body image · diets · eating · Weekends with Womack

Struggles and strategizing: back at the beginning, again

I struggle with my weight. It’s been a lifelong drama, with many supporting players: relatives, doctors, well-meaning (and not-so-well-meaning) friends and boyfriends, teammates on the many sports teams I’ve played for, nutritionists, therapists, you name it. Sometimes there’s relative peace—when I’m active, social, well-rested, not too-too busy in my work life, and my relationships are on an even keel—life is calmer and I worry less about it.

Lately, as menopause has announced its presence in my life (I’m sorry, but who thought this was a good idea? evolution, you’ve got some ‘splaining to do) the struggle has resurfaced. My sleep is interrupted, and I have less energy (but more mood swings—yay) and my cravings for sugar and carbs are at an all-time high. Add to this a heavier-than-usual workload this semester and 108 inches of snow in Boston (and by the way, it’s snowing again now—argh) and it’s no surprise that my average baked good consumption is up, and I’ve gained weight.

Samantha, Tracy, Nat and the guest bloggers have written loads about the failures and perils of diets—they don’t work in the long-term and contribute to lowered self-esteem and increased weight. I know this, too—my research areas are obesity, eating, and health behavior change. And yet I keep flirting with the idea of dieting again. For me, diets are like bad ex-boyfriends—I’ve forgotten the pain and suffering they imposed, how the relationships failed or even backfired. I just remember how good-looking or charming they were, full of seductive promises that “this time, it’ll be different”.

So what am I to do about being back in a state of weight-panic THIS time? Here are three things I’ve done this week. I’ll report back later on to let you know what’s happening—what is working, what I’ve jettisoned, what other responses I’ve adopted, and how I’m feeling.

1. I bought a book.

For an academic, nothing is more reassuring than book purchases, especially when one is confused, frightened, stalled, or in need of comfort. Just the thought of reading books, especially in a comfy study or library, is reassuring.

library

The book I bought is Gretchen Rubin’s “Better than Before: Mastering the Habits of our Everyday Lives”. The New York Times Well Book Club is running an online discussion, which caught my eye this week. Partly out of academic curiosity, and partly out of need to do something, I got the book and checked out the online discussion.

There are loads of books with loads of theories about behavior change, and of course this blog has talked about many of them. When I actually get around to reading this book I will fill you in. For now, all I’ve done is taken the quiz to set the stage for where I fit in Rubin’s behavior-change taxonomy. From there she has lots of suggestions for tailored strategies to optimize effectiveness.

Now, I have no particular expectation that this book is better or more effective than others; I will report back on my experiences later on. But for now, just owning this book feels like it’s helping me regain a little more perspective, which is good.

2. I’ve stopped eating sugary foods (at least for now).

While talking with a therapist about my energy levels, cravings, menopausal moods and general dissatisfaction with life on planet Earth these days, she suggested that maybe stopping eating processed sugar for a while might result in improvement of my overall mood and well-being. Just to be clear, I’m not talking about stopping eating these:

apples

but rather, stopping eating these:

bakery

For now.

I’m on day 3 of the no-baked-goods-and-other-sugary-stuff plan, and will report back on what I’ve done and learned.

3. I’ve changed primary care doctors.

This was a very big move—I’d been with the same doctor since 1998, and value familiarity, loyalty, and the deep knowledge base she has. But I never felt comfortable talking about my weight with her, and dreaded what she had to say, which never felt supportive. We squabbled about calcium and vitamin D supplements, and frequency of mammograms (she disagreed with the USPSTF recommendations which I wanted to follow). I would delay physicals in order to avoid being weighed.  Again, even though I know how bad the effects of weight stigma are on women in healthcare settings, it still took me a long time to act.

The first meeting with my new provider was eye-opening: she spent an hour with me (unprecedented in my experience), and we talked about weight, activity, menopause, sex, etc. in ways that felt positive and centered on my goals and needs.  I told her that I was willing to be weighed for my yearly physical and also when there was a medical need for complete accuracy (say, if this was a surgery pre-op visit).  Otherwise, I said I really didn’t want to be weighed, that it was a deterrent to my seeing her  She agreed, and we moved on smoothly.

