I had promised a few people I would answer their questions about what I'm doing for weight loss and keep putting it off, so I'm going to post it to my blog and then I can link back to it if it comes again it. (Which it might, since I'm not done yet.)
I got most of this from a general practitioner I was seeing in Temecula, CA. He had at some point developed an interest in helping the morbidly obese lose weight and that had developed into a sort of side gig. He was a consultant at one point for Jenny Craig, and later for LA Weight Loss. That's all I really know about him. I'll explain a little about what it was he told me to do, why, and what I actually did, and why. And I will try to keep it short--so forgive me if I skip some of the details.
Dr. Whatshisface (I can't remember but if you live in Temecula and want me to track it down, I could with a few phone calls.) would begin by telling you that the single greatest health problem in the U.S. today is not obesity or heart disease but depression and anxiety and he would screen you for that first. If he decided you were depressed and you chose not to pursue treatment for that he would respect your decision but refuse to treat you for your weight issues because something like 95% of his patients with untreated depression quit on their own within three weeks anyway. So if you have a weight problem and a depression problem he would probably want me to convey to you that the weight problem is causing damage to your heart but your depression problem is what is ruining your life and to please address the depression first. In my case he knew I'd been referred to him by my therapist who specialized in eating disorders so we could check that box and move on. He didn't insist that you were *cured*--just getting treatment.
If you have tried and tried forever to lose weight and can't--I can't recommend enough the combination of talk therapy and diet.
Now the "diet" part.
Basically, according to Dr. WHF weight loss is a function of a couple of different variables including, but not limited to, your personal metabolism and the amount of calories that you consume as you are trying to lose weight. It takes a deficit of 3500 calories to lose one pound, no matter who you are, but there are very, very overweight people out there living each day on 1200 calories. (Things that affect your metabolism include but are not limited to your genetics and your activity level and the amount of food you eat.)
You can't change your genetics, but you can change your activity level and the amount of food you eat. HOWEVER, your metabolism will adjust to the new activity level relatively quickly (in a matter of weeks) which is why increasing your activity level will seem to have only a temporary effect on weight loss. (It can seem to have a greater effect than it does though since stopping will also have a negative effective on weight loss and it has a very good effect on mental health and stress reduction. People with less stress stay on their diets longer and lose more weight.) Dr. WHF recommends exercise but if you can only "deal" with *either* a diet *or* exercise, he's fine with picking the diet first.
Losing weight often motivates you to start exercising at some point anyway. Things get flabby.
SO. Dr. MHF would tell you to pick a diet, any diet--but you have to count calories for him. So do weight watchers or South Beach, or anything meant for long-term use (no cabbage soup or maple syrup diets), but use a program like FitDay (or there are others, often free, online) to track your calories. Keep your calories for any given day to 1500 or less. Don't go to 1200 a day without seeing your own doctor first and getting the okay.
If nothing out there appeals to you, he recommends: 1500 calories a day (I got the okay to do 1200), no more than 30% of the calories from fat. He recommends that you try to keep carbs to fewer than 80 grams a day--but you'd probably ignore that if you were doing weight watchers. I find that the best balance for me is a diet that is 40%/40%/20% protein/carb/fat, but this requires a lot of fish and most days are more like 30/40/30. (Fitday calculates all of this automatically for me. I just tell it I had a serving of rain bran and a half cup of skim milk and it calculates all the nutrients and percentages and sine waves I might need.)
So that's the diet. I eat whatever I want but watch the balance of nutrients and don't eat more than 1500 calories and a typical day for me is 1250-1350 calories when I am actively dieting. I eat chocolate and very small servings of Ben and Jerrys and anything else I want in moderation. I avoid trigger foods (bowls of pasta) and I buy very high-quality chocolates so that I can eat just one and feel "treated."
And this works pretty well. I tend to lose the first five pounds fairly quickly and the next five pounds pretty slowly.
And then I stop losing. This is called a plateau.
And Dr. WHF says the only way to deal with a plateau is to fix the underlying problem--the diet has killed your metabolism. The human body is best designed to fend off starvation. If you go on a reduced-calorie diet long enough, your body will learn to make the best of a bad situation. This is why it takes YEARS for an anorexic to kill herself. The anorexic body takes a while to eat its own heart. (Let's not make anorexia sound less dangerous than it is.)
