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Is permanent weight loss impossible?

6/9/2014

 
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A controversial article came out last week, saying that it is scientifically improbable that people who lose weight will keep it off in the long term. Well, the headline was actually "obesity research confirms long-term weight loss almost impossible." Understandably, there were wide and varied responses. It hits pretty close to home for me, having lost a lot of weight (though I never felt like a success because I didn't reach an ideal or goal weight), kept it off for just over two years, and now it's going back on. I'm not special, I'm statistically boring! I mean, normal.

I've been following the reactions, and the disappointing part is how predictable they are. How nobody is using it to really stop and think and discuss possible implications, but rather they interpret the findings according to what they already believe. Carefully read, it's actually a quite honest and balanced article. Pretty much the conclusions I've been coming to through blogging and reading: weight loss for the sake of weight loss is counter-productive, but attempts to get healthy (even when they don't lead to weight loss) are always valuable.

The size acceptance, Health at Every Size, and anti-fat-shaming community jumped on the study as vindication, further proof that diets don't work in the long run, and a way to say "see? we were right all along." People in the nutrition and fitness industry found it negative and disturbing because they feel it gives people an excuse not to even try, and it goes against everything they believe (or get paid for). And the many individuals who are trying, who are on a public journey of weight loss on blogs, forums, Facebook, and Twitter, see it as a personal affront to their efforts and want to be the exception to the rule. In essence, everyone is right, and still nobody is.

There is very little evidence of weight loss being maintained beyond 5 years. That's the main point to clarify: we're talking long term maintenance, not success stories of 1 or even 2 years. And as much as we want to believe that it's possible, that we all know someone who has successfully lost a lot of weight and "if they can do it, we can do it," clinging to that belief can give a sense of false hope. Worse, it sets people up for guilt, shame, regret, and loathing if they fail. With such a high probability of regaining the weight, is it right to continue wearing the rose-coloured glasses of denial?

My question is about the research. It sounds to me like the people involved were put on fairly strict diets, in "highly controlled experimental settings." Is it reasonable to expect long-term compliance with something which does not take into account your own sense of control? Think of it like rehab. Detoxing and getting sober within the confines of a facility is often the easiest part for an addict. It is maintaining sobriety in the real world, full of temptations and road blocks and pitfalls, where relapse occurs. It's the same issue I have with shows like Biggest Loser, because they're living on a ranch in isolation and there's external control over what food comes in and out. Contestants spend very little of their time in the real world before the show's finale, and then aren't allowed to talk about how hard it is to maintain habits in a real-life context. What really failed, here? Dr. Yoni Freedhoff asks the question: "
does it mean the people in the included trials failed to maintain their interventions, or does it mean that the interventions were too crappy to be sustainable in the first place?"

What this article and study should be is a call to arms to re-examine how we go about weight management.  Too often, people are told to lose weight with a simple eat less, move more mantra that just.doesn't.work. That seems to be proven time and again. It's why I hate the concept of a diet. Rather than determining that weight loss is impossible, we need to be looking for better solutions.
Different ones than the same-old tried-and-not-true-but-try-again-anyway solutions. Ones which can be sustainable long-term. The catch phrase for this is "lifestyle change" but we need more. Lifestyle change is usually a code word for "diet" when restricting and tracking is involved. True change is bigger than the individual. It's not just about changing your own habits, it's about working to change the society we live in, the sedentary environment which makes movement and exercise something you have to actively seek out instead of being part of a daily routine. It's about changing food industry standards and legislation and what kind of chemical crap gets approval for consumption.

It also highlights just how
prevalent fat stigma is, because there is no question in anyone's mind in this article (and others related to it) that obesity is something to be cured. What if we stopped making fat the enemy - as in, looking fat, carrying fat, being over a rather arbitrarily set body weight ideal - what if fat wasn't the worst thing you could be? Would the approach to HEALTH change, then? Would we focus on the whole person and quality of life and not simply on one's size?

The biggest flaw that I see with the article is that "science" covers a lot of bases, which is why everyone is right, and everyone is wrong, when they interpret it in this case. If you tell me that weight loss is biologically impossible, akin to growing taller, that's a pretty different story than if it is psychologically improbable. The studies referred to revolve around human behaviour. Biological findings about the body holding on to fat cells, or mutations in hormones, or increases in ghrelin levels - THOSE are the kinds of findings that could lead to a conclusion of "impossible." It's an example of sloppy writing (or genius, if the point was to generate controversy and outrage).


