Overweight (high BMI) and Treating...

I'm 1 month post treatment with SOC.

What is so wrong about people with a high BMI being encouraged to try treatment? If it doesn't work by 4 or 12 weeks they can just stop the way any other treater can stop. Why can't we be encouraged too? The reason I'm putting this out there is because I don't feel that there is a whole lot of support for the individuals who have a high BMI and are thinking of treating. In fact I've seen them discouraged!

[nygirl7]

Isn't this the same thread as before again?

Nobody isn't hoping that you do not succed - quite the opposite in fact everyone hopes to God that you SVR but pretending that the data says it's OK to be obese and do treatment = same or better odds is just not true.

The FACTS are the FACTS.  Just like I knew not being clear by week 12 gave me harder odds - I accepted it and did what I had to do.  but nobody ever pretended that my odds were similar or better than a regular geno1 at all and neither did I.

However I knew people were hoping even harder for me to succeed so it filled the gap.  Still it was a difficult decision knowing that my odds were worse and one I had to make on my own, for myself.  Just as you did.  But nobody didn't encourage me just because my odds were higher for failure and thats what you are implying.  

Negative predictors are just a part of the equation the rest rests on faith and determination.

[m_strings]

NOT supportive, NYGirl.  The truth is, people with higher BMI are NOT supported here because they are not encouraged to seek tx.  They are told to "take a walk around the block".  Look at your response.  Kathy was asking for support in this thread.  The FACTS ARE the facts.  The fact is, high BMI is NOT going to negatively affect her.  It appears people want to keep telling her how it should.  I'm always amazed at how many people respond by shoving useless data in her face that doesn't pertain to her.  Don't you hear what she is asking for?  SUPPORT!  Those who want to continue to post negative data about high bmi and tx, start a new thread.  That's okay.  And I promise not to be one of those people who responds to others on TX by repeatedly telling them how the data stacks up against them.  

[Kathy73]

I don't remember saying anyone hopes I don't succeed. In fact the thought that people here are against my success never occurred to me. And I never said it was ok to be obese and treat meaning it is equal or higher. I did say though that I don't think people should be discouraged from treating. I don't think I implying anything. I'm making a statement that if people want to try treatment, even if they have a high BMI, they should be encouraged.

I have respect for your preserverance during treatment. I think it took determination and guts to go the whole 72 weeks. I'm not putting you down. Why do you feel its ok to put me down.

[dabdees]

Kathy,

No one is trying to dash any one's hopes here.  If someone starts treatment with a high BMI, so be it.  It is a personal choice and to my knowledge there are no studies supporting a high BMI is a positive predictor.  The message is beware, look at the data that is presented and make a choice according to your own convictions.  That isn't discouraging people, it's giving them the opportunity to take a long hard look at themselves and the data and what they are comfortable with.
Cutting edge specialists and researchers from around the world have all concluded the same thing about high BMI and treatment so it's not a matter of validation if a person chooses to start treatment with a high BMI.
When the facts are given and the patient chooses to treat regardless of negative predictors it's irrelevant at that point.  It's up to the individual to encourage themselves whether others agree or disagree.

[Kathy73]

I thought it was the med"help"'s objective to encourage and disseminate information. That is certainly why I came on here. To get information, advice and support. To take that information and advice, correlate it with my doctor's advice and make my own decision. After making that decision to seek support here and elsewhere.

I never said BMI is a positive predicator.

[m_strings]

What?

[jdwithhcv]

I think in general the members of this forum encourage every member regarding their treatment.  I have not seen any particular group singled out for specific support (or non-support) whatever their diversity.  I suppose nobody comes on to specifically encourage persons with high BMI but neither does anybody come on to specifically encourage persons with (for instance) nicotine addiction.  

[m_strings]

That would be ideal.  But we are all categorized in one way or another, be it by genotype, or stage of liver failure, bmi, etc.  If someone identifies themselves as being in a specific category, and people continue to bring up useless information to them based on that category, we have now moved into the realm of talking about specific "groups" of people.  Referring to negative studies about tx outcome for a specific "group" (High BMI for example) in a thread where someone is requesting support is not supportive.  I hope this information is useful.  

[jdwithhcv]

I believe clinical studies and the resulting information are useful, even when the information flies in the face of what we wish to believe.  You are entitled to your opinion, of course, but in my opinion facts are important, even unpalatable ones.

[m_strings]

Does it occur to you that Kathy's facts may be so hard for you to digest?  Why are they so unpalatable to you?  

[m_strings]

The problem with scientific research is that it gets into the hands of the uneducated who make broad and misinformed assumptions about what the data means.  Just my opinion.  I'm going to duck and cover now.  :>)  TTYL!  Off to work on a clinical research project.  Good luck to all you who are treating and/or considering treatment.  

[FlGuy]

I guess that I will never consider Geno 1 as a difficult genotype to treat.  It's puts all people with Geno 1 in a negative category.  So, to all those with Geno 1 and cirrhosis, congratulations - it must be a very happy day for you.
Geesh.

[merryBe]

I have the same problem and you are right, I was told from the get go by my clinic I had less chance of success due to this.

What they did not tell me was WHY.

I would strongly suggest you look at the possibilty that metabolic syndromes, endocrine deficiency, diebetes (diabetes) etc play a part in treatment due to the effect they have on tissue repair, overall organ/gland response to chemo, and higher blood sugar levels affecting the amount of Interferon in the system and it's and abiltity to do it's job at reduced levels due to body chemistry.

The person who first clued me as to WHY of all this is so was Cowriter...see her journals.

http://www.medhelp.org/personal_pages/user/568322

the bottom line is that even mild insulin resistance (type 2 diebetes (diabetes)), even a fasting glucose that is say 10 or 20 points above normal, can reduce the chances of a cure by 10% or more. Since many with mild IR don't treat for it, this lowers the chances of the group. This is because higher blood sugar means insulin resistance, means more insulin is produced to compensate, and insulin interferes with Interferon.
The higher the untreated IR, the lower the cure rate. Same with Type 1, because then you are introducing injectable insulin to compensate for not enough, and again insulin interferes.
I'd strongly suggest you see an endocrinologist to see if your glands are still working, most of mine were not and varied from 50 down to 20% of normal output. Correct for these conditions first and it will be easier to take weight off, as well as give you a greater chance of treating successfully.

mb

[m_strings]

MerryBe: It's good to be educated about IR, but I'm curious as to why you assume Kathy may have IR?  

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
And I have to add something I found on another website, just because:

Doctor: "I’ve got your test results and some bad news. You have Hep C and Alzheimer’s."

Patient: "Boy, am I lucky! I was afraid I had Hep C!"
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

(Okay, now I'm getting back to work.  I mean it this time.)

[Kathy73]

So nice to see you on the forum again. I've missed you and your wealth of knowledge and information. I have been and continue to be checked and I'm not insulin resistent nor do I have diabetes. I had my yearly physical this morning and I have lost 49 lbs since last year at this time. I told the doctor its the Hep C diet since that was the only good side effect while I was on tx.
I just finished SOC a month ago and so far so good as far as UND.

[copyman]

I don't think New york girl meant anything by her post. She was just stating the facts! She does nothing but support people on this forum. No one is knocking fat people here.
Actually many doctors will not treat someone obese until they lose weight. Besides hurting your chances of clearing the virus it can be especially dangerous to a heavier person, heart problem, blood pressure, etc. Several studies show that a lower BMI is one of the main factors in acheiving SVR.  if i was overweight the only way I would treat is lose weight or if absolutely necessary take weight based ribavirin. There have been some obese people on this forum that have taken as much as 2000 mg of ribavirin and still did not clear.

[Rockerforlife]

Its best to have you BMI at the normal range before you attempt to TX...simple as that.

[Marcia2202]

Ron, if I remember correctly you were in that position and if I'm not mistaken you lost a whole lot of weight before you started tx.

[Marcia2202]

I still believe the best scenario would be to try take care of any negative predictors before starting tx, whatever they are.

Personally I worked on putting on some weight before starting tx, because I was afraid to become too skinny and weak. Thank God I was able to put on about 4 kilos, because I did loose too much weight. Also I had low iron and low hgb. I wanted to be as healthy before starting tx and I worked on getting that up too.

I don't think it is about encouraging or not encouraging people to do treatment. People here want to encourage people to treat with the possibility of the best outcome.

It is sad when people treat and don't make it. For the people who treat and for everyone else watching. It is heart breaking and that why people want to give good advice.

[Kathy73]

While I'm sure some studies have shown what you state, I'm stating that I treated, I was obese and did not suffer from terrible blood pressure or heart problems. I cleared at 12 weeks and remain UND at one month post. I'm sure some people who weren't obese treated and didn't clear too! You seem to me to be pretty judgmental and I'm not sure why. I never picked on anyone on this thread, but I feel that some of these reponses are becomming judgmental and critical. I thought we were supposed to learn from other people and their experiences. Some of you seem not only not to want to credit my experiences, but want to diminish them.

