Debra’s Gone Defunct (not entirely — I’m not dead)

Welcome, newcomers and old friends, to Debra’s Just Maintaining!  For roughly a year, starting September 29, 2010, this blog set about exploring the cultural mythology and science surrounding weight-loss maintenance, especially after “radical” loss (more than 10% of highest body weight).  As blog owner, I found myself moderating a discussion involving mostly weight-loss maintainers and size acceptance proponents, two seemingly disparate groups who ended up having more in common than any of us might have expected.   It turns out we are all betrayed by the myth that radical weight loss is some hard-won victory, to be followed (of course!) by maintenance, a less challenging, zippy “lifestyle” composed of tips and tricks.  It’s much more complicated than that. 

This blog is not a “big” blog, but big enough, and certainly has much heart.  Over the year it received just over 60,000 “views” of its various posts.  Many were repeat visits from people I came to regard as friends, dear friends.  We shared a sort of cathartic grief process as we stripped apart the mythology, and discussed from a lay vantage point some of the science surrounding weight-loss maintenance.   In addition to the maintainers and size acceptance advocates, we also entertained a scientist visitor from time to time, and a couple of trolls.

The blog is now mostly defunct because I have gone on to other time-consuming pursuits, and I also need time to be a good Mom, and to continue my weight-loss maintenance, an endeavor that I regard as a third- to half-time unpaid job.  To be competent at these things, something had to give. 

Since the blog is mostly defunct, it’s likely that you arrived here because someone sent you here or you conducted a search for “Weight-Loss Maintenance” or some topic discussed here.  A lot of people find this blog with searches to the effect: “Is obesity killing our children?”  If that is you, you are looking for this post.  Other people are apparently interested in a maintainer’s take on intuitive eating.  That would be here and here.  And a lot of people want to know what I think about journalist and anti-carb pundit Gary Taubes.  Those posts are here and here. 

If someone sent you here, it may be because you just lost a lot of weight and said something silly like, “If I can do it anyone can!”  Then that person wants you to start with the post subtitled Skiing as Useful Metaphor.

Other reasons someone may have sent you here: 

•  You said something insensitive or rude about fat people being “in denial.”
• You said something insensitive or dismissive of someone who works hard to maintain a particular weight – along the lines of “but certainly the rewards outweigh any effort you expend.” 
• You said something definitively naïve, such as, “science has proven people are fat because of modern breakfast cereals.”  
• You announced that you are embarking on a weight-loss process/diet (what number?), and a friend wants you to have a realistic idea of what lies ahead, more so than what some women’s magazine or morning news show may be touting today as a “breakthrough.”
• You are struggling with weight-loss maintenance.  Perhaps your weight is sliding.  You need affirmation from a kindred spirit who knows how challenging this is, and doesn’t sugar coat it or pop off with “inspirational” platitudes.

The Penultimate Post: How do I Reconcile Size Acceptance and Weight-Loss Maintenance?

Two people in the last month have asked me to answer this question.   Here goes.

Call it serendipity.  Call it an act of God.  But a year or two into my maintenance, when I was still the “joyful jogger” in my own mind, I found Big Fat Blog.  I don’t know what I was reading that got me linked there.  It wouldn’t surprise me to learn it was a diet related blog that belittled BFB.  But I got there and got hooked.   (By the way, if you visit my profile there, it says I’ve only been a member 42 weeks, or some such.  That’s actually the time since a computer glitch eliminated my profile for a few days.  I’ve been there many years – probably since 2005 or 2006.)

I read deep into the archives and all I could think was, these people are right:  society’s hating on fat people (with the best of intentions) isn’t creating health, or even reducing the number or size of fat people.  I searched the site for information on the awful 95% failure rate statistic for weight-loss maintenance.  Even though I was well into my maintenance and I’d thought (hoped) that I’d “clicked” into some new mental or physical state that would support life-long maintenance, I was also painfully aware that I’d been part of that statistic before.  I had regained, yo-yoed, in the past, and I knew that I had not gotten any smarter (and may have, in fact, killed a few brain cells with age and Chardonnay).  I was desperate to know more about this failure rate, the science behind it, whether it was true and whether there were special “exceptions” that I might qualify for.  Sadly, my search of BFB came up dry.  But I noticed that there was another private area for “registered” people, and I thought that maybe my answer was in there.

