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.

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

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…

fitness · weight loss · weight stigma

Weight watchers is not kid stuff; what about other programs?

Since Weight Watches announced its program targeting teenagers, there’s been a flurry of posts here, chock-full of information and perspective.

One of Sam’s recent posts has (among other things) pointed to research on fat shaming. There are severely harmful physical and psychological effects of identifying children as fat (calling them fat or overweight, treating them as fat, subjecting them to dieting, etc.)   Enrolling a child in Weight Watchers is a guaranteed way to label them as fat.

While we’re talking about studies, the data on the long-term effectiveness of Weight Watchers (or any commercial diet program) is not promising.  A 2015 systematic review  of commercial diet programs suggests that, in the very short term (3-12 months, mostly 3—6 months), Weight Watchers might produce a slightly higher incidence of >5% body weight loss in some populations (all adult) than self-directed dieting, but in the longer term (>12 months), we either have no data, or the data show weight regains (and then some).

Tracy’s post on dieting and magical thinking really gets at the psychological pitfalls of yearning for some way to transform our and our children’s bodies into shapes and sizes that conform to medical guidelines and BMI charts.  It’s an illusion, one that does us and our children much harm.

So, taking Sam’s challenge to heart—if not weight watchers for children, then what?—I decided to look around town to see what programs were on offer.

As some of you know, I live in Boston, which is a very good place to be sick; we have highly-rated hospitals to treat whatever ails you.  I found out from my friend Janet, who’s a health care provider, about the Optimal Weight for Life program at Children’s Hospital.  It’s associated with (and I assume partly funded by) New Balance  (the athletic shoe manufacturer), which has a named Obesity Prevention Center and also sponsors the OWL program at Boston area community health centers.

The OWL program is for families who are worried about their children’s weight and risks for type 2 diabetes, or who have children with type 2 diabetes.  After doing a bunch of medical tests, the treatment services focus on nutritional counseling and individual behavior modification.  Some group therapy is offered, and follow up is required for at least 6 months.  They tend to favor a low-glycemic index diet (one of their directors is David Ludwig, who leads research investigating and has written popular books promoting low-glycemic index diets; look here  for research and here for popular books).

I have to say, I really like the approach they use in the OWL programs at community health centers.  Here’s what they do:

10-week comprehensive program that introduces families to healthful eating and supports them in making changes to benefit their entire family.  The program offers group and individual counseling and is led by a dietitian and psychologist from the OWL clinic.  Group discussions and interactive activities allow for peer support, skill building and knowledge sharing. 

The first six weeks are spent in a group format.  For the groups, parents and youth are separated and both groups discuss the same educational topic.  Following the educational intervention, the groups unite for a healthy meal and a question and answer session.  Each class concludes with a hands-on activity to reinforce the main messages.  Upon completion of the groups participants attend 2-4 weeks of individual counseling with the dietitian and psychologist to develop behavior change strategies to support individual goals. 

Through the program, patients learn:

  • How to shop for and prepare balanced meals and snacks
  • How sleep and screen time impact health
  • How small changes can be implemented to benefit the entire family
  • How to address body image and bullying

All of this sounds reasonable, comprehensive and evidence-based.  By the way, what’s good for the goslings is also good for those of us on the spectrum from geese to ganders—that is, adults can also use support around shopping, screens, sleep, small changes, body images and fat shaming/bullying/harassment.

But I don’t like the name of the program—Optimal Weight for Life.  Yeah, it’s cool to have OWL as your acronym.  You could give away T-shirts with owls on them, or maybe even have an owl-petting room at the hospital.  It’s already been done in Japan at this café, and I hear it’s popular.

Here are my three problems with the name OWL– Optimal Weight for Life:

1.Optimal.  Why do we have to be optimal? That’s a pretty high bar to set.  There are lots of reasons and causes for a child to be of non-optimal weight.  Maybe it’s not an optimal time in a kid’s development to be optimal.  I’m not a parent, but I have observed my niece’s and nephews’ growth patterns over time, and their sizes and shapes and heights don’t increase in perfect synchrony. It’s just not the way human growth works (as Sam pointed out about her own kids). Sometimes they are shorter and wider, and sometimes longer and narrower, and this varies over time and across people.

Also, who says that optimality should be the goal?  We know from epidemiological studies (and by looking around in the world) that there’s a range of body weights, shapes, sizes, influenced by a host of factors, many of which we have no control over.  What makes “optimal” optimal is presumably association of a class of body weights with lowered risk factors for disease; otherwise, this is just a matter of aesthetics/conventions, right?  When we dive deep into that data vortex, I argue that, given both the intractability of long-term weight loss and the small or nonexistent shifts in relative risk profiles that come with some weight changes, setting “optimal” weight as a general patient goal is both unrealistic and unnecessary.

