Michael had been my doctor since my early 20’s. He was one of the most decent men I had ever met and I considered him a friend, within the professional bounds of a doctor-client professional arrangement, of course. I was visiting him in July of 1997 for my annual medical and I was very aware of the fact that I was now pushing 135kg and was getting near 40 years old. This was turning out to be the least pleasant conversation that I had had with him since I had learned two years earlier that I needed both hearing aids and bifocals in the same day.
Michael looked at me: “Blood Pressure 130 /85, overall cholesterol, 6.22, LDL cholesterol 4.3, HDL 1.13, resting heart rate mid seventies. Your blood pressure is slightly high, your good cholesterol is ok, but your bad cholesterol is high. At thirty seven, Paul, you are not wearing that well.”
Well, let’s face it, I was part of an alarming demographic group. I was at the younger end of middle age, a late baby boomer, and my generation was replacing tobacco and cancer with obesity and heart disease as its greatest health risk.
“It’s not all bad” Michael said. “There is nothing here that requires immediate treatment. Take it as a warning.”
“Well, I am not dumb” I said, realizing as I said it how defensive I sounded. “I have known for a while that this discussion was coming.”
“It is time for some good, old fashioned preventative medicine,” he said cheerfully. “What I want you to do is to book an appointment here for next week. Between now and then I want you to keep a food diary.”
“A food diary?” I asked.
“Very simple concept” he replied. “Until you know what you are eating it is impossible for you to make changes in it. I don’t care how disciplined you are, you need the understanding of your habits before you can change them”
I found the entire conversation increasingly depressing. I liked my lifestyle, why would I want to change it? What was wrong with the occasional bag of tortilla chips with guacamole and extra hot salsa? Hey, I wasn’t even sure I could change my lifestyle, I traveled more than 50% of the time. Airplane and hotel food were significant parts of my diet and I had very limited control over that sort of thing.
“OK Michael, I will try to write things down as best I can” I sighed, “and I will see you next week.”
I walked out of his office and made an appointment with Arlene, his secretary, for the following week. I felt kind of tired – I needed a coffee. There was a coffee shop near my office so I decided to stop in there on my way back. As I drove back to the office, I became resentful. It was unfair, I wasn’t doing too badly. I felt fine. My wife and kids were doing well. My career was on the fast track to an executive position within the company. I had great friends and, with the exception of a bit too much travel, a lifestyle to which I could become accustomed.
Well, maybe the answer was to lose a few pounds, get Michael off my back and then carry on as before – perhaps I could skip an annual medical or two before I had to confront this again.
I returned to the office building that I worked in and parked the car. I stepped off the elevator at the first floor and spotted both the coffee shop and the variety store next to it. I looked into the coffee shop and there was a line – I hate lines. Hmmmm…. Maybe a cola instead. Caffeine, sugar – just what the doctor ordered. I actually did think that “Just what the doctor ordered” and it sobered me a bit. I walked into the store unsure what to do. Perhaps I could get something a little more “healthy” – coke and some chips, not as much caffeine, not as much sugar. What I was standing there thinking this through, I noticed some odds and ends on the counter in the store. You see this at every variety store in the world – little things that you don’t know you need but when you see them you suddenly want to buy them because they could be useful and there they are right in front of you! Sold at your local store with really great profit margins for the merchant – a win all round! Believe it or not, this particular store had some pens on the counter, $1.00 each, along with little notebooks which would easily fit into your back pocket – they were $2.00. I grabbed a pen, a notebook and a Mars bar, paid quickly and went out the door. The queue at the coffee shop was smaller so I stopped in there to get a cup of coffee. I take mine with milk only, my one concession to something approaching a healthy attitude, and I could drink, at that time, something in the range of ten large cups a day.
Not that it was a problem, of course.
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Ever write down everything you eat and drink for a week? If you are absolutely honest with yourself then you may find yourself surprised. An example of a food diary page from that time:
Now, what is the first thing you notice when you read this? Well, here are a couple of themes:
- No breakfast
- No vegetables
- No fruit
- High fat snacks
- Limited dairy
- Limited fibre
Nutritional content? Reasonable amounts of protein, significant carbohydrates and, alas lots of empty calories – probably 3500 to 4000.
Now this was mid-week. Let’s look at a weekend.
Now this was mid-week. Let’s look at a weekend.
Wow! Well some progress, I suppose – there is now at least some fibre, and a bit of fruit but there are still tons of empty calories and gobs of fat. This is probably a 4500 to 6000 calorie day.
I clearly had a problem. Maybe more than one…
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I clearly had a problem. Maybe more than one…
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Michael looked over my diary.
“Hmmmmmm…. Well do you want me to walk you through the challenges here?”
“No, I think I can see some things I have to change” I replied – I really did not want to be in that office at that particular time.
“Such as?” he asked
“Well, I could eliminate all the donuts and chocolate bars, maybe put some fruit in there” I answered hesitantly.
“How about having some breakfast?” he asked. I had only had breakfast on Sunday the entire time I had covered during the diary. That had been a big “fry up” with bacon, sausage, eggs and fried bread.
“Paul – you are smart, educated and well read. You know what the issues are here. You need to eat less and eat better. Cut back on the drink as well.” Michael said, looking me in the eye. “What exercise are you getting”
The answer was, basically none.
