Refuse To Regain

Summertime…And the Livin’ is Easier

By Lynn Haraldson-Bering

I dreaded summer during those years – about 14 of the last 20 – when I weighed more than 200 pounds. I’d sweat and be physically miserable even on 75-degree days. On the most beautiful days, I’d stay inside in the air conditioning. When I was obese, I even planned my vacations around the temperature, preferring to go away in the late fall and winter so I didn’t have to deal with the heat.

Thankfully I’ve spent the last three summers worshipping the outdoors and remembering (and doing) what I loved about summer when I wasn’t obese, namely biking, bird-watching and gardening.

My husband bought me a bike after I hit my goal weight in February 2007. I hadn’t ridden a bike in years and I spent most of last year getting comfortable with the gears and navigating traffic. But this year, I’ve got the process down pat, like I did when I was a kid. Only now I hang on to the handlebars when going down a hill.

I love biking. It is singly the most Zen thing I do next to meditating. Sure it’s good exercise, but as you know, when you’re maintaining a reduced body, you need more than exercise to keep you motivated and focused. You have to have fun things you didn’t do before to look forward to, and biking is one of those things I crave to do every weekend. Here’s the blog I wrote last year about my new bike: Bicycle, Bicycle, Bicycle.

I’m writing to you now while sitting outside on my deck behind our green house. It’s a small deck – about 12 by 14 feet – and surrounded on two sides by raised-bed perennial gardens. I’ve always kept some type of garden, regardless of my weight, but the process of planting, weeding, adding mulch, and pruning is much easier with a reduced body.

I’m not a fancy gardener by any means, and I usually plant things in the wrong order of height, but my gardens are good friends to me. The Shasta daisies are in full bloom, as are the Asiatic lilies, chives, coreopsis, summer clematis, and a few other plants that are pretty and the bees like but I have no idea what they are. Soon the mums, coneflowers, phlox and sunflowers will bloom. The basil, cilantro and oregano are growing like crazy, the rosemary is doing what rosemary does (this is the first time I’ve planted it so I’m not sure what it’s “supposed” to do), and the sage and lavender seem to be getting along growing side by side.

I can get pretty uptight and nervous in maintenance, always wondering if I’m eating the right thing and exercising the right way. So gardening – everything from planning to creating to sitting back and enjoying the plants be plants – is one way I stay centered. Here’s a link to the blog I wrote last year when my gardens and deck were being built: The Garden Of Lynn.

Watching birds is another way I focus. I have four general bird feeders, a finch feeder and a sunflower seed feeder. When Barbara and I were talking on the phone last week, I was sitting on the deck and a bird I didn't recognize stopped at the sunflower feeder. I mentioned it to Barbara in passing, saying simply, “Hmmmm…I wonder what that bird is…” and she immediately asked me to describe it. She wrote to me later and confirmed that it was a juvenile Downey woodpecker.

I was so happy to learn we shared an interest in birds! Sometimes when you get to know someone based on one common interest, it’s easy to forget that you might have other things in common, too. As people maintaining weight loss, it’s easy for us to get lost in talking about the nuts and bolts of maintenance – food and exercise – but it’s important to remember we share more than that in common. We’re under the umbrella of being human, so my hope is that through this website and in meeting others in your life who are maintaining their weight, you find true friendship based on lots of commonalities and not just “diet secrets.”

I have watermelon, strawberries, cantaloupe and blueberries in the refrigerator – summer at its finest. I brewed some iced tea and put some cucumber salad to soaking in brine. I love that I can take a walk outside most days and ride my bike and garden even on the warmest western PA days. While I don’t beat myself up for missing so many hot, beautiful summers in the past, I will remember these current summer days to help keep me focused on what’s best about maintaining my weight loss.

What’s In Your Life Charter?

By Barbara Berkeley

I enjoyed Lynn’s last post especially. Not only did it resonate with the essence of maintenance, but it was completely familiar. I suspect we’ve all come to pretty much the same way of feeling about the process of keeping weight off for a lifetime. In my soon-to-be-released book on maintenance, I discuss the usefulness of establishing a “life charter” to help clarify this permanent commitment. After reading Lynn’s blog, and following my challenge to readers to describe their maintenance plans, I realized that I was actually asking you to define your own Life Charter. Essentially, a Life Charter is what Lynn described in her post.

Going a bit further with this idea, I decided to reproduce the section of the book that describes this idea. If you have not already put a clear form to your maintenance pledge, please consider doing so. I think that you will find that, like other pledges, a formal pledge to yourself creates a special commitment.

Establishing A Life Charter (exerpted from Refuse to Regain, Quilldriver Books, 2008)

Let’s call your permanent eating plan your Life Charter. A Life Charter must be based on your beliefs about food and health. Your greatest job as a new maintainer is to create this plan and refine it so that it fits your tastes. This plan is like a government’s constitution. It is based on principles and rules, but should be basic enough that its framework can be easily committed to memory. Portability and ease of use are key. Once you establish your Life Charter, you should be able to consult it mentally to locate the guidelines for any eating situation.

