Xblog

I actually started on this path over a year ago. The year before, my body finally said “to hell with you” and gave me such a nasty case of gall stones that the pain didn’t mysteriously go away before a doctor could properly diagnose the source instead of saying “probably just a bad case of gas”. It was my first experience with major surgery, and frankly I wasn’t too interested in revisiting that experience any time soon. Combine that with finding oneself responsible for a child and I realized it was about time I really focused on fixing up my health.

It is a hard thing to do. Not just for the usual reasons of trying to find the time, energy and focus with competing challenges of afore mentioned child, aggressive career commitment, financial stresses from a real estate market gone mad, and maybe wanting to see my wife every now and then.

There were also huge psychological barriers as well. I wasn’t just a little out of shape or starting to look like I was carrying around an inner tube under my shirt. I was very overweight, and had been for over a decade. My BMI was (wait for it) ~45. The cut-off for morbidly (as in “deadly”) obese is 40. That’s at the point where your weight is likely causing severe and rather near term health problems (not to mention the long term health consequences that I’ll surely be better able to describe in a few decades ;-). Throw in strong family history of diabetes and some heart disease and your doctor starts sounding like he’s writing your obituary more than providing medical advice. That’s the kind of thing that makes you look up scary in the thesaurus and come to the conclusion that all the entries combined still don’t do justice to the debilitating fear you are experiencing every time you contemplate your peril.

Even more overwhelming than the fear of the consequences of my predicament was the fear of failure. Nobody in modern society ends up that fat without trying to not be that fat repeatedly. The cycle of struggling, achieving some progress, and then realizing it was a Pyrrhic victory as all the progress was undone “with interest” is just brutal for the psyche. After a while, it really seems easier, safer and downright healthier to not even attempt to address the issue. Just to make myself feel better, I was now living in Los Angeles, which is arguably the worst place on earth to be overweight (or really anything much heavier than your typical anorexic). About the only thing I could think of to make things worse would be if I had a career in the fashion industry. ;-)

Sounds really bad right? I sure thought so.

There were a lot of good things about my situation that were hard to recognize at at the time. First of all, despite my weight problems and I was in surprisingly good health. By some genetic luck, I didn’t (yet) suffer from any of the medical problems associated with being overweight. Indeed, as of a year ago the main side effect I was experiencing was the occasional case of acid reflux and a knee that got a bit sore if I stressed it too much. While I didn’t always make the greatest food choices, I actually like healthy foods quite a bit and ate reasonably healthy selection of foods at home, so eating the right foods wasn’t much of a challenge. I worked for a company with significant health benefits including…. gym membership reimbursement. Also, the upside to living in LA is you are kind of living in the center of the whole fitness and weight loss universe, providing no shortage of motivation or options (not all good ones, but choice is good). I also had a strong support from those closest too me. Finally, anyone who has had to keep up with a toddler will tell you that they kind of enforce an elevated floor on the level of physical activity you get each day.

So, a little over a year ago I timidly started down the path of trying to do something about my health and specifically my weight. I was very fearful of failure, so I started with very small changes. I tried making minor modifications to the level of physical activity I was having. On weekends I’d do more activities that involved walking around with my son a lot, like going to the Zoo, hiking, teaching him to ride a bike, etc. I started adding in activities during the week too, including walks or bike rides around the neighborhood with my son in the evening. Having convinced myself that that was a path to certain failure, I only made one change to my diet: I cut out alcohol. That wasn’t specifically to help with weight loss, but my doctor had advised me that being this overweight and drinking was really rough on my liver, and it needed a break. While I saw some initial progress, it really didn’t go that far.

We’d bought me a bike back around the holidays, and the plan had been for me to bike to work. The office had moved close enough such that biking really was an option. I’d started off doing it for a bit, but quickly given up as I was feeling too much in the way of time pressures. My next big step was to readjust my priorities and make time for the bike to work.

