My Personal Weight Management Under #StayAtHome

Yesterday I tweeted:

I did not expect the reaction! I promised to write in more detail what I am doing to achieve this, so here it is. I want to stress this is what works for me, given my current circumstances. It is really intended for people of similar age and in similarly physically challenging circumstances. While the #StayAtHome situation is common to most of us, of course the knee issue is an added complication. Unlike my recent short videos, this will be a long read, so buckle in folks!

Situation Summary

I have been in self-isolation since March 1. The gyms closed, the pools closed. I am a weight training person: suddenly I couldn’t even do upper body or hydrotherapy. The knee is preventing any lower body weights work or walking. I am also nearly 65. We all know as we get older it becomes harder to manage our weight than when we were 25.

I was terrified of gaining weight and making my knee pain worse. Due to several changes of medications and predisolone off and on over the period in question, I had gained a few kilos during late 2018/early 2019. I have been very successful in reversing that trend, especially once my clinical drug trial got underway, with the suggestion and support of my endocrinologist to adopt the philosophies of Dr Michael Mosley. I’d never known it was considered safe to eat 800 calories a day. I do now! Before you stop reading in horror, I’m not eating 800 calories a day now! But it is a damn good kick start to get you going and I do still apply the macro principles espoused by Dr Mosley.

Comfort Eating

Several responses to the above tweet raised the issue of comfort eating. This is an issue that is exacerbated by isolation, anxiety (e.g. about the current health crisis of Covid19) and boredom among other drivers. A chronic illness patient I know once said to me she stopped comfort eating when she realised she was “eating her pain” – and she didn’t just mean physical pain, she meant emotional pain as well. Once she had that epiphany she was able to stop. She looked for and found other ways to deal with her pain.

I find boredom can be an issue for me, especially when I can’t go to the gym or swim and I am locked away. For me, the recording (discussed below) helps immensely. I can see what I’m eating instantly.

I have no great solution for comfort eating, I am sorry, as it is a bit out of my field of expertise. I would suggest perhaps consulting a psychologist if it is impacting your weight management efforts. Mental health is a critical factor and if you have a chronic illness, in Australia you are entitled to a Mental Health Care Plan. Use it.

Understand Your BMR

Before we even look at food, my recommendation to anyone on a weight management journey is to understand your Basal Metabolic Rate (BMR). This is the number of calories your body burns being alive. Nothing else, just being alive. Our BMR drops as we age. This calculator at MyDr.com.au is the one I use: http://tools.mydr.com.au/tools/basal-energy-calculator

Pop in your details at various ages and you will see the BMR drop. Of course this is a average. If, like me, you are an avid weights person you will have more lean muscle mass and your BMR will be higher. Conversely, you may be on medications that actually reduce your BMR as a side effect. Even so, as a place to start, it is a good indication.

If you do no exercise and you eat more than your BMR, you will gain weight. There is more to it than that if we want to delve into the science, but for our purposes, it is that simple, really. Note well: exercise in this context includes NEAT!

Be very aware though, your current weight may drive your BMR reading up. If your BMR says 2,000 calories a day, you don’t want to be eating that if weight loss is your goal. Try putting your target weight into the calculator – work from that.

Net Calories

If I am exercising in my normal manner, I live by net calories. My calorie target for the day plus what I “earn” exercising less what I eat. When I cannot exercise “properly” as is the current case, I aim for less than my BMR. At the moment I aim for 1,200 calories a day or less, with the odd 800 calorie day thrown in for good measure.

When I fill up my car the fuel tank capacity limits how much I can put in. Unless the car burns the fuel, no more will fit. Humans are not limited in the same way – if we don’t burn it, we just expand to make room (store the fuel).

Record, Record, Record

I cannot stress strongly enough to record your food intake. If you are anything like me, you forget that snack you had at 10 am. Or you don’t realise that SMALL muffin you grabbed en route home from the pharmacy was actually 530 calories! I use My Fitness Pal, there is Cronometer and various other apps out there. Find one that you like.

Recording means measuring. Get food scales. Measure.

Dietary Protein

My next tip is to look at your dietary protein. Are you eating enough protein? From talking to people I suggest many, especially older people living alone, are not eating enough protein. Without enough protein we can feel hungry and snack (usually on carb heavy stuff) unnecessarily.

