Top Ten: Weight and see.

I talk about weight a lot at work. I talk to patients about it when they're reluctant to start another blood pressure pill. When knees are aching and hips are ailing, it works its way into those conversations, too. I calculate BMI measurements and explain what it all means. And most times, I find myself saying this:

"The extra weight didn't come on overnight, so it's okay if it doesn't come off that way."

Then I try my best to see where my patient is in the "stages of change" cycle.

 

Now. Most folks see this cycle used when discussing addictive behaviors like tobacco, alcohol, and drugs. For example, when someone smokes cigarettes, we are taught to assess what kind of readiness state that person is in. Like, are they precontemplative like this man I saw last week who told me that he "loves smoking, end of story" and that "somebody might as well go ahead and plan to bury him with a pack of Marlboros in his shirt pocket." 

Uhhh, yeah.

So someone like that? They aren't there yet. So there's no point in writing for Chantix or telling them to spend their hard-earned cash on patches and peppery gum. Nope. When someone is precontemplative? The best thing you can do is educate them with hopes of moving them from the one stage to the next. And the good news is that it often helps. A lot. 

So, yeah. Even though weight is technically not like crack cocaine or malt liquor, tackling it does involve these stages. Because just like those other things, it requires a lifestyle change from what is already known. It requires more than just saying you think it's a good idea and that you understand  the reasons why it should happen. Managing weight involves action. 

Yep.

So here's the deal. Unlike cigarettes and alcohol, most of the patients and people I know who could stand to shed a few pounds aren't exactly like my Marlboro man was. That man was precontemplation defined. I find those dealing with extra pounds to be stuck somewhere between contemplation and preparation. Or something nudges them into action, only to swing right back around to relapse. Either way, it's a complicated work in progress. 

The education part that we tackle when folks are precontemplative? That isn't really as necessary. I haven't met too many people who are above their ideal weight who don't fully recognize the benefits of losing some pounds. But, damn, it's so complex isn't it? Moving people from contemplation or preparation into some real, true action and maintenance? 

Maybe because it seems so daunting. There's the exercise component, the food component, and the mind component, too. All swirled together, it's a pretty big pill to swallow. 

So you know what? I break the pill up. Sure do. I look for ways to be encouraging for the mind part. I acknowledge the fact that people have different food relationships and that it's hard to change them. Then, for exercise, I tell people that the best exercises are the ones you'll do. Like walking. Or whatever it is you feel okay doing. And then there's the food component. 

Yeah, that.

So this is where I've developed lots of thoughts and strategies. And you know what? They are ones I live by, so I feel good about sharing them. I tell my patients, "I'm going to make a few suggestions. You can pick and choose what you want to incorporate into your life, okay? These are mostly simple things that, if you changed, could lead to a start in your weight loss." 

And a start in weight loss is encouraging. And encouragement moves people from preparation to action. Or relapse back to action. And the ultimately into maintenance. 

At least, that's what I think.

So this top ten? Pick from it what you like and leave what doesn't work for you. Today I bring you:

THE TOP TEN LITTLE THINGS THAT (IN DR. MANNING'S OPINION) YOU CAN DO THAT MIGHT HELP YOU LOSE A LITTLE BIT OF WEIGHT WITHOUT EVEN TRYING THAT HARD.

Like to hear it? Here it go!

#10   -- Sit down.

DON'T eat standing up. Anywhere. Period. And, unless it's water or coffee, don't drink standing up either.

Simple enough, right? Uhh, wrong.

Clearing the table and popping those chicken nugget leftovers into your mouth? Making a pot of chili and telling yourself that the "little cup" you just served yourself doesn't count? Standing in front of the fridge and popping some grapes/pineapple/lunch meat into your mouth or taking a few glugs of juice? It all adds up. And guess what? A lot of times it adds up to more calories than you realize.

Have a seat when you eat. Scoot up to a table and have both feet on the floor. Think about what you're having. Standing while eating? That leads to stealthy weight gain. That little change could shave a cool 500 calories off or your daily intake. 

