I'm morbidly obese. Where do I start?
September 12, 2016 2:49 PM   Subscribe

I’m in terrible physical shape. I've written a long explanation of my situation and a short question inside.

I’m a man in my mid-40s. Obesity runs in my family. My current BMI is 53.1. Most of my weight is in my gut. I weigh about 370 pounds (168 kg / 26.4 stone.) I was 330 (150 kg / 23.6 stone) when I quit smoking 2 years ago. I mostly eat fast food.

I’m far beyond my comfortable level of fatness. I can’t sit in a booth in a restaurant. I have a hard time getting in or out of most cars. Most chairs are uncomfortably small and narrow. I can’t sit on a high stool.

I’m extremely sedentary. I spend 40 hrs/week programming at a desk. Almost all my free time is spent reading, watching TV, or web surfing in bed. I have moderate to severe depression. Sometimes it takes all of my emotional energy to drag myself to work, even though I love my job.

I have a small but painful meniscus tear that is mostly relieved with a tight knee brace. The tear is at the point where it hurts bad for a few days and then doesn’t hurt at all for a few days. I wear the knee brace every day regardless of how it feels because I want to postpone having it scoped again as long as possible, or preferably never. (It was scoped almost five years ago. That was awful.) I think I could walk some days but not every day or maybe even every week.

I have no energy or strength at all. Even small amounts of exercise like housework make my back and hips hurt and leave me feeling completely wiped out. Exercise also makes my asthma worse.

My body feels very stiff. I have a hard time turning around to back my car out of the driveway. Bending down to pick something up off the floor is murder.

I have hypogonadism (low testosterone) for which I used to take androgel, but I’m not currently on it due to an insurance problem. I will probably take if again in the future after I see an endocrinologist again. (I have good health insurance now.) My thyroid levels were recently tested and are fine. I am pre-diabetic.

I’ve never enjoyed exercise at all, but between ages 16 to 23 or so, I was physically fit, thanks to high school sports and the military. I was only slightly overweight. Over the years, as I gained more and more weight, I would occasionally try to exercise. When I did this, my heart would pound and I was gripped with a terror that I was going to die on the spot. I haven’t tried to do that in over 5 years. According to a recent EKG, my heart is basically fine. By “fine” I mean I’m not in imminent danger of a heart attack, not that I’m ready to run a marathon.

I’m well aware that I’ll need to talk to my doctor again before starting any exercise routine. I’ve seen a few dietitians in my life. All of them were awful, judgmental and useless.

I will never be able to bike to work. Work is 30 miles (48 km) away via interstate highway. To be perfectly honest, I’m not completely sure a bike wouldn’t break in half under my weight.

There’s an Anytime Fitness near my house and a very busy YMCA with a pool. I’d consider joining either of them. I can't afford a personal trainer.

I want to lose weight and get healthy before I kill myself. I know there’s a wealth of information about diet and exercise, but it’s difficult for me to separate accurate info from woo bullshit.

I know I’m killing myself living like this. I have a strong feeling that I’m at a turning point right now where if I don’t do something, it’s going to be too late, if it isn’t already.


Where should I start?

(I’ve created a throwaway email account if you want to contact me privately.)
posted by anonymous to Health & Fitness (78 answers total) 25 users marked this as a favorite
Checkout /r/keto. Sort by top posts to see some inspiring stories. Then hit the sidebar for info.

For me it's been the only sustainable thing to keep my weight in check (granted I wasn't quite where you are).

Feel free to mefi mail me.
posted by pyro979 at 3:00 PM on September 12, 2016 [16 favorites]

Have you heard of the keto way of eating? Check out reddit' s r/keto boards. It has really helped people in your situation lose substantial weight and improve health markers.
posted by Thella at 3:00 PM on September 12, 2016 [2 favorites]

I would recommend one single change for now: follow the keto diet.

Pick where you want to learn about it from. In your case, I'll say that Reddit is probably the easiest (I don't use reddit anymore for ethical reasons, but it was an excellent resource a couple years ago and people are pretty passionate and organized about it so I think in this case screw ethics and go for ease) way. Even if you are not a very good cook, people there will help you learn and they will be kind. (But this is a very sort of white middle-class Dude Culture Hobby Lifestyle thing, so there is also a ton of YouTube and websites to help you with the shopping and cooking.)

Just do that. I've seen people, especially at the 350+ sedentary/limited mobility level, make extraordinary inroads just from that. And once you drop 50, 70, 80 pounds just from a relatively simple and followable dietary change, it will be much, much easier to walk and to get your knee looked at again and to feel like actually choosing to do more active stuff totally because you want to.
posted by Lyn Never at 3:01 PM on September 12, 2016 [11 favorites]

First off: it is never too late. You can always do something to improve your physical condition and feel better and stronger. It's very brave of you to try now. The great thing is that, the more you do, the easier it will be to do. You just need to get the ball rolling.

Are you taking any medication for depression? If it's not being treated, I would look into doing that. It will be a lot easier to work out when you're not struggling with another medical condition. But if it is, you should know that some anti-depressants can cause you to put on weight, and, if you're taking one of them, you might want to consider trying a switch to another one. (Bonus: exercise has been shown to be of some help with depression.) If you are concerned about possibly having panic attacks while exercising, talk to your doctor about a prescription for a small dosage of a benzodiazepine. Many people find just having the pill available to be very reassuring.

If you are comfortable swimming, I think the pool might be very good for you. Either swimming or water aerobics will be much less hard on your knees than other forms of exercise might be. Can you see if your local Y has classes for either?

With respect to diet, unfortunately there is a lot of conflicting science and opinions out there. You will have to restrict your caloric intake to some degree to lose weight--exercise alone is unlikely to be sufficient. I would ask my doctor for a referral to a nutritionist who can help you set up an achievable plan. Given your size, you can probably start seeing weight loss with relatively modest changes at first.

Good luck!
posted by praemunire at 3:01 PM on September 12, 2016 [17 favorites]

Ha! First three comments are recommending keto! It is well worth checking out. Best of all, it is a way of eating that doesn't leave you hungry!
posted by Thella at 3:03 PM on September 12, 2016 [4 favorites]

Sounds like serious exercise is out for you right now, but that's actually ok because diet is much more important for weight loss than exercise. Especially at your current BMI, you could probably lose quite a bit just with diet changes (not to make that sound easy, it's not! But it sounds more feasible for you right now than exercise). And then once movement becomes easier for you, you could add some exercise.

As for what diet, I personally think most of them can work as long as they are reasonable - it depends on what you can stick with. I personally have had decent success with Weight Watchers because I like the social aspect and they focus on the cultural/emotional stuff that can trip you up. Other people prefer low-carb diets, or vegan diets. Honestly, in your position I would just commit to try one regimen for, say, a month or two. See how it works.

One other thing about exercise - even if you can't do much, just the fact that you are carrying 370 lbs of weight means that you will actually get benefit out of even small amounts of exercise, like a walk around the block or a couple of laps in the pool. If nothing else, you might find that it helps with your mood, which in turn helps with dieting.

Good luck.
posted by the sockening at 3:04 PM on September 12, 2016 [12 favorites]

I know several people who have knocked off similar amounts of weight with gastric bypass surgery, and became much more active afterwards. I don't know if it's the right answer for you, it's a big move.
posted by slateyness at 3:07 PM on September 12, 2016 [4 favorites]

Swimming is a great low impact exercise. Just being in the water and moving around is good for your joints and flexibility.
posted by sulaine at 3:10 PM on September 12, 2016 [9 favorites]

Is your asthma woe, which you mentioned flares up when you do housework, due in some part to a dusty or mouldy house? I suffer from allergies that make cleaning an exercise in suffering so maybe you could look into solving the asthma flare ups asutch as possible as part of whatever more direct solutions you take.

Good luck, you are worth the effort.
posted by RolandOfEld at 3:11 PM on September 12, 2016

Oh, it sounds so tough for you! Great that you're wanting to get started changing things!

Given that everything in your day (except for sitting at your desk) is exercise enough to wear you out, I don't see a real need to join a gym; I'd just step up your current level of activity until you can't tire yourself out just walking around the office and cooking dinner. (ps - yes, cook your own dinner. I'm not going to go all diet-nut on you, you can start slow, make hamburgers or whatever you'd normally eat out if you want, but giving someone else the right to decide what goes into your food is ceding a lot of control. You and only you should decide if these potatoes get deep fat fried or baked.)

To my totally-nonmedical uninformed eye, I'd say your issues that kick in with an elevated heart rate are a panic attack. That used to happen to my husband, before he started treating his anxiety. Talk to a doctor about panic attacks, as well as heart health.

But in the meantime, stretch, walk, do pushups against the wall, etc. DOn't try to do a lot, and don't try to do long 60-minute blocks of exercise, just start with taking 5 minute motion breaks at work, stand up from your desk and stretch, walk down the hall just enough so you're breathing harder but not enough that you're hurting your knee. Tiny amounts of exercise, but if you do 12 5-minute intervals during the day, you've been moving for an hour. As time goes on, pick the time that is most conveniet for you to label "exercise time" and increase that slowly. Keep all the other 5-minutes, but work this one up to longer times. THis is not about slam bam new you, this is about working on your endurance and capability to get through a difficult but overall normal day without it feeling like Herculean effort.
posted by aimedwander at 3:13 PM on September 12, 2016 [6 favorites]

I can't say I have any advice here that you haven't heard before, but it sounds like doing a lot of little things are tough, and good for you for recognizing that and starting down the road of making life easier on yourself. I'm not sure how much of this is a medical or nutritionist question, and I'm neither, but in your shoes I think I'd try:

* Give up soda and minimize alcohol. Stick with zero calorie drinks and water.
* Maybe a recumbent exercise bike? That seems MUCH less hard on your knees than walking. You can coordinate bike riding with TV watching. Ride during every episode of your favorite two shows. "If I watch this show, I ride my bike." You may even be able to do this at the gym with Netflix/streaming or ripping your TV shows. I'm thinking you'll need a good comedy show!
* More vegetables. Push some fast food out of your diet by grilling/steaming/sauteing veggies. Some combination of extra virigin olive oil, fresh garlic, salt, pepper, garlic salt, lemon and lime makes for some quick, easy and tasty dishes. Make a LOAD of veggies at once. Way better than fast food, in more ways than one.

On preview - aimedwanderer has what seems like great advice! Good luck!
posted by cnc at 3:20 PM on September 12, 2016 [3 favorites]

One thing: keto is a pretty big lifestyle change, as is Weight Watchers, which I recommended. For some people that works really well - just a total re-set that gets them out of their habits and changes how they approach food and life. For other people, a more gradual approach works better. Maybe replacing one fast food meal a day with something you cook yourself (something that sounds good - doesn't have to be like a poached chicken breast and salad). I kinda think that if you suffer from depression, a mild approach might be better to start. But either way, remember you get to start over every day. So if you start with one approach and it doesn't work, you can go back to it, or try something new.
posted by the sockening at 3:21 PM on September 12, 2016 [5 favorites]

What everyone has said: You will eventually want to exercise, but for now you need to change your diet. Fast food is not for you. Low carb/high protein and high fat is probably what you want. Unfortunately it's not easy and requires a lot more active choices than swinging through the drive thru does. I have lived the drive-thru takeout lifestyle and it's so easy, and yet so awful.

