CHAPTER 2
How much of a problem do you have?
How Do You Know If You Are Overweight?
This
is an interesting question. There are many ways you can tell, but the
two best methods are to look at life tables or to measure your percent
of body fat.
The life tables
are tables that have been developed by the life insurance companies that
will tell you what you should weigh based on your height and sex. This
will give you a reasonable idea. The problem is that obesity is not just
about weight. It has a lot to do with body fat: the percentage of your
body composed of fat, and the percentage that is not. What you really
want to know is the percent of body fat that you have. There are many
ways to determine this, but in recent times most people either have a
body composition analysis done at work as part of their employer’s
wellness program, or else they use a set of scales that are specially
designed for this purpose. The scales have two metal pads that you stand
on. First it tells you what you weigh and then it will calculate your
percent of body fat. This is done with battery power. It is simple and
quite accurate. Scales like this can be bought usually for less then $70
and last for years; you can find them in large department stores, and
in many sports catalogues and stores.
What percent
of body fat should you have? To maintain optimum health, you need to have
some body fat. If you don’t, then your body will not function well
and you will be sick. If you look at the athletes who are very thin—for
example, the runners who win the New York Marathon--they are all very
thin and have 5% to 8 % body fat. For most of us, that is too thin. A
good percentage for men is 14% to 18% and for women 21% to 25% of your
weight as fat. Currently, however, many people in the United States carry
50% to 60% of their weight as fat. You can weigh 120 pounds and still
have 35% to 45% of your weight as fat. That is not healthy. Someone might
say that a woman weighing 120 pounds with this body fat profile is not
fat; however, the patient’s problem is that she has a lot of excess
fat and not enough muscle. Your muscle mass, frequently called the lean
muscle mass, is that part of your body that is metabolically active; it
is the healthy tissue and does all the work. If you are thin and most
of your weight is in fat then you will not have the strength to do a lot
of things because you have such little muscle. It is body fat that puts
you at risk for heart attacks and strokes with your cholesterol. So if
you have 50% of your weight as body fat, you will be at a greater risk
for those problems even if your weight is 120 pounds, than someone who
has 21% of their weight as body fat and weighs 180 pounds. On the other
hand, you could have a man who weighs 200 pounds with 15% of body fat,
who thus falls into an acceptably healthy range for his height and sex.
For this reason, scales do not tell the entire truth about your body.
The person who weighs 200 pounds in that case is not fat; he is muscular,
and his fat stores are, in fact, normal.
The reason
that body fat is more important than weight is that muscle-- which weighs
more then fat--is the metabolically active part of your body. If you are
overweight and go to the gym and start an exercise program in hopes of
losing 15 pounds, you may be discouraged when you gain 10 pounds. Why
would this happen? The reason is that you have lost fat and toned up muscles.
What you will notice in this scenario is that despite gaining 10 pounds,
you have lost 2 inches around the waist. It is not the absolute weight
that is the problem; it is the percent of body fat. Most people can weigh
themselves on their bathroom scale and get that number a lot faster than
they can have their body fat analyzed, so most know their weight but not
their percent of body fat. The person who has gained 10 pounds is, in
fact, healthier then he was when he was 15 pounds lighter if his percent
body fat has dropped.
So, to determine
whether you are overweight, look at the life table below to calculate
your body mass index (BMI). Or, if you prefer, you can calculate your
percent of body fat. For most people, the numbers will be similar. Don’t
get upset if your number varies a little based on what system you use.
You are after the big picture, not the fine print. So what is the BMI,
and why is it important? It is simply another way of looking at your body
weight in relationship to your height. It, like all the other indirect
methods, does not take into account your muscle mass--only your weight.
So with the BMI, if you are very underweight or if you are a body builder
you will find that the system does not work well for you. None of the
systems will work well except body composition. If you are in the vast
majority of people the BMI table will work. The formula is simple: if
you want to calculate it yourself, take your weight in pounds and divide
it by your height in inches squared then take that number and multiply
it by 703. It is easier to look at the table.