The article is not without bias, but that doesn't mean that it should be dismissed entirely, as many commenters seem to do. The byline of "no known cure for obesity except surgically shrinking the stomach" should trigger some warning signals in any logical person's head. First of all, treating "obesity" as a disease, as something to be cured, is a fallacy. Obesity describes the amount of fat you have in relation to your height. It does not indicate your health status. The evidence for surgical weight loss success is also pretty negative, spotty at best, and to start with the premise that the only cure is surgery suggests a strong bias by the reporter. She even acknowledges the drawbacks and failures of surgery in the body of the article, yet leads with such a byline about surgery. Red flag.

Nobody is suggesting that we just give up. Read the comments on any of the forums
and you'll inevitably find someone saying "this is just an excuse for 'them' to be lazy and stay fat." The biggest point missed is that the health benefits from exercise and trying to eat better still exist, even if the weight never comes off.  The focus on "obesity" itself is the red herring, here. Why, why, why do we insist on conflating correlation and causation? We talk about obesity as if the diseases which correlate to it are a given. You are super-fat? You will get diabetes. You will die of a heart attack. No, no, no. The risk factors increase exponentially, but there's not a direct-line connection. It's like smoking. Not every person who smokes gets lung cancer, and not every person who ever had lung cancer was a smoker. The likelihood of a smoker developing cancer is high enough that we associate the two. The difference with obesity is that the fat alone is not what causes various diseases, it's what makes the body's environment ripe for various diseases to occur. You know what helps change that? Fitness. Health. Nutrition. All of which can occur with and within a body that stores extra fat.

So, is weight loss a hopeless endeavour? Not at all. But clearly, in order to have long term success, it takes constant vigilance. I don't see how acknowledging that is negative. You have to be prepared for it. Willpower alone is not going to keep motivation going ten years down the road. There will be ebbs and flows, highs and lows, and the habits developed early on may not continue to work once the body gets used to them. There are some habits which seem consistent in those who have maintained their weight loss: weighing every day, writing down what they eat, and continuing to exercise. Tracking seems especially significant, which means it's something you are constantly thinking about. That makes sense to me. It's when you let down your guard for a moment of complacency that it's easy to slip up, and believe me: it's a slippery slope after that.

Correlation is not causation. Nothing is a done deal.
Improbable is not impossible.

But let's keep our heads out of the sand, and our eyes wide open.
Long-term weight maintenance is an uphill battle, and to pretend otherwise just makes it that much steeper.


Links that I hope you'll take the time to read in their entirety:
  • the original article: Obesity research confirms long-term weight loss almost impossible
  • Dances with Fat (blog): Seriously, weight loss doesn't work
  • Weighty Matters with Dr. Yoni Freedhoff: initial response (Is it really scientifically impossible to keep your weight off?) and follow-up (More on the "Almost Impossible" Feat of Maintaining a Weight Loss)

I think I found my new hero

5/20/2014

 
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You may have seen this post, called 10+ Reasons I Love My Ugly Body. In the health and fitness Facebook realm, it's gone viral. For good reason.

She espouses everything I aim to be: fit, healthy, strong, and honest. Honest about trying to love her body, even when she doesn't succeed 100% of the time. She lost 164 lbs. She is a fitness trainer herself. She is a triathlete. And she has saggy skin, and still carries fat. She may very well be my new hero and role model

She is another example of real weight loss success, and a bikini body worth showing. Especially since she is not merely posing, but is active in her shots, demonstrating her strength and skill.

Makes me want to try a cartwheel and climb a rope!