As an example, let me share my own Charter with you. Mine is based on my belief in eating scarcely and in consuming a Primarian diet. It is constructed to keep me at a low, healthy weight based on my belief that lower weights convey the best lifelong health outcomes. My Charter also reflects my belief that healthy nutrition can only work in the setting of a body that runs well, and therefore includes a commitment to exercise.

The primary goal of my Charter is to achieve the longest possible life in the best possible health, hopefully avoiding periods of illness or disability as I age. A secondary goal, important to me personally, is to properly honor the gift of life I have been given and to appreciate the miraculous nature of my body by treating it with utmost respect.

Here is my Life Charter:

1. I eat one major meal per day, and 90% of my diet is Primarian.
2. I eat starches and sugars extremely rarely.
3. I eat one allowable treat daily (more if the scale cooperates).
4. I eat processed foods extremely rarely.
5. I eat no trans fats and very few saturated fats.
6. I honor my body by not allowing junk foods to enter.
7. When I gain weight, I immediately reduce to below Scream Weight (the highest weight I allow myself to get to).
8. I work out vigorously six days per week.

My plan is utterly portable and has become second nature. When I am invited to a wedding, I know that I will be skipping any fatty cuts of meat (saturated fat) and the wedding cake (modern starch and sugar plus saturated fat). I will have eaten lightly for the rest of the day because I will have planned the wedding dinner as my one major meal. If I’m hungry after the party, I know I can have my one allowable treat, usually a good sized dish of low fat ice cream.

What about bread, grains, pasta, corn, rice and potatoes? I am 90% Primarian, which gives me the option to indulge in these very occasionally. The longer I spend as a Primarian, though, the less I want to deviate. I usually am aware that I can have a piece of that bread if I really want it, but I almost always opt out. I think that you will be surprised at how much easier food choice becomes when you have absolute guidelines.

Resolve not to be swayed by what others are eating or by their comments. Just as a vegetarian does not eat roast beef simply because others at the table are chowing down, so you must learn to rely on the wisdom of your Life Charter. Be proud of your plan and make every attempt to follow it staunchly. Many vegetarians avoid meat to protect the rights of animals and to spare them unnecessary suffering. Their motives in following an alternative diet are not questioned, nor should yours be. Remember that you have an equally noble goal: to preserve a human body’s optimal health and function (yours!)

Despite all the ideas about eating I’ve suggested, your Charter may turn out looking very different from mine. I don’t ask you to accept every idea I put forth, but rather to see what works for you and to follow your Charter faithfully, daily, and NOT moderately.

Lynn's "Balance Plan"

By Lynn Haraldson-Bering

Have you seen or perhaps even used a balance board? It’s basically a 2-foot by 1-foot wooden board with a rollerball underneath. The idea is to stand on it while performing other exercises such as lifting free weights. The goal is to teach the body how to balance itself, to be more stable.

The first time I got on one of those suckers, I felt like I was on an amusement park ride. I was all over the place! Wobbling here, wobbling there. I could barely stay on the thing, let alone lift weights at the same time.

Over time, however, my body adjusted to the subtle movement of the rollerball and I learned to trust my instincts – to feel the rocking back and forth and to stay stable – as I concentrated on lifting weights. I found the balance.

And so it is with weight loss/weight maintenance. As reader/fellow maintainer Susan said in a comment posted to Barbara’s recent blog, “Perfection is not the key to maintenance. It is finding balance you can live with.”

In response to Barbara’s challenge that we, those of us maintaining our reduced bodies, name and explain our “lifestyle change” plan that works for us, I offer “The Balance Plan” (or as I’ve nicknamed it: “How Lynn Walks and Chews Gum at the Same Time”)

The Balance Plan incorporates everything in my life. I blog, I answer email, work out, feed the birds, water the plants, babysit my granddaughter, eat, sleep, shower, go to parties, and go on vacation and all the while, maintenance buzzes in the background. It’s always with me, around me, and in me. It is me.

I’m adopting as my credo something my friend Sondra wrote in a comment: “I choose to stand my ground that I will put what is best for me first.”

Amen.

To maintain my weight loss, I’m learning to rely on my instinct and what “feels” right, in the same way I trust my body will keep me balanced on a wobble board. I also eat, as Vickie posted in her comment, whole foods as close to their natural state, most of the time. I allow for chocolate and pudding and vices such as that, but always, always in moderation. I still use, as a tool, the Points system to help me gauge my overall food intake, but even that is becoming more “natural” for me to determine. My goal is to one day eat in total accordance to my body’s needs.

I’ve always said there’s a reason why pregnancy is supposed to take 9 months. We need time to prepare. There’s a reason why weight loss isn’t overnight. We need time to prepare for maintenance. Whether you lost weight through diet and exercise alone or with some kind of surgery, how you lost the weight is only a preparatory class for maintenance and forever, and as Sondra said, you have to change your lifestyle to get to goal.

It's frustrating to read posts on my favorite Weight Watchers discussion board from people returning from vacation bragging about how much food they ate and how “off plan” they were. They were on a “food vacation,” happy and content to stuff themselves with all their old favorites.

