Maxine Mary has a condition called joint hypermobility syndrome that affects all her joints, including hips, ankles and knees. Maxine Mary was diagnosed with arthritis in all her joints and had hip replacement surgery and is waiting to have her knees repaired. Her main motivation to lose weight is her health and in the last twelve months she has lost three stone. She attributes it to life style changes rather than dieting.
Maxine Mary works part-time as a teacher. She lives with partner and has two grown-up children. Mixed ethnic background
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All through her adult life Maxine Mary weight has fluctuated, and there have been times when she has both lost and gained weight but she was also doing lots of physical activities: she was a keep fit and yoga instructor, practice several sports and was a dancer. Maxine Mary has a condition called joint hypermobility syndrome that affects all her joints, including hips, ankles and knees. Maxine Mary has also been diagnosed with arthritis in all her joints and has had hip replacement surgery and is waiting to have her knees repaired. She says that in the last ten years, her weight issues have worsened due to the effect of her conditions on her mobility and the regular steroid injections that are part of her treatment.
Maxine Mary diet has significantly changed in the last twelve months. She started, or at least tries to cut out carbohydrates from her diet and replaces it with protein. At the start of her new eating pattern her weight was eighteen stone and so far she has lost three stone. Her weight target is twelve stone so she would like to lose a total of six stone. She recently noticed that she had stalled and was no losing any weight. So she is adjusting her diet and is becoming stricter about avoiding food containing carbohydrates.
Maxine Mary is following the Keto way of eating. She says that she is learning how it works and has joined a couple of online support groups for guidance: the Kick the Carbs and Keto Eating groups. She prefers online support rather than public groups. Since she joined these groups she has started losing weight again; about two pounds per week. She feels that she doesn’t need to eat a lot of food in order to get by and get all the nutrients her body needs.
Maxine Mary feels that her weight loss is the result of a lifestyle change that includes a different diet, eating smaller portion and giving up sugar and alcohol. In the past, she thought of diets as a short-term solution and tried many and also took recommended drugs and pills in her effort to lose weight. Some of these behaviours were effective in the short term, but she would put the weight back again as soon as she stopped doing them.
Her main motivation to lose weight has been to improve her health. She is due to undergo a long surgery to repair both her knees and this has definitely been the spur for her decision to change what and how much she was eating. Since she lost three stone, she feels much lighter and fitter and has less pressure on her joints. She is, however, still in pain and her mobility hasn’t improved.
Maxine Mary feels that the NHS has been ‘wonderful’. Her GP discussed her weight issue with her and referred her to a district nurse who saw her regularly and provided information and guidance about adopting a healthier eating pattern. Before being provided with weight management support, she thought that the only solution was to have bariatric surgery. Now she feels happy to be able to lose weight in a less drastic way
Maxine says that it would be wonderful if she ‘could actually walk without pain’.
Yeah that would be good wouldn’t it. If I could actually walk without pain would be wonderful. But then you know, my ankle is playing me up and my feet are in a really bad state. So it’s not just these joints. It’s all of my joints: fingers elbow, wrists, shoulders. You know, all of my joints are completely wrecked.
I was just really, really heavy and my joints were beginning to fail. You know I had catastrophic failure in one joint on my hip. And eventually went and had it replaced, hip replacement because I really had to. I was actually in a wheelchair by the time I had it replaced. So there was no choice.
I was I couldn’t walk at all. And if we were going anywhere we took a wheelchair with us. And my husband would push me around shops and things like that. I could get in, I could walk to the car, so yeah.
And that was it?
That was it really, yeah.
Maxine Mary describes the emotional dimension of her overeating: “I get off the phone from my mother and I’ve got my head in the fridge”.
And I have to be really careful on portion size and how much food I eat in a day.
How easy? How difficult is that?
It’s extremely difficult. It, because it’s like [ah, pause] there’s also an emotional component to this. Echoes of my childhood come back to me and the neglect, abuse that I suffered. And, you know, I’ve found my. I get off the phone from my mother and I’ve got my head in the fridge. And I’m thinking, “What am I doing? Why am I doing this?”
So I know that there is an emotional aspect to my overeating. It’s not just physical. It’s, it’s also an emotional thing that I find it quite hard sometimes to recognise although I am getting better at it. But, you know, bad times.
Maxine Mary notes that being overweight and poverty are closely related.
People like to label and yeah they make assumptions about people by their appearance. So if you are overweight they think you’re a, lazy and even I think there is a socio-economic because thin people are very rich usually and poor people tend to eat a lot of carbohydrates and they get very fat. And they are very depressed. It’s not fun being fat is it. It’s not being fun being poor either. So I, I don’t know. I don’t know whether you think that’s reasonable but I find the two go together, a poor diet and, and, you know, not having much money and obesity.