[Trish77]

Kathy, what you did was beat the odds.  Your story is an encouragement that not everyone with high BMI will fail treatment, will have high blood pressure, etc. That does not mean that people with high BMI should not be told about the challenges they can potentially face when they start treatment.  My docs asked me if I was ready for a year of hell before I started treatment.  They asked me that because they knew it was a *possibility* that it could be a year of hell and they wanted me going into treatment with my eyes wide open. They wanted me to understand the potential challenges I would face and be mentally prepared for that.  I have seen too many stories here of people who are weeks or a couple months into treatment wondering what the heck hit them because they were poorly prepared by their medical team.  People with high BMI are supported here but they are also told the truth about their challenges, same as people who are African American, have low platelets, have cirrhosis, are later stage liver damage, older or younger and it goes on and on.  That means they will potentially increase their ribavirin accordingly or be monitored more closely, etc. etc.

It would be a disservice to tell people with high BMI that they do not need to concern themselves with the challenges of being high BMI because of how things went with you, agreed?  It gives hope to those who decide to treat in spite of the challenges that it can be done - same as it gives hope to those who MUST stop treatment early to know that there are others who stopped treatment early but SVR'd regardless.  That does not mean that it then is okay for everyone to stop treatment early because it turned out okay for some people.

I think you are possibly confusing talking in realities with not being supportive. My hepatologists told me to try to lose 20 pounds before I started treatment.  They knew I was going to treat regardless but they still told me what would give me better odds.  It's vitally important that we talk in realities here.  When someone comes on this board still in the consideration stage or haven't started treatment yet, you will often see posts that contain truths about what their challenges are.  We want to ensure people have all the information they need before they start treatment.  Once they've started or have absolutely finalized that decision, then we're with them 100%.  Just the same, you will still not find too much candycoating here as people go through their treatment either.  These drugs are too harsh and the outcome is too important to do anything other than talk in realities and truth.  People can tailor their treatment and be more diligent if they know *exactly* what their potential challenges are.

I didn't even know you WERE high BMI and I have been around more or less for pretty much your whole treatment - I'm not sure what was said to you that you didn't feel supported and, again, I'm wondering taking people speaking in realities as not being encouraging?

[Kathy73]

I agree it is vitally important to speak in realities. I'm a reality too. I'm very aware of the trials and tribulations of treating. I went through treatment for 47 weeks. I agree that people making the choice of treatment should have as much information as possible before making that decision. That is why I researched and also came here to get information. But just because I beat the odds doesn't mean that I am unique. I'm sure there are plenty of people out there afflicted with Hep C who can beat those odds too. I am not stating that I (me) was not supported. This forum has been wonderful to me. What I am saying and repeatedly, is that we are individuals and our reactions to SOC are as individuals. You can put everything in a box such as predicators, studies and odds and if you follow the rules perhaps you'll be safe, but I'm outside the box and I seem to make individuals uncomfortable with my suggestions. Once again, I ask why can't someone who is overweight, not insulin resistent and in good health other than Hep C treat?

[Rockerforlife]

I WAS 235 lbs at one point.i went down to 200 just before i started TX,im not fat at 200,im just big boned...all my family are huge,must be the Viking in me.My brother has a chest as wide as a stove

[Marcia2202]

"Once again, I ask why can't someone who is overweight, not insulin resistent and in good health other than Hep C treat?"

I don't see anyone saying this Kathy... People are suggesting that one address the problem of overweight, before starting treatment. The reason people are suggesting this is that according to research, studies, knowledgeable doctors/experts who have treated thousands of patients, one will have a much better chance of achieving SVR.

[Willy50]

I think you provide a service to people with high BMI.  It's good to know that it can be done and you no doubt provide some hope for people.

Still.....

I think that the people who post and answer the thread are also attempting to provide some help for people with high BMI.  Information is power.

By providing some info and data it can help people seek corrections which could improve their chances of clearing.  Surely that should be considered support.

Some people only have so many chances to treat.  *Might* some information and data on response help people either attempt to lose weight, check into metformin, review with their doctor to make sure that the doctor is up to speed on the odds and dosing? (sadly, not all are)

Unfortunately once one has started TX it is difficult to make mid course corrections, either in adding IR drugs, losing weight, embarking on exercise or shopping for a more informed doctor.  For people who breakthrough or relapse they may have spent months of TX, at great expense (emotional, financial, possible physical detriment).
I'm not sure that it's any easier for null responders or slow responders.

Embarking on TX sometimes seems to me to be as big a decision as buying a car or buying a house.  It may be even more important and it's impact further reaching. Maybe it's up there with marriage.  ; )

What harm in having all the information available before one decides?

Your intention is to help and you do.  The people who have provided some feedback also have the same intentions as you; they want to help.  
I consider it help.

All information and experience is good IMHO.  It's why bulletins boards help those who use them.

.....my 2 cents

Willy

[Kathy73]

I agree with everything you say as far as having as much information as possible. I also tried to inform myself both elsewhere, from my doctors (2 hepatologists), research and here before making my decision. I have never said that the people here providing feedback aren't trying to be helpful. I know they are. I find no bad intent here towards me or anyone else. The only reason I'm posting this is because I do want to help. I feel that my experience is valuable, perhaps not to most, but certainly to others like me. And I want to reach out to those people and that is what I am trying to do. Some people find it very difficult to lose weight. I am not going to judge them, but I am going to try to help them. If people feel that they are not welcome because of real or perceived body image they will retreat into themselves and that is not right or supportive.

[copyman]

Lighten up and be happy that you finished and were clear one month post. There is no need for all this nonsense about people on this forum not encourging fat people. This forum provides "OPINIONS" from its members. Many times these "opinions" are backed up with study data.  I'm sorry if you are obese but that has no business here. If anything this should be discussed on the HCV social forum !

And please keep in mind that you have not "beat the odds" yet.  You have not SVR'd yet so I would not get up on that high horse just yet. Everyone is different but I actually like the approach of being humble and grateful of the support offered on this forum. Not to post how members are insensitive to fat people. That is just wrong.
I will continue to tell overweight people to lose weight before treating and will provide them with links to studies that back it up. Bottom line is treatment is a personal decision that someone has to make on their own. NOT what is said on an internet forum!
Good luck

[m_strings]

Re: ""Once again, I ask why can't someone who is overweight, not insulin resistant and in good health other than Hep C treat?"  I don't see anyone saying this Kathy... People are suggesting that one address the problem of overweight, before starting treatment."

Being overweight is NOT a problem for some people who are treating.  
Let me repeat that, because it is not being heard:  
Being overweight is not a problem for some people who are treating.  
One more time:  
Being overweight is NOT a problem for some people who are treating.  
Does anybody out there here that???  Can anyone respond that they've heard that message without adding a "yes, but..." disclaimer??  It's hard to do, folks.  It takes a whole bunch of maturity and understanding.  

Here's another one:
Being overweight does NOT mean that person is unhealthy or has IR.
Being overweight does NOT mean that person is unhealthy or has IR.
Being overweight does NOT mean that person is unhealthy or has IR.

Stop the stereotypes people!  Stop making ignorant assumptions.  You are being really offensive.  I am overweight.  I have a high BMI.  I do NOT have diabetes.  I am NOT insulin resistant.  I do NOT have high cholesterol.  My hepatologists have encouraged me to treat and have NOT indicated that weight is an issue.  I AM offended by reading posts by people who just don't get it.  Kathy does NOT have diabetes and she is NOT IR.  She sees medical experts so please stop trying to give her medical advice.  Some people are trying to practice here w/out a license. I don't think people should respond so adamantly about studies unless they've taken at least three courses on statistics and research and how to interpret the literature.  Their lack of knowledge is clear.  I'm sorry that this will come across as offensive to some, but I don't know how else to state it.    

I've heard many "yes, butt" statements on this thread.  Shame of those of you who just couldn't be supportive.  How sad.  Give me a break.  No wonder I've heard from several people that have decided to leave this forum.  They do not feel it's safe here nor do they feel supported.  If you really want to be supportive of someone, you will ask that person what it means to feel supported, instead of cramming down their throats what you think they need.  

Sigh,...  

[jdwithhcv]

I don't think the problem is that you are not being heard.  The problem is that people disagree with you.  Being overweight does mean that a person is unhealthy.  Further, you are not the only person here with an education, and to imply that we are incapable of understanding someone of your supposed intellect is offensive.  You have stated your opinion.  People have disagreed with your assertions.  Such is the nature of discussion.

Consider the possibility that you are projecting your own issues onto others here.  You can repeat your arguments all you wish, but the members here are capable of drawing their own conclusions, however deficient you may assume our educations to be.

As for cramming down peoples' throats what you think, that appears to be what you are attempting to do.

[m_strings]

"Being overweight does mean that a person is unhealthy."

Wow.  You must know more than my current doctor, previous doctor, and last two hepatologist, because they all would disagree w/you.  All stated in one way or another that I am a very healthy person, other than having Hep C.  Glad to hear such incredible wisdom and intellect exists on this thread.    

