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No Fear —

June 12, 2012

Trigger Warning: I discuss low-fat, low-cholesterol diets and metabolic health in this post.

Do you know what terrifies me more than death? Dying and having it all blamed on my fatness.

Last August, I shared some rather personal, medical information, including my family history of heart disease and the fact that I had just received the results from my cholesterol panel. My lipids were elevated, which increased my risk of heart disease.

As a proponent of Health at Every Size® (HAES), I feel obligated to “represent” the principles outlined in that approach, and I fear that if I have high cholesterol or, worse, suffer a heart attack, I would be “letting down” the HAES community by not “proving” that HAES is a viable, evidence-based, health-centric alternative to the traditional weight-centric model.

According to the mainstream medical opinion, in order for someone of my BMI (5’7″, 265 pounds, and a morbidly obese BMI of 41.5) to be healthy, I would have to lose 106 pounds (or else grow an additional 21 inches to 7’3″ tall)  in order to get my BMI to just under overweight. Then, and only then, will I achieve “health” as prescribed to mainstream medical opinion.

This weight-based model makes weighing 159 pounds the axis around which my health behaviors should revolve. In order to weigh that much, I would (theoretically) have to reduce my caloric intake (thereby reducing my intake of both sugars and fats) and increase my exercise. Those two behaviors combined will produce both weight loss, and that weight loss will produce the metabolic changes that will improve my cholesterol, blood pressure, blood sugars and any other metabolic indicators.

The only problem is losing 100 pounds, and maintaining that lower weight for the rest of my life, is about as likely as me sprouting two feet taller. The more likely outcome is that I would attempt to lose 100 pounds, peak at 25 pounds (or 10% of my current weight) after a year, become discouraged, give up whatever healthy behaviors I adopted, and regain the weight because, fuck this, I’m never going to lose 100 pounds.

This up and down fluctuation is known as weight cycling and, based on the research, it seems to have a profoundly negative impact on our metabolic health. Not only that, but it’s pretty much a given that weight cycling leads to long-term weight gain.

In light of this depressing damned-if-you-do-damned-if-you-don’t reality, what’s a fatty in search of improved health to do?

Enter Health at Every Size®, which encourages people to track their metabolic indicators and make health changes based on those numbers, not the one you find on the scale.

The evidence for HAES is clinically impressive, with those who follow the health-centric model improving their metabolic indicators significantly more after one year than those who attempt a traditional diet with its inevitable discouraging weight loss results.

So that is the model I have chosen for myself, especially after discovering that my cholesterol was elevated.

At the time, however, I had already been going to the YMCA for just under a year and getting my cardio in on the elliptical. I was also taking the advice in the awesome book Health at Every Size by Dr. Linda Bacon (now $2 for Kindle)  and attempting to widen my palate by introducing foods, like blueberries, I had once shunned.

I consider that first year the experiment phase of my relationship with HAES. What I learned was that I enjoyed exercise, and blueberries, more than I imagined. And despite intervals of disruption when I have been unable to get to the gym for weeks, or even months, at a time, I find myself thinking about the elliptical frequently and eagerly anticipating my return.

The fact is, I know that regardless of how much weight I lose, whatever steps I take to improve my health will have some impact.

I was a little disappointed when my August cholesterol numbers came back high, though. I thought the cardio would inoculate me from unhealthy lipid levels. Of course, that was my first cholesterol test, so I had nothing to compare it to.

So, after I learned of my high cholesterol, I began with the convert’s enthusiasm and planned to shun all red meat in favor of Boca Burgers and eggplant parmesan.

Unfortunately, I am a hard-core omnivore and I love love love red meat. I also love Nutty Bars.

Weeks into my semi-vegetarian, semi-dieting lifestyle, I realized that I would not be able to spend the rest of my life without hamburger, let alone delicious treats.

Therefore, I began to compromise in order to increase sustainability.

I wouldn’t treat burgers as Death-Flesh, to be avoided at all costs. Instead, I would try to find alternatives that I enjoyed just as much as a big, fat, juicy burger, especially at fast food restaurants. And on those days when I craved a burger, I would get a burger. I had to find a balance.

So, the first thing I began to learn is to love salads.

As a man, I have eyed the salad section of menus with stereotypical disdain. Salad was weak, emasculating food that had no business on my plate, even though sometimes I’d see a salad that seemed appetizing.

Now, as I began to explore my options more, I overcame my fear of salads, which included the fear that others would see me eating a salad and decide that Fatty was on a diet. To me, that was the biggest insult of all. I want to be able to eat healthy foods without people assuming I’m doing so to lose weight and become Jack Six Pack.

