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Archive for August, 2016

On the Subject of Weight Loss 

This is a little outside the realm of my usual topics, but it’s come up enough times now in conversations that I want to write about it.

There is a lot of heated debate right now about obesity: how it affects health, whether it is the result of moral failings, who should have the right to comment on it or define it, what to do about it, and on and on.

Disclaimer first:

I am not a healthcare professional or a professional biologist. At this time, I am relying on my memory for much of this information rather than doing due diligence and looking up the relevant studies, although I certainly encourage others to do so. All numbers given in this essay are for the purpose of illustration only: they are not based on any actual data. Also, please excuse my tendency to anthropomorphise biological processes: your internal components obviously don’t actually “think” or “want” things, but it’s a convenient way to describe what occurs.

All that being said, let’s see if I can address one of the most common misconceptions about calorie intake and body weight: the idea that there is a direct, linear relationship between these two things. There is not. I commonly run across the argument that anyone can lose weight by reducing the amount of calories they ingest. Some people claim that exercise is also necessary, but the general point always comes down to the idea that fat is caused and maintained by eating more calories than one uses, and can be reduced by reversing this behavior. But biological systems are a lot more complicated than that.

First, it is a mistake to consider calories fungible (or equal or interchangeable). Our bodies may process the same number of calories very differently depending on the form of those calories, which is why we have terms like “empty calories” (calories that don’t have much nutritional value) and “good” or “bad” carbs and fats (based on how we digest them and what their health effects tend to be).

More importantly, though, there’s also an incorrect understanding of what it means to need a certain number of calories per day. I often hear people say things along the lines of “Well, just figure out how many calories you use per day and don’t eat more than that.”

Problem #1:
What do we count as “using” calories? We don’t just burn calories when we engage in deliberate physical activities. Energy consumption is involved in everything we do– breathing, moving, thinking, growing. We use calories to repair injuries, replace damaged cells, increase muscle mass, go for a walk, digest our food, maintain our fat reserves, and to perform all mental activity, from deliberate problem-solving to emotional regulation to sensory processing. And it’s not easy to determine how many calories are needed for optimal performance of all these tasks.

Problem #2:
Your body doesn’t necessarily prioritize calorie allocation in the order that you’d like. In fact, one of the first things that gets cut back in a calorie shortage is brain-power. Your brain is a massive energy-hog, and evolutionarily speaking, we don’t need to spend much time on math and science and history and office politics and romantic relationships and social activism and keeping our temper when our boss is being a twit. We can pretty much get away with: Find food, find mate, don’t get eaten.

So when you have fewer calories to work with, the cutbacks start in the brain. You may have noticed this personally. When we’re hungry, we’re often grouchy and easily frustrated and have a harder time focusing and thinking clearly. But don’t take your own experience’s word for it. There’s a lot of research evidence on this– comparing test scores of students who have and haven’t skipped breakfast, impulse control in hungry versus sated people, and so on.

Problem #3:
Your body has its own internal settings– what temperature it wants to be, how much sleep it needs, and so on. And your body is willing to put a lot of resources towards keeping things the way they are. These settings include an approximate set point for weight, which is why there are people who remain skinny regardless of consumption and people who remain fat even with healthy diets and high activity levels. And why medications, illness, age, and other factors can drastically alter a person’s weight even if the person’s diet and habits remain fairly constant. Lasting weight change requires changing your body’s set point, and some bodies make this change more easily than others.

Generally speaking, it is hard to get your body to change the set point to a lower one… and relatively easy to get your body convinced that it should have more fat reserves. Excess consumption obviously has this effect– the body says “hey, let’s store some of this extra for later!.” However, cutting back dramatically on calories can also increase weight, because your body thinks “huh– I’m getting fewer calories than usual. We may be preparing for a drought, lean harvest, or other time of scarcity, and we don’t know how long it will last. We’d better save up as much as possible now.” Your body then boosts your hunger signals and again starts cutting calories from other areas of functioning. This is one reason why drastic calorie restriction diets do far more harm than good.

As I understand it, body weight maintenance is highly prioritized by our physiology– pretty much right after critical systems like circulation and digestion. And I suspect one of the reasons exercise is so important to weight-loss is not just how many calories it burns, but that muscle-building is one of the few causes your body ranks highly enough to actually prioritize over maintaining fat reserves.

