We started talking about ways to address the weight gain and I stated the obvious: stop eating the junk, no more snacking and get back to exercise.  And therein lies my epiphany.  The weight comes on easily because all it takes to gain is eating too many calories or eating too much of the wrong thing (high fat, high sugar, low anything-good-for-you).   Know what? That’s awfully fun and pleasurable to do, too. 

But losing that weight once it’s in place is a completely different process.  It’s difficult to lose with food restriction alone.  Some will come off, definitely.  But at some point you will stall.  Why? Because when you gain weight you gain fat (unless you’re lifting copious amounts of heavy weights like a bodybuilder).  But when you lose weight, you generally lose a combination of fat and muscle, not just fat alone.  And muscle is what burns calories – it’s what makes up the majority of your “metabolism” in terms of calories burned each day.  So every time you diet, potentially you (a) actually become fatter even if the scale goes down since a larger percentage of your weight is made up by fat and (b) you slow down your metabolism making it harder and harder to lose any more weight without severe calorie restriction.

So is it hopeless? Of course not!  The antidote is exercise.  Weight bearing exercise, whether it’s walking/running/aerobic dance/weight lifting, will halt the loss of muscle while you diet, helping to maintain your current level of muscle (aka lean body mass) and maybe even build a little more.  Every pound of muscle burns extra calories each day- even while you sleep!

So while eating alone will put the fat on, only eating right and exercise together will take it off.  The combination allows you to lose the fat but still maintain your metabolism (your ability to burn calories) as well as maintain a lower body fat percentage (how much of your weight is made up by fat and how much by muscle).  Remember: the higher your body fat percentage, the higher your risk of high blood pressure, heart disease and cancer.  So don’t be a “skinny fat” person – don’t just lose a bunch of weight on the scales, but end up more unhealthy than when you started.  If you do it well, all the benefits of weight loss will be yours and are much more likely to last a lifetime.

Three or so margaritas into the afternoon, we got the bright idea to form a half marathon team in honor of little Zoe and give the proceeds to Arkansas Children’s Hospital (where she had gotten all of her care).  Needless to say, the next morning – in addition to a whopper of a hangover – I now had a commitment to propel my body 13.1 miles forward in space.  How many steps had I run in the previous decade prior to this commitment? Um……none.

But I put on my big girl panties and “trained”.  Sometimes I trained with more vigor, sometimes – like say, the whole month of November – with a lot less.  But I concluded my preparation two weeks before the race with a long “run” of 13.8 miles.  I say “run” because I would slog (slow jog) for two minutes, walk for one, take lots of potty breaks, change the channel…..anything to relieve the “ouch” of the effort.  My time? 3 hours 17 minutes.  Not really good, but the best I thought I could do.  I really wanted to do 2 hours 48 minutes which would be about a 13 minute mile, but I really didn’t see how I would shave a half hour off my time in two weeks so I didn’t worry about reaching that goal too much.

Yesterday, March 7, was the big day.  Half marathon in Little Rock.  Wanna know how I did?  Too bad, ’cause I’m gonna tell ya’ anyway.

2 hours 43 minutes which equals a 12minute 28 second mile. For 13.1 miles!! Five minutes LESS than my “I’ll never be able to do this” goal of 2:48 and about 34 minutes short of my previous “best” effort.

So what did I learn?

(1) Goals: you’ve gotta have goals.  You will never be able to fix what you don’t measure, think about and change.  If my husband (y’all know him as Dr. Hekier) hadn’t pushed me to define what time I wanted to achieve – and what pace per mile I needed to achieve that – then I never would have pushed a little harder on the hills, never would have glanced at anything but the scenery and certainly not at my watch.  If you want to lose weight, define for yourself how much you want to lose and how fast.  Each pound equals 3500 calories.  So how many calories do you need to not eat each day to reach that goal?  A goal you can measure every day or even every meal is realistic to follow and act upon.  A nebulous goal of “I want to be a size 6 by Christmas” doesn’t tell you what to do every time you sit down for a meal.  “I need to eat 400 calories this meal so I can meet my calorie deficit for today to lose one pound this week” is a measurable index.  And if you don’t meet it? Fine, you can meet it the next meal. If your goal is vague you’re much more likely to just give up and not try again next time.

(2)Amazing results don’t only come from amazing effort – sometimes they come from just some effort.  I am not a natural runner.  My legs are short, my endurance is terrible and I tend to stop any activity that starts to hurt.  I can’t tell you how many times I’d stop running and just walk when I got a little winded or tired.  But it didn’t stop me from getting on the treadmill two days later and trying again.  Over 7 months, even these half-hearted efforts made me stronger, faster and more resilient.  You may not want to eat the perfect “in the box” meal each and every day, three times per day.  But just by cutting out the junk – the chips, the sweet tea, the soda, the ice-cream – you will lose weight over time.  The harder you push – the more you stay in the box and the more you exercise- the faster the weight will come off.  But even some effort is better than none at all. 

