Endo Block and the Obesity Epidemic


We’ve spent the last two  weeks of medical school in our Endocrinology Block.  Returning from a much-needed and  very restful break for the holidays, I was excited to be learning about a new system and expected the coming days  to be filled with discussion of those elusive glands and hormones I’d heard of, but never really knew exactly what  purpose they served.  While we did spend plenty of time learning about things like T3 and T4, Chromaffin cells,  and the difference between the anterior and posterior pituitary, to my surprise (and perhaps also to my  fascination) a significant portion of the past two weeks revolved around obesity.

We have learned about the genetics of obesity, how hormones and neural networks control how much you eat and  how much energy you expend, and all the hormonal factors that our fat cells release contributing to insulin  resistance.   We talked about a number of endocrine diseases that lead to uncontrollable weight gain or loss, but what resonated with me most was this figure that seemed to kick-off every other seminar I participated in, highlighting America’s  “Obesity Epidemic:”

The Obesity Epidemic – http://www.cdc.gov/obesity/

With all this buzz about obesity, I was fascinated by how quickly the word “exercise” passed in and out of  conversation – as if it were some sort of fictional idea, a figment of the imagination that only worked in fairy tales  and highly-controlled research studies.  Instead, after rapidly dissuading the eager medical students’ suggestions of  “lifestyle changes,” clinicians quickly turned the focus toward pharmacology and novel molecular targets for  treating this epidemic.  Did I miss something here?  At first I was quite perplexed – if we know that exercise  affords  us countless health benefits and is likely to prevent diseases from diabetes to cancer, why are we searching so  hard for the “magic bullet” drug to treat obesity and leaving this thoroughly tested and proven antidote to the  wayside?

What strikes me the most about many of our seminar discussions with highly-esteemed clinicians is their sheer  lack of faith in the ability of any patient to adhere to an exercise regimen.  But then I stop to think – can I blame  them?  Though I’ve only been immersed in the field of medicine for half a year now, I’ve become accustomed to  the standard “diet and exercise” talk.  Patients in need of serious lifestyle change are sent off for an appointment  with the nutritionist and told to “exercise.”  Now talk about an elusive idea – if I had been living an increasingly  sedentary lifestyle for much of my adult life and was given these instructions, I would have no idea what to do  either. Heck, I had no idea what to do or how to exercise the minute I was set free from my high school sports  programs, and exercise had been part of my everyday life for years!  The plethora of weight loss and fitness advice  we are constantly bombarded with  doesn’t help one bit – with so many options, many of them contradictory, and  different people asking for your money, it’s nearly impossible not to become overwhelmed and discouraged before  finding a program that works.  So, why is it that doctors frequently leave it up to their patients to figure out?  Sure,  they might suggest Weight Watchers or purchasing a gym membership, but ultimately this choice is left up to the  patient.  Do we leave other choices of this magnitude up to our patients?  If I came in to see my physician with  strep throat, would he make a few suggestions of what medication I should take and the dosage and leave it up to  me to decide? Absolutely not!  If I needed to rehabilitate a torn ACL would my doctor point me to a few  online resources and send me on my way? Not at all!  Next thing I know I would be standing in a physical therapy  clinic receiving step-by-step instructions from a doctor who had helped countless others through ACL rehab, and I  would be returning several times a week to ensure my therapy was completed fully and properly.  So why is it that  exercise, perhaps the most important and life-saving treatment of all, is so improperly “prescribed” by our  physicians?  The problems are many-fold, and as far as I can see they stem not from the doctors themselves but rather the health care system in which these doctors work. However, at least in my mind, the complexity of these problems doesn’t preclude working toward a solution.

