Friday, June 21, 2013

Program not responding.

*Random rambling and unpacking ahead. Proceed at your own risk.

This program is not responding. 
It may be busy, waiting for a response from YOU, 
or it may have stopped running. 
and return to what you've been doing.
To close this program immediately, click END TASK. 
You will LOSE any unsaved information in this program.

~ Your body

Okay, so check it. I was talking to a patient not too long ago who wanted to lose weight. Badly. At least she said she did. She playfully suggested we give her some pills or some kind of fast fix to help her along. She was in her late thirties/early forties and probably about twenty-five to thirty pounds overweight. Young and motivated, she told me about all that she's been doing to shed those unwanted pounds.

"I'm working out with a trainer now. Really it's like a boot camp program and I've been doing it now for about two months. I watch what I'm eating for the most part but I'm still not really losing much weight. But girrrrrl, I'm trying so y'all need to help me out!" She laughed after that part and raised her eyebrows. After that, she was on to the next topic.

But in my head, I wasn't.

I often say to my patients and others that the weight thing is tricky. For the most part, I believe that it is. For some, their whole lives have been hallmarked by a curvaceous or husky build and the idea of slimming down into some altogether new body habitus isn't even a real, true consideration. Like. . the aim is for something respectable yet attainable. . . something closer to the green like the grass on the other side of the fence. And that? That thinking makes it tricky. It does.

The other tricky part is the whole self image thing. To really declare war on a spare tire, you have to admit that you aren't satisfied with who you are. And this is a real tug of war for all of us already, right? At least, it is for me. Not necessarily with weight, but in general. Striving to be satisfied with yourself is always a work in progress if you ask me.

See, that woman I was seeing seemed to be very confident. And she had every right to be. She had three nearly adult children who were contributing to society and to their household. Her employment was satisfying and she'd enjoyed longevity there. And she had the smoothest, prettiest skin that I'd seen in ages highlighted by eyes framed in delicately applied individual eyelashes. Her hair was freshly coiffed and her hands recently manicured. And I believed what she said about her workouts. This was someone who seemed to love herself.

But she needed to lose weight. Her blood pressure was high. She'd already developed some insulin resistance and was officially pre-diabetic. And her back was starting to hurt her some. She needed to kick things into higher gear.

And so, I told her just that. I pointed out that she'd kept all of her appointments and that it was obvious that she cared for herself. Then I asked her if she was ready to get serious about losing weight.

"I have been serious for the last ten years!" she laughed. But she was only partially joking.

"My feeling is that you can get even more serious. Are you prepared to do that?"

She narrowed her eyes and curled her lips. "I'm listening."

That's when I told her what my best friend Lisa D. told me she uses as a mantra to her patients in clinic almost every day:

"We lose weight in the kitchen. We get fit in the gym."

And that? That was where we spent the remainder of that visit.

Okay. I need to unpack about this. I need us to have a dialogue about this notion of weight management and how it happens and what at least partially has to take place for that trunk to have a little less junk.

First, I already acknowledged the complexities of weight and how it ties to self image. I mean, no I didn't address it fully because an entire blog could be (and probably somewhere is) dedicated to just that. But I'm saying that I don't want to be insensitive to "the struggle" by shrugging my own narrow shoulders and acting like I know what it's like to carry seventy five extra pounds. I don't. But I do think I have an idea of at least some of the paradigm shift that must, must, must take place for weight to get managed once and for all.

Now. There is a caveat. People who are in their twenties? They are still in that metabolism range where they can regularly enjoy things like deep dish pizza and fettucini alfredo without the least bit of concern. That's that age that allows you to do whatever the eff you choose as long as you're working out. In other words, when you're young like that, that's usually enough.

But when you get out of your twenties? As the Grady elders say, "that dog don't hunt." No, it does not. And the older you get, the more that becomes painfully true.

The truth: You just can't move enough to manage your weight. You can't. Sustained weight management happens on the fork and the spoon. Period, end of story.

Now. Step one is simply accepting that truth. Not tricking yourself into thinking that you can out run a big ass by solely hitting the gym. That's step one. Because you won't. Not if you're over thirty. You won't.

