She wasn’t supposed to have a heart attack.  I mean, she was only 42, but the EKG didn’t leave anything to the imagination.  There it was, clear as day, an elevation in the ST segment, a STEMI in doctor jargon, a classic sign of a heart attack.  She didn’t need this right now, with the new job and all.

            Even though Carol was not the classic heart attack victim: relatively young, female, normal blood pressure, she was 35 pounds overweight, had increased inflammatory markers and a lousy family history.  She is a perfect representative of the new wave of cardiac patients that are literally reducing the lifespan of US citizens for the first time...ever. 

            And one of the big culprits is excess weight.  A whopping 74% of adults over 20 are either overweight or obese.  Excess weight is a precursor for a variety of problems including type 2 diabetes, hypertension, fatty liver and senile dementia.  Obesity is the new smoking when it comes to public health issues. The successful anti smoking campaigns of the 70s and 80s reduced this form of slow suicide fairly successfully, and there was a corresponding drop in deaths due to cardiovascular disease. However, with the rise of obesity and weight issues, the likelihood of heart attacks and strokes also increased, to the point of offsetting deaths from cancers and other maladies.

            The most frightening statistic is that much of this rise in heart disease is in younger folks, mostly women.  Elevated body fat creates a number of scenarios that lead slowly to heart problems.  Elevated blood sugars and increased inflammation set up a process that ultimately results in blocked arteries and disease.  This doesn’t happen overnight.  Carol didn’t just wake up one morning and have a heart attack.  The process had been building for years.  With 45% of children being overweight, and 70% of overweight kids becoming obese adults, it easy to track why younger and younger people are experiencing problems.  The damage begins early.

            The good news is that if the weight issue is addressed early, the less damage is done.  And this is truly a case of it’s never too late.  Studies indicate that losing weight and adopting a healthy lifestyle with exercise, no smoking, and healthy eating can actually reverse damaged vessels.  

            So why is losing weight so hard?  Because in many instances it’s not so much about the weight but everything surrounding the weight.  By that I mean your stress level, how well you sleep, your home environment, social interactions and stories you tell yourself about your abilities. Nutrition and activity level are, of course, important, but weight control is much more complicated than simply calories in versus calories out.

            Michael Jordan, even at the height of his basketball superiority, had a coach.  He knew a fundamental principal about human nature, we have a hard time seeing ourselves. A coach can look from the outside, see things we miss or ignore, and make suggestions as to how we can better achieve our goals.  So it is with weight loss.  A trusted coach can be the key ingredient in any program and the difference between success and frustration.  As a bariatric trained physician working with hundreds of folks losing weight, one thing I can say with great confidence is that if you want to lose weight, working with a knowledgeable, caring partner will increase your likelihood of success immensely.  This is not where you want to “pull yourself up by your bootstraps” because those straps are likely to snap leaving you frustrated, confused, and probably at the same weight.



The older I get, the more I qualify as an “athlete.”   One of the great things about running in races is that some bright soul years ago decided that footraces needed age categories to properly handicap the event.  Indeed it seems a bit queer to equate a long lean 20-year-old with a frumpy, hair growing out of their ears, middle-aged, middle-of-the-packer, like me.  If I was the 20 something, I would be insulted just to be lumped in the same race as grandfather time.  But the running gods were smiling on us pentagenarians when races from 5k to the marathon divided the finishers based not on time but age.  There is a natural attrition in runners once you get into the fifties that is playing right into my hands.  As fewer and fewer men in my age group compete, the closer I get to finishing in the top one hundred.  It’s not that I am any faster than I was a few years back, in fact, I have decelerated to the pace of a pregnant slug, but I have steadily risen in my age group as more and more men my age have either stopped running or now enter the walker with the tennis balls on the end division.  I figure if I am still running by the time I am 109, I might even place in the top ten!  

            Running as you age does have its perils.  I was pushing mile 23 at what I thought was a respectable pace in my last marathon only to be passed by a runner on a prosthetic leg.  In my defense; however, this guy was really moving, but then I saw he was also blind, being led by a rope tethered to a sighted of a runner whose dust I was also eating! It’s just this kind of ego demolishing event that the older runner must assimilate so as not to stop in the middle of a race and hide out in a porta potty.  Over the last few years, I have been passed by kids as young as eight and every possible challenged runner you could imagine.  In fact, I no longer get upset unless the kid that passes me is younger than the underwear I have on at the time.  I even was passed in one race by one of the wheelchair competitors.  Now, this on the surface doesn’t sound so unusual because the racing wheelchairs can get going really fast, but in this case, the competitor was going backward!  Something about setting a Guinness World record of racing backward and humiliating as many old men as possible.

            Aging runners also have a propensity to wear running outfits that not only embarrass and humiliate their offspring but also scare small animals off their path. I will never forget purchasing some running shorts and a shirt online and proudly parading through the house before my morning run.  The silence of daybreak was shattered by the howling laughter of my daughters and wife and they almost choked on their PopTarts.  Once they settled down I asked them what was so funny, and they immediately went into another laughing paroxysm that left me wondering if General Mills was now lacing their products with marijuana.  My wife mercifully explained that my outfit looked like I was a guest on Richard Simmon’s Dancing with the Oldies infomercial and she and the girls would move that afternoon if I went out into the neighborhood looking as I did. Granted the shorts were cut a bit high and my kids explained that most folks don’t equate their waist with their sternum.  Also, they thoughtfully pointed out amidst sobs of uncontrolled hysteria, that mesh see-through jerseys went out with Metallica and Kiss.  Needless to say and under threat of physical harm, I changed clothes and once again regained a portion of dignity.  I now understand the web sites no return policy.

            The older runner also has to deal with a variety of physical maladies that are unique to their station in life.  A cacophony of noises, grunts, and sounds emanate from unexplainable sources while putting in the miles.  I have begun a little game during my runs called “where oh where did that come from?” to not only pass the time but also tune in to any life-threatening changes in my organ systems.  I figure that if I can identify an errant noise, much like when your car engine is about to explode after 100,000 miles, I stand a chance of dialing 911 before leaving to the ants and small animals that would find me on the side of the road. At 20 you don’t think of such things. At that age any strange eruption you write off to the ham and cheese burrito and six pack the night before.  At 50 and beyond these same noises may signify anything from a bowel obstruction to a cerebral aneurysm. Not that I am paranoid, but at more and more races as I converse with fellow age groupers, there seems to be a morbid trend to our discussions. “Did you hear about Harry? He was doing a 10 miler and his spleen fell out!  They didn’t find him for 2 days and that was only after tracking him by his Garmin 350.  What was really sad was according to his Garmin he was at a 7-minute pace!  What a waste of a good run!”
            I may not be getting any faster as I age, but dadgummit, I’m out there and so should you be!  The secret to longevity is exercise, even in spite of the intrinsic dangers facing older runners.  There is much evidence that running in your later decades reduces your risk of cancer, dementia, impotence, and the heartbreak of psoriasis.  Exercise is truly the fountain of youth.  If Ponce De Leon had entered the St.Augustine marathon instead of traipsing around in the swamps looking for some mythical elixir, he might have had more than a road named after him.  Even though we may get passed by runners in Elvis costumes, us older runners have one thing in common; we will very likely live longer which will allow for more time to embarrass children, sip vintage Merlot, and make a difference in the lives of those we touch.  Live long and taper!