One of the first salads that I got in spite of that fear was called the Sweet Louise salad, which was a bed of lettuce, pecans, goat cheese, cranberries and onions (which I discarded), topped with a poppyseed dressing.

I never thought I would describe a salad as orgasmic, but the Sweet Louise had my eyes rolling to the back of my head.

After that, zero fucks were given as to what others thought of my salad purchase.

Now, when we go to McDonalds, I look forward to the Southwest Chicken Salad. And when I mention it, some n’er-do-well has to mention the sodium in the chicken or the fat in the dressing or the — fuck that. I love the texture, the taste, the spiciness. I could give a fuck if it’s the ideal meal because it’s just one more option that isn’t red meat.

Having cast off the stigma of salad, I now find myself going straight to the salad menu at restaurants to see what’s available. Healthy or not, I like salad. I’ve also grown to like other fruits and veggies as well.

The other change I made was in my breakfast and lunch eating habits. I used to ignore breakfast and lunch entirely because I wasn’t painfully hungry and I was always rushing out the door. But HAES emphasizes regular meals, so I began incorporating breakfast and lunch back into my life.

So, I have boxes of oatmeal in my desk for breakfast and a giant bag of pistachios or almonds available for lunch. The addition of nuts to my diet has been another interesting “find,” as I have developed an intense love of pistachios and almonds. I’ve also found my hunger and satiety cues are much stronger now. I have no idea what impact it’s had on my daily caloric consumption, but I find myself in greater control of my appetite, which must be having some impact.

Although these are rather minor dietary changes, they’re also changes that I know I can sustain for the rest of my life. And since I have begun enjoying salad for its sensory delight, rather than its effect on my waistline, I have not tied my consumption of veggies to anything but pure pleasure.

The other area of my life that I changed after those cholesterol numbers was that I finally did what Dr. Steven Blair recommends in one of the upcoming interviews: adding strength training to my cardio.

I never really felt as though strength training was as important as cardio, but Blair emphasized its complementary relationship to cardio. I have enormous respect for Blair, so I figured I’d give it a go.

After discussing my goals with the gym’s weight room expert (building lean muscle, rather than the bulky, show-off muscles), he explained that I should start with reps of 12 at a comfortable weight, lifting, then slowly returning the weights to baseline. Our gym provides sheets with three recommended “tracks” of weight lifting, with each track incorporating seven or eight machines that will strengthen a comprehensive set of muscles.

Although Blair recommends three days a week of strength training, I have only been able to keep up with two at the most, but one consistently. It has not been easy to incorporate strength training into my life on top of cardio, but I try my best, and I’m still getting results.

The results I’m getting have nothing to do with my weight, or even the shape of my body. I haven’t grown massive biceps or six pack abs. I have, however, seen a steady, appreciable increase in how much I can lift. I can also feel the difference in my body, in the muscles themselves.

These subtle changes that are only apparent to me have motivated me more than anything to keep going.

Last winter, it seemed we were circulating virus after virus after virus, and just after cracking the 100 pound mark on many of the machines, I was unable to return for nearly three months (for some reason, gym daycares hate it when you bring sick kids in).

When I finally returned, I was sorely disappointed to learn that I had lost much of the strength I had built, and had to start 20 pounds lower.

In a way, I felt like this loss of strength must be similar to the disappointment dieters feel when they hit a “plateau.” Except, for many dieters that “plateau” becomes permanent, due to the body’s adaptive response to caloric restriction. No matter how much effort, energy or sacrifice the dieter puts into pushing beyond that plateau, they may never see any further physical changes.

Weight lifting is similar, but drastically different. There may be a “plateau” at which you just aren’t able to lift any greater weights, but by the time you reach that plateau, the evidence of positive, healthy changes is worth continuing your work.

And unlike the arbitrary goal of weight loss, strength training is about building your strength, which is demonstrable and quantifiable. So, after “falling off the wagon,” my motivation to regain that lost strength motivated me further, and I’ve been active in the weight room ever since.

Strength training has been the big surprise for me, as I have enjoyed the process much more than I thought I would.

And, it seems to be paying off.

Last month I found a new doctor, as my previous doctor seemed to be a dickweed. This new doctor initially recommended that I get my weight back to the “normal” BMI, but after discussing HAES with her, seems to appreciate that perspective as well.

I made the appointment to establish a relationship with my new doctor, but also to get an updated lipid profile. And while the results aren’t perfect, the improvements are quite noticeable.

  • My total cholesterol dropped from 245 to 219.
  • My HDL (the “good” cholesterol that you want to be high) rose from 37 to 41.
  • My LDL (the “bad” cholesterol that predicts heart disease) dropped from 174 to 143.

