Advice for Someone "Severely Obese"
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bowlerae
Posts: 555 Member
Hello,
Some of you participated in my thread "Quitting Tobacco and Food Cravings - Advice Needed plus LONG Rant!" in regards to my boyfriend replacing his chewing tobacco addiction with excessive eating. Well, my boyfriend is motivated to lose weight now but MFP, counting calories, cooking, exercise, and all that is a little much to throw at someone all at once. I'm helping him the best I can and trying to encourage him to eat low carb foods and to educate himself before anything else. Today was the first time in over a year that he has weighed himself, so that's a step. Not only is it looking the problem face to face but it gives us a starting point. I ran all of his numbers in different BMI calculators (minus body fat because he does not know that yet). He is 5'9" -5'10", 315 lbs, age 27, male obviously. The BMI I am getting is 46 which is classified as "severely obese".
Has any of you either started your journey or know someone else who has started their journey at this classification? What is some advice you can give? I know that's a pretty broad question but seriously anything will do. For example, I saw another thread a year ago saying when you start to exercise, start with walking and then slowly increase to jogging.
Also, I put his stats into a low carb macro calculator and selected "lightly active". He is an auto mechanic which is very physically demanding but outside of that he is incredibly sedentary. The calculator said 75g carbs, 120g protein (I guessed on BF %), and 146-206g fat. That's 2095-2600 calories per day (rounded). Of course that sounds like a lot to me but I know the larger you are, the more you can eat and still lose. Do these numbers sound reasonable then?
Some of you participated in my thread "Quitting Tobacco and Food Cravings - Advice Needed plus LONG Rant!" in regards to my boyfriend replacing his chewing tobacco addiction with excessive eating. Well, my boyfriend is motivated to lose weight now but MFP, counting calories, cooking, exercise, and all that is a little much to throw at someone all at once. I'm helping him the best I can and trying to encourage him to eat low carb foods and to educate himself before anything else. Today was the first time in over a year that he has weighed himself, so that's a step. Not only is it looking the problem face to face but it gives us a starting point. I ran all of his numbers in different BMI calculators (minus body fat because he does not know that yet). He is 5'9" -5'10", 315 lbs, age 27, male obviously. The BMI I am getting is 46 which is classified as "severely obese".
Has any of you either started your journey or know someone else who has started their journey at this classification? What is some advice you can give? I know that's a pretty broad question but seriously anything will do. For example, I saw another thread a year ago saying when you start to exercise, start with walking and then slowly increase to jogging.
Also, I put his stats into a low carb macro calculator and selected "lightly active". He is an auto mechanic which is very physically demanding but outside of that he is incredibly sedentary. The calculator said 75g carbs, 120g protein (I guessed on BF %), and 146-206g fat. That's 2095-2600 calories per day (rounded). Of course that sounds like a lot to me but I know the larger you are, the more you can eat and still lose. Do these numbers sound reasonable then?
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Replies
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Sounds pretty reasonable to me. I still am classified as Severely Morbidly Obese, but a lot of that is because I am short. I have to get to 220 pounds or so to move down to just Obese, if I remember right. And right now, my thyroid is in chaos still, so my focus is on leveling out rather than weight losses at this point.
My biggest thoughts would be...for someone being overwhelmed, just creating a food diary - where he writes out what he is eating is a good start. Not calories, not carbs, not fats...not weighing food, anything. "Restaurant Double whatever..." with times, if possible. Eventually any notes (not filling, etc.). Just tracking for a week or so without changing anything gives you a whole perspective that's foreign if you've never done it before. Honestly, when I was 319 pounds, I thought I knew what I was eating, but the mind lies to you.
Secondly, I would strongly recommend he focus on some tangible goals. Long term, and short term. Does he want to be able to run? Wrestle? Fly kids with kiddos/nieces/nephews/cousins/friends' children? Do a sit up? Wrap a towel around him and see it close? Be able to shop in a regular store? Drop a belt size. Look down and see something other than belly? I mean, really, what are things he thought he'd never be able to do (or do again) that he misses? Ride a bike? Fly in a plane without needing a seat belt extender? Do a workout? Live past 40? I mean really, have him dig in. Because honestly, if he can't even make a fantasy list and do some mental exploration at this point, it will be a very difficult run for him.
