Loved the recent Opus sunday comic where the lady has gastric bypass to lose weight, has her eyes sewn shut to stop temptation, etc.
Question
I have taken steroids for 10 years because of health problems and am on a daily dose of 10 mg prednisone. I am 5’ tall, and before I started taking the steroids, my average weight was around 115 lb. Now I weigh about 187 lb. How can I lose weight, and should I come off the steroids just occasionally?
Answer
Prednisone is metabolised to prednisolone in the liver and one of the side effects is weight gain. However it can also cause fluid retention, and it would be important to know that some of your weight was not due to that, which could be counteracted by reducing your salt intake and/or by taking a diuretic.
If the steroids are causing weight gain and this is not due to fluid, then it is due to increased adipose tissue.** That will not occur even on steroids if your dietary intake is 500-1000 kcals per day less than you require.** We are sure that you have tried diets, but perhaps we could give you a little advice. Try to avoid the food items that provide energy but little else of nutritional importance, such as sucrose and alcohol. Restrict the intake of fat, particularly saturated fat, because it is a concentrated energy source and because fat has a lower satiating capacity than carbohydrate or protein (i.e. you will feel fuller sooner with carbohydrates or proteins than with fats). You can eat any amount of fruit, vegetables and whole grain cereals. It is important that your protein intake is adequate to avoid loss of lean tissue.
Most of us eat more or less automatically, and it may be well worth while keeping a food diary. Dieticians find that we eat less when we are required to pay attention to what we eat, and also the food diary can perhaps give you a good indication of certain situations which precipitate binge eating. Weight loss groups are an important means of losing weight for some people.
Finally we should mention exercise. Although we do not advocate exercise for weight loss, it is important for energy expenditure, physical fitness and a feeling of well being. You should take as much exercise as you can and you will find that the more you take, the more you are able to take. However, exercise alone is not an effective method for achieving weight loss.
You mention stopping the steroids periodically, but that would seem unwise to us, given your health problems. Perhaps a very gradual reduction might enable you to achieve a lower maintenance dose. For example, we would suggest perhaps reducing by 1 mg every month. If your symptoms got worse during that time, you would know you would need to return to the higher dose, but if you were quite all right after 1 month you might reduce by a further 1 mg.
In addition, should they resume drinking after a transplant and ruin their donated liver, they can be denied priority placement on the UNOS list for a second transplant.
Define “obesity related illness.” Oops, you can’t, because there isn’t a single disease that obese people get that slender people do not get. There are illnesses which may be exacerbated by someone’s body weight – obese, overweight or thin – and there are diseases which one runs an increased risk of developing due to obesity, but in and of itself, obesity doesn’t cause those diseases. (As has been covered time and time again on the SDMB, correlation is not causation.) So what exactly would you have coverage denied for, other than weight loss surgery?
lets say if you are obese, and you have a medical problem that is 4X as likely to occur in an obese person than lean person. or whatever, i’d let the insurance company work out the details.
its not a steroid, its a corticosteroid.
cuz when you started talking about steroids causing you to get fat i was like - say whaat ? of all the evils of steroids this is not one of them.
Well, if your willing to let the insurance company “work out the details”, then why don’t you let the insurance company pay for gastric bypass surgery? Obviously, they are in the business of making money, just like every other business. Why would they pay for these surgeries it wasn’t saving money in the long run?
Your answer above shows that you simply can’t think of an intelligent answer to TeaElle’s question.
Also, if Prednisone doesn’t cause weight gain, then why is it there are countless stories from other people on message boards and from people I know that say otherwise. And why is it that my weight gain started when I started taking them? It’s one thing if I was overweight at all before, but I wasn’t.
No such disease exists. And even if one did, statistics games are not a good way to determine who lives and dies, and inability to pay for health care – because insurance has deemed you too poor/sick/stupid/fat to care for – is all too often a death sentence for people, even when their illnesses, as originally presented, were not fatal. And how would anyone control for other factors, for instance, there is some indication that being overweight is a risk factor for breast cancer, but there is also a genetic link. Should fat women be denied insurance coverage for breast cancer treatment even if their grandmothers, mothers, several aunts and cousins also had the disease, making a fairly clear case for a genetic predisposition? How many family members would qualify for a genetic link “exception” for a fat woman? Or should fat people with so-called “obesity related” illnesses have to lose weight before they get health care?
An interesting data point in a discussion of “obesity related illnesses” is the fact that the government has been misleading the public with their “400,00 people die of obesity related illnesses every year” figure.
The HHS had additional help exaggerating their dangerous increase in overweight and obesity from 1990 to 2000 because, as you’ll remember, in 1998 the NIH changed the definition of overweight from BMIs over 27 to over 25, instantly making some 29 million more Americans overweight. The change wasn’t made because being overweight increases mortality, though. In fact, recent data from Allison and colleagues themselves showed the lowest mortality among men at BMIs of 27.3 (fat by the government’s definition).
