A question of weight and feelings
August 10, 2022 1:28 PM Subscribe
My family has generally been on the heavier side, and my mom has a... not good relationship with regards to her body and dieting and I have complicated feelings about all of the above. I was thin as a teen, but as I have aged, I have slowly gained weight despite exercising, eating fairly healthy, etc. Today, at 31, I got my first lecture from my doctor about needing to lose a little bit of weight for my health. I really don't want to do what my mom did and diet indefinitely (and harshly) with no real results and increasingly bad body image. How can I healthily approach this?
At my annual physical today, my doctor told me that despite all my numbers being good and my lifestyle being healthy, that I need to look into cutting back just a bit, and lose 5-10 lbs. "Just cut back on the sour cream sometimes, and weigh yourself once a week, make adjustments based on what you see there." I've worked really hard to fight the idea that I need to lose weight. I exercise to be strong and capable and mobile. I eat plenty of vegetables because they're tasty and I feel better when I'm eating them. I have also worked really hard to be ok with the body I have, and the body I'm likely to have as I get older. My mom has dieted constantly and harshly for as long as I've been alive, and she's never lost weight in any truly appreciable way, and my dad is a very athletic person--think runs marathons, bikes and swims for fun--and is still a big, muscular guy.
I also have tried to lose weight in the past, when I was in a bad relationship where my ex was critical of my weight; I was trying to lose weight so that he would find me attractive when he no longer did. I now have a wonderful girlfriend who likes me at the weight I'm currently at, and that has felt wonderfully healing. I also listen to maintenance phase and so I am skeptical of my ability to actually lose weight and keep it off, and of the idea that I need to lose weight to fit a particular BMI especially when as far as I can tell, my family just... tends this way.
I'm really struggling with this instruction from my doctor to lose weight. Changing how I eat and trying to fit more exercise into my schedule feels like giving in to my mom's demons of bad body image and the awful things my ex ever said about my body, even though what my doctor is proposing is much less intense. YANMD but... how seriously should I take this instruction to lose weight? How can I try to think about this going forward? Is there a way to balance my doctor's instructions against... all the mental work I've done around my weight in the past? And all the awful stuff about losing weight in my background? Are there ways you've approached this that have worked for you in the past, either practically or mentally?
I am going to therapy and will be talking about my therapist about this.
At my annual physical today, my doctor told me that despite all my numbers being good and my lifestyle being healthy, that I need to look into cutting back just a bit, and lose 5-10 lbs. "Just cut back on the sour cream sometimes, and weigh yourself once a week, make adjustments based on what you see there." I've worked really hard to fight the idea that I need to lose weight. I exercise to be strong and capable and mobile. I eat plenty of vegetables because they're tasty and I feel better when I'm eating them. I have also worked really hard to be ok with the body I have, and the body I'm likely to have as I get older. My mom has dieted constantly and harshly for as long as I've been alive, and she's never lost weight in any truly appreciable way, and my dad is a very athletic person--think runs marathons, bikes and swims for fun--and is still a big, muscular guy.
I also have tried to lose weight in the past, when I was in a bad relationship where my ex was critical of my weight; I was trying to lose weight so that he would find me attractive when he no longer did. I now have a wonderful girlfriend who likes me at the weight I'm currently at, and that has felt wonderfully healing. I also listen to maintenance phase and so I am skeptical of my ability to actually lose weight and keep it off, and of the idea that I need to lose weight to fit a particular BMI especially when as far as I can tell, my family just... tends this way.
I'm really struggling with this instruction from my doctor to lose weight. Changing how I eat and trying to fit more exercise into my schedule feels like giving in to my mom's demons of bad body image and the awful things my ex ever said about my body, even though what my doctor is proposing is much less intense. YANMD but... how seriously should I take this instruction to lose weight? How can I try to think about this going forward? Is there a way to balance my doctor's instructions against... all the mental work I've done around my weight in the past? And all the awful stuff about losing weight in my background? Are there ways you've approached this that have worked for you in the past, either practically or mentally?
I am going to therapy and will be talking about my therapist about this.
Best answer: followup - your doctor is basing their remarks off nothing more than tables that correlate various bad health outcomes, on average, with overweight. I.e., thin people in general have fewer of these particular problems.
There are NO tables showing that healthy fat people can become even healthier by losing weight.
There IS a ton of data to show that dieting (i.e. the efforts by fat people to become thin people) CAUSES various bad outcomes, including gaining more weight back.
posted by fingersandtoes at 1:44 PM on August 10, 2022 [35 favorites]
There are NO tables showing that healthy fat people can become even healthier by losing weight.
There IS a ton of data to show that dieting (i.e. the efforts by fat people to become thin people) CAUSES various bad outcomes, including gaining more weight back.
posted by fingersandtoes at 1:44 PM on August 10, 2022 [35 favorites]
Best answer: by the way, the last time I challenged a doctor on a remark like this, she admitted that -- and I don't want to misquote her too badly here, but this is pretty close -- their industry practice is to admonish fatties to try to lose weight because maybe the admonishment will work, and the person will somehow become thin.
I asked her if she thought that being fat was so awesome and easy and without social cost that heavy people do it on purpose, never having considered that it's better to be thin. She changed the subject.
posted by fingersandtoes at 1:48 PM on August 10, 2022 [51 favorites]
I asked her if she thought that being fat was so awesome and easy and without social cost that heavy people do it on purpose, never having considered that it's better to be thin. She changed the subject.
posted by fingersandtoes at 1:48 PM on August 10, 2022 [51 favorites]
I'd tell the doctor that weight is off the table for discussion. You're saving the doctor time, as they (hopefully) won't push specific lifestyle modifications that they now know you're not going to take on.
posted by kingdead at 1:52 PM on August 10, 2022 [7 favorites]
posted by kingdead at 1:52 PM on August 10, 2022 [7 favorites]
Is there a way to balance my doctor's instructions against... all the mental work I've done around my weight in the past?
