Finding a Cause for Fat

One thing that I've been struck by during my week in endocrine clinic is the number of people who are looking for answers. They have varied complaints, and no one has been able to tie them together or determine the cause. Despite numerous tests and studies, they don't have an explanation. They have low energy levels, they are gaining weight, they just feel lousy. And they need answers! So they go to the endocrinologist, because of course, it must be due to the thyroid gland. That mysterious gland that is responsible for regulating weight, energy level and overall well-being. The problem is, most of these people have no evidence that their thyroid is not functioning as it should be. Their hormone levels are fine, their imaging is normal, there is nothing that we can find wrong with their thyroids. And without finding evidence that something is wrong, there is nothing that we can fix. I'm not saying that there isn't something missing, some element that we don't yet know how to identify, but with the knowledge that we currently have, there is no evidence that the thyroid is causing their problems.

So why are so many people overweight? Why do they have so much trouble losing weight? I don't have the answer, but I have ideas. When I talk with people in clinic, they are convinced they are overweight through no fault of their own. They eat right, they exercise. They are looking for some external explanation, something that can easily be fixed with a pill. I don't blame them, I would love a pill that would let me lost 15 lbs., but it doesn't work that way. There was a study recently published that shows weight loss is more successful if participants kept a food diary. When you think about, it makes sense. I don't think most people are really aware of what they are eating, when they are eating or how much they are eating. We want to think we are better than we are, we remember the carrot sticks and celery we ate with lunch, not the box of crackers we ate when we got home from work. But if you write down everything you eat, not only are you having to face the truth of your dietary indiscretions, but I think you are less likely to deviate from your diet. If you have to write down "three pieces of chocolate cake" you are not going to eat three pieces of chocolate cake.

I think if people are more aware of their own actions, they are better able to make changes. This may be why Weight Watchers is the most effective method for accomplishing weight loss (this may just be my opinion, I'm not sure if there is data to support this). Other programs may work, but if they are providing you with all your food, you aren't learning how to change your behavior. Someone else is doing it for you. What happens when you no longer get your week's worth of food in the mail? What happens when you want to start cooking for yourself again? With W.W., you have to keep track of everything you eat, and you can eat normal food. It is all about moderation. You learn to pay attention to what you are eating, you learn portion control, and you learn how to change your lifestyle.

All of this is a long way of saying that I realize I spend a lot of my time lecturing my patients on the importance of diet and exercise. I recommend they do 30 minutes of exercise per day most days of the week. I tell them it is all about portion control. I tell them if they want to diet, they should try Weight Watchers. Because I understand all of these to be good things. Then I come home, eat a box of crackers and half a brick of cheese while sitting on the couch. Most definitely not doing 30 minutes of exercise. Today I decided I need to practice what I preach. Who am I to tell people struggling to lose weight how easy it is without the magic pill, if I can't/won't even do it myself? So here's what I've decided... I'm keeping a food journal (and am a bit surprised I haven't gained much weight over the years given the crap I eat!). I'm going to exercise 5 days a week. Even if I just walk for 30 minutes, it is better than sitting on the couch, right? And I joined Weight Watchers. Let's see how good they really are. I could stand to lose 15 lbs (but hopefully not before the wedding, because my dress barely stays up as it is).

This may not help me figure out why people are fat, or figure out the elusive thyroid gland, but at least it will give me some insight into just how hard it can be to implement all this advice I keep handing out. All in the name of science.