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

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 that...so...yeah...no.". 

I hope my patients are better patients than I.

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! :-)

Don't let an "all or nothing" mindset let your attempts just turn into nothing

In my last post about trying to be healthy in residency, I said that my mantra would be, "You can do anything, you just can't do everything". After my first rotation, I'm realizing that "anything" might be more limited than I originally anticipated. So, unfortunately, my tried and true habit of cooking a week's worth of healthy meals a week at a time has been put on hold, at least for now. Time for a new strategy.

So I'm 3 weeks into a month and a half of being a zombie doctor (no I don't eat patients' brains... I'm referencing being on night shift). During this run of being only up at nights, I discovered two things: 1) I want to go to bed immediately when I get home and sleep for the little time I do have, and 2) On my days off, a combination of having other errands and having a completely zonked out circadian rhythm usually means I'm ready to go grocery shopping at around 1am... which hasn't proved very effective.

Steamed veggies at California Hospital's hot food bar

Salad bar at California Hospital

I also got to thinking... wait a sec... why am I spending so much money on groceries when the hospital pays for my meals at the hospital cafeteria? It is like how Google and other tech companies provides incentives and benefits for their employees working long hours... except the difference is, they actually have good food, or more specifically, more healthy food options. I find hospital cafeterias, just to be lacking in variety, particularly in the department of healthy proteins. So, I learned to compromise. Instead of spending 3-4 hours a week planning a weekly meal, grocery shopping, and cooking, now I spend 1 hour running to the grocery store and buying protein that I then throw random spices onto and bake for 30 minutes while doing other things. I then take 1-2 servings to the hospital every night and combine it with whatever healthy options are available in the cafeteria. Although it's slim pickings, at least so far in every hospital cafeteria I've found at least a bare bones salad bar, and then usually at the hot food station, one of their meals will come with a side of vegetables. So I'll combine my protein with their salad/side of veggies and make my own healthy meal.

Usually I'm a go big or go home type of person... but in this case, I've learned to be in a "I'll use the resources around me to make something work" frame of mind. It saves me time, saves me money, and helps me keep my habits sustainable, because unfortunately, sometimes all or nothing... just turns into nothing.

You can do anything, you just can't do everything

In the past 2 months, I've been busy transitioning to a new life in Southern California. Sorry for the delay in posts, but it took me a while to get over leaving Stanford as a med student, and adjusting to my new lifestyle as a new Family Medicine resident at UCLA, as well as adjusting to a new city. I think I'm finally hitting my stride though.

In orientation, we were warned about how common it is to gain weight our first year as a resident physician. A combination of stress eating, long and odd work hours that makes exercising difficult, and ironically unhealthy hospital food equates to weight gain for many. After working so hard to lose my 45lbs, I was determined to let this happen to me. My motto to achieve this with such a busy schedule is this: "You can do anything, you just can't do everything." In the context of extremely limited time, I'm just deciding to prioritize my own health and wellbeing, and in doing so, some other things might slide. We'll see how that plays out.

So far so good. I'm trying to just stick to what I know works. I started off my residency on night shift for our family medicine in-patient service the past week, and have one more week to go. Work hours are 6:30pm-7:30am every night, except Monday night where I work until 10am Tuesday morning, and then have Tuesday night off. My routine so far has been to get home and be asleep by 8:30-9am so I can get 7-8 hours of sleep. I then wake up at 4:30pm, and start my night off at my newly found Crossfit Sandbox around the corner for a 5pm workout on Monday, Wednesdays and Fridays. After an hour workout, I jump into the shower at the gym, and then bike to the hospital with enough time to grab a coffee before our 6:30pm sign-out to keep me going through the night. On the days I'm not doing Crossfit, I've been going to the gym to lift weights once a week. I tried to muster up enough motivation to run for an hour on another day, but instead chose to sleep. For diet, I'm also sticking to what I know best: preparing a week's worth of meals at a time. That takes up my Tuesday nights off. I cook enough food to last me through the night, with my "breakfast" at early evening consisting of a salad I get from the cafeteria before it closes. So far it has been fine. What have I given up to do this? Mostly my social life. I did go to dinner with a friend once, but other than that I haven't logged onto facebook, and am not so good about returning social texts/calls. I haven't even turned on my laptop except to write this post in the past week.

Preparing for a week's worth of meals overnight, with meatballs, chicken, veggies, and boiled eggs

In general though, in terms of my fairly recent journey towards a healthy lifestyle, the more things change, the more things stay the same. The only thing I'm really missing is the community I built while in Northern California and my Crossfit Palo Alto community that I used to cook with weekly. Besides being in a new city, it's hard to get people to come cook with you between the hours of 1am-4am. Hopefully the community will come with time, but for now, this works. More to come hopefully next week.