What Works For You May Not Work For Me
Monday, January 14, 2013
Last week, I described Mark, Julie, Gertrude and Janice, who each represented a prototypical cluster in the National Weight Control Registry.
All of them have lost a substantial amount of weight and have managed to keep the pounds off – but there are important objective and subjective differences between the four.
Before, going into the differences, it is perhaps important to point out the limitations of the ‘stereotypes’ that I have described.
They are based on the averages and/or common features of each cluster. So for e.g. While each could be the average age of the people in that cluster, it is impossible to be both male and female – so, as Mark’s cluster was the only one in which men made up a significant proportion of the group (~40%), I chose to make him a man.
With regard to the actual behaviours as well as the amount of calories consumed and expended through exercise, all of the NWCR data has to be taken with a certain amount of scepticism – they are all self-reported. As many of you, who read this and have participated in the registry, have rightly pointed out, the questionnaires and responses that you have provided (on which the registry data are based) may be both an oversimplification and approximation of what you actually do (which of course also changes over time).
Despite these caveats, here is what is evident: everyone, who has lost weight and is keeping it off is doing more than anyone I know, who is ‘naturally’ of a smaller size.
No one that I know of “normal weight” survives on 1400 Cal and the vast majority of “normal weight” Canadians do not even remotely get close to 2800 Cal of exercise per week.
Thus, no one (read that to mean – not one single person) in the NWCR registry is leading a lifestyle that is anywhere close to the lifestyle that a ‘normal weight’ person, not trying to manage their weight or obsessing about a healthy lifestyle, is leading – so here’s the first message to all ‘naturally’ normal weight people, who have advise on weight management – unless you have a professional degree or experience that qualifies you to give such advise – shut up (and I mean it!).
But before we get up in arms about thin people giving weight management advise – let’s also consider the advise that you can get from “naturally fat” people, who have “conquered” their obesity. As is evident from the NWCR (and my experience) – what worked for you, may not work for anyone else.
Imagine Mark, giving advise to Julie or Gertrude. I especially wonder what Mark would have to say to a Janice. Or imagine the advise that a Gertrude could give to a Julie. Or what possible help is a Janice to a Mark, you get the drift…
Not only, is what worked for you not necessarily the solution to everyone else’s problem, but just because you have lost the weight, does not mean you understand the issues relevant to others struggling with their problem – even less (perhaps) the issues of those large people, who are both healthy and content with their size.
Sure, your story is of interest and yes, it is good to know that you are managing, but this makes you no more an expert on obesity than surviving cancer would make you an oncologist.
Having said this – I sincerely love hearing your stories and there is little that I enjoy more than learning from my patients and readers – this continues to be a most humbling experience.
Especially as someone deeply rooted in the bio-medical aspects of obesity, my patients (and readers) have opened my eyes to the tremendous importance of psychosocial issues relevant to managing excess weight.
Incorporating these considerations into my medical practice is exactly what makes this field of health care so rewarding.
AMS
Edmonton, AB
Monday, January 14, 2013
Great points. I think I love the part where you tell the normal weight folks to shut up unless they have expertise/experience. I definitely have friends across the weight spectrum, and sometimes watching my “normal weight” friends tell my “obese” friend how to behave/eat/exercise is horrible; and they have a hard time understanding why I don’t side with them.
Monday, January 14, 2013
Thanks for this series. I liked it.
I’d describe myself as part Julie part Janice. I try to be a Julie I guess. I am extremely physically active, run 50-60 km/week, swim with a Masters group 3 x week. I am also a foodie. But like Janice, I struggle. At my highest I had a BMI of 37.8. I have a lot of difficulty getting and keeping my BMI below 25. The only time I was able to manage that feat was when I had an eating disorder — obviously not a viable solution. Currently I am at 27.
I find all of these fictional maintainers are consuming far fewer calories than I do, and I don’t know how they are able to manage that long term. I don’t count calories, but I do keep a food diary and every so often add up the calories for a recent day to the best of my ability, and I end up with 1800-2000 for a good day. Even that comes with a fair amount of obsessing about food.
It would be interesting if there were a way to test/quiz obese people who want to lose weight to find out whether they are more likely to fall into one cluster than another. That way they would not try to use Mark style tactics when they are more of a Janice, or whatever. Trying to use the wrong methods, or expecting that it’ll be similar for you as it was for another person, is just setting yourself up for failure, and it would better to avoid that if you could.
Monday, January 14, 2013
“Thus, no one (read that to mean – not one single person) in the NWCR registry is leading a lifestyle that is anywhere close to the lifestyle that a ‘normal weight’ person, not trying to manage their weight or obsessing about a healthy lifestyle, is leading – so here’s the first message to all ‘naturally’ normal weight people, who have advise on weight management – unless you have a professional degree or experience that qualifies you to give such advise – shut up (and I mean it!).” Dr B Sharma
I love this above quote….my hope is that it is shared with all healthcare providers/exercise ‘experts’
I have always tried to explain to people that I am not sitting on the coach eating bon bons and my weight has been a struggle on a number of levels for most of my life. I am high functioning, educated, work a 50-60 hr week, have a great marriage and kids, run a home and have an active social life. I try to meal plan, fit in exercise, drink my water, etc. The ‘ignorant’ sterotypes that are thrown around by’normal weight’ people that I work with, often doctors and nurses, is just not helpful. If someone that is overweight is already struggling with feeling of guilt, blame and self doubt the feedback received which is often inaccurate and irrelevant only leaves one feeling worse about themselves and their situation.
