Friday, June 10, 2016

You can only do what you're going to do

I'm continuing on my series of posts on advice I share with patients who are interested in losing weight or starting a healthy lifestyle. Today, I'm going to share my most used motto that I tell all my patients interested in lifestyle modification. They've all heard it at least once, but probably more, because it is represents my most firmly held core belief in approaching behavior change: You can only do what you're going to do.

I've heard colleagues complain about how patients never do what they tell them to do, particularly for diet and exercise. In my head, I think, "I feel like a lot of patients do what I tell them to do..." and then I realize, "Oh yeah, that's because I never tell them to do anything." That makes it a pretty easy goal to reach! However, as lazy as that sounds, this is more than me just lowering my standards of success.

When a patient asks me what they should do to be healthier, I won't answer. Instead I ask, "You tell me, what can you do to be healthier?" I want people to tell me what they think they can realistically do to be healthier. Maybe I'm just cynical, but I feel like if I tell someone what to do, they're not going to do it anyways, so I don't see the point. Sure, I can spout out the American Heart Association's recommendation of 150 minutes a week, or 30 minutes a day for 5 days a week, but if only it were that easy, all of us would be doing what we were supposed to be doing. Being un-athletic myself, when I first started exercising, hearing something like 150 minutes a week would have floored me. Someone might as well have told me to train for the Olympics to get a gold medal in men's gymnastics. In my mind's eye, both would have been equally impossible and unobtainable, so why bother trying?

Instead of giving recommendations that might seem unrealistic, I try to get people to tell me what they'll actually do. And that's when I say it: You can only do what you're going to do, so tell me, what is it that you're going to do? I never care how small the goal is, someone could tell me they'll eat 1 more raw baby carrot a week for 2 weeks. Fine. I'll take it.

It isn't about having good habits, it's about learning you're capable of making changes to develop better habits. It's about shifting the internal monologue from I can't, to I can, one baby step (or baby carrot) at a time. One might think that my general reluctance to educate patients on diet and exercise is absurd, but my other philosophy is: Patients aren't stupid. For the most part, people know some foods are healthier than others, or that exercise is good for them. They don't need me to tell them that. Granted, there are exceptions, including those that have been led astray by food marketing, or have already made obvious changes and are running out of ideas, or have a question if a proposed change is actually a healthy decision. However, the majority of average people, like you and me, probably have some pretty obvious things that we can think of to change for the better.

So my advice from today's post: don't rely on someone else to tell you what to do, because only you
Do, or do not. There is no try. - Yoda
know what you can and can't do. These are your habits and it's for your health, so take control and own it. Pick a healthy habit you're going to do for two weeks. Not "try" to do, but actually do. When I have a patient say they'll "try" to do something, I work with them to think of smaller goals until they stop saying, "I'll try" and start saying, "I will". I've named this very official medical technique, the Yoda maneuver. Then, once you've achieved one goal, pick something else you're going to do for a few weeks. Just keep focusing on what you're going to do. Don't worry about what you "should" be doing, because what's the point of knowing what you "should" do if you're not going to do it? In the end, you can only do what you're going to do.

Thursday, May 26, 2016

Don't lose weight to be healthy

For the next few posts, I just want to talk about pieces of advice that I give patients who tell me they want to lose weight. This isn't so much for other clinicians who have their own styles (that may or may not work better for you than mine would anyways), but more so for people that have thought about losing weight, and just want to hear the advice I give.

The first piece of advice is not to lose weight to be healthy. Instead, find a more concrete aspiration. Let me explain what I mean. When I ask patients why they want to lose weight, more often than not, I get told some variation of, "I want to be healthy." It seems like the right answer that a doctor should be happy with, I mean that's what we want for all our patients right? The problem is, I'm not really sure what it means "to be healthy", and I don't think most people do either. It is just something that sounds good.

Let me explain before my medical training gets called into question because someone thinks that, at baseline, a doctor should know what "being healthy" means. For me, the concept of "being healthy" is too conceptual and abstract. It can mean different things to different people. For instance, imagine you were walking down the street and happen to bump into someone you haven't seen in a while, who says, "Hey, you're looking really healthy since the last time I saw you!" I don't know about you, but I'd be like, "Wait, I think they just called me fat..."

