Monday, October 01, 2007

Weight Loss is Personal

Even if you're blogging about it.

So currently I'm working with one of the local newspapers as one of their panel of experts for a lengthy series on nutrition.

The launch was last weekend and included in the launch was an article written by a very young man who's just barely overweight. The article was about his month long experiment of following Canada's Food Guide and he's also keeping a blog about his experiences aiming at reaching a numerical goal weight (the weight needed to give him a body mass index of 25).

Now readers of my blog will certainly know that I'm not a fan of using BMI or "pound" goals because frankly they overlook the bigger picture - reality. Fact is, the best goal is whatever weight you reach when you're living the healthiest life you can enjoy. But put that aside for now. The important question to ask regardless is, "So is he enjoying his life?"

Not according to his newspaper articles and blog entries he isn't.

According to them he's been saving up his calories for supper and in so doing often finding himself starving and battling hunger demons (like the ones that live in Pizza shops). He reports being "desperate" for steak because his Food Guide approach doesn't allow him to eat large ones. He reports being tired and finding it difficult to find 60 minutes a day of exercise. He reports that he fell off his new wagon within one month of embarking on it. He notes that on at least one occasion when he ate more than he planned in the daytime he compensated and went to bed following a dinner consisting solely of a plate of green beans with two slices of toast. He reports that the "red numbers" on the scale motivate him and help him with what he feels his efforts require - "focus, attention and willpower".

In short, he's on a diet.

Given my chosen career and my experience with quite literally thousands of folks trying to lose weight, reading his article and his blog, I decided that there's no way that he's adopted a long term approach here. He's dieting and both anectdotally and in the medical literature, diets fail in the long term over 95% of the time.

So what type of diet behaviours does he admit to? By using the scale as a source of support, he's chosen the proverbial dark side of weight loss, letting the seduction of the numbers inspire him to greater acts of willpower - a problem when the scale stops whispering sweet nothings into his ear. By saving calories until the end of the day and cultivating blindly restrictive food limits, he's cultivating hunger which will lead him to battle hunger - a battle that if fought frequently, eventually just gets too irritating and bitter to fight. By trying to cram 60 minutes of exercise a day into likely a very busy and youthfully all over the place lifestyle, he's liable to get frustrated with the exercise and simply let the whole thing go. He appears to be trying to live the healthiest life he can tolerate - and for me, that's the definition of a diet.

So here's where it gets interesting.

I decided to write to him and in the email I told him that it seemed painfully obvious that he didn't particularly relish his new healthiest-he-could-tolerate lifestyle and that in the long run, if he didn't enjoy his life, he wouldn't continue living that way.

I also offered him our help with no strings attached. I recommended that he see our dietitian and told him that should he come and see her, he need not feel that he would have to mention the visit or our help in his blog or in his articles.

I logged onto his blog the other day and read what sounded to me like a fairly irritated entry from him stating that I had written to him, told him that he was going to fail and that I tried to convince him to join my office's weight loss program.

Now the later part's simply not true, I had offered him a free visit with out dietitian with no strings attached, but I'll chalk that one up to misinterpreted email, but the former part I suppose is true, and frankly, I'm sorry that I emailed him and more sorry that I clearly have upset him.

You'd think of all people, I'd know that weight loss is personal. It's my exclusive area of practice and thinking about weight and weight management probably takes up at least 2/3rd of my total waking hours.

I should have known better than to offer my opinions or even offer to help because the mistake that I made, was assuming he wanted my opinions or my help.

Weight loss is a personal journey. No one should feel comfortable muscling in on someone else's weight loss effort.

My mistake was an honest one. For heaven's sake, having a blog and writing articles about weight management pretty much opens the door to having folks comment on your efforts, but frankly I still should have known better.

Best of luck to him, and should he decide that in fact my opinion and help would be useful to him, he's still welcome to give me a call.

