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Saturday, May 18, 2013
Healthy Weight Center
Unsuccessful Weight Loss
My husband has struggled with his weight since he was a child. He has been in the military since he was right out of high school and the military makes a big deal about "making weight or tape". Here are the facts: 29 year old male Weight: fluctuates between 200-215 Height: 5 foot 11 inches Diet: we eat a pretty well balanced diet. I have taken a nutrition course in college to fulfill my nursing degree. We have tried all kinds of diets and he will lose initial weight but then levels off at a certain weight (usually 200lbs) and can`t go any further no matter how much he cuts back calories or exercises. Decided a well balanced "life time diet" is the best answer to nutrition. Exercise: Mornings usually consist of 30-40 minutes of swimming, 60 minutes of the Army`s Physical fitness training (he usually plans this for everyone so it is vigorous) running at least 3-4 miles plus sit-ups push-ups, etc. Usually they run an average of 5 miles. He comes home and then weight lifts for about 20 minutes. At night we walk 3 miles and about 2 nights a week he rides his bike about 10 miles to the walking track. We have just started a yoga routine to help with flexibility. He does a lot of exercise (training for triathlons)and is in excellent physical shape yet he can`t loose the weight. He has no fat on his legs, neck or arms. The fat he does have is around his waist. He even went so far one year to eat a 1000 calorie a day diet and was training for a intense Army race and still did not achieve the Army weight standard for his height. He has had a thyroid test done about 5 years ago and the doctor stated it was on the low end of normal but not low enough to medicate. Do you have any suggestions? He talked to a PA and she suggested the Atkins diet and I about fell off my chair just knowing that it in not healthy. Do you think he should have another thyroid test done to see if it is still sluggish or below normal? Right now he is taking a nutrition supplement that contains Ephedra and that worries me since I have read about some of the cases regarding its` side effects. We would appreciate any advice you could give us.
Thank you for your question. Your husband has a right to feel frustrated. Whenever we try to make individuals fit into a classification used for groups of people, we find some people unfairly classified. From your description of his regular exercise routine, he is fit. Many of our country`s elite athletes would be classified as "overweight" based on weight alone. A measure other than weight is useful in these cases. Has he ever had his body composition determined? This can be measured by underwater weighing in a special tank, measuring skinfold thickness in several parts of the body and by dual-energy X-ray absorptiometry. It may be that he has excess lean body mass which appears on the scale as excess weight. Muscle weighs MORE than fat. From a health perspective, excess lean mass is not a concern. I am surprised your husband was able to train when he was consuming 1000 kilocalories/day. That is too low for someone his size. Sometimes when our kilocalorie intake is too low, our bodies shift into a conservation mode, and weight loss slows or stops. When this happens, he may need to increase food intake. While this is often scary for our patients, it works when carefully monitored. Since your husband apparently is more efficient with his kilocalories than most people, it may be helpful to get a more accurate idea of the number of kilocalories he needs daily to maintain his weight. This can be measured using a metabolic cart. This simple procedure requires that he be resting and as stress-free as possible. He would then breathe into a device and exhale for a few minutes. The apparatus measures oxygen used by his body`s cells and the carbon dioxide given off. From this we can calculate kilocalorie needs. Repeating the thyroid test may be important to do in the future, but your physician will be the best judge of when. When people are efficient kilocalorie burners, we often suggest two things: resistance (weight) training and regular meals (no skipping). Your husband is already doing the weight training. Does he always eat breakfast, lunch and dinner? We tend to overeat at the next meal whenever we skip a meal. We also tend to eat more when we exercise intensively rather than moderately (and your husband is definitely an intense exerciser). Eating a balance of foods does not address the issue of portion size. Consulting with a dietitian to review the habitual meal plan may be useful. Occasionally minor changes in the protein, carbohydrate, and fat ratio can affect weight loss and satiety. You are on target with the Atkins diet. It is not a healthy diet that you can continue with for a lifetime. You are also right to question the nutritional supplement your husband is taking containing ephedra. You can learn more about ephedra and the Atkin`s Diet by returning to the Ask an Expert page. Use the "Search" option. Search on "ephedra" or Atkin`s diet. If your husband has not done so, he should discuss his concerns with his physician. Good Luck!
* Learn important new information concerning the FDA withdrawal of dietary supplements containing Ephedrine Alkaloids (Ephedra or Ma Huang)
Shirley A Kindrick, PhD
Team Leader of Comprehensive Weight Management
College of Medicine
The Ohio State University