Friday, May 22, 2015

News flash: Doctors don't know everything

As a nurse, I know that doctors don't know everything more than the general public realizes. Yet, I still managed to make myself believe that when I went to my physical today, my doctor would have a magical answer for my weight loss woes. He didn't. He told me things I've heard a million times before: more strength training (done), more protein (done), more smaller meals (done), different kinds of cardio (done), get more sleep (ummm, not done, but I like my early morning workouts too much to swing this one). The one useful thing he did tell me was that when you've lost as much weight as I have, your biochemistry is permanently altered in a way that is different from "normal" people's, and weight loss becomes much more complicated than calories in/calories out. They don't know why this is, and they have no way to change it. While this is disappointing to say the least, it is at least somewhat of a relief to finally understand more about why I am not losing weight despite burning many more calories than I eat per day. It drove me crazy the way the math just wasn't adding up!

My doctor gave me the speech I've become accustomed to over the past year or so. I hear a version of it from many people, and I always have a mixed reaction to it. He told me I needed to be proud of all that I had accomplished, and be proud of being able to maintain my weight. He said that he doubted 1 out of 1000 of his patients could do what I have done. He said I was very, very, healthy and looked great right now. You're probably thinking, who wouldn't want to hear a speech like that? I mean, it's really flattering! So yeah, part of me likes this speech a lot. But part of me gets frustrated by it. I am well aware that what I have done is pretty darn amazing and I am proud of myself. But me being proud of myself doesn't take away the fact that I know I can accomplish more. It doesn't take away the fact that while I have lost a massive amount of weight, I still have a bit more to lose. It's not like I have body dysmorphia and weigh 100 lbs and think I still look fat. I legitimately still have more weight to lose. But it's like all anyone wants to tell me is how I'm good where I'm at. So yes, that is frustrating. I need someone to help me figure out how to lose this weight without making me feel like I'm being crazy or too extreme for wanting to lose it.

While I'm on the subject of doctors, every time the topic of my weight comes up nowadays at my visit, I am slightly mystified. Because this topic does come up every single visit, even though I haven't dropped any significant weight in nearly a year. Not only do all the doctors in that practice congratulate me for my accomplishment all the time, but they also talk about it to the rest of my family when they come in for a visit! Again, not that it's a bad thing at all; everybody loves compliments! But here's why I get mystified: when I weighed well over 300 lbs, when I had pre-diabetes, joint pain, fatty liver disease, high blood pressure, and sleep apnea all at age 27, the topic of my weight was never discussed. And I do mean never. I can't recall one instance when it was brought up. We discussed medication and the need for a sleep study, but never the single underlying cause of all of those conditions. And I believe that is inexcusable. I get that it's an uncomfortable topic. It's embarrassing to address for all parties involved. I even get the argument that fat people know they're fat without having a doctor tell them. But you know what? If you have previously diagnosed diabetes and refuse to manage it, you still know you have diabetes without a doctor bringing it up. Same goes for asthma or high blood pressure or any number of conditions. But the difference is, a doctor will always bring up those conditions. Every single time. I find it reprehensible that a condition such as obesity that will substantially reduce life expectancy and life quality is not discussed due to it being uncomfortable. Or maybe just because doctors don't think it will do any good. To that I say, you never know until you try. You never know when a person is at their wit's end and ready to make a change. It baffles me that we are so willing to throw drugs at diseases such as the ones I had when losing even a small percentage of weight usually at least improves or even eliminates them all. I know I personally completely eliminated all of my problems I listed above by the time I had lost about 50 lbs and was still significantly overweight. I know that some conditions do require medications, but many conditions can be treated with simple lifestyle changes. Often these changes are not discussed because it is much easier to write a prescription.

Obesity is a medical condition and it deserves to be treated like one. Its origins are multi-faceted and don't just boil down to "Stop eating crap and get off the couch, you lazy bum!" We need to lose the stigma attached to obesity and start discussing it in a non-judgemental, helpful, and supportive way. And I feel like as someone who has personally experienced obesity and also has experience in the medical field, I am in a perfect position to educate both people having issues with this problem and also their doctors. As is the case in many areas, I think education and compassion go a long way towards solving this problem.

