Where am I today?

My decision to act this time resulted in a shorter delay than initially! I started our program Jan 1st, 2010 and have lost 20 pounds already! Although fully aware of the importance of proper balance in my diet and the need for regular exercise, I still struggle. Schedule changes have made my old positive patterns more difficult regarding exercise, and the cycle of splurging on carbs is hard to break! Focusing on developing new patterns seems to be working better than "getting back" to my old ones, since it is now clear that my old patterns are not possible.

Spirituality and centernedness are the cornerstones of the patterns I am now trying to develop. I can do daily Yoga before I even leave the house and focus on being centered when I eat. Lent is a good time to focus on spirituality and face one's darker side. Repentance is turning away in a Wholistic sense, body mind and spirit. Perhaps this will be a useful and inspiring concept for me over the next several weeks.

What is Wholistic Health?

As a starting place, for a practitioner to be "wholistic" there must be a genuine acknowledgement of Body, Mind and Spirit as related. My belief is that they are inseparable aspects of the same reality. To use the theological concept, a trinity. This is a multi-directional webwork of relationships. What affects the body affects the spirit and affects the mind. This is true of any permutation you can imagine. At Sage, each of our staff from reception to physician buys into this concept.

There needs to be a willingness to address each of these major areas in more than a superficial way. A complex web does not lend itself to a single program or a uni-directional approach. There needs to be an understanding that relationships are multi-directional and what affects one aspect will affect others in often unforeseen ways. Each strand has intrinsic value and a contribution to make. At Sage we have collected providers of as many different modalities to address as many different aspects as possible. (See our website: www.sageweightandwellness.com) We are open to others as availability and need present themselves.

Wholistic medicine is also integrative. It in not just a collection of different practitioners under one roof. To be wholistic, the model itself must be integrated. At Sage, we talk with each other, have a common record, share information and ideas and act as collaborators with our clients in their transformation to health. At a very real level we have a common mind, common body and common spirit.

These concepts need, themselves, to be more than mental constructs! They need to be integrated into the hearts and souls of those who would serve others. At Sage Weight and Wellness we have recruited an entire staff who not only acknowledge this but put it into practice in their own lives as well as their relationship with our clients.

I do not mean to imply that the "medical model" has no value. It is very valuable but is only one strand. As a strand, its values must be respected, including: the scientific method, "evidence based medicine," technology, and pharmacology among others. Wholistic Medicine is not simply discarding Western Medicine for other "alternatives" which may or may not be superior in a given situation. At Sage, we get this. You will not hear us badmouthing doctors or discounting science. We ARE aware, however, that Western Medicine is only ONE perspective.

Although as an entity, Sage Weight and Wellness has only existed for four years, our staff has been involved for decades. As a physician, my initial choice of Family Practice was heavily influenced by the fact that it recognizes relationships and family systems as important to health. It was the closest thing to wholistic or integrative medicine that existed 30 years ago! I have not abandoned this approach, but only expanded and deepened it. My recent Bush Fellowship, in Traditional and Alternative Treatments for Obesity, my experience and explorations into meditation, yoga, exercise and many other disciplines are evidence not just of an interest but a commitment.

My work with the Episcopal Church Pension Fund through CREDO has further broadened my understanding to include financial, and vocational aspects of health as well as physical and spiritual. Our other staff also have long journeys in wellness which need to be respected, but which I will not detail here.

I welcome questions or comments. Come and see for yourself! I'd love to show you around!

Physician Heal Thyself!

As I continued to adjust to running a business and all that involved my stress levels grew and my waist line with them! Excuses were too easy: I don't have time, I'm too tired, if I can just get ahead a little then... or I'll start tomorrow. Listening to myself talk to clients about their weight was educational. What I knew in my head had not yet made it down past my neck! Tomorrow was becoming a long way off. I had regained half of my former loss and it was time to do something. "Physician heal thyself!" But what I learned was even with all my knowledge and experience I could NOT do it myself! Fortunately I have the best staff in the world! (Come meet them and you'll see!) When I looked in the mirror and got on the scale, the change was evident. I was also starting to have the return of fatigue, less exercise capacity, more back pains and generally not feeling as well. I had regained almost half of the 60 pounds I initially lost. Time to act.

A New Venture

Our next major development was moving out of New Prague Clinic. This move could be more about the history of Sage than my personal history, but it did change the dynamics for me personally. I learned (or rather was reminded, since I have been in solo practice before) how stressful having a business can be. I had lost most of my excess weight and managed to follow my own advice as well as what I had learned from The National Weight Loss Register about keys to long term success. Soon after the move, I was accepted as a Bush Fellow to study traditional and alternative treatments for obesity in children, adolescents and adults.

There was some stress related re-gain of weight but only a few pounds and my program was on course. Having the Bush fellowship was exciting and in spite of the stress of having a business, things were going well. Focusing on helping others was beneficial for my own health. For me, key in staying healthy was exercise daily in the moderate to vigorous range, monitoring diet, eating breakfast and limiting my carbohydrate intake. I had learned my lessons, or so I thought....

So what is OPTIFAST?

OPTIFAST is a trademark of Nestle nutrition. It is a formula based diet (shakes and bars) which allows a physician to utilize a very low calorie diet with patients. It is specially balanced and formulated to allow for an intake as low as 800 kcal and still maintain full nutrition, vitmain and minteral intake, and avoid starvation response. Because of it's restricted nature it is only safe when used under a physician's care. It is only one tool which can be used for weight loss and is only effective if combinted with nutrition education, behavior change, and exercise. It is mostly for people hoping to lose more than 50 pounds or those with medical problems related to weight.

