
The Weight I Carry - danso
https://www.theatlantic.com/health/archive/2019/01/weight-loss-essay-tomlinson/579832/
======
nxc18
Being significantly overweight is really tough. Body issues and shame make it
so much harder. I wish people would understand that better. There’s a pretty
nasty cycle of looking in the mirror, feeling like shit, eating to not feel
like shit (the key problem step - note that it never actually works), looking
and feeling like shit because you eat too much.

I’ve lost 70 pounds in the last ~7 months. 50 pounds to go. I’m successful for
the first time because I’ve gotten over my image issues, I’ve accepted that
losing weight necessarily involves being hungry at least some of the time, and
I had a ‘spiritual’ experience.

They’re damn right that it gets harder to lose weight every time you do. My
metabolism is miraculously “efficient”. The insight is that you have to accept
that and eat to the amount that hits your goals, not try to find some miracle
diet.

Also, IME, exercise makes me hungry for more calories than I burn. Exercise to
get healthy, treat the metabolism boost as a bonus. Exercise does not cancel
out foods (this is speaking to fat people like me - if you’ve been skinny your
whole life your body probably works differently).

~~~
joeskyyy
> Exercise to get healthy, treat the metabolism boost as a bonus. Exercise
> does not cancel out foods

Thank you! Exercise should be completely supplemental to overall health, not
to lose weight. The amount of times I've seen people eat an awful meal while
trying to lose weight because they "worked out extra hard" is astonishing.

Losing weight is almost completely related to what you put in your body. While
you _can_ certainly lose weight from exercise, it's by far not the most
profound way to do so.

Congrats on your weight loss by the way, former fat kid myself, I know it's
not an easy process and keeping it off is just as hard!

~~~
JKCalhoun
Yep, it's the food. I took up running four years ago, but saw no real effect
on my weight. (Def helped me from getting winded and made hiking fun, etc. —
so exercise is cool, no doubt).

I had a medical emergency early last year that caused me to cut my food intake
(I feared too large of a meal would cause another medical emergency). So I
looked at the plate of food in front of me, measured out what I thought was a
"reasonable amount", and ate only that. No seconds.

Within two or three months I dropped 20 pounds.

Had surgery at that point. After surgery I no longer worried about medical
emergencies so I resumed my original eating habits.

And steadily put the 20 pounds back on.

------
zachruss92
I feel for the author. I have also struggled with my weight my entire life. At
my heaviest, I was 265lbs. I definitely struggled, and continue to struggle
with body issues. I was definitely addicted to food and was an emotional
eater. I literally had a term called "stress cheeseburgers" as when I was
stressed that's what I'd do.

I finally decided to make a significant change last year. It started with me
doing meal prep for my lunches. Previously I would eat out for lunch every
day, and I would never make good choices. I was able to lose about 35lbs by
just doing that and making no other changes in my life.

In August, I decided to start the keto diet. I started not for the weight loss
reasons, but for the lifting of the "brain fog". I didn't realize how much
carbs controlled my life until then. Eating keto 100% changed my life for the
better:

* My relationship with food has completely changed. I am now concerned about what I'm eating, nutritionally speaking, instead of just quantity and taste. I am eating a lot more whole foods.

* My overall pain level has gone down significantly (I have back problems).

* I literally crave vegetables. My first couple of weeks I ate nothing but bacon and other unhealthy meats. After a while, all I wanted was a big plate of broccoli!

* I have much more energy and mental clarity. I also noticed my recovery time from working out is lessened.

As of this morning, I weigh 196lbs. I don't know how long keto is sustainable
for, but I plan on sticking to this for the long term. If I do stop, I will
definitely apply the lessons I've learned from going keto: mostly eat whole
foods and carbohydrates that have nutritional value.

~~~
guitarbill
For me, with keto, I have much less of a hunger feeling, making things more
manageable (As I've said in another thread). Agree with the mental clarity
also.

How did you stick with it though? I can do the diet, but find it hard to do
with social stuff. For me, doing keto was quite a lonely thing.

