Diet and Exercise

This post is a response to Dr. Novella's post How to Lose Weight – Eat Less, Exercise More
over at Neurologica.

I have PCOS with insulin resistance.  So my postpubescent life has been a wave of failed diet after failed diet.  It's has been more than just damaging to my emotional wellbeing.  It's made me less healthy.  A few years prior to being diagnosed, I did a diet plan with a local GYN office which, when my weight shockingly did not respond to "the plan," resulted in six months of 600 calories of protein only while taking an appetite suppressant and calcium pyruvate (which I think helped me but doesn't have any real backing behind it whatsoever).  I also went on an exercise rampage.  I did videos and weights in the morning and I started roller derby which meant roughly 5 hours of skating twice a week and maybe 2 hours or better during free skates a couple times a week.  In that six months I only lost 25 lbs and was still overweight.

I then broke my ankle and, as you might expect with IR, I put it all back on in the first two weeks.

When I was finally diagnosed two years ago and put on Metformin, I made the decision not to start any sort of diet plan, to my endocrinologist's displeasure.  It just isn't sustainable and it makes me bananas.  But, when we finally titrated to the right dosage, the hungry ghost inside me disappeared and I started (slowly) losing weight.  All these years of high progesterone are written on my body and will take time to erase.  I can't fathom how I went so many years ravenously hungry and ONLY ended up at 192lbs.  The rate at which I've lost weight in the last 6 months in particular suggests that I should have become a much rounder person and all my dieting must have been much more successful than it seemed.  I've lost 10lbs since October eating exactly what I want to avoid the Metformin nausea and walking about a mile total to and from work or the library about three times a week... and a lot less often since February.  I'm literally sitting on my couch with weight falling off (or sometimes sitting at the computer in the library writing papers with weight falling off).  No lie, my lunches this week are Hot Pockets.  (They aren't usually, but this week they are.)

It upsets me that a GYN didn't bother to investigate why such an unhealthy diet wasn't producing the expected weight loss.  It's so simple.  And a note on diets.  If a normalweight or underweight person were participating in these behaviors, we'd practically lock them away.  And I'm not even referring to my specific scenario, but the obsessive calorie counting or food avoidance or multiple hours of committed exercise per day.   They'd be on medication and in counseling and possibly institutionalized.  But somehow this is healthy for someone as long at it results in them not being fat anymore?  I don't buy it.

And don't even get me started on the nutball nutritionist (he is an RD but describes himself as a nutritionist) who suggested race walking and whole wheat toast would solve all my problems--even after I informed him that my home is gluten free.

Maybe my ability to discuss this is highly clouded because I never was the person who spent 20 years going to AYCE buffets and then wondered why I couldn't get close enough to the buffet in my Hoveround.  But, frankly, I don't believe that person really exists.  I don't believe that people just eat and eat and eat for no reason other than some grave moral failing.  It is obviously an adaptation to retain nutrients in preparation of a possible famine... a famine that does actually occur in the lives of the working poor in this country who have the highest rates of obesity.  But what else is going on?  Is anyone asking?

If we were just fighting willpower, we wouldn't have a problem.  But we're not.  We're fighting a developmental system that's purpose is to deliver us to age 16 to breed and age 35 to care for our children's children and then conk out at age 50 if something hasn't eaten or poisoned us in the mean time by absorbing every scrap of food it can.  We're also fighting an environment designed around as little motion as possible and an economic system which depends on sedentary mental effort to advance humanity rather than physical effort.  And then there is the society that believes that health and good food are a commodity for those who can afford it because they have exploited those who can't for profit.  Tack on the public shaming so readily supplied to anyone who dares to do something about trying to be healthier.  She's not doing enough!  How dare you finish a good week with a cookie!  Why is that fat guy bothering with the gym?  I don't want to watch you jiggle while you run on and probably break the treadmill.  OMG Kirstie Alley put on weight again!!  And, frankly, I wonder if there isn't a systemic problem that we haven't looked for.  We know getting fat causes things like insulin resistance.  But what if there's another mechanism behind both?  And even if there isn't, why do we presume that this self-reinforcing system doesn't need to be interrupted so that people can actually make a difference with diet and exercise without becoming crazy, miserable, and unhealthy all for the sake of being slender?

No.  I don't believe that eating processed foods is slowly poisoning us and going raw vegan will cure the world.  That's just stupid.  But really.  What is the state of research on mechanisms underlying weight gain?  I keep hearing tiny little tidbits but most of them read like treatments.  Why should we assume that the natural state of the human body is in any way molded to promote slenderness and long, healthy lives?  Why shouldn't we be using medical technology to improve health with or without weight loss?  Because it's expensive?  Oh noes!  No one seems to mind that cancer treatment is expensive.  But treating high blood pressure?  Oh you shouldn't have to do that because I should just be less lazy.  Nice.  Working 8 or 10 hours a day isn't enough.  Got to spend half of the rest of the time running or picking up heavy things with no end and then four times as much time and effort into cooking fresh foods and becoming an expert on the drug properties of lentils versus whole grains and better make sure you get those eight hours of sleep or you might get fat!  There just aren't enough hours.

Need I mention that muscle gain increases testosterone, which would make people like me less healthy, not more healthy?

This isn't about me.  I have been pretty lucky and haven't gotten a lot of abuse from health care providers about my weight.  It's mentioned, but not belabored.  Which is good because I don't think eating as medicine and exercise as drug is emotionally healthy.  And while I'm still technically obese, I don't feel targeted by the weight loss propaganda.  But I know for a fact that my habits weren't behind my weight gain (I knew that before I got the diagnosis, but now I have proof).  I just wonder how many other people's weight gain isn't really caused by their habits.

This summer, a friend who will be interning with me and I are planning to walk after work three days a week.  I'm hoping this slightly more regular activity will help me get down another 10lbs or so by August.  I'm currently 3 lbs away from being "overweight" and getting further out of this red zone would be nice.  But am I really doing it for the weight loss?  Eh.  I really just want to move more.  This fat chick looks amazing in clothes :D

Funny last note.  As the Metformin has been doing its job and I've been losing this last 10lbs especially, my pants have been getting tighter.  Why?  Because I'm becoming female and everything is shifting downward.  Most of my loss has been off my chest wall, bust, and liver.  Measuring--that thing people depend on to pretend they're not obsessing unhealthily about weight--is now completely meaningless because my body shape is fundamentally changing.