Here’s how I handled the scale issue with the nurse (who I saw before the provider came in). She introduced herself and said, “I need to get your weight and height”.  I responded right away with “I’m not going to get on the scale, but I’m happy to tell you my weight; I weighed myself this week.”  She said okay.  When we got to the scale, she said, “you’re not going to get on the scale?”  I said no, but then told her my weight.  Then she asked, “are you willing to have your height measured?”  We both laughed, and I said yes indeed.  It turns out I’m the same height as the last time I was measured.

The issue of primary care office visits and weighing of patients is controversial and far from settled.  For what it’s worth, in a US National Institutes of Health document about treating obese patients, one of its recommendations is to weigh them during visits only when it’s medically appropriate.  I’m not here to speak authoritatively about this issue, but I did want to include how I handled my experiences and fears of weight stigma in this environment.

I’m very lucky not to be on any prescription meds, so I don’t see healthcare providers often. But I’m hopeful about my prospects moving forward with this new practice.

I’ll report later on progress, shifts, and lessons learned. For now, thanks for reading.

22 thoughts on “Struggles and strategizing: back at the beginning, again

  1. I’m glad you found a health care provider that you are comfortable with and who canot help make this journey a little easier on you! Have you been over to wwwww.fitwoman.com and read up on some of their blog posts? They are not far from you if you’re in Boston and may be a great support during this particular cycle. Best wishes!

    Liked by 1 person

  2. Interesting. My doctor no longer weighs me and I wonder what prompted that change. Instead she asks if my weight has changed much, up or down, in the past year. Let me know how the no added sugar thing goes. I try to limit dessert to twice a week but I am a fan of chocolate. Also, when riding, sports drinks, gels etc.

    Best of luck with it all. You sound so very much like me!

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    1. How interesting that your doc doesn’t weigh you; I wish more were like that (except when it’s needed, of course). I’m also a fan of chocolate, but right now the stress of life is triggering cravings, so keeping it at bay (for now)seems like better self-care. And of course I’ll have to have sports drink/bars for cycling. Will be blogging more about the Rubin book, behavior change and experiences with all of these. Thanks!

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  3. I love the buy-a-book step. I own sixty or so diet books, and that’s after giving away a couple dozen when I moved several months ago. Buying a book no longer gives me the comfort it once did, I still appreciate the process. The weighing as a part of the doctor visit was also interesting. Unfortunately, I am diabetic, so I can’t get out of it. Good luck with your new start. I am having one of my own.

    Liked by 1 person

    1. Glad you’re having a new start– it’s always energizing. For me the middle parts of the process are harder– maintaining focus and momentum takes energy. But spring is coming (or so I heard…) and that always feels great for food and activity.

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  4. I love your step wise and self experimentation approach.
    I have a physical next week and I was already obsessing about the weigh in.
    I don’t use a scale any longer and I am going to just say no. I am on some medications, but they are not weight dependant.
    Thank you for putting this out there. I feel much more comfortable just saying no.

    Liked by 1 person

    1. Hi there– so many women feel this way about the scale at the doctor’s office; it’s completely common. I talked to my new primary care person and explained my position, and she didn’t disagree at all. I hope and expect all will go well with your appt; we have the right to input about how our medical care is done, including what sorts of procedures and tests. Thanks for the comments!

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  5. I love how honest you are with your ups and downs. I can not agree more with you on the feeling a book gives you. It’s absolutely the best. Good luck and I look forward to reading more!

    Liked by 1 person

  6. Catherine, Weight and height recorded at each visit is actually tied to an incentive set up by insurance companies as a measurement of “quality of care.” I agree, it’s stupid and anxiety inducing for MANY patients. It’s not that your health care provider wants to judge you (in my personal experience) but it’s actually a way of the insurance companies’ judgement on my ability to deliver care. Our healthcare system at its best….
    Great post…thanks for sharing your journey. Just got back from conference in which a nutritionist provided this advice:
    Let yourself eat
    Don’t follow diet trends – “everything in moderation”
    Realizes there’s no black and white…only grey when it comes to nutrition
    Don’t compare your meals to others around you

    It was interesting to hear this advice from a dietician. This winter has been hard on all of us (no matter what our dress size was to begin with) and I continue to struggle with the rules above.

