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“I’ve become my mother!” cried Janice as she studied her reflection in a full-length mirror on her 40th birthday. She had ballooned from 130 to 175 pounds over the last 15 years. Janice didn’t think twice about her weight until after her first baby, Ashley, was born when Janice was 24. She gained 30 pounds during the pregnancy, but was down 15 pounds by the time she left the hospital. The other 15 pounds, which she called baby fat, hung around. During her teen years, Janice had been active in her school’s marching band and regularly played softball. She jogged two or three miles a couple days per week, just to keep in shape for her beloved softball.
After Ashley was born, Janice still played softball, but couldn’t find the time to jog. Her second child, James, was born two years after Ashley. Household life began to get hectic. Janice’s husband was working 60-hour weeks at the tire store. Her mother, 40 pounds overweight, remarked how hard it was to chase Ashley around the house when she babysat. Janice decided to table softball until the kids were older.
Janice added another eight pounds of lingering baby fat while pregnant with James. She got a job at a call center six months after his birth. She sat most of the day, processing orders for various products. The family’s evening meal, by necessity it seemed, was too often a sack of fast food she picked up on the way home. Janice didn’t have the time or energy for exercise after cleaning, shopping, and laundering. She drank four cans of Dr. Pepper every day for the pleasure and a boost of energy.
The surgeon who removed Janice’s gallstones at age 35 told her they were caused by her excess weight. She began to worry about other health effects and her lack of energy and stamina. Years after giving up softball, she tried jogging around the block just once and strained her right hamstring muscle. No more jogging for her, she decided.
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Over the next five years, Janice tried many of the popular diets: low-fat, Atkins, cabbage soup, NutriSystem, Jenny Craig. They all worked great. For a while. She lost eight to 15 pounds, then lost her enthusiasm. Two months later she would be back up to her baseline weight, if not higher.
Since breast cancer runs in her family, Janice came to me for a routine physical and referral for a mammogram. At the end of our visit, she asked, almost as an afterthought, “Hey, doc, what can I do to get this weight off?” It was the end of my workday so we had time to chat. She shared her frustration with her prior weight-loss efforts. She told me her dream of fitting into some of her old clothes and wondered if her husband would ever again look at her the way he did when they were newlyweds. She mentioned the stress and time constraints of a two-teenager household, and how the teens would eat only two kinds of food: fast food and junk food. She told me how it hurt when she had to turn down the school’s request to chaperone her son’s four-mile nature hike with his class; she knew she just didn’t have the stamina. I shared with Janice my own frustration in dealing with my patients’ medical problems that were caused or clearly aggravated by their excess weight. I saw hundreds of patients like Janice give their honest and best efforts to lose weight and keep it off, only to fail. Their medical problems were good for my business, but I longed for better outcomes for my patients. I had seen weight-loss methods of all kinds come and go, then come again. Surely, there had to be a better way. I vowed to review the situation comprehensively, to learn definitively what we should be eating and doing, and to share with Janice the results of my efforts. In these pages, you will see what I discovered.
[Continued....]
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