If it's so Easy, Then Why is it so Hard?

In my job in a physician, as well as my job as a health counsellor, I try to get people to change. Those people who are uninitiated in the medical world think that the Emergency Department is mainly a place of gunshot wounds, car accidents, and other major life threatening illnesses. In reality, these make up a minority of people who come through the doors of virtually any ED. These days, most of the patients we see are victims of what I like to call "diseases of lifestyle." These diseases are malfunctions of the brain and body caused by various voluntary activities that are not healthful. These diseases include:

Diabetes
High Blood Pressure
Obesity
Heart attack
Stroke
Gallstones (some cases)
Depression/ Anxiety (some cases)
Fibromyalgia or chronic pain syndrome
Cancer (some types and many cases)
Trauma (many types)

The activities that cause these diseases are as follows, in order of importance
Poor diet and lack of exercise
Poor diet and lack of exercise
Poor diet and lack of exercise (this is not a misprint. It is just that important)
Smoking
Excessive alcohol intake
Drug abuse

As such, I spend a lot of time speaking with people about how and what to change. The things that I am asking them to do seem so simple when I say them or write them out: Quit smoking, eat better, exercise a few times a week, pay attention to their health and follow through with routine medical exams. Despite how easy these changes seem, a surprisingly low percentage of people are able to change, even temporarily. Why?

As my wife reminded me yesterday when we were talking about this subject: "change is hard, even if it is from something you don't like." She is correct. Even if I can get someone to recognize that there is a problem with the choices they are making, and that they are responsible to change it (a very difficult proposition), habit is powerful. Even a habit that you don't want, and know is bad, like smoking or poor eating is difficult to change. We as human beings resist change, whether good or bad.

In order to create change once and for all, we must overcome that resistence. Fortunately, we were given one weapon to help us change. It is not our intellect. I can reason with a patient all day long about how smoking is going to kill them, and they will nod, say they understand, and light up the minute they leave the ER. The weapon that we have to aid us is our emotion. Strong emotions, like fear and guilt, can push us to act when we are faced with the necessity of change. Fear can be supplied by a medical scare, like a heart attack or a tumor, or by social consequences. That is why you often hear of people quitting smoking or beginning a diet and exercise plan after being diagnosed with cancer or a heart attack. Similarly, the alcoholic quits drinking when they experience enough pain or fear that they don't want things to get worse (rock bottom). The power of our rational mind is that we can create the fear without the bad consequences. Visualization in the brain is as real to us as reality is. If you explore your uncomfortable emotions and visualize the negative consequences of the decisions you make, it will be far easier to overcome them.

This is how I finally managed to change. I was forced by my circumstances to visualize the fact that my children would have to grow up without their father, and that I would not be around to see the important events in their lives if I did not change. In the span of a second, the change that had eluded me my entire life became simple. So to Christy and everyone else, I submit my version of her quote:

"Change is easy if you have the right reason." Find your reason.

Who Advertises for Apples?

So I was reading in the news the other day about a fight that is going on in Washington. This fight is between the government, who believes it is acting in the peoples' best interest, and the makers of processed foods and beverages, who are sure they are acting in their own best interest.

The fight is over what sorts of food are acceptable to market to children. In particular, the article was about Goldfish Crackers. The government was contending that Goldfish should be classified as junk food, and not marketed to children, on the basis of the fact that they are made with white flower and other processed ingredients, as well as the fact that they have saturated fat in them. The lobby group that represents Campbell's, the company who makes the Goldfish in question contends that they should be classified as 'healthful,' and thus acceptable to market to children.

I think that they are both wrong.

As a father of three, you might imagine that I have very strong opinions on this subject. Lets ignore for this post the association of TV with childhood obesity, and only consider the marketing aspects. What kind of foods should be OK to market to people who have poor impulse control, no or little rational capacity for decision making, and most importantly, no money of their own with which to buy those foods? The answer is none. Yet these corporations market directly to children. My children and yours. It is disgusting.

We all know why they do it. They figure if they implant enough images of their products in the minds of kids, those kids will grow up knowing and using their products, and they will have generations of brainwashed adults. Why not? It worked great with my generation. Earlier this month, I read that fewer than 25% of people my age remember that the USA used to be a British colony, but I'll bet that 80 or 90% can remember the Big Mac song:

Two all beef patties, special sauce, lettuce, cheese, pickles, onions on a sesame seed bun

It is clear that marketing is very effective. It is even more effective when done to children, who are more easily influenced and lack the impulse control that many adults possess. Why then does it occur?

