All posts by James Pate, MD

I am an OB/GYN physician in White Plains, NY. My professional interests include traditional OB/GYN as well as the medical care of minorities of gender, sex and sexual orientation.

We all fall down

Losing weight is a long and difficult challenge. It requires incredible self-control and persistence. It is all too easy to “fall off the wagon” and to not want to get back up. It actually takes a lot of energy and resolve to get up and try again, often to simply regain lost ground.

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On 6/20/12 I mustered the courage to engage my personal “battle of the bulge” yet again. As you can see from my weight record, I have fallen down several times since 2012. The important thing however is that I keep getting back up.

I have struggled with weight issues the majority of my life. Sometimes I like to say that I inherited the “fat gene” from my parents but genetics is only part of the picture. My relationship with food is actually the greater culprit. The art of eating is learned, such as what is eaten, how much, how often and why we eat it.

“Waste not, want not” is an idiom that applied to my dinner table growing up; my parents forced me to clean my plate every meal regardless of how full I was. On the more pleasant side, dinner was always followed by dessert.

Improper eating can also be triggered by emotion. We all want to feel good, satisfied and happy. Food can be comforting when eaten alone or when enjoyed with others. It can be used for celebration as well as depression. It can help take your mind off of things you’d rather not think of. Food can stimulate the reward center in our brains and can in fact become a powerful addiction and a dangerous friend. For my path to begin I had to recognize this, that I had eaten for many reasons other than hunger. I could no longer continue this unhealthy relationship with food.

Diets do not work. There are no magic foods, exercises, herbs, supplements or medications that have been proven to help people lose a significant amount of weight and to keep that weight off over time. The only way to achieve this is through a change in lifestyle. This means eating in a way that is healthy, satisfying and able to be continued for the rest of your life. If you choose to temporarily eat in a unique way (a diet) or to use products you think will help you lose weight, what will happen when you stop? How will you maintain your weight without having learned how to change your lifestyle permanently?

In order to change my eating lifestyle my relationship with food has become very supervised. Hunger alone is an insufficient mechanism for me to control my eating habits. Now I try hard NOT to clean my plate. I eat slowly and try to stop eating the moment I feel satisfied, not when I am full. I now take the time to consider what I want to eat, why I want to eat it and if it’s worth the Calories. I imagine that it will always be this way. I will always be tempted to eat more than I should for reasons like I listed above. And that is okay. I can be observant and continue to make conscious decisions regarding my food choices.

As I have written before, MyFitnessPal has been instrumental in helping me to keep track of my eating habits. I continue to be surprised by how an innocent-looking food can be harboring a huge amount of Calories. Talk about sticker shock! Checking Calorie content before I eat allows me to make an educated decision about whether or not I really want to eat it. That’s not to say that I don’t splurge occasionally. I just consider the cost and decide if it’s worth it.

Calorie counting is a lot like balancing a checkbook. If I overspend I get in debt but if I under-spend I save. My daily Calorie allowance is my budget. If I overeat I gain weight and if I eat less than my allowance I lose weight. Sometimes I want to go out and eat more than my budget allows. I can “earn” extra Calories to eat by burning them with exercise. If I go the to gym and do the elliptical for 30 minutes, I burn 300 Calories. That’s 300 more Calories I can eat for the day.

My favorite meal of the day is dinner. I want to eat as normal of a dinner as possible so I budget accordingly. I simply eat less for breakfast and lunch. My typical breakfast is 1 cup of FAGE Total 0% Greek Yogurt mixed with a Del Monte Fruit Cup and a packet of Truvia (~250 Calories) or an omelette of 6 egg whites with 1 egg yolk and salsa verde (~250 Calories). For lunch I eat a protein bar (Nature Valley or Clif Bar, ~200-250 Calories). If I’m really hungry before dinner I choose low Calorie snacks such as string cheese (~80 Calories). For dessert I like to eat either a JELL-O Sugar-free Pudding Snack (~60 Calories) or Ghirardelli Chocolate Square (~60 Calories).

And then there is dinner. ChooseMyPlate.gov recommends a plate that is 1/4 protein, 1/4 starch, 1/4 fruit and 1/4 vegetables. My personal plate is more like 1/2 protein, 1/4 vegetables and 1/4 starch. I confess that I don’t eat as much fruit as I’m supposed to. Good appetite suppressants for me are coffee and pickles. Go figure!

