I’m on a semi-starvation diet, why am I so hungry?

Today, I have another reader question shared by Mealtime Hostage.

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I’ve cut my portions to 1/2 of what I would usually eat (or) I’m trying to stay at 1200 calories a day but I’m soooo hungry!

Of course you’re hungry! You’re eating less than you need, and your body is poking you, trying to get you to eat more.

1200 calories a day is not enough food for most grown-up people.* Unless you’re simply a small, not-very-hungry person (ballpark: 4′ 10″ and 100 lbs.), you’re very likely not eating enough to support your needs.

When it comes to energy and appetite, your body attempts to match your energy intake to your energy expenditure. That means, if you use a lot of energy one day, running around more than usual, you will be hungrier afterward, as your body attempts to make up the deficit. I’ve even experienced “catch up” hunger several days removed from the event.

But the biggest chunk of your energy expenditure comes not from activity, but from existing and continuing to exist, and that depends a lot on how big you are. Bigger people tend to expend more energy just being alive, and therefore, they’re going to need to eat more in order to match their intake to their expenditure. Your body is remarkably accurate at doing this, and research shows a very narrow margin of error in matching intake to expenditure over very long periods of time, for most people. This results in a mostly-stable weight for years at a time.

It’s true that many people’s weights will slowly drift upward over years and decades, but from a survival perspective, your body sees that as less risky than if it were to drift downward. Some people experience dramatic weight instability, gaining and losing lots of weight, sometimes unintentionally, in relatively short periods of time. If there’s no underlying medical issue (like an illness, or a thyroid problem, or a medication interaction), it may be that their eating and/or activity has been chaotic enough to disrupt the body’s usual balancing act.

But, back to your question: if you’re purposely eating fewer calories than you expend, you will feel hungry and your body will attempt to get you to eat more. Sometimes using very sneaky means…like “Ooops a box of cookies!” or “I accidentally the whole pizza.” Your resting energy expenditure might also tank, as your body tries to conserve energy. You’ll be sleepier, less active, and less able to warm yourself up in the cold. And when the weight loss inevitably slows, or you begin regaining weight, you will blame yourself and your lack of willpower, instead of the true culprit: an energy deficit and your body’s clever survival mechanisms.

If long-term research on diet has taught us anything, it’s that most people’s bodies do not like being in negative energy balance — the state required to lose weight — for very long.

People can and do suppress their hunger by focusing intently on their diet, but as soon as their attention wavers — say, they get sick, or they get really busy at work, or some family comes to visit — it is almost inevitable that they will go back to eating more. Often, more than they would have if they hadn’t been restricting. And if their attention never wavers, there’s a chance they’ve triggered an underlying eating disorder.

Ignoring one’s hunger signals requires enormous effort, and I’m not convinced that for people who do it successfully, it’s always a good thing. In the case of an eating disorder, it’s definitely not.

If you’re on a calorie restriction diet, you have two options: you can continue restricting and just put up with the hunger (and the binges and weight regain that will almost certainly follow), or you can decide that your body’s hunger signals are not wrong, are not aberrations, and are, in fact, worth listening to and respecting. You can decide that you have the right to eat what you need, not go hungry, and to weigh what your body prefers…and that you can still improve your health and body image, if you want to, even if your weight never changes.

This does not mean that you must follow every single impulse toward food, because every single impulse toward food is also not respecting your hunger. Most of us are surrounded by hundreds of food cues every day, in the form of advertising, and it makes us think of food even when we’re not otherwise hungry. But you can commit to learning what hunger truly feels like, and then deciding, when it calls, that you will answer it by feeding yourself matter-of-factly and well.

Responding to your hunger appropriately will give you the best chance for long-term weight stability. If you were previously eating more than your body wanted or needed, responding to your hunger might even help you settle at a slightly lower weight. Bonus: it will also provide you with the energy you need to support exercising, running around with your kids, doing hard physical labour, or whatever your life requires. Physical activity will, in turn, further contribute to a stable weight, as well as more energy (and, hopefully, fun) in the moment, and better long-term health.

In my opinion, that’s a much better deal than giving yourself less than you need.

*But there are always exceptions and outliers, and some people naturally eat very little. Energy needs are also very different for hospitalized people, or people with medical conditions that affect their resting energy expenditure.

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Plenty of calories to go around in comments.

