(*I say "most" because I also perform osteopathic manipulation as part of my practice and this hands-on healing modality is something I often use to help restore optimal body structure and function.)
In the fall of 2022, a few things happened that started to shift my mentality dramatically. The first, is that I had suffered a violent assault from my former domestic partner a few months prior and was experiencing a tremendously difficult time moving beyond this trauma and loss of the associated relationship. In an effort to pursue my own healing, I was trying to re-engage with modalities that had served me in the past and decided to register for a 200-hr Yoga Teacher Training to get reconnected with my practice. The second occurrence that pushed me to become more focused on my own health, is that I noticed my clothes were no longer fitting properly. I established with a new PCP and went for a wellness visit for the first time in many years as I reckoned with the fact that I was now solidly middle aged. I was surprised getting on the scale and finding my weight was 10lbs higher than I'd ever known it to be before. No wonder most of my pants were feeling snug, if I could even get them on in the first place.
Applying my doctor-brain to myself and considering what advice I would give to a patient, I knew I had to make some changes. It was essential for me to deal with the trauma for what it was so that I could escape from the emotional paralysis it had on me. With respect to the added weight, I could accept it as a fact of life in getting older and buy new clothes - which actually seemed viable given that I still wasn't considered overweight by BMI or even an "unhealthy" weight by any medical standard. Or, I could recognize what I see so often in my patients was slowly happening to me too and start to make some changes to keep it from getting out of control.
A statistic I had come across in my training, is that adults in the United States gain an average of 2lbs of weight every year. Two pounds on its own may not seem that significant and could easily be ignored or taken as a small fluctuation that any one of us may have during the course of a week just due to things like hydration status, menstrual cycles, bloating, etc. But what I cared about was that 2lbs continuing to build, becoming 10lbs in 5 years or 30lbs in 15 years. I know with a certainty that losing 10lbs is a lot easier than letting it go and later trying to lose 30lbs, so I concluded that I needed to take this seriously and lose the weight.
In mid-December 2022, I began tracking my calories. I decided to use an app called FatSecret as I had learned about it a few years prior as part of a research study that I think was actually looking at the effects of meditation on lifestyle habits. The reason I preferred it to other apps I was aware of is that the free option was rather robust, it felt far less commercialized and less emphasis on trying to push their paid features (though there are some of these available). I used the in-app calculator to determine my RDI in order to achieve slow weight loss. My personal goal was 1-2lbs a month to allow my body to also gradually adapt to this change rather than get to goal quickly and struggle to maintain it. At the outset, I was tracking my caloric intake and expenditure through activity, but really wasn't attempting to modify what I was eating in any way other than to cut myself off if I was at / near / over my limit for the day.
An additional change I started to incorporate around this same period was time-restricted eating. A lot of attention has been paid to the concept of "intermittent fasting" though the interpretations of what that is and how to utilize it vary widely. For me, my aim was to try to optimize my metabolism in line with circadian cycles and cut out eating late at night. In particular, I was working frequent overnight shifts at the hospital and eating while at work was a pretty normal thing because these are lengthy 12-hour shifts. But I came across a study that indicated night shift workers weigh on average 11% more than our peers who follow the same diet but are working during the day. That was all the evidence I needed to know that the night shifts were working against me. Being unable to change my work schedule, I knew I had to change my consumption patterns instead. On the nights that I worked, I was frequently up during the day as well either seeing clinic patients or attending to tasks at home on the weekends, so it wasn't difficult to shift calories to earlier in the day. I would deliberately cut myself off and stop eating prior to going in to work around 6pm. Initially, it was absolutely challenging to consume nothing but water during those shifts. But gradually, my body adapted and I can honestly say that I no longer feel hungry during my overnights until I'm finishing up around 7am and I'm ready for breakfast as usual.
With respect to physical activity, I got back into the habit of some amount of regular exercise most days. Most often, this was vinyasa yoga as I was simultaneously going through my teacher training program. I had videos that I followed along with as part of my course but would also do self-guided practice as my additional goal was to get stronger and with greater endurance as a few months later we would have an intensive week of at least twice daily practices and I wanted to feel capable of participating at a high level throughout. My additional go-to for exercise was using a rowing machine at home, usually no more than 15-20 minutes at a time. I appreciate this as an energy intense full-body workout that is also low impact, offers resistance, and allows you to really accomplish a lot physically in a compact period.
The initial loss was slow going and even though that was my stated plan, I think it is still so common to get wrapped up in the numbers and wondering if what you are doing is really working. It took me a solid 3 months to achieve and sustain the first 5lbs of weight loss, remaining very diligent with my tracking, activity, and time restricted eating. I kept up the daily tracking for another 3 months thereafter (so 6 months total) at which point I had achieved a sustained 7-8lb weight loss. Although this was only half of my original goal, I also realized I could be really happy sustaining at this weight. I was pleased with the physical changes in my body and my clothes were fitting again without the need to buy new pants. Tracking was feeling burdensome and by this time, I already had a pretty good idea of the caloric content of the food I consumed regularly without having to input anything, so I transitioned over to autopilot on that front. I kept up the time-restricted eating, even on the days I don't work overnights, deliberately aiming to stop consuming any calories by about 7pm to allow for at least a few hours to metabolize before bed. My physical activity fell off a bit, though I do still make time for structured exercise at least 2-3 days each week. And I am happy to say that 18 months later, I have sustained this weight.
Interestingly, it was only through the process of trying to lose weight initially that I eventually started to look more carefully at my lifestyle habits as a whole and my food intake with a greater eye towards optimal nutrition and chronic disease prevention. Within my tracking app, there are breakdowns for macro-nutrients that I started to pay attention to, realizing I was rarely hitting their pre-populated goal ratios for Carbs - Fats - Protein in my daily intake. Additionally, in trying to counsel patients and friends about what I personally did, I became a lot more aware of the barriers for how an approach focused solely on calories in / calories out really isn't hitting the mark for most people. This also drove me to exploring more about nutrition science, impacts of our diet on chronic disease, and the integration of our modern understandings with the ancient practices of Ayurveda.
I plan to write about more of these concepts in detail over the next few weeks along with my personal experience trying to make additional lifestyle changes and the challenges I have encountered. I know the amount of information out there can be incredibly overwhelming, so it is my hope that seeing the imperfect journey and struggles of even a seemingly "healthy" physician may make it all feel a little more accessible.
This is a topic I really enjoy discussing with people and am constantly learning more about myself, so please feel free to reach out or post any comments or questions you may have for me.