Small steps: Buy a scale if you don't own one. Make sure it's one that goes up to whatever your current weight is (a lot of regular scales don't, but they're easy enough to get online). Take some starting weight pictures, weigh yourself, take measurements. This will be useful later.

Eat dinner that you cook: you can cook some using low carb/high fat, high protein recipes, and some that you would normally make, but don't eat restaurant food or takeout for dinner at all any more ever—unless it is at a restaurant socially with friends. Also, make better choices at lunchtime at work. Eventually you'll need to bring your lunch every day, but for now, just make better choices. Get an idea of what "better choices" looks like. Give up soda if you drink it, and just drink water. Do that all for a month. Weigh yourself again. Take some more pictures, and some more measurements.

After that month, make some more changes. Maybe you've lost 10 pounds, maybe 5. But it's a good start. So now you can start to tweak lunches, too. Lather, rinse, repeat.

Good luck. It seems so simple but it's so very hard. It's important to really get involved in your food. Restaurants are the devil. (they're my personal devil, so I know these things)
posted by clone boulevard at 3:21 PM on September 12, 2016 [3 favorites]

Chiming in to agree that what you eat is more important than exercise, especially to start off and also because of your bum knee.

I will also suggest Weight Watchers as someone did above, which I started in July and am actually enjoying. Change is hard, but you can do it! For me, I wanted 1. an official start date, and 2. accountability/someone to weigh me once a week. With Weight Watchers you get out of the house one day a week and have a short meeting with other people working on the same issues you are working on. They will be nice. They will encourage you. They will not tell you what to eat, only that you have to write it all down and gain a better understanding of the things you eat.

It is never too late. But you'll never be as young again as you are today, so why not find a meeting and commit to a month and see how it goes? Nobody can do it for you. But you can do it! (Also, do not buy WW food. It is mostly terrible and over-processed.)
posted by Glinn at 3:23 PM on September 12, 2016 [2 favorites]

Nthing work on your diet first. The weight will come off more quickly than you think and it will be a jolt in the arm of your depression, I promise.
posted by getawaysticks at 3:25 PM on September 12, 2016 [9 favorites]

I would start by going to your doctor and seeing what they recommend for people in your situation. I know that you say you already know you should do this, but your doctor is going to have much better and more comprehensive information for you than internet strangers who swear by a certain fad diet.

Personally, I would start by eating less fast food and cooking more. Or if you don't know how to cook or don't have time to cook every meal from scratch, downgrading from fast food to things you can find in your nearest supermarket that don't require a lot of complicated preparation. You don't have to go from zero to sixty right away. Start slow and build new habits that are actually sustainable for you. Making a sandwich takes the same amount of time and skill as the drive through, but is way lower in calories.

When I joined my local gym I got a free hour with a personal trainer. It's a tactic to upsell you into booking more time with their trainers, but honestly it was pretty helpful in terms of how to use the gym and how to put together a workout I can actually do vs. going way too hard the first day and hurting myself. Which was my usual M.O. before that. I feel like there might be a more "big guns" version of the gym staff personal trainers, like a physical therapist or even just a trainer who specializes in your issues. This is something else that your doctor could probably advise you on.
posted by Sara C. at 3:25 PM on September 12, 2016 [7 favorites]

(I should have mentioned, I follow Slow Carb, but keto is good, Weight Watchers is good. I don't think it matters what diet at first - just pick something you think you can follow and try it!)
posted by getawaysticks at 3:27 PM on September 12, 2016 [1 favorite]

I'd look into some sort of meal service that will provide you with ready to eat, low-carb, low-sugar meals, or whatever other diet plan you want. Yes, it will cost you, but if you're already eating fast food for every meal you may find a food service to not be very much more expensive. You might also be able to cut the cost by picking up your meals yourself instead of having them delivered. If you're already having such a hard time doing basic housework and dragging yourself through the work day it will be very difficult for you to start cooking all your meals, so I'd say it's worth the money for now. For the time being, reserve your energy for the rest of the housework and starting to get a little exercise. Once you've dropped enough weight that you can do basic housework painlessly and easily, you can start cooking for yourself.
posted by orange swan at 3:42 PM on September 12, 2016 [18 favorites]

It's possible to lose weight without dieting, much moreso than vice versa. In terms of exercise, as you start to lose weight and feel less worn out by basic chores and things, walking is good low-impact exercise, though your knee may interfere with this. Going to a gym with a pool or doing strength training that doesn't involve your knee may be better; I'd let a doctor advise you.
posted by stoneandstar at 3:45 PM on September 12, 2016

Oh, and I've done paleo and keto and found them difficult to manage. Finding meals that are a definite amount of calories and choosing between them for your three meals a day is fine, you don't HAVE to eat low carb.
posted by stoneandstar at 3:47 PM on September 12, 2016 [8 favorites]

When I did this, my heart would pound and I was gripped with a terror that I was going to die on the spot.

Those are panic attacks. Start with getting treatment for your anxiety and depression.
posted by MsMolly at 3:56 PM on September 12, 2016 [6 favorites]

And lest it sound like I'm just pulling that out of my ass, exercise-induced panic attacks are a real thing. Basically the symptoms of a panic attack and the way our body feels when we get our heart rate up are the same, so sometimes our brains cross the wires.
posted by MsMolly at 4:01 PM on September 12, 2016 [4 favorites]

Multiple thoughts:

1. Consider getting a FitBit or other step tracker and wear it every day. All your normal steps (to get from your car to your desk, etc. etc.) all count towards your daily total. Set a low goal (if you don't have a device that sets one for you) and enjoy the gamification of hitting targets, tracking your progress over time, etc. Just your normal walking counts as exercise - and if your device motivates you to park the next row farther away so you get those extra steps, that's a win.

2. Along the same lines, do you play Pokemon Go? I know that I walk farther and am happier about it if I'm playing than if I'm bored and focusing on not wanting to be walking. It's more gamification and distraction, but I find those things to be very useful for me when doing tasks I don't want to do :) If that particular distraction won't work for you, what about an engaging podcast while you walk? Or waterproof headphones so you can listen to a podcast or music while you swim laps/work out in a pool? Even if it's a ten minute walk or a five minute pool workout, it'll still go by faster if you're entertained.

3. If you don't know how to cook or are low on energy, Trader Joe's is a good place to start for a transition from fast food. For instance: Get a veggie stir fry from the freezer aisle, get a packet of microwave brown rice, and get some precooked chicken or other protein from the deli area. In my opinion, that's a way less intimidating place to start than a cookbook and ingredients, etc. It's certainly possible to eat unhealthily from Trader Joe's, but it's probably a much better starting point than fast food, and once you get into the groove, you can focus on looking at labels and making healthier/more vegetable-filled choices.

4. Also, batch cook. It takes me essentially the same amount of time to make 4-6 servings of something than to make 2 servings of something, but then we have two nights where we can eat leftovers instead of having to cook again. Despite the abuse sometimes heaped on leftovers, I *love* them and I find that nearly everything reheats just fine. Is it better on the first day? Sometimes a little. Does that matter when your options are 30 seconds of microwaving, cooking something new from scratch, or fast food? Nope. So get a bigger pan out and cook three things of stir fry instead of one, and then the next two dinners are literally Tupperware to plate to microwave.

5. Simple Green Smoothies also does a few 30 day challenges a year, where you swap out one of your daily meals for a smoothie. They send you daily smoothie recipes, and once you have a good blender and the general principle, it's also very easy to come up with your own. This would also be a way to ease into eating healthier and getting more fruit/veggies with some built-in structure. Though, if you're doing any carb limiting, this may be too much fruit sugar for your diet.

6. Just in general, I'd suggest picking *one* thing to work on a month. Maybe pick something small (making an appointment with your doctor and/or someone to treat your depression, maybe?) for the rest of September, and then something a little bigger (switching one meal a day to homemade or a smoothie rather than fast food, maybe) for October. It can get really overwhelming when there are so many positive changes you know you need to make and you don't know where to start. So, just pick one thing. Pretty much anything suggested on this thread should work. There isn't a magic right answer. Add one healthy habit now, and then another one next month, and another one the following month, etc. Yeah, there are probably some choices (like treatment for depression, or maybe diet before exercise) that could make things easier, but agonizing about which to start with, etc., is a recipe for not doing anything and getting more anxious (at least in my experience).

7. Good luck! You're really awesome for making positive steps towards getting healthy, and you should be proud of yourself for starting down this road. I know two formerly obese women who are now thinner and more energetic than me (I'm pretty average) and I think they're awesome, strong, wonderful rockstars. You are too.
posted by bananacabana at 4:09 PM on September 12, 2016 [9 favorites]

Everyone has already given you excellent advice (I want to favourite bananacabana's comment a hundred times, especially the TJ's thing; it's totally okay to slowly work your way up to cooking for yourself!) so I'm going to tell you: you ARE going to have bad days. You are going to have moments of failure, you're going to think you've fucked up. That's okay. It happens. The important thing is to take a deep breath, forgive yourself, and move on. Success isn't always straightforward or linear, and GO YOU for getting started!
posted by Tamanna at 4:18 PM on September 12, 2016 [2 favorites]

I've seen astonishing results achieved with gastric bypass + ongoing diet.

You'll get a lot of people admonishing you to just eat less, and of course you'll have to, but it's very hard to do that. If it were easy to muster that much will power there wouldn't be fat people. I'm not saying you can't. I'm saying don't assume that there aren't additional, powerful avenues of help.
posted by fingersandtoes at 4:29 PM on September 12, 2016 [4 favorites]

Your question talked a lot about exercise, but exercise is way down the list in terms of what I would recommend in order to lose weight. One of those weird quirks of all the horrible moralizing that goes on around weight in our public dialogue is this idea that exercise is the holy grail solution, that if only people would exercise, they wouldn't weigh so much. This is another one of those unhelpful lies that just perpetuates guilt and shame.

Weight loss happens in the kitchen. Do you cook for yourself at all? I imagine that sounds really hard with your depression, energy levels and hurting knee. When you don't eat fast food, what do you eat? Have you ever tried tracking your calories with an app like MyFitnessPal to see how much you're taking in?

I lost weight on my own in part because of a health scare--I started thinking about how I wanted to be mobile when I was 60 or 70. I also started thinking about food in terms of nutrients and fuel--was I getting enough calcium? Iron? Vitamins? It seemed a lot better to me to get that from my food than from a pill.