For all of the friends and spouses of folks trying to lose weight out there, here's the only question you should ever ask your weight-conscious friends, "Is there any way that you feel I can help you". If the answer's "No", then just leave it at that, if they want your opinion or help, they'll ask.

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  1. Your last sentence couldn't be more true. Individuals often have tried many 'name brand' diets, and having not succeeded in the long term, are pessimistic about 'professional' advice which requires change from what made them heavy in the first place. Doctors refer to me for assistance yet their patients would rather continue changing nothing. Sometimes it takes a few weeks to show them that small steps, good food, and regular eating can rally make them feel better, not worse. And then we change another small thing, and eat meals made at home with ideas for shopping and preparation that are simple to try. Like addictions, change is unlikely until desired by the sufferer.

  2. Anonymous1:15 am

    Your blog and perspective are interesting, but to people who have struggled with weight for a lifetime and have come to the conclusion that the struggle is more damaging to quality of life than the weight itself is, it's hard to distinguish between what you call "lifestyle change" and a diet. Of course, you see people who want to lose weight, but do you ever get people who want to improve their health and do not care if their weight changes much at all?
    I have type 2 diabetes, and during pregnancy and nursing, I utilized insulin to keep my blood sugars in the recommended ranges. I have a very healthy child (thank g-d) and didn't mind being on insulin in order to be able to have a healthy pregnancy, child, and in order to be able to nurse my child. But it wasn't until I switched from insulin back to Metformin that I lost the weight I had gained during pregnancy. Also, now that my child is a bit older, I am able to fit in more exercise, and I weigh 7% less than I did a year ago, without focusing in particular on weight loss but rather trying to manage my busy, full, work and home life with the least stress possible. Add to this my own continual "food awareness" and I've managed to be within 5 pounds of my pre-pregnancy weight (which is unquestionably higher than what most people would think is healthy).
    Honestly, at the moment, my actual weight isn't interfering with my life anywhere near as much as my internalized weight stigma is. I have the job I want, a healthy child, a good marriage, friends, good relationships with my family. I can do just about everything that I want to in my life, and time is a greater limiting factor than the size of my jeans.
    I think people who are in similar situations to me often do feel pressure (coming from public health, physicians, society as a whole) to "improve" in this area even if we aren't personally feeling our weight to be an issue.
    I know that I have type 2 diabetes, and I know the relationship between diabetes and weight, but I see the type 2 diabetes and weight as co-morbidities (I also have PCOS) not one causing the other (if anything, I think the insulin resistance and extra hunger I feel cause the weight, rather than the other way around).
    I'm interested in your opinion (more as a human and blogger than as a physician, although I wouldn't expect you to be able to put your physician self completely aside).

  3. Thanks for your comments.

    I think the distinction between what's traditionally referred to as a diet and what I refer to as a lifestyle is an easy one to make.

    Dieting involves blind restrictions in calories or foods or simply the purposeful acceptance of hunger as a necessity in life.

    Living, healthy living, may involve a change in structure and organizing (such as eating more frequently with the inclusion of protein) but by definition must exclude suffering, blind restrictions, forbidding foods and hunger.

    Regarding my thoughts on whether or not you should care about your weight - that's entirely up to you.

    There is no doubt that weight carries with it medical risk, however the acceptance of risk is a personal decision, and not one that anyone has the right to question.

    We all allow different degrees of acceptable risks into our lives. I for instance still consume red meat and drink alcohol and often times when I get overly busy (like these days), my exercise regime falls by the wayside.

    Sure I could be fitter, sure I could eat better but I choose to accept the risks of not doing so into my life and frankly that's my business just as the risk of anyone's excess weight is their business.

    I think a physician's job is certainly to point out those areas in a person's life that confer medical risk and ideally offer their advice and opinions as to how to minmize those risks. Beyond that however, the physician's job stops and the patient's job begins. The patient's job is to decide what to do with that advice and frankly any physician who takes themselves so seriously that they take it personally if their advice is not heeded, isn't a physician I would want to see.