Is diet or exercise more important for a healthier lifestyle? How about neither?

I saw my sister about a month ago, and since she also struggled with weight loss she asked, "So, what was it that worked? Diet or exercise?" I decided neither. Both are necessary, but neither are sufficient. I would go as far as saying even together, diet and exercise are not enough, because what's most important is having a strong foundation from which you can build a healthy lifestyle. Diet and exercise of course will result in better health, but is it sustainable? Sustainable changes towards a healthier lifestyle should be the main goal, and it requires a foundation of being mentally committed to yourself. In the words of En Vogue, "Free your mind, and the rest will follow". I've tried for years to lose weight... but never could do it sustainably. Looking back, I failed because I didn't lay the proper foundation of making a commitment to myself to be motivated, be honest, build a support structure, and set appropriate goals. All four are important, but I'm going to focus on the first two in this post.

Why do you want to be healthier? Knowing your personal motivation is critical, because starting a healthy lifestyle requires will-power, self-control, and conscious effort to deviate from your normal routine. The most difficult step is the first one, and I promise it gets easier as you get used to a certain way of living, but you will need inspiration to keep yourself dedicated while you're adjusting to a new lifestyle. I can spout the various diseases associated with obesity from heart disease, stroke, diabetes, osteoarthritis, liver disease, cancer, etc, but really, unless you have some personal connection to a disease, these are the easy answers. I've shared some of my personal motivations in my first post, such as wanting to be able to lead my future patients to a healthier lifestyle by example, however, I have more reasons. Some are based in improving my sense of self-worth by making myself a priority in my life. I also want to be able to do all the fun activities I see other people doing, like trek up Half Dome in Yosemite instead of having people tell me, "You know that's really hard right?" Those are my reasons...what are yours? I often hear wanting to be healthy for one's kids or boosting one's self-confidence as reasons, both of which are great! Finding your own reasons requires soul searching, and it's difficult to be honest with yourself about what you're really made of, but in the end you'll be stronger for it. When I see a box of donuts in the call room (or office), I think to myself, is that donut worth it? The answer is no because my reasons for wanting to be healthier are more important than a minute of donut induced pleasure. When I'm at a restaurant, I switch out fries for steamed vegetables because thinking of my motivations to become healthy drives me to implement small changes in my life everyday, which in aggregate, yield significant results. So, what drives you?

I've already mentioned the importance of being honest when thinking of your own motivation, but let's go one step further by looking at other ways we lie to ourselves and self-sabotage our efforts to become healthier. I'm guilty of it. Lies that I've told myself include, "This is just the way I am, I'm already eating right and working out, so it doesn't matter because nothing works for me". I've been "regularly exercising" for a decade, and I just couldn't lose weight, so I was obviously genetically prone to obesity...or thick boned. It's amazing that I could just ignore that both my parents are skinny. If you're not becoming healthier with effort, then it's time to re-examine what's really happening. Just last Friday, I saw a patient who shared in my plight. She was a morbidly obese patient in her 40's who was frustrated in clinic because despite doing everything she's supposed to, she gained 10 lbs since her last visit. According to her, she worked out every day, ate only fruits and oatmeal in the morning, salads at lunch, and cooked vegetables with some meat at night. For a few minutes, I was baffled, until repeated questioning prompted her husband to reveal, "Well... she does have a sweet tooth...". In the end, I learned she ate frozen yogurt 4+ times a week in the evenings and I can't help but wonder what else she wasn't being completely honest about to herself or to me that was impeding her success. Humans have an amazing ability to rationalize what goes on around us to perceive our environment in a way that conforms with what we want to believe is reality. I've done it too, so I'm the last person who can judge, and can only sympathize and hope to support others. Another lie I used frequently was, "I work so hard...so I'm entitled to this big mac combo with large fries...and 10 chicken nuggets... and a mcchicken (plus it's only $1.00 more!) just this once." Sadly, this is actually what I used to get at McDonald's when stressed, which earned me the nickname of "Big Mac" by my neighbors' son when I was studying for the MCATs for med school admissions. First of all, rewards are supposed to be good for you, but that aside, the lie really comes from thinking it only happens once... binge eating horrible food is a gateway drug to more bad habits. I'll share one more lie I told myself: "I don't have time". This one is the worst of them all, because what was I really saying? That I didn't have time for my own well-being? That there were things more important than me? Like what? Studying to get 2% higher score on a test? Doing another extra-curricular activity? And frankly, if I want to do well in the things that I was involved in, I should be taking care of myself. I was just using time as an excuse, because if it's important, you make time. For me, I thought about how I could make time by integrating other activities that are important to me. When I examine what's important in my life, my friends are high on that list, so I found a way to make healthy activities and healthy eating a social activity, and suddenly, I'm multi-tasking and taking care of my mental well-being as well! So what are the lies you tell yourself that are serving as your personal barriers to success? The first step is being honest with yourself, then we can start thinking about ways to work around perceived barriers instead of using them as excuses.

Two more equally important components of a strong foundation are having a good support structure and appropriate goal setting, but like an out-patient doctor's visit, we can't address everything today, so I'll save it for a future post. My post next week will be a sample of my weekly diet regimen, some initial thoughts about diet, and some fun recipes.