Vindication! Yes – Bodies Fight to Regain Weight.

Did you guys see this article in the New York Times about the follow-up study on Season 8 competitors of The Biggest Loser?

After ‘The Biggest Loser,’ Their Bodies Fought to Regain Weight

I sympathize so fiercely with the feelings they’re expressing, and I fully appreciate and understand exactly how frustrating this all is. I read this whole article nodding my head and going, “Finally! I’ve known this all for years! Finally science is validating my experience! I knew it!”

I lived this, and I’m still living this: “The body puts multiple mechanisms in place to get you back to your weight. The only way to maintain weight loss is to be hungry all the time.” Yes, for several years! It’s true! I got through those years with careful food choices and always picking high-satiety and high-water-content foods. But it’s so, so hard.

And now, even knowing that all the things I’ve suspected for years are true, what does it change for me? Nothing. Until they come up with a cure for those of us with messed-up metabolisms, I’m not just going to throw it all away and give up. I can’t.

One of the things that drives me crazy about The Biggest Loser, is that they don’t seem to give the contestants long-term support and tools to build the skills they’d need to even attempt to maintain their weight. The things we do to lose weight are almost always unsustainable long-term. I feel like it’s a moral failing to put people on TV, work them to exhaustion to lose large amounts of weight for the camera, then turn them loose with a hearty handshake and a “Good luck!” What does that prove? Only that yes, if you give up everything else in your life you too can lose weight. It doesn’t show you how to transition to a life that’s worth living. Now THAT’S a show I could watch. Or star in. Whatever.

Frustration and Acceptance

Last week I worked out 40-50 minutes 6 of the 7 days. Running was my form of exercise for 5 of those days, and I did a kettlebells workout the other.

This week I’m on track for the same sort of thing – yesterday I did 60 minutes of cardio conditioning using a DVD, and today I ran for 50 minutes this morning.

And yet…my body remains stubbornly the same size no matter how much I exercise. It’s frustrating. I track my food and exercise with MyFitnessPal and try to stay under 1600 calories each day, but no matter what I stay the same. I know there’s one way I could become smaller again – a VLCD diet. And I’m just not interested in starving myself again, only to watch as those pounds come back, again, over the next few months.

I remain 20 pounds above where I’d like to be. But 20 pounds beats 200. And when the only way to get them off is starvation, well. I need to work on acceptance.

10 Ideas for Hardcore Diet Programs

Optifast, Medifast, and HMR are hardcore programs that demand hardcore focus, and in return deliver serious results. But what if you’ve never been hardcore before where food and exercise is concerned?  I’ve got you covered! Here are some of the mental tools, tricks, and ways of thinking that have helped me through a medical diet plan in the past and might help you if you’re currently participating in one of these hardcore weight loss programs.

1. First things first: police your environment. Put the food you CAN have into one place, like a cabinet that’s just for your food, and make that the only place you go looking for food. Keep non-program food hidden away and don’t go looking for it. One way to do this is to…

2. Create 2 categories in your head – your program food, and food that’s irrelevant to you. Yes, your kid/partner/co-worker can eat whatever he or she wants but what she’s eating? THAT’S NOT FOOD FOR YOU. You have to get your mind focused on creating a category of food that is FOR you – the stuff in your food cabinet – and stuff that is NOT FOOD FOR YOU – everything else. See if you can make it a mental game or trick to consider non-allowed food inedible – to you it’s made of plastic. “That cookie is inedible, it’s fake food that’s not for me, so I don’t even need to look at it. All my nutritional needs are being met by the program, I need nothing else.”

3. Do you have a slightly obsessive personality? Use your obsessive personality to get obsessed with your program – you know how when you cheat and you hate yourself it’s so dreadful? See if you can turn it around – if you focus really hard on planning, tracking your intake (journaling), doing your exercise, drinking your water, looking forward to your next meal of things you can have, you will both drive out the thoughts of things you can’t have, avoid cheating, and have no time for hating yourself. I used to hate myself all the time, like, it was an obsessive 24/7 job, but I found that focusing on making sure I was doing my program right quieted those voices and changed them into something supportive instead of corrosive.

4. Delayed gratification – if you’re good at it, then it should be easy to put it to use. Something looks tasty? It’s still going to be there when you’re done with this program. The world is not running out of (whatever thing is tempting you). Remind yourself that you already know what that temping thing tastes like – you’re not missing out on anything new or different or novel. (and most of the time, it’s not that great anyway – certainly not worth the feelings of remorse and hate that come with it)

5. Try not to let yourself get too hungry – if this means you have to eat your food at odd hours, do that, particularly if you have no choice but to be dealing with tempting foods – don’t handle them hungry. Make sure you’ve fed yourself before packing the kid’s lunch.