(3) Be accountable.  I did most of my training by myself which allowed for all of the walk breaks I described earlier.  One reason I kicked tail in the race is because there were a lot of people around me who were exciting and inspiring.  There’s a lot of fun to be had in shared pain (no, really!), a lot of inspiration that comes from seeing someone older/sicker/heavier do something better than you ever could.  But it’s also human nature not to slack off as much when other people are watching you as well as the natural competitive nature that comes from doing something with another person with similar goals.  So many diets fail because we do them alone.  One of the great things about the band is that it gives you a community.  If you go to support group, you can be inspired by others’ achievements, you can get excited by their solutions to problems (e.g. night-time snacking) or if you want, you can find a friend and set up a little competition.  Who can lose the most weight in 4 weeks or who can increase their exercise time the most… or whatever.  And remember, your office visits act as automatic accountability because every 4-6 weeks or so, somebody’s gonna be watching and sending you to the principal’s office if you’re off course.  If that’s not inspiration to straighten up and fly right, I don’t know what is!

(4) Turn to experts-then actually do what they tell you to do.  With my training I did the same thing many bandsters do: I said, “I know, I know”.  I knew I was supposed to gradually increase the distance on my long run every week, I knew I should do some interval speed work on the track to get faster.  But knowing and having a willingness to do something are very, very different.  Speed work hurt, long distances can get boring.  What I wanted to do was sit on the couch and read cheesy novels on my iPhone Kindle app.  But now that I’ve caught the bug, I’m willing to look back at what a really rigorous training program looks like and I’m willing to surrender.  Yes, once per week I’ll go to the track instead of another slow run on the treadmill and I’ll do my long runs when and how they tell me to.  D’you want to lose weight? Stay in the box, eat three meals plus one protein heavy snack per day, take your multivitamin every day and exercise.  Don’t drink with your meals and don’t eat or drink crap.  Do you want to do all that? No.  We repeat it over and over and patients say, “I know, I know” over and over, but until you actually DO it….nothing happens.  I wanna crash and read books, my patients want to drink sweet tea.  We both have to make a choice, which leads me to my last point…..

(5) Success is sweeter than you can even imagine!!  When you really, really, really just don’t want to give up that third slice of pepperoni pizza, stop for just one second and think about your ultimate goal.  I can now tell you from experience that reaching that goal is an absolute slice of pure joy and wonderfulness.  And I’ve got a tangible feeling to carry with me while I train for my next race, even during those dark early morning hours when it’s cold and my nose is running and my ankles hurt.  If you get into a size 6 or 8, then even if you gain a little back, you can hold onto that feeling of goodness that comes with achievement and use it to power your drive to get back there. 

Once you achieve a goal, nobody can ever take that away from you.  If you got to a level of health or fitness or thin-ness that made your toes curl with excitement, then that is who you are.  You are NOT the overweight person you were when you first walked in this office, even if you gain a little back.  You will always and ever after be that person that achieved their goals, you are strong, you are capable but you might have just gotten off course – temporarily.  Let that person be in charge to get you back to where you need to be, not the defeatest person who failed every other diet they ever tried.  I will always be a runner now – because I ran a distance that makes most people shudder.  I wasn’t the fastest, the most graceful, the most challenged – but I was a finisher.  You may never grace the cover of a fashion magazine, but once you lose your weight, you will always be a finisher, too.  If I could, I’d even share my medal with you. Maybe.

But then a few weeks pass and dust starts to collect on the parts of the machine that are exposed.  The rest of the machine is of course, covered with clothes.  Suddenly instead of a glorious emblem of fitness, the machine is a convoluted hat-rack.  A very expensive, sometimes guilt inducing hat-rack, at that.

I may just be projecting because this has certainly happened to me with several different pieces of equipment, but I don’t think I’m alone in this.  I’ve talked to lots of people who have bought fitness “stuff” that just ends up sitting around ’til it gets sold in a garage sale at $0.10 on the dollar.

So what to do?  Here are my New Year’s thoughts on actually exercising and using what you’ve got.

