Tuesday, January 7, 2020

How I Learned to Stop Being a Fat-Shaming Doctor

I’m not proud to say that before I gained weight myself, I would tell my patients in my gynecologic practice things like,

“Eat less, move more.”

“Eat more vegetables and less junk food.”

“You would be healthier if you lost weight.”

I wish I could personally apologize to each one of those patients. Until I struggled with weight myself, I didn’t have the vaguest idea of how to be helpful to other people. In fact, I was harmful. If your doctor tells you that your weight is detrimental to your health, the implication is that you don’t already that, or that you haven’t tried, or that you just need to try harder.Are you ever again going to trust that doctor as a person who might be able to really help you with your challenges? In fact, why should you trust them at all, when all they have done is to pile on even more shame?

I imagine my words only made my patients feel worse about themselves and more discouraged about their prospects for change. I expressed warnings, but offered neither strategies nor support. Even worse than that, while I may not have overtly attributed their symptoms to obesity, that didn’t stop me from at least partially believing that was the cause. We live in a fat-shaming culture, and doctors are most definitely a part of that culture. I certainly was.

Before I gained weight myself, I just didn’t get it. Beginning at age 40, I gained 30 pounds over the course of 20 years. Like most of my patients, I knew what I should be eating. Like most of my patients, I tried various diets that worked — until they didn’t.

I became increasingly angry with myself, which only made things worse. Finally, thank goodness, something within me clicked: it was the realization that being disgusted with myself was not going to motivate me to change in a sustainable way. Instead, I decided to shift my thinking. I would think about being more active with my kids. I would think about being able to live an independent and vigorous life as an old lady. I was going to make more space in my brain by not playing the endless loop in my head about what I wanted to eat but shouldn’t eat or shouldn’t have eaten and now felt ashamed and undisciplined and hopeless.

Most of all, I made a commitment to stop body-shaming myself or anyone else.

Once I reframed wanting to lose weight into a new paradigm of wanting to take care of myself, the day-to-day strategies fell into place, most of which consisted of reframing what I “wanted” to eat. I gave myself constant, gushy positive feedback. I started every meal with vegetables. I planned ahead for what I was going to eat at the next snack and at the next meal. I committed to 30 minutes of physical activity every day. Aside from those practicalities, though, the truly significant change for me was insisting that I stop playing the self-loathing tape in my head. I became my own no-shame zone.

In six months, I had lost 30 pounds. And here’s the important part: it’s now seven years later, and I have not regained the weight. Sure, I’ve had temporary “relapses.” But I refuse to go back to that shaming, negative space again; and that’s what’s made all the difference. I get back on track with the mindset of wanting to take care of myself – because I owe that to myself and the people I love.

Once I had achieved success with my strategies, I then tried out my ideas with patients who were struggling with being overweight and who were open to trying something new. Together, we would devise short-term and long-term goals that were achievable and sustainable. The experience had to be positive. I was moved and excited by how many of these women were able to make significant changes – not just in their weight, but much more importantly, in how they thought about themselves and their bodies.

Along with a nutritionist and a therapist, I then started an education/support group for patients who were struggling with issues related to being heavy. We never talked about actual weights or calorie counts. Instead, we talked about changing our relationship with food. Every week for six weeks, these people shared their frustrations, their struggles, and their shame. But by the end of those six weeks, their mindsets had shifted dramatically. They began to learn that feeling good about themselves would result in, not result from, weight loss. Eventually, I even wrote a book with a former patient and current reddit user/u/Jarmani729, who lost 140 pounds and has been maintaining for five years. I urge you to read her story if you haven’t already – she’s so amazing!

I’m grateful to my patients for letting me enter a dialogue with them where I can offer support and encouragement. My suggestions may work, or maybe they won’t. Goals change. Strategies change. The important things, however, do not change: there is no judgment or blame or failure. There are only difficulties that are followed by new opportunities. It is all positive.

