No, Really, Treat the PROBLEM

A comment for Treat Weight First? that I did not approve, but found striking for its ability to completely misunderstand, was:

There must be some powerful drugs in that koolaid you’re drinking. You admit you are morbidly obese, you have multiple health problems directly related to obesity, yet you shun the doctors that are trying to help you and others like you to lose weight. Amazing!

I posted here before that I’ve recently been diagnosed with multiple conditions that cause fatigue, muscle loss, and weight gain.

I repeat: cause fatigue, muscle loss, and weight gain.

What I haven’t posting about is that it’s been TWO MONTHS since the test that confirmed I’m deficient in human growth hormone — and I haven’t started treatment yet.

(Why? Combine a rare condition with an expensive, injectable drug treatment and you get fun “Who’s on First?” times with the doctor, insurer, pharmacy, and the drug manufacturer. I am not thrilled to have the drug manufacturer’s help line in my cellphone contact list. On the other hand, I do have the drug manufacturer’s help line in my cellphone contact list.)

Because I try to be a good patient, I read up on this new condition.  It has fun, familiar symptoms like:

  • A higher level of body fat, especially around the waist  (Like the 30lbs I gained since my dad died? Or the 50lbs between 97 and 2001? Or, er, my entire life?)
  • Anxiety and Depression (I didn’t have a problem with anxiety until about 4 years ago. Uh…)
  • Fatigue (So, not just hypothyroid?)
  • Feelings of being isolated from other people (So…not just getting older and less patient?)
  • Greater sensitivity to heat and cold  (So… not just getting older or hypothyroid?)
  • Less muscle (lean body mass) (Yeah, my weight lifting hasn’t had results it used to, it’s harder to build muscle…)
  • Less strength, stamina and ability to exercise without taking a rest (Like how I could walk a mile a few years ago and now I need to rest after a couple blocks? YES IT’S VERY NICE TO KNOW WHY.)

And a symptom that’s very, very scary for me: hypothyroid can cause impaired memory.

So let’s go back to that “koolaid” I’m drinking. And about how weight loss is going to “help” me.  Because weight loss will obviously fix the “obesity-related” health problems I have.  Except, wait — those hormonal deficiencies are “obesity-related” in terms of “people who have this tend to be fat”, not “caused by fat”.  And they’re screwing up my life. 

  • Weight loss isn’t going to fix hormone deficiencies.
  • Weight loss drugs won’t fix hormone deficiencies.
  • Weight loss surgery won’t fix hormone deficiencies.

If I were to lose weight without treating those hormone deficiencies? My quality of life would not be improved.  FUCK THAT.  Or, to be precise I am going to continue to focus on improving my HEALTH.  Because THAT will improve my life.

(How RUDE to put MY priorities first!)

And if, in the course of improving my quality of life — things like restoring my former energy levels (horrors!) and my former stamina (eek!) and regrow my muscle mass (Aack!) and reduce my anxiety and depression (gasp!) — I may end up losing some weight?  That’s up to my body.

Treating Weight First?

The Twitterverse has been busy talking about some new treatment guidelines for fatties. Ragen Chastain posted about a piece from Medscape called “New US Obesity Guidelines: Treat the Weight First,” which also has quotes from the lead author.  I also clicked over to the guidelines themselves. They start with an extremely helpful objective, to wit:

Objective: To formulate clinical practice guidelines for pharmacological management of obesity.

That’s the goal here. That tells you what this is primarily about: weight-loss drugs.  Two more were approved in 2014, at least in the US – Europe has been slower to approve the drugs.

There are a few things in the guidelines that I like.

First: Some medications have weight gain as a side effect.  I consider this is a useful fact for medical practitioners.  It makes no sense to prescribe a drug that has weight gain as a side affect and then chastise patients for the resulting weight gain.

Second: Yes, it makes sense for medical practitioners to be aware that medications can cause weight gain or loss, and to discuss that with patients. A fat patient may prefer a drug that doesn’t cause weight gain. A slender patient may want to avoid drugs that cause weight loss.

Third: They’re measuring that a weight loss drug is “effective” if the patient loses 5% or more of their body weight in 3 months.  If that seems low? Yes, yes it is. Worth anal leakage? I think not.

Fourth:

Historically, patients and providers thought that weight loss medications could be used to produce an initial weight loss that could subsequently be sustained by behavioral means. The available evidence does not support this view.

