Advice for Someone "Severely Obese"

bowlerae
bowlerae Posts: 555 Member
edited November 15 in Social Groups
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?
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Replies

  • tcunbeliever
    tcunbeliever Posts: 8,219 Member
    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.
  • Kirstie155
    Kirstie155 Posts: 1,001 Member
    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!
  • bowlerae
    bowlerae Posts: 555 Member
    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.
  • KnitOrMiss
    KnitOrMiss Posts: 10,103 Member
    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.
  • KnitOrMiss
    KnitOrMiss Posts: 10,103 Member
    edited January 2017
    @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?
  • RalfLott
    RalfLott Posts: 5,036 Member
    GrrraaAAAaarrrrr!

    The hunger vs. craving thing... :s

    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.
  • bowlerae
    bowlerae Posts: 555 Member
    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?
  • cstehansen
    cstehansen Posts: 1,984 Member
    bowlerae wrote: »
    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.
  • bowlerae
    bowlerae Posts: 555 Member
    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.
  • Gallowmere1984
    Gallowmere1984 Posts: 6,626 Member
    RalfLott wrote: »
    GrrraaAAAaarrrrr!

    The hunger vs. craving thing... :s

    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. ;)
  • Sunny_Bunny_
    Sunny_Bunny_ Posts: 7,140 Member
    bowlerae wrote: »
    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.
  • cstehansen
    cstehansen Posts: 1,984 Member
    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.
  • idocdlw
    idocdlw Posts: 208 Member
    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.
  • nvmomketo
    nvmomketo Posts: 12,019 Member
    Wow. @KnitOrMiss

    standing-ovation.gif
    bowlerae wrote: »
    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.
  • Sunny_Bunny_
    Sunny_Bunny_ Posts: 7,140 Member
    nvmomketo wrote: »


    Omg! Loved the ovation! @KnitOrMiss is a goldmine of info and support.

    As are you @nvmomketo ;). Always offering great advice and support as well.


    I hope I did the quote thingies right.
  • nvmomketo
    nvmomketo Posts: 12,019 Member
    nvmomketo wrote: »


    Omg! Loved the ovation! @KnitOrMiss is a goldmine of info and support.

    As are you @nvmomketo ;). Always offering great advice and support as well.


    I hope I did the quote thingies right.

    Thank you. :blush: You too. So many people here have taught me so much. A HUGE help to me on a number of levels. :)
  • nvmomketo
    nvmomketo Posts: 12,019 Member
    I didn't read all the replies but one thing I'd say is don't push the exercise. Reason I say this is I see my son's friends, young lads who have got big sitting around playing computer games decide they want to lose weight and start with making themselves walk or go to the gym or use weights but they are basically lazy creatures at heart and this does not last long. It also does not produce much in the way of results and they return to their natural food/activity level. Even now the only exercise I do is the exercise I feel like doing. I don't force it. Getting the food under control and the weight loss started is 1000% more important. Once that happens and you start seeing results and you feel better and your knees hurt less and your energy is higher you will start to physically do more without having to force it.

    So true. I didn't start walking again until I was just 20 lbs above goal due to sore joints. I can't imagine how hard it would be to walk or exercise with over a 100lbs extra to carry. I'm amazed by people tenacious enough to do it.
  • bowlerae
    bowlerae Posts: 555 Member
    edited January 2017
    nvmomketo wrote: »


    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.

    All great, but I don't live with my boyfriend. In fact we live in two separate states so I really have no control over the grocery shopping or cooking.

  • KnitOrMiss
    KnitOrMiss Posts: 10,103 Member
    @bowlerae - One thing I would also specifically highlight - that I disagree with in the post above... Having sugar-free gum and diet drinks on hand, for me at least, would just result in trading addiction for another. It's hard as heck to switch from fully leaded (sugar, caffeine, etc.) foods and drinks to the healthier options, and I still use Stevia in some things, but for me, the key to making that work was to learn to sweeten to tolerance, not to taste. If we don't ever attempt to reset our sweet threshold, we'll not gain control. Since you already know how great he is at transferring addictions ("he says snacking helps his tobacco cravings..."), I really really suggest working to avoid this.

    Of course, it's 10,000 times harder, since you know his history, to get him to understand this and embrace it. It's easier to transfer a compulsion from one thing to another, but unless he's transferring the urge from snacking to push-ups or something, I don't really see this being a healthy way to cope. I don't know of any single food (or group of foods) eaten in excess that don't end up creating some havoc or damage in the bodt.

