Q I'm a 29-year-old woman, 5 feet 9 inches and 275 pounds, and concerned because I have gained 45 pounds in the past two years and I don't know why.
I am active, my blood pressure is normal, I don't have any health problems, I watch what I eat, but I simply cannot lose weight.
The nurse practitioner in my doctor's office suggested weight-loss surgery. I don't like that idea, and I couldn't afford it.
I come from a very large family and was not taught anything about eating right. I have tried every diet under the moon and most of the programs.
Please help me.
--S.H., Olathe, Kan.
AYour rapid weight gain is unusual. Has your doctor or nurse practitioner already screened you for medical problems that cause weight gain, such as hypothyroidism, polycystic ovarian syndrome and Cushing's syndrome?
Extremely rare tumors called insulinomas, as well as adult growth hormone deficiency, can cause weight gain in some cases, but I am not an expert in these areas. Your health-care provider will know about these conditions, or you could ask for a referral to an endocrinologist, a physician who specializes in hormonal imbalances.
You can find an endocrinologist online at hormone.org or by calling the Hormone Foundation at 800/467-6663.
It's also a good idea to see a dietitian. With your history of unsuccessful dieting, I recommend asking for a dietitian who has experience with the non-diet approach or with eating disorders. I'm not saying that you have an eating disorder. I'm simply acknowledging that traditional diets have not worked for you, and you might have better luck with a different approach. Also, dietitians who have experience with eating disorders can help you improve your body image, not to mention help you discover delicious ways to eat well.
I also recommend that you visit nourishing connections.com, a Web site run by two dietitians. They have an excellent, free food-journal form that helps you record not just what you eat and how much, but also your thoughts, emotions and level of hunger and fullness before and after a meal.
You could fill out the journal and take it to a dietitian near you. A good dietitian can help you spot patterns in the food journal: Perhaps you get really hungry in mid-morning, don't eat and then overeat at lunch. Something as simple as a mid-morning snack could help satisfy your appetite.
Or maybe the journal will reveal a misunderstanding. I knew a person who couldn't lose weight but was drinking nearly a gallon of low-fat milk a day with meals. Although low-fat milk is a healthy choice, the person didn't realize that the portion was too big.
Or perhaps the food journal will show that you are eating perfectly, which might suggest a that medical problem--not your eating habits--is causing the weight gain.
A dietitian can help you sort this out. You can find a nearby dietitian through the American Dietetic Association at eatright .org. Click on "find a nutrition professional," or call toll-free 800/877-1600, ext. 4844.
You say you are active, but you don't mention how much exercise you get. Most people need to exercise 45 to 90 minutes a day to lose weight rapidly. I have seen a handful of people lose weight slowly by making some behavioral changes, such as not eating in front of the TV, changing to healthier snacks and exercising as little as eight minutes a day. But that's not enough activity for most folks.
Going for walks or taking a gentle yoga class are helpful steps for someone trying to become more active without getting injured. I'm not sure whether you've tried these already, or whether perhaps you are more active.
I do know that it helps to find an activity you enjoy, not dread. A buddy also helps you keep your exercise "appointments." If you can't find someone to be active with, have a supportive friend call you once a week to ask how you've been doing with your new routine. It helps to be accountable to someone else, whether it's a friend or a trainer. Please forgive this advice if you are already very active.
Counseling also may help. If you suffer from stress, feelings of hopelessness or problems saying no to people, a counselor might be a helpful resource to add to your weight-management plan.
Weight-loss surgeries are usually considered a last resort. They're for people who have tried supervised diet and exercise programs, behavioral therapy and medicines (if appropriate), according to the National Institutes of Health.
The surgeries cost $20,000 to $35,000 and are not necessarily covered by insurance, according to the institutes. Insurance companies that do cover the surgery often require people to see a dietitian for six months prior to the surgery anyway.
Weight-loss surgeries have long-term consequences and can have serious complications, even death. But the surgeries can be lifesaving for people with severe diabetes, high blood pressure and other problems related to being more than 75 to 100 pounds overweight.
Keep in mind that some overweight people are very physically active and have no health problems--and even have better cholesterol levels than skinny couch potatoes. Your rapid weight gain is a concern, however, and you are right to explore the cause.
JENNIFER MOTL, a registered dietitian, welcomes reader questions via her Web site, brighteating.com, or mailed to Nutrition, The Free Lance-Star, 616 Amelia St., Fredericksburg, Va. 22401.