No. Your doctor’s instructions are worth zilch here. And the great news is, you already know this! You’ve already done the incredibly hard work of unlearning our culture’s horrific anti-fatness. All that is left is accepting the disappointing truth that your doctor hasn’t done that work, and then ignoring their instructions on this matter forever.
If your doctor brings it up again, you have many options. You can say, “I’m not interested in discussing my weight,” repeated as many times as necessary. You can push back, using what you have learned about intentional weight loss or other scripts you will no doubt get in this thread. Or, you can just smile and nod and let them get it out of their system, secure in the knowledge that they are wrong and acting out of bias, and then let yourself forget they ever said anything about it.
posted by CtrlAltDelete at 1:57 PM on August 10, 2022 [20 favorites]
No. Your doctor’s instructions are worth zilch here. And the great news is, you already know this! You’ve already done the incredibly hard work of unlearning our culture’s horrific anti-fatness. All that is left is accepting the disappointing truth that your doctor hasn’t done that work, and then ignoring their instructions on this matter forever.
If your doctor brings it up again, you have many options. You can say, “I’m not interested in discussing my weight,” repeated as many times as necessary. You can push back, using what you have learned about intentional weight loss or other scripts you will no doubt get in this thread. Or, you can just smile and nod and let them get it out of their system, secure in the knowledge that they are wrong and acting out of bias, and then let yourself forget they ever said anything about it.
posted by CtrlAltDelete at 1:57 PM on August 10, 2022 [20 favorites]
The thing that strikes me about your doctor's remark is that s/he thinks you need to lose 5 to 10lbs. I can't imagine there is any disease, joint pain, or life expectancy factor that is going to be meaningfully influenced by you losing 5lbs. I mean, really, do we honestly think things are that finely calibrated to weight?
Maybe s/he really means "you've reached a stage in your life where you have to be more careful to avoid slowly gaining weight now and into the future" and that's not a message that is without its own problems, but I just find the idea that losing 5lbs would make a medical difference wildly implausible.
If you think exercising more or eating less sour cream would make you healthier or happier, you could certainly do so, but the idea that it will literally make you healthier sounds like a load of absolute bullshit to me.
posted by jacquilynne at 2:00 PM on August 10, 2022 [76 favorites]
Maybe s/he really means "you've reached a stage in your life where you have to be more careful to avoid slowly gaining weight now and into the future" and that's not a message that is without its own problems, but I just find the idea that losing 5lbs would make a medical difference wildly implausible.
If you think exercising more or eating less sour cream would make you healthier or happier, you could certainly do so, but the idea that it will literally make you healthier sounds like a load of absolute bullshit to me.
posted by jacquilynne at 2:00 PM on August 10, 2022 [76 favorites]
YANMD but... how seriously should I take this instruction to lose weight?
None seriously at all. Zero seriously. IANYD, but IKMATTYDASDY (I know more about this than your doctor and so do you). Find a new doctor.
posted by babelfish at 2:10 PM on August 10, 2022 [8 favorites]
None seriously at all. Zero seriously. IANYD, but IKMATTYDASDY (I know more about this than your doctor and so do you). Find a new doctor.
posted by babelfish at 2:10 PM on August 10, 2022 [8 favorites]
i come at this from the perspective of a person who is super morbidly obese.
5 pounds is nothing. it's water weight. unless you are already quite slim, it likely wouldn't even be enough to notice an item of clothing fitting differently. this was your doctor wanting you to fit better in a bell curve and has nothing at all to do with your health.
lose weight when it is making you feel physically bad or is impeding your ability to do something you want. i highly doubt 5lbs is doing this.
posted by misanthropicsarah at 2:15 PM on August 10, 2022 [21 favorites]
5 pounds is nothing. it's water weight. unless you are already quite slim, it likely wouldn't even be enough to notice an item of clothing fitting differently. this was your doctor wanting you to fit better in a bell curve and has nothing at all to do with your health.
lose weight when it is making you feel physically bad or is impeding your ability to do something you want. i highly doubt 5lbs is doing this.
posted by misanthropicsarah at 2:15 PM on August 10, 2022 [21 favorites]
Please list len to The F-Word episode of On The Media to get a quick intro into the complicated and misunderstood history of how we talk about fat and then go find a fat friendly doctor who won't give you questionable medical advice.
posted by brookeb at 2:17 PM on August 10, 2022 [3 favorites]
posted by brookeb at 2:17 PM on August 10, 2022 [3 favorites]
Virginia Sole-Smith's latest newsletter is focused on refuting the idea that there's an emotionally healthy way to promote weight loss for kids, but you might find it affirming of your prioritization of your mental health in the face of this unsound advice from your doctor.
posted by EvaDestruction at 2:17 PM on August 10, 2022 [3 favorites]
posted by EvaDestruction at 2:17 PM on August 10, 2022 [3 favorites]
I mean, how much sour cream would you even have to eat before it was the cause of a ten-pound weight gain?
posted by The Underpants Monster at 2:23 PM on August 10, 2022 [11 favorites]
posted by The Underpants Monster at 2:23 PM on August 10, 2022 [11 favorites]
Best answer: What everyone else is saying.
I dealt with this kind of medical advice by refusing to be weighed at appointments. I told my docgtor flat out that there is a history of disordered eating in my family and I don't want to get involved in that kind of thing. He passively-aggressively put "anorexia" in my chart and I politely asked him to remove it because I have never been anorectic in my life.
My blood work is fine, I'm a competitive athlete, and I wasn't having any other weight related health problems. I'm 71 and in excellent shape for my age. When I finally let the assistant weigh me last week, I had gained about five pounds.
However, I did struggle with eating too much in a dysfunctional way at times. It got complicated. The last couple of years, therefore, I took myself in hand and decided to eat whatever I wanted whenever I wanted it. Cake, sardines, cookies, soup, candy, yogurt, etc. No "self-control." No "bad foods."