Now I am more than halfway toward my goal weight. I look skinny enough perhaps by my picture, but I am still overweight by my BMI (see earlier post). It’s been a long road but I can see the finish line… well, at least the beginning of a less steep and difficult road up ahead.

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Gay doctor? – Why I’m out, loud and proud

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To this day I do not know a single LGBT person from my youth. I was not privileged to have understanding parents nor to have role models with whom I could connect.

Many youth today find themselves in a similar position. Growing up gay, bi or trans* is never easy and each generation has their own struggles. However no generation has felt the wrath of homophobes quite like the youth of today. There are finally words to describe who we are and worldwide communities to which we can belong but these beacons of light also gaze upon and identify kids to themselves and their peers. All too often LGBT kids experience rejection, isolation, discrimination, harassment and physical violence. And this results in low self-esteem, risky or self-destructive behaviors, homelessness and suicide.

While I cannot reach out to those of my community who are suffering and alone, I am yet another adult who is proud to say that I’m here and queer and it does get better.

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  • The Trevor Project (http://www.thetrevorproject.orgis a 24 hour help line that is available to anyone who needs a listening ear.
    • 866-4-U-TREVOR (866-488-7386)
  • It Gets Better Project (http://www.itgetsbetter.orgis an inspiring collection of 1,000s of user-created videos from around the world that was created to show young LGBT people the levels of happiness, potential, and positivity their lives will reach – if they can just get through their teen years.
  • Parents, Families and Friends of Lesbians and Gays (http://www.pflag.org) provides support and resources for families and friends of LGBT people.

New favorite app: Wake-up

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I have Seasonal Affective Disorder which basically means that my mood and energy are significantly affected by the amount of sunlight I receive. I tend to want to go to bed when the sun sets and to get up when it rises. If there are prolonged periods of overcast skies then I become sluggish and I just want to hibernate. Clearly this is not helpful in trying to maintain a modern lifestyle and it is one of the major reasons why I moved away from Seattle. Getting up on time during the winter months has always been a difficulty; the alarm clock sounds, but it’s pitch black and cold so I end up hitting snooze way too many times.

Finally there is a solution: the Wake-up app by Pico-Brothers available for iPhone and iPad (It works best for me on iPad). Basically I put my iPad against the wall and set the alarm. When the time approaches for me to get up the screen gets brighter and brighter. There is also a sound function which I have set to “birds”. Now I don’t have trouble getting up and I can get to the gym before work, a previously unobtainable dream. This app is now a part of my essential apps collection.

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New favorite app: GoodRx

Want to save $100s without traveling to Canada or Mexico or buying from shady internet sources? Check out the iPhone App GoodRx! If you don’t have an iPhone, you can access the same free coupons from http://www.goodrx.com/.

This is not a gimmick. I used it myself to purchase a medication from Target that costs over $200 per month for less than $30. It almost felt like stealing. If you want to read more about the company, check out this Huffington Post review.

In a better world

Reproductive choice would be reproductive freedom.

Sex education would be nonjudgemental and complete and contraception would be accessible to everyone.

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Pregnant individuals would find support to scale financial hurdles that threaten lives, families and futures.

They would not have difficulty paying for services that align with their decisions and the futures that they envision.

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Protesting would focus on the harms committed against living children.

Not on the individuals who find themselves facing difficult decisions.

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We do NOT want to cut your beautiful baby boy!

IMG_5505Dear Dr Pate,

I’m a third-year medical student who is strongly considering going into OBGYN. Unfortunately, I’ve been really dismayed to discover how common it is for OBGYN residency programs to require their residents to perform circumcisions. I’ve begun to worry that my moral opposition to circumcision might be incompatible with going into OBGYN. I don’t want to get into a situation where I might be fired if I don’t perform circumcisions because I would rather get fired–and if that’s the case then why go into that field in the first place. I started to google about the topic and your blog was one of the first to come up.

Do you have any advice for a student in my situation? Should I try to seek out OBGYN residency programs that don’t require residents to circumcise? Should I just match into OBGYN and then refuse once I already have the job (can I be fired for that?).

Thanks,
MS3


Dear MS3,

Thanks for writing! I find it so refreshing to hear more and more from students, such as yourself, who desire to refrain from performing circumcision. Clearly you are not alone but tradition is deeply engrained in culture and deviation therefrom is considered illogical and threatening. If you are interested in OB/GYN, don’t worry about circumcisions. I wouldn’t even bother mentioning it in your interviews — it falls under the same legal protection as beliefs about abortion.