1) You’ve got to like exercise before you actually do it.  If you dread it – whatever “it” is – you ain’t gonna do it.  Don’t buy a treadmill because you think using it will make you look like the skinny-Minnie marathoners in the magazines.  Buy a treadmill because you’ve got a stack of movies you’re dying to see and getting on the treadmill will allow you 30+ minutes every day to watch them.  Or better yet, because walking/jogging/running gives you a hit of endorphins that makes your whole day great!  We just got this slippy-slide thing that lets you mimic speed skating in your living room.  It’s a blast, so we use it.  But a stationary bike? Not my speed, so never had one.  Makes my behind sore.  But I’ve got patients that swear by them.

2) You’ve made your choice, now work it! You found something you like – so do it.  You can’t just go through the motions, tho’, you’ve got to actually sweat.  Are you an outdoors person and enjoy walking? Groovy – but 30-40 minute miles while chatting with a friend is called “strolling” not exercising.  If you’re a walker, pump those arms, move those legs, get some huffing and puffing going.  Here is a link to a program that will take you from barely able to walk out the front door to running (ok, slogging, but still!) a 5K. You can do it! http://www.c25k.com/

3) Speaking of intensity, here is one of the great fat burning programs of all times and it will accomodate anyone from the least to most fit, from the idle rich to hardworking folks with no extra time.  It’s called HIIT and it goes like this: warm up for 5 minutes, then for 15-30 sec exercise all out doing whatever you’ve chosen to do (run, swim, walk, jumping jacks, skipping, squats-whatever!), then go back to a restful, relaxed pace for 2-4 times that length of time, then repeat a few times.  For example, you run all out for 15 seconds, walk slowly for 45 seconds to catch your breath and let your  heart rate come down, then you repeat this cycle 10 more times, then cool down for 5 minutes.  Total time: 21 minutes.  For some people, the “all out” phase may be walking briskly, and the rest interval may need to be 5-6 times the length of the high intensity interval in order to do it again.  But you’ll find by doing this several times per week, that you’ll soon expand your exercise tolerance dramatically. Knees hurt too much to do this? Try doing it by tossing a basketball in the air or throwing it hard onto pavement instead.  There are all kinds of upper body-only exercises that will allow you to raise your heart rate in the high intensity phase.

Now get moving!

All of the following can be considered equivilant to a “moderately” strenuous exercise.  What does that mean? A brisk walk (15-17 minute miles), pick-up basketball, riding a bicycle at a pace that allows you to carry on a conversation – all of these are “moderate” exercises.  For a woman who weighs 140 lbs, an hour of doing any of the above would burn roughly 370 calories per hour.  To get a rough estimate of how much you would burn doing these exercises, divide your weight by 140 and multiply that answer by 370.  It’s not superscientific, but it will give you a rough estimate of the calories you’re burning per hour.  Men weighing 170 lbs will burn around 470 calories doing the same activities for an hour (sorry ladies, they’ve got more muscle than we do so they burn more calories per hour).

So back to everyday stuff that’s the same as moderate exercise: washing and waxing your car (by hand, not in a drive-through carwash), raking leaves (’tis the season again), washing windows, and even walking up stairs (‘tho you can do this for about half the time to burn the same number of calories).  Other possibilities depending on vigorously you pursue them: weeding, mowing the lawn with a push mower (not a riding lawnmower) or spring cleaning the house (like scrubbing baseboards, vacuuming every square inch of floor, scrubbing tiles).

If you find it hard to stick to a fitness program, consider any of the above for 30-60 minutes as a reasonable substitute.  Exercise is movement and getting your heart rate up, so to quote a famous shoe company, “Just Do It.”  You don’t have to pay hundreds of dollars per year to join a fitness club (although we highly approve of that if you then actually go to said fitness club regularly) – if you just can’t make it to the gym, wash your car.  You’ll be healthier and have a shiny car to boot

“hey !!! I’m up to 45 minutes of slog time out of my 1.25 hours and 4.7 miles of exercise 3 times weekly, and every single time i add slog time and decrease walk time i am exhilerated. hurt… you bet it hurts, but i’m doing this, me, and nobody else !! the pain of accomplishment is so different from the pain of indifference it’s phenominal. everytime my foot hits the ground i pray for strength, and thanks to people around me, I HAVE TAKEN MY LIFE BACK !!!!!!!!!!!!!!!!!!! my fisrt race will be the quadrangle with my fitness trainer daughter, and i’m so excited, i also turned 55 last month, and i’m gonna live forever !!!!!”

