Saturday, August 25, 2018

Why I Stopped Dieting

Like most women, I could tell you a lifetime of diet stories.  The first one I remember is from grade five, when I was 10 years old, and I decided that I was tired of being the biggest person in my class*, the boys having not hit their pubertal growth spurts yet.  In a moment of inspiration, I created for myself an elaborate system in which I could eat whatever I wanted, but only if I exercised first.  Every food, from a carrot to a can of Coke, was assigned some cost in terms of sit ups or distance walked.

I think the system lasted for a few hours, which isn't very surprising given that it involved doing something like 50 pushups before I could eat a single apple, and I have never successfully done a pushup in my life.  But where it failed in getting me to lose weight, it succeeding in taking a kid who had always been a good eater and turning her into someone who didn't trust herself to know how to eat.  Someone who no longer thought of food in terms of things she did and didn't like, but rather in terms of things that were "good" and "bad.

And someone who, like lots of women, would spend decades of her life on and off diets.  When on a diet, I would try to be constantly virtuous, eating only small portions of healthy foods and watching the scale more closely than I currently watch my net worth.  When off, I would allow myself to eat anything I wanted, knowing that this was my opportunity to scarf down whole tubs of Hagen Daas and make regular trips to the McDonald's drive-thru.  I never quite got to the point of binging and purging, but my whole dietary pattern was essentially a slow-motion binge-purge cycle.

The most "successful" diet I ever did, if success is measured by weight lost, was Weight Watchers.  A few of my friends lost weight by counting "points" and going to weigh-in meetings, and one offered to share a copy of the material with me.  For six months, everything to cross my lips was assigned a point value and recorded diligently in a food journal.  If I didn't have enough points for everything I wanted, I could earn more by exercising; for example, a walk to and from the ice cream shop at the bottom of the hill by the university where I worked was enough to earn me a small scoop of ice cream, as long as I didn't get it in a cone.

And it worked!  The pounds melted off, and I lost about 25% of myself.  I got to buy a whole new wardrobe, and people constantly complimented me on how good I looked.  When I see pictures from that time, I miss my almost-tiny body and the huge confidence boost that came from finally being skinny.  The only drawback?

I was utterly miserable.

I was existing on about 1200-1400 calories per day, even with the extra calories I earned from exercising, and there was no way for that to ever feel like enough.  I spent every minute of my life thinking about food - about how hungry I was, about when I would eat next, about how I could save or earn enough points to eat half a chocolate bar.  And all I could talk about was food and weight.  I became the person that people avoided in the lunch room, because they knew that I was going to talk about the number of points in their lunch or encourage them to join me like a Weight Watchers missionary.

Eventually, it broke me.  The satisfaction of being skinny didn't make up for the misery of being hungry, so I stopped.  And watched as every single one of the pounds I had lost came back, bringing a few friends with them for good measure.

Weight Watchers was the last serious diet I ever did.  I still had periods when I would be frustrated with my weight, and I would try to lose it for a week or a month or two, but after the long-term failure of Weight Watchers, I had become disillusioned.  Maybe, it occurred to me, dieting didn't actually work.

When I started medical school, I once again got hit with the dieting mentality in full force.  Lectures were filled with slides about the "growing obesity crisis" and about how we should counsel our patients to "lose 1-2 pounds a week for sustainable weight loss".  Except, now I started to push back.  I asked professors how realistic it was to expect patients to lose 1-2 pounds a week, and they had to admit that almost none of their patients were able to do it.  I started to read the scientific literature, which shows that even under optimal conditions (clinical trials with nutritional and exercise support), only a small percentage of people lose weight, and almost no one keeps it off long term.

Diets.  Don't.  Work.

So I vowed to never diet again.  In the beginning, this led to a frenzy of eating.  Everything was allowed!  In a short period of time, I made up for all the ice cream and pop and chips and candy that I had deprived myself of for years.  And it was great!  Except...I felt like shit.  And I actually started craving healthy things, like salads and blueberries.

So I did what any bookish nerd would do, and I read.  I read about the impacts of lifestyle (not weight!) on health, and about Health at Every Size, and about intuitive eating.  And I learned that being anti-diet and anti-scale doesn't mean that you have to shop exclusively in the junk food aisle.  One can fight against the oppressive capitalist system of the diet industry and still be healthy.

My focus now is on eating and exercising in a way that keeps me healthy and mentally sane, regardless of what happens to my weight.  Not in a "I'm really trying to lose weight but will pretend it's just a healthy lifestyle" way, but in a legitimate "I'm trying not to give any fucks about the scale, but it's hard because I've been conditioned to view my weight as a measure of my value as a person" kind of way.  I'm using the novel system of eating when I'm hungry and stopping when I'm not.  I'm packing my fridge full of healthy foods, but I also have three tubs of ice cream in my freezer, because ice cream is good for my mental health.  I'm walking all the time, not because it earns me more points, but because I live in a beautiful city and it is much more fun than spending my evenings cursing the right-wing assholes on Twitter.