In real life – in real weight loss and in real maintenance – there are no such “food vacations.” Yes, there are times when we might indulge in some particular food, but we know it can’t be all the time and we know that to continue our maintenance balance, we must plan for such splurges. And as Susan reminds us, “…the most important thing is getting right back to good/clean eating after a couple of not so great meals.”

When these people return from their food vacations, the often post that they are are sad to get “back on plan.” They miss their old lifestyle. They see the new lifestyle they must embrace and resist it, like it’s their enemy.

On the Balance Plan, I understand that I have to be a friend to my body, to my food choices, and my exercise regimen, and to stand on the same side as my “lifestyle change,” to be fully immersed in it and not leave it at home when I go on vacation or out with friends or to a party or on a picnic. I take it with me at all times because it’s who I am, just as sure as I am a 44-year-old female.

The Balance Plan is open to new ideas and research. I educate myself and question “authority.” I ask lots of questions, try new foods and various approaches to obtaining the right nutrients. As I said earlier, I trust my instinct. I trust there’s a balance.

If I fall of the balance board, I get right back on. Not getting back on is not an option just as I can’t choose to not be 5’5” tall. The Balance Plan is innate so its “rules” change from person to person. But in the end, it’s about being your own best friend – walking and chewing gum at the same time, so to speak. 

Let’s Get Specific

By Barbara Berkeley

Mrs. Irving, our ninth-grade English teacher, was the terror of Snyder High School. Standing just under five feet, clad in voluminous orthopedic “space shoes” and a shapeless shift, Mrs. Irving still managed to strike fear into our 15-year-old hearts. With her shock of white hair, her smear of blood red lipstick and her piercing glare, she commanded the classroom. Woe to the student whose homework was left undone or who conveniently forgot to read the assignment. Mrs. Heller’s tiny frame would shake with indignation as the poor offender was singled out and subsequently reduced to a trembling mass of teen-aged jelly.

As an aspiring writer (medical school came much later…a story for another day), I found Mrs. Irving’s opinion of my stories and essays to be immensely important. If she smiled and showed nicotine-stained teeth as she handed back my paper, my day was made. Just as frequently, though, my poor works came back slahed with bold red marks. Her favorite comment was: “Vague! Vague! Vague!” scrawled across the top in oversized crayon.

Mrs. Irving liked specific writing. For her, the greatest sin was language that didn’t go anywhere.

Some teachers change your life and I believe Mrs. Irving changed mine. She helped me to believe that I could write. Along the way, her fierce devotion to good, clear language infected me as well. So, it is in honor of Mrs. Irving that I now prepare to do battle with the vaguest phrase in the language of maintenance: “LIFESTYLE CHANGE”. Mrs. Irving, I hope you would be proud of me.

Lifestyle change. As in, “I don’t rely consider it a diet, it’s more of a LIFESTYLE CHANGE”. Or, “I know I really have to make a LIFESTYLE CHANGE” if I’m going to keep this weight off permanently.

These two words drive me utterly batty because they are vague, vague, vague. What the heck is a lifestyle change? It is a phrase with the cloudiest possible shape; a generalization, a feeling. Worse, it means different things to different people. For most, it suggests some sort of permanent shift in their attitude toward food and exercise; less of one, more of another. But let’s apply such a vague notion to the process of weight loss and see where we get. Suppose someone who wants to lose weight says, “I really have to diet.” That’s all well and good. But simply stating that fact tells us nothing about the specific behaviors needed to get the scale to move. When people diet, they generally reference a plan: Atkins, South Beach, Weight Watchers, Jenny Craig. If we know someone is an Atkins dieter, we automatically know the rules they follow (lots of meat and no carbs). If someone else wants to reproduce this person’s success, they know exactly what to do. They buy the book, they look at the website, they follow the rules.

On the other hand, maintainers have no specific plans to describe their “lifestyle changes”. We’ve never been able to move from the general to the specific. It’s no wonder that newcomers to maintenance have to invent the process for themselves. They have to figure out what “lifestyle change” means because we haven’t developed a number of maintenance plans that are named and have rules. Maintenance remains vague, vague, vague.

I’ve attempted to introduce the Primarian approach as a lifestyle changing plan. But just as there are many ways to diet, there are probably many ways to maintain. These techniques need names and specifics. Who would know more about these plans than the people who’ve invented them? For this reason I’m asking you, our readers, if you have any names and plans to contribute. Can you put the plan that’s working for you into a form that has clear rules and a title? To do this, be creative. Make up a compelling plan name (or name it after yourself!) and then flesh out the details. Specify the plan rules for foods consumed, monitoring techniques, exercise frequency and any other elements that make it work.

If we can start promoting weight maintenance plans that work, the process of transitioning to maintenance will be so much easier for those that come after us. Dare to be great! Here is your shot at maintenance immortality!

Can’t wait to hear from you!

Adding Up The Numbers

By Lynn Haraldson-Bering

If I measure once, I have to measure ten more times: my waistline. Some experts say to measure your waist at the belly button and some at the “natural” waistline. For me, that’s at least a 2-inch difference in numbers! If I go by the belly button measurement, my waist-hip ratio is “high” and I’m allegedly at risk for heart disease and diabetes. If I use the waist measurement from my natural waist, where it curves in, I’m fine. 

Very frustrating.

