That’s my experience, hopefully it’s helpful.

I just returned from the The Obesity Society’s 2009 meeting in Washington DC. I was hoping to find something to help me and my patient’s, but there was nothing. Not a single drug trial showed anything promising. The best weight loss was in the 5% to 10% range and if the study was carried out beyond a year weight regain appeared. The studies mainly involved psychoactive drugs and anticonvulsants.

Studies involving exercise and behavioral modification involved unrealistic amounts of exercise in my opinion and the results were worse than with the medications.

There was one lecture though was very interesting. It was titled: Fitness is More Important Than Fatness in Determining Health and Disease Risks. The lecturer showed clearly that obesity is not an independent risk factor for mortality. In fact, thin unfit people were 5 times more likely to die than even very fat fit people. Though his research was backed by strong data, the lecturer was challenged aggressively and it was clear his findings were not popular. For anyone interested it seems weight lifting may be a very good type of exercise for us and one of the researchers felt it was the oxidative capacity of skeletal muscle that confers the benefits from exercise.

Since the conference ended I have been considering stopping my weight loss medications (Bupropion and Topamax) and simply exercising and eating healthy and accepting my weight whatever it might be. I may encourage my patients to do the same. The only exception might be the very rare patient that is so obese that they simply can no longer function adequately (yes, they do exist and in some cases cannot walk and have to have a tracheostomy in order to breath).

I have studied obesity for for over 10 years now and I think you conclusions are correct. I suppose this is blasphemy for one in my profession. I think the main reason for classifying obesity as a disease is so certain (not all) obesity researchers and pharmaceutical companies can make money from government grants on future drugs.

Incidentally, I have endeavored for several years now to never assume one of my fat patient’s problems was due to their weight. To be honest, even as a fellow fat person it is still a prejudice I have to fight since it if so ingrained into my education. I caution my colleagues against it too.

Appreciate your work.

Bob

I hope you stick around and keep reading the archives; you’re not alone.

I do not want to lose weight because I want to look different. After many years of hard work, I’ve learned to accept my body and love it for the pleasure it gives me. I’m an academic and a feminist, and feminism has played a huge role in helping me to see disciplinary power at work in the barrage of images and advertisements we face every time we turn on the t.v. or walk out the door. I never thought I’d have a sexually fulfilling relationship, but I do. My life is very full and very rich.

I have always hated dieting; I’ve never been able to do it for very long. Binging relieves my anxiety and is an expression of several emotional issues. I’ve been in therapy for a long time. While my self-awareness has increased dramatically, my binging has only decreased nominally. I’m still working on it.

The thing is, I want to lose weight now. Not a hundred pounds. Maybe 50. Maybe 30. Anything that I can accomplish which will lower my blood sugar and blood pressure would be wonderful. (My joints ache, I have orthopedic issues that are exacerbated by my weight, but they hurt the same when I was at 250-290, so maybe it’s not at all in my power to resolve that.) My blood sugar, however, goes down when I exercise, when I eat less carbs, when I lose a little weight. (I’ve lost 15 lbs and gained back 5 in the past year.) I’ve seen how small weight losses favorably affect my blood sugar and my blood pressure. I do NOT think this is the case for all fat people, but it is for me.

I know diets don’t work, but I hope that if I stop binging, my weight will go down and have positive health benefits. I don’t know if I can really stop binging. I know that my size is a factor of genetics. I am, have always been, and will always be a fat woman. I know that diets, whatever you call them, don’t work in the long-term. But I want to lose weight because I want to lower my blood pressure and my blood sugar. I want to delay or prevent the onset of full-blown diabetes. I don’t want to diet, but I do want to stop binging, and that’s the equivalent of dieting for me.

This post dismayed me because it reminded me of studies I’ve read before. The ones that say that nobody really ever loses weight and keeps it off. The five years is crucial. Can I be an outlier? I feel even more discouraged after reading this post than I generally do. It’s been a long journey from hating myself, to accepting myself and hating dieting, to realizing that my weight is actually having a negative effect on my own health. I hate the obesity myths as much as anyone with a brain, and I’m aware of how science is complicit with dominant ideologies. But the numbers don’t seem to lie in my case.

I have it too. It started with a large, fast weight gain in my later teen years.

High sex drive, too (because the testosterone levels).

Carb cravings that felt like a junkie craving a fix (because your insulin levels skyrocket with your testosterone levels).

Did you also develop breasts and secondary sex characteristics earlier than your peers? This is another possible symptom of PCOS.

My biggest suggestion is that you take a look at a book called “The Savvy Woman’s Guide to PCOS” and read a little bit about the issues that come on with PCOS.

