Wednesday, February 19, 2014

Tried Everything To Lose Weight? Think Again...

"I've tried everything...It's not happening."

This has become the anthem of dieters world-wide.  As I write this, I'm sitting in an outpatient clinic where the majority of patients are obese, diabetic, and sick.  Weight loss recommendations are often made in the form of a fleeting suggestion, "Have you thought about losing weight?"

"I've tried everything...It's not happening," so says the patient.

Obesity is highly prevalent and very costly for our nation, which is why physicians routinely address it during office visits.  According to the CDC, 37% of the U.S. population is obese (defined as BMI equal to or greater than 30).  Treatment of obesity-related disease is estimated to upwards of $210 billion annually.  Our health coaching clients often walk away with much more to brag about than a slimmer waist line, but their driving motivation is their image in the mirror.  Unfortunately, addressing obesity in the physician office visit is coming up short in the battle to curb obesity.

There are many known health benefits that come with weight loss, including:
You don't need a snappy dresser to tell you that these disease processes can lead to an early death and poor quality of life, so why haven't we seen improvement in our nation's collective waistline?

In my experience, most individuals pursuing weight loss do it for aesthetic appeal.
Gordian knot: contemporary
metaphor for the impossible
Sometimes this is even a stronger motivator than avoiding the long-term consequences of high blood pressure or diabetes.  At this point, I'm certain that, in most cases, the "why" is understood.  The "how", on the other hand, is a gordian knot.  

I have watched family members struggle with weight loss for years.  Those who persevere eventually break through.  A healthy, lasting weight management program will address underlying emotional stressors and tendencies to overeat.  It might require readjustments to your sleep patterns or a little bit of muscle pain once in a while from a tough workout.  But a break through is possible.

When I talk about my history as a triathlete, many people react immediately with something like, "Oh...I've thought about doing that, but I don't know how to swim."  Guess what?  When I took up the sport, I couldn't swim.  I registered for an Ironman-distance triathlon (2.4 miles open water swim before biking 112 miles then running a full marathon) without knowing how to swim.  The registration fee was $500 that I barely managed to scrap together.  My first day at the pool, I had all of my gear in tow: goggles, skin tight booty shorts, and a swim cap.  I jumped in and found that my form sucked so badly that I was winded after 50 meters.  I struggled through numerous workouts, and I competed in a sprint distance triathlon to test my fitness.  I finished dead last and was forced to complete the majority of the swim using a doggie paddle.  Needless to say, I was incredibly discouraged.

Instead of resigning to never becoming an Ironman, I signed up for lessons at the YMCA. There were little kids swimming in the lane next to embarrassing.  When that strategy didn't work, I contacted collegiate swim coaches around my city to ask if I could join them for swim workouts.  This required me to get up at 4:00am, ride a train for 45 minutes into the city, try not to drown for an hour, return home, shower, get ready for work.  When that didn't work, I bought several books and DVDs.  On one occasion, I was trying to float in the shallow end, and, out of frustration, chucked my goggles in disgust.  Throughout this whole process, I was working a full-time job.  The final two months of my training took place at the very beginning of medical school, meaning I had to wake up a few hours earlier than my peers to run, bike, swim, or lift in order to meet my goals.  I persevered for nine months, and now I'm an Ironman.  And I'm also a very strong swimmer.
You are, indeed, unique and beautiful,
but your excuses are old news

My point is that if you want something badly enough, you need to keep trying.  Very few people have a genetic predisposition to obesity.  If you haven't accomplished your weight loss goals, it's likely because you simply haven't found the best method for you.  

If you have been living a life comparable to that of most Americans, you are overweight, inflamed, and perpetually fatigued.  To correct the metabolic derangement that has led you on your weary way, you may have to make some sacrifices.  You might have to try some new things.  You might even have to wander gradually from your comfort zone. But something will work, and, if you want it badly enough, you will keep at it.  Half of the battle is motivation.  How badly do you want it?

Nowadays before and after pictures have become common place.  The typical story reads something like this: "I struggled with my weight for years, but I didn't see great results until I tried ______ !"  Fill in this blank with HCG injections, Crossfit, P90X, jogging, juice fasts, coffee enemas, durian fruit, Atkins, or the paleo diet.  The impression conveyed by these media stunts is that "scientists" have finally found a miracle cure for your weight loss.  What these before-and-after pictures leave out is all of the perspiration, pain, tears, and determination that led the charge.  Maybe the scheduled, repetitive nature of P90X workouts is the key to getting you off the couch, but simply ordering their product isn't going to help you lose weight unless you put in the time.  Furthermore, if you want lasting, healthy weight loss, there is no magic bullet.  There are tools like home exercise DVDs, diet plans, and health coaching to help alleviate the burden of planning, but the rest is up to you.
Before and After.  
But what happens in between? 
Your lifestyle is what got you here in the first place.  You'll have to work really hard, and make some uncomfortable changes to your lifestyle, but it will pay off in the end.  You need to be honest with yourself.  Until you've truly changed your lifestyle, you haven't tried everything.

At the clinic yesterday, one of the nurses sat down at the table in the break room as we were all unpacking our lunches.  She deftly swooped a hand across her mouth followed with a big swig of water.  She caught me watching her, and she said, "Just took my fat pills."  I pried deeper. "My doctor says I have to lose 30 pounds, and nothing else works for me."  I asked, "Have you tried health coaching?"  "Oh, honey, I've tried everything...It's not happening."

Tried everything?  Perfect...that's our specialty.

Nathan Riley is a 2014 MD candidate at Temple University School of Medicine.  He writes about food, movement, sleep, relationships, and stress in order to bridge the gap between his patients and evolutionary theory and clinical evidence. You call follow him on Twitter @BeyondtheMD.  He can be reached at  You can also connect with him on Google+. 

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