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


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