"Dude, did you lose a ton of weight?"-- Missy

[re-post from Facebook because I know some of you (okay, just one, Liza) are not on Facebook and missed this.

I posted before and after pictures of myself from the past 7 months to illustrate just that: Yes, Missy, my size has changed. I'm hedging about how much weight I've lost because I don't know. I am afraid to step on the scale because that is always depressing-- but I do know that Between August 17 and August 29th, I lost ten pounds. I was at my parents' house and weighing myself during that brief period. Because I have continued to lose inches this Fall, I can safely assume it's more than ten pounds.

It's funny-- people always want to know why and how someone loses weight, but we don't ask (and why would we?) why and how people GAIN weight. Because we know why, right? We gain weight by eating too much, right? And we lose it by restricting our food intake and exercising, right?

That's what I thought for the past 7 years. But I couldn't figure out for the life of me why, when I was up to running 8 miles at a time two or three years ago, I couldn't lose any weight or change my size. It was horribly defeating: I began to view myself as a person who couldn't take care of myself. Every attempt I made to eat healthily and exercise resulted in... nothing. No changes. I still felt sluggish and tired all the time. Ask my blog readers (http://jenorama.com) about my posts from the last two years at LEAST. The recurring theme is that I was *tired*. So tired.

I have spent the past seven years telling my doctor how frustrated I am that I can't feel better, can't make myself healthier. I spent two years complaining about the fatigue. It was only after Christian was diagnosed with diabetes and I insisted that something be done that he actually paid me any mind. He prescribed Wellbutrin, guessing that my anti-depressant (CELEXA-- REMEMBER THAT WORD) had "pooped out."

With the Wellbutrin, I did notice a change in energy. But when I complained (AGAIN) about my weight, my doctor shrugged it off: We worry more about active lifestyle (by that time I had stopped running. It was difficult to run, it was slow, sluggish, and it didn't do any damn good. So, why bother?). He told me that people my age who are thinner than I was are hungry all the time. Even the most disciplined person usually can't sustain a weight loss. Well, that's encouraging.

But it doesn't explain the smaller 40-year-old women around me.

Finally, when I was visiting with my ob-gyn nurse practitioner (hurray for nurse practitioners!) in August (between trips to Utah to help my father after his heart surgery), she asked me what kind of anti-depressant I was on. I said CELEXA. She said, "Oh. NO NO NO NO NO."

I had suspected for YEARS that maybe the Celexa was contributing to my inability to change my size. However, I was afraid to change my medication (and my dr would just say, "Is it working?" How do you know? Because you're not suicidal? Even though the rest of your life is in the toilet?) so I stayed on it (because weaning myself off the anti-depressant inevitably failed-- I became instantly anxious and depressed and un-focused by the time I was done with the weaning.)

So, my wonderful nurse practitioner prescribed PROZAC to go with the Wellbutrin. I began taking it that night, and flew back to Utah the next day. I was depressed about leaving my family, but I was oddly elated and in a good mood in the Las Vegas airport. Interesting.

I weighed myself two days after I had started the Prozac and was elated to note that I had lost 2 pounds. ELATED. Because it was the first time my weight had budged (apart from brief thyroid troubles the summer before).

So, the picture in my album that is dated August 2009 reflects about ten days of the Prozac. When I came home, my family and friends noticed an immediate difference.

I have been posting this Fall about my running. The running has nothing to do with my weight loss, any more than overeating had to do with my weight gain. I am running again because it doesn't suck to run anymore. I have gotten faster and it feels good.

I *am* eating more healthily-- in that I have tried to eliminate processed foods from what I eat. But I don't run daily, or even, in the past month, more than once or twice a week. And I have continued to hear, "You look like you've lost more weight just in the past WEEK."

That's great. That's nice. I feel really good, and I am writing poetry again and productive and making strides on organizing my house and my life in ways that I haven't had the energy for for literally YEARS.

But I feel like I sort of lost 7 years, you know? My joy is tempered with the sadness of that fatigue, those feelings of helplessness and worthlessness I experienced-- my perception that I was slothful because I was unable to make changes no matter how much I tried.

Our society needs to re-examine the idea that there is an equivalent equation between calories in and calories out. It needs to re-examine the idea that weight gain is normal in women because they have reached a certain "age." I'm not saying that what happened to me is happening to everyone else, but I am willing to bet that this will resonate with some of you.

UPDATED AND EDITED TO ADD:

Oh don't worry-- it's mostly joy and relief at feeling like myself again! It's funny how fast you can remember what that feels like. I didn't have time to finish my note earlier, so I wanted to take the chance to finish, because it's relevant to that paragraph about the sadness.

My dilemma now is what to do about my doctor. This is not the first... well, let's just say that it is not only NOT the first time that I have seriously wondered whether I should find a new one. I just hate to yank my family out of his practice because he has known us for so long. However, he convinced me to cancel an appointment 90 miles away with an Endocrinologist, insisting he could provide my thyroid care.

When he suggested that we also ditch our Diabetes team in Columbia so he could monitor Christian exclusively, I was struck with the inappropriateness of his suggestion. He has only had 2 patients with diabetes. Ever. So, even as I am writing this I am wondering, actually, how I could consider NOT finding a new physician. Just for the simple reason that I think he did not and DOES not take me seriously. I think if he had really listened to what I was telling him, or if I had insisted earlier or changed physicians earlier, perhaps...

Of course, you're right. But I just want to round this up by saying that I am not dwelling on this (or inclined to)-- I just think that I should ACT on that reality of 7 years and a) stay proactive about my own health care and b) find a new doctor.

I have thought about writing about this as an essay for a medical journal (that is kind of what I do for a living, so I even know where I would send it). However, I don't think I can claim this is a comment on anything except my own situation. Anecdote is not the singular for data. Even though my NP based her prescription on clinical trials that suggest that Wellbutrin and Prozac can work together to assist weight loss, that doesn't mean it will work for everyone. (Again-- see Melissa's study and Arwen's comment below).

I feel *less* that I have lost weight and more that without the Celexa, the obstacles to my happiness and sense of self have been removed. Ha, that's pretty ironic, isn't it?

Anecdotally speaking, maybe the push I can make here is for us all to realize that our health is ultimately our own responsibility. And I'm glad I kept complaining about it-- because if I had just given up and accepted what my body was refusing to do, I'd probably be as tired and inert as I was before. Don't give up on yourself, and don't doubt yourself. I feel that I spent about ten years of my adulthood learning how to doubt my intuition and instincts, so I am actively trying to hone my awareness of my instincts, and not to back down when I know that something is not quite right.