The Importance of Finding Body-Positive Physicians

[OldSchoolGamer]

I think another problem here is that medical science has precious little to offer obese people in the way of fixes for their situation.  Let's face it: the "solution" to obesity in 2012 is the same as it was in 1412: starve yourself and be a human hamster running in pointless, unproductive exercise routines.  This is in sharp contrast to most other ailments, for which doctors can offer substantially more effective and useful treatments than they could in the Middle Ages.

I think this will be changing over the next decade, thank God.  But even if I had a primary care physician I wouldn't bother discussing my weight with him or her because there's nothing they could tell me or do for me that I don't already know: I need to suffer for my health and be hungry all the time and sweat and be miserable for 45 to 90 minutes a day.  No thanks.

[Aoife]

Actually, it's just all about reducing calories. The average American adult eats roughly 2.8-3.2k calories a day.  The recommended daily intake is a full thousand calories less than that.  Effectively, if you cut down all of your portion sizes by a third, and manage to eliminate most sources of empty calories (processed sugars), you'll be on your way to a healthier lifestyle.

Surprisingly unhealthy foods:

White bread
Most fruit juice (they are actually fruit drinks on the packaging loaded with sugars)
Oils (it doesn't matter if its olive or sunflower, they can and will destroy your system - salad dressing is the biggest offender)
Processed Soup (just... no)
Non-citrine or melon fruits (apples, pears, and bananas are all effectively pure sugar)
Alcohol (it's directly processed into sugar, with beer being the single worst example - and no, light beer is virtually no better)

Bad foods:

Oily, fatty meat (hamburger, fatty steak, most pork, hot dogs)
Desserts (a broad category, but acceptable IN MODERATION) I love lemon cake, but a slice or two a week is considered a healthy amount of sugar.

Good foods:

Beans in almost all forms
Brown Bread
Broccoli
Spinach
Oatmeal (plain oats, not anything prepackaged or pre-made.  Quaker oats absolutely saturates their prepared products with sugars)
Milk
FISH (if any food can magically help you out immediately, switching from red meat to fish is the answer. It's basically a super-food.)

A managed diet of 2k calories will, by and large, keep you at your set weight while lesser amounts will reduce it.  A good, systematic weight loss plan is one that doesn't require starvation (which shuts down your metabolism and actually helps you gain weight), is easy enough to maintain (doesn't cut nutritional corners), and allows a degree of flexibility (vices here and there).

It's hard.  I'm 194' cm., which is about 6'4" in US terms.  My average healthy weight is 180 (+/- 18 pounds).  Throughout college and my medical residency, I crept up to 220 through lack of exercise and eating 'easy' food.  Macaroni and cheese still has a special place in my heart.  I'm now down to 184, and it's only there because I make a point to really look at what I'm eating.  In restaurants, you want to avoid sauces like the plague, as well as anything with a lot of overall preparation.  Fresh steamed fish with greens and a helping of mashed-potatoes is fine.  The steak drizzled in a soft white cream sauce served over a bed of pasta is something you'll want to watch.  In everyday life, the secret is cooking.  Pre-made or 'instant' meals are absolutely terrible for you (a blanket statement, and if someone proves me wrong, it'll be a first).  Just making your own food (even if it's just a brown bread sandwich stuffed with some meat, cheese, and lettuce) is a hugely beneficial change. 

Nonetheless, losing weight doesn't make you look good - that's what exercise is for.  A managed exercise routine of 20-30 minutes every other day is more than enough to get you healthy and physically toned.  Just focus on cardiovascular exercises (running, jumping rope, most non-contact sports). A play-date with my niece on the playground, a pick-up football game (European version ;) ), a jog on a really nice morning - it's all it really takes.  Breaking the chain of being sedentary is really all you need to do to get your metabolism running, and once it cues in, weight loss becomes even easier.

[Acid]

I think we're finding out more and more that obesity has its roots in biochemistry and evolution.

Simply put, the human body evolved optimized for low-calorie, high-exercise environments.  Thanks to technological growth, we now have a high-calorie, low-exercise environment.  And that's not going to change.

(Warning--semi-rant ahead)

Myself, I've been told I could stand to lose about fifty pounds.  And, unfortunately, medical science really hasn't come up with jack-shit to help.  So not only am I on my own, I have to fight a body that has evolved to hang onto every calorie and every ounce of fat.  Everything that's "healthy" and low-cal tastes like shit patties excreted by an elephant fed a diet of straw and cardboard, and everything that I enjoy is bad for me somehow.

Diets?  Yeah, good luck with that.  Try being productive as a writer and manager when you're hungry every minute of the day.  And even when you manage to resist the urge to eat--when you successfully delay breakfast until the early part of the afternoon, eat a tiny lunch around quitting time, and skip dinner--and lose weight, guess what?  Your body just reacts and eventually you give in and gain all the weight back.

http://www.buckapound.com/blogs/dr-art-ulene/homework-why-fasting-does-not-work

Exercise?  A fine concept, but it doesn't help nearly as much as we would like to think.  You just can't burn enough calories at it to count.  And, just like with diet, your body works against you.  It WANTS to be fat and unhealthy.  Say you go to the gym first thing in the morning, and burn off 600 calories (a pretty good workout).  Then you go to the office.  Well, as soon as you settle into your chair to actually do work you get paid for (as opposed to wasting time you could get paid for making up for the fact the human body is craptastically designed to fail), your body goes into a sedentary mode where it does what it does best: turning calories into fat.

http://www.time.com/time/magazine/article/0,9171,1914974,00.html
http://lifehacker.com/5800720/the-sitting-is-killing-you-infographic-illustrates-the-stress-of-prolonged-sitting-importance-of-getting-up

The bottom line here is that I'm not going to quit my job as a project manager so I can chase gazelles or be a hobby farmer.  And I can't work if I'm hungry all the time.  I can do the starvation thing for a couple weeks, tops.  And as we've already established, it doesn't work over the long run. The Body goes "WTF?!?! You want me to NOT have a stroke or a heart attack?  Fuck you, Mind.  I WANT to be obese, so I'll make you gain all that fat back and then some!"

So when it comes to weight loss, I quit.  Fortunately, it seems like medical science is finally starting to treat obesity like the evolutionary/biochemical issue it is rather than "you just need to act like a hamster a couple hours a day and punish yourself by starvation around the clock."

http://articles.latimes.com/2011/nov/10/health/la-he-drug-fat-loss-20111110

So, for those of us not into self-flagellation, meth, or a return to the Bronze Age, there is hope.

Obesity is mainly an issue of calories and insulin control, not genetics. If you're having trouble losing weight, it's not evolution working against you - you're simply making the incorrect food choices.

Genetics can make you more predisposed to BECOMING obese (or losing your hair earlier, or getting acne, etc.) but genetics will never make you overweight on their own. In reality, genetics play the smallest part in weight maintenance. If you're eating healthy, you're not going to be obese or even overweight. I've never met anyone who wasn't able to lose weight provided they were eating the correct foods and not foods they thought were healthy, but in all actuality aren't. Case and point: whole grains/whole wheat products such as cereals and breads. Horrible for your overall health (intestinal, cardiovascular, even brain health) AND your waistline. Not to mention, they encourage inhumane business practices via modern agricultural (factory) farming.

Giving up on losing weight is giving up on life and that's not something you want to do.

Secret to effortless weight loss: Low-carbohydrate, moderate-protein, high-fat diet.

Things that help: Ephedra (if legal where you live.) Coconut Oil/MCT Oil, DHEA, Gymnema Sylvestre.

[Trieste]

I believe most doctors advocate a more balanced approach than an Atkins-esque approach such as you are outlining. Ephedra is also horribly unsafe, for several reasons.

Please feel free to contribute to the subject matter, but please stay closer to the topic rather than espousing a particular dietetic or pharmaceutical approach. Thanks. :)

[Caela]

Having a more body conscious doctor is a true blessing. I consider myself lucky in that mine doesn't harp on my weight. There are differing components to my being overweight, some of them I've gotten over, some I'm still working on. The biggest one for me, right now, is that I don't sleep well. I have sleep apnea so I wake up multiple times a night and do not get the rest I need. This leaves me tired and groggy and chugging soda at work for the caffiene since I can't drink coffee without getting sick. The doctor I just switched to is the first one to EVER ask me to do a sleep study. In truth I thought I was sleeping just fine and that my mental fog and chronic fatigue was some sort of depression! There's some paperwork to do between the docs office and the sleep center but I should be going in, in the next couple of weeks, to be fitted for a CPAP soon. Once I'm actually sleeping I should be able to entirely cut out the soda because I'll be rested and hopefully have increased energy to be more active instead of tired ALL the time.

The whole point of sharing that is that I have a doctor now who looks at me as a whole person and not just as a number on the scale. I think too often doctors see the weight and stop there without looking at whether there are underlying factors to that weight gain. Sometimes a person needs to be referred to a nutritionist to learn about healthier eating, sometimes they may need to be referred to a psychologist to discuss and learn how to break poor patterns (probably not just related to food) in their lives etc. There is a lot that a doctor can't do, and once we're out of their offices they have no means of forcing compliance on us, but it does help if they treat you like an entire human being and not just your weight.

That being said, I do get why they ask a lot of the same questions repeatedly. The sad fact is that doctors get lied to...a LOT. Asking the same questions over and over is the only way to gauge if a person's story is changing and possibly get to the truth so they can do their jobs and help their patients. It sucks for those of us that tell them the truth the first time around but it is a fact of life. 

[Trieste]

Well-said, Caela. And I'm glad you'll be getting rest soon. (Just be careful about cutting out caffeine cold turkey, because the headache can be brutal.)

[Caela]

Well-said, Caela. And I'm glad you'll be getting rest soon. (Just be careful about cutting out caffeine cold turkey, because the headache can be brutal.)

Thanks!!!

I think I'll be o.k. with the caffiene actually. I don't drink it every day, only at work and I only work 3 days a week courtesy of 12 hours shifts at my hospital. :D I don't drink it at home and I limit it at work to no more than 2 bottles no matter how bad i slept the night before. Means I DRAAAAAAAAAG some days but I make it through.

I am prepared for it to trigger a couple of migraines though so I'll wait to stop until I have a four day weekend in my schedule so I can go through that at home! lol