Weight Gain Over The Holidays
TW: Talk about weight gain, diet, and exercise.
When you are a kidney patient, you weigh multiple times a week to make sure you aren’t gaining too much water weight, but what about when you hit the holiday season and there are rich foods galore? Let’s talk about weight gain, water weight, and dialysis.
The holidays are known for rich food, and if your clinic is anything like my mom’s you are encouraged to eat more of the foods you normally aren’t supposed to during the holidays so that you can enjoy life a bit more. Nothing wild, just a little less restricted than normal for most people. (Mom is encouraged to go wild, her diet does well at keeping her in range so they tell her to have some fun.) If you have just gone a little (or a lot) wild, you may notice the scale creeping up, and that you have weight you just can’t seem to lose like normal. I’m here to say that’s normal and not necessarily something to worry about, though everyone is different and you should be in contact with your care team to be sure.
For our family, we do home hemodialysis for mom so there is some flexibility in treatments when we notice extra weight that won't come off. While we normally do 4 treatments a week, if she has water that just won’t come off we get a 5th approved to try to pull off the excess “water” and judge from there. What we have noticed is this time of year there is a 1-2kg weight gain that happens, and that slowly comes back off. Watch how quickly the weight comes on, and what your diet was like that week, it will help you to determine if this is genuine weight gain or excess water weight. The water weight can be dangerous, but putting on a couple of kilos over a holiday filled with favorite foods you don’t normally eat is not if done healthily.
Dialysis creates an awareness of weight that is not normal. Since you are “weighing in” multiple times a week to check your water levels, it can be easy to get fixated on that number. It can also be easy to get fixated on keeping that number in a certain place or dropping it lower. If you are someone who has struggled with weight for a long time, have been part of diet culture, and are now on dialysis: beware. Your old thoughts and emotions on diet and calories can trip you up at this time when excess weight is likely no longer your biggest concern. Your health is dependent on you getting the caloric intake, protein, and nutrients your body needs to run. That doesn’t change because you have struggled with weight in a small or large way for a long time. Years of doctors telling you weight loss may be the only answer to your problems can wire your brain to make it feel like it’s the most important thing you can do for yourself. I’m not a dietician, but I know what the dietician at my mom’s clinic has told her: That may no longer be true for you. It’s a conversation to have with your team, but in my mother’s case, they have asked her to try to stop losing weight. When you have an emergent kidney problem crop up, you will find you lose weight quickly in some cases, and because of that, they would like her to keep herself about 22kgs heavier than she would like to be. Her initial weight drop when starting dialysis was about 20kgs over 3-6 months. For someone who has struggled to lose weight for as long as I can remember, it felt like a miracle weight loss. She even got back some energy and was feeling good! That’s great, but what happens if she has sudden weight loss again and only has about the same amount to lose? What about if it happens a third time? What I am saying is that the scale is most likely no longer the end all of your health metrics like you may have been told it was in the past. (Whether that is 100% accurate is hugely debated now anyway, as weight may be more of a sign of an underlying condition than the actual condition itself and BMI is flawed as a metric.) Let yourself embrace a few kilos of weight gain over the holidays, and watch as it naturally comes down as you eat well again. If it doesn’t come back down and it bothers you, talk to your care team about how to safely handle that.
If you find the weight isn’t water, you’ve talked to your care team and they feel it’s healthy for you to lose the weight, and you are ready to start losing here are some tips.
Go slowly. You don’t need to drop all 4kgs in a week or even in a month. Let your body direct how quickly you lose any excess weight you’ve gained so that it happens healthfully.
Make sure you are drinking your water, but don’t go over your restricted amount. If you notice you are gaining a lot between sessions, make sure you are logging everything you drink or eat that has fluid contents. Soups/stews, gelatins, and fruits/veggies can have hidden water, remember to count them too.
Don’t restrict anything so much that you get wild cravings for it. If you are hungry for a cookie, eat a cookie. Just don’t eat a bag of cookies. Moderation is key to maintaining a healthy diet and weight.
Know your lab numbers. If you are doing anything with your diet, it’s key to be in communication with your dietician about how your labs look so that you make sure you are on target with your goals. For example, mom struggles with getting enough protein, so we are constantly trying to find ways to sneak protein into her daily foods.
Remember dialysis burns calories! If you are increasing your exercise regime or restricting calories, remember that you burn about 2,000 calories per treatment. This information comes from the dietician at my mom’s clinic, so check the info with yours. I believe all treatments should be about the same, but it’s worth asking before you put a number down for your treatments.
Talk to your dietician about caloric and protein requirements for your situation. Do you need more protein and fewer carbs? Have you restricted carbs too much and are in ketosis? These are important things to discuss with your care team, especially your dietician. They will be able to help you find your sweet spot that works for your body and your treatment plan.
Walking is great exercise. Don’t feel like you have to do anything wild to start a routine, start with an additional 15-30 minutes of walking in your day and you may be surprised how quickly you lose some weight.
Finally: Don’t feel discouraged if the scale doesn’t move immediately. If you are changing how you move, eat, etc. then you may see slight weight gain before you see loss depending on your current body weight and routine. If the scale stays where it is, or even goes up slightly, don’t let it discourage you. There’s a chance you are gaining some muscle, and the fat burn hasn’t caught up with the muscle growth yet. Pay more attention to how your clothes are fitting and how you feel when you look at yourself or move. Is it easier to pick something up from the floor this week than last? That’s a win! Is the waistband on your pants a little looser feeling than it was last week? That’s a win! Scales are not the only measure of whether your efforts are paying off, especially when you hit plateaus whether it is early in a journey or after you’ve lost some initial weight.
If you notice you are gaining or losing weight quickly, please talk to your care team. None of this advice matters if an underlying condition is causing gain/loss.
Anytime you are changing how you eat or exercise, you should let your team know what you are doing and how. If they see a problem with it, discuss it with them and learn from them. They are human and so may make mistakes at times, but they are much more experienced than most with how dialysis works and what the majority of dialysis patients need. There are always exceptions to known wisdom, but they are in your corner and rooting for you to be the healthiest version of yourself.
Remember: Don’t let the scale dictate anything to you about your worth. You aren’t a number, and the number it displays is simply a tool to help you be the healthiest version of yourself. It’s data, not a judgment.
