Women, Take This Doctor's Advice to Heart

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Happy American Heart Month! 

February's best-known day is Valentine’s Day, and what with all the heart-shaped things associated with that occasion, it is the perfect month to highlight heart health and share with you what you can do to protect your most precious asset.  Your heart will be there for you during all of your life’s adventures, but heart disease is a big threat to all of us!   Heart disease is America’s number one cause of death. 

According to the Centers for Disease Control and Prevention:

• 1 in 3 deaths in the US is from heart disease and stroke
• That's equal to 2,200 deaths per day.
• 2 million heart attacks and strokes occur each year
• 80,000,000 adults are affected by heart disease
• Heart disease & stroke cost the nation $444 billion/year in health care costs and lost economic productivity.

How can you start taking care of your heart? By being mindful of your lifestyle--and knowing that lasting change is not accomplished without knowledge and a little work.  You will find that SparkPeople is a great resource to help you accomplish not only your weight-loss goals but also your heart-health goals! (Visit SparkPeople's Healthy Heart Condition Center today.)

In the not too distant past, heart disease was erroneously labeled as a "man’s" disease.  The seemingly healthy father that suddenly dies of a heart attack leaving young children and a wife behind is a stereotypical nightmare scenario.  Views like this have placed too much emphasis on men in heart-health research, and, as a result, both treatment guidelines and public health initiatives are skewed toward men. 

But are you aware of the prevalence of heart disease in women?   More than 42 million women are currently living with some form of cardiovascular disease.  Heart disease is the leading cause of death in women in America!

To change America’s perception that heart disease is a "man’s disease," the American Heart Association in 2004 created the campaign Go Red for Women  to bring awareness to this largely preventative disease.  Efforts such as Go Red for Women Day work because studies show that when women are aware of their risk for heart disease they are much more likely to make the effort to make the necessary lifestyle changes. 

The same simple, lasting changes you're implementing as a way to lose weight will also help you keep your heart healthy: eat a healthy diet, maintain a healthy weight, exercise regularly, don't smoke (or quit if you do), and limit your alcohol intake.

So, as women, what can we do specifically to improve our heart health? What should we be doing to keep our ticker ticking?

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Spotlight on High Blood Pressure: The 'Silent Killer'

Happy May! Have you moved past the ''resolution'' phase and established a consistent diet and exercise routine?  Hopefully your new lifestyle consists of healthy habits and you are really starting to get a feel for what it takes to make a permanent lifestyle change.   If you aren’t quite there yet, it’s OK.  Bumps in the road are expected! Continue to try to make more good choices than poor choices and reevaluate your plan on a regular basis. 

Today is a great day to look over your plan and make sure that everything is working well for you.  If you are having trouble with maintaining consistency and sticking to it, ask yourself if it’s time to do some tweaking.  Perhaps you are still not getting to the gym 3-4 times a week as you initially promised yourself. If that's the case, then maybe it’s time to start a home workout regimen.  Consider enlisting the help of a personal trainer in order to add some accountability and to shake up your routine.  If you still have trigger foods in your kitchen, it’s time to finally get rid of them!  Leaving your triggers in your home and attempting to avoid them saps your willpower and leaves you empty when you are faced with other challenges that you can’t control.  Commit to being consistent!  I will now step off my soap box and move on to discuss a condition that you can help prevent by getting into a consistent healthy routine.

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6 Ways to Improve Your Health Today

We are well into 2012 and I hope you have been successful with establishing your healthy lifestyle habits so far.  If you have fallen off the wagon, today is the perfect day to recommit to your new habits.  If you’ve been consistent with your new habits and are seeing the results, keep it up!  Finally, if you have reached your goal, then congratulations!  But to each and every one of you, remember that your habits must continue in order to maintain a healthy weight and to be your healthiest self.

Some of you might like the sound of living a healthy lifestyle, but might not know where to start. Getting healthy sounds simple enough, but there are so many areas to focus on that it can become overwhelming. If you're still having trouble identifying how to get healthier, the basics are a good place to start. As a physician, wife, mother of 5, weight loss success story, and a regular person just like you, here is a list of what I believe are some essentials for improving your health. 

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Dr. Birdie on the New Women's Health Guidelines

Being healthy is about far more than the number on your scale. Just because you lost weight and look fabulous does not guarantee you're healthy on the inside.  As a physician, I have seen many people who are thin and look healthy, but are actually sicker than many overweight and obese people. 

The best way to stay healthy for years to come is to prevent illness.  Focusing on diet and exercise is an important part of being healthy and preventing illness, but there are other aspects of your health that can't be managed with diet and exercise alone. Some areas of your health require regular visits to a qualified medical professional, especially for women. 

