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Lipodystrophy and WastingLipodystrophy and Wasting
           
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Am I the only hiv+ person who wants to lose weight??
May 31, 2001

I am constantly hearing about wasting, but I'm on the other end of the spectrum. I am about 60 pounds overweight, I was about 40 pounds overweight when I found out I was hiv + and then when I found out I got depressed and gained another 20. I know some of it is due to the meds that I'm on (Combivir, Viramune, Valtrex, and Paxil) but some of it is also due to a not so healthy diet. Is it safe for me to lose this weight, and can I now that I'm on meds, I heard someone say that the meds will stop me from losing weight. I know this may sound weird coming from someone with hiv but it's a serious issue for me, can I healthfully lose weight or will I promote wasting in myself?? Please let me know.

Thank you

Response from Ms. Fields-Gardner

No, you are in good company on wanting to lose weight. The primary question (which you brought up) is whether or not it is safe to do. I can offer a couple of recommendations.

First, not all weight gain is the same. Before losing weight through diet and exercise, you should ask for a body composition evaluation to figure out what type of weight you put on and if you have enough of the lean weight you need to sustain a typical diet-induced weight loss. When you normally gain weight, a lot of it is generally in the subcutaneous fat compartment (you can pinch the inches with your fingers). But, you should also gain some muscle in carrying that extra weight around. If you have not gained weight normally, that is that your lean tissue has not increased a bit along with the fat gain, then you might not be able to afford the risk of diet-induced weight loss where you are likely to lose a reasonable amount of lean tissue along with the fat.

Many HIV-specialist dietitians are trained and equipped with the skills to conduct and interpret body composition measures using BIA machines and anthropometry (body dimension and fat-fold measures). If your weight gain is normal, the dietitian can help you to improve your diet (the most efficient, but not always the best way to lose weight). If you are exercising or plan to exercise, you may request an evaluation by a physical therapist who can also provide and "exercise prescription" tailored to your needs and limitations.

If your weight gain is not normal, then there is a greater risk in using diet to induce weight loss. Just because you carry more weight does not guarantee that you are not "wasted" in terms of muscle tissues. In this case, you will need to shore up the muscle volume before you restrict calories. Obviously, exercise will help. But in this case, you may require some anabolic support while you exercise to preserve important lean tissues while losing weight to a healthier level.

So, find out where you are first. Then work with your team to get safely to the healthy level of weight and body composition that is right for you.


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