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.