[jacuna]

I work as a wellness specialist and do nutrition coaching for a Behaviroal Health agency. I would say that 80% of our clients are on depresion or anxiety medications.

I work heavily with members who are obese, morbidly obese, and suffering from diabetes.

I have one client in particular who is a 39 year old female weighing 462 lbs. and is on citalopram, prazosin, and clonazepam. We've worked extensively over the last 8 months to improve her diet habits and choices, enough so that she has maintained an ~10 weight loss.

Currently she averages an intake of 1500 calories. According to the H-B formula, a fat loss oriented BMR would be around 2,988 calories.

I am wondering what would be the best approach to take with her. I know her body may be storing on to excess weight due to low calorie intake, but at the same time her BMR may be lower than normal due to her medications. Does anyone have any experience with this? Maybe I should just a pick a route, track and adjust using outcome based decisions?

Thanks for any help.

[Mark Shields]

462#s and eats 1,500 cals/day? I know meds can increase weight gain (maybe through increased appetite or hormonal regulation), but she's lyin to you about that intake.

Someone that heavy most likely has some food issues, one of them, not wanting to admit how much they eat.

[jacuna]

Absolutely true Mark. We have worked together for the past year to breakdown some huge walls and build rapport. She has suffered from eating disorders (ie closet eating and binging) so I know this could be a problem as well.

Taking all that into account, we don't focus on eating exact calorie counts or number meals, rather focus more on education of healthy choices, cooking, and working through the 5 habits.


Just seeing her complete a dietary record and having the numbers out for myself kind of prompted me to ask for advice.


(all of this is done with her PCP and BHMP being kept updated of course)




I used her as the prime example, but I've had numerous folks (all on meds) report dietary records that just don't add up to what they weigh. Any tips? I've worked with teaching them how to measure and review the record with them after they turn it in.

[Tally78]

None of those meds should cause weight gain in themselves. However, once a person's mood starts to lift they may find they get back their appetite, as this can drop away in depressive episodes. It may also be that the sedatives make her too drowsy to train as much as she could do.

Having said this, I'm with Mark. If she was really eating 1500 calories a day and training, she'd be losing weight. These medications wouldn't change that.

I see people a lot who blame their medication (I'm a psychiatrist) and in most cases they're massively underestimating their calorie intake and overestimating their output.

Do you think she is being accurate in her measurements?

[jacuna]

Thanks for the comment Tally. I don't believe she is misreporting. She has pretty good about reporting binging episodes in the past. I will definitely do an education workshop with her on food portions and how to report them on the tracker. maybe even do an extended week long journal, she's pretty good about it and more than willing.

Currently she is increasing her activity levels slowly (ie walking 20 minutes each day). We've built up to this because she had complications with her knees and back when we did train (for a week or two), and she tends to get overwhelmed with an overloaded schedule which causes severe anxiety.


I feel a bit handicapped when working with this population, but I will continue to keep trying. Thanks for any and all the advice.


I've had several folks come back this week with records indicating low calorie intake, however that does not match their body composition. I'll do a better job as a coach teaching them how to report. Hopefully, that may help.

[Tally78]

Do you ask them to take photos of everything they eat? Might give you an idea if they're reporting portion sizes, etc, accurately.

[nadolsky]

the citalopram could theoretically cause some weight gain but it's likely something else.

I would make sure other underlying comorbidities were addressed with the doc (e.g. diabetes, sleep apnea etc)

I also use the method as the OP mentioned with taking pictures of the meals. Seems to work well hope this helps!