Tuesday, April 5, 2011

The Lies They're Feeding You About Your Weight and Health

 And, what you can do about it

Blatant misinformation comes from perhaps the least likely sources, including well-intentioned doctors and the media. Unaware, you continue to be misinformed about your weight, your eating and their impact on your health. Let's take my patient Dave. A pleasant, driven man in his late 60s, Dave takes medical advice to heart. He has a history of high blood pressure, for which he takes medication, religiously. Yet his pressure remains too high. So his doctor told him "You gotta lose weight, Dave, and your pressure will get under control." Reasonable enough, right?

I think not.  Now only 8 or 10 pounds above his college weight (pretty good, I'd say, given his age), here's a little secret about Dave’s blood pressure--it was elevated even when his weight was at its lowest, back in his early 20's, when his weight was just fine. Oh, and did I mention Joe's fitness level? Despite being in his seventh decade of life, Dave runs 6-8 miles, 5-6 days per week, and he's been doing so for years.
Great art. Terribly high sodium content.

From Dave’s perspective, his referral to me was a blessing in disguise. He's learned that his sodium intake was way too high—3-4 times the recommended level for those with hypertension. Reducing his sodium intake may have much more of an impact than simply losing weight. To focus on his weight was simply foolish, as his weight, historically has had no bearing on his blood pressure. If he put his energy into losing weight and then his blood pressure remained high (as I'd expect given his history) he would feel like a failure. Changing his food choices, however, reducing his very high sodium intake would increase his odds of normalizing his pressure.

Thinking it's all about sodium? Not so fast. Here's a bit more personal story. My father, when he was in his 20s developed high blood pressure, as well as pre-diabetes. He was a normal (actual rather slim) weight, and was active, as he walked everywhere. His father and grandfather before him had Type 2 Diabetes, although I am unsure about their blood pressure. When I was in my 20s I had my first bout of hypertension, which I blamed on the crazy level of stress at my first job. But in fairness, even years later, I still have high blood pressure.
My Dad, 26 who survived his diabetes
and high blood pressure and died of lung
cancer (no, he didn't smoke)

Managed with diet? Exercise? Isn't that what you'd expect from a dietitian? Not so! For the record, I am in a normal weight range, and I watch my sodium. My eating (besides the cake you so often hear about) tends towards freshly prepared food, with lots of fruit, vegetables, grains, and nuts, and my fair share of my favorite oils (olive, walnut and truffle). And yes, I am active. So basically, my healthy diet, normal weight and exercise have done nothing for managing my blood pressure. Thank goodness for meds! But perhaps my healthy lifestyle, in spite of my genetics, may be helping to prevent diabetes.

Me & Mom in NYC
And then there's my mother. I won't mention the dreaded O word, but let's just say that her current BMI qualifies her for gastric bypass. Oh, and that's even after the procedure was done some years ago. And even at her highest weight, prior to her surgery, her blood pressure and cholesterol were always perfect. She actually eats rather well, but does no regular exercise. She does have knee problems, perhaps due to years of carrying the extra weight, perhaps not. Did I mention I also have knee problems?

Now don't get me wrong. I am not suggesting that obesity has no impact on your health, physical and emotional. That is simply false. It increases the risk of Type 2 diabetes, high blood pressure, and cardiac risk. It also contributes to knee and joint problems and has been associated with breast cancer. It presents challenges when people are trying to travel--renting small European cars, for instance, sitting on airplane seats—and in dealing with social stigma and job discrimination. I certainly support making practical, realistic changes to feel better on all levels—eating healthier, being more fit, lowering your stress, getting more sleep. But the focus should be on the impact of those lifestyle changes on your quality of life now, today. If you're motivated simply to lower your blood pressure, you may be disappointed if the outcome isn't as expected.
Not fitting for everyone.