In retrospect, I must have been insane to worry about the meagre time savings that came from driving in to the office. Driving probably shaved 5-10 minutes off of my actual commute time each way, plus another 10 minutes for cleaning up and changing clothes. Overall we’re talking maybe a half hour a day, and in exchange I was getting benefits beyond what I would achieve from spending that kind of time at the gym. More importantly, because it was my daily commute to work, it became part of my routine and so was much easier to sustain. Additionally, I found I arrived at my destination feeling significantly more relaxed and focused than when I was driving. I attribute this to a combination of endorphins, not being stuck in traffic, plus actually having a bit more time to mentally separate home and work life. Seriously, if you live within 10 miles of your office, find a way to bike to work.

Once I started biking, the progress really started to pick up. Because I’m a geek, I did the math and computed that all the extra exercise I was getting should result in me losing about one pound a week, and that was based on a likely false assumption that my previous lifestyle resulted in a no net change in weight. Shockingly, I was moving along at about twice that pace! It turns out that all that exercise was building muscle mass and increasing my resting metabolic rate, providing far more benefit than I had “earned” so to speak. It was hard not to get too excited.

At this point, I was getting nervous about falling off the wagon. I finally got up the nerve to try out traineo. It’s kind of a “Web 2.0 Weight Watchers” concept (that’s “WWW”, how can it fail? ;-). The idea is you track your progress through the site and it sends out a weekly report to a list of “motivators”, who help to provide you with positive feedback and support when you need it. I figured the commitment to loop them in on my efforts would make slacking off terribly difficult, but as it turned out the positive feedback and support helped a lot too. Using the service also encouraged me to start tracking my diet and trying to manage my caloric intake. The progress started adding up.

After that, things did start getting more difficult. In particular, my body seemed to be really having a problem sustaining the 5-days a week of biking along with all the activities with my son. Being paranoid about failure, I stubbornly stuck to my routine, thinking that taking a day off would soon lead to two days off, etc. At some point, my body seemed to just reject the whole notion and I got a bit of a cold. I toughed it out for a couple more days, but realized I had to give it a bit of a rest. After taking a few days off the bike, I discovered my legs were much stronger and the ride in was much easier. I also discovered the pace of my weight loss was unaffected by the break. After that I stuck with 4-days a week of biking for a while before feeling like I was in good enough shape for five days a week.

The other challenge I ran in to was discovering that bikes aren’t made for overweight people. I’ve talked to a few people who know the industry well, and they say that really men’s bikes are kind of optimized for a rider whose weight is about 160 pounds. If you weigh more, the parts start to wear out quicker. I went through two different kinds of seats with built in suspensions before forgoing a suspension system in my seat altogether. I also was constantly breaking or bending spokes in the rear wheel, even after upgrading to high quality spokes (I’ve heard that wider mountain bike wheels as well as fancier wheels with a higher number of spokes are somewhat more resilient). This sometimes resulted in days of down time while I waited for orders to come in and the bike shop to install them.

Once I started tracking my calories, I realized a simple dietary change that would have a huge impact: stop drinking fruit juices and flavoured coffees. While they aren’t nearly as bad for your overall health as soft drinks, for the most part they match them calorie for calorie. I tend to naturally drink a lot of liquids and work provides free juices, sodas, as well as various coffees and teas, so it wouldn’t be that unusual for me to pack away a half dozen cans of juice and maybe a mocha or two in the course of a work day. That’s like 1200 calories right there and I hadn’t even gotten around to solid food yet! I’ve also confirmed that by eating healthy snacks between meals actually results in me eating fewer calories overall for the day.

One other thing I started doing recently that seems to help is getting more sleep. I kid you not, but sleeping turns out to be a great way to lose weight. If you don’t get a proper night’s sleep, it elevates your cortisol levels, which appears to tied in with obesity and weight gain. Getting a proper nights sleep also made it easier to push myself while biking (not to mention all the other upsides).

I have hit a few plateaus along the way. Normally these present as my body stubbornly sticking at around the same weight for more than a month at a time. It’s tough not to get frustrated after a while, but usually I’ve been able to observe physical changes that reassured me that I was making the kind of progress that doesn’t show up on a scale. Really, all I want to know is that I’m continuing to make progress. The rest is gravy.