You can also
look at your waist to hip ratio as a method of looking at your risk for
health problems. Men who have a waist measurement of greater than 40inches
and women with a waist greater than 35 inches are at increased risk. The
ratio of waist to hip is another way to look at who is at the highest
risk for medical complications. If the ratio is 1.0 you are at a high
risk; the ratio for men of .9 or less is considered safe and .8 for women.
When you measure the waist you measure the smallest diameter below the
ribs and above the umbilicus. The hips are measured as the largest extension
around the buttocks. The waist to hip ratio is the number that you got
from the waist and divided by the number you got for the hips.
One thing
that you don’t want to do if you are wondering if you are overweight
is to ask your friends and family. They are probably the worst judges.
I have patients who are approximately 80 to 100 pounds overweight, and
their friends tell them they need to gain weight. Why would they do that,
you might ask? That is a good question. One can only guess that by getting
their friend to gain it will make them look better. It is hard to believe
that they actually think that someone who is 5ft. 5in is thin when they
weigh 230 pounds. It is possible that their perception is that skewed,
but I don’t think so. I suspect that there are other issues motivating
them. Jealousy may be one of them.
I remember
one of my patients, Sylvia, had breast cancer and was overweight. Sylvia
was a 68 year old lady, who was very concerned about her cancer and what
she could do to stay healthy. She weighed 200 pounds, carried on her 5
ft 6 in frame. She was very religious and put a lot of her faith in her
religion, and valued what her family and her church family thought. She
was not of much means but always tried to look her best, and I never saw
her without a smile. Individuals who are overweight have a greater likelihood
of the cancer returning and proving fatal. Sylvia was motivated to be
cured of the cancer, however, and she lost 80 pounds. We were very pleased
with her progress. No sooner had this happened than she started gaining
weight again, though. I was puzzled and asked her why? What had changed?
It turned out that some of her family was making fun of her and saying
she had chicken legs. Sylvia was hurt by this, and for her, it was better
to gain weight than to address the lack of respect they were showing her
and tell them that her goal was to take care of herself. Ultimately, she
did deal with the issues and kept her weight within a reasonable range.
Her cancer, fortunately, has not returned. But I was amazed that her family
members would taunt her like that. The problem, I suspect, was that she
began looking better than they did, so they found it necessary to lob
some insults at her so she would gain back the weight. This is not an
easy problem, especially when it is family that is making the comments.
Although family
and friends may not be a good judge of whether you are overweight, your
own perceptions may not be accurate, either. For example, people with
anorexia may feel fat, when in fact they have just 6% of body fat and
are underweight. When they look in the mirror, they see themselves as
fat, and you cannot change that belief. Others who look in the mirror--and
are obviously overweight with a 50% body fat--may see themselves as thin.
The bottom line is that you ought to get some objective advice either
from the tables provided, or by having your body composition analyzed
to determine your percent of body fat.
One issue
that you need to address is whether or not you are happy with your weight
the way it is. Is it a problem for you or not? This is a question that
you need to answer. If it is not a problem for you, then you will not
be successful in changing it. After all, if you don’t see it as
a problem then why should you fix it? Well, to be honest you won’t
fix it. If you weigh 500 pounds and are happy, then that is okay. Until
you see the issue as your issue, you will not address it. Once you take
ownership of the problem then you have the ability to fix the problem.
I am not saying that weighing 500 pounds is healthy, because it is not.
However, you will not be successful with your weight loss program until
you accept that it is your problem.
If you choose
to stay overweight, that is all right. Just be aware of the complications
that go with it. In the same way, if you choose to go through a red light,
you have to be willing to accept the consequences of getting a ticket
from the trooper who happens to be behind you. You need to accept the
ticket and be happy. You make choices every day and you need to accept
the consequences of the choices that you make. If you don’t like
the consequences then you have to re-evaluate the situation and see if
you need to make different choices so you can have a different outcome.
What problems
do you need to deal with from a medical perspective? People who are overweight
have a lot more trouble with back, knee and hip pain. They have a lot
of problems with arthritis. Weight reduction will frequently allow pains
in those areas to dramatically improve.
