I am well acquainted with the ravages being out of shape and overweight take on the human body. After all, I am the repairman for the human spine. Even the small daily “wear and tear” can take a toll on the spine just as it does on the knees, the hips and the ankles. The more weight you carry on your frame, the more stress is placed on the spine itself. The weaker those spinal stabilizing muscles are, more likely you are to be injured at any given time. The abdominal and back muscles that provide the stability to the spine, especially the lumbar spine, are known as the core muscles. A strong core is critical to long term stability of spine. But the core is not just the muscles, but also your mental, emotional, and spiritual stability. See my blog post on the Core Commitment Curriculum regarding the need for a strong mental and physical core.
Why is this relevant? Well, I am like many of you. I work at a very stressful job (yes, it is stressful, even though I don’t show it J). I work too much, I exercise too little, I love food (really love food) and I enjoy life. Which means that over the course of the last few years while I was busy taking care of other people’s back problems, I allowed myself to get out of shape. This was driven home most recently when on a holiday vacation, I barely recognized the man in the pictures. “When did that gut develop?”
My mental self-image goes back to my beach lifeguarding days (when I was working out an hour and half a day, sitting in the sun, working 6 days a week at the beach, not a bad job…). Before I was married, almost 25 years ago, I was 6 foot 1 inch and 182 pounds, fit as a fiddle, a “lean, mean, fighting machine”. In many ways, as I have grown older (and just a bit more mature), I have improved: my hand-eye coordination has gotten better, I can now take up almost any sport and I acquit myself reasonably well on the court or playing field (obviously this neurosurgery thing seems to have been good for that). But on the other hand, it is not been so good for my weight and my core fitness. I have gained about 10 pounds at every professional stage of my life.
BY THE NUMBERS:
We are a numbers-obsessed society. Putting things into numbers helps to make the situation digestible and to draw statistical conclusions which support our hypothesis; but in some ways to depersonalize what is truly a very personal and subjective feeling. My numbers: 182 lbs., when I was married, 192 lbs. a year later at the end of my General Surgical internship, 205 lbs. 7 years later at the end of residency and fellowship; 215 lbs. about 5 years ago when I was 10 years into practice and sadly, this past holiday vacation, I hit my highest weight ever: 226 lbs. (that is 44 pounds higher than my marriage weight, that is 71 pounds greater than when I graduated high school, at 155 lbs).
Now granted, when I graduated high school, I was underweight from swimming 4 hours a day to keep up with the incredibly gifted and talented other members of my world-class and National Champion high school swim team. Although I was a “good” swimmer by most standards, I swam in a pool filled with people who spelled good with one ‘O’. Several of the people in my pool went on to various Olympics for swimming; I could not even make my college team at Penn. But from swimming I learned how to work hard. I had, in the last few years, put taking care of myself so low on my list of priorities that it had essentially fallen off.
TIME TO RE-PRIORITIZE!
Looking at those pictures, I decided that while the person in the picture was having a lot of fun with his family, if that person (i.e., me) does not want to wind up on somebody else’s OR table to fix his back (or worse, to fix a coronary artery problem that might develop later in life), then it is about time that I rebalanced my priorities and put taking care of myself as one of them.
It is not just about the weight, although the weight is clearly a problem. It is about 3 other things:
- I do not like the way I feel; my bigger belly makes it actually harder for me to have flexibility.
- I do not like the way I look, I want to feel better about myself.
- I want to be in better shape.
I want to be able to do activities with my kids who are coming into their teenage years and won’t want to be seen with the dad who cannot keep up. So begins my chronicle of my struggle with trying to keep my new year’s resolution alive, not just as a short term goal, but as a commitment to change the way I view myself and treat myself. I want to be around as an active participant in my family’s future. This is an investment in my future as well as that of my family (after all if I have to go out on disability, at some point, the bills won’t get paid).
TIME TO COMMIT TO CHANGE:
It has been said that the journey of a 1000 miles begins with a single step. Never has that been more true than with weight loss. It is easy to say “lose 25-50 pounds”. It is a lot harder just lose the first 10, let alone the last 10. But since it is also been said that “you never achieve any of the goals you do not set for yourself”, and there is a 100% correlation between not trying and not succeeding, we have to start somewhere. One way to improve your chances of achieving any goal is to be committed to that goal. Another is to make sure that those whose support you count on also are committed to helping you. To understand the role that plays, think for a moment how difficult it would be to quit smoking if everyone around you is still lighting up. Or to lose weight if everyone you eat with or whomever may prepare your meals doesn’t know how important it is to you. Or to try to work out and then find out your heart, knees, or lungs aren’t healthy enough. Failure is disheartening, but preparation (including getting the support and buy-in from those who have a stake in your well-being) goes a long way to ensuring success.
HOW TO CHANGE?
Making a commitment is important, but sharing that commitment can help to strengthen your resolve as well. If those around you know you’re trying to get in shape, then they will likely support you, but you also won’t want to dissapoint them either. A support network works both ways. Sharing your exercise in a social network (like in the Apple Activity app, or in Fitbit) can be useful to maintain your commitment to activity increases. So can blogging about your experience (kind if like this…, 😉). Fitness and diet are two ways to lose weight and get in better shape. Finding ways to support your exercise and your diet are also important. For example, all you really need is time and a place to do exercises, but if you want variety to keep from getting bored, then you probably want to consider a number of different activities to mix in – biking, running, swimming, erging, etc. One way I maintain my workout, even at all hours of the night (given my long work hours), is through inspirational music. Having upbeat tunes going allows me to forget for a moment how much it hurts when I’m doing crunches, or cycling at high intensity.
