We were talking in an epidemiology class the other day about the association between obesity and diabetes. It’s a pretty strong association, with a lot of good evidence that obesity causes diabetes. As the students and the professor talked about this, the other teaching assistant in the course took some pictures of us. I was standing at the podium as he took the pictures. When I saw the pictures… Well, I’d be dishonest if I didn’t admit that I was a little bit disgusted by my appearance.*
I had managed to trend downward in my weight all of 2016 and some of 2017. But then the baby girl arrived and with her came very little sleep. That triggered habitual snacking, poor food choices for the main meals, and a total lack of will to go to the gym or head outside. Little by little, I gained back the weight I lost in 2016 and then some.
Now, I’ve been going to the gym and swimming as much as I can over the last few months, but I traded in swimming, running and cycling each and every single day for a swim every few days. Sometimes I’d skip a week. The pressures of parenting and doctoral school came down hard.
The other problem is that I have a ton of bad food options on the way to the school of public health. Because of the lack of sleep, or because I have to take the baby to daycare, or because of some other thing, I run out the door late and don’t have time to make a good breakfast. As my blood sugar is probably way down from not eating overnight, I crave just about everything I drive by… Or I crave the donuts in the display at the gas station. Before I know it, I’m eating something made with the least natural ingredients, loads of fat and carbohydrates, probably no vitamins and minerals, and I’m eating a lot of it to satisfy the overnight fast.
So I’d posit that it is my fault that I’m fat for not being more mindful about planning meals, choosing better foods when I do stop somewhere, and working out a good schedule with my wife so we can maximize our sleep. The thing is, all of those things become secondary or tertiary, or lower, when the baby gets sick, when the baby needs to go to daycare, when the baby has to be picked up from daycare early or dropped off late.
Planning also takes a back seat to my work on my doctoral dissertation. I have all the data lined up. I just need to find time to write it. This has brought upon me a certain degree of anxiety over getting it done in time for a final defense in the summer. That pressure and anxiety are then dealt with by snacking, or by overeating. So I’d posit that it’s my parents’ fault that I’m fat because they always dealt with stress through eating.
Then there are family gatherings, which we’ve been doing more of now that my wife’s parents and my siblings want to get to know Baby Ren. All of those gatherings revolve around food. We either make a lot of food or order some unhealthy food from the Italian food place down the road. Then we eat and eat and eat while chatting or enjoying the baby’s shenanigans. Calories are not counted at family gatherings, though those calories certainly do count.
So now it’s my culture’s fault.
You see where I’m going with this, right? There isn’t one overarching reason why I’m fat. There are many reasons, and personal choices/responsibility is one of them. But that personal fault is just a small cog in a very big mechanism that had me gaining weight to the point where I really felt sorry for the big Mexican at the podium… So sorry that I went and swam a mile and then did 5 miles on a stationary bike and 20 minutes on a treadmill. (More on this later.)
The same can be said for large swaths of the population who are overweight, obese or morbidly obese. There’s the personal responsibility of being mindful of how much food they’re eating, but then there is the complex mechanism around them. If they live in a food desert, they’re probably not getting healthy meals. They’re probably getting — for very little money — some of the most unhealthy food out there. But that’s all they can get. Also, poverty bring with it crime. Who wants to go for a jog when there’s a real chance of being the victim of a crime?
Like with very many public health issues, obesity and its consequences is a very complex one. There are things that can be done at an individual level, but they’re very much worthless if the environmental influences are not changed. I can work on getting a schedule down, only eating what I cook at home, and exercising more. But none of it will work if I am not able to attain healthy food to cook, or a job that allows me the flexibility to deal with life’s unexpected things (especially with the baby).
The opposite is also true. We can fix an environment so only healthy food is attainable and open spaces for exercise are plentiful. But none of that will matter if we don’t find a way to motivate people to eat better and get moving. This is where both public health and individual medical practices need to join forces. The former can influence large groups while the latter can influence individuals.
So while all that is being sorted out, I’ve gone ahead and done two things. Number one, I’ve made a commitment to find at least one hour each day to work out. Either I work out when Baby Ren is at daycare and I stop at the gym before going to get her, or I put her in the stroller and head out for a walk if the weather is cooperating. If the weather is not cooperating, I get the playmat out and throw some toys on it for Baby Ren to play while I make use of the dumbells in the basement. Just one hour a day is all I need to reverse the weight trend and feel stronger and more agile.
Number two, my wife and I have gotten rid of unhealthy snacks around the house. Instead of grabbing a bag of something processed and munching on it while I work on the dissertation or while I fret about some stressor in my life, there are now oranges and bananas that I can eat to my heart’s desire. (Yeah, they have calories, but they make up for it with fiber, vitamins and minerals.) The next step is to always make breakfast quickly in the morning or having something ready to go from the night before.
Future steps include being mindful of what I buy at places on the way to and from school/work. That one is tricky because the mind can be a tricky thing. You drive by a fast food place and you make a deal with yourself that you’re only getting one thing — or a healthy thing — and, before you know it, you’re getting the supersized fries and sugary drink. This step is going to require some reprogramming, which humans are notoriously bad at doing for themselves.
Finally, I haven’t given up on my goal of doing a triathlon someday soon. It’s just that I can’t do one with all this weight on me because it might actually be damaging to my health. So I’m taking baby steps towards that goal. The mile I swam was more in anger than anything else, and I’ve been paying for it with soreness and some pain. That could discourage me from swimming next time. (I wrote could because I’m not going to let it.) Once the weather gets better, there’s more bicycle time planned, including getting something so Baby Ren can come along. (She’s too young still, though. But soon!)
If you’re struggling with your weight, don’t despair. There are a lot of things out there that are science-based and evidence-based and have been shown to work. For many people, more exercise and a better diet are enough. Others need medication or a medical intervention such as gastric bypass or a gastric band. Still others need psychotherapy because food has gotten a stranglehold on their lives. The first step is to take inventory of what you are doing to gain the weight and/or not lose the weight. Then take that inventory to your healthcare provider.
If you don’t have a healthcare provider, find one. If you can’t find one because they’re not available where you live, or because you cannot afford them, look to other sources of help with nutrition and exercise planning. Many local organizations are tasked with helping people improve their lives and prevent obesity and its accompanying diseases and conditions. There has to be something out there. (Drop me a line in the comments if you really can’t find something.)
When you accept that there is balance that can be achieved in how many calories you consume and how many you burn, and that the imbalance is not 100% your fault (though you do have some control over the situation), you start moving in the right direction. Good luck… We’re going to need it.
*Yeah, I was disgusted by my appearance but only because I realized I’d let myself go. Once I realized that there were sensible and plausible steps that I could take to correct the situation, I wasn’t so disgusted anymore. The fact that I want to fix this is plenty of evidence that I am not disgusted with myself.
René F. Najera, DrPH
I'm a Doctor of Public Health, having studied at the Johns Hopkins University Bloomberg School of Public Health.
All opinions are my own and in no way represent anyone else or any of the organizations for which I work.
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