Analyzing Weight Loss Reversals

Today is my weekly weigh-in day, and I have mixed news to report.  My scale says I’ve gained back five of the 12 pounds I’d lost since beginning the project.  Rats.

Of course, this is a fairly common situation in any weight loss project.  Since we generally place a lot of stock in our scale weight, a bounce up can feel like a total failure and even a disaster.  At this point, many people just stop trying to lose weight.  That isn’t always done as a “big decision,” but rather you just “kind of start to forget” to keep track.  Motivation sags and pretty soon a year has gone by since you’ve been back to the gym or written down what you’ve eaten.

Clearly, the mental game of weight loss is key at times like this.  So I am thinking, what to do?  And I realize, the real key is to analyze the gain as best I can.

First of all, not to panic.  Five pound variations in weight are actually within the normal range for anyone.  I’ve had readers tell me that normal monthly hormonal shifts could account for even more weight gain than that — one person commented that she had a regular seven pound gain once a month.

So my five pounds might be partly just random fluctuation.

Second, I should look at other measures.  For instance, my blood pressure is slowly dropping again, after a brief tendency to rise a few weeks back (never to the pre-program level).  And my resting pulse is generally running ten beats per minute lower, and is steadily improving.  This says something important about my overall conditioning — that it is improving significantly, and continuing to improve. Likewise, my blood sugars are generally or always in a good range.

Then there is the tape measure.  While my pounds are up a bit, my waist and hips have shrunk about an inch this week.  Chest is the same, but therein may be part of the explanation for some new weight.

About 2 weeks ago I decided that my legs don’t need much more by way of weight training.  Partly due to genetics and partly due to hauling a lot of weight around, I have always had strong legs.  My calf muscles are huge and bulging and it’s pretty much all muscle down there.  The recent program gave me a leaner, less puffy lower leg look, and so I felt all I needed was maintenance.

But my upper body has never been super strong.  I lift a laptop and books most days, not tools and lumber and cinder blocks.  So I decided to add 10 minutes to my upper body workouts, which amounts to 20 more minutes a week of upper body strength building (a full additional weight workout a week), along with pushing myself a bit more to increase my strength.

I doubt I’ve actually added five pounds of muscle all of a sudden, but I probably added some.  I know I’m stronger, more able to do more in the gym with less sense of effort.  Muscle is heavy.  The fact that my weight is up but my body is slightly thinner does suggest some new muscle.

In terms of diet, I’ve been under my calorie limits most days, but was away on the weekend at relatives’.  So it’s restaurants, both on the visit and during the trips to and from.  Plus generally I’ve felt I’ve been a bit slack a couple of days, and did have two or three days of being over my calorie allowance (like last night,  when all the extra working out and the fact that it was “free cone day” at Ben & Jerry’s in Vermont, led me to a bit of overindulgence.  Guilty as charged.)

In general, then, I can break this extra poundage into a couple of causes: some is probably new muscle, some is last night’s heavy meal (I’ll verify that tomorrow), and some is a need to tweak the diet a bit.  I need more veggies anyway.

The main thing is: if you keep records, you can make sense of seemingly “random” weight fluctuations.  This is never 100% — our faith in having total control over nature is never completely justified.  But some of it is.  And the more sense things make, the less likely we are to just give up in despair.

Because we just can’t.  Ever.

Using medical news for weight loss efforts

Yesterday I wrote about the problem we face when confronted with medical reporting on weight-loss related matters.  Part of what I discussed was the tendency of the media (and of unethical entrepreneurs with their eyes on your money) to make too much of premature medical findings — the kind of thing where one study suggests some important discovery, but where either the area needs much more research, or where there really aren’t any clear ways to make use of the results yet (and there may never be, for all we know.)

I could go on about the problems with much medical research on obesity that makes the headlines, but it might be more helpful to cite a few things that do seem worth reading and knowing about.  Today I have two articles to recommend — one on diet, and one on medical care.

News on diet

First is a report on a study on healthy diets, which was recently published in the Archives of Internal Medicine.  Researcher Andrew Mente, Ph.D., and his colleagues at the Population Health Research Institute did a thorough review of fifty years of research on various diets that supposedly are healthy.  They found that for the most part, there isn’t enough evidence to recommend many diets.  However, there is one exception: the so-called Mediterranean Diet.  This one seems to be really heart-healthy.  This study strongly suggests that the key to healthy eating is not just “eating plenty of” veggies and such.  Rather, it involves organizing your entire diet around these things: fruits, vegetables, legumes, nuts rich in monounsaturated fatty acids (such as walnuts), fish, whole grains, and cheese or yogurt.  (The difference is important: if you continue to live on burgers and bacon, it probably won’t help much to add the occasional salad to your diet.  What you have to do is — gradually but not too gradually — change your entire diet to something different.  Probably something you did NOT grow up with.  Possibly something that most of your friends or relatives don’t eat.  We’re talking low-meat, high fish, high veggies (like five to ten servings of vegetables a day!), and getting your protein from stuff like fish, soy, nuts, other legumes (soy is a legume), cheese, yogurt, etc.)

