I just found out I have low thyroid and am now taking a prescription for it [about a month now]. I haven’t been able to lose weight for two years and I’d been working out like a crazy person. I tried to gain muscle but my body fat just went up to 31 percent. I thought, WTF? Have you trained many people dealing with this medical condition, and if so have you seen success stories of people finally losing weight with the combination of exercise and Rx?  I think I’m about ready to invest again in weekly/daily exercise now that I know it’s not my diet or exercise routine that is the problem.  I just got so frustrated and gave up for a while.  Damn you, thyroid!  [well at least I now have a name for it and know what the problem is].  Just wondering your thoughts on the situation. —Betty, Lansing, Michigan

[Note from Sam: I asked my physician friend John (who's had low thyroid issues of his own) to share his thoughts on your question.  Here's what he said].

From a personal standpoint, I can tell you that I did not find much of a correlation between [weight loss and thyroid medication].  I’ve been on it for about 5 months now, and went off of it for about a month approximately two months ago. And, while that five month period roughly corresponds with my weight loss (which started in March), I do not believe the two are related. Actually, that one month that I was off the drug was the time when I began to really lose a lot of weight. It surprised me. The only explanation I can come up with is that I was falling asleep at 8PM because of the hypothyroidism, and therefore didn’t snack at night.

I know that a ton of people out there, who are morbidly obese, and want to attribute that to a thyroid deficiency. Never mind that their lips are shiny from Kentucky Fried Chicken even as they tell you this.

The gold standard for internal medicine is Harrison’s Principles of Internal Medicine. My copy is a bit old (1987), but here’s what it says:

“Obesity can result from hypothyroidism because of decreased caloric needs. However, only a minority of hypothyroid patients are truly obese, and an even smaller proportion of obese patients are hypothyroid. Indiscriminate use of thyroid hormone in the treatment of obesity is to be deplored, and should never be instituted in the absence of documentation of decreased thyroid function.”

Perhaps the correlation with being simply overweight is clearer, but I don’t think there are many studies out there documenting this. There actually probably are not a lot of studies. But, still, lower thyroid function, so lower metabolic rate. Few calories expended, and before you know it, horizontal stripes are completely out of the question.

By the way, there are a ton of other great benefits from the drug other than just being able to stay up later. I found that it gave me a little more of a sense of well-being. Took away some sadness. Increased sex drive.

Worried about low testosterone? Researchers at St. Louis University have developed this self-screening quiz to screen for low levels of testosterone and growth hormone.

1. Do you have a decrease in libido (sex drive)?
2. Do you have a lack of energy?
3. Do you have a decrease in strength and/or endurance?
4. Have you lost height?
5. Have you noticed a decreased “enjoyment of life”?
6. Are you sad and/or grumpy?
7. Are your erections less strong?
8. Have you noticed a recent deterioration in your ability to play sports?
9. Are you falling asleep after dinner?
10. Has there been a recent deterioration in your work performance?

If you score higher than 5, consult your doctor.

Guest post by:
Dr. Arshavir Blackwell

Stickk is a web-based motivational tool that describes itself as an online “Commitment Store.” One of its founders, Yale Economics Professor Dean Karlan, developed the system.

Users sign contracts to achieve goals: losing weight, quitting smoking, exercising more, for example. Karlan and his cofounders claim their site is based upon sound psychological principles; in particular, two well-known principles of behavioral economics: 1) people don’t always do what they say that they want to do and 2) incentives work.

Stickk has been available since 2007 and as of this writing Stickk’s website boasts:

• $11,523,156 “on the line” (more on what that means in a moment)
• 174,020 commitments created
• 300,659 workouts completed
• 2,502,250 cigarettes not smoked

This is not a website that provides motivation via vague exhortations to be a better person. Stickk is quite concrete in its methods and its goals.

How It Works

Say that you want to lose 25 pounds in time for the Hawaiian-themed office Christmas party where everyone wears leis and swimsuits. Go to the Stickk website, create an account, and enter your goal, e.g., weigh 175 pounds by December 20.

Each week, you report your weight (or whatever your goal is—the best one I saw listed was “Have no more John sex”) and Stickk tells you if your week’s loss keeps you on track for your final goal. If you’re trying to lose 25 pounds over 25 weeks, and you lose a pound that week, you have reached your week’s goal.

But Wait There’s More!

So far this is just a normal performance-tracking website. But there are two optional features designed to make it more effective:

First, you can designate a referee. Every week, this person confirms your progress in order to prevent cheating.

Second, you can put money on the line. Let’s say you wager $250. Divide this over the number of weeks that your goal is in play. Every week that you fail to lose a pound, you forfeit ten dollars: $250/25 weeks = $10 (they deduct it automatically from your credit card). Again, a referee can improve effectiveness by keeping you honest.

Where Does the Money Go?

Here is Stickk’s mean little trick: you choose an “anti-charity,” a group whose work you strongly disapprove of. When you lose, they get it.

This small, yet devious, bonus feature makes the punishment that much more burdensome. Did that pizza binge this weekend result in your donating $25 to the Organization for Experimentation on Unwanted Puppies? Better luck next time.

But, Does It Work?

I have used Stickk twice, each time to lose about 25 pounds. Both times I used a wager tied to an anti-charity, and never you mind which.

The first time, it worked. The second time, it did not. From the ashes of my failure, here are observations which might improve Stickk and give you a better chance of succeeding. But first, a bit about behavioral psychology to provide some context.

Punishment Versus Reward

Psychologists have long studied the dynamics of punishment versus reward in motivating behavior.

Punishment is defined as any action which decreases a behavior. Zapping a rat with an electric shock when it goes in to a particular corner of its cage is punishment. Over time (and pretty fast; rats are smart) it will no longer demonstrate the behavior of going into that part of the cage.

Reward is defined as any action which increases a behavior. Giving a rat a yummy treat when it goes into a certain (hopefully different) part of its cage is a reward. Over time, it will tend to demonstrate the behavior of going into that part of the cage.

You and I are no different.

Tools For Braving the Urban Jungle

For nearly two decades, I underestimated the sheer stress that comes just by choosing to live in an urban jungle. Amidst the traffic, poor air quality, high cost of living, and the general pace of life — Los Angeles is by far the most stressful places I’ve lived.  You actually have to TRY to relax here, which is really saying something. It led me to wonder: What are some easy ways to self-soothe? I found a few I wanted to share with you.

1. Outdoor exercise – If you live in a big city or have an indoor desk job, you might have a deficit of exposure to Mother Earth. People with Nature Deficit Disorder who exercise outdoors in a natural environment are less agitated and have an easier time focusing. Take my NDD challenge.
2. Indoor exercise – One psychologist I interviewed told me in his 25+ years of clinical practice, he firmly believes that a full 90 percent of his patients experiencing depression would not require therapy if they would just exercise regularly. The bottom line is that the stress has to go somewhere. Exercise releases the stress and gives you a boost of mood enhancing endorphins. Think of it as natural morphine. More…

You’ve heard about “affirmations” since the dawn of the Stuart Smalley. They’re those “I statements” that go something like this:  I am grateful. I am lovable. I am open. Proponents of affirmations say—without reservation—that they work, releasing you from years of pent-up fear, pain, and shame.  But is there any real science to back this up?  The answer is unequivocally: yes.