Dietitians and Anti-Obseity Bias

This Forbes article highlights an issue amongst dietitians specifically. However, this quote mentions the bias is more widespread.

But the students aren't alone in their beliefs and share the biases with other health-care providers, Puhl said, adding that other studies have shown that many health professionals have negative perceptions about very overweight patients. Patients have reported "very many examples of providers who really make very stereotypical comments that suggest that they are making assumptions about a patient's character, intelligence or abilities because of their weight," she said.

While I can understand a sort of self-selection bias to be found amongst student intending to become dietitians, to find this idea prevalent amongst many health-care professionals is disheartening. From my research when looking into weight-loss surgery, I found that about 95% of people fail to keep weight off for 5 years after starting a diet. From here that number is questioned, but mostly by changing the definition of success, moving the goalposts. About 80% of people lose 10% of their body weight and keep it off for a year.

What makes this all the more galling for potential patients is that many of them are the sort who are trying to lose weight. They are coming into the office in an attempt to get help to lose the weight they are having trouble losing by themselves. They arrive only to be looked down upon by the person they are hoping to get help from.

Oh the perversities of life; the situation seems not too much unlike a masochist going to meet a dominatrix in her office.

Continued Cycling

Other than about 2-3 instances caused by weather or interviews, I have ridden my bicycle to work for nearly two months straight. My route is about 7 miles long one way, which ends up being 70 miles a week just getting to and from work. Then on my off days, I usually get 5-9 miles of riding in each day, more when I missed a day riding my bike to work.

So I've averaged a little more than 10 miles a day.

Even more importantly though, I find excuses to ride my bike everyday. Even those days I can't ride to and from work I get at least 5 miles in. I don't think I've gotten less than 5 miles of riding for any day since mid-December. My energy level is through the roof and I feel great nearly all the time. (Except for when I have to ride 7 miles against a 20 mph wind. ugh.)

However, my appetite has gone crazy and I am having trouble controlling it. I may only lose 4 lbs this month which actually means I am losing ground on my 3 year goal. Of course, fitness appears to be more important than weight-loss. Diabetes and fitness and Survival rates correlate better with fitness than lower BMI for veterans(Trying to find studies for younger/non-diabetic people more analogous to my situation.)

BMI and its failings

I talk about my Body Mass Index quite a bit. In general, it forms a useful way to compare relative obesity for people of different heights. Of course there are several flaws in this mechanism.

However, people are talking about the failures of

From Malicious to Morbid

I had my monthly doctor's appointment yesterday and I now weigh 310 lbs. I am under 50 BMI. I'm now morbidly obese and not super obese. Yay.

Really, I'm happy though. That's a movement of 18 BMI from when I started about 14 months ago. I just don't want to celebrate yet; I still have a long way to go.

Originally I had set this as a very unrealistic 6-month goal. My much more realistic aim of losing 250 lbs in 3 years, putting me at 175lbs, is nearly 50% complete in about a third of the time. My doctor even offered to remove the skin tags on my neck for free if I could lose 200lbs.

All this makes me think back to why I started the diet in the first place: to prepare for a bariatric surgery. IN order to qualify my insurance required I complete a 6-month diet plan guided by a physician. Also, most surgeons fear operating on super-obese patients. Both those criteria are cleared, so, in theory, I am ready to go under the knife. However, surgery seems like a terrible idea right now. Why take the risk while the diet moves along well?

Pissing it all away

What is the actual chemical pathway of weight-loss? I tried to think this through logically and managed to get about half the story. Talking with my doctor revealed the second half.

To explain my thoughts

1. I was fairly sure that the actual weight of the food contributed very little to my long term weight. For the most part, food simply traveled through the system and any useful energy or chemicals were pulled out by various enzymes and bacteria. Basically the weight of input food was fairly close to the weight out output feces including the various enzymes excreted to digest the food. The only inputs that mattered would be those things my body actually absorbed. Fats, sugars, proteins, and minerals would be taken in while fibers and the like would simply keep on going.

2. I also figured other excretions such as sweat would be offset by input water.

3. The only input that was easily show to be less than the output was breathing. The body disproportionately absorbs oxygen compared to what it exhales, the converse being true of CO2. So I would take in O2 and exhale CO2. Losing a carbon molecule many, many times over. Silly me though, I didn't seem to make the connection that this was of course part of cellular respiration, which has water as a product also. Combined, these two products would make up most of the weight-loss caused by proper diet and exercise.