To get the full effect of her story, you need to see the pictures. I urge you to click and read the original. If the link happens to be overwhelmed because of all the visitors, here's the gist of it:

Even though I have lost 164lbs and  I am at my doctor’s goal weight…

Even though I have been doing crossfit 4-5 days a week for almost 2 years and eat a very clean diet (90% of the time)…

Even though I am a certified personal trainer and a Spartan, a Rugged Maniac, a Warrior and a Triathlete…

This is what my body looks like (almost) naked. [see photo above]

Because of this I try very hard to stay focused on fitness goals as my measure of success rather than my appearance or the number on the scale or the size of my jeans…but sometimes…just sometimes, I forget. A few weeks ago I did just that…I forgot. I was faced with a “Look Good Naked Challenge” at my gym that I knew I had no chance in hell of winning. I remembered that summer was just around the corner and realized that I would go a 25th year wearing shorts over my bathing suit to hide the legs I’ve hated since I was 11.  I tried on a jean skirt that I wanted so bad only to see my misshapen knees that have kept me from wearing anything above them throughout all of my adult years and out of nowhere it hit me like a ton of bricks…I felt frustrated, discouraged and sad. Like really, really sad.  I even cried a little. I felt like all the hard work that I’d been doing wasn’t paying off and it made me want to give up. I spent a good week or so feeling sorry for myself, getting caught up in the vanity of it all.  I didn’t work as hard at the gym, I didn’t eat as well as I usually do and every time I looked in the mirror I felt worse than I had the time before. I can’t recall if there was something specific that got me to pull my head out of my ass, but fortunately something did. Regardless of what it was, I decided that it was time to REALLY celebrate what my ugly body CAN DO rather than focus on what it looks like…or doesn’t look like. So I asked my friend Emily, the amazing photographer at Southern Star Photography, to take some pictures of me DOING the THINGS I have NEVER, EVER…EVER in my entire life…not even as a kid (with the exception of the cartwheel) have been able to do until now. So here you go!  Today I am celebrating what my body is capable of doing because of the lifestyle changes that I’ve made and the hard work I’ve done in and out of the gym.


I am PROUD of my ugly body because…

THIS BACK AND THOSE ARMS ARE STRONG ENOUGH TO DO THIS PULLUP (no strings attached!)

THIS BACKSIDE
CAN DO A CARTWHEEL A GRACEFUL AS ANY (NOVICE) GYMNAST

THESE SADDLEBAGS, STRETCH MARKS AND CELLULITE CAN’T STOP ME FROM BEING SUPER FLEXIBLE

THAT LOOSE UNDERARM SKIN DOESN’T MEAN I CAN’T CLIMB THIS THING

THE REMAINING FAT ALL OVER MY BODY DOESN’T MEAN I’M NOT STRONG ENOUGH TO FLIP A FLIPPIN' TIRE

MY FLABBY TUMMY HAS THE CORE STRENGTH THAT ALLOWS ME TO ACT LIKE KID

AND I'M FASTER, STRONGER, BETTER THAN EVER BEFORE. I'M MAKING PROGRESS.

Fit and Fat: keep going, it's working!

5/2/2014

 
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You don't always see results in obvious or expected ways, with exercise. Especially if weight loss is your goal (or one of your goals), it's easy to overlook what is referred to as NSV's: non-scale victories. I've been so self-conscious, hyper-focused, and self-flagellating about the weight I've gained recently (from admittedly bad nutrition) that I've questioned the value of the classes, training, and fitness exercises I kept doing.

And then Outdoor Fitness Challenge began this week.

Now, it's been a year since I smashed ropes, planked with fire hoses, and flipped tires outside. I felt pretty darn out of shape, and showed up Wednesday morning with some trepidation. It was cold (like, November cold!). It was rainy. It was early. So, I was fully expecting to hurt - capital h, HURT - the next day. I felt my arms and legs, because that's what was deliberately worked, but I could still move. I didn't, like, want to die. And I was mildly surprised at that. Mat emailed the participants to check in and see how we felt after the first session, because he knew it was designed to be hard, that it was movements that even athletic and in-shape bodies might not be used to, and probably because he wanted to make sure nobody was so damaged they were going to demand a refund.

My response to him?
"So far, so good, for how I feel. What I notice most is the difference in my core. Last year when I tried battle ropes for the first time, everything hurt. I felt it in my back a LOT and was sore and stiff all over my whole body. Not this year, though! It’s the first time I can feel what it means to have core strength. It was more theoretical before, for me. Guess I was starting to question what good Group Core was doing me, since I’ve put so much weight back on, but clearly it’s helping."

