“I heard a definition once: Happiness is health and a short memory! I wish I’d invented it, because it is very true.” – Katherine Hepburn
When I was working as an intern, I was at an underserved community health clinic on the Southside of Chicago where there is a high prevalence of obesity, high blood pressure and diabetes. I was taught to treat the symptoms of these conditions via drugs with only cursory attention given to advising patients on lifestyle modifications. After watching this approach only slow down or “manage” the conditions as patients were oftentimes only passively involved in their care, I found myself wanting some structure to get to the “root cause” as a doctor in training.
Finally, I began to have patients journal their dietary intake and what they ate everyday for two weeks, as well as document their activities such as walking or other forms of exercise. Then I would invite them back for an office visit and ask them to take an honest assessment of what they ate and what they could do without. Patients were amazed when they reviewed their diets and often commented on certain habits and “automatic eating” types of behaviors relating to stress or “self-medicating”. For some of the patients, the awareness gained from creating a journal propelled them into “I can do without that second snickers bar” or “I can take the stairs instead of the elevator”. They embarked on successful weight loss programs with this simple strategy by decreasing dietary intake and increasing physical activity. Several patients succeeded with this approach, and one in particular that I recall (Mary G.) lost over 60 pounds and kept it off the remainder of my residency training!
So, why does this matter?
We know that when patients are more engaged in their care, it leads to better outcomes. That’s a fact. On average, patients with high blood pressure and diabetes when stable, go to their doctor 4 times a year for a 15 minute appointment – so that is 1 hour of time with their doctor per year. Really, it’s what patients can do on a daily basis with their own health that can make a positive impact on their health… and of course, working in collaboration with health care providers.
In musculoskeletal medicine and for conditions such as chronic neck and back pain, we see that this engagement of the patient via therapeutic exercise along with spinal manipulation works. As reported in a review on spinal pain in The Spine Journal, 2008, a patient’s commitment to recovery decreases pain and increases function. I never get tired of repeating certain pieces of advice or “truths” in my experience: get informed, get involved with the entire program to recovery, make sure a sincere commitment has been made to move forward. Make sure your friends and family understand what your condition is and what recovery looks like. Get support. Do the exercises.
Eat ice cream (unless you are lactose intolerant – then have some dark chocolate!). That last suggestion is for unplugging and lightening up, too. Obesity is often a disease of the mind as well, so focus on reversing inertia tendencies in your lives and ask yourselves what you could do without? Get a journal and write it all down – two weeks worth of food and drink. Write down some goals you have, too. You might be surprised at what the results will tell you. Time to get going. Let you and your doctor work together for a full recovery. It’s a two-way street, right? You can do this!