So, women of SparkPeople, when was the last time you visited your gynecologist? 

Can I see a show of hands?  Do you know how often you are supposed to get a Pap smear? How about a mammogram?  You are probably thinking I’m trying to trap you into the wrong answer. 

Of course, I am!  Most of you probably said you need to get an annual Pap smear and an annual mammogram starting at age 40.  Right?  Not anymore.

The rules we've all heard have changed, and I'm here to explain the new recommendations for Pap smears, mammograms, and more.

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Ask Dr. Birdie: Straight Talk about Binge Eating

This journey to a healthy lifestyle is a worthwhile, but at times, difficult endeavor. If you're dealing with an eating disorder on top of a weight issue, it can feel downright impossible to reach your goals.

Most of us are familiar with the eating disorders anorexia and bulimia, but I would like to focus on an eating disorder that is actually more common.  This diagnosis is rarely discussed on diet and exercise blogs and not given the attention that it deserves, which is not surprising.  After all, eating disorders are typically suffered in secret.   

What am I talking about?  Binge eating disorder

Let's discuss this medical condition in detail so that you can understand the diagnosis, and, if you think you are affected, you can seek the help that you need.   

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So, You've Reached Your Goal Weight... Now What?

I have lost well over 100 pounds and have maintained the majority of those lost pounds for over 3 years. Because of the length of time I have been on my weight loss/maintenance journey, I am at a point that I really spend much of my free time (which is not much at all), looking back and reflecting upon my journey. One of the questions that I have asked myself on many occasions is, "What was different about this last and most successful attempt?" If you have read any of my blogs then you may know that it’s hard for me to give credit to any single factor.  I almost always attribute my outcome to a multitude of things. 
 
I have tried to lose weight on many occasions. My first formal "diet" was at age 15.  I started at 180 pounds and dieted (starved) down to 140 in 3 months, utilizing a national weight loss program.  At the end of the diet, I went back to my old ways and it probably took me about 3 months to gain it all back. I can’t really blame my teenage self for that and all of the subsequent failures to come.  I had not yet learned about the concept of calories and the importance of balancing my energy intake and output. Not surprisingly, I went on many more "diets" with my last major attempt in 1996, when I lost 25 pounds on yet another national weight loss program (this was my fourth national weight loss program!).  I then went on to gain about 100 pounds in that following year and gave up on losing weight for about 10 years.

During those 10 years that I spent being morbidly obese, I accomplished quite a bit. I got married, graduated from medical school and gave birth to 5 beautiful children. So, it’s not like I wasn’t busy. I was very busy with the transition from adolescence to adulthood. I was also very busy with avoiding my increasing girth.

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What's Your Secret, Dr. Birdie? Willpower

"You've lost over 100 pounds! What's your secret?"

I've heard that question countless times.  When I first lost the weight, my answer was always simple and the same: "diet and exercise."  Disappointed looks always followed and I would walk away thinking, "Why did I disappoint them? I was only trying to be honest and helpful!"  But, over time, I started to really think about how unsatisfying my answer must be to those who are serious about wanting to lose weight and change their lives.  I believe that everyone to some degree has an understanding that "diet and exercise" boils down to what we call here at SparkPeople "calories in vs. calories out."  I know that there are millions of people who are uninformed about how many calories they should consume in a day and even more if you throw in the concepts of nutrition and how to incorporate exercise into your daily lifestyle.  So, if the purely educational barriers are overcome, is this still enough for everyone to achieve long-term success?   

There will be a certain percentage of overweight people who, just by providing them with tools and accurate information about diet and exercise, will be able to successfully their reach weight loss and maintenance goals.  Kudos to them!  Unfortunately, I believe is that is a very small percentage and, to my dismay, I am not a member of that group.  You don’t end up weighing close to 300 pounds based solely on pure lack of knowledge about what it takes to create a calorie deficit!  Let me clarify to say that educating yourself about nutrition and exercise is important; what I am asserting is that knowledge of nutrition and exercise ALONE will not be effective for MOST of us to achieve our weight-loss goals.  This may be a bit shocking to hear, especially coming from someone who spends time and energy in the pursuit of educating people about "diet and exercise."  Knowledge about diet and exercise is the key to shedding weight and maintaining the lost pounds, but what I want to discuss today is how one places the key in the ignition to incite change and get excited about that knowledge.      

With these thoughts in mind I would like to share with you some of my thoughts on another concept that is widely associated with weight loss, willpower.  This is a core element that most believe to be paramount to the success of any weight-loss endeavor. 
 
What is willpower?  Willpower as defined by the Merriam-Webster dictionary as "the power to control one's actions, impulses, or emotions." 