Let’s look at a couple fictional scenarios illustrating the ramifications of all this. Imagine you consume an average of 2000 calories per day (the numbers and proportions here are completely fictional). Let’s say you spend 300 of those calories (about 1/7) on basic internal maintenance tasks, including maintaining your current body weight. Maybe 1000 calories go to mental activity, and the remaining 700 to physical activity.

You want to lose some weight, so you cut down to 1500 calories daily. There are several possibilities for how your body can react.

1) Your body keeps the ratios the same: 1/7 to keeping your body as it is, about half your calories for the brain, slightly less for voluntary movement. This isn’t too bad– you’ll lose weight slowly and have to put up with being a bit more tired than usual for a while.

2) Your body keeps putting those 300 calories per day towards homeostasis (including body weight), leaving you with only 1200 calories to be split between physical and mental activity rather than 1700.

3) Your body decides you may be facing a calorie shortage and increases the percentage of calories it turns into body weight, at an even higher cost to other functions.

4) Ideally, your body would trim fat without making any significant cutbacks in other areas, resulting in weight loss with no negative side effects. This is certainly possible, but it is far from being the only, or even the most likely, result of cutting calories.

In short, reducing intake alone is a pretty poor gamble to take if you’re trying to lose weight. The real trick is to get your body to change its ideas about how to allot your calories, and that’s a lot more complicated. Excercise can help, but isn’t necessarily sufficient. A more complete answer involves eating more nutritious food, increasing both physical and mental activity levels, and a bunch of other subtle epigentic factors that we’re far from understanding. We know that stress and general happiness have a huge impact, and so do sleep schedules. And there’s compelling evidence that eating a diet closer to the traditional diet for wherever your people came from can be a huge help regardless of calorie count. And so on and so forth.

It’s even harder to study all this than it sounds, since people who make significant body weight changes often have many of these factors involved, and the factors themselves can interact. When people get into exciting new relationships or more high-pressure jobs or experience other major life events, their stress levels change, their priorities change, their personal habits change, their mental health changes, other medical factors change… and it’s nearly impossible to untangle the order and magnitude of all these changes. Similar factors are involved in quitting smoking and other such things that require a fair bit of wrestling against the instinctual reactions of one’s own mind/body. So chances are good that the person who just “up and decided to lose weight one day” had life circumstances that played into making that decision, being able to stick to all the lifestyle changes necessary, and having their own biology respond in the way they wanted. 

This certainly isn’t to discourage anyone who wants to lose weight from trying; rather, people who want to lose weight and have failed with only diet and exercise may simply need to take a more holistic approach that prioritizes improving general wellbeing rather than merely reducing waist size. But it’s also important to acknowledge that we are very complicated systems, both physically and mentally, and some of the factors that affect our systems are generally beyond our awareness, much less our control. 

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Categories: Disability Rights

Beach Days

It’s something of a cliche that autistic kids adore water, but you know what they say: a cliche is a cliche because it’s true.

Over the past few weeks, I’ve gotten to join several families on beach outings, and it’s always a wonderful experience. It’s fun to compare the experience of two clients in particular — two nonverbal autistic 9-year-old boys with very different personalities. 

The Flapmaster General is a “hummingbird” child — always in motion, full of energy, exuberance, curiosity, and, often, frustration with the rest of us who obviously can’t keep up with the world as he experiences it. He is desperate to communicate with the people around him, too. He uses a handful of spoken words now, clumsily and inconsistently, and is rather more capable with a speech device, although still only with very straightforward requests.
Flapmaster can spend hours happily playing keep-away with the waves, darting and dashing, giggling and shrieking, following each receeding wave down as close as possible before scampering back to dry sand just barely ahead of the incoming surf. It’s one of the few situations in which he can truly run as much and as quickly as he likes. 

I run with him, giving him his space but staying near enough to grab him if he tries to go into the water, or seems likely to crash into other people, or takes it into his head to go jump on someone else’s sand castle or steal their toys. (This particular day, he actually approaches another child and asks for “my turn” with the kid’s bucket and shovel. I am pretty impressed by this. However, since I can’t always just ask strangers to give him things, I take him to go fetch his own toys instead, and he seems happy with this solution.)

