Joan gained weight drastically at 39 after suffering health problems, including hyperthyroidism and Sjogren’s disease, as well as a period of caring for her mother. Joan was also diagnosed with osteoarthritis, and found she was unable to do many of the activities she did before. After her weight reached over 20 stone, Joan decided to lose weight through an NHS weight management program. Approaching her diet as a “lifestyle change”, Joan has lost over 6 stone in a year and a half. Joan hopes to continue to lose weight for health reasons.
Joan is 57, and before giving up work for health reasons, worked as a community psychiatric nurse. She is white Scottish.
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Although her weight had previously fluctuated between 10 and 11 stone, Joan gained weight drastically at 39. Around this time, Joan became very tired and was diagnosed with hyperthyroidism. Joan also started having problems with her eyes, tongue and joints, and was told she had Sjogren’s disease, as well as stenosis in the spine. Joan had limited success and several complications with her medications, and had to give up many of the activities she used to enjoy, like skiing and hill walking. Around this time, and alongside her job, Joan also began caring for her mother, which meant she had to rely on ready meals and snacks. As she gained more weight, Joan started to isolate herself from friends, “the more restrictive or the less that I could do, the less I wanted folk to see me”. Joan decided she wanted to lose weight, “I was sick of looking at myself being at twenty stone. It was just, I felt as if somebody’d got a pump and pumped me up”. After losing around 2 stone, Joan asked her GP to refer her to a weight management program. Over the last year and a half, Joan has lost almost 6 stone. However, she has also been diagnosed with compacted discs and osteoarthritis in each shoulder. Although medication and weight loss have helped with pain management and have made movement easier, around a year ago, Joan had to give up work for health reasons. Joan now lives with poor mobility, although she continues to work to improve this and find ways to carry out every day activities.
Joan has previously tried several weight management groups and diets including the 5:2 diet. However, after suffering health problems and gaining more weight than she had in the past, she found it hard to follow these plans. Joan has had strong support around her weight from her practice nurse and rheumatologist, who told her, “If you continue to put on weight, I don’t know how long you’ll be on your feet”. Joan appreciated this direct approach, “as much as a lot of the truth hurts, I’m more perceptive to people who are completely up front with me”.
The program Joan now follows encourages her to count calories, and follow a high carbohydrate, low fat diet. She enjoys how certain foods are “free”, and bulks out meals with vegetables, often making large batches of soups, which she can fill up on. Joan has swapped to brown carbohydrates, and has stopped buying dips, making her own out of Greek yogurt and spices, and eating these with vegetable sticks instead of crisps. She now avoids takeaways in favour of cooking fresh meals, something she finds easier since giving up work. Joan has also stopped buying unhealthy foods she will be tempted to eat; she snacks on fruit if she is hungry between meals. If she fancies something sweet, Joan will have jam on a rice cake, although often finds that distracting herself with a walk or a phone call can stop her cravings, “by the time you’re done that the emotion has left you”. Joan has reduced her calorie intake to 1400 calories a day, which she tracks, alongside her activity, on a wrist device. Although Joan gained some weight after her mother passed away, since changing her eating habits, Joan has been losing weight gradually.
Joan values the supportive environment of her NHS weight management program, where people often share tips on weight loss. Joan has accessed psychology talks around overeating as part of this, “they help keep my motivation going”. She has also been encouraged to become more active through a chair exercise class run by the physiotherapist. However Joan dislikes how, after 6 months, participants are weighed only monthly, which has made it hard not to go back to bad habits in between. Joan’s weight management program, lasting 18 months in total, is due to come to an end soon. Joan plans to join another commercial weight management group as being weighed motivates her to maintain her diet and exercise regime.
Since losing weight, Joan is more confident in social situations, and enjoys being able to buy clothes “off the peg”. The health implications of gaining weight motivate Joan to maintain the changes to her diet, “if I put on the weight that I’ve lost, ending up in a wheelchair not being able to walk and that scares me more than wanting to eat does”. Joan now sees her diet as a “lifestyle change”. Although she accepts that she will only lose weight gradually, Joan is positive about the future, “I have still got quite a long way to go but I feel as if I’m on the right track”
Joan describes her symptoms before being diagnosed with Hypothyroidism and Sjogren’s. At her heaviest she weighed twenty stone ten pounds.