~~~
misiti3780
how long did it take you to go into ketosis - im on day 10 and still havnt not
gone in (im not really overweight)

~~~
bonestamp2
How are you testing... urine strips? For me, I can feel the difference in my
brain when I change over. It's subtle, but I'd compare it to the change in
feeling when you drink caffeine after not drinking it for too long.

~~~
misiti3780
im also drinking exogenous ketones too now

------
johnkpaul
I've been 400 pounds most of my life. I empathize with every single sentence
in this article and cannot imagine making myself write something like this.
The vulnerability is incredible.

I'm really glad that exercise is being called out as useless to treat obesity
more and more. I hope that trend continues and things like Michelle Obama's
"Let's Move" campaigns never happen again.

Carbohydrate addiction is no joke, even though most don't believe it exists.

~~~
neaden
While I agree exercise isn't very effective to treat obesity, it is still
healthy for you to exercise, even if it's not going to help you lose weight.
There are a lot of people who are overweight who have healthier hearts and
lungs then normal weight people due to exercise.

~~~
cflewis
I can not give you more +1s. If your goal is to be healthy, and not
necessarily be pretty, exercise is integral. You can be skinny and be
unhealthy. You can be overweight and be heart-healthy, if you exercise.

I am obese according to the BMI, but I run 3 times a week and my resting heart
rate grazes into the "athlete" territory. My doctor is very happy. But I don't
look it, that's for sure. I do not like running. I see it like brushing my
teeth. I don't like it, but I do it because I have to if I want to maintain my
body.

~~~
adrianN
Are you concerned about your joints? Running is pretty hard on the knees even
for skinny people.

~~~
ashtonbaker
I have always felt that this is a myth or misconception. Humans probably
evolved as distance-running specialists [1] so it would be pretty strange if
our knees were some sort of exhaustible resource as seems to be the popular
idea. If people have trouble with their knees, I think there are lots of
potential explanations, for example running too far or too fast before
building fitness, which includes conditioning of stabilizer muscles in the
knees, or poor running form caused by lack of fitness or encouraged by modern
running shoes. I'm a bit biased, but I don't like to see the sport of running
blamed for these things.

[1]
[https://en.wikipedia.org/wiki/Endurance_running_hypothesis](https://en.wikipedia.org/wiki/Endurance_running_hypothesis)

~~~
adrianN
Humans also evolved to be pretty much useless after their children (or maybe
grandchildren) are self-sufficient, so being mostly immobile in your fifties
is probably of little concern to evolution.

------
bko
I found this study from 1973 interesting where an extremely obese individual
performed a supervised fast for about a year and dropped from 456 to 180
pounds.

> A 27-year-old male patient fasted under supervision for 382 days and has
> subsequently maintained his normal weight. Blood glucose concentrations
> around 30 mg/100 ml were recorded consistently during the last 8 months,
> although the patient was ambulant and attending as an out-patient. Responses
> to glucose and tolbutamide tolerance tests remained normal. The
> hyperglycaemic response to glucagon was reduced and latterly absent, but
> promptly returned to normal during carbohydrate refeeding. After an initial
> decrease was corrected, plasma potassium levels remained normal without
> supplementation. A temporary period of hypercalcaemia occurred towards the
> end of the fast. Decreased plasma magnesium concentrations were a consistent
> feature from the first month onwards. After 100 days of fasting there was a
> marked and persistent increase in the excretion of urinary cations and
> inorganic phosphate, which until then had been minimal. These increases may
> be due to dissolution of excessive soft tissue and skeletal mass. Prolonged
> fasting in this patient had no ill-effects.

> During the 382 days of the fast, the patient's weight decreased from 456 to
> 180 lb. Five years after undertaking the fast, Mr A.B.'s weight remains
> around 196 lb.

I don't know why I haven't seen more studies where extremely obese individuals
just stop eating.

[0]
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2495396/pdf/pos...](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2495396/pdf/postmedj00315-0056.pdf)

~~~
jemfinch
> I don't know why I haven't seen more studies where extremely obese
> individuals just stop eating.

Primarily because it's not considered medically safe, and a study along those
lines would be too dangerous to the patients to be permitted.