This was an example of HAES (Health at Every Size) in real life. I was fat, and I was fit. The two were not mutually exclusive. And the work I'd been doing all along, even as my eating went downhill, came into play. The weight lifting. The core training. Body weight exercises. Some endurance. Cardio. It all came together so that I could complete an intense hour and still be able to function at work for the rest of the day. I was also able to train arms the following day (hello, triceps! yes, I feel you burning), and do this morning's early morning Outdoor Fitness Challenge boot camp.

Today, the tires came out. Holy Mother Trucker, they were heavier than last year's! Mat managed to get two rather thick truck tires with smooth treads. Not like the tractor tire with mud grooves that made it easy to grip, from last summer. Oh, no. These ones were slippery suckers that I had a helluva time lifting. It didn't help that it was another wet and muddy day.


It felt good, though, because it was a challenge. A very well-intentioned participant came to help me with the big tire that I was struggling with. I was like, "uh ... I need to do it. Myself." I might have given up had she not come over, just left the tire and claimed it to be too slimy to keep flipping. I wanted to walk away. But when she ran to my rescue she stirred the fire in me and I thought, "I am figuring out a way to DO this. Don't just work harder, work smarter. I'm not someone who needs assistance!" I realized that only one side was hard to grip, so at least half the flips were do-able. And the others? I compensated by using my whole body, my knee, my chest, and yes ... even the gut I hate so much came into play. It took all of me to lift and flip, painfully slowly, but I did it. There is now a new nemesis to defeat over the next few weeks! I'm gonna get good at flipping the big tire.

It was also awesome because there was competition. I forgot how much that drives me. I'm sore now, because I truly used my whole body in the final showdown of pushing the giant tire against an opponent, wrestler-style. We all had a chance to pair up with each other, so there were three rounds (since there are 4 of us crazy enough to get up at the crack of dawn). Some strategy came into play (including a fake-out, a deke to the right when she thought I was going left, and a rather opportunistic move on my part when a kind soul paused to ask if I was okay and I was like "yeah!" SHOVE). But I also had a formidable foe who was freakishly strong and I had to work for it to knock it down. It was deeply satisfying to hear "holy crap, you're strong!" from him.

See, I don't look like someone who's strong. I am often underestimated. Given the struggle I had with flipping the tire, it's no wonder there was some shock for him when it came to wrestling the tire against me. This guy knows I'm a slow runner, have bad knees, and has seen me in lots of other classes where strength doesn't truly come into play. I'll admit: my pride was pretty happy with hearing "wow, you're strong."

Because that's what fitness should be. It should be functional.
Fat and Fit.
Yeah. It's possible.

Even if - no, especially if - it's not visible.


If there was ever an anecdote to illustrate the reasons to keep going, even if you don't feel like you are getting results, then this is it. I don't know if I'm totally out of the mental rut I fell into; there's still the weight gain to deal with. But the fire is back. Because the workouts were working, even when I thought they weren't.

Health at Every Size

4/5/2014

 
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The HAES (Health At Every Size) concept is what helped to change my life and my way of thinking. Before I started exercising, before I even started to change habits and eating patterns, I needed to get just a little bit angry. See, I'd spent most of my time being sad about being fat, and when I was angry it was at myself. A few years ago I came across a blog by Kate Harding called Shapely Prose. I spent hours reading back through the three years of posts, clicking on links to other articles, other blogs, other big names in the HAES community. I finally turned some of that fat anger outward, towards society and some really messed up expectations and messages, rather than inward, towards myself and my perceived failings and shortcomings.

The premise behind HAES is that diets don't work, and fat itself is not the mortal enemy it's made out to be. Too much focus, even within the medical community, is on losing weight. At all costs. And when you make fat loss the end goal, you don't necessarily get healthy results, you just get a thinner person. An example is that you can cut off a limb and lose weight according to the scale, but you are not better off or any healthier. Other less grotesque examples are the extreme bariatric surgeries (which carry huge risks and side effects), or crash diets which often lead to eating disorders. All of which may technically lead to weight loss, and none of which create healthier people.

HAES promotes health and fitness, plain and simple.

Except that it's clearly not simple. More and more people in the fitness industry and medical community are coming around to this notion, especially as more studies are done which demonstrate that it is your actions, your habits, which determine your health - not your body size. Yes, it is possible to be fat and fit, and it is equally possible to be thin and unhealthy. What you put into your body determines your health. How you move your body determines your fitness. Health should be measured by blood glucose, cholestorel levels, flexibility and mobility, lack of pain, quality of sleep, and all of those things which are not visible. The number on the scale? Not the only or the best indicator of health.