I guess when I first started putting on weight I must have been thirty-nine. Don’t get me wrong, I was never really, really skinny, but I used to be fit. When I became eleven stone I was fat. I tried to keep my weight between ten and ten and a half. Did hill walking, hill climbing, skiing. I was really very active. Went to the gym. Then I became really, really tired. Was putting on weight really, really easily and that’s when I discovered I was hypothyroid. It’s, the hypothyroidism, over the years the dose has increased of thyroxin that I take. Shortly after that, the fatigue never ever went away, and I would say for about six or seven years, thereafter, was I had days where I could sleep on the edge of a knife, do you know, kind of struggled a wee bit at work with the tiredness, concentration was appalling. The GP did all my bloods and my inflammatory factors were really high and I seen the rheumatologist and he said, my GP thought it was Lupus. Seen the rheumatologist who said, “I’m ninety nine per cent sure that you’ve got Sjogren’s syndrome. He said, “Your tongue’s really coated,” he said, “how’s your eyes?” and I said, “nothing wrong with my eyes.” He said, “Can you cry easily?” And at that time if I was watching a sad film, yeah absolutely. So, he said to me, “Look, there’s no active treatment for it just now but I will see you again.” Two years later, seen him again. My eyes were dreadful, really dry, really inflamed. Became really itchy. My tongue was much worse. Was getting pains in my joints for no apparent reason… I and he seen me, and he said, “Oh you’ve definitely got Sjogren’s,” and he followed me up. He started me on hydroxychloroquine which is used to treat malaria but it’s also used to treat inflammatory disorders. So I was started on 200 twice a day and was pretty good for a couple of year on that. He then retired, and I’ve seen another doctor in the NHS at [hospital] and she said, “Your inflammatory factors are still really high.” At this time, I was getting pains, especially my shoulders and hips and couldn’t really do any exercise. Went to the gym and couldn’t lift a thing. Became a bit despondent and I was putting on weight on the, I think my weight eventually went up to about twenty stone ten pounds.
Joan was getting ‘bigger and bigger’ and had limited mobility. She was becoming isolated from her friends.
It’s a lifestyle change but I’ve had to change my lifestyle dramatically from what I used to do.
In which ways?
I used to every winter go skiing. I would go hill walking in the summer. Loved walking. Can’t do any of that now. It’s an impossibility and I probably isolated myself from friends. The more restrictive or the less that I could do, the less I wanted folk to see me, you know.
Was that because you have put on weight or…?
I think it was a combination of both. One, because I could hardly walk, hardly move, and secondly, because I was getting bigger and bigger, you know, and I was, don’t get me wrong I had a few close friends that, ‘Look Joan, you know, what are you doing?’ and I was like, you know and I think over a period of time I spoke to my GP and I said, “Look could you just refer me to the weight management service,” and they was like, “okay,” you know. But I mean it took about six months for me to get assessed for that. It was a long period of time.
Joan’s eating habits suffered when she became the main carer for her sick mother.
I felt as if, for a year I felt I was like a hamster on a wheel, you know. I would get up, go to work. Finish work, go to my Mums. Come home, have a shower, wash my hair. Go to bed and it was, my mum never ate a great deal but what she did like was anything sweet, so it was, you would go into the supermarket and you’d look at that high calorie stuff for my mum. So you would go up there and I’d be like, “Do you want a wee bit of scrambled egg or try this or how..?” and it would be, “No, no, no, no, no.” Or it would be “Yeah that’ll be nice,” and you’d make her it and then you’d be lucky if she took a teaspoon of it and then it would go in the bin. But what I find is I was eating biscuits, I was maybe go in and having toast and a sandwich, you know, and it was all kind of ready made foods. Like I would get home here maybe half nine, quarter to ten at night, exhausted. Get to bed and be up at five the next morn.
Joan’s health ‘isn’t brilliant’ and she knows it could be much worse if she gains weight again. She fears she might end up unable to walk.
I can see myself, if I put on the weight that I’ve lost, ending up in a wheelchair not being able to walk and that scares me more than wanting to eat does [laughs].
Okay, that’s a big motivation.
That’s a huge motivation for me. My health isn’t brilliant, but it could be a lot worse and I know if I put on weight then I guess my biggest fear would be, ‘Would I be able to lose it again?’ and it’s taken a year and a half for me for lost what I’ve done. I think that would be insurmountable if I put on all the weight that I’d lost, you know specifically for me and the health problems that I have.
You cannot afford to put weight on.