I encourage you to check out my post — Do medical students have to assist circumcisions? There are links to resources available to you. Hold you head high! Where there is a will there is a way. You don’t have to compromise yourself.

Some will tell you that refraining will limit your career opportunities. It is true that some jobs will try to push you. You can take either approach — put it out there so that potential problems will fall away before you become too invested or discuss it after the fact and assert your rights.

I chose to be proud and loud throughout my process; I stirred controversy and rocked the boat. This did result in expected consequences and more than a few blows to my ego however it was the right path for me. At least one attending physician and another resident refuse to do circumcisions because of my example. And that, for me, made the pain and suffering worth it.

And I have not been pushed aside by all employers as I was warned. One recruiter even told me that I didn’t have a chance landing a job in a major city. I dropped him like a rock. Instead I have joined a phenomenal group practice in a very coveted location just 20 minutes north of Manhattan.

So my advice to you is this: Follow the path that feels right for you and do not fear the obstacles that you will find. Be true to yourself and work hard and your path will continue to unfold before you. Keep your eyes on that path and drop the rocks!

Sincerely,
James Pate, MD
http://JamesPateMD.com

My hunt is over

i-love-nyIt’s official, my hunt is over… I have joined a small, single-specialty OB/GYN group in White Plains, NY and will starting in July of this year!

My journey to this trailhead has been long and arduous. I could not have made it without the amazing support of my family and friends. I would especially like to thank my husband, Patrick, for his love and encouragement. I truly could not have navigated this climb without his support. I thank our children for putting up with our limitations theses many long years and for the joy and happiness they bring to our lives. To Dr David and Monk David, thank you for providing me with foundation when my entire world had burned to ash. You will always have a central place in my heart. Mom, Dad, thank you! In spite of our many differences throughout the years you were willing to extend that out-stretched-hand when I needed it most — I would not have been able to scale the massive financial boulders in my path without your generosity. For this I will be forever grateful. Finally, to my wise faculty advisors — Dr Thorp, Dr Terrell and Dr Rauk — you are my mentors, advocates and role models. THANK YOU.

New York, here I come!

Music to my ears

ghirardelli-chocolateToday was the first day someone asked me, “Have you lost weight?” I was shocked, ecstatic and gave her a big hug. I have now lost 20 pounds and am no longer obese (barely, still quite overweight), but how wonderful it is when someone notices! I am very pleased with the MyFitnessPal program I’ve been using. I feel like I have an allowance of 1500 Calories and I can spend them any way I want. I had a beer with dinner and no biggie! I’m still within my budget. MyFitnessPal simply functions like a checkbook where I get a daily allowance; it helps me keep track of how many Calories I have consumed and how many I have left for the day. And if I decide to splurge — like the weekend my partner had his birthday — a couple days may be “in the red” but by watching the rest of the week carefully I can still come in under-budget. I love the flexibility and I feel like it is teaching me the skills I need to make a true “lifestyle” change… it’s not just losing weight, it’s knowing how to eat for the rest of your life so that you can keep it off. Real life, real food, real change.

Some things I have discovered: Coffee with cream and Splenda makes a great mid-morning snack. It curbs my hunger and only has 25 Calories. One of my favorite comfort foods is cereal. You may think it’s healthy but holy Calories! Eating a real serving size (not the 3/4 cup suggestion) has nearly the same amount of Calories as a greasy hamburger! And the amount of comfort it gives me is not worth the Calories it costs. A can of regular pop has about 150 Calories while a bottle of beer has only 170. Hello?! Gimme the beer! Ghirardelli Chocolate Squares have less than 100 Calories each. They are very rich and satisfy my sweet-tooth without eating up too much of my budget. And aside from the Splenda, note that everything I’ve mentioned is NOT diet food. Yet I am still losing weight… My way!

Physician, heal thyself (part 2)

high-fructose-corn-syrupThis is a continuation of my thread Physician, heal thyselfCheck it out: I’ve lost 16 lbs! I only need to lose 3 more pounds to no longer be obese! I am very happy about this though I still have a long way to go before I reach my goal. As I mentioned previously, what I love about the myfitnesspal app is that I can eat wherever and whatever I want — no diet food required. In fact, the only diet product I consume is diet pop for 2 reasons: 1. I don’t want the added Calories and 2. Fructose has multiple negative health ramifications compared to other sugars.

