How do most of us react when our doctor tells us that we need to lose weight? Typical responses might be, “I know, but it’s too hard. I’ve tried,” or “I should do that in a few years.” And how do we react when we develop a health complication of obesity, such as diabetes, hypertension, or heart disease? “I guess my luck ran out,” or “Doctor, please do something to fix the problem.”
These reactions relating to being overweight have run through my mind at different times. Finally, because of some wisdom that I gained over the years through my work as a pediatrician, the time came when I reacted differently. I learned how to help myself accomplish major weight reduction.
My personal physician held a small green leaf between his thumb and index finger. This was the beginning of the odyssey that reshaped my life and taught me a lot about how physicians, family members, and friends might improve their treatment and support of patients.
“Do you know what this is?” My physician of nearly 15 years asked me.
I stared at the leaf, bewildered, because my medical training was not helpful in figuring out which species this plant was from. I looked at my wife who was sitting next to me because I wanted her to hear what my physician had to say about my health. She shrugged.
“This is a new leaf,” he announced, while flipping it. “It’s time for you to turn over a new leaf.” This demonstration by my physician was different enough that I paid closer attention than usual. Further, use of the leaf as a symbol may have spoken to a different part of my mind than did words. Perhaps, this was one of the reasons for the effectiveness of our interactions that day.
I understood what my physician was talking about. My fasting blood sugar and hemoglobin A1C, which are measures of sugar control, recently were documented as elevated.
“You have type 2 diabetes,” he explained. “In the old days we would tell you to go lose weight, and when you had your first heart attack 10 years later we would begin treatment. But now we can take care of you immediately with medications.”
I knew that my weight was an issue, and my cholesterol had been high for over 20 years. My physician had told me that I had familial hypercholesterolemia because my mother and maternal grandmother also had high cholesterol. I reacted to that information by consoling myself that there was no history of heart disease in my family. I had a similar reaction when I was told that the mild elevation of my liver enzymes was a result of a fatty liver, which leads to the development of liver failure in 20% of patients. I reassured myself that since I did not drink alcohol, which predisposes to the development of fatty liver, I did not have the same risk factors for liver disease as other patients.
My physician was drawing a graph and explained, “At some point insulin production in the pancreas is insufficient to keep up with the body’s requirements and the blood sugar begins to rise. Now, if you lose a significant amount of weight, then your diabetes would resolve. We can give you an oral hypoglycemic and I’ll probably prescribe injections as well.”
Wait a minute, I thought. If weight loss can resolve my condition, why would I want to take any medication? And I certainly did not want daily injections. So, I decided on the spot, if weight loss will solve my issue, then I will lose weight.
My wife asked what was healthy for me to eat. My physician handed her a colorful booklet that she examined. “This only talks about the caloric content of fast foods and brand name products. I like to prepare foods for my family. What are good foods?”
He paused, and then replied, “I don’t have any written information about that. The current basic idea regarding diet is portion control. Limit the total amount of caloric intake, no matter the source, and you will achieve weight loss.” Both my wife and I had the same thought. If diet control was so important, why wasn’t literature available for us regarding how to affect a significant change in diet?
The Right-Sizing Plan
My wife and I went to have lunch after the appointment. We shared a vegetarian wrap, an unusually small lunch for us, and which I learned later was not the best food choice.
“This is a real opportunity for us!” I told my wife. “My body is saying that I can no longer continue to eat the way I have been. We can take this opportunity to both adjust our diets, which will help us be healthier,” I explained. My wife acknowledged that she too could benefit from weight reduction. “So, this is very good news for our family,” I concluded.
In part of my practice as a pediatrician, I instruct patients in self-hypnosis techniques as a way of helping themselves accomplish their goals. Through this work I have learned about the power of words and suggestions, which I decided to employ to help myself.
Thus, rather than engaging in an effort to lose weight, I decided to “right-size.” I chose to keep my focus on the positive: To imagine how I would appear once the right-sizing took place, rather than think about the weight I was losing. Who wants to lose anything?
Very quickly I learned that by restricting our caloric intake, my wife and I became hungrier. I figured out that the helpful response was to make hunger my friend during this journey rather than something to be avoided. Hunger before a meal meant that I had eaten a reasonable amount during the previous meal to help me achieve the right size. I decided that since hunger starts with the letter “h”, whenever I felt it, I told myself I was “happy” or “healthy”. Many times, my wife and I would discuss how happy we were. Sometimes, very, very happy. Thus, the sensation of hunger thus was reframed from a negative to a positive self-suggestion regarding this beneficial sensation.
