I’m not sure what to do. I’m a morbidly obese 40 year old guy. Here are some stats to scare you.
5’6’’
237 pounds
Fairly thick build. Big chest and shoulders. Big quads. Most people who look at me are shocked that I weigh so much. They often assume I’m less than 200.
Almost all fat in belly and chest. I have no hip and ass fat. Maybe only a little on inside of thighs. Most of belly fat is below the abdominal muscle wall.
Waste is 44’ around belly button
Moderate body hair on chest and legs. Moderate facial hair. Little hair on arms and back.
I’ve put on about 60 pounds in the last 12 years. I always exercised sporadically. For the last year, I really dedicated to a work out routine under the direction of a personal trainer who works at the small gym at my work place. I usually get four, sometimes five workouts per week in the middle of the day. I do a 10 minute elliptical warm-up, go to super set pairs of upper and lower body exercises and then rest one minute. That takes about 35 minutes. Then I do another 20 minutes on the elliptical doing interval resistance. Then stretch during cool down. I keep my heart rate over 150 for a solid 60 to 70 minutes. For a fat guy, I’m really hustling. Every time they have a substitute trainer in the gym for the first time, the guy keeps coming up to me and checking to see if I can still hold down a conversation because he assumes I’m pushing too hard. I bought my first house last summer, so weekends are full of yard work (2 hours to mow the lawn) or shoveling snow (corner lot with sidewalks that have to be clear). I don’t feel like I’ve put on much muscle mass or burned any fat. I was around 240 when I went from completely sedentary to fairly active more than a year ago. Exercising seems to make little to no difference compared to no physical activity at all.
So five months ago, I decided to really get my diet together. I went on a whole-foods based diet and started eating healthier in general. I eat four or five small meals during the day, usually about 300 to 500 calories each. Greek yogurt, organic, non-GMO granola, raw almonds, fresh fruits and vegetables, frozen fruit and vegetables, whey protein powder, grilled chicken, grilled salmon, canned tuna in water, lots of kale and tomatoes and organic bananas. I average about 1800 calories a day. I usually have two or three cheat meals a week. Not a whole cheat day, just a cheat meal. I’ll sometimes go out for a lunch just to get out of the office. Those meals are somewhere in the 800-1200 calorie range. But I get right back on the horse with the next meal, and usually compensate by eating less. Days with cheat meals are maybe in the 2500 calorie range, and occur 2 or three days a week. Again, not much difference as when I ate whatever I wanted, which, admittedly was pretty bad. I saw a dietician who didn’t recommend anything other than getting a few more calories from complex carbs and less from protein. I disagreed, as my family has a history of type 2 diabetes and I’m always worried about insulin resistance. The upshot is that she thought I was pretty much doing everything right.
So, basically, I have a personal trainer and a dietician who have no idea why I’m so fat. So I talked to my PC and got a referral to an Endo.
I’ve known for six years that my triglyceride levels were very high (near 400). So my diet clearly sucked before. I had to go on Tricor for that, and it’s down to around 200 after two months. Up until the last couple of months, my blood pressure and cholesterol levels were good. Two months ago, my BP started averaging 150/85. I’m on meds for that now. My cholesterol also just got slightly high, and my ratio a little off. Nothing terrible, but I’m on meds for that. I’ve had problems with depression, aggression and anxiety for years. I’ve been on either Celexa or Lexapro for 12 years (when I started putting on weight). I’ve weened mostly off of that and I’m down to 10 mg a day of Celexa, which is barely clinical. Without it, I tend to have two good panic attacks a month. I’ve switched to 300 mg per day of Welbutrin, which is supposedly more friendly to losing weight. It’s definitely improved my mood, and it hits me kind of speedy. I’ve got more energy and feel quite a bit more motivated since I made the switch in January. It could also be the reason behind the BP increase.
So I went to see and Endo and requested a Thyroid panel, Vitamin D, Cortisol, Testosterone and anything else they could think of. The only thing they came back with was low total T at 320 and low free T (not sure). I’ve been told SHBG was also tested okay, but I don’t know the numbers. No test for E2. I’ve never considered T as a problem. I’ve never had an erectile problem, although my libido is shot. I always assumed it was mental because I feel and look like shit. The Endo got me on 2 pumps of Androgel 1.62 that day. That was two weeks ago.
Since then, I’ve been reading about HRT. I think it may be responsible for my inability to lose weight, but I’m not sure. Some of it fits. But what concerns me is how the Endo is handling it. He’s not seeing me until I’ve been on Androgel for 10 weeks. When he does, he’s not testing E2 or free T (both of which were never tested). I called him and asked that these be added to my panel for my next visit. He wouldn’t do it. I asked him if he would prescribe injectable T, AIs or HCG. He said no. I don’t trust this guy at all. In the fifteen minutes I was in his office, two Pharma reps showed up with big bags of samples. As soon as I came out of his office, there was a commercial for Androgel 1.62 on the TV in the waiting room. I’ve seen a bunch commercials since. I’m concerned that this guy is just pushing the Androgel to get a free trip to Hawaii from his friendly Pharma rep. He never asked if I was planning on having kids in the future. He just put me on Androgel and will test total T to see if the amount is good.
So here I am. I’m out of ideas. I know my diet and exercise routine aren’t perfect. But I truly believe there is no reason for me to be this fat. Furthermore, I’ve done enough research to know that a better diet and exercise makes no difference in my BMI when compared to eating shit all day and laying on the couch. What in the hell is going on?