diets · eating · monthly check in · weight loss

Sam’s monthly check-in: What’s up, what’s down, the September version (CW: some discussion of weight loss)

    Bright red maple leaves against a blue sky. Photo by Unsplash.

    What’s up…

    Here’s the fun, easy thing. I’ve started swimming lessons and I’m excited about that. I love learning new things though I feel like I have been learning to swim my whole life! And maybe that’s okay. We’re working (so far) on breathing and kicking. I feel like I am learning lots, I’m not hopeless, and I feel like someday I might be able swim lengths of the pool again. The lessons are semi-private and the other student is a 4th year undergrad, an international student, hoping to learn to swim strokes. The instructor is also a senior undergrad and we’re all having fun. The lessons are short–30 minutes–but twice weekly and I can come early and stick around after for extra time in the pool. This weekend I’m shopping for a second fitness-y, swimming pool type bathing suit and new goggles. Woohoo!

    Here’s the thing that’s hard to talk about, doctors and weight loss. I met with a family doctor with some experience/expertise in the area of weight loss. Why? Well, less knee pain is the short answer. But also better surgical outcomes and quicker recovery if I go that route. I also stand a better chance of avoiding knee surgery until the inevitable knee replacement many years down the road. I know doctors recommend weight loss for everything but in this case–I’ve read a bunch of the journal literature–I think they’re right.
    I don’t think it’s a case like this.

    So in my case I’m not being extra active in order to lose weight. I’m trying to lose weight to preserve my level of activity. There’s nothing magical on offer. The best diet is the one you can live with. I knew that going in. Weight loss is tough. Read Everything You Know About Obesity is Wrong if you want to know how tough. But with my active lifestyle which I love up for grabs, I have to try. The odds aren’t great. I know that. Given my size and the knee problems, I qualify for weight loss surgery. I declined. I also qualify for appetite suppressing medication. Again, for now, I declined. I might try it later. Instead I’m using MyFitnessPal and tracking all the things, trying to find a lower calorie life I can live with. I like this, from Yoni Freedhoff,

    Now, you should know that I too have a weight-loss agenda. It’s fairly easy to describe. In a nutshell, I don’t believe that there’s one right diet to suit everyone. In my clinical practice, as well as in my book, I embrace the fact that there are dozens, if not hundreds, of factors that influence an individual’s chances of long-term success. Low fat, low carb, keto, paleo, intermittent fasting, vegan, Mediterranean, meal replacement, whatever – there are success stories out there with each and every diet that exists.

    While I’ve seen proof of this in my own clinical practice, you don’t have to take my word for it. Instead, look no further than the National Weight Control Registry for evidence that, when it comes to successfully keeping weight off long term, everyone’s different. The massive database established in the 1990s tracks why and how over 10,000 people have managed to keep an average loss of 67 pounds off for over five years. And there, as I’ve described, there isn’t one answer.

    The one thing successful dieters have in common is that they reduce their calories on their new diets and like their lives and diets enough while on it to sustain its adoption for good. So, while it’s true that you might be able to lose more weight, or to lose weight faster, with one diet versus another, unless you keep living with it forever, that weight’s coming back when you head back to the life and diet that you actually liked before you lost.

    To put it even more succinctly: If you promote the notion that there’s one right way to lose weight or live healthfully, you’re part of the problem. The more weight you’d like to permanently lose, the more of your life you’ll need to permanently change. And, when it comes to something as pleasurable as food, merely tolerable lives just aren’t good enough. What’s best for you is undoubtedly worst for someone else.

    I reviewed his book, The Diet Fix, here. I’m seeing a family doctor, who as part of his training did a placement with Yoni Freedhoff.

    In the photo below, Aric is on the left and Yoni, on the right. They’re both proponents of evidence based medicine and I like that neither downplays how hard it is to lose weight and keep it off.

    At no point have I felt like I’m not believed about what I eat and my current level of activity.

    Where am I? I started at 240 lbs for my all time winter high and I’m down to 225. I’d like to get down to 175, which is still solidly in the ‘overweight’ category for my height. But I’m pretty muscular and the normal range 121-158 lbs are weights I haven’t seen since elementary school me! I’ve been keeping my weight loss updates to the monthly check-ins, complete with content warnings. Tracy and I are pretty committed to keeping weight loss talk to a minimum. But I’ve been writing about it at all because it’s very closely tied to my desire to stay active.

