"Nothing great was ever achieved without enthusiasm." -- Ralph Waldo Emerson
Thursday, September 17, 2015
I've decided to try to lose weight -- a nearly impossible-to-lose amount of weight. And I've decided to be public and brutally honest about it.
Me at about 305 lb.
How I Got Here
I'm just a quarter inch under six feet tall, and when I reached my current height around age 20 I weighed 165 pounds, which is right smack in the middle of the mythical "ideal weight" charts. If you were draw a line between that point and the 283 pounds I weighed on my last birthday, it would be equivalent of adding about the weight of a nickel (5 grams) every day. If you've ever tried weighing yourself daily, you'll know that the readings often go up or down by hundred times that amount on successive days.
Of course the process wasn't quite as linear as that. There were periods where I plateaued, others (usually after some kind of injury) where I suddenly put on five pounds or so that stayed on. But the point is that the underlying trend is tiny on day to day basis. So tiny as to be imperceptible. And it's very difficult to monitor a trend that that's too small to see, and if you can't monitor it it's nearly impossible to control it.
And in fact there wasn't much objective reason for me to try hard to control it. My blood pressure was generally OK to good. My cholesterol was OK -- low LDL and sky high HDL. The only red flag was the distribution of the fat I was putting on. My limbs are quite lean; nearly all of the fat I put on is belly fat. That's important because the fat that accumulates around your organs, the so-called "visceral fat", has been implicated in a number of inflammation-related diseases including diabetes and dementia. But aside from the location of the fat I was putting on I could have been the poster boy for "Health at Every Size." Until December 27 of last year.
I was driving home from Christmas dinner at my sister's house when suddenly my hands stopped working; it wasn't a cramp exactly but my fingers would not ungrasp the wheel. The following day I went to the emergency room where I had a random blood glucose reading of 349 -- normal would be 100-120. They gave me a shot of insulin and immediately I felt better than I had in years. Which is interesting because it shows how feeling "OK" isn't necessarily something you should put much stock in. "OK" can be what "lousy" feels like after you've got used to it.
Diabetes runs in my family so the diagnosis of Type 2 diabetes was no surprise. I went home with a prescription for metformin, a drug which prevents high blood sugar by inhibiting the body's conversion of stuff it has lying around (like lactic acid) into glucose. Metformin is the mildest diabetic medication there is, and it's unique in that it cannot cause low blood sugar. As long as you can manage your diabetes on metformin, you don't have to take onerous daily precautions to avoid dangerously low blood sugar.
This was an opportunity for me; despite my large size I've always been active. Even being in my 50s and weighing nearly three hundred pounds I can get on a bike and ride thirty miles, or hike for four or five hours over rugged terrain. My doctor says I'm "robust" for my age. So I set out to manage my diabetes with an aggressive regime of exercise, and initially it paid off. One of the most useful yardsticks for how well you're managing your diabetes is called "Hemoglobin A1C"; it's a measure of the cumulative effect of high blood sugar over the past several months. When I visited the doctor in mid January I weighed 281 pounds (about 30 pounds under my maximum body weight ever) and had a super-high A1C of 10.5. When I followed up three months later I still weighed 283 pounds, but my A1C at 5.8 was just a hair above normal.
I'd also joined the Y and found I could easily burn about a thousand calories an hour on an elliptical machine, but the real foundation of my diabetes control strategy was simply walking. Whenever I walked for two hours or longer my blood sugar levels would drop back into the normal range -- low 100s or even under 100 -- and stay there for the rest of the day.
Setback my Exercise Regime
Although it required a high level of commitment, it looked like I'd come up with an effective long-term strategy for managing my diabetes. Then I slipped on the ice crossing the street on one of my walks and injured my knee.
That actually happened in February, a month and a half before my excellent April checkup. Despite hurting my knee I continued to burn 3000-4000 extra calories a week, but over the course of April my knee deteriorated fast. By the start of March walking more than a few steps had become painful and I could only walk with a cane. I had essentially become almost entirely sedentary.
This turned out to be almost like an experiment. I had super-high A1C (10.5) in January. In April after three months of intensive exercise my A1C was practically normal (5.8). Then after three months mostly sedentary my A1C crept into the moderately high range (6.5). Surprisingly I'd also lost about seven pounds. Of course some of that could be muscle, but my experience in this period suggests what may be the problem with the idea of losing weight by exercising. When I stopped exercising a lot of my appetite went away. A big sandwich that a few months ago I'd have snarfed down without even tasting now looks like way too much for me to tackle now.
Why I've Decided to Lose Weight
Thanks to a combination of steroid injections and and physical therapy I can now walk for about 45 minutes before my knee starts sending warning signals. And despite the inactivity imposed on me by my knee injury, my A1C remains well within the therapeutic target range for diabetic patients. So being forced to be sedentary isn't exactly a health crisis. The problem is that my knee limits many of the activities I enjoy. I can't hike, or bike for very long and I can't kneel to paddle my canoe. Even if my knee get better, the writing is on the wall: my orthopedist tells me I have arthritis in both knees, and from the increased strain I'm feeling in my "good" knee I can tell I don't have a lot use left in either knee. At least not at the levels of stress they've been getting. And I've been having other inflammation-related health problems which are almost certainly related to central obesity (i.e., visceral fat).
I've decided that the only way I can continue to enjoy the things I used to enjoy is to lose weight. A lot of weight. Around least fifty pounds I'd say, although half-again that would be even better. The problem is that losing this much weight is statistically improbable, and keeping it off for more than a few months is nearly unheard of. And, although absence of evidence is not evidence of absence, there is no scientific evidence that diet and exercise can achieve sustainable weight loss. But I'm going to give it try anyway.
Right from the outset it's a virtual certainty that I'm going to fail. I have certain advantages that most people attempting this don't have, but realistically my chances of success are something like 5-10%. But that's OK. One of the things I learned in my professional life is not to be afraid of failure. The real problems with failure are taking to long to acknowledge it, stubbornly refusing to learn from it, and being so afraid you get too timid to take risks. And after all, what am I risking here? A couple of years of effort surely. A chance that I might come out of this a little bit heavier.
On the other hand even if I fail I may get a window of opportunity in which I can strengthen my knees and extend the time I can enjoy strenuous physical activity by several years. One of the keys to being a "successful failure" is finding something useful you can take out of a project that doesn't meet its goals.
Why I'm Sharing This
I've also decided to be very public and open about this. Normally I keep this sort of thing to myself because I'm an introvert. That doesn't mean I'm shy or socially awkward, it means I don't particularly enjoy being the center of attention. But weight management is something a lot of people struggle with; it makes people feel like failures. I, on the other hand, am not afraid of failure. In this case not even a tiny bit. I don't think it'll mean I'm a bad or contemptible person.
So although it's contrary to my usual inclination, I'm going to share my personal successes and failures. I intend to take one almighty hell of a whack at this thing, and if I fail I'll move on and take whatever useful I can from it. I also intend to be brutally honest about what it's like to attempt this, in the hope that other people who are trying (and perhaps failing) can take some comfort in my experiences.