DebraSY

“Experts”: Phooey

In Weight-Loss Maintenance on March 22, 2011 at 2:18 pm

Well, my colonoscopy has been postponed.  Yeesh.  And it wasn’t me; I didn’t chicken out.  The nurse called and the doctor is taking a day off on Friday.  I got all wound up, and now I’ll wind down until April 18th – prep day, followed by the no-big-deal procedure on the 19th.  Thank you for all your well wishes.  When it FINALLY happens, I’ll let you know how it goes with more subtlety and decorum (but less humor) than Dave Barry.  Thank you, alert reader, Mulberry for the link.

I am especially pleased to learn that many maintainer friends did not experience a weight shake-up from their colonoscopies.  Had I not heard from you, I wouldn’t have taken it for granted.  I don’t trust the words of doctors and other “experts.”  With regard to weight management and weight rebound, simply, they’re out of their depth.  What’s more aggravating, they don’t acknowledge how out-of-their-depth they are.

Regular reader, Ali, just recently ran into an “expert” (chiropractor) who dismissed her dietary choices (which were working pretty well for her) in a conversation that lasted less than ten minutes.  With the pseudo-scientific authority granted by the likes of journalist and weight-loss opportunist Gary Taubes, she stated simply, “you must go low carb.”  Well, Gee, lady.: thanks but no thanks.  Low carb works for some people, and I’m happy for them, but if it worked for everyone we’d all be trim.  Anyone over the age of 20 in this country saw the rise and crash of the New Atkins Revolution (which nearly killed our grain markets and bankrupted our grain farmers at the beginning of this century). Had the Revolution worked for everyone, I’d have jumped on board too.  Instead, most of us witnessed sad stories of radical weight loss and rebound among earnest, disciplined people.  The few who succeeded then must now work at least as hard as I do to maintain their losses in a carbolific society (who pushes them to portion control, while pushing Ali and me to drop our bananas).

One sure sign that you’ve found a person who knows something is that they are secure enough to acknowledge that they don’t know everything.  That’s why Arya and Yoni have charmed me.  And I especially love this post from Barbara Berkeley, The Perfect Diet:  Does it Exist?   The one word answer is “nope.”  People who have earned their bona fides do not pretend to have the one and only answer. 

I have been trying recently to find a doctor locally who might help me, be my partner, in figuring out this whole weight game. Maybe, as a bonus, we’d improve my health too.   

I’m not having any luck.  I’ve Googled my city’s name and the words “weight-loss maintenance” and other related search terms, and all I get are a bunch of weight-loss product sales reps, who happen to have MDs.  At their websites they brag about helping people lose weight rapidly, and make vague claims about their patients’ success, sans year markers or other tangible signs of maintenance.  None has a maintenance support group or other system in place for after the big loss.  Pretty clearly, you lose weight and then you’re on your own (and they claim you’re a success, regardless of what happens to you, since they don’t care to know).  Sure, the door is always open.  If you regain after their program and have the courage to return and tell them about it, then you can try again, or they’ll refer you to a bariatric surgeon. 

Gee.  That’s the state of this field?  (I gotta wonder how Arya, Yoni and Barbara feel about all these yahoos.  They probably feel they can’t say anything negative, but I can:  it’s a sorry field and I’m sad they’re lumped in there.) 

Since what I want doesn’t exist in Kansas City, I will again enter into Fantasyland.  What would I want?  Let me dream it into being. This is the 2012 precursor to my 2050 fantasy.  The people exist right now who could make this happen, if they just were willing.  Woof.

I’d like a staff that uses words like “weight management,” as Arya does, or “maintenance,” as Barbara does.  I know my size acceptance friends find that unsettling, since they feel medicine really should be about health, not weight, but that vocabulary would be far superior to the flim flam we now hear.  And I’ll accept that my maintenance is probably a cosmetic concern.  We don’t have trouble with doctors dealing with both health and cosmetic issues in other fields – plastic surgery, dermatology and the like – so let’s allow some doctors to help us with weight management, even if it’s not solely about health.  Ideally, I’d want to find a practice with several doctors in related specialties, and a Registered Dietician. 