My interest in dietary protein came about from my own experience. I noticed my protein levels had dropped when I reviewed my My Fitness Pal recording at one stage back in 2017. I was also in more pain from my psoriatic arthritis, although I wasn’t thinking of a causal link. I upped my protein for general health reasons and suddenly my pain levels dropped. Hmmmm, I thought. At the physiotherapist, I picked his brains, “Are you aware of any research around dietary protein and pain levels?”. No, he wasn’t aware of any so I came home and researched. This is one of the articles I found, which I rather like as it is succinct in stating the findings.

Effects of inflammation and/or inactivity on the need for dietary protein

Remember too that a 100 gram steak is NOT 100 grams of protein. It is about (depending on cut, quality, etc) 23 grams of protein. Know your protein sources.

Serving Sizes

All food packets have a recommended serving size. These are guidelines, not mandatory rules. Most bread packets have a serving size of two slices. I do not need two slices of bread under my omelette (see main photo above), I won’t burn that extra fuel.

My favourite high fibre muesli has a serving size of 45 grams. I have 35 grams with 160 grams of high protein yoghurt. I don’t miss the 10 grams, but over a week it adds up to less calories.

Adjust serving sizes to suit your circumstances. When I’m able to lift weights again, I’ll go back to 45 grams of muesli!

Ease of Preparation

Some people love cooking, others do not. Other people have physical challenges around standing chopping up vegetables, for example. Some of us have days where our medical conditions flare. Living alone can result in wastage as fresh vegetables go off before we use them. How I deal with this is frozen vegetables. No, I don’t find them particularly wonderfully cordon bleu – but they serve a purpose. Prepped, pre-measured, 2.5 minutes in the microwave. Here is one instance where I double the serve – as each bag contains two standard serves.

Another variety with chicken.

I’ve found this frozen spinach great for omelettes!

Two blocks of this (about 50 grams) with two eggs. I microwave it per the first half of the instructions, drain and pop in my non-stick pan for a minute or so, pour beaten eggs over. Cook. Greens and protein in one simple meal.

I stick to fresh salad vegetables such as lettuce, cucumber, mushrooms and tomato. They are easier to buy in “as needed” quantities. Of course, as I am in isolation and receiving grocery deliveries, that is more difficult. Another benefit to frozen vegetables at the moment as I’m not dependent on deliveries to have vegetables.

Meal Replacement

Eating the increased amount of protein as discussed above and keeping calories down can be a challenge. I was also told by a friend (I have NOT substantiated this) that in some cultures older people eat very little late in the day, but it makes sense, especially when there are reduced levels of activity.

I have been replacing most evening meals with a protein shake. This brand was recommended to me by a work colleague who is a amateur marathon runner. I chose this product.

I’ve tried various meal replacement shakes and work out protein shakes over the years, but I really do like this one as it is virtually all protein and suits my particular needs well at this time. Once I’m back in the gym, I’ll change to one of their “work out” formulated products and probably not use it as a meal replacement but as a work out supplement.

The cost is $2.13 a serve, which is cheaper than a steak! I buy the large container because it is cheaper per kilo and is delivery free.

Carbohydrates

You will notice not one photo of potatoes or rice. I am a very low carb, healthy fats, high protein eater. I do eat fresh fruit: bananas, peaches, apricots, apples, grapefruit, plums, mandarins. While sugar is the bane of my existence, as it is in everything, fruit has other health benefits. I do limit my intake to two pieces of fruit maximum a day.

Did you know there is 11 grams of sugar in a cup of milk? Anything low fat is often high/added sugar. I tend to triple check the sugar content of anything that is labelled “low fat”. The version that isn’t low fat may actually be better for you.

I found a great low carb, high protein bread that is really nice, highly recommend!

Watch out for “hidden” carbohydrates. This label is a classic example.

Knowing the calorie value of each macro (fats X 9, carbs and protein X 4) my mental arithmetic could not see where the 337 calories was coming from. See the red arrow? Yes, glycerol. 4.32 calories per gram. A whopping 14.3 grams! In the USA it is required it be included in the total carbohydrates. Not in Australia, it seems. Read labels, be aware of possible hidden stuff you don’t want.

