This blog is an accounting of my personal journey to find fitness. All the content on this blog should be read as a biographical piece of literature, not a medical resource. I am a physician, but I am in no way giving medical advice or establishing doctor patient relationships with my readers. I am simply keeping a diary. If you are starting a diet or exercise program or require medical evaluation or advice, please see your own family physician.

Wednesday, August 18, 2010

Maybe I Shouldn't, but I Did

I've been thinking a lot the last couple of days about a post from a blogger which was critical of one of my posts. If you have been reading my blog, you know the one. If not, please read it now.

I know I shouldn't worry about it. I know I didn't mean my post the way some people took it. I know this person probably only read the one day and has no idea who I really am. But, it just bothers me that there may be others out there that feel the same way about me. I just don't think it's fair to be judged on one post. I don't think it's fair to have all their readers judging me on what this person wrote ABOUT me and their interpretation of me and what I wrote.

I know part of this is that self doubt issue I was talking about earlier. I know part is the little fat girl in me wanting approval that worries about people not liking her. But, a lot of it is the physician in me that wants to make sure that the facts are not lost here. I really want people to understand why I posted that rant AND what it is really about.

It was not about trashing people who've had or will have or want to have or NEED to have WLS. What educated self-respecting physician would? What decent person would? It was not about trashing people who struggle with making the right choices. We all have. I have. That post was about pointing out the fallacies in the thought processes I was seeing in some blogs. Am STILL seeing. SOME were by WLS people, SOME weren't. There are some bloggers out there that I am just going to stop reading because they clearly don't get IT....yet. And that's ok. We've all been where we don't get IT or we wouldn't be obese. I hope they get it and soon. I wish everyone success here.

Hell, my job every single day is to try to make people feel better, live healthier. It goes against everything I am and stand for to try to stand in someone's way or make them fail or doubt themselves or be their "6 foot tall, buck-toothed, horror-film style bunny" that "jumped out from behind the bushes and just SWALLOWED ME (them) WHOLE." The fact that someone took my words which were really more about how I was feeling at the time than anything and turned them into some kind of attack just confuses me and frankly hurts my feelings.

My post, that rant, came out of frustration with this drive in me to help people who say they want help, but won't accept it. OR who won't even admit to themselves they need help. OR when given help and the tools, won't use them and help themselves. Do you have any idea how frustrating that is for me? Probably not. It is especially frustrating now that I've finally gotten IT. I see through all their excuses and rationalizing because I've used them all myself. I just want them to stop hurting themselves, that's all. I want them to understand. To be ready to change. To show them the light.

But you can't make them change. You can't MAKE someone get IT. I know this. I do. And I'm OK with people who aren't ready yet. I don't judge them. I'VE BEEN THEM!! It's the people that say they're ready to change, but when it gets down to the work part, you find out they don't mean it because they won't do the work.

And let me be clear, my statements about everyone needing to make healthy food choices (banded or not) and get regular exercise is not OPINION. Surely everyone knows that, right? I want to give you some information. This is medical information, not advice. Sometimes I worry about some of the stuff I read. Some of the things people say out here in bloggerville are just either wrong or misinformed. I'm not trying to hurt anyone. I'm not trying to win an argument. I just want to help. I'm not going to name names or call them out the way this other person did to me. Most of these things all go back to the fact that you have to work on the mental aspects of this journey to really be successful. I'm sorry, but you do.

Somewhere I read that one of the "banders" said their surgeon didn't even want her to diet because that's how she got to be 350 pounds in the first place. As a physician, I'm pretty used to patients having selective hearing. Sometimes people only hear what they want. (All married women know this already, btw.) This really worried me. I am 99% certain that no reputable surgeon would tell their patient not to worry about eating healthy foods. I am 99% certain that no bariatric surgeon would tell a patient they can eat whatever they want and as long as it is smaller portions, they'll lose weight. I am 100% certain that following a diet did not make someone 350 pounds. What makes someone gain that much weight is not being able to follow a diet long term. Not being able to say no to certain foods. Not exercising regularly.

I'm not judging that person or ANY person for being obese. I'm one of you. But the facts are these: You can't just eat whatever you want. You can't. I'm sorry. Not all the time anyway. Not even most of the time. Not even if it's just a little bit because you have a band. Why? Because it just isn't good for your body.

I am pretty darned sure that what that surgeon meant was that "diets" don't work, not that you shouldn't worry about what you are putting in your body. There was a lovely post today on that word. It's all about how you view your eating. I hope that surgeon was trying to get across the need for a change in ATTITUDE regarding food.