For example,
one patient I saw named Carol was overweight and needed to have her knees
fixed because they had “worn out.” Her orthopedic surgeon
had told her she was too heavy and needed to lose 30 pounds before he
would perform the surgery. Carol was motivated to lose weight; she wanted
the pain in her knees to go away. She succeeded at getting her weight
down Carol weighed 255 pounds and lost the 30 pounds that she had been
instructed to lose. She was not as obese as many who need the surgery.
I was never sure why the surgeon told her she had to lose the weight because
I know they have operated on people much heavier than her before. Perhaps
he wanted to motivate her to see if she could do it by herself. She simply
put her mind to it and used moderation. She cut out some of the sweets
and soft drinks, and cut back a little on portions. She limited her deserts
and in no time had the weight down. At that point, the pain in her knees
went away. She canceled the surgery. Of course, this is not good for orthopedic
surgeons who make a living fixing knees. Unfortunately, the majorities
of patients I see do not bring their weight down and do have to have surgery.
Overweight
people also have problems with hypertension and ailments associated with
it, including strokes, heart failure, and renal failure. Weight reduction
generally causes a drop in the blood pressure. As the blood pressure is
lowered, then the risk for the other complications comes down as well.
Overweight people are also at an increased risk for diabetes. Those who
develop diabetes have to deal with potential complications such as blindness,
kidney failure, hardening of the arteries, and possibly amputations of
the legs. Many adults who are overweight and have diabetes can greatly
improve their condition by getting their percent of body fat down to a
normal range. Some can eventually come off their medicine and control
their diabetes with diet alone.
Being overweight
also decreases your energy level. Think of it this way: if I were to ask
you to carry an extra 50 or 100 pounds on your shoulders every day, you
would find out fairly quickly that you were tired. You just did not have
the energy to do the things that you wanted to do. You just had to sit
down and rest. As overweight people shed pounds, their energy returns.
If you have ever had a pet that was overweight and put him on a diet,
after he lost the weight, you probably noticed that he acted frisky again,
like he did when he was young. The same is true for people.
All of this
has a profound impact on your quality of life. Is it what you want it
to be? If not, then you have to look and see what changes you can make
that might allow you to improve it. The choices are yours. Whatever you
choose, realize that it is your choice and accept the consequences of
the decisions that you make. Don’t blame it on your parents, co-workers,
or friends. Accept your choices and go forward with your life.
Automatic BMI Calcuator
Life tables
Percent body fat
Are you happy with your weight and body fat as it is?
Yes_______ No _______
Why Do You Want to Lose Weight?
Why
do you want to lose weight? Are you ready emotionally to do what you must
do to be successful? These are very important questions that you have
to ask yourself.
Until you
know the answer, you may not be able to reach your goal. There are a lot
of ways to look at the problem of losing weight; one is to ask yourself
what is it that you are supposed to learn from this experience? Many people
believe that we are given lessons to learn while we are on this earth.
After you learn one lesson, then you get another to learn. If you choose
to look at life in this way, then the question is what is it that you
are here to learn? You may not be able to get the answer until you have
lost the weight. What you have to learn may have more to do with other
life issues that you will face.
When asked,
most people will say that they want to lose weight in order to become
healthier. They want to take care of their diabetes or help with their
hypertension. It is well known that obesity increases your risk for developing
diabetes and if you lose weight, you may no longer be a diabetic. If obese
patients with Type II diabetes--the type that comes on in adulthood--
can get their weight down to the ideal range, there is an excellent chance
that they can come off some or all of their medicine. Most of the time
however, they do not lose the weight and therefore, do not come off their
medicine. We often wonder how we can motivate patients to take care of
themselves; the answer is fairly simple. They have to want to take care
of themselves first. We can give them the information, but they have to
apply it.
It has been
demonstrated that people with hypertension and obesity can also come off
their medicines if they lose weight. For most though, the idea of stopping
a medicine is not enough of a motivating force. Many people will come
up with the “I can’t” excuse when asked to walk or exercise.
“I can’t” is in a lot of people’s vocabulary.
