A Turning Point

A Turning Point

From Chicken Soup for the Soul: Say Hello to a Better Body!

A Turning Point

Saying Hello

For over twenty years I’ve practiced medicine while my husband and I have raised our three kids. It’s been a life filled with joys, challenges, disappointments, and pleasures: building a family and career, caring for aging parents and growing children, finding time for friendships, traveling, reading, gardening, volunteering, and, too rarely, just relaxing.

Whether you’re married or single, a stay-at-home mom, retired, or work outside the home, live in the U.S., Canada, or elsewhere, I’m sure that as a woman over fifty you can recognize yourself in the picture I’m painting of a full and busy life.

As a woman over fifty reading this particular book, there’s something else to which I think you will relate:

All during this time, amid these varied activities, one theme was constant for me, like a drum beating insistently in the background: concern that my body was not as healthy as I wanted it to be.

By my thirties I’d moved beyond the years of fad dieting and obsession with a particular weight or jean size that had dominated my teens and twenties. But, as a young and then early middle-aged mother and doctor, I often ate too much, exercised too little, didn’t get enough rest, and responded to the stress of increasing responsibilities at home and work by simply pushing myself harder.

Sometimes, for weeks or months at a time, I ate more healthfully, exercised more consistently, and made more time for relaxation. But these efforts always felt like, well, efforts: tedious and, inevitably, temporary fixes. And with each lapse back into old habits my confidence eroded still further that I’d ever be fit or make peace with my body.

When I turned fifty, yet a new variable entered this seemingly unsolvable equation: menopause. Practically overnight, I gained fifteen pounds, all in my waist — which had always been my trimmest area. Joints I didn’t even know I had started to ache. Fatigue, which previously descended late each afternoon, began arriving earlier each day. My panicked attempt to reverse these changes with too-vigorous daily running resulted in a knee injury requiring surgery.

I wondered if I was destined to grow old and out of shape, having never really been in shape in the first place!

A turn in this discouraging state of affairs came from an unexpected source: my patients. Though, over the years, I’d tried just about all the usual (and some unusual) ways to lose weight and get fit that millions of other women have tried — too numerous to mention diets, exercise regimens, and even liposuction (it was new and they were offering steep discounts to student “guinea pigs”) — it turned out that I had one avenue not available to the average woman: I acquired expertise in the medical management of obesity.

My colleagues began to refer patients who struggled with their weight. I counseled these patients — mostly women — about how shedding excess weight could reduce their risk of heart disease, certain cancers, and a wide range of other conditions, including arthritis, depression, and sleep disorders. I helped them sort out the pros and cons of weight loss drugs and surgery. I reviewed their diets and exercise routines. And, in the process, I learned much that should have helped me get healthier, too.

But… it didn’t.

After a while, I wondered if simply giving my patients information about weight loss and health was enough. After all, I’d learned lots of facts about nutrition and exercise, and I still struggled with my own weight and health habits. Let’s face it: knowing how many fat grams are in a slice of pizza or how many calories are burned by jogging a mile (about 10 grams and 100 calories, respectively, in case you were wondering) is one thing, and passing up the pizza or saying yes to the jog are another. How could I best give my patients not only the information they needed, but also the tools to act on it — and not only for a few weeks, but for life?

You know the old proverb: “a problem shared is half solved?” I became convinced that rather than meeting with my patients one at a time, it would be beneficial to have them meet in groups so they could trade tips, and compare triumphs and struggles as they worked on losing weight and getting fit. I knew from what patients had confided to me over the years, and from my own experiences, that being overweight can feel very shameful and isolating. It’s a huge relief to find out that you’re not the only one who’s ever hit the fast food drive-thru on your way home to dinner, hidden candy wrappers at the bottom of the garbage pail, or paid for membership in a health club you’ve never set foot in — and hugely motivating to hear that someone else managed to stop doing these things. Several studies support my impression that losing weight and exercising with a group or a buddy is more likely to lead to success.

So, with some of my colleagues, I started a group program for patients with diabetes, high cholesterol, and other conditions related to being overweight and inactive. Once a week we meet in a hospital conference room. Over yogurt, fresh fruit, and other healthy snacks, we talk about portion sizes and saturated fat, hamstring stretches and pulse rates, yoga and cardio. But the main thing we talk about is how to change our minds. For nearly all of us — and I include myself along with the patients here — the most challenging part of getting healthier is leaving behind decades of self-blame, perfectionism, and unrealistic expectations.