If your surgeon says don't worry about it, eat what you want or that with the band you can eat like a "normal person", find another surgeon. They aren't doing you any favors. What we think of as eating like a "normal person" is not necessarily the healthiest way of eating. I have plenty of skinny patients who eat like shit and end up with heart attacks.

If you have the band or not, eating things like cheeseburgers or french fries or cake or ice cream or bacon on a regular basis isn't good for you. It's not whether weight is an issue or not. Am I saying you can never ever have these foods? No. But they should be rare treats. Period. And banders who eat this way are not only endangering their weight loss, but their overall health. If all you can eat is a little bit and what you choose to eat is 1 McNugget, 4 fries and a 1/4 of a shake, you are hurting yourself. You might lose weight for a while because your overall calories are down. But these foods have no nutritional value, or at least very little. That leads to metabolic changes and changes in your brain chemistry. These changes slow your metabolism and make your brain send out signals that you want and need more of these bad foods. Over time it can cause nutritional deficits that lead to serious health issues.

This is not opinion. It is science. Telling me: I don't like veggies. I don't like fruit. I don't like fish. I don't have time to cook. I don't know how to eat healthy. I can't afford healthy foods. It's just hard for me to give up the things I like so much. Doesn't change the facts. If you want to be healthy and keep the weight off forever, you have to do eat healthy things.

And exercise.

It is not my opinion that exercise is necessary to long term health. It is scientifically proven. Having the band you may be able to lose weight for a while and let this slide because your intake is so reduced, but that doesn't make it OK. Multiple studies have shown cardiovascular benefit with reduction of incidence in heart attacks and stroke in patients who exercise regularly, with or without weight loss. The American Heart Association says that the level of exercise needed to see this benefit is at LEAST 20 minutes 3 times weekly. Here are specifics:
From the AHA:
Do moderately intense cardio 30 minutes a day, five days a week
Do vigorously intense cardio 20 minutes a day, 3 days a week
Do eight to 10 strength-training exercises, eight to 12 repetitions of each exercise twice a week.

Moderate-intensity physical activity means working hard enough to raise your heart rate and break a sweat, yet still being able to carry on a conversation. It should be noted that to lose weight or maintain weight loss, 60 to 90 minutes of physical activity may be necessary. The 30-minute recommendation is for the average healthy adult to maintain health and reduce the risk for chronic disease.

This stuff is a culmination of many research studies. These guidelines are put together by some of the leading minds in science, the best physicians in the country.

So....if you want to lose weight and keep it off, you really really need to exercise. Band or no band. That may mean you have to turn off True blood or hey, how about instead of watching Biggest Loser, you turn the TV off and workout. Or even workout WHILE watching TV. I love TV. I don't want to miss my shows either. That's what TIVO is for. The fact is I've finally realized that I'll give up whatever it takes to see my grandkids grow up. Will you?

It's not ALL about the scale or what size I wear.

When I read on blogs things like: I can't afford a gym. My gym is too far away. It's too hot to exercise. My knees/back/joints hurt when I exercise. I don't like exercise. I'm just not athletic. I don't have time. I'm so tired when I get home from work. I can't exercise at home, I need my home to be my sanctuary. I don't want to get a treadmill or bike or whatever at home because I don't want to be one of those people who has one, but never uses it. I feel silly exercising. I'm too embarrassed to walk outside. I bought these new shaper shoes for running so when I start running it will be even better. I'm only going to exercise 2 times a week because I know that's all I'll do forever and I don't want to give up and just stop all together. I'll get started now that the kids are in school.

It just makes me nutso. I hear this all the time from patients. All. The. Time. Exercise is not easy. Sometimes it hurts. Sometimes it's no fun. But you need to do it. NO you HAVE to.
I stole this from my fellow MD over at Writing to Wellness...

I can't say it any plainer than that. This is now posted in my exam rooms at the office. I do not expect everyone to join a gym. I do not expect everyone to get a trainer. I do not expect everyone to lift weights or do push ups or 5Ks or DVDs or buy a Wii fit. I do expect everyone to move somehow. Yoga, walking, swimming, biking, zumba, dance naked to your favorite Billy Joel song. I don't care, but move EVERY DAY. It is absolutely necessary to your survival.

As I posted earlier, I've come a long way. I've got a long way to go. There is still self doubt at times. There are times when I falter. There are times I feel frustrated. But there are never times when I want to quit. There aren't times where I make excuses to myself or others. I hope not anyway. I personally need good examples and support from people who are doing IT. I feel sorry for people who don't get IT.

And my friends that are really making changes and trying and pushing themselves to be healthy, even when it's hard, even when they don't want to, I will be here for you to cheer you on in your successes and lift you up if you stumble. But, if you start down the road of denial and self-deception, I care enough about you to point it out. Even at the risk of making you mad. I expect the same from you.

