Prevention, anybody?

I have always kept journals. It has been a good way for me to reflect back on what I have done, notice patterns, and laugh at youthful silliness. The past couple of days I spent time reading my journal from when I was 18-19, and I cried for, was embarrassed at, and laughed at my younger self. But that is another story. The journal that relates to this entry is my weight loss journal. I have kept it for years, writing on and off and documenting my struggle with weight loss. Appropriately labeled "Morphing Journal," I have been keeping notes in there since 2006. That was truly the beginning of the "Ups and Downs, and Wardrobe Changes." In there I journal my successes and defeats related to this never ending process. Recently, I grabbed the journal again to jot down my new workout routine. It is a rather small notebook, perfect fitting for my gym bag, easy to carry around so that I don't forget that after squats I have to do push ups, and then mountain climbers.

I'm not Emily, but I'm certainly strange, and this is
my Morphing Journal.

Well, I took a peek at previous entries, and saw that in 2007 I had gone to a nutrition program and was able to lose a total of 10 lbs in a month. How did I manage to do that, I wondered? I kept on reading and remembered that it was a great program covered by my health insurance, with a very extensive initial assessment by a nutritionist, counseling, and follow up appointments in which I had to report back on my progress. I left the first session with a very comprehensive list of food items that I could purchase that would help me in keeping a healthy diet. I saw the nutritionist every two weeks, and I took a report on my eating habits for that period. Based on this, changes were made to adjust for calorie goal, and to get rid of empty calorie items. A month after I started, and making adjustments as appropriate, I had lost 10 lbs!

I got excited. I wondered if I could do this again. But I did not want a repeat of my previous experience with the diabetes program, which left me frustrated. I called my insurance company and inquired about nutrition program coverage. Of course, it wasn't easy - I needed a referral from my doctor, who in turn needed to submit the referral to the medical group for approval. The referral had to state that it was "medically indicated" for me to receive these services, and for how long should I receive the services. I called my doctor's office right away and let them know what I wanted. Knowing already that if it the referral didn't have the right information, services would not be covered, I stressed the following: "I need these services because I am OBESE; it is not related to my diabetes." I also dictated the language used in the insurance manual to the referral coordinator to avoid any potential mistakes. I got what I needed.

In addition to education, follow up and support is needed
when attempting to make meaningful changes in your
eating habits.

I called and scheduled the appointment right away. As usual, I got prepared for my appointment: I printed my reports from SuperTracker, and prepared a list of questions to ask her. Well, let me start with this: I was dismayed when I saw the Nutritionist; she looked as if she had not eaten in about two years if not longer. She looked, well, desnutrida. I got uncomfortable right away. I felt as if she was going to  judge me - while she looked as if she had not eaten in a while, next to her, I looked as if I had been robbing her food and eating it in addition to my own share! Putting this initial feeling aside, I started to present my case: I had tried the diabetes program, did not like the "cookie-cutter" type of menu given, no attention was given to my specific situation, my general knowledge of nutrition and yet my inability to implement it in a way that impacts my health and wellbeing, etc. She was impressed with my knowledge and commended me on the changes I have been making. She went on to confirm that in order for me to lose weight, I had to maintain a 1,500 calories a day diet, and exercise. She recommended that I increased my daily 30-minute cardio exercise to 45 minutes or an hour. She looked at my reports and suggested some changes for the foods that were contributing to empty calories. So far so good.

And then I asked her the question: When am I seeing her again? I was shocked when she told me that that was it: this one half hour visit was my "healthy diet counseling and obesity screening/counseling" offered by my insurance. What a joke! How can anybody make meaningful and positive changes in one's diet based on a half an hour consultation with no follow up? I attribute the success I had with the other program to the follow up I was given and the whole issue of accountability. I had to report back to somebody and show the changes I was making, and I was given guidance on making other changes. I asked her if they had a similar program and the answer was no, they didn't. At best, I could divide the grand total of 4 hours allowed into 8 half-hour sessions and make the most of it. I left frustrated once again.

I have been pretty consistent with exercise.
My next step is cleaning my diet.

Despite reports about the obesity stigma, and recommendations of a comprehensive approach to weight loss, our healthcare system still generally disregards this as a health concern and deals with it more as a personal choice rather than a potential problem. As with other health conditions, minimal approaches are directed to preventive efforts even when these would potentially save thousands of dollars in healthcare resulting from the consequences of being obese, such as heart disease, high blood pressure, etc. Some major changes are needed in our healthcare system.

As for me, I came back home with the intent of doing this on my own. I have the knowledge and the means to make positive changes. And I will be accountable to me, to my husband and to my daughters. They will get the benefits of these changes by having a healthier wife and mother, one that is quick to join them in activities rather than stay at home because she's too tired to do anything. One that encourages and support physical activity and healthy eating habits. A mother and wife that is happy because she is healthier.

That is my promise to myself.