After these past two weeks, the disconnect between medicine and fitness has never been so apparent to me. While I always knew it existed, there is just quite nothing like experiencing first-hand the Grand-Canyon-sized gaping hole between experts in sickness and wellness, and experts in fitness.  My favorite of CrossFit’s models of fitness is by far the “Sickness-Wellness-Fitness” continuum, yet in the context of medical care, this continuum is not quite as smooth as we might hope.  Instead of individuals oscillating freely along from wellness to fitness, fitness to wellness, and occasionally (God forbid) inching over to sickness, we have a serious traffic jam on the Sickness-Wellness side of the spectrum.  People are stockpiled on the cliff we call “Wellness,” peering over the edge   and looking down at the polluted waters of “Fitness.”   That’s a scary jump to take – and who knows where you will end up once you do?  A $10-per-month gym membership?  $100 for a video that promises to give you a six pack?  What we need is something to bridge this gap – someone who can take patients by the hand and lead them toward the right side of this continuum, and it’s clear to me that CrossFit may just help us find that someone we need.

“Your doctor is a lifeguard, not a swim coach” – Coach Greg Glassman.

The Human Body


The human body is absolutely fascinating: a beautiful, complex, resilient machine.  From the macroscopic level of the heart – pumping 60-100 times per minute, every minute, often for decades on end – to the microscopic level of the immune system – constantly fighting off invaders we don’t even know we have, the more I learn of the intricacy and efficiency of the body the more amazed I become.  But what exactly is the meaning and purpose of the human body?  What is our relationship with this body, and how does it change over a lifetime?  As we prepare to intervene when the body is not working optimally, caring for individuals who may soon part ways with their bodies, these are the types of questions we have been pondering as medical students in our most recent Foundations of Medicine block, “The Call of the Body.”

As captivating as the human body may be, there is nothing like anatomy lab to remind you of its fragility.  At 8 am every Monday morning, those oh-so-fascinating bodies, sprawled out on stainless steel tables and ready for their insides to be cut and poked and prodded, gently remind me that there will come a day when I will no longer inhabit my own.  Though we often allow our bodies to define who we are, this weekly scene demands us to recognize that in fact our bodies are just the temporary vehicles through which we experience life.

As such vehicles, every unique body allows for a unique experience of life.  The body presents challenges to each individual in a way that is often neither fair nor pleasant.  These challenges range from nuisance to life-threatening, from a broken leg to blindness to cancer.  Though it may be easier to see the body as burdensome in these cases, it is in accepting these challenges we cannot control and learning to use one’s own original body to experience life that we find fulfillment and continue to inch toward our maximum potential.  For the person with a broken leg this may mean navigating daily life with crutches for a few weeks, for the person with blindness this may mean learning Braille, and for the person with cancer this may mean continuing to learn and love with friends and family between treatments while fighting for his or her life.

Through CrossFit, we recognize the necessity of meeting life’s challenges head-on.  We refuse to take the easy way out, as comfortable as it may be.  Not only do we learn to live our lives with the challenges our bodies present, but we actively seek out new challenges for our bodies to overcome every day. In the box, the uniqueness of the body becomes even more apparent as every individual has his or her own limitations – poor shoulder mobility, low cardiovascular endurance, a stiff knee.  We realize the importance of attending to our own personal weaknesses so that we might use our bodies more efficiently as we continue to challenge them in new ways.  More important than the time on the clock or the weight on the barbell is the fact that we are constantly expanding the unique limits of our own bodies.  Using the vehicles that are our bodies in such a way allows us to grow stronger in mind as well, so that we may develop the fortitude to handle all of life’s challenges, large or small.  After all, the body is just a temporary vehicle, but  the person, and how that person chooses to live through his or her body- choosing to succumb to life’s challenges or overcome them, lives much longer.

 “What doesn’t kill us makes us stronger” – Nietzsche

Improvement through Human Connection


I recently had the fantastic opportunity to spend a weekend with the Barbells for Boobs team on their October Amazing Grace tour across the country.  I, like most CrossFitters, always jump at the chance to participate in all sorts of local events whether they may be fundraisers, competitions, or seminars. Do a workout or two, cheer some people on you just met twenty minutes ago, and then hang out and swap stories with these awesome, newfound friends? Yes, please!  And if we can raise money for a great cause, well that’s even better.  The events I experienced at CrossFit Chicago and CrossFit DuPage were no exception, epitomizing the camaraderie and power of the CrossFit community.