Sometimes it is important to remember that “can’t, can’t
do anything”. If you have the chance of going to boot camp in the
military, it is not uncommon for the drill sergeant to make sure that
you remove “can’t” from your vocabulary. They know that
word is lethal. People need to remember that they can do almost anything,
but for most things they choose not to rather then they can’t. I
know someone will say, “I can’t win the gold medal at the
Olympics.” That may be true, but that is not what we are talking
about. We are talking about things that everyone can do. Unless you are
paralyzed from the neck down, there are lots of activities that you can
do.
As you deal
with the problem of your obesity, you will probably come to the realization
that you have a better understanding of the difficulties associated with
other addictions. Your obsession is related to overeating, while another
person’s may be cigarettes, alcohol, drugs or sex. Addiction and
obsession come in many forms, and when we accept our own weaknesses we
are usually a little more compassionate towards those with other addictions.
Humans are quick, it seems, to judge others; perhaps this is because it
makes us feel superior. So as you deal with your own problems, perhaps
you will be kinder to those with other imperfections. It would be great
if, with time, we could be gentler to others.
How do you
feel about your body image? Do you see yourself as normal, large, or small?
We all see ourselves differently than others do. Many times we are too
harsh on ourselves. Many times we do not see our bodies as they really
are, and that is why it is more important to believe the scales or the
percentage of body fat. Sometimes you cannot trust your own feelings.
This is true with flying also. You may be in an airplane and it may be
flying straight, but you think it is turning. This sensation often occurs
when you cannot see the ground, such as when you are in the clouds. Sometimes
we are in the clouds, figuratively speaking, and cannot trust what we
feel. The pilots of the plane don’t rely on their feelings to fly
the aircraft; instead, they use instruments to chart their course. In
the same way, if we don’t go by the scales and measure our percentage
of body fat, we may also crash. The good thing is that companies like
Tanita make scales that will tell you what your percent body fat is and
you don’t have to guess. They cost about what you would pay for
a good pair of walking shoes.
Many of you
have had to face unkind comments from people about your weight. For example,
when I was growing up, I had three sisters and one of them, Susan, had
a weight problem as a child. The other kids made fun of her, as children
will do. I remember their taunting songs, such as “Fatty, Fatty,
two by four, can’t fit through the bathroom door.” My sister,
who loved to read and was not particularly active, had a problem with
her weight then and now. Although the songs children sing today may be
different, I am sure the comments have not changed much over the years.
It’s still painful to be on the receiving end of such remarks.
What are you
going to do in these situations? What has been your response in the past?
Do you get angry? Do you go and eat? Do you tell them off? We all have
our pattern of response. I would suggest that the best response is to
try to accept where you are in your life, not get angry, and realize that
we all have problems. No one is perfect; the person making the snide comments
is not perfect either. They have their own issues. Don’t take the
comments personally, just chalk it up to ignorance and continue on your
way. Keep your goal in sight. It is important that you do not let negative
comments get you off your path. If you have not figured out what your
responses are, then you need to role play in your mind and figure out
what they will be. Pretend that someone made a negative comment to you:
what will you do or say? Try to have your comment be positive and not
negative. Negative energy does no one good, not even you. You may think
of lots of things that you would like to say or gesture to them, but instead
try to find a positive approach. If you play some of the scenarios out
in your head, then when they occur you will have a response and it will
not take you off guard.
Maybe you
want to learn how to control impulses such as compulsive eating, that
occur in your life. Maybe that is one of the lessons that you feel is
there for you to learn. Perhaps that is one of the reasons that you want
to lose weight. How are you going to control the impulses? That can be
hard, but then life is hard, as well as fun. One way to is acknowledge
what they are; once you know what they are and are willing to admit them,
then you are better off and on the right road to controlling your impulses
and not letting them control you.