In this particular case, the 27yo male patient informed the doctors of his
plan and said, "This is what I'm doing, you can monitor me or not." They
didn't propose the study themselves.

~~~
bko
It may be dangerous. But I imagine being 400+ pounds is even more dangerous,
especially at an advanced age. Experimental treatments that may be more risky
should be encouraged. Otherwise being that size is a death sentence.

~~~
_jal
One can imagine what one likes, of course. I personally prefer to base medical
decisions on, well, medical advice than on mental meanderings. And the medical
advice leans the other direction[1].

> Otherwise being that size is a death sentence.

Being any size is a death sentence. Balancing tradeoffs more or less well
determines the appeals process length.

[1] People quibble with for all sorts of reasons, some of them even somewhat
reasonable. But

> Experimental treatments that may be more risky should be encouraged.

Eh? Do whatever you like with your body, and more power to you. But this is
the same flavor of ignorant social pressure game the anti-vaxxers get up to,
and is deeply irresponsible.

~~~
bko
Body mass index (BMI) is associated with a reduce lifespan.

Compared to a normal-weight BMI, a BMI of:

40-44.9 leads to a loss of life of 6.5 years

45-49.9 leads to a loss of life of 8.9 years

50-54.9 leads to a loss of life of 9.8 years

55-59.9 leads to a loss of life of 13.7 years

Assuming a 445 pounds at 6 feet tall is a BMI of about 60, at about the top of
the highest range. I think extreme obesity is a big enough health risk that it
should be studied with more experimental treatments

[0]
[https://journals.plos.org/plosmedicine/article?id=10.1371/jo...](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001673)

------
tracker1
This guy sounds a lot like me at my heaviest (468# at 6'1" tall). I have a lot
of correlated health issues, the bad knees predate the extreme obesity, and
recently discovered via elimination diet that I am allergic to legumes and
have trouble with grains in general. I went keto last year (mostly eggs, meat,
greens and sometimes nuts and cheese).

Without trying much I dropped to under 380... where I've hovered mostly for
the past year. When I'm strict and track I get closer to 350#, but getting
below that has been incredibly hard.

Everything I've read and understand leads me to believe that longer fasting
periods are what I need to do to break through this. But I tend to get fidgety
around day 5 and stop early. I also do pretty consistently when I only eat one
meal a day.

I don't think it's for everyone, and it isn't magic. More fat is more sating,
and a lot of disinformation starting in the 60's has now been disproven. I do
think that the majority of human kind was keto for significant portions of the
year for most of human history. I feel that refined sugars are the single
biggest factor in terms of obesity, followed by refined grains and vegetable
oils.

In general, low fat and lots of sugar has spun society into obesity. Not
understanding the role of hormones, or underestimating their effects are
another compounding issue. Doctors need to start testing against resting
insulin levels as part of a regular checkup. They need to push for changes in
diet over supplemental insulin. And absolutely need to convey the message of
why refined sugars (mostly the fructose component) are bad for you.

------
hombre_fatal
I found one of his fears interesting:

> I’ve never been anything but fat. Is there something in the fat version of
> me that also makes me likable and creative and a decent human being? Are the
> best parts of me all knotted up with the worst? Is there some way to
> untangle it and keep just the good stuff? Most of the time I think of my fat
> as a husk—something I have to shed so the best part of me can come out. But
> sometimes I wonder if I’m more like the shells you find on the beach, where
> the outer part is the attraction, and the animal inside is dull and
> shapeless.

~~~
notus
I think this observation can resonate with anyone who has struggled with
changing a of themselves that is so big it is part of their identity. For
example people who are chronically depressed sometimes believe (including
myself in the past) that taking pills to not be depressed will remove their
intellectual edge and prevent them from having the insight of an outsider.
It's objectively false, you actually get smarter since the depression isn't
interfering with pursuing intellectual interests anymore.

------
TheDauthi
Naltrexone and Bupropion. It doesn't make the other parts of losing weight
unnecessary, but it does make it easier to handle cravings. I don't care that
I'm getting some willpower in a bottle - I'd simply like to weigh less.