It’s a blazing hot day, and the Flapmaster scorches his feet on the hot sand when I take him to the bathroom. I should have thought to go find his shoes first. He firmly declines to step back onto the beach after this, so I, feeling guilty for my part in getting his feet hurt, offer to carry him instead, to much laughter and eye-rolling from the rest of his family, who think I spoil him. Which I do, whenever I get the chance, because he is an awesome kid who deserves to be treated like royalty on occasion.

On the boardwalk, he flaps excitedly at the seagulls for a long time, jumping and fluttering as though he too might take to the air at any moment. And then, to my great surprise, he selects a nice park bench and sits, just sits with me, holding my hand, for the longest time I’ve ever seen him be still. He is so relaxed, so happy.

Lest you think it’s all idyllic, I will mention that there was a fair bit of stress and drama on the long ride home, but what do you expect on a day trip with 4 kids in one car? In the end, tears were dried, spills were mopped, and various stops were made to solve various other problems, and all was well if rather behind schedule.

The trip to the beach with the boy I call Soundtrack was a very difficult experience. Just me and him and his mother on a grey and somewhat chilly day at a local beach. Soundtrack is even less verbal than Flapmaster, but a good deal more vocal, with loud exclamations amidst his verbal stimming, in addition to whistling, humming, and occasionally imitating bird calls. He isn’t as fond of direct interaction with people, either, but he’s affectionate in his own way.

​While his mother rests, Soundtrack and I play in the surf. Loud cries of joy burst forth amidst his usual humming as the waves crash. I encourage him to yell as much as he wants here where the wind and water scream with him. (He gets shushed a lot at home, understandably given that there’s a baby in the household). He has a strong voice, and people occasionally look over at him in surprise when he hollers. One girl about his age looks at him nervously. “Don’t worry,” I call over to her cheerfully, “he’s just excited!” Her frown clears and she goes back to playing.

To the dismay of many parents, a recent change to my company’s respite care rules states that I cannot be responsible for a client in water more than a few inches deep (ie, the shallowest possible wading). The liability concern makes sense, of course, and the ocean here is a very different one from the sheltered bays I swam in as a child. Most of these kids, in my experience, have a healthy respect for that danger, and aren’t actually likely to go in deep enough to get into trouble… but that’s somewhat beside the point. 
Soundtrack loves to jump in the wet sand. He often prefers me to stand behind him holding both his hands, as he plays. What he actually wants, really, is for me to wrap my arms around under his and lift him, “jumping” him over the waves as you would do with a small child. He is not, however, a small child — he’s quite a solid and large child and I could barely do this with him when I  met him a year-and-a-half ago. I make various attempts to explain this, but that doesn’t stop him from jumping up and expecting me to take his weight on the way back down. I do my best not to drop him too hard or pull any muscles… but I also try to do what he wants to the best of my ability, because he’s smiling, and that’s something I don’t get to see very often. 

As for being restricted to wading, clever kids know how to find loopholes in any rule, and Soundtrack is no exception. And he plans on getting the full ocean experience even if he isn’t allowed in any deeper than his ankles. First, he drops to his knees in the shallow surf so that he can see the waves at eye level. Then he lies on his belly in the “seal” position and does “the worm,” rippling his body up and down so that the incoming waves can wash under and over his body. Lastly, he turns about so that his feet face the ocean, and lies there kicking, “swimming,” as it were, in water 3 inches deep. I can’t help but laugh… but I’m impressed as well.

Later, his mother joins us in the water in order to take him a little bit deeper. With the water at our knees, she and I hold him between us, and finally he can pull his feet up and float on the waves. Next time she says she might try teaching him to boogie board, because I pointed out to her that he spent quite a while watching another kid on a board– and Soundtrack doesn’t look at people very often, much less watch them as though they interest him!

These experiences make me smile. I may come home exhausted, sore, sunburnt, or having been kicked and pinched multiple times… but when you come right down to it, I got paid to go to the beach, get some nice healthy exercise, and watch kids I care about enjoying themselves. Sometimes, this job just plain rocks.

Categories: Disability Rights