It's like the many clients I see who report a history of starting to exercise. After a short time, they fail to see the weight loss they were expecting for any number of reasons. And so they stop exercising. They forget that there were clear benefits they experienced from exercise—lower stress, better sleep, better mood, greater energy, to name a few. But with a singular focus on exercise to drop pounds fast, they had failed. And so they stopped exercising, giving up all the benefits they were getting from it. How quickly they forget.

Try to change what's in your hands to change, to feel better and to potentially lower your risk of and from chronic disease. And it helps to focus on the imminent changes—those immediate benefits you can see, and feel and experience—not just the benefits far in the future. Those, too, are important, but it’s much harder to motivate for those off-in-the-distance benefits that you can’t even feel.

But if in the end you need to add a medication to keep you healthy, accept (without guilt) that you have done your part, and continue your healthy lifestyle changes because of all the benefits it brings you. This applies to those who are overweight, as well as those with restrictive eating disorders. You need to do your part, in addition to using all available resources as well.

Biking and fundraising for MS with a little help from my friends.
While perhaps unrelated to the weight struggle, I will share one more personal piece. Nine years ago this month I experienced my first symptom that led to my diagnosis of MS (multiple sclerosis). This unpredictable disease is not caused by lifestyle changes, and does not run in my family. Yet while diet and exercise neither cause nor cure MS, they can certainly allow me to stay healthy on all fronts. I don't live with the illusion that my actions will cure my disease, but I can appreciate that I feel well doing what I am doing, and taking control, in a healthy way, of those aspects of my health I can control.

Thanks to Quincy Carole for a past comment, prompting this post!

Thanks for reading.


  1. Wow very good information! I am looking fowards to reading your whole blog.

  2. Great stuff Lori, this is an often overlooked aspect of the project I did. Most people were too caught up in what I was eating and the weight loss without thinking about why or what philosophic/health/moral issues were involved. Our society pushes obesity/weight loss so much that the message of health and quality of life are overwhelmed. Balance is difficult, but it's such an amazing state of being once it is found. Living healthy and balanced may, or may not, lead to a lighter body weight -- just like striving for a lower body weight will not always (rarely?) bring balance/happiness or improved QoL.

    Keep up the great work -- Mark Haub, PhD

  3. In the last couple of months I have had the weight isn't everything "conversation" twice related to two health matters (Type 2 diabetes - I don't have - and Poly-Cystic Ovarian Syndrome - I do have). It was amazing and frustrating to me that the intelligent, educated people I was talking to could not see past the rhetoric that neither is strictly a function of the numbers on the scale.
    Thanks for the post!

  4. Take into account that obese mothers increase the risk of diabetes, obesity, hypertention in their offsprings because body fat changes how genetic pool expresses itself, latest studies show it can go untill the 3rd generation. Also there are several types of hypertention that do not respond to exercise or sodium restriction. Before cutting down salt all patients should do a salt sensitivity test.

    Cátia Borge

  5. This really highlights the importance of perspective. We focus so much on the details and miss out on the big picture of our overall health. Great post!

  6. Well maybe your blood pressure is NORMAL. Do you know that a blood pressure in the 140s/80s is NOT high, and in the UK and Europe they do not medicate for this blood pressure considered normal.

    There is little benefit in religiously adhering to a common sense principle with food, if you are just going to turn around and be a victim of predatory pharma marketing bumpf.

  7. @ Anonymous: Well, mine has topped that level, and in fact I think I was untreated for way too long because of "reverse weight bias"; I didn't look like someone who "should" be treated for high blood pressure!Failure to treat lower levels (whether BP or BS levels) are generally more about cost-effectiveness from the public health perspective, versus the actual benefit of tighter control. Lowering BP to US targets lowers stroke and progression to/of kidney disease.

    @Catia: No denying that obesity can impact future generations. But if you are (as the pregnant woman) or have always been obese, and maintain a healthy lifestyle, that is the most we can do. The offspring may be obese because of genetics as well. I certainly support, as mentioned, taking charge of the variables we can change!
    As for salt sensitivity, I'd love to hear about a practical test that is used in practice. In the US, it's non-existant (except perhaps in studies with small samples, but never even mentioned in professional conferences) (yes, I've asked!)