Which means shaving a little of that junk out of your trunk.

#9  -- Separation of Church and Plate.

If you never go to church, no worries for you on this one. But for those who do -- try this: Eat before you go. This takes the urge (and tradition) of feeling like you either have to a.) go somewhere for a big azz brunch, b.) come home and prepare a big azz brunch, or c.) alternate between the two every other week.

For the non-church goers, the same can be said for the big azz breakfast that you prepare on one of the weekend days. Cut something out of it to make it less. . . I don't know. . .big azz. 

Now. I admit that this is one that I struggle with. We enjoy breaking bread together as a family after church and, almost always, we do. Instead of something shmancy, we hit our favorite Waffle House. Harry and I can make smart choices and the kids have their waffles.

#8  --  Don't eat it if it isn't worth it.

I believe in allowing yourself something tasty. I do. Like, at the BHE's restaurant (Mardi Gras Cafe) there is this white chocolate bread pudding that is a religious experience. Yes. It is full of gooey, warm, sweet goodness which means a ridiculous amount of fat grams and calories. 

But.

It's worth it. Every last bite. And I feel zero guilt after enjoying it because it is just so dang good. 

Now. In contrast, I ordered some food at the Sweet Auburn Curb market last week. And for whatever reason, it wasn't that good. This was one of those things that needed to be good for me to be eating it. So you know what? I just stopped. I stopped eating it and that was that. 

And so. A dry azz cookie sitting in a boxed lunch? If you're trying to watch your weight, ask yourself if it's worth it. Don't eat anything "bad" that's not really, really good. 

Oh, and making kids clean their plates? That's so last century. So don't.

#7  --  Don't drink your calories.

Period. Not a juice. Not a soda. Not a sweet tea. Not a nothing. You want to drop a few pounds? Refuse to let drinks that have more than twenty calories touch your lips. You'd be surprised how much they stack up. 

#6  --  Diet Nope.

That's what I now call Diet Coke. I gave up Diet Coke two years ago this month. And let me tell you, I lost five pounds the month that I did and those pounds have stayed away. 

Yup.

So the data on this? Okay. It's inconclusive. You can't say, like, all scientifically that diet pop leads to weight gain. But anecdote-ally? Man, please. 

The word on the street is that when you drink more diet soda, you eat more. Whether or not this is true remains a topic of debate but I know that drinking water instead made me lose weight.

And for the record? I am like the smoker who still loves cigarettes when it comes to Diet Coke. A super cold one still looks good to me and I feel very tempted to take a swig whenever one is in my presence. 

But fitting my clothes feels better.

The caveat? Adult beverages. But not really a caveat. I no longer order margaritas with reckless abandon or mojitos, like ever. Maaaan, I saw how many calories were in those drinks one day and just about passed out. So. If you must have an alcoholic beverage, learn to like wine. Or drink only half. Or drink a whole drink but factor those 550 calories into what goes onto your plate. 

Yep.

Get creative. My cure for margarita cravings in hot Georgia summer months? Mexican beer with a salted glass and some lime. You'd be surprised how satiating it is to be only 110 calories. Margaritas and such? They've pretty much moved over to my "not worth it" list. I'd rather have some Key Lime Pie.

#5  --  Exercise for the heart, watch the food for the weight.

Unless you are like twenty one years old or less, if you are serious about weight loss it won't come primarily from exercise. Now. Before you go off on me, I'm not saying don't exercise. But here's what I am saying:

Want to lose weight? Then change your food intake. Because it ain't gonna happen from the treadmill alone. 

I remember a few years ago when Harry, the kids, and I all went out to cheer on the runners passing by our neighborhood in the Atlanta Publix Marathon. I was astonished to see how many of them were overweight. I said to Harry, "How can someone run 26.2 miles as fast as that guy and have a spare tire?" It was a rhetorical question, really. The answer was simple. That guy was eating too much food.

I read in this running book an idea that stuck with me. It simply said, "Don't exercise for weight loss. Exercise for heart health and to feel good." Now. I will say that the good thing about feeling good from exercise is that you sort of don't want to eat just any damn thing. You feel tempted to be good.

