Super morbidly obese. Where do I start?

[Anonymous]

Did you see this essay in the NYTimes?

Noom might work for you.

https://www.nytimes.com/2022/05/11/magazine/weight-loss-pandemic.html?referringSource=articleShare

[Anonymous]

Anonymous wrote:

Anonymous wrote:All this advice is great, but I’m telling you talk to your doctor about Wegovy. Life changing. I’m maintaining a 100lb weight loss. I’ve posted about it.

But what happens when you stop taking the mediciation?

Not that poster, but regain is common. However there is no reason why it can’t be a lifelong medication. It is foolish to assume SMO patients have “normal” pancreatic and insulin function. They demonstrably do not.

[Anonymous]

You need medically managed weight loss. If you have binge eating disorder, vyvanse is a lifesaver. Theory is that BED can be a form of OCD.

Wegovy or semaglutide can also help and improves type 2 diabetes.

Yes, you may never get down to an "ideal" BMI, but even losing 50 lbs would do amazing things for your health. You may need to be on meds for the rest of your life, but I don't see the big deal. We don't expect diabetics to wean off of insulin.

signed, used to weight 390 lbs. Now 190 and holding steady.

[Anonymous]

I can’t recommend a personal trainer enough. A lot of these suggestions are great but it all comes down to just exercise and diet. A personal trainer will keep you accountable and on schedule and will ease you into it. They will have all the knowledge and expertise. Usually they can help you with the meal plan or you can find a nutritionist.

[Anonymous]

Anonymous wrote:I can’t recommend a personal trainer enough. A lot of these suggestions are great but it all comes down to just exercise and diet. A personal trainer will keep you accountable and on schedule and will ease you into it. They will have all the knowledge and expertise. Usually they can help you with the meal plan or you can find a nutritionist.

With morbid obesity this is just simply not true.

[Anonymous]

One thing that semaglutide has convinced me of is that there is a pre-pre-diabetic state that is not well-diagnosed. There is a group of people with problematic insulin management that fall well below even pre-diabetic levels, but that can cause obesity.

[Anonymous]

Dr. Now diet

And watch my 600lb life. Do you want to continue to live like that?

[Anonymous]

Anonymous wrote:I would start with getting rid of the goal to lose 200 pounds. That goal is too big, and it isn't really maintainable. Your goal needs to be to change your lifestyle to one where you're taking care of yourself, both mentally and physically.

First stop needs to be a PCP - you need to get any diseases diagnosed so you can begin treatment.

Then, start taking steps. For your body, pick a step and then implement it -- not as a temporary measure so you can lose weight, but a permanent lifestyle change. Start walking 20 minutes every day. That's it. Once you've been doing that for two weeks, add another step (cut out a day of takeout, add one veg to your diet every meal, switch one snack carb to a healthier option, etc). Keep adding a step every two weeks.

For your mind, start looking into therapy - eating when you're full/comfort snacking is really common, but people often need help to break that association. Cognitive behavioral therapy will be extremely helpful, especially since this has been such an entrenched pattern for you.

Finally, if you're goal oriented, that's great! Definitely use goals to motivate yourself, but I wouldn't use weight as a goal. If your dr says you have high blood pressure, make your goal to get your blood pressure under control. Maybe your goal is fitness related -- you want to be able to walk a 5K. Keep picking goals as you achieve them, but make them achievable and health-centric.

The only way this works, long term, is if it's a series of steps, not one big push. You can do this. Good luck.

This is the advice I was going to give. Baby steps. Small changes do make a difference because they add up over time. If walking 20 minutes feels daunting, tell yourself you will go out for 10. 10 minutes is better than no movement. Or consider a Fitbit to measure your baseline activity level. If you are currently getting 1500 steps a day, aim for 2000. After a week, 2500. And so on. And for diet make one change at a time and when you feel that you have that down, make another. PP gave good suggestions there. You want sustainable changes not fad diets. Don’t focus on the scale for now. Most importantly, be kind to yourself.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I can’t recommend a personal trainer enough. A lot of these suggestions are great but it all comes down to just exercise and diet. A personal trainer will keep you accountable and on schedule and will ease you into it. They will have all the knowledge and expertise. Usually they can help you with the meal plan or you can find a nutritionist.

With morbid obesity this is just simply not true.

Yeah, pass on this advice until you get your weight down.

[Anonymous]

Anonymous wrote:Dr. Now diet

And watch my 600lb life. Do you want to continue to live like that?

OP here. I really appreciate all the advice!

To pp, no I don't, hence asking for advice, if you couldn't tell =)
I've never been in denial. Always aware that I was gaining and didn't care about myself in general for a long time so if I died from obesity, it wasn't something I was concerned with, since other things seemed worse. Thanks.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:All this advice is great, but I’m telling you talk to your doctor about Wegovy. Life changing. I’m maintaining a 100lb weight loss. I’ve posted about it.

But what happens when you stop taking the mediciation?

Not that poster, but regain is common. However there is no reason why it can’t be a lifelong medication. It is foolish to assume SMO patients have “normal” pancreatic and insulin function. They demonstrably do not.

Agree, it just hasnt been approved as an indefinite med for obesity yet. For diabetes patients stay on GLP-1 medications indefinitely unless there is a specific contraindication or side effect that develops.

[Anonymous]

Anonymous wrote:The first stop is therapy. If you treat all the emotional issues that got you to this weight and has kept you at this weight, you will lose weight without dieting.
-- Trauma survivor and formerly obese person with 20-yr eating disorder who did EMDR + CBT (and a LOT of it).