You are playing
the role you have chosen for yourself. Perhaps you are tired of this role
and you are ready for a different one; maybe that is why you want to lose
weight. You want to see what it is like not to have to carry all the extra
weight around. You may want to lose weight so that you can look like a
magazine picture, or fit into an old pair of jeans. The reasons for losing
weight can be many. If the reasons are not for you, but for someone else
then they probably won’t last. Your best chance for success is if
the goal is 100% for you. You do need to think about why you are doing
it, and then write it down. What are the three main reasons that you want
to lose weight? This is for you, and you alone, so put down the reasons
that feel right for you; be honest with yourself. Only with your own honesty
will you be able to move forward.
Once you are
successful and start to lose weight, how are you going to deal with the
negative comments from other people? What are you going to do when someone
tells you: “You’ve lost too much weight. You look too skinny”;
or “Your skin is sagging,” or “Your wrinkles are more
prominent.” I hate to say it, but you will hear these comments.
Some will be from your closest friends. The best thing to do is to realize
that it has more to do with their insecurities than with anything else
and try to forget it. This says more about them then it does about you.
You need to be comfortable in your own skin. If you are, then don’t
worry about them. They will figure out their own issues with time. Again
role play with different scenarios and figure out what your responses
will be if you get some of the comments noted above. I have had patients
tell me that family members have said all those things to them.
My reasons for losing weight are:
1.
2.
3.
When I get negative comments from friends and family as I lose
weight I will:
1.
2.
3.
Anorexia and Cachexia
What
is anorexia? Anorexia is a condition characterized by lack of appetite
for food. People do not feel like they are able to eat.
This can be
due to either medical or psychological factors. The psychological causes
may be deep-seated and frequently require professional help; among the
more common are anorexia nervosa, depression or bipolar disorder. Anorexia
nervosa is a psychological condition in which people may induce vomiting
or diarrhea after eating in an attempt to keep their weight down. They
perceive themselves as being obese, but in reality they are thin to very
thin. Yet when they look in the mirror they see an obese person. Many
times they obsess over food, in that they will cook the food for the family
or others but will not eat it. The patient with just anorexia is someone
who has an aversion to food but it may not be the specific type of anorexia
nervosa. The singer Karen Carpenter allegedly had anorexia nervosa and
died from it.
From a medical
perspective, anorexia can arise from any long-term illness or even drug
abuse. When people have cancer, they frequently lose their appetite and
have trouble eating. People with AIDS can have the same problem. They
may develop an aversion to food. In some instances, you can give them
food and they will be able to eat one or two bites and that is all. If
they continue to eat, the food will feel as if it is growing in their
mouths and then they will spit it out. They do not feel that they can
swallow the food. Frequently they lack the desire to eat, and they do
not feel hunger.
You might
wonder how can this occur. You know that when most people miss a meal,
they get very hungry and are looking for the closest place to get some
food. When cancer and AIDS patients have anorexia, they would like to
eat but may not have a desire to and can’t think of anything that
they want. If they do think of something, then they may be able to eat
a bite or two and they are full, or have the feeling that more food will
make them sick.
This is as
difficult a problem as it is for someone who is obese who wants to lose
weight and chooses not to say no to his or her cravings. Anorexia causes
a lot of problems for families. The families of patients with anorexia
will go and buy all types of food for them to eat, hoping they can find
something that the person will eat. When they exhibit no appetite, the
family will plead with them to eat. At that point, both the family and
the anorexic person become frustrated, and everyone is unhappy. The family
members frequently gain weight, as they end up eating the food that they
bought so that it is not thrown away.
Some people
with anorexia obsess over their weight. They know how much they weigh
with a full bladder and an empty one, before they have a bowel movement
and after. They know how much they weigh dry and after a shower. They
may weigh themselves compulsively 6 or 8 times a day. This degree of obsession
is not normal and people with this condition should seek professional
help.
So what can
we do about anorexia? If the patient has a psychological problem, then
of course get them professional help. What we will be talking about here
are those people who have a medical condition that affects their appetite,
not those with psychological problems.
On the plus
side, there are things we can do that help. Usually anorexics are placed
on a high potency vitamin. This should not increase their appetite, but
it will at least give them the vitamins that they need. If you do not
eat the proper foods, then eventually you will become vitamin deficient.
