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I mentioned in my previous post that one of my primary goals in improving my health is getting back down to a healthy weight. I have a way to go. I also have high cholesterol, high blood pressure, high triglycerides and the occasional borderline high glucose. In addition, the extra weight is murder on my joints (as if RA wasn’t bad body-weight-scaleenough).

I sound like a weight-loss commercial when I say I’ve tried low-carb, no-carb, commercial programs, Weight Watchers (which really works), and just trying to watch what I eat.

I looked at bariatric surgery. I have friends and family who have successfully lost weight with lap-band, but I am so sick of surgery that I can’t hardly to stand to think of it. Plus there are long periods of follow-ups with these surgeries. Then I ran across the gastric balloon which is non-invasive (it’s a balloon they place in your stomach). It remains in place for six months, during which time the average weight loss is 20-30 lbs. It costs about $6K and is not covered by insurance. Then I thought, if someone would pay me $1K/month to lose five pounds a month for six months, could I do it? So I’ve decided to keep the money in my own bank account and just be very serious about losing the weight.

But how?

When I got a new PCP about 18 months ago, I also got a relationship with his PA, whom I adore. I would have to do several posts about why that is, but when considering such a major change in my life, it just felt right talking to her about it, and I was right.

She said there are four elements when it comes to weight loss:

  • Diet. Diet is critical. Not only lowering your calorie intake but making sure you get enough calories so that your body doesn’t go into starvation mode. If that happens, your body start hording calories, which also causes stress which makes you put out stress hormones (such as cortisol) that act a lot like prednisone. The key is trying to get good nutrition within a reasonable calorie allowance. I had originally thought 1200 calories, but she had me move my calorie target up to 1300 to make sure I was getting the nutrition I need. To help, I track what I eat with My Fitness Pal (www.myfitnesspal.com). The basic plan is free and you can track online or on your computer. It has thousands of foods including packaged foods and restaurant items as well as letting you input your own recipes.
  • Exercise. Okay. This is really, really hard for me but I am hoping that once I get healed enough from my surgery and I’m no longer working full-time that I can get back to the gym/pool. This is my goal. I will soon have no more excuses.
  • Mental. This is critical. You have to be motivated (I am). Beyond that, you have to understand the mental and emotional triggers that cause weight gain. I eat when I’m stressed and my job causes a great deal of stress, so by retiring, I’m removing a huge contributor to my weight gain. Not everyone can quit their job, but it’s important that you learn coping methods for stress. As noted above, stress hormones act just like prednisone in many ways (and my waistline proves it).
  • Medical. I take about 10 oral prescription medicines and a handful of supplements and vitamins. Add to that the OTC pain relievers, allergy meds, occasional rounds of prednisone, etc. and you can understand why taking even one more pill was more than I wanted to consider. But I knew I probably need some help to jump-start this plan while I wind down my work and help me get used to eating less. The PA recommended a drug called Saxenda. It’s marketed under another name to help diabetics get their A1C results in line. It was noted that diabetics were also losing weight right and left while on the drug, so FDA agreed to let it be marketed for weight loss under the Saxenda label. It’s a daily injection, but after years of taking injections for RA, that didn’t faze me. In fact, the needle is so small that I don’t even feel it going in. The down side is that it’s not covered by insurance and it’s very expensive. The PA gave me a starter sample that is good for a couple of weeks and I’m about to find out how expensive as I’m picking up the first prescription today. The PA said that she could prescribe it under the other label so insurance would cover it, but she’d have to give me an official diagnosis of pre-diabetes, which I really don’t want. She also said she’d be glad to provide samples if she has them (which she doesn’t always). I’m very impressed so far. I’m not hungry — at all. I’ve even lost my stress “munchies”. The problem I have is getting enough calories in since I really don’t want food.

So that’s where I am. I have a lot of work to do and I know it will take me several months to attain any significant weight loss and to get in better shape. But I have the motivation, a plan, and medical support (along with that of my husband), so I think I’m off to a good start.

If you have RA and are carrying around the extra weight, I urge you to start making changes, however small, to reverse that situation. Nothing will pay more dividends not only for RA, but your overall health.

Thanks for checking in.

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