Monday, March 22, 2010

More Calories Out than In? It's Not that Simple.

I wrote the following sometime last week, and decided not to post it because I figured maybe folks were getting tired of my talking about my diet and exercise thing. However, I ran into this and now I can’t resist. In the comments section a lady talks about her experience:

I invite you to come and spend a week with me, while I weigh and measure and record every GD thing that goes in my mouth; while I walk, swim laps, or ride my bike and also do resistance training WITH a personal trainer (who is also a nutritionist) EVERY DAY EXCEPT SUNDAY (that's the day I do a spring water fast).
I also invite you to observe my weekly weigh ins, which, sadly, produce nothing in the way of LOSS--which confounds my trainer, but even SHE is slowly coming to the realisation that NO, you can't just necessarily change your body with sheer will power and self control--something she and I argued about a lot our first couple of weeks.

But, as this woman mentions, when an overweight person says this, we are assumed to be lying. No matter how healthy we claim our diet is, it is assumed that we are like the guy in the song “Junk Food Junkie” -- presenting a pious face to the world while secretly pigging out on Ding-Dongs. So, here’s my take:

Everybody knows the drill about weight loss, right? You have to burn more calories than you take in. One pound equals 3500 calories that you’ve not used and stored away in that spare tire around your middle. To get rid of it, you’ve got to exercise more or eat less -- preferably both.

Now, I’ve been working on this for the past few years -- initially, I was quite successful and took off 30 pounds, and to date, have kept them off. I’m still, however, medically obese -- which is a lot thinner than what is generally thought to be “obese”. I’m not, nor have I ever been over 230 pounds. I’d have to get down to 170 to be medically just “overweight”. (Just picture me shouting “Hooray! I’m overweight!”) That’s a weight I haven’t seen since my mid-20s.

According to Nutrition Data (which I really like and recommend), a woman of my age, size, and activity level is burning between 2300 and 2600 calories a day, depending on what exercise I happen to get done. I eat between 1600 and 1800 calories per day, pretty consistently. That means, if the formula of “burn 3500 calories to lose a pound” works that I should be losing a pound a week, at least. I’m not; I’m stuck in the same 5 pound range I’ve been going up and down in for the past three years. This is not the notorious “diet plateau” -- this is the weight I’ll stay at, unless I start going to starvation level calories. The depressing thought that torpedoed dieting in my youth -- that in order to be thin, you have to eat like a Third World famine victim for a lifetime-- turns out to be actually true. And who but an obsessive-compulsive would voluntarily starve themselves for longer than a few months? My husband thinks I’m already obsessive enough. .

However, every number other than the one on the scale is great. My last blood sugar test results were “excellent”, according to my doctor. My blood pressure and cholesterol are down where they should be -- with the help of medication. (The blood sugar I control without meds.) Nutrition Data, which tracks your actual nutrition as well as calories, shows me that I’m eating a very healthy diet, chock full of protein, vitamins, and minerals -- and where there are gaps, I supplement. (I’ve discovered one reason you see 2000 calories as a standard is that it’s almost impossible to get all the RDA of your nutrients from food alone unless you eat that much.) I almost never go beyond the recommended amount of fat, and seldom go over with carbohydrates. I really can’t eat healthier than I’m eating right now.

When it comes right down to it, I don’t think any of the diet or nutrition experts really know all that much about weight loss. My doctor once told me, in another context, that if you have a dozen remedies for a disease then it’s a sure sign that nothing really works. God knows there’s more than a dozen contradictory theories about what will make people lose weight permanently.

So, maybe a little kindness is in order. I get a little resentful of the “just stop stuffing your face and get out and exercise once in a while” attitude you get from the obsessive types who think that if you don’t run five miles a day and totally renounce any form of dessert you aren’t really trying. My injured back muscles won’t take running for five minutes, and I‘m working on healthy ways to satisfy my sweet tooth. Even when I eat something “bad”, I’m very careful to have only a small portion. In fact, one of the major changes I’ve made is that I never “pig out” any more.

But I’m not losing weight. Nor will I, unless I eat a diet that is less healthy than I eat now.

