Patricia Yarberry Allen, M.D. is a Gynecologist, Director of the New York Menopause Center, Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. She is a board certified fellow of the American College of Obstetrics and Gynecology. Dr. Allen is also a member of the Faculty Advisory Board and the Women’s Health Director of The Weill Cornell Community Clinic (WCCC). Dr. Allen was the recipient of the 2014 American Medical Women’s Association Presidential Award.

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Dear Dr. Pat:

I have just finished a grueling five-day marathon of Thanksgiving preparation, execution, and nonstop entertaining.  It was a successful holiday in many ways.  There were no major fights, no travel-related accidents, the turkey wasn’t dry, my guests seemed pleased with the meal and the accommodations—but I don’t know how I can make it till January 1 unless I change something in my life.  I just don’t know where to start.

I gained 5 pounds in the last week, and I was already 30 pounds overweight. I am 55 and in menopause. I am an untenured Ph.D. assistant professor in a small college. I am great at my work and love teaching and mentoring, but I work 50 hours a week for a 20-hours-a-week salary. I work longer than I need to, perhaps, because I hope that one of these days I will get the brass ring of a tenured teaching post. I have a good marriage and three adult children who support themselves, have good character, and treat my husband and me with respect.

I seem to be unable to control my weight. I just can’t seem to stop eating, since I am often tired and I don’t have time to prepare foods that are healthy, so I eat at the college cafeteria and drink lots of coffee. Believe me, I need a drink or two every night with my late-hour dinner. I sleep poorly and often wake up tired. I seem to say yes to almost every request, even when I need to say no. I don’t have time to exercise. I don’t have time to meditate, and I often forget the many things that are right in my life. I know I am not alone. I have many friends who would describe themselves just as I have described myself. My question is: What do I fix first in order to have a healthier, more serene life?

Phyllis

 

Dr. Pat Responds:

Dear Phyllis:

You are right: You are not alone. There are many women in midlife who would describe themselves in some of the ways you characterize yourself.

Many of us begin our holiday marathon with Thanksgiving entertaining or travel. At our job we work hard before the holiday so we won’t return to chaos. At home we work hard to make the big day perfect, whether we are host or guest. This day of gratitude is often lost in the misery of overeating and drinking in a setting of exhaustion from too much preparation and too little sleep.

You are right to understand that you don’t have to wait for New Year’s Day to make resolutions. You can start today and end 2013 with new habits that will improve your life. It is fascinating that so many of the behaviors that you would like to change are interrelated. It is hard to lose weight if you aren’t mindful. It is harder to be mindful if you are exhausted and unfocused due to poor sleep. It is hard to improve sleep if you overeat and drink. Self-care and gratitude are concepts that are far down the list when you have a tired brain, an anxious mind, a body that is poorly nourished and underexercised, and a life that seems be a treadmill of always saying yes.

Phyllis, use this time both to recover from Thanksgiving and change the behaviors that are negatively affecting you. Focus on changing behaviors for the next 28 days, and you will have new habits that can slowly improve the quality of your life. Nothing will change, however, until you choose to put yourself first.

Get serious about your diet. Many Americans increased their weight over the last week. Thanksgiving is, after all, the American holiday associated with overeating, consuming too much alcohol, having no physical activity, and enduring lots of stress.

1. Take a break from booze.  Alcohol is converted to sugar and increases abdominal fat.  Alcohol increases the appetite; makes it harder to make good food choices; and worsens sleep for many people. Poor sleep impedes weight loss. This is an easy choice for 28 days.

2. Cut out the sugar and the unhealthy carbohydrates.  Food is a temporary fix for fatigue, and you are making bad choices throughout the day. Stress eaters tend to prefer high-carbohydrate foods because these foods trigger an increase in the brain chemical serotonin, which has a calming effect.

3. Eat frequently, and eat smaller portions.

4.  Avoid late-night eating, since it is bad for the waistline and bad for sleep. And poor sleep is bad for weight loss. I don’t know why you are eating dinner late every night, but if that is impossible to change, make dinner your smallest meal of the day. Eat lightly in order to sleep better nightly!

5. Say yes to a nutritionist or to a weight-loss group in your town.  A support group is often helpful when weight gain has been a longstanding problem, and mindfulness and planning for meals does not come easily.

Be smart about your sleep. The scientific interest in sleep disorders has improved our understanding of the dangers of poor and inadequate sleep:  Daytime fatigue decreases cognitive function, causes impairment in conflict resolution, and, yes, leads to weight gain.  Inadequate sleep often results in excessive eating, obesity, and poorer response to many diet plans.  Alcohol use impairs the pattern of sleep.  People who drink alcohol in the evening often fall asleep easily, but may endure early wakening and daytime fatigue due to impaired quality of sleep. Phyllis, stopping the nightly alcohol use will improve weight loss, improve sleep, and improve daytime energy.

Begin to lead a mindful life. I know that you are working 50 hours a week at a 20-hours-a week salary, in order to pursue the goal of becoming a tenured professor at 55.  It could be time to reassess this goal. Perhaps a serious conversation with a trusted member of the faculty who understands your dilemma could be helpful, or you may choose to have a few sessions with a therapist who may be able to help you understand how to accept the price you are paying for your career choice.  If you learn that your chance of getting tenure is almost nonexistent, then this could be a good time to trade in part of that extra workload for some time for self-care.

If you make the decision to reassess your workload that is not required by the college, cut your work hours back by 10 hours a week as soon as it’s feasible. Use this extra time  to begin an exercise program and to start a lifelong study of a meditation practice.  Exercise improves sleep, cardiovascular health, and cognitive health, and will make weight loss easier. An  option might be for you to join a walking or running group in your neighborhood. Research your local runners’ organizations for walk-or-run groups. Many women find the sense of community with other women helpful and encouraging.

The art of meditation is not easy to master, but learning to let go of ruminating thoughts or attempts to control situations that are out of your control will improve your energy, your mood, your sleep, your cognitive function, and your overall sense of well-being. Try the Oprah and Deepak 21-Day Meditation Challenge. Many of their meditation series are free online.  When you are mindful, you will become more comfortable with the word no as well.  When you learn to say no to your many invitations or presumed obligations, you will be learning to say yes to self-care.

Learn the joy of gratitude. You have so much to be grateful for:  your health, your marriage, adult children who are doing well, work that you do love, friends and family who want your time and attention . . . and that is just starting the list. This is such a wonderful time for you to make decisions that will allow you to have both a healthier life and to choose how you want to live in this next stage.

Take this time, Phyllis, to change what you can change and accept that which you cannot change.

Dr. Patricia Allen

 

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