The most important thing about making changes to your diet is that it should seem like something you can keep up long term. For some people, that's paleo or keto. For me, it's been trying to eat mostly whole foods and trying to make sure at least half my plate is taken up with vegetable or fruit. I like Cookus Interruptus's recipes and videos. (I don't succeed at this all the time, but I feel better when I do.)

I like bananacabana's idea about putting together meals from Trader Joe's. That is also a good strategy. You might a small, measureable, achievable goal like "this week I will cook three of my dinners." Then plan ahead, shop on the weekend and celebrate when you achieve it. Next week, pack 2 lunches and cook 3 dinners again, something like that.

Also, please consider getting help for your depression if you haven't already. All of the changes you want to implement might be a bit easier if you have support for how you feel.
posted by purple_bird at 4:31 PM on September 12, 2016 [3 favorites]

Nthing Trader Joe's for good healthy convenience food. It's very easy to assemble a meal with, for example, a packet of their heat & eat Indian curry, a thing of frozen rice, and maybe some frozen veg. Their frozen foods are also really top notch in my opinion. I keep a few packages of Char Siu Bao and Tamales in the freezer for emergency dinners.

They also have a whole section of grab & go salads, sandwiches, wraps, soups, etc. in the produce area for if you need dinner tonight or something easy to grab for lunch tomorrow. I guess running into TJ's for just a wrap and a salad would take a little longer than fast food, but not by a lot. And it's way healthier.
posted by Sara C. at 4:34 PM on September 12, 2016 [5 favorites]

Add a bit of fidgeting into your daily routine! Tap your toes, bop your knees up and down or in and out, "dance" your torso a bit from the waist. It seems silly but it will up your caloric output, get your energy flowing, and help you feel more connected to your body. Do it when you think about it at your desk for a few minutes, or when watching TV or lying in bed in the morning and at night. Even a few minutes a day, spread over several sessions, will help.
posted by pseudostrabismus at 4:35 PM on September 12, 2016

First, congrats on quitting smoking, that's the best thing you can do for your health! One thing your doctor might be able to help with is your mood going through this. Perhaps welbutrin which increases dopamine, could help with the food cravings you are satisfying at the drive thrus, and with other food choices. Coming down off the bad food will be hard, something like welbutrin might help with that. Welbutrin is sometimes used to help smokers quit, and it sounds like your recent weight gain is due to replacing the joy you got from smoking with the joy of eating.

You will not lose a significant amount of weight without completely changing what you put in your mouth. Most sources say losing weight is 80% what you eat(not necessarily how much) and 20% exercise. When mentally preparing yourself, give yourself a complete break on the exercise part of this and focus only on diet for now. You'll probably find yourself making excuses to eat what you want, versus what will help with your weight goals. Develop a mental plan for that. Envision a guardian angel of sorts slapping bad food out of your hands, the temporary joy is not worth all this physical suffering.

Changing your eating habits is HARD. Consistent good choices are required so break it up into steps - all or nothing is overwhelming and makes it incredibly easy to quit. A good place to start that's not overly drastic could be to drink only water for a month. Eat whatever you want but get in the habit of making that one good choice, and go from there. Maybe the next month, replace breakfast with all-you-can-eat fruits, vegetables and nuts of your choice. Or all-you-can-eat eggs, cooked however you like. The next month you could commit to cooking something healthy for dinner just one night a week. Spaghetti made with beef and spaghetti squash isn't too difficult and it's quite tasty! Paleo and keto cookbooks are good places to find healthy & simple meal ideas. Just once a week to start! That's not un-attainable. You can do this. It's a mental game. Consistent good food choices over time equates to a healthy weight. Don't let a screw-up here and there make you abandon efforts. If you were to adopt the three ideas I mentioned above, I guarantee you would lose at least 30 pounds by the end of three months. And your usual diet would still be pretty much the same. Eating fast food feels good (easy, convenient, more time for other joy-inducing activities). The joy you get from eating needs to be replaced with something else, I can't tell you what that might be.
posted by txtwinkletoes at 4:38 PM on September 12, 2016 [3 favorites]

First of all, thank you for your honesty and for sharing your story here.

I'd like to suggest an alternative to the keto diet. A year ago, I weighed 70 pounds more than I do today. I took some time to think back to the kind of eating patterns that had worked for me in the past for losing weight, and what had not (as I had gained / lost / gained / lost weight over decades). My A1C was in the pre-diabetic range, and my primary care physician wanted to put me on Metformin. I had reservations about that, and I told her that I wanted to get my A1C down through weight loss. I knew I needed a way of eating that could be sustained for the rest of my life. I had limited time for exercise, and at any rate, the research I reviewed made the case that reduced caloric intake provided better weight loss results than relying on exercise. These are the steps I took (many of these I found out about through Ask MetaFilter):

1. I'd been able to lose weight on a vegetarian diet before, but this time I tried to do it with more information and mindfulness. I watched the Forks Over Knives documentary, and spent some time on the Forks Over Knives web page, especially the Articles / Success Stories section. While I don't eat an entirely plant-based diet--I eat a hard-cooked egg and a banana every morning--I do not eat meat or poultry, I only rarely eat fish (the amount you might find in a piece of sushi), I eat only a small amount of cheese, and consume only plant milk. I eat a diet full of vegetables including leafy greens, beans and legumes, whole grains, and fruit. I avoid oils and tofu, because they provide a lot of fat for their calories.

2. I watched "Sugar: The Bitter Truth" by Dr. Robert Lustig (pediatric endocrinologist). I didn't understand all the science, but I did the best I could. As a result, I don't drink any beverage with sugar in it. I drink water, plain tea, or coffee with almond milk. I don't eat cookies or cakes or similar sweets--apparently I gain weight quickly on the combination of white flour plus sugar plus fat. When people bring sweets in to work, I might allow myself a crumb to taste. On my recent birthday, I had a cupcake for the first time in a year. Almost nothing I consume has sugar (in any form) in it.

3. I use the My Fitness Pal website and app to track everything I eat. I made a pact with myself that if I ate it, I'd have to track it.

4. I wasn't seeing results fast enough to suit me on 1200 calories per day (I'm female and that number is often given as a daily caloric intake recommendation for weight loss). After searching Ask MetaFilter, I saw that other females had had the same problem. I switched to 1000 calories per day. Then the weight started coming off, and the downward trend shown by My Fitness Pal encouraged me. My point is that you may need to start with a suggested number, then adjust it as needed. I'm now eating about 1200 - 1500 calories per day.

5. I weigh myself daily. I expect to do that for the rest of my life.

6. I identified "safe foods" for eating out: Vegetarian Vietnamese summer rolls. Certain dishes at the Chinese restaurant. Salads, vegetables, and fruit from the cold food bar at the Korean cafeteria in my work building. The bean and cheese burrito at Taco Bell (only one for me!) I also identified "safe foods" for home, and cleaned out my refrigerator, freezer, and pantry of the foods I don't eat anymore.

7. What I learned was that I could eat a far greater variety of interesting and tasty foods than I could when I was eating meat. Some things I learned to eat: I'd never been a big fan of beans, but as the meat consumption went down and the bean consumption went up, I learned that each type of legume has its own unique taste. I've learned more about seasonings and making my own meals from supermarket staples (I'm now actually testing recipes for a vegan cookbook author!) The amount of fiber I consume went up, and much to my surprise, not only did I lose weight but my skin looked so much better! I wasn't expecting that. Every day at lunch I eating a big, satisfying plateful of food--it just happens to be plants, fixed in a variety of ways (in salads and cold vegetable dishes, as roasted vegetables, as fruits, as whole grain noodles, and so on).

8. A year later: My A1C is normal. I've gone from a BMI in the obese range to one in the normal range. Now I feel more like taking a hike or taking my pedal boat out on the lake--it's not a chore anymore, it's just something fun and low-key to do. I'm wearing a dress size that I haven't worn since high school. I've had people do double-takes when they see me: it's quite gratifying.

9. One last thing. When I started, I wasn't sure that any of this would work. I only focused on what I would do a day at a time. Looking at the slow but steady results on My Fitness Pal, especially the charts that track weight lost over weeks and months, I felt cautious enthusiasm. It was a big surprise to me when I started to lose weight, and from that time on, it felt like I had a kickstarted a kind of mental momentum. I felt like I was on my own team for a change.
posted by apartment dweller at 4:51 PM on September 12, 2016 [11 favorites]

Personally, I couldn't comfortably exercise until I was down to a BMI of about 30. I ended up losing a quarter of my body weight on diet changes alone. Weight Watchers Online (I hate meetings) retaught me how to fuel my body in a reasonable way. I can also recommend a few concrete tasks that'll make you significant inroads without signing up for a structured diet program just yet:

1. Cut out sugary drinks and if you're a soda addict like me, switch to diet sodas. They're crappy for you too, but they're not 150 calories every time you want a can of something bubbly. La Croix is a godsend if you really like that effervescent burn you get from sodas. Coffee drinker? Try it with skim milk and, say, those zero-calorie flavor shots from Dunkin Donuts or a single sugar packet instead of cream and multiple shots of syrup. It definitely won't taste the same, but that's nothing that can't be overcome with time.

2. Restrict your fast food to chains with healthier options that still taste good like Subway and Taco Bell. There is nothing even remotely safe to eat at most fast food places, but you can still fill out some of your diet with fast food if you stick to things like turkey subs and "fresco" tacos (in which they replace cheese with pico de gallo). Avoid breaded anything, choose "no cheese" for your sandwiches, and if possible opt for less bread. For example, Jimmy Johns offers an "unwich" option that replaces the bread with a lettuce wrap.

3. Food logging is a huge aspect of Weight Watchers, but it is truly daunting to directly face a such a tender side of yourself that you may not understand. Doing so every day is even more of a slog. But you can't know what you are doing inefficiently without knowing what you're doing, so try to mark down what you're eating daily. Email it to yourself, keep an Evernote folder, mark it in a Google Doc, jot it down in a spiral notebook, or post it privately on social media. Even if you don't write down what you ate every day, there's always the next meal. Don't obsess about writing exact portions and measurements just yet, but be aware that Weight Watchers does ask for that stuff. It's more important at this point to develop the habit.

Sometimes you just have to prove you're capable of losing a couple pounds to get psyched about losing more than a couple. At that point, after dropping five, I actually got excited about hacking at a structure like Weight Watchers for my own gain. Learning a new diet is a huge paradigm shift in understanding one's own body, but you deserve to feel good in your skin, and you're totally capable of harnessing that power.
posted by theraflu at 4:52 PM on September 12, 2016 [7 favorites]

As someone who lost a vast amount of weight, I'm going to go against the grain here.

Where to start? Treat your depression! Therapy, group, medication if indicated. Is there anyone you like to socialize with or talk to on the phone? Do you have any interest in pets? (I swear when my cat purrs I can feel my depression and anxiety lessening.)

If I tried to go from zero to keto I'd be in for a soul-crushing failure. I'd start with adding a few good things, things you can use rest of your life, like learning to cook a couple simple healthy dishes and making a habit of grabbing some fruit. Once you get a handle on these, your specific eating program can be designed with a doctor or you can try something like Weight Watchers which has a tracking component. Tracking was vital for me and made it sort of a game.

