Dear DOCTOR Owen:

I lost weight rapidly on a supplemented diet, and maintained the weight loss very well for a year. I was involved in a motor vehicle accident and suffered a nagging back injury. I stopped exercising and have re-gained all but 10 of the 40 pounds I lost. I was walking 3 miles a day. My diet has not changed one bit, and I’ve been keeping food records to verify my caloric intake. The only different thing I allow myself is one restaurant meal a week with my husband on our weekly “date.” What is the deal?

Dealt a Deal

Dear “Deal”:

First, let’s be objective—not emotional. At 150 pounds, walking 3 miles a day is 100 calories/mile, or 2100 calories/week, or 8400 calories/month. Since 3500 calories equals 1 pound you are minus 2.4 pounds month, or 28.8 pounds a year. You are now not burning almost 30 pounds or 105,000 calories/year by not walking. I can easily imagine that the restaurant meal week once a week could make up the 1.2 pounds (28.8 plus 1.2 equals your 30 pounds). The 1.2 pounds equals 4100 calories. If you eat out once a week (50 times/year), you are overeating by 82 calories/restaurant meal (4100 calories/50 meals equals 82calories). This is one fork-sized bite of red meat!

Actually, you are doing pretty well. In fact, your awareness and focus are remarkable. You simply do not appreciate how little changes in math end up with major gains over time. Try taking those numbers over the next five years! Pretty scary, eh?

A 1999 French study, -published in the International Journal of Obesity, Vol.23, No. 3, revealed that the average decrease in calorie expenditure from active to sedentary is 200- 400 calories/day. Yours is right in the middle. The study also revealed that exercise decreased daily intake of calories primarily from fat in the exercisers. Further, the study found that the level of exercise intensity did count, because intense exercisers lost more, and kept more off, long term. This appears to be due to an increase in adrenaline production and an increased sensitivity to adrenaline long after the exercise has finished. Walking is not considered intense. It is easy and enjoyable, however, which does count towards quality of life.

My advice is to get two types of help. First, make sure you are seeing an exercise therapist who understands back injury and can help you to rehabilitate your injury. Second, insist on having that therapist instruct you on additional exercises to equal the 3 miles you were walking. I have paraplegic patients who do some serious exercise; so-with the right instruction-disability is not an obstacle. It may not be as much fun, but will likely allow you to rehabilitate yourself and eventually return to the Great Outdoors.

You will also have to re-diet. This can be either the very low-calorie program or a food exchange program, which is slower. You will get there!

This will not be your last setback-it’s only the latest. I tell patients to weigh themselves daily. To confront themselves daily. When that scale is really up 3 or 5 pounds, then it is time to re-focus! Do whatever it takes to get that weight off, right away. Even if you have must “plug” into a very low-calorie, supplemented diet for one or two days a week to give you some “date” eating, so be it. There are no good or bad, or right or wrong, ways to maintain your weight. Malnutrition is a “rare beast” in the Western culture these days, and eating disorders are completely different from under-eating.

Keep the focus, and congratulate yourself for being actively aware. A 25% success is far different from a100% failure.