Can’t afford it, no. I mean, yeah, I can put on a couple of pounds and that’s manageable, if you’re really good you can lose that. I would even say up to half a stone but over that you’re on the, you’re on the right slippery slope.
Joan has been eating more healthily for two years and thinks of it as a lifestyle change rather than a diet.
So what has helped for you to lose weight? Correct me…
I guess I’m not looking at it like I’m on a diet. I’m looking at it right, it’s a lifestyle change. I’m eating a lot more healthily now than what I did before.
Whereas before I used to be, sometimes if I hadn’t had anything to eat up at my mums, I would stop and have fish and chips and bring them home or I would get a carry out. I don’t do that now. I will still have a curry, but I make it myself. I use the spray fat instead of like oils. Haven’t had anything out of fish shop in maybe two year, yeah.
Joan talks about the physical benefits weight loss has had on her mobility.
First, first and foremost, I can move better now that I’ve lost. Don’t get me wrong, my walking is really limited. In the house, I’m not bad, it’s all on the flat. Going outside any gradient, you’re up hill or down hill causes me huge problems. Before I could really struggle to get into my car. Now I can probably walk to my car but when I get to my car I’m glad of a seat. What happens when I walk is my two legs feel as if they weigh tons and I find it hard to lift them up and move them and I get pain running mid back down the buttocks down my legs. On the left side it goes right down to the knee. On the right side, it just goes to the thigh. When I sit down the pain goes away. So I what I tend, how I started increasing the amount I walk is [street name] is a great place to walk because there’s lots of benches [laughs]. So I would start from where the disabled parking is to Costa. Have a seat and then I would walk to one bench, have a seat and then I walk to the other bench. Now it took me about three months, but I can, still stopping and starting but I can make it to [shopping centre] which was do you know, I thought, ‘Right, do you know what you’re going to do is one day get down to the front door there,’ which was great.
I started with the weight management doing chair exercises and I then go to a vitality class at the local gym which started on chair exercises but I’m now up to tone, it’s, you do maybe like a twenty minute warm up and it’s very gentle, it’s not and then it’s like there’s seven or eight stations that you do three minutes at and then I slow down, so I’m going to that once a week and that I think’s helping keeping me active. I’m also going to be moving flats, so I’ve had a lot of running about to do. But again, I’m really fortunate because my family and close friends have been really, really good, you know, but that’s probably the journey of the weight loss.
At work, Joan and her colleagues weighed themselves once a week and put money in a kitty to be shared out before Christmas.
When you started losing weight, was it gradual?
Yes, I had lost about three stones before anybody noticed. I: Okay. Because some of the guys in work went, “Have you lost weight?” and I was like that “Ay, I’ve lost a wee bit.’ And one of my other colleagues, “What do you mean, you’ve lost a wee bit. How much have you lost?” And I was like, “Nearly three stone.” And they’re like that, “Oh my God.” But what we used to do in work when I started losing weight was that we would, everybody would weigh themselves once a week and we all paid two pounds a week but rather than and, at Christ-, the week before Christmas you all got your money back [laughs]. So that went quite well, and it was just one girl who done it and it was only you that knew your weight and at the end of the time the used to ask, “So who’s lost the most weight this week?” “Oh, that’s a secret.” You know, so it was quite confidential, so that was quite good, that helped as well.
Joan was encouraged to lose weight by her rheumatologist who made it clear that if she carried on gaining weight she might become unable to walk.
Were the doctors or nurses suggesting that you ought to lose the weight, the extra weight?
Yep, especially the rheumatologist ,…….Yeah. …..you know, she kept saying, “That’s you put on another two kilos, Joan,” and I was like that, “I know.” And she had written to the GP to ask if they would discuss the weight management with me.
The GP didn’t. I brought it up and said, “I would like if you could refer me to the weight management at the Health Board,” and the GP was like that, “Good idea. Okay I’ll put the referral off for you.”
Okay. The rheumatology was the one that has been encouraging you and said, that, “losing weight has a very positive effect on your,..?”
Yes, what she said is, “If you continue to put on weight, I don’t know how long you’ll be on your feet,” so that was a really good motivation, you know, because I was really struggling with walking.
Okay and she was blunt?
She was, and do you know, I would rather as much as a lot of the truth hurts, I’m more perceptive to people who are completely up front with me rather than, ‘Oh well,” you know. Whereas she was like, you know, “You really need to lose weight. You’re not doing yourself any favours. It’s up to you. I’ve told you what my opinion is.”