The term healthy is just so vague. It's not like we can wake up and go, "I'm more healthy than I was yesterday". There's no real way to know when you've progressed. It is a very abstract descriptor, like being rich. When would you know if you were rich enough, and similarly, when would you know if you were healthy enough? So instead, I try to look for more detailed answers to define health, specifically, what are the things a patient would like to realistically do that he/she currently can't do. What are they trying to get out of this improved health? Sometimes it is as simple as getting off of a medication, but sometimes it is more emotional, like being able to do some activity with their children. I believe you can't take away something someone enjoys (and unfortunately a lot of unhealthy habits are really enjoyable), without finding something else that is worth giving it up for.

So that's my first piece of advice, don't try to lose weight to be healthy, instead try to soul search to find a more detailed answer as to what it means to you to be "healthy" and why you want to be healthy. (Plus I don't like how weight is a proxy for health, but that's another topic for another time). What is it you're hoping to achieve? Hopefully the desire to achieve whatever it is you are driving towards will override the desire to have a donut, or ice cream, or fried chicken (all the above are my vices, everyone has their own). Dean Ornish, Clinical Professor at UCSF and preventive medicine guru, put it nicely in his Ted Talk when he said, "Many of you have kids, and you know that’s a big change in your lifestyle, and so people are not afraid to make big changes in lifestyle if they’re worth it[...] For many people, those are choices worth making -- not to live longer, but to live better." So would make you feel like you were living better? What are the things you love that you want to be able to do more of or better? Everyone has to answer that for themselves, but I don't think it is even worth talking about diet and exercise, as mentioned in a previous post, until we've figured out why we're going to undertake a healthy lifestyle journey in the first place.

In case you're curious in what ways I'm living better and how it motivates me, I'll say that what brings me great joy is to be able to do fun activities that I never thought possible. It makes me really proud to do something new, like finishing my first sprint length triathlon earlier this month. I always put people that could do things like that on a pedestal and felt like I'd never be good enough enough to do it, and so it feels kinda awesome to know that I am good enough! It is a huge self confidence booster. The other thing is I love to travel, explore, and have fun adventures, so I love being in shape enough to do unique activities when traveling and/or exploring. For instance, this past weekend I biked 32 miles around Los Angeles to see the sights, and am preparing for a trip to Scandinavia this July to bike from Norway to Finland. I'd never be able to do these types of unique adventures, or experience a country in this way, without being in shape enough to do it. This makes me happy.

Map of Los Angeles bike ride for "City of Angeles Fun Ride"
Biking in the Wildflower Triathlon May 1, 2016

Tuesday, May 17, 2016

Return to Blogging

"Trust me, I'm a panda"
Sorry for the hiatus from posting, but being a family medicine resident the last 3 years left me with little time to do much else. As mentioned in a previous post, "You can do anything, you just can't do everything". Something had to give, and unfortunately for me, I had to stop blogging. However, recently, a few incidents got me thinking about restarting up my blog (including almost finishing residency).

The first incident came a little over a month ago, when a medical student was working with me in clinic. That particular day's schedule was filled with one success story after another of patients that I had been working with to successfully lose weight. The medical student asked, "How do you do that? Your patients are so compliant!". The compliment triggered a thought that maybe I should start blogging about the ways I counsel my patients, as it seems to work for some, so maybe others could find some value in the advice I give in clinic on a daily basis.

I'd also like to note that the either intentional or unintentional brown-nosing totally worked in making me feel good about myself, and I subsequently wrote that medical student a stellar evaluation.

The second prompt to have me thinking about blogging again came in a form of a text message from a fellow resident, also about a month ago. She asked me for my blog address. I let her know that I hadn't blogged in years, and her encouragement to start back up to inspire others also got me thinking.

Finally, the third reason to start blogging again was the recent article in the research journal Obesity, (or a more digestible summary/characterization here from the New York Times) that discussed how many of 'The Biggest Loser' contestants regained their weight after the show. They talked about how each contestant's body metabolism changed and subsequently sabotaged their efforts to sustain their initial weight loss. I personally found the article to be really discouraging. I felt like it made the journey to sustainable weight loss seem almost impossible. However, three and a half years after my own weight loss journey, I'm still about the same weight/body composition.

I'm just an average person. I believe if I can sustain a healthy lifestyle, then others can too. I hope coming back to blogging, I can share strategies that have helped me so that others can benefit. I'm going to start off in the next month with a series of common things I tell my patients that helped some (definitely not all) find success.

