Saturday, January 25, 2014

Comment Corner: How Can You Lose Weight When You Can’t Lose Weight?

A while ago, a girl by the name of Sissy left the following comment after my “small steps” post (I’ve edited the text down somewhat):
Over the last two and a half to three years I've had two patellar dislocations and a meniscal tear (which I've had surgically repaired) all in the same knee. I am 238.4 lb (this morning) at 5'9", and I just turned seventeen. I saw your other post about losing weight to help knee pain, and I totally agree. In theory, it's an amazing cure. In reality, when I have tried it, I screw up and quit and start back up again.

When I was a lot younger, I used to do tae kwon do, play soccer, basketball, almost everything. Now I feel like I can't do anything because one day my knee is excellent and then next it's trying to commit suicide. I started Insanity (the workout program), and was following its nutrition guide. The first days I felt amazing. This past Thursday (getting closer to the end of my second week), both of my knees hurt so bad that I was afraid to get off my chair an hour after my workout because I felt like my knees were both about to dislocate or collapse.

You say to take small steps. Look...I just turned seventeen, I'm way overweight, I hate the way I look, I'm constantly uncomfortable, I'm extremely insecure, and I'm just sick and tired of this lifestyle, but no matter what I try to do about it, I can't finish what I started. I really do not know what to do. My doctors didn't sugarcoat anything. They told me to lose weight. But I need help. And quite honestly, I hate having to face that "taking small steps" is the solution. Can you suggest something or post a solution using me as an example, please?
Sissy sounds like a bright, thoughtful, self-aware ... and extremely frustrated teenager. She wants to lose weight. She wants her bad knee to get better. And she wants all that now -- or pretty soon anyway.

She joins a workout program called “Insanity.” If I were 5’ 9” and 238 lbs. and suffering from knee pain, I would look for a different program -- maybe one called “Sanity”? :) But I understand the “Insanity” appeal -- edgy moniker, the promise of fast results.

Truly, much is at stake here. Carrying a lot of extra weight is bad for anyone, but it’s really bad if you’ve got knee pain. I can’t be hopeful of Sissy finding a fast solution -- it takes time to expand to 238 lbs., and it’ll certainly take time going in the other direction. However, I don’t think the process has to be miserable.

Here are some thoughts I have (note: I’ve never had a challenging weight problem, I admit). Instead of organizing this by, “Do A and B and C,” I decided to take a more fun approach. Namely, I start out by asking, “What kind of person are you?”, then offer ideas based on that. Something different!

(1) Are you a social type?

Are you the one in your group of acquaintances with the most Facebook friends? Are you chatty and gregarious?

If so, try enlisting a support network to help you reach your weight goals. These people can be friends who can listen to you complain about your food frustrations or who can lend encouragement when the going gets tough.

(Note: This would be a special role, so I’d try to choose members of a support network wisely, and not make their duties too onerous. Or you might go from having 40 friends to four!)

(2) Are you a competitive type?

Do you like to win, even in situations when winning doesn’t (or shouldn’t) matter much?

Turn weight loss into a challenge. Compete against friends. Compete against yourself. Who can drop 20 lbs. by (insert date here)?

(Note: I would strongly suggest sensible, realistic goals. Crazy starvation diets -- or skipping meals you need to function properly, and alertly -- is dumb.)

(3) Are you a researcher type?

Are you more of a quiet, introspective person, who prefers reading and self-directed learning to clamorous discussion and debate?

Very well. You have an enemy: excess weight (and the bad food and high caloric intake that leads to excess weight). How to beat your enemy? Through research.

Learn how many calories are in common foods. Learn which kinds of calories. Learn about saturated vs. unsaturated fat. Learn which foods fill you up faster.

And don’t stop there! Study your own eating patterns. When are you most prone to overeating, or eating junk food? Use all this data to modify your eating behavior, and to beat your enemy.

(4) Are you a hobbyist type?

Are you someone who tends to get absorbed by hobbies, whether they’re collecting old glass medicine bottles or hanging out for hours and watching for different kinds of birds along migratory routes? If so, great. You’ve got a new hobby: cooking!

Now here’s the thing though: you’re going to be a cook who specializes in tasty, low-fat meals. You’re going to be someone who figures out how to saute spinach and sprinkle on a little grated cheese and just the right seasonings to make it taste like something off the menu of a 4-star French restaurant. That’s your goal anyway. Be creative. And have fun!

Note: Everyone loves a good cook, so don’t be surprised if your circle of friends expands. Who knows? You might get your own TV show (or get on a TV show anyway).

Okay, those are some of my ideas on losing weight.

But what if none of these works for you?

Well, there is what I would call the “nuclear option”: surgery. A procedure such as bariatric surgery can accomplish what a weak will cannot. But -- and it’s hard to overstate this -- surgery is a serious choice. Try everything else first. And then, be sure to consult with doctors and loved ones to make sure surgery really is your best option.


