Picking a healthy weight after extreme weight loss

April 11, 2009 9:08 PM

How do I know if I'm at a healthy weight, given some complications?

Background: I'm a woman in my mid-30s. I'm about 5'5. Due to chronic illness, I gained a huge amount of weight in my 20s. About 6 years ago, I weighed 235 lbs. Over the course of a year, I lost about 50 lbs through moderate exercise and a pretty restrictive (but safe) diet. I then went on to have two children, the second by C-section. In the past year, through weight training, increased activity and breastfeeding, I dropped to 160 lbs. For three months, my weight has fluctuated from 158 to 162, from week to week, in spite of me eating 1600-1800 calories while breastfeeding a toddler 2-3 times a day and exercising a fair amount, including weight training.

Recently, a close friend took me aside and said that she did not think I needed to continue dieting. This friend is a doctor. She said she is concerned that I have become dysmorphic.

I pointed out that my BMI is a bit more than 26 and that my waist is 33" and that all the online calculators say I still have a lot of body fat and a poor hip/waist ratio. I noted that I also have a small frame and that I thought it was reasonable to drop to 135 lbs.

My friend, who is a doctor, said that she feels I am dysmorphic because I have been dieting. She also said that she does not think I understand what two children, a C-section, and extreme weight loss would make my stomach look like. She said that she thinks my stomach fat is not fat but instead excess skin. She also said that I have extremely muscular legs and that I should consider that I'm still breastfeeding and have a 34J bust. She said that I may also have increased bone density from carrying extra weight for several years. For these reasons, she feels my BMI and waist measurement are not "right".

My personal trainer said before that I have legs that most of her clients would have worked years to get -- if at all. She said there is not an ounce of fat on them. I am now into size 6 pants, although I have a serious muffin top. And I'm in a 34J bra, so I'm pretty trim around the chest.

My friend, the doctor, said that continued dieting could have long term implications for my health and that she doesn't think it's a good idea. She said my body will probably hang on to 10 or 15 lbs till I stop breastfeeding and that she thus thinks I'm already at a healthy weight. My personal trainer has said before that most of her clients hang on to 10 or 15 lbs till they stop breastfeeding.

Is there some way to tell if all this is true? I would have thought I should be aiming for 135 lbs. I will go see my own doctor, but I suspect she's either going to think about the BMI and measurements or else she's going to agree with my doctor friend, since she isn't a specialist in weight loss.

Is there any standard for figuring out if your BMI and waist measurement are thrown off by a history of obesity? Thanks.

posted by anonymous to health & fitness (14 comments total)

Maybe obvious, but have you had your body fat percentage calculated? I had mine calculated with the bioelelectric test, along with a general fitness test which supported the bioelectric test results. The results were way (weigh-pun here) different than that my BMI would indicate.

Healthy body-fat percentages are fairly well known, and should help you figure out if you're overdoing things.
posted by Benjy at 9:25 PM on April 11

J? BMI is going to be off by a hell of a lot if you're carrying around a size J bosom. It has no way of knowing whether your weight is allocated in your chest or your thighs, and will also be higher if you have lots of muscle. Seconding the body fat percentage test.
posted by notquitemaryann at 9:40 PM on April 11

See what happens after you stop breastfeeding. Studies have shown that prolactin reduces fat metabolism and promotes appetite and insulin resistance. Are you lifting heavy enough to see significant gains in muscle mass? If so, you might be inadvertently boosting your prolactin that way too.

And for what it's worth, the quickest way to get rid of a muffin top is to buy pants that are cut differently. Life's too short to put up with ill-fitting clothes!
posted by aquafortis at 9:59 PM on April 11

Add about ten pounds to whatever you consider your goal weight to account for your boobs. When I had my breast reduction the doctor took about a kilo from each (I was perhaps DDD(?)* before surgery) and still left me with C cups.

*who knows what size bra I should have worn, but I was falling out of the largest (DD) cups I could find in regular department stores at the time.
posted by QuakerMel at 10:11 PM on April 11

Have you thought about seeing a doctor f'reals? It's common for doctors of various stripes to advise their friends and family to "go see a real doctor" just because it's so hard to diagnose your friends and family impartially. "Oh, he always worries too much" -> "That lump is probably nothing" and the like.

However, based on your description, I'd say you're doing just fine. 34 around the chest, size 6 pants, those are both well within the healthy range. And as far as BMI, the only study I've ever seen on BMI vs. life expectancy showed longer lives for people with BMIs above "normal" (i.e. "what the average was in the 40s"). Dieting *is* generally unhealthy, however. If you're getting good exercise, I wouldn't be worried about extra "flab" that could easily be extra skin and loss of muscle tone due to pregnancy and quick weight loss.
posted by Lady Li at 12:09 AM on April 12

she did not think I needed to continue dieting.

But dieting is something that everyone should do.... "dieting" in that you're eating healthy and keeping track of what you put into your body. So many of us (and we've all done this from time to time) coast through the day without really thinking about what we're eating (as evidenced by the fact that most of us eat really incredibly terrible things like junk food.)