Saturday, May 2, 2015

If you do what you always did, you'll get what you've always gotten

It's confession time. I've always prided myself on being 100% honest (even if it wasn't exactly flattering to me) in this blog, and there is no reason for me to stop now. I've gotten crazy again lately, and seem to have forgotten that this is a way of life, not a diet or a race. I have been undereating (usually only about 800 calories a day) and overtraining (running up to 20 miles a day some days). Then on my treat days, I've been indulging a bit too much because I felt so deprived the rest of the week. In my frustration to lose this last bit of weight, I have adopted an "ends justifies the means" attitude, and it is has not been healthy at all (or for that matter, effective either!). I thought it showed my dedication that I was willing to do whatever it took and make whatever sacrifices that I needed to make. It seemed only logical that the more work and sacrifice I was willing to put in, the better results I would see.

It's the old all or nothing attitude all over again. It will always be a part of me, one that I must guard against. I have not been vigilant about it lately. I thought I could save moderation for when I "finished." But you know, it just doesn't work that way. My stubborn mind insisted that calories in/calories out would prevail and I would lose weight, as I was obviously burning many more calories than I was taking in. I mean, it's basic math, right?!? Part of my brain still insists on believing it, despite the lack of results on the scale. Because even with all that effort, all that sacrifice, I'm not losing weight. And that drives me crazy, and makes me act crazy.

When I push past the stubborn, crazy part of my brain, the rational part of me knows that I have stalled my metabolism. My body thinks it is starving, because with all that exercise and that few calories, for all intents and purposes, it is! And a body that is starving is going to hold onto every spare bit of weight that it can. I've not been being kind to my body at all. I should have been looking at food as fuel, not as the enemy. Instead of making me stronger, my extreme attitude has just made me very tired lately. My knees and hips hurt from all that running, a problem I have not had since I was 300 lbs.

I am ashamed of myself because I know better. What will it take to drive the message in my stubborn head?!? I feel like a hypocrite too because I tell others that it is about making a sustainable lifestyle change, and I haven't been doing that lately. I let myself believe that the end goal was weighing 140 lbs, when the end goal should really be about me being happy and healthy. I mean, does it really count as a victory to be 140 lbs if you mistreat your body to get to that weight? It would be better to be carrying a few extra pounds like I am right now and be doing what is right for my body.

But you know what? Everybody makes mistakes. Everyone gets off track at some point. The important part is recognizing where you've gone wrong and correcting it. After all, isn't the definition of insanity doing the same thing over and over again and expecting different results? So undereating and overtraining isn't cutting it for me. I need to switch things up, and so I've decided to try Chris Powell's carb-cycling methods. As a general rule, I don't like "diets", but this really isn't one. It focuses on clean eating, like I do anyway (when I'm not starving myself, that is), but has you alternate high and low carb days, and have one treat day. I already know that going low carb is effective for me, but I also know that I have an intense love affair with bread, and so swearing off carbs entirely is not realistic (nor healthy) for me. Alternating high and low carb days revs up your metabolism because it doesn't know what to expect.

I felt like Chris Powell was reading my mind as I read his book. He asked if I was undereating. He asked if I was overtraining. He told me that all of this combined to stall my metabolism. Honestly, I already knew I had stalled my metabolism, but it was nice to see it in writing. With his plan, you eat 5 times a day. You can count calories, but you don't have to. You just eat the right portion sizes, using your hand as a guide. On high carb days, you eat a protein and carb at every meal with no fats. On low carb days, you eat a protein and fat and vegetable at every meal, no carbs. And every day, you have a protein and carb at breakfast. I'll admit, this has proven hard for me, because of course I want to know exactly how many carbs I should be eating. As far as calorie counting goes, it is so ingrained in me now, I doubt I could stop if I wanted to.

It's been tough so far to eat so often. I feel like I'm eating so much, but really on low carb days I'm eating around 1200 calories and high carb days I'm eating 1500 calories, just like I'm supposed to. Sometimes it makes me feel panicky to eat that many calories (and yes, I know it's really not a lot!), especially since I haven't weighed in yet, but I know that is just my crazy thinking. But it also makes me feel good to know that I am finally correctly fueling my body again, no matter what that fickle scale may say.

I think I'm also going to scale back on the running, and incorporate other forms of cardio like bike riding and tennis and soccer, as well as strength training. Running is still my favorite, but I also don't really want to need a hip or knee replacement when I'm 50.

I lied to myself lately. I told myself that it didn't matter how I reached my goal, just that I reached it. But it does matter how I reach my final goal. Not just because of my health (though that is very important!), but because of my integrity. Do I really want to know that I lost nearly 200 lbs by doing it the healthy way, except at the very end because I got impatient?  No, I want to finish knowing that it's not about sacrifices or depriving myself, not about driving myself crazy with counting calories and carbs and miles run. It's about living a healthy, happy, and fulfilling life. It matters how I finish this because it shows who I am and what I stand for.