2. Weight. Why do we have to focus on weight? Why not health? There are lots of metrics that track health quite well, and weight is arguably not one of them. Yes, this is a contested position, but it’s held by lots of medical and public health experts.  Physical activity happens to be one of those metrics.  See here for results of a very large European study showing strong association between even small increases in physical activity and lowered all-cause mortality risk.

3. For Life. That sounds scary to me. Why?  Because it seems controlling, demanding, and not understanding about the ups and downs of our experiences through the life trajectory.  There are going to be times in every child’s life when their physical state will be non-optimal.  This is not a cause for panic, and it may not even indicate that anything is wrong. So, setting people up with this humongous and unrealistic (yes, I said that before—it’s still true) goal is not very nice and not, uh, well, realistic.

We’ve got a lot to learn about how to help people identify, move toward and find some stability around health-according-to-them.  Owls are a great symbol, but how about we go with more variation, in keeping with our own glorious variation?  I have something like this in mind, but need help with names/acronyms.  Any thoughts?

Animated brightly colored animals of all types, shapes and sizes.

 

body image · diets · eating · fat · fitness · weight loss · weight stigma

The new health target of the century: kids

The news made the rounds of the health at every size (HAES) contacts I have in my social networks. I shouldn’t have been surprised to learn that Weight Watchers was offering free six-week memberships to 13 year olds, and yet I was.

Shortly after that, I learned the makers of FitBit were launching a fitness tracker for children. According to TechCrunch, the makers of FitBit are targetting the eight- to 13-year-old market because as the Telegraph noted, we need to do something about getting “couch potato kids” off the couch and into the gym.

Because child obesity y’all. (Insert eye roll here.)

I’ll admit I’ve been on diets, and I also have used a FitBit (see this post for how I use mine). I went on my first diet with WW when I was 14 and I needed my mom to sign for me. I can’t say it was a success because despite an endless variety of diet plans, I have continued to be my own fun-sized self and not the one society said I should be.

I stopped dieting when I reached my 40s. I read the literature, I looked at the research, and I considered the methodology of the studies. These days I try to eat most of my fruits and veggies every day, be moderate about my meat consumption, and add more whole grains, beans, pulses, and fish to my plate.

I still eat chocolate, potato chips and ice cream treats on occasion, but I am more mindful about my daily choices. And when I really, really want the chocolate bar, I go for the good stuff and thoroughly enjoy it.

Diets are all about deprivation, regardless of how they are marketed. And they don’t work. The problem with marketing to teens, especially teen girls, is they already have a decade of misdirection on what a female body is supposed to look like behind them. All those messages have been accumulating and Weight Watchers is stepping up to take advantage of the anxiety-fertilized soil to grow their market.

Ultimately, the only thing the plan will do is teach girls deprivation is the norm, their bodies at 13 are unacceptable, and it is on them to change their bodies rather than society change its expectations for the form expected for women.

At first blush, there shouldn’t really be an issue with creating a tool for kids. However, there are many people who see the number of steps reached as tacit permission to indulge. Weight Watchers for awhile had an exercise component that allowed users to collect food points through exercise and then spend them on either more, or fun type foods.

Many of these exercise tools track not only steps or other types of activities but also calories and weight. If you want off the diet train and onto the gym track, it can be very hard to find a gadget or tool that doesn’t link weight and fitness. In fact, it is one of the reasons I and my trainer make a point to track personal records that are strength based instead of scale based.

Whatever your size, age and body type, we are, at least in North America, a more sedentary society. Television, junk foods and in house gaming systems are factors in the higher weights we are seeing. But the problem with marketing fitness gadgets to kids is that after awhile the appeal is going to fade. While gamification of anything works effectively in the short term for setting goals, once kids and youth get where they want to be, there isn’t a point to doing it anymore and it stops being fun.

A co-blogger on this site shared with me some thoughts she and her sister had about the Fitbit and they echo mine: “My experience with fitbits with grown ups is they don’t understand the correlation between steps and food so it almost gives them more ‘permission’ to eat that piece of cake or whatever. I only know two people who use it in the way it was designed (make sure I get in my steps to stay fit) and they are both people who would be fit anyway. For kids, it’s a good awareness raiser and a ‘game’ but if it becomes the gadget it kind of loses its function.”

My co-blogger’s sister also made an important point that links to unpacking, resisting, or creating a new culture around fitness: “Fitness especially in kids comes from values, habits, home discussions, role modelling, fun activities, and doing things that don’t seem like fitness to the kid.”

Doing things that don’t seem like fitness are often more fun when you don’t have the “must” factor. Even I think it is more useful to say to myself: “It’s a gorgeous day out — let’s go for a walk!” instead of “I need to get 2500 more steps in to meet my time for today’s fitness.”

While I think the offer from WW for 13-year-olds is more problematic than FitBit’s plan to extend its market share by focusing on kids, I do believe we need to think carefully about how we look to change the behaviour of children when it comes to eating and moving.

Because in some respects is not how we change the behaviour, but why we feel it is necessary in the first place.

— Martha enjoys getting her fit on with powerlifting, swimming, and trail walking.