Friday, January 11, 2013

Successful Weight-Loss Maintainers: Janice, the Struggler

In contrast to Mark (the Golden Boy), Julie (the Fitness Enthusiast) and Gertrude (the Poor Eater), who all appear to be managing rather well, Janice, is having a hard time and continues to struggle with her weight.

Janice (whose story I made up), represents the fourth cluster in Lorraine Ogden’s analysis of weight-loss maintainers in the National Weight Control Registry, published in OBESITY.

While the folks in the other clusters had either no (Mark) or rather mild (Julie and Gertrude) family histories of obesity and did not have a significant weight problem till their late teens or adulthood, Janice’s mother and older brother are both severely obese. As Janice clearly recalls, teasing and bullying about her weight started back in Kindergarten.

Not surprisingly, Janice, at 45, is younger than most NWCR registrants and despite having lost over 100 lbs, still has a BMI of 29 (down from 45). Although, she has maintained a significant amount of weight loss for the past 5 years, she continues to weight cycle often regaining 10 or more pounds, before getting “back on track”.

Janice is single, has a few years of college (which she never finished), and works as a stocker at a local super market.

Despite her relatively young age, Janice has struggled with hypertension, type 2 diabetes, sleep apnea, arthritis and major depression.

Janice has tried almost every commercial weight loss program, has taken over-the-counter diet-pills and prescription anti-obesity medication (which she can ill afford), and has even seriously considered bariatric surgery (but lacks coverage).

Her current “success” is the result of continuing struggle using virtually every trick in the book (keeping meticulous food and exercise records, counting calories, limiting her intake of many high-caloric foods, occasionally using meal replacements and low-calorie diets, regularly weighing herself, not eating out).

She struggles to maintain an exercise routine of about 2500 Cal per week and tries to limit her caloric intake to about 1500.

She is the first to admit that any challenge like vacation, illness, change of season, or increased stress at work is likely to make her “fall off” her diet.

Despite her considerable weight loss, she is anxious to lose even more weight, is very dissatisfied with her appearance and feels stressed out about most things in her life.

While Janice makes up about 25% of registrants in the NWCR, she is clearly the kind of patient, most likely to be seen in a bariatric centre (where average BMIs tend to be around 50 and childhood onset obesity is the rule rather than the exception).

Having met many patients like Janice in my practice, I would not be surprised if Janice also has a history of childhood trauma or abuse, an alcoholic dad, has struggled with anxiety and panic attacks most of her life and has more than once contemplated putting an end to it all.

I am certain that many readers of these pages will immediately recognize patients like Janice and it is no surprise that these are not the people for whom simplistic “Eat-Less-Move-More” mantras are likely to work.

Indeed, I am surprised that Janice has even managed to make it into the NWCR; very few people in her situation do.

Whilst, Mark, Julie, and Gertrude, may well have found their “Best Weight”, Janice, even at a BMI of 28 is well below a weight that would be considered reasonably sustainable. This is clearly evident in her constant and daily struggle.

Thus, although, Mark, Julie and Gertrude may seem to have “conquered” obesity and are often held up as exemplary “success stories”, it is Janice who commands my deepest admiration and respect.

Of all clusters in the NWCR, it is clearly Janice who has fought the greatest battle and continues to put in the greatest effort (in my books, if you spend a lot of time doing something you either don’t mind or even like doing, it does not count as “effort”).

It is clearly people like Janice who will likely benefit most from ongoing interdisciplinary medical and perhaps surgical care as well as psychosocial support.

Now that we have met the typical “success” stories in the NWCR, we should discuss what this exercise perhaps teaches us about obesity management – but I’ll save that for next week.

AMS
Edmonton, AB

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7 Responses to “Successful Weight-Loss Maintainers: Janice, the Struggler”

  1. Miranda says:

    I know a Janice. She is constantly judged and pressured to ‘make an effort to lose weight’. People tell her “it’s so easy”. This causes her to blame (and possibly hate) herself at times. The sad thing is, she’s actually already doing everything she is able to do to lose weight. Society does not understand the Janices of our world.

  2. Phyllis says:

    I AM an shorter older Janice who had a RNY 20 years ago, and have been a member of NWCR for about 5 years. Bariatric surgery brought me from 271 down to 160 and then a creep back to the 190s. 8+ years ago, I started logging all my food in a computer software journal, and lost to a “normal” BMI of 115. For the past 7 years I’ve been struggling to maintain in that weight range, with a 10 lb creep to 125, despite my best consistent, onging efforts. My Food Journal record tells me that out of the past 3036 consecuitve days, I have no missing data…which means I’ve logged my food every day for 3036 days … so far… every day adds a number. For more details you can read ABOUT ME at my website which can be found at: http://www.diethobby.com/index.php?n=10&id=10

  3. Phyllis says:

    Adding to the above post: At 125 lbs, my current BMI is 24.4.

  4. SLCCOM says:

    “Janice” sounds very much like she has an autoimmune disease, with that constellation of symptoms. Do you test your patients, and send them to a rheumatologist?

  5. NewMe says:

    In this post, you say:
    “Having met many patients like Janice in my practice, I would not be surprised if Janice also has a history of childhood trauma or abuse, an alcoholic dad, has struggled with anxiety and panic attacks most of her life and has more than once contemplated putting an end to it all.”

    Although I don’t question your clinical experience, I think there are many overweight people who struggle to keep their weight down (and usually don’t succeed) simply because they were never meant to be slim in the first place. In fact, you yourself said that Janice has an obese mother and brother.

    I know that you recognize the hereditary aspect of weight. If one comes from a long line of hefty people, one is much more likely to be solidly built oneself. There are many people who have always weighed more than the norm, from the very beginning of their lives and this excess weight is not always traceable back to being fed Coke from the bottle or being stuffed with Cheezies as soon as they could eat solid food.

    Yes, emotional trauma can play a huge role in severe obesity. But so can yo-yo dieting and the trauma of being picked on constantly as a child just for being slightly chunkier than the norm. I firmly believe that many obese people would never have reached such high weights if they had been accepted as normal and encouraged to be part of the mainstream at BMIs of 29-30 (I think the BMI is crap, but I use it here for illustrative purposes only).

    I consider myself lucky to not have dieted myself into obesity. I’m just overweight. Always have been, always will be despite my addiction to regular moderate exercise and eating of a variety of healthy foods in moderate quantities.

    I also expect to receive negative reactions to this comment from readers of your blog who cannot accept that some of us are just fat, just like some of us have brown skin, or blue eyes or curly hair.

  6. struggling like Janice says:

    Geez… she sounds just like me. :S

  7. Mir aka Princess Dieter says:

    I’m a struggler. I have a history of depression and anxiety issues, and almost became agoraphobic at age 12, seriously. I had Metabolic Syndrome and have hypothyroidism. I’m 52.

    Tried many diets over the decades. Finally lost 123 pounds, but have regained some, though still out of “obese” range, just barely. I began exercising before I could control calories–2 years with a trainer before I got a handle on the binge-eating and food issues. I still would rather sit and read and eat pizza all day, but I choose otherwise. I’ve pretty much maintained the major loss for 1.5 years, but I do have to keep focusing on it and I do struggle. I wish I was like the Golden Boy Mark. :D Ah,w ell….

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