Health lessons from Reverend Al Sharpton…

However you see the Reverend Al Sharpton, one thing is certain: you see less of him now. His Twitter pic tells you he is proud of his 167-pound weight loss. Good for him, he should be.

Screen Shot 2013-10-11 at 4.52.25 PMIf you care about health, the disappearance of the Sharpton-of-old is worth mention. His story teaches us a lot, and, if one dares to look a little deeper, bigger lessons bulge out. Surely this is more than just a weight loss story.

The obvious question: How did he lose the weight?

Yes, of course, we all want to know about the process of shedding 160+ pounds. But I ask you to call time-out and first look carefully at the pronoun in the six-word question. The pronoun of note is he. “He” lost the weight. No doctor or nurse or bariatric surgeon lost his weight; “he” did. That’s huge.

The second notable thing Rev Sharpton said was that he decided to lose weight. Note the verb: decided. His caregivers didn’t decide; nether did his friends or co-workers. Simple verbs can be quite important for health. His action, to choose, that is, is also huge.

Third, the process of his weight loss is a recurring one that I see often. Rev. Sharpton gave up red meat; he ate plants, and stopped eating late at night. In reality though, and this is key, he ingested far fewer calories. And like most people who remain thin, he adhered to a regular exercise schedule, the key adjective being ‘regular.’

It is most important to note what he did not include in his regimen: bariatric surgery, medical therapy or fad diets.

I read and I study and I think a lot about public health and human behavior, and yet, whenever a Sharpton-like story comes up, I have trouble understanding why this message of simplicity, common sense and personal responsibility doesn’t stick. Such a message is neither mean nor complicated.

This week, I read a Harvard professor’s take of the obesity epidemic. He pointed out something that Rev. Sharpton figured out: one has to learn how to live with constant exposure to excess calories. In science we call it equilibrium. The answer to curbing obesity is not banishing McDonalds, PapaJohns or Coke; the answer is choosing wisely–for yourself. That’s what the Reverend did. He decided. He nudged himself. This is what all people who succeed in achieving a balanced healthy life do.

The New England Journal of Medicine recently featured a Perspective piece on training physicians to manage obesity. It was a good article that urged academic centers to better educate young doctors on the biology and psychology of obesity. That’s reasonable; I’m very open to improving my motivational skills. (Based on how often patients adhere to my advice, my nudges need improvement.) The underlying problem with this article, however, is its premise: doctors do not manage obesity. Patients do, like Al Sharpton did.

If you do not yet consider me insensitive, unsympathetic or naive; if you haven’t clicked away in disgust; I have a little more:

What I found most remarkable about the Sharpton story is something he said about the perception of his health.

In this short video interview, Rev. Sharpton tells how his weight loss caused concern among his friends. They thought he was sick. The perception being that skinny people are sickly. (This happened to me in cardiology fellowship in the 1990s when I lost 40 pounds. More than one colleague worried I had AIDS.) Reverend Sharpton had a wonderful answer to these concerns:

They should have thought I was sick when I weighed 300 pounds; that’s when I was sick.”

I’ve written before about our distorted perception of what is a normal weight. Changing the default of what America sees as healthy should not be underestimated. It is neither normal nor healthy to be jiggly or sedentary. I saw three patients today with pre-hypertension. Each one could have been put on medicine. But each was overweight, and I am convinced that if they decided, they, not I, held the key to better health. You bet I told them that.

What are we thinking? As a nation, a strong and proud nation, it is imperative that we harden up a little. The case of Reverend Sharpton–his decision and his action plan–supports my thesis: Health cometh not from health care, but from within. From simple verbs.

I hope the influential leader uses his influence to promote such an important and just public health message.

JMM

7 comments

  1. Because of Al’s past, including tax issues, drug videos, being caught in lies, and general questionable behavior, people would naturally think the weight loss was not through some legitimate means. However, lets say he did it the natural honest way as he claims. He says the reason he lost so much weight is linked closely with the vegan diet. I have seen people lose weight this way when mere portion measurement didn’t work. BTW, I have eaten no red meat for many years. I eat only healthy foods (fruits, vegetables, beans) every day. I was never 300+ ponds nor an I the 138 pounds he claims to be. I have exercised all my life. So I would like to know what he eats and how much. I have a feeling it may be less than what is considered healthy. And I also wonder about his protein intake. I’m sorry but what I read is a healthy amount of food and balanced diet won’t make you look emaciated like Al. Let’s say he is exercising. I still don’t think you would look like that on healthy diet and exercise alone. But let me get some questions I would like answered. Are there any medical guidelines that support a vegan diet, and if so, where can I find these diets. What sources of protein (please don’t say tofu) support this diet? It is easy to eat apples, pears, grapes, vegetables, and greens every day. But what about protein? Is it okay to eliminate all dairy, fish, and foul as a sustained diet? How do you “assemble” a complete protein diet? I know about lentils, beans, quinoa, and tofu. What else? What about grains? Good or bad? I found this website http://mikesmixrecoverydrink.com/there-are-no-health-foods-3/ that compares the USDA diet, the Paleo diet, the Vegan diet, and the “Healthy” diet. Which one is best? I have to tell you, it doesn’t seem the public is getting good information. And it doesn’t seem Al is getting good nutrition.