So I posed the question in an email to Barbara: Where exactly am I supposed to measure? She wrote back: “The answer is that we really should call it a ‘belly circumference’ as calling is waist circumference is a little euphemistic. You're supposed to measure just above the top of the hip bones on your sides, which usually corresponds to the belly button in most people.  In your case, as I've said, some extra external fat that's left over from your weight loss probably doesn't count.  I'm sure you have no visceral fat at all, and that's what we're worried about.”

That was good news. Visceral fat can only be measured by a CAT scan so a simple measuring tape can’t project the entire health-risk picture. Larger waistlines mean more visceral fat, the stuff that plays a major role in heart disease, diabetes, high blood pressure and Metabolic Syndrome. What I have around my belly now (and causing me this measurement distress) is excess skin. Not much, but enough where it impacts that waist (or belly) measurement a bit.

I started keeping a close eye on my waist/belly measurement when I got closer  to my weight-loss goal, sometime around September 2006. I’m more an apple than a pear, prone to carrying more fat around my stomach than my hips (thanks, Dad). So once I got close to goal-weight range, I took a look at other numbers than simply my weight. What was my body fat percentage? My waist-hip ratio? How did those numbers, including the scale, fit in with my Body Mass Index?

As a guideline, a BMI under  25 is considered “acceptable.” Yet when my BMI hit 25 and I was no longer considered “overweight,” my waist size was still 34 inches, my hips were 43.5 and I weighed 153 pounds. These numbers didn’t add up to “goal” for me. I wasn’t comfortable at the edge of “normal,” so I did some research.

While I didn’t know Barbara back when I was trying to figure out exactly where “goal” was, I did find that many experts, including Dr. Oz, recommended the same thing she does – using waist size as a better indicator of “ideal weight” than the scale. As a general guideline, the “ideal” waist size for a woman is 32.5 inches and 35 inches for a man. (Please note that Dr. Oz also says that , as a guideline, a woman’s waist size should be half her height, which puts me (at 5’5.5” tall) at a “healthy” 32.5 inches maximum, but what about my daughter who is 5’8” tall? Does this mean she’d still be healthy with a 34-inch waist? You can see how confusing this can all get.)

I decided, in the end, to declare goal when my waist measured 31.5 inches. I reached that goal in February 2007. The scale read 138 pounds and my BMI was 22.6. My body wasn’t done, though, and I lost another 10 pounds and, depending on what time of day I measure, and  another 1 to 1.5 inches off my waist. My BMI is 21.1. These numbers feel much more comfortable than the standard recommended maximum.

FYI: I recommend reading an article at the Harvard School of Public Health regarding healthy waist size if you want more information. (Click here.) I wish I’d seen this a few years ago.

So…the question of the day is: Do your numbers add up for you? Or are you still wedded to the scale?

As Barbara told me recently, “The bottom line is, the less fat around the middle, the less fat inside the middle part of the body.”

That’s advice we can live with. 

I’d love to hear your numbers/waistline stories. Please send us your comments and email.

Does Your Body Want to Regain?

By Barbara Berkeley

Bravo to Lynn and her last entry on maintenance! Indeed, maintenance is the journey. Weight loss is simply the first step on the path. Time and again I watch people make a rookie error: assuming that their journey is finished once they lose weight. We all know where that ends up….back in the large- sized clothes in short order.

But what of those who decide to pay serious attention to maintenance? They are left with the task of inventing maintenance all on their own. There is very little support for maintainers compared to what’s out there for dieters. For this reason, I know that most of you are anxiously looking for guidance about your “maintaining body”. How does it store fat now? What has happened to your metabolism? Is regain inevitable?

In looking for the information, you will come across many magazine articles and newspaper headlines that seem to offer answers. You will hear about studies, experts and theories. As obesity becomes a more pressing problem for our nation, these articles will be coming thick and fast. They already are.

My advice to you is: be careful about what you accept as truth. Always filter the information through your own experience. If it doesn’t ring true to you, there’s probably a reason. As someone who is inventing his or her own maintenance from scratch, you are the one who is in real possession of the truth.

Here’s what I mean. In the article Lynn referenced in her last post (LA Times), there a number of statements from experts. I take many of these with a grain of salt and I encourage you to do the same. Here are some examples:

Expert: “The recent estimates are that 5 percent to 10 percent of people are successful at keeping weight off on a long-term basis."

My response: Well this is discouraging! But, in fact, that number is most likely wrong. In reality, the number of maintainers who keep their weight off long term is unknown. The 6,000 people in the National Weight Control Registry (NWCR) are highly successful at long term maintenance, for example. The majority are maintaining successfully, not 5 percent! The 5-10 percent success figure is based on an old quote that gets recycled again and again and is not borne out by any kind of research.

Expert: “Metabolism has changed: the body now needs about eight fewer calories per day for each pound of weight that was lost. That means someone who loses 40 pounds will require about 320 calories fewer each day than they did before the weight loss.”

