Tuesday, June 25, 2013

June 2013: Annual Health and Fitness Letter

This is the tenth year of writing this monthly letter.  I have written several health and fitness letters.  I have not written one in two years.  It is about time to do so again.  The last few Health and Fitness letters have been more aspiration than accomplishment.  The truth is that I was going in the wrong direction and simply have not been motivated (could have easily used the word ashamed) to write one.
     I am again headed in the right direction and, thus, am motivated to write another Health and Fitness Letter.
  This week it was announced by the American Medical Association that obesity is a disease.  From the June 20 Los Angeles Times:

The American Medical Assn. voted Tuesday to declare obesity a disease, a move that effectively defines 78 million American adults and 12 million children as having a medical condition requiring treatment.
     The nation's leading physicians’ organization took the vote after debating whether the action would do more to help affected patients get useful treatment or would further stigmatize a condition with many causes and few easy fixes.

     78 Million American adults are one-third of the population.  In 1960, only 12% of American adults were obese.  While the adult numbers are eye opening, the fact that 17% of children are obese is simply astonishing.  In 1970, only 5% of US children were considered obese.  The increase in obesity in this country has been exponential over the past fifty years.  This problem has become epidemic.  Not surprisingly, the increase in childhood obesity is a significant contributor to the increase in adult obesity.
     The Los Angeles Times was right about one thing.  There are indeed few easy fixes. Food abuse is like tobacco, drug or alcohol abuse in one way.  All are difficult habits to change.  Food is unique in another way.  With tobacco, alcohol, and drugs, reform means stopping the substance abuse.  It means never drinking, smoking, or using drugs again.  No matter what, we still have to eat.
      I am not so sure I agree with the other Los Angeles Times claim that obesity has many causes.  I believe the exponential growth is fueled by one major factor:  Processed Foods.  The food companies employ an army of marketing professionals and food scientists.  The role of the food scientists is to create really tasty foods at very economical prices.  These foods get their taste from heavy doses of sugar, fat, or salt.  In general they are unhealthy.   Not only are they unhealthy and contribute to a variety of obesity ailments, they are addictive because of the havoc they play with our blood sugar levels.  The highs make us feel good, the immediate lows make us want to each more to get the good feelings back.  The job of the marketing folks is to entice us to consume more and more of these products each year.  Like lab rats, we have done just that.  I am as much of a lab rat as anyone.
     OK.  So what?  We are fat.  What is the big deal?
     The big deal is our health.  Being obese contributes to a variety of conditions that includes:
  • Stoke 
  • Heart disease
  • Cancer
  • Asthma
  • High blood pressure
  • Diabetes
  • Acid Reflux
  • Sleep Apnea  
  • Infertility
  • Back issues
  • Knee and hip joint deterioration
 Often times these conditions will require surgery as in hip and knee replacement.  Others such as diabetes, hypertension, and heart disease necessitate prescription medications that must be taken for the rest of the patients' lives.  Consider the following:
  • A Wake Forest University study has shown every pound we lose, we relieve four pounds of joint stress on our knees.
  • Weight is a huge contributor to high blood pressure.  Eating the right diet, exercising, and being at one’s target weight could eliminate the condition and the need for lifelong medication.
  • For people with Type 2 Diabetes, a 5% weight loss can improve insulin action, decrease fasting blood glucose concentrations, and reduce the need for diabetes medications.
The worst kind of fat is what is known as visceral fat.  All obese people have this kind of fat.

Visceral fat, on the other hand, lies out of reach, deep within the abdominal cavity, where it pads the spaces between our abdominal organs.   Visceral fat has been linked to metabolic disturbances and increased risk for cardiovascular disease and type 2 diabetes. In women, it is also associated with breast cancer and the need for gallbladder surgery.

The good news is that visceral fat yields fairly easily to exercise and diet, with benefits ranging from lower blood pressure to more favorable cholesterol levels. Subcutaneous fat located at the waist — the pinchable stuff — can be frustratingly difficult to budge, but in normal-weight people, it’s generally not considered as much of a health threat as visceral fat is.

Let’s see how the insurance companies will react now that the AMA has classified obesity as a disease.   They should be encouraging all obese people to seek treatment.  Losing weight is much less expensive than treating diabetes, hypertension, and heart disease later on.  