I don't want to take over this thread with my own question, but I'm curious about your experience. Did you know that your untreated trauma was the reason for your weight issues? I'm also very overweight and I know I have unresolved trauma from my childhood. I've been thinking about finding a trauma therapist and working through it. I have a hard time understanding the connection between my emotions and my weight, but I'm sure there must be an emotional aspect to it. When you started to feel better about yourself, did the eating healthier and being more active come naturally or is it still a constant struggle?

[Anonymous]

Anonymous wrote:

Anonymous wrote:The first stop is therapy. If you treat all the emotional issues that got you to this weight and has kept you at this weight, you will lose weight without dieting.
-- Trauma survivor and formerly obese person with 20-yr eating disorder who did EMDR + CBT (and a LOT of it).

I don't want to take over this thread with my own question, but I'm curious about your experience. Did you know that your untreated trauma was the reason for your weight issues? I'm also very overweight and I know I have unresolved trauma from my childhood. I've been thinking about finding a trauma therapist and working through it. I have a hard time understanding the connection between my emotions and my weight, but I'm sure there must be an emotional aspect to it. When you started to feel better about yourself, did the eating healthier and being more active come naturally or is it still a constant struggle?

DP. I had a lot of childhood and young adult trauma and have always struggled with my weight. I never in a million years would have linked the two. But the last two years I have made a substantial effort to just like, work on myself I guess. It involved exercise, diet changes and therapy. I’ve tried to lose weight plenty of times and failed and there were extenuating circumstances this time that set me up for success (namely COVID, as it kept me home not eating out all the time and my outlet for stress turned out to be cardio). But there were also circumstances that should have meant instant failure (I had three kids under 5!).

It worked, I’m down 50 pounds, I’m no longer in the obese classification and I don’t think I’ll regain. Hard to draw a direct correlation but I honestly think working through a lot of my trauma, which I’ve been doing concurrently with a therapist, has really really helped and improved my chances of success. I am just generally calmer and more stable and in control of my emotions and life. And that does lead to less emotional overeating and honestly just less health problems overall

[Anonymous]

NP. I’m a childhood sexual assault survivor who became significantly obese in high school. I also have ADHD, something that wasn’t diagnosed until adulthood. I am highly successful in my career but always struggled with weight. I binge dieted, lost 50 lbs, gained it back, etc. I didn’t hide and I traveled the world, but I was fat.

It wasn’t until I started doing significant and deep therapy, along with immersing myself in the body acceptance movement, that I was able to lose weight and keep it off. It took years of work. I had to accept that I gained the weight in part to protect myself and to accept that weight gain isn’t the moral marker that the fatphobes on DCUM make it out to be. There is a huge correlation between super morbid obesity and childhood sexual abuse, and learning about that and finding a compassionate and fat-positive therapist was key. I also worked with an endocrinologist and a doctor who specialized in obesity. It was an extremely expensive and time-consuming process.

But I’m fit and have been for years. I work out almost every day. I will not as part of my healing focus on actual weight, but I wear a women’s medium or large depending on cut as opposed to 2x. I have low blood pressure and excellent labs. I’m happy and have a good marriage (to a man who has stood by me throughout).

You cannot control cravings by willpower alone in a society that makes unhealthy food so easily available. To say that is to tell people to fail. But you can, with a focus on healing, make small changes that might eventually cause weight loss. I started with walking. But when I say it took years, I mean literally years. And, candidly, a lot of money that wasn’t covered by insurance.

Personally I do not think we will make any progress whatsoever on solving the obesity epidemic until we drop the willpower narrative entirely from any discussion of obesity. Obesity is a metabolic condition that is influenced by complex biological and mental processes. The idea that “willpower” can fix obesity is laughably naive.

[Anonymous]

Anonymous wrote:NP. I’m a childhood sexual assault survivor who became significantly obese in high school. I also have ADHD, something that wasn’t diagnosed until adulthood. I am highly successful in my career but always struggled with weight. I binge dieted, lost 50 lbs, gained it back, etc. I didn’t hide and I traveled the world, but I was fat.

It wasn’t until I started doing significant and deep therapy, along with immersing myself in the body acceptance movement, that I was able to lose weight and keep it off. It took years of work. I had to accept that I gained the weight in part to protect myself and to accept that weight gain isn’t the moral marker that the fatphobes on DCUM make it out to be. There is a huge correlation between super morbid obesity and childhood sexual abuse, and learning about that and finding a compassionate and fat-positive therapist was key. I also worked with an endocrinologist and a doctor who specialized in obesity. It was an extremely expensive and time-consuming process.

But I’m fit and have been for years. I work out almost every day. I will not as part of my healing focus on actual weight, but I wear a women’s medium or large depending on cut as opposed to 2x. I have low blood pressure and excellent labs. I’m happy and have a good marriage (to a man who has stood by me throughout).

You cannot control cravings by willpower alone in a society that makes unhealthy food so easily available. To say that is to tell people to fail. But you can, with a focus on healing, make small changes that might eventually cause weight loss. I started with walking. But when I say it took years, I mean literally years. And, candidly, a lot of money that wasn’t covered by insurance.

Personally I do not think we will make any progress whatsoever on solving the obesity epidemic until we drop the willpower narrative entirely from any discussion of obesity. Obesity is a metabolic condition that is influenced by complex biological and mental processes. The idea that “willpower” can fix obesity is laughably naive.

This is incredibly helpful. Thank you for sharing.