Will you benefit from that exercise? Of course! Your heart health asks that you do about thirty minutes or so of activity that raises your heart rate. And if you step out of your front door and go for a brisk walk or if you meet up with a trainer or walk on your treadmill or run with a group or whatever it is you do, that's wonderful. It truly is. So don't think I'm saying don't exercise. I'm just saying, don't exercise thinking that THIS is the way that you will fit into your clothes. Because it's not.

I should also say that, whether you're a betting person or not, if you were to place your nickel down to bet on the thing most likely to cause you death or disability, it would hands down be your heart. So moving with that in mind is very, very important. Move to stay alive. To keep your heart happy and healthy. And yes, managing your weight helps your heart tremendously, but you have to do everything in your power to try to see at least cardiovascular exercise as FOR. YOUR. HEART. NOT. YOUR. BUTT.

*rolls neck, pops knuckles, getting loose*

Okay. Now I'm really ready to unpack.

Here is what I'm suggesting. Every single time you think about weight loss, connect it to your kitchen and your plate. Think about the guacamole you are about to dunk that chip into and the margarita you intend to wash it down with. Visualize the twenty grams of fat per bite and the six hundred calories per drink. Then imagine your metabolism like the little hourglass or spinner icon on your computer. The older and less muscular you are, the slower that sucker runs. And the more you eat, the more you "freeze up" your computer.

Does it mean NEVER eat your favorite foods? No. But it does mean that you have to make a decision. Either you're serious or you're not. Exercise helps. But without fork-and-spoon management, count on a pop-up screen telling you "Program Not Responding."

Yes! Program Not Responding. It's not responding because of the fork and the spoon. Or because of those bites, licks and tastes that we *think* don't count but do. (I'm definitely a bites, licks, and tastes person.)

So, here's what everyone who desires to lose or manage their weight should ask themselves today: Am I serious or not? Period. If the answer is yes or even maybe, read on. 

Check the cupboards. What's in there? Salty snacks? Pop Tarts? An assortment of cereals? Open the fridge. What's in there? Skim milk? Whole milk? Veggies? Chicken wings? Guacamole?

Look at it all and make a decision. What is in there that you absolutely love? And by love I mean that you can knowingly enjoy all five thousand calories of without a trace of guilt? Like that thing that is so yummy that, hands down, you always think it's "worth it." Turns out that it isn't most things. Usually that list is short and often the things that are making us booty-licious aren't the things we absolutely love. It's just the things that are absolutely . . .there.


So GET. THEM. OUT. OF. THERE. Get them out if you're serious. Toss it, chunk it, do what you have to do. That is, if you're serious. If not, just keep on tricking yourself into thinking that paying that $80 per hour trainer will do the trick. But don't be surprised when your program isn't responding.

And let me just quickly say that I'm not referring to those who have medical reasons that make weight loss difficult. I'm not talking about the very small percentage of people who take steroids or who have uncontrolled hypothyroidism or some other metabolic issue. For those folks, the playing field is different so that's not what I'm talking about. I'm talking about ALL of the rest of us who don't fit into that category. So let's just get this out of the way before someone mentions it.

And one other thing? For anyone who has ever wondered: There has never once in the history of radiographic images been a case of proven "BIG BONED-EDNESS" as a valid explanation for being overweight. No sir, no ma'am. (I'm a doctor so trust me on that fact. For reals.)

Wait--where was I?

Oh. Yeah. So my patient was drinking a Mickey Dee's sweet tea in clinic that day. Yes. And she told me that she loves-loves-loves that sweet tea. Which I told her is fine as long as she recognizes how many calories are in it. She had no idea. Neither did I, so we looked it up right then and there.

"230," I told her. Yes. 230 calories. In that drink. Which, for me, just isn't freakin' worth it. I mean I, too, love a good sweet tea every now and then. But I'd rather eat my 230 calories than drink them. I think of all of the foods I can enjoy for that many calories and I just make the decision that, for me, sweet tea isn't good enough for me to make it an allowance.

So I suggested that she mix it half sweet/half unsweet (which you can do in the McDonald's drive through.) Or get unsweet and add Splenda. Or get full sweet and KNOW that you are drinking a meal along with your meal so don't be mad when your program doesn't respond.