Weight Management:  This has been a problem for me my entire life.  Given the statistics quoted above, I am not alone in this.  I have lost and gained it back several times.  Earlier this year, I was most definitely on the high end of weight roller coaster. 
Beginning April 1 of this year, I have been on a medically supervised meal replacement diet.  I eat two bars and drink five shakes a day.  Sometimes I eat three bars and drink four shakes a day.  Lately, I have been putting some blueberries or strawberries in the shakes.  This is an 800-900 calorie high protein plan.  The goal is to achieve a reasonable body fat percentage and then learn and reinforce the habits to maintain that weight and body fat level.
     Clearly, in the photos above, I do not get the basics of weight loss marketing.  I am supposed to look dour in the before photo and ecstatic in the after.  Oh well...
While this diet has not been the most social diet (think weddings and dinner parties), it is very effective.  I am down 64 pounds as of this writing an equal amount to go to achieve my objective.  I have not been hungry either.  There are days when I have to force down the last shake of the day.  While I have not been hungry, I do crave certain bad foods.  For some reason, pizza tops the list by far. 
When I began, I was definitely obese based on my percent body fat and the threshold for obesity given my age.  I was delighted a few weeks ago when I went from obese to merely overweight.  I am looking forward to a day in the next month or two when I leave behind the overweight class and enter the normal range.  I do not think I have been a normal weight for the past thirty years. 
I am doing this for a variety of reasons.  Certainly health is one of them.  I am also doing this in honor of turning sixty on the very day I am posting this piece.  I am doing this for me to be as healthy as possible for as long as possible.  It is not about living as long as possible but as fully functional as I can be for as long as possible.  It is about not being in a home or wheelchair for as long as possible.
A few weeks ago, two of my musicians buddies were talking about me.  One said "have you seen Gavoor lately, he has lost a lot of weight."  The other fellow said, "yes, it is pretty amazing."  The first then said, "he'll gain it all back."  I was not privy to this conversation.  it was reported to me NOT by the one who said “he’ll gain it back.”  I imagine I could write a whole separate bloggy bit about the dynamics at play here…
“He’ll gain it back.”  My friend did not really go out on a ledge here.  This is my track record.  This is my biggest fear.  I am most worried about gaining it all back.  I know that the real hard work will begin when I get to my weight loss target.  I am purposely not calling my target weight loss my goal.  When I do that I naturally ease up when I get to that point  My goal this time is to get to my target body fat percentage and weight and then to maintain it for the remainder of my life.
Failed diets are very common.  Again, I am not alone here.  I know many people, including myself, who have lost weight and backslid right back to where they were... or worse.  I will say this.  There is no worse feeling than doing that.  It makes motivating oneself for the next weight loss all the more difficult.  It is a horrible cycle to repeat.  I never want to repeat this again.
 People like me simply love food.  I am very good at not only eating but overeating.  With gusto.  It is, of course, not a desired trait.  I did not need the AMA to tell me that obesity is a disease.  If alcoholism is a disease which I believe it is, then my bad relationship with food is also one.  I have believed this to be true simply because of my own struggles over the years.  The losing takes a lot of fortitude and willpower.  After losing, maintenance takes just as much fortitude and will power.  The habits developed and honed over a lifetime are very hard to change.
As stated above, I have an addiction to over consumption that is every bit as nasty to overcome as quitting for an alcoholic or a heavy cigarette smoker.  It may actually be more difficult to overcome food addiction or abuse.   The smoker has to stop smoking and the alcoholic has to stop drinking alcohol.  But, the food abuser still has to eat to sustain life.
So, I have been thinking about maintenance the whole time I have been losing weight.  I have come to one conclusion.  Each of the other three times I have lost a lot of weight, I have had the goal of losing a certain amount of weight.  I would do that.  I would achieve the goal and then ease up.  Easing up, at least for me is bad, because it signals the beginning of a regression, regaining, or backsliding depending on what you want to call it. 
I have thus decided to change the terminology I use.  Instead of having a weight loss goal, I now have a weight loss target.   I am calling this weight loss period the Preparation Phase.  Preparation for what?  Preparation for the Maintenance Phase which begins when I get to my target weight.  That is the real start of what I am trying to do.  The goal is to maintain my target weight.  This goal is perpetual. 
This is a different way of thinking.  As I can never achieve this goal, there can be no letting up.  It is the relentless pursuit of an ideal.  It is the relentless pursuit of perfection like the tagline for Lexus automobiles.  Health and wellness must be a relentless pursuit and commitment for me.  There may be a point where adopted lifestyle becomes the norm... but I will not allow myself to believe I have achieved a goal.  The funny thing here is that I work in the field of continuous improvement.
I have to be successful because I never ever want to have to do this again.
Exercise:  Exercise is another key to a healthy lifestyle.  Diet alone is not enough.  We have to exercise because our work is not what work used to be.  We are sedentary.  I am sedentary.  I spend most of my day in a chair or lecturing.  I suppose if I were working in the fields in some kind of agrarian ideal, I would not have to exercise.
My exercise of choice is bicycling.  Three out of the last four years I managed, even at an elevated weight, to log 2,000 outdoor miles.  This year, because of the very late spring and work, I am off to a slow start.  I will be lucky to break 1,500 miles this year.
I have a small fleet of five bicycles.  Mostly I ride a used Schwinn Paramount that I bought a few years ago.  I like it more and go faster on it than my custom made Italian Mondonico for which I paid five times as much! My red Schwinn has a hodge-podge of older Shimano components on it whereas I have a full Campagnolo Veloce kit on my Mondonico. 
My Schwinn Paramount
Per my bariatric physician, bicycling is not enough.   He has me doing weight lifting as well.  I have been doing that for about two weeks and look forward to keeping it up.  Weight lifting for muscle maintenance and growth for older folks, and, egads, I fit this demographic, is more and more important.  It is critically important in rapid weight loss, like what I have been doing. 
I have read and am reading again a very good book, Younger Next Year by Crowley and Lodge.  The sub-title is A Guide to Living like 50 Until You’re 80 and Beyond.  It is geared toward men, very well written, and informative.  The authors point out that aerobic exercise is necessary for heart and lung health.  It builds endurance in the muscles.  The authors point out that muscles have both strength (fast twitch) and endurance cells (slow twitch).  So, strength training is needed to maintain the strength cells.  Strength and balance training is even better.  We forget or simply have never realized how complicated the very act of walking or taking stairs can be from musculoskeletal perspective.  The physics and chemistry of such simple acts is astounding.   Balance and strength will deteriorate with age… we may see it in ourselves and we certainly see it in others.  Weight training and aerobic exercise improves our general overall performance.  Even those of us with osteoarthritis, can benefit from weight training.  Keeping ones muscles sound and fit for strength and endurance helps do the work of joints and prolongs their lives. 
Given the minimal amount of cartilage left in my knees, I am counting on weight loss and strength training to stave off the knee replacement for as long as possible.
Turning 60:  We make a huge deal of birthdays that end in zero.  Why not?  They are milestones that should be noted and celebrated.  On the other hand, it is just another day in another year.  Our aging is gradual for the most part.
I read that 60 is the new 40 or 50, maybe a delusional 30.  That may be.  I remember my grandparents at 50 seemed ancient.  They looked and acted old.  Hair color and fashion has done wonders for this perception.
I do not know what 60 means these days.  Is it the new 40 or the old 70.  I do not care.  That is just rationalization for something.  I know that I do not plan to color my hair… or what little is left of it.  I will shave my head before doing that and I am not likely to shave my head even though my hair cuts are getting shorter. 
I know I will try to live with as much physical and intellectual vim and vigor I can muster.  I know I am committed to maintain the body and mind to be able to do just this.
Perceptions and priorities change with age, hopefully for the better. I will close with two copy pastes from Facebook:
First is a quote from Friedrich Nietzsche, “We love life, not because we are used to living but because we are used to loving.”  If we truly desire to age gracefully, it is more than just physical health and fitness.  Loving people close to us more will help us age gracefully mentally and spiritually.
Secondly, a ten step guide that can basically be summed up with the word “chill.”