When I registered I only briefly contemplated lying to get in.  Ultimately, I figured, I’d feel more comfortable participating if I were there honestly.  In my essay I revealed that I was a weight-reduced person, but some things just didn’t feel right.  I promised that it would not be difficult to play by the rules and avoid diet talk.  God bless Paul McAleer, the founder and moderator of BFB at that time:  he let me in.   I guess he knew I needed to be there.

Sadly, in the BFB forums, I couldn’t find an answer to my burning question about the 95% failure rate of maintenance.  But I did find there compelling, intelligent, heart-felt, truthful discussions covering the  many facets of living fat, which I had not forgotten.  (For a time, among my real-world friends, I called myself a “fat chick in the closet.”)  When I participated in discussions at BFB I never used the word “we.”  I would say “fat people fall victim to . . .”  or “most fat people understand that . . .”  To my knowledge, no one noticed this pattern.  It didn’t stick out.  I became a member of the community.  Some people there attacked me for being “healthist” (and I think I was once disparaged for being a “good fattie”), but many fat people at BFB are subject to the healthist moniker (including DeeLeigh, who now administers the blog), and we supported each other’s views.

Within a short time of my joining BFB we discussed creating “cheat sheets” to help us with the most common challenges to size acceptance.  I volunteered to write on the 95% failure rate (which I would learn is actually 97%).  It gave me an excuse to do more research.  My early musings on that topic are still there.  Above the BFB logo are two tiny links, one to Big Fat Index and the other to Big Fat Facts.  My essay is down the page and entitled NEW:  The Truth About Long-Term Diet Success.   You’ll likely recognize my “voice” if you read it.  I also helped by doing some line editing in the other pages, so my “voice” is elsewhere too.

Climbing Out From Under a Rock?

Actually, I’ve just been in contemplation mode, mainly.  When I was a child, that would have meant sitting on top of a rock, down by a neighborhood creek (thoughtlessly trespassing on someone’s property, but it didn’t matter in those days), feet in the cold, rushing water.  As an adult, I prefer to perch on a softer landing spot.  I often have a book too.

First of all, I’d like to thank everyone in my last post for being so encouraging about my writing, my perspective, my voice on this topic.   You have given me pause.  I had pretty much given up on writing about weight-loss maintenance, at least in any compensated fashion.   It is nice to think that others find my thoughts worthy. 

While I haven’t entirely given up on writing on this topic, I am going to postpone and turn my attentions elsewhere.  Mid-September, I enter training in the Clinical Pastoral Education program for St. Luke’s Hospital in my hometown of Kansas City. 

Back in January, a close friend died, one who had been encouraging me to plumb spiritual depths, ponder imponderables and (as she had done) go to seminary.  Her career path led her to edit a national religious publication for a time and serve as a congregational pastor for a time.   I was shaped most, however, by being present for nearly all of the penultimate chapter of her life, in which she was technically mostly retired (but spent her days advancing peace in creative ways), and parts of her final chapter (as I could travel, and as time allowed).  It occurred to me that being present, God’s emissary, during people’s most important and challenging chapters would make for meaningful work, especially once my nest goes empty in five years (a chapter I’d like to plan for).  

Muriel and I met shortly after she had had a radical mastectomy following breast cancer.  At the time, she decided not to follow up with chemotherapy.  She preferred to fortify her body’s defenses against the internal enemy, through nutrition and other means, rather than try to poison it and herself.  Her children were grown, her obligations on this earthly plain mostly met, so she claimed the luxury of declining an ugly fight, knowing her decision might result in a shorter, if more comfortable, life.  Actually, however, her strategy kept her alive for nine lovely years.  Years that would change me.

As Fearful as I Ought to Be

At the end of the last post’s comments, 9-year radical maintainer “mem” shared that her co-exercisers and Zumba clients at Curves sometimes say things to her to the effect, “You don’t even need to be coming here. You’re one of those people who probably couldn’t get fat if they tried.”  It is uncomfortable and disconcerting, and she knows it is important to tell them that she once weighed nearly 100 pounds more than she does now, and she appreciates remembering “the almost inhuman effort it took and takes to change that.”  She has to pop her acquaintances’ bubbles, in service to authenticity, because their words are framing one of the biggest and most disheartening cultural myths of weight loss and maintenance.  That it is easy, as easy as being naturally trim, once you get it figured out, once your brain or your metabolism has “clicked over,” or you’ve adopted the healthy lifestyle (with the secret handshake), or you’ve assembled just the right tips and tricks, or some other magic has happened.  