I became convinced that right-sizing would be very manageable when I learned that in order to become 50 pounds lighter within a year I would need to exercise for 30 minutes a day and cut back on my daily intake by 300 calories (kcal), which is the equivalent of one hamburger.
I learned to make smarter food choices:
- I began eating a lot of vegetables instead of bread and pasta, when I realized, for example, that ¾ of a pound of cauliflower contained only 80 kcal, which is the same as is in one slice of bread.
- I found that pickles curbed my appetite and contain almost no calories.
- I learned that a “healthy” sandwich wrap contained 150-250 kcal, so I began to avoid them.
- I began eating a lot of fish, because a serving typically contained less than 200 kcal.
- I discovered that most restaurants make the caloric value of their foods
available, which made it easier to pick healthy selections.
- I learned that a chicken Caesar salad can contain 1200 kcal because of the dressing, and therefore started asking that the dressing be served on the side.
- Even Chinese restaurants would serve many of their dishes with gravy on the side. This allowed me to drizzle gravy on my food rather than it being soaked in calories. I found that food still tasted good
As I told my patients, my 6-step right-sizing plan was simple:
- Realize that right-sizing is an opportunity to take charge of your health. You do not need to wait for a health crisis to come to this realization. You might find your inspiration to change your health habits from talking with your health care provider, listening to the suggestions of your family members or friends, or thinking about the consequences of unhealthy vs. healthy behaviors.
- Reframe hunger so that it helps you feel happy and healthy.
- Recognize that a consistent small caloric reduction leads to major right-sizing.
- Make smart food choices consistently. A smart food choice may include eating a smaller portion of a calorie-rich food you love, rather than omitting it from your diet.
- Exercise regularly.
- Tell your friends and family about your right-sizing plans. Better yet, support and be supported by a close friend or family member who also is engaged in right-sizing.
Three weeks into the right-sizing program my weight had improved and my blood sugar became normal. My physician was impressed, and asked how I had made such progress. I replied that I decided to take care of myself after he told me that I could get rid of my diabetes with weight reduction.
As he examined me, he said, “Well, if you keep this up you will be quite healthy.” “What do you mean ‘if’?” I retorted. “I will be healthy ‘when’ I keep this up.” “That’s hypnosis talk, isn’t it?” he asked.
“Yes,” I replied. “It’s a suggestion. Instead of expressing doubt with an ‘if’, you
can express confidence and support with a ‘when’.”
As my right-sizing continued, I felt much more energetic and had a lot more stamina. Most of my friends and colleagues were very supportive. I received many compliments regarding my improved appearance and report of success with my weight, and was told that I appeared younger.
However, I was puzzled and somewhat disheartened by some negative responses to my success. “Are you sick?” was a common question. I remember I had asked that of some of my acquaintances in the past when they right-sized. It seems that many of us believe few people choose to right-size without a compelling reason. “Don’t lose weight too quickly” and “Don’t become anorexic” were common reactions as well. I do not believe that the people making those statements realized how harmful such comments can be, because of their implicit suggestion that something might be very wrong.
After I corrected my weight, my total cholesterol levels and my fatty liver had become normal. There was no sign of diabetes.
My physician asked me, “Do you know what I am most pleased about?” I wasn’t sure. “I am most pleased that not only did you lose weight, but so did your wife!” Indeed, we had helped each other through encouragement, and sharing healthy meals with single portions. At restaurants, where serving sizes often are very large, we often decided to split one meal between us.
As he was further contemplating my case, my physician mused, “I didn’t believe you could lose so much weight. You must have amazing will power.” I thought to myself, is it possible that your patients don’t right-size, in part, because you don’t have the expectation that they can succeed?
I asked myself why it was that I hadn’t decided to right-size when I was younger, for example, when I became aware of my high cholesterol level. I realized that when I was told that my problem was related to “familial hypercholesterolemia” I thought there was nothing I could do about it, and I would just have to learn to live with the issue. Thus, I believe that health care providers often inadvertently lock patients into their diagnoses by implying there is no alternative.
I tell my patients today, “You may have a genetic predisposition to an illness, but this does not mean that are going to develop a problem. It just means that you have to take special care of yourself.”
My hope and expectation are that consideration of my experiences and adoption of the 6-step program I have outlined will help improve the lives of many people who will benefit from right-sizing.
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Portions of this article were first published by the Syracuse Post-Standard in 2011.