Trying to lose the babyweight

This is my way of giving myself a pep talk for weight loss, it contains advice I often give patients, so you are all welcome to take it or leave it.  Plus, I’m interested in hearing what my other doctor/nutritionist/health care or other friends out there tell people (and would tell me) so please feel free to comment.

1. It is simple math.  If you create a 500 calorie deficit on a daily basis (from your baseline needs) you will lose a pound a week (3500 calories = 1 lb).  Whether you do it with diet or do it with exercise doesn’t really matter for weight loss (although there is evidence that exercise even without weight loss may prolong your life so it is good in and of itself). People don’t like hearing that it is simple math when I tell them this in the exam room I have been met with eye rolling and people saying, “but I already do that and I STILL am not losing weight.”.  So I encourage food journaling for 3 days (I find asking someone to do it for longer than 3 days is too hard for them to do) and bring in their journal to me and show me.  Do you know how many people have come back to me with that food journal?  ZERO.  Which leads me to believe they either ignore me completely or they do the food journal and realize that they aren’t actually reducing their caloric intake.  I currently am using the Lose It! App on my iPhone for food journaling.  It has some nice little features, like a bar code scanner (so you can scan your cereal container in the morning with your phone and it automatically puts it in your log), it also helps you see where you are in terms of your daily and weekly weight loss goals based on your caloric intake and exercise.  I would be interested in hearing if anyone else has other calorie counting apps or websites that they recommend.

2. When you are trying to lose weight, food should not be your friend.  Food can be a lot of different things for me and for other people too: it can be a creative material (cupcakes!), it can be tradition, it can be celebratory, it can be a show of kindness and love, and it can be fuel.  There are probably other things not on that list that it can be.  But, when food becomes really emotional it puts a level of control over a person that is probably not healthy.  Occasionally I have people in the exam room start crying when we talk about diet/weight loss when they start talking about their relationship with food.  To me that is a sign of an unhealthy emotional attachment to food. I encourage them to seek counseling, and I have seen people finally able to successfully tackle their weight loss goals once they work through their emotional issues.  For me, I do better with changing my diet when I look at food as fuel.  I’m not saying it shouldn’t be enjoyable or taste good, but somehow looking at it as energy for my body is helpful for me in terms of weight loss.  I often recommend the book “Eat what you love, love what you eat” to patients; I saw this author (who is a Family Physician) speak at a women’s health conference and she has a great story and message and if you have an opportunity to hear her speak I would encourage it: http://www.eatwhatyoulovelovewhatyoueat.com/

3. Make small changes.  The human body and mind doesn’t like change.  Trick it if you can.  Substitute whole grains where you would normally have rice or pasta, it’s not as hard as it sounds!  Or make changes in activity that are continuations of routines you already do.  For example, if you walk your kids to the bus stop every day, walk a little farther than the bus stop each day after they leave and soon you’ll be walking a mile or more.  I don’t encourage people to try things that seem painful or hard to do or difficult in terms of timing.  Plus, I really think activity should be fun as you’re more likely to keep doing it.  I also think it’s good to take advantage of your natural attributes as well.  For example, if you’re a competitive person, set a goal for some sort of race or competition to keep you active.  If you’re a social person, find a group activity or class that you might enjoy.  (Personally I’m going to be signing up for a half marathon in late spring to motivate me).

4. Get and maintain support.  Use a spouse, family member, friend, trainer, nutritionist, or anyone you can find who is willing to support your efforts and help you.  It’s good to have someone to bounce ideas off of and to look over things with you to keep you on track and make sure you maintain balance.  Of course it goes without saying you should see a doctor if you haven’t in awhile to make sure that your plan is good as well (it can also be a good motivator if you find out you have high blood pressure or high cholesterol).

5. Accept it will not be easy.  I always laugh a little when commercials make weight loss sound easy.  It’s really hard.  Just accept that your body will hurt sometimes (I mean muscle soreness, not a real injury, which everyone is at risk of having and should make sure to start off slow and build up a good aerobic base before pushing their limits) and that sometimes you will be hungry.  I don’t mean starving, but it’s pretty hard to cut your calories and not be hungry at times, I think it actually helps you listen to your body better when you occasionally can say, “oh, that is what hungry is like, I should fuel my body now.” (instead of always being in a state of semi-fullness, which is where I probably spend too much of my time!).

