Sunday, July 30, 2006

A Weighty Issue

I cannot describe how pleased I am that so many of you are heeding my call to wedge yourselves into your running bras and get out on the pavement.

But I am dismayed to see how many of you immediately started talking about your weight—that you wanted to lose some, that you did lose some, that you weren't losing any.

If you go back to my original post, you will see that never once do I mention weight loss as a reason to run.

Whaaa--? I hear some of you thinking. Why would I do something so unpleasant if I'm not going to get skinny?

Sigh. OK. I will tell you why you should later. But first let me tackle the topic of getting fat.

You probably already know that the country is experiencing an obesity epidemic. The majority of adults in the U.S. are above a healthy body weight. This in turn has caused an epidemic of Type 2 diabetes. And diabetes is the number one cause of 1) blindness 2) amputations and 3) kidney failure requiring dialysis. How great would it be if we could avoid all that? So doctors are desperate to find a way to get people to lose weight. Fat people are also desperate to lose weight, because even as everyone has gotten fatter, discrimination against fat people has not decreased at all.

So if everyone's on the same side, what gives? Why is everyone getting so big?

It's tempting to say that it's the fault of the fast food chains. And they do play a role, but I would argue a small one. The problem is multifactorial. There are several important differences between the U.S. now and forty years ago (or the U.S. and some other countries where people have not yet started to expand). First, people no longer have to move. Most people can now do their jobs by lifting only their fingers; correspondence, chatting, ordering, everything can be done by computer. (Being a physician is one of the few professions where we must keep moving — from room to room, down the hospital hall, to the front desk.) Second, people and jobs have moved away from the city centers, so almost everyone commutes by sliding their padded butt into a carseat and driving to a parking lot next to their job. People don't even expend the energy to shift their own car gears anymore. Third, food is now available everywhere, at any time of day or night. Not just at fast-food joints; everyone has a vending machine no farther than an elevator ride away from their desk, a 24-hour convenience store (with a parking lot) on the corner down the street from their house, and a huge refrigerator stocked with goodies.

Humans are genetically programmed to eat when we can and rest when we can, because we evolved during a time when if you passed up a meal or a rest stop, you were that much closer to being the weak one who got left on the rock to distract the saber-tooth tiger. (This programming is not uniform; some of us are jittery and jumpy and more easily distracted and tend to stay naturally slim. It was probably an advantage to a tribe as a whole to have a few people like this, so as to be able to alert the calm ones to danger and to run really fast if need be.) It probably didn't happen often that anyone got fat back then, but even if a tribe were so lucky, the consequences of this—premature death—were not, evolutionarily speaking, undesirable; these folks had already had their offspring, who cares if they lived to be 90? It's not just humans who are like this, either. I used to feel really sorry for birds in cages, because flying seems like such a wonderful thing, and they're being prevented from doing it. Then I learned that when birds live in a place where there are no predators on the ground, they give up flying. They get fat and lazy and waddle around, just like humans.

So when you pass up running and instead pull your car into the 7-11 for a Slurpee, you are simply heeding your DNA. That's right, it's not your fault. So quit feeling guilty; it's unproductive. But do realize that you are not in the environment your DNA thinks you are, and it's now up to you to adapt yourself.

It's been shown over and over again that if you put people into a controlled environment, calories in minus calories out equals weight gained or lost. No one is immune from this law of physics. What can't (yet) be measured, though, is just how hungry a person gets when they take in less than they put out, or how unpleasant a person feels when expending calories. You may suffer more when trying to lose weight than I would, I can't deny that.

