Refuse To Regain

Question to Readers From Readers: Is Maintenance Possible?

RTR reader Rebecca from Washington D.C. poses a very basic yet incredibly complex question: Is maintenance really possible? Barbara and I will chime in with our thoughts later in the week, but we’re more interested in what you have to say on this subject. As always, leave a comment or send email to refusetoregain@gmail.com.

Here’s Rebecca’s email:

I've been reading your blog for the past several months. It's an excellent website. Kirstie Alley's recent interview on Oprah triggered me to write. One issue that I'd be grateful if you'd address are your views on why it is that maintenance seems to be so difficult for virtually everyone to achieve. 
 
I'm 46 years old, and I have recently lost the same 30 pounds that I've lost four times before in my life since I was 18. After 5 months of changing my eating habits, I'm back down to a comfortable weight range, where I'm wearing size 10 clothes, instead of the plus size clothes I was wearing. (My exercise habits have been good for the past 15 years or so; I've done 30-45 minutes of cardio and strength training regularly for this period.)
 
Each time previously, I maintained the weight loss (sometimes for a number of years), but somehow found myself back at the weight at which I started. I'm old enough to know that I do not have this figured out, and I am really struggling with thoughts about maintenance, the approach to take, and, most fundamentally, whether maintenance really is possible.
 
My life feels so much better when I am thinner. Being thinner doesn't fix everything, of course. But I feel so much better in my clothes, and I love not feeling out of control around food. I love not feeling anxious that I may be setting myself up for the unhealthiness of diabetes. More than with any previous weight loss experience, I feel that I've actually changed what I am eating (cut out processed food, refined carbs, sugar) in a way that has minimized "binge-y" feelings. Yet I still feel extremely worried and insecure about maintenance.
 
In my own life, besides myself, virtually every woman I know has been unable to maintain her loss over the long term. The only woman I know who has done so (a friend of my mother who has maintained probably for 20 plus years) is a long-time member of Overeaters' Anonymous. I see that the blogger on "pastaqueen.com" (linked on your home page) just announced a weight gain of 35 pounds, and other bloggers seem to have had the same experience (dietnakedblog.com, yawwblog.blogspot.com/). Oprah Winfrey and Kirstie Alley recently discussed the issue and their recent weight gains on Oprah's show.

Kate Harding, and the other fat acceptance bloggers, basically argue that maintaining weight loss is impossible, and women should simply accept themselves at the weight at which they wind up. I must say, I have a feeling like, "If Oprah can't maintain with all of the support and resources available to her, how is it possible for the average woman?" All of the scientific studies seem to suggest that it's impossible to maintain a weight loss (although I suppose there are those 10% of the persons who have done it).

Thank you for any thoughts, and thank you for this website.

Questions From Readers To Readers: Do You Still Have Food Demons?

By Lynn Haraldson-Bering

My Maintaining Diva friend Sondra will be featured in next month’s Weight Watcher’s magazine. Her story is online now. Click here to read how she went from an inactive 242 pounds to a sleek 129-pound marathon runner.

Sondra's story prompted an email question from reader B.B. that I wanted to throw out to all of you. Sondra's answer is below, but we'd love for you to offer your insights to B.B., too, all you wise, wise RTR readers!

Here's B.B.'s question: "You know I've maintained my weight lost for 8 years now, but I still have the demons that send me to the pint of ice cream or cookies or whatever every once in awhile. I'm curious. Do you? Does Sondra? If not, how did you finally release these devils; you know those devils called feelings, memories, insecurities, etc?"

Sondra's reply: "What a great question and I think it is one that every person on this journey has. I can honestly say that I do still eat foods that some would consider taboo…including my good friend, Lynn. (NOTE FROM LYNN: This is probably true. Ya'll know what a militant I am. However, in my defense, I do eat chocolate and stuff I "shouldn't" sometimes...LOL)  I allow these foods at times because I am a firm believer that if you tell yourself that you can never have something again, you will always crave it. Once you allow yourself to have a little you can learn to control it…at least I have. I also find that I have substitutes for many of the foods I felt that I could not live without.