So my point? If you're exercising? Good. It will extend your life. But if you want to lose weight -- like for real lose weight? It ain't gonna happen just from that.

Nope.

#4 -   If you can't say no to it once it comes into your pantry, then make it a no for the whole house.

So. Your kids love Cheetos, Lays, and Cheez-its. But guess what? So do you. But you're just getting it for their lunches, aren't you? And they're kids for crying out loud. They should get things like Cheetos and Lays and Cheez-its, shouldn't they?

Nope. Not if you can't keep your hand out of the bag or the box. Look. Kids are resilient. They'll get over the absence of Cheetos. Trust me.

Bottom line:  If somebody needs to lose weight in that house, things like that shouldn't make it home from the grocery store. Period.

#3 --  Make your husband's or wife's plate.

Hee hee. This is my pesky way of controlling the BHE's portions. I make plates and then put everything away. So, OH DARN, I already put it all away and can't give seconds. I heard him telling a friend recently,

"Yeah, bruh. My wife puts me on a plan without even telling me. She's all like, Alright baby you getting a little thick around the waist."

Bwaah ha ha. 

#2  --  Ration the bread.

You already have heard me say it here before. BREAD is NOT YOUR FRIEND. No, 'tis not. Here's what I say:  Just pay attention. If you have bread at breakfast, have a low carb lunch. Pace yourself with the bread because it is the great inflator. 

But!

Putting down the bread? Best deflator there is. Yep. Whenever I feel the thighs beginning to thunder more than they should? The bread is first to go. And you know what? I'm back to fighting weight in no time. 

Bread. Is. The. Devil.

Yup.

#1  --  Start a list of "not worth its" and get okay with not having them.

My kids love Cinnamon Toast Crunch cereal. And you know? I probably could, too, if I let myself. But 230 calories on a bowl of sugary cereal? Not worth it. 

A baked white potato? Not worth it. Pop Tarts? Not worth it. A whopper from Burger King? Not worth it. Pizza Hut Pizza? Not worth it.

Now.

Key Lime Pie? Worth it. White Chocolate Bread Pudding from Mardi Gras Cafe? Worth it. But everything CANNOT be worth it. That list has to be short. Pick a few indulgences and allow yourself to have them. 

Or, if you're super disciplined, you can allow yourself small tastes of many decadent things. Kind of like the French do. But me? I ain't French. So I can't have a long list of things.

Lastly--read the calories of a serving of whatever it is you're having. Then, allow yourself to be appalled at it. Here's a small part of my list of OMFG appalling things that I can no longer enjoy now that I've seen the damage:

• Chick Fil A cookies 'n' cream milkshake:  690 calories, 33 grams of fat.
• 
  KFC chicken pot pie :  790 calories, 49 grams of fat.
•  
• Big Breakfast from Mickey Dees:  1097 Calories, 56 grams of fat.

So my point is -- find out the damage. It's a powerful motivator. And whatever you do, DON'T ignore the damage. Remember:  A good thirty minutes of cardio might burn you 300 - 400 calories, depending upon what you do. Imagine working out and then having that milkshake. If you decide it's one of your indulgences, then recognize that you have to balance everything else out to fit it.

Oh, shoot. I almost forgot something I like to call "friend-poundage." This is where you only meet your friends over food. Make a list and check it twice. Do you and your buddies only get together when food is involved? If so, you probably aren't paying attention to what you're eating. Try getting together at non meal times. Or going for a walk or run together. Or just hanging out in the park while your kids play. Friend-poundage is dangerous. Watch out for it -- especially during times like wedding engagements, happy times, etc. 

Mmmm hmmm.

Does any of this make sense?

I hope so. I say try a few of these things and see what happens. Or none of these if they don't suit you. Either way, let me know your thoughts. And your cool (but not overly hard core and oppressive) tips so that I can share them with my patients at Grady.

***

Happy Sunday.

Weight, Weight, Don't Tell Me.

image credit

Overheard at Grady, true story verbatim. . . .