Which brings me to the running thing. Simply running will not cause you to get skinny. Running more and eating less will. The running part is simple; the eating less, harder. But I'll give you a rough idea of what has been shown to be helpful (and in fact, I follow most of the rules myself):
  1. Eat breakfast. People who put off eating until late in the day tend to be fatter.
  2. Avoid simple sugars. This includes, but is not limited to, soda, juice (yes, even 100% fruit juice), candy, cakes, pies, chips, and white starchy foods. Simple sugars go down easy, then shoot your blood glucose up, which shoots your insulin up, which makes your blood glucose plummet, which makes you hungry. Hello, vicious cycle!
  3. Make it a rule to stay away from the vending machines, the corner store, and the coworker offering donuts. Fast and easy snacks result in fast and easy pounds.
  4. Don't keep bad food you can't resist in your house. What's that? You need to keep stuff around for your kids? Why on earth would you want your kids eating crap either?
  5. Get enough sleep. Sleep-deprived people tend to get fatter; it's not known why.
  6. EXERCISE. Exercise alone doesn't guarantee weight loss, but it does seem to prevent weight gain. Over the years, I have watched everyone I know slowly, slowly expanding, with the exception of those who get regular exercise.
But please do not run for the weight. Run because a fat runner is much healthier than a skinny couch potato. Run because it makes you strong. Run because it makes you happy in your own body, whether it's lumpy or flat, tall or short, square or round. Run because you'll live longer (and no, you won't wish you were dead, ha ha). Run because when you're out there running (as slowly as you can stand to, remember), you will have the experience of being alive in the world with your body doing what it was designed to do.


Anonymous said...

Great post- one thing you said really struck me re: seeing your friends get bigger over the years, except for the ones who exercise regularly.
Trying not to sound obnoxious here, because this is a hard thing to talk about. Here goes: I've always been 15-20 pounds over my ideal weight. Yet at the same time, I have been the same weight since high school (give or take 5-10 pounds), because I started excercising regularly in college and still do. So now I'm in this weird position where I've always thought of myself as "heavier" than friends from high school and college, yet the older I get, the more I realize I'm now on the thinner side of those same friends.
Not that this is a competition mind you :), but its hard not to compare when its always been one of my hang-ups.

P.S. Did you know your post was referenced over at Mommy Weight (

Orange said...

I've been going to the trainer at the gym to lose weight because (1) dammit, I looked good in those jeans I outgrew when I gained weight because I wasn't sleeping well, and (2) I gain preferentially in the belly zone, and my dad died of heart disease, and I'll be healthier if I don't carry excess fat in that area. There's still more sheer flab than I'd like, but I'm psyched that I've built up muscle tone and strength.

But you can't make me run, no ma'am.

Anonymous said...

Funny I should happen upon this post because as I was running this evening in 98 degree and horrible humidity I was so proud of myself for getting off my butt and running but even more than that I was thinking about how I don't really care what my weight is I just want to get back in shape and I was really surprised by that thought because at first I was bound and determined to lose 30 pounds - now I just want to fit in my cute jeans without the muffin top!

Felix Kasza said...

Orange@11:00pm --

maybe the good Doctor cannot make you run, true, just as she won't get me into a sports bra (I tend to wear guy stuff, being a guy :-) ). Bit if she were to learn that you took up some other form of exercise, I am sure she would be very happy.

If you live near Puget Sound, for instance, I'd be glad to take you out on a short bike tour; once you have seen those beautiful woods up close at a reasonable pace instead of zooming past them in a tank-like SUV, you may just want to keep doing that.

Do you like getting wet? If yes, well, biking in fall/winter/spring around here should satisfy you -- but you could always go swimming, an excellent work-out and a perfect time to rest the brain and de-stress.

I think I actually understand what you feel about running. I myself only run because I prefer a well-rounded exercise program; left to my own devices, I would likely bike all day, do some lower-body weight training, and never miss the rest. So pick a sport, hie yourself outside, and have a go.

In a pinch, you can even go to a local gym -- not Curves, please, as they are completely useless -- and spend half an hour or an hour on the elliptical while staring at a wall. Don't bother bringing a book, of course: If you can read while working out, you are not working hard enough. :-)


Gregory House, PA-C said...

Wow, that post made me so happy. I love it when people explain things in terms of evolution. It means I'm not alone. But you explained it all so much better than I ever do.

Anonymous said...