Here’s what I would say to my patients now:

· Your body is not enemy territory, and it has not betrayed you.

· Don’t body-shame other people, and don’t body-shame yourself. Don’t be your own bully.

· Being obese not a moral failing, and you do not deserve to be in solitary confinement.

· Reframe the way you think about your body. Move from “I hate my body” to “I appreciate what my body can do.” Do you have to love your body? That’s up to you. But surely, you can acknowledge what it’s doing for you right now.Your brain and eyes work — here you are, reading. Your body works — it got you out of bed this morning. You can take it from there toward moving in the direction of something closer to love.

· Honestly, I don’t care what you weigh. I care that you eat healthy food and that you incorporate movement into your life. I care that you don’t hate yourself. I care that you get enough sleep. I care that you spend time with people you love. I care that you go to the dentist twice a year and practice safe sex. The rest is up to you.

Feel free to contact me and ask questions. While I’m a physician, I will not give you medical advice. But I’m happy to talk about the medical research that’s out there and about my own journey. I am not extraordinary – I just got tired of letting all that self-criticism take up so much space in my brain, and I figured out a path that worked – and works – for me.

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A Word of Warning!

I’ve technically been losing weight since early 2018 but in the last year, I stepped it up a lot and lost around 70lbs. Overall, I’ve lost 106 lbs and have been feeling great. It’s the usual CICO eating about 1300 calories a day, every day.

However, I started getting some bad pains under my ribs a few days ago and upon a trip to the ER, it turns out I’ve created a good amount of gallstones and have to get my gallbladder out. The doctor told me it was likely due to the rapid weight loss over the last year. Beware the gallstones, guys! It may be common knowledge for a lot of people but I honestly had no idea that was a side effect of weight loss.

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Anyone else recovering from BED?

I am a 20 year old female. I suffered of severe anorexia from ages 13-16, but started to recover a few months before turning 17. But age 17 was the worst year of my life. I had crippling depression to the point where I attempted to end my life. Like many, I turned to food. With constant eating combined with my depression keeping me bed bound, my weight blew up. I went from 96lbs at 16, to 200 by my 18th birthday. I managed to maintain that 200 for a while, but it crept up to 210lbs. But I’ve successfully beat this disorder for the most part, and I am now 180lbs. It took so much effort. Not to lose the weight, that is the easy part. But to reprogram my mind. For 3 years, all I did was eat. I had to learn to tell myself that I don’t need all that food, and that’s a lot harder than people may think. It is hard as fuck. What really helped me was going for walks. Not for burning calories, but because it was a good distraction. And if I walked long enough, I’d be too tired to eat anyways upon coming home. Distraction was key for me. Also a big thing for me was realizing that recovery and weight loss will NOT be linear. There will be so many ups and downs. And if the weight goes up a bit, or I eat something I know I shouldn’t, I had to force myself not to be like “fuck it” and binge again

Anyone else have similar experiences to share? I’d love to hear from people like me and how you overcame it, or what you’re doing to try and get through it if you haven’t beaten it yet.

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I don’t know what else to do, why isn’t it happening? Why isn’t the weight shifting?

I (F33) started a very dedicated diet and exercise plan 15th May 2019. My starting weight was 104kg (229.3 lbs) and I am currently 93.5kg (206.1 lbs). I weigh myself once a month now. I weighed myself today at the gym, and I’m ashamed to say around 5 mins later, I burst into tears in the toilets out of frustration. I had lost a mere 0.1kg (0.22 lbs) since last month. How can this be? My weight loss has come to an near halt lately, and I have been more focused and dedicated on exercising than ever. I didn’t even eat Christmas dinner to keep on track, telling myself that my body doesn’t care if it’s Christmas or not.

I have been swimming 5-6 days a week, usually for an hour. Since September, I’ve been hitting the weights 4 days a week. I recently also started doing circuit training to get me sweating more. I basically work out almost every single day.