So why is this such a radical concept?

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The thing that the haters miss about HAES is that it's not called "healthy" at every size. If you want to save  your sanity, don't read the comments in any article or blog post related to HAES because guaranteed there will be at least one troll who snarks about how HAES and Fat Acceptance is just an argument for the fatties to continue unhealthy lifestyles and to justify their laziness. What a difference that "y" at the end makes.

Health at Every Size does not necessarily mean that everyone and anyone IS healthy at any size. That includes the very skinny, the normal, and anyone in any BMI category. No one is truly arguing that obesity is healthy. (Well, some may. I'm not.) The point is that there are far better determinants of health than just your body size, or how much fat you carry. It all comes back to you can't tell what a person eats, how often they work out, or anything else about them except how their body stores fat.

Obesity is a really complex issue. There's no clear-cut solution, because if there was, trust me: us fatties would be all over it. The problem is that so much reporting and discussion about obesity is over-simplified, so that the message is basically "FAT = DEATH! OMG! DECLARE WAR ON OBESITY!" It's not helping. It's not working. HAES offers a more health-based approach.

The bigger point that resonates with me and HAES is not just that it's possible to be healthy at any size, but that we have the right to be healthy. I don't think I truly believed that. I felt like getting fat was my own fault (rather than considering various social, economic, genetic, environmental, and cultural factors), and so I forfeited my rights to be treated with respect or dignity. HAES changed that. If it was solely about weight loss I'd still be on the diet yo-yo train of starvation and eating frozen Lean Cuisine dinners and buying Weight Watchers snack cakes. The focus on health has led me to attempt varied exercise and clean(er) eating.

It's also saved me a lot of sanity points because there's a lot of tie-ins to body image with HAES. Mat has said to me that "Fitness is about feeling good." Happiness should be part of health, and accepting your body and your self is a crucial stop on that journey. I know that not all of the science that is spouted in support of HAES concepts is sound, and some arguments over-reach. Dieting is contrary to HAES practice, so attempts to control weight go against it, and I am clearly working to control my weight and to continue losing. Still, it was HAES which got me to adopt a more balanced approach to life, health, and fitness. It worked in the beginning, and then disordered eating and a really F'd up body image were re-triggered by losing the weight; exactly what I didn't want to have happen. In my quest for making this the year of balance, it is time to revisit some of the old HAES articles and concepts, and get back to a focus - a true, sincere, honest focus - on becoming HEALTHY. No matter what size I reach. 
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Why Biggest Loser lost this viewer

2/9/2014

 
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I watched the first few seasons of Biggest Loser, and then I just couldn't stomach it any more. When this latest season ended a few days ago, the show came back on my radar because all of the newsfeeds were flooded with pictures of an emaciated winner. There have been lots of responses, and I have been trying to figure out whether to bother adding my own, and how to even formulate my thoughts about the show, and about the reaction to Rachel.

And then I came across an article at Jezebel by Golda Poretsky, kind of a guru and big name in the Health at Every Size world, and I realized that I didn't have to make the arguments and points that were in my heart. She articulated them for me.

Biggest Loser lost me early on as a viewer because it was not motivational for me. I felt the fat shaming that the contestants went through. I saw how the trainers treated them. I also don't believe that any of it is sustainable or realistic outside of the show. It makes for entertaining tv, I guess, but as a huge person who wanted that kind of weight loss but felt that it would be an insurmountable task, the message I actually got from the show was that the only way to do it would be to quit my job, train for 8 hours a day, and be monitored closely so that I wouldn't eat anything. It was de-motivational, and didn't encourage a love of exercise or of eating. It skewed my idea of what a personal trainer is, could be, or should be. And it solidified the already deep beliefs that I held about how fat people are to blame for their lot in life and should therefore not be treated with respect or dignity. The show reinforced all the reasons I already had for hating myself and my body.

Not so entertaining, after all.

Some people say that they find the show inspirational and motivating. Studies show the opposite effect, that the show actually promotes weight bias and increases stigma towards fat people.