  2. I looked up what Al eats. There is a video of him revealing what he eats on NPR (not something I know anything about). I listened to it word for word. The summary of that video looks pretty unhealthy to me. Correct me if I’m wrong:

    “Sharpton says he tried several diets but “none of them worked.” Finally, he decided to go almost entirely vegetarian. He eats fish, usually sea bass, on Saturdays. Otherwise, he follows a strict regimen: two pieces of toast about 5:30 a.m., and then a treadmill workout; a salad, banana and hot tea for lunch about 12:30 p.m.; two pieces of toast and tea in the afternoon. “I don’t eat anything after 6 o’clock,” he says. His staff and others close to him say they are amazed, and sometimes worried, that a 58-year-old man who eats so little food can maintain his usual pace of 16-hour days, usually seven days a week.”

    1. The Reverend has, shall we say, made mistakes. And yes, there is the possibility that he lost weight with aid from something he didn’t tell us about. But if I assumed that, than one might call me cynical. What’s more, I was serious about seeing his sort of method in my practice. When people transform their lives, and then it sticks, it is always with basics. Here is what they tell you 1) They decided to do it; 2) They radically improved nutrition, jettisoning junk food almost entirely; 3.) They adhered to a regimen of regular exercise. That’s it. No tricks.

      Whether one gets healthy with a plant-based diet or Paleo or whatever is not a big factor in my mind. For me, a healthy diet is one that includes real food–not in packages or boxes. And less of it. There are folks who make compelling arguments for plant-based diets. Dr. Esselstyn recently visited our campus.

      As for the reverend being under-nourished, I doubt it. In fact, your concern highlights my point about perception. Little people, and he is little now, don’t need as much food. The thing that happens to lean and fit people is that they feel well at a lower weight and these good feelings incent them to stay there. Another observation from the office practice: you don’t see many obese 90+ year-olds. Though the calorie-restriction animal studies may not apply to humans, the fact remains that carrying less weight into old age reduces the risk of morbidity.

      Please do not misunderstand, I am no advocating for under-nutrition or starving oneself. I aim to promote simple concepts, like choosing to decide to be healthy and following a regular balanced life plan. These simple things don’t come from doctors, they come from within. I take it is my job to educate patients that overweight isn’t healthy or normal. Doctors should move obesity up in their problem lists. Obesity is often the problem, especially in the Internal Medicine arena.

      1. I support and echo comments by Dr. John. There is a lot about Al Sharpton’s dieting on the internet (sensationalism) – but I didn’t find clear reference that truly gave me specifics of calorie count, amounts, etc. of foods consumed – so I’m not really certain as to what he did when … Having dieted myself (and maintained diet, body weight, and healthy lifestyle for the past ~ 40 years) – as well as having counseled patients and taught young physicians in primary care regarding diet, weight loss, exercise and other healthy lifestyle habits over my 30+ year career – I found like Dr. John that it is indeed the “simple stuff” that determines if weight loss will be effective not only in the short term, but for the long term. The person (patient) needs to WANT to change – and then they need to actually CHANGE their entire everyday existence in terms of perception, approach and mindset. Only when that is done in my experience will there be meaningful improvement in lifestyle (and bodyweight) that lasts more than the short-term. The specifics of the diet are less important. Fish is a great source of protein that can be prepared in tasty, low-calorie format (if you don’t like tofu). There are other healthy, low-calorie foods that can be selected for sustained weight loss that don’t necessarily need to leave you feeling hungry – though I fully admit much effort is needed and it isn’t easy. FINAL POINT: Given the statistics (realistically it is the distinct minority of folks who succeed in truly losing and keeping off significant weight in the longterm) – as clinician needing to maintain my enthusiasm and positivity – I realized long ago that as good as I might be in counseling and encouraging (I got to be excellent) – it was NOT up to me whether or not the patient succeeded. The patient had to REALLY want to succeed – and then they had to commit to changing – then change – then maintain all of the multiple changes in lifestyle that they made through thick and thin and over time. Until I saw this effort and process of change occurring in the person – I fully accepted that longterm success was unlikely, and therefore did not put “too much of myself” into my efforts. Success rates that are well <10% longterm lead to clinician 'burn-out' if clinician feels it is solely up to him/her regarding the patient losing weight. It isn't up to the clinician. It is up to the patient. THANK YOU for listening.

  3. My mind drifts back to the Stanford marshmallow experiments.

    Delayed gratification is tough for humans. It pays huge dividends in health, wealth, education, and relationships. It was also a potential liability for much of our evolutionary history.

  4. I have to agree with Dr John on patient responsibility.
    In my case as a pediatrician it becomes a family responsibility too.
    The issue of what people see as normal and healthy is often a problem.
    Parents think their child does not eat enough yet has a BMI > 85%.
    When I lost 25 lbs a year ago to go from 5’11” 180 to 155lbs people asked my wife if I was sick.
    No just a Mediterranean style diet and exercise.

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