Sunday, October 1, 2023

Being on phentermine+topiramate has been...strange.

5'11" male, 214 pounds at the start of my most recent weight loss journey.

My yearly physical said my triglycerides were high, so I decided it was time to take my weight loss more seriously. My prescription deductible was still a little rough on my pocketbook for Wegovy, so we decided on phentermine+topiramate to get me started until I could switch over to a lower-deductible plan.

Half an hour after I took my first combined dose on September 6th, I got laid off. I'm afraid I wasn't very concerned with proper nutrition or building good habits that first month. I got up, took my pills on an empty stomach, and went out in the evening to get a wrap because I was vaguely aware I had to eat something even though I had no desire to. I did go to the gym, but mainly just 20-30 minutes on the elliptical, not going too hard, reading something or scrolling Reddit on my phone.

First checkup, about a week ago: doctor told me I shouldn't be continuing to lose 14 pounds every month, because I was unlikely to be able to keep that level of restriction up once I was off phentermine, and it wouldn't be good for me in the long run anyway. I decided to try eating a bowl of cornflakes with skim milk the following morning, and discovered by accident that breakfast blunts the meds enough that I feel actual hunger again, and even a little bit of food noise, just much less of both. Time to start working on actual healthy eating habits, which is still a work in progress.

My point is...I think maybe I've had an eating disorder my whole life and just now realized it. Like, I still want food, and enjoy it, but the signals my stomach make feel like something I should attend to in the relatively near future with a little bit of forethought, rather than a reason to head down to Casey's for a a slice RIGHT NOW.

Pizza Ranch seems like someplace I might want to go if I were hungry, eat one plate, maybe another half a plate if I were really hungry. (If you're unfamiliar with the franchise, I'm sure you can still guess it should not be a frequent stop for someone interested in maintaining a healthy weight) It no longer seems like someplace I should go every other Sunday and eat myself sick to "beat the buffet" regardless of whether I am actually very hungry around mealtime. Same with ordering from Dominos or Papa John's...right now, I have no interest in eating terrible greasy pizza or mediocre breaded chicken, because I am not hungry. I understand that this is how mentally healthy people probably feel about food all the time, but the idea that you would just not want food because you are not hungry is new to me.

(It might also be relevant that I've switched out diet soda for tea recently and stepped up water consumption, but I'm pretty sure that's minor compared to everything else)

I still want my snacks and my carbs, sometimes, but it feels like a choice now instead of a struggle that's futile because I'm just going to go back and eat the unhealthy choice later on top of the healthier choice. I make the less healthy choice sometimes because I know I won't stick with a regimen where I never make that choice once I come off phentermine anyway, but it's strange for it to feel like an actual choice now.

When I count calories, I'm not thinking, "Okay, this is how many packets of peanut M&Ms we can fit in because I went under today, and then I'll have one more because I was mostly good, and then I'll make it up tomorrow" and then I don't make it up tomorrow. It's more like "I should eat a little more fish because I didn't get enough protein today....and since it's the weekend and in-budget, I guess we'll have the one packet of peanut M&Ms and I can finish the rest tomorrow if I don't feel like eating them all today." Having a snack smaller than family-sized and not wanting to eat all of it immediately is another new thing.

I even feel like doing things other than playing video games. I feel like working on my programming skills again. I feel like going outside and walking! I'm having a little trouble getting motivated to lift weights, but I'm going to try again Monday. I haven't felt this way in a few years. (I am, of course, spending more time on job applications than exercise right now, but I have a few scheduled over the next couple weeks, a couple of which I feel good about.) It probably helps that the extra energy makes me feel a little more inclined to cook a little bit.

I am worried about how much of this I'll be able to carry over once I have to come off the phentermine in a month or so. My doctor says I can stay on the topiramate for a while, which should help with my appetite, but not as much as the phentermine. On the other hand, it looks like BED might be my problem more than appetite, which means that the topiramate might be more what I need anyway. I haven't had significant brain fog from it. Hopefully I don't start experiencing it once I come off the phentermine.

I still have some work to do. I weigh just under 200 now, and I'm not very muscular. Also, I know if I don't cement good eating and exercise habits this will all have been an absolute waste of time anyway. If I catch myself falling back into unhealthy thought habits about food, I might need to see about therapy.

I know when I'm hungrier I will want to eat more, but I'm really hoping I can continue this pattern of taking a moderate amount of time to prepare myself reasonable amounts of mostly healthy food most of the time. It feels very liberating to feel like I have this control over what I eat that I've been missing before, and if I could keep some of it going forward, maybe I could keep something like a healthy weight going forward.

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