"But I have kids in my house. And they play sports and are growing and . . . "

I hear that a lot. Reasons for pantries filled with temptations that are linked to children and teenagers. But guess what? They'll get over it. You feeling good about yourself is far better for them than being able to grab a plate full of potato chips and salsa on a whim. So when they complain, tell them "Oh well." And also tell yourself that you are actually probably helping THEM with their future food relationship.

Is this making sense? I hope so.

I went for a run yesterday and it felt good. I ran almost four miles and my legs felt strong and able. And the whole time, I was telling myself:

This is for your heart. Especially for your heart. You have a strong family history of heart disease so this is important to you. Not just to fit into your pre-baby jeans. I mean, yes, things tighten up somewhat when you run like this. But know that this--what you're doing now--is mostly for your heart more than anything else. And to maintain the weight that you desire, that part depends mostly on what you do after you finish this run and walk into your kitchen.

And that's some real talk. You know? When I got inside of the house, I didn't really want to eat anything bad. That's a great by product of exercise. But sometimes you can feel so good that you tell yourself that you *deserve* something more. Something yummy. Something bad. And next thing you know these allowances have added up.


This is why you see heavy people running long distances like marathons and such. You wonder: How can someone run 26.2 miles and still have love handles? It's because of the fork that's why. And the spoon. And the bites, the licks, the tastes, and the sips. And if you don't believe me when I say that no one over 35 can outrun a big ass? Just go and cheer on the sidelines of any marathon. You will see that it is possible to run an 8 minute mile and to simultaneously be significantly overweight.

Sigh. I know. This sounds mean. It sounds like the kind of admonishment that we all hate getting because we sort of know it already. But you know? I don't think of it as something we know already. Magazines and advertisements for fitness clubs always focus on how the body will look. Names like "bikini bootcamp" or "summer bum-bum workout" trick people into thinking that for just the cost of enrollment that they will get to the six-pack promised land. When they won't.

Maya Angelou said "When you know better, you do better." But we are wired to think differently than this so it's hard. And, to quote a good friend of mine, "Damn. Food is just good." So knowing better doesn't always translate to doing better in this instance. You have to know better and then decide that you are ready to get serious. And you know? Sometimes you just aren't ready for all that. You aren't. And I get that. But if your main goal was weight loss and you really, really wanted to shed weight, instead of shelling out duckets for a trainer, spend that money on planning the right meals. Because no matter how sweaty you are while you eat that five-dollar-footlong from Subway, mayonnaise is still mayonnaise and white bread with refined sugar is still just that.

See I'm unpacking about this because I struggle with it, too. Even though I said those things while I was running, it was hard to make myself believe it. The fourth mile came out of vanity and really wasn't about my heart. Even though I was telling myself otherwise.

Okay--one other caveat about the whole food and exercise thing when it comes to weight loss: Weight training. That is definitely a part of exercise (especially as you get older) that can help you to lose weight and burn fat more effectively. The stronger your large muscle groups are, the more effective your body burns calories. So squats, lunges, lat pulls and all of those things? A thumbs up when it comes to weight loss.

Ultimately, all of this should be about heart health I suppose. Like, at some point, we should all want to manage our weight to protect ourselves from the absolute number one killer of human beings in this country. Because, yeah, losing weight (especially around your mid-section) is super important to lowering cardiovascular risk. But if needing to zip up the dress you bought for your high school reunion motivates you more than fear of heart disease, then I say go with whatever will get you serious.

And to those who already have this figured out because they got serious a while back? Good for y'all. But a whole lot of folks are still works in progress. I'd even imagine for the fittest among us it's an ongoing battle that has its highs and its lows.


Look, man. We lose weight in the kitchen. We get (cardiovascular) fitness in the gym. Period.Want to lose weight? Get serious about the fork and mouth. Otherwise YOU are the only person to blame when you keep on rebooting your hard drive over and over again. . . . only to find that. . . . despite your best efforts. . . .  the program's still not responding.

So what will you do? Click cancel or end the non-working task and start over? It's up to each of us to decide.