"That said, when I have an urge to eat not because I am truly hungry, but because I am bored, upset, tired, happy, breathing or whatever, I do two things: I grab a healthy snack first - a few (4-9) plain almonds, a piece of fruit, a slice of toast with sf fruit spread or tsp of peanut butter, a cup of tea or coffee, or even a piece of strong flavored gum. If I finish that and still feel the urge to eat, I think about what I am doing and analyze again if I am truly hungry. If it is just that I really want that Entenmanns’s coffee cake (yes, that was my demon last night) then I portion out just a few bites - it might not even be a full serving - and I eat it. 

"There are times that I have cravings that I need to make sure it isn’t just my body asking for more of something - protein, iron, carbs, etc., and that is why I take the time to really think about why I am having 'hugries.'  I have found that if I am wanting something out of frustration or some type of emotion, writing it down helps the most. I am blessed that the Divas are great listeners, but there are times when I just sit and write in my journal. I have also taken up doing jigsaw puzzles again. It has helped with my nighttime snacking a lot. It even has slowed my dinner/meal eating down because we are a 'eat in front of the TV' family and I have been eating while working on the puzzle instead. I don’t find myself rushing through my food anymore.

"Do I still have demons? Heck yeah. The great thing is that we have learned to live together in harmony. They know they will only be placated sometimes. But most of the time I get my way."

What are your thoughts on B.B.'s question? Do you still have your food demons in maintenance? Leave a comment or send an email. As always, we look forward to your replies.

Doctor Phobia - Lynn's Response

By Lynn Haraldson-Bering

When I weighed 139 pounds for five minutes back in 1991, a doctor told me to lose weight. I was pretty disheartened with his diagnosis, especially since I’d just lost 50 pounds and was feeling really good about myself.

So what did I do? Did I step back and look realistically at the situation? Assess what I thought was best for me in light of what he thought was best for me? Nope. I tried for a few more weeks to lose more weight, and when the scale didn’t move, I beat myself up and gave up. I eventually gained it (and an extra 100) back.

This enormous gain wasn’t that doctor’s fault. Back then, I had a hierarchical view of the doctor-patient relationship. Doctors were always right and I knew nothing. I thought I always had to take their advice because, well, they were doctors and knew everything. I never questioned what they said or sought a second opinion. I allowed them to intimidate me because I lacked self esteem and respect for myself.

I remember going to an urgent care clinic when my lungs hurt and couldn’t stop coughing. I’d been sick for two weeks, but I refused to go to my regular physician because he’d make me step on the scale and tell me to lose weight. The doctor at urgent care didn’t care what I weighed. He just treated my bronchitis and chided me for not coming in sooner because I could have developed pneumonia. I had no problem being scolded for not taking care of my lungs, but I always felt like crap whenever a doctor brought up my weight. I always felt like I was a bad person for being fat. It took me years to get over that. Years of therapy, actually. Until I cared about myself, I based most of my self-esteem on what others, particularly doctors, thought of me. 

As Barbara said in her blog, Doctor Phobia, “Our knowledge of the body has become so vast that it has become nearly impossible for any one person to treat all of its parts. Yet in dividing up our bodies into the tiny territories of specialists, we’ve lost the overriding personal relationship that once defined a patient’s connection to his doctor.”

This doesn’t bode well for a person with doctor phobia, and I ache for people with horror stories and a reluctance to go to a doctor because of such negative experiences. But take it from someone who’s been there. If I hadn’t gotten over my fear (at least for the most part), I wouldn’t be as healthy as I am today.

Barbara also said: “There is no reason to be afraid of someone who has your best interests at heart.”

By rethinking the doctor-patient relationship, I’ve been able to see that no matter how insensitive they might seem, most doctors really do have our best interests at heart. I just had to get past the sting of their delivery and realize that what made me wince were my self-esteem issues. I allowed doctors to make me feel bad, even though that (probably) wasn’t their intent. I took their words far too personally. My darkest fear? That they were right and I had to change something about myself. Deep down, that was the problem. I didn’t think I could change.

When my arm doctor diagnosed a torn rotator cuff in my right arm in September 2008, I wrote about it. It’s taken me years to be my own best friend – in sickness and in health – and rereading that blog reminded me of how I used to “protect” myself, when really I was hurting myself by not seeking medical attention when warranted. I hope some of you find yourselves in my words or will find strength in them, knowing you get to decide what’s right for you. Your health is the most important thing you have. It’s worth protecting and standing up for.