The only thing that didn’t improve were my triglycerides, which went from 170 to 175. These numbers aren’t radically high, but, as with all metabolic indicators, they can always be improved. Trigs are influenced by diet, so that seems to be the area I need to focus on next.

However, the nurse practitioner who reviewed these numbers with me (my doctor was gone for my return visit) said that there my levels were good, I wouldn’t need medication and to keep doing what I’m doing.

Great news, right?

But here’s the kicker: despite making these improvements, I haven’t lost a single pound, or grown a single inch.

I’m still 5’7″. I’m still 265 pounds. I’m still morbidly obese.

Now, if I pursue a diet that will lower my trigs as well, I may lose weight. I may not. But that’s not the metric that matters to me.

What matters is that I’m moving my cholesterol numbers lower through diet and exercise, neither of which has resulted in a change in the scale.

That is the heart of HAES: improving your health through sustainable behavior changes regardless of how it affects your weight.

In writing this post, I grappled with the fear of exposing myself to criticism (“But your trigs are still high!”), but I decided that using myself as an example may serve a valuable purpose for those who are in the same situation I am.

Obviously there’s more I could do (I could become a mountain-biking vegan), but I refuse to start something that I won’t be personally happy with. For the past 10 months, I’ve been experimenting even further with making the kinds of lifestyle changes that I can live with. Now it seems that I’ve not only come closer to that golden mean, but that I’m also reaping the health benefits.

21 Comments leave one →
  1. June 12, 2012 12:07 pm

    I don’t know what the hell trigs even are, so as far as I’m concerned, you’re doing the right thing by being honest and open, regardless of whatever arbitrary measurement isn’t “right”.

    • June 13, 2012 10:47 pm

      High triglycerides are a risk factor for heart disease. Mine are exactly halfway between “normal” and “high.”

      But, yeah, putting it out there felt right, but still kind of weird.


  2. Theresa permalink
    June 12, 2012 12:07 pm

    Awesome results, Shannon! Strength training is the bomb, not because of fat loss, calorie burn or any of that other BS … I love it just because it makes me feel badass.

    • June 13, 2012 10:46 pm

      I do too. I’m not trying to get ripped, just build lean muscle, and I love the way it’s just barely achy/twitchy/burny. It’s pretty cool.


  3. fatology101 permalink
    June 12, 2012 12:23 pm

    Great blog, thanks for being so honest. It is a process to make any changes.

  4. L.J. Utter permalink
    June 12, 2012 12:58 pm

    ‘kay, only jerks who completely miss the point of the article would comment about your trigs. Triglycerides are tricky things, my doc didn’t even ask for them last time I had a lipid panel done.
    I see this as the greatest example HAES can work. You made simple, enjoyable changes that improved your health, not to whittle your waistline.

    • June 13, 2012 10:43 pm

      Thanks LJ. And I’m only partially worried about my trigs. All I can do is keep taking baby steps toward better numbers.


  5. vesta44 permalink
    June 12, 2012 1:48 pm

    That’s the point of HAES, and you’re being successful at the goals you’ve set for yourself by doing things that you like and will continue to do. Good for you, and congratulations.
    I have a new doctor (finally) and I go tomorrow for lab tests he set up to check blood sugar, cholesterol. and liver panel, and to turn in my 10 days’ worth of blood pressure numbers that he wanted me to track. My BP was a bit high on the top number when I saw him for the first time, so he wants to know what it runs at home before he decides whether I need to take medication for it (although he already gave me a diet to follow, go figure). I’m not sure how this is going to work out, he’s still of the calories in/calories out mindshift, even when I told him that I refuse to diet anymore. He looked at my record and said that 2 years ago I had lost 20 lbs and then gained it back and that wasn’t good. I told him I hadn’t done anything to lose that 20 lbs, and I hadn’t done anything to gain it back, my eating habits and exercise habits have been the same for the last 6 years, so that 20 lb variation doesn’t mean shit (and really, when you weigh almost 400 lbs, is losing 20 lbs that big a deal anyway?). If he keeps giving me fits about my weight, I’ll be firing him and looking for another doctor, again. I’m done dealing with doctors who blame my weight for everything that’s wrong.

    • fatology101 permalink
      June 12, 2012 1:59 pm

      Good for you, bravo. Hope you find a dr. that is good for you.

    • June 13, 2012 10:43 pm

      Keep looking vesta. Keep this doctor while you look, but there will be a doctor who understands. Good luck!