The power of studies like this is in their size and consistency: when one study finds something, that’s information that may or may not pan out eventually. But when study after study points in the same direction, and when different kinds of research keep showing the same findings, from experiments with lab animals to studies of healthy populations to experiments where people change their diets — then it’s really “news you can believe in.”

I believe this one.  And it reminds me, personally, that I do need to crank up the veggies in my diet more.  (I mostly avoid meat and such, but know there’s a gap between the number of vegetables I eat per day and the number of servings — probably seven to ten — that I should eat.  The problem with calorie counting as your main dietary “guide” is that it doesn’t care if the calories you ate yesterday were based on a few servings of asparagus and lettuce and spinach and broccoli, or marshmallow “peeps.”  But your body cares.)

Getting good medical care

Another recommended reading is a discussion in a recent NY Times article on the issue of patients’ need to really understand their medical conditions, and the role doctors can play in this (or that they may fail to play.)  The article makes the point that it’s important for medical personnel to take the time to help patients understand their conditions and the recommended treatment.

I agree completely, but I don’t think the article goes far enough, in two respects.  First, there is often a big gap between teaching patients about their medications and how to treat their conditions (which the article focuses on), and the bigger issues of teaching both prevention and life and health enhancement.  When a doctor tells me I have high blood pressure and so starts talking more medications, I feel a bit depressed.  The message, in my head, is: “This won’t go away, so it’s time for still one more medication that I’ll now have to take for the rest of my ever-shortening lifespan.”

I don’t know about you, but I don’t like that message.  It triggers a subtle form of depressed thinking — not a clinical depression but a feeling of “nothing I can do will make a difference.”  And when people feel that, they tend to care less, try less hard, and so medically, they are at risk for deteriorating faster.  (Depression, if it does go to the clinical level, is a strong risk factor for earlier cardiovascular disease and death, too.)

What I prefer in a doc is information about how to restore health.  And also encouragement: someone telling me that this or that symptom or issue can be made to shrink or vanish if I can manage to, say, lose some of that weight.  (The best medical news I ever got along those lines has been docs saying that if I could lose my excess weight, I’d quite possibly be able to eliminate all my meds and such.)

So doctors who can point toward health are most appreciated.

Of course, having been to some extent on the other end of that kind of medical interaction (as a psychologist for many  years), I also know that getting that kind of discussion going with patients isn’t always easy.  Some patients are too poorly educated to even recognize that you are discussing something that is life-threatening, or to understand how or why to follow recommendations. Some are already too depressed to be able to process the “this can improve!” message you’re trying to send.

Others may just not have much frame of reference for understanding how to use this information.  It is easy to overestimate people’s abilities to actually make small changes.  You may say “eat vegetables” to someone who has absolutely no experience knowing what vegetables even are, other than maybe having a vague idea that lettuce is a vegetable and they hate lettuce.  Knowing how to plan, manage portions, shop for good veggies (not canned peas?), or cook palatable veggies, is really not that uncommon a set of problems.  (I’ve mentioned using calorie counting software, for instance, but recognize that many patients might not have the faintest idea what that means… presumably, if you’re reading a blog on the internet, you’re not one of them.)  So doctors and other medical personnel have to be ready to take the time to really talk with their patients about this stuff — to assume the role of teacher, mentor, and supporter.

(The fact that insurance won’t pay for that kind of time with a doc is all the more reason to get active in working for a better health care system.)

But patients also have to overcome natural psychological hurdles to getting good medical information.  Even though I’ve worked side by side with physicians through my career, and even had physicians as my patients in psychotherapy, I recognize that when I get into a medical setting my own anxieties and vulnerabilities kick in.  I get less active, don’t always find asking questions to be very easy, forget things, leave without realizing that I don’t really understand the instructions for that medicine.

Those of us who battle being overweight have need for the best diet, exercise and medical information we can get.  That means keeping up on the best research (and reading it with a critical eye), and getting the best medical advice — and support — we can.

Moving targets: predicting weight loss by calories burned

As I mentioned the other day, last week I lost three pounds.  Since I’ve been obsessionally faithful in logging nearly every morsel into my CalorieKing software, I can report that I ate an average of 250 calories a day LESS than the software recommended.  Here’s the way that worked (warning: math follows):

• On a day when I would have no exercise, the software recommends that I should eat about 1850 calories in order to lose about a pound a week.  What I actually at on average, then, would have been about 1600 calories a day (assuming no exercise).
• On days when I did exercise (which happened to be every day last week, though the Sunday workout was just a half-hour stroll through the woods), I entered the exercise done and the time I spent on it, and the software provided an estimated amount of calories burned in the workout. (I average about 650 calories per workout, combining weights and elliptical.)  In those cases, the software ADDS those calories back to my 1850 cal allowance for the day.  So instead of an 1850 cal limit, I actually am able to eat an additional 650 calories on days I work out, for a total of 2500 calories.

In short, last week I averaged 2500-250, or 2250 calories eaten per day.  Which, given my exercise, was enough to lose three pounds.