I leave you with: “I’m The Decider.”

Some people’s bodies are temples. Mine is a drunken barroom with body parts going to hell like drunk people falling off bar stools.

My toes, feet, knees, wrists, elbows and now my shoulder with arthritis and a nearly full rotator cuff tear and biceps tendonitis – all of them are in some degree of disrepair. I feel like an old house with drafty windows and crumbling drywall. I need to get ahead of the destruction and find a way to stop or slow whatever is going on inside my joints.

I hate surgery and the thought of surgery and everything about surgery. It scares me. And no one has anything good to say about rotator cuff surgery. Everyone I’ve talked to – doctors, patients, relatives and friends of people who’ve had the surgery – say it’s extremely painful with a long and difficult rehab. 

A friend suggested that many of these stories could be like the ones we heard while pregnant, of how horrible childbirth was. They might be, but I’d sure like to hear from someone, anyone, who had a good experience with rotator cuff surgery and recovery.

Part of me wants to say forget it. Rotator cuff tears are not life threatening and the worse that could happen is that I lose the use of my shoulder. Guess what? I already can’t use my wrists and elbows the way they were intended so what’s the difference if I can’t use my shoulder? I can’t lift much weight the way it is. I have to be careful how I twist jars open, chop food, use a mouse, type, feed myself, wash my hair and the list goes on and on. So big deal if I become the Gimpy Grandma who can’t lift her arm above her head? I’m still me. I’m still a thinking, feeling, dreaming human being who can find ways other than using my shoulder to express myself.

I realize doctors want to heal. They want to make us feel better. My shoulder guy is a very nice guy, but he said, and I quote, “Lynn, you’re 44 with the shoulder of a 70-year-old…I don’t know what to tell you…I can let your decision go to not do something about your wrists just now (NOTE: he recommends a full fusion of both, eliminating my ability to move them in any direction), but I can’t let this injury go.”

Um, Mr. Doctor? Yeah, the last time I checked I, ME, I was the one in charge of what I do and not do. I am, to use my favorite Bushism, The Decider.

My doctor has no choice in this matter. He’ll have to “let it go” if I decide to let it go. He can choose not to see me as a patient anymore if I don’t take his medical advice, but he doesn’t get to tell me what to do.

Maybe that’s what’s at the heart of what I’m feeling. Like I don’t have a choice. Like everything about my body is being decided for me. Like I’m being talked about in the third person.

I don’t want to be the Bionic Woman just yet. Something tells me it’s not time. I need to sit back and regroup. Collect my thoughts. Investigate. Learn. Most of all, I want to enjoy the anticipation of my grandbaby’s arrival in five weeks. That’s gotten muddled in all this negative surgery talk, all this fear. I get my thoughts tightly wound into a ball that then behaves like a skipped record. Time to lift the needle. Time to turn off the turntable. Time to turn fear into power.

I might be crumbling to pieces like an old brick stoop, my body might not be the temple I desire, but I still am The Decider.  

Doctor-Phobia: Barbara Responds

By Barbara Berkeley

I’m trying to remember just when it was that people started to develop doctor-phobia. When I was a kid, my doctor was someone who was slightly scary, but mostly because he was from a different social class. He had nice suits, looked rotundly well-fed, and drove a Cadillac. Doctors were different then. They played golf and were off on Wednesdays, while our fathers worked in stores, factories and offices and always seemed short of cash.

On the other hand, my doctor was loved. I remember lying in my bed, hot with fever and waiting for the doorbell to ring. Dr. Shapiro would burst into the house full of a jovial bluster. “I’m coming, monkey!” he would shout as he bounded up the steps. Then he would smell like rubbing alcohol and his hands would be clean and slightly red from washing. His round face would be even larger and pinker than it seemed in the office with big tortoise shell glasses that covered most of this face. His magnified eyes, a watery blue, would peer at me excitedly. All would soon be well, his very presence shouted. After a bit of poking and prodding and a peek at my eardrums, I would get a shot of penicillin and be gifted with a little rubber monster with wiggly hands that could sit over the eraser on a pencil. Within a day, I would certainly be cured.

