Dr. Patricia Happel grew up in a family where obesity and unhealthy habits were common. One grandfather used to hide his heart medication in a chair instead of taking it. In sixth grade, Happel witnessed her grandmother's stroke - the woman hadn't gone to a physician despite having high blood pressure. Other family members smoked and their diets were poor.
In medical school, Happel ate fast foods. As a practicing board-certified family medicine physician, she weighed 275 pounds.
"I felt like a fraud, a hypocrite having conversations with my patients," says Happel, an assistant professor and clinician at NYIT College of Osteopathic Medicine.
With the help of a trainer, Happel began working out and changing her approach to food. She dropped to 143 pounds. Today, she weighs 155 (with a goal of getting to 150 pounds), is preparing to take a medical board examination to be certified in obesity medicine, runs half-marathons, and counsels patients on weight loss and lifestyle changes.
Happel says it's important to get an idea of your resting metabolic rate, which can reveal how much energy your body burns in a day. The number is based on several factors, including gender, age, current weight, and activity levels. From that, Happel can help a patient develop a plan to drop one to two pounds a week by lowering caloric intake, eating at the right times, exercising, hydrating, and positive affirmations.
"I tell them to get the word 'diet' out of their heads," she says. "This isn't counting calories. This is your lifestyle. You didn't gain all of that weight at once so you're not going to lose it at once."
Happel says a successful weight loss plans needs attention in many areas:
Time - Happel's own transformation took 18 months but maintenance is ongoing. Knowing that the journey to better health will take time takes the pressure off a patient. "There is so much behind it - it's not just calories in, calories out." Sleep and stress also play roles in the body's chemical processes, affecting hunger and cravings. So the approach to losing weight has to be comprehensive.
Journaling - "To this day, I still write down everything I eat: the good, the bad, and the ugly," says Happel. "It helps me keep on track." Journaling can help reveal patterns that lead to poor food choices.
Avoidance of Fad Diets - "If a diet is too restrictive, you're not going to be able to sustain that for life," says Happel. "Maintenance is the hardest part. And yo-yo dieting (continually losing and regaining weight) wreaks havoc on your metabolism." Skipping meals can actually cause your body to go into "starvation mode," leading to more weight gain once meals are consumed. "You need to eat every four or five hours to help 'keep the fire burning,'" she says. "And being hydrated is very important. Divide your weight in half - that's the number of ounces of water you should drink each day."
Mindfulness - Staying attuned to feelings is important for anyone trying to lose weight. "Can we find a pattern of what triggers you to eat unhealthy foods?" The emotional component is central in any patient plan, says Happel, noting that it is important to have a strong support system and avoid those who might sabotage efforts.
Exercise - Happel advises that patients try to build some form of exercise into their schedules. The American Heart Association recommends 150 minutes each week. Large blocks of exercise time might not be practical, so Happel recommends trying to fit in short bursts: dancing, working out with videos, walking, taking the stairs, etc. "Can you get 10 minutes of exercise in a day to start? Some people need two weeks to work up to that. You can't rush it. "
Mental Strength - "Perfectionism is the enemy," says Happel. "You need to cut yourself some slack. Life has curveballs and it's OK to mess up. So if you do, use the next opportunity you have to get back on track." It's important to think of meal times and shopping expeditions as opportunities to make good choices - avoiding processed foods high in sodium, fat, and sugar. "I ask people to consider what they can start with: what's the one thing you can change this week? Is it not having the 3 pm Twinkie?"
Happel says she's happy to be able to "pay it forward" by sharing her own story and mentoring patients as they begin a journey toward better health.
"I think we can do more - the amount of money that's invested in obesity-related diseases is high," she says. "We need to spend a little of that on prevention."
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