It would be nice if it had an endocrinologist who would run tests that would far exceed the simple blood tests I get at my annual physical.  Perhaps we may find additional thyroid issues that may be treated with more precise medication than what I now take.  We could look at my insulin and test for insulin resistance, of course (which I don’t suspect are my issues), but also plasma ghrehlin, leptin, peptide YY3-36, aghouti-related protein, cortisol, among others.  Perhaps we could look at my numbers both after fasting and after meals. I’d spring for that.  Many people spend much more on their hobbies than what I’d spend with a good endocrinologist to help me with my unpaid job.  Maybe he or she would find something that would benefit from medication or could pass my results along to the dietician and others.

Respecting the endocrinologist’s findings, I’d like the dietician to talk to me about more than portion control, and maybe also look at issues like eczema, in addition to weight management.   I’d also like to have access to a sports medicine practitioner and an orthopedist, who both understand the importance of maintaining a structure that can withstand the kind of exercise regimen that maintenance requires.  I’d appreciate some supervision as I adjust that regimen, to make it less onerous while preventing a weight slide.  

Instead of medical practices like this, we have know-it-alls conveying little knowledge at all, and inflating the easy, breezy weight-loss mythology that’s making us all crazy. 

Next post, I think I want to look at some more science.  The state of culture and medicine is depressing me.  Friends, could you send me some good links to look at, please?

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  1. Hi Debra,

    One of my all time favourite jokes.

    Q: “What do you call the guy or gal who graduates last in their class in med school?”

    A: “Doctor”

    Sadly weight management has more than its fair share of quacks as it will also select for the group of folks whose ethical shortcomings allow them to take advantage of a very vulnerable population.

  2. You have claimed to be a firm believer in Set Point Theory, yet you wonder why there are no better ways to achieve and manage that which, by definition (according to the theory), appears to be an unnaturally low weight. Thus, on the one hand, you pooh pooh the BMI cultural mythology, and on the other hand you hope to find professionals who will help you continue with what may be a pathological effort (if Set Point Theory is valid). In such a scenario, any professionals you locate may not have your best interests at heart (and may not be ethical) if they suggest they have tools to help you achieve an end run around your Set Point.

    Sigh.

    This is not meant as a criticism of your beliefs or your efforts, but the tension involved in such mental gymnastics has got to have some physiological consequences…the conflict between your beliefs about physiological processes and your beliefs about what your body can accomplish in spite of those must result in some kind of stress, which in turn sets off alarms throughout your body, which in turn results in more tension…

    Sigh.

    I think, in your shoes, I would feel like a victim of crazy-making. But who is the oppressor? You have rejected the popular b.s. about weight loss, with its zippy fairy tale ending, at least on at an intellectual level, but you appear simultaneously to want the weight loss story to be true for you, anyway, at least at an emotional level.

    I feel like I’m witnessing an Escher (sp?) drawing come alive before my eyes but in the form of a living breathing human being with feelings and unmet needs and a longing for so much more than a life trapped inside a Sisyphus (sp?) montage.

    Sincerely,
    RNegade

  3. Once I asked my doctor what I should do if I planned to get pregnant. I was expecting “eat plenty of green leafies and take this vitamin.” I got “lose 20 pounds”.

    Today I got my latest blood sugar test result which says “impaired” (not even pre-diabetic yet, but heading there). The doctor said “Eat fewer carbs at meals.” The nurse did say I could go to nutrition counseling, but I think I’m going to pass. What could they possibly tell me that I don’t already know?

  4. I like the Escher image. Why don’t we say an Esher puzzle image, but as if rendered by Gary Larson. I am funky looking cow character walking on two legs, with a glass of Chardonay, and on stairs that simultaneously ascend and descend.

    Because . . .

    Yup. I believe in set point. I return to certain set points when I act “naturally.” But I have behaved “unnaturally” for nearly eight years now, and outsmated my set point (sort of — creeeping upward, ever slowly).

    I, indeed, want to continue outsmarting my set point and will pay cash dollars to someone I think may be able to help me do it.