There are many high potency vitamins, all of which are good. Nonetheless,
the companies that make vitamins will tell you that theirs is the best,
but this is just part of their marketing campaign. Just be aware that
it is a sales pitch.
There are
other medicines that will help people as well. One of these is Megace
or megestrol acetate. This is a hormone that helps increase the appetite.
People who take this medicine tend to put on weight, but primarily they
gain fat and not protein or lean muscle weight. This drug does stimulate
the appetite though, and once the patients are eating better you can stop
the drug and the patient continues to eat. They seem to have regained
their appetite and desire for food. In order for people to put on muscle
mass once they gain weight, they must exercise or stimulate the muscles.
If you eat and do not stimulate the muscles, then you will primarily put
the weight on as fat.
Marinol or
dronabinol is another agent that tends to increase the appetite. This
is the active agent in marijuana and it stimulates the desire to eat.
It causes people to get the “munchies.” For some this works
well; for others the side effects limit its usefulness. Most patients
tolerate this agent well. I have had both older and younger patients on
the drug, and when it works it works very well. Younger people seem to
be willing to deal with the side effects of the drug. I have also had
people in their 60’s and 70’s that have done well with the
drug. Sometimes the problem with the drug is the fact that it is a derivative
of marijuana. We have a society that encourages us to “say no to
drugs,” and therefore, some people will not use it because it is
derived from marijuana.
Occasionally,
we also put patients on “elder tonic.” This is a tonic that
is elderberry-based and is fortified with vitamins. The alcohol content
is close to that of wine, and we frequently give two to four tablespoons
about 30 minutes before lunch or supper. For some this works well. Others
can get the same benefit from a can of beer or a glass of wine 30 minutes
before the meal. Alcohol will lower your blood sugar about 30 minutes
after it is consumed. When the blood sugar drops, people feel hunger and
they eat. That is why you see snacks such as nuts or pretzels when you
go to a bar for an alcoholic drink. What you will find is that a few minutes
after the drink, you feel hungry and that is due to the drop in your blood
sugar. Those in our society who abstain from alcohol may choose to use
elder tonic instead, as it is fortified with vitamins and is for medicinal
purposes.
Once the patient
starts eating again, you may need to look at what type of weight they
are putting on. Megace, for example, will primarily result in the accumulation
of fat. In some settings, you may want to use male hormones so that the
person can put on muscle mass. This is done in AIDS patients to help them
regain muscle mass and to recover from the weight loss syndrome.
Why do these
patients experience the loss of appetite? This is probably due to cytokines
or chemicals that the cancer, AIDS, or chronic medical conditions make
that interfere with the desire for food. At present, there is not a lot
one can do about this other than to treat the underlying condition. As
the medical problem gets better then the appetite should improve. If the
condition is not going to get better, then the appetite will not improve.
For patients
who are dying from their medical condition, whatever it may be, it becomes
important for the families to realize that the patient is not starving
to death. The patients do not have a desire for food; they have an aversion
to it. We need to let the patient be the captain of his or her ship, and
we should accept our role as that of merely the first mate. We need to
let them be in charge. We need to remember that someday, when we are the
ones with the medical problem, we will also want to be the captain of
our ship. Many times guilt gets in the way; family members feel guilty,
and try as hard as they can to get the person to eat. This results in
the patient getting upset. The family gets upset, and at a time when the
person is slowly dying of his or her illness, this is not the time to
have everyone stressed out and unhappy. What the family needs to do is
to focus on what is important and, in that instance, what is important
is to sit and hold their hand, fluff their pillow, get them a glass of
water, and tell them you love them. That is what they need: not food for
the body, but food for the soul.
In contrast
to anorexia, cachexia is a state of general ill health and malnutrition.
We have all seen pictures of patients around the world who are starving
to death--and this is what someone with cachexia looks like. So a cachetic
person is one who suffers from malnutrition. Patients, when they are near
death, frequently look very malnourished. They are thin; you can count
their ribs; their muscle mass is very low. They are frequently weak and
do not have much strength.