Maxine Mary was unhappy and often hungry as a child.
I was compensating I think with overeating for my, for my, how can you put it, my unhappiness. My mother made me very unhappy. She was not particularly a loving, caring mother although she had loads of kids. She had 6 children She wasn’t. She didn’t like children. She didn’t like any of us, I don’t think or she had her favourite but she, you know. She treated us all pretty, pretty badly but that’s because she was treated really badly too. And I, I realise this and, you know, every. I also believe that every mother does her best even if the best was pretty shoddy it was still her best at the time that she could do because she had a difficult life too. So, you know I’m not angry at her but it was really difficult for me to recognise that the emotion was, where it was coming from for a long time. And I needed somebody to help me see clearly that I was trying to make myself happier by eating. And in fact I wasn’t. I was making myself more unhappy because I was gaining weight and it was, I was on a slippery slope, a vicious circle as they say of overeating, becoming depressed and dealing with my elderly parents and their illnesses and which I found really difficult to do.
Actually staying the same weight has been virtually impossible for me in my adult life. I, I was a very malnourished child, actually very thin. I was hungry quite a lot because I was on my own and mother was away working. Father was away working and I had to look after myself. This is, this is really young child, 6 or 7. As a teacher now I realise that that was neglect abuse. So I was very, very hungry as a child. I remember being hungry a lot. And I was very thin. Then when I got older and I was able to provide food for myself. I was able to go and get it and I put on weight. As soon as I was 13 or 14 I got really fat but then I lost it.
Maxine Mary loved bread but had managed to get used to low-carbohydrate diet.
No it’s not, not for me because I love bread. I could easily live off bread totally. So I just had to change, change the things I have. For breakfast I would always have toast and for lunch I would have a sandwich [ha]. And for dinner I would have potatoes, I love potatoes. But now I don’t. I have a small amount of oats for breakfast and for lunch I will have some soup or today I made some curry that I had in the freezer, a little, small amount of curry but without rice. And you kind of get used to it. You get used to not eating the carbohydrates. And if I have dinner, a typical dinner for me would be a small amount of steak or meat like chicken or, or something and broccoli and Brussel sprouts. If I’m going to have a potato-ish product it will be a sweet potato or yam or parsnip or something like that. But yeah it’s like that old saying my dad used to say it years and years ago. If you want to lose weight ditch the bread and the spuds. Who knew he was going to be right. We’ve gone full circle.
Maxine Mary describes the many ways she tried to lose weight, including orlistat (Xenical). The diets worked but only in the short term.
And when the doctors told you, you are overweight or your body mass index is too high did they suggest anything? Did they suggest you do something to lose weight or?
Yes I’ve been prescribed things in the past. I’ve been prescribed diet replacement, food replacement thing that you bought every week. And they’d come back and see if you’d gone into ketosis. That didn’t work, just made me very ill. So and then I had a drug that I think it was called Xenical that shifted the fat or something but that just made me smell so bad I couldn’t stand myself. It just, I could smell it in my skin and everything and it was horrible. What else did I have? Oh I had diet pills when I lived in the States. I was prescribed amphetamines to lose weight. Very effective in the short term but, you know, you just put it straight back on again as soon as you stop taking them. It’s like whoosh there it goes and more. I’ve been to Weight Watchers. I’ve been to Slimming World. Just about every diet going. The Cambridge Diet, The Atkins Diet, the Grapefruit Diet, The Cabbage Diet.
Why do you think? I suppose these diets in the short term made you lose some weight or no? Some of them have worked?
Yes some of them work. What all of them work actually in the short term.
Why do you think they didn’t work in the long term? What was missing or what was happening in your life?
I think because I approached it as a diet. And, you know, I’m going on a diet until I lose this much weight. Then I’m going to stop being on a diet and eat normally.
Maxine Mary did not like being weighed in public as part of weight management programmes.
So for you things like Weight Watchers programme didn’t work because you didn’t like this kind of public exposure, to be weighed in public and things like that?
Absolutely, absolutely [ha ha]. Yeah no the getting weighed in public. What’s that all about? I just
How long were you doing this programme?
Oh I’ve done Weight Watchers many times. I learnt, I actually learnt how to cheat at Weight Watchers as well. I, [laugh] I learnt pretty early on that if you, if you reach a target weight you don’t have to pay anymore. So on the first weigh in because I’ve joined Weight Watchers many times and, and left again. But on the first weigh in you just put a load of rocks in your pocket. And then the next week [chuckle] and then you soon learn, you soon reach your target weight and you don’t have to pay anymore. Because it’s expensive, you know, just to be weighed and to be humiliated or clapped even if you’ve lost 2 pounds, even that’s humiliating. It’s degrading. So yeah that didn’t work for me, Weight Watchers didn’t work. And also Slimming World that didn’t work for me either. Couldn’t get my head around it how you just eat red one day or green the next day or something. So yeah just smaller portions and leave out the bad stuff like alcohol and…
Although she knows what to do to maintain her lower weight, Maxine Mary finds it a constant battle, made harder by her arthritic problems.
