Multiple Sclerosis And Obesity, Following Up
As I outlined in this article, obesity is a modifiable risk factor for several comorbid chronic health conditions and is associated with the progression of disability in people who already have MS. Excess body weight also impacts quality of life in a number of ways including:
It puts a strain on joints and can contribute to joint pain.
It is associated with increased urinary incontinence.
It can aggravate fatigue and mobility challenges.
Should I Focus On Losing Weight or Gaining Wellness?
That is an excellent question! Maintaining a healthy weight is an important part of overall health but it is not the whole story… Being overweight or obese is one modifiable risk factor for chronic health conditions but it is not the only one. Other modifiable risk factors include:
Elevated Blood Lipids
High Blood Pressure
Poor Glucose Control
Focusing all of your energy on just one of these modifiable risk factors (weight) might not be the best way to go about gaining wellness. Being thin does not vaccinate you from the other modifiable risk factors. Just like people with excess weight, thin people are at risk of chronic illness if these other modifiable risk factors are not well managed.
Weight Is One Of Many Objective Indicators Of Health Risk
Many of the changes to diet, physical activity, stress management and sleep that are prescribed for weight loss are intended to improve your health. Weight loss may be one result, but it is not intended to be the only result. The health benefits of physical activity and good nutrition are independent of weight loss. Which means that if you make healthy food choices, engage in regular physical activity, adopt ways to manage stress and get good sleep you may see improvements in health in spite of not reaching your weight loss goals.
Weight is measured and often discussed in terms of numbers, LOTS of numbers. BMI, weight, pounds gained or lost, calories consumed or restricted, inches gained or lost… But when you only count or consider weight-related numbers instead of considering health or wellness related numbers, you may be missing out on some really important information. Look beyond the scale to make sure you are considering measures of health and not simply weight.
Is your blood pressure in the optimal range: 90-110 systolic /60-79 diastolic?
Is your LDL cholesterol optimal: Less than 100mg/dL?
Is your HDL cholesterol optimal: 60 mg/dL and higher?
Are your triglycerides optimal: Less than 1500mg/dL?
Is your Total Cholesterol optimal: Less than 200mg/dL?
Do you have good glucose control?
Fasting glucose: between 70 and 100 mg/dL?
Random Glucose: below 125 mg/dL?
HgA1c: Less than 6%?
If you answered no to one or more of these questions, you may want to make some changes.
As you decide what changes to make to live your best life with MS, focus on gaining wellness. Doing so will improve your blood pressure, blood fats, blood sugar control AND help you achieve and maintain a healthy weight.
DIET Is A Four Letter Word
By definition, a diet is something with a beginning and an end. And, by the way, statistics suggest “diets” have a very high long-term failure rate. If you are only going to make changes to your eating , exercise or other habits for two weeks (or any other finite period of time for that matter…) and then return to your previous habits… what has been gained? Not much. Because as the saying goes: “You are your habits.”
Sometimes, a little humor can make the truth a bit easier to swallow, right? 😄 But what this points out really well is that the elusive magic ingredient missing in most diets is… sustainability. Can you eat differently, move differently, behave differently… Forever? Many restrictive diets or meal replacement shakes might start to lose their luster when you begin looking at them in a forever context.
If Not A Diet, Then What?
Many of you have emailed with questions about the intermittent fasting approach for folks with MS, which I wrote and shared my concerns about here and here. Like you, I am eager to see how (if at all) this approach benefits humans with MS. It is being researched as we speak, so stay tuned. What should you do in the mean time?
Every day we all make choices about what to eat, when to eat, how much to eat. Whether or not to exercise, how long to exercise, specifically what kind of exercise to do? Rather than dwell on your metabolic rate or the number of calories that some app on your phone has allotted for you each day why not focus on the healthy choices that you can control. Start by assessing what kind of choices you are making now.
Evaluate your everyday habits and assess where you may be able to make changes. For example:
Are you eating 2-3 cups of vegetables and fruits per day?
Are you eating a variety of colors of vegetables and fruits each day?
Are at least ½ of the grains you eat whole grain?
How often do you eat fast food, fried foods, convenience foods with high salt, fat and sugar?
Do you read nutrition labels and use the information there to make informed food choices?
Are you moving your body 30 minutes per day?
Are you managing your stress?
Are you getting good sleep?
These are only a few of the questions that could point you in the direction of where to start. But when you consider all of these questions and others it begins to feel overwhelming and may paralyze you in your tracks. To prevent “analysis paralysis” it is better to Think Big and start small.
Think BIG as you outline your long-term goals: where do you want to be a year from now?
Start small with the sustainable baby steps that will get you closer to your long term goals.
Make one change at a time and practice it until it has become successfully integrated into your daily life. Then decide what the next step will be. Repeat the process until all of your wellness numbers and modifiable risk factors are well under control. You may find this article about setting SMART goals helpful as you strategize and prepare for the obstacles ahead.
Focus Less On Restrictions
As you begin to make changes, think about what you can add to your daily habits; for instance: more colorful plant foods, more fiber, more minutes of physical activity, more hours of sleep. Focus less on restrictions. This may sound like a small detail but it can really impact the perspective you bring to this challenge. Every bite you take, every move you make and every other healthy habit you adopt is an opportunity to promote your health. Not a punishment or restriction imposed on you. A positive attitude really goes a long way.
By replacing unhealthy habits with healthy ones you can shift your focus to a a positive, health promoting outlook and avoid the feelings of deprivation that are often associated with restrictions.
Remember, Slow And Steady Wins The Race!
Small changes adopted slowly over time will get you to your BIG long-term goal in a sustainable way. Which means the changes will last. And that is what we are all working towards, right?
Change is always difficult and there are really no shortcuts; you have to actually make sustainable changes to see results. BUT the payoff for your hard work is promising! Making lasting changes to some of your daily habits will really move your wellness numbers in the right direction. You will gain wellness AND lose excess weight. Improving your blood pressure, blood fats, glucose control, becoming physically active and losing weight can lead to significant health benefits. It will also make you feel better both physically and emotionally.
Aphramor L. Validity of claims made in weight management research: a narrative review of dietetic articles. Nutr J. 2010 Jul 20;9:30. doi: 10.1186/1475-2891-9-30.
Marrie RA, Elliott L, Marriott J, Cossoy M, Blanchard J, Leung S, Yu N. Effect of comorbidity on mortality in multiple sclerosis. Neurology. 2015 Jul 21;85(3):240-7
Marrie RA, Horwitz R, Cutter G, Tyry T, Campagnolo D, Vollmer T. Comorbidity delays diagnosis and increases disability at diagnosis in MS. Neurology. 2009 Jan 13;72(2):117-24.
Marrie RA, Rudick R, Horwitz R, Cutter G, Tyry T, Campagnolo D, Vollmer T. Vascular comorbidity is associated with more rapid disability progression in multiple sclerosis. Neurology. 2010 Mar 30;74(13):1041-7.
Subak LL, Wing R, West DS, Franklin F, Vittinghoff E, Creasman JM, Richter HE, Myers D, Burgio KL, Gorin AA, Macer J, Kusek JW, Grady D; PRIDE Investigators. Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med. 2009 Jan 29;360(5):481-90. doi: 10.1056/NEJMoa0806375.
Vergnaud AC, Bertrais S, Oppert JM, Maillard-Teyssier L, Galan P, Hercberg S, Czernichow S. Weight fluctuations and risk for metabolic syndrome in an adult cohort. Int J Obes (Lond). 2008 Feb;32(2):315-21. Epub 2007 Oct 30.
If you want to save this post for later, you can pin it here: