Thursday, March 25, 2010

Power of Perspective:
Pediatric Obesity and Running

Earlier this week, while out on a long run, I listened to an NPR podcast that discussed the capacity for different animals to think and process thoughts. One of the key points the researchers were trying to make is that unlike other animals who think very concretely, humans are uniquely capable of thinking in abstract terms. We are able to dream, imagine and ponder possibilities and make real-life choices based on these machinations. Our capacity for abstract thought also gives us the ability to approach a problem from a variety of perspectives in order to arrive at an optimal solution.

This past week, with the announcement of Michelle Obama's campaign to fight childhood obesity by promoting health and wellness in America's communities, I've been finding myself having to discuss and teach this power of perspective to many of my obese patients who have been curious about the message but do not see themselves as avenues for change. Because most of the kids/parents I see come from obese families and underserved communities where the norm is to be on the heavier side, it is extremely difficult to impress upon them that their overweight is a detriment to their health, both old and young. It doesn't help either that some social advocates, researchers, and doctors choose to focus on the fact that obesity is in large part is a genetic disease and ignore the contribution of behavior and the environment entirely. As a specialist who sees and deals with pediatric obesity on a daily basis, I fail to see how impressing on my patients the message that certain genetic mutations that are largely unidentified that they may or may not have are causing them to eat more and metabolize less and become obese will help in any way to improving their long term health. It is somewhat of a fatalistic approach to take in my opinion. Instead, I choose to tell my patients that although genetics has predisposed them to a certain body habitus with its inherent increased risk for metabolic and cardiovascular complications, the lifestyle they lead and the dietary choices they make will go a long way in determining how those risks will play out. For families who have to fight this battle on a daily basis, it is much more heartening and inspiring to hear what can be done instead of focusing on things that cannot be changed. Let the experts and researches work on the gene and the genetics, I say. I'll help my patients modify what they can their everyday life to improve their health today. Sometimes, all it takes is a little change in perspective.

Lest you think that this obesity debate has nothing to do with running, have you ever not wonder how far/fast you could theoretically go? Science would have you believe that your ultimate speed is encoded in your genes. No matter how fast you train or how many weekly miles you put in, there's no possible way for us to outrun the Kenyans. On top of that, if you are in your mid-30s or older, science also says you've likely reached your max in terms of speed and efficiency. It's right there in your genes. You should just give up. But those of us who know better know that the training, the lifestyle, attitude, and the nutrition really does matter. We can maximize our athletic prowess by being diligent in the way we train, smart in the way we prepare, and healthy in the way we eat. Why else are there so many "older" elite athletes defying their age, crushing their races and taking home medals in the national and world stage?

So thanks for all the scientists and researches working hard everyday to define and limit our potential. I'm going to do my best to teach my patients the power of perspective and afterwards go out for a run!

For my sanity, please share stories of how the power of perspective resulted in success in your life - whether obesity related, running related, or something else entirely. Maybe somebody will read and be inspired to make a change. Thanks!


DumpRunner Matt said...

For most of my running life, I haven’t trained that wisely; mostly too fast and too hard. It is easy to get away with when you are younger but that doesn’t mean that type of training has merit. I used to be mad at myself or embarrassed at running ANY workout “too slow”. 8 minutes a mile was an unforgivable sin. A few years ago I was bumping around the internet and came across an article by Hadd (called Hadd’s approach to distance running ). Here, he makes a scientific and reasoned case for “slower” easier running. The idea that efficiency at lower effort improves all efficiency was a game-changer for me. There are some other elements to his plan like higher mileage but the main idea really brought a lot of patience and structure to my running. It’s still a work in progress but I am seeing the results in dramatic fashion. In my first season after the switch, I saw PRs in the half marathon, a mile on the road and times closer to what I was doing in my 20s.

Running and living said...