I’ve had a few other setbacks/challenges as well, but most importantly I haven’t ever observed myself putting on weight beyond the usual day-to-day fluctuations you expect. My latest challenge is that I’ve changed where I work and now have the kind of a commute that you just can’t do safely with a bike (LA sooo needs a bike path between the San Fernando Valley and Santa Monica). I’m biking to the metro, which is only a 2 mile bike ride each way. I’m looking at adding some more biking to the route. If I can get it up to a 5 mile ride each way I’d be psyched.

So after all that, what are the results? Well, a few months ago I officially lost my morbidly obese status and have joined the “swelling” ranks of America’s obese. I’m still a ways away from being merely “overweight”, but I’m amazed that I’ve been able to sustain this work for over a year now. Since I started this process I’ve nearly shaved off one quarter of my weight, and burned off over a megajoule of body fat (how insane is that?). My resting heart rate has dropped to around 70bpm, which is impressive considering how much extra bulk I’m still carrying around. My knee doesn’t seem to bother me now that it doesn’t have quite so much load to bear. I haven’t checked with the doctor, but I suspect my liver is feeling better too. I definitely have far more endurance (which is proving handy as my son continues to grow and get stronger, while remaining essentially indefatigable). I’m fitting in to clothes I haven’t been able to wear for years before I was married. (Fortunately I’ve been able to avoid that unfortunate mental disease that causes fat people who’ve lost a bunch of weight to think they look good in clothing styles clearly intended for those with physiques similar to a fashion model.) Not only am I seeing a big difference, but so is my wife. Friends and coworkers who’ve known me for a while make spontaneous observations of the progress I’m making and are just wonderfully supportive.

I think the logical next step is to start taking advantage of that gym membership option and to start being more serious about managing my diet. I’ve been looking at The Hacker’s Diet for pointers and tools. I’m not nearly OCD enough to really follow that program, but I think just doing some basic tracking and adjusting to my diet might help.

So, a couple of the points were selective use of statistics (the one that really blew me away was pointing out that Americans have shorter wait times for elective surgery as some kind of counter claim against them having longer wait times for non-elective surgery… doesn’t that suggest a complete misprioritization of resources?), but there were a number of points there where CNN just got their facts wrong. It’s just sad that within hours, Michael Moore can put up facts and links to back up his claims and demonstrate that CNN is off in left field.

Of course, it would be nice to see a similar list from Dr. Gupta’s piece, but that is not how the television medium works. Hopefully CNN will provide links on their website. I checked, and while there was a great shot of Dr. Gupta right on the front page of CNN’s “Health” section, I couldn’t find mention of any backing information for their story. They do have a written version of the story that reads a lot less ridiculously than the video I saw, although it still reads like he grabbed a few of his facts from a PR guy from the health industry and didn’t bother to check them. In CNN’s defense, I will say that I suspect most of the problems actually come from trying to compress a story down to the very short window that fits the TV format.

One thing this shows: CNN and TV news in general aren’t ready to for the Internet just yet. A 24-hour news service, with the resources that come with that, if really cognizant of Internet would have not even waited for Michael Moore to post his references, but would have immediately gone to the reporter’s notes and the fact checker’s notes (let’s just assume for the moment that CNN is still following those time honored traditions of journalism) and updated the web story to provide links to them. Instead, you will find plenty of links to promote other areas of the CNN site, as well as a number of links to advertisers, a link to a review of the movie, but no links to back up any facts in the article.

Indeed, a truly web-savvy news service would always include links to data that backs up their story, just on the off chance that their viewers were interested in learning more (sure the links would be selective, much as Michael Moore’s are, but like Michael Moore did, if you were smart you would select sources who were entirely credible, and most importantly, people would know where your data came from).

I mentioned in a previous entry that it seems the TV is coming to the Internet, and it perhaps isn’t going to be much better than the original. I guess one thing I am hoping gets better is that when TV news starts really moving to the Internet when a random factoid is bandied about in a story, there might simultaneously be a link to the source for that factoid. It might cut down on that time honored tradition of tossing about statistics without context or worse still, getting the context or stats so wrong that one has a hard time associating anything but deliberate intent to the cause of the problem.

