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So, it's not news that The Biggest Loser is terrible, but this article adds at least one new reason why it's terrible to the list: I wouldn't necessarily have guessed that rapid fat loss plus intensive exercise would slow down your resting metabolic rate even more than just rapid fat loss.

"Ravussin and his team compared 12 people from The Biggest Loser with 12 people who lost similar amounts of weight via gastric bypass surgery. Because of the former’s extreme exercise regimens, the show’s contestants lost less muscle and more fat than the surgery group, but their drop in resting metabolic rate was double that of the gastric bypass group."

I found the full text of the actual study (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3387402/). How much did the contestants resting metabolic rate drop by? An average of 504kcal/day beyond what could be accounted for by their weight loss alone. That's a substantial number of calories.

Lots more research needs to be done to figure out exactly what caused the drop in resting metabolic rate, but I think the takeaway lesson here is that significant caloric restriction plus intense exercise is a bad combo. 

So, my dentist is encouraging me to do Invisalign to straighten my lower front teeth. I have a bit of crowding in my lower jaw, and one of my incisors slightly overlaps its neighbor. While I don't doubt that having straight, uncrowded teeth would improve the ease of keeping them clean and tartar-free, I'm reluctant for two reasons.

The sensible reason is that by far the biggest improvements in my oral health have come from just being more consistent about brushing properly, flossing, and using antiseptic mouthwash. While I've come a long way on all these habits, I think that maybe I'd be better off investing more time and energy in getting even better at that, rather than spending money on orthodontics.

The unsensible but far more powerful reason is that I spent a goodly chunk of my young life wearing braces and a headgear to correct an overbite. And the thing that got me through the worst parts of the experience was the promise that "when you grow up you won't have to do this any more." (And when I turned 18, I ceremoniously packed up my retainer and stuck it in a drawer and never wore it again. I was a horribly literal child.) And even though the rational part of my brain knows that Invisalign would not be nearly as dreadful for a whole host of reasons, just the thought makes my inner twelve year old howl, "Nooo! You promised I wouldn't have to!"

Normally, I have great respect for my inner twelve year old, but in this case, I think her judgement may be suspect.

On the other hand, I also think my dentist's judgement may be influenced by the prospect of getting to sell me expensive orthodontic treatments.

It's probably too much to hope that someone's actually done a good study to look at whether people who get modest tooth-crookedness corrected actually experience better dental health outcomes in the long term, but I'll have to hie me over to PubMed and have a look.

So, today at my PT appointment, we measured my range of motion and compared the numbers with what they'd been on my first visit:
lifting arm straight up in front of me: range of motion increased from 130 degrees to 160 degrees
lifting arm straight up to the side: range of motion increased from 110 degrees to 160 degrees
holding elbow at side and rotating lower arm outward: range of motion increased from 30 degrees to 60 degrees
My PT doesn't record a numerical value for the "reaching up to scratch between your shoulderblades" motion, but he considers me now able to reach my "mid-back" rather than just "lower back".

I've still got some way to go, but that's a very nice rate of improvement!

As my reward, I get a new batch of exercises to add to the ones I'm already doing. Wheeee!

Had my first physical therapy appointment today. The good news: the therapist agrees with my doctor that I'm very likely to get better without surgery. The bad news: It's going to be slow (months?) and painful - the exercises he's given me basically boil down to "move your arm to the point where it hurts, and hold it there for a bit."

The therapist would like me to avoid overhead pressing and rock climbing for now. Other than that, I can do whatever.

I deadlifted with the big girl bar today - 85 lbs. for 6 reps!

My trainer is doing a really good job at coming up with great workouts for me despite the limitations imposed by my shoulder injury. There may even be a silver lining in all of this, which is that we're doing a lot of core work, which I probably need to do anyway.

So, the AMA has declared obesity a disease, which I guess means I have an extra diseases that I didn't have last week. Funny, I don't feel sick.

I've seen a number of folks applaud this decision by saying, "Well, at least now fat people can get the treatment they desperately want/need."

Which baffles me. Because for most of my adult life, my doctors have insisted on treating my fatness whether I wanted them to or not, often at the expense of what were arguably more urgent medical problems.

And the thing is, most doctors are pretty crap at treating obesity. Which in part is not their fault, because we don't have any good scientifically-validated ways of reliably getting more than a tiny percentage of people to lose weight and keep it off. Most doctors don't seem to be terribly aware of that.

Here are some of my favorite ways that doctors have tried to get me to lose weight:
* Threatening to withhold prescriptions for birth control pills unless I lost weight. (Because fat people don't deserve to have sex anyway? Interestingly and possibly non-coincidentally, they stopped pulling this shit on me after I got married.)
* Telling me to "drink more water" (Not horrible advice in and of itself, but at the time I would have had to lose 100 pounds to be "normal" on the BMI chart, so the idea that a couple extra glasses of water a day were going to get me there was pretty laughable.)
* Instructing me sternly not to butter my toast at breakfast. (Without bothering to inquire whether I ate toast, or even breakfast. At the time I habitually partook of neither. This was merely the most hilariously memorable of a general pattern of doctors telling me to eliminate certain foods or categories of foods, usually without bothering to check if I actually ate them. Notice that you can tell that this example was from the 1990s, because the dietary bugbear du jour was saturated fat. If the same thing had happened 10 years ago, the doctor might have been just as likely to tell me to skip the toast and eat the butter.)