10 to Zen
From the Facebook page Buddha Heart
  1.  Let go of comparing.
  2.  Let go of competing.
  3.  Let go of judgments.
  4. Let go of anger.
  5. Let go of regrets.
  6. Let go of worrying.
  7. Let go of blame.
  8. Let go of guilt.
  9. Let go of fear.
  10. Have a proper belly laugh at least once a day (especially if it’s about your inability to let go of any or all of the above).


  1. You look wonderful Mark. I hope you feel wonderful too. Love yourself, take care of yourself. Life is good.

  2. Congrats on the weight loss, and for lifting weights so that you lose fat and not muscle. My brother and I ride recumbent trikes every day we can. Not many people have seen such a trike; imagine a Lazy Boy with pedals. A lady said, "That looks like cheating." Well, if using your common sense is cheating. My weight is spread out across a comfortable seat, unlike other bikes which provide a hard saddle to sit on, There is no weight bearing on my wrists either. I don't criticize anyone who rides, but my trike is the best exercise device I have ever bought. And probably the best investment I ever made. I am following the Primal Blueprint, which includes a lo-carb, moderate protein, and high fat diet. The Plan encourages 3 to 5 hours a week of moderate exercise, at 50 to 70% of max. heart rate, and brief intense weight lifting. (Like once a week of lifting for 20 minutes.) It has worked for my brother, down 25 pounds, and me, down 20 pounds. We feel great.