  6. June 12, 2012 11:41 pm

    Way to go, Shannon! Excellent real life example of what HAES can do. I’ve done similar things that have improved all my numbers and the weight didn’t change. I have yet to discuss HAES with my doc and she says eventually we will have to “address” my weight. We’ll see…

    • June 13, 2012 10:41 pm

      Thanks Rija. And don’t be afraid to discuss HAES with your doctor. I’ve done it twice now with my two recent doctors. And tonight I just talked to two of the women at my gym (one is an aerobics instructor who is heavier, and I wanted to see if she would let this news crew that I’m talking to next Wednesday to film her class because she kicks ass (she demurred, sadly), and the other is a friend of the family who I don’t really know that well. Although I’m a huge proponent on here, I feel kind of weird sometimes talking to people I see all the time, but don’t really know all that well. I don’t know if that makes sense, but that’s how I feel about talking about it in public, unless the subject comes up in conversation. Then I’ll slip some facts in here and there. If the person is interested, I gradually mention HAES.

      Anyway, people are generally receptive to it. Doctors will definitely disagree with the fact that weight shouldn’t be the focus, but you still get to decide what information is important to you. If you don’t want to be weighed, don’t. If you just want your metabolic indicators, or not, that’s up to you. “Addressing” your weight is not as important to them as making the lifestyle changes anyway (usually).

      If not, you can always find a better doctor somewhere. 🙂


  7. June 13, 2012 8:43 am

    If your doctor and FNP say that you are on the right path (and that everything ‘looks good’), I wouldn’t worry. I have known perfectly “healthy” people whose numbers on various things weren’t “optimal”. You need to stick with what’s right for you, and tweak things as you go along.

    I love the HAES perspective, and am encouraged by your writing and insight.

    • June 13, 2012 10:34 pm

      Thanks rennratt. HAES is an amazing way to go, isn’t it?


  8. June 13, 2012 11:51 am

    One of my favourite meals is the Thai chicken salad from a restaurant near my house. I would marry this salad if I could.

    • June 13, 2012 10:33 pm

      Ooooh Thai chicken salad from Straubbs. Yum yum.


  9. Linda Ramos permalink
    June 13, 2012 8:27 pm

    Mine usually tests below 150. I am avowed carnivore, which makes my diabetes much more manageable (not a big lover of cheese or tofu, so proteins sources get limited for me on veggie diet). I like the occasional salad, but not a big fan of most. Most of what I’ve learned about cholesterol is: your body makes far more than you consume, the ratio of good to bad matters more than overall number, new science suggests the size of the cholesterol knocking around your body may be the culprit in rather than the numbers, and simple carbs impact your numbers much more than previously thought (like refined rice, breads, etc.) even possibly more than meats. My bad usually tests around 100 and my good is welded to 32. Nothing I do: fish oils, exercise, niacin supplements, avocado, olive oils, etc… budges that baby. I am 49 years old and an unknown number of lbs far north of 400…. it truly is ymmv….

    • June 13, 2012 10:06 pm

      I’ve seen the thing about ratios, but I forget which one you compare to HDL. LDL or trigs?

      I’m a little concerned about trigs, but the physicians of the family act like my levels aren’t bad at all, and I trust them inherently. So, I’m just gonna keep doin’ what I’m doin’ and adopt other health improvements whenever I’m ready. I might give a shit what other people think if society were as dickish about unhealthy lifestyles of all people.


  10. Happy Spider permalink
    June 25, 2012 4:03 am

    So here you are talking about exercise again. I’m been thinking about that more and more lately. I’ve been extremely sedentary for, oh, years now. The only times I ever threw myself into exercising was when I as dieting which was, I forget, maybe six and sixteen years ago. So it’s hard not to associate exercise with the starved feeling of dieting. And, beyond that, it seems like whenever I hear people talk about exercising they are much thinner than me ( well, duh, most people I know are thinner than me) so exercise seems like something thin or trying-to-be-thin people do, not something suitable for me.
    So it is encouraging for me to hear you talk about exercise. I’ve been keeping an eye out for such posts and am pleased when you make them.
    On a slightly unrelated note, a year or two ago, when I first started reading these fat acceptance blogs, I tried forcing myself to eat better food by resolving to everyday put some fruit and vegetables into a lunchbox and taking it into work. And that totally worked! Just as you’ve been saying, it is much easier to eat better food if it is not connected to a diet. It turned out that if I ate exactly the way I’ve always eaten, ie lots of not particularly healthy food, but I in addition threw in some fruits and vegetables, then I felt much healthier.
    The point is, since I feel you FA folks were correct that it is possible to eat better without dieting, that gives you a positive track record with me so I am more willing to trust you that maybe exercise isn’t so monstrously tedious and unpleasant as I fear.

    • June 27, 2012 10:32 am

      Aaaaw, I’m glad my writing had that effect, Happy Spider. My hope is that by sharing my experience (for better or worse) with exercise, that others will feel better about working out just for the fun of it. So, this comment really made my day. Good luck in finding your own happy movement.


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