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51 Comments

  1. Posted August 21, 2015 at 8:36 am | Permalink

    This is so hard for me right now. I found your blog sometime around early 2011 and it helped me to stop dieting and to accept my weight for what it was. I was so happy and it worked so well! My weight stabilized and I never felt deprived. Then, in 2013, I had a baby. Post-baby, I am about 25-30 pounds heavier than I was when I was when I was listening to my body’s cues before. At first, I thought I could just go back to what I was doing and somehow lose weight because my body “wanted” to be at my pre-baby weight, but that didn’t happen. About a year ago, I finally started tracking/restricting calories. I did so for about 4 months and lost about 3 or 4 pounds. I felt like it was SO MUCH work for so few results, I quit and gained more back. Then, earlier this year I tried again but adding in intense exercise (think P90X). Fail again, same results. I quit again when I went on vacation in April. I am back up in weight. I have been considering going back on calorie restriction again. I’m just struggling so much to accept my body at my current weight, and I get mad at my inability to lose weight. I know all of this that you say here, but it seems like accepting it is an even bigger struggle than calorie restriction.

    Sigh.

    • Posted August 21, 2015 at 8:42 am | Permalink

      That is so hard. Bodies often change after a big event like having a baby, and sometimes you’ll find yourself at a new baseline. That can be very hard to accept, but as you say, it’s also hard not to accept. Neither path is easy, but I do think there might be a third way: choosing to put your weight on the backburner (even if you don’t accept it), and switching your focus to taking care of yourself in the best way you know how. Sometimes your weight will respond to that, but if it doesn’t, taking good care of yourself puts you in a better frame of mind for possible acceptance, even if it’s in the distant future. You don’t have to accept your weight in order to take care of yourself.

      • Posted August 21, 2015 at 9:49 am | Permalink

        This made me tear up!

        I am going to try this. I really don’t want to go on calorie restriction again. I am going to try to take it one day at a time, and just take care of myself.

        • Posted August 21, 2015 at 10:06 am | Permalink

          I’m glad, and I think you deserve it.

        • Elly
          Posted August 21, 2015 at 10:32 am | Permalink

          Kim, reading your comments made me tear up. I just recently had a baby, and I’m working on adapting to having a “mom’s body” now. It’s hard. New lumps and bulges, new aches and pains, new worry lines…I feel like I’ve “spent” myself on having a baby. But I’m trying to learn to take pride in the changes, as a badge of experience and accomplishment. Our culture does not make this easy…but then, a culture of valuing inexperience in women (physically AND otherwise) is one I try to resist in other aspects of how I live my life, so why not with my body? And as far as eating goes, I find that the baby is GREAT motivation to treat myself well. I picked up a lot of restrictive-eating norms from my mother at a very young age (I remember having a concept of “counting calories” when I was in preschool!) and that’s something I desperately want not to pass on. So I’m trying to eat well, love my body, and take pride in setting a healthy example for my kid. Of course, some days it’s easier than others…

          • Posted August 21, 2015 at 12:31 pm | Permalink

            I’ve got those unhealthy eating behaviors coming from my mom as well! I remember the first time I ever thought I was fat – I stood in front of a mirror thinking I was fat, and I was only FIVE.

            Through this blog (I think), I found Ellyn Satter’s work and I’ve been working hard to follow her when feeding my son. So, that’s good!

          • Lauren
            Posted August 21, 2015 at 5:14 pm | Permalink

            Kim…we have the same story!! Mother was on diet all of the time and was a binge eater and calorie restricter…and never fat by the way. I struggle with this so much with my daughter especially. But I am determined to fight these demons with the help of a counselor/nutritionist. If you have one in your area that follows this thought process..I highly recommend it!

      • Lauren
        Posted August 21, 2015 at 5:11 pm | Permalink

        This is beautiful. just found this site. Love it.

    • mickey
      Posted August 21, 2015 at 11:02 am | Permalink

      Kim, I feel like I could have written what you did above – including the same timeline.

      I’m slowly making more time for exercise and working on eating more variety. I want my son to see the movement is important to make yourself feel good, and I want him exposed to lots of different foods. That’s helping me *start* to accept where I am now. But I’m not going to lie, a part of me also wants my weight to go down. I’m sick of being asked when I’m due…

  2. Heidi
    Posted August 21, 2015 at 9:18 am | Permalink

    Thank you for this, Michelle!

    “This does not mean that you must follow every single impulse toward food, because every single impulse toward food is also not respecting your hunger. Most of us are surrounded by hundreds of food cues every day, in the form of advertising, and it makes us think of food even when we’re not otherwise hungry. But you can commit to learning what hunger truly feels like, and then deciding, when it calls, that you will answer it by feeding yourself matter-of-factly and well.”