So, if you’re a 6-foot man weighing 185 pounds or more, or an average 5-4 woman weighing 145 pounds – the government says you’re fat. Should you be hit by lightning while jogging, your death will become part of its “fat-kills” stats. And if you’re fat you can never die of old age – the government won’t allow it.
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Who lied to you today?
i only use the word steroids to refer to AAS ( anabolic androgenic steroids ) ? you wont gain much fat taking winstrol or primobolan hehe.
I’m rather skeptical of the “bad thyroid” excuse because I have a sister who really does have a bad thyroid, and although I wouldn’t describe her as “skinny” she’s far from obeses. A little heavy, maybe 20 lbs. Of course, she actually follows her doctor’s advice, takes her synthroid, gets regular follow-ups, eats healthy, exercises… you know, all the really hard stuff to stay healthy. Her weight has been stable for the past 25 years. She’s got the problem under control.
That said - while being 10 or 20 lbs overweight is one thing, someone who weighs 400 lbs is pretty much a picture of “not normal”. The question is - WHY are they so overweight. And that’s a complicated question in some cases. It may be a psychological problem. There may be a medical problem. There may be medication side effects involved. Maybe several or all of the above.
I think surgery is an acceptable course of action when other less drastic alternatives have been exhausted. And, as several others have pointed out, successful surgery - meaning sustained weight loss - involves counseling and lifestyle change as well as the surgery.
I do have extreme reservations about WLS being performed in children. There are some serious concerns about possible side effects like early-onset osteoporosis which may result in no net gain in either health or lifespan. But to some extent only time will tell.
I also dread folks who aren’t life-threateningly obese getting the surgery. If you need to take off 40 lbs you need fewer calories and more exercise, not surgery - either WLS or liposuction (which also has a relatively high fatality rate when compared to other cosmetic procedures).
That’s your definition - medicine defines both the anabolic steroids and the corticosteroids as “steroids”, along with other things like sex hormones (estrogen, testosterone, progesterone…) and adrenalin.
This may come as a shock, but most of the world is not obsessed with body-building. You might want to adjust your dialect when speaking to “civilians”.
Drop your health insurance, then, so you won’t be paying all those expensive premiums. I mean, a paragon of health like yourself doesn’t need health insurance anyway, right? You’re perfectly fit and going to live forever, right?
Since I work in the health insurance industry, and even have some connection to the research and medical policy end of the business, I will state that insurance companies are very reluctant to pay for such surgery, and many do not cover it at all. So no, vasyachkin, you are not, in fact, paying for the surgery for most people who have it.
Insurance companies have, for some time, been willing to pay for a very few such surgeries under very stringent guidelines, often involving a year’s worth of tests, documented proof that other alternatives have been tried and failed, indications of certain severe conditions - these are not easy qualifications to meet. Why do they consent in these few cases? Because it is cheaper to perform the surgery than to pay for a decade or three of treatment for heart disease/diabetes/back problems/joint problems/lung problems/etc. A rather cold-blooded financial decision, in other words. They’ll only approve the surgery when they believe that, in the long run, it will save money. Hard to argue with that, isn’t it?
One problem is that insurance companies are coming under pressure to lower their standards for approval of the surgery. That I don’t agree with. It IS a risky surgery, and unless the odds of disaster are greater by not having the surgery you should not go under the surgeon’s knife. By that standard most obese people will not qualify.
i’ll be lucky if i live past 40 the way i am going 
as for bad thyroid, you do know we have these wonderfull things called T3 and T4 ( the two forms of thyroid hormone ).
even without prescription its quite affordable ( though illegal ).
No need for illegalities in my sister’s case - as I said, she is under the care of a competant doctor.
And while she may not be thin enough to satisfy you, when you’re discussing putting someone on a synthetic hormone for 40 to 60 years (or even more if she exceeds normal lifespan), you sometimes have to weigh the long-term side effects of the drug in a dose sufficient to bring her to an ideal weight vs. the side effects of being 20 lbs over ideal. Since it’s her body and she must deal with the consequences, I will let it be her decision.
i wasn’t talking about your sister but those who blame their obesity on bad thyroid.
Ah=) You must be talking about me=)
I broke my back in 1980 in 3 locations…though I am not yet in a wheelchair, I am unable to do much in the way of any exercise…walking is out, I can stand and walk about 300 or so feet at a time. I would swim, but you know - with all the cost cutbacks, there isnt a public access swimming pool for over 35 miles, and I have very limited access to transportation [my husband works 75 miles from our house, and he gets to have the car for some odd reason.] I was diabetic before I broke my back, but you know, the lack of exercise is a b*tch…I have gone from 135 to over 200 in the past 12 years. And I haven’t been sitting on my @ss tossing back bonbons, I am @nally careful about my diet.