***

Lady: "You got a little something in there, doc?"

Grady doctor: "Pardon me?"

Lady: "A little bun cooking in that oven?" Points at torso. Ginormous smile. Exaggerated wink.

Grady doctor: Looks down. "Wait. . .uhhh. . .you mean. . .am I. . .?"

Lady: (without even flinching) "You 'spectin, ain't you?"

Grady doctor: (Looking mortified) "Uuuuhhhh, no, ma'am. I'm not."

Lady: "Oh. . . .okay, then. . . . . you just need to make sure you hold yo' stomach in a little more." (Demonstrates belly suck in case she didn't know how.)

Grady doctor: (Blank stare)

Lady: "Yeah, girl. . . .Don't worry. That be happening to me sometimes, too."


Damn.

The Break-up: A Longterm Relationship Redefined

Back when everything was cool. . . .

______________________________________________________________________

I had a lovely lunch with myself on Tuesday. I finished up early at Grady that morning, and had the chance to sneak over to Rosebud for a delicious turkey burger with some kind of zippy chutney on top. It should have been super-psycho-yummy but. . .something was missing. And despite how yummy that turkey burger usually is, this day it just wasn't the same.

::Sigh::

The truth? Nothing is as good as it used to be ever since the break-up. Not even the turkey burger from Rosebud. Yep. You read that right--I said break-up. I'm in the middle of a horrible break-up.

We tried to make it work, we really did. But every time I thought we could co-exist, I'd look up and find myself betrayed. Early on, there were no holds barred. I never felt guilty about our relationship, despite what others were doing and saying. So comforting. . . .so warm and inviting. And no matter where I was. . . .Surprise! There you were -- always popping up. . .on the side, in the middle, and even late at night. We'd even fall asleep together, and first thing in the morning, you were the first thing on my mind. I loved our time over coffee in the mornings. . . Sigh. This isn't going to be easy for me.

And after all these years, too. It's crazy to even imagine it. . . . but I knew we couldn't keep going like this when I turned 35. That was the first time you left me wondering if this love was really a mutually good thing. Aaaahh. . . .but you were so wonderful to me during my pregnancies. . . .so dependable. . . early in the morning, in the middle of the night, and even when I was in labor. In fact, you were one of my best memories during my labor with Isaiah. And I feel bad turning my back on you, but like I said. . . .now that I'm older, I just can't do it. I made every effort to stay close to you in my late thirties, but by the time I turned 38--that's when you really started showing your true colors. At 39 and a half, I stood in the mirror staring at my reflection asking myself,

"Why do you keep doing this to yourself? Just leave this abusive relationship alone already."

Now, there's no question. It's a wrap. We will never ever be the same, and I have finally come to accept it. I'm not stupid. I realize that I will have to see you sometimes and deal with you in moderation. And you know what? I'm actually okay with that. In fact, that's my preference. But this all the time, every day thing? No way.

Not even two months since our break up, and I can see the difference already. I feel better when I look at myself. Oh, and remember the way my energy was so sapped at first? Even that's gotten a lot better. The headaches and drained feeling I had in the beginning have faded, too. Now I know for sure that I can live my life just fine with our love redefined. I will just deal with you in small bits and pieces.

And I'm okay with it. I really am.

Just because you look good, doesn't mean I still want you.

Yes. It's official. I have officially broken up with bread.

Buns? Rolls? Bagels? I'm talking to you. Don't call me. Don't ask to sit on my table with garlic butter or act like you just want to sit by my omelet masquerading as a biscuit. Mmm hmm. Don't act all inconspicuous in my salad thinking I don't realize it's you just because you're cut up in little squares. Oh, your name is "crouton" now? Yeah right. By any name, the verdict is the same.

Don't believe me? Last week when that lady in Panera Bread asked me if I wanted "a whole grain or French baguette" with my salad I just put my hands on my hips and said, "How 'bout neither?" Take that, you complex little carbohydrate. Like I told you before, it's a wrap. (And a lower carb one at that.)

