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.

Good News on BP and Suggestions for Tracking Your Results

The chart is a screen shot of my blood pressure measurements, which I try to take every morning when I sit down at my computer.  What it shows is that over the course of the time since I started monitoring it, my systolic pressure (the “top number”) has dropped significantly and more important, consistently.  This can’t be due to anything other than my exercise program.

In the long run, blood pressure will generally respond to weight loss, and also, to some extent, to diet (which is why we get all that “lower your salt” advice.)  But personal experience tells me that whenever I’ve been physically pretty active, particularly with lots of good aerobics, my BP tends to be fairly healthy (if you consider still needing a med for it “healthy,” but I take what I can get.)  On the other hand, I’ve never, over many years, stopped in to the doc’s and had it checked and look okay when I was going through one of my “not so much exercise” periods.

So I’m glad that it’s going down.  But I’m also glad that I have the data here to prove it, and in the long run, this may be more critical than my current BP, because it tends to confirm that my skills at monitoring health data are getting better.

As I’ve been mentioning, the real and often unspoken key to weight management is often contained in how well we can manage our behavior.  And very often, we sink or swim in that regard based on ridiculously little things.

Psych of weigh-in day and the “cat drop metric”

Today is “weigh-in day” and so there is some need for psychology.  So just a word on how that tends to go.

Many folks working on weight loss are familiar with the basics here:

1. Your weight fluctuates — it can actually bounce around as much as five or so pounds from day to day.  So the usual advice is: don’t weigh yourself all the time and get highly reactive to the results, because it’s easy to get discouraged if, say, you weigh the same or even more today than yesterday.  (Especially if you’ve worked your buns off and missed a favorite dessert last night in hopes of a big change today.) (Also, don’t weigh yourself on Monday morning, unless you spend weekends at Camp Lejune or in a monastery living on broth.)

2. If you’re doing a lot of exercise, you’ll probably be adding muscle, and muscle weighs lots more than fat.  So while you’re actually losing fat and replacing it with muscle, which is a much more efficient tissue for weight maintenance (muscle needs more energy to live; fat is basically storage and hardly needs any), you may be disappointed by the scale’s results.

This is all state of the art science and also common sense.  Still… it’s kind of disappointing, isn’t it?  Because for those of us who are chronically tormented by our weight, we still would feel better if the scale said “LESS!!!” every day.

Intro to the “Big weight loss project” blog

As I mention in the “about” page, this is a log of a project that involves my trying to lose a lot of weight.  If you’re someone who has some weight issues, particularly if you feel like you’re “chronically” overweight (meaning, it’s something that you’ve struggled with, or known about, for a long time — maybe so long that it feels like a big part of “who you are”), you’ll probably be familiar with these kinds of struggles.

There is a lot to share here, and I’m taking the liberty of not broadcasting my name and other personals so I can hopefully feel a bit freer to just share my experiences with you.  (Of course, blog identities “leak” sometimes — it’s hard to know whether you’re actually keeping things as private as you think you are — but I at least want to pretend to some privacy here.)

The plan for now: I am starting out with a latest doctor’s office weigh-in at 252 pounds.  I have a goal of getting that down considerably, and I would not mind if it dropped a full hundred pounds (though technically, even a few pounds should help, blah blah blah.  I may say “blah blah blah” a lot, by the way — my experience with being heavy is that you tend to hear the same, seldom helpful advice over and over and over and over… as most heavy people know.)  Since any loss is good, I won’t try to be grandiose in my project’s goals.  But people do manage to lose lots of weight, so let’s see what happens.