Author: Dr. Julie

When was the last time you thought you were eating something healthy only to find out it’s not so healthy after all? I had this painful and unpleasant experience just this last Saturday.

I was sharing a beautiful breakfast with my husband who had lovingly prepared a pastured egg, spinach and avocado omelet. I savored the delicious food with all its complex flavors and textures.  I enjoyed every gram of cancer fighting herbs and spices and muscle building protein and microbiome feeding fiber and luxuriously satisfying fat that I was putting in my body not just for fuel but for repair of my damaged cells and to nurture the creation of my new cells. 

Kenny and I sat together at the table and made small talk enjoying each other’s company. The sun was shining through the winter whipped windows reminding me I needed to add spring cleaning to the calendar. But that did not rattle me. I was relaxed and I thoroughly relished the meal.  I had even toasted a piece of low carb lavash bread so I would not feel “bread deprived” having chosen to eat few starchy carbs due to my own insulin resistance.

I took another bite and nonchalantly turned the bread wrapper over. Apparently, I made a horrific guttural sound which stifled my swallow and I spit my food all over the kitchen table. “Are you choking?” my husband yelled as he simultaneously stood and reached around my waist instinctively prepared to administer the Heimlich maneuver. I shook my head “No” but remained dazed and speechless.

“What is it then?” he asked almost irritated that I had broken the spell of the morning. “Look!” I wailed with shock and dismay, “Soybean oil!” and I thrust the plastic in his face in the most Scarlet O’ Hara kind of way. Admittedly, he had every husbandly right to retort “Frankly my dear, I don’t give a d*mn!!” Instead my heroic husband grabbed the package, read the atrocity for himself, and flung the remaining bread into the compost bin.

I hung my head in disgust. Here I was eating and recommending my patients to eat a certain flat bread with all it’s great nutrients like flax seed and oat bran and whole wheat. And guess what? It has corn starch, soy protein isolate, and soybean oil. One may be able to argue their way through the innocuous properties of corn starch or soy protein but soybean oil? What was I thinking? How did I let this one get past me?

My husband sat back down and picked up the bottle of Vitamin D3 that was sitting on the table in front of him. He had innocently purchased it from a local pharmacy because we had run out of the one we usual use. And guess what? Soy bean oil! Arrggghhh!!!!!!!

What’s so bad about soybean oil you are asking. Well, just as we are trying to avoid processed and refined carbohydrates, we are also trying to avoid processed and refined oils.  Soybean and canola oils are the most common and are found in most packaged or bottled grocery store items. They are referred to as vegetable oils (which is confusing because the oils come from the seeds not vegetables) and also include safflower and sunflower oils. They are deemed healthy because they have polyunsaturated fats which are supposedly healthier than saturated fat and therefore are given the heart healthy stamp of approval by the ADA and AHA. (More on this later).

It is true that the oils in the seeds in their natural state are the polyunsaturated omega 3s and 6s we require because our bodies do not make them; so eating the seeds raw or lightly roasted (not honey drenched or barbecued) can be part of a healthy diet. But once the oils are extracted, usually at very high temperatures, they become rancid or spoiled. Spoiled oils. Say that five times fast. They stink in this changed state and must be deodorized with chemical solvents before being packaged into bottles and placed on grocery store shelves for human consumption. Even expeller or cold pressed seed oils are unstable which is not good news for our cell membranes or our fat cells, their usual final resting places.

I have written about how refined carbs raise blood sugar and glycate or damage the proteins our bodies make for cellular function. Well, these unstable oils oxidize or damage our cell membranes. In other words we rust. All this leads to the dreaded inflammation and increased risk of chronic disease, cancer, unhealthy aging, and weight dysregulation.

I can see her now, my sweet grandmother perched in her rocking chair in her front room. “What the hell am I supposed to eat?” I can hear her say. (This is a vivid memory for me as a young child because it was the only time my grandmother every swore).

Thank you for asking, Grandma.

Healthy fats include cold pressed olive oil, avocado oil, coconut oil (all fruits, by the way), oil from fatty fish like wild caught salmon that ate algae, and butter from cows that ate grass.