Walking outdoors is my favorite exercise and that too helps with depression. It's great because I don't feel intimidated like at the gym, plus I can turn around and go home whenever I want or need to.

Rome wasn't built in a day, as they say. Give yourself time and room to do this in a way that feels right to you. Do not presume weight loss will cure depression because it won't. You deserve to be happy regardless of obesity and if you start there everything else will come easier.
posted by kapers at 5:01 PM on September 12, 2016 [25 favorites]

Agree with kapers! Small walks with an aim to working on your depression may be all the exercise you need right now. Walking is a habit which can be sustained, and won't cause you pain and make you stop.

Please beware anyone who says there is only one true diet. If you believe it and it fails, then you're going to blame yourself. Small changes are good changes because you are going to need to sustain the loss. You can figure out which diet works for you.

I had a friend at your weight with very good experience from the gastric bypass surgery, but he did a year of counselling before he did the surgery since in NL they wouldn't do it with unresolved depression. He's kept the weight off for three years now.
posted by frumiousb at 5:05 PM on September 12, 2016 [3 favorites]

I will also recommend Weight Watchers. It's easy to follow, very supportive, and it really works.

Good luck to you, any positive change you make is something to be proud of.
posted by biscotti at 5:34 PM on September 12, 2016

There are definitely a lot of different takes on diet, it's for sure confusing. Most diets that people seem to be successful on do tend to have less going on in terms of simple carbs, and many of them include more fiber in the form of complex carbs (veg, fruit, and whole grains) and meats (or other protein). That seems to be the sort of the lay consensus on any weight loss board I've been on; that a diet with more protein + fiber (and good fats) helps with satiety, and that's been my experience. I couldn't do an extreme diets; I aim to eat 80% food like that, and 20% food that's not like that.

It's certainly possible to lose weight just eating less of whatever you're already eating, because ultimately (and technically) it's the calorie balance that's going to do the trick, and some people do that and are successful. Many others find that approach painful, because they find they're having to spend more time and mental energy managing hunger. (You can check out individual foods for estimated satiety here, and see how they work for you.)

Diet is the main thing, for sure. Research has shown that exercise does tend to help with motivation, compliance, and maintenance (and for some people, appetite regulation), so it's great if you can do it, but it's not essential. (If you can swim or do water aerobics, that'd be ideal for your knee. If not, highly recommend seeing a physiotherapist, who may have ideas on what you can safely do until you're able to use the bikes many gyms have. [Biking being great for most knees, per every physiotherapist I've talked to.] People who start from high BMIs do tend to lose quickly, so that time may be closer than you think. I just found this site - may be worth doing a bit of research on that option.)
posted by cotton dress sock at 5:38 PM on September 12, 2016 [2 favorites]

I highly recommend you start with your YMCA for a couple of reasons.

1. Most YMCAs will offer financial aid/sliding scale for membership. So if finances are an issue, they will work with you. You may even get low cost personal training. You'll generally get a few free sessions to help you work out a plan.

2. Most YMCAs are super friendly and welcoming. You won't be in a judgy environment. My Y has several very obese people who come in regularly and no one stares, make untoward comments, or anything.

3. Many YMCAs have nutrition program, so if you're looking for help with changing eating patterns and support, they can help.

4. Building up some muscle around your knee will help with the issue and help you postpone surgery.

5. Exercise can help you with depression and mood.
posted by brookeb at 5:40 PM on September 12, 2016 [10 favorites]

I like kapers' advice of working on your depression first. I'm also going to add another suggestion that may seem totally far out compared to all the practically-oriented stuff that folks have volunteered, but it's totally serious:

Each day, find one thing to be grateful and happy for, about your body. Or maybe two, or three, or eight, but one is a good start. Start a practice of gratitude and appreciation, specifically about your body.

Even though I have never met you, I am 100% sure there are many, MANY things that you can identify to be grateful for. Examples might be:
-- grateful for the lungs that keep you supplied with oxygen every moment of every day
-- grateful for the nerve endings in your fingers, that let you feel how pleasurable it is to stroke a fuzzy sweater (or pet a cat, or the delight of warm water over your hands when you wash your hands)
-- grateful for the feet and legs that hold you up when you stand and walk
-- grateful for the brain that lets your figure out challenging problems at your work
-- grateful for the strong muscles in your legs that lift you when you stand
-- grateful for your soft skin, your furry pelt, your lovely eyes, your masculine beard, your long eyelashes, your beautiful hands or chest or butt, your awesome package, or whatever aspects of yourself you think are your most appealing assets

Write it down? Take pictures and make a diary? Tell it to yourself in the mirror? Whatever works for you. But really, commit to doing this for 3 months, with option to continue, and see what happens.

In short, I think you'll do a lot better if you cultivate the notion that your body is a wonderful thing deserving of appreciation and excellent care, and go from there. Because, you know, it is.
posted by Sublimity at 5:44 PM on September 12, 2016 [8 favorites]

Swapping out some of the fast food for other choices (vegetables, protein) will probably help you feel better (potentially giving you a bit more energy) and help you be healthier, even if you do not lose weight. I know I feel like crap if I don't eat vegetables for a while (or eat mostly starchy foods) and I can imagine that my "feels like crap" just becomes some people's "normal."
posted by needs more cowbell at 5:55 PM on September 12, 2016 [1 favorite]

With the stiffness and the soreness, would yoga be something you'd try? There's a wrestling yoga dude - Diamond Dallas Page, DDP yoga - and he does videos and stuff so you can do that at home (it's very much about muscle control and is v dudely). It doesn't really jam your heart rate up so you can slowly ease your way into being in your body as it does its thing. I've been there with the heart rate triggering panic attacks and it sucks and it takes a long time to rewire, but I can always do yoga and it's been a boon for my knees and hips.

Take it slow.

I'd suggest batch cooking or diet food delivery before keto, just to ease your way into controlling these things. It's hard work! It takes emotional and mental energy! So be kind to yourself.
posted by geek anachronism at 5:56 PM on September 12, 2016 [2 favorites]

Calorie Count with My Fitness Pal to start!
posted by Locative at 6:03 PM on September 12, 2016 [1 favorite]

Keto! Keto keto keto. If you can't exercise right now, don't worry at all, seriously. Exercise is for the future when you've dropped a chunk of weight and want to start getting all muscle-y. Diet is for weight loss. The Reddit keto group is overflowing with success stories of guys like you getting fit and feeling great, and weight loss via keto is where it all starts. Start with the FAQ there, and take the advice about electrolytes seriously.

When you're eating fast food, first google the name of the restaurant plus "keto" and figure out what the best options are, then eat that. Are you at McDonald's and hungry? That's fine, three bun-less McDoubles is a perfectly keto meal; they will serve it to you in a plastic clamshell container with a lettuce leaf and knife and fork. I mean, eventually you might come to prefer to cook the same thing at home, with some veggies smothered in delicious cheese sauce on the side, but start where you are. You can do this.
posted by beandip at 6:07 PM on September 12, 2016 [3 favorites]

Forgot to say, ultimately keto is going to help you cut calories by reducing hunger, but for the first few weeks, don't even worry about calories. Track your food only enough to make sure you aren't accidentally eating too much carbohydrates, and the rest will follow much more easily once you are keto-adapted (takes a few weeks).
posted by beandip at 6:09 PM on September 12, 2016 [2 favorites]

Treat the depression. AGGRESSIVELY treat the depression.
posted by listen, lady at 6:27 PM on September 12, 2016 [4 favorites]

You've gotten some good advice here, so I'm just going to suggest a few things to read.

1. Dr. Yoni Freedhoff, The Diet Fix. This is by far the best book I've read on the problem with "dieting" and the need to make a lifestyle change. While the "ten-day reset" is a bit gimmicky, in that it doesn't have to be done in 10 consecutive days, the advice is spot on: especially the observation that if you can't find a new way of eating and living that you enjoy, you won't stick with it.

2. John Walker, The Hacker's Diet (free e-book). Walker treats weight loss as an engineering and management problem, not a moral issue. I also think he's funny. Some of the physiological analysis is outdated, but the basics are spot on.

3. Richard Watson, The Philosopher's Diet. This quirky little book really isn't about dieting per se; the weight loss advice is basic (and some would say, questionable at best). It's really about the dedication required to achieve something difficult, and why it's worthwhile. As Watson says, dieting is the content, but philosophy is the form.

Best of luck! And BTW, at your weight you should be able to find a bicycle that would carry your weight. Google Scott Cutshall for more.
posted by brianogilvie at 6:35 PM on September 12, 2016 [1 favorite]

Another Keto (Nutritional Ketogenics) vote here. The Reddit link has many men of your size who write similar posts - and get support. Read the FAQ and read posts daily. There is always interesting tips, ideas and success stories. Lots of links there to other Keto sites.
If you stick to your macros - it is a very satisfying diet. First week or so of Keto can be rough for some....but it balances out. Exercise is not necessary. Tips on what to eat in fast food places. Like many 'diets' - men tend to loose much faster than women.
Many branch off of Keto into other ways of eating - whatever works for you!. It's a great place to start.
posted by what's her name at 7:13 PM on September 12, 2016 [3 favorites]

Walk. That's it. Walk to the mailbox. And get myfitnesspal app to reduce your food intake. Begin with that. Don't make it too complicated. Keep it simple.
posted by metajim at 7:29 PM on September 12, 2016 [2 favorites]

Sumptuous has some potentially useful thoughts. The article is geared towards women, but I don't see why it couldn't apply to anyone.
posted by bunderful at 7:50 PM on September 12, 2016

As far as losing weight is concerned, I'm not sure you really need exercise. I do think you need to start exercising because you sound incredibly unhealthy right now and exercise will help your heart and your health. But just to lose weight, it really starts with diet. Even people in great shape will tell you that it's like 90% diet because you'd have to jog for an hour to burn a slice of cake. That's just a fact. There are a lot of reasons to exercise, but weight loss is not one of the top ones. It may be best to add exercise after you've lost some weight and become more agile.

I would recommend Atkins/low-carb to someone like you. It's really easy to follow and definitely delivers results. The principle is that you just don't eat carbs (or eat very few carbs) so your body enters ketosis, a metabolic state where your body starts using fat for fuel and you burn a lot of fat. And you don't have to wonder if it's working because they sell strips that you can use to test your pee and it will actually tell you if you're in ketosis or not. So, I'd tell you to buy the Atkins book and start there, honestly.