[m_strings]

Oops:  Meant to say "last two hepatologists" (plural).  

"Consider the possibility that you are projecting your own issues onto others here."  Do you think that might also be what's happening w/you?  Would you be willing to put your defenses aside to at least consider that possibility?  

"...to imply that we are incapable of understanding someone of your supposed intellect is offensive"  Okay, whatever I said must certainly have come across offensive if that's how it was received.  Boy, I most certainly did not intend that to be the message and I do apologize.  I reacted out of frustration.  Perhaps the reality is that I feel others are acting on a level of intellect alone and forgetting to keep in touch with the basic human quality that is so intrinsic to mental, spiritual, physical, AND intellectual health.  Perhaps I was wrong - I hope so.  I was frustrated at not being heard on a very basic and simplistic level.  I also was trying to support Kathy as I don't believe she was supported.  Yes, some people disagree w/me.  Others agree w/me.  Doesn't matter who agrees w/whom.  My experience is what it is.  It's my reality and my truth.  Kathy's experience is what it is. It is her reality and her truth.  No scientific research will be able to refute that.  

No cramming down throats here.  I came in support of the original poster.  And you???

[m_strings]

Food for thought: "What we look like on the outside doesn't matter as much as what's going on in the inside."  People w/high BMI are not necessarily at increased health risk.  Don't discount the message b/c you don't like the messenger.  Just reporting the facts.  Resource: http://www.medicinenet.com/script/main/art.asp?articlekey=91817

[comeagain]

What is the real issue (message) here??

I can imagen many people how suffers from overweight has been treated real bad ever since childhood because of that.

I also can imagen in due to that, you who are overweighted could use a little exra encouragement because you have been patronized maybe all your life.

If thats the message I can buy it that specially since I know touchy most of us can get on the meds.

I also know how very difficult it is to lose weight and I can imagen you have tryed that
time after time and failed.

So Kathy if you were UND at a test made 4 weeks post and your not stage 4
I would say your almost there congrats.

ca

[comeagain]

I rewrite one sentence so bad written!

If thats the message I can buy it , specially since I know how touchy most of us can get on the meds.

[Trish77]

"Once again, I ask why can't someone who is overweight, not insulin resistent and in good health other than Hep C treat? "

I haven't seen anyone saying that someone who is overweight cannot treat.  There are ALOT of overweight people treating on this forum.  The thing is, these drugs are pretty brutal and can be.  So I suppose the approach is taken to give it the best shot you can the first time out in hopes that you don't have to do it again.  It is responsible for us to tell the truth and say that best case scenario is to lose weight if you can and to be honest that, statistically, chances are improved if a person's BMI is at a "normal" level and it's also responsible for us to discuss what challenges someone faces or what strategies they'd need to implement if they choose to go ahead with treatment, to mitigate the known risks - higher ribavirin, get IR testing prior - not everyone with high BMI has IR but it's a higher risk group for that so it makes sense to test for that and be aware of all your risk factors, yes?

For some people, losing weight is a piece of cake.  For others, not so much.  I went at my treatment like a warrior woman but I didn't lose a single pound of the 20 pounds my doctors recommended that I lose before I start treatment.  I have always struggled with my weight. Now some on here would be appalled with that, that I couldn't or didn't do a simple thing like drop 20 pounds when my life was at stake, so to speak and when I was going into treatment.  Well, it might just go to show how tough that is to lose weight.  Tough to quit smoking, tough to lose weight...I've never been a smoker but I do try to appreciate how tough it is to quit.  Sometimes I wish people would understand how hard it is to lose weight.  I do okay, I'm pretty active - play squash and whatnot - my beautiful, intelligent daughter is quite overweight and it bothers me how society treats that.  They don't see her at all, they just see her weight - at least until they take the time to get to know her and some don't.  But I digress here.

I have to say that you bringing up this topic makes me think about how it might cause someone to despair a bit to be told they had better odds if they lose weight  because, for a significant number of people, that's much easier said than done.  If it were that easy, we'd all be doing it.  So - I do agree that a certain amount of sensitivity and understanding is required when discussing treatment options with someone who is high BMI.  
.
I hope you're not feeling attacked on THIS thread.  I admire your courage in speaking up and it's good to bring up topics like this.

Great discussion Kathy and valuable one.  Now THAT is what this forum is for.

Trish

[Trish77]

"I've heard many "yes, butt" statements on this thread.  Shame of those of you who just couldn't be supportive.  How sad.  Give me a break.  No wonder I've heard from several people that have decided to leave this forum.  They do not feel it's safe here nor do they feel supported.  If you really want to be supportive of someone, you will ask that person what it means to feel supported, instead of cramming down their throats what you think they need.  "

Okay .. .a bit of fairness here.  We're a bunch of people coming together who don't know each other from Adam and we ARE trying our best to support each other and I think on the WHOLE, it's a damn good place to come for support.  This place is not as "fuzzy bunny" as some people like to make it out to be, granted. There is some nasty sh!t that goes down here sometimes.  But on the whole, the group of people here try their best to be supportive in whatever ways they know how - and I think the approach that is generally taken here is to speak in truth and reality with some attempt to temper it with a measure of compassion and understanding.  There IS alot of truth-telling here, however and I think that's a valuable commodity.  

Nobody means to be UNsupportive.  It's too much to ask that we're all perfectly cognizant of what support means to each individual who comes on here.  Sometimes we're going to drop the ball and that's unfortunate.  However, what it comes down to is that support is up to that person individually to seek out.  I never felt that the forum was responsible for being my support system.  If I came here on a day looking for support and it wasn't available, I didn't get upset about it.  Each person here has their own lives to live and it's up to ME to support ME first and foremost.  It was up to ME to put my support system in place and if this place was not meeting my needs it was not the fault of anyone here at the forum, it was that the individual that I am does not find my needs met in THIS place and I am free to move on.  There is another Hep C forum that I found while on treatment and I chose to "hang" on THIS one because the atmosphere on that one wasn't to my liking as an individual.  

I'm lucky to have found *incredible* support here .. I've also been attacked for my viewpoints and as a person.  Some people move on, some people stay.  This place is far from perfect.  But it's still one of the best places I know for someone on treatment.

[copyman]

any one who thinks being overweight is not UNhealthy is a fool.  Once again many studies back up this statement. Here is just one statement out of hundreds:

"You should not take heart in the idea that if you are only overweight you are OK," said Dr. Robert Kushner, a professor of medicine at Northwestern University who specializes in nutrition and diet.

"Given time, there is a high likelihood you will be obese because people gain weight as they age in this country," Kushner said in a telephone interview.

He said many studies have shown that as one starts gaining weight, health risks develop. "We've done very well at medicating people to keep the medical complications at bay, which allows people to live longer," he said.

The study, conducted by Katherine Flegal of the U.S. Centers for Disease Control and Prevention, looked at specific causes of deaths in relation to body mass index, a ratio of height and weight.

A BMI of 25 to less than 30 is considered overweight, while a BMI of 30 or greater is considered obese.

The study did find significant risks linked to obesity, including a higher risk of death from heart disease, diabetes and kidney disease, and several cancers that have been linked with obesity, such as breast, colon and pancreatic cancer.

[Kathy73]

That's it Trish! You got it! That's exactly what I was trying to impart here:

"I have to say that you bringing up this topic makes me think about how it might cause someone to despair a bit to be told they had better odds if they lose weight  because, for a significant number of people, that's much easier said than done.  If it were that easy, we'd all be doing it.  So - I do agree that a certain amount of sensitivity and understanding is required when discussing treatment options with someone who is high BMI."

Can we all do this? Studies aren't absolute. Can we get a little past them as being absolutes and start to see a bigger picture.  

[Kathy73]

I understand where you are coming from and I appreciate it, but no I haven't been patronized all of my life because of being overweight. I was tiny (size 2-3) most of my young adulthood. When I was in my late 20s I was brutally raped and, in compensation, for many years I ate to make myself unattractive. This is no longer true and hasn't been true for over 6 years. I have come to terms with my past and when I was diagnosed with Hep C decided to fight the dragon. Now what I'm getting to is I've seen weight issues from both sides, both being too thin and being too fat (as copyman was so kind to point out). I know that body image affects alot of individuals and settles into how they react to so many things in society. But I don't think it makes them less able to treat. Maybe the predicators make them less likely to clear, but that doesn't mean they shouldn't be encouraged to treat and perhaps clear.

[GSDgirl]

After reading all the posts I must say I am glad for your 4 week UND.  Hope it all works out and you get that SVR!!

Denise

[m_strings]

Thanks for sharing.  I, too, was not overweight until adulthood.  I also have been assaulted.  That's an interesting link.  Anyhow, I'm sorry that happened to you.  

