Found And Lost, Part 1

 (Midnight Never Ends - Dance With The Dead)

I'm fat.  

Medically, I believe they refer to people like me as 'Morbidly Obese'.  Clearly, they use that term because the more festively plump among us don't have enough on our minds, so... thanks for that, whoever thought that one up.

How fat am I?  Well, let's talk about that.  Like most other parts of my life, or at least the parts I recount through storytelling, it's...complicated.

In March of 2019, I paid a visit to my doctor's office for my yearly physical.  Yes, fat people go in for physicals too.  We get bored easily, and we like to entertain ourselves by listening to all of the new ways that the doctor can suggest that we really should try and lose some of that weight.  

They mean well.  

This is also the part where I tell you that, all joking aside, my PCP is freaking amazing, and has never once insinuated to me that I really should try and lose some of that weight.  We'll get back to her in a moment though.

Like all such appointments, I weighed in.  The scale read 455 pounds, the largest that I'd ever been in my life.  That day, I elected to have a discussion with said doctor about why, precisely, I was that fat.

Yes, I absolutely know how weight gain and weight loss both happen, generally speaking.  Ingesting food creates a certain amount of fuel within you.  If you don't expend enough energy to burn that fuel, the fuel turns into KITTENS!

What?

Don't misunderstand me:  I know how I got fat.  I ate a ton of food, much of it garbage, and I did it with remarkably skill and determination for around 15 years.  That's how I got here.  What I was confused about was why I was still fat.  "Do you think you should weigh less?" she asked.  I thought about it for a moment and then said, "Yeah, actually.  I don't think I should be uber-svelt, but...yeah."

That was when the conversation got very atypical.  

"Why are you concerned about your weight?"
"Because I'm fat, and I don't think I should be."
"Are you concerned about your health?"
"No.  I feel fine.  I'm just fat, and I'm not sure why."
"Do you understand that your health could be failing as a direct and indirect result of your weight and you might not know it yet?"
"I do.  This is the part where you ask to draw blood, right?"
"If you're concerned about your weight, yeah. Are you interested in losing weight?"
"Not particularly.  Should I be?"
"Maybe.  Your bloodwork could tell us a lot on that front, but we'll get back to that. Are you unhappy?"
"Not really."
"Is your weight inhibiting your ability to live your life in some capacity?"
"Not really."
"But you're worried about your weight anyway."
"I'm specifically worried that it's still present in such large quantities, yes."
"If you're concerned that you're not losing weight and you should be, your bloodwork might give us clues as to why.  It's a good place to get data."

She knew she had me at that point.

There was no fat shaming, no pressure to lose weight.  No lectures. She was simply interested in my happiness, and helping me get the answers to the questions I had.  She gave me the facts, and let me act on them as I wished.

What a novel thing.

In addition to drawing bloodwork, we also agreed that it would be prudent for me to begin keeping a food diary.  She wasn't interested in how much I ate, and encouraged me not to alter my diet in any way.  She just wanted me to track it.  She wanted three solid weeks of data points to work from.  The nerd in me approved.  Once we knew how much I was eating on average each day, we could hold that up against my body's caloric requirements to function at what was an admittedly sedentary level.  If I was eating more than my body required, we would know that, yes, I should still be that fat.

In general, healthy weight loss begins when you take the calories your body requires to function at your usual activity level -- that's a number dietitians refer to as your Total Daily Energy Expenditure -- and you create a deficit of anywhere from 10-15% in terms of calories you consume.

Say you normally eat 3,000 calories a day.  Want to start healthily losing weight?  Accepted medical knowledge today suggests that you would need to try and keep your calorie intake at around 2,550 to 2,600 calories.  That's a rough way of looking at it because it doesn't take into account what your calories are comprised of, but that's a discussion for later.

Blood was drawn, goals were set, and I toddled off to the rest of my day satisfied that I was moving in a good direction.

----------

Three weeks later, I returned to the doctor, plopped my paperwork down in front of her, and waited.  After a few minutes of waiting, I asked her what the verdict was.  She looked perplexed for a moment before taking a deep breath and uttering one of those phrases that's both really good and really bad:

"I have no idea why you're not losing weight."

It was really good because I love the fact that I have a doctor willing to admit when she doesn't know something rather than bullshitting me and throwing a pill at me.  It was really bad because...yeah.

My food diary suggested that I was consuming around 3,200 calories a day.

Yes, I know that's a lot of food!  Did you miss the part earlier where I said I was fat?!

"That would seem to explain why I'm still as big as I am."
"Actually, no.  That's part of the mystery here.  See, I took your vital statistics and fed them into a medical program designed to tell me what your base metabolic rate is.  That's basically the caloric need that your body has to simply keep you alive.  No moving, just waking up and being alive takes energy.  This number doesn't account for any energy expenditures."
"What number did the machine give you?"
"Approximately 4,000 calories a day. That's what you'd need to eat to stay at your weight level while doing nothing other than eating.  And I happen to know that you do more than that because you do things like walk around your house, take a shower, use the restroom.  All of that burns calories."

Remember that math equation I was talking about earlier?  For those playing along at home, 15% of 4,000 is 600, which means I could have been eating even MORE than my food log told me I was, and I still should have been losing weight.

Missed opportunities, am I right?

Turns out, the calorie intake was only half of what was baking her noodle.  The other half was the bloodwork. We went over the results in detail, and the gist of it was that I had the blood of someone half my age and half my weight.  Someone eating enough to get to my weight and stay there should have the bloodwork to show for it.  I didn't though.  My sugar levels were fine.  My cholesterol was fine.  Vitamin levels were fine.  Thyroid panel was fine.  Everything was fine except for a rather alarmingly low vitamin D level, which...

I'm a fat nerd who is extra-sensitive to light because of his eyes and doesn't tan as much as I spontaneously combust.  I don't spend much time outside when the sun is in the sky.

Or the moon.

"Ssssoooo....what's next?"
"What's next is, I refer you to a team of specialists that know way, way more about this than I do.  I'm sorry. I'm officially out of my depth here."

Great.