I do not think this is the fault of the government. Not because I think the government is doing a good job, but mainly because as is true of most things they get involved in, the government has no role here. The government's job is not to tell people what to advertise and what not to advertise.

The blame goes only in one place: us. We are all to blame for this mess. We, the CEO's and marketers of corporations who should value their customers more than their bottom line, and recognize that they have violated basic ethics by marketing to children AT ALL. We, the people who permit this kind of unethical advertising by watching the TV programs in the first place. Finally, we who do not punish the companies who are harming our children by boycotting their products. Instead, we expect elected officials who listen to the selfsame companies via lobbyists to fix the problem, so that no lifestyle changes will be required by us.

Join me in taking responsibility for that blame, and help guide your children away from TV and advertising, and toward healthy activities and foods. Remember that the foods that no one advertises or lobbies for are probably the best ones for you and your children!

Thag Hot!

You may or may not have noticed the last week or two, but it is kind of hot out. If you live in Kansas, like me, it has been REALLY hot. Burn your feet on the pavement hot.

Heat like that brings up a few special considerations when it comes to health, so I thought I'd dedicate today's blog to dealing with the heat.

First, I will let the doctor in me talk for a minute about heat exhaustion and heat stroke. These are the two main heat related illnesses.

Heat Exhaustion is when you have been out in the heat too long, but not long enough to kill you yet. You begin to feel tired, weak, and sometimes lightheaded. You  are sweating profusely, and feel shaky. Passing out is possible at this stage. The symptoms are not subtle. You will know that something is wrong. The cure is to get out of the heat RIGHT AWAY, and drink something (non-alcoholic).

Heat Stroke is what occurs if you ignore your body's warning and don't (or can't) get out of the heat. You stop sweating (a very bad sign), and can get confusion and loss of consciousness which progress to coma and death. This is obviously not very good.

There. That is the public service announcement part of the show. Dr. Ott is satisfied. Now, on to how to exercise in the heat.

1. Choose a good time: OK, so you may be one of those people who love to run every afternoon at 3:00 exactly. If you have to wait until 3:02, you start to get the shakes. Believe me, I understand this kind of obsession, but temperature speaking, this is probably not the best time to run. Truly, the best time would be around 3AM, when temperatures are at their lowest, but since that is usually not practical, early morning and late evening are the next best choice

2. They invented the treadmill for a reason. I know that treadmills are boring, but they are infinitely better than dying of heat stroke. Trust me. When it gets super hot, sometimes discretion is the better part of valor, and just giving in and running on the treadmill is your best bet.

3. Drink water: Here is a news flash- when it is hot, you sweat. A lot. Those fluids need to be replaced. Unless you happen to be a frog (who can absorb water through their skin), the only way to replenish fluids is by drinking them. Drink water every 10 minutes or so. Drinking water also helps to lower your core body temperature, so it gives you a double benefit.

4. Take breaks as needed: You have your 20 mile long run scheduled for Friday. It is 100 degrees on Friday. That doesn't necessarily mean that you have to cancel your run (but you should consider it). You could instead break it down to four 5 mile runs, with a 10 minute inside break (to cool off). This strategy would keep your core temperature lower, so that you can finish, rather than overheat.

5. Protect yourself from the sun: If heat stroke doesn't get you, skin cancer might. Melanoma is the deadliest form of skin cancer, and your chance of getting it is greatly increased by sun exposure. Be sure to wear a had, and technical clothing which has a high SPF (a cotton shirt only has an SPF of 5, but you shouldn't be wearing that to run outside anyway, as it does nothing to wick sweat away). Wear sunblock, but don't be fooled by the hype- while it will prevent you from getting a sunburn, studies have not ever shown it to be effective in preventing melanoma.

Remember these steps, and your run in the heat will only be painful, but not deadly :)

Thag Write?

There was a great article in HealthDay today about food journaling. As part of my job, both as a physician, and as an health and weight loss advocate, I spend time reviewing the medical and lay literature for new developments, or ideas that may help my patients and my readers lose weight.