Your comment about having the experience of being alive in the world with your body doing what it should is dead on. I started playing soccer in my mid-30s and have gotten thoroughly addicted to it. I don't enjoy running without a ball to chase! Had to take many months off to recover from a recalcitrant broken ankle (broken while hiking not playing soccer) but now play 3-4 times a week and do weights a couple times a week. I'm 45 and have 3 kids. Being fit is energizing and makes everything else easier.

Anonymous said...

Until I hurt my ankle the other day, and I'm still not sure how I did that (but it's slowly healing, thank goodness), I've just been running for the fact that it's nice not to sit on my more-padded-than-it-used-to-be rear end. I've never let myself get particularly heavy and am still within 10 lb of my high school weight (when I was in fabulous shape due to tennis and crew). But with my PCOS, and the fact that my mom's been diagnosed with type II diabetes, I know I need to get my eating habits under control. So I've combined my running with cutting out many of those simple carbs and, over the course of the last month, I've lost 4 lbs. It feels great, but I know the running alone wouldn't have done that.

Also, as a scientist, thank you for more evolution-speak!

Anonymous said...

I've been running almost every other day since June 19th. I ran this morning. And I decided just this morning, that I'm done with being on a "diet". I've been trying to cut down on carbs and sugar, but that means no fruit or whole grain bread. I think as long as I exercise (yay running!) and eat a variety of healthy foods in moderation, I'll be good to go. Thanks so much for inspiring me to run again and to just be healthy.


OMDG said...

I couldn't have said it better myself. Also, don't forget the increased risk of cardiovascular complications and stroke that come with diabetes -- those mess up more people than blindness, amputation, and kidney disease combined.

And heed the sleep advice. It is not cool or macho to be sleep deprived (though alas, it can sometimes be unavoidable). It drives me crazy when I'm told I'm "lazy," or that there must be something wrong with me, when I say that I need 8 hours of sleep a night.

Orange said...

P.S. And after two months of moderate-to-wussy workouts, I do have more energy, I'm not as hungry for junk food, I can tell I'm stronger and more fit. Win-win-win!

shetha said...

I got into running in my 30s for 3 reasons: 1) peer pressure from other mamas (I love them!!!) 2) To fight back against the diseases my parents and their parents struggled with (cardiopulmonary, cancers, diabetes) and 3) to provide a good example for my offspring. Not one of them was weight! The side effects have been very interesting (also three -- good things come in threes right?) 1) It helps keep me on a more even mental keel 2) It makes me crave healthier foods (maybe that's just me... I totally don't drink sodas at all anymore and I prefer carrot sticks to jelly beans). 3) I sleep better at night and have more energy during the day.

Again, "dieting" doesn't come into it... although my "diet" does. I have this weird feeling about the word diet... I just see it as a noun, not a verb. Your diet is what you choose to eat. "Dieting"... I don't get. Oh and I suggest to anyone who thinks they could never run (barring any major joint issues) to go and cheer on the runners at a local race. You will see every shape/ability there and it is SO inspiring. I mean as long as you don't find yourself at the Boston Marathon or something...

PS -- I used Curves to get up to a fitness level where I could run. I'm not a huge advocate but for some people, it's a good starting place. I've seen some amazing things happen there...

Artemis said...

What a great job! May I copy this and hand it out to a few key patients?

Keep up the good work. (Yes, I'm still out there at 6:15 each a.m. slogging away.)

Anonymous said...

Running can become an addiction. I'm missing it more than I miss white wine now that I'm 7 months pregnant. And that's saying a lot.

And I know that technically I *could* be running, but my bladder gets really uncomfortable really fast with all that bouncing around and the heat index is 110 and I'd rather not kill myself in the dead of summer because that would be TWO people I'd be killing. But walking is just not the same. I miss it, and five years ago I would never have thought I would say that and really really believe it.

Anonymous said...

Sing it sister.