To Michael Pollan’s oft quoted “Eat real food… mostly plants,” I would add:

 Yes, eat your vegetables!  Skip the vegetable oil!

And to myself I say “Physician, heal thyself.” Or at least if you buy something in a package, Julie, read the label!

(If you want to do more reading and research on the subject, let me recommend Cate Shanahan’s book, Deep Nutrition. She also has some interesting interviews on YouTube.  Nina Teicholz and Gary Taubes are good sources for digging into the research on saturated fats.)

Next weekend my family is gathering in Kempner, Texas to celebrate my mom’s 80^th birthday. Children and grandchildren will fly in from all parts of Texas and beyond to honor this tiny Texas Aggie. That’s her name, Aggie, short for Agnes.  

We will eat delicious barbecue smoked to perfection by my brother, Steve. We will laugh at tall Texas tales describing Mom’s hilarious escapades told by my sisters, Beth and Amy.  We will listen to sappy songs sung by beloved grandchildren. We will admire a very special gift carefully planned by my brother, Greg. And yes, we will eat cake baked by my sister-in-law, Amy, chef extraordinaire.

It’s not a surprise party. That failed early in the plotting. We had a stream of group texts between siblings, and somehow Agnes got in on it. We didn’t even realize it until she chimed in with a few of her own suggestions. Oops. But then again, Mom could never be surprised. She had an uncanny way of finding things out.  She’d talk to one of her kids, then innocently question another as if she knew nothing. Yes, the planning had to go deep into stealth mode. We kids still have a few tricks up our sleeves.

Mom has always been petite, 5’1 1/2” at her tallest, but has shrunk to a diminutive 4’ 9” not from osteoporosis but from scoliosis. She may be tiny, but she is a vivacious. Apart from arthritis which eventually led to replacements and of both knees and one shoulder, Mom is in great shape. She takes no medicine. She goes to her gym three days a week. She volunteers at the community hospital and takes meals to the elderly. She plays Bunco. She travels.

For eighty years now she has worked hard and played harder. She was never afraid to try something new. She raised 5 kids, added 3 more, ran an ER early in her nursing career, and trained many a doctor, including me.

So a few years ago when I told her the orange juice she was drinking on a daily basis was not good for her, she looked at me cross-eyed. “It’s fruit!” she informed me and continued pouring. Of course, she comes by this misconception honestly. Its what the old dog organizations like the American Heart Association and the American Diabetes Association and the USDA have told us for years and are still telling us to this day: 100% juice is a nutritious choice. Even the hospital from where her husband had been recently discharged, like most hospitals for that matter, suggest orange juice in their post hospitalization, heart healthy diet plans.

I took the hospital where I serve on associate staff to task on this once. I was so adamant that they should not sell or serve any sugary beverages including orange juice that I refused to get the required flu shot in protest that year. I’ll show them! Primum non nocere and all that! I was going to change the world, at least this hospital. I felt exuberant like I did in 1993 when I was chief resident and I protested my hospital’s sale of candy cigarettes. That was when hospitals still allowed smoking. Well, I bought all the candy cigarettes on the hospital’s dime and handed them out to my interns. We moseyed down the halls like James Dean with the packs rolled up in our scrub sleeves and the powdery cigarettes hanging from our lips.

In both instances something changed. Smoking was banned in the Kentucky hospital. And the other hospital cut out deep fried foods shortly after my rant. Now whether I actually had anything to do with those changes is not the point. Old dogs can learn new tricks.

I am so very passionate about avoiding sugary beverages including juice because they give the body a one-two punch.  Yes, juice comes from fruit. But just as you would not eat ten oranges in one sitting, you should not drink the juice of ten oranges in one sitting. The fructose overwhelms the liver and addicts the brain to sugar while the

glucose overwhelms the pancreas, spiking insulin and inducing energy storage. Additionally, the brain does not recognize the calories from sugar sweetened beverages and hunger is not diminished. Ghrelin does not decrease when you drink soda or juice or energy drinks. You are no less hungry, so you keep eating despite drinking hundreds of calories. Over time this firestorm of out of control hormones causes the liver to store fat, and the body goes down the slippery slope of weight gain and insulin resistance all the way to Type 2 diabetes.