And the most powerful tool in changing our minds is hearing one another’s stories, as you will in this book, which is like a weight loss and fitness support group you can hold in your hand.

As the weeks go by, new habits slowly replace old ones and participants begin to feel healthier, leaner, and calmer, mostly by adopting a few simple strategies. Here are just a few of those strategies — ones that I, as well as my patients, have found most useful:

• Don’t Follow Rules — Change Habits. Instead of worrying about downing eight eight-ounce glasses of water a day, focus on keeping a water bottle on your desk and kitchen counter and drinking from it often. Instead of counting saturated fat grams, start cooking with olive oil, low-fat dairy products, and leaner cuts of meat or vegetarian proteins. If the gym’s not your thing, walk, take dancing lessons or plant a garden. Rules, as the saying goes, are made to be broken, but habits become part of your identity.

• Make It Easy. Join the pool or fitness club closer to your home or work. Stop buying chips and cookies “for the kids.” (When they’re over fifty, they’ll thank you — obese children are much more likely to become obese adults.) Pack your lunch and gym bag the night before. The time most critical to the success of a weight loss or fitness plan are those few seconds when you’re deciding: “Should I eat this, or that?” “Should I exercise, or skip it?” Make it as easy as possible to choose well by removing as many obstacles and temptations as you can.

• Change Expectations. Erase all the old “tapes” that have played in your head for years and have never helped you get fit. You know the ones I mean: I need to lose two pounds every week. I need to get in shape by summer, etc. I’ll talk, at the end of this chapter, about other stale and unrealistic expectations that are best abandoned.

Meanwhile, you can also, gradually, change your family’s expectations about your behavior, about what kinds of foods you’ll keep in the house, about the amount of time you need to take care of yourself, etc. You do this not with grand pronouncements such as “I’M ON A DIET!” or by asking your family to police you — how well has that ever worked? — but by the way you act, day in and day out. For example, my kids never call my cell phone, except for an emergency, during that regular hour when they know “Mom’s working out.”

• Get Support. Though groups such as the one I run, or those offered by commercial weight loss programs, can be very helpful, support comes in many other forms. A personal trainer, a walking buddy, or a yoga or healthy cooking class can all aid your fitness efforts. Any person or group who notices when you do or don’t show up, applauds your progress, and cheers you on when you’re feeling discouraged counts as support.

In this book you’ll find lots of information about diet, exercise, stress management, injury prevention, and the countless health benefits of achieving and maintaining physical fitness.

But, even more importantly, you’ll learn from the stories what the patients in my group have learned from one another: how to leave behind some of the psychological baggage that’s been keeping you from incorporating this information into your daily life — your crazy, busy, wonderful life.

Not one woman who tells her story here achieved a “perfect” body, ate a 100% healthy diet, or exercised every single day without fail. Yet, I think you’ll consider their stories successes. And the secret to these successes, as you’ll see, lies in persistence, flexibility, and a sense of humor.

Be prepared to be inspired by a menopausal tango dancer, a middle-aged novice cook, a ninety-two-year-old yoga practitioner and many other women who decided, that over fifty is the perfect time to say hello to a better body.

I know I am.

Not Your Mother’s Menopause

If you’re a middle-aged woman, and you have the feeling that everything is changing — you’re right!

First, there are the changes happening outside your body: your kids are likely leaving home or close to doing so; your parents need more of your attention, or pass away; your spouse, siblings, and friends start having health problems and/or think about retirement; and divorce, re-marriage, downsizing a home, and re-entering (or leaving) the workforce are common and dramatic transitions at this time of life.

Then, there are the changes happening inside your body: Usually beginning in a woman’s early forties, the ovaries start decreasing their production of the hormone, estrogen, that makes pregnancy possible. This phase is called perimenopause. Eventually, the ovaries shut down altogether and menopause occurs. A woman is considered menopausal when she has stopped having menstrual periods for one year. The average age of menopause in the industrial world is fifty-one, though some women go through menopause as early as their late thirties and some as late as sixty.