I did find it interesting that people are so quick to defend studies but not when it comes to supporting people w/higher BMI.  There are studies that indicate healthy people are out there with a high bmi.  Kathy, you are obviously one of them and that's why tx is working.  Now that being said, I do agree that being overweight is not ideal for most people.  And yes, there's all sorts of links to higher risk groups for those who are overweight.  I'm not refuting that.  Not at all.  I did get quite defensive here, partly because I'm wore down from people's comments that automatically assume people w/high bmi are unhealthy.  You see, it's not about the warm fuzzy feelings I hoped to get.  It's about hoping to be treated without the stereotypes.    

Trish: This is not my sole support system, obviously.  I'd be in big trouble if it was.  I really appreciated reading your comments to Kathy.  Thanks for sharing something so personal.  And thanks for being positive and adding something really valuable to this thread.  

[Rockerforlife]

BMI is supposed to be 25 or under,so at this rate i am supposed to weight 180-185 lbs as i am 6 ft tall....no way i will be 180....i am built wide so BMI isnt always the golden rule,200 lbs is where i feel and look ok,the main thing  is to have no love handles or fat around the waist,I cant help if my bones big and heavy.

[m_strings]

Point well made.  

[Rockerforlife]

There are two types of fat — subcutaneous and visceral. Subcutaneous is the type of fat located directly under the skin. Visceral fat is actually deeply embedded surrounding the organs. Metabolized by the liver, visceral fat is then turned into cholesterol that goes into the blood stream.

[dabdees]

Ironic how things get so twisted and then the thread is pointless, burned out and ridiculous.

Good luck Kathy, isn't that what this is all about.  Acceptance regardless?  Go yea forth and do great things.

Be well, SVR and live a happy with or out without the poundage, it just doesn't matter.  

All the Best
Dabdees

[Kathy73]

I agree with you and appreciate your good wishes.
All the Best to you too!
Kathy

[nygirl7]

"that being overweight is not ideal for most people"
No it's not ideal for ANYBODY. PERIOD.

"Being overweight does mean that a person is unhealthy.  Further, you are not the only person here with an education, and to imply that we are incapable of understanding someone of your supposed intellect is offensive. "
AMEN!

300,000 people die each year from obesity - it is not healthy.  Approximately 25,000 people die each year from cirrhosis - they are not healthy.  Both high BMI and cirrhosis are known negative predictors for SVR.

However, even with these FACTS you repeatedly seem to want to call everyone on this forum stupid because we believe in science and studies and hard data.

That's quite amusing because some of the smartest people on the internet are on this forum. It's too bad your are too prejudiced in your own infirmity to realize it but I hope it does not prevent others from seeing it or paying attention to any of the rubbish that goes along with it.

[Kathy73]

Are you speaking to me? I didn't know I was infirm.

[m_strings]

Calm down.  I'm not calling anyone stupid.  Never did.  I also believe in using hard scientific data - but as scientists, we know not to use the data as the sole source of information.  Yes, you are correct.  Too many people do die from obesity-related diseases.
  
But also, lets look at both sides.  How many people have a high BMI who are living healthy?  What are those stats?  I think Rocker might disagree w/your statement that being overweight isn't ideal for anybody.  Did you read his recent posts?  He's considered "overweight" according to the charts.  I'm guessing if his body weight matched the charts, he wouldn't be at his healthiest.  

[comeagain]

Yes but look at kathys profile shes heavily overweighted and I bet she has that visceral type of fat and that is dangerous and never healthy you got to admit that

[Marcia2202]

Nevertheless Rocker worked very hard on losing 35lbs before starting treatment. I remember his struggle to do so. So I think he would probably disagree.

Anyway, he doesn't fit in the category, 'cause he is big boned and weight trains every day. So most of his 'overweight' is solid muscle.

[m_strings]

I was wondering if it might help some of us (myself included) if we could consider not talking/writing in absolutes.  I think that does add to my own defensiveness and perhaps the defensiveness of others.  I know it's a bit basic, but I felt the message was timely:  Retrieved from http://mariaboomhower.blogspot.com/2006/07/speaking-in-absolutes.html:  

"When we start to pay attention to how we talk to another person,
we may find that we use the words always or never.

For example, if we say things like:

Women always get emotional
Men never understand women.
People of ____ race (fill in blank), never work hard.
Employees always waste time in meetings.

This almost certainly brings out the defenses in the other person.
It brings in generalizations and hurts those who definitely don't fit those categorizations.

In essence, you are saying that your thought or opinion is absolutely correct and there is no room for argument.
Others can then feel threatened or angry at your statements.
There own beliefs and attitude are now put on the line for debate and scrutiny.

They may feel attacked by your statement and stop listening to anything that you may say, which ultimately stops communication.

Using words like some or sometimes keeps the doors of communication open. It enables you to have a discussion about your thoughts and solutions to be worked out. Moreover, that's when success comes in."

[m_strings]

Now you are just being rude.  Don't attack people on a personal level, please.  Let's be respectful here.  

[comeagain]

I know this isn´t the issue but I think string resons about rocker was not just
relevant.
And I looked at your profil to see that you wasn´t stage 4 and I perhaps made a blunder when I wrote about that. Should have looked before I wrote my first comment.!

[Rockerforlife]

This thread will be deleted soon....so i just thought id post my pic...if you looked liked this,you may need to drop a pound or 2 m :]


http://healthhabits.files.wordpress.com/2008/11/love-handles-vs-visceral-fat.jpg

[Marcia2202]

I don't think comeagain is trying to be rude. English is not his first language and if you would speak Swedish or any of the other Nordic languages, you would understand that he is not being rude.

[m_strings]

You crack me up!  That is not you.  

[m_strings]

In my culture, it's rude to discuss a person's personal weight/profile in a public forum.  I understand you didn't intend to be rude.  

[Rockerforlife]

O yes....i just finished eating my dog

[m_strings]

LOL!

[comeagain]

She has put out her weight for all to see in a public forum otherwise thats not polite
in my culture neither and its way older than yours.

Seems like you like to twist everything are the meds hard on you??

[m_strings]

LOL! re: med comment.  Not on meds yet, but you made me laugh.  
No, I'm not twisting things.  Our profiles are things that should be left on the profile page unless we personally choose to share it here.  Lots of people post personal info on their profile pages to use for other reasons.  I don't believe Kathy asked to have her specific weight looked at with a fine tooth comb, if you will.  We have to limit that sort of thing because people have misused personal profile information in the past.  I hope that makes sense.  This is about a broader issue, not an individual one.  Again, I know you were trying to be helpful.  I should have been a little more courteous in my initial reply to you.    

[FlGuy]

Of course it's publically viewable and any person knowingly putting it out there is aware that it is shared.

"We have to limit that sort of thing because people have misused personal profile information in the past".  Oh yeah, how?

[m_strings]

It a boundary issue.   Some of the same reasons as mentioned on the thread apply.  People use personal information & begin stereotyping, making assumptions, etc.  That person could feel attacked.  Also, If I was a member of another thread, for example, I wouldn't want people to bring it up in this forum and start discussing those issues here.  It's inappropriate.  Let people share here what they are comfortable with.  I'd hate to see people stop being able to list personal things, such as weight, on their profile page because they are too worried that others will start discussing it in a thread.    

[Kathy73]

I don't mind if you "check me out". If that gives you more information it is fine with me. I'm not embarrased or ashamed of myself and I try very hard not to put those types of labels on others. I think there are so many people on especially this website who have skeletons in their closets. I'm not ashamed of mine or my present situation.

[comeagain]

We have the profiles also to inform other members so we don´t have to repeat everything.

If someone is asking about treatment you can see geno type and yes weight, viral load and much more, the more you write there the more others can see what your dealing with.

Its much more effective then when people have to ask all the time.

Easier to get valuable comments about your treament that way.

So you heppers who hasn´t write anything in your profile its a good advise to do
so.

BTW I had that dangerous fat my self lost about 25lbs during tx though.

First tx didn´t loose one lbs also relapsed!!
But also just half the lengt of tx and 400mg less riba a day.

[FlGuy]

It is obviously not an issue for Kathy.  She posted the information for public viewing.  She is a healthy person (except for the HCV) and she has demonstrated progress in her goal.  I don't see what you term as "issues".  She being forthright and open just as Rocker is being big-boned.

[jdwithhcv]

You wrote "It a boundary issue.   Some of the same reasons as mentioned on the thread apply.  People use personal information & begin stereotyping, making assumptions, etc.  That person could feel attacked.  Also, If I was a member of another thread, for example, I wouldn't want people to bring it up in this forum and start discussing those issues here.  It's inappropriate.  Let people share here what they are comfortable with.  I'd hate to see people stop being able to list personal things, such as weight, on their profile page because they are too worried that others will start discussing it in a thread. "

Kathy started this thread, and her subject was her high BMI.  She began the discussion, yet you are trying to cast her as a victim of our bad behavior.  If it is inappropriate for us to discuss Kathy's BMI, then why did she make it the subject of the thread?  If you do not want a discussion of your personal statistcs it would be wiser not to post them on a public forum.