I have heard it said 22 teaspoons of sugar a year for 20 years will cause diabetes. But our kids are drinking orange juice and Big Gulps and energy drinks and coffee drinks to the tune of over 40 teaspoons of sugar a day. And as a result, our kids are developing fatty liver and diabetes at alarming rates and at earlier and earlier ages. Not to mention they are hungry all the time.

What you eat can decrease hunger not just due to sheer volume but due to how certain foods activate hormones to talk to your brain. Protein (best from the highest quality your budget allows: grass-fed, free range, or wild) causes the release of GLP1 from the small intestine. GLP1 tells your brain you have had food and you are going to make it for another few hours. GLP1 slows food moving through the gut so you are fuller longer. And GLP1 assists insulin’s work in the cells which gives the pancreas a break. Lower insulin, less energy stored in fat cells. That’s a triple win for weight regulation.

Non-starchy vegetables have fiber. Fiber makes you full and feeds healthy gut bacteria. Healthy gut bacteria can decrease calorie absorption and improve weight regulation. Healthy fats from avocado, olive oil, fish, and nuts and seeds, make you feel full and satisfied and help the absorption of certain essential vitamins.

The message is clear. Eat food. Drink water. And eat food that makes you full: high quality protein, non-starchy vegetables, and healthy fats, and you too can live weigh different.

Happy 80th Birthday, Mom! I love you! And now that you have given up the juice, you’re going to see 100!

I have the privilege of working with third- and fourth-year medical students from Western Oregon University in Lebanon, Oregon. The school has a Lifestyle Medicine track which fits very well with my new specialty, Obesity Medicine. I enjoy demonstrating to them in very practical ways how I work with patients in the areas of nutrition, activity, sleep, and stress management to improve health and if possible, avoid prescribing medication. The work is energizing, and I love it.

Each student brings a unique set of strengths. I am always impressed by their intelligence and well-rounded experience which gives me hope for our future. In addition to their stellar academic achievements, they have accomplished near Nobel prize winning research or joined the Peace Corps or traveled the world or some other amazing or incredible thing which did not even come into my view finder when I was their age.  I wonder if I could make the cut in today’s competitive med school meat market. To be sure medical school and medicine have changed.

When I was a medical student, all I did was study. I went to every class, listened to every lecture, bought every note from the note service whether it was worthwhile or not, spent every Friday in the cadaver lab going over and over anatomy, and consequently, stunk like formaldehyde which made it impossible for me to go out because it would take the whole weekend to wash that acrid  stench from my pores. Who had time for travel or research or bathing, really? When I was on call, I’d try the Crash Cavern, a huge pitch-black room filled with bunks stacked three beds high. It was impossible to sleep, beepers going off incessantly and in irregularly irregular rhythms akin to atrial fibrillation so my brain couldn’t make it white noise. People snored, and loudly. Or they did other things. All this to say, sleep eluded me. I invariably ended up searching the corridors of the hospital wards for an empty room and dozing at least a few moments on a hospital bed or in the cot in the corner hidden from Nurse Cratchit’s view. Not every nurse was Nurse Cratchit, but there was always one.

I remember an Internal Medicine rotation at Houston’s Hermann Memorial, rounding on an elderly African American woman who had been admitted with an exacerbation of heart failure. Her lungs were filled with fluid and she struggled for every breath. She talked slowly and in spurts, “Good mornin’… Chil’… how is… the worl’… treatin’ you…t’day?”

Though she struggled she was at peace. I sensed a sacred presence in the room as I approached her lying there in the bed, despite the irreverent red lights and screeching beeps coming from the monitors snitching on her lack of normal vital signs. But there was no monitor for the spirit in her, the inner strength that exuded her small frame. I could hardly bring myself to invade the sanctuary of her personal space. Yet I felt compelled to know that space.

With my right hand I placed my stethoscope softly on her left chest over her heart and steadied my left hand delicately on her right shoulder. A serene smile unfolded across her entire face like a gentle wave on the ocean shore. “You have healing hands,” she said, her eyes closed as her warm breath exited her slight body.

