Striving toward wellness means retreating from the “War on obesity”
A friend’s TEDx Talk and an frameshift in the journey toward metabolic health and wellness
According to the CDC, the US obesity prevalence from 1999–2000 through 2017-March 2020 increased from 30.5% to 41.9%, and severe obesity increased from 4.7% to 9.2%. When we see statistics like this, we might even hear people say words like “we are losing the war on obesity.” One reason this may be the case is how we frame this problem and how we avoid the root cause of it. Another contributing factor may also be in the focus on a weight-centered paradigm in medicine, as described by O’Hara and Taylor in their article in SAGE Open 2018.
For many diseases, poor metabolic health is a cause or contributor to the initiation of progression of disease. Metabolic syndrome, also called insulin resistance, is defined as having at least 3 of these 5 conditions: high blood pressure, high triglycerides, low HDL cholesterol, elevated blood glucose levels, or abdominal obesity. And metabolic syndrome is therefore associated with many conditions, including hypertension, prediabetes or type 2 diabetes, and obesity, as well as other diseases like obstructive sleep apnea, heart failure with preserved ejection fraction (HFpEF), nonalcoholic fatty liver disease, and PCOS.
In my clinic, in addition to treating diseases with the best medications we can find for their conditions, we also strive to work toward improving metabolic health to reverse insulin resistance and, subsequently, put these diseases into remission. Nothing brings more satisfaction than when people adopt some simple yet significant lifestyle changes, reverse their insulin resistance, and then in a few weeks need to lower their blood pressure medications or stop some of the oral diabetes medications. They feel this sense of accomplishment and I thrive on that. I love to tell someone, “You’re blood pressure is better, you’re losing weight, and you’re breathing better, and it is all from you!”
What is the method? We strive toward making food choices that do not cause the spikes in blood glucose levels that then require the pancreas to release insulin into the bloodstream. Insulin is a signal our bodies make that help cells remove glucose from the bloodstream and store it either as glycogen or as fat. The more insulin we make, the more we are putting our bodies in fat storage mode. So if we eat solid protein and non starchy vegetables, and avoid foods that are high in sugar or starch, we can help our body produce less of this fat storage hormone, insulin. This is the method in a nutshell, and you can read more about it in my prior post, but I think a signifiant part of the method is also a mind shift that happens, and I would like to talk about that here.
I was fortunate to attend TEDx Breckenridge on September 30, and I heard so many incredible talks that opened my mind to different ways of thinking, but one of the most inspiring that led to a personal “unlock” was that given by my friend, Dr. Isabelle Amigues, of Unabridged MD. She talked about how we need to change our approach to illnesses and diseases so that we can better recover. Getting more granular, she shared her personal story about how as a rheumatologist in academic medicine, she was trained to take up arms in the fight against diseases with the strongest medications she could find to battle rheumatoid arthritis, fight lupus, and defeat gout. It was not until she herself was diagnosed with Stage IV breast cancer that she felt how perhaps the “war on cancer” in which she was now drafted as a patient did not resonate with her. She shared why these words did not resonate: Weren’t these cancer cells a part of her? Did they not share the same DNA? As she underwent treatments with the best evidence based medicine could offer, she started to really investigate her perspective and discover additional tools to help her body and mind heal. Her perspective shifted toward acceptance and learning from this experience of having cancer. And she continues to be in remission. Additionally, she now helps the patients in her practice with this frameshift in addition to prescribing the most potent biologics, and has found more effective healing and improved quality of life in her patients as well.
This shift in her approach made me think about successes we have seen in our practice, and I think those who really succeeded in making nutritional shifts to put their insulin resistance into remission were those who embraced this concept of striving toward wellness rather than fighting our body or fighting our physiology. Often when people try first and foremost to lose weight, they start with the calories in and calories out approach that is one of restriction and working on not being overweight or obese. In our clinic when we talk about improving our metabolic health, we focus more on making choices that lead one toward a healthier lifestyle, and the weight loss becomes the side effect, if you will, of embracing a lower carbohydrate strategy. The focus in on health and how do we feel, rather than on trying not to be a certain size, weight or whatever negative image we have of ourselves. The striving toward wellness mindset is one of curiosity, acceptance, and doing one’s own n=1 experiment to see what helps the person feel their healthiest. The fighting our body strategy is one of running away from a negative image, and it often leads to defeat. People who embrace the former striving toward wellness mindset have a meaningful “why” and start to see how daily choices become habits, which then become a practice and lifestyle. Those who embrace the latter seem to have less of a “why” but are fighting themselves. It seems like a war against oneself.
Her approach resonated with me strongly, because in my own life I’m approaching one of those signature decade years in life, and I’ve felt a whole mixture of feelings about it and where I am right now in my life. My ongoing work is to change the way we think about healthcare, and I strive to do that in the clinic as well as in programs that we are growing at my institution and through our nonprofit, Team PHenomenal Hope. Some of that work has at times felt like I was fighting to bring something into existence. But what if there is a better way to see it? What if it’s more about learning and nurturing something into existence. Rather than fighting, maybe it is more about learning from the challenges, and continuing everyday to breathe life into one’s dream to make it a reality.
On an even more personal note, outside of work is to strive to see how I can truly live life to the fullest, with family and friends as well as my passion for riding and racing my bike. In order to do all of these things, I need to be at my healthiest. In order to race my bike in the mountain towns against the fit Colorado women, I need to be strong and fit, and there is an advantage in cycling to having a higher power-to-weight ratio (being able to push more watts and being at a lower weight). For so long I’ve found myself saying “I just need to get back to race weight,” which feels to be a not-so-subtle rejection of my current self. It’s a struggle, a battle, a fight. But maybe not only does it not have to be but it shouldn’t be. I think that getting to my goal of realizing my full potential as an athlete is about striving toward being the strongest and healthiest I can be, and the rest will follow. And it starts with appreciating where I am right now rather than rejecting certain aspects of my being (not strong enough, not light enough, etc). What can I learn from being where I am right now that I can take forward to help be be the best version I can be? And then what decisions can I make today to help me feel better, and then repeat them day in and day out to become habits, practice, then results and success? I think this is the unlock that also penetrated my consciousness when Isabelle’s message from her TEDx talk resonated with me.
What obstacles are you facing? Have you been fighting them? Or is there a way to learn from the challenge — perhaps something about the problem itself or something about yourself — that will help you go forward and succeed?
To learn more about Unabridged MD and Dr. Isabelle Amigues (or book an appointment with Colorado’s Premier Direct Care Rheumatologist) you can go to her website here: https://www.unabridgedmd.com. You’ll also find an archive of all her prior podcasts, including the very first podcast, a seed to her TEDx talk and current life path!
