The reasons for my weight gain are numerous and include months on prednisone, multiple surgeries (including three joint replacements, knee arthroscopy, and two spinal fusions) that kept me from being active for long periods, a stressful job that lent itself to ordered-in pizza and BBQ for the team, lots of travel and long hours that led to loads of eating out and not much healthy home cooking.
The effects of the weight are equally numerous and very dangerous. Besides the terrible toll that extra weight can have on your joints (on top of the RA damage), over the years I’ve developed high blood pressure, high cholesterol, high triglycerides, and borderline/occasional/oh-my-gosh insulin resistance and pre-diabetes.
Another important thing to consider is that fat, particularly belly fat, plays a part in developing chronic, long-lasting inflammation in the body1. When you are fighting RA or other inflammatory arthritis conditions, reducing fat is a huge step in the right direction in helping control inflammation.
When I left the workforce a few months ago to focus on my health, I knew that nothing would make more difference in my life than losing the weight. Unfortunately, losing the weight generally isn’t the problem. I’ve lost weight all my life. I’ve been on so many low-calorie, low-carb, no-carb, portion-controlled, points-controlled diets that you could probably build a family of four out of the pounds I’ve lost (and regained) over the years.
But then I was talking about how I’d look in the swimsuit or getting back into my size 4’s. Now I’m talking about both the quantity and the quality of my life. And even though losing weight is harder as you get older (trust me on this) and being on all the RA drugs can actually make you GAIN weight, I have no other option.
The first thing I did was talk to my doctor who was (predictably) a major supporter of this decision. We talked about the four elements of weight loss:
Of the four points, medical was the one about which I most uncertain. Frankly, I’m tired of doctors and tired of drugs and had already decided I didn’t want to go the route of weight-loss surgery or even the non-invasive gastric balloon. And honestly, I have known people who have had major life changes as a result of weight-loss surgery. I just decided that route was not for me. But there are other ways that medicine can help you lose weight. In addition to new drugs that help control hunger (some of which also have the benefit of moderating your blood sugar), there are other drugs that keep you from absorbing fat or assist in breaking the addictive power of eating (especially things like sweets). Some of these are only suggested for short-term use, but getting a jump start by losing some pounds quickly is a great motivator for many people to keep going.
Mainly, I look at involving my doctor as a monitor to my overall health. I want to make sure that I don’t deprive my body of nutrients or even cause damage. For example, some diets are very hard on the kidneys. By checking in with my doctor on a regular basis, I’m helping ensure that I’m staying on track with both my weight and my labs.
The result? I’ve lost 20 pounds and counting since the first of November. That’s about five pounds a month – a great steady rate.
How? The real answer is that I’ve just been eating less and trying to eat better. This effort has been supported by taking some medication for my insulin resistance that also helps control cholesterol and triglycerides and has the (wonderful) side effect of reducing my appetite. I’m also more active since I’m not working full time and sitting in front of a computer all day. Since I have the time, I am able to make better meals at home and we’re eating out less. And my stress levels are way down. Stress causes your body to produce cortisol which is very similar to and acts in many ways like prednisone – including helping to pack on the pounds. All of these things have added up to a lighter, healthier me.
I also give myself permission to “be bad” occasionally. I remind myself that a short-term lapse does not mean that my long-term goals are derailed. There is an old saying that God doesn’t expect perfection, but he does expect consistency. A few years ago I had the habit of going out to get lunch during the work week. I would walk about a block and a half to the salad bar, fix a healthy salad and I’d buy a lottery ticket when I checked out. My boss asked me about it one day. I told him that my goals were to be skinny and rich. So every day I was working toward that goal by exercising, eating salad and buying lottery tickets. Granted, it wasn’t much of an effort, but it was an effort I made every day.
That’s what is working for me. The one piece of advice I’d offer to anyone who is interested is to get serious and find what works for you. If you cook for a family, then choosing a program that makes you eat pre-packaged meals may not be the best option. Be sure you talk to your doctor(s) before you start. Some diets like those that involve fasting or grapefruit may not be good choices with the medications you’re on. But just remember that whatever you choose to do, whether eating less or exercising more or both, the key is commitment to the long-term goal. You didn’t gain the weight overnight and you shouldn’t expect to lose it overnight either. (Unfortunately …)
Quiz: Which is NOT a common risk factor for osteoporosis?