In my youthful naivete, I did not know what to think or how to respond. I suppose I felt a sense of pride. I took her hand and thanked her. I quickly completed my exam and exited the room to finish my rounds for the morning.

Now that I am teaching medical students, I realize my patient was not reporting about my unique abilities as if I possessed some supernatural power as a rookie medical student. She was declaring something over me. It was a kind of prayer or a commission even.

“You will have healing hands,” she was praying as a hope for my future.

“You! Have healing hands!” she was admonishing me as a necessity for the challenging work to come.

“You have healing hands,” I said to the most recent medical student I hosted as she practiced her osteopathic skills on one of my willing patients. And as I said it, I realized just how far adrift I had gone from this original calling. In the recent years I could see how I had allowed the evolving institution of medicine to give way to busy-ness and crowd out the real vocation of medicine which is healing. The pressure of RVUs, Meaningful Use, Medical Home, CCO, ACA, MACRA, USTSPF, have basically stripped away time spent with the patient and the physical exam and therapeutic touch. Stop the world (of medicine) I want to get off!

And so, I find myself going rogue, at least for the foreseeable future. I am not sure what this new venture is going to look like exactly or where it will lead, but I am confident it will be way different and closer to my patient’s hopeful, prophetic commission than I have ever come. Healing hands are essential as a physician and I intend to discover them again.

• 

December is a rough month.

The days are the shortest. The weather is the greyest. Vitamin D is at its lowest. You drive to work in the dark and drive home from work in the dark. Energy wanes for after work errands, never mind evening exercise.

Time constraints of the holiday season rock routine. There are office parties and family gatherings, school concerts and tournaments. If you have school aged children, you must figure out different meals and childcare because of the long winter break. And it really does not matter whether you celebrate any of December’s many holidays or not. Some change in routine is inevitably imposed upon you.

Everywhere you go, a relative carb/fat fest awaits. Neighbors shower you with homemade Christmas cookies and candies. Coworkers litter the break room with cheese balls and crackers, party dips and those little sausages. You get invited to party after party and even though you don’t go to the party hungry (you’ve learned that lesson) people look at you cross eyed if you don’t have a plate full of food in your hand. Not a party goer? Doesn’t matter. Grocery stores sample the winter wonderland of delicacies wafting deliciousness down every aisle. The demons of white sugar and refined flour dance with saturated fat like innocent sugarplum fairies whispering sweet nothings in defenseless ears. It’s just one bite. Even the strongest will powers give way. 

I know mine did.

I’d been burning the candle at both ends, trying to finish strong at one clinic all the while readying my new clinic. My sleep, disrupted from training my puppy, became even more frayed with work worry. I was able to keep my exercise routine going but I cut back to a slower pace, brisk walking without intervals. From December 22 on, my adult children rolled in one at a time from hither and yon: Jacob from the Bay area, Zeke from Bozeman, Elena from Bend, and Zach, Carol and Uriah from down the street in Jefferson. In lieu of presents, we logged time together. We took in a movie, caught a Blazers game, ventured to the coast, checked out a new coffee shop. We even coordinated a family photo thanks to Jacob’s friend, Casey, a feat we had not been able to accomplish for ten years.

We logged a lot of time and we ate a lot of food. Good food, healthy food, prepared at home food, but a lot of food. And then there were desserts: ice cream by the pint, freshly baked gingerbread, stockings filled with candies,  cookies from a brother/sister bake off, and some sort of chocolatey concoction that ended up in the cart on one of my husband’s many Costco runs.  While refined carbs usually don’t tempt me, this year, they drew me in. Admittedly, I was more vulnerable. I was sleep deprived. I had less energy.  And everybody else was eating their hearts’ desire. Why couldn’t I?

When you don’t eat refined carbs and then all of a sudden you eat a lot of refined carbs, guess what happens? FLC Syndrome. What is FLC syndrome you ask? Feel Like Crap syndrome. FLC syndrome occurs when your blood sugar spikes, and fructose, the sweetest sugar molecule, hits your brain like jet fuel, you get a drug like rush for brief seconds and then in 30 min or so a precipitous drop in blood sugar which make you feel tired, and wired; sluggish and  jittery at the same time. And you crave the very thing that made your blood sugar spike in the first place: sugar. You have heard me say it before because it is true: Carbs beget carbs. And that roller coaster ride is no fun.