Sorry this was so long. I feel better now. Good night.


  1. I appreciate your focus on health, not just weight. I do more exercise than I have in my whole life, but I need to dig a little deeper! The clear guidelines from the AHA are really unmistakable.

  2. I'm still kind of new here and don't think I've left you a comment yet. I just wanted to let you know that I love your blog. You make me want to do C25K.

  3. Hey wait - I bought the running shoes because I plan to start running! In the meantime, I'm walking. Can't go from 0 to 60 instantaneously. It will happen. :P

    Anyhow - that person's post was WAY out of line. She didn't read your blog with her mind, she read it with her fragile emotions. She had her mind made up before she read it just because you are friendly with a blogger she doesn't like. Girlfriend's got problems in the head for sure. You didn't say anything wrong in your post. You don't have anything to defend yourself about. The only people who are going to agree with her are those who don't use their own mind to see objectively what you're saying.

  4. Oh the excuses! Another difference I've noticed between the people who want to loose weight and the one's who are actually making long term sustainable changes are the long list of "Going to do's" People who want to loose make long lists of rules and goals.. "I'm going to work out 3 times a week for 45 min." People who are actually doing it usually just tell you what they did.

  5. Well spoken, erudite, concise, completely lost on those that think that this is easy, with or without a tool. You are doing a great service for those of us that can listen. Nothing to do with your path or my path, but listening to educated people is a start. I wish you only good things, and yes, April 2011, Frozen Hot chocolate for the herd, on me..

  6. Amen again. Don't worry, Dr F2F, you're doing fine. I enjoy your posts and am a fellow traveller down that road. Chin up. [and, as my DH always offers when I'm hurting, do you need me to punch somebody in the nose?]

  7. Allot of heart in this post. Allot of learning to be had here too. None of us can get far on our journeys with out leaning on the the large hearts & learnings offered from others like yourself. Together we'll get where we desire regardless how long the way ahead may be.

  8. The truth hurts sometimes, and people often have knee-jerk reactions. The downside of writing is that people can (and do) put their own interpretations on things, often quite removed from what the author actually intended. No worries! I think you explained yourself well. -- You are doing a great job so far! Keep it up! I'm not so sure I'd expose my blog to family and friends, but only because I'm afraid I'd start editing what I wrote, and one of my purposes in writing is to keep myself accountable.

  9. I loved both your original post, and this one. I thought they were both spot on. And I think the protests have a spark of "doths protests too much."

    I started my journey at 240 pounds. Last night, I finally saw the top of my ideal weight range at 157 pounds. It's taken me *two years* to get there. It's taken changing my whole life. And yet every day I have to put up with people telling me how "it's not fair" how thin I am, or how "it's easy" for me, or how I had some advantage because I gave up every other luxury in my life for six months so I could hire a personal trainer and join a gym, or how I'm somehow less busy than they are working my forty hours a week, and then heading out to the gym.

    There are no excuses. There is nothing inherent stopping anyone from succeeding but themselves. Sometimes people just don't like to hear that.

  10. I always enjoy your blog. There are a couple other fitness bloggers who seem to be misunderstood often, and I just don't get it. I think it is because this is such a personal journey filled with very personal decisions.

    One blog I read is by a mother who makes it a priority to encourage healthy food and exercise habits in her children. If she was feeding them soda and Pringles, no one would think twice, but she sometimes garners negative comments about being too strict or, worse, encouraging anorexia or something.

    We live in a culture that encourages us to be unhealthy. Some people are just very offended by being showed what healthy looks like. It is sad that when my son plays online games the trash talk from European kids toward American kids are comments about fat Americans eating x-large cheese burgers.

  11. I have used all of those excuses. And when I got out of my way and started walking the walk I was finally able to "get it" too.

    Wishing us all continued success!

    There is a quote on the gym wall where I work out. It says, "I believe in good luck and the harder I work, the more of it I seem to have."

  12. I so empathize with where you are as professional (trying to motivate folks to change) and as a person working hard on one's own health behaviors. 'Nuff said about that or I'll regress into a rant myself...

    I do believe some surgeons say "eat what you want" - lap band surgery can be performed by anyone with a scope and hospital privileges. I would never recommend anyone even discuss WLS with a surgeon unless the surgeon and the facility were accredited by the American College of Surgeons Bariatric Surgery Center Network. (Yes, my bias is showing.)

    Keep up your honest posting for your benefit and the healthy, sometimes feisty, exchange that goes on between readers and bloggers. Lovin' your writing!

