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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