Wednesday, September 10, 2008
I can't lose weight, no matter what I do!
At least two or three times per week, my patients tell me that they can't lose weight, no matter what they try. Often, they feel their metabolism or hormones are to blame. They would like me to test their thyroid levels and other hormones.
Well, for every one patient who legitimately is severely low thyroid or has their hormones "out of whack", there are a hundred who come back with completely normal lab values.
So, how do I, as their physician, try and help these patients when it would be harmful to prescribe thyroid medicines or appetite suppressants? Many physicians fall back on the old standby of saying "there is no metabolic explanation for your problems." As true as that is- and I certainly do tell patients this- that is NOT all there is to say.
Ultimately, we all know that losing weight means burning off more calories than we consume. What I try to make clear to people is that they need to take ownership of what they are putting in their mouth as well as how many calories they are burning off. It is human nature (proven in study after study) that we will OVERestimate our exercise and UNDERestimate our calorie consumption. The only way to truly assess this is to log what you eat- and I mean MEASURE it and log it as the day goes along; do NOT rely on your memory, or you'll forget the handful of chips or M&Ms that you grabbed from your friend's house/desk, PLUS log in the amount of exercise- count minutes and/or miles- and MEASURE it. Patients tell me all the time that they walk 2-3 miles in a half hour, but never break a sweat. Hmm... I don't think so. Try it on a treadmill.
There are a dozen easy, free calorie counters on the web that will help you catalog your ins and outs daily- pick one!
OR... try this: simply count your servings of fruits and vegetables each day. You need 5-10/day. A serving is roughly what you can hold in your hand. So yes, a big person (big hand) gets a bigger serving than a kid. A huge banana, for example, is likely two servings. An apple- usually one; a handful of berries or grapes- one. A huge lettuce/tomato/carrot/cucumber salad might be four or five servings.
BOTTOM LINE: fill up on fruits and vegetables, ten servings per day, and the protein, fat, and carbs that round out your plate (should be only one quarter of a round plate) will still likely add up to fewer calories than you need, and the weight WILL come off.
P.S. The only people who maintain weight loss in meta-analysis studies exercise daily. Yes, that would be every day, seven days per week. It's not magic, it's habit. And yes, walking counts.