    I wanted to add, as someone who’s been working on intuitive eating a LONG time now, recovering from compulsive eating disorder, that this paragraph is both the most meaningful and the hardest for me. Even a good thirteen years after I stopped dieting I still have to be so careful about when ignoring a desire to eat will trigger overwhelming craving because my subconscious reads it as an attempt to diet or when recognizing it for an impulse and choosing not to react will be okay. It is frustrating and angering and saddening and all sorts of other -ings, because it shows how unhealthy I was around food for so very long, even though the people around me never saw it (my mother still doesn’t quite believe, I don’t think, that I had a genuine ED even though she’s been very supportive of my HAES and intuitive eating approach).

    I’m so much happier now than I was then and don’t regret my thirteen years of effort but this paragraph really reaches me because I still live it every single day!

    • Posted August 21, 2015 at 10:01 am | Permalink

      That can be really difficult to sort out – because sometimes a craving worth following up on isn’t necessarily prompted by physical hunger either, but a desire for pleasure, which I think is also a valid reason to eat sometimes. This can, I think, get easily mixed up with environmental food cues.

      I think one way I learned to sort this out for myself was, after choosing to follow up a craving, to ask myself, “Did I enjoy it, and was it worth it?” Sometimes the answer would be YES, and sometimes…not really. Just by observing this non-judgmentally, I think I have slowly gotten better at knowing beforehand which things are real cravings, and will thus provide me with lots of pleasure and be worth it, and things that are just passing whims that actually don’t provide much pleasure.

      • Nebet
        Posted August 21, 2015 at 12:00 pm | Permalink

        This is somewhat of a tangent, but as someone with a lot of (non-life-threatening) food allergies and intolerances, I want to point to your comment here, Michelle, and say THIS! — because sometimes the ice cream or the green beans or the fried rice or whatever is delicious enough to outweigh the (mostly-immediate, uncomfortable) downsides.

        I can make that decision to eat, and I can make the decision of when I’ve had enough to satisfy my desire for the food (or to decide that this particular instance of ice cream or green beans or fried rice or whatever actually ISN’T delicious enough to bother with it) — and I can remember that I can have it pretty much whenever I want, that nobody is taking it away from me, and that it is MY DECISION to eat it or not.

        And then when I get stomach cramps or whatever later, that’s a good prompt to decide: is it worth it to continue eating this particular thing in this particular quantity with this particular frequency and this particular preparation? The answer varies. Sometimes the answer is: yes, it’s delicious and totally worth it! And as you said: surprisingly often, the answer is, “not really worth it.” And my response to that is a mental shrug and an “oh well! Now I know.” But I can still decide again the next time, if I want to!

    • Jessica
      Posted August 21, 2015 at 6:46 pm | Permalink

      Heidi, I am right there with you. Only for me it’s been about 8 years since I began. And while I haven’t dieted at all since the day I made the decision I was done with dieting, I’ve still struggled with that infamous “diet mentality.” And I, like you, have to do battle with the ED demons that see my choices to not eat something as restriction, even when it’s so not about that.

      It’s really a daily struggle sometimes. It’s very frustrating, and always it’s worse at the times when I’m dealing with poor body image feelings.

      But like you, I am so much happier this way, overall. It’s hard work, and that’s something I get really upset about when people act like I’ve “given up” because I’m not trying to lose weight. The work I’ve done, and continue to do, has been freakin’ hard. Worth it, but so not easy. And if I’d “given up,” I’d have just let my ED take over completely.

  3. Beth
    Posted August 21, 2015 at 9:52 am | Permalink

    You mentioned this:

    “That means, if you use a lot of energy one day, running around more than usual, you will be hungrier afterward, as your body attempts to make up the deficit. I’ve even experienced ‘catch up’ hunger several days removed from the event. ”

    I’ve experienced this as well, but have gotten into arguments with people when I’ve said I’ve experienced this. I usually pay attention to my hunger cues, but sometimes in the evening I don’t have any convenient snacks and don’t feel like making anything so I just go to bed hungry. I notice then that I’m ravenous the next day. However, I’ve had people try to tell me I’m just imagining it, which is very frustrating. I honestly hadn’t heard of anyone else expressing this phenomenon until you mentioned it, but I guess it’s not something I think about often because I try to avoid it happening!

    Is there any “evidence” for it, or is the “evidence” implied by articles like the one you linked to– that our bodies try to match energy intake to energy expenditure?

    • Posted August 21, 2015 at 9:57 am | Permalink

      The article I linked to mentioned some early studies that showed that energy intake didn’t correlate with expenditure over a one day period, but that it did over a 2 week period – which means it took as much as up to 2 weeks for a person’s intake to catch up with their expenditure. Seems to explain it.