Now, here’s the problem with this data:  It doesn’t really account for the amount of weight lost very well. Why?  Well, let’s do the math (okay, more math):

Shaping your food preferences for weight loss

Recently, more experts seem to be saying that exercise alone is seldom effective in helping a person to lose a lot of weight.  Rather, exercise has to work along with attention to one’s diet.  Whether you believe in the high-protein/fat/veggie and low carb diets (like Adkins), or some more traditional “food pyramid” with more grains and less fat, the main thing in weight loss is to take in a reasonably nutritious diet that is not too high in calories or unhealthy things like saturated fats or cyanide.

If you track your eating on a daily basis and are pretty accurate about doing so, you can actually be fairly clear day-to-day about how many calories you are ingesting.  Many food guides and both online and computer-based software (such as CalorieKing, the software I use) will make this process even easier than the old fashioned methods involving looking up what you’ve eaten in a paperback guide and then writing it down and guesstimating your portion size (“hmm… and then I added some butter… was it a teaspoonful or…?”)  In fact, a simple combination of a well-stocked collection of measuring cups and spoons, software that is easy and fast to use and that gives you all the nutritional info you need on what you’ve eaten, and the religious habit of measuring and recording everything that goes into your mouth, can give you considerable control over your caloric intake.

At which point, you start to learn some necessary, but painful lessons.  The main one is that many of your favorite foods may pack quite a caloric wallop.  For instance, even though you did a 30 minute treadmill, that pint of Ben & Jerry’s totally overwhelmed your day’s allotment of both calories and fat.  Even perfectly “innocent” and “healthy” foods (like that pint of Chinese take-out) may give you six-, seven- or even nine-hundred calories — a huge amount when your software helpfully informs you that “an average woman of your height can expect to lose a pound a week if you consume no more than 1200 calories a day…”

This is another of those dilemmas that are hard to solve if you rely only on the diet-exercise combo. The “diet” approach traditionally relied on a sort of half-imaginary superpower called “willpower,” which thin people seem to have and you don’t.  And as we’ve discussed, exercise alone never works because it is so easy to eat double whatever number of calories you’ve run off in the gym.  (A handful of Oreos can compensate for any length treadmill workout.)

What you may need to do is to retrain your psychological food regulation system.  This can be done several ways:

A weight-loss tool kit – food tracking

As I mentioned in an earlier post, at the highest level (what the business writers often call the “30,000 foot level”), I think it makes sense to assume that a weight loss program has to consist of three components: exercise, diet, but also a set of effective psychological strategies — attitudes and skills that help you stay on track during what is absolutely guaranteed to be a highly frustrating and slow process.  In some upcoming posts, I plan to share some of my own favorite psychological strategies, as well as some favorite guides to mastering the mental game that you might enjoy.  But I don’t want to drift off into a discussion of weight-loss psychology without also tending some other fires first. In particular, I want to talk about diet, particularly how you can track what you eat, and why it’s important to do so.

When I look back at my own earlier, often marginally successful efforts, I realize that my most common mistake was generally to assume that if I was doing vast-seeming amounts of exercise, I was guaranteed to lose weight.  The problem was that it is so easy to eat way more calories than you burn at the gym, that I generally would become a fit fat guy.  I could spar at the martial arts dojang and break boards with my hands or feet, or I could enjoy a forty mile Saturday bike ride, but then I’d stop at Dairy Queen or eat a few large meals and all the work would be for naught, weight-wise.

In short, it was ultimately important for me to find some way to track and manage my caloric “input.”

Three parts to a weight loss plan

Years ago, most people working to lose weight would have said there was one of two basic strategies that they would use: exercise or diet.  Indeed, “going on a diet” was probably the single most common strategy used by the majority of people. Whether the particulars of that “diet” were very effective or (more often) not, the point is that the total list of possible weight loss solutions available to most folks consisted of that either/or choice.  More often than not, people would not make a serious effort to combine approaches.

Nowadays, most people are aware that you have to combine diet with exercise in order to succeed at weight loss.  This is for many complex reasons, but the two most important are these:

1. If you only focus on diet, your body may not lose much weight; in fact, it may start to adapt to a reduced caloric intake by slowing your metabolism or doing other things to adjust to the new “famine” conditions that it senses; this may not only thwart, but it may actually reverse your desired weight loss efforts.  By eating less, you may “train” your body to hold onto fat better!  Adding exercise corrects for this effect by increasing the calories you need in order to survive — so your diet actually helps you lose.

2. If you focus only on exercise, you may lose more weight.  But if you ignore diet issues (what you eat and how much, etc.), you may plateau or even get fatter, because it’s a natural human tendency to compensate for all that extra exercise by eating more.  Not only are you likely to feel more hungry as a result of your workout, but you’ll also tend to tell yourself that you’re “in the clear now” and so can chow down on that 2000 calorie meal of fries, double triple thick burger and shake.  The result can be a somewhat more “in shape” body that ends up weighing even more than it did before you lifted a finger — and not all of it will be “muscle.”

While we now know that the most effective plans involve both diet and exercise, there’s a third, and generally neglected “essential ingredient” to a weight loss plan.  I mean the mental game.