The result was that I gained maybe five pounds and also got bored with most of the things I yearned to binge on.
I'm eating lightly now because I have a big competition coming up in a couple of months and want to be a bit more mobile for a while. For that kind of goal-related loss (you know, like for bad feet or knees, or for getting ready for joint surgery), I have used MyFitnessPal for tracking meals, and I recommend setting it to a more calories than most diets recommend because your goal should not be to lose weight but to eat healthy. Most of the research on weight loss says it cannot be sustained for long. Most medical research also doesn't find a correlation between longevity and weight, except that underweight people tend to have more problems.
posted by Peach at 2:45 PM on August 10, 2022 [10 favorites]
I dealt with this kind of medical advice by refusing to be weighed at appointments. I told my docgtor flat out that there is a history of disordered eating in my family and I don't want to get involved in that kind of thing. He passively-aggressively put "anorexia" in my chart and I politely asked him to remove it because I have never been anorectic in my life.
My blood work is fine, I'm a competitive athlete, and I wasn't having any other weight related health problems. I'm 71 and in excellent shape for my age. When I finally let the assistant weigh me last week, I had gained about five pounds.
However, I did struggle with eating too much in a dysfunctional way at times. It got complicated. The last couple of years, therefore, I took myself in hand and decided to eat whatever I wanted whenever I wanted it. Cake, sardines, cookies, soup, candy, yogurt, etc. No "self-control." No "bad foods."
The result was that I gained maybe five pounds and also got bored with most of the things I yearned to binge on.
I'm eating lightly now because I have a big competition coming up in a couple of months and want to be a bit more mobile for a while. For that kind of goal-related loss (you know, like for bad feet or knees, or for getting ready for joint surgery), I have used MyFitnessPal for tracking meals, and I recommend setting it to a more calories than most diets recommend because your goal should not be to lose weight but to eat healthy. Most of the research on weight loss says it cannot be sustained for long. Most medical research also doesn't find a correlation between longevity and weight, except that underweight people tend to have more problems.
posted by Peach at 2:45 PM on August 10, 2022 [10 favorites]
Best answer: Hard agree to all the advice above, and while it's too late for this particular visit, I've found it extremely freeing to just...refuse to step on the scale at the doctor's office. A sunny "oh, no thank you!" when they ask you to do so does wonders. Of course this is highly varied by doctor, and I'm sure is easier to pull off as a smaller fat person, but I've successfully refused to get weighed by three different doctors now and felt like a million bucks each time.
posted by LeeLanded at 2:47 PM on August 10, 2022 [17 favorites]
posted by LeeLanded at 2:47 PM on August 10, 2022 [17 favorites]
Best answer: Here's the thing about doctors recommending weight loss: it's like if you had back pain and your doctor prescribed a medication. So you ask, do most people feel better on this med? And the doctor says, yes, for the first three months to a year, almost everyone feels better. And you go, ok, what happens after that? And the doctor says, well, about 5-20% of people keep feeling better, and about 80-95% of people have their pain come back. And you say, so I can expect a three-month to one-year period of feeling better, and then it's most likely my pain will come back to where it is now, and I'll have to find a new treatment? And the doctor goes, well... it's not quite that simple, because about a third of that majority go back to their original pain, but two thirds end up with worse pain. So you ask, what happens if I'm in that unlucky two thirds group and I come back with worse pain? And the doctor says, first I'll imply it's your fault your pain came back, and then I'll prescribe a higher dose of that same medication. So you go, oh, is that the trick to getting it to work for most people? And the doctor laughs and says, oh no--it's the same thing all over again. So you ask, why would I take a medication that's most likely going to increase my pain over time--can you give me something else? And the doctor says, I see you're not really serious about taking care of your health.
There is no (non-surgical) method of intentional weight loss that has been shown to be effective long-term for more than a very small number of participants, and for most people intentional weight loss efforts lead to weight gain. You probably know some people who have successfully lost weight and kept it off. You probably also know a redhead or two. Statistically, both are rare.
The good news is, weight isn't actually an effective indicator of health, and there are plenty of evidence-based health-promoting behaviors you can adopt to improve your health--quality sleep, abstaining from tobacco, managing stress, exercise, social connections, weight-neutral nutrition. (It sounds like you're already doing a lot of these.) The bad news is, the medical field has a huge fatphobia problem--studies show doctors are biased against fat patients, and many fat patients experience doctors making assumptions about them (e.g., "You should start exercising--maybe take a walk every day" to someone who is very active but also fat) rather than asking about their habits. You can look for a weight-neutral doctor in your area, or if you want to stay (or are stuck) with this one, you can make a habit of asking, "What tests/treatment/recommendations would you have for a thinner patient?" And if the doctor isn't willing to give you the same treatment as a thin patient, it's a good idea to say, "Can you note in my chart that we discussed XYZ test and you're declining to order it?"
posted by theotherdurassister at 3:30 PM on August 10, 2022 [38 favorites]
There is no (non-surgical) method of intentional weight loss that has been shown to be effective long-term for more than a very small number of participants, and for most people intentional weight loss efforts lead to weight gain. You probably know some people who have successfully lost weight and kept it off. You probably also know a redhead or two. Statistically, both are rare.
