Monday, May 5, 2014

Guest post: Gaining More Than Just Weight

Twenty pounds into my pregnancy with no end in sight, I began to dread stepping onto the scale at my Ob/Gyn appointments. Even more, I began to dread that moment in the exam room when my doctor would review my numbers for that day. My blood pressure was invariably okay and my urine dip was normal, but my weight continued to bound upwards in increments larger than what was apparently advisable. I would nod with shared concern as she read out the new tally – seven pounds since my last visit? Oh, my – and with determination as she listed suggestions to watch what I ate and try to get some exercise. Even just take a walk a few times a week, she said. The implication being, how hard could it be?

I would leave the office with new resolve to pack healthier snacks for work and to make time to go back to the gym, or at least to start taking the occasional evening stroll. The snack resolution I met with reasonable success, but the exercise portion proved difficult. Now in my second year of residency, I had stacked my schedule so as to complete my months on certain services – those with the greatest intensity and the longest hours – in the fall and winter prior to my delivery in exchange for a reasonable stretch of call-free maternity leave in the spring. As a result, I left the hospital each night in darkness, exhausted. I stopped even pretending that I might stop by the gym or venture out along the icy sidewalks near my home. Besides, I spent at least half of every shift on my feet, rounding on the wards or hurrying between emergencies. Surely all that activity must count for something.

Hoping that my mediocre efforts had paid off to at least slow the accumulation of pounds, at the next visit I would slip off my heavy Dansko clogs, get back on the scale, and watch as the medical assistant slid the little weights ever further to the right in order to balance my growing mass. Then the entire scene would repeat.

Eventually I gave up.

My new attitude was a mixture of It’s no use, I can’t, and Why bother. I was doing what I could, I reasoned, and if I gained some extra weight, so be it – I would work extra hard to lose it after the baby arrived. I continued to attend every check-up, only now when I nodded at the numbers, my concern was only mild and my determination feigned. I left the office feeling a combination of relief and resignation, already dreading my next appointment.

And suddenly I was not so different from my own clinic patients and their families: from the children and teenagers whose growth curves make me cringe as they surge skyward, brazenly crossing percentile lines, and from the parents (often overweight themselves) who grimace when I show them this evidence of too much intake and too little output – it’s that simple, I explain. They nod earnestly as I outline a plan of attack: cut out soda and juice, add vegetables, find time for exercise. And they look abashed when they return months later to find the curve inching ever onward in the wrong direction.

I’ve been lucky in terms of weight for most of my life. Sure, I’m a fairly typical female; I have certain body parts that I find too loose or jiggly or poorly shaped and I’ve spent too much time staring from different angles in the mirror, obsessing over these flaws. I have gained and shed pounds according to my level of stress and just how hard – probably at times too hard – I have worked to lose them. But I have never been truly overweight, never begun to dance with the complications of hypertension, diabetes, sleep apnea. Never before had a doctor grow concerned about the number on the scale.

And because I had never been in their position, I had never understood how difficult it is to try to get out of it. My belief and the implication of my advice had always been: how hard could it be?

Now I knew. The specifics of our challenges aren’t exactly the same –many of my patients can’t afford to join a gym whereas I pay for a membership and don’t go – but if neither if us is working out, what’s the difference? We’re both gaining too much weight too fast and have been unsuccessful at making the changes our doctors push for. And we’ve both felt bad about it.

I didn’t suddenly develop a grasp of how to move past the roadblocks in my life or theirs. If anything, this new knowledge makes my job even more frustrating and my motivational interviewing less motivational; how can I enthusiastically pitch ideas that, given the backdrop they are set against, are so unlikely to work? What I did gain was new understanding and empathy. And while I don’t have any brilliant solutions to offer to busy, tired people with potentially limited resources who are struggling with the trials of diet and exercise for themselves or their children, I hope that I am better able to partner with them to search for solutions or simply provide support now that I have stood in their shoes . . . on the scale.



I am a second-year pediatrics resident and mom to a 2-month old boy. I blog about my experiences at The Growth Curve (www.thegrowthc.wordpress.com).

3 comments:

  1. Beautiful post. Reminds me of how my experience of my brother's illness gave me more understanding as a third year med student on clinicals.

    The issue of weight control is so complicated. I don't think we will ever get a handle on it if we continue to let our society barrage us with processed and junk food ads from the time we are little. We learn that food is comfort and food is good and any moment of weakness becomes a set up for overeating. Plus all our bodies are different and respond differently to eating at different times in our life. When you turn on the airbrushed, beautiful faces thrown at us from every direction in the media its hard to remember that we are all human and have cellulite and sagging skin as we age and that tends to compound an already spiraling issue.

    I could go on and on:). Thanks for sharing.

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  2. You are supposed to gain weight in pregnancy. I hate to see our national obsession with weight ruining so many womens' experiences of their pregnancies, which are supposed to be one of the happiest times of our lives. Here's a post I wrote on the topic not too long ago.

    http://www.tbtam.com/2009/03/pregnancy-week-by-week-or-pound-by-pound-2.html

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  3. I can COMPLETELY understand. I was in the same boat myself, having had a baby almost a year ago. I gained the most weight with the third pregnancy, and exceeded the recommended amount of weight gain. This third baby was also the heaviest! And now I'm struggling to lose that pregnancy weight. It's just so hard, and I can certain empathize with my patients!

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