While for some, December heralds joy filled celebrations and festive foods, for others, it is a harbinger of loneliness, sadness and grief. The deployment or dysfunction or death which separates families and friends tends to be felt most in December. I can relate. Though this year ranked in the top 10 best ever family times, in the past I would have done anything to skip December altogether. My son Sammy’s birthday falls on December 17^th. He died from a brief illness when he was just two and a half. In the ensuing years my other young children’s excitement for the season pushed me to at least go through the motions. I often felt guilty if I found myself enjoying life. Sometimes I resented others’ happiness. Food comforts in those dark times.  And most of those comfort foods combine both carbohydrates and fat together.

Think peanut butter and jelly. Think macaroni and cheese. Think potatoes and gravy. Popcorn lathered in butter. Pizza.  Ice cream. Any baked good. Carbs and fat together. When you combine two energy sources, your body preferentially metabolizes the carbohydrate, using it for fuel. Then the break down product of the carbohydrate metabolism signals your body to store all the fat you just ate. In celebration or consolation, if you combine carbs and fat for too many days in a row, it’s a recipe for the roller coaster of weight gain.

I’ll say it again December is rough, especially in the weight loss arena. It is no wonder that most Americans gain at least two pounds between Thanksgiving and New Year’s Eve.

Although I am grateful for the family time and will cherish the memories, I am relieved that January is fast upon us. So long, December. I can get back to my healthy habits.

The good news is healthy habits can be reclaimed. And there’s nothing like a New Year to reclaim them. It’s never too late and you’re never too far gone. At Oregon Weight and Wellness, we would love to help you get off the roller coaster of refined carbs and comfort foods and get back on track with your healthy habits. Maybe start new ones. No impossible New Year’s resolutions, just one small change at a time. Work with us for at least six months and we will equip you with tools so that next December will be way different.

It doesn’t take a psychoanalyst to figure out the dream I had in the wee hours of Monday morning, opening day of my new clinic. I’ll give you a few details and you can decide.

I was driving to the clinic right before dawn. It was dark and drizzling and damp and the kind of cold that cuts right to the bone.  Oncoming cars glared at me as I took every wrong turn possible. Not recognizing any road signs or landmarks, I ended up in Timbuktu. I stopped by an unnamed beauty salon to make an appointment with a stylist I had never met to get my hair cut.  I waited impatiently for at least twenty minutes chiding myself that now I was going to be late for sure. Finally, I decided not to make an appointment after all. I walked down a steep flight of stairs and tripped at the bottom, dropping my purse and spilling its contents everywhere. It took every ounce of energy to collect my scattered belongings. Prostrate on the ground, I army crawled to the car. Apparently my legs wouldn’t work.  The car door opened like an oven door and I struggled to get in. I finally made it to my office and someone asked for Julie. Three people looked up at once. Which Julie do you want? The receptionist, the MA, or the doctor.

Can you say anxious? More like petrified.

The truth is I made it to my office on the first day in plenty of time, with no wrong turns mind you, despite my crazy dream. And much to my surprise and delight, my five adult children (orchestrated by Carol, my daughter-in-law) had sneaked in the night before and left a thoughtful gift and hand-written note, each one having penned their personal words of encouragement for my first day.  Even my grandson, Uriah, contributed. “I like some of the food,” he wrote. Cherishing their sentiments, I paused to reflect on all the people who had been helping with this huge change.

For the last several months, Stephanie and I have been stealing away talking, planning, dreaming. My brother, Greg, has been so patient and kind helping with web design, logo, printing, the list goes on. During the previous weeks, family members and colleagues gave helpful advice or came by with well wishes and flowers. Lisa, my friend who owns a small business a stone’s throw away, lent words of affirmation and beautiful art for the walls.  My husband and son willingly assembled furniture and hung pictures.