The good news is, weight isn't actually an effective indicator of health, and there are plenty of evidence-based health-promoting behaviors you can adopt to improve your health--quality sleep, abstaining from tobacco, managing stress, exercise, social connections, weight-neutral nutrition. (It sounds like you're already doing a lot of these.) The bad news is, the medical field has a huge fatphobia problem--studies show doctors are biased against fat patients, and many fat patients experience doctors making assumptions about them (e.g., "You should start exercising--maybe take a walk every day" to someone who is very active but also fat) rather than asking about their habits. You can look for a weight-neutral doctor in your area, or if you want to stay (or are stuck) with this one, you can make a habit of asking, "What tests/treatment/recommendations would you have for a thinner patient?" And if the doctor isn't willing to give you the same treatment as a thin patient, it's a good idea to say, "Can you note in my chart that we discussed XYZ test and you're declining to order it?"
posted by theotherdurassister at 3:30 PM on August 10, 2022 [38 favorites]
Best answer: Ugh I'm so sorry. I'm going to share an anecdote that's related. I lived in a small town for some time and there were limited OBGYN options. I found the best option but over time it became less-than-ideal. One year I was asked if I wanted kids, and then was told to lose weight first. I was actually quite skinny at the time, much more than now. The next year I was told to hurry up and have kids soon because I was getting older (I had just turned 30.) I mentioned how she had advised me to lose weight before having kids the previous year, which she did not remember, and asked if that had changed. She told me I was actually thinner than almost all of her patients so I was fine and should go for it. While I had gained weight since the previous year, I had not suddenly gained a wish to have children so this advice was bizarre. The following year? She started the appointment by asking me if I wanted to have "any more kids?" What the heck?! That was it. I found a new doctor locally who was good, then a doctor further away who has been truly truly amazing.
I come from a thinner family and am one of the only non-skinny people. I am bigger than before; I exercise multiple times a week, don't smoke, and cook lots of healthy food. My doctors have been entirely supportive of me and my well-being: I see my OBGYN annual, and both my psychiatrist and therapist monthly. None have brought up weight or children other than to support me in my choices and/or default. I think it's great that you are in therapy and can bring this up.
There are a lot of doctors out there: some crappy, some average, and some truly excellent. A good match will get to know you and your history and understand how to have such a conversation, even a hard one, in a way that you feel seen and supported rather than judged or confused. You deserve to find one who respects and understands you just as you respect and understand them. I wish you luck!
posted by smorgasbord at 3:40 PM on August 10, 2022 [4 favorites]
I come from a thinner family and am one of the only non-skinny people. I am bigger than before; I exercise multiple times a week, don't smoke, and cook lots of healthy food. My doctors have been entirely supportive of me and my well-being: I see my OBGYN annual, and both my psychiatrist and therapist monthly. None have brought up weight or children other than to support me in my choices and/or default. I think it's great that you are in therapy and can bring this up.
There are a lot of doctors out there: some crappy, some average, and some truly excellent. A good match will get to know you and your history and understand how to have such a conversation, even a hard one, in a way that you feel seen and supported rather than judged or confused. You deserve to find one who respects and understands you just as you respect and understand them. I wish you luck!
posted by smorgasbord at 3:40 PM on August 10, 2022 [4 favorites]
Best answer: Just to help you expand your idea of what normal healthcare looks like: my doctor has never weighed me. I am definitely fat but not once not ever has she weighed me because it is irrelevant to my health profile. Recently I was in hospital and they weighed me to dose a drug and I asked the nurse not to tell me my weight and that was treated as perfectly normal because it is.
posted by DarlingBri at 4:10 PM on August 10, 2022 [8 favorites]
posted by DarlingBri at 4:10 PM on August 10, 2022 [8 favorites]
>Is there a way to balance my doctor's instructions against... all the mental work I've done around my weight in the past?
Yes, or I think so - if you’re active and generally eat well, maybe just cut out *one* sweet/higher-cal drink (or treat), and swap it with water or black coffee or herbal tea (or fruit or veg). A small change like that could make a big difference over time - 100 extra calories a day = 10 lbs gained over a year. That way all you’re really thinking about is staying where you are. It’s just one little change that’s easy for most people to do.
Link
posted by cotton dress sock at 5:08 PM on August 10, 2022 [4 favorites]
Yes, or I think so - if you’re active and generally eat well, maybe just cut out *one* sweet/higher-cal drink (or treat), and swap it with water or black coffee or herbal tea (or fruit or veg). A small change like that could make a big difference over time - 100 extra calories a day = 10 lbs gained over a year. That way all you’re really thinking about is staying where you are. It’s just one little change that’s easy for most people to do.
Link
posted by cotton dress sock at 5:08 PM on August 10, 2022 [4 favorites]
I remember back in the early 2000s I had a yearly physical (I think that's what I was there for) and my morbidly-obese GP wanted morbidly-obese me to talk to his dietician. This was around the time I was doing Atkins and was actually losing substantial weight. There were no issues with any of my numbers going weird because of it, but the dietician ended up extremely frustrated with me because she didn't think Atkins was at all healthy, that I was doing tremendous harm to myself by doing it, and I needed to stop, and I just told her no. It was the only thing I had done in my entire life where I actually lost weight (and I grew up during the low fat/low cal hysteria of the '80s and '90s), and I wasn't willing to set it aside when she had one opinion and there were studies to the contrary.
I did kind of slowly lose "interest" in Atkins eventually because I am too much of a bread/pasta lover, but that event sticks with me and might explain why I am so reticent to have a GP and regular physicals today.
posted by tubedogg at 5:46 PM on August 10, 2022
I did kind of slowly lose "interest" in Atkins eventually because I am too much of a bread/pasta lover, but that event sticks with me and might explain why I am so reticent to have a GP and regular physicals today.
posted by tubedogg at 5:46 PM on August 10, 2022
Pretend your doctor gave you some actual good advice: Add some (additional) strength training to your workouts. As we age, the rate of muscle loss increases so it's a good idea to stay ahead of that curve.
posted by ananci at 5:59 PM on August 10, 2022 [5 favorites]
posted by ananci at 5:59 PM on August 10, 2022 [5 favorites]
Best answer: I'm going to link to two interesting research studies I have come across recently, with a few key points from each. If you're not into reading long and fairly technical research studies, that's fine, because the main message of both studies is: Exactly what you are already doing is exactly on the right track.
#1. Beyond the Calorie Paradigm: Taking into Account in Practice the Balance of Fat and Carbohydrate Oxidation during Exercise? Nutrients, 2022.