I am a vegetarian. I eat 1350 calories a day, 95% of what I eat is fresh, unprocessed food, the processed stuff is like tofu or a veggie sausage. I weigh everything to the gram and log my food, and pre-plan my meals.

I’ve had my thyroid tested twice, my insulin levels checked, everything is fine. What is happening? How can I work out every day, pushing myself, counting calories, eating unprocessed food and not lose more than 0.1kg in a whole month? And no, my clothes are not getting baggier. I don’t look slimmer. I’m confused as to what more I can do.

Has anyone experienced this? How did you overcome it? I don’t want to be fat anymore.

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Enough is enough

By making this account I am admitting to myself, and all of you, that my diet has been a problem. I'm not super out of shape - I'm an Army Officer who consistently scores a 290+ on the APFT (if that means anything to you). I've been hitting the gym 5x a week for the past 4 months and, honestly, I'm loving it. But I haven't been watching what I eat. I've always known that weight loss comes 99% from your diet but I've never wanted to acknowledge it because I love food and consuming large amounts of alcohol.

But then earlier this week I saw a video of myself and... holy fuck. The neck. the fucking neck, man. Back in high school I was a cross country runner weighing 135lb and looking at a side view of me you'd see a clear cut chin, jawline, and neck. But now it's just a diagonal line from my chin to my sternum. If I'm looking in the mirror and I look down at all - boom - double chin. I absolutely hate it and I;m sick of it. That and the slight gut/love handles. I know there's no such thing as spot-weight-loss, therefore: Enough is enough and I've got to lose some weight.

So. This is day 2 of my new eating/drinking choices. I've got MyFitnessPal Premium and I've set a daily 1600 calorie limit with 25% carbs (100g), 30% fat (53g), and 45% protein (180g). I'm trying to drink 1 gallon of water per day (not including water in protein shakes). I've cleared my fridge of beer, the goal with alcohol is to cut back what and how much I drink - I think quitting cold turkey is a silly idea. In the gym, I do whatever bullshit PT the Army has in store for us in the mornings and then after work I hit the gym where I'm doing a rotation of Coolcicada's PPL followed by ~25 minutes of cardio.

I think this is a specific, realistic, measurable, and achievable standard BUT I'd be happy to hear from y'all out there who are currently/have been through similar before.

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Round 2

I’ve lost 145+ pounds since September 2018.

I feel pretty great.

But the truth is I have been slacking for the last 6 months (Moving states, depression, getting married, holidays) and I have put back on 15 pounds since my lowest weight. I’m still really fat, at 5’4” and 219. Like I said, I feel great, but only in comparison to how terrible I felt before. I know I could feel so much better another 50-80 pounds down.

So I am back on the wagon.

I am hoping to get pregnant late March or April (we’re a queer couple, planning to do IUI or IVF). I would really like to be down at least 50 pounds at that point, but I understand that’s really aggressive weight loss, but I don’t think I can go ahead and get pregnant until I am at or under 185. I’m 38, so time is of the essence.

New for this round of weight loss is being on a very low dose of medicine for low thyroid function. My level was such that normally it would not be treated, but research suggest a narrower range for those trying to conceive, and that is the protocol my reproductive endocrinologist follows. I have a few weeks before I retest. As of right now I don’t notice any actual effects.

My plan is to return what worked that first time. That is increasing the amount of produce I eat to about 1-1 1/2 pounds per day (half raw). I can have a cookie if I want, but if I haven’t had my veggies I have to eat those first. My body likes the fiber and all the micronutrients.

Second, I am back to measuring and logging. I can’t tweak my diet if I don’t know what I’m eating.

Third, I am upping my water intake. Sometimes I don’t drink water, and it makes my everything grumpy and I seem to hold weight a little more.