I recently lost 33 pounds with a combination of diet (pretty much exactly what you said with special attention paid to eating lots of fresh fruits, veggies and high fiber whole grains) and exercise. For the first time since I was 21 I now actually weigh what it says I weigh on my drivers license. And while the exercise was key for me as far as motivation and keeping the weight off it is generally a lousy way to lose weight. Running will make you fit but it won't make you thin. It takes a 3500 calorie deficit to lose a pound of fat (give or take because of course metabolism is part of it). That is a heck of a lot of running for someone just starting out. (my typical run even now burns less than 300 calories but when I first started it was closer to 150. So if I hadn't cut calories it may have taken me 2 years to lose the weight instead of 6 months) In my experience what you eat (or don't eat) is the most importnat factor for weight loss and how much you exercise is the most important factor for keeping it off and maintaining a healthy weight. Now that my body is used to exersicing I find I can indulge a little more often without the weight creeping up.

Another key point is that weight training will rev up your metabolism and keep you feeling young much longer. My mother is 60 and only started weight training 3 years ago. She always says she wished she had realized how great it would make her feel because she would have started 30 years earlier. I second that. Running without some sort of resistance training at least 2-3 times a week isn't a complete workout in my opinion. Especially for women who lose muscle mass at a faster rate than men as we age (or so I have been told). I feel and look younger now at 33 than i did at 23 because for the first time since I was a teenager I am actually fit. It is a great feeling and one I never plan to lose.

Anonymous said...

I agree with most of your post, except for the black and white take on the "calories in/calories out" mantra. In my experience (admittedly limited), the things you eat are also quite important. Sure, I can eat just 1200 calories of pizza per day (two slices? eek!), but I won't lose weight as effectively as if I eat a good breakfast, large-ish lunch and small dinner (small dinner is best for me because I tend to be hungriest earlier in the day).

I don't mean to nitpick, but the whole "calories in/calories out" thing is why women who are on Weightwatchers don't understand how they can stay within their points and merely lose .5lb, while their compatriots are losing 2-3lbs. It really DOES have to do with the quality of what goes into your mouth. I know you partially addressed that, but I think it's important to clarify it fully.

Anonymous said...

What about adding red wine to the list? Good for the arteries and all that...a big attraction of my PCOS diet.


Anonymous said...

Okay, I think I've been convinced. I will walk though, cause I can't run (major joint problems as mentioned above). At this point, walking will probably be as aerobic for me as running is for others.

I had a friend who said once that you shouldn't exercise to live longer, but exercise to feel better tomorrow. My mom was a serious runner who died at age 57. My grandma never formally exercised, and she lived to be 91. I think it's best to focus on feeling good in the present, although I know that's my bias based on probably not a lot of science.

Felix Kasza said...

Ariella@8:12am --

In my experience (admittedly limited), the things you eat are also quite important.

Healthwise? Sure. Weight-loss-wise? Nope. Laws of physics and all that.

Assume that we lived in a perfect world, where we could accurately measure every calorie consumed and expended. (That world is called a "calorimetric chamber" and requires the most boring diet _ever_.) Also assume that we could accurately distinguish the three pounds of water that you retain for a few days after consuming a really salty curry from the 0.1 pounds that are part of every pound of fat tissue -- important, because the 0.1 pounds only leave when the fat goes away.

In this world, we would know how large a caloric deficit (or excess) we have. The two remaining variables then are, Which tissue type do those calories go into (or come from)? and, What else comes along with that?

Energy can be stored as carbohydrate, like glycogen, at an average of 3880 kcal/kg (~1760 kcal/lb). Or it can be used for protein synthesis, at around 3600 kcal/kg (~1630 kcal/lb). Or it can go into fat storage, for an approximate 8950 kcal/kg (~4060 kcal/lb).

Glycogen stores are built or rather rebuilt mostly after intense, long, exercise. Muscle is built, v-e-r-y s-l-o-w-l-y, after exercising it to overload, and even slower after loading it close to overload. In a steady state, these two are cancelled out to the point of being negligible. That leaves us with fat.

