Metabolism

  The new patient sat there looking at me with a facial expression that was a mixture of frustration and bemusement.

   "I really don't eat that much" she said.  "I don't know why I have trouble keeping my weight down."

   We ask patients to provide us with food diaries.  For breakfast she had written yogurt.  Lunch was a salad, and dinner was a boneless skinless chicken breast with vegetables.  No snacks or alcohol were listed.

   This patient is a sister of another patient who had lost 80 pounds in less than a year.  I knew that the sister was a reliable person, but I figured this new lady must be lying through her teeth.

She was 42 years old, weighed 357 pounds, and was seeing a fertility specialist who told her that her chances of ovulating were greatly enhanced if she lost weight.

   I tried to probe without letting on that I didn't believe her.  "Is this a sample of the way that you have recently been eating?  Perhaps you have only been seriously dieting for only a few weeks and prior to that you took in more calories?"

   She looked annoyed.  "No doctor, I've been trying to lose weight my whole life.  I'm not that

hungry, but I just can't seem to lose anything."

   She admitted that she didn't exercise, but continued to insist that her intake was not excessive.  On her history form, she stated that she had been in Weight watchers for 20 weeks, was placed on a 20 point/day diet (1000 calories) and lost only two pounds.

   An individual's Resting Metabolic Rate (RMR) is how many calories someone needs to consume to either not gain or lose weight, assuming that they sat in one place all day and did

not move.  There are equations to predict the RMR, and her predicted RMR was close to 3000

calories.  If her metabolism was normal, she should have lost plenty of weight on a 1000 calorie diet.

   That turned out to be a big "if".  In our office, we can measure peoples metabolism with a piece of technology called an Indirect Calorimeter.  It is a machine that you breathe into for about 10 minutes.

   Most of our patients think their metabolisms must be slow, but when we measure most of them they aren't.  A careful diet history will usually reveal that people are taking in many more

calories than they suspect.

   Not this woman.  When we measured her her RMR turned out to be just over 1000 calories a day, or almost one third what it should have been.  No wonder she couldn't lose weight.  I should not have doubted her.

   She took some comfort in knowing that her metabolism is slow.  She is going to be a tough patient to treat, but as long as she is willing to be patient and work at it, she will do well.

   Everyone is different.  We all have different metabolisms, and having a tool t measure it is a great asset in customizing a weight loss plan.