Emergencies

Have healthy food you can prepare with no effort if necessary. This prevents grabbing something carb/sugar heavy. I keep four of these in the freezer for flare days. I like these ones, but everyone’s tastes are different. Find ones you like that you can have on hand for emergencies. These two are usually on special for $4.00 each, other varieties may be dearer.

I also have tinned salmon which requires no preparation or cooking. Never run out of eggs!

Treats

Yes, treats. Gotta have treats! At nearly 65 and not aiming to appear on the cover of Vogue anytime soon, I’m not going to be a martyr.

At the moment I am alternating between two treats I allow myself, ONE treat a day.

20 grams of this:

or 67 grams of this:

The 20 grams of chocolate is basically 50% sugar – not really a good choice, I’m eating 2 teaspoons of sugar. But we have to cut ourselves a little slack!

The ice cream (comes in chocolate too) is a much healthier choice as you can see from the label. This is a serving (on a bread and butter plate).

If I am out going to the doctor or the pharmacy I may well indulge in a skinny flat white and a sweet treat – but that would be once a week at the most. More likely once a month under our current #StayAtHome rules and doctors doing telehealth!

One-liners

  • Drink plenty of water – helps you feel full
  • Watch how many coffees you have – can be 50 calories an instant coffee (4 grams raw sugar)
  • Get enough sleep (lack of sleep affects cortisol levels)
  • Eat breakfast
  • Eat slowly (mindful eating is a thing)
  • Eat ice cream with a teaspoon
  • Use smaller plates, the meals I have pictured here are on my entree plates
  • No or at least very minimal alcohol – empty calories
  • No soft drinks (unless used as a small treat)

In Conclusion

I’m reiterating: this current regime of mine is for a particular set of circumstances: minimal activity, isolation, age, pending replacement knee surgery (so very important I not gain weight), pain management requires weight management.

This is certainly not how I eat when I am weight training three or four times a week and swimming two or three times a week. It would not be how I would eat if I was 25.

Some of my weight loss this last month will have been muscle, which concerns me, but there is little I can do about that at the moment.

ALWAYS check with your health care professional for your specific circumstances!

Please ask questions in the comments, as anything you are wondering about may be a question other readers have as well.

 

Food scales

Lighten Up to Limber Up

Many people with chronic health conditions are told by their doctor to “lose weight”. Having a chronic condition can mean the weight creeps on, often prior to diagnosis when we don’t know what is wrong, just that we aren’t well. This may continue after we are diagnosed, while we wait for treatment decisions to be made or for treatment to kick in. We may be on a steroid for a while (as I was) which despite the best intentions in the world can result in patients gaining unwanted kilos. Lots of stuff going on that disrupts our normal patterns, can effect our ability to see we are gaining a kilo or two.

How many times do any of us get home from work too tired to cook a proper meal, so we have a toasted cheese sandwich? With Vegemite, of course! Or grab take-away on the way home? Maybe even Vita-wheat, Vegemite and cheese. That’s 232 calories, but not really nutritionally balanced. Doesn’t look too appealing either, to be honest.

Vita-Wheat Vegemite Cheese

In addition, because we don’t feel well, we aren’t exercising enough to compensate for our often less than optimal food choices. We are defeating ourselves from both aspects: too much in, not enough out. We are NOT¬†necessarily¬†able to just ramp up our weights or cardio and burn that cheese sandwich right off. In fact, walking from the car to the lift at work may be as much as we can manage some days. Adjusting to our new activity levels means adjusting to new fuel levels as well.

I can see some¬†readers rolling their eyes already: “I knew she’d get to the weight loss eventually, but I want a coach who isn’t all about the scales“. ¬†Hear me out. Let me assure you I am not all about the scales (actually, I am all about food scales), but I mostly certainly AM about helping my clients attain and maintain a weight that supports their efforts to manage their condition – or conditions. Take a good honest look at my picture below – do I really look like Vogue are going to invite me to appear on their cover next month? Of course not – I am no Australian size 6 – nor do I aspire to be. That photo is 12 months old – taken shortly after my medication change but before I was able to ramp up my own weights, but I have used it deliberately to illustrate the challenge we face.limberation-small-15

What I aspire to is being pain free and in control of my conditions. I’ve achieved that as far as my autoimmune conditions are concerned, but I can still improve my back support (detail later in this article). I am not going to complain if I lose a few more kilograms, but neither am I going to obsess about it. While the lighter I am the less stress there is on my joints, where I am right now I’m more interested in building strength (to support my joints and increase my metabolism (in turn encouraging those kilos to drop off as a nice side benefit).