Then there’s Gayle. The entire week prior she made phone calls, ran errands, helped me decide between this rug or that. Furthermore, Gayle has been the mature kind of friend who can identify with and validate your frustration and still direct you to take the high road.  Did I mention that in my dream Gayle was riding in the passenger seat? Not saying a word, she was like a guardian angel, steadfast and true.

Though my first day had its bumps, it was overall very satisfying. Patients were patient as I fumbled through the new electronic medical records system. My former boss and his wife dropped in mid-morning with reassurance and a lighted exit sign. The phone rang just enough to encourage me that I was not off my rockers to start this new venture. By the end of the day, Gayle and Stephanie and I were breaking into song. “People who need people are the luckiest people in the world.”(Don’t worry. I’ll keep my day job.)

But whoever said that was so right on. There is no way I could make this huge change all by myself.  And you know what I am figuring out? I don’t have to do it all by myself. I need help and that’s ok.

We all need help and support in change. It’s a creature feature and there is no shame in that.

At Oregon Weight and Wellness, our team wants to help support the changes you are making, no matter how big or small, to help move you in a direction, perhaps a new and different direction, of health and wellness.

I need to add a PS to all those dreamers out there. Just for fun, I looked up the meaning of Gayle. I found several: “festive party; to have the uncanny ability to stay calm in chaos; quiet confidence; a peaceful warrior; one who sees the light in others.” Interestingly, in Hebrew, Gayle means “a father’s joy.” At the risk of seeming overly sentimental or spiritual, I believe that even in my fear and trepidation, I have the joy and favor of God my heavenly father right with me.  I forget that oftentimes. The dream was a good reminder that change is hard but with God’s help, I can do all things. My hope is to hang onto and extend that same outlook to all He brings our way.

That overwhelming Déjà vu feeling enveloped me as I was cleaning the bathroom last Saturday at my new to me clinic getting it ready for opening day. Like a hug from an old friend it welcomed me back as if I had been there before and this was just part of my routine. It felt right, like I was supposed to be there.

You see, every Saturday as an 11-year-old kid I cleaned doctors ‘offices including Dr. Warren’s office where my mom worked as a nurse. It paid exceedingly well: $26 per week which was much better than the 50cents an hour I earned for babysitting.

When I first started, I worked for Rosetta Palone, an elderly Italian woman from coal country Pennsylvania. She taught me how to clean. She didn’t whistle while she worked but she told lively stories which made the time pass quickly.  Once we made the exam rooms shine, we’d take a break, “a fiver” as she called it. She always gave me 2 cookies and a Dixie cup of Coke.

Rosetta was a kind lady with a sparkle in her eye and an encouraging word at the ready on her lips. “You missed a spot,” she’d always smile as she admonished me, never shaming, but cheerfully pointing out dirt or dust in every last nook and cranny. She took pride in her work and taught me to do the same. “We need to do our best for the patients who come here to get well,” she’d say.

Eventually, I took over cleaning Dr. Warren’s office all by myself.  My mom served as Quality Assurance. She would let me know if the cleaning job was not up to snuff.My breaks involved sitting in Dr. Warren’s private office and peering through his thick medical books. I was captivated. I knew I wanted to go to medical school and become a physician.

Fast forward forty-three years. It struck me funny that I had come full circle, cleaning my own clinic, excited and nervous all at the same time. Am I ready for this?

Though this particular déjà vu experience was extremely positive, I realize they are not always. And it struck me that what we refer to as triggers might be considered negative déjà vu. Something we encounter in our present stirs up a negative subconscious memory from our past and triggers an old coping mechanism which has now become self-destructive. Stress eating might fall in this category. But it is oh so hard to change.

At Oregon Weight and Wellness, we provide a safe place to explore and address emotional eating triggers. “When did you start believing…xyz” is a question l find very instructive. It takes conscious effort to recognize This is not That. It takes courage to say That will not have control over me anymore. It takes confidence to try one more time to respond differently. Stephanie Husk, LCSW our therapist, has experience in helping people identify barriers for change Our health coach, Rachel, will also be available for support.

We may not have to dig under every rock, but we may need to get into a few nooks and crannies. No shame. No guilt. No judgement. And we will do our best so patients who come here can get well and discover that they really can live “weigh” different.  