Focus on some short term goals? Want to drop a notch in his belt? Change shoe size? Be able to fit his hands into tighter spots in a car engine? Get under the car with a normal jack only? Cross his legs? Tie his shoes without awkwardness? Be able to skip a favorite food? Find new foods?
Also, make sure to get some health goals in... Get off a medication? Drop weight by XYZ? Drop BP by 10/5? Drop FBG by 10, whatever. Drop cholesterol. Pick several. Just kind of get him thinking. Also, you might want to cover the basics. Any lowering of carbs, even if he's eating 500 a day now and only goes down to 450, will cause some water/sodium losses. Some nutrient deficiencies will surface that he probably didn't realize before, especially dropping "fortified foods" that might have camouflaged certain issues.
A friend of mine likened it driving a car around without maintaining it, washing it, or doing anything to it except filling it with gas. Then, 5 - 10 years down the road, you get it and check out, start doing maintenance, and washing the mud off the car. Now you see the deep dents hail made, the flat tires, the engine needing a tune up and a dozen oil changes, the routine maintenance like changing the belts, and doing a detailed internal cleaning, etc. Since you mentioned that he's a mechanic, I figure this might ring true with him.
Now that he's weighed in, will you see him soon enough to help him take reference pictures and measurements, @bowlerae? Because those will be critical. Tell him that once he reaches XYZ point that he can burn them if he wants, but all of us who've made progress at all wish we had pictures at all, more/better ones...because he WILL make progress. Let him know that he will probably make huge strides at the beginning of any changes, but that it will slow down. Let him know that some people have to gain BEFORE they can lose, even at his weight, because they have health issues that have to be treated before the body will tolerate the stress of weight loss. Show him pictures from folks like @Sunny_Bunny_ and Staci from NerdFitness... Let him know that weight is nothing but a number, because I can show you two pictures at nearly identical weights but taken years apart, and I look 50 pounds heavier when I was carb burner than when I went lower carb - and a lot of this is related to inflammation or differences in body processing reactions. Let him know that things like testosterone and men's health hormones require fat to exist...
Let him know that at times, this will be the easiest thing in the world, at times it will seem impossible. Remind him that everyone has different health, issues, DNA, requirements. He should evaluate if things are working well about every 12 weeks. Things may and very likely will seem worse before better. While I'm thinner than I was, sometimes I feel worse about my nude self, because I'm lumpier and floppier now since my skin hasn't tightened any and I've still got a long way to go, etc. (Compression garments are said to help with this - if he has that option). Let him know that he might change sizes quickly - and that belts will be his best friend, as will clothing swaps/discount shops, etc., but that he will need to buy stuff periodically, or it gets really hard to see progress.
Let him know that his buddies will probably give him crap about it...because it isn't consider "manly" to diet. He just needs to come up with some things to help his confidence when that happens... My responses would be different than his I'm sure, but with guys, focusing on virility, renewed vigor, testosterone improvements, and such....are probably good ways to go.
I could probably go on for days...but there are some men here, too who can probably help as well.
I would also say, start annoyingly slow with exercise. He wants to protect himself from injury so that he can work easily and all that... I'd recommend starting with weights. It's where he'll see the most improvement, particularly since he is man. After some of the weight starts coming off, walking/moving/standing/etc. get easier. Maybe challenge him to step competitions...most smartphones have built in ones even if y'all don't have trackers. Encourage him to find things he enjoys. Maybe he'd like martial arts...or competition body building...or just anything. Don't rule anything out...
Let him know that getting healthier is so much more about the mind that the body. I've spend six months at a time sometimes just getting right in my head first...there will be plateaus, there will be setbacks. Never question your intuition. Ask every question, no matter how embarrassing...because someone out there has probably already been there. And consider this a lifelong thing....not until XYZ goal, and then I'm back to normal...because it never happens well if you do that. Tell him it's depressing and demoralizing, but he will find a new level that works for him, and occasional dips back into old behavior won't be too detrimental down the road (some old indulgences may be allowable eventually, but you'll bet they won't feel the same), but slipping at first happens to nearly everyone.
