Keeping the weight off
October 25, 2011 8:52 AM   Subscribe

I'm obese and recently went on a new medication that's causing me massive weight loss. I can't handle the other side effects, so I'm unfortunately going to have to switch eventually. I'm looking for tips on how to maintain my lower weight once I'm off the drug, and hopefully lose some more.

So I recently switched onto lamotrigine for my epilepsy. It's been found to work for weight loss in obese people, but we're talking nine to twelve pounds in a year. I've gone from 289 to around 245 in ten weeks. (I'm a 5'10 dude.) My doctor has run tests for diabetes and hypothyroidism, both negative; at this point he's thinking it's the drug. I swear, I'm case study material.

Basically, it wipes out my appetite. I get physically hungry, and I can eat and enjoy it when I want, but there's never that nagging urge.

At this point I have to actively remember to eat, so I've taken the opportunity to go on a crash diet. I just have a small meal whenever the hunger is uncomfortable enough to be a distraction. It adds up to 1100-1600 calories a day, usually on the low end. I don't have a scale at home yet, but I'm guessing my weight loss has eased up a bit, as it does for everyone. So it's not quite so scary-fast anymore, but we're still talking 2.5+ pounds a week.

I'm doing all the stuff you're supposed to do. I do light to moderate exercise two hours a week to keep my metabolism up, I take a multivitamin, I eat a lot of fruits and veggies, and I make sure to get a decent balance of macronutrients, with lots of protein for weight training.

Unfortunately, I need to switch drugs soon, because the lamotrigine is giving me short term memory loss, trouble balancing, and other problems. I'm hoping I can dial back to a sub-clinical dose and take it alongside my new med, but I'm not betting on it. It's pretty depressing: this might have cured my obesity for life. I can put up with the other side effects maybe two to five months before I really have to switch.

Even with all the good habits this is helping me learn, I will very likely relapse and gain all of the weight back once I'm on the new drug. It feels like I could handle it now, but stats are stats: 95% of diets fail within five years. Mine always fail within six months. And since I didn't even lose the weight thanks to (much) effort or commitment in the first place... yikes.

What can I do to have a glimmer of hope for keeping this weight off, or some of it? Can I use the fact that I can essentially dial my appetite back up slowly to my advantage? Is there anything I can do now to help train myself to do better? All thoughts and ideas are welcome.

Thanks in advance for the wisdom.
posted by anonymous to Health & Fitness (13 answers total) 4 users marked this as a favorite
Brazilian Jiu-Jitsu works for alot of people.
posted by the cuban at 8:59 AM on October 25, 2011 [1 favorite]

I can't tell you what works for you, but I can tell you what works for me: tracking.

Obsessive, detail-focused, meticulous tracking. Calories and macronutrients. You sound like you're already doing this, so keep it up.

It helps me if I think if it as a 'lifestlye change' and not a 'diet.'

r/fitness (reddit's fitness sub-section) and r/loseit (reddit's weight loss sub-section) have helped a lot of people.

There is a lot of information out there - what helps me is to make small, incremental changes. Don't try to change everything at once. Set concrete goals for yourself. Write them down, and check them periodically to see how you are progressing.

Good luck!
posted by the man of twists and turns at 9:03 AM on October 25, 2011 [1 favorite]

Actually you are doing the right things--diet, exercise and balanced nutrition. The drug may have provided a framework for the weight loss but it is your behavior that makes it happen. Give yourself a bit of credit. If I would do anything it would be increase the exercise (moderate) to 5 hours a week and add 200 +/- calories to current intake. You have to be aware of calories and forgive yourself when the inevitable slip takes place. You only have to maintain the diet/exercise one day at a time. Good god that sounds trite. Best Wishes
posted by rmhsinc at 9:04 AM on October 25, 2011 [2 favorites]

Aside: Are you taking lamotrigine or Lamictal? If the former (the generic), have you tried the brand? I take a combination of Lamictal (the brand) and Zonegran for my epilepsy and experienced similar weight loss which plateaued when I had lost about 15% of my body weight. (Yay! Now I'm merely fat!)

I had serious memory loss (and hair loss (?!) - damn, pharma, you scary!) issues with the generics, but the brands have been much kinder. I'm still a little stupid, but nowhere near as stupid as I was on the generics. Never had balance issues. Anyway, have you talked to your neuro about the brand or dropping the lamotrigine dose and adding something like Zonegran (which is actually a known off-label obesity drug)?

Oh yeah, and diet, exercise, etc. etc. which everyone else is going to tell you.
posted by The Bellman at 9:18 AM on October 25, 2011 [1 favorite]

I lost 35 pounds through a metabolic trick when I got pregnant with my second kid. (I lose weight like CRAZY while I'm pregnant. Sadly, being pregnant doesn't last forever, nor do I want three more children.) I have not gained any of that weight back, and in fact I've lost an additional fifteen pounds over the past ten months or so. (twenty-five total, but I got sick in the middle and couldn't cook or exercise, and gained ten back.)