This Thanksgiving falls very near the closure of WVP Medical Weight Management Clinic. As I reflect on this coincidence, I find myself overwhelmed with gratitude for the past four years.

First and foremost, I am thankful for my boss. I remember the day I sat in his office and started a conversation with him which very much resembled a friendly game of tennis. “Obesity is a problem, a big problem,” I served the dialog nonchalantly.  He looked up from his computer and the reams of paper which sprawled across his desk. “What do you want to do about it?” he volleyed right back to my court more interested and knowledgeable about the issue than I would have guessed. “Let’s start a clinic,” I chipped and charged. “You’ll need a grant,” he returned with an ace. I didn’t see that coming and I didn’t know the first thing about grants. He did and he got one. Game, set, match: Dean. He’s a superstar.

It was the support of WVP that enabled us to move forward with the project. I am so thankful for the WVP staff who put time, effort, and expertise into building us out. I might know something about building an obesity medicine program but I knew nothing about all the back end work of building a clinic. Kudos to the personnel in IT, HR, billing, and NextGen who had the patience and know-how to get things off the ground.

We started humbly in my original family practice office, but quickly grew and moved, not once but twice landing in a beautiful new building on 12^th street. We had our ups and downs to be sure, figuring out referrals, experimenting with clinic hours at the hospital, finding the right staffing, adding providers, trying out different groups, learning how to bill, being rejected again and again. I suppose the most fun for me was getting our program name out there, knocking on doors with Stephanie or Jeanine, meeting colleagues over their noon hour, promoting the medical treatment of obesity. The work was energizing. Again, I was surrounded by coworkers whose attention to detail made my job easier. Their excellence, encouragement, and enthusiasm carried me many days.

Finally, I am grateful for the patients from whom I have learned so much about the respectful and real treatment of people with obesity. I am particularly indebted to my very first patient. It was our brand spankin’ new body composition scale’s inauguration day and I waited eagerly if not smugly in my office while the MA roomed the lucky patient who was getting to use it first.

“What’s her BMI?” I inquired when the MA finally popped her head in to let me know the patient was ready. “I didn’t weigh her,” she replied and explained the patient was in a wheel chair. “’Well, I’ll help you,” I offered a little irritated, moving past her to solve the problem. “She is paralyzed,” the easygoing MA smiled softly, “she can’t be weighed.” Oh, that was a different story. And I sat back down surprised and embarrassed at my own arrogance. In addition to her inability to exercise and decreased metabolism, the patient was taking several weight promoting medications. I wanted to quit before I got started. How in the world was I going to help her?

Then I remembered the original vision I had for the clinic. I was not the helper; I was only a vessel through which the Helper would work if I would just let Him.

And so I am grateful. I am grateful for every person, every opportunity, every mistake, misstep, fumble, fear which has driven me forward to this point in time and without which I would not be here.  These last four years and WVP MWMC has been a great success. And I got to be part of it. Thank you.

As a general contractor, my husband enjoys good quality tools. “Good tools make you better at your craft,” he often declares to our kids who watch in awe as he lifts huge beams with ease or cuts through concrete like butter, skillfully employing whatever gizmo is in his hand at the time. We stand amazed at his completed projects as if he leaped tall buildings in a single bound. He’s an expert craftsman to be sure, but his tools rocket him to superhero status. Consequently, he never balks when I want to spend money on another useful kitchen gadget. And when he saw the ticket price for the doctor’s scale I purchased and placed in our bathroom, he just shrugged a low humph, unimpressed.

The scale is an extremely important tool when it comes to weight management. I have to know where I am in order to get to where I want to be.  The scale reveals trends. It helps with correlations. When I do X, my weight does Y.  When I choose A, my weight does B, and so on. And in order to measure these trends, I have to weigh on the scale regularly. For me it is every morning. Like clockwork, the alarm goes off; I stumble out of bed, use the facility, and stand on the scale. I greet it like a trusted old friend who is not afraid to tell me the truth, no matter what. I’ve worked very hard on my relationship with the scale.