Two years ago, I was ~300. I had been constantly gaining weight since I
started taking Seroquel. I also had ankle surgery (unrelated to my weight),
and was completely bedridden for 6 months, then in PT for another 5. After
that, my doctor put me on those two medications.

I still had to be careful about what I ate, but the occasional snack was
occasional; I could eat something bad for me once a week and not lost much
progress. After a while the exercise was more pleasant, too.

I hit 220 a few months ago. When I switched jobs and stopped taking the two
medications (doctor and I just wanted to see if the weight would stay off
without them), my weight jumped back up to 250, but stabilized there. A good
bit less than the 300. I started taking the two medications again, and now I'm
losing it again.

~~~
willsun
Out of curiosity - when you stopped taking the meds, do you feel like there
was some residual craving-preventive effect that remained? I'm surprised
medications like this aren't prescribed more frequently, and my assumption is
that payers / doctors aren't keen on having their patients use it indefinitely
(which I'm not sure is necessarily a bad thing, if there are no side effects)

------
tengbretson
I really hope that we start putting some social pressure on parents of very
young obese children. It's obvious to me that getting your child obese and
getting them set in the habits that will keep them that way is miles worse
than things we have already weeded out with social pressure, like smoking in
the car with children in it.

------
drakonka
I have always been underweight before putting on more muscle just a few years
ago. While I logically understand the challenges of being overweight or obese,
nothing I've heard or read really drove just how much it weighs on you not
just physically but emotionally quite like this article.

------
bradenb
I've been way too close to 300 pounds for all of my adult life. This article
really hits home hard. I can completely empathize with every statement the
author made. I have realized his same struggles with weight loss and how hard
it is to keep the weight off. I've had some success with Keto, but I seem to
love eating carbs way too much to stick to it for longer than 3 months. I've
told myself I'm trying a similar approach to the author: trying to do just
enough to reduce slowly, but honestly to me it feels like a cop out. A way I
can say that if I mess up then it's OK because most days I'm doing right.
Hopefully some day I can finally snap myself into a life-changing mindset.

------
maerF0x0
I think we need to start treating extreme obesity as an addiction. No one in
their right mind tells an alcoholic to "just moderate yourself". I think the
decisions of food need to be taken out of the hands of the obese. Eat what
you're allotted, we promise its enough, and nothing else.

I recommend people lose weight via fasting until they're "normal" weight. Best
done with doctor's supervision, but it basically boils down to eat nothing,
drink only 0 calorie drinks and take a daily dose of multivitamins and get
some sodium + potassium.

    
    
      Barbieri took vitamins on various occasions throughout the 
      fast, including potassium and sodium supplements.
    
      He was allowed to drink coffee, tea, and sparkling water, 
      all of which are naturally calorie-free. He said there was 
      the occasional time that he'd have a touch of sugar or milk 
      in tea, especially in his final few weeks of fasting.
    
      At the end of his ordeal, Barbieri tipped the scales at 180 
      pounds. Five years later, he'd still kept almost all the 
      weight he'd lost off, weighing in at 196 (89 kg).
    

[https://www.sciencealert.com/the-true-story-of-a-man-who-
sur...](https://www.sciencealert.com/the-true-story-of-a-man-who-survived-
without-any-food-for-382-days)

------
hsnewman
I began reducing the carbs in my diet due to what I believe is gluten
intolerance. I'm basically doing a Paleo diet. I've lost 25 lbs in the past 3
months, and feel great. I have no cravings. I'm done eating sugar and any high
carb food (pizza, etc). My wife feels that I'm very regimented but my
intolerance to gluten makes me so. I feel better and hope to have a longer
life as a result.

------
metabagel
I feel like one of the best things you can do if you're trying to lose weight
is to consciously avoid the urge to finish everything on your plate. Try to
habitually leave some food on your plate. I call it leaving an offering to the
food gods. I think this leads to better mindfulness about what and how much we
are eating.

~~~
Qwertystop
While it might help with eating less, it does mean you're deliberately wasting
food (unless you collect all the scraps into leftovers for a later meal),
which is... not good.