I am currently taking metformin to deal with the testosterone/insulin levels that are screwy because of the disorder. It helps to regulate my sugar cravings (imagine that, I can eat a cookie or two without eating the whole box because of the horrible cravings that make me feel like I am DYING if I don’t eat another cookie). I’ve also switched to a mostly-low glycemic index diet, and do my best to balance out all my carbohydrates and sugars with a protein of some sort. I’m not perfect, but I was able to get pregnant after being told I was infertile and I lost a good amount of weight during the pregnancy while being perfectly healthy (my hormones seemed to “normalize” while pregnant).

I’m now about 20-30 pounds lighter after giving birth than when I started the pregnancy (and while I know that this is horrible, I never felt so good about myself under the approving eyes of my doctors and family members who saw me look “so good” while pregnant simply because of the weight loss). Even though I was exercising just as much as I was before the weight loss, I suddenly got attention for it and people seemed to believe me when I told them what I was doing “right” to be healthy, even though I was doing the same stuff before when I was fatter.

Now, I feel a lot more active and comfortable in my skin, but I also know that I have large problems with body dysmorphia. I look in the mirror and see something that is far larger than I (think) I really am. It affects my pictures too, because I used to see pictures of myself as a teen and thought they were horribly fat, but now I look at them and see that I was normal sized.

I am still trying to accept myself, and now I’m so afraid about my own daughter. She’s perfectly sized (I had borderline gestational diabetes that I controlled with diet/exercise alone, but that was more due to my PCOS than my eating habits and lifestyle), but she’s got a tall frame (20 inches at birth, and only 6lbs/13oz ). Everyone always says “wow, she’s so big!” and I keep trying to correct them by saying, “No, she’s TALL, tall not big.” because all I can think of is that I don’t want people thinking that I (as a fat mom) am some kind of horrible person who is “abusing” her child by making her fat.

I know it’s going to get worse when she gets older. Every stray pound or two is going to be looked at like a black mark on my parenting abilities, and my daughter is going to pick up on it and I hope that it doesn’t lead her to develop an eating disorder. And I hope that this child will be normal sized as a little one (like my husband and I were before we gained weight in teenage years) because nothing is worse than being the fattest kid in class, because even if you’re autistic or have ADHD, you have an “excuse” for your condition.

Oh, and can I take a second to mention how horribly degraded it is that the “obesity epidemic” assholes are making type 2 diabetics look like heathens who brought it on themselves? There are ways to “increase” your genetic propensity to get diabetes, but there is no way to “make” yourself get diabetes. Many kids with type 1 or type 2 diabetes are being made fun of because they are being told that it is “their fault” that they are sick. They are being made fun of and treated horribly because popular culture is using diabetes as the ultimate “health reason” as to why obesity is “bad”. But there is so much evidence that DIABETES MAKES YOU FAT, not the other way around. And then adding INSULIN into the equation CAUSES YOU TO GAIN MORE WEIGHT.

Even smokers who get lung cancer don’t get treated as badly as a fat person with diabetes. I can’t understand why, except to think that cancer seems to make you look “thin” if you are getting chemo. My friend’s aunt had lung cancer and was absolutely ecstatic when the chemo caused her to lose over a hundred pounds, even though she looked like a skeleton and was obviously unhealthy. To her, it was more important to be at the size she was in high school than to be able to live pain free and actually breathe.

My question is this: why is it so much “better” for a fat person to be thinner, or to lose weight, if the end result is that doing it makes them unhealthy and feel like crap? Why is weight loss without any regard to health MORE IMPORTANT than health at any size?

Even though I know that I have gained some weight back and keep telling myself that it’s because my breasts are full of milk because of breastfeeding (I’m like 52 inches around the bust now, but they don’t seem to make anything in my cup size that also fits my frame and shoulders), it still doesn’t stop me from feeling full of shame when I see my doctors look at me like I’ve been doing something bad. Also, their gasps of surprise when my pulse and blood pressure are normal, “even though you’re so big!”

I don’t want to feel like crap every time I look at my weight, (I just had a baby, for goodness sake, and should cut myself some slack as it is for the way I look), but it’s just something that has been so ingrained in me, that I almost want to scream every time I hear someone give me the “calories in/calories out” routine or the “you’re killing yourself/hurting US and the rest of the family by being fat” lecture.

*sigh*

Just gotta take it day by day. Immersing myself in my “mom role” helps a lot, so I don’t need to make myself so conscious of the fact that I totally fail at being sexy and attractive in a conventional way.