I think it is safe to say that Michael Moore has on occasion done his own bit of misrepresenting things, and he certainly does not have a monopoly on the truth, but it seems that more and more traditional news services have been drawn so far from that hallowed ground by PR reps, a focus on profit over quality, etc., that it sadly non-traditional sources like Mr. Moore are the only ones who actually bothers to get their facts straight.

One parting shot on the health care issue itself. There was a time in American history when health care was often provided by practitioners who were expensive, had a poor track record of patient care, but who had the highest rates of customer satisfaction. These practitioners turned health care in to a confidence game, because they realized that making people feel like they were being taken care of was far cheaper and more profitable than actually taking care of them.

Those practitioners were called frauds and quacks, and it is high time that when someone like Dr. Gupta agrees that the US has significantly higher costs for health care, longer wait times for needed care, fewer people having access to health care, higher infant mortality rates, shorter life expectancies, doesn’t even make the top 30 nations in terms of quality of health care, and then points out that more context is needed because the US ranks highest in patient satisfaction, they ought to name that larger context: fraud and quackery, or at least use the more modern vernacular: “salesmanship”.

A short while ago, some folks tried to fund emergency rooms and hospitals with a new surcharge on phone bills. It turned out the electorate didn’t hate phone companies and those who used phones enough to vote the proposition in. So, this time we’re coming at it with more easily vilified targets (at least in California): tobacco smokers, growers, and vendors.

We hate smokers here in California. When I think about it, I’m surprised the folks behind prop 83 didn’t throw smoking on to the list of eligible crimes to improve their chances. How can you possibly vote against a measure that goes after smokers?

Well, first of all, let’s keep in mind here that smokers are really involved in the funding side of this equation. They are going to hit a massive tax increase per packet of cigarettes to help us fund emergency rooms and all other kinds of medical expenditures.

The real aspect of this bill is how it effects hospitals. One of the insane aspects of our private health care system in the US is that we still require hospitals to provide life saving health care to the uninsured. If they can’t pay, that’s the hospital’s problem. The logic is about as faulty as popular logic on tax policy that suggests one is cutting taxes if one reduces the tax rate, even if one doesn’t reduce spending. It’s silly, the bottom line is as long as you are okaying the spending (by requiring health care for the uninsured), you are okaying the bill as well. Sooner or later that money has to come from somewhere, or all your hospitals are going to declare bankruptcy.

Of course, by going the “save them and then try to make them pay even though they probably can’t” is horribly inefficient. You end up with people not getting cost saving preventative treatment but rather very expensive last-minute interventions. This leads to expensive bill collection expendatures for the hospital, and quite possibly bankruptcy for the patient. The bankruptcy process is just a more expensive way for the hospital not to get paid, and in order to make a profit that bill gets passed on to the rest of us in increased medical costs which finally present as… increased health care premiums.

So, we’re all paying for socialized medicine right now, but because we can’t just acknowledge it and build a system around it, it ends up being far more expensive for everyone. It’s kind of like the bond measures vs. tax increase situation that I’ve talked about on previous propositions. Proposition 86 attempts to buffer this insanity a bit by providing some funding from tobacco taxes.

My problem with this is that the measure doesn’t really address the fundamental problem, it just shakes down smokers to provide a small short term band aid on massive open wound. What I’d really like to see is a straight up or down vote on either going with socialized medicine or allowing hospitals to refuse patients they feel can’t pay for their services.

One other aspect of this bill that opponents have gone after is that it provides exceptions to anti-trust laws for hospitals trying to coordinate a emergency care (“how about you cover all cardio work on wednesdays when I give my specialist the day off?”). This just seems like another area where the existing system makes it far too difficult to provide medical services efficiently.

Okay, so my Canadian is showing a bit.

I’ve not really made up my mind on this one, but I’m leaning against it. It just seems like a bunch of half-measures that don’t come close to adequately solving the problem. The problem I have in voting it down is that our current situation seems so bad, even a half-measure seems better than nothing.