or two. I finally figured out the only way to get things moving for me is to constantly jolt my body into reacting. I was accomplishing NOTHING on low carb after the first 30 pounds or so, so I switched over to Weight Watchers. I do that program a week or two till I seem to be stalling out, then I switch back to low carb for a week. I also vary my calorie intake a lot. I average about 1500 calories a day overall, but I'll have at least one day where I eat 3000 calories and another where I only eat about 1100 calories. Not saying that will work for anyone else, and I still have a long way to go. But good grief, it's so FRUSTRATING to be doing everything "right" and have no tangible results to show for it. Does that mean we're doomed to be forever fat? I like to think not, but I do think if we've been dieting off and on for years it will take a herculean effort to do it...and a LOT of patience.

Low Carb Band-It said...

Well, all I can tell you is I can RELATE 100%. I have a lapband and when I got it my Endocronologist said "Why? You can't lose on 800 calories a day and since it works on caloric restriction, it probably won't work either."

So here I am, I originally lost 70lbs with my band, and gained 20lbs back and am STUCK at 240. I'm only 5'4" so I'm technically STILL 100lbs overweight and no matter what I try, I basically stay the same.

I've had 5 doctors tell me that I'll always be big. I have PCOS, insulin resistance/high insulin levels (that no matter how many drugs and suppliments I take will NOT go down). It really sucks big time.

I have serious skin flappage due to what I've lost, but no one will take it off for me because I'm still too fat. So I live with daily rashes and have a CRAZY hard time finding clothes that will fit around the rolls. The plus size are too big, everywhere except my GIANT arms and the regular sized clothes are not made for people with skin/fat rolls.

I stopped posting at my blog for the EXACT reason you stated. I feel like such a failure and yet I logically know it's not my own fault.

As for low-carb, although I believe it is the HEALTHIEST way to go, I could only lose weight eating less than 5 carbs a day. WHO can maintain that for their life. It's like the fat person who loses all that weight and is expected to eat 700 calories a day for the rest of their life to keep it off!! You just can't do that long term and live a "normal" life.

So I feel ya and I hear ya! I think there are a lot more of us out there than the doctors would like to admit. They just tell us, eat less and move more and blame it on our lack of willpower when we don't lose.

BamaGal said...

PJ---have you ever thought it just might be something physically wrong. Thyroid, high cortisol in the body-----there are a number of things that it could be. Diets do not work--WLS does not work. Body shape and size is genetic---there is VERY little you can dfo about. Concentrate on being active and eating healthful. Forget that hunk of metal in the bathroom. Accepting yourself no matter your size goes a long to way to being a healthy person.

nonegiven said...

I think you should eat and exercise in such a way that you feel as healthy as you can while being fairly sustainable long term and let the number on the scale take care of itself.

Gary Taubes answered some questions posed by readers a while back

Q I have been living on a low carb diet since being diagnosed with T2 diabetes 6 years ago. I have lost over 160 lbs and have the disease in very tight control with a usual A1c at 5% or close to it. I am still 30 lbs overweight at 5 ft tall & cannot lose any more no matter how low I cut carbs. I see no way around counting calories to lose these last pounds but my calorie needs are so low that I am intensly hungry all the time which is defeating me. What do you suggest?

A All I can do here is speculate, as I have no clinical experience treating people with carbohydrate-restricted diets, I'm just an investigative reporter with a somewhat obsessive interest in the subject. That said, between 1956 and 1972, the British physician Robert Kemp prescribed carbohydrate-restricted diets to almost 1,500 patients. He concluded that a small proportion, particularly the most obese and those who had been obese the longest, often failed to lose weight on the diets even though they faithfully followed them. It is possible that if you were heavy for a long time, your fat tissue has accumulated chronic damage and so you're just stuck with those 30 pounds, and little or nothing you can do will change that.

Also, without having access to one of those dunk tanks where they figure body fat percentage, how do you know you aren't replacing some fat with at least a little muscle even if it is changing slowly?

Or maybe it just isn't possible to eat enough protein or calories on a regular basis to be able to lose any faster.

Reckon where this guy will stall?
According to this article he has already lost more than you ever weighed.

I remember you saying your female relatives were also very large and that you put on the weight very rapidly. Maybe there is some metabolic problem or nutrient deficiency that has a genetic basis or something that interacts in a bad way with the environment. Maybe some of those fat cells will stay full no matter what but that doesn't mean you can't still get healthier the way you're going.

btw... In case I forget, Happy Birthday for the Sunday after next (I'll be 52 on the same day.)

Nina said...

I think first of all that blogging about weight isn't all about being a constant success. If you were, you're be one of those irritating people on the Nutrasystem ads, look how easy it is! Unfortunately, that's just not reality, and it's particularly not reality when you have a lot to lose.