I'm on a diet and I hope I stay on it for the rest of my days... That said, it needs to be a well rounded and healthy diet.

As for BMI the more I read about it the more I realize that it seems to be only useful and applicable within a very narrow range of body types and only then at certain times. Obviously your body is going through an exceptional time right now (you're nourishing yourself and another human being!) so toss BMI out the window for now.

From my limited understanding a better guide would be body fat percentage - of the type given by a high quality scale that can do it electronically through you bare feet. And even then, because you're breast feeding that may throw it off.

It sounds like you've made incredible progress with loosing weight. That's awesome. Most people struggle with weight their entire lives. Keep doing what your doing within reason, heeding the advice of your doctor-friend and don't be afraid to consult a nutritionist.

Ultimately, don't over think it right now. Yes, you need to be healthy and strong, but body sizes and fat are (within reason) often completely arbitrary.

It sounds like you're doing well and the fact that you're asking this question shows a self awareness that people with serious body image issues aren't able to articulate.
posted by wfrgms at 12:55 AM on April 12

Between weight training, breast feeding and exercising a lot you might not be eating enough to lost fat. Breast feeding puts alot of stress on the body, and with exercising you could be creating a calorie deficit so big the body just won't let go of the last fat stores for fear of starvation.

Go to a nutritionist, preferably a sports nutritionist. She will factor in your exercise and breast feeding, weigh you, measure your body fat and give you a balanced diet. Either way, you should focus on your body fat percentage and not your weight - those muscles are heavy.
posted by yeara at 1:32 AM on April 12

The google tells me that a breastfeeding woman should increase her daily caloric intake by 500-600 calories. Taking 500 calories off of your posted dietary intake leaves 1100-1300 calories a day for you, which is quite low.

Maybe your doctor friend is suggesting a shift from a losing-weight diet to a maintaining-weight diet?
posted by Maxwell_Smart at 7:12 AM on April 12

I'm sure your friend means well. It sounds from your description that she is just trying to make sure you haven't become obsessed. She also might be trying to read your mind- mistaking your desire to improve your body and health for an unreasonable desire for perfection. It's a common thing that people do- mistaking a reason for an excuse. Yes, having kids is a reason why many people's bodies change. But it's not an excuse to stop trying, if that's what you want to do.

(That's a pattern I see here on ask mefi a lot- someone asks a question, and people answer with reasons why it's happening and justifications as to why it's ok. This is helpful in making sure someone doesn't feel bad, but misunderstands the desire to change. "I'm a young person and not good at basketball. How do I get better?" "Don't worry about it, not everyone is good as sports." That's great, and true, and hopefully makes the person feel better. But they *want* to change, they don't want an excuse to not have to.)

When someone is overweight, focusing on weight is the easiest way to get down to a healthier body. But as you get closer to the target, you have to focus on more varied indicators of health. The BMI is a very broad indicator- if it's 50, you know you are carrying extra fat. If it's 10, you know you need to muscle up. I guess I'd say it's accurate, but not precise. Trying to use it to figure out perfection is an exercise in futility.

Many of the above posters are correct- as you get closer to your general target, there are other things that come into play. Body fat percentage is one way. Muscle mass is another, complimentary, method. You can stay the same size and weight, but be far more healthy and feel much better by focusing on building muscle. (That's why a hypothetical young person looks "better" than an older person at the same weight/height- the older person has less muscle mass.) Don't worry about looking "muscle bound"- if that starts happening, shift focus to maintaining rather than building.

Finally, focus on eating and living well. Eat good, wholesome foods that your body agrees with. Each person is somewhat different in this regard. Some people can eat the recommended high carb, low fat diet and thrive. Others need a more protein heavy diet. Experiment and determine what works for you. Shift the meaning of "diet" from "eating to lose weight" to "eating to maintain a healthy body".
posted by gjc at 7:24 AM on April 12

I tend to agree that 1) it's probably not worth worrying about losing more weight while you are still breastfeeding, 2) your breasts probably should add 5-10lbs to your goal weight, and 3) watching what you eat even for the rest of your life is not necessarily unhealthy. And yeah, you almost certainly have some extra skin around your stomach given all of your past circumstances, and that skin might be fooling you into thinking you are fatter than you really are. So throw me into the camp that says it is very likely that you are at a healthy weight given the complications.

The fact that your friend chose to reach out to you, in what sounds like a very thoughtful way, probably means something. Are you particularly obsessive about your diet? Are you regularly refusing to participate in activities that might mean going off your diet a little bit? Are you just loudly bemoaning the fact that you aren't losing any more weight?

