My interest in childhood obesity and the surging epidemic of diabetes and Metabolic Syndrome is both professional and deeply personal. I grew up in a large close-knit family in northern New Jersey, where most of the neighborhood was comprised of aunts, uncles, cousins and the family matriarch- my grandmother, Florence. Widowed in her early forties with ten children of her own and several she supported out of kindness, she was the very physical representation of strength, faith and family values. She was a pillare for her family, church, neighborhood and the small town in which we lived. Born on Christmas Day in 1916 to a family of modest means, she was always a "gift" to those who knew her. Her short stature and rounded figure earned her the nickname "Humpty Dumpty"; shocking to today's self-esteem-focused society, but always taken in the loving manner in which it was intended. She was not fragile, however, and was known to garden, remodel her small house, hang drywall and cook huge meals, all while giving birh to ten children in less than twenty years. (All but three or four of them were born at home, including the twins!)
Back in the 1930's and 40's it was a source of pride to deliver ten-, eleven- and even twelve-pound babies as my petite-framed grandmother did. Today we know that giving birth to overly large babies is a marker for untreated gestational diabetes and a serious risk factor the the future development of diabetes in the mother. My grandmother was also at increased risk due to her Native American heritage. (Native Americans, Blacks and Hispanics have a much greater likelihood of developing this disease when compared to Caucasians and Asians.)
Diagnosed with Type 2 diabetes in the late 1970's, my grandmother struggled to cope using the limited knowledge and resources available fompatients at that time. She tried to limit sugars and decrease starches in her diet, but still suffered from angina, eye complications and ever-decreasing stamina. After suffering a debilitating stroke in 1984, she was sent home, expected to live only a few weeks. Under her family's care, she lived an additional eighteen months before ultimately losing her fight with diabetes in December 1985.
At the time of my grandmother's death I was a soophomore college student studying biomedical engineering on a full scholarship with hopes of later attending medical school. More was being learned about diabetes at that time and I was acutely aware of my own risks. I had struggled with weight issues throughout my childhood and by the time I graduated high school, I was over 200 pounds. During the summer before my senior year, my list of symptoms was impossible to ignore: relentless thirst, increased appetite, unexplained weight loss, poor stamina, difficulty concentrating on my studies and frequent urination. I went to the Student Health Center on campus and requested testing. Scoffing, the nurse practicioner asked why I was so concerned. (At that time, type 2 diabetes was considered very rare in adolescents and young adults.) I detailed my list of symptoms and noted that my father had eight sisters, six of whom were diabetic, as was he. I was given the test right away and the results were conclusive. My fasting blood sugar was nearly three hundred. (Normal should be under 100.)
I was referred to the university's diabetes clinic, where I was educated on the mechanics of diabetes, its management and the importance of diet and exercise. I worked closely with a dietician and a counselor, who reviewed my food diaries, gave me tips on healthy food choices and brought me, kicking and screaming, into the world of exercise. It started slowly, thirty minutes three times a week around a local park. By a stroke of luck (or Divine intervention) I won a pair of walking shoes in a box of cereal and eventually grew to love my speed walks so much that I literally wore a hole in the sole of my shoes by the end of the year! At this point I was speed-walking three to five miles a day and had lost almost 90 pounds. My blood sugars were normal without medication. I entered medical school in the fall of 1988 feeling like I had "conquered" diabetes.
You can probably predict the next chapter in this saga. Under the pressures and stress of medical school and without the support of my diabetes team at the university, I resumed my old eating patterns and quickly ballooned to over 250 pounds. I struggled, but was determined not to let diabetes stand in my way. After graduating with an M.D. in 1992, I began my internship and residency in pediatrics. Within a few months I was hospitalized and started on insulin injections, something I had promised myself I would never allow to happen. My biggest victory (losing weight and "conquering" diabetes) had becoe my greates failure.
I did a poor job of prioritizing y health throughout residency, always expecting to take better care of it at the next phase of my life and career. Things did not miraculously become easier in private practice, however, and my weight continued to yo-yo its way upward. The list of complications, seemingly minor at first, contined to grow: pancreatic failure and complete dependence on insulin, eye disease, kidney disease, and neuropathy (painful sensations in the hands and feet which ultimately result in the loss of sensation, a contributing factor to amputations in diabetics.)
At my doctor's urging, I began using an insulin pump in the winter of 1998 to help regulate my wildly fluctuating blood sugar levels. I continued to experiment with every diet plan out there, joined various gyms and bought home exercise equipment. I even tried the prescription drug Redux briefly, but found the side-effects overwhelming. (Redux was later removed from the market after being associated with potentially fatal heart valve problems.) Despite my efforts, my weight continued to climb to over 300 pounds by the time my daughter came home from Guatemala in December 2003. Perhaps the only bright spot in this saga is the fact that my diabetes in some way led me to my daughter. When I decided to become a single mother at the age of thirty-seven, my health issues were severe enough that my doctors cringed at the thought of me coping with a pregnancy.After fifteen months of paperwork, travels, tears and much angst, my daughter came home just one week before Christmas. I had a beautiful, healthy daughter, unmarred by my defective metabolism or genetic make-up. Now that I had someone to live for, I needed to save my life!
My parents retired and relocated to live with me and help care for my daughter while I continued to work and take call as a full-time pediatrician in the new practice I had started with two dear friends. Their help was invaluable as my weight increased and my stamina and general health decreased. My sister moved in six months later and we soon moved to a larger home where we could all fit comfortably.
My daughter blossomed as a toddler with her unique mult-generational family. My weight soon hit 330 pounds. Desperate for a solution and with my physician's support, I turned to bariatric surgery as a last-ditch attempt to "cure" my obesity. I was not looking for a quick fix, as many mistakenly label such surgeries. My sister had undergone gastric bypass surgery four years eearlier and lost over two hundred and fifty pounds. I saw how much effort she had to put into her food choices and knew that permanent weight loss did not just "happen", even with surgery. I decided that a gastric band was a better option given my situation and had my surgery in May 2006. Two years later, I had lost over 100 pounds, but it was too late to reverse the diabetic complications my body had already been experiencing. I was admitted with angina in March 2008 and eventually had a heart attack that fall, requiring angioplasty and the placement of s stent. My eye complications persisted and I underwent three surgeries on the right eye within three months. At the same time, I still experienced odd food cravings and when I gave in, my body responded with bloating, constipation, sluggishness, more cravings and weight gain. All this, despite the fact that the lap-band limited my portion sizes! I needed to change my eating habits in a way that I could enjoy, and get my picky diabetes-prone family members and even-pickier daughter to enjoy as well. Although it was not a magical cure for my weight issues or diabetes, I have no regrets regarding my weight-loss surgery. It has been a trememdous boon to my weight loss efforts. I lost one-third of my body weight and gained the life-changing stamina and hope I needed to continue my journey.
I poured over all the food articles in magazines, books and online articles. I printed lists, took notes and revisited the library of diet and nutrition books I had amassed over the years. Every one had a theory. Every theory seemed to have a small connection to another theory before it spun off tangentially to "the ultimate weight loss cure." One thing was clear: I was not going to find the answer to the mystery that thousands of laboratory scientists and doctors were researching furiously. I was determined, however, to find a plan that worked in the meantime. A survival plan for me, my family and the families and children I saw everday, struggling with this same issue. They needed someone to wade through the theories, cut to the chase and tell them what to do to improve their health and protect their children from the epidemic of obesity engulfing our nation. Who better than me to do just that?