  1. Are you sure losing weight is a good idea? Will it not result in a decrease in (leg) muscle mass which exacerbates the problem?

    1. Well, it's all proportions. You'll lose a bit of leg muscle mass, but what's more relevant, you should lose much more from the tire around your belly. Anyway if shedding muscle mass were really a reason not to lose weight, then what about the converse: Gain 100 lbs. to add to your leg muscle mass to beat knee pain! Clearly that's absurd, prima facie.

  2. Good luck to Sissy!
    I lost 50 lbs by completly changing the way I eat. No processed food - means a lot of cooking from scratch, salads etc. Might sound untempting but the strange thing is that after a short time my taste buds changed quite alot. Califlower was suddenly yummy. Have heard that the cells for taste buds renew every day.
    Keep going Sissy you will do well!

    I have osteoartheritis and I have a couple of questions:

    I had read that walking barefoot aids those with osteoarthertis. Part of the reason supposed is that one takes smaller steps and the knee angle is better than when wearing shoes with a heal. I was wondering if you (R.B) or anyone else has had experience with that?

    Walking with nordic walking poles - do you have any thoughts about using them as a way to distribute weight off the kness when walking?


    1. I've heard good things about walking poles. I never used one, but they make sense to me, in terms of offloading the joints while walking. I'm not sure about walking barefoot, but taking smaller steps to me makes sense, again, because that would take some load off the joints.

  3. I really like Sissy's post. She sounds like a very bright young woman. Sissy, just one piece of advice from someone who is more than twice your age but remembers being an extremely impatient teenager. Taking small steps seems infuriating, but if you want to achieve long term, it's your best bet. There is no fast and easy way to lose weight, unless you want to end up in a yo-yo hell that will make you miserable your whole life. Good luck, and don't despair, a fall back is not the end of the world but you have to keep the long term goal in mind.

    Richard, I have a question for you and your readers since I couldn't find an email address to contact you (sorry for highjacking your post, Sissy!): has anyone experienced change in the 'quality' of their pain? I know PFPS gives inconsistent symptoms, you might be in pain one day, not so much the next. But would you have also changes in noise(s), as in additional clicks (it started to happen to my left knee when I walk quickly, I'm paranoid that people all around me can hear it!), or a new pulsating pain that comes and goes?


    I'd also be interested in the answer to the previous poster's question: would walking poles help? I'd love to start hiking when the weather improves

    Regarding walking barefoot, it really depends on your feet. Mine are very high arched and when I tried running with barefoot 'shoes', I ended up with a a stress fracture and plantar fasciitis on both feet (why, of why, am I doing this to myself....). Apparently, having flat feet is not good either for barefoot walking.

    1. As I recall, the nature of my symptoms did change over time. I don't have great notes on this. There was a point when I did notice a bit of a clicking in my left knee (which no longer seems to be there). I'm not sure the changing symptoms is unusual; maybe others can weigh in with more insight. My biggest observation there: you'll find a lot of weird sensations coming out of that bad knee. My best suggestion, as I note in the book, is to try to learn the language of your "hurt knee" -- some sensations are not meaningful, while some definitely are.

  4. Losing weight is like saving knees in some ways: it's about honesty, self assessment and accurate information. Sissy, I would have to know what your diet consists of... Everything you were/are eating, before I could make any recommendations about lifestyle/dietary changes.

  5. Hi,

    Just sending a link to a page that gives a sum up on barefoot walking and osteoartheritis.

    Footwear Can Impact Knee Osteoarthritis

    At the bottom of the page there are links to the research referenced in the article.

  6. I'm not sure if this is mentioned but there is a documentary called "Fat, Sick and nearly dead". The guy loses 100 lbs by going on a juicing diet.

    I would say make it a priority to change your diet. Don't push yourself so hard/fast that you mess up your knees more. Gradual approach.

    Easier said then done. You're 17. I was not patient when I was 17 and not sure I am today (in my mid 20's).

  7. Hi,
    Sissy, one thing that is very important and I think you should be applauded for is that you have become conscious about the situation and working to change.
    I would like to ask a question, but don't know where to post it. While loosing weight I guess one also wants to do exercises that don't damage the knee more.
    I have read Saving My Kness and find it very inspirational but would have liked a bit more of ideas about different types of "light" exercises. Could an an idea be a list of such exercises and a general guideline?
    For example walking. Guideline : to walk slow and smaller steps - or this is what I understood.

