Challenges of Post-Weight-Loss Life

woman exercising to lose weight

The previous Childhood Obesity News post, like this one, endorsed the idea of never becoming overweight or obese, because of the challenges faced by people who do that, and then go on to lose a huge proportion of their body weight. One way to lose a lot is through extreme clinical fasting. We talked about the HBD, or hypoenergetic balanced diet, and the VLED, or very low-energy diet, but this is a whole different level of intervention.

An old case report which details the “Features of a successful therapeutic fast of 382 days’ duration” says that “starvation therapy can be completely successful.” The subject was a 27-year-old man whose health was sustained during the fast with multivitamin supplements.

That is an extreme “calories in” modification if there ever was one. The report says:

[…] he adapted so well and was eager to reach his ‘ideal’ weight, his fast was continued into what is presently the longest recorded fast (Guinness Book of Records, 1971).

The patient started at 456 lbs and ended up losing around 275 lbs total. What is more, he managed to stay close to his new weight for at least five years after the prolonged fast.

Most big “losers” have one thing in common. Their lives become focused on doing whatever is necessary to maintain the lower weight. Perhaps inevitably, the people who experience the worst difficulties after a major weight loss are those who accomplish it with the help of bariatric surgery. Unfortunately, the surgical option is no longer regarded as an extraordinary measure that should be saved for the last resort. Surgery, especially on younger people, becomes more common every day.

Credit where it’s due

Undoubtedly, the rapid weight loss that occurs after these procedures can make a dramatic difference. When a person loses 30% to 70% of excess weight inside a year, co-morbidities like diabetes, high blood pressure, arthritis, and sleep apnea all improve. Annoyances like heartburn decrease. Cholesterol tests come out with better numbers. Maybe without all those extra pounds to carry around the person’s knee joints don’t hurt as much, or at all.

But there are other physical changes — unwelcome ones. In addition to loose skin, which any weight-loser might encounter, people who have their innards truncated run into other problems. They will still go ahead and eat more than their new little stomachs can deal with, which is painful and makes them throw up. “Dumping” is the insider word for this, and it’s pretty much like bulimia.

Along with vomiting, both voluntary and involuntary, post-op patients suffer from newly developed food intolerances, faintness, constipation, thinning hair, flatulence, and other conditions that interfere with the enhanced social life they hoped to achieve through weight loss. On the other hand, studies show that these patients do make more friends than previously, and date more, and self-report a greater enjoyment of life than was experienced by their obese selves.

Where is the credit due?

On whether to interpret this as a side effect of the more slender figure, or as a side effect of generally improved health, opinion is divided. Probably it is both, in varying proportions for different people. This aligns with the concept that there are few one-size-fits-all answers. As product disclaimers proclaim, “Results may vary.” Some answers that seem universally self-evident are not. For instance, health professionals and public service announcements may exhort people all day long to drink plenty of water. But in a lot of places, potable water isn’t available, period. That advice doesn’t work for everyone.

This is also how movements fall apart, when energy is diverted into too many channels. One caring volunteer for the cause might say, “I now see that clean water for everyone must be the number one goal. I’m outta here.” The former comrade-in-arms might say, “But wait, we need you to teach the middle-schoolers’ step-aerobics class.” Both these well-intentioned people are right, but they may end up not being friends any longer.

Your responses and feedback are welcome!

Source: “Features of a successful therapeutic fast of 382 days’ duration,” PMJ.BMK.com, March 1973
Photo credit: Tawng/123RF Stock Photo

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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:

Presentations

Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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