Many of us have struggled with our weight all our lives. Even as children, our metabolism was slow and sluggish, leading to teenage or childhood obesity that persists into adulthood. This has implications to go well beyond the cosmetic issues related to obesity. Self-image and mental health, as well as relationships and job opportunities are affected by body weight. Many medical conditions are affected by excess body weight including heart disease, diabetes, and orthopedic problems. Obesity is also a risk factor for the development of breast or uterine cancer because estrogen levels are higher.
Achieving and maintaining weight loss is a lifelong process. As we age, managing our weight becomes more and more challenging. After the age of 40, muscle mass declines by an average of 1-2% per year. This means that our metabolic rate also declines by 1-2% per year and our capacity for sustained exercise declines by 1-2% per year. If we continue diet and activity levels that were established as a young adult into later life, we find that we will gain between 2 and 4 pounds each year. This amounts to a 20-40 pound weight gain over a period of 10 years, even though we are eating what we consider a responsible diet.
Much of the age-related loss of muscle mass is hormone mediated. For both men and women, testosterone levels steadily drop after age 40, and drop even more rapidly after age 50. Thyroid dysfunction is also more common in older adults, especially women. Metabolic rate declines with the natural loss of hormones as we age.
Preventing or reversing mid-life weight gain requires conscious and dedicated action on our part. Both sides of the equation must be addressed; dietary needs change as we age, and exercise becomes more important, even as it becomes harder to do. As our knees become stiff and our bladders drop, exercise becomes both more painful and less convenient, but no less necessary.
A delicate balance
Appropriate body weight is achieved by maintaining a delicate balance between nutrition and calorie intake, and physical activity. This balance point changes with advancing age, and also changes with occupational demands, physical health, and activity levels. Both sides of the equation are under the control of each one of us. Even those with marked physical handicaps can find a way to increase their physical activity levels. And everyone can control what foods they eat and the quantities thereof.
An adequate breakfast sets this stage for a successful day of diet control. While it is tempting to skip breakfast, particularly when dieting, the resulting hunger makes overeating later in the day almost inevitable. A good filling breakfast with just a little bit of sweets releases serotonin in the brain giving a feeling of satisfaction that lasts many hours.
Eating at bedtime, is very destructive. There is no physical activity to deploy the calories consumed and they end up stored as fat. You may have to train yourself to sleep through the night without eating. It is much like training a baby to sleep through the night. The baby might cry all night the first night, but by the end of the week he or she is sleeping without a midnight snack. So can you.
It is extremely important to restrict junk food. It is almost impossible to eliminate junk food, but if you keep healthy snacks, such as fruit and vegetables handy, you can reduce your intake of junk food. Sugary soft drinks are extremely destructive, adding calories, but no nutritional value. Making the switch to diet drinks is a horror if you go cold turkey. Make the switch first to water for several weeks, then adopt sugar free soft drinks to enjoy the carbonation without the calories.
It is impossible to lose weight while at the same time indulging in Little Debbie and Hershey’s on a regular basis. While an occasional snack may not be harmful, a habitual “just this once” will guarantee failure. Fast food can be your enemy or your friend depending on the choices you make in the fast food restaurant. The smell of French fried may be more than you can handle.
It is quite possible to learn to enjoy the smell of food without it creating a desire to eat that food. Once you eat the food you can no longer smell it. The smell is drowned out by the taste. To continue to enjoy the smell of it, just resist the urge to eat it. Learn to appreciate the smell of wonderful food, like fresh cookies, without being compelled to eat the fresh cookies.
Eat only when you are truly hungry. Eat only until you are no longer hungry – not completely full. And drink a lot of water. The more water you can drink, the more weight you will lose.
Be careful of the content of your drinks as well as your food. Sugary drinks pack a lot of calories, and they don’t have to be carbonated to cause weight gain. Excess sweet tea has almost as many calories as a coke. Alcoholic drinks also have a lot of calories. Alcohol itself has calories, and together with the caloric content of the beer or wine, can be a substantial source of excess intake.
Suggested Diet: For women, 1200- 1800 calories per day is sufficient depending on your height and age.
Keep track of how much you are eating and write it down. You may be eating more than you think.
I do not recommend any of the imbalanced diets popular today. These diets may be unsafe and are unsustainable in the real world. Similarly, a severely restricted 500 calorie diet may be immediately effective,but is unsustainable and unsafe. Numerous fads have come and gone over the years.
I would recommend the No Convenience Store / No Fast Food Diet. I need to write a book about it and get famous.
Any amount of exercise is better than no exercise at all, but exercise that is incorporated into your daily routine is more likely to be consistent and rewarding. Find a set of activities that you enjoy and mix them up so you won’t be doing the same thing every day. Build up your distance, improve your time, set a goal for endurance or strength, and make a game out of it. Make a habit of it. It takes 21 days of repetitive action to establish a new habit.
Muscle building exercises improve your metabolic rate and allow you to eat more without gaining weight. Exercise also stabilizes your joints and helps prevent arthritis and degenerative joint disease.
As you exercise, you will naturally gain more muscle mass. Muscle is metabolically active and burns a lot of calories. But muscle tissue is denser than fat. It takes up less space – your waist line gets thinner – but it weighs more. Your weight on the scale may actually increase instead of decrease. That does not mean you are failing; your body composition is changing. Don’t obsess over the scales. Look at the whole picture.
