Monthly Archives: January 2018

Goal Setting

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When you are losing weight, it is very important to set specific and tangible goals for yourself. This helps to ensure a few things:
1. That your goal is attainable and safe. The recommended rate of weight loss is 1-2 pounds per week. Losing weight gradually has been shown to produce better, more sustainable results. A good example of this is the show a the Biggest Loser. Anyone can lose weight in that environment- exercising all day and eating very little, but when those people go back to their daily lives they nearly always gain the weight back. Longevity and sustainability are keys to lasting weight loss. If you set a weight loss target that is not achievable, then you are setting yourself up for failure.
2. Goal setting helps you focus on not just the weight and the number on the scale, but what benefits you will see on a day to day basis in your life. For example, daily arthritis aches and pains are extremely common in obese people- the extra stress the weight puts on our joints is severe. Improving pain from osteoarthritis is a great goal to have. Another option is set goals based on the activities you want to be able to do. I want to be able to walk up two flights of steps without feeling like I am going to keel over- that’s a good easily trackable goal that I can improve on over time.
I started off weighing 275 pounds in the summer 2016, which was an all time high for me. More seriously, my BMI was 40.6- placing me in the category of morbid obesity (BMI > 40), yikes! That was truly a wake up call and had me considering gastric sleeve surgery. I have been close to that weight multiple times in the last 10 years and it is not uncommon for me to lose and gain back 50 pounds in a single year. This roller coaster has been very disheartening and difficult to endure, but it is imperative to keep a positive attitude and keep looking forward!
My weight goals are both short and long term.
My initial goal was to get my weight down to 220 pounds, down from a start of 275.
Past this my goal was to get down to 200 pounds by the end of August 2017 (BMI 29.5 and not obese but overweight!) and I achieve that goal! I set this goal for myself because my husband and I went on a 3 week long hiking trip out West. We traveled to Wyoming, Montana, Utah, and Colorado to hike and see state and national parks. We took a similar trip in 2015 and it was the best thing we’ve ever done, but at the time I was not in good enough shape to do strenuous multi-mile hikes in the dead of summer. I fell several times on the trails and we had to cut short several of our hikes because of that. So this time I was well prepared and in shape to safely complete strenuous hikes in the mountains and desert. Injury is a real and scary possibility when you are out of shape, and I was fall and injury free! This trip was a wonderful adventure, and it was great motivation to keep on track!
My next goal is to lose 100 pounds total. It has been really hard. Since my big trip a few months ago, my weight has been plateaued. I continue to get more in shape, but the numbers on the scale just aren’t budging. I am relying instead on improving my strength and endurance to measure my progress. I know I’ll lose 100 pounds eventually, but it sucks to see the scale taunt me!

When You Have a Bad Day

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Here’s something that won’t surprise you- I’m not perfect. None of us are, and from time to time we are going to slip up.
For example, I made it my goal this year to try and do some exercise every day. That’s a pretty high bar, and I am approaching a full year of everyday exercise!!! In the beginning, there were days I just couldn’t do it and as time went on I’ve been more and more consistent. I don’t freak out if I am sick or feeling badly… slipping in a quick 15 minutes of yoga or walking is still exercise! Go up the steps at work, whatever you can do to fit it in. You don’t have to run a marathon everyday, just do the best you can.

Also, I am still trying to not eat any fast food or fried fatty foods. Well I continue to blow this one. When I was sick I was totally exhausted and just wanted something fast and filling- so I had Fazoli’s one day and Applebees another and maybe some nachos and Taco Bell. And you know what, they hit the spot at the time!
The most important thing is to not let these bad days derail your whole plan. I have done this in the past… one bad day leads to a week leads to a month. I’m learning resiliency by being able to start each day fresh, and not dwell on my past mistakes.
“I tried and failed. I tried again and again and succeeded.”
(Gail Borden)

When is selfishness a good thing?

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When you make a huge change in your life as I did in the last year, you really have to put your priorities in order. Because to work on yourself, you actually have to prioritize yourself first. I was doing a crappy job of this before. At the top of my list has always been medicine… whether it be my schooling, training, or my current job.
Now don’t get me wrong, I absolutely love my job as a physician. But my problem is my job is also my identity… who am I if I am not a physician? I got so wrapped up in my work that I was sacrificing other parts of myself, and this had to change. I still love my job and I will always go above and beyond for it… but it is taken a backseat in my priorities.
In order to get healthy, I had to put myself at the very top of the list. This means you need to be a little selfish. You have to be willing to say no to other pressures and obligations in order to devote the time needed to better yourself. That might mean 30 minutes totally to yourself to work out… or 30 minutes to cook a quick dinner instead of getting takeout… or even 30 minutes to soak and relax in the bath.
I have found that when you put yourself too far down on the list, you start to burn out and lose sight of the joys in everyday life. So, whatever it is that works for you, taking the time to devote to it is worth it.

