Saturday, October 9, 2010

On the upswing

Last week I was lucky enough to attend a talk by the internationally renowned obesity expert, Dr. Arya Sharma here in little Peace River. Although I was one of the main people involved in arranging the talk and have taken additional training in obesity management, I was still amazed and delighted by the talk.

For those of us in the crowd that struggle with overweight and obesity there were many statements he made that, although true and backed up by research, were very depressing. For example, there is a substantial body of evidence showing that exercise plays very little role in helping people to lose weight. It is important for preventing regain of weight, but the biggest impact that one can make on their lifestyle when wanting to lose weight is in the diet. I won't get into specifics, but suffice it to say that once Dr. Sharma finished his explanation, we all agreed.

The other statement he made that I love is that obesity and overweight is not a problem of the individual or a sign of sickness of the human body. In fact, it is quite the opposite. The reason modern North Americans are overweight and obese is precisely BECAUSE our body is so good at regulating our caloric inputs and outputs. We're designed for handling long periods of famine, not perpetual abundance. His conclusion: "Obesity is the response of a very healthy natural system to an unhealthy environment."

This helped me mentally prepare for a later statement: over the long-term, weight loss efforts are only moderately successful. At best, with lifestyle change alone, long-term weight loss will be roughly 3-5%, meaning that someone like myself starting at 200 lbs when I started on Weight Watchers can expect, at best, a 10 lb weight loss long-term. Of course, this is based on population studies so you cannot predict any individual's success. Looking at long-term studies, roughly 50% of weight loss from behavioral interventions is regained after 1 year.

And this brings me to "on the upswing".

As the chart above so sadly shows, I started Weight Watchers in October 2008 at roughly 200 lbs. In roughly 5 months I was finally a healthy weight (164 lbs). I maintained that weight for almost 7 months. In October 2009, my wife and I went to Edmonton on a weekend away from the kids. I let loose. Put on like 3 lbs in a week. Ever since then I have not been below 164 lbs once. But until recently I've been hovering close enough to the mark that I've only had to pay at Weight Watchers two months. (As a Lifetime Member, as long as I weigh in once a month at no more than 2 lbs above my goal weight (=164 lbs for me + 2=166) I don't have to pay to attend). But then this September we went to New Brunswick to visit friends and I ate an unhealthy amount of seafood. This week when I weighed in at Weight Watchers for the first time since that trip, I was devastated to see that I was threatening 180 lbs (179 to be precise).

What have I done wrong? Sadly, my scientific mind jumps to all the above data and concludes that I'm really just abiding by population statistics. The graph of my weight loss and subsequent regain is eerily similar to that shown by Dr. Sharma to chart weight regain in large populations of obese and overweight patients. My emotional side does not want to accept that though. It seems much too defeatist.

So, in some soul-searching with myself, my wife, and my glorious sister Andi, (who has managed to stay within a 2 lb window all summer despite no longer explicitly tracking what she eats and being injured and unable to run), I have identified the following character flaws that lead me to gain weight.

1. Although tracking what you eat has been shown to aid in weight loss and maintenance, it is honestly something I cannot see myself doing for the rest of my life. I've been doing it for 2 years now, and I've just had enough. It's so exhausting. And as Dr. Sharma and his colleague, Dr. Freedhoff, say in their newly published incredible book Best Weight, "If you do not like the way you are living while you are losing your weight, you will almost certainly re-gain the weight when you go back to the way you were living before you lost it." ie. anything you do to lose weight must be sustainable...FOREVER.

2. I am a grazer. When I'm bored, tired, excited, depressed, anxious, happy, or just generally alive, I enjoy grazing our kitchen. My mind shuts off, all my tracking mechanisms go to sleep, and I consume. I need a hobby to replace it.

3. I hate wasting food. As such, I almost always clean off the food my children leave behind. Not into the garbage. Into my mouth.