Not too long before heading to Chicago, I had watched a CrossFit Journal video in which Greg Glassman discusses the “Philosophy of CrossFit.”  Coach describes this philosophy as “The belief in the improvability of ourselves and each other.”  He goes on to describe the manifestation of this philosophy in one of the most common occurrences at any CrossFit event, or in any box on an average Tuesday evening for that matter.  As the last person to finish a workout fights through the last few rounds and repetitions, “The crowd goes wild. Why are they going wild?” Coach asks. He answers, “Because they know that the person out there hears them.  You’re believing in your capacity to improve someone by cheering for him.”

CrossFitters believing in their ability to improve each other by cheering at B4B CrossFit Chicago

Now that is a beautiful and powerful thought, and one that was on my mind throughout my weekend with B4B.  Heat after heat after heat of CrossFitters performing Grace, I saw this philosophy come to life.  Though an uninterrupted stream of cheers could be heard throughout the day, I couldn’t help but notice that these cheers amplified at the end of each heat, as the last few finishers lifted their barbells for reps 28, 29, and 30 faster than reps 1, 2 and 3.  Crazy, right? It’s not as if the cheers of the crowd suddenly changed these peoples’ physiological states, enabling their muscles to extract oxygen more efficiently so that they could lift the barbell faster at the end of their workout.  Then what happened? What was it about this mass of screaming CrossFitters that elevated their peers in this time of struggle?

The Doctor by Sir Luke Fildes (1887) - more like a CrossFitter than we thought?

As I ponder this question I can’t help but think about a painting by Sir Luke Fildes titled, “The Doctor.”  I was first exposed to this painting my freshman year of college, and it seems to be a favorite in the profession, as I’ve already run into it again at least three times in my first four months of medical school.  The painting depicts a physician in the 1880s watching over a dying young girl at her bedside while her parents despair hopelessly in the background.  In a time before antibiotics, there was nothing more this doctor could do medically for his patient.  Despite this fact, he sits with her deep into the night with the belief that in so doing he might somehow improve her condition, or at the very least, relieve some of her suffering.  It was the belief in his capacity to improve his patient by sitting with her that drove the doctor to do so.  I believe the physician-patient relationship, though different in its polarity, is in many ways reminiscent of the philosophy that Coach describes for CrossFit.  Even with the rapid advancement of medical technology, in many cases this image of the 1880s doctor is still seen in hospitals today – there comes a time when more cannot be done medically to improve a patient’s condition, and at that moment the best doctors depend on their ability to provide comfort simply by being there and connecting with their patients.  Again we see that it is the belief in improvability through these connections- between physician and patient, between two CrossFitters- that elevate individuals.  Magical, isn’t it?

One aspect of the B4B events separating them from other events such as competitions or seminars lies in their very purpose.  This event wasn’t about doing a workout and having a good time, it was for a much greater cause – raising funds for Mammograms in Action and providing support for those affected by breast cancer.  The fact that we had all gathered for a cause much larger than ourselves or even the small community in which we resided at that moment seemed to amplify everything about the usual camaraderie of CrossFit events that keeps me coming back.  The cheers were louder, the Grace times were faster, and the conversations among complete strangers were deeper and more thoughtful.  At this event, it became apparent to me that maybe Coach’s philosophy extends beyond the improvement of the person standing next to you by cheering for him or her – maybe what unites the entire community, what allows us to walk into any CrossFit box in an unfamiliar city and feel welcome, is the belief in the improvability of “each other” in a much greater sense – maybe it’s the belief in the improvability of humanity.

As I thought more and more about the capacity of these human connections to facilitate improvement, I became eager to make more connections and share some of the crazy and often nonsensical ideas that float around in my head.  I’ve created this blog to do just that, and I hope you enjoy my musings in this exciting time of growth in my life- as I begin my medical training at the Cleveland Clinic Lerner College of Medicine and continue my love affair with the sport of fitness.  Please feel free to tell me what you think and share your own ideas here!