Some of you may have read my earlier post (if not, see it here http://blog.noscales.com/working-through-the-tough-times.html) about my recent quest to start running with plans to run the Little Rock half-marathon in March, 2010.  Granted, my commitment came from the stupidity granted me by several Louisiana margaritas, but now that I’ve started slogging (that would be slow-jogging since I don’t think I can call what I do “running” per se) it seems like I’m part of a growing movement.  Our Nashville Band group is running a 3K this month and the Mt. Pleasant folks got together a group for a 5K in October.  A patient who happens to work as a nurse in a busy ER and is a grandma in her spare time, used the program “couch to 5K” to go from a complete non-exerciser, to a 30 minutes, 3-4 times per week runner and I think she’s planning on running in the Komen 5K next month.  Look here for more information on this program http://www.coolrunning.com/engine/2/2_3/181.shtml.

I bring all this up because I guarantee that before surgery none of these people would have ever considered running (and, yeah, I changed my mind – any movement above a walk – even if it’s a shuffle – is still RUNNING) as an exercise they could do, much less run in a public race.  Yet here they all are, doing just that.  I’ve exercised almost all of my adult life, but running still seemed out of my reach until I stopped messing around, picked out a program on the internet (http://www.jeffgalloway.com/training/index.html) and just started doing it.  Betty May’s daughter saw me at the gym after one of my runs and she had this look in her eye that said, “wow, please don’t die… I don’t know CPR!”  But as ridiculous as I look with my beet red face, dripping sweat (no gentle glow here, folks) and dumb t-shirts, I’m still going out and trying to do it.  And you know what? It’s actually kind of fun.  Okay, not the chest pain part, but there is definitely a happy glow that comes with running that I’ve never experienced with any other form of exercise.

Walking is good, but by trying to run forces you to push your limits and not just stroll around and then being shocked when the scale doesn’t budge.  Try it! You might just find yourself next to me at the gym.  Just don’t make fun of me

1)  I have kids (or grandkids) that I chase around.
Nope, sorry that is not exercise unless your 4 year old is running around a track for 2 miles.

2)  I’ve got a lot of acres on my property and I clean brush and tree limbs.
Not going to cut it, that’s not exercise.  Before you tell me I’m a city slicker that doesn’t understand manual labor, as a high school student and college student in Los Angeles I had summer jobs with contractors and landscapers and worked in 110 degree heat digging, building, cutting, sawing, and everything else in between.

3)  My workplace is in a large plant and I do a lot of walking.
Unless you are walking for about 30 minutes straight at 3 miles per hour, that doesn’t cut it.

4)  I do [fill in the blank]  and I know it is good exercise because I sweat a lot.
Sweat doesn’t mean it is good exercise.  Get a heart rate monitor instead.  A high heart rate indicates adequate exertion.

5)  I mow my lawn on a riding mower and it is very bouncy.
Are you freaking serious?  Bouncing is not exercise.

6)  I clean my house.
Once again, not exercise.  If you think it is such great exercise, I will give you my address and you can clean up after my 7 and 5 year old daughters.

7)  I walk with friend.
If you walk with your friends and catch up on the latest gossip, you aren’t walking fast enough.  Remember, exercise is supposed to be hard.  If you can easily carry on a conversation during your activity, it probably isn’t adequate exercise.

In order to reach your weight loss goal with the Lap Band, you need to exercise.  Enough said for now.

That’s a tough question to answer because it’s different for every person.  Increasing age decreases the elastic stretch of the skin, so older patients are less likely to have their skin shrink back with weight loss than younger people.  Smokers’ skin is dramatically less elastic (which is why they have such dramatic face wrinkles) so they, too, are more likely to have loose skin after weight loss.  Women who have dramatic stretch marks after pregnancy also are more prone to loose skin, especially on the abdomen, given that the skin there has already been over-stretched. 

But all of that is variable: we have patients in their 60′s with minimal loose skin and smokers with no batwings whatsoever. We can’t predict ahead of time which category you will fall in, so it’s a little bit of a dice roll- you’ll just have to see what it looks like when you get to your goal weight.

Having said that, there are things you can do to help loose skin recover as you loose weight.  Remember first that the weight and the skin stretch didn’t happen overnight, so it may take significant time for the skin to recover.  Many plastic surgeons advise waiting for up to two years after you reach your goal weight before doing any surgical procedures for your loose skin.  This is to allow enough time for your skin to “shrink” some on its’ own and to make sure that you are nutritionally stable before trying to heal a major incision. (People in active weight loss phase are “catabolic” meaning they are breaking down, not building up tissues which is counterproductive to healing).