Dr. Shapiro did not simply make house calls and give shots. When I broke my leg in five places at the Roosevelt Stadium ice skating rink, it was Dr. Shapiro who set the bone. Months later, it was Dr. Shapiro who cut off the cast, got me off crutches and helped me to start walking again. Dr. Shapiro was the cardiologist who diagnosed and treated my father’s heart attack. He was the psychiatrist who dealt with anxiety and depression. He was the gynecologist who did PAP smears. He was the radiologist who read xrays. And, perhaps more than any of that, he was the calming, reassuring presence that confirmed that, yes, we were in good health once more.

Where has Dr. Shapiro gone? His kind of medicine has been erased and we all miss him. To some extent, his demise was inevitable. Our knowledge of the body has become so vast that it has become nearly impossible for any one person to treat all of its parts. Yet in dividing up our bodies into the tiny territories of specialists, we’ve lost the overriding personal relationship that once defined a patient’s connection to his doctor. We need to be whole, to be taken care of as a whole being. And something deep within us rejects being cared for as if we were a bunch of disconnected provinces.

Another problem has arisen as a result of advanced medical technology. In Dr. Shapiro’s day, you might expect to be sentenced to the dreaded “shot,” but that was about the worst outcome of any visit. Today, we live in fear that doctors will tell us that we need to spend an hour and a half in a claustrophobic, noisy, magnetic tube or to undergo cardiac catheterization or have this or that body part biopsied. We fear the result of our yearly mammogram, the report of our PAP smear. A visit to the doctor seems to have become a moment of judgement in which an often distant figure decides our fate. Drugs? Tests? Diagnosis? It all seems pretty frightening coming from someone we may not know very well anymore.

But there’s another side to this story and that’s the doctor’s side. As much as patients have lost, there’s just as much missing for those of us sitting behind the desk. A doctor’s power has always come more from the laying on of hands than from any specific knowledge, and in order to heal, a doctor has to have a patient’s respect and trust. When fancy tests replace the stethoscope, the gentle hand, and the listening ear, there is no room for a healing relationship to develop.

From the doctor’s point of view, there has also been a change in the very profile of illness. So much of our modern disease, particularly as we live longer, is tied to the way we live. Suddenly, doctors find themselves in new territory. They can either add drug after drug or they can try to counsel patients about changing the way they approach life. Medical school has ill prepared them for this task and thus many doctors are stuck giving the stilted, uncomfortable advice our commenters have described.

So, what to do? For the patient, I would suggest that good medicine, well-practiced, remains enormously valuable to your health. There is no reason to be afraid of someone who has your best interests at heart. So your job is to find that person. Since you are the consumer, I would suggest that you interview a number of doctors before you choose one. Make sure that wellness is as important to your physician as it is to you. Make sure, too, that your doctor will do everything possible to treat you as naturally as possible. Drugs are terrific, but only after lifestyle interventions have failed or when there are no other choices.

For the doctor, well…I can only speak for myself. I try to spend as much time with my patients as I can. I try to remember to touch them, to find out about their families and to worry about them. I try to keep in mind the fact that practicing medicine is an incredible privilege because of the access it gives you to people’s bodies and emotions. And I try to remember that facing a doctor can be scary at times.

On balance, I guess I’m grateful that I can rely on the latest CAT scan, the best MRI, the most detailed digital mammogram. But how I miss the jiggly little monster that used to sit atop my pencil.

Questions From Readers to Readers: Going to the Doctor

Time once again to ask you to answer a question for a reader. This month’s Questions from Readers to Readers comes from Trixie who actually posted this question in a blog I’d written over on personal weight site, Lynn’s Weigh, about a doctor who told his patients he hoped they gained weight over the holidays! Insane. Anyway, Trixie wrote:

“(T)his post makes me even more nervous to go back to the doctor. I honestly haven't been to a physician in about 7 years (OB-GYN, yes). I had such bad experiences when I was overweight with doctors being rude and insensitive and telling me that the actresses on magazine covers were "healthy" and should be my role models (hello, Hollywood is totally crazy!) that I don't trust them. Now that I've reached and maintained at my goal I'm scared to go back because I'm still at the upper end of the weight chart for my height and I really don't want some, excuse me, a**, telling me I NEED to lose more weight. I know that I might ultimately be doing more harm than good to myself by avoiding doctors, but I just don't know if I can put myself through it, or trust anything they say if they can't respect my weight. Does anyone else feel like this about doctors?”