My Response: The article makes you think that something bad happens to your metabolism after you lose weight, but much of the data doesn’t support this. Information published by the NWCR shows that the metabolism of POWs (previously overweights) who exercise is the same as that of NOWs (never overweights) of the same size. For example: if you weighed 200 pounds and you now weight 140, you burn fewer calories now. But you burn the same number of calories as any other 140 pound person. Smaller bodies burn fewer calories because they take less energy to move around. So yes, it’s true that you burn fewer calories when you are reduced, but not because of a problem…which is what this quote seems to say. The new calorie burn is appropriate for your new size.

Expert: "The hormone leptin, for example, is a major appetite regulator -- it tells the body to stop eating and store fat after meals. Some people may be genetically prone to having lower leptin levels, making them more prone to obesity. But studies also show that, after a weight loss, leptin levels are lower than what they used to be. That means appetite is less easily quelled. It's like a car that has suddenly lost its brakes."

My Response: This information seems important, but there are some major distortions. First, how about the people who can’t avoid obesity because of genetically low leptin levels? It turns out that this condition is vanishingly rare…hardly ever described in fact…. but the article does not tell you this. You are left to wonder whether you have leptin deficiency. You don’t. Second: most obese people make too much leptin. You would think that this would tell the body to stop eating, but it doesn’t because obese people have leptin that isn’t working normally. When they lose weight leptin works better and levels can return to normal. So, in fact, just because leptin levels go down it doesn’t follow that your appetite is like a car without brakes. Perhaps the brakes are working more efficiently, not less.

Expert: "Moreover, animal studies show that most of the regained weight is distributed as visceral fat, the abdominal paunch that is linked to heart disease and diabetes."

My response: This is an animal study. Has this been shown convincingly in humans? Not that I know of. The second part of the article observes that maintenance appears to get easier once its techniques are learned…after the first year or two. This doesn’t seem to make sense if we believe what the “experts” have said; that we are doomed to be perpetually tortured by hunger once we lose weight and that every neurological and endocrine process is working to regain pounds. If that’s true, how can behavioral changes overcome this permanent barrage? Here’s where your own experience comes in. Most successful maintainers will tell you that a commitment to deep, permanent behavior change works. Their biology is not their destiny!

The moral of this story? Be very careful about making too much of the scientific information you read. Remember that the science of obesity is very young and still very contradictory. Print articles and TV stories like to grab headlines and often publicize study results that are later proven wrong. A good source for scientific information on weight and nutrition is the Harvard School of Public Health (a link appears on the right). Harvard looks at all the studies and writes conservatively about what is truly known of the evidence.

More importantly, remember that the largest impediment to keeping your weight off is not your biology. It is the force of the overeating culture around you. While I do believe that POWs are forever more prone to weight gain than NOWs, the outcome is not pre-determined. Maintenance is learnable. As Lynn has said, “…as each month passes, I get better at it.” Lynn’s story, as well as those of countless other maintainers, suggests that our bodies are not trying as hard to regain their weight as the LA Times article might suggest.

Maintenance is the "Meat" of the Journey

By Lynn Haraldson-Bering

The more I learn about the biology of weight maintenance, the more I realize just how complicated our bodies are. I used to think losing weight was the be all and end all of my journey. I understand now that losing weight was no more than packing my bags for a one-way trip. Maintenance is the meat of the journey.

One of Barbara’s patients told her about several articles on weight loss and maintenance published recently in the Los Angeles Times. The one I was most interested in was the one on maintenance (click here to read it).

Once obese, the article states, our bodies remember (and almost prefer) the level of fat that we stored in our bodies, and so when we lose weight and are maintaining, we’re constantly fighting food cravings because our bodies want us to stock up on fat again. There are several hormonal and central nervous system-related reasons for this, scientists believe, but all I know is that when I read that part in the article I said, “I KNEW it!” There are days when I crave things more powerfully than I ever did in my overweight or morbidly obese days. At least now I know I’m not imagining it, that I really do have cravings and that there is a physical, not merely emotional, reason for it. I do, however, believe that because I am more aware of my cravings and am better able to identify and deal with them now than I was at 300 pounds is a factor as well.

“Moreover, animal studies show that most of the regained weight is distributed as visceral fat, the abdominal paunch that is linked to heart disease and diabetes.”

I’ve been noticing since I’ve been in maintenance that if a few pounds creep up on me, they always show up in my stomach region. At 300 pounds I couldn’t tell if I’d gained a pound or two, but now I can feel it and see it. When I watch my food intake and up the exercise at little, those few pounds come off and my stomach goes back down. Again, I knew it but I didn’t know it was a proven fact. This scientific confirmation of my personal observation has taught me to trust my “gut,” so to speak, and that it’s wise to stay finely tuned to my body’s signals.

“Scientists don't know how long it would take to return the physiological responses of a once-obese body to normal -- or if, indeed, that ever is quite possible.” I could beat myself up for having gained weight in the first place. The thought actually crossed my mind. But where would that get me? I was where I was then. I am where I am now. I can only go forward, and so I will live with and learn from the body I’ve got now.

Overall, though, I was feeling a little discouraged, thinking ‘What vigilance it takes to keep weight off! What a tightrope we walk! It’s like the wolf is always at our door.’

By the end of the article, I felt my hope return.