    I say this about avoiding the swapping for "diet" mind process for two main reasons (based on personal and medically recorded experiences).

    1) I did Atkins back in the early 2000's. I failed once I figured out exactly how far I could push my intake and stay in ketosis. I would binge-eat the Atkins dark chocolate covered almonds (among other foods). I never addressed my sugar addictions and cravings. I failed miserably. After I'd succeeded for months upon months.

    2) binge eating sweeteners like maltitol and others can have hellaciously painful side effects (google "sugar free amazon gummy bear reviews" for details, but consider yourself warned), as well as trigger inflammation, destroying gut balance, flaring up sweet cravings, and driving up eating triggers/increasing appetite.

    Cutting as many of those things as possible, trimming them down, choosing one or two items to consume after that, or a barely sweetened coffee, etc., helps. But since diabetes runs in his family, and he's already beyond obese, it is very likely that he is, actually nearly impossible not to be, insulin resistant - which has recently been labeled diabetes in situ (meaning, diabetes "in place" or "on premises" essentially, diabetes waiting to show you it is hiding there ALREADY). I don't know if knowing that would help him or hinder him, as far as motivation. I know it has done BOTH for me, and I'm still struggling to accept the reality of what that means...

    If he must come up with go to comfort foods to prevent him from falling off his plan, that is fine, as long as they are foods he can eat in reasonable quantity and that don't trigger more cravings, etc. Like as a reformed pizza junkie, finding a way to fill that pizza urge, in controllable portions, was important to me. I found that I liked it without the crust or on a low-carb tortilla as much, if not more, than on crust... This allowed me a great transition period of being able to have one of my favorite foods, but in reasonable portion (I never made more than a tray worth or so...) and it satisfied the craving, rather than fueled it. Burger in a bowl was the same principle, etc.

    But as I said originally, I truly believe that the mental side of this is the hardest...and if he can't get his head around that part of it, it's likely he's not fully ready to do this for himself...yet. (hugs)


    P.S. Thanks all for the love. It really helps me to process through my own thoughts to share my own personal struggles with others. I'm glad if anything I've said has helped anyone along the way... (hugs to all)
  • KnitOrMiss
    KnitOrMiss Posts: 10,103 Member
    @bowlerae - You're welcome. It's just like you're singing my song, really. You know the way it goes, right? "Second verse, same as the first!" I can speak to these things because I have personally suffered these things... I know that things like artificial sweeteners and such work for some folks. I also know that I have an addictive personality, which I turned to food and passions, rather than drugs/escapism (luckily?) for me... Because of that, I have to be really careful about anything that fuels that side of me... I am also insulin resistant, with diabetes in the family, with family members who have died from complications of diabetes. I am too large, even now, for much activity, due to certain outlying physical issues, and I'm very injury prone. I also know better than to attempt to force changes on myself...I have to work them in, on my terms.

    That being said, these are just my opinions. Some things may help, other things may be in left field. No two people are exactly alike - even identical twins might need different tweaks to make a dietary plan work properly, due to environmental factors, etc.

    I'm thrilled to hear that he's making some progress already. It's a huge motivation to make it through the harder times in and of itself. Nothing like that jumpstart to set your motivation on fire! That being said, remind him that even though the 11 pounds is primarily water, and some of it may come back in the next week or so (rebound when first losses are really large - helps balance electrolytes), if he worked in any way to take off that weight, which we know he did, because he has been eating low carb, HE EARNED EVERY SINGLE POUND OF THAT LOSS. He put in the starting effort, so he got the starting reward. Make sure he stays on top of those electrolytes (sodium, magnesium, etc.), because with 11 pounds lost of fluid/fats, he's dumped a tone of sodium and magnesium, possibly even potassium, too... If he's not upping sodium and magnesium, he's the Titanic heading for the totally avoidable but hidden crash or that iceberg...aka carb flu!!!

    But good on him for diving in. I wish him continued successes!
  • nvmomketo
    nvmomketo Posts: 12,019 Member
    bowlerae wrote: »
    nvmomketo wrote: »


    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.

    All great, but I don't live with my boyfriend. In fact we live in two separate states so I really have no control over the grocery shopping or cooking.

    Ah, I missed that. So he's doing it on his own then. Good for him.

    All you can really do is lead by example and make it seem wonderful when he visits.

    And congrats on his success so far. :) Impressive start!
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