I speak from experience: I used to be addicted to fast food and I had the body to match. It was way out of hand. This sounds nasty and it's embarrassing to admit, but I would get double cheeseburgers from McDonalds and bacon cheeseburgers from Wendys and take them off the bun, scrap off the ketchup, throw out the tomatos, and eat them. That was a meal. I ate the fat and protein but I avoided all carbs I could. Snacks were slices of salami and sticks of cheese. I made modified recipes where instead of bread crumbs I used crush up pork rinds. I ate a ton of meat. My ketosis sticks were dark maroon. Fat melted off me. Eventually, once I lost a bunch of weight, I just started eating normally but watching my calories and I stopped eating fast food. So, I'd recommend the Atkins book. My mom got the Atkins book when I was living with her and I didn't really follow it exactly -- I just took the principle of "avoid carbs" and ran with it.
posted by AppleTurnover at 7:51 PM on September 12, 2016 [1 favorite]

I've recently decided to live and eat as if I love myself. Like cooking for myself and not eating myself numb. It's surprisingly hard to do since I've spent a lifetime trying to numb my feelings by stuffing food down. Also I grew up watching my mom do that, so I think I modeled after her. I'm buying more vegetables but still pretty much eating what I want. But I'm trying to stop when I get too mindless and frantic. It's kind of hard but I think I can do it. It just might take awhile. I've been able to kick Diet Coke although I haven't kicked carbonated drinks yet. So little steps. I also bring in veggies and fruit to work for when I just need to eat mindlessly. Like slicing up tons of cucumbers or zucchini or whatever. Even if I eat a bag of chips, it's better than eating two bags of chips.

I did a no carb diet four years ago and lost a ton of weight. I basically brought in two huge chicken salads to work everyday for breakfast and lunch. Literally just lettuce, veggies, chicken and dressing everyday for like 8 months. If I was feeling lazy than just lettuce and chicken and dressing. I didn't have to think about anything so it was super easy to follow. But I gained the weight back three years later because I stopped caring, so I'm trying more love this time. The loving myself part also includes cleaning my place more, and doing stuff I like that I didnt do before out of laziness or fear.

Good luck and I hope that in addition to losing weight, you will find some peace of mind and an increased sense of self love. Food can be like any other addiction. We are just trying to feel better somehow and stuffing food into ourselves worked at one time.
posted by gt2 at 8:10 PM on September 12, 2016 [4 favorites]

So, I'll tell you what my doctor told me, and what the bariatric surgeon also told me.

You can go on a diet tomorrow. Pick a diet, any diet, doesn't matter. The results will be the same. There's a better than 98% chance that in three years' time you'll weigh exactly what you weigh now, and probably then some. Losing weight is easy. It's easier for men. But keeping weight off - and their definition of success was a very modest 'lost 5 per cent body weight, maintained this loss for three years' - is pretty much impossible.

Yes, there are people out there who did it. There are people in this thread who did it. There are in any online forum about dieting, and in that small sample, they seem common. But the truth is they are a tiny, tiny minority. People are vocal about success, less so about their latest weight loss failure. The overwhelming majority of obese people who try to lose weight through diet and/or exercise fail. And with the amount of weight you need to lose, and the range of physical and psychological barriers you've raised, the odds are stacked against you. Really, really stacked.

So if you want to lose weight, get a lap band. This is not an easy option. It's risky. Post-op recovery can be unpleasant. It's not a guarantee. The surgeon said that in a few decades we'll look back on lap bands the way we look at leeches now and say 'what were we thinking?' We'll probably have discovered some straightforward chemical means of adjusting people's internal satiety thermostats, or adjusting the way they metabolise macronutrients. But for now, it's the best chance for somebody in your situation - somebody who needs to lose a lot of weight, quickly, and keep it off.
posted by obiwanwasabi at 8:12 PM on September 12, 2016 [2 favorites]

As an expert on Trader Joe's convenience food, it might help you wean from fast food, but it's not low calorie-- a frozen packet of Indian food might be as low as 300 calories, but without anything accompanying it you'll be hungry again in an hour. I do eat their bibimbap bowls and sometimes frozen mac & cheese for dinner, but they're more in line with dinner amounts of calories (500-600) than lunch calories.
posted by stoneandstar at 8:19 PM on September 12, 2016

I'll be forever thankful to the MeFite who mentioned keto here 4+ years ago. I was a Weight Watchers veteran who had regained what I had previously lost a number of times. As an over 40 yo woman, the prevailing message I got was that the weight would be virtually impossible to lose and keep off and that I could either starve myself forever or be satisfied with trying not to gain more. I decided to give strict keto a try for 100 days and was so successful and felt so great (the energy! the lack of afternoon slump!) that I kept going. I lost 70lbs in a year with no excercise. Exercise is great, but I added that later for fitness reasons. My job is extremely sedentary and keto was wildly successful for me despite that. I still eat low carb today and I've kept it off for 3 years with little effort because this is just the way I eat now and I don't feel deprived. The Reddit board people have linked to is an amazing resource.

I'm off all meds, my numbers are now excellent, and one of my doctors had tears in her eyes when she saw what I had been able to do on my own. Give it a try. It's one of the very best things I've ever done for myself. Feel free to PM me if you want to chat about it (that goes for anyone here).
posted by quince at 9:06 PM on September 12, 2016 [10 favorites]

Hi, I'm in a very similar boat as you, thanks to PCOS. I'm also morbidly obese, but much healthier than I've been in the past at this weight. Here are some things that made a difference to me, and some goals I'm still working on:

1. Address any underlying health problems first. Get your asthma under control, and see if you need a CPAP. Chronic oxygen and sleep deprivation make daily life much harder than it needs to be.

2. Find something you enjoy doing. Get a dog to walk, join the Y to swim, walk in the park or woods so you have nice things to look at & fresh air.

3. Make tiny, gradual, LIVABLE changes. Stop drinking sugary drinks because they're empty calories. Sub in diet sodas or carbonated water. Make a few changes with fast food. Swap a salad for fries, grilled for fried, etc. Not all at once, if you're like me and hate deprivation. Just until your tastebuds adjust, and you can move to the next change. Little changes add up faster than you think, and you give yourself time to make new habits this way.

Best of luck. Feel free to memail if you want.
posted by jhope71 at 9:27 PM on September 12, 2016 [3 favorites]

I once met someone 2-3 years after the doctor told him that he was morbidly obese and that he had six months to live.

He rode a recumbent bicycle and he loved it so much he had to stop us in the bike path (bike touring and I was also on a recumbent bike so it was socially appropriate) and tell me how biking saved his life. Bolded emphasis because that's what it was like hearing it from him. He said he biked for a 2 hours every morning and it made him so happy. He was so passionate, he seemed like he was in limerance with life. A changed man, he told me.

It doesn't matter where you start. Just start somewhere.
posted by aniola at 10:18 PM on September 12, 2016

I have hypogonadism (low testosterone) for which I used to take androgel, but I’m not currently on it due to an insurance problem. I will probably take if again in the future after I see an endocrinologist again. (I have good health insurance now.)

This is the thing that jumped out at me. If your hormone balances are out of whack, that's going to affect a whole host of other issues in your system. Hormones are really important.

My one suggestion to start out with? Get thee to the Endo for an updated Testosterone reading, and if you're still genuinely hypo, go back on Testosterone Hormone Replacement Therapy. And then, give the HRT a little time to balance out the levels and start to work. If insurance won't pay for AndroGel, there is a generic Testosterone gel available; I use that.

I take HRT as I'm transmasculine, and even on the low amount of Testosterone I am on? I have SO much more energy, and things that would seem impossible before are now possible.

Once the hormones are straightened out, it might alleviate some of your anxiety/depression/energy levels issues.
posted by spinifex23 at 10:48 PM on September 12, 2016 [4 favorites]

I think you need someone in your corner. A professional someone. Find a counselor, therapist, life coach, assistant, whichever kind of ally clicks well with you, and work together to make a plan and help you stick to it.

A life coach type person might be really good for you, because they can help you to wrangle other folks like doctors and gym people and things like grocery budgets or conflicting nutrition information, while encouraging you and reminding you why you're worth all the hard work. But I really think treating your mental health will go a long way to making other physical changes achievable, and something I have seen make definite lifelong positive impact on friends who have similar weight problems.

Starting with a psychiatrist referred by your health insurance is something that can lead you towards a bunch of avenues. They could prescribe something to help you cope with panic attacks (that's what that was when you tried to work out that time) but also they can refer you to other mental health folks who have experience with your challenges, as well as help you figure out the likelihood of medications causing weight gain or appetite problems so you can be on the right stuff for you as you are right now.

For the food issue, because you know that eventually you're going to have to make your own, get a counter height stool that can support you. Even better if it's on wheels. Make food prep as low-impact for yourself as possible. Arrange your kitchen so you don't have to bend down to get stuff. Get a big lightweight plastic cutting board and keep it on the kitchen table so you can sit down and chop things. Get some sharp knives and learn how to keep them sharp (it's incredible how much of a difference this makes!) and some easy to care for simple stainless steel pots and pans.

One of the easiest and most rewarding things to cook is chili. Freeze individual bowl sized portions for yourself and buy tortilla chips to have on-hand to eat with it. Make it however you think is most delicious - with or without beans, spicy or mild or sweet, turkey or vegetarian or beef chuck, flavored with stout or smoked chilies or whatever! Then sometimes instead of fast food for dinner or lunch, reheat a bowl of your chili. Bask in your accomplishment and also have lots of yummy protein and veg without sacrificing fullness.

Anyway, what you're trying to do is really hard and I think you shouldn't feel like you have to do it alone. Treat your depression and get some people to work with you. Focus on the things you can do and increase your ability to do them as you currently are.
posted by Mizu at 11:19 PM on September 12, 2016 [3 favorites]

Round two now that my day has calmed down again: You've gotten some good advice here. I didn't notice anyone mentioning sleep, however. Sleep is key. Everything I've read says that you will never be successful at losing weight and keeping it off without good sleep. So I noticed that you web surf in bed. Cut that out. Web surf in a chair/at a desk, save bed for sleep and sex and nothing else. Get a consistent amount of sleep every night. (the people who are recommending that you treat your depression are spot on. Getting sleep will help with that, too, but maybe you won't get good sleep without treating the depression first so keep that in mind.) I am not good at this myself, as here it is 2:21am and it's a work night. But I want to be!

A couple of tools I have found particularly helpful over the years:
  • My Withings scale is wifi-enabled, so even if I try to convince myself that my weight is not trending up! It's always been this much! the uploaded actual real data tells me the reality in a sometimes-depressing line chart. Watching the slope trend upwards can be sobering. Data is good, though, as it helps to clearly identify problems.
  • For a long time I used LoseIt to track what I ate, keeping track of both calories in and exercise expended. I had about a year and a half record of every morsel I ate. During that time I lost 75 pounds and started walking and felt pretty good. I had some other health setbacks, so I got out of the habit, and now I've lost interest in using it. It's really up to you to decide if a food tracker is something that will help. I guess it depends how much you want to gamify your daily existence. For me, while I was using it, it gave me a feeling of control. I could bargain with myself, too, like "oh, I have 200 calories left for today. I could have half a cup of ice cream! Or two apples. Hmm."
  • I have been wearing a FitBit for almost two years now, tracking every step I've taken. I had a long recovery from a surgery a couple of years ago, and as a result my daily steps aren't as good as they can be. But I know what they are, and it helps me get a little motivated—if I'm just at, say, 6750 for the day, I might get up and walk in place to at least round it out to 7000. I also have knee issues very much like yours (although my scope was good! Maybe you just got unlucky with yours?), so even though I might be a little sore, there's something about having the cold electronic numbers staring me in the face that gives me just a little push to do just a little bit more.
So basically sleep, water, food you cook instead of get handed, and tracking. You will see results. If you can get below, say, 300 in the next six months, add in some light exercise. But for now, focus on the basics.