“Studies do show, however, that weight regain is most likely in the first couple of years after weight loss. And Rena Wing, director of the weight control and diabetes research center at Brown Medical School, says that (National Weight Loss Registry) data shows that people who maintain their weight loss find the first two years difficult but eventually adapt comfortably to their new habits and lifestyles.

"After that, it's as if you master the technique," she says.”

I’ve got 16 months of maintenance under my belt. I’ll mark my 2-year anniversary next February. Do I expect maintenance to suddenly be easy in February and beyond? No. But as each month passes, I get better at it.

Education is key to maintaining. So, too, is staying in touch with other people who have lost and are maintaining their weight. It can be daunting staying on task day after day. What our bodies require of us, what we need to do to stay vigilant, can seem overwhelming at times. But if we stay real, take a few deep breaths, and talk about it amongst those who understand, this long trip we’re on will reward us with fun and some great views along the way.

FYI, we have discussion boards set up for maintainers to meet and discuss maintenance, life, whatever! Don’t be shy. Post a post. The board links are located on the right hand side of this site.

Friday the Thirteenth: Russert Dies Too Soon

By Barbara Berkeley

I will miss Tim Russert badly. As a political junkie, I have been riveted by the spectacular fireworks of this year’s presidential race. No one has told the story or shared my passion as well as Tim Russert. He was smart and decent; an everyman whom anyone could relate to. But Tim Russert’s death, just like the deaths of approximately 300,000 other good and decent people each year, was unnecessary. After the tributes, mourning and remembrances....who will focus on that part of the story?

In recalling Russert’s health in recent months, Tom Brokaw commented that there was “the issue of his weight”. The two of them had been on a diet, competing to see who could lose more. But it seems that the competition had lost steam. Brokaw remembered that Russert was “cutting back on the snacks”. But it was too late by then. On Friday the thirteenth, Tim Russert collapsed and died at his desk at NBC. An autopsy showed extensive coronary artery disease. He was 58 and he will never know who won the election that so fascinated him.

I’m a body watcher by profession and for some time I had been noting Russert’s expanding waistline and thin legs. This is the shape that should strike fear into our hearts because it is the shape of heart disease itself.

Ironically, on the very day of Russert’s death, the front page of the New York Times ran a story about a new health initiative in Japan. Health care in Japan is nationalized, and with the population aging the government does not want to find itself awash in medical costs related to obesity. So, it has mandated that companies and local governments measure the waists of all those aged 40 to 74. Moreover, the government has set limits for waist size: 33.5 inches for men and 35.4 inches for women. Those who exceed these limits are given education about weight loss and told to reduce. If they do not, the companies they work for face strong financial penalties. In this way, Japan has tightened the screws on business: do something about your obese employees or pay. How would Americans fare if our government decided to do the same? Poorly. American men have an average waist size of 39 inches and women of 36.5. Virtually no one would pass muster.

While mandatory waist size could never be enforced in the United States, we should take a page from something else that Japan has done about obesity. They’ve changed the way that it is discussed. For some years, Japan has focused on the metabolic consequences of too much fat, rather than simply on the weight itself. The country has become educated about Metabolic Syndrome, the gang of deadly companions to fat that probably killed Tim Russert. These fellow travelers include high blood pressure, problems with blood sugar, elevated cholesterol and/or triglycerides, increased inflammation and increased blood clotting. All of these things stem directly from the accumulation of fat that sits in the middle of the body. In Japan, the word obesity has been replaced by the word “metabo”. It is a much more comprehensive description of the overweight state; one that is tied to all of its consequences. In Japan, no one wants to be a metabo.

The word metabo is no small adjustment in vocabulary. Right now in America, we see weight in terms of scale numbers and the numbers on our clothing. We need to see weight in terms of the numbers that measure the damage to our arteries. We lose weight by competing with each other to drop a few pounds but have avoided taking a good look at the deadly seriousness of that fat. Suppose we are not overweight but metabo. Would a “metabo” Tim Russert have been more worried about his expanding waist than one who was simply “overweight” ? Had NBC measured waists every year and insisted on treatment for those who were in trouble, might Russert have lived? Had our government advanced more initiatives to make us aware of Metabolic Syndrome, would people like Russert have thought twice about getting heavier? I believe the answer to all of these questions is yes. The death of Tim Russert reminds us that our national weight problem is no small matter. America is metabo and it’s time we faced up to it.

A Doc’s Life - Part One: What’s in the Mail?

By Barbara Berkeley

As I leafed through the mail yesterday, it occurred to me that those of you who are not physicians may be unaware of some of the small details that make up the lives of docs. One of these details is the daily postal bombardment. In addition to the usual assortment of underwear, outdoor furniture and clothing catalogues, in addition to the credit card offers, the pleas from charities, political campaigns and causes, in addition to the monthly bills, flyers and junk mail, doctors are on the receiving end of a stream of medically related mail, most of it unsolicited. 

Each day brings invitations to continuing education seminars which are short on content and long on location. Learn about addiction medicine while lounging on the beach in Costa Rica. Absorb the intricacies of diabetes management aboard a cruise in the Mediterranean. None of it is cheap, so into the trash it goes. We get mail about hospital meetings, mail from the state medical board, mail from our malpractice carriers. We get updates to the PDR, the bible of currently available drugs and letters with red “attention” stickers that alert us to the fact that some new medication has been taken off the market or has suddenly shown a frightening side effect. But mostly, we get something we call “throw-away journals”.