Whether you find Rachel's transformation positive or not, whether it's physically healthy and she achieved it "naturally" as she says, there's something missing in this equation. She did it so fast. She was able to lose the weight ... but did she change her mind and her thinking? I believe she might have actually formed new habits, ones she might be able to maintain on her own in the immediate future. But there's a reason she put on weight in the first place. I find it incredibly hard to believe that the thought processes have truly changed for her in such a short time.

There are so very many things wrong with this show. Tons.

Here. Let Golda break it down for you:

Freaked Out By Rachel Fredrickson’s Biggest Loser Win? Read This.

The Biggest Loser
crowned a new winner, Rachel Fredrickson, who lost nearly 60% of her body weight. She went from 260 pounds to a gaunt 105 pounds to win the show. As is typical of the rhetoric around fat, weight, and women's bodies, Rachel was deemed "too thin" and "not healthy" by viewers and the media.

There's a fine line in the media between too fat, just right, and too thin. If Jennifer Lawrence is too fat and Rachel Frederickson is too thin, then I'm assuming the swing is a mere 15 pounds or so.

But to those who are decrying Rachel's weight loss as too much, I ask you, what did you think this show is about? Do you think The Biggest Loser is about health? Well-being? It's a show that promotes weight loss at any cost.

The winner is not the person who eats reasonably, exercises moderately, and makes time for family, friends, and fun.

The winner is the person who loses the largest percentage of body weight. It's that simple.

Lest you think that I am supporting the producers of The Biggest Loser, I am not. I am asking you, dear reader, to open your eyes to the reality of this show.

Here is what The Biggest Loser is NOT about:
  • Health.

Here is what The Biggest Loser IS about:
  • Shaming fat people.
  • Promoting diet products.
  • Promoting other merchandise tie-ins.
  • Manipulating viewers into thinking that their show is "saving lives."
  • Ruining the physical and mental health of contestants season after season.

I could probably write a treatise on why The Biggest Loser should be taken off the air. But I'll share my top 3 reasons.

  1. The Biggest Loser Is Physically And Emotionally Dangerous For the Contestants. Just from watching The Biggest Loser you can glean some things about the way the contestants are treated. (In this one clip alone from Australia's Biggest Loser, you can see the emotional and physical duress the contestants are under, and the fact that they cannot even open a door to get fresh air.) About two and half years ago, I interviewed Season 3 finalist Kai Hibbard about her experiences on the "ranch." She talked about how contestants were encouraged and, I would say, brainwashed, into intense dehydration, overexercising (sometimes while injured), and eating disordered behavior.
  2. The Biggest Loser Reinforces The Idea That Thinness, At Any Cost, Is Healthy. Diets don't work, and that includes extreme diets. You won't hear about it in the media, because facts don't sell diets and weight loss drugs. And you also won't hear about Biggest Loser contestants who gain the weight back, not because it doesn't happen, but because they sign a huge contract without the benefit of counsel when they sign up for the show, and that contract includes a gag order with million dollar penalties. Even so, a few contestants have admitted to gaining all of the weight back, including Erik Chopin and Ryan C. Benson.
  3. The Biggest Loser Bolsters Fat Hatred And Stigma. More and more evidence is suggesting that the real danger of obesity has nothing to do with fat, and everything to do with the stigma of being fat. For 14 seasons in the US (and multiple seasons in over 20 countries around the world) The Biggest Loser has been reinforcing the stereotype that fat people are lazy and unhealthy and deserve to be berated, forced to exercise in pain and with injuries, and malnourished all for the sake of weight loss and entertainment. Millions of people watch this show every week and internalize this message. The show, in essence, makes "bullying for health" a viable and particularly dangerous concept, especially given the fact that fat kids are the most likely to get bullied.



Click here to read my other articles on The Biggest Loser.

Golda is a certified holistic health counselor and founder of Body Love Wellness, a program designed for plus-sized women who are fed up with dieting and want support to stop obsessing about food and weight. To learn more about Golda and her work, click here.


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    Whose blog, now?

    From the gut, about the gut, trying to listen to what my gut tells me.

    I'm just a girl, fighting the same weight battle as much of the population. Lost 100 lbs, working on the rest, trying to find balance between health, fitness, and vanity. I'm also a librarian who wants to share credible information and reliable resources, in addition to my own musings and reflections, what I call "my writing from the gut."

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