While you are losing weight and while you are waiting your waiting your two years, here are some other things you can do.  Exercise dramatically improves skin quality in several ways: it increases circulation to the skin, it decreases the subcutaneous fat under the skin and it improves the “frame” on which the skin is draped.  All of these improve overall body/skin appearance.  Taking a multivitamin every day, especially with Selenium, vitamin E, C and A will help with skin elasticity.  Smokers benefit from extra helpings of folic acid, B6 and B12 9which can be found in combination in many drug or health food stores).  Adequate protein is crucial, and soy protein appears to have a slight advantage over animal based proteins (like chicken and beef) when it comes to skin health.

Keeping your skin in optimal condition from the outside in is important, too.  Exfoliate your skin with a loofah or buff puff while in the shower or bath, then immediately after bathing and drying off, apply moisturizer with aloe and/or shea butter all over your body.  This gets rid of old dead skin cells on the surface which can trap free radicals causing skin damage and then the moisturizer protects and nourishes the new healthy skin revealed underneath.

After all is said and done though, I want you to remember this: even if you end up looking as wrinkled and saggy as a Shar-Pei dog when you reach your goal weight, I guarantee you will be a happier healthier person than if you were overweight but with cheeks and tummy smooth as a baby’s behind.  Don’t let the fear of loose skin be an excuse to keep you from losing your excess weight.

TIP 4:  always take the stairs.  Although you will not lose 100lbs doing it, every extra calorie you burn helps get you toward your goal a little quicker.  I have seen estimates that just by taking the stairs instead of an elevator, you can lose 11 extra pounds per year! Consider that free weight loss without having to suffer calorie loss

TIP 3: watch out for “naturally” sweetened products or “organic” products. Just because the sweetening isn’t sugar doesn’t mean it doesn’t have lots of calories! “Natural” brown sugar and honey have as many calories as sugar. “organic” just means it was grown without chemicals, not that it is low-calorie or even particularly healthy for you in other ways.

TIP 2: When you go out to eat in a restaurant, ask for a “to go” box when you order your meal. Yes, this may seem a little odd at first, but if you carve out the portion you’re supposed to eat and put the rest away in a box at the very beginning, you’ll be less likely to overeat at your meal. Plus, it will mentally prepare you/remind you to eat only what you’re supposed to and not everything that’s put before you.

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A recent comment on one of the posts suggested we start a “Tip of the Day” section which I think is a great idea.  I’m not sure if I can actually manage to come up with a new quickie idea every day, but I’ll try to post a tip at least 4 times per week.

So with no further ado, my first quick tip: Find something to mentally distract you while you work-out. If you can hear yourself panting, huffing and puffing it will make you feel more fatigued than you really are and make you quit a lot earlier than your body really needs you to.  Playing music on headphones serves this purpose well, but studies have also shown that if you play music with a moderate to fast beat, you’ll actually walk/jog/gazelle at a faster pace and therefore burn more calories.  TV also works well as does exercising with a friend or in a super pretty place (like a beach).

After a few days of staying there, I came to the conclusion that it’s simply fun to be in shape in San Diego.  It’s often sunny, about 65F in the morning with a high temp of about 73F and has a cool breeze coming in off the ocean.  No matter how dedicated a couch potato you are, you can’t resist the simple pleasure of walking/slogging/running along the beach with the seagulls flying overhead and scores of young, handsome servicemen running along with you (there are at least two Navy bases in SD).  There are lots of marinas with boats to sail, both open ocean and sheltered bays to swim through, lots of flat waterside streets to rollerblade along.

Sounds just like Texarkana, right? Well, okay, maybe not.  It’s hot as the inside of a brick pizza oven here for 4-6 months per year and I definitely look like a piece of pizza that’s been left in too long after I work out in the sweltering heat.  There aren’t many public parks with jogging or biking trails and running/biking on the roads can be hazardous given the lack of shoulders on most of the major thoroughfares (and a plethora of crazy speed demons just itching to mow you down).

But despite the heat and the lack of trails and the crazy drivers, we can still learn something from the lovely people of San Diego.  And it is this: if you can find something you enjoy doing for exercise, you’re more likely to do it, you’re more likely to stick with it and you’re more likely to reap the rewards.  If exercise becomes something you have to do, it’ll just end up as one of a million obligations you already have – and likely resent.  Exercise needs to be a fun part of your life, not a chore; a time for yourself and a time to relax, not something you dread.  I’m not a huge treadmill fan, but I love slogging outside.  I really dislike big aerobic classes, but love being by my lonesome on the elliptical.  But there are lots of people who feel exactly the opposite.  The point is to find what YOU like, what YOU’ll stick with and what YOU’ll enjoy – then go do it.  You don’t have to be a jock (I’ve never read an issue of Sports Illustrated in my life) but you do have to incorporate fitness into your world in order to lose the weight you want and keep it off for good.  And, by the way, look good doing it.