APPS CAN HELP:
Figuring out a routine to get started and to maintain momentum can be daunting, but once again, preparation will make the formal start easier. Fortunately, there are many apps out there that can give you a very condensed workout that will get you on the road to recovery*. First, there is an app on the Apple Store called “Daily Ab Workout”; if you have access to this blog, I am presuming that you probably have a smart phone of either the iPhone™ or the Android™ type. If for some reason you are unable to access an app of this type, there are numerous websites that have exercises like these. The exercises are written out, many with videos that you can follow along with. If that doesn’t work for you, you can go old school: write it down on a piece of paper and list it, and put check boxes next to it for you to congratulate yourself when you complete one.
Another app that I find useful (technically not an app, but a link that you can save on your home screen just like an app) from the New York Times “Well” column and it is called the “7-Minute Scientific Workout”. This is based on research that shows the high intensity interval training (HIIT) of this sort can allow for a condensed workout that works almost the entire body, gives you a cardio lift, and if done in the morning, will keep that burn going (in the increased metabolism that it generates) through at least part of the day, making the workout even that much more effective. There are many other HIIT workouts that we will likely discuss in this blog overtime, as I discuss what does and does not work for me. Caveat Emptor. Your mileage may vary.
Both of these apps were already on my phone, iPad and other devices; some of them I had used sparingly, but it was time for me to make it a commitment (I had heard a great discussion on compliance verses commitment in The Great Courses lecture entitled “Influence”.) Compliance is when you do what you are supposed to when people are watching, but when the attention gets shifted elsewhere, you will likely shift back into your old habits, and no longer show the commitment to continue without reminding, whereas true commitment means that you believe, you bought in, and you make it your own priority.
CORE COMMITMENT CURRICULUM:
I understand what my patients are going through because I am now going through it myself. Occasionally, I get a twinge in my back (I do stand all day long over patients who are often twice my weight: positioning them, operating on them, walking them in the postoperative period; that takes a toll on even the fittest of people, let alone somebody who let himself get out of shape). To help my patients as well as myself, I have developed a new program called the Core Commitment Curriculum. It is not enough to fix a back when it is broken or damaged, because without a commitment to change in the way the back and the person is treated, the biomechanics of the back will fall back into the old habits that led to the damage in the first place.
The biggest dietary change I could recommend is not a diet per se, but wisdom and insight: eat slowly because your brain has about a 10-15 minutes lag between when your stomach is full and when your appetite registers that your stomach is full. Do not go back for seconds until you waited at least 15 minutes and you are still hungry; and most importantly while it seems obvious to say, but in reality it is not: stop eating when you feel full, no matter how good that desert, piece of steak, or whatever tempts your palate that is sitting on your plate or on the desert cart.
That is why it is so important to get family and friends on board when you set a new goal. They can help you (or at the very least try to get them to agree not to hurt you). I will give you updates as to my progress as we achieve them together. There are many out there who do not have the struggles that I am currently having. I used to have a metabolism where I could eat 2 full meals at a time and not gain weight. That was 35 years ago; those days are long gone. But, I have friends who still do: boy, are they lucky. I hope they appreciate that. The rest of us struggle, but the struggle is worth it because it helps to define who we are, and that we do not give in just because it is hard.
Speaking of hard, ab exercises are really hard, especially for someone who is out of shape. The first time I tried to do the 5 minute Daily Abs app, I could barely do any of them, and frequently had to stop and catch my breath in the middle of a 30-second exercise.”Well, I can’t even do 30-seconds straight, let alone 5 minutes, how am I going to do this?” The answer is, “just keep trying”, “catch your breath”, “do it again”, “at least try to finish out the 30 seconds”, “do the last 5 seconds as best you can”, “get a brief break before the next one starts”, the list of things to think while struggling goes on and on…
My advice for anyone else starting off (especially if you’re starting back at the bottom), is if you need to, you can even alternate, one day do the 1st 3rd, 5th 7th and 9th exercises in the sequence, stop as often as you need to, and then the next day do the 2nd, 4th, 6th, 8th and 10th. The more you do this, the more you keep trying, the more you will train your body, the easier each set of exercises will become.
I can tell you that after a month of doing these exercises almost every single day, I still have trouble getting through several of them and some days still have to stop in the middle of an exercise to catch my breath; or I can still have trouble lifting my back high enough off the floor to get the shoulder blades off for every exercise as is the intended technique, “This Sucks!” I frequently yell or think (depending on whether anyone else is in earshot), but I do not give up. After a month, I am 8 pounds down from my peak (218 and hoping to keep dropping!).
“If all you ever do is all you’ve ever done, all you’ll ever get is all you’ve ever gotten”.
I want to be in a different place, and not following the same upward trajectory in my weight, and downward trajectory in my physical fitness. I hope you find these anecdotes helpful. I will post more if there is interest in following my progress along.
You are not alone, and together we can get through this.
Arthur L. Jenkins III, MD
This blog does not constitute medical advice. For you to receive medical advice, you would need to have a two-way relationship with a physician who can examine you, not just exchange emails or comments with.
*I do not make any money to give any endorsements for any product.
At some point as I collate all of the products that I do believe in, I may very well utilize a web portal to facilitate people getting the items and products they need; at that time, I will disclose any interest that I have, but for now, I have no conflicts to disclose and only recommend those products that I truly have used, recommend, and believe in.