Dr. Ed Tyson The Up and Downs of Weight Loss

I had a discussion with one of my patents the day I finished preparing this article. She was complaining about being so very tired and "wanting to climb into bed and never get up again." When I was pretty certain that particular aspect of her symptoms was due to hypoglycemia (low blood sugar), I offered that perhaps she should try a very small dose of a medicine to treat her complaint—a piece of peppermint. She reluctantly agreed, but after about one minute of sucking on it she suddenly said, "I am not going to eat this!," and she threw it away. When I asked why she did that, she said, "I don't want that. I want to lose weight. I liked it better before when she was thinner (below 80 pounds)."…as if the peppermint would add a microgram of weight to her body.

I offered to her that she must be feeling very fragile and conflicted. I pointed out that her primary and first complaint to me today was about how very tired she was. But when I offered her a very quick, cheap, and reasonable treatment, she rejected it. I said, "You must really be torn, saying how much you don't want to be tired, but not wanting to do what it takes to make those feelings go away. You were physically miserable when you had lost all that weight, and, from my perspective, you were emotionally miserable then, as well. Yet you still insist you want to not eat?" I might add that she has been losing a fair amount of weight lately and paying a hefty price for it. I have many patients who want to lose weight and, yet, to do so would be, in many cases, perilous. One of my favorite questions to ask is, "What makes up the weight that you lost?" The initial answer is always, "Fat." I respond with, "How do you know it's fat you are losing?" That usually brings about a "deer in the headlights" kind of look. Of course they hope that what they are losing is fat. Is that really what they lose? Is it really what they should lose? So, what's in a number? When you get on a scale, how do you interpret the number? If your weight is up, is that good or bad? If you lose weight, is that good or bad? If it stays the same? Is it a sign of improving health or declining health? How do you know? Your body tries its best to keep a certain amount of fat on it to protect itself from the cold, pressure sores from sitting, and to protect some of the internal organs (eyes, kidneys, heart). Fat in the diet is also needed for other reasons, including to help the absorption of certain vitamins, for breast tissue, and as substrate (building blocks) for important body chemicals like hormones. Also your body is using muscle every minute of every day, if nowhere else other than your heart. As muscle is used, it breaks down. This is especially true for the heart, which never stops working and, therefore, always needs repair. The same is true for tendons, ligaments, and cartilage. These tissues get usually repaired in an ongoing way—but only if there are spare parts available. To use a contemporary analogy, if you don't have lumber, you're not going to be able to repair the house damaged by the hurricane. And if it is a really destructive hurricane, you will need a lot of materials for repair. Those spare parts and lumber you need come from your protein, carbohydrate, vitamins and minerals, water, and, yes, fat. What if you don't have those spare parts? What if your intake does not have enough protein to use for rebuilding damaged tissue? That is what happens in malnourished patients (no matter their weight). The damage just keeps getting worse. It is as though the hurricane never leaves. Destruction is ongoing. Another contributor to weight is water. Most weight change in the acute time period is from water gain or loss—not fat. While it changes the scale, only those who truly have too much fluid in their body and who have certain heart conditions need to lose water. A doctor will diagnose and treat that carefully. Of course there are those who do need to lose some weight. But they need to lose fat, not muscle, organ, or water. If one's diet does not have enough calories and enough protein, then muscle and organ tissue will be lost. Period. And their metabolic rate will drop, which means they burn fewer calories at rest than they did before they went on a diet! The paradox is that if you restrict too much, you will lose fat (and weight) at a slower rate. So, if you keep dieting in an effort to be "healthy" and these things I described above are happening to you, then it is a distortion of your original intent and can have the exact opposite of what you wanted. If you are losing to regulate your emotions, there are more effective and satisfying ways than by dieting, purging, or over-exercising. There are more things to learn about what happens when you gain or lose weight and what that means. You can learn about them at my website, www.DrTyson.net, or