I ask these questions because while I think it is totally healthy to have a general diet that you stick to for the rest of your life, it should really not come off to others as being on a "diet". Think really carefully about whether you want to raise your children always thinking that mom is on a "diet". (I really hope not). Start searching now for a way to eat that is both able to maintain your weight loss but not obviously obsessively restrictive. As gjc said above, now is the time to figure out how to live and eat well. This is a necessary part of the journey from "fat" to healthy, and I suspect once you achieve it your friend will stop worrying about you.
posted by ch1x0r at 7:44 AM on April 12

You sound a little dysmorphic to me. I'm 5'5" and I think I look pretty good despite weighing a bit more than you do.

You've got a size J rack and you're breastfeeding and you've lost a lot of weight. There is going to be extra bone density and there's going to be extra skin and you have got a rack that far outstrips my still-busty-looking size C.

Listen to your doctor buddy, go see your own physician, and perhaps weigh your breasts.
posted by kldickson at 2:44 PM on April 12

If you are muscular, breastfeeding, have large breasts, and extra skin, BMI is very, very unlikely to be an accurate gauge for a healthy weight for you. Dieting (in this case, defined as restricting calories) is not necessarily effective for long term health--I would focus intuitively eating lots of healthy food for your body--after all, you're already exercising, and it sounds like you're leading a very healthy lifestyle. Rather than counting calories or obsessing about weight, which would be an inaccurate measurement for you anyway, I'd just focus on being kind to your body, providing it with lots of nutrients and taking care of it by exercising.

If you're unable to get away from the minute control over your body that counting calories gives you, and you're unable to feel proud of the significant improvements in lifestyle and diet you made because your body isn't perfect, then, yes, you're being a tad dismorphic.
posted by PhoBWanKenobi at 3:18 PM on April 12

I've struggled with an eating disorder, and one of the hardest things is determining what is a healthy body weight. At this point in my recovery process, I've realized that a healthy body weight for me is a weight that I'm healthy at. I know that's a circular definition; what I mean is that if I eat in a way that is physically & psychologically (just as important!) healthy, and exercising in a way that feels good, my body will settle at the weight that is right for me.

While your height, pants size, bra size, amount of muscle, and bone structure all hint at an appropriate weight range for you, bodies are so variable that I don't think ANY method - BMI, body fat percentage, or otherwise, can give a good answer for your body.

If I were you, I would shift away from "dieting" (if that's what you're doing) and towards a way of eating that you feel comfortable with for the rest of your life. For me, that's eating nutritious foods most of the time, but also eating non-nutritious foods if and when I want them (that's the hard part for me, letting myself do that). I would find & stick with an exercise routine that you like and that keeps you relatively active, but doesn't feel punishing.

Then, just see where your body ends up - maybe you'll hold steady, maybe you'll lose a little more. If you lose too much weight, you body WILL freak out and you will get tired, hungry, cranky, and generally feel run down and miserable. Then, you'd know you needed to eat a little more. At your body's ideal weight, you should, barring health problems, have energy and feel strong.

I don't know if you're dysmorphic or not, but I think the path towards a healthy body & a good body image is letting go of the numbers and focusing on eating and exercising in a way that makes you feel good. I think that focusing on a goal weight or BMI is not particularly healthy or helpful. IANAD, but it might be good to get some bloodwork done and see how your cholesterol, blood glucose, blood pressure, etc are - if they're in the healthy range, it would probably indicate that you're at a healthy weight for your body.

On preview, I totally agree with PhoBWanKenobi, who I think said exactly what I'm saying, just in a more succinct way.
posted by insectosaurus at 3:44 PM on April 12 [1 favorite has favorites]

follow-up from the OP

Thanks for all your replies. Just to clarify, I’m breastfeeding a toddler a couple of times a day, which is not the same as nursing an infant on demand. I’ve only been losing ¾ lb per week for the past year, so I have not been doing anything extreme. (I’ve been cutting back on calories since I started my various lifestyle changes last year, since I’ve partially weaned and also lost weight, necessitating fewer calories.) I’ve checked in with nutritionists along the way. My cholesterol, glucose, and blood pressure have been consistently low – even when I was obese. I do not look in the mirror and think I look awful, but I did think my large stomach was a band of fat. I’m not so sure it’s the cut of the pants. I’m starting to think maybe it is excess skin, and, if it is, I can accept that. I only want to know if I’m at a healthy weight because I’d look at shifting toward a caloric intake that leads to weight maintenance AND because I’d like to be at a weight that, in combination with my lifestyle, reduces my health risks. I’ll still exercise and eat healthily. However, if I am in fact still overweight, I’d like to work toward dropping to a healthy weight. Although I do keep track of what I eat, I’m not obsessive about it and I will do things like eat yam fries or have a burger now and then. Given the answers I’ve got here, I think I’ll just check in with my own doctor and get a body fat analysis done and look at moving to eating for weight maintenance. I'll ask the admins to post the results here, in hopes that this post can help someone else (perhaps with muscular legs and a huge bosom) stop beating themselves up for being above the "ideal" healthy weight suggested by BMI, Weightwatchers, life insurance and other charts. Thanks everyone!

posted by jessamyn at 7:12 AM on April 13