One patient
that I took care of with cachexia simply had an aversion to food. Lillian
was never hungry and did not find anything that appealed to her when it
came to mealtimes. She weighed 75 pounds and occasionally we could get
her up to 85 or 90 pounds. She was approximately 5 ft 6inches and had
sunken eyes and facial structures. Lillian was 53 years old, very pleasant
to talk with, and well aware of her size and the fact that being this
thin was not healthy. In working with her, I began to understand how it
could be as difficult for thin people to gain weight as it is for heavy
people to reduce. When Lillian ate food, she just nibbled a few bites
and that filled her up. She did not have any apparent medical condition
causing this; rather, she had always been little and food was not very
important in her life. There was no obvious psychological reason for the
lack of eating. In her case it appears that on a scale of 0 to 10 where
0 is no desire and 10 is the strongest desire you could have for food,
hers was a 0 to 1. She was an outlier so to speak, not in the normal curve,
but then again the patient who constantly is obsessing over food would
be a 10. The danger for patients like her is that she did not have much
muscle mass or stored food supplies, so that if she were to get sick,
she might not have the nutrients to help her recover. That never happened,
but she continued to stay small and cachetic.
Some cathetic
patients get better because they suddenly have access to food; for example,
they are no longer confined in a concentration camp or are victims of
famine, living in an area where food is scarce. These patients require
a lot of support to get better.
In contrast,
patients who are dying of a medical condition will not get better; they
will continue to decline until they die. Usually when a patient’s
weight falls to 80 pounds and he or she is an otherwise normal adult,
then death is not far away.
As people
lose weight in this setting, they shed a lot of muscle mass. In turn,
as their muscle mass decreases, they grow weaker. They do not have the
muscles to do the work that needs to be done. They do not have the strength
to get up and go. The body will conserve the scant energy that it has
just to function. It has to keep the brain, lungs and heart and other
critical organs operating. So the body will do what it has to do to make
sure that the energy is there for this to happen. Because arm and leg
muscles are not as critical as the brain or the heart muscle, you will
see them begin to waste away. Ultimately, the patient lacks the strength
to get out of bed. If they are able to get out of bed, it is not for a
long period of time since they do not have the muscle power to function.
Their legs may not hold them up; they may stumble or fall. This is normal.
As you replace the calories and the patients get better, you also have
to work with their muscles to rebuild them. The muscles will come back
and they will do quite well, but they will have to use the muscles in
order for them to get stronger. The old saying “Use it or loose
it” is true with muscles. But if you have lost them, you can regain
them just as easily. Age does not matter; older people can regain their
muscle mass just like the younger population.
To develop
muscles, you need to get the appropriate building blocks of nutrition—namely,
the amino acids needed to build muscles. You also need to supply enough
energy in other forms so that the body does not have to catabolize or
destroy the muscles that are there for food. As you learn more about what
the body needs, you will have a better idea of what you must do to properly
feed the body. You also need to remember that the human body--although
it may be complex in many ways--is very efficient and if you give it just
a little flexibility in what you feed it, it will respond well. It is
not like a high performance car that can only take high-test fuel. The
body will work on all forms of fuel. It just needs a little variety to
work at its best.
Perhaps you
currently have a friend or family member who is dying of an illness and
no one, not you, the doctors, or the clergy will make this person get
better. They are going to die. In fact we are all going to die; we just
think that for us it is still a long time away. This person is dying;
you want to make them better but no one can make them better. What are
you going to do? As I said earlier, I hope that you will be there for
them and fluff their pillow during the day, give them a glass of water,
hold their hand, as this is what is important. All too often we get caught
up in the mechanics of what is going on and forget the human aspects.
We forget that what humans need is acceptance, so hold their hand and
tell them that you love them. Give them the spiritual food that they need,
which they need more than the worldly food, sing to them if they would
like, read to them--in a word, love them.
Recommended Reading:
Dying to Be Thin: Understanding and Defeating Anorexia Nervosa and Bulimia:
A Practical Life-Saving Guide,” by Doctors Ira Sacker and Marc Zimmer.
Chapter 3 >
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