Lest I tar the entire medical profession with the same brush, I should mention the rather wonderful nutritionist I worked with when I was in graduate school, who introduced me to the revolutionary concept that it was perfectly okay to eat when I was hungry, and who encouraged me to look at foods from the perspective of their total nutrients and overall effect on my health or mood rather than just calories. I didn't lose a lot of weight working with her, and it took several more years of going 'round the weightloss merry-go-round before I was able to fully incorporate everything she taught me into my daily life, but she actually gave me sane, practical advice.

I had an insanely long and complicated anxiety dream last night that basically boiled down to, "The Zombie Apocalypse sucks for introverts, because it's not safe to be alone." Seriously, I could have coped with civilization ending, if only I could have had half an hour alone with a book somewhere.

Of course, what I'm actually anxious about is that I'm going to see a new primary care doctor today. It's actually very rare these days that I have a medical professional be horrible to me about my weight, but I still get nervous about it whenever I see someone new.

If this guy is horrible to me, I'll just never make an appointment with him again. (I also hope that I'll be brave enough to tell him so and explain why, but I can't guarantee that.)

Went for a short run yesterday morning. Felt a bit sore afterwards. Bah. Had my follow up appointment with the orthopedist today.

He poked and prodded me and had me move my hip in every possible direction. If my case is unusual at all, it's in that most of my pain is now in my butt and in the muscles at the top of the front of my thigh. This is slightly atypical for bursitis, but I don't have any of the other symptoms that would indicate torn cartilage, or sciatica, or another exciting nerve disorder that I've forgotten the name of. He did say that if I continue to have pain in my butt, I should come back in a couple of months and he'll do an MRI to make sure I haven't torn a gluteus muscle, but neither of us thinks that very likely. (If I'd torn a muscle, it ought to be giving me hell when weightlifting.)

Otherwise, I just have to be patient, keep my running mileage low for a while longer, and keep weight lifting and cross training as much as I can.

I'm thinking that maybe I'll devote the month of October to seriously working on my performance on the rowing machine. As much as it sucks to not be running, what I think I miss the most is having a clear plan for what I'm going to do on the days I've allotted for aerobic exercise, and having a set of well-defined fitness goals that I'm progressing towards.

So, I came perilously close to dispensing weight-loss advice to someone yesterday, and I still feel kind of dirty. I guess this post is my penance.

I'm not categorically against the idea of pursuing weight-loss. It just seems hard for most people to do it without a) getting hung up on unrealistic standards for what their bodies should look like and b) falling prey to people peddling weird diets backed by dubious science that promise to provide that missing link that explains why just eating less and moving more didn't do much for them. (As indeed it doesn't for many people.)

I'm constantly struck, lately, by how often I hear something roughly along the lines of, "I want to be healthy, so I'm going on a diet." And it always throws me, because there's a huge logical leap happening between the two halves of that sentence, and we're so culturally conditioned to equate thinness with health that most of us don't even notice that leap. I'm still trying to come up with a way to say, "If you want to be healthy, how about doing something that actually promotes health?" without totally harshing people's squee.

I'm either the world's best or world's worst advocate for a health-first approach: I've been overweight my entire life, and throughout my twenties, I sporadically dieted in an effort to avoid various weight-related health problems that I was assured were headed my way. Basically, I'd lose twenty pounds and then gain them back, along with twenty of their friends. At some point in my early thirties, having dieted myself all the way up to being morbidly obese, I was sitting in my doctor's office, looking at a particularly dispiriting set of lab test results, and I thought, "You know, this weight-loss thing has kind of been a bust. How about we just focus on being healthy?"

So, I did. And within a couple of months, my lab test results had gone from being nearly universally crappy to being normal to excellent. And then over the course of the next year, I lost about a third of my body weight.

Which is where I become a bad advocate, because when I talk about this, people understandably find the whole "third of my body weight" thing rather arresting, and then we're having a weight-loss conversation again. Except that this time it's "If you really want to lose weight, you have to focus on health instead of on losing weight." Which is sort of interestingly Zen, but is it an improvement?

I don't know. I still think the best advice is: If you want to keep up with your kids, or climb stairs without getting winded, do some aerobic exercise. If you want to be strong, pick up heavy things repeatedly. If your cholesterol is bad, eat more fiber and less saturated fat. If your blood pressure is high, eat more fruits and vegetables and less salt. If you want to stop falling asleep at your desk mid-afternoon, consider whether you can balance what you eat at lunch so that it doesn't make your blood sugar spike and crash. Doing any or all of these things might also result in your wearing a smaller pants size, but setting out to wear a smaller pants size might not get you anything but smaller pants. If that.

I was recently privy to a discussion of dieting over on Google Plus that ranged all over the Fat Hate Bingo Card 1 and Fat Hate Bingo Card 2. There was enough there for a dozen ranty blog posts, but I particularly wanted to respond to a question posed to those of us being negative about weight-loss dieting: "Why are you against exercise and healthy eating?"

Now, I am very far from being against exercise and healthy eating. So are most people, I expect. You might be able to find someone who is against exercise and healthy eating, but they're probably hanging out in the corner with the Man-Hating Feminist, the America-Despising Liberal, and the Unicorn.

So, having cleared that up, here are a few things that I am against:
( Cut for brevity )