I feel even those who are professionaly educated and of ‘normal weight’ and working in the weight loss/weight management programs are biased. I wish there was research that could be done to explore this.
Thanks for your ongoing support and passion in this regard.
Monday, January 14, 2013
“Sure, your story is of interest and yes, it is good to know that you are managing, but this makes you no more an expert on obesity than surviving cancer would make you an oncologist.” What a great quotation, Dr. Sharma!
This piece is a great reminder that our experiences are just that – *our* experiences, and advising based on them can be at their least powerful, fruitless, and at their most, dangerous (if advice is taken that hasn’t taken into account other medical or psychological/emotional problems).
It’s true with obesity and it’s true these days with all kinds of medical issues. We pretty freely give each other dietary and lifestyle advice on everything from the common cold to cancer – and I think part of this has to do with the much-increased availability of information, combined with a very human problem of wanting to *do* something, to intervene, on any
difficult topic, rather than sit with the deep discomfort and at times the powerlessness of being able to really change something for someone else (certainly part of it can be a desire to be helpful that keeps us spouting suggestions and “information”) – and that’s only responding to when the other person feels it’s a problem: it can be at least as hard to accept that some people are “healthy and content with their size” at larger sizes if you, the listener, cannot imagine that being your reality.
I think being confronted with someone else’s weight, or their struggles with it, or their at-easeness with it, can bring up bucketloads of anxiety for all kind of personal and societal reasons. What would it be like if before giving that “advice”, we all stopped for a minute and just reflected on how we were feeling and what we were really trying to make happen by saying whatever’s on our minds? My guess is alot would change, and for the better.
Thanks as always for the thought-provoking blog.
Monday, January 14, 2013
Great post Dr S! I’d like to mail a copy to everyone who thinks I am “obsessed” with exercise, or “pushing myself too hard”.
Monday, January 14, 2013
Really an excellent series. My physician asked me for *my* advice last year. I told him what appears to work for me only partly works as it is a constant struggle and involves nearly two hours of exercise a day along with diet. I can’t say it is successful or that it would be for anyone else.
These days, when people ask me “how do you do it?” I tell them it probably wouldn’t work for anyone else – they have to find their own path. Then I change the conversation and say the real task for them as well as me is to make sure our children stay in the normal range – that they eat right and get enough physical activity. That’s what led to my problems in the first place.
Monday, January 14, 2013
This has been an interesting series to say the least. I do agree with Dr. Sharma’s comments. I would like to add that since I have lost and maintained a significant amount of weight I have learned that it is not the “how” of doing it that people want to know about. I believe the people that I meet that are upset about their current condition mostly want to know there is hope for them. It is why they take time to go to a physician, a dietician or the gym.
I think hope is an under rated attribute today. Hope gives everyone a positive outlook on their future. That is why obese people keep trying to accomplish their goals, despite devastating repeated set backs.
I always share my experience with others, because I see how my success builds their hopes, their resolve and their attitude about their potential to solve their issues.
I am always careful to avoid giving negative advice about their current efforts. For anyone that has lectured an obese person about “how their way won’t work and why”, it should have been painfully obvious to you just by the recipients facial expression how devastating your 2 cents can be, especially when the obese person is optimistic about the choices they are making.
Tuesday, January 15, 2013
Thank you Dr. Sharma – you always succeed in helping me feel more like a ‘normal human’. I absolutely agree with you that psychosocial issues may be the most important for managing weight. I couldn’t even think of starting even a cleanse without dealing with the hurts and patterns suffered and developed around food, and from a very early age (e.g. memories of being left in my crib hungry and crying while my Mother was busy with 3 other siblings under 6). In co-counselling we call some of these patterns ‘frozen needs’ which are needs that will never be met no matter how much, when and what type of food is consumed. Recognizing how I use food has been the only way I’ve been able to loose the unwanted weight, and after 50 or 60 more lbs, how I will be able to maintain the loss, so I believe. Only time will tell, and a whole bunch of counselling, organizing, preparing and positive thinking. Its such a time consuming thing, but so are many other important and necessary things in life. Begrudging the effort is not going to help.
I’m glad I found your site!
Tuesday, January 15, 2013
I guess I’m the opposite of Jodi K. Instead of encouraging and providing “hope” for long-term weight loss, I think it is important to merely affirm the humanity of people without regard to their weight, despite their weight. To affirm weight-loss efforts that may in the long run fail is akin to affirming someone’s decision to divorce a spouse. If the two divorcees get back together, then your affirming comments — “Good for you for freeing yourself from that #%@*&!*” — will haunt you. Affirming someone for losing weight has about a 97% chance of creating awkwardness when Jo Friend “remarries” the weight she freed herself from.
I go so far as to tell people to do as I say, not as I do, unless they really find what I do appealing. And what do I say? “Live joyfully most of the time, eat healthfully most of the time, exercise most days and treasure the body God gives you.” That is all. And that advice will NOT result in long-term weight loss and maintenance for most people.
Friday, January 18, 2013
Hi Dr. Sharma,
I think this very small group of long term maintainers may have different neural circuitry wiring than most of the population which allows the conscious desire to over power the basic (unconscious) biological drive.
These people also report being constantly hungry and feeling cold.
Take care,
Raz