      • Beth
        Posted August 21, 2015 at 10:43 am | Permalink

        Thank you for simplifying for me!

      • inge
        Posted August 22, 2015 at 2:03 am | Permalink

        This is very interesting! I have observed something similar myself (I keep a food diary to channel my restrictive impulses into more-or-less stable eating, instead of restricting-bingeing, where they *want* go go) — it takes about one or two weeks for “more food” or “more activity” to balance again.

        And when I go to bed on an empty stomach, not only am I cold all night, but I also wake ravenously hungry. Which is to be expected, if there were a reset triggered at midnight (which my mother seemed to believe), science would have noticed by now.

      • SarahTheEntwife
        Posted August 22, 2015 at 10:17 am | Permalink

        Neat; that makes a lot of sense!

        I’m on medication that tends to suppress my appetite, so I’ve had to learn to snack more often or I’ll sometimes find myself ravenous despite having just eaten a good meal, and realize that I’ve barely eaten more than a meal a day for the past week, and my body has just realized that it desperately needs an entire pizza now.

  4. Posted August 21, 2015 at 9:58 am | Permalink

    I just got a copy of “What I Eat – Around the world in 80 diets” by Peter Menzel and Faith D’Aluisio. Out of 80 people, only 3 of them ate below 1200 kcals. Average intake was closer to 3000 (men and women included) and many people of smaller stature had intakes over 2000!

    • Posted August 21, 2015 at 10:05 am | Permalink

      That’s interesting! I think I was reading in the Cambridge World History of Food that intake analyses of historical populations (like, I think, colonists to North America?) put the average intake somewhere around 3,000 based on anthropological evidence.

      A lot of people would argue that, of course people living in poorer countries and people living in the past would have had much higher physical activity, and while that’s true, it’s also true that physical activity makes up the smallest proportion of total energy expenditure, so the difference between what a more active and more sedentary person needs might not actually be so huge. I think the difference only becomes extreme when you get into endurance athletes and people with an abnormally large lean body mass.

      • Gretchen
        Posted August 21, 2015 at 10:41 am | Permalink

        I can’t tell you how excited I am to see these numbers. I’ve always felt like I was starving if I ate anywhere near as low as 2000 calories (even if that was the “correct” amount to maintain my current weight).

        I’ve been working towards intuitive eating for the last 8 years, and lately I’m proud to be more able to recognize the times when it’s “mealtime” but I’m not actually hungry. It always takes me by surprise to notice the variations in my appetite even when my day-to-day routine doesn’t change much. Bodies are pretty awesome!

        • Posted August 21, 2015 at 10:46 am | Permalink

          Appetite is a fascinating thing. There’s a great textbook called Appetite and Food Intake: Behavioral and Physiological Considerations that talks about how there is a difference between physical processes that are REGULATED (which means, the body attempts to keep them at the same level all the time) and processes that are CONTROLLED (which means, the body makes them change, sometimes dramatically, in order to keep internal conditions stable.)

          They talk about how food intake is a controlled variable, not a regulated one, which means you are supposed to sometimes eat a lot, and sometimes a little, and this is all directed by biological pressures that adjust appetite up or down. Your intake is SUPPOSED to vary from day to day or, at least, it’s supposed to have the ABILITY to vary from day to day. The reason for this is that your varying food intake is keeping something else stable – and there a few different theories about what that “something else” might be. Some people say it’s level of adipose tissue (the lipostatic model), some people say it’s energy production in the liver (the energostatic model.) Either way, appetite is supposed to go up and down, and it’s mostly driven by our biology, which attempts somehow to match energy intake the expenditure.

          This is very different from the popular narrative about appetite, which is that it’s based on a person’s character (greedy, not-greedy, high self-control or low self-control) or based on their random personal decisions (“I’m going to eat 1200 calories today and this is entirely a matter of choice!”)

      • Posted August 22, 2015 at 8:06 pm | Permalink

        I was watching this Yoni Freedhoff video recently, and he was talking about some studies (done with labeled water, so no possibility that it’s due to inaccurate self-reporting) showing that we actually don’t burn less energy than in the 1980s or when compared to less industrialized countries. I didn’t look at all of them, but at least in this meta-analysis and this study, that is true after adjusting for weight/BMI. (So it could not all be explained by us burning more energy just by existing because we’re bigger. At least, if they controlled for weight as well as they say they did. I guess some of it could be explained by it burning more calories when someone weighing more does a particular task, but it’s debatable whether that should count as “less exercise” or not.)