6. Hot beverages can quell a lot of cravings. I like hot green tea when I’m feeling cravings for something I can’t have. Tea in general is pretty good for that.

7. Chewing gum – sugarless gum. Pop it in your mouth when you’re craving something, usually the taste will wipe away the craving and give you something to do with your mouth.

8. If you have an episode where you get off track, the best thing you can do is accept that it happened, and use it to strengthen your resolve to not let it happen again. Don’t beat yourself up for too long. You’ve gotten it out of your system now and know how bad it feels so you can move forward even stronger, right?

9. Try breaking the cheating routine. If you know that certain situations or times of day lead you to stray, instead of trying to brute-force your willpower through them, change the script. You always wander to the refrigerator when you get home from work? Work stress makes you want to reach for chips? When you feel that urge, lace up your walking shoes and go for a walk around the neighborhood. You’ve taken yourself out of the situation and changed the scenery – nice!

10. Try not to get too bogged down in why you have overeaten in the past, or why you’re tempted to cheat. Focus on the present and your process. I have a thing I like to say, “WHY I eat doesn’t matter, WHAT I eat is what matters.” Instead work on your skills for avoiding tempting situations, planning ahead for each days’ food and exercise, and meeting all your program’s requirements. These are actions you can take that will build skills you’ll need once the program is over and you’ve started maintaining.

These aren’t meant to be the ONLY way, what I’m doing is trying to throw out a few new ideas or perspectives you might consider putting into your toolbox. Take what works, leave what doesn’t. I’d love to hear some of yours in the comments! How do you stay on track? What tricks, skills, and perspectives do you use to stay focused and on track?

 

Reader Question: Medically Supervised Weight Loss Programs

I received something completely awesome this morning – a question from a reader! I thought her question might be a topic of interest to others, so I’m posting my answer here too.

The question was: “I have a large amount of weight to lose. What should I look for in a medically supervised weight loss program?  How can I find a good one?  Any advice/direction would be appreciated.”

If you can’t get to the HMR program in Sunnyvale, CA (my gold standard – a program which was a huge component of setting me up for both short-term and long-term success), here are some things that you should look for when considering a program in your area, and which I think a good program should incorporate. These are the things that contributed significantly to my success in such a program:
  • Weekly and mid-week check ins. I was required to attend class every week, and if I didn’t I would be dropped from the program. I was also required to call or email in the middle of the week to report my progress so far and get coaching/guidance as needed. (This also means I was required to track my intake, a skill which has been invaluable ever since.) This kept me really accountable.
  • Medical supervision. This is necessary for any VLCD (very low calorie diet) as the change you’re undertaking can be quite a shock to the system. You should be monitored by both a nurse and a doctor: regular blood draws, weigh-ins, blood pressure, temp, and EKGs for your heart health are part of this monitoring. Also this means any questions you have can be answered by a medical professional in a confidential setting.
  • Qualified Nutritionists and Behaviorists. The people teaching the classes need to be registered, credentialed nutritionists and behaviorists using science-based methods and materials. None of this “I lost 30 pounds once so I’m an expert” bullcrap. Truly educated instructors, not just enthusiastic amateurs.
  • A required maintenance phase. When I signed up for HMR I was told that the Maintenance Phase of the program would last 18 months, and I was required to sign a statement saying I agreed to participate throughout the entire course of the program (and I did). The maintenance classes met once a week for an hour with a midweek check in, and I took them just as seriously as I took the weight loss phase (honestly, they are probably more important in the long run).
  • Bonus: Any program that promotes “positive thinking” as a weight loss tool should be shunned. Hard.
Those are the things I can think of off the top of my head. What did I miss? Anybody else out there have ideas based on your experiences with such a program? (Note: if you haven’t had personal experience with such a program this question is not for you).

Will power. Last resort of a badly planned day.

Yesterday I was a force of nature.  An immovable object. A…nah, just kidding. I totally screwed up in my planning and prep and I had to fall back on will power to save my day.

I spent the afternoon from 2-5 over at the Sheraton in a conference room meeting. I’ve mentioned these meetings before? They are fully catered. Like, I’m not sure if the point is the meet and share ideas or to fatten us all up for the slaughter. Usually it’s easy to ignore when I’m on a focused diet program like now because – cookies and brownies? Yeah, no question those are off the plan!

Yesterday though…well, I got there at 2pm, after having a late lunch around 1pm, so I was a little behind on my food schedule. I wasn’t prepared to go straight through until 5pm and I didn’t expect that the meetings would go straight through so I didn’t have any food with me. But of course they did. And of course at 3pm the caterers brought in mounds of beautiful fruit (off my plan for now – I told you this program was hardcore, nothing but shakes for now) and they were extremely enticing. I love fruit. And then…oh, they brought in big, soft, doughy pretzels. And mustard. MUSTARD! The bastards. It’s like they were targeting me and my diet specifically for ruination.