    Two different knee surgeons say that no matter what I’ll never run again and though weight didn’t cause that (lots of skinny people have osteoarthritis–it’s not caused by my size) if I want to keep walking, hiking etc I need to lose weight. You can read about my left knee here. You can read more about it here.

    Given that it’s tied to me having an active future, I feel like I want to write about it. The content warnings should help people avoid it, I hope.

    Why is it so hard to write about weight loss? Why?

    I know what’s hard about it for me. For years I’ve been happy and active at a larger size, sharing the message that you don’t need to be thin to be fit. I’m not throwing that message out now this larger body isn’t serving me so well.  There are so many imperatives to lose weight. See Wishing for weight loss. Looks, caring about pay and teaching evaluations even, and so many medical arguments that aren’t true. So many reasons I reject. But then there is this one, pain. It’s awful and urgent and I want it to stop.

    Wish me luck. 

    motivation · weight loss

    Better to be a corpse with ripped abs?: On looks, performance, and health

    Here on the blog we often make the distinction between athletic and aesthetic values when it comes to exercise goals. We’re about the former, not the latter. You know, run to improve your 5 km time not to lose those last five lbs.

    That said, you do you.

    Our worry is that appearance, in particular weight loss, is a lousy motivator. See here. People try. It doesn’t work. And then they stop exercising even though it’s good for their mental and physical health to workout.

    But looks and performance aren’t the only games in town. You might also care about health.

    At the elite level health and performance might come apart. They often do. Lots of athletes train in ways that aren’t great health wise. At the other end of the spectrum, the kind and amount of exercise recommended for health might not have much effect performance wise.

    Health goals might also conflict with appearance goals. I was chatting with some young people this week about the latest news about health and ultra low carb diets. Interestingly, they didn’t care. The news wasn’t that ultra low carb diets don’t work for weight loss. The news was that they are bad for your health. Low carb dieters don’t live as long as people who eat a moderate amount of carbs.

    It made the news everywhere. Here’s this story from Running World on low carb diets leading to premature death.

    But, said the young person, who cares about living long? I’d trade five extra years of life for ripped abs. My low carb diet is about being shredded not about being healthy. If low carb is key to weight loss, who cares if it’s bad for your health? I have a few Facebook friends who feel the same way. Some want just to be skinny. Others want to look muscular and chiseled.

    I don’t want to argue the facts of it here, that is, really low carb versus moderate carb diets, but I am interested in the relative weight we give to looks versus health and longevity. And it’s interesting to see the weight loss set admit it’s not about health really after all. It’s about chiseled abs. Fine.

    So where do you stand? Are you in it for the abs, the long life, or for winning the competition, whatever competition that is?

    Lately I’ve been thinking that what gets left out of these goals is a broader definition of health, one that includes functional fitness, pain free living, and mental well being.

    A picture of a breakfast. A mug of black coffee and a bowl of muesli and fruit
    weight loss

    Exercise and weight loss, in the news again

    Lots of people are applauding this story that’s been making the rounds this week.

    I liked Yoni Freedhoff’s comment on Twitter about this study, and the resulting media attention, that anyone who thinks this is good news has probably never tried to sustain a commitment to an hour a day of exercise.

    Also, in the news is this story about the weight reducing benefits of bike riding. Now I love riding my bike as much as the next person but I find hours and hours on the bike don’t make much difference to my weight. I reread the story more carefully and it turns out the weight loss benefits of cycling amount to 1.6 pounds. I’m not sure that anyone who is concerned about losing weight cares much about 1.6 pounds.

    Finally, in the exercise-weight loss news world there was this story about Americans exercising more and also gaining weight.

    I’m with Yoni Freedhoff (again): Exercise is the world’s best drug. It’s just not a weight-loss drug.

    There are so many reasons to exercise that have nothing to do with weight loss. Here’s 11 of them.

    We need to sever in our minds the connection between working out and losing weight.

    I’ve read the research. See Why you shouldn’t exercise to lose weight, explained with 60+ studies .. and The science is in: exercise won’t help you lose much weight but still even for me, I’m sometimes surprised. How about you?

    Photo by Everton Vila on Unsplash Lovers share a silhouetted bicycle ride, hands reaching out to each other against a pink sky
    athletes · blogging · fitness · injury · monthly check in · motivation · sailing · weight loss

    Sam’s monthly check-in: What’s up, what’s down, the July version (CW: long, some sad bits, some discussion of weight loss)

    Down, is of course, my knee

    Saw the surgeon and his team on Monday. I’ve been crying on and off since.