Make no mistake, when it comes to your health, the risk of developing a range of conditions is dramatically increased if you are overweight or obese (comorbidities associated with obesity are conditions such as diabetes, heart disease and cancer to name just three) . The risk of negative long term health outcomes are higher if you remain overweight or obese. The medical and scientific evidence is overwhelming.

Being overweight increases the load on joints for conditions such as the arthritis family. The heart has to work harder to pump blood around. If you find doing stuff an effort, imagine how hard your internal organs are working. My lumbar spine is not a lumbar spine I would recommend either – as we get older, lots of bits and pieces tend to show wear and tear, irrespective of any conditions we may have. In my case my lumbar spine is a bit unhappy. So core and glute strength is important for me.

At L3/L4 I have “marked facet joint hypertrophy” and a disc bulge. At L4/L5 I have a broad-based disc herniation and facet joint arthropathy. The complete findings run a full page, that’s just a sample. I don’t need or want to place any more stress on my back by making it carry around extra kilograms or not supporting it with good muscle tone. I still have some intermittent pain we suspect may be the result of this wear and tear, but it is improving.

To give your body the best chance of serving you well for the next 20, 30 or 40 years, you need to take care of it. Especially now a medical condition/(s) is making a darn fine effort at undermining your plans. Reduce the strain on the joints, give your heart and lungs a lighter workload, give your body the right fuel in the right amounts.

Speaking of fuel, when you take your car to fill up the tank with petrol or diesel, the fuel tank has a finite capacity. My car has a 60 litre tank. I can’t put 70 litres in the car. Our bodies are a little more flexible. My body will use an estimated 1,388 calories a day to stay alive: breath, pump blood around, blink (refer BMR Calculator below this article). I’m 62, so my metabolism is already slowed just by the fact I’m not longer 20. If I eat more than 1,388 plus whatever my activity calorie burn is but don’t use it, I’ll just expand.¬†Unlike the car’s fuel tank, my body has no capacity¬†limitations. Nor does yours.

Example: 1,388 + 100 for steps for day + 380 for a strength workout = Total 1,868

If I eat 2,200 calories, guess where the excess over 1,868 is going? Fat stores. That puts more stress on my joints, internal organs have to work harder.

Many of the learned articles on overweight/obesity talk in financial terms of the costs to the community and the country. I’m concerned about the personal non-financial costs to YOU, the individual.

I won’t lie to you. Getting into the groove of eating less calories BECAUSE you are burning less calories is a bit tough initially. As I mentioned in my opening paragraph, it may be a while before you even realise your activity levels have dropped or your metabolism may have slowed as a result of your new friend, your condition. We have to adjust to not burning as much as we used to: it requires us to develop new habits, change behaviours: that is hard. But only for the first few weeks. What bothers you more? A difficult¬†few weeks – ¬†or a tough (possibly shortened) rest of your life? The sooner you take positive action, the shorter the road will be.

Am I saying I never have a Murray River Salted Caramel with Macadamia ice cream (my nemesis)?

Connoisseur Murray River Salted Caramel

No, I’m not saying that. I like to have the things I really enjoy every now and then. I am also well aware that “little” indulgence is worth 339 calories. In other words, worth a whole meal (for my calorie levels, you may be able to have more). If I’ve burnt off 400 calories through activity that day, I can indulge and still hit my calorie deficit target. If I’m having a day where for whatever reason I’ve done very little activity, I make sure I am strict with myself. Keep on top of it, because we no longer have the luxury of going for a 40 kilometre bike ride to pull back a couple of naughty days.

All that discussion was without even looking at ensuring we are getting balanced nutrition. Our body is fighting an internal battle for us now – we need to give it the right nutrients (micro and macro) to put up the best fight it can. That’s a whole different topic for another day!

This article should be read as an introduction and conversation starter only. The concepts discussed are general and not tailored for any individual circumstances. Limberation can provide healthy eating support and guidance.

Additional resources:

PwC report, Weighing the Cost of Obesity

BMR Calculator mydr.com.au

BMI Calculator mydr.com.au

Australian Guide to Healthy Eating

Also check the references on the Science Stuff page.