4. I am a consummate offender in the all-or-none department. My Weight Watchers leader explained this nicely once. "If you were taking an egg out of a carton to make an omelet and accidentally dropped it would you throw up your hands in despair and smash the other 11 on the ground? No. You'd clean up the broken one and continue on as before." But when I slip and have a piece of cake that really wasn't worth it, my natural response is, "Well, I've shot today all to hell now. Might as well pig out and make it worth my while". Or if I decide that running would be a good way to burn some calories and keep off the weight but then realize for it to make an appreciable difference I'd have to do it 5-6 days a week my response is not to still do it when I can because something is better than nothing, but to plant my tush on the couch.

So here I am, telling you that I'm kicking my own ass back into gear. I'm going to recognize these character flaws and work with them to achieve my goals. I'm only going to weigh myself once a week. I'm going to try and go for a walk whenever I can but not beat myself up if I don't get the chance every day. I'm going to start tracking what I eat again, not so much to make a lifelong habit of it, but to regain awareness of the cumulative effect of consuming small amounts of unhealthy foods over prolonged periods of time. I'm not going to do celebratory Dairy Queen Thursdays anymore. I will still go to Dairy Queen and get a small treat if the scale proves to me I've done well. However, it will stop there. I got in the habit of celebrating just a little too much on Thursday nights after weigh-in. I think my Thursday night consumption was starting to approach 2 days worth of calories. Calories don't follow calendars. Speaking of calendars, I'm going to stop making excuses for special occasions. You'll see if you start to do this that every weekend has a special occasion of some sort or another. I will limit special occasion culinary celebration to Christmas, Thanksgiving, Easter, our anniversary, and my birthday. That is all that is necessary, really. When you're starting to use Victoria Day as an excuse to eat more food, you know you have a problem.

Most importantly, I'm going to start publishing regular updates of my progress on this blog. Not only is tracking what you eat an incredibly effective way to lose weight, but so is having a strong social support system. I figure the more I divulge about my struggles here, the more likely I am to succeed. As payment for subjecting you to this, I will focus each week on something interesting about obesity management. You'll be surprised to find out how little you actually know about this incredibly complex topic.

Here's a teaser.

Many people want to know the secrets to long-term weight loss maintenance. Thankfully, the work has already been done for us. The National Weight Control Registry has, for many years, been tracking roughly 5000 individuals who have lost 30 lbs or more and kept it off for 1 year or more. From this incredible study have come key behavioral components necessary to successfully maintain weight-loss (after all, losing weight actually isn't that hard; keeping it off is a real pain in the ass). Some of the most interesting findings from the study are:

1. Registry members have lost an average of 66 lbs and kept it off for 5.5 years.
2. Almost half of the members lost the weight on their own; the other half used a program of some type.
3. The most frequently reported form of activity is walking.
4. Almost 80% of them eat breakfast EVERY DAY.
5. 3/4 of them still weigh themselves once a week.
6. 90% exercise, ON AVERAGE, about 1 hour per day.
7. Most of them continue to consume low-fat, low-calorie diets.
8. They consume regular meals (less than 3 out per week and less than 1 fast food per week)


Talia said...

I love you, Tony. Your self-aware attitude will never let you down even if your weight fluctuates, and I think that's what is important. Life is something to celebrate- and the healthier you live, the more you'll WANT to celebrate, and the longer you'll be able to do it. Thanks to my condition (I think) I've been able to stay stable at a healthy weight for the first time in my life. I'm still not happy- because I know my body doesn't get out, get to walk, or even get challenged once and a while. Once again, my sloth gets in the way. You inspire me to take initiative. I am also an all or none individual, especially when it comes to exercise. I know I always feel great after even a little activity, but I can never convince myself to get off my arse. I will now challenge myself, thanks to you.
We'll see what comes at Christmas :)

Sarah said...

One thing that I have heard encourages people is to find a photo of themselves from a time when they were at their goal weight. Then post this photo on the fridge, where you are mostly likely to snack. It is supposed to be quite motivating.