Weight loss and Psychological Blocks

Medical Q&A [Moderated]
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Listening to BBM recently has me somewhat discouraged. I’m overweight, especially since I haven’t been training for over a year, and I find I’m losing all motivation to “try again” with the weight loss journey. A big part of this is hearing the two doctors discuss weight loss and just how much of your eating habits are out of your control. In my case I live with a big family and there’s really not much I can do to change the environment, as any suggestions are met with significant pushback. As my understanding grows it appears the solution to obesity disease is medications, ones I don’t have access to as I’m not morbidly overweight and I don’t have diabetes. That’s one block… it feels pointless to even try knowing it’s overwhelmingly likely I’ll regain the weight as my body starts to fight back against the loss. The second block is loose skin. Knowing I’ll look like garbage either way really bothers me, even if the loose skin I’ll retain is minimal. For nearly 30 years this second block has prevented me from truly keeping the weight off, as I’ll get down to a healthy weight, see the skin, and slowly start gaining it back.

How does one get over this? Clearly, I don’t want to actually give up, but at some point you have to realize trying to climb a 40-foot wall over and over again is futile.

For the record I don’t want to appear as if I’m blaming BBM or anyone else for that matter. I’m truly thankful for everything you have taught me over the years.

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B_rose,

Thanks for the post and sharing with us. I can see your point that hearing certain things may be discouraging depending on your experience(s) and perspective(s). That said, I do think shifting people’s focus towards modifiable factors that make a difference increases the likelihood they’ll be successful rather than lying to them, and later on blaming them for failing to “try hard” enough.

Regarding your food environment, I can see that many aspects of it are not under your direct control. However, you do have control of shaping your food environment at work, controlling what food you purchase, and further modifying the food environment at home by moving less health-promoting foods out of sight and placing healthier foods in front of them, not keeping food in your room, cooking (presumably), and more. I don’t pretend these are simple things, but I suspect you’re in control of more things than you think.

Regarding the medications, the current guidelines recommend that with individuals with BMI of 30 or more or 25-29.9 and one or more medical conditions (or risk thereof) related to excess body fat should be considered for pharmacotherapy. If none of these things apply to you, we probably need to talk more about your current situation. Silver lining, you absolutely would not have to worry about any skin issues. I wouldn’t expect that to be an issue either if we’re not talking about extensive weight loss.

Our main goal in discussing obesity is to try and reduce the stigma surrounding the disease and empower people to take steps that are likely to work. We consistently recommend lifestyle changes to include a health-promoting dietary pattern and meeting the physical activity guidelines, which both improve health independent of weight change, but can also help with weight maintenance and body composition. Similarly, we recommend modifying the food environment, increasing food prep skills, etc. to help with adherence given that most food behaviors are not under our conscious control. Finally, we recommend additional interventions - to include medicines and/or surgery- as necessary to improve someone’s health and quality of life.

I don’t know much about you outside of this post, but I do think increasing confidence in your ability to change the course of your life is step 1. If you need more practical tools, skills, and resources to boost your self-efficacy, we can do that based on your individual needs. If you need encouragement and/or affirmation that you’re taking the right steps, we can do that. Finally, if you need knowledge to answer a pivotal question, we can do that too.

If you get to read this today, I would encourage you to exercise even if you don’t have a plan and even if it’s for only 10-minutes. Getting started is more important than how you start.

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Thank you for the reply Dr. Feigenbaum. I checked my BMI and it’s at 37.4 (at best), so I suppose I should retrack my “not morbidly obese” comment in the initial post. I didn’t realize it got so bad, but I suppose that’s how weight gain works. It sneaks up on you as bad habits compound. With this knowledge and your post I made an appointment with my GP to see if I can find a medication. I do qualify counting my BMI and my (managed) hypertension. I really appreciate the advice and encouragement in your reply, and I’m going to force myself to get outside and move even a little bit today. I went from 7 days a week of heavy weight training to literally no activity over the course of a year and a half, and I’ve been constantly pushing my “restart” date back further and further. It’s always, “I’ll start on Monday,” which of course, doesn’t happen.

I need to reframe how I view the medication. With my mental health I saw a therapist for a year before getting on medication, and it wasn’t until I combined the two that I saw bigger improvements. I suppose the weight loss medication could be viewed likewise.

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There was one more block that often gets to me, the idea that it’s “too late” to start. I have this idea that my health outcomes are already dire due to being overweight off and on for the majority of my existence, and that losing weight is again, futile, in a sense. Even typing that I know it’s ridiculous, but it’s interesting how easily my brain throws up walls to impede potential positive progress.

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There aren’t really any weight-related medical conditions that do not improve with weight loss. I think that developing specific strategies and resources for your individual needs and concerns would likely be useful, which is where a professional would come in handy.

Additional challenge for the day. If you get to read this today, I would encourage you to exercise again and even if it’s for only 10-minutes.
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Thanks again for the response. BBM offers this professional service directly, correct? I’ll check the main website and go through the steps.

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Update: I talked to my GP who agreed that the medication was a good idea and oddly enough my insurance covered it without issue. I’m going to start Wegovy tomorrow, and with it I’m going to push for consistent life changes as well. Funnily, I brought in a list of notes from your podcast on the medications, ready to “convince” my GP, but instead she was very well researched on the subject.

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How fortunate! That’s excellent news. Hope it all goes smoothly for you.

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If it’s okay I’d like to post the occasional update, as I know as a BBM reader I would be interested in hearing from somebody with direct experience with these new medications. I just injected my second dose.

I’m on the smallest dosage available, in order to ease into the medication and prevent common side effects (this was mentioned on the BBM podcast). I definitely have felt the nausea, but it’s tolerable, especially with a periodic Zofran tablet. Other than that, I feel totally fine. The appetite suppression kicked in the following morning and the effects were very noticeable. It really does feel as if you have more control over your hunger response, especially in the face of highly palatable foods. Prior to this medication, if somebody were to offer me some kind of junk food, I would almost feel a sense of guilt saying no, like I was missing out on some kind of opportunity. Now it requires barely any thought, as if it’s second nature. I also find I reach fullness much quicker, and the need to overeat has gone down significantly.

As far as weight loss progress, I’m down 2.5 pounds. I checked and this seemed to stay consistent. I’m not sure if it’s water weight, but I know I’ve been eating quite a bit less already, and I’m inclined to believe this is actual progress.

Overall, this has been a very interesting experience, and I really appreciate BBM’s candor and education on the subject.

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Awesome! All of this is exactly in line with what I hear from the majority of patients going through this.

Appreciate you sharing your experience.

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