What I find inappropriate is the implication you have superior intellect, together with your statement  that other members should not discuss information without having taken at least three courses in statistics.  

[m_strings]

Okay.  Good for Kathy!  I like that attitude.  I personally would prefer if someone simply asked if they could discuss my profile info in a thread, so hopefully that will be respected for me.  I did have someone discuss my weight in a thread once in the past.  That person wasn't using it in a helpful way, but in a derogatory way.  The thread ended up getting pulled, but that was once instance when someone took the personal information and abused it.  Nobody comes here to be verbally abused, right?  So now I've become a bit more protective of my personal info.  But I'm happy to share it, as long as it's respectfully used.  

[m_strings]

Get over the superior intellect thing.  We've moved on.  Oh you mortals,...  
(That was a joke!)  

[nygirl7]

Our profiles are things that should be left on the profile page unless we personally choose to share it here.  "

In this case though Kathy is the one who brought it up originally months ago and again and again and again.  It was not as if someone found a secret from her past and was being viscious it was the point of the entire conversation.

Personally I feel people that post their every single move on a myspace or facebook are quite ridiculous but in this case - it's not as if somebody went to one of those sites, found out information then copied it over here.

And nobody is being rude by not saying "sometimes" everyone has said all along that your odds are WORSE when you have certain conditions. Something there simply really is no debate about if you believe the experts who spend their lifetimes compiling the information to HELP people with a disease.  If you can't believe them then really why come to an internet forum where PATIENTS have any opinion?

And comeagain is a friend of mine and could never be construed as rude  - spelling / grammar might not always be so perfect but rude? That's be like Rocker eating a cheeseburger.


"BTW I had that dangerous fat my self lost about 25lbs during tx though. First tx didn´t loose one lbs also relapsed!! " Taking extra riba...........yes this is the reason we all so rudely pointed out that a high BMI is a negative thing - some people find out taking extra riba and losing weight in advance DO have benefit and to not point that out would be a complete disservice.  I cannot see how you cannot understand this?

Rocker did you lose the weight this second time while you are UND on the way to SVR or before the first time you relapsed? We've been together so long on here it's all blended together at this point...I cannot remember but it seemed interesting to me. Either way like taking extra riba you did add the trial drug - which again is the reason in the first place anyone said anything about it rather than lie and ignore it.

[Rockerforlife]

Both times on TX i started out at 200 lbs exactly....the boceprevir i think was the ticket that got me my 12 week SVR,but it is documented being obese is does affect TX outcomembeing a wee bit over you BMI is not soo bad...as long as you dont look like the pillbirys dougboy youll be ok

[m_strings]

NY Girl:  Keep up.  Already aware that Kathy is okay with her profile info being used.  I think comeagain and I have resolved (hopefully) the communication issue.

Moving on...  

[Kathy73]

Have I offended you in some way?

You said:
"In this case though Kathy is the one who brought it up originally months ago and again and again and again."

I guess my trying to share what I feel is valuable information, maybe not to you but perhaps others, is repetitious.

[nygirl7]

I don't think being a bit over your BMI is going to do anything either - some people (like me) are built with bigger bones and taller than most. Amazons like me (you) should have a higher BMI otherwise I look emaciated when in fact I'm just normal.  People were always saying your toooo skinny when in fact I was just fine....but I appear even taller than I am.

Dem bones dem bones......... ;)

(I think the boce got you SVR too).

[copyman]

I hope this thread doesn't move into "your mother is so fat" jokes. I see it heading that way.

By the way on a serious note, I put on weight after stopping tx almost 6 months ago. I'm about 25 lbs overweight and see how the metabolic syndrom (syndrome) markers are rising. When my weight was almost normal during tx and all my #'s, i.e. BP,Glucose,Cholestoral all were normal. I have seen them steadily increasing as I gain weight. So for me BMI is a major factor in my health. For me I have to lose weight and I know it will add years to my life.

[jdwithhcv]

"For me I have to lose weight and I know it will add years to my life. "

You are so right!  Apart from quitting smoking, losing excess weight is about the best thing any of us can do for our health.  

I lost about 35 lbs of muscle mass during tx, and since finishing tx I have gained about 25 lbs of jiggly fat.  This was not unexpected.  During treatment for cancer I lost a lot of muscle mass and afterward I gained back every pound of it.  I'm struggling to lose the weight now, and although it is no fun at all I will do it because I know it will add years to my life, and the quality of my life will improve.

[FlGuy]

Your momma is a Xerox machine.

The problem with comparing anything to treatment is that treatment is not all reality.  I'm not even sure that pre and post treatment is comparable.  After treatment, I put on the weigth that I lost, and then some.  I committed that I was not going to act like the post treatment gorging (which I thought I deserved) could continue.  We read a lot here 'all things in moderation' - so true.

Sorry about that momma crack.  Hope you don't have a short fuser about it.

[Marcia2202]

That was funny...

My mama is a Martian....

[Isobella]

Congrats Kathy on remaining UND...wishing you all the best to SVR!!!

FLGuy:

~~I guess that I will never consider Geno 1 as a difficult genotype to treat.  It's puts all people with Geno 1 in a negative category.  So, to all those with Geno 1 and cirrhosis, congratulations - it must be a very happy day for you.
Geesh. ~~~

Not only are you abusing copy's mama, you're stereotyping us geno 1's.  I'm totally offended. ;)

[nygirl7]

NY Girl:  Keep up"

Thanks but I think I'm already ahead for the night I just don't really see the point any longer.  There are a lot of people on here who care about people in general and have spent years trying to help them.  People who seriously want help and discussion - not to just say / do the same thing over and over expecting a different answer.  You know what that is the definition of?

After all ostriches don't REALLY bury their heads in the sand......and some of us are smart enough to realize that.

Good luck and SVR for Kathy.

[m_strings]

Can we agree to disagree on some things?

[Kathy73]

Thank you each and everyone who posted and for all the good wishes that came my way. I wish a wonderful outcome for you all!

[copyman]

Kathy, I was so caught up in the discussion that I wasn't sure if I wished you good luck. Anyway just in case I didn't, best of luck with becoming SVR. I think you will be fine.

FLGuy, funny stuff. Since we are talking about momma's... your momma is so fat that she needs her picture printed out on a wide format copier ! (blue print machine).

and by the way I did pick up on the word you used "fuser". this is a very common part used in every laser printer or copier.

Good stuff

[LuckyLiver2009]

Uh oh... one more thing ? I hadn't heard anything about BMI affecting your success with tx.  Guess who is REALLY overweight?  So, this the deal.... I am stage 3/4 and feeling extreme fatigue and body aches as a result of HCV.  I am trying to arrange my treatment and now I read this.  What a stunner!  I had no idea and my doctor never shared this information with me.  Now I am super worried about the choice for tx.  Due to my fatigue and achiness I really don't feel like exercising.  I am often dizzy too, which creates a problem for exercise.  My mindset was that I would get through treatment, feel more energy and  THEN I would be able to focus on my weightloss.  Now I am super confused.  This whole thing makes me want to spit.  I can't get insurance to approve the treatment, there is a question of whether the treatment will even work and now I find out that my weight could also affect the outcome.  What a kick in the pants!  It just makes me shake my head.

[Trish77]

"Being overweight does mean that a person is unhealthy."

jd, I think that's quite inaccurate.  You don't quantify what you mean by overweight and it's not true to say that all overweight people are automatically unhealthy.  I think I've been overweight for some time, statistically.  When I started treatment, I didn't have a single health issue or concern other than HCV. I had no thyroid issues at the time, I had no diabetes, no high cholesterol, no high blood pressure, in fact my blood pressure was quite low, so low my nurse was shocked. My cardio was in great shape.  If someone came up to me and said I was unhealthy because I was overweight, it would be laughable.  

I think it's more accurate to say that being overweight puts you at a higher risk for health complications and the more overweight you are, perhaps the greater the risk.  

[Trish77]

kathy:  That's it Trish! You got it! That's exactly what I was trying to impart here:

"I have to say that you bringing up this topic makes me think about how it might cause someone to despair a bit to be told they had better odds if they lose weight  because, for a significant number of people, that's much easier said than done.  If it were that easy, we'd all be doing it.  So - I do agree that a certain amount of sensitivity and understanding is required when discussing treatment options with someone who is high BMI."

Can we all do this? Studies aren't absolute. Can we get a little past them as being absolutes and start to see a bigger picture.  "

----------------------------------------------------------------------------------------------------------
Kathy, don't get me wrong.  I maintain that it's important to talk in facts.  What I would do differently after your thread giving me reason to digest this topic a little more is to deliver that truth with a little more understanding and sensitivity.  Studies don't actually say that people with high BMI or people who are obese or overweight should not treat.  They point out the risk factors.  Anyone going into treatment should be aware of the risk factors and approach treatment with full awareness of these risk factors and with strategies to mitigate them wherever possible.  In your case, the risk factors generally associated with being obese, such as diabetes and IR, are not present and that's a good thing for you.  Someone else who is obese may not be so lucky.  