    Before I realized how rigged the game was, and when I believed that I simply needed a good attitude about my “lifestyle,” that was truly crazy-making. That’s when I silenced my doubts and accepted the upward creep as shameful personal failure. Now I see it as natural, and my work against it as a scientific experiment that may reveal something of value — to me? to others?

    Now I throw all assumptions on the table and check all theories against my reality.

    And I try to create a new way to frame the Escher puzzle with our language. “Lifestyle” has failed us, for example. The “experts” continue to fail us.

    I also believe the 97-percent elephant in the room needs to be included in the conversation with the 3-percent Gary Larson cow.

    Am I making any sense?

    • LOL. Of course you are making sense. I guess you and I have very different worldviews. And that’s okay.

      I have a very clear vision of the ways in which humans construct knowledge (rather than discover and describe it), so I have learned to pay attention for the exceptions that don’t fit within a theory (sort of like listening to what is NOT being said in a political speech–paying attention to what is left out–rather than focusing on what is being said). If 3% represents every attempt at weight loss through dieting, for instance, well, that is still an incredible number of instances which thwart the theory’s major foundation of SET-ness. Something different sometimes happens, which cannot be explained by the accepted story.

      Also, I think and act within awareness of systems and multiple paradigms, and I recognize that beliefs, culture, rituals, and social influences (among other processes) have as much impact on the human brain’s physiology and communication as, say, genetics and endocrine function. Systems are interdependent with more holistic processes.

      However, I forget that others see just fine with their own unique lenses on existence.

      I can offer an invitation to entertain alternative possibilities, but I can’t supply the driving need to pull back the wizard’s curtain. I can’t bring others with me through the looking glass. LOL.

      Yeah. We’re back to art as experience. Again. 🙂

  5. Ah, No1, the pregnancy advice was “expert” advice if I’ve ever heard it.

    I might consider nutritional counseling. There could be benefit there. But take it with a grain of salt substitute.

  6. And I’ll accept that my maintenance is probably a cosmetic concern.

    Which is why you’re one of the few “maintainers” I can stand. That, and you actually acknowledge that you are the definition of “results not typical.”

    Being hounded to lose weight live longer see your grandchildren grow up blah blah blah, on an endless repeating loop by the great Wurlitzer (even though my own doctors know better than to pull that crap on me) has made me very stabby at the very mention of dieting, especially since they have NO evidence AT ALL that serious voluntary weight loss, should you actually be able to attain and sustain that, makes any positive difference in lifespan or even healthy life years in and of itself. (If you happen to lose weight as a result of dietary change for a medical reason like diabetes, and subsequently live longer/healthier, it’s likely that the dietary change was the cause and not the weight loss.)

    But if they ARE gonna offer the option, I’d like to see them at least come up with an accurate fat-cell scanner, which can tell you how many fat cells you have, how large they are, and how full they are, which will tell you what your chances of success are likely to be. And knock off the “lose weight NOW NOW NOW for your HEALTH HEALTH HEALTH” crap already. It’s tiresome.

    • Hey, Meowser, what a great idea. I Googled “fat cell scanner” and came up with this Science Daily article from May 6th of last year that seems to indicate that the micro version is in prototype. Cool. A tool that will offer a little more precision regarding insulin sensitivity and what about our cells promotes that. Yeehah. I truly beleive that More knowledge + Better knowledge = Less blame on hapless fat people. At least after that knowledge settles in. It seems to take a while in this culture. Now they need to be working on your macro version too.

      Your exercise also got me back into Science Daily, which is a great place to look for Science links. Thanks.

  7. I lucked out, I got a lady family physician who is a few years older than me and who had weighed more than me. Not a word was said about bmi, or reducing carbs, there was some discussion of my stress level and suggestions to take the dogs for a walk (good for stress, exercise and the dogs), and to maybe lift some weights. When I told her how I cooked she asked for recipes. She actually took the time to get to learn about my lifestyle, my job, my studies, my marriage and my family. She’s wonderful.