Remind him that each bite, each step is a new chance to start over. A day is never ruined until it's gone, and even then, if you learned something from the misery, it wasn't wasted... Nutrition ALWAYS trumps any calorie or carb. Every time. Even if you screw up off plan, if your next bite is nutritious food, setting you up for a better next day or next minute, you are still winning. The whole health journey is about progress. Perfection, willpower, they are myths and will fail. Create backup plans for your backup plans... Don't be afraid to try foods you used to hate as your body changes, your mind and mouth and such will change, too....
Okay, I'm stopping before this comes a novel...
Above all, be kind to himself, love himself, know that setbacks and failures will happen and they don't mean anything long term. Step back and think about the fact that a year from now, 5 years from now, 20 years from now, you won't remember what you screwed up last Tuesday. 80% compliance, 80% of the time...nearly anyone can see that perspective...it doesn't give you permission to mess about in those off percentages... It just means you're ahead of the curve if you beat it, but you're stick in the pack with the rest of us if that's your average...
Oh, and there will be hungrier days - and less hungry days. Caloric deficit - once he gets to that point - should bee looked at on a 7-14 day average...not every day. No two days are exactly the same. He doesn't see the exact same cars for the exact same problems every single day in and day out, right? So his body's needs will change. And often...adaptability will be his favorite best trait... And if dropping something like sodas seems impossible, trying watering them down a little bit at a time until you won't even notice anymore...
Feel free to hit me up with ANYTHING ELSE...EVER.44 -
You really are the best, @KnitOrMiss11
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I would definitely start with logging food, walking 30 min a day, and lifting weights 3x/week with a total body routine - he can skip walking on the weight lifting days if he is really pressed for time, but walking will help with recovery and muscle soreness so if he has the time he's better off to keep it in there.
Also, from a cardio standpoint 10 min of walking 3x/day is just as effective as walking 1x/day for 30 min, so nothing wrong with starting small.
All men want to be muscular so I think the weightlifting will help, not just with retaining muscle mass, but also with his ego, and it's a quick way to get positive feedback as most people get stronger much faster than they get slimmer.2 -
I just want to give @KnitOrMiss a standing ovation!! I'm going to apply some of that advice in my own life. Thank you for that!
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Oh, girl, I know how you feel. My husband was tipping the scales at 290 at the beginning of the year, no exercise and did not follow any kind of diet plan. He lost over 100 pounds a few years ago eating a keto diet and then gained it all back with interest after adding carbs back in. It is frustrating seeing him eat bread and fries whenever he felt like it, but he would say "I know how to lose weight, I just need to eat low carb.!" But then he'd eat more carbs
Anyway, you are ahead of the game if he is looking to lose weight! Yay!
The biggest think I think, is motivation. He has to want it, and it sounds like he does. I would tell him to start off slow with working out, walking at first like others suggest. He doesnt *have to* work out to lose weight, either. He can get injured if he doesnt know what he is doing, and at that weight it can be hard on his joints to run and well, its hard when you weigh that much. He might get tired, sore, hurt, lose motivation. Personally, I'd focus on the food part. Show him how awesome low carb meals are. Steak and bacon! At 300+# the weight should melt off him and that will be very motivating. My husband rejoined the LC bandwagon this month, and lost about 12# already.
Knit has a lot of good advice there as well, especially choosing life style goals and taking pictures. A comparison picture is very powerful when you see that you look totally different, or lost 4 pant sizes!
Best of luck!4 -
Holy crap! I don't know how anyone could do better than what @KnitOrMiss said.
I'll only say, to make it simple to start. You don't want him to feel overwhelmed.
I'd say...
No white foods. Except cauliflower... if it's white, don't eat it.
Eat meat and don't use fat free junk. So, at a fast food place, get a double or triple burger with bacon, cheese and mayo and enjoy it! Still hungry, get another patty or get a salad and add a good amount of dressing... just make it simple and so he knows he doesn't need to go hungry.
Later on, maybe you can get a little more detailed. Let him see some results first.5 -
Thanks everyone who responded. Really great advice in this entire thread. @KnitOrMiss you continue to be such an amazing and supportive friend. I love your analogies and trying to relate it back to his profession. That will help me explain it to him in terms that he will understand better! I never thought about comparing maintaining your health and weight to maintaining a car. Absolutely brilliant!
As for progress pictures. I won't see him again until end of March. I will talk to him about talking progress pictures but I bet he won't be open to it. I think he feels a sense of embarrassment, shame and denial even though I have seen him naked before (and he is actually REALLY, perhaps overly comfortable with being naked lol). I will ask him though if he can take photos so we will see what he says.