What is really important is to talk about the why here and I really have to thank you for bringing up this topic.  It made me read more and I came across an article that explains they "why" in better detail.  There have been discussions about IR here but not every overweight person has IR, as you've capably pointed out.  It is, however, something that overweight/obese persons should investigate prior to starting treatment.  Also, different responses per Genotype:

"Different HCV genotypes seem to be associated with steatosis through differing mechanisms. Genotype 3 HCV appears to directly promote the build-up of fat in liver cells, while steatosis in genotype 1 patients appears to be linked with co-existing metabolic conditions such as insulin resistance."

http://www.hivandhepatitis.com/hep_c/news/2006/072806_a.html

Did you know that excess fat in the body can decrease the amount of interferon "on active duty" in the body when you take your injection?  I didn't:

"Finally, excess fat tissue reduces the amount of circulating interferon in the body during treatment, possibly due to impaired absorption after injection. "

I'm going to post the article in it's entirety in this thread - or another one - because there was just so much good stuff in it.  Your question was why can't obese people treat - and again, this article does NOT say that they should not treat.  It promotes awareness of the challenges for obese persons and it doesn't avoid the truth.  The best case scenario is to lose weight.  No doubt about that.  It goes on, however, to talk about other strategies if this is not a reality and let's face it, it is extremely hard for many people to do.  That does not, however, change the risk factors.

"Management of Obesity

The Mayo Clinic researchers reported that reducing body weight and improving underlying metabolic factors may help "overcome the low sustained viral response rates observed in obese patients infected with HCV."

The first-line approach to managing obesity involves lifestyle modification, including exercise and a healthy, balanced diet. Weight loss has been shown to improve insulin sensitivity, lower ALT levels, and improve liver histology.

If such measures are not adequate, anti-diabetes drugs such as metformin (Glucophage), pioglitazone (Actos), and rosiglitazone (Avandia) may also be used to increase insulin sensitivity, which may help reduce fat accumulation in the liver. While these medications have not yet been studied extensively in people with hepatitis C, there is data suggesting that they are associated with reduced ALT and improved liver histology in HCV negative patients with non-alcoholic fatty liver disease.

The authors also suggested that use of higher doses of pegylated interferon and ribavirin for extended periods might help overcome the lower response rates observed in obese patients. Weight-based dosing and longer treatment durations are currently the subject of considerable research, but the authors also suggested higher dosing based on levels of insulin resistance or amount of visceral fat, rather than body weight alone.

Together, these studies suggest that liver disease progression should be considered among the deleterious outcomes of obesity and the metabolic syndrome, along with diabetes and cardiovascular disease."

I want to thank you again for bringing this up.  I think it's an important discussion and one that is far more nuanced than simply saying that being overweight is a risk factor in and of itself for positive treatment outcomes.  That would be misleading and not enough information on it's own to allow people to properly address the risk factors that COULD be introduced as a RESULT of being overweight.  

That blanket statement with no explanation could induce the kind of panic that I see in LuckyLiver's post.  

I hope you are SVR, Kathy.  I've seen your posts all along and I've felt your encouragement in the past for my own treatment outcomes and for many others. We often see posts from people who say things like "this is my situation, has anyone been successful with this situation?" and they are desperately looking for some hope.  I hope you will be able to say "I treated while overweight and I am SVR" and it will give them hope.  

Trish

[Trish77]

Sorry.... had no idea the post was THAT long...did post the article in another thread, however.  Hopefully induces good discussion on the topic.  I think it brings out the subject in better detail rather than simply saying obesity period is a risk factor.

[Trish77]

I don't know how overweight you are but being Stage 3/4, I would not let it keep you from treating.  There are other people here treating with risk factors that are different than yours .. or the same as yours.  That does not mean you won't be successful.  It means you need to be aware of how to tailor your treatment to improve your chances.  

There's no getting around it .. if you can lose some weight it will most likely decrease your risk factors.  By how much, I'm not sure the studies bear that out sufficiently as it seems to be dependent upon which co-existing condition exists as a result of you being overweight that would introduce extra risks for you when undergoing treatment.  

If you can't lose weight right now - and you would not be alone in that, then learn as much as you can about what the conditions are that can create extra risk for you and get tested for those.  Your treatment drugs may need to be adjusted accordingly.  Make sure you have weight-based ribavirin, etc.  Get tested for IR - not a subject I know alot about but others here certainly do.  The key is to learn as much as you can about your risk factors, be aware and choose the best strategies you can.  However, at stage 3/4, I personally would go through treatment but with eyes wide open.  I would also make sure you have a doctor - a hepatologist - who really knows his stuff.  If your doctor hasn't brought up weight at all and you are, as you say "REALLY overweight" then...I'd wonder a bit on his experience level.  When you are at Stage 3/4, you really want a hepatologist who knows what they're doing, who is up on the latest treatment protocols and will give you the best shot possible.

Trish

[sunqueen]

I'm staying out of most of this hot mess.

First, good luck to you Kathy. I hope you acheive SVR.

I always toss in the part about being a porky g3 when I've talked about my journey on many threads. I was ignorant. Information freaked me out so I resolved to remain ignorant and then take a leap of faith into treatment.

Please note: I do not recommend this approach.

I arrived here two weeks after I started tx. People asked me if I was on weight-based Riba. My response was "huh?"

I did not know that weight impacted SVR.  I did what any good treating hepper would do in their third week of tx when I got the news that my outcome would probably be bad - I pooped my pants.

Then I went to see a hepatologist, especially since I didn't clear in 4 weeks. Close, but that only counts in horseshoes and hand grenades.

Fast forward to today. I'm SVR. I'm healthy as a horse except for debilitating arthritis. Arthritis has been my biggest demise factor n the last 12 years. Up until I was 40, I ran 20+ miles a week, played racquetball and  went skiing when I could. It came on so suddenly that everything became a challenge. I also (stupidly) quit smoking around the same time that my activity level plummeted and I packed on the poundage.

I worry about two things - all of my joints are totally shot and I may have cleared HCV but I still have fatty liver.

I'm not unhealthy but I am at risk for a big boatload of other health problems if I don't get some of this weight off. The orthopedist who gave me a shot in the hip a few weeks ago suggested that I use the time to MOVE MORE since I don't look like I belong on a poster at the moment.

And now I'm off to run the halls of a local hospital for the next 8 or 9 hours. This weekend I will swim or bike or do something to raise my heart rate.

I wish you all a beautiful sun-filled day.

[comeagain]

Allthough very long post it wasn´t too long at all ( this time ) very good post thx a lot
for making an effort!!

God bless !!
ca

[Marcia2202]

Great information. It's good to see that you were able to find the reason to this problem and offer an approach to tackle this negative predicator.

[Kathy73]

Thanks for all the great information! You're the best!
Kathy

[jessiejames1973]

you lot honestly

NYGirl is not out of order she said nothing wrong, just stop bitching now for gods sake

[merryBe]

nobody's assuming what she has anything, only that she may. What I said was she may have a metabolic syndrome of some sort. Perhaps IR, perhaps thyroid, perhaps pituitary, to name but a few.

The assumption I do not make is that everyone with a high BMI has an eating disorder.
Often times it is chemistry not emotional or over eating that creates a high BMI.

How do I know this, because this is what I had. On 1200 calories weighing and measuring every drop of oil and morsel every day for a year I lost no weight due to these deficiencies. My doctor argued vociferously that I did not have these syndromes, but proper testing at our local teaching hospital proved I did have exactly what I had diagnosed myself as having.

Item: hcv people have a much higher rate of thyroid disease than the general public.
They also have far far more pituiatry dysfunction, they also have far more pre-diebetes AKA Insulin resistance.
The current research is showing that HCV itself is slowing the endocrine system to a crawl and hence creating metabolic syndromes.

All I am suggesting, is that she be checked for such things so that she does not have to endure years of starvation diets with little result. In order to lose the weight and give herself a better chance at treatment it would be advantageous to make sure the systems that effect whether calories are burned or stored are working as they should be.

You may want to read my thread in here on HGH, or search pubmed for connections between hcv, endocrine dysfunction and high BMI.

mb

[Sandbur]

Kathy
I never had a high BMI until I took Interferon the first time in 1994 and ended up with much less energy than I had prior to taking the treatment.  
The people that are giving you a hard time, have never had a hard time with their weight.  I didn't read all the comments, but it's been my experence that the strong pick on the weak only because they can, and if something were to go wrong with their treatment, making them take a turn for the worst, then were told that they couldn't take the treatment!!!  You would never hear the end of their of their screeming.

I try to exercise and eat good food, but I can't seem to even budge off my weight, maybe some day the worm will turn for us.
Sandbur    

[m_strings]

"You may want to read my thread in here on HGH, or search pubmed for connections between hcv, endocrine dysfunction and high BMI."