The decrease in estrogen levels, as well as fluctuations in two other hormones — progesterone and testosterone — can cause women to experience many different symptoms and feelings. Some of the more familiar of these are: hot flashes, night sweats, weight gain, irritability, insomnia, vaginal dryness, and loss of sexual desire. Also common in perimenopause and menopause are increased intestinal gas, heart palpitations, depression, and difficulty concentrating.

Some women, it’s important to mention, actually feel better during these years. Several surveys have identified women who have more energy, increased interest in and enjoyment of sex, and overall improved satisfaction with their lives around menopause. The hormonal changes that cause such distressing symptoms for some women may have the opposite effect on others. It’s also possible that, at this time of life, many of us have more self-confidence, improved economic security, deeper relationships, fewer care-giving responsibilities, and more privacy and free time than when we were younger, and that these contribute to an improved sense of wellbeing.

For millennia, most women didn’t have to worry about the changes — good or bad — that came with menopause: they didn’t live long enough to experience them. A century ago, the average lifespan of the American woman was roughly fifty years. Now, women in the U.S. can expect, on average, to live nearly eighty years. This means we may live more than a third of our lives in menopause!

Over the last few decades, both society’s and the medical profession’s views about menopause have changed — and are still changing.

In 1966, a gynecologist named Robert Wilson wrote a widely popular book called Feminine Forever. Wilson argued that menopause was a disease, and that if women wanted to avoid becoming “dull and unattractive,” they should take estrogen. The Women’s Movement, not to mention the increased rates of uterine cancer among women who took estrogen, caused many to question the wisdom of Wilson’s advice.

In the 1980s and 1990s, millions of menopausal and perimenopausal women took a combination of estrogen and progesterone. The most popular of the estrogens was synthesized from pregnant mare’s urine, hence the name: Premarin. Adding progesterone (sometimes with estrogen in a combination pill called Prempro) protected women from the uterine cancer that estrogen can cause when taken alone. At the time it was thought that, in addition to alleviating hot flashes and other symptoms, these hormones prevented hip and other fractures caused by bone thinning (osteoporosis), cardiovascular disease, and Alzheimer’s disease. When I first joined my medical practice in 1990, it seemed that every woman I met over fifty was taking these hormones, whether she had menopausal symptoms or not.

Then, in 2002, a study from the Women’s Health Initiative (WHI) showed that women who took estrogen and progesterone had an increased risk of breast cancer and, what’s more, they were more, not less, likely to have heart attacks and strokes than women who hadn’t taken the hormones. Overnight, millions of women stopped taking estrogen and progesterone. Now, doctors tend to prescribe estrogen and progesterone mostly for women who are having severe hot flashes, vaginal dryness, and other symptoms and, even then, not for more than a few years.

But the hormone story isn’t over yet. The results of the WHI study are now being reconsidered because of two issues. The first is that the women in that study were, on average, in their sixties — usually several years past the onset of menopause. Also, the hormones used in that study, Premarin and similar medications, were synthetic. There are other hormones available, such as estradiol, called “bio-identical,” that is, closer to those that occur naturally. Several studies are now underway to see if it’s safe, and even beneficial, for younger women, those in their forties and fifties, to take these kinds of hormones.

Certainly, even before that information becomes available, you should discuss with your doctor whether hormone therapy is right for you. Women suffering from severe hot flashes, insomnia, irritability, and depression can often get fast and effective relief through hormone treatment. The distress that some women feel at menopause is real and can be disabling. I treated one of my patients with estrogen when, among other intolerable symptoms, she became so irritable she couldn’t bear the sound of her husband’s voice. (And she loved the guy. Really!) Cynthia Gorney, a journalist who described her decision to use estrogen in a 2010 New York Times Magazine article, wrote of those infamous perimenopausal mood swings: “I’m sorry, but only someone who has never experienced one could describe a day of ‘I would stab everyone I know with a fork if only I could stop weeping long enough to get out of this car’ as a ‘mood swing.’”

But let’s say you’ve decided that your symptoms aren’t quite that bad, or you have a history of breast cancer, blood clots, or other conditions that make hormone treatment inadvisable, or you simply choose not to take hormones. Does that mean there’s nothing you can do about some of the uncomfortable symptoms that can occur with menopause? No!