    @ all other commenters: Thanks you for reading and for your words of support! Now spread the word however you can, so we can do something valuable for others with this information!

  8. Thanks for this post, Lori. Much appreciated! I've felt from various doctors "you are what you eat". (Not all) Of my parents and grandparents only one ever made it to 60! My mom (made it all the way to 61!). Heart disease runs rampant in my mother's side. My father and his mom both died at 59 of pancreatic cancer (six weeks apart in age!). At 52, I have another ten years to go and I will have "topped them all off" in terms of age! I once had a brand new primary dr. walk into the room (he'd never met me) and say "You can't do anything about your genetics, but you can do something about other risk factors." (Weight being one of them!) I've often carried the burden of guilt when it comes to doctors. I'm always waiting for them to tell me what I'm doing "wrong". So, once again, I appreciate your gentleness in regards to this issue. The "we change the things we can" while realizing some things may be outside our control. I have always had high cholesterol, triglycerides, too much bad cholesterol, not enough good cholesterol and for many years now high blood pressure (and I've also been told I have "insulin resistance"). Oh, and degenerative disc disease, knees, etc. As medical conditions piled up, so did the weight. Yet, I seldom miss a day of work for sickness. Thank you for posting this article. I'll be more gentle with myself and continue to "change the things I can"! I would never expect you to have high blood pressure, by the way! So it is interesting to me and does debunk the myth that "you are what you eat".

  9. A few years ago my dad had a MI and then a CABG x 5. He was 65, survived, and is doing fantastically now. My dad walks 3-5 miles/day, eats very well, has an RD for a daughter and an MD for a son in law, and is very healthy.

    But...his dad had a massive MI and died on the spot at age 60.

    So clearly there is a large genetic component to HTN and cardiac problems. I am a big fan of statins and medications. Of course, make the lifestyle modifications first. But for a lot of people that just isn't enough and so they can benefit possibly from meds.

  10. Glad your dad is so healthy. We do get better medicine than generations before us, but some of it causes horrid side effects. I have had many side effects from statin drugs, going as far as extreme difficulty walking. It was a physical therapist who made me question the statins. She said "I've seen people disabled by statin drugs." Every time they are decreased I feel better and when they are increased I have more issues with things like mobility and muscle pain. Right now, I'm only on a 5 mg baby dose of Crestor. I see my primary Monday and am hoping he doesn't suggest increasing it. One drug caused horrible memory loss. I've done a lot of reading on the side effects of statins and some of the stuff is very scarey! I wish they were safer, didn't have the side effects. Yes, they prolong our lives if they don't disable us along the way first.

  11. Actually statins do not prolong lives, except for a very small percentage of middle aged men who have established cardiovascular disease. If only read INDUSTRY funded studies you will not get the full information.

    Further, there is NO evidence for statins for women, either with heart disease or without. See the STATIN page at the folowing website, which is NOT industry funded, but headed by a clinical pharmacologist and funded by the British Columbia Ministry of Health.

    No evidence for women. Period. Have a look at the actual numbers and graphs.

    As for high blood pressure medicating? It's the same. Stop reading only industry funded studies. There is no medical evidence.

  12. Hi Lori,
    I am interested in what you think of vitamin D supplementation especially with the link it supposedly has to MS?
    Thank you for this excellent blog.

  13. As with all the Vit. D studies to date, the studies reveal correlation or association, not causation. Does supplementation with Vit. D cure MS? No. Nor do we know if it will control all the other ills it is now associated with. If your level is out of the healthy normal range, than certainly supplement to get it in range. No harm taking a modest dose until the evidence is out. So yes, I now take 2000 IUs'day personally.

    1. We need to rid our society of weight stigma. Skinny does not equate health. When will doctors start prescribing evidence-based options?