High fructose corn syrup (HFCS) is the traditional sweetener in most carbonated beverages and many other U.S. products thanks in large part to governmental subsidies to corn farmers. Because of these subsidies, HFCS is much cheaper to produce than sucrose, a compound of fructose and glucose commonly known as table sugar, and so the food industry uses it to cut financial costs. But as mentioned, this benefit in production costs is plagued by increased physical costs to the consumer.

In his article, Dietary Fructose and Metabolic Syndrome and Diabetes, Dr John P Bantle reports that there is mounting evidence that fructose does not inhibit appetite as effectively as other sugars and thus may contribute to the increasing prevalence of obesity, diabetes, high cholesterol and metabolic syndrome. It has also been associated with increased risk of gout and kidney stones. He reassures however that “the fructose that occurs naturally in fruits and vegetables provides only a modest amount of dietary fructose and should not be of concern.”

So in summary, all simple sugars like those mentioned above are bad for dieting. However, refined fructose should definitely be avoided for multiple health reasons.

Physician, heal thyself

weight

It’s been quite a while since I posted last, but today it feels like the right thing to do. I’m supposed to be working on a presentation I’m giving on the 11th , but I’m going to take a little break.

So one of my ongoing personal struggles has been my weight. I have struggled with it my entire life and total understand why losing weight is not as easy as skinny people make it sound.

The best shape I was ever in was during my years as a competitive gymnast in junior and senior high school. Though I was quite fit by general standards I was always embarrassed about the stubborn layer of belly fat that I could never lose to show off my ripped abs. After that I went to college and my physique went downhill.

When I finally got fed up with the extra weight I started working out again and trying to eat right. Yet after 2 years of trying I was still above my goal weight. So I joined LA Weight Loss and the weight melted off. Check out how skinny I got in the photo from 2005! After enough people pestered me that I was getting too skinny I stopped the diet and within 6-12 months was heavier than I had been before. I have contemplated doing the LA diet again numerous times but I honestly hated it — I like REAL food, sorry! — so I stayed heavy.

Well, my weight continued to creep up until I was barely able to fit into my 36 inch pants and I could not wait to take them off when I got home from work because they were so uncomfortable. I was too proud to go up another pant size. Check out the muffin top hanging over my pants just a couple months ago. Vanity aside, I am soon to have my 40th birthday and with my family history of diabetes I knew that I needed to make some major changes.

Where to begin?

Obesity in adults is defined as a having a Body Mass Index (BMI) greater than 30. The BMI is a number calculated from your height and weight alone; it does not take into consideration gender, ethnicity, bone density or lean muscle mass. In spite of these limitations the BMI remains the most utilized marker of overall body composition and a good tool to see where you are. You can find out your own BMI using the calculator from the CDC (Centers for Disease Control and Prevention).

BMI between
18.5-25 is normal weight
25-30 is overweight
30-40 is obesity
30-35 is class 1 obesity
35-40 is class 2 obesity
40 or more is class 3 obesity
40-50 is morbid obesity
50 or more is super morbid obesity

As I alluded to above, obesity is not just about looks. Rarely a day goes by in clinic that I’m not counseling at least one patient to lose some weight. Studies have shown that the majority of overweight women with irregular menstrual cycles only have to lose 5% of their current body weight to get regular periods again. And that’s a big deal for women who want to become pregnant. Infertility aside, obesity is associated with many medical conditions including heart disease, stroke, type 2 diabetes and certain types of cancer, some of the leading causes of preventable death.

Though diet books and spokespeople abound and the diet industry rakes in approximately $35 billion a year from U.S. citizens, Americans are on average getting fatter and fatter. According to the CDC over 1/3 of us are obese — not just overweight. My current BMI is 31.7 and places me in this category; thus I also have a higher risk for all of the conditions mentioned above.

So why don’t all us fat people just lose weight? It is certainly not for a lack of trying. You can ask any person with extra pounds and the vast majority of us will tell you that we have tried numerous times to lose weight. In fact, while some of us are successful at losing some weight for a period of time (note my 2005 pic above) 80-90% of dieters fail in our attempts to keep the weight off permanently (my 2012 pic). It is very hard to stick to a special/fad diet to lose weight to begin with and damn near impossible to stay on that diet indefinitely to keep it off.