    The easy bits are that I got another shot of synvisc under my kneecap. What is it and what’s it for? “SYNVISC is a viscosupplement injection that supplements the fluid in your knee to help lubricate and cushion the joint. SYNVISC is for people with knee osteoarthritis who have not received enough pain relief from diet, exercise and over-the-counter pain medication.”

    Read more here.

    View this post on Instagram

    Knee injection

    A post shared by Samantha Brennan (@samjanebrennan) on

    I’m also still wearing the knee brace and it’s helping on days when I’m on my feet a lot. I spent the weekend in New York and even though I took the subway more than usual and hopped in a few taxis for good measure, I still got 13,000 steps in on Sunday including a walk through Central Park. Thanks knee brace. I did some shopping for more leggings for under the brace and for short skirts and dresses to wear over the leggings. The brace presents some fashion challenges and I’m warmer than usual with black leggings on no matter what.

    Image description: A photo of Sam just outside Central Park. I’m wearing black leggings, sandals, a sleeveless black jumper and a purse over my shoulder. Also, a knee brace. I’m smiling and the sun is shining.

    I’m still going to physio and doing lots of knee-supporting exercises.

    I still meet the conditions for knee replacement surgery (in both knees actually though only the left hurts) but neither of the surgeons I saw recommend it. I’m too young and I’m too active. The surgeons made me laugh, which is something, given the general message they had to deliver.

    They said they like to make people happy. The person they make the most happy through knee replacement is somebody who arrives in their office, sad and older. Someone who just wants to walk to the grocery store without pain, the kind of person who says they want to lead a normal life, get a decent night’s sleep, and not suffer all the time. Knee replacement apparently makes that person very happy but they said for someone like me it wouldn’t make me happy.

    Why not? Because I want to regain function and their line on knee replacement is that you shouldn’t do it to regain function, you should do it to lose pain. Also, knee replacements don’t last very long maybe 20 years and I’m young. I want to do things like ride my bike and some patients after knee replacement have difficulty bike riding because they don’t have the full range of motion back necessary for riding a bike.

    So, no.

    Instead they discussed a different surgery called high tibial osteotomy. That surgery involves breaking bones and resetting them so I have a bigger gap in my knee cap on the side that’s in a lot of pain. It’s a good sign that the brace helps because this does surgically what the brace does mechanically. But it’s not a permanent fix. There’s a chance the other side of my knee will become painful as arthritis advances. So it’s good for 2-10 years maybe. Also, it’s big deal surgery. Like knee replacement it’s months and months of recovery. I’d trade off 10 years of active living without pain for six months painful time consuming recovery but I’m not sure about 2 years. There are no magic globes I can peer in to see the future.

    I’m trying to decide. See them again in three months.

    In the meantime my fit feminist friend Sarah is having that same surgery. Wishing her well.

    But the other depressing piece of news from the surgeons was the strong recommendation of weight loss, both as a way of avoiding surgery and as essential to recovering from it. Either way I should lose a lot of weight. It will definitely, they say, help with pain relief. The pain is all about weight bearing. That’s why downstairs is harder than up. It’s all about force on the kneecap. And as far as motivation goes this is pretty horrible pain. Like pain that makes hard to think about other things.

    Now as I’ve said before I wish that it were the case that medical reasons for weight loss changed the facts. But that’s not so. Your body doesn’t care how good, how “pure” your motivation is. It’s still tough. It’s tough losing weight and tough keeping it off.

    I don’t have any choice but to try. The worse case scenario is that I lose it, gain it back, and more and need knee replacement surgery. But that’s the same worst case scenario I face now. I’ve lost significant amounts of weight in my life, 70 lbs in grad school, 60 when I turned 40. The trick, the hard part, is keeping it off. This time, if I actually lose weight, I’ll be unicorn training, learning the habits of people who actually keep weight off.

    Don’t worry. This won’t become a weight loss blog. Likely I’ll save any angst, any updates, to my monthly check in posts. I’ll also add content warnings.

    I thought about leaving blogging but making this pain manageable and movement possible is a big part of my life right now. And I’m very much still a fit, feminist just one who is coping with injury and aging and hoping to keep in moving.

    Wish me luck.

    Up, still Snipe racing

    View this post on Instagram

    Our Snipe!