The idea that maintenance will be easy takes the fear out of the whole process of loss and maintenance.  That maintenance is easy, however, is the biggest, baddest weight-loss lie of all.

Most of you know, I follow Barbara Berkeley’s Refuse to Regain.  We don’t always agree to the letter, but we are sisters in spirit:  maintenance is complicated and individual.  Currently, in the comments of one of her posts, a woman is hawking a book to be released next year.  With great gall, Ms. Libby Florence tells Barbara how she used to believe as Barbara does, but now Ms. Florence has seen the light. 

Perhaps Ms. Florence is self publishing.  I would find that less tragic because the lapse in judgment would be singularly hers and not a publisher’s too. 

Or perhaps she found a publisher because she’s selling the party line:  weight loss and maintenance are effortless, once you have the “key.”  It’s all very easy, doncha know!  Her comment, before she gives the book’s website URL, ends as follows:

More Thoughts on Endocrine

It’s useless to try to persuade me to be uninterested in endocrine.  If your interests lie elsewhere, I forgive you for skipping my entries on the topic.

First the news:  I heard from Katarina Borer, author of Exercise Endocrinology. 

As a lay person, it’s hard to know what qualifies as a respected source on a particular topic.  What I know is that in terms of textbooks, it’s the first that pops up when you do searches on Google, Yahoo or Bing using the terms “exercise endocrine.”  It gets Google’s top honors, in that it appears in the number one position, above articles from clearly “popular” sources, such as bodybuilding.com.  Moreover, two other articles from Katarina Borer appear in top ten slots.  That’s my confession.   I have accepted this woman’s qualifications on the basis of her Google Quotient.  She, of course, rose even higher in my esteem when she contacted me by email, and attached three articles for my review (two in which she was lead author, one a commentary on one of the other pieces).  She attained nearly saint status by paying me a compliment, “I found your postings interesting and remarkably well-informed for a person who is not actively engaged in research.”

There.  Confessions dispensed.  I will, sometime soon, review those articles, but they will require time to digest.  I have read each one’s first two paragraphs, and it is apparent to me that I will need to read these articles when my intellectual cylinders are all firing properly and I am under the influence of a precise dose of caffeine.  (Too little and I don’t make important, rapid mental connections; too much and I start cleaning my house instead.)

Several things emerged in the comments on my last post that gave me “Eureka” twinges:  

1. That other people experience “eat impulses” and at least one commenter feels relieved to have language to describe them.   Our vocabulary, clearly, is constrained by having only two words to describe the sensations that precede eating:  hunger and appetite.  With dozens of hormones, peptides, proteins and the like, reacting in hundreds or thousands of combinations with our individual gene profiles and contributing to our metabolic processes, it seems a bit silly to me that we reduce the entire process to two, singular tense, words.  Moreover, the limits imposed by these two words have created a perfect Petri dish for fomenting the social discord we size acceptance proponents know as weight bias and the oppressors are happy to use in a “war on obesity.”  To wit:  “If you don’t eat when you’re hungry, obviously you’re simply responding to appetite, you out-of-control schmuck, and we, society, will judge you harshly for that if it results in a larger body than we find pleasing.  Hmmmmph!  (We’ll leave you alone or even venerate you if you can eat sans hunger and remain trim.)”

An Open Letter to Weight-Management Scientists

Dear Scientist Friends:

Consider this a personal invitation to test a theory, especially if your area of expertise is endocrine and/or you have a personal interest in exercise physiology and weight management.  (Er, and if you’re just one of my regular blog readers, please eaves drop on this letter.)

For several years, I have been synthesizing scientific information and personal experience as a radical weight-loss maintainer, and I would appreciate an experiment designed to better test the relationship between exercise and endocrine, especially those dicey signals that I believe cause most people to regain lost weight – the imbalance of leptin and ghrelin, PYY3-36 and aghouti related protein.  If you know of an experiment that has already explored this relationship, then please provide me a link.  (Disclaimer, as a lay person, my knowledge is embarrassingly limited.  I have not yet read Katarina Borer’s book on Exercise Endocrinology, or any other scholarly text, so maybe I’m naive, but if we do know all that we could know on this topic, it sure hasn’t made it into the mainstream marketplace of ideas.) 