The second question is the really difficult one. Water does not come in two colours ("gone when the curry has left" and "sticking around with the fat"), and the water contents of tissues are not constant, nor are they the same between individuals. But, as a figure of merit, assuming an energy contents of 7700 kcal per kilogram of fat tissue (~~3500 kcal/lb) is good enough.

In this ideal world, with a controlled diet, fluid and elecrtolyte intake, and output, our weight would change in a completely predictable manner.

In the real world, we can reasonably well control our caloric intake (to about +/- 30%, IF we use a gram scale instead of volume measures). We cannot come close to this precision as far as energy expenditure is concerned -- for instance, the basal energy expenditure (close enough to the resting metabolic rate) is in large part determined by the activity of your thyroid.

But none of this depends on what we eat. The "what" only comes to have an influence if it gives us diarrhea, causing nutrients to pass through undigested.

And coming back to Weight Watchers: Ditch them. Go to the meetings for motivation; but go to your scale for measurements. For a few bucks a month, you can sign up with or pick a plan on, with all the logging and estimation tools you'll ever need. Another extremely useful reference is the USDA nutrient database, at (off-line search tools at SR-18 mostly has basic foods and ingredients; offers huge amounts of info on restaurant dishes, convenience foods, frozen meals, and the like. I use both myself.


DoctorMama said...

Leggy — see, you’re moving up in the rankings!

Orange — I bet I could make you run if I woke you up and told you that you were in the top three and were late for the crossword finals.

flybunny — less muffintop sounds like a reasonable motivation, and definitely doable.

Felix — I guess that means you don’t have man-boobs?

Dr. Wannabe — no, you’re definitely not alone.

leslie — “Being fit is energizing and makes everything else easier”—amen!

bihari — fraught indeed. I think my patients sometimes look at me while I blather on about exercise and think, easy for you to say, you skinny white girl. (Job offer is friends, not us.)

Erin — I could probably concoct some bullshit evolutionary explanation for anything.

Jess — “you wouldn't think a quick jog 4 times a week would make a difference strength-wise” – but it does, it definitely does.

Jessica — yay no “diet”!

Old MD Girl — you’ll find that physicians as a group probably need MORE sleep than the rest of the population. And the idea that it is morally superior to wake up early? Gah!

shetha — I wish I could say I prefer carrot sticks to jelly beans. And you are so right about seeing all shapes & abilities. I think Curves can be helpful, too.

Artemis — of course.

Emily — I couldn’t run pregnant either, and boy did I miss it. It came back more quickly than I expected afterward, fortunately.

auburn — I’ve always hated those calculations for calorie-burning when running — they so miss the point, don’t they?

ordinary neurotic — even if you do get the “endorphin thing,” doesn’t mean you can’t ever grab a pastry, right?

Ariella — no matter what form your calories go in as, if you do everything else exactly the same, you will gain or lose the same weight whether you eat nothing but donuts or three well-balanced meals. But I think what you’re getting at is that what you eat influences what you do—e.g., sit on the sofa in a torpor after donuts vs. getting up and painting the kitchen, or whatever.

Fiona — who said you can’t drink red wine? God forbid.

CherylC — sorry about your joints. And your mom. My dad was a gymnast who died at 36, and the sense that one can go at any time has never left me. (Though he was somewhat to blame for how he went — he died on a motorcycle. But that’s a story for another time.) I agree about focusing on feeling good in the present, but it depends how you define “the present.” Sometimes when I’m running I feel like I’m just punching the clock; I’d probably feel better at that precise moment if I were lounging on the patio sipping a margarita. But I run for how it makes me feel in the general “now.”

Felix again — um, yeah, I believe you.

Kristie said...

its nice to see someone talking about this. i have to admit, i dont go and do a structured work out very often. but i run around outside with my son and we go on walks and i also work as waitress so i am always on my feet running back and forth. i also never take elevators and park far away from the stores. i try very hard to feed myself and my son healthy food as well. i hate hearing people complain about being in an unhealthy state but absolutely unwilling to change thier lifestyles. and your right, running is not only about losing weight, but i am sure they go hand in hand to a certain extent. at least to the point of not gaining anymore. good advice and i really like the evolution part.