This is an important admission. The human body doesn’t like to have its weight set point messed with.

The things I disagree with?  It’s hard to limit myself to just a few, but:

  • I disagree that patients need to be moved from drugs that control chronic health conditions just because the drug may cause weight gain. What are the side effects of the new drug? Is it as effective?  Does the patient have support during the transition?  That matters too — especially with psychiatric meds.
  • I disagree that patients should postpone treating conditions like hypertension until they lose weight. If the patient wants to try lifestyle changes first, fine — but it should NOT be under duress. The medical profession is already known to mistreat fat people. This can become another justification.

On the flip side, I was prescribed a drug that can cause weight loss (Levothyroxine) this fall. The endocrinologist was thrilled that I lost 3lbs after a few weeks of taking the drug.  I don’t care about that.  I care about FEELING BETTER.  Obviously I’m un-American.

Guidelines: Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline,

Medscape: New US Obesity Guidelines: Treat the Weight First

Medpage Today: New Guidelines: Treat the Weight First

Day 12: Celebration of the WinterTide

Today is the 12th and last day of Christmas.  Thanks to you who’ve been following along.  This last recording is from Alexander James Adams’ album WinterTide

Comparisons keep us at odds-
There’s room inside for all our Gods-
Embrace the things that we all share,
For then we find compassion there-
To those that thirst, you offer drink,
It’s not as hard as you might think!

I confess – I laughed

I live in Seattle, which means The Stranger is a local institution. From The Stranger‘s “regrets” of the previous year — a mishmash of errors they made and regret, errors and non-errors they don’t regret, and various other sarcastic local commentary — comes this sarcastic and possibly blasphemous gem:

Jesus Christ, our Lord and savior, regrets that former Mars Hill pastor Mark Driscoll was such a fucking pussy that he couldn’t even keep his church from falling to shit this year. What kind of man can’t hold down a job?

This is blasphemous in that Jesus himself didn’t necessarily hold down a job. “Itinerant preacher” doesn’t usually come with a boss, paycheck, or a W2. The Jesus that welcomed women would probably not use “pussy” as a putdown. But the god that Mark Driscoll preached definitely would use that slam, and would definitely be contemptuous of a preacher getting kicked out of the church he cofounded and ran.

So yeah. I laughed.

 

Quote of the Day

In dealing with the “encouragers” who want you to eat less, move more, and maybe have a few organs amputated to lose weight:

These fat hating types don’t know you and they don’t want to. They don’t care to know if you are or aren’t doing sit ups or exercising or what you really eat. And they don’t care. Their objective is to make you feel bad for being fat. It’s that simple. They’re sadists and nothing but suffering satisfies them.

These assholes will scream “why don’t you get on a treadmill fatty!” even if you’ve just gotten off one. They’ll just shout, “Stay on longer until you’re thin, lard ass!” They don’t care if you just found out you’re 25lbs lighter, even. So long as you are fat, they hate you and want you to suffer.

But when you figure that out, things can come into focus. You can start understanding that you’re not gonna argue your way to them being lesser douchewads than they were. They will never not hate you. That makes them the one with something deeply wrong about them, not you.

The winning move here is simple (but not easy): live the happiest and best life you can right this minute, as you are. Be good to others and yourself, try your hardest, and enjoy as much as you can about being on this Earth while you are here.

Sadists hate your happiness, so I suggest cultivating as much of it as you can, as you are, right this minute, as you are.

Madame Thursday

Tests Are In …

I posted before that I’ve been having some medical tests.

And that I’m seeing an endocrinologist to treat hypothyroid.

Some of you may have seen my tweet about getting a growth hormone test.

Turns out I’m deficient in human growth hormone.  This may explain why I have less strength, stamina, and endurance than I used to have. I have met with my doc to discuss treatment, and am starting it soon. I’m not sure how long it will take to show improvement.

I am finding that having hormone deficiencies that cause fatigue, muscle loss, anxiety, and depression can be similar to simply having depression in that it’s hard to get help when you’re fatigued and depressed. Especially when the deficiencies came on relatively slowly and gradually.

There will be more tests, such as an MRI of my pituitary gland. I’ve got potential posts in my brain about various things related to the tests and new doctors and so on. But right now, it’s still the busiest time of year at work. It gets dark about 4pm every afternoon. At least I know why I’m so tired.