I don't have anything profound to say, and I certainly don't have a magic suggestion. I do think that the level of knowledge about high levels of obesity is abysmal, though possibly getting fractionally better. I think that people's metabolic rates vary enormously, and that any way of eating has to be tailored to you and your particular metabolic requirements. But I do think that there's always a way. It's just that sometimes the price you have to pay and the time that it takes are significant. And not always worth it.

Tracey said...

Great post. What you write about here is why I am so often torn between two ideologies: weight-loss and fat acceptance. Losing weight is HARD, not always an exact science, and weight is not always proportionately related to health. A person can have so much to celebrate due to positive health changes brought on by low-carb, but it's still so easy to be down on ourselves when our weight-loss slows or stops. In my experience, I low-carbed my way down to about 15-20 pounds higher than my goal weight, but I've never seemed to get it to budge below that. I just keep re-gaining and re-losing the same 10-15 pounds.

Sometimes I beat myself up for not giving up even more carbs or by sacrificing more foods, but the more I deprive myself, the more I am tempted to quit doing this altogether. And I've avoided posting about in places like message boards where people will tell me, "You just have to give up x, y, or z to make it work," because those types of answers get so old.

I don't think constant weight-loss is a necessary requirement for blogging about low-carb eating. I started blogging as a way to keep it interesting and to motivate myself, and it can be fun whether I'm shedding pounds or not. Hang in there. I think a lot of us can relate to what you're saying here.

Zuleikaa said...

I feel for you. I can only seem to lose weight every other year. I don't know what I's not anything that I haven't done before but the weight goes fairly painlessly.

On the off year I can do the exact same things and nothing/very little weight loss results.

I once was put in the hospital on a 800 calorie diet and gained weight (it was for a study).

I remember that after that I went to a Chinese herbalist for some weightloss herbs. He made me keep a food diary for a while and when I turned it in he said I wasn't eating enough to be healthy never mind enough to cut calories/amount of food to lose weight.

After that it was about a year and a half of not dieting but concentrating on eating healthy. At first I gain weight, then my weight stablized for abount 3 years, then I lose some weight.

So I don't know what to tell you. I feel your frustration. I can only sustain vlc for a period and then I crave carbs.

Reading what I wrote I think I might need to relax for the rest of the year and chill. Concentrate on my supplements, getting adequate protein, and eating healthy for a long periods as I can.

I don't really have any wisdom to offer, just empathy.

Anonymous said...

I'm down with that!

PJ, when I started at 337 I ate between 300 and 800 cals for nearly a year to lose the initial 100 pounds. Eleven years later I am just under 200.

Like Zuleikaa, I find that there are times that I can lose and times that I can't. I seem to have a window of opportunity in which I can lose 20 - 40 pounds then I stop for at least 6 months, sometimes a year. Recently, I dropped calories way down and dumped 13 pounds. Most of that came back and now I am slowly drifting down. I do mean slowly -- in fact, that may have stopped but it was so slow I won't know for another 2 - 4 weeks.

Each time I start to lose it is slower than it was before. This is true even at the same calorie levels, even with the addition of strength training and/or cardio.

My doctor has told me to just stop. Same with my husband and sisters. When I posted that in my journal people immediately said Don't Quit. And I bought don't quit for a couple of weeks. But the truth is I simply don't have the energy to put into dropping the calories way down and hoping for some results.

I'm asking the same question you are: this can't possibly be the lowest sustainable weight for my body, can it? My doctor is saying yes, it can be. The last endocrinologist said yes, it can be. The mirror says you have got to be kidding.

Part of me wants to say I give up or I have given up. Another part of me wants to say you can't give up. All of me has decided that I need more balance in my life -- I can't allow myself to be fixated on weight or on every bite of food I eat.

I don't have any answers, but I know that I do not have a normal person's metabolism and I am now convinced that I never had it. I was obese the day I was born. I have been obese or morbidly obese my entire life. I am closer to normal weight now, in percentage terms, than I have ever been in my life. But something is not right, and I've tried everything anyone can think of but nothing seems to work other than severe calorie restriction.

I just don't think I can eat that little for months on end. And if I do, what will I be able to eat once I get to wherever? Will I simply bounce back to where I am now? That is exactly what both the endocrinologist and my doctor believe will happen. They both tell me something doesn't work right, and they tell me they can't find anyone who has any idea what the something is.

No answers from me, but I hear what you are saying. I know my frustration at being stuck where I am, and I honestly cannot imagine yours.

What I am doing now is choosing to eat healthfully, in a way that I feel good and is sustainable, and trying not to be worried about the scale or sizes. I'm doing pretty well with the eating part, but not so great with the rest.

Man do I hear you!

lowcarbrecipes said...

I to am not counting every last gram of carbs I am eating. I hate numbers! I hate obsessing about the numbers in my foods.

Whole foods, as close the the natural state, or made from scratch. No, I am not going crazy and eating huge amounts of carbs all day, but I have left the counting of numbers to others, and will enjoy my food with the idea I am eating healthy.

Anonymous said...

3 words - human chorionic gonadotropin. check it out.

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