* The overall study is summarizing research relating to low-volume, low-intensity exercise in improving health. What they find is that this type of activity has an unexpectedly beneficial effect on overall health - far more than can be explained by calories expended.
* Their general recommendations is walking 3-4 times per week for 45 minutes, at a speed you can maintain for that 45-60 period. More times per week exercise and including time at higher intensity would undoubtedly have further positive effects if they can be maintained. But their research showed it was far better to shoot for 3-4X45 minutes per week and actually achieve that than aim for say 6X60 minutes per week and give up on it after a while (which the vast majority of their research subjects did).
* Even more important, though, the main point is to do however much exercise or physical activity you enjoy doing and are able to maintain over the long term because you enjoy it with 3X45 minutes walking weekly as a lower baseline.
* Generally, calories restricted diets don't work, lead to the weight cycling issue, and end up with people worse off than when they started. The one dietary change they found beneficial was to modestly increase protein intake, because that supports the body changes the regular exercise will bring.
* They literally counsel people to avoid calorie restricted diets, or other similar diets like low fat: "We thus propose a dietary check-up and counseling to avoid [calorie or food] restriction, with special emphasis on the need to maintain an adequate protein intake, rather than a restricted diet."
#2. Obesity treatment: Weight loss versus increasing fitness and physical activity for reducing health risks, iScience, Oct 2021.
The point of this article is pretty well summed up in abstract:
They don't just state these main points, however - they marshal a mountain of evidence to support both the lack of effectiveness, and positive danger to health, of traditional dieting. And they document just as thoroughly the myriad benefits of maintaining or increasing physical fitness.
posted by flug at 6:16 PM on August 10, 2022 [16 favorites]
#1. Beyond the Calorie Paradigm: Taking into Account in Practice the Balance of Fat and Carbohydrate Oxidation during Exercise? Nutrients, 2022.
* The overall study is summarizing research relating to low-volume, low-intensity exercise in improving health. What they find is that this type of activity has an unexpectedly beneficial effect on overall health - far more than can be explained by calories expended.
* Their general recommendations is walking 3-4 times per week for 45 minutes, at a speed you can maintain for that 45-60 period. More times per week exercise and including time at higher intensity would undoubtedly have further positive effects if they can be maintained. But their research showed it was far better to shoot for 3-4X45 minutes per week and actually achieve that than aim for say 6X60 minutes per week and give up on it after a while (which the vast majority of their research subjects did).
* Even more important, though, the main point is to do however much exercise or physical activity you enjoy doing and are able to maintain over the long term because you enjoy it with 3X45 minutes walking weekly as a lower baseline.
* Generally, calories restricted diets don't work, lead to the weight cycling issue, and end up with people worse off than when they started. The one dietary change they found beneficial was to modestly increase protein intake, because that supports the body changes the regular exercise will bring.
* They literally counsel people to avoid calorie restricted diets, or other similar diets like low fat: "We thus propose a dietary check-up and counseling to avoid [calorie or food] restriction, with special emphasis on the need to maintain an adequate protein intake, rather than a restricted diet."
#2. Obesity treatment: Weight loss versus increasing fitness and physical activity for reducing health risks, iScience, Oct 2021.
The point of this article is pretty well summed up in abstract:
We propose a weight-neutral strategy for obesity treatment on the following grounds:* "Multiple surveys demonstrate a high prevalence of weight loss attempts over the past 40 years, during which, obesity prevalence has increased approximately 3-fold. Thus, the intense focus on weight loss has not prevented excessive weight gain in recent decades. Moreover, repeated weight loss efforts may contribute to weight gain, and is undoubtedly associated with the high prevalence of weight cycling, which is associated with significant health risks..."
(1) the mortality risk associated with obesity is largely attenuated or eliminated by moderate-to-high levels of cardiorespiratory fitness or physical activity,
(2) most cardiometabolic risk markers associated with obesity can be improved with exercise training independent of weight loss and by a magnitude similar to that observed with weight-loss programs
(3) weight loss, even if intentional, is not consistently associated with lower mortality risk
(4) increases in cardiorespiratory fitness or physical activity are consistently associated with greater reductions in mortality risk than is intentional weight loss, and
(5) weight cycling is associated with numerous adverse health outcomes including increased mortality. Adherence to physical activity may improve if health care professionals consider physical activity and cardiorespiratory fitness as essential vital signs and consistently emphasize to their patients the myriad benefits of physical activity and cardiorespiratory fitness in the absence of weight loss.
They don't just state these main points, however - they marshal a mountain of evidence to support both the lack of effectiveness, and positive danger to health, of traditional dieting. And they document just as thoroughly the myriad benefits of maintaining or increasing physical fitness.
posted by flug at 6:16 PM on August 10, 2022 [16 favorites]
Hey, bridgebury! All solidarity and support to you. You've had the wise insight that your highest priority here should be continuing to feel good about yourself, and that the feeling of relief and healing that you get from your girlfriend's attraction, affection, and affirmation has been wonderful for your wellbeing. Please hold on to that healthy mindset! If at any point you feel you're making a choice between liking yourself and weight loss, prioritize liking yourself every time.
Is that definitely the tradeoff you face? Well, you'll have better information about that question than we can have. If your history of feeling unduly bad about the topic of weight makes you suspect that any possible weight loss project would reawaken insecurities and unhappiness, then I wholeheartedly agree with the consensus in this thread that it's best just not to risk that.
On the other hand, maybe you're one of the people for whom it could be realistic to enjoy the best of both worlds: never for a moment to stop feeling good about yourself, and simultaneously, to entertain the possibility of making small tweaks to your habits that approximate your doctor's advice. The decision to adjust a habit wouldn't in and of itself mean that you have embraced your mom's demons or your ex's unkind judgment! Especially if you consciously make that decision in the spirit of a precaution that will contribute to your remaining strong and capable and mobile, consciously take pride in your existing capabilities and accomplishments, consciously remind yourself to be forgiving and kind to yourself throughout it all. (5-10 pounds is genuinely not a big deal. I would guess one of the possibilities on your doctor's mind is that if you make small changes now while it's just 5-10 pounds, you'll be less likely to face a harder scenario later. I speak from experience.)