  13. Dr. F, and I said on my blog the other day, your "Ranting" blog post the other day inspired me. I GET IT. I totally understand what you're trying to say. I never thought for a second that you were saying that WLS was bad. I'm sorry that other people have misunderstood you or misread your post. I think that's going to happen even if you write something as simple as "Have a nice day!" (Have a nice day? What did she mean by that? Doesn't she understand that I live in godforsakennowhere and having a nice day is just not an option? DOESN'T SHE KNOW WHO I AM?!?!") You should know that some people get it; some people don't. There's a reason why there's a multitude of personality types and communications methods. To each their own. If she doesn't understand where you are coming from, then she is welcome to find other people to listen to. I've, ahem, purposely ignored a few bloggers myself that I just don't get and find offensive. Rather than get upset about it, I just stop reading.

    Anyway, I'm babbling. I just wanted to say that I think you're Da Bomb. Keep doing what you're doing.


  14. You are very honest in your posts and give factual information. Some people want to ignore the facts, thus the protests. They don't get it. Please keep on doing what you're doing for us.

  15. I have friends I wish would just "get it" too.

    I was told by doctors I should do gastric because I needed to loose weight fast at 387lbs with cellulitus. I suggested swimming as I had done for 10 years as a kid and they told me I couldn't loose weight swimming like other dry land exercise and REALLY I needed to loose weight faster than that.

    I took a chance with my health, thanked them very much and went home and signed up for 9 hours a week in the water swimming masters and aqua aerobics in april 2007. So far Ive taken off 158lbs mainly in that pool and saved my already bad knees from further damage.

    I talk to the fit tech students at my college and personal trainers at the gym about this EVERY chance I get. I know every persons journey is different... but walking in water is something the super morbidly obese can do day after day with low risk of injury.

    I think the last 40 or 50 pounds may take more dry land exercise for me... but now I have evolved to someone who can handle that on my knees and hips and back. Please check out my blog and if you in some way agree or want to discuss this further... feel free to reach out to me. I want the world to encourage water to those who need to save their joints for later in their journey because this road is life long and a lifestyle and not just a diet or fitness program with an end date.


  16. I read your "rant" post, and I can't see where in the world you said anything dismissive or unsupportive of WLS. You were frustrated at folks "gaming" the dietary system (be it WLS, counting calories or points, exercising, or WHATEVER).

    Thing is, you were totally right. You can fiddle with stuff like nutrition in the short run. In the long run, though, it's only going to hurt you. The hard work has to be done, lifestyles have to change, and we all must use the tools we have (including WLS for those who have opted to utilize that option) to the best of our advantage.

    We owe it to ourselves, and to those who love us.

  17. Wow, very well written.

    I, being a bad student, didn't read the 'rant' blog first. I'm off to read it now though.

  18. Wowza! If you don't read Bobbie's blog(http://www.anonymousfatgirl.com/), you should check it out sometime. I think you and she have some very similar feelings and you are not afraid to speak your minds and put them out here.

  19. Don't feel bad about any thing you said. I totally agree with you. I worked in a hospital for 16 years. I had several co-workers who had the lap band surgery. I already KNEW before they had the surgery that it wasn't going to work for them. This one RN had been to WW several times, lose 50 lbs, then gain it back over and over. So, she decided to do the lap band. She wasn't quite heavy enough so she purposely gained another 20 lbs or so to reach the minimum weight limit to have the surgery. After surgery, she lost the weight and then promptly gained it all back. The surgeon who performed the lap band surgery at our hospital had the surgery himself only to gain all his weight back too. You have to put in the WORK to keep the weight off no matter which diet you choose. I am big now, and it is no mystery to me how I got this way. I didn't just wake up one day and say, OMG! WHAT HAPPENED?? I know how I got here. I just didn't "want" to do the work. It's just that simple.

  20. This is not a criticism of you, but I would be careful about being too critical of peoples efforts to improve, however small. Making someone feel that them exercising twice a week is a waste of their time may kill their motivation and stop them trying. Each improvement is worthwhile. A person will see an improvement in their fitness and energy from exercising twice a week and they may decide to do more once they see how good it feels and they get more confident that they can do it...you never know where baby steps will lead. I think we should encourage baby steps...even when we may feel the changes are not enough...

  21. Thank you Sparkler for making that point. I agree with you completely. Any step taken in the right direction is a good step. I tell my patients this all the time. You start where you can and then see how you can improve from there. It's so hard to get all your thoughts across in one post. I was really trying to convey that people need to watch their "self talk" that might be holding them back. Don't let what your mind is telling you talk you out of good choices because it can. Mine has and still does some times. Sometimes people don't even realize how they are holding themselves back.


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