I signed up with MyFitnessPal and started tracking my calories, and I began a quite rigorous and consistent exercise program. I found that if I stay away from starchy carbs and grains and instead eat tons and tons of vegetables, that I can feel perfectly satisfied on about two-thirds as many calories as I'd previously been consuming. Eating vegetables with every meal has been the number one factor for me, along with 30 minutes to an hour of vigorous exercise 5-6 times per week. To help keep me focused on the exercise, I started training for a triathlon a couple months ago; it's a hard goal, but I have a tendency to blow off easy ones, so I'm sticking with it.
posted by KathrynT at 9:37 AM on October 25, 2011

The best thing I've found for getting me back on the wagon of exercise/good eating/etc. after I fall off is the MeFi team on Health Month. It doesn't work for everyone, but knowing I have to report my failures makes me work harder to succeed, and knowing they'll encourage me if I screw up keeps me from slinking off in shame.
posted by immlass at 9:38 AM on October 25, 2011

Since you're epileptic, maybe you should talk to your doctor about whether a ketogenic or modified Atkins diet would be appropriate for you. The lack of carbs should make it much harder to put the weight back on, and apparently there is some evidence that it may reduce seizure frequency in some adults.
posted by Acheman at 9:47 AM on October 25, 2011 [3 favorites]

Regarding the balance thing - I don't have a scale, I just weigh myself on my wii Fit balance board. My balance is terrible. I was considering digging out a level to check my floors because surely I couldn't be that out of whack. Anyway, I tried this wacky Shangri La diet I read about somewhere on mefi and elsewhere. I took a lot of flax seed oil every day for a few weeks. My balance on the wii fit was PERFECT while I was taking it. Even when I wasn't trying - dead center. (I went off the flax oil because it was gross and although it made me much less hungry, I didn't lose any weight. My balance is awful again.) So that's something to try if you can figure out a way to alleviate some of the other side effects.
posted by artychoke at 9:49 AM on October 25, 2011

I will very likely relapse and gain all of the weight back once I'm on the new drug. It feels like I could handle it now, but stats are stats: 95% of diets fail within five years. Mine always fail within six months.

Yes, but statistically most people taking this drug don't lose weight the way you did! So banish any defeatist thoughts and don't assume that gaining the weight back is inevitable. Your metabolism might be changing for the better and it could be that change was kick-started by the drug. That doesn't mean all the positive effects will stop once you stop the drug. Or maybe something else entirely was going on before, but now you are back where you should be, like you're body has just fought off a virus (obesity has been linked to a virus, actually.

If you keep up what you're doing you should still be able to maintain your weight and maybe even continue to lose but at a reduced rate.

I don't understand why, if you are losing weight, your doctor ran tests for diabetes or hypothyroidism, though. Those are counter-indicated for weight loss. Could it have been hyperthyroid, maybe? Or do you mean he couldn't find the reason for the original weight gain or inability to lose weight before you started this drug?

Anyway, keep the healthy habits you have put in place, and expect good results.
posted by misha at 9:59 AM on October 25, 2011 [1 favorite]

For maintenance, try to eliminate most food with added sugar from your diet.

My understanding is that if you're eat both sugar and fat, you body will burn the sugar and store the fat in case you're short of food later. (Apparently, it's easier for your body to convert sugars into glucose, and retain the fats as fat.) If you eat a diet that's fairly high in sugar, you'll gradually gain weight over time because of this. If you eat very little sugar, you body will go ahead and burn the fat for energy rather than storing it. Carbohydrates fall somewhere in between.

I'm not a nutritionist or anything, so take this with a grain of salt.

I do eat a diet that's a lot like this, not because I'm particularly trying to avoid weight gain, but because I don't have much of a sweet tooth, and I cook most of my own food (so very little pre-sweetened stuff). I stay pretty thin doing this. Even recently, when I've been fairly physically inactive, I haven't gained much.
posted by nangar at 10:11 AM on October 25, 2011

I'm sorry to potentially rain on your parade, but I have to say this: Please don't rely on medications that eradicate your appetite as a way to lose weight. A friend of mine was on Adderall or some similar ADD drug and had gained a little extra weight recently, so took quite kindly, like you did, to the disappearance of his drive to eat anything, ever. He developed a serious dependancy and an eating disorder. Do you want to develop anorexia? I'm anorexic, trust me, you DON'T. It sounds like you already have a binge eating issue and are using this medicine to control it, not to mention using medication to lower your appetite is already a form of disordered eating. This does not lead good places. Yes, use the new habits you have learned, if they are healthy (reasonable diet, reasonable exercise, self-control/portion control to some extent.) If the habits you're referring to involve doing or taking anything to make you not give a shit whether you eat or not, please don't continue them.

Having sad that, that number of calories doesn't sound awful, but honestly I would up it to like 2500 - for someone of your weight, you will still lose at this level, and it won't put such excessive stress on your organs as eating 1600 calories on a 245lb frame. Yes, you should be eating more than you are now. And you'll still lose weight, especially if you get a good exercise thing going. You can decrease your calories later, if you want.
posted by jitterbug perfume at 10:28 AM on October 25, 2011

jitterbug perfume, I have no idea where you came up with the 2500 calories number.

With light exercise, and taking in around 2250 calories daily, the OP could lose ~25 pounds in 6 months (a pound a week for 25 weeks) IF he is in line with most weight loss charts, and that is a big assumption (I find that I need to go way under what the charts say personally just to maintain my weight).

A pound a week, providing that stands up, is still only a modest loss; 2500 calories a day would cut that down to only 1/2 lb a week. I don't think that 2500 calorie suggestion is what the OP is looking for.
posted by misha at 11:06 AM on October 25, 2011

I would guess that your best chance is to use the time you have left on this drug to develop habits that are easy to build now, and that will hopefully be so ingrained by the time you come off the drug that you'll keep them up. Choose some specific times of day to eat, and only eat at those times, and you'll probably find that when your hunger drive gradually returns, it is tuned to show up at those times. Get used to the reasonable smaller portion sizes now, and resist the urge to increase them later.

One thing you'll probably have to do is to INCREASE what you are eating now. 1010-1600 calories a day is not going to be sustainable, so you need to find a level where you are still losing weight, but that you might be able to keep up once your hunger drive returns. If I were you, I'd find that level sooner rather than later, and stick to it, so that your body learns that this is how much food it gets. It will be much harder to increase your food amounts that much and no further when you no longer have the appetite suppressant assisting you to not start binging instead.

Good luck!
posted by lollusc at 5:18 PM on October 25, 2011

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