Research shows that women who exercise regularly have fewer hot flashes (or are less bothered by the hot flashes that they have). Limiting caffeine and alcohol also decreases the number and severity of hot flashes. Mood, metabolism, sleep, digestion, cognitive function, and even sexual function have all been shown to improve with exercise. A high fiber diet helps digestion. If you smoke, this is a perfect time to stop. Smoking accelerates the decline in estrogen levels and worsens perimenopausal symptoms — as well as increasing the risk for osteoporosis.

But alleviating the symptoms of perimenopause and menopause isn’t the only reason to exercise, eat more healthfully, stop smoking, and adopt other healthy habits at this time of your life. Such habits can help make you stronger, more productive, and happier, for many more years than your mother and grandmother ever dreamed of.

New Seasons, New Reasons

There’s no doubt that menopause makes it harder to lose weight and get fit. A slower metabolism, decrease in muscle mass, stiff and sore joints, increased sugar cravings, and fatigue from disrupted sleep all make getting in shape more challenging as we get older. However, middle-aged women do have some advantages:

For one thing, we have more confidence than when we were younger. We’re less likely to feel self-conscious about making a special order in a restaurant or showing up at the gym without the coolest outfit than we might been have years ago.

We’re older and wiser. We know from experience that thirty days don’t, actually, lead to thinner thighs and that the stuff they advertise on late night TV and in the backs of magazines doesn’t melt pounds away while you sleep.

We’re also often more motivated than we were in the past. The reasons to get fit are more meaningful to us. The stakes seem higher. How important is fitting into a particular pair of shorts compared with living to see your grandchildren grow up? How satisfying does a certain number on the scale seem next to having the energy to pursue that second career? Continue living independently? Prevent cancer?

Time after time I’ve seen women who’ve tried for years to lose weight finally succeed when they have a goal that really means something to them. An example is Suzanne Ruff, whose story, “Tending My Rose Garden,” you’ll read here. She was so upset about being heavy that she decided to stop shopping for clothes altogether. But it wasn’t until her sister became desperately ill and needed a healthy kidney donor that Suzanne found the will to get in shape. Mary Elizabeth Laufer, the author of “The Whistle that Woke Me Up,” had packed away her too-small clothes and, with them, all hope of ever losing weight, until her doctor told her she had high blood pressure.

If you’ve not yet found powerful motivation for adopting a healthier lifestyle, here are some recent research findings worth thinking about:

• Post-menopausal women who walk 30 minutes per day lower their risk for breast cancer by 20%. Obese women in this age group are 30-50% more likely than thinner women to develop breast cancer.

• Women who replace animal fats with vegetable oils in their diets cut their risk of heart attack in half.

• Women who are chronically stressed, depressed, angry, or socially isolated are more likely to die of heart disease. Older women who have a strong network of friends are much less likely to die of heart disease than those with weaker social support.

• Exercising, quitting smoking, and getting diabetes and high blood pressure under control markedly reduce a middle-aged woman’s chances of ending up in a nursing home later in life.

• Exercise boosts brain power. Regular workouts improve intellectual capacity, creativity, and even empathy. The brain scans of adults who exercise actually demonstrate growth of gray matter. Exercisers are less likely to develop dementia, and exercise can slow the progression of memory loss in people who already have it.

• Regular weight-bearing exercise and a diet rich in calcium and vitamin D can help prevent osteoporosis. One in two women will break a bone at some point because of osteoporosis. An older woman who breaks her hip has a 25% chance of dying within a year.

• It’s never too late to reap the health benefits of exercise. Even women in their nineties can sometimes stop using their canes after following a simple strength training routine.

The bottom line? Small changes every day — trading mayonnaise for olive oil in salad dressing, meeting a friend for a walk rather than watching TV alone, lifting a 3-pound weight instead of a cigarette, can, when added up, drastically improve your quality of life in the years to come — and may even be the difference between life and death.

Sounds like a pretty good deal, doesn’t it?