The optimal mindset here certainly isn't "internalize the cruelest messages you can find, and let your self-worth depend on the size of your body!" But -- contra one of the subtexts that's been appearing in this thread -- the optimal mindset also isn't "your weight never has any health implications, and you should ignore your doctor, who's just reciting baseless lies!"
Rooting for you no matter what approach you choose. Remember that you're allowed to change your mind about it after experimenting with one or the other. And -- I can't stress this part enough -- never lose sight of your hard-earned observation that serenity and self-kindness are indeed more important to your wellbeing than the number on the scale is.
posted by foursentences at 7:27 PM on August 10, 2022 [7 favorites]
Is that definitely the tradeoff you face? Well, you'll have better information about that question than we can have. If your history of feeling unduly bad about the topic of weight makes you suspect that any possible weight loss project would reawaken insecurities and unhappiness, then I wholeheartedly agree with the consensus in this thread that it's best just not to risk that.
On the other hand, maybe you're one of the people for whom it could be realistic to enjoy the best of both worlds: never for a moment to stop feeling good about yourself, and simultaneously, to entertain the possibility of making small tweaks to your habits that approximate your doctor's advice. The decision to adjust a habit wouldn't in and of itself mean that you have embraced your mom's demons or your ex's unkind judgment! Especially if you consciously make that decision in the spirit of a precaution that will contribute to your remaining strong and capable and mobile, consciously take pride in your existing capabilities and accomplishments, consciously remind yourself to be forgiving and kind to yourself throughout it all. (5-10 pounds is genuinely not a big deal. I would guess one of the possibilities on your doctor's mind is that if you make small changes now while it's just 5-10 pounds, you'll be less likely to face a harder scenario later. I speak from experience.)
The optimal mindset here certainly isn't "internalize the cruelest messages you can find, and let your self-worth depend on the size of your body!" But -- contra one of the subtexts that's been appearing in this thread -- the optimal mindset also isn't "your weight never has any health implications, and you should ignore your doctor, who's just reciting baseless lies!"
Rooting for you no matter what approach you choose. Remember that you're allowed to change your mind about it after experimenting with one or the other. And -- I can't stress this part enough -- never lose sight of your hard-earned observation that serenity and self-kindness are indeed more important to your wellbeing than the number on the scale is.
posted by foursentences at 7:27 PM on August 10, 2022 [7 favorites]
Best answer: hey, folks chiming in to wag a lil finger at OP and tell them to cut out the treats: OP has already clearly stated in the question that they already eat healthy, and already exercise.
Newsflash: some people's bodies get overweight despite eating healthy and despite getting plenty of exercise. I'm one of them, so I know.
So popping up here to tell them to "make small tweaks" to lose weight -- when they ALREADY HAVE BEEN MAKING THE TWEAKS THEIR WHOLE LIFE - and when they are already experienced dieters - is not responsive to the scenario outlined, and is also gross.
posted by fingersandtoes at 9:06 PM on August 10, 2022 [15 favorites]
Newsflash: some people's bodies get overweight despite eating healthy and despite getting plenty of exercise. I'm one of them, so I know.
So popping up here to tell them to "make small tweaks" to lose weight -- when they ALREADY HAVE BEEN MAKING THE TWEAKS THEIR WHOLE LIFE - and when they are already experienced dieters - is not responsive to the scenario outlined, and is also gross.
posted by fingersandtoes at 9:06 PM on August 10, 2022 [15 favorites]
Best answer: I wish I could hug you.
I also wish I could, um, do something less nice to the doctor who said that to you.
But mostly I want to hug you.
Hearing family, partners, doctors, etc say outright, "Lose weight," is horrible. It is a direct hit to our psyche, a punch to the metaphorical and literal gut that these people often want us to get rid of. But it's the "little tweaks" idea that is worse. It seems benign. It seems manageable. It seems fair and reasonable and healthy. And it makes any self-doubt you already have about yourself just fester. How do you measure "tweaks"? How can you go safely go from eating an already balanced diet to suddenly feeling compelled to look at a dollop of Daisy and say to yourself, "Could... Could I scrape off that one little swirl here and have that count? Is that the right tweak?" You can't. The math doesn't math.
You know your body. You know your family history. You also already know what a healthy you looks and feels like. You are already doing right by you. Continue to do right by yourself by ignoring what should now be your former doctor's [keyboard smash because I legit cannot articulate what I want to say rn] words. I am proud of you for calling foul and asking this question because to me it means all that hard mental work you've done over the years is paying off. You already know the answer is "eff this noise." So eff it. :)
posted by The Adventure Begins at 10:26 PM on August 10, 2022 [6 favorites]
I also wish I could, um, do something less nice to the doctor who said that to you.
But mostly I want to hug you.
Hearing family, partners, doctors, etc say outright, "Lose weight," is horrible. It is a direct hit to our psyche, a punch to the metaphorical and literal gut that these people often want us to get rid of. But it's the "little tweaks" idea that is worse. It seems benign. It seems manageable. It seems fair and reasonable and healthy. And it makes any self-doubt you already have about yourself just fester. How do you measure "tweaks"? How can you go safely go from eating an already balanced diet to suddenly feeling compelled to look at a dollop of Daisy and say to yourself, "Could... Could I scrape off that one little swirl here and have that count? Is that the right tweak?" You can't. The math doesn't math.
You know your body. You know your family history. You also already know what a healthy you looks and feels like. You are already doing right by you. Continue to do right by yourself by ignoring what should now be your former doctor's [keyboard smash because I legit cannot articulate what I want to say rn] words. I am proud of you for calling foul and asking this question because to me it means all that hard mental work you've done over the years is paying off. You already know the answer is "eff this noise." So eff it. :)
posted by The Adventure Begins at 10:26 PM on August 10, 2022 [6 favorites]
It sounds like you have a great attitude, and good for you for fighting the ever-present emphasis on weight.