This is a universal question for all stages of weight: obese, overweight, comfortable and maintaining. How do you find a doctor you’re comfortable with? How do you talk to a new doctor? How do you talk to your current doctor? What’s your relationship?

Send your answer via a comment or through email to refusetoregain@gmail.com. You can also submit a YouTube video and we’ll embed it into the blog post for reader comments.

Interesting topic. Let’s hear what you have to say. 

Here are a few comments we've received via email:

From Lynette: I would like to add a comment about finding doctors who will work in a supportive, compassionate way with those of us who live  the journey of health/healthy weight/maintanance.

1. Ask your friends for a referral to a Dr. who they have had a positive, professional relationship. Interview Drs. and be very clear about your goals, expectations and past experience. Find a Dr. who will work with you and not beat you up.

2.  Take back your power!  For too long I gave away my own sense of what was right for me because I always felt that since I was and obese person I had no rights.  No right to speak up and to defend myself and my health.  Again be very clear about your goals. I found a Dr. who worked with me at my heaviest weight, while I had stopped dieting and was working with a therapist.  He helped me and supported my goal of a healthy weight. I  found him to be supportive and compassionate, so I know that there are good Drs. out there! 

3. Accept where you are------I mean really accept it. Once I was able to accept myself with the same compassion I expected from a Dr, things began to turn around.

4.  Accept that our culture is screwed up when it comes to women and weight, diets and cultural expectations. Doctors are human and they believe the same junk I did until I changed my thinking. We as a society spend millions of dollars for weight loss solutions that don't work to only repeat the process. Find your own balance and ground around the whole diet and maintanance thing.

5.  I refuse to  be weighed in each time I went to the doctor.  It took the pressure off of me and my doctor was fine with it.

6.  Log on to Body Positive web site. They list practitioners who have a much balanced, non-judgemental approach to weight and health. 

These are a few ideas that helped me throught this tough issue. Hope some of these are helpful.

From Elli: Oh my gosh I can so identify with what Trixie said! And thank you thank you thank you for posting her comments to share with us! I feel like I'm not the only one in the world with this weird thing about going to the doctor anymore. Wow. What a revelation. Because most people have absolutely no hangups at all and I've always felt like such a freak.

The very first time I went to a doctor by myself was to get birth control pills. I was 18 years old and thought I was being responsible. And the doctor looked and pointed at my stomach and said "oh, is that an appendix scar?"  Flabbergasted and mortified I said "ummm, no...just a little stretchmark." I was always very shy and easily embarrassed and boy that didn't help. At that time I was about 20 pounds overweight. A few years later I went to another doctor for some pain I was having in my arm and he ridiculed me by coming to see him at all. He literally told me " you know, everyone has pains and lumps from time to time."  He was extremely condescending to me. And somehow those two experiences in my psychological makeup did something. I know it wasn't reasonable but it happened. It shaped me and my thoughts and I cannot seem to break out of it.

I have been to a few doctors now and then thru the years for serious things but other than that, no, I do not go. I don't want to go. I am terrified of seeing doctors or hospitals or anything medical in general. So far I've done a great job of keeping myself reasonably healthy. I stay on top of checking my blood pressure and cholesterol (with a home kit), eating right, losing 70 pounds, exercising almost every day, sleeping well, and all the other things I can do myself.  I know there has to come a point where I get over this but as to how to make that happen. I am clueless! It's a full raging phobia now after all these years. 

I am going to be 45 this year. I have such a mistrust of doctors and a really bad attitude about the way practices are run. I honestly feel like there's not a single doctor anywhere in my region who would work for me so why bother. Is there any hope for me?

To Elli I strongly encourage you to, before seeing a medical professional, perhaps talk to someone such as a psychologist to discuss your phobia so you can be more comfortable making an appointment to see a doctor. I know Barbara is going to address this issue in an upcoming blog, but I really hope you'll do something soon. Preventative medicine is the best medicine and now, when you're feeling good, is the time to get everything checked out in order to stay well.