Monday, October 14, 2013

THAT was an awkward doctor's visit: Being on the other side

I went in to see my primary care physician last week... and learned I had gained around 10 lbs in the last few months. The conversation went like this:
Doctor: "So... you gained 10 lbs since I last saw you... you're still ok, but is this becoming a trend?"
Me: "Oh...I wore shoes on the scale this time."
Doctor: "Shoes don't weigh 10 lbs..."
Me: "I...I...also had my wallet and keys..."
Doctor: "We're still looking at at least 5 lbs..."
Me: "It's all muscle!!!"
Doctor: "Oh have you been weight training?"
Me: "Yeah! See?" <flexing so he could see my new muscles>
Doctor: "It's not all muscle... what have you been eating? Are you still exercising?" 

AAAHHHHHH!!! How did this happen? After all the time I spend counseling patients on diet and exercise... it was surreal to be on the other side of it. I felt like a kid being scolded, and I came up with one excuse after another. I wonder if that's how all patients feel when they sit on the exam table: this feeling of being in trouble and not knowing what to do but minimize the problem with excuses. I wonder if I make my patients feel like that. Moving forward, I'd like to be more aware of trying to make lifestyle change discussions more inspirational instead of just pointing out problems. I want my patients to leave the room going, "I'm going to do it" instead of thinking, "I wasn't doing it right..." I'm just not entirely sure how to accomplish this yet. The doctor-patient dynamic inherently makes these discussions so difficult. It is a power dynamic similar to getting sent to the principal's office, and even my first reaction was to go on the defensive. So how do you bring out the pal in princiPAL (saw that on a sign once as a way to remember the different between principle and principal... stuck with me all these years), for the doctor-patient relationship? 

On another note... I'm apparently a non-compliant patient too... At my last visit, my doctor discovered I had a heart murmur and ordered for me to get an ECHO just to see what it was. I wasn't overly concerned about it given that I have been able to run and do Crossfit without feeling light headed or anything... and completely forgot about it. "So did you get the ECHO done?" "What ECHO?" "Last time, we heard a murmur and I ordered an ECHO" "Oh you did? I didn't know". 

I hope my patients are better patients than I.

Friday, August 23, 2013

Tips to cook with limited time

Hey everyone! Five consecutive weeks of nights down, one more to go. I'm still alive, still kicking, and still cooking. I've gotten some comments about how amazed people are that I'm cooking while working night shifts, and how people feel like they don't have enough time to do it. Not true at all. You can make simple, and delicious meals in barely any time at all. I literally shop and cook for one hour a week. That, along with then just picking out salads or veggies at the hospital cafeteria as I mentioned in my last post, is enough to still have healthy foods around all week. Here's two things that have made cooking super easy:

1) Glass tupperware - What a genius invention! I literally cook, refrigerate, and transport all in the
Chicken in glass tupperware
same container. I cook two servings per container, and then take the entire thing to work, eat one serving that day, and leave the leftover in the fridge in the call room for the next day. Afterward, I just bring the entire thing home and toss it in the dishwasher, it can't get easier. I remember how long it used to take when I cooked in a group to first do the cooking, then have to wait for things to cool before transferring to a container for people to take it home. I just cut out all the time.

Various spices from Penzeys
2) Pre-made spice blends - There's this store around the corner from me called Penzeys spices that sells tons of spice blends that are delicious, but let's be honest, you can buy spice blends from any super market spice aisle, and if you're being Paleo, the ones at Whole Foods are paleo compliant. Just try some random spice, coat your meat/veggies in it, and you're done. If you use multiple spices, then you can have several flavors going the same week. Especially since I'm cooking 2 servings per container, and 3 containers, I use 3 different spices each week.

I cook a week's worth of meals while doing laundry. Literally, I'll go out and buy the groceries while my clothes are in the washer, then come back, put my clothes in the drier, and then cook the food while the clothes are drying. All I do is coat the meat/veggies in spice blend and toss in the oven (if chicken breasts around 25 minutes at 425F). The food is ready and placed on my counter for cooling before my clothes are finished drying. Then after I get my laundry, I'll cover the tupperware and put the food in the fridge. If the containers are still warm, I might put pot holder under so it doesn't hurt my shelf, but other than that, it is done until I take it to work. So if you have time to do laundry, (which I hope you do, because otherwise you're stinky, and according to Kristen Chenoweth who is wise in many things... nobody likes a stinky witch. I'm sure the same applies for doctors.) then you have time to cook.

Do I supplement with eating out? Why yes, yes I do. Do I supplement with some store bought snacks? Yup. I'll write more about those later, but in the meantime, just wanted to show that there's always time to cook. Not having time isn't an actual reason, it is a random excuse because either you don't really want to do it, or don't know how. If the latter, now you know how! :-)