The easiest way to lose weight and to keep it off for good is to make healthy eating choices and to watch how much you are eating. Several free eating guides are available from the USDA , the CDC and the FDA. But what it all boils down to is Calories and that input equals output.

What is a Calorie?

It is a measure of the heat produced by the combustion of food products. In general, 1 gram of protein or 1 gram of carbohydrate has 4 Calories of energy and 1 gram of fat has 9 Calories. The U.S. Recommended Daily Allowance (RDA) is 2000 Calories. Some of us need less, others more. Though we may not think of them as such, people with a low metabolism are like cars with high fuel efficiency. A little fuel goes a long way. People with high metabolism are like gas guzzling trucks; they need lots and lots of fuel throughout the day.

This analogy breaks down when we talk about overeating. If you try to put too much gas into a car the tank will simply overflow. The body of a person who eats too much will convert all those extra Calories into fat. Our bodies make fat to have reserve for when food is not available.

In modern society, low quality foods with high Calories have become remarkably less expensive than their high quality low Calorie counterparts. For example, ramen noodles cost less than $1 per package but have 400 Calories each. On the other hand apples cost $1 to $3 per pound but generally have less than 100 Calories each. So, if you are financially challenged then you are more likely to be fat.

We can try to increase our Caloric needs (decrease our fuel efficiency) through exercise, but exercise can be difficult if you are working long hours and cannot afford a gym membership — running down the road is generally an option only for people who are already in shape and accustomed to inclement weather. Again the cards are stacked against those with less means or with physical limitations.

I mention socioeconomics and other limitations because it is important for people to consider them. Just like the old saying, “Walk a mile in my shoes”.

Now before I continue rambling on, please know that I am speaking for myself and have not been paid nor asked to endorse the product I am about to discuss.

So, knowing that I am “blessed” with remarkable “fuel efficiency” and have difficultly finding time to exercise I knew that I needed to reduce my Calories. And if I was going to make a permanent lifestyle change that I would have to do it with the foods I am already eating, not start another fad diet.

For anyone who has tried it, keeping a food diary and counting Calories is a pain in the ass. It is tedious, time consuming and requires a decent amount of math skills. I had previously bought a Calorie counter pocket book but even that was painful for me — what do I do when I can’t find the food that I’m eating? There had to be another way.

MyFitnessPal

I was looking for a free Calorie counter app on my iphone when I discovered “MyFitnessPal”. If you don’t have a iphone they also have a website. What I love about this app is that it is so easy to use. I don’t have to eat special food and I can almost always find the food I’m eating in its database. I recently ate a Wendy’s Asiago Grilled Chicken Club Sandwich WITH the dressing (570 Calories) and am still losing weight.

Given my gender and activity level, the app tells me that I am supposed to eat 1610 Calories daily if I want to loose 2 pounds per week. If I increase my activity or want to eat more, I simply change the settings and the app recalculates how many Calories I should eat.

Too lazy to look things up? The barcode reader makes it super easy to simply scan the packaging of whatever I’m eating and presto, all the nutrient info is at my fingertips.

What if I eat more or less than the serving size suggestion, like when I eat 3 servings or only 2/3 of a serving? No biggy, the app allows me to make this adjustment and does the math for me.

I must confess that I am still not working out as much as I’d like to be… Working 14-30 hour days in residency just about kills me and I don’t have it in me to do much more than eat, and sit on the couch with my husband for an hour or 2 before going to bed. But if I were, the app has the ability to not only record exercise activities but also to on the spot increase my Calorie budget for the day with the Calories I burn.

I started dieting after Thanksgiving because I seriously ate like a pig and felt like a beached whale for 2 days afterward. I was not going to wait until New Years Eve this year to make my annual resolution. Since then, I have been losing weight on a weekly basis eating exactly what I want, just less than I would have eaten before. I occasionally do feel a little more hungry than I like but often a small healthy snack will tide me over until my next meal. And now that I’m in the groove it is getting easier and easier to stick to the plan. I’ve already lost over 10 pounds! Not that I can see it yet — I still have that annoying muffin top — but my pants are starting to feel looser and that makes me happy.

I was going to do this diet thing all by myself but after thinking more about it I decided that I should share my journey with you. Maybe if you see this physician heal himself, it will inspire you on your own journey. Best wishes to all of you and happy holidays. I’m going to go make myself something to eat!

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