check back here periodically. DR. ED TYSON Professional Biography of Edward P. Tyson, M.D For seven years Dr. Tyson was a faculty member at the University of Oklahoma Health Sciences Center and the OU Medical School in the Division of Adolescent Medicine with the Department of Pediatrics. As Director of the Adolescent Clinics at Children's Hospital of Oklahoma he taught medical students, residents, and others in the health professions about adolescents and other areas of particular interest to him. In addition to adolescent medicine, Dr. Tyson was also considered the expert at the OUHSC in several other areas, including the evaluation and treatment of eating disorders and in a form of child abuse called Munchausen By Proxy. Dr. Tyson returned in the fall of 2002 to Austin—a town he has always loved—where he had been in practice before going to OU. Dr. Tyson continues his faculty appointments with the Department of Pediatrics at the OSU College of Osteopathic Medicine in Tulsa and at UT in Austin. In the Department of Kinesiology and Health Education at the UT, he lectures frequently and co-teaches a course on adolescent risk-taking behavior. Dr. Tyson especially enjoys teaching the community and other professionals about the issues his patients face and does so whenever he gets the chance. Dr. Tyson describes himself as an advocate for adolescents and has been a member of many different professional and civic organizations that affect the healthcare and status of teens and young adults. It seems he has always had an interest in that age group: before his career in medicine, Dr. Tyson was a swim coach and high school teacher in Houston where he taught biology and physical science for over four years. In Austin, he was physician for the Travis County Juvenile Court Home for six years and served on the Board of Directors of the Travis County Mental Health Association and the Texas Comprehensive School Health Initiative. For the Texas Medical Association, he served as its representative to the Texas Education Agency, a member of its Adolescent Health Task Force, and was a primary author of the TMA's position papers on Teen Sexuality and Substance Abuse. He was also on the Texas Education Agency's HIV/AIDS Education Review Panel. As a member of the faculty of the Family Practice Residency Training Program at Brackenridge Hospital he helped train residents in all aspects of Family Practice, but especially in the care of young adults. Dr. Tyson is Board Certified and fellowship- trained in Adolescent Medicine Family Practice and is also Board Certified in Family Practice. He is a Fellow of both the Society for Adolescent Medicine and the American Academy of Family Physicians. In addition to the all of the above, Dr. Tyson has been interested in the treatment of non-surgical orthopedic and sports-related injuries. He has been on faculty at the OU School of Physical Therapy where he helped teach Spinal Dysfunction. He has been an instructor in a post-graduate program in Orthopedic Physical Therapy with Douglas D. Kelsey, PhD, PT, OCS. Along with Dr. Kelsey he is co-patent holder on the "Newton", a special machine which provides bodyweight support to patients with orthopedic injuries, promoting faster recovery and allowing them to train with activities such as walking, running, and jumping as part of their rehabilitation. Dr. Tyson is a co-investigator in a NIH grant with the University of Texas Medical School at Houston's Department of Internal Medicine, using the Newton to treat patients with osteoarthritis of the knee. Over the past 15 years, Dr. Tyson has focused more and more of his efforts on the evaluation and treatment of eating disorders. While at OU he had the only clinic in the area for outpatient medical and psychological treatment of eating disorders. He realized the large and growing need for help with this problem but also the scarcity of resources for help. To rectify this, he is committed to educate the community and other professionals as well as his patients and their families about this problem, eager to speak to whomever will listen. Dr. Tyson believes that people with eating disorders need very thorough medical care and skilled therapy for the emotional issues that are always present. Besides a great deal of medical training in eating disorders, Dr. Tyson has also had over 17 years of training in psychotherapy. While he usually incorporates the skills of other therapists for treatment of his patients, Dr. Tyson is eager and able to address those issues as well with his patients and their families. Because of his interest in and dedication to these patients, Dr. Tyson has focused his private practice primarily on the treatment of eating disorders. Through his efforts he hopes to not only provide highly competent care but also to generate widespread compassion and understanding for those struggling with this difficulty.