    A post shared by Samantha Brennan (@samjanebrennan) on

    It can be tricky moving around in a small boat in ways that don’t hurt my knee but I’m learning how to do it. I haven’t raced a small sailboat ever. All of my sailboat racing experience is on relatively big boats so this is new to me. With all the knee misery, see above, it’s good to have something new to focus on. It’s fun and exciting and lots to learn.

    body image · weight loss

    Why make it all about weight? Can’t it just be a good hair day?

    Saturday night I went to a concert.

    I looked good, if I do say so. A snazzy new pink dress. Pink lipstick. Blonde wild curls.

    It had been a humid day, the best kind for making perfect curls.

    Here’s a serious selfie and a smiling selfie complete with photobombed bunny ears.

    No big deal, right? Except after the concert I met up with a friend who was seated on the floor of the church. I’d been in the balcony. We met over coffee and cake in the church parlor.

    And then it began.

    “How much weight have you lost? You’ve lost weight, right? You’re practically slipping away into nothing. I couldn’t recognize you you’ve lost so much weight. How much weight have you lost anyway?”

    Now to be clear, I haven’t lost much weight. Maybe five pounds since the whole talk of knee replacement surgery began back in November. That’s less than one pound a month, if I quickly do the math.

    Here’s the post where I talk about the knee surgeon’s recommendation that I lose weight to help avoid surgery.

    I weigh more than 200 lbs. Even if I’d lost more weight, I’m hardly slipping away into nothing. I’m pretty solidly, largely here.

    Like Tracy, I hate the you’ve lost weight, you look great talk.

    I think that night I did look great but I don’t think it was about weight at all. Nice dress, good hair, pink lipstick and toenails! But if you look good, it must be that you’d lost weight, right? Sigh.

    And what’s with this “slipping away into nothing” talk. Why is that a good thing? Can’t women, shouldn’t women, proudly take up space?

    I’m curious friends, followers, and readers, how to you handle weird, well meaning weight loss comments? What do you say?

    health · stereotypes · weight loss · weight stigma

    6 things Sam hates about seeing doctors, as a larger person

    None of this is true about my current set of health practitioners. But they took awhile to find. Right now I’m halfway between jobs and cities and I’m looking for a new family doctor to start. It’s tough. And here’s why!

    1. They believe ridiculous things about me. See this article about doctors and bias against larger patient. “Much research has shown that clinicians have biases related to overweight and obesity, conditions that affect more than two-thirds of U.S. adults, Dr. Gudzune said. “[With] the magnitude of the effect of obesity in our country, a substantial number of people are experiencing health care disparities as a result,” she said. Studies have consistently shown that physicians associate obesity with such negative attributes as poor hygiene, nonadherence, hostility, and dishonesty, Dr. Gudzune said. “These types of attitudes are pervasive. It’s not just in the U.S. … [but] physicians across the world as well: Australian, Israeli, European physicians. … These attitudes have been documented as far back as 1969, and they continue to persist up until today,” she said. In surveys of primary care physicians, more than 50% view patients with obesity as awkward, unattractive, and ugly, Dr. Gudzune said. “They have less respect for patients with obesity. They also believe that heavier patients are less likely to follow medical advice, benefit from counseling, or adhere to medications, which are some of the things that are really critical in thinking about managing obesity,” she said. She added that these attitudes may extend to other health professionals, such as medical students, nurses, and nutritionists.” Not fun.

    2. They prescribe weight loss for everything. The evidence bar is very low. If there’s even a small chance that weight makes a difference, they mention it.

    3. They don’t believe my attempts at trying to lose weight. I just haven’t tried hard enough apparently. It’s as if once a have a serious medical reason, like putting off knee replacement surgery, I’ll snap to it, get down to business, and the pounds will just melt away.

    4. They don’t have anything useful to say about how to lose weight. See this post on unwanted weight loss advice. “Why do doctors weigh patients and offer weight loss advice? Other than “eat less and move more” which is kind of like the weight loss equivalent of “buy low and sell high,” what recommendations do they make and why?”

    5. But they recommend diets anyway even though the most likely outcome is that the patient weighs more at the end. In this post I wonder if doctors would do that with any other “likely to fail spectacularly” treatment. See Well intentioned lies, doctors, and the diet industry: If weight loss is impossible, ctors-and-the-diet-industry-if-weight-loss-impossible-then-what/

    6. They never believe my blood pressure readings or my cholesterol levels. I’ve had a complete work up with a endocrinologist who gave me a clean bill of fat health but still, it’s an uphill battle being seen. See this post and this one.

