The secret to weight loss

I thought I'd take a divergence from pediatrics for those of you who may be reading that don't have small kids and talk about something I have very intricate experience with... weight loss. Of course pediatricians don't have to deal with weight loss right? The sad truth is incidence of childhood obesity and diabetes increase every year. But more importantly, 3 years ago I was 50 pounds overweight, and decided I needed to change my habits. I lost 50 pounds in about 6 months (which I acutally don't really recommend).
Here was my 'after' photo:

Everyone asked what my secret was, but after I told them they always seemed disappointed. Its actually quite simple (conceptually at least).

Here it is:
Calories eaten - calories burned = weight loss or weight gain

Sorry, I know you were looking for an easier way. But the secret is, there are no shortcuts. When you are ready to accept this reality, you are ready to make some positive life changes that will help you lose weight and keep it off. If you are looking for a shortcut, you will continue to fight a losing battle. Don't get me wrong, I think there is a place in this world for crash diets.. a wedding coming up soon and you need to fit into your dress, the Oscars are coming up and you don't want Joan Rivers to mock your bulge, or you are appearing in the latest "Men on a Mission" Calendar:

But crash diets have no place in the quest for long term weight loss, and most of them will make you end up heavier than you were before you started. Its the truth!

A good friend of mine in medical school had a million dollar idea... He was going to mow his lawn and package it into capsules and sell it as a weight loss supplement. He was going to sell it as a 'doctor recommended' item. On the packaging of the supplement he was going to make sure to include the footnote *best results obtained when combined with low calorie diet and regular exercise. That is the basis of all the 'tricks' to lose weight... they work well if you exercise more and eat less.

I'll post more in the future (I'm trying - but not succeeding - to make my posts shorter) on the things I found to be the most helpful in my weight loss quest, and maybe they will help someone else. Just being the kind of person I am, I heavily researched it before I jumped in, and at the time felt I could write a book on it. But I figured no one wants to know that weight loss takes a little work, and there's actually a million books out there that already say that.

Here's a little tidbit of knowledge that can take you a long way: A 12 oz can of soda is about 150 calories. To cut one can out per day, you decrease your calorie intake by about 55,000 calories per year. For most people that would result in a 9-10 pound weight loss in a year. In fact, I lost my first 10 pounds by deciding to drink only water and lots of it (and an occasional glass of milk), but I ate pretty much the same. I lost 10 pounds in two months with just that change. Try it!

I've been waiting FOREVER

Why do I have to wait soooo long when I get to the doctors office? The reasons are numerous. Many times you have a slow doctor that frequently gets behind. Many times (as is the usual problem with my personal clinics) the patients earlier in the day were late, thus putting the clinic behind for the rest of the day. I can't tell you how many times I've been twiddling my thumbs early, only to be totally slammed later. But probably the thing that backs up the clinic the most are lame complaints. (Is it still PC to use the word 'lame' or is is offensive to the weak and/or paralyzed members of the community?) Yes those complaints that really should have just stayed at home and saved the copay. Let me first say that I came from a family where you had to be dying to go to a doctor, and in fact I was once at home with a broken collar bone for a week before my parents took me to the doctor. I'll outline some of these complaints and we can all save some time together, starting today with:

My all time most annoying complaint:
Dr. Jay, my son woke up with a temp of 100.3 today, and I just wanted to bring him and make sure everything is okay. No he doesn't have any other symptoms. Can you please tell me what to expect?

Point 1 - The definition of a fever is 100.4 or higher. Some physicians are very strict about this and won't even listen to you unless it is measured rectally, as that is the most accurate way to measure. I for one, am not that picky (my wife will laugh because I used to be), and have never measured my childs temperature rectally, so wouldn't expect that to happen with my patients, either. The studies to compare rectal vs axillary (armpit) vs oral vs forehead/temple have all been done with pretty poor scientific reliability. So I don't usually subscribe to the add one degree here or 0.5 degrees there philosophy. Truthfully, the exact height of the temperature in kids doesn't really make that much difference until you get to the 106-107 range (unless you are dealing with a newborn - less than two months - in which case you want to let your pediatrician know about any fever over 100.3). Please don't use the kind of thermometer pictured below. It won't give you the desired results.

Point 2 - Lets assume the fever is for real (and not just due to overbundling a baby or running a mile); it just started. It is very difficult to determine where a fever is coming from on the first day, as it will most commonly just precede a cold. Just wait a day or two to see what happens. If cold symptoms develop, there you go... a cold. Some kids get a fever for a couple of days and nothing else and then a rash all over after the fever is gone. This is called roseola, and you definitely need to see the doctor for this right? Nope. The rash is the extent of the illness, and your baby doesn't notice it and it doesn't last long. I usually spend a significant amount of time preparing for the many things that could come up to save the next days annoying complaint: "Dr. Jay, my son has a runny nose, so now what do I do." We'll talk about annoying cold complaints in another post. I'll do it soon, as it is cold season and all.

Point 3 - Many times a parent says, "I just want to make sure the ears are okay," at this point. Ear infections typically come AFTER a cold or late in a cold, so this early of a check is usually completely worthless.