Try deliberately reducing your serving size instead.

~~~
metabagel
Yes, you should do that. But, many times you will end up with too much food
anyway. When possible, save food, rather than throwing it away, but it's
better to waste food than to add to a weight problem.

------
woodandsteel
Here's my understanding, based on a fair amount of reading and thought. First
of all, condemning someone for being fat is rarely if ever useful.

In terms of what is useful the first thing is that people need to be eating a
diet that is very low in processed carbohydrates, with lots of fiber and
moderately low calorie foods, and they should eat until they are full, instead
of counting calories.

Now people's bodies are different, so this won't work for everyone, but for
most people it will.

If someone isn't eating this way, it is either because they don't know that is
the way to go, or they do but they have other problems, like psychological
issues, so they need to try to deal with them, if possible.

That's pretty much it.

~~~
RealityVoid
> and they should eat until they are full, instead of counting calories.

I am curious why you say this. In my experience counting calories works great
to put into perspective the caloric cost of everything you consume. You don't
have to always do it, but do it for a while and you can eyeball pretty well if
you can or cannot handle something in your diet.

~~~
woodandsteel
Be aware of calorie content of different foods is essential for choosing a
healthy diet. But what people usually mean by counting calories is setting a
goal for how many calories you eat a day, and then eating only that much, even
if it leaves you hungry. That does not work over the long term for most
people.

What does work much more often is focusing on eating foods that are filling
but low or moderate in calories, and eating when hungry.

------
notus
I personally enjoyed this article and I wish more people would write things
like this. Just reading someone eloquently list their thoughts and anxieties
about a certain issue really makes you feel not alone if you are going through
the same thing. There was a paragraph where he questioned whether he would
lose the good parts of himself by losing weight and I've had that same type of
thinking applied to so many other aspects of my life, not necessarily weight,
but mental illnesses that I sometimes believe give me insight I wouldn't
otherwise have.

~~~
danso
I was a bit astonished by how the article started: that this was the first
time the author had confronted his weight problem in writing. This is someone
who has had a long award-winning writing career in newspapers and online, who
has had no problem writing about many other subjects. Just goes to show how
deep the personal shame he has felt his whole life.

------
kerrsclyde
We've all be gamed by the food industry for years. We should be eating mainly
vegetables, some fruit and a little meat.

Hardly anyone eats lots of veg because they taste bland compared to the other
processed treats we are sold. It suits the food industry to sell us processed
food because it is cheap, it has a long shelf life and they know it tastes so
good we will eat loads of it.

I'm not blaming them, they are businesses with a profit to make, but somehow
doesn't feel like a fair fight.

------
bproven
It is a complete lifestyle change (nutrition and exercise)...plain and simple.
Any other approach sets you up for failure (I need to lose x pounds for new
years, I need to lose this for an event, etc).

It is also very much discipline (not motivation..) and hard work to get
started and maintain for a while. Like pretty much anything. But after a few
years of feeling great you will wonder why you ever lived your previous life.

At least in my experience :)

~~~
metabagel
It might be discipline, but it can't come from a feeling of depriving
yourself. It has to be associated with positive feelings, or most people can't
stick with it.

------
amriksohata
Watch the Fed up documentary, explains it so well that no matter how much we
try, exercising and eating less wont work. Our environment is saturated with
products now which almost all have added sugar, only way is to look at
ingredients and change your environment, dont bring these things home and
instead bring better stuff home thats not got added sugar.

~~~
chrisseaton
> no matter how much we try, exercising and eating less won't work

How can that be? If you burn more calories and you take in less calories, then
surely at some point your body must start to lose mass. At very least is the
equation that you're breathing out carbon and you're not getting that mass
back from anything apart from what you eat.

~~~
graeme
Because all of this is regulated by hunger. If you move more, you get
hungrier.

The issue in the case of most overweight people is that their body is trying
to maintain a set point at a high level of body fat. Hunger serves to maintain
this weight set point.

The way to sustainable weight loss is to eat in such a way that the body
starts to target a lower set point and decreases hunger.

Obviously this also results in less calories taken than expended, but if it
were as simple as a math formula most people would have six packs.

------
metabagel
It's hard to lose weight.

~~~
frogpelt
And even harder to not find it again.