I absolutely agree with you on the issue of obesity. However, there are good studies out there which show that there is an inherent set point in weight for everyone, and that weight, like other characteristics is on a normal curve. However, when someone is too fat or too skinny (obese and anorexic) there is a clear problem (overeating/lack of activity and undereating/overactivity). I completely agree with you on how important if to focus on what the patients can change. However, given the stigma associated with obesity, I don't think it is enough to tell patients that they have to exercise, and tell them what to eat. Emotional eating is multifarious, and these patients need more help than a diet, in order to relearn how to eat, learn to sit with powerful emotions rather than escape with food, etc, etc. CBT works amazingly well for emotional eating. These patients are also v depressed, and overly stigmatized by our society as lazy, etc. Of course, that only makes the problem worse.

Betsy said...

I have been at a healthy weight for most of my life, but gained quite a lot during my pregnancy. After my son was born, I lost some, but not all, of the weight. I deluded myself into thinking that I ate pretty well - mostly healthy food with the occasional indulgence. Then, I decided I wanted to be a bit fitter and joined Weight Watchers. Having to track my points made me realize that those occasional indulgences were a lot more unhealthy than I realized. That perspective - and the accountability I felt for my choices - made things snap into place for me.

Andrew is getting fit said...

Well, I think I'm a living example that running a lot helps fight obesity. I started off at a BMI off well over 40 and am current at 25.

Having said that just running won't do it. You have to eat right as well.

The greatest thing for me is that I am setting an example for my child who thinks it is normal that her parents go for a run most mornings.

kristen F said...

I was a "fat" kid and eventually developed into an obese adult. I have since lost 130lbs on my own (no surgery, no fad diets, etc.) and managed to keep it off for some time. As a former overweight person I can own up to having coined my weight struggle up to being a "big person" and "fat running in the family." What I learned through my weight loss journey was that none of this was not true. In fact it was very far from the truth. What was true was that I didn’t know enough about nutrition, portion control and exercise to maintain a healthy weight and that my ignorance alone was keeping me fat. I also found that when I worked WITH my genetics they worked for me. The best analogy I have heard concerning weight and genetics is that “Genetics loads the gun but you pull the trigger” and I couldn’t agree more.

My parents both battled with their weight and continue to do so. At this point, both are obese and have been for some time. I don't think either of them are bad people but they had poor dietary habits, and ultimately passed them on to me. In basic terms, I did as I saw. My mom would constantly encourage me to lose weight, but it was hard advice to follow - after all, would you listen to a smoking cessation speech from a smoker and take that advice seriously?

I truly believe that most parents do not consider what kind of power they hold in helping influence and mold their children. If parents make a point to enforce and set an example for how important it is to eat well, exercise regularly and treat themselves in moderation I do not believe obesity would be in epidemic portions like it is now.

Kristen, Philly

EZEthan said...

Another great post... you may genealogically have a higher maximum potential for running but until you actually reach the upper limits of that potential through training the entire arguement is irrelevant.

For all we know there might be someone with the potential sub 3:40 miler sitting on their couch, 50 lbs overweight, eating a cheeseburger right now!

Anonymous said...

i don't have a story to share but i wanted to tell you that i think youre taking the right approach to the problem of childhood obesity. focusing on what the patient has the power to control makes the task of losing weight easier to fathom. you can only move a mountain one shovelful at a time (or the saying goes something like that)

Kim said...

My mom was 600 pounds when she died, or so her doctors said. I don't think anyone really new because the scales couldn't hold her. Her body couldn't even hold her after living her entire life overweight.

As I watched her get heavier and heavier each year, I failed to see that I was doing the same. Soon I was 24 and 245 pounds - not so great. Morbidly obese, actually. It was who I was - who she was.

But it didn't have to be that way, I soon learned. A breakup and move prompted me to change my eating habits and begin to exercise. In six months or so, I lost 50 pounds. Four years later, I'm down 100 pounds and 3 pounds away from a healthy BMI.

In the process, I learned that I might always have a more "womanly" physique but I didn't have to be obese. I might not ever be able to run a 5-minute mile but I can run a mile. I might not ever win a race but I can run one.