Happy Friday.

Now playing on my mental iPod. . . . De La Soul's Me, Myself, and I which is who has to be held accountable for all of this stuff.


  1. This is fabulous! You nailed it. This is what happened for me that convinces me that you are completely right. About 3 years ago I ended up at piedmont after fainting in Piedmont Park. I decided that it was time to get really serious. So I looked and looked around the internet and found one Atlanta doctor who specialized in weight loss. She didn't specialize in surgery or "secret pills and shakes". She was a family practioner who got tired of treating high blood pressure and diabetes and decided to treat the cause of it. I went to her and told her that I didn't have a weight loss goal, I just wanted to work on my blood pressure and cholesterol. She jumped out of her chair and hugged me. Did a lot of tests, including a full blood work-up. At the next visit she showed me the result,it was dismal. Then she handed me a diet that consisted of meats, cheeses, nuts, non-starchy vegetables and berries. She told me to stay on that diet for a month and we would redo the blood test. When I saw the second blood test report I could not believe my eyes. My triglycerides had gone from 322 to 106, in one month. All of my numbers were in the normal range. Sadly she left Atlanta in May, but she taught me a lot. The second thing that happened is that my grandson is a severe type A hemophiliac. In his life he has had fewer spontaneous bleeds than most hemophiliacs have in a year. The CDC asked my son if they could study him to find out why. The only thing that they could come up with is that his diet (very similar to mine) is so superior that his veins are healthy and tear less easily. I am absolutely convinced that eating healthy to be healthy is the way to go.

    Thank you for this superior post.

    1. Wow, that's deep. I'm so glad you are so empowered about your health!

    2. You know, I would really love to repost this on Thepinkteeshirt. It is such good advice, and you lay it out without laying on the guilt.

  2. I am going to go back and read this a couple of more times...lots of info. I am sixty years old...have kept my weight steady for the past five years but have yet to lose my last 10 pounds. I have been thinking about this very thing for the past six months...I really like what you happens in the kitchen! My two favorite sayings are..."Every bite counts" and "Don't bring the enemy home"...

    1. Those are good sayings! And keeping your weight steady from 50 to 60 is a huge accomplishment. You go, girl!

  3. Replies
    1. And you know what I say. . . .I write these words so that I can read them. I am glad you read them, too. Love to you and yours.

  4. Way too much truth for a Friday.... now I have to justify my give a new meaning to the phrase food for thought.


  5. I was talking to some ladies in my running group about this last night. How it all adds up. We're runners so I put it in miles. You burn about 100 calories per mile. So you can have those two cookies at 400 calories... but you just negated the 2-mile workout you should otherwise feel proud about.

    One girl didn't know putting whipping cream in her smoothies is terrible for you. Another one admitted she has a sweet tooth. I asked what that translates to per day. HALF A DOZEN DOUGHNUTS!! And she said she could easily eat a dozen. And she wakes up between 12 and 2 a.m. and eats a pop tart or waffle every night. And the thing is, she wasn't horribly overweight. You just can't look at people and automatically know! She said she doesn't feel right without sugar. I said, start with cutting it to 3 doughnuts per day and 0 pop tarts, switch waffles to multigrain. I know that sounds crazy! Trust me! Baby steps. She looked like I suggested poison to her with just those two things.

    Both women said they gained weight trying to eat healthier. All the vegetables in the world can't balance daily cookies & heavy whipping cream and half a dozen doughnuts. There are unhealthy and overweight vegetarians and vegans, too. You're so right. It's thinking about whether those calories are worth it.

    1. I only dream of half a dozen doughnuts, thank God, I can't have gluten anymore, that saves me from myself.

    2. All I can say about the friend and the 2 am snacking is. . . really? I mean, seriously? Please, please tell me she is 22 and not 42. . . .

  6. This is an excellent post and I thank you for the truth. I heard this same thing from a very old doctor and did not believe him because I thought he just didn't believe in the benefit of exercise for weight loss but hearing it again and from you, I am set straight. Hearing it again kind of makes me want to cry but I know it is up to me. Thank you. Really.