Breastfeeding Blues

I’m on the verge of throwing in the towel on exclusively breastfeeding Vivian.  It has been a rough road and I don’t know how much longer I can put in this level of effort and get very little in the way of results.  Now, I know many of you out there are really passionate about breastfeeding and so am I; I think it is what is best.  I also know that many people have no problems with breastfeeding and it is very natural without any struggling; their infant latches beautifully and their milk supply flows so freely they could feed 5 infants at a time and still have a freezer full of milk.  I’ll try not to hate you for it if you’re that person (but please don’t rub it in right now please). 

I’ve never been a great milk producer and I have said before that if I was a cow I would definitely be slaughtered for my tender ribeyes and not kept around for milk production.  I was able to exclusively breastfeed Avery for the first 4 months but she probably wasn’t getting that much (she was getting enough to grow but she was scrawny), when her day care provider started giving her formula at 4 months she sort of exploded and rapidly doubled her weight and as one of our friends said when they hadn’t seen her for a couple of months, “wow, this Avery ate the other Avery!”  But I simply didn’t know how much she was getting until I started pumping at work and so I’m letting myself off the hook for that.  With Asher I went back to work when he was 2 weeks old and so he was supplemented a little bit from the beginning and I didn’t worry about it too much.  With Vivian, since I started pumping from the beginning during her NICU stay I knew I was behind the curve in my production from the start.  And then it ended up she has a weak and disorganized suck, a tight jaw and neck, and she is generally a lazy/sleepy nurser.  Those are all things that make it more difficult to breastfeed (maybe SHE should put forth a little more effort!). 

We have been doing a lot to try to make this work.  We have been to the lactation consultant on an almost weekly basis and to the physical therapist a few times and done craniosacral therapy.  Our feeding routine is a little bit crazy (and time consuming) because first I nurse her (which is usually frustrating because I either have to do all kinds of things to keep her awake and well latched or she gets frustrated and screams at the boob) and then afterwards I have to give her 1-2 oz of supplemented previously pumped breast milk or formula (because she can’t empty the breast on her own) and then I have to pump to obtain the aforementioned milk to supplement at the next feeding.  Occasionally I use a syringe and small tube to feed her the milk while she is breastfeeding, which is time consuming and difficult too, getting that little tube into the corner of her mouth while she is nursing without breaking her latch is like threading a needle that you can’t see and I usually end up with milk all over the place.  Then there is the cleaning of all the bottles/syringes/pumping equipment.  We also have to try to do her jaw and neck exercises (which I frequently forget to do because I’m exhausted and they make her cry).  I estimate I spend between 8-10 hours a day with these various breastfeeding related tasks.  With the other 14 hours of the day there is the holding/changing/other baby care activities and of course there is all the normal life stuff like getting the kids off to school, cooking, laundry, etc.  I try to get some sleep too and do what I can to take care of myself (take all my vitamins and herbs and mother’s milk tea) but it’s not easy.  And in my spare time I have (of course) collected the data of when and how much she eats, when and how much I pump, and made a spreadsheet so I can track any trends.  I find it surprisingly therapeutic to record that information, even if it does just point out how badly it is going.

People often say that many of the things you feel you need to do you don’t have to do when you have an infant (like some daily household stuff) and I agree, but sometimes those things also are the things that make you feel human.  The other night I cooked a real meal and it took me about 75 minutes, it was a main course with two side dishes and a dessert, and it was a crazy hour because the baby was crying off and on and it took a lot of pre-planning in terms of when to feed her and everything and Andy was like, “you didn’t need to do that, we could have picked something up.” But the thing is I did need to do that because sometimes I just feel so engrossed in this complicated feeding routine (one that I am not exactly succeeding at) that I need to do something else so that I can, for even an hour, feel like a capable person. 

I won’t even get started with the guilt factor.  I’m going to feel guilty either way (whether I give up the hope of exclusively feeding her or just continue being sub-par with half time breastfeeding) because it feels like one of those things that you are supposed to do as a mother.  You are supposed to provide for your baby.  To fail at that is really crushing.  I have seen patients who go through this, and I support their decision either way, and now I finally understand what a painful decision it is.  I have another lactation appointment today so we’ll see how things go.