Most importantly, I learned that I don't have to allow a genetic predisposition to determine my destiny. It is me, alone, who can do that.

Lauren said...

I'm not sure I really buy into the genetic thing. I get to a certain extent that your body TYPE has something to do with it but I don't believe anyone is born with an obese body type. Maybe a big boned, or more fatty, or less athletic build, but not an obese build. my mom was overweight, as was my sister and other family members and I was so terrified of having to be overweight because of my genes that I actually ended up developing on eating disorder. I wish I had realized sooner on, obesity is a choice. I'm just now finally learning how my body works, when it's hungry, how to eat. And i'm 20 years old! I wish I had learned sooner!!

X-Country2 said...

This isn't exactly what you were asking, but I was really thinking tonight about obesity and running. As I haul around these extra 20lbs, I have a much better understanding of why heavy people stay heavy. It sucks being even this much bigger than normal. I can't imagine people with 100+ too many pounds. Running isn't nearly as much fun.

If nothing else, it confirms that I NEVER want to be obese. Getting up the stairs feels different.

Jamie said...

I have been everything from a size 16+ to a size 4. Now in my 30's I fall somewhere in between at my bodies "happy weight" even if I'm not entirely happy with it (I love food too much somedays!)

I find I always fall back to bad habits when I return home to my family who has bad habits. These kids need support. If no one around them want to follow a healthier path they will be less inclined and it's so much easier not to be the "outcast" in the family. And sometimes it's just safe being heavier.

I think everyone has the potential to change and make it better for themselves. Empowerment comes through when the weight loss process starts. The hardest part is getting started.

Julie said...

Hi Lam,
Another post to make me go hmmmm:) I am going to have to think of a story and come back later to share it. I am so far behind on my blogging but wanted to stop and say "hi"! Thank you so much for all of your lovely comments:) They always make me smile:)

Oh and about the beer....I am not a huge fan of beer but am trying to keep an open mind. I am on a mission to find the perfect one for me. The beer that I tasted on Saturday was Finnegan's Irish was okay. I really enjoy wine and I like the foo foo drinks:) How about you Lam, do you like beer?

I hope that you enjoy your weekend in the big city:) Take care!

Marathon Maritza said...

Excellent post! I have been hearing a lot lately about genetics, specifically it being used as an excuse for obesity and poor health, but totally agree with you. I have a pretty average metabolism but I'm short and a pretty curvy girl. It's very easy for me to gain weight if I don't watch my exercise levels and what I eat. Sure there are people out there who could eat what I eat and be underweight or stick thin, but that doesn't mean I give up my hard work because I was dealt 'unfair' genes. I can't worry about what other peoples' genes are, I have my own health to worry about. Sadly, I do realize this is not the norm.

I'm curious if you will be watching Jamie Oliver's new show, I think it premieres tonight actually, and what your thoughts are on it. :)

Sonya said...

hi nothing to do with this post - but really enjoyed your post on running the GG bridge.
Will be in SF soon, staying at the Sheraton fisherman;s wharf - was wondering where a good starting point for the bridge run would be ? would like to do a 4-5 mile run at the longest - nothing like yours !

Lisa said...

This is a very interesting and thought provoking post. And, the stories here by readers are inspiring.

I think what you are doing, working with obese children and their parents, is incredibly admirable and necessary. As I sat in a panel discussion co-sponsored by NEDA and the STOP Obesity Association, I thought it would be something you'd find interesting and no doubt have many opinions on.

I believe that the parents set the example and need to walk the walk (with a healthy diet & activity) to teach their kids healthy habits. Unfortunately, many parents need to be educated themselves. My mother was overweight while I was young (since lost 70lbs on WW and kept it off) and I learned bad habits from her. She didn't know she was doing it, it was just what she knew. She thought we were okay, but I have struggled with weight all my life. I'm turning things around, but there are those times when I slip up. now though, I know how to deal with them and the majority of the time, I eat well. Now, if only my foot would heal, then I'd be running again!

Good luck.

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