Yes. I have broken up with bread. And Lawd have mercy, on Tuesday I nearly fainted from the temptation to get back together when they brought that turkey burger out to me on top of that soft-and-doughy/crusty-but-chewy/warm-and-toasty/freshly baked ciabatta. That server was smiling at me all goofy-like when she said, "Mmmm! And the bun is fresh from the oven!" OMG. The minute that aroma wafted into my nostrils. . . .gaaaaahh! It was screaming, "Oh come on! It's only lunch, baby! Must it be so final?"

And I admit, y'all. . . . I was weak. I was overcome with passion. . . and allowed our lips to touch. (That's how I knew it was crusty-but-chewy.)

Chal-laaaaahhhhh!!!!!

Why the break-up? Because the relationship is just too much for me. Oh my. . . . our relationship over the years has been so intense. . . . .a little too intense even. . . .

My feelings in a breadbowl:

I like a lotta ciabatta.
Challah makes me holla.
Yeast makes me a beast.
And if you say "focaccia," I say, "fo' sho!"

See? That's the problem. That day I couldn't comfortably wear a pair of jeans that I'd paid $100+ for, I knew then that it was time to walk away. That ciabatta roll at Rosebud, though? I almost completely fell off the wagon.

Aaaaahh, but don't worry. When I was 39 and a half, I might have gotten weak and gave bread back the key and the garage code--but not at 40. This time, I mean it. We're dunzo. I simply can't afford the ten pounds you guarantee you'll give me every ten years no matter how much you look at me with those crusty eyes of yours.

Can't we just give it one more try?

Nope. I am a doctor, so I have tried the American Heart Association's recommended diet and even though I don't have high blood pressure, I've even tried the DASH diet, thank you very much. But seriously. . . .unless you are training for a 10k or a marathon and running, like, really, really, really far every single day, when it comes to the AHA and DASH diets, as one of my patients once told me, "That dog don't hunt." Oh and that food pyramid with all the bread on the bottom? Puleaze. Unless being the shape of a pyramid is what you're going for, I hope you have a plan b.

Uhhhh, okay.

So to all of my beloved patients, friends, and family who are over 35 and who don't run like really, really, really far every single day AND to those under 35 who are perplexed at why the junk just perpetually remains in their trunk: I'm talking to you. Consider my break-up as an intervention. You want to be a little smaller? Then accept it. The days of liberal bread and refined sugar consumption are over. (Unless, of course, you are like my friends Julie J-M and Julie E. who actually DO run like really, really, really far every single day. . . . )

And still I rise. . . .

I will need your support through this break up. . . . . . . but with your help, I know I can achieve a new "normal." Occasional weekends, holidays, and special occasions. That's it.

::sniffle::

Thanks for your support.

Wait--I just know you didn't think I was talking about the B.H.E.? (B.H.E. = best husband ever)
(Don't worry, I didn't THINK you did 'cause he's wonderful.)

Reflection on an Awesome Day: No Excuses

my sister, the trooper after early morning Pump

Today was awesome. My younger sister came to town from L.A. for her birthday and--get this--actually allowed me to drag her to my (as she calls it) "crickety crack o' dawn" Body Pump class. (Happy Birthday, sis. . tee hee hee.)

JoLai

My sister, JoLai, has never been a "skinny girl." She has always had curves, going back as far as I can (sometimes painfully) remember. Okay, so enough time has passed for me to admit that my intense jealousy of the aforementioned curves was the source of some serious passive-aggressive "hateration" on my part back in the day.

For starters, JoLai is 10 months younger than me (yeah, yeah, 10 months is a narrow interval, we know, we know. . . .) Anyways, when her body got the memo to go into puberty like two years before mine, somehow my stick figure missed that memo and stayed painfully trapped in an African-american version of Olive Oyl. (Case in point: My uncle Woody gave me the nickname "Blade" back then, as in--uggghh-- a blade of grass. . but okay, I digress. . . .)