        Also amusing in that Yoni Freedhoff video: he kept pointing out studies claiming that the study showed that we need to promote exercise for weight management, when their results were stuff like “Exercising 6 hours a week results in gaining 3 lbs less over 10 years”, and being like, “No it doesn’t!”

        • Gretchen
          Posted August 22, 2015 at 11:52 pm | Permalink

          Thanks for sharing the video link! I really appreciate his critical approach to exercise – I wish he’d extend it to looking at the futility of trying to control diet over the long term.

        • Posted August 23, 2015 at 6:21 pm | Permalink

          That’s really interesting, thank you for the links. I had heard that argument, that our energy expenditure doesn’t actually appear to be lower when measured, but I haven’t dug into the research myself.

      • Camilla
        Posted August 23, 2015 at 5:16 pm | Permalink

        I live in the Northeastern US and commute by bicycle throughout the year, and my winter caloric intake is between half again, and double what my summer intake is (at stable weight). I also keep my bedroom quite cold in winter. There may be other confounders, but I want to bet that historical studies are skewed by lack of central heating, especially sleeping in cold conditions.
        It’s also obvious with my kids that if we go camping at the ends of the season, the whole party will eat (a whole lot) more. Enough so that it guides the grocery decisions a bit.

        • Posted August 25, 2015 at 8:57 am | Permalink

          The two that I looked at were for 1980s vs today, and for Nigeria vs Chicago, so those particular ones, probably not; but in general, or applied to “Around the World in 80 Diets” (probably, since I haven’t read it I don’t know what climates they looked at), yes.

          I went to a talk by Joan Slonczewski about living & doing research in Antarctica, and she was talking about how much they ate and saying that they ate a LOT of chocolate.

    • ksol
      Posted August 22, 2015 at 9:45 am | Permalink

      Interesting. I tried tracking for a while last year and found that if I even restricted to my recommended maintenance level per all the calculators I could find– 1600-1700 calories before adding exercise calories back in — I was perpetually hungry and losing weight. I’ve thought for a long time the recommended intake levels are too restrictive. I have no idea how anyone manages on 1200 calories, which is what I’ve seen recommended for me for weight loss. I stopped tracking when life got busier, because I didn’t have that much time and energy into to put into it any more. Although I’ve rebounded slightly, it was well worth quitting. I feel less cold and depressed now. I think I tried it because I’ve never really been a dieter, but the message I got from nearly everywhere was that this was the path to health. It was like, “OK, I’ll try it your way and see if you’re right.” Yes, it was effective for weight loss, at least in the short term, but not worth continuing in the broader context of my life. I have other projects — I don’t want to make my body my primary project.

  5. Laura
    Posted August 21, 2015 at 10:05 am | Permalink

    This makes so much sense. Thank you.

    I think the aspect of “accepting” that may be harder for a lot of people, if not the hardest, isn’t accepting it for myself but being okay about other people (not) accepting it. Taking the comments in stride from friends and family members about “are you ok these days?” and “are you getting enough exercise lately?” and “didn’t your doctor tell you to lose 30lbs?”. It wears your confidence down and leaves room for so much doubt.

    I find the biggest influence on my hunger and where my weight settles is stress/anxiety level. So, it follows that your recommendation about taking care of yourself really is the priority. It also follows that the weight struggle for me (and others, I’m assuming) is a vicious self-perpetuating cycle of worrying about weight, eating more or more calorie dense foods. There’s also a point where if you’re trying to eat “less” the devil on your shoulder (or at least my shoulder) says “than you might as well eat this [food engineered to taste good without much nutrition… chips, alcohol, pie, etc.].

    I’m trying to stick with your first piece of advice about giving yourself permission to eat as much of what you want, when you want. This takes the forbidden out of it (allowing me to eat treats when I really want them, not just when they’re there or I have opportunity to) and takes the scarsity mindset out of it (letting me feel as though I don’t have to eat the whole portion or eat until I can’t anymore when I do get treats).

    The process continues! Your suggestions and posts always put things into perspective. Thank you for what you do.

    • Gretchen
      Posted August 21, 2015 at 10:44 am | Permalink

      “I find the biggest influence on my hunger and where my weight settles is stress/anxiety level. So, it follows that your recommendation about taking care of yourself really is the priority. ”

      This is so, so true for me. My most reliable indicator that I’ve got an unhealthy level of stress in my life is that my weight starts going up about a pound every month, pretty much linearly no matter what I’m doing or not doing for diet and exercise. I have to be careful to remember that the weight gain is a useful reminder for self-care, not yet another thing to stress about!