Though this reminds me of a revelation which shook up my thoughts on the body when it came. The idea that the digestive system really didn't absorb your food and the excrete the waste back into the system for elimination. Of course, my thoughts on digestion were hardly systematic before and many things fell into place after such an understanding. The moment of "Eureka!" really sticks with me though. This is about the closest I get to a religious experience, the moment of clarity when you realize a fact about the world and suddenly so many separate facts which seem to contradict each other spin around and fit together. This is why I say science is more than simply practical knowledge. Science has enriched my life even if I never find a useful thing to do with any particular piece of knowledge.

Cold Hands, Empty Stomach

The diet plan I set up for my time on Phentermine seems to be too much food. I find myself forgetting to eat for long stretches of time. Then, when I do eat, I only eat what I had planned to eat for the last meal. If I try to make up for lost calories, I feel as if I have eaten a feast. So, I'm not even hitting the 1400 calories on a daily basis.

This worries me. My hands, feet, and tip of my nose have started turning ice cold during these forgetful fasts. If I go too long, I suddenly lose all ability to focus on any task and must eat immediately. It's almost as if the narrator from Gauntlet is intoning "Your Hero needs food." over and over. Then I rush out, eat all of 360 calories and feel as if I am going to burst once the food hits my stomach 30 minutes later. If I try to use this 30 minute window to eat a respectable number of calories, then I feel nauseated later.

Though, I'm not really complaining so much as I am amazed. Still, I am looking forward to not worrying about my health as much.

Another worrisome development, I have developed periodic tingling and numbness/reduced sensitivity in my left hand ring and pinkie fingers. This radiates a bit downward into my hand, also.

The causes I can find in my research are diabetes and carpal tunnel. Diabetes has long been a worry, but is unlikely in this case. My urinalysis didn't contain sugar a few months back, so pancreas function probably wasn't decreasing. Plus, given the amount of time I spend typing about a computer in any given day, carpal tunnel seems the most likely cause. I have an appointment with my doctor on Friday of next week and will bring it up then.

Update: I realized that carpal tunnel syndrome affects fingers other than the pinkie. I found another source which suggest I have nerve compression and that I should splint my arm at night and take ibuprofen. Still going to talk to my doctor about it though.

Oats of Diets Past, Present, and Future

Yes, yes, I like puns way too much. Aren't I clever?

I made up a Diet Plan table on Google Documents to show my past diet plan, the current plan, and I am working on getting the future one done.

I know this may sound odd, but I am not really at all sure how much food I will want to eat after I get back off the phentermine. A lot of the eating I was doing during my lull in diet loss wasn't so much to feed hunger, but because something was telling me I needed to eat.

The nice thing about the Phentermine is that it helps me get used to smaller amounts of food again. I'm eating half portions for 2 out of 3 meals. (This scares me though, so I will be adding some vitamins to my routine.)

Still, I have serious doubts that I will be able to maintain a 1350-1400 calorie diet and maintain the exercise routine I have managed to stick to for the last week and a half. I may have to revise the plan, but we'll see when the pills run out. I remember in college I was able to eat a similar number of calories but I had to use nicotine as a meal replacement to do so.

Though, this reminds me of another funny thing. In both cases a drug cost was mitigated by the lower cost of groceries. I am buying almost literally half the amount of groceries I was previously. The phentermine is only $45/month supply so the groceries completely offset the cost. (I remember food being so much cheaper when I was broke.) The cigarettes of course were more expensive than buying food and left me feeling terrible. I will ramble about quitting some other time, as this is already "Too long, didn't read".

Getting my due from the devil

I found a way to describe my feelings about phentermine.

Phentermine is the devil. If I'm going to make a deal with the devil, I want to get my due. This past month I did just that.

Went to the doctor today and I had lost 22 lbs since last month. Big, big swing.

If you look at the second tab on the chart (the one with the graph), you'll notice that I went from being 28 days behind schedule to being 37 days ahead of schedule.

Of course, only about 12 lbs of this is "real" weight-loss. The first 10lbs or so came off easily and so were most likely the water weight people always talk about. I had most likely gained that water weight back when I was eating out the month before last.

Also, I've managed to keep walking the past few days. I am still trying to make it into part of my daily habit. Just a morning walk everyday before work.

So today is good news, but it's hardly time to celebrate too much yet. I want to make the changes I am working on become habitual before the 3-months on phentermine is up.

I'm also adding a menu plan to the left hand side.

Crazy Crash Diet

Yesterday, Saturday, I ate about 950 calories. I cut my lunch, supper, and one snack by half and my planned calories per day is now at 1250. However, the first day I was trying this was Saturday. Instead of eating my planned 320 cal tortilla for supper, I fell asleep. That's crazy. I even woke up and took a walk today.