I did not always harbor these positive vibes.  I hated my scale just like some of my patients tell me they hate theirs.  And like them, for a long time I refused to weigh myself. I even went bouts without owning a scale. When I did step on it, the scale only screamed obscenities at me. “You fat, lazy slob!” (I’m toning this down for reader discretion.) I was suffering from what many of my patients suffer: PTSD. And I don’t mean Post Traumatic Stress Disorder which I do not want to minimize as I know it is very real and I believe needs to be addressed in order to maintain a healthy weight. The PTSD to which I refer is POST TRAUMATIC SCALE DISTRESS.

Post Traumatic Scale Distress stems from the chronic relapsing nature of the disease of obesity we talked about last time. You step on the scale one day and see that you’ve lost weight only to gain weight the very next day despite all the hard work you are doing practically starving yourself. This gives way to feelings of hopelessness and so you stop weighing. Like I have done on more than one occasion, you may even start refusing to be weighed at your doctor’s office. “You and what army are going to get me on that scale,” I chided a poor MA once who was just trying to do her job. (But seriously, have you noticed that in most doctors’ offices the scale is conspicuously right in the middle of the hallway and you get weighed with your shoes on while everybody and their brother in law is walking by eyes darting in your direction? I mean it is criminal and worse, maybe a HIPPA violation.)  But how is that working for you? Not weighing. It did not work for me either.

Studies show that people who weigh regularly are better able to maintain a healthier weight. Thems the facts.  Let’s talk about the limitations of the scale though. 1) It measures one point in time. 2) It does not tell the difference between fat mass or muscle mass or water weight.  3) All scales are not created equal. 4) I can’t compare my scale at home to the scale at my doctor’s office where I weigh later in the day with my clothes on.  5) It is an inanimate object. 6) It has no voice. 7) It only has the power you give it. 8) It is a tool. A very useful tool when used correctly.

Do you need to work on a different relationship with the scale? At Oregon Weight and Wellness we help with this.  We will not weigh you unless you give us permission and then not until the end of your appointment.  In private.  Without judgment. The focus is on you, not the scale. That’s the Weigh Different Way.

According to the Obesity Medicine Association, obesity is defined as ” a chronic, relapsing, multi-factorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, bio-mechanical, and psycho-social health consequences.”

Wow, that’s a mouthful. Let’s unpack that definition one or two words at a time.

First let’s look at “chronic, relapsing.” Our bodies actually fight to defend a higher set point even at the expense of unhealthy weight. We are superb energy conservationists, designed to maintain homeostasis. Our brains can become blind to the satiety hormone leptin that is released from fat cells(mostly because of what we are eating) and then weight loss itself increases the hunger hormone ghrelin that is released from the stomach. Blind to satiety, driven to hunger. That’s a recipe for weight recycling.

Understanding the chronicity of obesity really sheds light on why so many of my patients are able to say without exaggeration, “I have been battling weight my entire life.” Furthermore, anyone who has gone on a diet only to regain the same 10, 20, or even 100 lb testifies to the relapsing nature of the disease. No wonder it’s so hard to lose weight; it’s the very nature of the disease!

With medical treatment for obesity, however, the dysfunctional cycle of weight loss and regain can be broken. After performing a complete history, physical, lab and body composition analysis, an obesity medicine specialist helps you to strategize unique, sustainable lifestyle change which correct the communication between the gut, the brain, and the fat cells. The focus is on small changes in nutrition, activity, sleep, and stress management. Sometimes medications are needed to target metabolic function, hunger and satiety hormones, or cravings. Bariatric surgery can also be a helpful tool.

Understanding the chronic, relapsing nature of obesity helps understand why weight loss and weight loss maintenance may need to be treated differently. At Oregon Weight and Wellness, we have what I call the R3 program to protect against weight regain. We establish a Realistic Goal Weight, a Refocus Weight, and a Reach Out Weight.

Many diets promise enormous amounts of weight loss in just three months. After working with people and truly understanding the chronicity of the disease, my conviction is that we need to work together over time and seasons, ups and downs, through celebrations and hardships, not rushing the process.

This Weigh Different approach builds resilience and helps you maintain your healthy goals. Its a marathon, not a sprint and we are in it with you for the long haul.