PREVENT WHAT DOES IT TAKE?

WRITER: RICHARD T. BOSSHARDT, M.D., FACS

“AN OUNCE OF PREVENTION IS WORTH A POUND OF CURE.”

—BENJAMIN FRANKLIN

When you are training for a full Ironman triathlon, there is lots of time for reflection on those one-and-a-half hour swims, two-plus hour runs, and five-plus hour bike rides. Your mind can be your best friend or your worst enemy. Where are spiritual battles, moral/ethical battles, and battles of the will waged? Yes, they are waged in our minds. Our thoughts, in turn, lead to our actions.

The old cartoon where the character has a little angel on one shoulder and a little devil on the other, both whispering conflicting advice, is not too far from reality. In truth, we have two natures in us. One is good, moral, disciplined, industrious, etc. The other is exactly the opposite. It is not exaggerating to say they are constantly at war with one another. In an old Native American tale, a grandfather tells his young grandson that inside every person are two ravenous wolves, a good one and a bad one. The wolves are symbolic of our contrasting natures and are constantly locked in a titanic struggle. Mesmerized, the little boy asks, “Grandfather, which one wins?” His wise grandfather answers, “The one you feed.”

Therein, as the Bard said, lies the rub. Which one are we going to feed? Without a doubt, it is a lot easier to “feed” our nature that is lazy, self-indulgent, and undisciplined. This side of our nature is also prone to make excuses and rationalize all sorts of reasons why we enable it. Think about it. Which is easier: going through a fast food drive-thru and spending the rest of the evening on the couch in front of the TV or taking the time to buy fresh ingredients to prepare a healthy meal and exercising for an hour? I think this question would qualify as a no-brainer.

A good example of this struggle is the issue of obesity. Some readers who have followed my writings on medical matters through the years would argue that I am obsessed with this issue and/or that I have something against overweight people. The former is probably true to a significant degree. The latter could not be further from the truth. The fact is the statistics on obesity in the United States are positively frightening. Two-thirds of adults in the U.S. today are overweight, and one-third have crossed the line and fit the medical definition of obesity. The number of children who are overweight has doubled in the past decade and for adolescents, the numbers have tripled.

Women and men carrying as little as 22 extra pounds have greatly increased risks of heart disease. Weight gain of as little as 18 pounds doubles the risk of Type 2 diabetes, an illness whose frequency has increased 50 percent in the past decade.

With ever increasing frequency, overweight children are developing “adult” illnesses such as high blood pressure, elevated cholesterol, and adult-type diabetes. Some experts say the medical costs of obesity may overwhelm our health care system in the next decade. Personally, I don’t think there is any “maybe” about it.

As a physician, I know all too well that the issue of obesity is complex. There is much more to it than just people eating too much and being too sedentary. Research has uncovered genetic factors that impact how people process food, how fat is metabolized in the body, and how people process, utilize, and store energy from the food they eat. In a classic line from the old situation comedy “Rhoda,” actress Valerie Harper, while holding a cookie in her hand, observed, “I don’t know why I bother eating this; I should just stick it on my thigh.” Yes, some people put on weight more easily than others. However, to blame everything on genetics — something we cannot control or change — is a cop out. We are not plants, after all, and cannot manufacture calories and fat from thin air and sunlight.

One of the recent, exciting discoveries of genetics is that even though we may have genes that predispose us to certain things — mental illness, heart disease, high blood pressure, diabetes, a number of other medical problems, and yes, obesity — those genes are not necessarily always expressed. There are many “regulators” that can turn on or off certain genes so they never create the medical problem for which they are programmed. Some of these regulators are nothing more than lifestyle decisions.

I was at the local YMCA recently and could not help but notice a grossly obese man who was working with one of the personal trainers. It only took a few moments of observation to determine he was new to the gym. The Y has a great program called “The Coach Approach.” Members of the Y have access to a personal trainer, free of charge, who teaches them how to use the equipment. The trainer will also assess their capabilities, design a program for them, help them get started, monitor their progress, serve as a mentor, and encourage newcomers in hopes they will keep up with the program until they begin to see results. That’s when things get exciting. I don’t know what it was that got this man into the Y in the first place, but if he sticks with it, who knows where he might be in a year?

My question to readers is this: what will it take? What will it take for you to begin to feed the good wolf? Will it be a heart attack? Stroke? Your doctor telling you that you are now a full-fledged diabetic and need to start medication? Perhaps it will be when your knees are shot and your doctor isn’t too thrilled about doing a knee replacement on someone your size. Maybe, it will be seeing your children following in your footsteps. That can be very motivating when you realize that your decisions affect not only you but also the next generation.

It has been said that in life you will pay either the price of discipline or the price of regret. The former is dirt cheap compared to the latter. Which will it be?