Our formerly thin, physically active friend had gained close to 80 pounds following two years of debilitating orthopedic problems that left him with chronic back pain. His previous constant exercise, which included tennis, skiing, long bike rides, hiking, and running had kept his weight normal, but became no longer possible. Now he was able to move only with the help of a back brace and two hiking sticks that he used as canes.
“I am trying to lose weight,” he told us, “but it is slow going.”
When we were guests at his home, it was obvious how physically impaired he was as well as how hard it was going to be for him to attain a weight that would help relieve his back pain. The one day he walked on his long hilly driveway to point out a particularly beautiful landscape, he paid for it in increased pain the next morning. Simply moving from living room to dining room was difficult for him. He talked about how he never needed to diet before he developed a back problem because his level of physical activity kept his appetite down and burned off excess calories. A review of the relationship between physical activity and weight change confirms his experience. (“The Role of Exercise and Physical Activity in Weight Loss and Maintenance,” Swift, D., Johannsen, N., Lavie, C., Earnest, C., Church, T Prog Cardiovasc Dis 2014, Jan-Feb; 56 (4): 441-447.)
Routine physical activity like the type my friend used to do slows, or even prevents weight gain, without any change in calorie intake. And the long duration of many of his physical activities may even have dampened his appetite according to a very recent study published in the Journal of Endocrinology. (“Acute effect of exercise intensity and duration on acylated ghrelin and hunger in men,” Broom, D., Miyashita, M., Wasse, L., Pulsford, R., King, J., Thackray, A., Stensel, D., J Endocrinol. 2017; 232 (3): 411-422.) Now, however, the beneficial effect of exercise, when added to a reduced calorie diet on hastening weight loss is out of reach for him.
Told by his physician that a substantial weight loss might lessen his back pain has motivated him to decrease his calorie consumption. His strategy, as he told us, is to consume less than he had been eating. But he has lost very little weight over the past few months of attempting to do just this. His lack of success may be due to his inexperience in dieting. He doesn’t know how much he is eating, nor does he know whether what he is eating is particularly high or low in calories (he does know the difference, however, between salads and cake.) Another family member, who has never had a weight problem and likes to cook dishes containing high calorie ingredients, prepares his food. Butter, heavy cream, and cheese are routinely added and her sweet tooth motivates her to bake or buy cakes, cookies, pies and other desserts that are offered to our friend. Eating in restaurants for dinner (and occasionally both lunch and dinner) occurs frequently, and this adds to the uncertainty of how many calories are being consumed. Overly large restaurant portion sizes, and the habit of chefs to add butter or oil to food to keep them moist, also inadvertently boosts his calorie intake. And, unlike experienced dieters, he has not developed an eye for judging portion sizes and not eating the entire amount if it is too big.
None of this would matter if losing weight were for cosmetic rather than medical reasons. However, when weight loss is crucial to improving health, and, in his case, restoring lost freedom of movement and removing his pain? Dieting must be done with the same care and knowledge as any other intervention to improve health. The approach cannot be casual or haphazard, and would probably benefit from the professional services of a dietician or nutritionist. The type of diet must also be sustainable and balanced nutritionally for the many weeks it takes to lose the necessary weight. Many alleged quick weight-loss diets, so tempting because results after only a few weeks are supposedly so dramatic, often lead to weight gain as soon as the diet is over. (Remember the Oprah Winfrey’s famous fast weight-loss from a low calorie liquid diet, and the subsequent rapid regain several years ago?) Regaining weight is not an option when it may bring about a return of the medical problem like intolerable back pain. Thus the diet plan has to be malleable enough to change into a long-time maintenance program to keep the now lower weight stable.
Being honest with family and friends about how hard it is to lose weight and consequently asking for help will improve the chance of success. Imagine how much more weight our friend would have lost if his meals had been significantly lower in calories and size. Preparing meals at home that that could be made without the addition of fat-dense ingredients such as cheese would help reduce the calories he was eating. If others wanted to add more cheese to their dishes, for example, they could do so after the food was prepared. His problem in reducing calorie intake in restaurants could be solved by either eating in establishments that served normal-size portions, or ordering appetizers for a main dish or splitting an entrée. The temptation to eat dessert would disappear if it were not on the table in front him.
Dieting is like any new activity. As it is with playing the piano, speaking a foreign language, or planting a successful garden, it has to be learned. Instruction is needed, along with patience, the willingness to practice and make mistakes, and encouragement from others. And like taking on any new activity, even small successes are worthy and worth striving for.