Food journaling is not a new idea, and it is one that I have long been a proponent of. I thought I would revisit the topic, since I read about it today. Like many things in our society nowadays, the mainstream idea is right in principle, but hits off the mark. Using a food journal as most nutritionists recommend will help you lose some weight. Effective food journaling, on the other hand, will help you lose A LOT of weight. Other than actually eating right and exercise, a food journal is probably the most important weapon in your weight loss arsenal.

Let me explain. A conventional weight loss journal would include things like what foods you ate, what times you ate them, and the calorie counts of those foods. If you use a pretty advanced food journal, it might also help you calculate your protein, fat, and carbohydrate intake. By looking at how many calories you have eaten, you know how many you have to go, and the mere act of writing down the foods you eat helps you to think about exactly what you are eating, so that you will hopefully make better choices.

This is all well and good, but it misses the point.

What you should really be journaling about is not only what you ate, but WHY you ate it. For most overweight people (myself included), the reason you carry extra weight is less about the what than it is about the why. I spend a lot of time talking about how the food culture in America sets up for failure, and it does. There is just too much food. We, however, set ourselves up for failure as well. I, for example, used food as an emotional coping device, entertainment, and a comfort aid. Most of my overeating occurred when I was stressed, bored, or lonely, but I never really realized it.

Part of the reason I write this blog is to share with you what I did wrong, so that you can hopefully benefit from my mistakes. One of my biggest is that I assumed that being overweight was purely a proposition of eating too many calories. Until I learned that there were triggers for my overeating, and how to avoid them, I had no chance.

When you write your food journal, I want you to concentrate on three things: what, why, and how. Write down:

1. What you ate- Write down everything you ate and drank, so that you can accurately review and eliminate poor food choices.

2. Why you ate- Write down why you chose that time to consume food. Were you hungry? If so, how hungry, on a 1-10 scale? Was it a mealtime, a planned snack time, or an impulse snack?

3. How you were feeling- This is the most important. Write down what emotions you were experiencing. Particularly note the negative ones, such as boredom, sadness, loneliness, or anger.

Finally, once a week or so, review your journal, and try to focus on patterns. Note if a particular emotion or reason stands out as an eating trigger. If so, whenever you feel that way, avoid food like the plague. You can't fight what you can't see, so this knowledge is key in your fight against obesity!

Thag Change

Let's face it. Change is hard.

Well... that's not exactly true. Change can be pretty easy, under the right circumstances. We can probably all remember times when we have made a change which seemed nearly effortless. In fact, sometimes the change almost seems to make itself, then we can hardly imagine doing things like we used to.

So why is it that some changes are so hard, while others seem so easy? What is different about the changes that we make without much effort?

There are several factors which go into changing or not changing a behavior. If you want to make the changes that lead to weight loss, you must understand those factors. They are:

1. Fear. We are our own worst enemies. Many times the biggest obstacle to change is our own fear. This can be fear of what others think, fear of the unknown, or fear of failure. Fear is paralyzing, and has a powerful effect upon us, when we listen to it.

2. Benefit of our current situation. Though you may be dissatisfied with your life at present, you are getting something that you want out of it, or you would do things differently. For example, when I was overweight, I was very dissatisfied with my body, but I enjoyed eating very much, and I also used food as a coping mechanism, eating when I was sad, lonely, bored, or disappointed. Even though I did not realize it, I was getting a lot of validation from myself for overeating.

3. Lack of motivation or inertia. In order to overcome the first two, and do work to reach a different state, even one that we find desirable, we must have motivation. I call this motivation combined with positive motion "inertia." Inertia has a power of its own, and tends to build on itself once started, but in order to get the ball rolling, you have to be motivated.

All of the factors involved in the process of change can either work for you or against you. Fear, for example, can either paralyze you or impel you forward. Why is it that most people change only when they hit "rock bottom," or they have some sort of health complication? Because they experience fear over the possible consequences of their lifestyle, and that is enough to overcome any other fear or negative inertia. Therefore, in order to make a change, you must understand several factors:

1. What are you getting out of where you are
2. What fear(s) are keeping you from moving forward
3. What fears or factors could you use to motivate yourself? To assist with this step, think about all of the worst case scenerios that you can come up with to associate with not changing.