    1. Awww. It's always up to us. Which is both terrifying and liberating. . . .

  7. BIG BONED-EDNESS-the only thing that made me lol at this very serious post. I agree with almost everything that you say, except the Splenda part. Teach your patients to retrain their taste buds to not desire so much sweet in their diet. Artificial sweeteners are poison, all of them, even Splenda which is "made from sugar", a highly altered chemical based sugar. The best thing that I have done to change my eating habits is to look at something and if it is easily identifiable as a fruit, veggie, grain or protein, then I consume it, the rest of the stuff is just garbage and a spare tire looking for a home.

    1. Stevia picked from your plant is no more poison than oregano.

    2. I said "artificial sweeteners" in my comment, not "natural sweeteners", are poison. Stevia is a natural sweetener, however, Splenda, is not.

    3. I'm terrible because I do consume my fair share of artificial sweeteners. Jill, I like this idea of retraining my palate to not crave sweets so much. And Lisa, I think if I can't I will try some stevia again--wasn't a fan last time I tried it.

      Thanks for engaging, y'all.

    4. You kinda have to overpower it's aftertaste. Try hiding it in a Greek yogurt fruit smoothie, or boiling it wit a tea bag and a twig of lemon balm. No, I'm not a crazy herb lady. I just have a pretty good kitchen garden.

  8. Okay. Jeeze Louise. I read this then went into my kitchen and threw away my ice cream that I had been dipping into because I'm almost sixty and I'm losing my job and ice cream seemed like a better idea than going for a walk and now it doesn't. This is the first article of its sort EVER that I've been able to read without feeling cringy or beat up.

    Rebecca Loudon

    1. Oooooh! I'm so excited to have you here on my blog! Can I tell you that I tried reading yours many times in the past but it was private. Your wise comments on other blogs always intrigued me so thanks for coming here.

      I appreciate that last sentence so much. I don't want anyone to feel cringy or beat up. Nor do I want to sound like the preachy, smug lady who has never struggled with her weight.

  9. So very, very true. I started working on losing weight about four months ago by tracking everything I eat using an online program, and I was shocked initially by how many calories I was consuming through things that seemed insignificant (like chai lattes from Starbucks). Four months in, I've made significant changes to what I'm eating, and I'm down 15 pounds without starving myself or feeling deprived. Fifteen more until I'm back in the "healthy" weight range...

  10. Thank you for this! This is great advice not just for me personally but for how to effectively talk to patients about weight.

    I know for myself, it also helps to ask "How will you feel after eating this?" Not as in "how guilty will you feel" but as in "how will your BODY feel." If I think about how lethargic and sick that big old piece of cake will make me feel afterwards, it's easier to resist :)

    1. You know it. This has helped me with counseling my patients a lot.


  11. I love you. Thank you for telling it like it is. Thank you for putting what I KNOW (deep down inside me) into words.

    I can do better.

  12. This is just what I needed.


  13. S.J.G.V.R.
    I know it, and the re-MIND-er is a good thing.
    I swim 4 or 5 times a week, I do it for my mental outlook ONLY. My kitchen is good, my wife cooks great and healthy food, and I am Slowly! training myself to stop eating when I am no longer hungry. Will be a lifelong process for me, and that's ok, too, as I am mindful of it every meal.
    Thanks for these true words!

    1. Mary that's awesome. And I can't stress enough how key it is for your better half to be on the same team as you with this. I'm glad hats one less thing for you to have to stress about. I wish The BHE cooked! LOL

    2. Yes, to have your partner cook is great - she does the grocery shopping, and all the yummy cooking and I do dishes. Sweet deal! She cooks with lots of spice so everything has flavour - seems that if something really tastes good, I am satisfied more with the whole experience, bland food is kind of MEH I haven't eaten so I'll eat more... Not good :)

  14. Dear Universe,

    OK, OK, OK, I get the message!

    Seriously, Doc, this is coming on the heels of a variety of calls (doctor, friends, boss...) for me to get serious about my health. It's time to listen. I read this Friday, and it tugged at me all weekend. So ... here goes! Thanks for sharing ... much appreciated! :)


"Tell me something good. . . tell me that you like it, yeah." ~ Chaka Khan

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