Another thing I am worried about is that he works 6 am to 6 pm, most doctors offices are closed and he really hates losing time at work (for example, taking 30-60 minutes to go to the doctors office during lunch). I told him he really should get some baseline biomarkers measured like his body fat, blood glucose, blood pressure and cholesterol but he is adamant that the readings he got a year or so ago are good enough (which he doesn't even remember those readings just that things were "ok"). He mentioned the "minute clinic" which I think is either a CVS or a Walgreens thing. Does anyone know if the minute clinic will measure these biomarkers? I'm not sure how full-serviced it is.2 -
He should be able to find a clinic with after hours in his area. It might take some work. Most places like independent labs can have some great hours, too for lab draws. Even some "healthy" places like smoothie/nutrition shops might have lab draws, plus, you can often get lab orders on your own if you choose, and hospitals have to have folks available 24/7 to do draws, so getting a doc affiliated with a hospital can help... Many options, but you might need to help with exploring. Many doc offices in areas like that might have a limited Saturday appointment, and even some functional folks (expensive known ones like Maria Emmerich and Chris Masterjohn and others will do web consults and send you to local labs for bloodwork), so LOTS of options...
The car reference was from my friend Patrick...the maintenance comparison I added. And I have lots of experience tying in to odd ... references folks understand to make a point (started with my kiddo, I think...)... I really don't know why my brain works that way, I guess I'm just lucky it does...
I'm glad it is helpful...and you're welcome. I really benefited from writing it all out this way, too.2 -
@bowlerae - something else too...it might get him excited to progress on his own if he realizes how much he can really accomplish before you see him again and how fun it might be to shock you with the changes... I don't know if he works that way, but something in your wording made me think he might... Maybe a bet is in order, if he's competitive?2
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@KnitOrMiss hit pretty much everything, but I am a bullet point kind of guy, so here is some of that from that perspective:
- take pics
- avoid white foods except cauliflower
- log everything (embarrassment at volume may limit it)
- don't overdo exercise because injury may derail everything
- focus on "real" foods
- only eat when hungry and not to hit some magical macro
- stop eating when no longer hungry
As for the comment about being on a diet not being manly, this is the greatest thing about low carb. What is not manly about eating bacon, burgers, steak, etc.? This WOE was made for a real man!8 -
GrrraaAAAaarrrrr!
The hunger vs. craving thing...
The first time I decided to ignore what sure smelled like hunger and just wait it out was very instructive - nothing bad happened.
Before long, it became a challenge to shut down the pie hole early in the evening, go to sleep early, and delay breakfast - I survived that, too. Who'd'a thunk it?!
If you think about not eating as jolly elves snacking their merry way through your onboard pantry and not urchins unleashing pangs of deprivation and hunger, it's a lot easier to handle.4 -
I would like a little clarification about macros and what it will take for someone to be in ketosis. I have been doing the 30g net carbs and 1500 kcal per day for myself and get into ketosis no problem. For my boyfriend who will be eating 2000-2600 calories per day, would 75g NET get him into ketosis? (I'm pretty certain 75g TOTAL would) Does it have to be strictly 20-30g or more so the 5-10% rule? Basically would it be higher for him since he will be eating more calories?1
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I would like a little clarification about macros and what it will take for someone to be in ketosis. I have been doing the 30g net carbs and 1500 kcal per day for myself and get into ketosis no problem. For my boyfriend who will be eating 2000-2600 calories per day, would 75g NET get him into ketosis? (I'm pretty certain 75g TOTAL would) Does it have to be strictly 20-30g or more so the 5-10% rule? Basically would it be higher for him since he will be eating more calories?
This is quite variable. What I see typically recommended going all the way back to Dr Joslyn pre-WWII is to start very low and then, once in ketosis, you can gradually increase to see what your limit is.
Some factors that will effect this are total calories/TDEE, timing of intake (spreading them out over 3 meals vs all at once),protein intake, insulin resistance, activity level and timing of activity in relation to carb intake.
I am very active and not IR (typically burn 3200-3500 cal/day), so I have found I can stay in ketosis up to at least 50-60 net per day. I have not really felt the need to try to go higher than that yet.3 -
Ok so it is probably unlikely that my boyfriend will get into ketosis at 75g net. I want to start him there or even do 100g just to introduce him to low carb and to develop his craving for fat and protein. Over time I will see if he is willing to go lower to maybe 50g.1
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GrrraaAAAaarrrrr!