      • Laura
        Posted August 21, 2015 at 10:50 am | Permalink

        Agreed! There’s so much power in being aware of this.

  6. Nebet
    Posted August 21, 2015 at 12:28 pm | Permalink

    Content warning: discussion of severe calorie restriction (including specific intake numbers) and specific weight numbers.

    My partner was recently diagnosed with severe obstructive sleep apnea, and when we went to the sleep doctor to get a prescription for a CPAP, the doctor — with an expression of dire seriousness — counseled my (26-year-old male) partner that he needed to lose weight, and that since “you’re young, so you can eat less than a thousand calories a day.” (Oh, and these all-of-two-sentences he spent on this horrible advice? Billed us for it as “weight counseling.”)

    ?!?!!!?

    For the record, my partner’s nickname is Bear, and for good reason. He is 6’2″, broad-shouldered and barrel-chested — at the lowest weight I have ever seen him, he was about 275 and looked like he was sick, and this was after he had spent three months subsisting on cabbage and rice while working ten-hour days doing manual labor. We both suspect that that screwed up his metabolism a bit, because he got bigger after that (though his having a spine condition that required surgery a few years ago because he couldn’t stand for more than five minutes — he’s still recovering from that! — didn’t help).

    We estimate his current BMR at around 3250 kcal/day — that’s just sitting and breathing and existing. Even at his supposed “ideal weight” (according to a chart, of course, not how he feels best) he’s still at around 2500 JUST TO EXIST. And this doctor wants him to eat LESS THAN A THIRD of what his body needs JUST TO EXIST?

    I was livid, but I kept it inside because we just needed to get the CPAP prescription (which actually WOULD help his sleep apnea, and immediately! unlike whatever advised weight loss might — and never f— mind that apnea contributes to weight gain!) and get the hell out of there.

    My partner and I have been learning about HAES and intuitive eating (including basal metabolic rate, as you discuss, Michelle) for a few years, and so we were both able to blandly smile and nod while rolling our eyes at each other behind the doctor’s back — and yes, get the CPAP prescription and get out.

    But I am a little terrified to think of what that kind of advice might have been like for other people in our situation who haven’t had the benefit of an education in health at every size. I don’t know if we can risk trying to educate him, though — we don’t know this doctor very well, don’t have an established relationship with him, and are worried that he might write us off as a “difficult patient” — or fire us.

    Thanks for listening to this rant. I think I needed to get it out somewhere.

    • Mich
      Posted August 22, 2015 at 3:27 pm | Permalink

      I never understand how doctors can fire their patients. You are, after all, their boss, so that would be like taking a Safeway cashier and firing the store manager, and then walking out on the job.

      This doctor sounds like a load of bunkum, and if he’s never learned that apnea causes weight gain, he should go back to school.

      • Nebet
        Posted August 22, 2015 at 3:43 pm | Permalink

        The reason doctors can “fire” their patients is to limit their liability with patients who are noncompliant (refuse to take necessary medications, for example, without discussing it with the doctor to try to find an alternative). Just a reality of malpractice suits, unfortunately. However, doctors must give I think 30 or 60 days’ notice to give the patient time to find a new doctor, and they must send over the patient’s medical records to the new doctor at no charge – in Texas, at least.

    • Posted August 24, 2015 at 2:20 pm | Permalink

      That doctor’s comment is unbelievable. What adult could exist on less than 1,000 cals/day?

      I have mild sleep apnea. Before CPAP I had so little energy and was so tired all the time, I honestly thought I had cancer. I’ve had a CPAP for over two years and it has been a GODSEND. Quality sleep is everything. I’ve had more energy and less fatigue than I have had in years. The CPAP saved my life, literally. And yet now that I’m feeling so much better my sister in law thought I should go off my CPAP. I looked at her like she’d grown another head. “It’s just air” I told her “not like I’m taking a drug with major side effects.” {she’s one of those types that barely takes an aspirin if she has a headache}

      The by product of using my CPAP has been better health all around.

      Just like the by product of adjusting my diet {with the help of a dietitian} to include more protein / less carbs/ more fruits and vegetables has been more energy, less pain and, yes, weight loss.

    • Posted August 24, 2015 at 3:09 pm | Permalink

      Wow, that does sound very questionable. I am really glad you got the CPAP, but unfortunately it sounds like it came with a side-order of badgering.