It has occurred to me that there are different kinds of “hunger.”  Those of us who maintain radical weight losses have pretty much mastered how to quell insulin-triggered hunger and vacuous (empty stomach) hunger using macronutrient management.  In short, we use carbs (such as bananas or dark chocolate) to quell immediate, sharp (vacuous) hunger, and we use proteins and fats to keep sneaky insulin-triggered hunger at bay.  But this is not the full story.  If it were, more than 3% of people would be successful at maintaining radical weight loss for five years, the depressing figure that empirical research suggests.

According to the National Weight Control Registry (which could also be called the 3% Club), where I am listed as a participant, 90% of us exercise on average one hour per day.  This finding is one of the most dramatic commonalities among us, more so than eating breakfast (78%), regular weighing (75%) or limiting our TV viewing (62%).  In fact, the only two characteristics that are more common than the hour of exercise are that we have restricted our food (98%) and increased our exercise from our fat days (94%).  (It should hardly come as a surprise that one hour daily represents an increase for most people!) 

Learned people debate the value of exercise compared to food restriction in losing or maintaining weight, assuming that  exercise is a function of energy balance – calories expended v. calories consumed.  Energy balance, however, is not a simple equation, and I think exercise serves an additional, more important, function beyond expending energy.  I think we need to know more about its effect on endocrine. 

The Plate

It’s the topic of the day (or recent bygone days) at many blogs and websites:  The new US dietary guidelines replacing the old Pyramid, aka “My Plate.”

Knowing full well that I’m howling in the wind, I just blasted off the following missive to the “Contact Us” email address.

Warning to my size acceptance friends, restriction talk, could be triggering.  I also apologize for using the “O” word.  Had to consider my audience, and “fat” wouldn’t fly with them.

No Salutation.  Email address is Support@cnpp.usda.gov

Thank you for your hard work to date.  Here are suggestions for the new plate, which is better than the pyramid, but still inaccurate.  I hope you will integrate them into a new improved plate in the future:

1.  Refined grains have no place on the plate, they should be off the placemat in a distant place (that may look like an ice cream stand or some such) called “now and then treats.” 

2.  Replace the “grains” category with “nutritious starches.” Corn, legumes and baked potatoes are better switched out with the whole grains, not with the green leafies, etc.

3. Change the Dairy glass to “Dairy or Alternative” and link to your alternative section.

I’m not an RD, but I am an eight-year radical weight-loss maintainer (27% of my body’s highest established weight), which is probably more rare.  I think most RDs would agree with my adjustments to your plate. The milling and baking industry and dairy farmers might have a bone to pick, but you serve the broader citizenry, yes?

Regarding your weight-loss advice:  it is outdated and based in the cultural mythology that weight loss is routinely permanent.  Empirical science does not support this.  You would do more to promote health if you shared that weight maintenance is noble, challenging and rare enough in itself.  Most adults over 30 gain 1 to 2 pounds per year.  Preventing that would be helpful.  People should live joyfully most of the time, eat healthfully most of the time (following the revised plate I’m suggesting), exercise most days, then treasure the body that happens, regardless of its BMI category. 

Back When I was “Inspirational”

Yesterday, Barbara Berkeley posted an essay on the value of embracing exercise.  In it she encourages all of us (and inspires those of willing spirit) to keep trying to fall in love with physical exertion.  Good advice.  Her drug of choice is tennis.  Once upon a time, mine was running. 

Barbara’s essay prompted me to do a word search for “running” in some pages I’d written.  I was hoping for something inspirational that I could update for this blog.  Instead, I happened upon a discomfiting draft of an essay that dated to 2006 or thereabouts.   The context tells me it was a time when Oprah was trim and bragging about doing 300 sit-ups a day.  I was gloriously in love with running, and never suspected my joints would put an end to that affair.  I didn’t know whether I actually qualified as “high” when I ran, but I knew that I loved to run (or, more accurately based on speed, “jog”), I craved it, and often while running I lost track of time and place.  I ended up back at home at a time that would indicate I’d trod my usual course, but not remembering specifics.  Here’s what I wrote about the process: 