    Here's a sort of list of proposed activities when knees hurt and would appreciate feedback/ideas on it:
    walking slow
    walking with Nordic walking poles,
    walking barefoot
    kickbiking (?),
    kickspark sleding (?),
    cross country skiing (slow),

    1. Swimming: works for me as long as I don't use my knees. I use a pull buoy to maintain my legs afloat. I tried kicking with my leg straightened and the pressure from the water on my patella is uncomfortable (not exactly painful, though)
      Walking slow: I realised after a few days of walking 'as per usual' (i.e. pretty fast with long steps) that it was making my knees far more painful. Yes, it took me several days to realise it... I also noticed that striking the ground hard with my feet was causing more pain
      walking barefoot: I walk barefoot at home, try to achieve 100 steps every few minutes. It seems to help, but I think it's mainly because I'm walking much slower than outside
      Bicycling doesn't work for me. I get very unstable knees after even the gentlest of rides
      Cross country skiing, I wouldn't even approach it. If you fell on the side, your feet would still be stuck to the skis, twisting your knees.
      I started rolling my hips on a gym ball (fitness ball), with my feet firmly planted on the floor. It seems to help.
      Pilates: while some exercises seem to put too much pressure on my knees, some definitively make them better. It also strenghtens my hips and legs without any impact, and no stress on the joints (make sure to find the moves that don't make your knees more painful. For instance, I can't do the plank)

    2. On light exercises, I think easy cycling is great (IF your knees tolerate it well). Slow walking is good, again if you tolerate it well. Swimming or water activities more generally can be great (if you swim, you may want to put float bands on your ankles so you don't have to kick or can kick minimally; readers of my book will remember that's what I did). Yes, I'm skeptical too about cross country skiing, and any kind of "kicking" activity I'd probably steer clear of.

  8. Have I understood this correctly, from your blog and book that first one should do very, very gentle exercises till feels OK, then increase distance (weight) but still gentle exercises - always making sure there is no discomfort?
    Doug Kelsey mentions kickbikes on his site, looks fun, but is that perhaps something one should wait with until knees are better?

    1. Anonymous: Essentially, that's what I did. Very easy movement at first, then graduated to harder activities, but very gradually. For me, I began with a lot of slow walking (with breaks), just to give the joint motion.

      However, I realize that for people who are always in some kind of pain, this isn't an option -- so that's a trickier situation. Motion is very important, so they may have to put up with some discomfort at first. Last, as for kickbikes, I don't really have an opinion on those, though after just looking at the pictures, I wonder if they're appropriate for really weak knees.

  9. For Sissy - as an (ex!) triathlete, I wanted to say something about swimming. It is great for fitness, but not great for losing weight unless you do some hard interval sessions combined with diet changes. The only hard aerobic exercise I can now do is swimming (using a pull buoy to limit kicking) and a good hard set I do is this (all swum freestyle).
    200m easy warmup
    6x100 hard as you can go, leaving every 3 mins (or longer if you are a slow swimmer)
    100m easy
    400m time trial - swim it at a string pace, but obviously not as hard as the 100s above
    200m easy cool down.

    This takes me about 35mins and is a tough session, but really gets the heart up.

    As for diet, I've gone a bit paleo, but not entirely - less bread and pasta, more fruit/veg/brown rice/quinoa. More meat esp fish, chicken. Less refined sugar. More nuts, dates, dried fruit for snacks. Cutting highly processed white carbs is the main thing for me.

    1. Should add, I only do the hard swim session once/week. I do 2 other swims/week of 20-40 mins which are mostly 100m repeats leaving every 2 mins in blocks of 5, starting the first very easy, and building speed till the 5th is quite fast.

      I don't know how pro swimmers can swim 20+ hrs per week - it can become pretty boring compared to cycling and running, but it is better than nothing.

  10. It seems you and the other commenters have never had weight issues. When someone with an eating disorder, and your weight, Sissy, indicates disordered eating, the function of the eating needs to be addressed. Food is like a drug in that it can numb feelings of loneliness, fear, grief, etc. and can dissociate us from our bodies. It is as effective as any drug or alcohol in helping one not deal with life. Shifting to healthier eating is important, but it keeps the focus on food and, believe me, someone with disordered eating already focuses on food almost 24/7. When the comforting food is given up the feelings underneath will arise and without having the tools, support and capacity to deal with them, they will sabotage whatever changes one is attempting to make. I'm 64 years old, a therapist and someone who has struggled with disordered eating in my life, so I know from whence I speak. :) I strongly suggest, Sissy, that you work with someone to help you deal with your food issues, as well as, perhaps a trainer or PT who can help you with this approach to your knees. Weight loss will definitely help your knees, but using knees as the motivation to lose weight won't work. I wish you well.

  11. Sissy, I want to say I reread my last comment and realize it may sound a little opinionated. I don't pretend to know what will or won't work for you, I just want to acknowledge your struggle and let others know weight loss for someone with disordered eating is not a simple fix. May you find the support you need on your journey to health and healing.