If your numbers (cholesterol etc, not the number that is your weight) are good and you have a healthy lifestyle, then it makes no sense for your doctor to have told you to lose weight except in context of deeming some arbitrary number of pounds as “overweight” and therefore “bad.” As long as your numbers are good and you have a healthy lifestyle, you’re good.
If at some point in the future the numbers indicate a health issue, then I’d continue to focus on exercise and general diet (not restrictively, but in the sense that you are already doing) rather than on weight. We can control how we behave, but in the end we can’t control our weight, only factors that we think/hope/have been told will affect our weight. And it is both wrong and fruitless (and often actively harmful) to tell someone to change something they can’t directly control. Also, as several people have provided data for above, weight/losing weight doesn’t correlate with health - so it’s not even the right thing to focus on.
(Btw in the US, at least some insurance will actually reimburse medical people for bringing up weight. I’ve seen this on my own EOBs. Maybe this is why your doctor brought it up. It sucks, but it helped me accept a little better when my doctor brought up weight in a kind of off-hand way. I basically told her what I said above - “you can talk to me about exercise or food (in context of my actual diet, not random “drink less soda” type advice) but you can’t tell me to lose weight” - and she has not brought it up since.)
posted by 2 cats in the yard at 5:19 AM on August 11, 2022 [2 favorites]
If your numbers (cholesterol etc, not the number that is your weight) are good and you have a healthy lifestyle, then it makes no sense for your doctor to have told you to lose weight except in context of deeming some arbitrary number of pounds as “overweight” and therefore “bad.” As long as your numbers are good and you have a healthy lifestyle, you’re good.
If at some point in the future the numbers indicate a health issue, then I’d continue to focus on exercise and general diet (not restrictively, but in the sense that you are already doing) rather than on weight. We can control how we behave, but in the end we can’t control our weight, only factors that we think/hope/have been told will affect our weight. And it is both wrong and fruitless (and often actively harmful) to tell someone to change something they can’t directly control. Also, as several people have provided data for above, weight/losing weight doesn’t correlate with health - so it’s not even the right thing to focus on.
(Btw in the US, at least some insurance will actually reimburse medical people for bringing up weight. I’ve seen this on my own EOBs. Maybe this is why your doctor brought it up. It sucks, but it helped me accept a little better when my doctor brought up weight in a kind of off-hand way. I basically told her what I said above - “you can talk to me about exercise or food (in context of my actual diet, not random “drink less soda” type advice) but you can’t tell me to lose weight” - and she has not brought it up since.)
posted by 2 cats in the yard at 5:19 AM on August 11, 2022 [2 favorites]
Supposedly, the standard is that it takes 15 calories to maintain 1 pound (15 x 5 = 75 to maintain 5 pounds). Sour cream, for example, has 25 calories per tablespoon. So, supposedly, it would take 3 tablespoons (25 x 3 = 75) of sour cream per day to maintain 5 pounds.
There are a couple of recent, really good articles about doctors and weight in The Seattle Times. I think you can sign up for a free account (with limited amount of articles) to view them.
What Will It Take To Get Weight Inclusive Healthcare
Weight Centric Healthcare Is Status Quo But It's Not Helping Patients
posted by SageTrail at 6:50 AM on August 11, 2022
There are a couple of recent, really good articles about doctors and weight in The Seattle Times. I think you can sign up for a free account (with limited amount of articles) to view them.
What Will It Take To Get Weight Inclusive Healthcare
Weight Centric Healthcare Is Status Quo But It's Not Helping Patients
posted by SageTrail at 6:50 AM on August 11, 2022
I don't know which I find more horrifying--your doctor, or the apparent anti-sour cream bias on AskMe, lol. (Just kidding, of course, it's your doctor.)
I also struggle with the legacy of a parent who had disordered eating and exercise habits for most of my life. It's been a challenge to create a lifestyle for myself that feels good without anxiety that maybe I'm slipping into disorder--especially since BOTH of my parents had unhealthy approaches to exercise. I have had to pay such close attention to what's going on internally when I make choices about food and exercise; do I still feel good about going to the gym or do I just feel anxious about NOT going? Am I enjoying and looking forward to the meals I'm having this week, or am I feeling restricted and denied?
I agree with folks above that you can just mentally tell that doctor to fuck right off. 5 to 10 pounds is not medically anything; that says to me they just have a vague sense that they don't like looking at heavier bodies and also a vague sense that there's nothing wrong with you and don't know how to square it. That's a yo problem, as in, sorry doc, that's yo problem, not mine.
I don't know how long the sting of it will take to fade, but it sounds like you have a really great baseline of feelings about yourself and your body that you can work your way back to as long as you stay conscious. Good luck!
posted by We put our faith in Blast Hardcheese at 7:00 AM on August 11, 2022 [2 favorites]
I also struggle with the legacy of a parent who had disordered eating and exercise habits for most of my life. It's been a challenge to create a lifestyle for myself that feels good without anxiety that maybe I'm slipping into disorder--especially since BOTH of my parents had unhealthy approaches to exercise. I have had to pay such close attention to what's going on internally when I make choices about food and exercise; do I still feel good about going to the gym or do I just feel anxious about NOT going? Am I enjoying and looking forward to the meals I'm having this week, or am I feeling restricted and denied?
I agree with folks above that you can just mentally tell that doctor to fuck right off. 5 to 10 pounds is not medically anything; that says to me they just have a vague sense that they don't like looking at heavier bodies and also a vague sense that there's nothing wrong with you and don't know how to square it. That's a yo problem, as in, sorry doc, that's yo problem, not mine.