I am simply taking care of myself.

And dammit if I haven't lost weight.  I don't know how much, because I refuse to step on the scale, but my face is a little less round and my jeans no longer leave a mark on the middle of my stomach.  In a weird way, this makes me angry, because dammit I've finally let go of the need to be skinny and of the quest to not to take up so much space.  And as I lose weight, it's hard not to listen to the old voice in my head that says that it's better to be thin.  That if I just cut my portions a bit, walk a bit longer every night, I could be thinner.  I have almost thirty years of practice with dieting and only one with self care, so it's tempting to go back to my familiar routines.

Except that I'm so much happier now.  I'm happier eating like pre-diet me, simply because I like food and it makes me feel good.  I'm happier without the diet/no diet cycles and the despair when the number on the scale won't go down.  So fuck dieting.  I'm officially done.

*Like many girls who diet, I wasn't even overweight at the time; I was simply tall.  I was in the 99th percentile for height and the 90th percentile for weight, so my diet wasn't a response to being fat but rather to feeling huge next to all the short girls and knowing, even then, that huge was bad.

Saturday, August 11, 2018

Self Care

When medical schools interview prospective students, the question "How do you deal with stress?", or some variant, inevitably comes up.  Having been an interviewer on a few occasions, I know that every interviewee with at least basic interviewing skills will come up with some combination of the following:

Adequate breaks
Healthy eating
Time with friends and family

When I said those things in my medical school interviews, just like everyone else, I was very earnest.  I legitimately thought I would find the time and energy for all of them in my medical training.

(Insert sound of my laughter here.)

Medical training was the hardest and most life-altering thing I have ever done.  Not so much the first two years - those were almost entirely classroom based, and I had long ago mastered the art of sitting in lectures and writing exams - but definitely everything that came after.  The moment I set foot on a ward for the first time, I transformed into a human-shaped bundle of stress and anxiety, constantly terrified that I was going to be responsible for letting someone die.  And unlike with many of my classmates, that feeling didn't go away for a very long time.

My strategy for dealing with this terror was to pretty much never stop working.  I would come in earlier than everyone else, work through lunch, and stay late.  I convinced myself that double, triple, quadruple checking everything would make me perfect and prevent me from ever making a mistake.  (Spoiler alert:  It doesn't.)  Any time I thought about putting in less than 100% of my maximum effort at work, I would remind myself of what was at stake:  People will die if you screw up.

Not surprisingly, my perpetual state of panic and overwork wasn't very conducive to taking care of myself.  I essentially stopped exercising on day one of my clinical rotations.  I gave up cooking for myself and ordered food so often that the receptionists at the delivery services recognized my voice.  And I started spending all the money I wanted, whenever I wanted, because "I deserved it". 

Yoga?  Did my stomach doing nervous back flips count?
Healthy eating?  If I bought my Coke and Nacho Cheese Doritos from the vending machine on the Cardiology ward, did that make them healthy?

I don't know how long I would have continued being so completely and utterly negligent of myself had it not been for a few key events.  The first was a crisis at work, which woke me up to the fact that I might not ever graduate and earn a doctor's salary.  (Spoiler alert:  I did!  And I paid off my student loans yesterday!!!)  Suddenly it no longer felt okay to spend more money than I was earning, so I discovered the great Mr. Money Mustache, started a budget, and got my financial life back in order.  The second was some upheaval at work, during which I reached out to some of the other attendings, and which ultimately led to me being connected to a wonderful performance coach.  While I have only seen him twice, I credit him with enabling me to let go of my self-destructive perfectionism and to forgive myself for being human.

The third thing wasn't a specific event, but rather years of working with people with lifestyle-related illnesses.  I spend a lot of my time at work counseling people about the negative effects of poor diet and lack of exercise, as well as treating them when their bodies break down after years of misuse.  Somewhere around the thousandth time that I said "Pop is basically poison", the message started to sink into my brain.  I'm not immune to the things that affect my patients.  I also need to care for myself.

So slowly (sometimes oh so painfully slowly) I have started to change the bad habits that I learned in medical school.  I've almost completely abandoned sugar-sweetened beverages.  I've started mostly eating brown rice* and brown pasta.  I cook a lot of my meals from scratch, and I try to pack them full of veggies and other healthy things.  I'm even exercising again and (amazingly) kind of enjoying it.

And so many other things, like getting enough sleep and meditating and taking enough vacations and quitting Twitter.  All of the things that I said I would do in my medical school interview 13 years ago, I am finally getting around to.  And it feels really, really good.

*This is huge for me, because I love white rice with a fiery passion and can happily eat two large bowls of it, smothered in butter and salt, in one sitting.