      I’ve said it before and I will say it a million times: some doctors are knowledgeable about nutrition, but many are not. The ones who take an interest but still have limited training in it, in my experience, tend to view nutrition in a very mechanistic, reductionist way that can result in advice like this. It doesn’t take into account nutritional adequacy or quality of life. More doctors should get in the habit, if they are in a position where they need to offer nutritional advice or weight management advice, of referring people to RDs. RDs are not perfect, but I can almost guarantee you would not receive the advice to eat less than 1,000 calories a day from one. The only time that would be appropriate would be if someone was extremely small with very low energy needs, or already severely malnourished. So sorry that happened, but I’m glad you were able to move forward.

      • Courtney
        Posted August 25, 2015 at 7:25 am | Permalink

        In searching for an RD to work with in overcoming my ED, I was warned multiple times to be careful in choosing one, because RDs and nutritionists often tend to suffer from disordered eating themselves. I guess a lot of people with EDs have encountered RDs telling them that they should gain weight only until they reach x BMI and then they need to adjust their calorie intake so that they don’t gain any further, or they put them on meal plans that only allow for x meals/snacks per day and do not encourage them to eat more than that if they still feel hungry. Do you have any experience with this or thoughts on it, Michelle?

        • Posted August 25, 2015 at 8:05 am | Permalink

          This can happen, and it’s right to be cautious. I don’t know how much research there is on the topic of prevalence of disordered eating among dietitians – a quick search provides only one small study from 1992, but it is a question worth asking. You can always look for an RD who specializes in eating disorders – they do exist, and they do great work. It’s not a guarantee, but the odds are much higher that you’ll find someone who understands the need to be non-restrictive. There is some information on my Get Help page about this.

          • MP
            Posted August 26, 2015 at 7:49 pm | Permalink

            Michelle, do all RDs utilize doubly-labeled water calorie levels? Is there good data on doubly-labeled water for those with BMI>30?

          • Posted August 27, 2015 at 6:02 am | Permalink

            No, I believe that kind of test is not practical for most clinical use. Most RDs rely on equations (Harris-Benedict, Mifflin-St. Jeor, etc.) to estimate calorie needs. I don’t know if there is research using doubly-labeled water on people with higher BMIs (update: looks like there is), but it would be interesting to read if there is.

      • Mich
        Posted August 27, 2015 at 2:37 am | Permalink

        The RD I went to, which was part of the clinic that I was going to, advocated 1,400 kcals/day. This was 3 meals, and 3 snacks. I also think it was 0 fat.

        • Posted August 27, 2015 at 6:03 am | Permalink

          Yikes, that seems pretty extreme.

  7. Terry
    Posted August 21, 2015 at 1:07 pm | Permalink

    I think you are on to something with the intuitive eating and such. Figuring out how to live in your skin without quick fixes is the way to go. My cautionary tale of experience:
    My metabolism is all messed up from extreme dieting. I also go to food when stressed and that is the real weight gain time. I started dieting with my mother when I was a teen although now I see that neither one of us was overweight, especially me. When I had my second child I had a residual 30-40 lbs left over when she was a year old so I went on the liquid diet only with Oprah. I lost 50 lbs in less than two months until I started eating again and gained back 80. That started the whole REAL weight problem. I have been losing and regaining the same 100 lbs for 25 years. My metabolism is so messed up I can hardly lose weight on 600 liquid calories a day and you can imagine that isn’t too fun. I had a sleeve gastrectomy two and a half years ago which I lost down to only 50 lbs overweight but then I got stressed and regained 60 of what I had lost. I was warned that a yo yo dieter doesn’t have complete success with a sleeve. I hate that they were right.
    Anyway, here I am again on liquids trying to shrink down my sleeve. I am in my fifties now so if I can maintain at 200 lbs I will be happy if I can get there again. I just really want to share my story so if you haven’t gone as far into extreme dieting as I did in my twenties perhaps you can work on letting your body do it’s reasonable work with real food, an appropriate amount, and avoid this vicious circle.

    • Posted August 21, 2015 at 2:21 pm | Permalink

      Wow, you have obviously been through a lot. The lose-regain cycle is very, very familiar to me from working with clients. I agree that if people can sort out their eating early on, they are less likely to get into this cycle. One good thing about metabolism though: while you can slow it down (the resting energy expenditure part of it, that is) through dieting, it can also speed back up again if you’re well-nourished and moving. I think people at any age, even people who are severe dieting casualties over decades, can benefit from learning to eat intuitively. Thank you for sharing, and take care.