Normally I’m a sweet-tooth kind of girl, but I’m a total sucker for a hot, soft pretzel.

I’m not a fan of willpower for dieting, but willpower is a last resort kind of tool, and yesterday was a last resort kind of situation – I’d failed to plan or prepare myself, I was hungry when I got there and becoming hungrier as I went the full three hours, and having to pay attention and be sharp the whole time.

Here’s how I talked myself through it: First things first, every time my mind started down the, “But there aren’t that many calories in a bunch of grapes…” path I’d shut it down. “It’s not the point. Get some water.” Then my mind would wander to the pretzels. “Oh my god how I love pretzels, I haven’t had one in ages, they are so good, as cheats go they’re not THAT bad…”

I dug deep. I thought about all the work I’ve been doing so far. The results I’ve had. I reminded myself that once I got to my goal, I could plan to go out and have a GOOD pretzel, not a hotel catering pretzel – in fact, if I wanted to, I could get a ticket to a hockey game, where they sell the BEST pretzels, and have one in the right setting! That would be WAY better than a chintzy hotel pretzel. I thought about that for a bit, about rewarding myself for vigilance with not just a better pretzel, but a whole experience – I’d even get GOOD tickets, splash out for lower bowl, maybe near the glass!

When the hunger sprung up I got another glass of water. I reminded myself that a few hours were minuscule in the grand scheme of life and next week, even later tonight I wouldn’t even remember that I was a little hungry in the afternoon one day this week. I would get through. I focused really hard on the meeting topic. I got through.

And this morning I walked to work, and I’ll walk home, that’s a full hour of walking. Where do I apply for my bonus points?

This Week I’m: Focusing on Long-Term Improvements

I had to wait two weeks to check in on the scale due to some of my long-standing rules around weigh-ins cropping up last Saturday, but after two weeks on my strict program I’m down 7.5 pounds to 199.5 this morning. I’m super-pleased with this result. I expect it to slow down in the next few weeks to about 1-2 pounds per week. I’m 10 pounds from where I want to be, and I am very motivated that I can get there. I can see my waistline starting to reappear already.

I’m enjoying a break from food decision-making and all the doubt and angst that they sometimes cause me. I don’t have to worry if I’m doing it right because I know that I’m following my program so I can’t go wrong.

These last few weeks I’ve been taking steps to get my migraines under control, and work on the stress and anxiety that I’m experiencing around work, so I guess I could say that right now is a re-building, re-setting, and re-focusing time for me. Sometimes it’s uncomfortable, sometimes it’s hard (sometimes it feels like it’s one step forward and two steps back), but I am keeping focused on my goals of calmness, control, and harmony in my daily life. It feels pretty good to be taking positive steps in the right direction.

Lose Weight Slow, or Lose Weight Fast?

Time for some compare and contrast.  I am regularly asked by friends about various weight loss methods out there. I definitely have opinions, but I should make the disclaimer right now that I am not an expert, merely an interested amateur. As somebody who’s run the gauntlet of weight-loss methods, I like to think I’ve got some experience in the field.

There are two main ways you can lose weight – fast or slow. Both have their place in the weight loss world, and each one comes with a different set of pros and cons. Which type is best for you depends a lot upon your starting weight, your tolerance for rigid structure, attention span, and, of course, money.

Any of the major plans for either method can show you hundreds of success stories, people who have successfully lost weight using their methods, because either way you go, if you follow the plan you will lose weight. That being said, here we go…

SLOW

Slow weight loss methods tend to be marry the concept of teaching new habits with actual weight loss. Slow weight loss doesn’t require medical supervision, and is great if you don’t have a lot to lose – less than 30 pounds, generally – and there is no urgent medical reason to lose it fast.

Most people are familiar with slow weight loss plans, most commercial plans are slow plans.

Any of the diets on the US News and World Report list of best diets fit the category.

Eligible:

Anybody that wants to lose weight.

Pros:

  • Go at your own pace
  • Cheaper – price can be anywhere from the cost of a book to a minimal charge for weekly meetings
  • Easier to maintain a social life
  • Low level of commitment required – nobody hunts you down if you miss a meeting
  • More flexible food options

Cons

  • Slow weight loss can be demotivating – you may just give up if it’s too slow
  • No medical supervision, less support overall
  • No on-going behavioral modification aimed at helping you keep it off

FAST

Fast weight loss methods are usually medically supervised. They are generally for people with a lot of weight to lose – around 35 pounds or more. They require regular meetings with both a medical team and a behaviorist. They tend to be VLCDs (very low calorie diets) and should be considered to be a medical solution to a medical problem.