JoLai would nicely ask me to borrow my shirts in middle school which makes sense considering we are separated by less than one year, right? Ha. Too bad-- I'd promptly shut her down, insisting that I didn't want people to think we wore the same clothes, knowing all along that it was because, unlike her older sister, she actually needed that brassiere Mom bought each of us over the summer. (You kidding me? No way I was going to draw attention to the full house she'd been dealt while trying to overcome the inadequacies of my own low number pair from the same deck.)

In her adulthood, JoLai's had a few health problems and has also experienced some fluctuations in her weight. But that was then. I remember it like it was yesterday. She called me up one day and said, "I refuse to be unhealthy, and I refuse--do you hear me? REFUSE to be fat." And that was that.

Anyone who knows her will tell you: The girl has declared war. And not in that crazy-lose-50 lbs-by-next-week-way, but in a logical, consistent, sustained way. Yesterday, when I saw her in her gym clothes, I patted her flatter-than-mine tummy and said, "Girl, you wearing a Spanx?" She smiled and told me in the nicest way possible, "Hell no." The hateration did threaten to return, but frolicking into Pump with her this morning and enduring miserable lunges beside her made it go away.

In addition to the overall novelty of having my sister working out with me in my favorite class, there was an added highlight: I got to introduce my sister to one of my favorite people and inspirations in my Pump class--my friend Charles.

Charles in class celebrating his 75th birthday
(a GREAT sport for letting us put a tiara and sash on him!)

Charles

Okay, let me tell you about Charles. First of all, he's a 75 year old granddad who throws down in Body Pump like he is 35. No, take that back, 25. If you are under the age of 75 and never get up off of the couch because :

a) something hurts now that you are older,

b.) you are feeling kind of crotchety now that you are older or

c.) you are finally retired/off for the weekend and you ain't exercisin'/empty nesters/just had a baby/just had another baby/had a baby a long ago but, dammit, you look good to have two kids/busy with your kids/busy with your business/just got your hair done/just got married/just got divorced/just not a morning person/just not an evening person/"walk a lot" when you are at work (yeah right)/are naturally skinny/are naturally big boned-ed/are doing weight watchers/are gonna start Monday/are gonna really start Monday/are full of you know what, or

d.) all of the above. . .

I assure you that meeting my friend Charles will officially make you ashamed of yourself. Oh yeah, let me add that he lost over 100 lbs, like, a long, long time ago and has kept it off for more than a decade through a disciplined vegan (whew!) diet and regular exercise. (Yeah, I said 100+ pounds, you read that right.) One. Hundred. Plus.

What also makes Charles so cool is that he is really funny, but never crude, and even more than that, he's been married a long, long time and loves his wife (How do I know this? Because he speaks of her by her name which, I have come to learn from working at Grady and living almost 40 years, is actually a very loving gesture vs. "the wife," or "the ol' ball and chain" or. . .you get the picture.) Where was I? Oh, Charles. He knows the name of every person who has come to our class more than once, and warmly greets them by name even if it surprises the bejangles out of them that he remembers. He groans like really loud at all the right parts in class that every one else wants to but doesn't (like during scary repeater "bottom-half" squats, horrid slow push ups, and dreadfully dreadful side planks.) Best of all, he reminds me that a big part of my health and well being (as well as that of my patients) sits squarely in our own hands. For that reason more than any other, every time I see him, I feel inspired.

***

Today, I am reflecting on two people that regularly inspire me to take charge of my health and appreciate my body for what it can do. It was nice to see these two healthy parallels intersect this morning. Whenever I'm feeling like I don't want to exercise or pay attention to what I'm eating, they serve as constant reminders that I should stop bellyaching and just do what I have to do. And when I sit across from a patient who really needs to lose, like, 100+ pounds, and who really is motivated to do something about it, I think, "You actually can lose that much weight," instead of "No, you can't." JoLai and Charles, you both personify the mantra: "No excuses."

JoLai, thanks for demonstrating to me and all who know you the power of the human spirit. And Charles, thank you for inspiring me and a whole lot of other folks to be healthier--even if it is at the crickety-crack o' dawn.



Now. . . .what's YOUR excuse?