When I jog, I find myself writing essays or creating fiction plots that I will later take down, mumbling long passages of dialog and playing multiple characters.  Sometimes I mentally stage and win arguments with PTA moms who disagree with my fundraising ideas, or I refurbish my house.  Some days I engage in conversations, musical duets or more intimate liaisons with movie stars or musicians. (On rare occasions I think about liaisons with my husband.)  I discuss the future of the planet with scientists, politicians or other newsmakers.  I negotiate peace accords in troubled countries where I don’t speak the language, but I charm my fellow delegates by feeding them their favorite native desserts prepared by my expert chef.  I talk through my interpreter of a peaceful co-existence, and we all strategize about reducing the world’s horrible stockpile of weapons one by one.  Then I exchange my bulletproof brassiere for a standard Maidenform and go talk to Oprah about it on her show.  (I know Jim Lehrer would be more appropriate, but this is my fantasy.)

Word Play: Addiction v. Compulsion

I thought my most recent post would be a “quickie.”  Here’s something interesting in Science Daily on food addiction linking ghrelin to excessive sugar consumption.  I expected a few responses.  “That’s nice, and resonates with me because blah blah.”  Or, “Fine, but that’s not my issue.” 

We all go home. 

What I learned instead is that the word “addiction” is not even recognized in certain professional circles (those who treat substance abuse, e.g.) and that many find the word “compulsion” less judgmental and more useful in treating people who engage in excessive behaviors. 

For some reason, in our discussion, we were compelled to raise the topic of “sex addiction,” and I, for grins, visited this site analyzing the Tiger Woods debacle:  Sex Addiction:  What Tiger Woods’ Story Forces us to Confront.  

Here are the first two paragraphs:

From Tiger Woods to Lifetime movies, there has been no small amount of conjecture about the slippery concept known as ‘sex addiction.”  But does such a condition really exist?  Finding out requires sweeping aside the presumption, dismissiveness, and shame that clouds the subject.

The phenomenon didn’t have a name until 1983 when psychologist Patrick Carnes published the influential book, Out of the Shadows: Understanding Sexual Addiction. Prior to that, the behavior was described as “hyper-sexual arousal.” In short, the term “sex addiction” is used to describe a pattern of frequent, progressive, and often secret sexual behavior, even when the behavior jeopardizes a person’s time, employment, financial stability, relationships, and reputation. While often conflated with adultery, sex addiction does not necessarily mean cheating—or even intercourse. Rather, it can manifest as a dependency on pornography, masturbation, phone or Internet sex, and other related behavior.

Now, that opening reads sensibly enough to these eyes, trained by our “developed” culture to accept certain logical leaps.  However, it was easy to see that we, indeed, may have a problem (practical and/or semantic) when we “translate” it to a comparable analysis of the less understood/accepted concept of “food addiction.”

Arya! Arya! Arya!

Let me start by saying I don’t agree 100% with everything on Dr. Arya Sharma’s blog.  For example, I think his Best Weight Practical Guide to Office Based Obesity Management (which he co-authored with the venerable Yoni Freedhoff and from which he regularly draws material for reposts) is a gross oversimplification of what is required of doctors and patients if they really want to have an impact on weight.  In this most recent repost, for example, he suggests

“. . . it is safe to assume that a patient who is unable to commit to 30 minutes per day of combined dietary and fitness effort will be unlikely to succeed with weight management using a purely behavioural strategy. Asking patients whether they feel they can find 30 minutes a day for their weight management effort will help to assess their readiness and willingness to change.”

To that I gasp, THIRTY MINUTES?!  No wonder the mythology persists that it’s all just a zippy “lifestyle” change, when our wise doctors promote this kind of crap.  Thirty minutes devoted to a less toxic diet and some exercise may marginally improve someone’s health, but it is nowhere near enough time to have ANY permanent impact on weight.  

On the other hand, the man, Arya, on another day can be brilliant.  I’ll say it:  genius.   For example, on Friday he talked about the complexity of calorie intake as related to weight.

Clearly, he respects his own field of specialization, and yet he has not dropped the notion that General Practitioners can and should press patients to manage their weight.  He is disappointed that they are “unenthusiastic,” but maybe he should hear that as a clarion call.  His Practical Guide presses GPs to make behavioral prescriptions in the name of weight management (as opposed to mere health improvement), but the GPs know, intuitively, that those prescriptions are hollow, at best.  They may even be damaging, because their dismal results can foster disillusionment and depression.  To my thinking, asking GPs to help their patients with weight management is ludicrous.  You might as well suggest that the GPs should be performing routine brain surgeries too.