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Tuesday Apr 09, 2013

Fit Physicians Can Lead by Example

Years ago, I attended an event where tennis legend Arthur Ashe spoke about the need for sustainable exercise -- finding something you enjoy that can be done indoors or outdoors and at any age on a regular basis. His words resonated with me. Teaching people -- including my patients and friends -- the tremendous benefits of regular exercise from an early age has always been important to me.

I have tried many sports in my time, but when my children were old enough, I signed them up for what I hoped would be a sustainable activity. When I told my kids I was enrolling them in taekwondo lessons, their response was, "Only if you do it, too." The usual negotiations ensued.

Fair enough. It's important to be a good role model.

Ten years later, I am a black belt in taekwondo and am working on becoming a second-degree black belt. It is a commitment that takes time each week. I share a weekly lesson with my husband and, typically, on the weekends we practice, train or just "play" together. I also make time to exercise -- even if it's a shorter workout, like a walk with my daughter -- on weekdays.

Our children aren't the only ones who can benefit from a good example. It helps me talk with patients about doing the right thing when I am doing the right thing myself. I tell them that if I can do it, so can they. And sometimes, you have to show them.

About 20 years ago -- before I had children -- I made a standing offer for my patients to walk with me before office hours. I said, "I'm going to be at the office at 6:30 a.m., and whoever wants to join me can. If nobody comes, I'm still doing it."

Some days only a few people came. On others, there were more than a dozen of us. That effort lasted for a few years until my office changed locations.

This wasn't targeted only at patients with diabetes or other chronic conditions. It was for anybody, because everybody should exercise.

Sadly, we know that only one-third of adult patients are advised by their physicians to exercise(www.cdc.gov). We also know that physicians who lead a healthy lifestyle(www.amednews.com) are more likely than those who do not to counsel patients about issues such as diet and exercise.

It is important to me to try to be a good role model. We all have too many patients who are not making good choices, but we can make a difference in their behaviors.

I have a patient who, at age 58, had slightly elevated blood sugar and elevated blood pressure. We discussed nutrition -- including high fiber and the DASH (Dietary Approaches to Stop Hypertension) diet -- and exercise, especially cardio. When the patient came back a month later, she said she was having a hard time finding low-salt and high-fiber foods. Together, we found a website that sold foods that could not be found locally. She joined the Y, started going at least three times a week and quickly lost five pounds.

At a recheck two months later, she still was following the diet and exercise plan and had lost eight more pounds.

Fast forward three years, and she is down more than 30 pounds. Her blood pressure and blood sugar are normal, and she's been able to stop taking medications for those issues. Diet and exercise were the prescription she needed.

The take-away message: We should be telling our patients about the tremendous benefits of a healthy diet and regular exercise.

There are five keys to succeed at losing weight and keeping it off:

  • Eat a high fiber, low-fat diet.
  • Weigh yourself on a regular basis for feedback.
  • Eat breakfast daily.
  • Exercise regularly.
  •  Document everything you put in your mouth so you are mindful of all the calories you are taking in. 

Eating mindfully is essential. I advise my patients to use a calorie counter. If they have an appropriate app on their phone, they can put their food options into the calorie counter before they put the food in their mouth. Seeing the caloric imbalance of poor choices allows people to have second thoughts before an unhealthy selection passes between their lips. Is that large plate of nachos really worth it? Probably not. You would have to spend four hours running on the treadmill nonstop to burn most of those calories.

We have had good success with calorie counters because they educate people about what they're putting in their bodies and about energy balance.

Another tool that works (and it's free for Academy members) is the food and activity journal available through the Americans In Motion -- Healthy Interventions program, which positions fitness -- physical activity, nutrition and emotional well-being -- as  the treatment of choice for the prevention and management of many chronic conditions.

Of course, some patients need more encouragement, and you have to be creative. I have made bets with patients about how much weight they can lose before a birthday or some other significant date. If they reach their goals, I take them out for a healthy lunch.

Now, I have to admit -- I like to win. I have been fortunate to be a volunteer physician for the U.S. Olympic Committee and Team USA, and I have served as a team physician for a local high school for 30 years. But when it comes to helping a patient push him- or herself to a healthier way of life, that is one instance where I don't mind losing.

Rebecca Jaffe, M.D., M.P.H.is a member of the AAFP Board of Directors.

Posted at 03:20PM Apr 09, 2013 by Rebecca Jaffe, M.D.

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