Not that I particularly want to have the operation, not even considering it, but at least the fat modified atkins I am following now has gotten my weight stabilized. I hope that in the long run I can lose weight…
I had lap-band surgery a little less than 11 months ago at 372 lbs. I’ve lost over 100 pounds so far (I will probably keep losing weight for another year or two). Personally, I am a strong advocate for the lap-band as a first resort once you’ve reached the point of considering surgery because the RNY (“gastric bypass”) is so very drastic and dangerous.
The band has a much lower risk of mortality than the RNY because the band doesn’t require cutting or stapling the stomach or intestines (the surgeon just stitches the band to the outside of the stomach). In the event of problems, the lap-band is easy to reverse, whereas reversing the RNY is a major, risky operation that is only attempted as a last resort.
The band basically just restricts stomach capacity, with nothing done to the intestines. Since the intestines are left alone, you don’t have dumping with the band - you just can’t eat as much in a sitting. For many people, just cutting back on portion size is enough to lose a significant amount of weight and improve their health - so, personally, I don’t feel that the RNY’s risk of death or nutritional deficits is justified for MOST people unless a person has tried the band and failed with it.
Still, to be fair, there are definitely cases where the RNY makes sense. A 500 pound person who needs to lose a lot of weight fast to survive may be better off with the RNY. On the other hand, I’ve run across so many stories of young women who were <250 lbs. (morbidly obese, yes, but not to the point of being in imminent danger from the weight), who got the RNY and died. Those kinds of tragedies shouldn’t be happening when there are safer operations available.
Anyway, to get back to the original question: Yes, surgery does work by the same old principle of “Eat less, exercise more”. It just makes it less of a struggle to do what we know we need to do.
Some fat people do have psychological issues as well. It seems that a disproportionate number of fat women are sexual abuse survivors who eat as a defense mechanism. To some extent, I think we all use food for emotional reasons. But I don’t think that’s the only factor!
I believe that, in many morbid obese people, our sense of satiety is out of whack.
Whether it’s caused by genetics or because our childhood environment teaches our body to ignore satiety (i.e., the “Clean Plate Club” mindset, huge restaurant portions), I dunno. But I know I didn’t sit down and consciously decide, “Hmm, I love food so much, I’ll make myself a social pariah by eating until I weigh 370+!” I doubt that very many people stop eating until they’re satisfied - it’s just that for some of us, that sense of satisfaction from food is harder to come by.
Now, as a post-op, it’s a whole different story. Generally, my desire for food just shuts off after I eat a small, normal portion (NOT the obscenely over-blown “restaurant size” portions - those are 2-3+ portions for me now, the way it SHOULD be).
Nowadays, there are many times when good food looks unappealing to me because I’m well and truly not hungry. I suspect that is what most thin people experience: their body’s sense of satiety is in balance with what they actually need to eat, so it’s not a struggle to stop when they’re had enough like it is for many morbidly obese.
Having been on both sides of the issue, I can see how people who have never known how it feels to be morbidly obese and perpetually unsatisfied might think that “JUST STOP EATING!” is a simple answer.
However, I think those who are hateful to fat people will soon find themselves a dying breed. As more and more fat people become thinner thanks to surgery and become “accepted” into mainstream society, I think society will be forced to acknowledge that fat people are not inferior sub-humans like they often are made to feel.
Even though I’m at my thinnest adult weight, I’ve never felt more empathy for those who are bigger than me. I now know that size doesn’t make a person better or worse - because I know that I am just as good now as I was when I was 100 lbs heavier.
I wanted to say Congradulations to you. I am going to be having the lap-band procedure done as well. I have an Apt on the 17th with Dr. Alexander Onopchenko to discuss this. I know I have to lose weight before I have the operation because my BMI is 54 now and he won’t operate unless it’s below 50. Being a male is a risk factor for this operation and so is the BMI over 50.
Right now I’m doing Atkins and losing weight and I’m sure some of you just read that and thought if he is losing weight on Atkins why is he considering a major medical procedure. To that I can only say I don’t want to be on a “diet” for the rest of my life saying I can’t eat X because it’s not on my diet What I have to do is change my habits entirely. Change what is a porton to me and the only way I can do this I feel is with the band. It is an AID or TOOL to help me lose weight. I could get the band and drink milkshakes 24/7 and it would do me no good, but if it forces me to cut down on the size of my meals and makes me feel fuller longer that it will accomplish the goal I have for myself. I don’t expect to get down to 125 but to be around 200 which would mean a loss of about 150 from where I am now would change my world. I know with the gastric bypass you do lose more weight and at a faster rate but the possibility of dumping scares me and many people do suffer from it.