Letting Go, Holding On

So you’ve decided to embark on a weight loss and fitness program and you’re excited about it, but you’re a bit apprehensive, too. After all, you’ve tried to get in shape so many times before. Your past is littered with abandoned treadmills, warped aerobics videos, and countless food journals, calorie counters, and packets of artificial sweetener. And you’re in good company. It’s estimated that on any given day, half of all American girls and women are trying to lose weight. One study from the U.K. estimated that, on average, British women spend thirty-one years of their lives on diets.

The bad news is that, by the time you’re in your fifties, you’ve likely accrued a long history of repeated failure with regard to weight loss and fitness and, understandably, your confidence that you’ll ever succeed is shaky.

The good news is, that at this time of life, you may finally be ready to let go of some of the self-defeating attitudes that have hampered your efforts.

I once wrote a blog for Psychology Today in which I coined the term “the un-nesting Instinct.” I was referring to the urge that many women feel, at menopause, to de-clutter their lives, both physically and emotionally. This urge — the opposite of the drive to “feather the nest” that made many of us fill linen closets and refrigerators when we were pregnant — can take several forms: We may, finally, feel moved to empty the garage, give away our kids’ old books and toys, end relationships that haven’t felt nourishing, or mend fences with people with whom we’ve been in conflict.

This desire to “clean house” can be put to good use in your weight loss and fitness efforts. Those mental “tapes” to which I referred earlier have not really helped you get in shape, have they? Maybe it’s time to pack them up, along with those wooden tennis rackets and dusty Sesame Street puppets, and make room for some new ideas.

Here are some “oldies but baddies” — untrue and unhelpful things you’ve probably been telling yourself for far too long:

• I have no willpower, no self-discipline. Really? Aren’t you the same woman who raised those kids? Showed up for work every day? Cared for all those sick friends and relatives? My own experience counseling women who struggle with their weight is that they are unusually self-disciplined, and that, in fact, often food is the only aspect of their lives in which they allow themselves to lose control. Furthermore, recent research in behavioral psychology suggests that we may be thinking of willpower the wrong way: it’s not something you’re born with — like blue eyes or red hair — it’s more like a muscle you strengthen with repeated use.

• I’m good for a while, but then I always cheat. What’s with the moral self-judgment? The last time I looked, “Thou shalt not eat Doritos straight from the bag” is not one of the Ten Commandments. Your diet and exercise habits do not make you a bad (or good) person. Believing that they do causes a lot of unnecessary stress — which drives many of us to overeat!

• I’ve blown it for today, so I guess I’ll just skip my workout and eat even more. As my patient, Tina, put it, this makes about as much sense as getting a flat tire, and then deliberately puncturing the other three. Lose the all-or-nothing, black-and-white thinking.

• I’ll get in shape when work slows down, in time for my daughter’s wedding, starting Monday morning… Somehow, the “right time” never comes, or it does come, and then the next roadblock or artificial deadline looms. Besides, being busy and stressed out is a good reason to take better, not worse, care of yourself. Mary, a participant in my group, was tempted to drop her new walking program when her daughter’s cancer relapsed. Then she realized that a daily walk would increase her ability to cope with her daughter’s illness.

The “right time” is now. This very minute. And the next. And the next…

As you’re questioning some old, ineffective approaches, take some time to review ways of thinking and behaving that have worked for you. Reflect on something you’re proud of having accomplished: mastering a skill such as quilting or playing the piano; tackling a home renovation or major project at work; planning a special vacation, or your retirement. How did you do it? Did you seek the guidance of experts? Then maybe you’d find a class, personal trainer or dietician helpful as you try to get in shape. Or perhaps you enjoyed working on your own, at your own pace? Then maybe formal instruction is not for you. If you have a creative streak, then a dance class, journal writing, or experimenting with new recipes could be part of your weight loss strategy. A numbers person? You might have fun with one of the many free online sites and smart phone apps available for tracking diet and exercise.

As much as possible, play to your strengths rather than struggling against your challenges. To borrow a phrase from Boston-based health coach Margaret Moore, you want your fitness plan to feel “less like a wrestling match and more like a dance.”

Albert Einstein once wrote: “We cannot solve our problems with the same thinking we used when we created them.” At mid-life, many of us may feel that an overweight and unhealthy body is a “problem” we can never overcome. But I’ve known many women — and this book is filled with the stories of women — who did just that. And, as Einstein implied, changing our thinking is the first, and perhaps most important, step.

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