I don't mean to sound disrespectful or "yes, but" your comments, but I have done PLENTY of reading and research in that area and have also read numerous threads here.  Trust me when I tell you I'm not lacking of knowledge in this area.  I'm not a medical expert, but far from being uneducated in this area.  That being said, I understand where you're coming from in that everyone, esp someone w/high bmi, should be checked out for such conditions.  Without a doubt that is an excellent recommendation.  I was primarily referring to an implied assumption from some people that people w/high bmi are unhealthy, which isn't accurate.  My objections, often, have to do with the language that's being used when it implies an absolute fact in which there is no room to disagree.  And I also wasn't referring to eating disorders.  But by all means, I stress this again, people w/high bmi should certainly have a thorough medical workup for the issues you mentioned.  That is a really good point that you made.

[Steve']

Can I say this to encourage anyone with a few extra pounds on board (High BMI) I really don't like seeing any discrimination, like I said in another thread I started Tx at 253 pounds but 33 weeks later I'm 170 pounds & I'm going to do my absolute best to never regain that excess weight because everything feels better now... Good luck to you all ....

[m_strings]

Way to go!!!!!!!!!!!!!!!!

[merryBe]

you are correct in that there are a few healthy overweight people, but consider this, no matter who you are, no matter what your genetics, the greater the volume of body the greater the volume of blood needed to pump through it and the harder and faster every heart must pump. It is univerally accepted now that higher heart rates equal lower life spans so eve if choleserol and blood pressure etc are fine, it's only a matter of time before joints, hearts, etc etc etc break down. Those are just a few well known and well established medical facts.

My point in all this is each person needs to evaluate what the issues are. We all come to the table(pardon the pun)  of ill health with a variety of issues. Some are genetic, some are emotional, some are the result of the disease or some other exposure.
Weight of course, causes rather emotional reposnses from people, how well I know.

I'm trying to remove the meotion from such conversations and stick to the facts so that people can get healthier if that is their desire.

Since discovering that my IGF was 30-45.......(normal was 150-190 for my age)
I have corrected for the deficiency with Humatrope. Since then I have been able to lose weight like a normal person when I apply myself. What a revelation!!

Since half the people with HCV have some sort of endrocrine deficiency you think they'd all be clamoring to know more about this connection.
Especially when you consider that either hypo or hyper thyroid can harm the heart, low HGH can accerate liver death, high BMI or IR can effect treatment outcome.etc etc etc
Why some folks don't want to explore these concepts rationally vs. emotionally only God knows...but I figure if a person asks a question..............

they should be able to benefit from all points of view.

mb

[m_strings]

Okay, first - Happy New Year.  

Yes, the thread did become emotional.  Emotions are an important part of this process.  The initial question of this thread involved emotionally laden content.  Sometimes we have to be sensitive to, acknowledge, and respond to the emotions - sit with them for just a bit - rather than ignore them or try to rationalize them away.  The thread was moving in other directions prior to that process occurring.  The result = emotional snowball.  That being said, let's now move on the some rational facts, as you suggest:

Fact: We agree that high BMI is typically associated with higher health risks.

Fact:  The majority of people in the U.S. are overweight (Centers for Disease Control and the Office of the Surgeon General).

Fact:  Body weight is the result of a combination of genetic, metabolic, behavioral, environmental, cultural, and socioeconomic influences (Office of the Surgeon General).  

Fact:  According to the National Institute of Health, many people think that individuals who are considered obese are gluttonous, lazy, or both. This is not true.  As a result, people who are considered obese often face prejudice or discrimination.  Feelings of rejection, shame, or depression may occur.  Making blanket over-simplified statements about losing weight (when a weight problem is often a very complex problem) are not only not helpful, but can also contribute to the problem.  Therefore, a little sensitivity and understanding from people, especially those who are not obese, could go a long way.

Fact: People with high BMI and/or HCV should have their hormone levels checked.   Endocrine gland dysfunction may play a larger role in obesity and/or HCV tx outcomes than previously thought.  

Fact: People with high BMI and/or HCV should also monitor diet and sleep.  Dysfunction in these areas also play a large role in the immune response/obesity connection.  

How's that, MerryBe?

[m_strings]

I'm rewording the last point for clarification:  

Fact: People with high BMI and/or HCV should also monitor nutrition (meaning vitamin, mineral, and fluid intake) and sleep.  Dysfunction in these areas also play a large role in the immune response/obesity connection.

(I'm a case example of how sleep-deprivation can affect cognitive health.)  

Good night!  

[merryBe]

Happy NY back!!  ditto and then some!  

you are right on the money. perfect.

now the question of treating or not should NOT revolve around size, obviously.

it's just that size does effect outcome. A known item.

what I don't get is why they told me THAT, but not how to fix that, not one suggestion.

It was a total uphill battle to get my hormones checked, resolve the IR issues etc etc.
My doc thought I was A. nuts, or B. obbsessive. C. wrong.

truth was A. I had endocrine dysfuction (several glands shut down, as HCV can cause this it baffles me why they don't check.)
B. I diagnoses 4 dieases before the specialist did, and was right, they were wrong.
C. even the much disputed IR connection is proven. Dr. Flochart and others have proven insulin cancels out interferon, and so both disease progression AND outcome during treatment are effected by high HOMA scores.

Bottom line is, sure a large person should treat, although we are so close to the PI's coming on line I'd advise any stage 1 or 2 person to wait for them)
sure large people got large by different modalities.
the main issue is should she treat, and should she do anything else.

You know what, I ran this by both my liver docs...why don't you guys have an endocrinologist on board for each HCV patient, knowing what we now know...
I got blank stares off into the distance.

think about it....every aides patient has various other apecialists on board...guys to watch their skin, their hearts, etc etc etc...

you'd think they'd at least consider endos in light of all the recent studies connecting this disease not just to liver failure but to endocrine failure as well!!

One more way people get large from this disease is that when the fatique is operative activity takes a nose dive, and that leads to weight gain.
Another aspect is that depression is a result of these systems being sluggish, and that leads to more weight.

the best way to overcome all this is to get the treatments needed and we can't get those treatments until we stop thinking we are healthy, and admit that maybe some things are not right!!
I know, I was a whirling dirvish for years, and kept telling myself I was basically healthy in spite of many indicators quite the opposite. When I finally asked for testing my doctor argued NONE of what I suggested could be possible, and yet EVERY test proves I had 60, 50, and in one case only 20% of normal gland function.

Because HCV takes the system down so slowly many folks will just attribute changes in weight, activity level etc. to age and so forth.

Yet as God is my witness HCV is taking out endocrine functions, including the pancreas which is part of the endocrine system and all this is part of why weight gain is going on.

I've been saying this the whole 2 years I've been on this forum.

By the way, NIH estimates for worldwide HCV cases within 10 years now approaches
1 Billion people.  How's that for an epidemic.

BTW, what do you think about the weight loss issue. I mean, if one is stage 3-4 and doesn't have NASH, shouldn't one weigh the pro's and cons, i.e. oxidative stress vs. lower weight?  I've been paring down very slowly due to my concern about this but have never seen a real discussion about it. It makes sense to lose, but we have to be aware of HCC and not sc.rew the pooch in the process by building up too many free radicals common in weight loss right?  That's why continuing with healthy fresh oils is so important.

mb

[Rockerforlife]

If you are obese,odds are your liver will be "fatty" also,not good for TX.Data is out there proving this in studies.The Tx drugs do a better job at eliminating the virus with the liver not fatty.

[merryBe]

you are correct, although not all overweight people have fatty liver, it depends on their diet, their consumption of fats and what types, alcohol consumption as well as other health issues such as diabetes.

The liver stores and releases fat every day, all day, and so some fat in the liver is normal. The first line of defense needs to be to replace saturated and hydrogenated fats with good healthy fats in the diet. These do less damage and in some ways reverse damage already done, and are burned easier, and don't clog arteries.

The important thing in losing weight and trying to remove fat from the liver is not to try to do it too quickly. Not only does this increase the risk of hepatic cancer, but it also can do a number on your gall bladder, which can happen anyway in weight loss but is more likely in those going on crash diets. A good rule of thumb is to keep weight loss to no more than 2 lbs per week. The gall bladder must release its bile into the system in order not to form stones etc. and it only releases in the presense of fats. Ergo a no fat diet in NOT good for us.

mb

[Kathy73]

What a surprise to see this thread brought up again! After over a year of trying to get someone on this forum to actually say what you've said:

"Bottom line is, sure a large person should treat, although we are so close to the PI's coming on line I'd advise any stage 1 or 2 person to wait for them)
sure large people got large by different modalities.
the main issue is should she treat, and should she do anything else." When I tried to say something similar to this I felt I was insulted, denigrated and dismissed.

I'm sorry MerryB that you have tried so long and hard to get your points across on this forum. You have wonderful information to impart and, as I've experienced, certain individuals try their best to block it.  

I certainly don't have the knowledge and ability to impart the information both of you have so I will thank you both for sharing it.

If I do attain SVR in a couple of months I will jump for joy. If I don't I'll wait until the new and improved drugs are available and do it all over again.