The absolute only way to increase your metabolism over the long haul is to eat more.
So you quit the diet and very, very, very gradually increase the amount of food you eat. If it doesn't drive you crazy to count calories while you are no longer losing weight, the ideal rate is 200 additional calories per day, every 5 to 7 days. So if you were eating 1300 calories a day at the time you decided you hit a plateau, then you would go to 1500 calories and then 5 to 7 days later to 1700 calories and then 5 to 7 days later to 1900 calories and so on until you were at 2500-3000 calories a day. This will result (depending on your metabolism) in a weight gain of 3 to 10 lbs--but after a week or two at the top calorie level you go back on your diet. And 99% of people who do this lose all the weight gain in the first week back on the diet.
I can't count calories going up. It drives me crazy. So I just stop counting calories and use common sense and take a long break from the diet. It usually works out to two months on the diet and two to three months off.
I started this at 215 lbs in September of 2004 and I'm 167 lbs today. It's not a massive head trip because every time I start the diet it's "only" for 10 lbs. I really needed to lose 80 lbs in all and I took a one year break from November of 2004 to October of 2005 while we sold the house and move. So most of my weight loss was in one year. I hope to do again this year what I did last year which would put me at my goal weight by next summer (since I reached 167 back in June and just maintained all summer).
Using this approach has changed the way I deal with food. I get bored on the diet part but it's not so bad--I know it's only for 6 to 8 weeks. Then I can branch out again. Last time I was so bored with the diet that I decided to just do the Kellog's approach, LOL. I ate Raisin Bran twice a day and had fish and veggies for the third meal. This turned out to be a really healthy blend nutritionally--Raisin Bran has a nice balance of protein and healthy carbs and enough sugar on the raisins to make it taste good. (Have you ever had bargain bran Raisin Bran? Why does it taste so much worse? Target brand Raisin Bran in particular is awful. It's like pre-staled.)
So on the one hand--I have yet to see my pre-pregnancy weight (the first pregnancy. I passed Ben and Milo's pre-pregnancy weight a while ago) but I *am* at my lowest weight since having Max.
Also, I've gotten so I increase the amount of calories I eat at such a gradual pace during the maintaining phase that I don't even gain more than 3 lbs during the maintenance phase.
I feel so much healthier at this weight than I did at 215 that I could be happy here--so it's kind of ironic that I have every confidence now that 135 is mine for the wearing. It's feeling about time for me to tackle the next 10. I want to do that and be done with it before Thanksgiving :) Thanksgiving to Christmas is a very good time to be maintaining or gradually increasing the amount you eat--not losing!
But I think if Dr. WHF were here today he would say, "Let's get through this change in medications first, okay? Then we'll jump back into counting calories." So that's what I'm doing. The one and only negative side effect of weight loss for me has been that since I hit 175 the medication I was taking stopped working right. I couldn't sleep and I worried 24/7. I'm two weeks into changing meds and it's just going to be another month of white knuckling--assuming that the new med works fine. It's a med I've used in the past with great success, but it'll make you really sick, really fast if you increase the dose too quickly.
So I hope that all makes sense. The idea is to diet until you hit a plateau, then gradually consume more calories until you're eating a "high normal" amount of calories. Then go back on the diet and whoosh through the plateau and keep going till you get to the next one. It works well because it takes a large weight goal and breaks it up into smaller, more "do-able" pieces. You can time your "increase" periods to coincide with upcoming celebrations (say, a wedding) or holidays (say, Christmas) and after the second time you lose (having gone through one loss, one break, and a second loss period) you'll develop this wonderful feeling of "This works!" and it's all just so deliciously sane. At any given moment I'm not trying to lose more than 10 lbs. Oh yeah--another benefit? It's been really tough at times to make the mental adjustment to a new size. I saw myself as being 192 for LONG after I was no longer 192. It could seem like the fact that it takes "longer" is a real downer, but in fact, I think it is a huge part of why it works.