Point 4 - Coming in early in the course of a fever may result in more invasive evaluation that may not have been needed. If you bring a child that is less than 6 months with a fever and no other symptoms, many doctors will feel the need to find the source. This will include blood tests and urine tests. And since most 4 month olds aren't good at peeing in a cup it will buy him/her a catheterization of their bladder, which most people find uncomfortable. Two hours later they get a runny nose, and we say, "Now we know where the fever came from, too bad we did all those mean things to the baby." I personally won't usually chase a fever in a baby (unless less than 2 months old) on the first day unless it is high (>103) or the baby looks sick, but many doctors will. I won't ever chase it in a bigger child unless it is >105 or there is something else going on (but then I guess that takes away the fever with no other symptoms distinction).

This visit usually ends with me saying, "Your child looks perfectly fine. I can't tell you what's causing the fever, or if it is even a fever. I can't predict what's going to happen the next few days, but your child will likely be getting sick." This kind of answer is unsatisfying for the patient and the doctor, so please wait at least a couple of days before coming in (unless a newborn, but you already picked up on that). The only time I feel a fever, in and of itself, NEEDS to be seen is after 5 days with all other things being normal and the patient is >12 months old.

Bonus point: Q: At what temperature is it best to give tylenol/motrin? A: At the right temperature (or any other smart alec remark you want to insert). Stop getting hung up on numbers (this was actually hard for me personally to do). Give the medicine to your child, not to the temperature. If your kid's temp is 99.1 and they look miserable, give them the medicine. If your kid's temp is 102.5 and they are happy and running around like normal, don't give it to them. A fever is a good thing when you are sick and helps your body get better. There is no reason to bring it down unless your child is miserable.

Bonus bonus point: Tylenol/acetaminophen vs motrin/ibuprofen. Motrin works better for both pain and fevers, in my opinion, but comes with more side effects. These include stomach upset and, in rare cases, stomach bleeding. So if you give it to your child, give it with some food. I personally give my kids tylenol first and if it isn't cutting it, add the motrin. So, yes, you can give both. The most frequent you can give tylenol is every 4 hours, and motrin every 6 hours. Giving them both does not affect these frequencies. In other words, they don't interact, so you can still give tylenol every 4 hours counting from the last dose of tylenol, not the last dose of motrin. Some parents find it beneficial to alternate every 3 hours, so there is always new medicine coming in and each medicine is spaced from itself by 6 hours. I don't personally do this because, as above, I treat my child not the fever, and people who do this tend to be more obsessed with the actual the fever itself, rather than how their child looks/feels.

Pick a winner!!!

Okay, well I decided to start blogging. I mainly did because I enjoy my cousin’s blog so much and hearing what he has to say on different issues. Since I’m attempting to remain somewhat anonymous, let’s just say his name is ‘Brian Smith’, which is a generic name that is nothing like his real name. I thought maybe someone might be interested in what I might have to say about things, too. Either that or I’m getting more and more narcissistic in my older age. Which could easily be the case because I’ve spent a lot of time around surgeons, and I did take that class in medical school, “How to act really important around non-physicians.”

I think I do have a unique perspective to add on a variety of subjects, but people are probably most interested in hearing what I have to say about kids. So I will post about anything that happens to be on my mind at the time, but most of my posts will probably center on being a pediatrician. And I’m sure a post or two will pop up about prop 8, since I am Mormon, even though the election is over, it seems to be an issue that will never go away.

You should listen to what I have to say, because I AM A DOCTOR! (please read sidenote about italics = sarcasm). Actually that leads to the first subject I thought I would post about… picking a doctor. I have been scared many times by parents in my office who disagree on a certain issue, and I come down on one side of the fence. Then one parent says to the other, “We need to listen to him, he is a doctor!”

Let me say, I have met many people along my trek in medical school and residency that I would not want near myself or any loved one of mine. And I picture these people telling patients (and their parents) what to do, and those people saying, “We need to listen to him/her, he/she is a doctor!”

So how do I know whether my doctor is a quack or stud? Well I know lots of people who go to him and everyone loves him! Nope. One of the scariest realizations I had in residency was that some of the worst doctors were the most popular ones. Their clinics were always full and their patients/parents LOVED them. I also know popular doctors that are good, too.

Here’s the point were I give you the solution to the problem, because I HATE when people bring up problems and no solutions. Oh wait, I guess I don’t really have one. If you have a doctor friend you can run things by them to see if what they say makes sense. But then again your friend may be a quack, too. You could check their malpractice record, but that is likely to be deceiving, as many of these docs are loved, and loved doctors don’t get sued.

Okay, here’s my take home message: Always keep your mind open. Don’t take everything your doctor says as gospel. I’m sure I will have a future post about ‘scientifically proven facts’, but here’s the readers digest version: there aren’t many out there. Do your homework and don’t be afraid to think for yourself. And if you are diagnosed with a something serious, or think you have something serious and your doctor is blowing it off, don’t be afraid to get a second opinion. But whatever happens, please don’t get your second opinion from Jenny McCarthy! (there will also be a future post re: vaccines and autism)

*** And if you are one of my former classmates and you are reading this, and you think I'm talking about you as one of the quacks, here is my response: No, I'm not talking about you. It's someone else. You are a wonderful doctor.