There is an old saying in Medicine, “Medice, cura te ipsum”, which in English means, “Physician, heal thyself.” This doesn’t mean that as a physician I can’t go to the doctor or that I have to perform surgery on myself. What it does mean to me is that as a physician I should set a good example for my patients, and practice what I preach. I can’t say that I have always done that.
My father, who is very fit and active in his 70’s, has said to me that there are people who eat to live and people who live to eat. I fall into the second category. Food for me has been something to celebrate with, console myself with, stave off boredom or fatigue with, and occasionally, nourish my body with. When I was in college playing basketball 2 hours a day and sporting a 20-year-old’s metabolism, I could get away with eating whatever, whenever. But as happens to most of us, our activity levels decline with age, our stress levels may increase, and our metabolism decreases. And we gain weight.
Dr. Elisabeth Kubler-Ross in 1969 described the five stages of grief as denial, anger, bargaining, depression, and acceptance.
While she was relating this to people faced with a terminal illness, I think that her model can be applied to those people dealing with a chronic disease, such as diabetes, hypertension, or in my case, obesity. I’m sure that over the years, as I grew more sedentary, and larger, I went through all of these stages. The last stage is acceptance. When talking about a chronic illness, such as obesity, I think acceptance is the realization that you have a chronic condition, you’re not going to wish it away, and you have to learn to manage it.
I had that realization early this year when I got the courage to step on the bathroom scale, and the digital readout read, “OL”. In case you’re wondering, OL means over the limit. The limit on that scale is 350lbs. Now I’m very tall, 6’7”, but even so, I would have to be about 8 feet tall to justify more than 350lbs. I remember thinking, “Kevin, you are so fat that the scale won’t even tell you how fat you are.” In that moment, the first four stages of grief ran through my head at once, followed by a moment of clarity. I realized, and accepted, the fact that I suffer from obesity. At that moment, like many other people who realize they have a chronic condition, I had to decide what was I going to do.
The first thing was, to be honest with myself about why I wanted to lose weight.
Having a scale that doesn’t go up high enough is a wake-up call, but not a reason. The scale in my office goes up to 450lbs, and I’ve seen 5x and 6x scrubs for sale. Also, I have a fantastic family who I know loves me no matter how much I weigh. So why go through all the diet, exercise, frustration, and self-denial it takes to get back on track. I was able to come up with quite a few reasons. A lot of them had to do with my family. I also feel like I was blessed with a healthy body, and in some way, I feel that it is a sin not to take care of it. Another reason goes back to the proverb, “Physician, heal thyself.”
Every day, I see patients who are overweight, or obese, and I see the consequences of this. Obese patients often have high blood pressure, diabetes, infertility, irregular periods, or are pregnant and have pregnancy complications. As you might expect, I would try to talk to my patients about healthy eating, exercise, and the benefits of weight loss. But as the words came out of my mouth, there was always the feeling that I was in a “do as I say, not as I do,” moment. Sometimes I would try to rationalize my way out of it by saying to the patient, “I know that exercising and losing weight is hard,” with my out of shape, obese self as living proof. I’ve always felt very comfortable talking to my patients about other healthy lifestyle choices such as quitting smoking, alcohol in moderation, don’t use drugs and practice safe sex. But when it came time to talk about weight loss, I felt like a hypocrite.
Having made up my mind to do something, I sat down with my family and told them where I was and where I wanted to go, and I asked for their help.
They helped me get all the junk food out of the house, and together we’ve come up with better meals to cook at home and less eating out. We switched to using smaller plates to avoid the “have to finish your plate” syndrome and help with portion control. And then I started exercising again. When you’re out of shape and trying to get back, the number of excuses you can come up with not to exercise are almost infinite. You have to, as the Nike commercials say, “Just Do It.” I don’t recommend expensive exercise equipment or gym memberships unless you are truly committed to using them. I am however, a fan of watches or phone apps that track your steps. If you’re walking, then you’re moving, and if you’re moving, you are burning calories. I’ve worked my way up from walking, to using an elliptical machine, to cycling and jogging. I also mix in some weightlifting to try to tone up my muscles (this helps keep up your metabolism because muscle burns more calories at rest than fat). I have gotten to the point where I try to exercise at 30-60 minutes 5 or 6 days a week, and I try not to take more than two days in a row off. It probably took me 3 or 4 months to get to this point, and I constantly have to remind myself, “you always feel better after a workout than you do before or during it.” As long as you exercise sensibly and don’t overdo it, I think you will agree.
The last thing I had to do, and still do, is not be so hard on myself.
The journey to losing weight and becoming fit is a marathon, not a sprint. I remind myself every day that every meal is a choice and the choice to exercise, or not, is a chance to make a good choice. But if I slip up for a meal, or don’t get to work out one day, it’s not the end of the world. As I’ve worked on my diet, exercise, and gradually seen the results, I’ve found it easier to put together a long string of good meal choices, and days in a row of exercise. Personally, I also pray and thank God for blessing me with good health, and I ask for his help in taking care of the body he gave me. Whatever way you want to look at it, the journey to getting yourself back into good health is a long, hard road. It’s ok to ask for help wherever you can.
So, in case you are wondering, how has this all worked so far? Well, about nine months ago, I found a scale that would weigh me, and I was at 356lbs. At the moment, I’m down to 290lbs, and my kids tell me I need to buy clothes that don’t look so baggy on me, I’ve gotten back into running, and I finished a 5k. I remember texting my wife and kids a picture of myself on a flight without a seatbelt extender, and I definitely took a picture of the scale the first time it went below 300lbs! I’m not all the way there, but I plan to keep going. By the way, if you’re reading this and you are at a normal weight, let me give you one piece of advice. It is MUCH easier to stay in shape, than it is to get back into shape.
But like other people who have chronic conditions, I remind myself that even when I get to where I want to be, I’m going to have to remain vigilant to stay there.
Just like a person with chronic hypertension who’s used diet, exercise and medication to control their blood pressure can’t just stop all that when their blood pressure measurements become normal, I know that I will ALWAYS have to be careful about what I eat, and ask myself why am I eating and how much am I eating. I will always have to leave the excuses behind and stay physically active. I will always need to lean on my family for support, and I will always try to remember that by practicing, “Medice, cura te ipsum”, I will be setting a good example for my patients.
I hope that this post gives you some hope and encouragement to take the first steps to becoming healthier. In future posts, I plan to talk more about obesity, diet, and exercise. Good luck. I truly hope that you achieve your health goals.