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On Call: Reversing the Covid 15

Fri, 12/11/2020 - 06:21
In East Hampton Village on Friday afternoon
David E. Rattray

Lately, I have had a number of patients refer sardonically to their “Covid 15,” a play of words on the colloquial weight gain that many college freshmen experience their first year at college. The effects of this pandemic are myriad and will be years in the delineating, but among them is definitely some degree of physical deconditioning for many people, myself among them. 

Just last week, a patient bemoaned the 10 pounds or so they had gained this year and asked my advice about where to start in terms of reversing the trend. As I shifted in my chair and thought about the uncomfortably tight nature of my dress pants, I did my best to communicate the following. 

First, if you find yourself among those of us who have gained a few pounds this year, don’t be too hard on yourself. Given such widespread disruptions to our routines, it’s certainly not surprising to see people exercising less and eating more. Gyms are closed, group exercise routines are curtailed, and the comfort of a bag of chips at midnight after a long shift or an extra muffin with breakfast to offset the isolation are all understandable. 

These choices do not make you a bad person. (I’m writing this because I’m reminding myself of the same thing.) I have been fortunate to lose about 50 pounds over the past six years through dietary changes and exercise, and the fact that I’ve gained five of those back during this pandemic makes me feel like a failure. It is vital, though, for me to remember that stressful eating is simply a pattern of behavior. And behaviors can be changed. 

So what can you do if you find yourself in the same shoes? 

First, I recommend keeping a food diary. For a week or two, write down everything you eat, and I do mean everything. Get a concrete idea of what your habits are so that you can identify the most unhealthy ones and/or the ones you most want to change. 

Then, remember that study after study has shown that successful weight loss comes down to creating a caloric deficit. Yes, certain diets and challenges like the Keto or Whole30 diets can accentuate those deficits or make them easier to attain, but it still comes down to taking in less than you expend. A food diary can help you identify some key high-caloric players in your diet, such as late-night ice cream or daily sodas. 

Start with these. At the same time, try to add a few more fresh vegetables in with your meals or for snacks. Don’t try to build Rome overnight, but do start working on the foundation. I also often recommend giving yourself at least 12 straight hours a day where you aren’t eating. This may help decrease insulin resistance given what some studies on intermittent fasting have shown and, equally important in my opinion, it also cuts down on late night snacking. 

Then, give yourself time and space to see what happens. Don’t get discouraged if it’s a slow process. Nutritional science has also shown that successful weight loss (if by successful, we mean weight loss that stays off in the long term) happens gradually, often around a half a pound to a pound per week. Give yourself that time, and do your best to remember that the goal is movement in the right direction, not speed. 

If you are someone who needs a framework, consider looking over something like the Mediterranean diet, which has quite a bit of evidence to support it as a heart-healthy approach to eating. You should also, of course, ask your doctor if there are specific things you need to keep in mind or aim for given your own medical history. A diabetic patient, for example, should be mindful and careful about going extended periods of time without eating so as to avoid dangerously low dips in blood sugar. 

Obviously, these are just baby steps on what can be an incredibly complicated and individual journey. For many people, myself included, just the topics of weight loss and body image provoke a tsunami of emotional responses, not the least of which have to do with how the medical profession has struggled to de-emphasize fat-shaming and instead promote both body positivity and healthy behaviors. I don’t pretend to have all of the answers, but these are some of the approaches that have worked for my patients and me, and hopefully they will do the same for you. 


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