  8. Posted August 21, 2015 at 4:55 pm | Permalink

    Oh, wow, this hit home. I gained a lot of weight a couple years ago while struggling with join pain, fatigue, achy muscles, etc. I assumed that these symptoms were related to my Hashimoto’s thyroiditis, so I went to an endocrinologist. She prescribed me a 1200 calorie diet. She said it would be difficult but that if I succeeded I would lose the weight. (She didn’t say if it would help my energy levels etc.) I knew absolutely nothing about calories at the time, but I started up a calorie counting app and went with it. And it made me miserable. Cranky, unfocused, and hungry all the time in addition to tired and achy. I went back to my regular cooking and eating routines, which were still pretty low-calorie due to my lack of activity. And later a different doctor raised my synthetic thyroid hormone dosage, and that took care of the pains and fatigue.

    I’d made my peace with the unhelpful medical advice, but it must still rankle a bit because I felt very comforted by this post.

  9. marni
    Posted August 22, 2015 at 9:21 am | Permalink

    I’m curious if you have any words of wisdom…I am currently on prednisone for a health issue. I will be on it for at least 6 months. Prednisone really increases appetite. I feel like I can’t trust my hunger cues.

    What to do when you don’t feel like you can’t trust your own hunger?

    Marni

    • ksol
      Posted August 22, 2015 at 9:38 am | Permalink

      I can only speak to my own experience having been on a drug that caused over-the-top carb cravings and subsequent weight gain. What I mostly want to caution you is to avoid any self-blame, the “I’m so weak” idea that you just need some discipline. I was engaged in that kind of self-flagellation when a wise friend essentially told me to cut myself some slack — some drugs induce powerful biological effects that are not so easily overridden. I don’t do hungry well, so my choice was to accept the weight gain as the price of treating the illness that was more important to get under control. You will, of course, have to make your own choices on that front.

    • Beth
      Posted August 24, 2015 at 9:05 am | Permalink

      I was on Celexa a couple years ago, it really increased my appetite and carb cravings. Prior to being on the meds, I’d been pretty good at eating intuitively and keeping a stable weight. I also wasn’t told that this was a potential side effect (even though it’s been reported in a number of papers), so I didn’t even realize at first that I was gaining weight because I was overeating.

      If I could go back in time, I would not have gone full vegetarian at the exact same time, because that eliminated easy protein choices for me. That’s not to say that it’s impossible to get protein in a vegetarian diet, but I think it takes more planning and prep than doing something like grabbing a can of tuna. The meds also made me tired, which took away motivation to prepare food. So, I would have made sure I was eating a lot of protein to increase satiety, as well as fiber. I would have also made sure I constantly had healthier snacks around (carrots and hummus, popcorn, fruit) so that I wouldn’t be tempted to go to the convenience store and get ice cream bars.

      But I do have to agree with the other commenter.. while I believe I wouldn’t have gained quite so much weight during this time had I been eating more protein, I was eating mostly healthfully (just carbed out like crazy) and would have still gained weight.. just maybe not as much. So be sure to cut yourself some slack.

    • Posted August 24, 2015 at 9:54 am | Permalink

      Hi marni – I’ve worked with people in a similar situation, and it can be so difficult. Like the other commenters mentioned, I think avoiding self-blame is key.

      You can trust your hunger cues, or rather, you sort of have to. Even if those cues are being changed by medication, it is very difficult, or maybe impossible, to just ignore them indefinitely. The reason I caution against doing so is that it can set you up for binge eating, which can compound the weight side effects of the medication, and of course disrupt your relationship with food in the future. If it was effective to simply restrict yourself and put up with the hunger, this situation wouldn’t be such a struggle for so many people.

      The best thing you can do, in my opinion, is take care of yourself with food as best you know how. Promote your own weight regulation as best you can, by being organized, faithful, and positive in feeding yourself and moving your body…but not clamping down with heavy restriction or forcing yourself to do more than feels right. All you can do is all you can do – you may need to accept that your weight is going to find a new baseline while you’re on this medication.

      Being organized with eating means offering yourself nourishing meals at regular times, once you’ve observed the times of day (or the amount of time between eating) that allows you to get moderately, comfortably hungry. (And “nourishing meals” means meals that you like, and that also contain 3-4 food groups at a time.) Then it means giving yourself permission to eat as much or as little as you need at those meals to feel comfortably full.

      This would also be a good time to see a registered dietitian, if you think you need help. RDs are trained to help with medications that interact with nutrition and weight.

  10. Josée
    Posted August 26, 2015 at 9:45 am | Permalink

    Hi Michelle,

    I’m so happy I found your blog. I am also a Canadian RD who uses a non-diet, intuitive eating approach. I look forward to learning from your wisdom through your posts and tweets. :) I’m sure I will be sharing a lot of your content in the future! Happy to connect! :)

    Josée Sovinsky, RD
    http://www.joseesovinskynutrition.com

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