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Jenny asked...

I am a 66 year old woman, suffering from severe Menieres disease, visual impairment-bilateral ptosis, proximal leg muscle weakness, proprioceptive deficit and hypotension-low blood pressure. I also have ischaemic heart disease with mildly impaired left ventricular systolic function. As a result I experience sudden unexplained falls, including drop falls. I have been fitted this week with an implantable loop recorder. This combination means I cannot stand or walk unaided and am prone to fall off chairs or a bed without extra support. Consequently most exercise has been ruled out. I have been to a dietician at the hospital and she has agreed I do not over-eat but my weight has now reached 17 1/2 stones, from 16 stones about 2 years ago. I was only 12 stones when we moved here 9 years ago. I would appreciate any advice or help regarding weight control as my health/weight is becoming very worrying.

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The Answer

I’m very glad you’re having your drop attacks (sudden loss of consciousness) investigated – they can be caused by abnormal heart rhythms, which is why you’ve had a loop recorder fitted to check your heart rhythm. As for your weight, it can be very hard to avoid putting on weight if you’re unable to exercise. However, I’d be very surprised if your dietician simply said that you ‘don’t overeat’ as this suggests she’s saying there is nothing you can do about your weight. I assume you attended with a food diary – it can be very easy to underestimate your calorie intake, especially from snacks and drinks, and by underestimating your portion sizes.

Lots of factors can affect how fast your body burns energy, and maintaining, gaining or losing weight is all down to the balance of the energy you take in as food and the energy you burn up. Exercise clearly uses energy and makes it easier to lose weight, as well as strengthening your heart and bones, and improving stamina. However, even people who are very sedentary because of illness use up most of their energy from basic body processes involved in staying alive – this is the so-called ‘basal metabolic rate’.

I’m assuming you’ve had your thyroid function checked – an underactive thyroid can result in putting on weight even without changing what you eat. There is no easy answer to losing weight – most fad or ‘crash’ diets can cause weight loss in the short term, but it’s regained quickly if you haven’t learnt sustainable healthy eating habits you can maintain in the longer term. It will be harder for you to lose weight than for someone who’s active, and you’ll have to cut your energy consumption more than some other people to do so. However, it’s absolutely not impossible and it is really important. As you’ve clearly worked out, there are multiple benefits to your health from getting your weight down towards the healthy range.

Answered by Dr Sarah Jarvis

 

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