Fast weight loss methods divorce the concept of “getting it off” from the concept of “keeping it off.” The goal is to get it off quick – you can learn how to keep it off once it’s off, through a strict course of behavioral modification, ie, a maintenance phase. Better programs will require anywhere from a year to 18 months of attendance at focused maintenance classes. These classes are focused on behavioral modification, and they work if you actively embrace the content.

Here are some of the fast weight loss methods I can think of off the top of my head:

  • HMR Program
  • OptiFast
  • MediFast
  • HCG Diet
  • *Weight Loss Surgery (I’m putting this here because it tends to produce fast loss, however many of the features of the other fast methods don’t apply. This one probably should get it’s own category and I freely admit don’t know enough about it to speak intelligently)
  • *Nose Tube Diet (Despite the fact that it is mainly used by already-thin women wanting to look skeletal for their Big Day, it does technically fit the category)

Eligibility:

You are probably eligible for one of these methods if you have a large amount of weight to lose, your EKG comes back clean, and you have demonstrated the ability and the willingness to follow the plan requirements – weekly meetings, blood draws, behavior modification sessions, and the on-going maintenance program.

Pros:

  • Rapid weight loss – high motivation factor!
  • You need make no decisions – they tell you EXACTLY what to eat to lose weight
  • Medically supervised – high level of support
  • Long-term support via maintenance program

Cons:

  • $$$ Expensive – Medically supervised means you will be paying a lot of money for the privilege
  • Hard to maintain a social life during the intense loss phase due to food restrictions
  • Gallstones (you will need to take ursodiol to prevent the formation of gallstones during a VLCD)
  • Requires a high level of commitment – you will be required to attend weekly sessions in many cases or you will be booted

Some further considerations about fast weight loss programs I think it’s important to address. A question from a friend I received recently:

What I worry about with this (or ANY) way low calorie diet is that my body will think I’m starving and then store every calorie I eat so I won’t ever be able to live a “normal” eating life again.

Ok, science says that while you’re on the VLCD, yes, your metabolism will take a bit of a dive. However, you will continue to lose weight because you will STILL be consuming fewer calories than you need to maintain your weight. Also, any good VLCD program will require you to exercise, which helps to counteract the effects of a depressed metabolism.  Also, this is FAR from being a scientifically settled point.

Here’s some science on the topic, (emphasis mine:)

Wadden and colleagues’ work indicates that this disproportionate reduction reflects metabolic processes associated with the hypocaloric dieting itself. When calorie balance is resumed, the resting metabolic rate is dependent on the new body mass, especially fat-free mass. This is relevant for motivated patients who adhere to severe hypocaloric diets to achieve rather large weight losses. When they get to goal weight their metabolic rate is severely depressed, and they can experience almost immediate weight gain if they resume their prior higher calorie intakes. Recent studies have not continued to measure changes in resting metabolic rate for extended periods to determine whether the reductions are self-limiting. Again, the work of Wadden and colleagues supports a self-limiting hypothesis. More research is needed on this critical issue.

What this says is that you will experience a lowered metabolism while on the diet, and that if you immediately upon ending it go out and eat like you did before you started it, you will gain back that weight. You need to transition off carefully (which any of the good programs will give you support to do). However, over time your body will even out and your BMR will be what it should be for somebody at your new weight.

The number of calories required to keep your body running each day depends upon how much you weigh – how much mass those calories are running. But the myth that you will forever be stuck eating carrots and celery is simply a myth.

I think it comes from the fact that often people who lose a lot of weight had no idea that to maintain their new weight they’d get to eat so little at their new weight. The math is a rude awakening – it was for me, as well. To go from eating whatever you want at 400 pounds to getting to eat 1800 calories at 200 pounds feels like a punishment at first. Getting used to a new base metabolic rate based upon a lower weight can be a very jarring experience. Looking for an excuse or rationalization is a natural human instinct (“Oh, I couldn’t keep it off because my metabolism slowed down permanently.” No, it didn’t).  And yeah – it seems horrifically unfair sometimes to have to measure and be careful every day, and if you’re not used to, e.g., 1800 calories a day, it seems like a punishment.

It does take a lot of work to keep it off – if you read me regularly you already know that. Anybody embarking upon a medically monitored VLCD needs to be aware, up front, that managing a lower weight long-term is a lifetime undertaking, particularly if you were never in the habit before of monitoring your intake and disciplined eating. Anybody who tells you differently is selling something.

Conclusion

Pick the program that works for you based upon a clear understanding of your own situation, abilities, and personality. But don’t buy into myths because you read them on the internet. If you have a lot to lose, and understand that once it’s off you are going to have to work at maintaining the loss forever, I would highly recommend looking into one of the fast methods. I lost 80 pounds in 6 months on HMR, and as you can see, it has created no on-going issues for me physically (other than a tendency to blog copiously).

Bottom line: Either way you go, you’re going to have to learn to keep it off.