Wednesday, March 10, 2010

The Difference Between Asperger's Syndrome and High-Functioning Autism

I find it somehow comforting to read articles about Asperger’s Syndrome -- to read about the symptoms and characteristics and be able to say “Aha! There’s Trevor!”. I guess it makes me feel more able to deal with his differences to know that they are part of his disorder and not some kind of unique weirdness that only we have to live with.

A story hit the news a while back that they (whoever “they” are) are considering getting rid of the Asperger’s label altogether and simply lumping them in with high-functioning autism. According to Dr.Tony Attwood, the only real differences are in early development, but as they grow older, there really isn’t much difference between them.

Some quotes that struck me:

They also noted that the profile of social skills in children with autism includes self-isolation or rigid social approaches, while in Asperger's syndrome there can be a motivation to socialise but this is achieved in a highly eccentric, one-sided, verbose and insensitive manner.

In other words, autistic children really don’t care if they socialize, whereas Asperger’s kids do -- they just don’t know how. Trevor’s approaches tend to be awkward -- when he was younger he tended to open with inappropriate questions like “How old are you?” to an adult. He’ll talk your ear off with details about a story he’s writing -- he’ll do that even to strangers, and he really doesn’t appear to care whether or not they are interested. He can be insensitive -- then when he makes someone angry, he gets very frustrated and down on himself, even self-punishing.

There is general agreement that children with Asperger's syndrome may not show any conspicuous cognitive delay in early childhood. Indeed, some can be quite precocious or talented in terms of learning to read, numerical abilities and in some aspects of their constructive play and memory. Children with autism can be recognised as having developmental delay in their cognitive abilities from infancy and diagnosed as young as 18 months of age with a mean age of diagnosis of five years. Children with Asperger's syndrome are often not diagnosed until after they start school with a mean age of diagnosis of eleven years (Howlin and Asgharian 1999). However, the signs of Asperger's syndrome in very young children may be more subtle and easily camouflaged at home and school

With autistic children, it’s usually quite clear early on that something is wrong. Every autistic child I’ve seen in my work as a substitute teacher starts Kindergarten in a Special Education classroom. Even the highest-functioning one I know of started there, even though by fourth grade he was in a general ed classroom with an aide who helped him, and I’ve heard that in middle school, he didn’t even need the aide any more. However, I’ve never seen a child with an Asperger’s diagnosis in Special Ed or with a one-on-one aide; they are in regular classrooms and get the support they need from pull-out programs. (Speech, for example.) As far as the disorder being “camouflaged”, you can check out my own
on just how long it took for us to understand that something was wrong with Trevor. The school never diagnosed it, either. As I've said before, Trevor's precocious abilities in reading and math misled us into thinking we were raising a budding genius, not a kid with a learning disorder.

The DSM criteria refer to children with Asperger's syndrome as having, in comparison to children with autism, no clinically significant delay in age-appropriate self-help skills and adaptive behaviour. Clinical experience indicates that parents, especially mothers of children and adolescents with Asperger's syndrome, often have to provide verbal reminders and advice regarding self-help and daily living skills. This can range from problems with dexterity affecting activities such as learning to tie shoelaces to reminders regarding personal hygiene, dress sense and time management.

Trevor was ten before he could tie his own shoes, and we’re still working on “self-help and daily living skills”, even though he's a young adult. He's made a lot of progress with hygiene, taking care of himself without reminders now. But it was an issue throughout adolescence.

The final, and to me, the most important difference that Attwood mentions is that a diagnosis of autism gets help; a diagnosis of Asperger’s does not. The reason that Far Northern put us through all their testing, even though they knew they couldn’t help a kid with Asperger’s, is that they were hoping they could re-categorize him. But, to no avail; he has Asperger’s Syndrome, and the state won’t pay. Virtually every agency I’ve contacted asks me if we have gone to Far Northern, which appears to be the funding conduit for most forms of assistance for learning-disabled adults. Not qualifying there closed a lot of doors for us.

Anyway, I have mixed feelings about getting rid of the Asperger’s diagnosis. I know I would have been a lot more resistant to a diagnosis of autism -- and Trevor is definitely different than the autistics I have known, both in his history, his abilities, and his problems. On the other hand, if Asperger’s were not considered a separate disorder, he would qualify for a whole smorgasbord of programs -- SSI, independent living assistance, job training, etc. The label isn't nearly as important to me as getting the help he needs to become a functional, independent adult.