I am still seeking advice all the time because I know it’s going to be an on-going thing for the rest of my life. I used to smoke years ago. And I know I’m only a one pack away even though I stopped smoking 30 years ago I know I’m only one pack away from being a smoker again. If I was ever to take it up it wold be really easy. And it’s kind of like that with weight loss. It’s going to be a battle all your life. If you’ve, if you’ve put on weight at any time in your life. I feel like I am on a huge piece of elastic, you know, and the more weight I lose the tighter and tighter the elastic is pulled and then all I’ve got to do is have one portion of fish and chips and I’m bang. And I’m right back there again. The elastic pulls me back in. And I will be 20 stone next time I look, you know. It, it’s an on-going thing. It’s an on-going battle especially as I get more and more sedentary as I get older with my arthritic problems.
Ok. So how do you feel about weight management now? I mean after having all this experience. So you feel that you know what to do in terms of how to maintain the weight or how to carry on losing weight?
Oh yeah I know what to do alright. I know what I should do but, you know, knowing what you should do and doing what you should do can be very difficult especially if you have an emotional problem that can trigger over eating as a way of comforting yourself. Whoa that is a big one to overcome. I mean I’m not uneducated. I know. I know about overloading the system. My Batchelor’s degree was actually in agriculture so I know how to feed pigs so they get lean weight mass put on instead of just fat. You, you feed them small portions 6 or 7 times a day rather than one big portion because then it will all go to fat. And the British housewife does not like fat in her bacon. She likes lean meat in her pork and bacon. So that. I, I know what I am doing wrong. I know what I should be doing but actually having the will power, the to do it is really difficult. I think explaining that to somebody who has never had a weight problem. They say, “Well just eat carrots. Just buy a bag of carrots.” Yeah.
Maxine Mary’s GP suggested she see the nurse every week to get weighed and receive support. This helped her lose weight.
No. So talking to the GP she said, Well go and see the district nurse every week and get weighed. So this is what I did. And I, you know, I felt kind of guilty going to see the nurse because I’m relatively healthy and this lovely nurse was giving her time just to me. And she was weighing me and we were talking about diet and what I had had this week and what I think I’d done wrong. And it definitely helped and it got me through to the next level, you know, tick. So now I am Level 3. So if you want to go ahead and get bariatric surgery you’ve reached that point. But then I thought, “Nah, it’s not for me. I can’t do this to my body.” So here I am. Twelve months after I changed my eating habits I got rid of alcohol. I got rid of carbohydrates and I reduced my food, my portions. I haven’t really upped my activity because I find it really difficult to, do anything. I mean I can’t even walk. So that’s really. I can’t really walk more than a few yards.
For Maxine Mary, who had felt out of control with her weight, the crucial thing was understanding the root causes and seeking help.
So based on your own experience do you think that one of the messages to other people who are trying to lose weight, who are overweight or obese would be to try to understand or to give answers to the why they are overeating?
Yes definitely. I think it you can get to the bottom of the reason why, why you are seeking to fill this hole in your soul with [ha] pasta, [laugh] Just recognising that certain triggers will lead you to self-destruct. is really crucial, a crucial part of this I really do.
Is understanding that bit isn’t it?
I think so. I think it is understanding that. I mean nobody want to be fat, nobody. And for a lot of people they feel out of control. I certainly did. It was beyond my control. So I would say get help. Get every kind of help you can. Take every bit of help that’s available to you. Go for psychiatric counselling. Go for [ah] physical help from your doctor, dietary help from a group of people. I hate that Weight Watchers where you get weighed. I hate that in public. So I would. So my groups are online. And they are anonymous. The people are living in the States most of them. So I know I will never meet them but it’s good honest advice from them how they’ve coped. So yeah take all the advice and help you can get because it’s difficult.
What would you advise people based on your own experience?
What do you think is important for them to…?
Well you know, what I would say, “Get some counselling if you can.” Get support from a trained person because you don’t, you don’t really want to expose yourself if you are vulnerable. Psychologically if you’re in a difficult space in your life you don’t want to be exposed to anybody who is not really professional in what they are saying. And somebody who can give you good advice and find out the root cause and help you to love yourself again. Because a lot of overeating is self-harm. And so yeah that’s what I would say. I’d try, I’d say try, try and get the root cause of this sorted, sorted out.