Binge Eating

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What is binging? No not the Netflix kind where you are unmoved for an entire day watching 13 Reasons Why, but food binging. To binge is to compulsively eat a large amount of food and then feel shame or guilt afterwards.
Now we’ve all done that right? Holidays, parties, special occasions all deserve a good binge. But when does it get to be a problem? I have been a binger all my life. And unfortunately I even meet the clinical criteria for binge eating disorder, from DSM V:
The key diagnostic features of BED are:
1. Recurrent and persistent episodes of binge eating
2. Binge eating episodes are associated with three (or more) of the following:
* Eating much more rapidly than normal
* Eating until feeling uncomfortably full
* Eating large amounts of food when not feeling physically hungry
* Eating alone because of being embarrassed by how much one is eating
* Feeling disgusted with oneself, depressed, or very guilty after overeating
3. Marked distress regarding binge eating
4. Absence of regular compensatory behaviors (such as purging).
Um yeah, definitely me. When I was younger I used to buy big bulk amounts of candy and hide it in my room. Then I would eat the whole bag and hide the wrappers in the bottom of the trash bin. Now back then I was crazy athletic, so my weight was pretty controlled, but over the years that binge eating pattern has been a constant. And when you take exercise of the equation, the pounds just pile on.
What bothers me the most about binging is the completely sick feeling I get after. Not just physically, but emotionally. In my darkest times I have cried and called myself disgusting. And I still feel this way when I binge… why aren’t I strong enough to control myself? It makes me so angry that after all these years I can still engage in binging.
But guess what- I am flawed. We all have our personal demons and this is one of mine. I can say that with time and hard work, I am binging less and less. I may never be binge-free, but I am not going to let it control my life anymore!!!

Why do doctors put our own health last?

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As doctors, we are good at many things- we are smart, efficient, hard-working, proficient, role models and leaders. Why then do so many of us prioritize our own health and well being beneath our jobs?
As a physician my most prevalent discussions with patients always boil down to very simple recommendations: eat right, exercise, sleep, and manage your stress. Lifestyle changes are really the key to solving many of the medical problems in this country. How many physicians do you know that actually follow this advice themselves? Most doctors I know devote the vast majority of their time to being doctors. Working 80+ hour weeks, working early and late hours, missing family events, sleeping little, skipping meals or eating fast food for time’s sake, fitting in a workout or two when and if they can.
When we were training in residency, do you remember thinking how hard you were working and how you couldn’t wait to finish and be an attending? Little did we know that when we finished our training we would continue working harder and longer hours then we ever imagined.
As time went on these last few years, I came to feel like a fraud with my patients. Here I was telling them what they needed to do to get healthy and treat or even cure their medical issues- all the while becoming dangerously more unhealthy myself. I let my weight ballon to 275 lbs never exercised, ate thousands of empty calories, and worked so many extra shifts that I had few days off per month.
So I finally did what I have been preaching to my patients for years: I changed. I changed my diet, I started exercising every day, I started to track my calories and macronutrients, I cut back on my shifts at work, I don’t work when I’m at home, and I made sure I was getting 7 hours of sleep regularly. My husband- who has been with me since college and gone through all the ups and downs of me becoming and being a doctor- was stuck in a similar unhealthy rut as well, and we have been brought closer by this experience and have been able to get healthy together.
Let me tell you, though I am still on my journey to good health and lasting impactful change, my life has already been irrevocably and positively altered. It is like I have been reborn after so many years of neglecting myself for the sake of my work. It has been the best possible thing I could have done for myself.
And the icing on the cake is this: it is making me a better physician. Since I cut back on my shifts, I am more engaged at work and more genuinely able to connect with patients and their families. Particularly with my many obese or morbidly obese patients, it has helped me connect to them on a very personal and authentic level. It is not only making me a better doctor, but a better human being- and isn’t that what we all strive for?
If you are a doctor that is stressed, unhappy, unhealthy, overworked I encourage you to reprioritize your life and put your health first.

Can you cure yourself?

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Why do we as doctors keep singing the same old tune of lifestyle changes? Because it is the only treatment that has been shown to cure many chronic diseases!
I myself have four chronic conditions, three of them directly related to obesity
1. Prediabetes. This is basically when your glucose levels are increased but not to the level of diabetes. The vast majority of prediabetes will progress to full on diabetes. The only way to stop this from happening is weight loss and dietary changes. You can in fact cure your diabetes if you lose enough weight. This can be done with diet and exercise, but bariatric surgery also produces the same results. I am off my medication and my long term health risks from diabetes have dramatically decreased!
2. Osteoarthritis. Due to the extra weight on my joints as well as past injuries I have signs of arthritis at the ripe old age of 35. I take vitamin d, glucosamine, and chondroitin but the best way to prevent my arthritis from progressing is good ol’ weight loss and exercise!
3. Chronic pain. This is directly related to the arthritis above. I have chronic neck pain, back pain, knee pain, hip pain you name it. The kind of pain that keeps me up at night. Are medications the solution here? You guess it- nope! Again weight loss and exercise as well as sleep hygiene and stress reduction are all proven treatments for chronic pain. Yoga has been instrumental with helping my pain.
4. My other and most long running chronic condition is migraine headaches. I’ve had them on and off for many years. Sometimes up to several weeks at a time of day in and out misery. In making my lifestyle changes, I have dramatically changed my diet, sleep better, exercise regularly, meditate for relaxation, and cut out caffeine. Guess what? Migraines gone! Off of all my many migraine meds and supplements. My headaches can now be managed with a simple dose of ibuprofen of a small glass of diet soda.
What an amazing difference! And all just with lifestyle changes. So worth it 🙂

How I am doing it Exercise #4

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I get a lot of questions about what specifically I have done to lose weight and get fit… I’m going to write up a few pieces to give the details
This one is about exercise, the 4th in the series
With all this talk about workout regimens I forgot one of the most important pieces of advice!
Do exercise that doesn’t feel like exercise!
Make it fun! Get outside! Get your family and friends involved!
For me that means hiking with my husband and dogs, kayaking, bike rides, trampoline jumping, and anything I can figure out to do outside!

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The more fun you make it, the less it’s going to feel like work! This is where that variety comes into play as well- if you hit the gym hard 3-4 days a week and then do something fun and preferably outside the other days- it won’t be so hard to get back to the gym the next time.

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