The hunger vs. craving thing...
The first time I decided to ignore what sure smelled like hunger and just wait it out was very instructive - nothing bad happened.
Before long, it became a challenge to shut down the pie hole early in the evening, go to sleep early, and delay breakfast - I survived that, too. Who'd'a thunk it?!
If you think about not eating as jolly elves snacking their merry way through your onboard pantry and not urchins unleashing pangs of deprivation and hunger, it's a lot easier to handle.
Heh. I had never in my life experienced true hunger, until the last week of my Cat2 RFL cut. When even random stuff next to a dumpster starts looking good, you've finally felt something that most Westerners will never understand.
It was definitely a worthwhile experience, even if just for that. The absurd fatloss was a definite bonus though. 3 -
Ok so it is probably unlikely that my boyfriend will get into ketosis at 75g net. I want to start him there or even do 100g just to introduce him to low carb and to develop his craving for fat and protein. Over time I will see if he is willing to go lower to maybe 50g.
That's probably a good idea so it's not too much changing all at once.
He doesn't have to do keto to lose the weight so honestly, unless there is some other reason to specifically want blood ketones, it's not necessary for weight loss. It can help with insulin resistance and diabetes but even those make great progress toward reversal at low carb above keto levels. It's more a matter of where do you need to be in order to lose the desire for the high carb foods. It appears we each have a carb tolerance level at which the temptation is gone.4 -
If he has a grill and likes to use it, go to bbqpitboys.com for some ideas. Some are perfect for low carb and most can be modified to be low carb. I use a smoker rather than a grill for many of these. My favorites are bacon crusted ribs and beer can bacon burgers.4
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You have come to the right place! Congratulations and best wishes toward better health for you and your boyfriend! Keep coming back for words of wisdom from those who know. He is so lucky to have someone who cares enough about him to take the first step of asking for help. You will get a lot of great ideas from people with personal experience here...take the advice to heart.0
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All excellent advice thus far. Here's a rejoinder if your friend frets about how long it could take to get to his goal. When I was debating whether or not to return to complete my college degree, I whined to a friend "But I'll be 34 years old when I finish." The reply: "Well, how old will you be if you DON'T go back to school?"8
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Wow. @KnitOrMiss
Ok so it is probably unlikely that my boyfriend will get into ketosis at 75g net. I want to start him there or even do 100g just to introduce him to low carb and to develop his craving for fat and protein. Over time I will see if he is willing to go lower to maybe 50g.
That sounds like a good plan. That's how I did it too. I eased into low carb over a few weeks by first cutting out the real junk and the reducing what most people consider to be healthy carbs. I think I had two weeks of lowering carbs, but I still was having more hunger and cravings than I wanted, but it was definitely improved, so I took the plunge to keto levels.
As I understand it, ketosis is reached when the body is making glucose (gluconeogenesis) for those few parts that need glucose like red blood cells and a portion of the brain. I wouldn't think the amount of excess fat would affect that. Insulin resistance does affect it, and those of us with IR sometimes find we need to go a fair bit lower than 50g to be in ketosis to gain the theraputic and appetite suppressing benefits of ketones. If he is still metabolically healthy, then he may not need to get lower. That would be tested by A1c, fasting blood glucose, insulin levels, triglycerides, HDL.... um, I'm not sure what else. BP could be interesting to know too.
Otherwise, like others said, I would just help make it easy on him. Keep LCHF friendly foods in the house. Phase out the foods he overeats, if there are specific triggers. Maybe stock up on sugar-free gum or drinks to keep his hands and mouth busy. I tend to sip coffee from a really well i nsulated coffee mug throughout my entire day. Maybe he will find diet cola as a treat of carbonated water will be a stand in?
If LCHF foods are his triggers, like nuts or cheese, don't keep much of them in the house, Or store the bulk of it somewhere out of mind with only a couple of days' worth of that food available at any time.
It's really good of you to help him. If he does well without keto levels, I would go with that. Not many people want to stick to ketosis for life, and the transition to increase carbs is a time of regaining the weight for many. It's probably best to start like he means to finish.
Best wishes.4