Once you understand all the forces at play with a difficult decision, it is often easier to take that first step, and once you take that first step, an avalanche of change often results.

Courage

Most people have a list of things the want to accomplish in their lives. This list can include the grand and world changing, such as get elected president of the United States, or the small, such as learn to ride a horse. You can have many or few things on the list, but rare is the person who has absolutely no goals that they wish to accomplish.

Goals are great, as they help to create momentum and positive change in our lives. Without goals, I would still weigh 350 lbs and I would not be writing this blog. In fact, many studies have shown that people who have written goals accomplish far more in their lives than people who have none.

The problem is not with the goals. It is with the reasons. Lying next to that list of goals in our heads, many of us have a list of reasons that we do not accomplish them. Here was my list of reasons for not losing weight:

I don't have time to exercise
I don't have time to cook, so I go for the easier fast food
I am addicted to food
I have a genetic predisposition to weight gain
If only I could start over, I would be able to maintain my weight
My life is too stressful. I have to eat to cope

As you can see, although I called these "reasons," they are really just excuses. If you examine why you have not achieved all of your goals, you will probably find a similar list of "reasons."

When you come right down to it, virtually none of these excuses are true. The reason behind the excuses is fear.

Though I had (and believed) my list of excuses, the fact of the matter was that I was afraid to really commit to losing weight. What if I failed?

I was afraid of what my friends and family would think of me.
I was afraid of what I would think of me. Did that make me a failure? I was afraid of being a failure.

Fear is a powerful emotion. It's power is mainly rooted in its ability to paralyze. When you are afraid, you will not act. This paralysis kept me from taking productive action against my obesity for years.

Fear is also weak. Though it seems all consuming, it is often based upon concerns or ideas which are just plain wrong. Yet when we believe them, we cannot move.

Thus, there is an antidote to fear. It is called courage. Courage is the ability to act despite fear. We usually ascribe courage to heroes, who run into burning buildings, and falsely believe that they are not afraid. They feel fear just like you and me, but have a reason for acting that is stronger than the fear. Thus, they act in spite of it.

Overcoming fear is a two step process:

1. Examine your reason for fear: Often times, if you simply ask the question "what am I afraid of?" you will notice that your reason just doesn't make sense, or is something minor that you don't need to be afraid of.
2. Act: Even if your reason for fear is valid, if the goal is something that you want to achieve, just moving in the right direction can snap the paralysis and reduce or eliminate the fear.

The most important thing to remember is that fear should be a counselor. It is there to warn you of a potential danger identified by your mind. It should not be a jailor. It should not keep you from acting to achieve your goals. Identify the fear, and its source, and you will find the courage to overcome.

The Pursuit of Happiness

We hold these truths to be self-evident. That all men are created equal. That they are endowed by their Creator with certain inalienable rights. That among these are life, liberty, and the pursuit of happiness.

The approach of the Fourth of July got me thinking about this historic document. I know what you are thinking. This is a health and weight loss blog. What does the Declaration of Independence have to do with health. As it turns out, everything.

Mr. Jefferson wrote that we all have the inalienable right to the pursuit of happiness. I think that most people hear the last part of this statement, but not the first part. When you ask most people what they think of this passage, they will invariably answer what we are all (wrongly) taught in school: that it guarantees our basic rights. This is a vast oversimplification of the truth.

If you read the Declaration closely, you will notice that it does not guarantee us happiness, as most people think. It merely identifies our right to the PURSUIT of happiness. Mr. Jefferson does not say that someone will come and give it to you, or even that you will succeed in getting it. He says that part of our endowment as human beings is the right to go after it. In fact, he is not giving you a gift, but a great responsibility. No one is responsible for your happiness but you.

Mr. Jefferson was probably not thinking about obesity when he wrote this, but it is a universal principle. Until we take responsibility for our own lives and destiny, we can never change our circumstances. Until you realize that your obesity is not a product of anything but your own actions, you can never change it. That is what he meant by the pursuit of happiness. That we are in charge of our own lives, and that no government, king, or other person can take that away from us, unless we give it to them with our consent.

Join me this Independence Day in reflecting on the circumstances in our lives, and how, good or bad, they are the result of our decisions. Then exercise your personal independence to change your actions, and through them, your life! Leave a comment about how you can use your independent will to change your life circumstances.