    I know Catherine and Nat have blogged here about issues with doctors. I often think, hey we’re all strong feminists with serious amounts of post secondary education and some good attitudes, we’re white, English speaking, able bodied, if we have problems with doctors what’s it like for other women who don’t share our bundle of privileges? If you’re a larger person, what’s the medical world like for you. We want to know.

    fitness · weight loss

    Weight-loss surgery for teens: a disturbing trend

    We bloggers and readers been writing and talking amongst ourselves lately about children, weight, fat shaming, and concerns about policing and medicalizing kids’ bodies. Once you start down this path, it’s really hard to stop. And where does this lead? To increased health and fitness, an end to worries about body appearance and function and social acceptability? Not if you read the studies.

    The recent news (and blog posts like this, this, and this) about Weight Watchers targeting children with their new teen diet programs has been a hot topic around here. I wrote here about what I don’t like about diets for children even when they’re informed by extensive research. In short, I don’t like weight loss programs that set up kids with possibly unattainable goals that also may not be necessary for them to live healthy and long lives.

    But in the realm of kid weight problem concerns, nothing worries me like the increasing push to use both weight-loss drugs and bariatric surgery on children.

    Let me repeat this last part: bariatric surgery on children.

    What?

    No, really, this is a thing now. Here’s Columbia University’s Center for Metabolic and Weight Loss Surgery’s take on age minimums:

    Our consensus is that adolescence is really the boundary for performing weight loss surgery, and the World Health Organization defines adolescence as starting at age ten. However, aside from age, we look at other physiological factors such as sexual maturity and bone age growth when deciding whether or not bariatric surgery is appropriate in adolescents. With all these factors taken into consideration, the average age of adolescents undergoing surgery in our program is 16 years old.

    Okay, ignoring the horrifying idea that a 10-year-old child is considered both an adolescent and potential candidate for this surgery, what’s so bad about this idea? That is, what makes this kind of surgery so worrisome for teens?

    You asked (well I actually asked myself), so I deliver– here’s a short list:

    Nutritional risks: teenage children are still developing, and weight loss surgery permanent compromises their ability to absorb nutrients. In particular, bone density and skeletal development may be (and have been shown in some studies) to be adversely affected. Deficiencies in levels of calcium, vitamin D, iron, B12, are common, so patients have to take supplements and be screened.

    No real informed consent: in order to be able to perform any surgery, health care professionals are required to get informed consent from patients. This means explaining the nature of the procedure, possible and likely outcomes, side effects, and other important features of what life will be like afterwards. Teenagers are demonstrably not developed enough cognitively/neurologically to engage in long-term complex decision-making on this kind of scale. It seems to me grossly unfair to ask them to make such a life-changing decision at this point in their lives unless they are in extremis.

    Pregnancy risks: yes, you read that right. In one study, the rate of pregnancy in a post-surgery cohort was twice that of the regular adolescent population. That’s not enough to conclude this with confidence, but it is enough for the American Society of Metabolic and Bariatric Surgery site to post this about that study:

    This finding suggests that the risk of pregnancy in adolescents undergoing bariatric surgery might be increased. All female adolescents should be informed about increased fertility after weight loss and that pregnancy during the first 18 months after bariatric surgery has possible risks. These patients should be counseled to avoid pregnancy during this period and offered contraception.

    In short, what are some things to worry about here? They are the usual worries about teenagers:

    • Teenagers can be short-sighted and lack perspective about long-term effects of actions.
    • Teenagers aren’t well-known for planning carefully against potential negative outcomes of actions.
    • Teenagers don’t excel at being perfectly compliant with rigid dietary or other behavioral regimens imposed on them.
    • Teenagers aren’t equipped to understand and process information to make the best decision about complex and emotionally fraught situations that they’re in the middle of.

    That’s okay– this is part of what it means to be a teenager, and the rest of us are here to help them get through it. But putting them in a position to go through and deal with the outcomes from gastric bypass means exposing them to enormous risks and experiences they’re not equipped to handle and certainly will not want.

    Tonight I’m going to this talk by a medical researcher who works with adolescents who get bariatric surgery. She’s going to talk about the complexity of weight and weight loss. I’ll report back later this week. Hope there’s a Q&A– I have a few questions for her…