Developing a new set of family meals proved very challenging. On the first day of the new eating plan, Tom came home from work hungry, but the family dinner his wife had prepared was not flavorful, delicious, or satisfying. He did not show his disappointment at the dinner table. Instead he remained positive and thanked his wife, in front of the children, for her hard work to make dinner for the family. Later, his wife acknowledged that her first attempt fell flat and they brainstormed about some favorite meals she could adapt.
The following night she hit a “homerun” with an outstanding healthy meal that everyone loved. Each week she had more and more hits, and less painful “misses”. She recorded her healthy recipes in20a personal “cookbook” and by 3 months she had 20 winning family meals. She used the cookbooks she already had to find and adapt new recipes and meals. She became faster and more efficient each time she repeated a winning recipe or meal. After 6 months she was comfortable improvising new meals at will. Soups, salads, entrees, and side dishes became second nature to prepare and the whole family came to enjoy the new menu.
In the meantime, Tom and I strategized together to devise a plan to increase his exercise time. He did not think it would be realistic to exercise before work on weekdays. We aimed for weeknights and weekends, 7 hours of exercise each week. He recognized his job was interfering with his availability to get the exercise he needed. We agreed he would leave work one hour earlier each day. He was working 45 hours per week including a 45 minute lunch break daily. He cut his lunch break time to 15 minutes, by bringing a light lunch from home instead of going to the food court at a nearby mall.
Also, as a manager, he recognized he could get his job done more efficiently in less time by managing his employees better and allocating more responsibility to them. By strengthening the leadership skills of his employees he improved the overall productivity of his office while leaving more time to take care of himself physically.
In addition, by leaving the office at 4pm instead of 5pm, he beat some of the evening rush hour traffic which saved an additional 15 minutes off his previous commute. Instead of getting home at 5:45, he was getting home at 4:30. He would join his wife in the kitchen and together they would hive dinner on the table by around 5:15. Tom specialized in soups and salads and his wife focused on the entrée and additional vegetable side dishes.
Each evening at 7:00 Tom would take one of his 3 children to the gym. They would play basketball or walk on the track. The older one became interested in tennis and took lessons one evening each week while Tom lifted weights. They would play tennis together one evening each week as well. By 9:00 Tom returned home with more energy than he left for the gym. He and his wife agreed to set aside the time from 9:30 pm to 10:30 pm as a “husband and wife time” free from errands, chores, or anything other than relaxation or romance. On weekends the whole family would go to the park, gym, or school athletic field to play together or practice sports like soccer, basketball, and softball. In short, Tom was spending more quality time with his family, doing a better job at work, eating much better, getting mu ch more exercise, improving his love life, and serving as a great role model for his family and friends.
At 3 months into the program he had lost 25 pounds, exceeding my prediction by 3 pounds. His A1c dropped from 7.3% to 6.3% by 3 months, and was down to 5.8% by 6 months. By that point he had lost 40 pounds. During the following 1.5 years he maintained a 45-50 pound weight loss and an A1c around 5.6% even after discontinuing the metformin.
His type 2 diabetes has been in remission for nearly two years.
A set routine, finely tuned over many months, has been a crucially important element of his successful maintenance. Maintaining this routine eventually became automatic or “second nature” for him. The main challenge became managing “threats” to his new routine.
Occasionally he did need to stay late at the office. Occasionally he went to parties or other social events with family or friends. Occasionally he would travel for work, or with his family for a vacation. Occasionally he succumbed to tempting unhealthy foods or skipping a workout because he was=2 0not diligent in his planning, or because he was simply tired, hungry, or upset.
I helped him navigate through various “threats” by reassuring him that all successful individuals have tough weeks and slip ups, and what makes them resilient is their ability to get back on the plan quickly and move on. After all, the aim isn’t to be perfect, the aim during the maintenance stage is to find a balance that allows one to live life to the fullest–staying healthy and enjoying what life has to offer without being excessive or overly indulgent.
Over time, with lots of practice, Tom became skilled at anticipating threats to his new lifestyle routine and minimizing the damage. He knew which restaurants were especially favorable for him and his family. He became accustomed to ordering healthy choices from nearly any menu from any cuisine, and consulting with the waiters as needed to get tasty healthy food every time he dined out. He had a stash of “backup meals and snacks” at work and at home, in case he forgot to bring his lunch or in case some other random occurrence or misstep interfered with his usual plan. When a social event with rich food was upcoming, he would eat even more conservatively prior to the event, and for days afterward, so that he could eat more liberally while celebrating and socializing. “Life’s special occasions are to be enjoyed, including indulging in rich food from time to time, but special occasions do not come every week” we reasoned.
I still see Tom monthly. We met weekly for the first 3 months, then every other week throughout the remainder of the first year, then monthly. He still keeps a daily food record and exercises 7 hours per week, including weight lifting 30 minutes 3 times per week. He asks me “why don’t other doctors and patients work together to reverse diabetes like this more often? Why is what I‘ve done so unusual?”
I tell him I’m working to change that and get the word out. Then, I tell him I’m proud of him and I thank him for making my own job such a pleasure.
– Michael Dansinger, MD
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