Something I've heard from many sources: Keep in mind that you've put this weight on over the course of your life. Don't think you can lose it all in one year. Give yourself time to adjust to new lifestyle choices, but try not to lose momentum. It's the main thing you don't want to lose!
posted by clone boulevard at 11:24 PM on September 12, 2016 [2 favorites]

I'm essentially you, but ten years older.

Twenty-five years ago, I dropped from 150kg to 95kg over the course of a year. I did it by just doing Whatever It Took to drop a kilo a week. Being 95kg beats being 150kg all hollow. I felt strong, I felt healthy, I felt happy, and the exercise I'd started introducing at 130kg and stepped up at 110kg actually felt good.

After about ten years, I was back where I started.

Over the years I have used keto (reasonably successful until I fell off the wagon), tracking my weight with a chart on my wall (lost 15kg, fell off the wagon), intermittent fasting (lost 20kg, fell off the wagon), and various other approaches.

Of these, intermittent fasting was the pattern I found least stressful to maintain.

What threw me off that one was that instead of sticking with it I started experimenting with longer fasts, on the grounds that after the first two days, fasting becomes almost effortless; for a while there I was dropping 20kg on a 20 day fast, then putting 15kg back over the next ten days, then doing it all over again. That was kind of insane. Don't do that. I should have listened to me in 2007 and not done it either.

You can go on a diet tomorrow. Pick a diet, any diet, doesn't matter. The results will be the same. There's a better than 98% chance that in three years' time you'll weigh exactly what you weigh now, and probably then some. Losing weight is easy. It's easier for men. But keeping weight off - and their definition of success was a very modest 'lost 5 per cent body weight, maintained this loss for three years' - is pretty much impossible.

Both the stats and my personal experience bear this out. For several years, I allowed this fact to make me feel doomed, and to undermine all efforts to lose fat; it was hard work at 30, it's harder work at 55, I have more responsibilities now and can't apply the same kind of monomaniacal focus I did at 30 so fuck it, I'm just a big fat bastard and that's how it's going to be. And anyway I'm fat enough now that I just pin my bathroom scales against their top stop, so I can't actually weigh myself anyway. Doom, doom, doom.

I considered having the lap band surgery that my chronic fatigue specialist recommended. But I know several people who have chosen to have it, and have put up with years of not-really-working-properly digestion and assorted kinds of discomfort as a result, and lost a hell of a lot of weight, and then 15 years after the surgery they're getting fat again.

All of that got really depressing, and in any case that attitude is not sustainable, as I found out when I recently started having real difficulty with the process of reaching around to wipe my own arse. When basic bodily functions start involving that amount of pain and indignity, something needs to change.

So, what to do?

Here's the thing: you and I have bodies that run to fat. For whatever reason, our satiety-detector and/or hormonal feedback systems just don't work properly.

It took me a very, very long time to accept that this fact about my body is not some kind of moral failing: as I said in 2005, it's essentially an engineering problem. You and I need some external mechanism to tell us when we've been eating more than we need to, because our bodies are just not going to do that for us.

The task at hand is not losing weight. That's actually just a side effect of a successful approach to the central issue, which is finding some method that one can stick with for life for closing the feedback loop, correcting for the body's inability to do that by itself, so that weight stays under control.

Lap band surgery does that to some extent by causing physical discomfort any time a large meal is eaten. But that feedback isn't actually sensitive to whole-body weight, and I think there's a less invasive way.

So, where I'm at right now: I've got back onto a much, much simpler version of the wall chart method I last used in 2005, informed by my subsequent experience with intermittent fasting.

Here is my current spreadsheet. This time around I haven't printed out its chart and stuck it on my wall, and I don't intend to; in 2005 there was a performative aspect to my weight loss that I've now managed to learn how to do without.

I think of this sheet in much the same way little ms. flabdablet thinks of her insulin pump: interacting with it every day is just a part of my life now, and is something I just need to do in order to stay alive. So I intend to just keep on doing that for the foreseeable future.

Every day, first thing, I step on my new industrial-strength digital bathroom scales, and transcribe the number into today's cell in column C. Then I look at the cell to the right of that in column D. If it's green, today's an eat-whatever-I-feel-like day. If it's red, today's a two-litres-of-water-only day. That's the whole thing.

I have deliberately chosen this brutal and primitive feedback method because what knocked me off the wagon last time I tried using a daily feedback chart was internal rules-lawyering about what I could and couldn't eat when getting close to the line, to the point where the feedback just wasn't effective and my weight went back out of control. This time around, if I'm under today's target mass I eat whatever I feel like eating; if I'm over it I fast, and as long as that's what I actually keep on doing, there is simply no way for the feedback to fail.

Giving things up cold turkey has always been much easier for me psychologically than trying to regulate them sensitively (in fact the body's inability to give up food entirely is, to my way of thinking, one of the major factors that make losing weight harder than quitting smoking or drinking) so this kind of bright-line rule suits me very well, and I'm pretty convinced that I will in fact be able to stick with it from here on.

Obviously this is still very early days, and the initial loss rate on the weight target curve I've set for myself looks a tad ambitious. But feedback can work for that too: if I end up experiencing a three week period where I need to be fasting more often than the two days out of every seven that Michael Mosley recommends, I'll dial the loss rate back some from that point on.

When I first designed this spreadsheet I actually had the rate set to -0.001 rather than -0.003, and if you're interested in playing with this method I suggest you do the same. I jacked it to -0.003 after finding over the first ten days that simply weighing in every day caused enough psychological feedback on its own to cause some weight to come off; -0.003 was the fastest rate I could pick that didn't change any of the existing eat/don't advice that the sheet had already given me.

The overall design of the target curve is the same as I used in 2005, flattening out as the selected asymptote weight is approached, so that at no point will I ever have "reached my goal weight" and have an excuse to stop. My body is not going to magically stop running to fat just because I'm carrying less of it.

Diets designed to achieve a specific weight loss goal all fail. A weight regulation process based on an effective negative feedback mechanism, if stuck to for life, really can't.
posted by flabdablet at 1:37 AM on September 13, 2016 [13 favorites]

Hey there. When my BMI was 39, walking around the block was excruciating (we did live on a hill). Now it's 33 (and dropping) and on my birthday 12 days ago, I walked 37km in a day. I'm going to give the easiest plan that works for me.

Use fitness pal to track your calories and movement. That's it.

The finer details:
Over time, you may discover that food high in protein & fibre keeps you fuller longer, and you will choose foods you enjoy that suit you without being locked into a restrictive diet.
You may want to gamefy your situation by aiming for 10 less calories until you are usually eating the recommended daily allowance (maybe check with your doc - don't go too low too start because after 2 days of starving yourself, you will say "fuck it, this isn't worth it".
You might keep protein snacks on hand for emergency hunger because no shop/restaurant sells sensible quick food. I have boxed protein shakes - keeps me going until I get to my next sensible meal.
You might want to try a food delivery service that is calorie controlled - but I think initially it won't give you sufficient energy.
No food is off limits but my very favourite breakfast (eggs Benedict) has enough calories for 1.5 days. So I save that for days when I'm going to exercise heaps. Alcohol isn't a problem either, but remember the fuck-it factor the more tipsy you get.
My most common meals are eggs for breakfast (poached, omelette, frittata, boiled and packed in my handbag) and some sort of meat for dinner with salad/veges. I generally don't eat lunch. Pasta makes me bloat/fart if I don't eat it daily. I love pasta but it doesn't work as a regular food. If I do takeaway, it's subway, or Japanese (sushi) or Thai soup.
It hurt. My heels were permanently cracked. My knees hurt. My buttocks made me cry if I had to walk uphill AT ALL. People who haven't been in your shoes just aren't going to get it, how body parts get in the way of using exercise equipment, lack of coordination, lack of breath and the pain! I can tell you my 37 km walk involved less pain X 100 (OK, I'm not mathing good) than an hour long walk when I was at my most unfit. So I sympathise with what you will experience, but I'm telling you, there's light at the end of the tunnel too. So what I did was spent 5 years relying on public transport and making sure I lived close enough to walk to things like work / shops / bus stops. I wasn't consistent, I wasn't even really trying, and then one day, I accidentally walked 32km, because I'd made a couple of errors of judgement on a holiday. My feet were pretty sore, actually, everything was - I had 5 hot showers and made sure to keep moving and stretching that night, and to keep walking the next day (over the next 3, I did another 70 - because hey - maybe 100?) This was at the start of June.
So walk, little and often. Have your phone in your pocket to track your steps. Beat your record every day by another 10 steps if you can. Walk in shopping centres (flat & airconditioned). At work, get up every half hour and get a drink of water. Walk. (Do other stuff if you want, water should reduce joint pain, but walk anyway). It's going to hurt. Walk. You'll get annoyed / bored with it. So what - go walk.

That's it. I'm doing a 21k grade 4 hike this weekend and I feel completely confident. I have never ever been athletic and at 49 and 12 days, I'm the fittest I've been in my life. I believe you can do this.
posted by b33j at 1:40 AM on September 13, 2016 [4 favorites]

Oh and get some really good hiking shoes for your daily walking. It makes a huge difference.
posted by b33j at 1:42 AM on September 13, 2016 [2 favorites]

Walking is a habit which can be sustained, and won't cause you pain and make you stop.

With respect, those of us with BMI > 50 strongly disagree with this assessment.

Walking hurts.
posted by flabdablet at 1:53 AM on September 13, 2016 [13 favorites]

Congratulations on quitting smoking! Been there, I know it's a real challenge.

You've gotten a lot of great advice here, emphasis on a lot. With so much helpful information it may seem tough to know where to start, what to focus on first, which exercises and/or eating plans to try, and so on. Since weight loss is such a personal journey that's different for each one of us, I'd like to encourage you to just pick something and run with it. If one eating plan or form of exercise doesn't work, chuck it and move to another recommendation from this thread.

The thing I want to emphasize, though, is that if you try something that ends up not working for you please try not to let it discourage you. For many people, weight loss is trial and error until we find something that clicks for us. Let me give you an example.

Many years ago, my husband lost over 100 pounds with Weight Watchers. Due to a variety of factors, his weight crept back up again so he decided to give WW another try. This time it didn't work at all for him. Maybe it was because he was 15 years older and physiologically different, maybe it's because the newer WW methods don't work with him psychologically, who knows. He's a big proponent of WW and we've seen it do wonders for friends, but it just doesn't connect for him anymore.