Anonymous said...

Since you first wrote about this, I started running.

Now I am up to running for 25 of the total 30 minutes.

I even entered a local race. It was only a two mile race, but I did it, and finished in 17 minutes, 30 seconds.

Thanks for the motivation!

Maybe next time I'll enter the 10K... Yikes!

Anonymous said...

I wonder if all the anti-depressants aren't also making us fatter.

What's odd is that we've gotten fatter since the '70s. Were the '70s really that different? Did people drive less then? There's a part of the 'obesity epidemic' that doesn't make sense to me.

Anonymous said...

Thanks for another running post. I'm taking a 2 week break whilst vacationing and I'm surprised to be missing it. I'm hoping walking all over Manhattan will compensate. I read your initial running post on the same day as I chatted in a checkout line with a 44 y.o. non-smoking, average built Dad of two who is recovering from a major CVA. He was not expected to survive, and will always have pretty significant deficits. I have a Protein C deficiency and have gained 40lbs over 5 pgs, so I felt like these coincidences were a wake up call. I'm sure clotting quickly after a sabre tooth tiger attack helped my ancestors, but it stinks in today's modern world! I'm hoping to lose weight after baby starts sleeping longer stretches, and I am determined to just keep running on The DoctorMama programme. DH tried to buy me a pedometer recently, but I snapped at him 'That just complicates the run!'. And so, my mantra for life....


PS A tip for large-breasted lactating runners...Get out of the sweat-soaked running bra ASAP and dry off. Let's just say I've known moms who ended up with a yeast rash under the breasts. EWWW,

Cat, Galloping said...

I admit that i get discouraged by not losing weight when I work out regularly. But okay, the fear of *gaining* weight was a nice kick in the pants! I went running yesterday (on the treadmill-- hello it's a million degrees outside) and lasted 17 minutes.

Any suggestions for cramps? I remember now that I've always gotten them a lot when I run.

Also, my legs get really itchy when I run. What's up with that?

Cat, Galloping said...

(stomach cramps, not leg)

Anonymous said...

Dr. Mama - thanks for all your great info and motivation regarding the whole running thing. I'm the one who commented on your original post about wanting to run, but I was recovering from a broken leg. I've always hated running, but now I think I've seen the light. So much more convienient than going to the gym! Requires almost no equipment, and can be done pretty much anytime, anywhere!

But I have a question. Is normal to feel like crap after running the first few time?

So, this week I decided it was time to start. I put in my half hour Monday and Wednesday. (Probably 15-20 minutes of actual running, but I finished out the 30 minutes with walking.) I didn't mind the running, but once I got home, I was wiped. I was exceedingly grumpy and easily frustrated. I was trying to learn something new on my guitar, and I was about ready to just smash the damn thing, which is not how I usually am.

So is this normal? The catch is that I should run again tonight, and I want to, but I'm also supposed to practice with my band, and if I'm going to be all pissy and easily frustrated, I kinda want to skip the running.

How long till I feel energized after running instead of wiped out? Couple of weeks? A month?

Post surgery leg x-ray, if you're into that sort of thing. I think it's pretty cool:

Thanks again.

Egg Mama said...

I've never left a comment before, but...

I love you, Dr. Mama! Your attitude is so inspiring. I just had to say that. :)

Chris said...

Thanks for the point of view. I'm currently trying to work up to running. At 340lbs, it seems impossible. I appreciated the comments on exercise/running not losing the weight for you, but preventing weight gain. Maintaining a healthy diet is much harder than working out. Thanks again.

Anonymous said...

You really are inspirational . . .

A Homeschool Story said...

Excellent post; and it answers my much sought-after questions in my own posts on exercise and eating right...and NOT losing weight. This is a great commentary on keeping the focus on what one IS doing. I will link to this in my next "Mama Fitness" post, my blog is Last post on fitness was today (9/26/14).