Wednesday, September 26, 2012

Thoughts while Jogging with My Staff

     The Colasante Clinic running coalition got together again yesterday, after a regrettable hiatus, to run two miles.  It was long past dusk and there was a gamey breeze tossing about the Howard Bishop Middle School track where we met up after work.  Running with others improves motivation.
     "My body feels like a ten ton truck," I lamented, halfway through the first lap.
     "We haven't been running together for two months and one day," the medical assistant informed us cheerily.  She wasn't short of breath, because she had kept up with the running program on her own.  I had bailed out, however, and so had the others, with the usual vacant excuses:  "It's too hot.  It's raining.  I don't have time.  I forgot my running clothes.  There are too many mosquitoes.  I'm hungry.  I'm exhausted.  I have to write in my blog.  I didn't sleep last night.  I have a headache.  Maybe tomorrow.  Maybe the next day."  Truth was, we just plain didn't want to run.   We thought we were plenty noble, just showing up for work, taking care of patients.  But our morale had been suffering.
     "Can't we just lose fifty pounds while crocheting and watching movies?" moaned another provider., panting to keep up.
     "Yeah, and let's include a glass of red wine and some brownies in that request," I added.
     Most of the people on my staff want to lose weight--so do the patients, and so do most Americans.
     I recommend setting a goal of ten percent of a person's current body weight.  A two hundred pound woman, then, wouldn't feel so hopeless aiming for a twenty pound weight loss, instead of sixty.  Studies show that overweight people who are able to lose ten percent of their body mass are enjoy vastly improved health, and have a lower risk for heart disease and diabetes.  Once that ten percent falls off, the patient is sometimes optimistic enough to lose another ten percent.
     My staff and I invite our patients to join us at the track, but it's rare for a any of them to show up.  However much they want to lose weight, most can't seem to commit to a regimen.  I can't blame them.  I stopped running, too, for two months.  And one night last weekI ate an entire pint of Haagen Dazs rum raisin ice cream for dinner.
     How can I help my patients?  This question is constantly on my mind.  I sometimes feel like a failure as a physician, because I know that losing weight and exercising is exactly what would cure many of them of all their ills--more than the pills and easy panaceas they constantly request.
     But I'm failing to convince them, or  inspire them, or fix the fattening culture in which we're enmeshed.  Is being overweight and inactive a psychological problem?  Or is it a problem amplified by corporations which aim, via in-your-face ads, to increase consumerism?  Or is it compensation for our empty spiritual lives, lack of community, breakdown of family?  Is obesity related to environmental toxins, food additives, or malnutrition?
     Malnutrition?  Yes, my patients are obese, and malnourished.  Many are deficient in vitamins, protein, and probably trace minerals, even as their blood is gushing over with cholesterol and fats, and their legs are swollen with fluid--signifying too much salt, and too much sitting.  It's no secret:  much of the food available to us is empty of real nutrition.  It shouldn't even be classified as "food."
     I donated my clinic waiting room for Weight Watchers meetings, because there isn't a single site for my patients on the east side of Gainesville.  It took three months and a lot of paperwork to get approved.  But now, we can't recruit the minimum number of members--fifteen--to start having meetings.
     Surely there are fifteen people who could commit to a proven weight loss program (Weight Watchers is the most successful weight loss program in the world) on the east side of Gainesville. Ninety percent of my patients want to lose weight--need to lose weight, more than anything else, to cure their symptoms.  Almost everyone in America would benefit from regular, vigorous exercise.  But I am failing at the all-important task of motivating people to join the $10/month gym down the road, or show up at the track to run with our group, or eat more nutritious foods, or join Weight Watchers.
     I have considered giving classes in nutrition, gardening, cooking, food shopping.  Our clinic put together a program for obese children two years ago.  I try to address, during clinic visits, the emotional underpinnings of overeating, and the relationship between food and feelings of deprivation, or childhood abuse, or pain, loneliness, grief, pain, boredom, lack of purpose, and hopelessness.
     I didn't solve any problems last night, as I ran eight laps with my staff.  I kept thinking about my patients, and how great it would be if I could get every one of them down to a normal, healthy weight.
     And at least, for a change, I wasn't thinking about the federal investigation, or the raid, or injustice, or my begrimed reputation, or FBI agents, or spurious crackdowns on fraud that give government agents an excuse to pose as protectors of the people.  For an entire twenty-five minutes, I wasn't thinking about any of that stuff.

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