Even weirder, I didn't bother taking my phentermine until around 3 hours after I woke up. I wasn't hungry until my usual time.

Another thought I had. On saturday, I took the pill at 9AM because I was taking my brother to the airport (2 hours away). So, I was able to stave off cravings long after the pill should have worn off. As best I can tell from my reading, each dose is effective for 10-14 hours.

Of course, while I was figuring out my new menu plan, I realized that previously I was eating about 2150 calories per day and still losing weight. The slow down and backtracking didn't kick in until I stopped walking entirely and started eating out.

My scale at home is reading 325 and it's rather consistently measured 3 lbs heavier than the doctor's scale. Maybe tomorrow will bring big news.

Slowest Speed-freak ever.

Last month, I gained 13lbs due to poor discpline in my diet. In response, the doctor prescribed phentermine to help get back on track.

Taking a stimulant makes me worry due to the associated heart risks. I suppose due to a lowered cholestrol count (From 207 to 91) that my risk profile is much lower, but still I worry. Of course, I was joking with a friend that I am becoming paranoid about being paranoid (one of the possible side effects).

Another effect, is that I have cut out almost all soda. I made the mistake of drinking a cafeienated soda while on Phentermine only once. It would have been a very productive time, if not for the extreme restlessness the combination caused.

I am trying to use this time to re-establish an exercise routine. I did go out walking 4 days in a row. Then missed 7 in a row. I have also tried using the bike I have up on a trainer (makes a normal bike a stationary bike), but my heart-rate always goes out of control. I have trouble regulating my pulse when I don't see how fast I am going. Though, that may not be the problem either. My heart-rate was always faster on a bike.

Still trying to come up with a good strategy to get exercise back into my daily routine.

Tomorrow, I am going to try riding the bike at a measured pace.

Mike Phelps News Network: All Phelps, All the time.

For the nerds.

History repeats itself minus the 'stache.


More relevant to myself, Michael Phelps and his 12,000 Calorie diet.

This really means, I need to get out and exercise. Walking, biking, and maybe swimming. I love swimming, but a gym membership usually ends up going to waste. Also, the last time I swam with any regularity, I would get out of the pool and quickly eat as much food as I could. Swimming really drives my appetite.

Birthday Blowout

Tomorrow is my brithday. In celebration, I went out to dinner with my parents.

Bad News: I don't know how many calories I ate. For anyone familiar with dieting, this is really bad. If you have no idea, you probably ate way too many.

We went to Olive Garden, and had a communcal salad bowl. The dressing being olive oil and vinegar. Lovely, smooth, oily without that greasy feel. Also, pure fat. At least the dressing.

We also had artichoke and spinach dip. Not only high in fat, but saturated fat. (They use cream cheese). Also very tasty. I had about 6 or so little bread slices loaded up with the dip.

Then of course came the dinner. I should have gotten a nice simple noodle and sauce combo with some vegetables on the side. I suppose I did get that, except the vegetables were eggplant parmigiana. (I suck at cooking eggplant. I'm just terrible. I tried soaking them in salt walter, as I was told and failed miserably and had the worst sandwiches ever. Really, worst ever.) The chef did not have my same troubles and I had excellent and fattening breaded and fried eggplant doused in marinara, mozzarella and parmesan. On the side I had a serving of spaghetti and pomodoro sauce I believe.

Of course, all during this time I was eating breadsticks. I had three lovely little breadsticks coated with butter and salt.

Then to top it off, I had a slice of lemon cream cake and two of those little Andes mints.

Convservatively, I ate around 3000 calories in one meal by my estimates.

Oddly though, the scale this morning showed me down to around 326 from 334 on 5/23 when I went to the doctor last. I wonder what the lag time is on weight gain from eating like I did.

Still, I suppose the best lesson I could take from this is that sometimes you can cheat big and not completely obliterate your efforts. I just need to make sure this isn't a weekly or even monthly occurrence.

Don't flush where you drink

I've only worked one day since I decided to stop eating at my desk. One minor failure when my mother stopped by and gave me a muffin.

Normally a muffin, would be a major blow, but in this case it was a very small no-fat muffin that my father made. They make a dozen muffins using oatmeal they grind up in a food processor instead of flour. As best I can estimate it's about 15grams of carbs or less. Much better than typical muffins which are 400+ calories on the low end.

Anyway, that's not what inspired me to post. I have been using water to blunt my cravings between "scheduled" snacks and meals.

While filling up my bottle I noticed something stomach-turning.

The water fountains are right by the bathroom. Whenever someone flushes, the flow into my bottle drops off by a half or more. I know the water going into the bottle is clean (as clean as tap water) but I still get a twinge of disgust when it happens.