The principles involved include proper balance of protein, fat and carbohydrate. This balance helps reduce hunger. Another is called "stimulus narrowing". I call this the "reverse buffet" effect. When we go to a buffet we overeat in part because of all the stimulation of seeing and smelling the food. It seems we are taking small amounts but we take and eat more than we think. By limiting choices, we eat less. having a choice of only shakes, soup, and bars in a few flavors, just makes people lose interest.

There is a lot more information on the OPTIFAST website. Most of the questions I get have to do with safety (only under MD supervision) and weight regain (no more than any other program and dependent on PEOPLE STAYING ACTIVE in their treatment.)

Although we utilize this tool a lot, we never force people to choose it. It can be very effective, however.

Better and Better

I had been running my weight loss practice through my family practice office. I was trying to do it all, managing behavior change, exercise and diet with my clients. i was getting good, if average results and it was taking a lot of time. It was becoming more difficult to do within the context of a 15 minute office visit and I started running way behind if people brought up weight issues. I also had not learned yet how to determine readiness to change and therefore wasted a lot of time. Also the weight loss was often not fast enough for clients who fell away after a month or so, which is pretty typical.

I read about the OPTIFAST program and talked to them about their methods. There was ANOTHER traning program to go to but this was only three days since I was already Boarded by the ABBM. With this program I made some changes and began working with a team. The basic concept is a formula diet for rapid weight loss (more on that at a later post, or check our website for more info: www.sageweightandwellness.com ) and extensive education for retraining of eating and exercicse as well as behavior. I concluded that this would work best with a team and after hours. The first major revision was complete and our results were much improved.

Study, study, study

I decided I really needed to pursue Diplomate status with the American Baord of Bariatric Medicine. If I was going to do this, I was going to do it right. I did not want to be just another "fat doctor!"

I started my bariatric (weight loss medicine) education by getting some tapes from former academy meetings. These were very helpful and I followed up by attending meetings. There was a total of 50 credit hours required, but I exceeded this greatly to learn all I needed to know. There was a written exam as the first official step toward certification, and I knew I had to pass with an absolute percentage. There was no "grading on the curve." I was pleased to do pass on my first try.

Now I was authorized to take the ORAL exams. More studying and case reviews! Standing in front of 3 experts in bariatrics and answering questions about cases was daunting, but in a strange way fun as well. I passed and went on the the next stage.

To be a Diplomate of the Board I was required to have a program running for a year and meet specific quality criteria. I had about a year and a half under my belt (no pun intended!) and the program was going well. I was struggling with the realization that many of the people who were initially interested were not yet ready, so my numbers were small, but the results were good. This was to be an on-site evaluation by another member of the board. Our program passed without difficulty (although it has improved a lot since then!)




To my great joy, I received diplomate status in 2004.

Excitement!

I received a lot of attention for my weight loss and that felt great. People kept asking me how I did it, and that made me think they were interested. Some in fact were, many were not. In any event, it generated a lot of enthusiasm in me and I decided I could offer something similar to what I did in New Prague. After all, it is not rocket science!

I looked to see if anyone was doing training in weight loss and found the American Society of Bariatric Medicine. This group or physicians does training in obesity and related diseases, and tests for competency. This seemed like a good idea, so I started the process. I was sure I would be having people break down the doors, given the excitement generated.

Out of the mouths of children

The year is now about 1999, a mere eight years from my initial revelation! It is before Christmas, I am up to about 220 pounds again and have my "winter growth" of beard. Upon walking into the exam room I am greeted with great delight by a 5 year old girl: "Doctor Santa!!"


Mom was mortified, I was entertained, but also saw a little more clearly. My research began again and this time I knew I could do it with help. I signed up for a comprehensive weight loss program and the real success began. My program included diet, exercise, behavior modification, and initially medication.



My success was transforming! I lost about 60 pounds over 6 months and felt great. My exericise program benefitted greatly as well. As my weight came down I was actually able to do more and felt so much better. People started asking me how I did it, and like a fool I thought they really wanted to know!

Clearing the decks

Although my weight was my primary concern, the elephant in the livingroom was my work schedule. I realized that I would never have the energy needed to make the changes needed if I didn't stop working 80+ hours per week. I managed to find my way out of solo practice and into a small group. This turned out to be more turmoil that I expected, but my hours were less. I started exercising and felt the weight would just melt away like winter snow in April. Many of you who have lived in Minnesota know snow does not always melt in April, indeed some big storms can happen then. Alas so it was with my weight loss efforts. On the plus side, I was exercising and feeling better. Change, however was feeling as remote as a Minnesota spring seems on this snowy early February day. There is always hope, perhaps soon action as well.

Taking immediate action!

So being a man of action after this revelation I stayed in the "contemplation" stage of change for about 2 years. At that time I applied for a life insurance policy and had begun a few changes in terms of exercise. When I met with the agent I told him I was in the process of trying to lose some weight, and asked if I should delay my application until this had occurred. His response was "like that's ever going to happen!" The primary outcome from this interchange was an immediate change in insurance agents! I decided at that point to investigate and see if anyone really did manage to lose weight and keep it off. What I found was the National Weight Loss registry, a database of people who had lost over 50 pounds and kept it off long term. This was the beginning of my realizing that I COULD do it but would need some help. Commitment was now tied to hope, and progress could begin.