Don’t let the weather slow you down. You can bicycle indoors by lying on your back, propping your hips on your hands and bicycling your legs in the air. You can climb the stairs in a public building. You can walk at the mall. Join a gym that offers aerobics classes. A group setting and upbeat music can enhance the experience for you.
Your Ipod may be your best friend when it comes to exercise. Music makes the time fly and keeps your tempo up. Make an exercise playlist of fast-paced upbeat music that you enjoy listening to. Only allow yourself to listen to those songs when you are working out. That will help motivate you to get up and exercise. Music does amazing things to the human brain; it even increases your pain tolerance and endurance.
Hormone imbalances can contribute to weight gain or the inability to lose weight. Low thyroid levels, impending menopause, low testosterone levels, and inadequate cortisone levels can all lead to metabolic disturbances that influence body weight.
Low testosterone levels in women are associated with loss of sex drive, loss of energy, generalized fatigue, muscle weakness and resulting joint pain. If it takes more effort to get up out of a chair than it used to, you need your testosterone checked. If you can’t get yourself off the floor without pulling up on the furniture, you need your testosterone checked. A simple blood test can tell if your testosterone levels are too low.
Menopause and insufficient estrogen can cause hot flashes, night sweats, insomnia, vaginal dryness, pain with intercourse, and loss of sex drive. Even after the hot flashes have passed, sexual problems can continue indefinitely unless hormones are replaced. Many women experience both low estrogen and low testosterone, leading to serious problems.
Hormone imbalance can cause difficulty losing weight and can also threaten your relationships because of sexual dysfunction. Some women experience memory loss, inability to focus attention, anxiety, and depression, which interfere with daily activities and impair job performance.
Often when the hormone imbalance is properly diagnosed and treated, the weight problem solves itself as you regain lost energy and muscle tone. Metabolism is restored and the food you eat is used properly – for energy – instead of collecting as fat. Hormones can’t go to the gym for you, but they can make it possible for you to go to the gym, and actually accomplish something without that overwhelming feeling of exhaustion.
Testing includes a thyroid test, testosterone levels, estrogen, and adrenal hormone levels. Hormone replacement can be with pills, patches, creams, or pellets that are calculated specifically for you based on hormone levels and symptoms. If commercially available hormones do not resolve your problems, bio-identical hormones compounded from naturally occurring plant materials are available. Most insurance plans do not cover them, but the costs are moderate.
The risks of hormone replacement are real, and depending on the dose and route taken, may be substantial. Estrogen increases the risk of breast cancer and uterine cancer. Testosterone can cause oily skin, acne, facial hair growth, and aggression. Even natural bio-identical hormones have risks associated with them. It is important to keep up with regular mammograms and check-ups to catch problems early.
There is a role for medical therapy to assist in weight loss. If you are markedly obese, hypertensive, diabetic, or have orthopedic problems, medication assisted weight loss can be lifesaving. Medication is an adjunct to, not a substitute for the exercise and dietary measures we have discussed.
You should be tested prior to starting a medication regimen, with a kidney function test, a cholesterol check, a glucose level, and a blood count. Any abnormalities should be corrected prior to starting medications. All other medications need to be taken into account as well as your health history.
Ali is an over the counter fat blocker that prevents the absorption of excess fat in the diet. Side effects include diarrhea if you eat too much fat in your diet.
Adipex is a prescription stimulant that reduces appetite and increases metabolic rate. Side effects include headache, palpitations, insomnia, and jitteriness. It does not increase metabolism as well as regular exercise does but is an option for those who cannot do serious exercise because of orthopedic or other conditions. Adipex is a controlled substance because as a stimulant is can be addictive. Your use of Adipex will be carefully monitored and will not exceed six months at a time. Adipex generally is not covered by insurance.
Qsymia is available on a limited basis but is not covered by most insurance plans. It is a mixture of Adipex and an anti-seizure medication topiramate. Since it contains Adipex, it is also a controlled substance. The topiramate component can cause serious psychiatric side effects, especially if you are on other psychiatric medications such as anti-depressants.
Qsymia is very expensive. We often substitute generic topiramate and Adipex to achieve the same thing, but side effects including excess sedation are common.
Belviq is a newer medication that is not yet covered by most insurance plans but is on the market. It is similar to anti-depressants already available, it affects serotonin metabolism, and should not be used with other serotonin related drugs such as anti-depressants and migraine medications.
Medications should not be used long term – longer than 6 months at a time. They are not a substitute for diet and exercise, but rather an adjunct to healthy eating and increased physical activity.
Medications do not build muscle tone – only you can do that. They do not prevent you from eating when you are not really hungry; only you can do that. And they do not choose healthy foods for you – you are the only one with that authority.
The lap-band procedure is available in Marshall County from two of the most experienced bariatric surgeons in the nation, Drs. Groves and Britt. They have strict protocols for medical evaluation prior to surgery, and their success rate is impressive. To maintain your weight loss after surgery it is important to modify your diet and exercise habits as you grow stronger post operatively.
Surgical risks are important to consider, but the risks associated with uncontrolled obesity generally exceed the risk of surgery. Again, surgery is not a substitute for exercise and health eating, but rather an adjunct to lifestyle changes.
Summary: There is no magic bullet. If losing weight were easy, more people would do it. It is not easy. But if you are willing to put in the effort, day after day, one day at a time, you can do it. And you will have a lot more respect for yourself when you do.
Record your activities including walking, bicycling, swimming, weight lifting, stair climbing and aerobics. Include distances and times.
Record your symptoms of hormone imbalance – hot flashes, weakness, fatigue, loss of sex drive, etc.