Doctors subscribe to journals that reflect their interest and specialties, things like the New England Journal of Medicine, or (in my case) the International Journal of Obesity. Subscription journals are where the serious science lives and where authorities and researchers publish their scholarly work. But plowing through statistics and detailed controlled studies can become tedious and many doctors simply want to know what’s new in the treatment of the diseases they commonly see. Throw-away journals meet this need. These journals look a bit like subscription journals but are usually colorful and written in plain language. They have articles about the latest medicines and what’s new in the treatment of common problems. They often have pictures, sometimes on the cover, of horrendous rashes, skin ulcers and other gross conditions. Don’t ask me why. I guess someone thinks that doctors are attracted to lurid pictures. (Growing up, my kids sorted through the mail with trepidation lest they come across some of these). Docs don’t subscribe to throw-away journals. They just show up in our mail box. A lot of them.

Yesterday, along with many other medically related mailings, I received my copy of Internal Medicine News, a throw-away which is not into gross pictures and which I enjoy reading. As I leafed through it, I was struck by a simple fact. Medicine is being overtaken more and more by the diseases which stem from obesity.
This is a fact which is rarely discussed. Overweight is still treated by most physicians as a peripheral issue to be addressed with a “by the way”. (As in: “by the way, you should lose weight”). But a glance at Internal Medicine News will tell you that overweight is central to disease and disability in this country. It is a warning, as clear as can be, that we are headed for financial and physical disaster if we continue to treat overweight as a trivial problem.

So, since I’m letting you in on the life of a doc, let me briefly recap the number of articles in the 45 or so pages of Internal Medicine News that relate to obesity.

Page 1: “Low Vitamin D Tied to Poor Prognosis in Breast Cancer”. A study in Toronto has showed that those women with low vitamin D levels when the diagnosis of breast cancer was made were more likely to have hi-grade cancers and to die of their cancers. Who has low vitamin D levels? Often, the overweight, because vitamin D gets trapped in their fat cells and can’t circulate in the blood as it’s supposed to. The study researcher notes this connection and then suggests that the study should be done again with subjects who are given Vitamin D replacement. My question: why not just get rid of the fat that’s trapping the vitamin D???

Page 10: “Redefine Diabetes to Lower Costs of Care”. A Georgetown medical professor suggests that we stop calling mildly elevated blood sugars ‘pre-diabetes’ and call any kind of blood sugar problem by its real name diabetes! I agree! We waste time with people when we tell them they are pre-diabetic. They simply have early diabetes and they need urgent lowering of blood sugar while they still have a working pancreas. Why do they have elevated blood sugar? Because they are overweight (90% of the time).

Page 21: “Diet Gaining Legitimacy as Potential Factor in Acne”. Turns out that what our mother’s said was true. Acne is worsened, or created, by what you eat. Various studies implicate, “milk, high-glucose-load diets, and low fiber/high saturated fat intake.” In other words: the SAD (standard American diet). The article goes on to report on the contrast between acne in our teens versus the “essentially zero” incidence in two non-Westernized populations who eat hunter-gatherer (Primarian) diets. These people not only eat “minimally processed plant and animal foods” but have low insulin levels. (see my post on The Case Against Calories) . In a study done in Australia, 43 teens with acne were given either a low carb or a high carb diet. Guess what? The acne improved on the low carb diet AND the kids lost weight. Yet another endorsement for eating Primarian.

Page 29: “Screen for Geriatric Syndromes in Diabetic Elderly”. If you make it to old age with diabetes, here’s the list of problems you’ll face. An increased risk for dementia because of your microvascular disease, your experience with high and low sugars and all the medicine you’ve ingested. An increasing list of medications, all of which have their side effects. (One study showed that 14% of elderly diabetics were taking 10 or more drugs.) “Patients will be struggling to follow your instructions for additional medication..and some will not be able to afford all of these medications”, says the author. (Note from BB: lose weight now and don’t put it back on!). An increased risk of depression. More falls. Urinary incontinence. The disclaimer at the end of the article lets us know that the author received money from a drug company which makes diabetes medicine. Yes. They do make more money from people who take these medicines than from those who have lost weight, eat well and exercise.

Page 29 again: “Diabetes Linked to Risk, Not Cause, of Parkinson’s”. Want something else to worry about if your blood sugar is high? You’ve got a 34% higher risk of new-onset Parkinson’s.

Page 37: “Ratio of Sodium to Potassium Affects Cardiovascular Risk”. Hey! You know what? If you eat a lot more salt than potassium you’re going to have a lot more cardiac and vessel disease. People with the highest ratio of salt to potassium had a “highly significant 50% increased risk of a cardiovascular event” (read: heart attack or stroke). Why? Our ancient ancestors ate a diet high in potassium and had no access to added sodium. We’re built the same way, but we’ve reversed our intake. Again, the authors ponder the question: “Should we be looking into the use of salt substitutes in which sodium chloride is replaced by potassium???” This is just the kind of suggestion we’re always coming up with… add more of something good to a bad diet. Why not just eat Primarian?

