When weight *does* matter

I read quite a lot of articles, blogs, and books about dieting, the science of weight gain, appetite, weight loss, health at higher weights, why diets fail, and so on. Secrets from the Eating Lab by Dr Traci Mann is the latest one (I highly recommend it). The Gluten Lie by Alan Levinovitz is also fantastic.

BUT.

Not one of these books or articles ever mentions the need to lose weight when you have structural problems with your hips / knees / legs / feet. It's not an issue of metabolism, or biochemistry, or social pressures to be thinner, or whether or not being fatter affects the development of different diseases, or feminism, or whether the process of dieting harms you, or if curvier ladies are more or less attractive, or anything like that.

It's the weight. Weighing more puts a lot more stress on your joints. Cos it's weight. Mass. Every step you take loads multiple times that weight through your joints. It's. The. Weight. Full stop.

If you have hip dysplasia, osteoarthritis in your hips or knees, other structural abnormalities, or even some types of foot pain — weighing less will be better for you. And if you have an artificial hip or knee, the same thing goes. Those babies don't last forever, especially if you've had joint replacement at a younger age, like me. And trust me, the longer you can avoid revision surgery (replacement of the prosthesis) the better. Revision surgery is no picnic, and is usually less successful.

Pelvis — illustration © Denise Sutherland

I always feel caught between a rock and a hard place on this one — it's clear that dieting isn't a good way to go, it's rarely sustainable, and over 90% of dieters regain their lost weight plus some. There really isn't a clearly good way to lose weight long term. I've tried a lot of things. I even did calorie counting for nearly a year some time ago. Yes, I lost weight, but I went a bit (more) insane in the process.  Never again. NEVER.

But I can't just go all body positive and 'accept myself at the weight I am' — I really need to lose weight to help the longevity of my hip prosthesis, avoid my next lot of hip surgery for as long as possible, mitigate the decline of my other dysplastic hip and crappy knees, and maybe even have less joint pain if I'm extra lucky.

Hip prosthesis — illustration © Denise Sutherland

And because of said hip and knee problems, as well as my autoimmune disease, running around exercising like mad isn't really possible either.

My strategy at the moment is sticking to the 5:2 intermittent fasting* (which I do find sustainable, even on the food intolerance diet I'm on) — I have lost about 7 kg over the last few years this way. Slowly. Hugely frustratingly slowly. Not even halfway there, more like a third ... wherever 'there' is. Fuck it.

I go for walks, and am about to get back in the pool (just for hydrotherapy at the moment, but hopefully I'll be able to work up to swimming). Exercise bike when my knee is cooperating (it isn't at the moment). Halving my mirtazapine dose (which I take for sleep) has helped reduce my appetite and cravings a bit more, too.

But, I really wish that all these great books about how dieting doesn't work, and how healthy you can be at any size, would at least mention the fact that sometimes you have to lose weight, because the weight itself is the problem. Some acknowledgement of the existence of this problem — which surely must affect millions of people — it's not like hip and knee osteoarthritis is uncommon — would be nice. Even if all they can say is 'Well, fucking sucks to be you, doesn't it? Ignore everything we've just said, and go on a diet. Forever.'

September 2016 update: I am finally having success! It's all a bit amazing. The low carb high fat regime (LCHF) combined with intermitted fasting is WORKING for me. After six months on this way of eating, I am down 13 kg (halfway to my goal), my fasting insulin is normal (I was heading towards type 2 diabetes), my triglycerides are normal, and I have less knee pain! No exercise required.

March 2019 update: I have now been on the ketogenic (very low carb) regime, with intermittent and extended fasting, for three years. Most days I just eat one meal, with a few snacks. I have lost nearly 25 kg, reaching my goal weight, my fatty liver disease is completely cured, I no longer have glaucoma (!), my fasting insulin has gone from 18 (too high) to 5 (really good), my cholesterol readings are all normal, and am not consumed with hunger. I have done all this with diet alone, and despite being menopausal. I will not be changing this regime!

If you wish to discover more, I highly recommend The Diet Doctor website, and these books:
The 8-Week Blood Sugar Diet, Dr Michael Mosley
The Obesity Code, Dr Jason Fung
Why We Get Fat — and what to do about it, Gary Taubes
Fat Chance, Dr Robert Lustig
Good calories, bad calories, Gary Taubes
The Big Fat Surprise, by Nina Teicholz