    Liked by 1 person

    1. Hi Emily– thanks for your comments; yes, a lot of protocols and care in general are driven by insurance reimbursement practices, which frustrate health care professionals and patients. In my professional life, I just wrote a perspective article on the recent Lancet series on obesity. One of the articles recommends added training for healthcare professionals not just to deal with weight bias, but also on behavior change strategies. Here’s the link to that article:
      http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2814%2961748-7/fulltext

      Sounds like this nutritionist has some wise words– I especially like the “no-comparison” advice. We all have different preferences, cultural contexts, emotional connections, etc. which in part drive our food choices. Recognizing this and customizing our eating, taking into account lots of features and needs is important.

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  7. Thank you for sharing. I am reblogging this at RobertCullen3S.wordpress.com because, aside from menopausal issues, all the rest are relevant for everyone. I am writing a book on 3S–Success, Significance and Satisfaction for those 50 and beyond. Pursuit of good health is a key element in the Satisfaction front. Your article is very useful.
    Please visit and check out my blog. Your opinion is valuable. Thank you again,

    Liked by 1 person

  8. Reblogged this on ROBERT CULLEN'S 3S BLOG and commented:
    Fitness is a #3S issue as well. Common to all.
    Check out Catharine Womack explain the “Struggles and strategizing: back at the beginning, again” from Fitness is a Feminist Issue

    Like

  9. Good for you, for taking control. I just had a conversation the other day at a business dinner, the discussion of yearly exams came up and most of the men actually choose the “avoidance” method. Hard to believe–I mentioned I loved going, aside from getting weighed, because you can benchmark where you are, and if there are any issues, you can deal with them now, rather than too late! Anyway, about weighing–it’s awful. Sometimes I turn around from the scale and tell them not to tell me, but as a 45 yo woman, feel kind of dumb to have to be like that. Even though I’m at a very normal weight, it’s a degrading measure and causes me anxiety because of the ups and downs for weeks, months….

    Liked by 1 person

    1. Hi– thanks for sharing your misgivings about being weighed. This is a very common experience, and it really is time for healthcare providers to start taking this into account, and work to make some new markers of health status.

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  10. Hey Catherine – long time no see, but I enjoy your posts! I am also fit but weigh more than I should. It bothers my mom more than me, but I would like to lose a bit of excess weight, especially since I can identify that plenty of my eating isn’t hunger-related (working from home doesn’t help with this!) I’ve never dieted and don’t want to start now, but a book that was very interesting was Slim By Design, which is by the same guy who wrote the mindless eating book. Some of it was eye-roll worthy but in all it was a very interesting (and engaging and easy-reading) book: http://www.slimbydesign.org
    Without a scale, I don’t know for sure if I’ve had any “official” effect from adopting some of his guidelines, but I definitely am eating fewer crazy cookie binges 🙂

    Liked by 1 person

    1. HI Karen– yes, long time no see! Hope to see you out on the road when it gets warmer. So glad you like the posts– they’re fun to write. I’ll check out the book you mention; mindful eating is something that Tracy has written a lot about. Congrats on not having a scale! We don’t need them in order to know about our weight– clothing, appearance, how we feel, how we move, etc. all tell us about our physical selves… Hope to run into you soon.

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  11. Congrats on making the PCP move! All of your changes sound positive too. It is so difficult to strategize … Recently, reasoning that if cutting calories alters metabolism and strenuous exercise on top of cutting calories sabotages it even more, I experimented with the hypothesis that the best way to get lean and mean for cycling is to exercise lots and also eat liberally. Yeah, I promptly gained a couple of pounds … 🙂 (though possibly I wasn’t living the first part of that formula enough).

    One thing I find fascinating is how being weighed at the doctor’s is traumatic/invasive, but willingness to report the number is less so. I agree with that. But it’s interesting because it is presumably the same number, or within a pound or two. So in a way it may be less judgment about the number as … The anxiety that the number might somehow shift from what it was in the bathroom at home? The ability to control a process that is otherwise wrought with humiliation? Judgment is worse when there’s also a power dynamic?

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  12. That’s great that you like your new family doctor.
    I was not aware of the weighing-in issue at the doctor’s office. I actually NEED to weigh myself at the doctor’s office because sometimes my weigh scale at home is not working properly.

    Like

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