    Barb

  8. I seem to have lucked into a good NP for me and a great set of pediatricians for my kids. Adding complexity to my “mixed marriage”, my husband and I both see the same nurse practitioner; she actually told him to stop losing weight as he was finishing his weight loss.

    Debra, I wonder if you would consider a visit to the Duke program or the Rudd center or one of the other major weight loss centers affiliated with academic programs. From the sound of it, you have long-term records on both your weight and your strategies to maintain it. When the pool of successful maintainers is so tiny, even and N of 1 would probably be welcome information for them.

    • Funny you should bring up Duke. I called on the Duke program a couple of years ago. Before I started this blog I was feeling pretty lonely, odd-ball and down (and I was still recovering from two fairly-close-together emergency surgeries), so I called Duke to see whether they had a program for maintainers who didn’t lose weight on their program. Answer: not really. I could tag along and “audit” one of their refresher courses if I were with a program participant, in place of a spouse, for example.

      I also asked them whether they might share my name and email with a long-term maintainer in their program who fit my profile. I was hopeful to connect with someone who had made it through menopause, something else that’s been flirting with me recently. Well, I was shocked that they didn’t have clear records to consult that would immediately yield hundreds, or at least dozens of names, or maybe just ten or five or. . . Apparently, they don’t keep close, detailed track of their program participants once they leave the program, other than to check in periodically and ask them their weight. They base their success rate, I later learned, on the following criteria: Whatever a person loses while on campus enrolled in their program is that person’s benchmark number, and as long as they maintain that much loss or more they’re counted as a “success.” Based on this, I believe Duke claims an 80% success rate. Well, some people are only on campus for a week (others stay for a month or more). So, at any rate, for those people who are only there a week, They may need to maintain only a five-pound loss to be counted a “success,” even though after they left campus they lost an additional 90 pounds. Pooh. So much for “experts.”

      I shouldn’t be so hard on Duke, though. A really nice woman there said she’d do some research and see if she could find me a mentor. And she did find me an email buddy who had maintained 110 pounds of loss long-term (she initially lost 135 pounds at age 49; she was 66 when we first got connected — 25 lbs of creep in 17 years ain’t bad). I haven’t heard from her in a while, and need to reconnect, but she was really good for me and kind to me at the time. So it’s snarky of me to criticize Duke. On the other hand, it’s applicable to your suggestion. If they aren’t even trying to keep accurate communication going with their own people, why would they be interested in my story? They didn’t even want my business as a maintainer (or perhaps they just didn’t know how to deal with my business as a maintainer), since I’d already lost the weight and not on their program. Phooey.

      As for the Kelly Brownell crew at Rudd. Same thing. I’m pretty sure they just bury their heads in their research, and don’t care much about anything else. I’d feel pretty foolish contacting them.

      Now, the NWCR is another story. They solicit participants, and I am one. I just got my contract renewal form to sign up for another five years. I’ll get that in. I’ll fill out their forms, as I get them, and send them additional “love letters.” Sigh. But they don’t offer medical support, even though they are affiliated with the Mirriam Hospital weight control program. They try to keep the research arm separate from the medical arm, to avoid conflict of interest, which would actually be noble if the lead researcher didn’t have some kind of contract with “Slim Fast,” for crying out loud. Experts, experts, experts. I hang my head.

  9. For about a year, I saw a wonderful endocrinologist who I referred to as “Dr. Scary Smart.” He unfortunately only saw women who have diabetes (type 1 or 2 or other) during pregnancy. I saw him when I was attempting to be pregnant, while I was pregnant, and stopped seeing him when I had a miscarriage. I still miss him.
    He’s the kind of doctor you describe wanting to see. He’s amazing.
    If you want to drop me an email, I can see if I can ask him if he knows anyone who is remotely like him in your part of the world.
    I know that if I were able to see him, and I were to say, hey, Dr. Scary Smart, I’m willing to pay out of pocket to see what the results of the following tests are, he would order them, and then help me interpret them. He would scratch his head, and he would mention about 10 conflicting studies that might pertain to them. I miss him.
    Here’s a link to something I wrote that mentions him:
    http://wellroundedtype2.xanga.com/692657876/recovery-room/

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