Thank you again.
Kathy

[child24angel]

The important thing in losing weight and trying to remove fat from the liver is not to try to do it too quickly. Not only does this increase the risk of hepatic cancer,

I've never heard this before, losing weight too fast can
increase hepatic cancer? doubt it, hepatic cancer can cause
a person to lose weight.

Two types of cancer affect the liver:

Primary cancer first begins in the liver and may spread to other organs. The most common primary cancer is hepatocellular carcinoma.
Metastasized cancer of the liver comes originally from another part of the body. Cancer cells can easily travel from another affected organ to the liver because of the role the liver plays in filtering the blood. The most common cancers that spread to the liver are from the colon, pancreas, stomach, lung, and breast.
The average person diagnosed with liver cancer is over 60 years old. In Canada, about 1,800 people are diagnosed every year with liver cancer, and well over half of them are men.

Causes of Liver Cancer
The causes of liver cancer still aren't known, but some risk factors have been identified. They include:

chronic hepatitis B and C infection
cirrhosis of the liver
diabetes mellitus
exposure to toxins, such as certain types of fungi (aflatoxin), vinyl chloride, anabolic steroids, and arsenic
smoking

[nygirl7]

Gotta admit I never heard losing weight too fast could do anything about causing HCC either.  It doesn't seem to make sense to me much - how much weight would you have to lose that fast?  I'd be afraid to discourage anybody from doing their best to lose weight if they needed to.  Maybe I just never heard that before?

[merryBe]

Kathy,
thanks for the encouragement so much, I know you will do well with your treatment because you have such a good attitude and also you are not afraid to ask the hard questions, or recieve all the answers. Actually reading all the posts I think everyone was trying to encourage you albeit in their own ways, it just takes time sometimes for folks to see that and not read too much into what others are saying,

we all know it's a tough uphill battle when so many things to change get thrown in the mix at once...but it's really no different than hearing that our ateries are clogged, or we a prediebetic, or any number of other things...so many conditions are either helped to be cured or even cured and reversed by dealing with the weight issue that we cannot just not talk about it. We do that only to our own detrement.

I can tell you it's a heartbreak to go through 2 years of chemo and relaspe because I did. If losing another 50 lbs could have helped that, well I shall never know, but I did remove 40 lbs prior to treating...couldn't do more than that in the 6 month time slot I was given between diagnosis and commencement of tx.

People do need info to be well informed. One theory I've heard as to the WHY the liver may do worse with more fat is that the virus hides in fat, and meds don't penetrate fat cells as readily as other types...just a couple more theories among many.

Angel and NY girl...well live and learn ladies. Actually that research has been around for about 30 years now. It's called free radical formation and it's cheif cause (besides the daily couple dozen xrays we get living on this planet) is from the oxidation of fat. When fat is burned it uses oxygen to be burned same as your car needs oxygen to be mixed with it's gas (a form of fat/oil) before it can burn.

This conversion to usable fuel produces a by product known as a free radical, nasty buggers known to have influence on the cells near them wherein they rupture and/or mutate healthy cells, and hence cause aberrant cell diviision, and while the healthy immune system scrubs these outlaw overgrowing cells cancerous or sick cells from our bodies each day if we overwhelm the system it can cause more cancer cells to form than the body can eliminate, especially if the liver is already compromised to boot.

Bottom line is every day your body makes tons of cancer cells, but normally the lymphatic system removes them.
I taught anatomy and nutrition at college in the 70's and this research was known even then.

So why is weight loss an issue? Because the biggest cause of free radicals in the diet, well one of them, (nitrates and other things hurt too) but the biggest dietary cause is saturated fat. Particularly aggregeous is animal fat...meat sources etc....it is solid and sticky by nature, and hard to burn and it produces the most free radicals, many more than vegetable sources of oil. THAT is why doctors have been saying for years to switch to veggie oils for many years, because of all the research.

Well, say you go veggie...out of the woods...yes and no...out of the woods until you go to lose weight...then all that animal fat on US....yes WE are animals, goes into circulation as it is getting burned....and suddenly it's like we are eating a steak every day...iy is steak tartar ala child4angel, or broiled NY girl, or merrybe Wellington, but it is steak none the less...and if you diet correctly, it is VERY high fat and low muscle ratio.....so at that point, while dieting, we produce more free radicals you see.

Now since the liver is at higher risk anyway what with fibrosis and HCv, and especially with iron overload already causing too much oxidation in many, it makes sense to lose weight OF COURSE, but it makes sense to do it more slowly and sensibly than some folks advocate in order to avoid the dreaded HCC getting the upper hand...in my opinion.

I insisted on a slow steady weight decline and regular iron checks (which this forum clued me into) while going through this process and my hepatologist had NO proplemo with my approach once I rattled off what little I remembered from my teaching days.

I suppose if one was young and still relatively healthy and in stage 1 or 2 than a quicker weight loss might be appropo...but I was stage 3-4 and with high iron I would never have considered that approach worth the risk.  I was able to lower my iron 250 pts. lose half the weight I wanted to, so it is a reasonable approach. After all, the "cure" is supposed to do more good than harm.

mb

[GoofyDad]

Dang Merry. All that fat talk made sense. It also made me hunger for a cheeseburger.

[merryBe]

tubular!!  Only free radicals can go here. Me I'm thinking bacon!!

[m_strings]

Great discussion!  I'm a bit too tired to respond at any length tonight but will do so when I have more time/energy.  Kathy - I've learned a lot from you.  I think you have more knowledge/ability that you admit!  :>)  I'm glad that you, MB, C24Angel, NY, Rocker & Goof are having this discussion.  It is important.  And, as I said, I, for one, am learning a lot.      

"Tubular?"  Oh man.  Haven't heard that in ages!  Brings back memories of big hair, blue eye shadow, and leggings.  lol!  

Going to bed earlier tonight.  Why do I have the feeling I'm going to dream about bacon cheeseburgers?  Thanks guys.  

[child24angel]

Live and learn ?

[Kathy73]

Thank you...that was so informative. I truly appreciate your input!
Kathy

[nygirl7]

*Sigh* my biggest problem should ever be that I loose weight too fast. Or I win too much money in the lotto.

Seriously it's something I don't think will ever be that much of a problem ;)

Although technically we do lose a ton of weight really fast on treatment - I wonder if that is enough? It's kind of getting me paranoid now. Take the tx to kill the disease so we don't get HCC but...loose 20 pounds in 3 months and get HCC anyway?  I didn't want to say that outloud but it's concerning me. That would just be my wonderful luck!

[child24angel]

Nothing makes sense does it? Many people lose weight fast on
tx along with muscle .  Now we are hearing on this very forum that it can
cause HCC....splendid !!

[merryBe]

nope, you got that right...stuff gets more convoluted the more we look into it for sure.

But to recap just so folks know where I'm going with this, weight loss to get down to our correct BMI is a good thing.. GOOD.

Losing too fast is what's not good.

A pound of calories is roughly 3000 calories

a stick of butter roughly 800 calories,

a 8 oz steak contains roughly 1/2 oz. of fat.

a persons calorie intake must not exceed their body requirements in order for stored fat to get burned.

so

let's say you tried to loose a pound a week. Reasonable.
that would be a 52 lb loss in one year. Is it doable? yes, is it safe, yes BUT you need to realize you STILL WOULD an HDL requirement, meaning you need to get some good fats, i.e. olive oil, fish oil, etc into your diet each day.

what you need to do is eliminate HDL type fats, so that your stored HDL..body fat will be burned as fuel.
You also need to restrict calories to an amount beneath what your body requires or else sugars, starched, non fat items, will nevertheless turn into stored fat.

you would need to recognize that that would mean you would need to shave 400 calories off each days requirements so that your body will use YOUR steak fat!!

when we don't loose weight it means we are storing too efficiantly, or we are eating as much fat or other calories as we need....otherwise the body will convert fat.

My figures show if I cut my meat consumption to 3x a wwk, 5 oz servings only, and cut deserts to 1 per week, I should be able to burn about half a stick of MY BUTTER off my cute tush everyday!!

Not bad!1    But what folks shouldn't do is crash diet, because A. this can destroy the gall bladder, and B. it can create so much peroxidase in the liver that HCC becomes far more likely.  (folks in countries where dairy and meat are not consummed have almost no HCC, unlike in the USA where it is the 7th biggest killer.)

One thing however, LIVER patients do not all have functioning pituitary or thyroids.
GET them both  checked.  (IGF-1 test, and TSH test)

A rat with diminished pit function will have 3 times the BMI on the same calorie count and activity regime as a rat with normal HGH function.
Half the HCV patients tested in one study had abnormally low pituitary function, meaning try as we might, the body simply will not burn fat. So it's important to make sure your glands are working.

[merryBe]

correction, we need to eliminate the LDL (low density fats) so that our bodies will burn their owns stored of it up...but keep the healthy lipids..(HDL)  (high density lipos) up

sheesh...this happens everytime I start rattling stuff off late at night...sorry.