Page 40: “Bariatric Surgery Leads to Bone Density Decrease”. Uh oh. Cutting your stomach in half and rerouting your intestines may not be the best idea in the world. Many patients who go in for gastric bypass start out with low vitamin D levels (see above), so already have a tendency toward weak bones. The bypass itself makes it harder to absorb nutrients and one of those is calcium. There also can be a problem absorbing the B vitamins and iron. It’s controversial, but bone loss may be an issue after this surgery.
Just to finish up, let’s look at the ads in this journal. The drug ads tell us what medicines are common and are competing for market share. Remembering that the conditions associated with overweight and poor diet are high cholesterol, high blood pressure, high triglycerides, joint problems, reflux, high blood pressure, irritable bowel and diabetes, let’s look at the ads (I’ve included all of them and highlighted the ones related to weight):

1. Lipitor (high cholesterol)
2. OsteoBiFlex (joint pain)
3. Bystolic (high blood pressure)
4. Oxycontin (narcotic pain med)
5. Transderm Scop (for nausea with travel)
6. Lexapro (antidepressant)
7. Bayer low dose aspirin with heart advantage (aspirin for your heart and soy for your cholesterol)
8. Aricept (for dementia)
9. Trilipix (high triglyceride medicine)
10. Amitiza (irritable bowel medicine)
11. Omnaris (allergy nasal spray)
12. Tylenol Arthritis
13. Tricor (high triglyceride medicine)
14. Namenda (dementia med)
15. Pristiq (anti-depressant)

Sixty percent of the ads in this journal relate to conditions that can be prevented or made dramatically better with weight loss and a healthy diet.

We as doctors have a choice to make. We can read our journals and see our patients. We can choose to ignore the connection between diet and health or, if we recognize the connection, we can choose to believe nihilistically that our patients are incapable of making real change. If that’s what we believe, why bother to counsel them on diet? Why tell them to lose weight? Why work on encouraging them to Refuse to Regain???

But you, readers, know the truth. Continue to give yourself the supreme gift of good health. Along with it, you will get some bonus gifts: an increased chance of longevity and of many more disease-free years. Add exercise and you will reduce your incidence of depression, raise your bone mass and prevent the muscle loss that leads to falls and fractures.

A Doc’s Life can be a strange one at times. We want to do what’s right for the patient and we have so many darned meds. They come in pretty packages and they’re brought to our attention by attractive, enthusiastic drug reps who often serve lunch along with their wares. And patients seem so happy to have their problems solved with a pink pill in a shiny wrapper. But we, like you, have to make a choice.

To quote a higher authority: "… I have set before you life and death, the blessing and the curse. So choose life in order that you may live, you and your descendants, (Deuteronomy 30:19). Each of us, both doc and non-doc alike must figure out exactly what that choice means.

Kicking It Up A Notch

By Lynn Haraldson-Bering

I was in the middle of a two-arm row last Friday when it occurred to me I’d lost count. My mind was off somewhere thinking about god-knows-what.

‘How many was that?’ I wondered. My muscles couldn’t tell me because my routine had become so easy there was no “burn” anymore. That’s when I knew it was time to kick myself in the butt and develop a new strength training routine.

I like the variety of hand weights at the gym, those odd sizes that are hard to find in typical sporting goods stores, but I really enjoy working out at home. I had outgrown the 10-pound weights and was holding them in addition to 2-pound weights for a greater challenge, but that was awkward and often hurt my wrists. Rather than special order 12- or 13-pound weights, I decided to buy a barbell.

I felt so he-manish when I walked into Dick’s Sporting Goods last Sunday and talked to a sales associate about a 20-pound curl bar. I had no idea how to add weights to it, but he was very nice and showed me a variety of attachable plates and how to use them. I chose two 2.5-pound plates to start. That way I could use the bar at 20 pounds or at 25 pounds.

I consulted my favorite exercise book, “The Body Sculpting Bible for Women” by James Villepigue and Hugo Rivera, and found seven different strength training exercises, most of which incorporated my new barbell and the adjustable bench I owned but hadn’t used in awhile.

I started Monday and what a difference in my attention span! Three sets of 15-20 reps of seven new exercises – I definitely suffered no mind drift. I couldn’t even listen to music because the new routine required all my attention.

Yesterday, my triceps and traps, biceps, shoulders and lower back were saying, “What the …?”, but they’ll survive. They’re a little sore still today, but in a good way. I’ll give them another day off, but tomorrow, it’s back to the bar and bench.

I didn’t realize how complacent I’d gotten. This new muscle challenge is just what I need to keep the momentum going. As Barbara said in her last blog, exercise can be magic, mesmerizing, sublime. Strength training is like that for me. So is biking and walking and stepping on the arc trainer when I have a lot on my mind. Exercise is a friend, a healer, a therapist. Sometimes it needs a little fine tuning, like my change up in routine. When you’re in tune with your body, that fine tuning becomes as natural as breathing.

Here’s wishing you the joy in discovering an exercise you really love doing. There’s really nothing like it.