Walking the Talk

BVF ben downhill

The Journey and the Struggle

18 months ago I wrote about my plan for maximizing menopause preparedness.  As with so many missions, this one has experienced both successes and failures.  Since January 2016, I have grooved my exercise routine in the most awesome way.  I am all over the TRX, doing Spiderman push-ups, incline presses, pistols and more.  I get my cardio intervals and I’m foam rolling.  I feel stronger now than at any time since high school, and I’m proud of this accomplishment.


The eating, on the other hand, continues to be a challenge.  Earlier this year a patient looked at me without expression, and stated bluntly that I had gained 8.7 pounds since the last time he saw me.  Right after that’s kind of inappropriate, I thought, well, he’s right, I have been gaining weight.  Last March I wrote about weight loss strategy, thinking mainly about my exercise habit formation.  Sadly, my own weight has gone opposite to the desired direction, despite an honest attempt at adherence to my own advice.  Evidence suggests that weight loss really is about 80% diet and 20% exercise.  But sometimes you can only focus on one thing at a time.

Back in 2008, when I finished nursing, I thought, I can get my body back!  I knew I was not going to exercise, and I had no energy to police my food choices.  But I also knew I was eating too much, so I decided to just cut my portions in half.  It felt easy, decisive, and empowering.  I lost 25 pounds in 9 months, and got down to my wedding weight.  But eventually I acknowledged that though I was thin, I was squishy.  So I connected with my trainer in 2014, the primary goal being to get moving without injuring myself.  Right now I’m up 17# since my nadir in 2009, though I’m much more fit than the last time I lived at this weight.

Talking the Walk

I’ve always had a love-love relationship with food, and it shows in my weight/habitus.  I notice also that my own state of mind and body has influenced the advice I offer to patients.  Before I exercised regularly I spoke to patients a lot more about diet; now it’s more balanced.  One patient brought it up recently.  He asked, “What about the doctors who smoke, or the obese ones, how can they advise anybody about healthy habits?”  I’ve thought a lot about it, so I was ready to answer.  To me, there are three main options, all of which I have tried.

Disclaim.  We doctors can rely on our authority to tell people what to do to get healthier.  They notice our fat rolls, or smell cigarette smoke on us.  They see the dark circles under our eyes and surmise that we don’t sleep enough.  Maybe they can tell we don’t exercise.  But we admonish them to eat less and move more.  We say (subconsciously) to ourselves, “Do what I say, not what I do.”

Avoid.  Rather than give lifestyle advice at all, we can focus on prescriptions and referrals.  We feel we have no place instructing patients to eat more leaves, go to the gym, or quit smoking, when we don’t even do so ourselves.  So we don’t even bother, feeling like hypocrites.

I think both of these responses are rooted in shame and perfectionism.  And I think we should not fault physicians for choosing them—that would be meta-shaming–never helpful.  These are normal, human responses to our professional training and expectations.  Physicians have long held positions of authority and expertise.  Until very recently, our relationships with patients were mostly paternalistic.  But with burgeoning access to information, a culture evolving (rightly) toward patient autonomy, and physicians experiencing historically high levels of burnout and suicide, we cannot afford to burden ourselves with the illusion that we must be perfect in order to be credible.

Connect.  I think the healthiest response, for both patients and physicians, is for us doctors to acknowledge our own struggles; to empathize with the difficulty, the conflict, and the utter disappointment of not being able to control our actions and choices as we would like.  I think patients don’t expect us to be perfect.  But they do want us to be human and relatable.  I often find myself saying, “I know that feeling,” or, “Yep, that’s my weakness, too,” or, “Oh, and what about x-y-z?  That’s my problem!”  Only once has a patient said to me, “Shame on you!”  He was a perfectionist himself; I didn’t take it personally.

I stress eat. I eat when I’m bored.  I eat late at night, and I love sugar, starch, salt, and fat.  The struggle is real, and I know it all too well.  So when I ask you, “What small changes can you commit to in the next month?” believe me, I’m asking myself also.  And if you tell me something that has worked for you, I’ll probably try it.  I still think my ‘4 A’s of goal setting’ apply: Assessable, Actionable, Attainable, and Accountable.  I just haven’t found my 4A formula for eating yet.  But lately I have taken a more lighthearted approach to healthy eating trials.  Nothing is life or death, and I know iterative changes are best.  If one thing doesn’t work, hopefully I can learn something and move on to the next.  No dessert on weekdays.  Vegetarian on days I work.  No eating after 8pm.  No starch at dinner…  Meh, none of it seems to stick yet.  Even my cut-it-in-half strategy doesn’t appeal to me these days.  It’s so frustrating!  And it’s also okay, because I know I’m doing my best, just like my patients are.  We can all just take it a little more lightly, one step at a time.

So by the time menopause actually hits, I’m confident that I will be prepared to meet it, with grace and maybe a little irreverence.  I’m learning to judge myself (and thus others) a little more gently.  I’m learning to love my body, whatever shape it’s in.  After all, it’s the only one I’ll have this time around, and I need to maintain it for the long haul.  Turns out, my patients have been my best companions and consultants on the journey.





On Walking the Talk


NaBloPoMo 2016, Letters to Patients, Day 4

To My Patients Who Wonder, “How Healthy Is Your Diet, Doc?”

I cannot tell a lie, it kinda sucks sometimes!  I’m not a foodie, really.  In fact, I have maybe the least discriminating palate of anyone I know—everything tastes good!  I particularly love sugar, starch, salt, and oil—especially in combination.

So when I talk to you about the picnic plate method of eating—half stems/stalks/leaves/fruit, a quarter high quality lean protein, and a quarter whole grain—believe me, I understand the challenge!  In fact, every time I counsel you, I review my own food log in my head, and I resolve to visit the raw salad bar more often.  When I give advice or make suggestions, it’s not that I necessarily know better than you, or that I think I’m better than you.  We’re all here doing our best every day.  It’s my job to look out for your health, which research tells us is only 20% related to what I do in the clinic or hospital, and 30% related to your own habits (incidentally, it’s 40% related to your environment).  So if I can help you make even the smallest change for the better, then I feel useful.

When I ask you about exercise, sleep, stress management, and relationships, I am also taking stock of my own habits in those realms.  To me, these are the central domains of health.  And nobody has a perfect balance all the time.  Maybe you’re great at exercise, but your diet is the pits.  Maybe you eat really well, but you stay up too late at night.  Everybody’s patterns are different, and they shift over time.  Sometimes I might share my own fluctuating experiences with you, if it feels relevant and helpful.  But our time together is about you, not me.

I want you to feel free to ask me how I manage my own health.  It’s important to me that I Walk the Talk.  I will answer honestly, if sheepishly.  I will share my struggles with you.  I risk judgment by you when I do this, and I accept that.  One of you actually said, “Shame on you,” to me one time.  Maybe you feel judged by me, also?  I think that is inevitable.  We all judge ourselves, and then subconsciously project our judgments onto others.  I’m working on self-compassion—ask me about that, too!

It’s about strategy and execution, trial and error, and repetition.  No matter what the behavior change, the more times we try, the more likely we will finally succeed.  So the next time you come in and we talk about health habits, think of it as comparing notes, rather than reporting progress or regress.  If you found something that works, please share!  I might just steal the idea for myself.