Dear DOCTOR Owen:

I recently stepped on the scale and couldn’t believe my eyes: I had gained 30 pounds. I didn’t really feel bad or fat, although I have gone up in dress sizes over the last few years. I haven’t stepped on a scale in years. I was told not to obsess about the scale years ago by a dietitian and by my psychologist. I used to be a fanatic about my weight. I don’t want to be that concerned every day about my weight. How could this have happened?

Oh Me, Oh My

Dear “Oh Me”:

It is probably miraculous that you have put on only 30 pounds. In fact, when I help patients lose 30 pounds of weight, I tell them that they have performed a miracle by gaining only 30 pounds.

A registered dietitian (R.D.), who worked for me as a diet counselor, gained 39 pounds in one year after she started working at a local hospital. She studied her calories closely but couldn’t figure out why she had gained so much, so fast. As a new patient at my clinic, she began to use our calorie system and realized that she was calculating her daily muffin as “standard,” according to a diet book. Well, 20 years ago, “standard” was 2 ounces. Today, “standard” is 6–10 ounces. At 100 calories/ounce, this is at least a 400-calorie daily mistake. At 3500 calories/pound, she “found” her calories and her 39 pounds.

It is hard to imagine that an R.D. could make this kind of error, but her situation is not unlike yours. In a Diet Therapy class at my clinic, we diet and health counselors recently used our calorie analysis system on local fast food menu listings. Not one of the items listed there was less than 100% off the calorie amount listed on the menu. We have found that the labels are 20%–100% calories “off” on most food items on these kinds of menus. The fast food chains’ costs lie in the marketing—not in the food. The more they “give” you, the better the sale.

This is why I find that gaining only 30 pounds over time is miraculous these days. Even counting calories religiously is fraught with mistakes. Researchers at Glostrup University in Denmark, reporting in the International Journal of Obesity, Vol. 23, No. 10, 1074–1079, found multiple variables in obese subjects, which contribute to weight gain over 30 years. They looked into the “set point” theory, which states that people stop losing weight because a metabolic set point prevents further loss.

The researchers found that most obese people [defined as Body Mass Index (BMI) of 27] had gained small amounts of weight each year. Most of them gained less than 3 pounds/year. Since 3 pounds equals 10,500 calories, these people were “off” their set points by about 30 calories/day. There are 30 calories in a third of a single bite of red meat or a full teaspoon of sugar in coffee. The researchers concluded that it would be an exercise in futility to determine a set point for the following reasons: Every morsel of every food must be weighed and measured over a one-year period. As a clinical researcher, I can tell you that this would never happen.

There is a cheap, convenient, easy-to-find tool—which you must use daily—to keep track of your weight: a scale! This mechanism measures weight, or the body’s fat and lean tissue. Since lean tissue is mostly water, fluctuations in weight of several pounds, due to water flux, can occur often. At the clinic, we teach patients to confront their weight problem via the scale—daily. We also teach the mathematics of fat gain or loss. The scale becomes an emotional platform only for people who do not understand the difference between fat gain and water gain. To gain more than 10 pounds of water, your feet would look like balloons.

People do not “feel” calories. In your case, you never “felt” or acknowledged a 30-pound weight gain.. In spite of all that is said about not “obsessing” over dieting and weight loss, you must confront the following:

• Your weight.
• What you eat.
• How much you eat.
• A “payback” method to use when the scale “inches” up.

Set up a “no tolerance” limit on the scale. Tell everyone else to “bug off”—you need to take control. You will need to do this every day, forever. It is your choice.