Instead, my husband decided to go low carb and he dropped 50 pounds practically effortlessly. I, on the other hand, see no difference in my weight when I try low carbing it. My weight changes when I walk a lot but my husband can log 20 miles a week and it doesn't make a dent in his weight.

My point is, please don't get discouraged if the first couple or few things you try don't give you the results you're looking for. The right answer for you is out there, it just may take some time to pin it down. In the meantime, take pride in the fact that you're taking steps to improve your health. That's the first achievement right there.

Best of luck to you!
posted by _Mona_ at 5:08 AM on September 13, 2016 [4 favorites]

My wife has chronic pain and fibromyalgia. She lost close to 100lbs several years ago and is working hard to keep it off, despite gaining a bit back. In any case she started attending a water aerobics class at the y. She was the youngest of the people there, but this assisted her mobility. Once she could do this without significant pain. She introduced Leslie Sansone - Walk away the pounds dvd's. These are older, they're corny, but they got her moving more than she was. She got to the point where she was able to complete the DVD's without much pain, she started doing her walking outside.... to running outside.... to completing obstacle courses... and P90x.... All of these things were made possible from the start by going to the water aerobics classes. In there was some diet adjustment, however without the increased mobility gained from the water classes, she wouldn't have been empowered to do the rest of the work.
posted by TuxHeDoh at 6:10 AM on September 13, 2016 [1 favorite]

I injured my back a few years ago and my doctor suggested that rather than swim in the pool, that I should walk in the pool, as it was low impact and unlikely to cause me to reinjure myself, but it offered enough resistance to help me get my core strong.

I also nth looking into a keto diet, it was part of what helped me lose about 80lbs a couple of years ago.
posted by vignettist at 7:58 AM on September 13, 2016 [1 favorite]

It seems like those with more direct experience have offered great advice, I am chiming in to underline about working on healing your depression as a root cause of this. Transforming your life and body is hard, and requires an enormous amount of willpower. Which is (despite the findings that came out this month) more or less a finite resource.

So make things as easy on yourself as possible. With food, that might mean allowing yourself to eat as much of things you like as you want-- chili is a great example here-- as you are doing the hard work of re-adjusting from the ease and chemically-perfected-ultra-tastiness of fast food. Or ponying up the extra money to buy pre-sliced veggies so you actually cook at home. Or making awesome sandwiches with whatever craziness on them your heart desires.

This might sound absolutely ridiculous, but you might want to look up a restorative yoga class in your area (at the Y?)-- one where you sit in very gentle stretches for about 20 minutes at a time. Call the studio in advance to confirm that it's taught by an experienced teacher who can modify for your injuries. I can attest that these classes are pretty judgement-free spaces for people who aren't just young thin women.

Online, I really like Yoga with Adriene, partly because she is always repeating very body positive phrases like "find what feels good." You deserve to feel good in your body right now. Some very gentle stretching and movement set to deep breathing might help you think of your body as something to love and feel grateful for rather than something that needs to be disciplined into shape. Once you start liking yourself and eating like you like yourself, I bet a lot of the rest will (sloooowwwwlllyyy) fall into place.
posted by athirstforsalt at 8:40 AM on September 13, 2016 [1 favorite]

First, congratulations on making the decision to make changes. I feel like I have some kind of internal trigger that I can't predict that will tell me when enough is enough. I just hit that trigger this weekend.

You have a lot of great advice above, but I want to stress that at your weight (hell, at MY weight), your body will shed a ton of weight on diet alone, and it wouldn't even take that big of a difference in caloric intake to see results. Find a calculator on line that will give you your resting metabolic rate, which will tell you how many calories you have to consume in order to maintain your current weight. Then eat just 80 percent of those calories on a daily basis and you'll see results quickly. Also, you'll shed a minimum of 10 pounds in a month (maybe less) just by cutting out refined carbs. But bottom line for me is diet first, exercise next. Don't go crazy, don't go into starvation mode, and ultimately use the metabolic rate calculator to determine the number of calories you would need at your ideal weight and eat that amount of calories. But start with 80 percent of your current maintenance needs, then you won't feel deprived, you won't be tempted to give up, and you'll see results more quickly than you might expect.

Good luck and please do keep us informed. As you can see, we all are interested in and supportive of your endeavor!
posted by janey47 at 10:20 AM on September 13, 2016

On depression: mine lifted substantially the day my new scales arrived, because the main thing that had been feeding it was feeling completely helpless in the face of inexorable and crippling weight gain.

Even though I've only been back on the chart thing again for four weeks now, and even though wiping my arse is still painful and awkward (though noticeably less so already), I feel quite different about my weight now. It's less like an unavoidable degenerative disease and more like a solved problem, and the resulting mood lift has been huge.

I am very much looking forward to being lean enough to get back on my bicycle.
posted by flabdablet at 10:30 AM on September 13, 2016

I'm another person on this thread who is so happy for you and so proud of you for quitting smoking. That is such a fantastic boost for your health! Quitting is a difficult challenge, and you did it! Yes!
posted by cadge at 11:50 AM on September 13, 2016

there's a lot of great and specific advice up here. I especially wanna echo the "take it easy on yourself" call!! you've got a lot going on, so keep it simple and easy outside of the other daily decisions and lifestyle actions to take.

state of mind can sabotage a person so easily before their body gets used to the healthy habits and automatic responses for cooking at home, eating healthy, and doing exercise on the reg. so. thinking of how/where you can START, here are some stupidly simple things to do:

Get. enough. sleep.
-- maybe use something like sleepyti.me *before* you enter bed each night (no internet in bed!), so you can pinpoint a good bedtime/wake-up based on the 90-minute sleep cycle. I feel a marked improvement between when I consult sleepytime and when I don't.
-- if I don't sleep well the night before, I am grumpy as fuuuuuck and my motivation to do anything healthy is nil. it's WAY too quick/direct for tired-brain to lead back to the usual-comfort/health-negative roads (carby treats even when I don't need 'em, fuck exercise I'm tiiiiiiired oh yeah and this world is shit plus I'm shit too cuz I went to bed late again). gotta allow yourself to rest and recharge; think of it as for your own battery life.
-- or, if you wake up feeling wrong/bad: still make yourself sit up, but then close your eyes, and count to 60 or something, breathe. you may feel slightly more ready for the world afterward.

An *absolutely miniscule* amount of exercise is *still* exercise.
-- it's more like exercise for the state of mind, but this can be built up to real exercise as you get stronger again.
-- start off your own exercise at home in this way. once a day, after you wake up or before you shower or whatever, set an achievable, *miniscule* exercise goal for yourself, like: 3 jumping jacks. or, 2 sit-ups. or, 1 push-up. or, literally half a push-up (a.k.a. falling on one's face). or, do 1 particular stretch. or, buy a stepstool appropriate for your weight capacity (they have 'em), and do 1 step. or, lift two jumbo soup cans over your head.
-- just allow yourself to do 1 thing you can -- as long as you make it low pressure for yourself. there is no shame. whatever you could do today, whatever was achievable: tomorrow morning, try to do it again. if it's easy, add one more iteration. as long as you do this, you *will* improve and actually be able to do the exercise. additionally, it's also a nice way to start the day, cuz if nothing else, then, hey, you did that! mark it as 'done' on the calendar!
-- and if you miss a day or a few, just start off another morning, no berating, no nothin'. feel yourself / your ability out, try your chosen exercise, and *know* that you are getting better just for trying it. then go about your day. [got this from a great episode of Mental Illness Happy Hour.]
-- I know this must sound dumb or small potatoes to you, given your sports/military history, but that's just the thing: it's dumb, and you can *totally* do it, and no one will be judging. (er, until the day you go out of your way to slip into conversation, "Well, you know, I did 1.5 pushups this morning." :-D)
-- in this vein, I found planking exercise to be a good morning thing for me. you can search around for YouTube guides on proper plank stance, and/or Google a month-long "planking challenge" schedule. like, day 1: hold body in plank position 20 seconds, day 2: hold 25 seconds.... or just make your own mini-version (day 1: 1 second! day 2: 2 seconds! and so on). pretty challenging but effective -- adjust it to your situation. (start easy.)

Talk kindly to yourself.
-- inner voice stuff. talk therapy can work wonders for this. even just one or two seshes, see if you like it (search "low fee therapy"+your town).
-- address yourself like a friend, or even just bemusedly, perhaps, but *never* negatively or "self, you always do this" neggy/naggy/abusive-spouse-style. you're just tryin ta live, and that's great, and that's enough.

you are already MILES AHEAD on an amazing track by quitting smoking. as the child of a 3-pack-a-day'er, I wanna emphasize this so hard! good luck tomorrow and each day after!
posted by cluebucket at 7:18 PM on September 13, 2016 [3 favorites]

I just wanted to reach out again and say you're welcome to memail me if you wanna chat, or support, but you've done an amazing thing in quitting smoking and in facing this issue and laying it out so clearly for yourself. This is vital to working out a way you can work with your body, rather than against it. That is one of the things I like about restorative/yin yoga. It's taken a few weeks but I can feel it working as I do it now, and it makes the rest of my days easier too. Which means I will hike up the stairs to grab something rather than only going up and down once, or I will walk the whole mall instead of sticking to one end. I will end up sore some days, but not the way it used to be.

(I second the 'walking isn't always painfree or feasible' - my knee is fucked and I seriously damaged myself listening to that advice while I was pregnant because actually, walking helped further separate my pelvis and misalign everything below my waist and it took ten months of physio to get it to a 'pain free walking more than a quarter mile' level)

(on that note, don't do any of those jumping exercises please, for the sake of your knee, just don't)
posted by geek anachronism at 8:32 PM on September 13, 2016 [2 favorites]

Just back to say, many of your health issues are likely related. Weight loss will probably help with the testosterone. If you're prediabetic & insulin resistant, a lower carb diet will help. Weight loss on its own might, too. Your joint pain will be lessened by less weight, as well. So I think your focus is a good one.

Keto is one approach that will probably get quick results... I don't know, though, I don't hear about many people lasting on it for longer than a few years. I know there are some, of course. I hear a lot from people who are either 1-2 years into it, or who "used to" do keto... I think it's a hard way of eating to fit into most people's social worlds. Eventually, they go on a holiday, or things get overwhelming at work, or they get sick of the food...

I think one reason people regain is that when they're set to lose, they get fired up, dive hardcore into an extreme (for our society) approach that although not un-sensible from a biological POV, necessarily, is just hard to sustain over time, with the stresses (and celebrations) life brings. And then they feel like they don't have a way of managing things.

That's why I go for the 80/20 approach. I couldn't imagine not being able to have a piece of someone's birthday cake, or enjoying the odd poutine, ever. I can and do have those things. Just, 20% of the time. I do have some guidelines about that, though, because like many, I do find the carb/salt/sugar/fat slope can be slippery. If I have fast food a few meals in a row, or a few days in a row, I'm much more likely to want more. So, I don't do it two meals or days in a row.

And, I don't keep stuff that I'm likely to overeat (like potato chips) in the house. Out of the house only, and in a single serve portion. As people have said, willpower is a limited resource. I like to make things easy for myself.

I will say that I think being a bit more strict about food quality than I am now was helpful when I first lost weight. It did help mitigate cravings - it kind of reset my palate, making it much easier to make better choices. (Less willpower needed.) I think there's a lot to be said for this kind of induction phase.

The plan I used (ages ago now) was the South Beach diet. Lower carb diet, not as restrictive as many others. Has three phases - the first involves very limited carbs, to cut the cravings. It was too restrictive for me, lasted only a few days; went to their Phase Two, which is the weight loss bit. Lets you have e.g. a piece of fruit and bread a day (and is what helped with carb craving management). Phase three is how you're meant to eat most of the time (and I do, 80% of the time). It's not far off the Harvard Healthy Eating Plate.

I'd also say, try to take pleasure in the food you're eating, so you can experience more of this change as positive. Let yourself get excited about new recipes, for example, so they're things you're adding to your life, vs. taking things away.

Congrats on quitting smoking, by the way, that's a huge accomplishment. I haven't been able to beat that addiction yet. It's one of the hardest things a person can do. And I think that if you could do that, you could do this.
posted by cotton dress sock at 12:05 AM on September 14, 2016 [3 favorites]

I'll add a few things that I haven't seen mentioned so far.

You said that you have health insurance again. And that you have a knee injury, and mobility issues. Speaking as someone who was once in absolutely terrible physical condition, I wouldn't be surprised if you also have pain in your back/neck/shoulders (especially with the desk job). Consider asking your doctor for a referral to see a physical therapist for your mobility issues.
I was in terrible shape when I was approaching 40 (think Shaggy from Scooby Doo, only pregnant with twins). I had a sedentary job and lifestyle, which was exacerbated by a back injury that prevented me from participating in much physical activity. My doctor and a family friend suggested I do physical therapy, but I was resistant for some reason. I tried a few yoga classes, but I didn't like the atmosphere and it seemed to make me hurt worse. Eventually I tried seeing a PT (physical therapist), and it was a pretty bad experience. She was really abrupt and judgmental, and I left feeling terrible. It took me 6 months to go back to the same clinic and ask to see someone different. My second PT had a much nicer bedside manner, but didn't seem to really understand the pain and mobility issues I was having. I stuck with it a bit anyway. Then one day she was sick and a third PT substituted for her, and I found an *amazing* PT. He really seemed to "get" the issues I was having with my body, and he lacked the smugness that many naturally athletic people have. I ended up seeing him twice a month for several years.
The exercises he taught me allowed me to (very gradually, over a few years), improve my posture and reduce pain to the point the I could participate in some "normal" exercise routines, and much more importantly, regained everyday mobility and "functional fitness." You said you can't afford a personal trainer, but if you have medical issues, a PT can serve the same role, and insurance will cover it.

Have you ever been tested for sleep apnea? It is fairly common for people with a high BMI, and symptoms can include fatigue, low tolerance for exercise, weight gain, anxiety, and depression.

Working with doctors and medical professionals can be irritating, time consuming, and demoralizing, but when I finally found the right ones, it really changed my life.

Best of luck to you. :)
posted by ethical_caligula at 8:39 AM on September 14, 2016

Oh, re: smoking:

I quit three years ago and will NEVER EVER smoke again because my brain chemistry was completely fucked for about a year after I quit and I cannot go through that again. Nicotine is an antidepressant. When you stop relying on it, yr brain needs time to sort it out. Could have triggered dysthymia or the like. Get serious about the depression & you will be AMAZED at how much easier it is to make "small changes" when you're like, not consumed with thoughts of death.
posted by listen, lady at 7:46 PM on September 14, 2016 [2 favorites]

I recommend keto too. Its best to think of it as a high fat diet. So you don't want to eat/drink about what people have been calling 'good fats' like skim milk or chicken breast, instead you try to eat saturated fats. You don't want too much protein. You want something like 80% of your diet to be from fat. Pork is better than chicken. Butter is better than yogurt. This is really critical because without enough fat you will not go into ketosis. You will use those proteins as carbohydrates. That's the difference between the science of ketosis and the atkins or whatever other low carb diet people do. It isn't the protein that helps with satiety, its the fat.

FAT is good. Nobody on keto is avoiding fats or binging on fats. That is what we eat. Once you are safely in ketosis then you can start to eventually think about how many calories you are eating, but that isn't until you are comfortable with the diet.

I too recommend r/keto. Its a very supportive community and is filled with tips. The FAQ is really clear and helpful for you to review to see if you should consider this diet.

I know we love doctors and all, but they are notoriously terrible about nutrition, as are nutritionists. They have been prescribing low fat high carb diets to anyone who will listen for the past 50 years.

a journal article on keto in obese people
posted by goneill at 2:29 PM on September 15, 2016 [2 favorites]

For a first exercise, you might want to try water walking. Easy on your joints. And don't feel like you gotta go apeshit in the pool. At first, just dick around and walk in the water walk lane a bit and maybe soak in the splash pool a bit and go home. Just get comfortable with it as part of your routine and then ask your body to do some work. The advice on the YMCA is spot on - they are often very affordable, offer financial assistance and often have perks, like personal trainers, at incredible rates.

When you start to enjoy your pool routine, you might want to try water aerobics. It may sound rather namby-pamby but you can work pretty hard if you want to really thrash around. And, again, it might be good for that knee.
posted by Foam Pants at 11:54 PM on September 15, 2016

Here is a scientific journal article about the metabolic slowdown in Biggest Loser contestants years after their major weight loss - you've probably seen something similar to this in your reading (HuffPo,NYT), but I'm putting it out there. People who have always been near a healthy weight (like say 30lbs over) have no idea how much they should be thanking their metabolism, and no idea how much a formerly-obese person would be fighting every day to maintain weight. There are, however, questions about whether that's related to how the contestants in the study were losing weight so quickly, and a slow steady approach might have less impact on metabolism. So think that over and discuss with your doctor as you're contemplating the timescale of your weight loss plan.
posted by aimedwander at 9:25 AM on September 20, 2016

Primarily I want to say congrats on both not smoking and deciding to improve your health.

But also, while I can't speak with any authority about losing very large amounts of weight I can speak a bit about the bad mental states that can come with a body you wish were different. I can say that the following things have proven helpful to me:

First, any progress towards a goal, even small progress, helps me feel better. If, at the end of the day, I can say "I ate healthy today" or "I exercised today" my ability to cope with shit increases notably. Thus, I suggest both keeping logs (food, workout, etc) and attempting to get even a small thing done every day, or at least most days.

Second, I would suggest that even very small amounts of exercise are good. For example, if you can gentle pedal the recumbent exercise bike at a gym for 5 or 10 minutes, that is good. I don't necessarily mean in the sense of massive caloric expenditure but in the sense that putting a little physical stress on the body is good in a wholistic sense but also in a mental sense. I would encourage you to find something even very gently physical that you can do, like the recumbent bike, and getting into the regular habit of it. I strongly suspect that, as you gain fitness, you will look forward to that part of your schedule and find that it is generally good for your mental health.

Best wishes to you.
posted by LastOfHisKind at 12:24 PM on September 23, 2016

Mod note: This is an answer from an anonymous commenter.
Before I say anything else, I HAVE to take a minute to congratulate you on quitting smoking. I know how hard that is, first hand. It's a huge accomplishment, and I hope it helps you realize how strong your willpower is!


You and I? We're similar. Same age, but I am a woman. In the last year, I have functionally stopped drinking alcohol,* quit a 30-year smoking habit, and now, I have lost about 15% of my body weight. I started with a BMI that indicated morbid obesity as well. Once I get my weight to a place where (like you!) my knees are less messed up, my plan is to begin exercise.

Mental health, obesity, smoking, substance use--all intertwined. So my plan was to take one thing at a time. I started with mental health. That was my choice. So i found a practitioner and got my depression, anxiety, and ADD better under control. Then I went for eliminating the alcohol, because when my primary care physician told me I had to change All The Things, that one sounded the easiest. Six months later I quit smoking. About 5 months later is when I began Weight Watchers. My dude-bro orthopedic surgeon who was all sporty and frat boy said I had to lose weight or I'd have to get a new knee in 5 years. That pissed me off and I said, quite sarcastically, "Oh really. And how do you recommend I do that, HM?" And so he told me about his weight loss journey using Weight Watchers. I did the online program, and opted to use their "Simply Filling" approach rather than counting all the points in each thing going into my mouth. Basically, there's a list of foods and you can eat anything on the list in the quantity that satisfies your hunger. In theory you can count a certain number of points for foods that are not on the list, but the whole points things makes me overly-controlling and competitive. So I eat from the list and very very very judiciously and mindfully allow myself something not on the list. Oh, and here is the list. I doubt WW realizes it's available with a simple google. The app and subscription allow you to get more specific on things like cuts of meat or brands of prepared food. At first I tracked everything, but I have loosened up on that.

So, I didn't actually tell anyone about it in my life at first. When I had tried making these changes in the past, I discovered I had a very people-pleasing streak. And the shame of failing was intended to motivate me to keep going. So I told everyone, and they cheered me on. This is often recommended, but it has always backfired on me eventually when I would rebel and say, "Fuck it, who matters? NOT THEM!" and then blah. My reaction wasn't rational, but these things rarely come only from the rational part of your brain.

I also started coming from a situation where I was eating mostly fast food. Part of my mental health crap was inability to see a way to be able to do dishes or keep things clean beyond laundry. So I didn't want dishes, which made me not want to cook. So that was an initial barrier.

I'm going to make a list of all the go-to don't need to spend much time/dishes/prep/cooking things that I eat. Just in case it might help someone kick-start their changes.

Nature's Own 100% Whole Wheat Bread (not just any other kind of sliced whole wheat bread)
Jones Canadian Bacon from Costco
Fat Free Kraft American slices
Fat free Kraft shredded sharp cheddar

Skim milk
Fiber one (or generic) cereal

Fat Free plain greek yogurt

Baby Carrots, cherry tomatoes/raw veggies with dip made from greek yogurt and ranch dressing mix powder
(Fruit of all kinds)
Frozen fruit like strawberries/blueberries/peaches/pinepple

Corn tortillas
Fat Free refried beans

Canned beans (not baked beans, though because of sugar)
Brown rice (made with broth not water)

From that I often eat egg sandwiches, yogurt with splenda and fruit, quesadillas made in a pan without oil that have refried beans and cheese, raw veg, rice and beans, cereal and milk. I do usually cook something on weekends to last through the week. This week I made grilled chicken breasts and brown rice.

I hope that helps. I totally feel you.
posted by cortex (staff) at 9:55 AM on October 8, 2016

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