Michael shook his head: “This is basically arithmetic, Paul. You need to eat less and exercise more. I want you to keep maintaining this diary but I want you to do a couple of things for me in addition to this.”
He listed things off with his fingers: “First, eat breakfast every day, plain cereal, low fat milk and one or two pieces of fruit – an apple and banana for example”
“Two, pack a lunch. Use lean protein – turkey, chicken, cheese is ok. Some more fruit. Then go for a 20 minute walk at lunch”
“Make sure your dinner plate is primarily colourful – green, yellow, orange. Lots of vegetables. Salads are good but watch the dressing. No Caesar salads. More fruit for dessert – berries for example. Make sure you have a walk after dinner – the weather is nice this time of year, no reason not to do it.”
“Finally, snacks. Low fat snacks – flavoured rice cakes as often as you want, fruit. Limit your alcohol consumption to the weekend as much as possible”
He looked me squarely in the eye. “Do this for two weeks, keep track of it in your diary and then see me afterwards and we will review where you are then.
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It was a bit hard. At first as I had a bit of enthusiasm for “my new life” but it did mean a fair bit of separate meal preparation as my wife wasn’t a big vegetable eater either. After a week, however, the pressures of life and previous habits began to sap my will a bit. Still, I kept at it. Two weeks later, I was in Michael’s office standing, barefoot, on the scales. Much to my surprise, I was down 3.5 kg.
Well, it was only 3.5 kg but it hadn’t been that hard to do. Still, Michael had a warning “some of that is basic retained water loss” but he then went on to encourage me “still, it is a good start”
He looked at me “So, what do you do next?”
I was a bit surprised – it hadn’t occurred to me that there would be a next, and for someone who planned out many details of his life, this was one plan I had never expected to construct.
“Well, Michael, I don’t know – I guess I keep up this food diary and walking.”
He nodded encouragingly “And…”
“Well, I could focus on food a bit more and increase the exercising a bit. The weather is nice right now so getting out some more is easy enough.” I said. This didn’t sound like it was going to be that much fun, actually. I was already dreading going down the path that had started with my annual medical.
Michael nodded again. “Great, why don’t you do that for six weeks and then we will rerun your blood work, check your weight and see what progress we have made. If you stick with it, I am sure you will be surprised.”
I made the appointment for our next meeting and wandered out of the office, grumbling to myself as I did so. I just wanted to lose a couple of pounds and be done with it. I liked my life as it was, so what if I was a big guy? I had always been that way. Unfortunately, my wife was supportive of my doctor’s efforts in this matter so I was not going to be able to just cancel the appointment in a week or two and ignore the issue until next year.
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When I returned home that day, I told Dorothy, my wife, about what had transpired. She, of course, offered to help in any way she could and suggested that I play with the kids while she finished getting dinner ready. I headed off to the living room and sat down with James, who was just coming up on his fourth birthday. Andrew, his baby brother and only four months old at the time, was asleep. James was watching TV and I sat with him. He cuddled into me, always a very affectionate boy, and we watched together. It was some kids’ show on but I started to notice the commercials – there were a large number of them about food. Either for fast food restaurants, snacks, candy. Well, that wasn’t good. How were kids going to grow up in any healthy way whatsoever when society was immersing them in propaganda for things that were bad for them?
Suddenly, I stopped. The problem wasn’t the TV. The problem was much closer to home. It was very clear to me suddenly that this was exactly why I gave up smoking before James was born. I wanted to be a positive influence. Whatever other pressures my kids had in their lives, their parents had to be positive influences and that included lifestyle. The only way the kids would seek out a healthy lifestyle was if they felt that was normal and expected of them.
I had it. That was why this was important – it wasn’t about me, well, not directly, it was about James and Andrew.
Suddenly, I stopped. The problem wasn’t the TV. The problem was much closer to home. It was very clear to me suddenly that this was exactly why I gave up smoking before James was born. I wanted to be a positive influence. Whatever other pressures my kids had in their lives, their parents had to be positive influences and that included lifestyle. The only way the kids would seek out a healthy lifestyle was if they felt that was normal and expected of them.
I had it. That was why this was important – it wasn’t about me, well, not directly, it was about James and Andrew.
With that in mind, I worked at it for the next six weeks. I won’t say I actually enjoyed myself, but it wasn’t as bad or obstructive to my life as I thought it might be and I found myself actually enjoying breakfast most days. The walks were pretty good as well. At lunch time, I could usually take 20 minutes to decompress and put things in their proper place with no interruptions. Interestingly the walks ended coming in at closer to 40 minutes rather than 20. Couldn’t do it every day, of course, weather and so on, but most days, say 16 a month, I managed to make it work. In the evening, I was walking by myself near my home which was just off the shore of a really pretty lake. Those walks came in closer to an hour. On the weekends I was taking the boys and sometimes Dorothy, we could be out for a while. James was always a great conversationalist even from the age of four, and Dorothy was always very humourous. It was a nice summer.
In addition to all that, I acquired a real taste for Cheddar Cheese Flavored Rice Cakes.
So six weeks later I am back in Michael’s office, again with my shoes off standing on his scale.
I was down a further 10kg!
I was down a further 10kg!