Fourth, I’m going to stop eating at 830 each night. I just started a new job, so I’m not 100% on my meal schedule yet, but the goal is to get back to a 12 hour fasting window. I really don’t need chocolate at 10pm... really I don’t.

I am also upping my workouts, but that for me doesn’t help me lose weight if I just eat it all back, so that’s a separate thing.

So here’s to round two of weight loss and moving into territory unexplored in my adult life.

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Day 1? Starting your weight loss journey on Tuesday, 07 January 2020? Start here!

Today is your Day 1?

Welcome to r/Loseit!

So you aren’t sure of how to start? Don’t worry! “How do I get started?” is our most asked question. r/Loseit has helped our users lose over 1,000,000 recorded pounds and these are the steps that we’ve found most useful for getting started.

Why you’re overweight

Our bodies are amazing (yes, yours too!). In order to survive before supermarkets, we had to be able to store energy to get us through lean times, we store this energy as adipose fat tissue. If you put more energy into your body than it needs, it stores it, for (potential) later use. When you put in less than it needs, it uses the stored energy. The more energy you have stored, the more overweight you are. The trick is to get your body to use the stored energy, which can only be done if you give it less energy than it needs, consistently.

Before You Start

The very first step is calculating your calorie needs. You can do that HERE. This will give you an approximation of your calorie needs for the day. The next step is to figure how quickly you want to lose the fat. One pound of fat is equal to 3500 calories. So to lose 1 pound of fat per week you will need to consume 500 calories less than your TDEE (daily calorie needs from the link above). 750 calories less will result in 1.5 pounds and 1000 calories is an aggressive 2 pounds per week.

Tracking

Here is where it begins to resemble work. The most efficient way to lose the weight you desire is to track your calorie intake. This has gotten much simpler over the years and today it can be done right from your smartphone or computer. r/loseit recommends an app like MyFitnessPal, Loseit! (unaffiliated), or Cronometer. Create an account and be honest with it about your current stats, activities, and goals. This is your tracker and no one else needs to see it so don’t cheat the numbers. You’ll find large user created databases that make logging and tracking your food and drinks easy with just the tap of the screen or the push of a button. We also highly recommend the use of a digital kitchen scale for accuracy. Knowing how much of what you're eating is more important than what you're eating. Why? This may explain it.

Creating Your Deficit

How do you create a deficit? This is up to you. r/loseit has a few recommendations but ultimately that decision is yours. There is no perfect diet for everyone. There is a perfect diet for you and you can create it. You can eat less of exactly what you eat now. If you like pizza you can have pizza. Have 2 slices instead of 4. You can try lower calorie replacements for calorie dense foods. Some of the communities favorites are cauliflower rice, zucchini noodles, spaghetti squash in place of their more calorie rich cousins. If it appeals to you an entire dietary change like Keto, Paleo, Vegetarian.

The most important thing to remember is that this selection of foods works for you. Sustainability is the key to long term weight management success. If you hate what you’re eating you won’t stick to it.

Exercise

Is NOT mandatory. You can lose fat and create a deficit through diet alone. There is no requirement of exercise to lose weight.

It has it’s own benefits though. You will burn extra calories. Exercise is shown to be beneficial to mental health and creates an endorphin rush as well. It makes people feel awesome and has been linked to higher rates of long term success when physical activity is included in lifestyle changes.

Crawl, Walk, Run

It can seem like one needs to make a 180 degree course correction to find success. That isn’t necessarily true. Many of our users find that creating small initial changes that build a foundation allows them to progress forward in even, sustained, increments.

Acceptance

You will struggle. We have all struggled. This is natural. There is no tip or trick to get through this though. We encourage you to recognize why you are struggling and forgive yourself for whatever reason that may be. If you overindulged at your last meal that is ok. You can resolve to make the next meal better.

Do not let the pursuit of perfect get in the way of progress. We don’t need perfect. We just want better.

Additional resources

Now you’re ready to do this. Here are more details, that may help you refine your plan.

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