- Posted March 30, 2014 by
This iReport is part of an assignment:
Your 'Aha' weight-loss moments
Doc, You Made Me Believe in Myself
As a resident in internal medicine, I treat patients in the hospital, ICU and outpatient setting. I have three more months left until the completion of my residency and wanted to share a brief and inspiring story:
One of my first patients (whose name shall be referred to as Mr. Z to protect confidentiality) I saw in my continuity clinic in 2011 stated that he was fatigued, could not functionally execute daily activities due to sleep deprivation and would turn to eating because his fatigue would not resolve. After doing a thorough chart review on our EMR(Electronic Medical Record) system, I had noticed that he had missed all of his continuity appointments for the last 2 years. This was the beginning of my "A-ha!" moment...
I asked him why he had not seen his primary care physicians in the past and he stated that no one wanted to believe in him. His Body Mass Index was 41 (regular should be between 18.5-24.9) and he was classified as Obesity Class 3 (previously known as Morbid Obesity). He said "The other doctors that I have seen keep telling me to lose weight but never gave me a plan so why would I pay money to come here to know what is already obvious to me?" I knew that if I wanted to make a difference, communication and the ability to create beliefs in him were a priority. I told Mr. Z "Sir, what if we worked on an agenda for you that would be as simple as having a food diary in which you can write down the times you eat and the ingredients you put in your food." His response back to me was, "Doc, I don't cook that often and Fast Food has all the vital ingredients I need don't they?" After going over the food groups and the portions for daily needed value, the next ordeal was to make sure I addressed the calorie count. Since he was not aware of his daily cumulative consumption of calories, he followed up with me in one week with a diary worth of 7-days of meals. He was eating almost 3,500-4,000 calories a day (most of which were snacking on candy bars). I provided him with dietary references and a website that were able to match up the food groups and level of grade (from A through F). We did our best to focus on portion control and made it a numbers game. We tried to shave off 500 calories per day which would be equivalent to almost 3,500 calories per week, which would be equivalent to almost 1 pound that he could potentially lose. Fortunately for him, he did not have any other co-morbid conditions such as hypertension or diabetes but the fatigue was still plaguing him.
After corresponding over the phone and solidifying our continuity visits, he returned in two months. Mr. Z said that he had already felt better and said that his attraction to unhealthy foods had reduced. Instead of eating candy bars, he substituted it with fruits and bought a portion plate which he used for breakfast, lunch and dinner. He stopped eating after 7 PM and made sure to be in bed by 11PM latest (without any intermittent snacking during those 4 hours). Throughout the next year, we met every 3 months for evaluations and we had begun a mild exercise plan as well. One day he said "Doc, remember last year when I had told you that my fatigue was so debilitating that all I did was eat and feel tired? Well now I feel so refreshed and I even have a job and a girlfriend now!" His BMI had come down from 41 to 36 within one year. In medical terms, he went from Obesity Class 3 to Class 2 which might not have seemed like a big difference for some, but for Mr. Z, it meant the world. For him, it was a rebirth and a new inspiration to live. It was purely performed through the art of communication and perseverance. As of February 2014, he has maintained a healthy lifestyle and cooks his own food with a calorie/ingredient conscious mindset. Since his initial visit with me, he has not missed his appointments. Whenever we have an encounter in my clinic, the first thing he always tells me is "Doc, you made me believe in myself."
Rohan Mankikar, MD