We are overweight. We aren't in good cardiovascular shape. Our most endemic disease is the metabolic syndrome - diabetes mellitus, hypertension, hyperlipidemia and all the consequences of that syndrome. While our genetics vary, and some (at the extreme the Pima Indians) have a greater tendency to these problems, I venture that all our diverse peoples suffer with the syndrome.

Why are we overweight and obese? The simple answer probably reflects reality - we eat more calories than we burn. We eat the wrong foods, although we can't easily obtain general agreement on our ideal diet. Few of us exercise enough, either aerobic exercise or strength conditioning. Too many become "coach potatoes", minimizing their caloric expenditure, allowing their natural muscles to atrophy slowly, while eating empty calories. I know, I've been there.

Thirty pounds ago I wore size 38 pants. I had frequent heartburn. My energy level decreased monthly. One day I looked at myself in the mirror, and wondered how it had happened. I've been an athlete my entire life - not a great one - just a dedicated recreational athlete. I played basketball (full court) until around age 45. Basketball kept me in shape. Nonetheless, I still struggled a bit with my weight.

When I stopped playing basketball, I didn't have an exercise plan. I played golf regularly, but I didn't fool myself. Riding in a golf cart doesn't represent exercise. Golf is a great game which benefits from ones physical conditioning, but it doesn't create the level of exercise that I needed.

So 3 years ago, I made a commitment to myself. A commitment to get in shape! Being relatively naive, I started with cardiovascular conditioning. That was a very reasonable place to start. I bought an expensive treadmill (I now know that when you use the treadmill regularly it isn't really expensive, it just costs some money). At first I walked at 4 MPH for 20 minutes. I was sweating, and tachycardic. I started dieting (not a very healthy diet, just worked on decreasing calories). The treadmill was my challenge. Running became my goal. Each day on the treadmill I would increase my speed a little. One day I could job at 5 MPH. While not very fast, this success excited me.

Over time I could actually run on the treadmill - as fast as a 9 minute mile or even better. At that time, my progress stalled. I needed more information on diet, and probably needed some strength training. I got to strength training through golf. One day I'm talking to one of my golfing buddies, and asked him if he knew anyone who specialized in golf training. He does a weekly golf radio show, and had a sponsor who had such a program. 11 months ago I walked in and started.

The first month we mostly stretched and learned balance, but over time my program has evolved to strength training and body shaping. My trainers (I've worked with several) have exposed me to nutrition and muscle. Being inquisitive, I began to read medical journal articles about nutrition and the importance of muscle mass. Readers of this blog know that I do focus on such articles often. This past February, we developed some goals. I had a complete evaluation of strength, flexibility, measurements, and body fat (using calipers). My July evaluation (5 months later) showed dramatic results. I've lost no more weight, yet my body fat percentage decreased from 23 to 18. As you can imagine, my proportions are changing.

My road thus far has been a long one; one which has become a central activity.

So what does my personal journey tell me about working with the average patient? I'll suggest some principles, without demanding a randomized controlled trial.

• Incorporating fitness into one's lifestyle is the goal - if one does - the weight generally takes care of itself
• We have an excess of dietary theories - but I'm certain that we shouldn't eat excess fats or "unrefined" carbohydrates. Calories matter, but so does the composition of the diet.
• Cardiovascular fitness and muscle fitness complement each other
• One should contemplate each week with a plan - when will I workout - how will I balance my diet
• As a country we must encourage studies which evaluate methods for making fitness easier and a greater priority for Joe and Jill six-pack

I hope that this ride on db's soapbox and personal journey was acceptable. The obesity battle requires hard work but that hard work is worthwhile. As physicians we should constantly encourage our patients to modify their lifestyle. Our research industry (especially the NIH) should fund research so that we can give our patients better information. And I will continue to cite articles that address this general topic.