I don't know how long the sting of it will take to fade, but it sounds like you have a really great baseline of feelings about yourself and your body that you can work your way back to as long as you stay conscious. Good luck!
posted by We put our faith in Blast Hardcheese at 7:00 AM on August 11, 2022 [2 favorites]
nthing the people who said to decline being weighed. I haven't let a doctor weigh me several years, and it's great. I only had one provider push back on it, and it was at a podiatrist, of all things.
posted by missrachael at 8:45 AM on August 11, 2022 [1 favorite]
posted by missrachael at 8:45 AM on August 11, 2022 [1 favorite]
I told my doctor, "I'll follow any diet, exercise, or lifestyle plan that has been published in a peer-reviewed scientific journal in which at least 50% of participants lost weight and kept it off for five years. Unless you can show me a plan like that, I don't want you to tell me to lose weight."
She hasn't mentioned weight loss to me since. Either she put a note in my chart, or (in my secret fantasy) she doesn't mention weight loss to any of her patients any more unless they ask for advice.
posted by BrashTech at 9:07 AM on August 11, 2022 [16 favorites]
She hasn't mentioned weight loss to me since. Either she put a note in my chart, or (in my secret fantasy) she doesn't mention weight loss to any of her patients any more unless they ask for advice.
posted by BrashTech at 9:07 AM on August 11, 2022 [16 favorites]
Best answer: I just wanted to point you to this amazing and jaw-dropping comment by DrMew about how, growing up in the body of a girl, there was endless scolding and pressure to lose weight - but after transitioning into the body of a man, and then gaining noticeable weight, there was zero pressure from doctors to lose any of it. As DrMew's experiences show, doctors exert MUCH more pressure on women to lose weight than on men.
I am not your doctor, but if I were your friend (or if I were an internet stranger who cared about you, which I am), I would say:
Mental health is health. Emotional health is health. The health issues that are the biggest concerns for you right now are your mental and emotional health. I am glad you're able to listen to yourself enough to know that. I encourage you to continue listening to yourself - YOU know what feels good and what feels bad, what feels healthy and what doesn't. And that encompasses ALL of you, not just questionable BMI charts.
If I were your doctor, I would encourage you to nurture your health by taking good care of yourself, in lots of different ways, all the time. Take good care of yourself by exercising to feel good. Take good care of yourself by eating tasty vegetables you enjoy. Take good care of yourself by talking with your therapist. By listening to all your inner wisdom. By enjoying time with your wonderful girlfriend; by noticing how good it feels that she loves you the way you are. By rejecting the unhealthy patterns your mom had. By finding balance and pleasure in your life. By cutting yourself plenty of slack. By enjoying as much of every day as you can.
I am so proud of you for paying attention to your inner wisdom, the voice that knows what you need to be healthy and has been nudging you in healthy directions for years. I am so proud of you for questioning advice that was wrong for you and for reaching out to others to help you figure out how to proceed.
I hope you can continue to pay lots of attention to how you feel, what feels good and healthy for you, based on what your body tells you directly, what your heart and mind tell you directly, to guide what you eat and how you exercise and how you rest and how you choose to spend your time and all the many, many facets that make up your whole health.
You deserve to feel good about all the excellent choices you're making for yourself.
posted by kristi at 6:40 PM on August 11, 2022 [5 favorites]
I am not your doctor, but if I were your friend (or if I were an internet stranger who cared about you, which I am), I would say:
Mental health is health. Emotional health is health. The health issues that are the biggest concerns for you right now are your mental and emotional health. I am glad you're able to listen to yourself enough to know that. I encourage you to continue listening to yourself - YOU know what feels good and what feels bad, what feels healthy and what doesn't. And that encompasses ALL of you, not just questionable BMI charts.
If I were your doctor, I would encourage you to nurture your health by taking good care of yourself, in lots of different ways, all the time. Take good care of yourself by exercising to feel good. Take good care of yourself by eating tasty vegetables you enjoy. Take good care of yourself by talking with your therapist. By listening to all your inner wisdom. By enjoying time with your wonderful girlfriend; by noticing how good it feels that she loves you the way you are. By rejecting the unhealthy patterns your mom had. By finding balance and pleasure in your life. By cutting yourself plenty of slack. By enjoying as much of every day as you can.
I am so proud of you for paying attention to your inner wisdom, the voice that knows what you need to be healthy and has been nudging you in healthy directions for years. I am so proud of you for questioning advice that was wrong for you and for reaching out to others to help you figure out how to proceed.
I hope you can continue to pay lots of attention to how you feel, what feels good and healthy for you, based on what your body tells you directly, what your heart and mind tell you directly, to guide what you eat and how you exercise and how you rest and how you choose to spend your time and all the many, many facets that make up your whole health.
You deserve to feel good about all the excellent choices you're making for yourself.
posted by kristi at 6:40 PM on August 11, 2022 [5 favorites]
5 - 10 pounds? That's a weird concern when your numbers (cholesterol, blood sugar) are good. Sour cream? The thing to watch is sugar in all forms. Obesity and overweight are correlated with poor health, so I think it makes sense to watch where your weight is headed. If it's stable and you're healthy, which it sounds like you are, then keep it stable, keep loving vegetables and exercise and not eating much sugar and carry on. Dieting is all fads and disinformation. Find nutrition information you trust that has good science behind it, which I think you've done. Keep appreciating and caring for your healthy body.
Most doctors use software and the software may have calculated your height and weight and popped up a recommendation. Your doc may be required or at least pressured to act on that, so maybe cut them a bit of slack.
posted by theora55 at 5:50 PM on August 15, 2022
Most doctors use software and the software may have calculated your height and weight and popped up a recommendation. Your doc may be required or at least pressured to act on that, so maybe cut them a bit of slack.
posted by theora55 at 5:50 PM on August 15, 2022
This thread is closed to new comments.
If you could lose weight by just "cutting back on the sour cream" you would have lost it already, right? Are you really randomly eating excessive sour cream? Or is your body just the way it is?
IGNORE YOUR DOCTOR.
posted by fingersandtoes at 1:38 PM on August 10, 2022 [84 favorites]