my new prescription

"You need to exercise less and eat more."

This advice was given to me last week by my primary care doctor. I would estimate that at least 95% of the time, when that combination of words falls from any health care provider's lips, they arrange themselves in a different order. I suppose some people would die to receive such a directive. Then again, they might die in the process.

The epidemic of obesity across the globe is astounding. In my line of work, I am acutely aware of how large people are, and it's not just out of morbid curiosity. I have to plan for the effect increased fat stores will have on the metabolism of anesthetic drugs. I anticipate having difficulties securing the airway in an obese patient, and once the patient is intubated, achieving adequate oxygenation and ventilation can be challenging.

There are numerous factors that have led to the fattening of the American populace. I have not done any recent literature searches on the topic, so what I am expressing is possibly more opinion than fact. However, to me, the most critical elements contributing to our nation's expanding waistline are inactivity and highly processed foods. In Albuquerque, it is almost impossible to walk anywhere useful. In contrast, when we lived in Seattle, I could have counted on one hand the times I drove to get groceries. And then the issue of fast and frozen prepared foods. . . well, that's several posts worth of material.

So back to my opener: exercise less and eat more. Do I have witnesses? Yes! My husband was with me, so he can attest to the advice, and he has enthusiastically accepted the responsibility of feeding me energy-dense foods at every opportunity. My mother has been on board with the plan before I knew it existed, but I don't live under her roof any longer. The tough part is knowing what to change. I am not a "dieter." I don't eat particularly small portions. I have seconds at dinner, and I always eat three meals a day. I love pie and ice cream, and am developing an affinity for chocolate. Ask any of my family members: I do not have an eating disorder.

On the other hand, I haven't eaten a meal from a fast food joint in over fifteen years. I never eat the "fry bar" options in the hospital cafeteria. (Does anyone else find it incongruous for a hospital cafeteria to serve a "complete" meal of deep fried foods?) And, most importantly, I love to be active. I feel one hundred percent better on days that I exercise compared to days that I do not. I have always been a runner, and last summer I discovered Bikram Yoga, which is a fantastic counterbalance to running. To make matters "worse," Micaiah finally got into running seriously about 2 weeks ago after finishing the book Born To Run, so suddenly I have a runner husband who wants to get in at least 8 miles a day, and I want to join in!

Any reader of this entry is likely wondering why it is that I've been instructed to gain weight. The things we post for public viewing would make my grandmother, the queen of privacy, spin in her grave. The basic answer is that, as a woman of childbearing age, it would behoove me to have some energy stores (i.e. fat) to encourage and sustain the development of a fetus. As we have a general interest in becoming parents sometime in the next few years (before menopause hits- yikes!) it seems smart to make sure that I'm in optimal "condition" for motherhood.

So, I get to have a bowl of Greek yogurt every morning, I bring a cup of peanut butter with me to work, and we are buying avocados like they're about to disappear off the face of the earth. I'm not disliking this new health plan. However, I can't stop marveling at the irony of it all, and I am determined to be true to my ethos on nutrition and exercise despite or at least within these guidelines.

So, is anybody up for a peanut butter, guacamole and brie sandwich? Yeah. . . me neither. I think tonight I'll start with a beer, tortilla chips and guac.