The ability to control one's actions and impulses!  That sounds exactly like what we need in vast quantity to lose and maintain our weight!  Those who have lost a significant amount of weight obviously had it in plentiful supply during their journey.  There are different paradigms that can be used to describe willpower.  Some believe that the amount you possess is predetermined at birth (like eye color).  Others believe that it resides in all of us whether we realize it or not and that we just need to learn how to tap into it.  The belief that that I am most fond of and interested in is that willpower is a resource that can be strengthened or squandered.  

Let's discuss a study that sheds light into what willpower is and take away some potentially helpful information that may help you on your quest to achieve weight loss and a permanent lifestyle change.  This study was not designed for the purpose of weight loss, but given that the whole science of weight loss and weight maintenance is incomplete at best I think it's OK to take a few liberties in order to try to understand why it's not easy to lose the weight and to keep it off.

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The Health Benefits of Losing Just 10% of Your Body Weight

It's now the second week of January, so let's check in: How are you doing with your weight loss or maintenance goals?  

Many of you are just starting on the road to a new lifestyle.  Welcome!  I’m sure you have an abundance of motivation and willpower, and I hope that you use this powerful force to learn and integrate the SparkPeople principles early and successfully! 

Many of you are like me, and you're recommitting to your goals. You might be struggling to find your way back to consistency and balance.  Kudos to you for never giving up and accepting that we are in it to win it! 

Whether you're new to SparkPeople or are a veteran, some of us are feeling burned out and are thinking about giving up. We are here to look for a "spark" that will start a fire.  I hope that you will decide not to take a break (learn the consequences of taking even a short break) and will keep working on it until you find success. 

Rather than delve into motivation or secrets of success, let's back up a bit, and ask another question: Why lose weight?

While your reason(s) for losing weight and maintaining that weight loss are as unique as you are, there are a few reasons that many of us share. Among them: to improve one’s health.  I know it was on my "reasons to lose weight" list. 

If you already carry the diagnosis of an obesity-related medical condition, such as high cholesterol, hypertension or diabetes, that knowledge alone can be a great source of motivation and willpower.  But, what about the relatively healthy overweight person who wants to lose weight for "health reasons," but doesn’t really know yet what "better health" means?  Losing weight for the sake of your health (as compared with aesthetic motivations) is a socially acceptable reason to lose weight, but other than doing the right thing, do you know why you added it to the list? Do you know will your health improve when you lose weight? Do you know how much weight you need to lose to start to improve your health?

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Should You Consult a Doctor before Starting an Exercise Plan?

"Consult a physician before using this equipment." 

Have you seen this statement before? If the exercise equipment was manufactured in the last 30 years or so, this statement or a similar disclaimer is likely placed somewhere in small print. I see it (well, ignore it) just about every day when I step onto my elliptical. Gyms, exercise videos and weight-loss reality shows all typically have similar disclaimers such as, "Consult a physician before starting any exercise program." 

Even though we tend to ignore them, they're there!

Have you seen the one that reads: "Stop exercising if you feel pain, faint, dizziness or shortness of breath"? This one may leave you thinking "you forgot sweat." Take it from someone who has gone from a sedentary to active lifestyle, I felt all of those things and still do on days when I do strength training for my legs! I didn’t exercise to extreme pain, I never passed out and I didn't feel severe pain, but I certainly felt all of those symptoms to some extent!

I’m sure many of you do what I did when I started exercising, which is to completely disregard the warnings and start working out due to being tired of being overweight and unfit. I didn’t want to overcome yet another obstacle by waiting to talk to my doctor. 

Let’s get serious for a few moments, though, and examine these disclaimers to determine whether you actually need to consult with a physician before embarking on your exercise plan. 

I feel slightly conflicted: I ignored the ubiquitous warnings to consult my doctor before I started working out 140 pounds ago, but I'm encouraging you now to take the extra step to visit a physician before engaging in an exercise program. I know that when the inspiration to change strikes you need to take advantage as quickly as possible, but as a doctor, I know it's better to be safe than sorry.

Thankfully, most people who choose to disregard these disclaimers do not suffer any consequences. But, some will find out that they have a heart condition the hard way during exercise, injure themselves or exacerbate an existing medical conditions. They may not even realize that they are putting their health at risk by trying to do what they believe is the right thing. The rest of you will be relieved to know that you can start exercising without pulling out your wallet for a co-pay (and not sitting in the waiting room at the height of flu season). 

So how do you know which group you're in? Should you see your doctor or not?

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'Tis the Season to Battle the Holiday Blues

The holiday season is in full swing now! Festive lights, the sounds of the season and holiday goodies are surrounding us on an almost daily basis. Just about everywhere you go you are reminded that it’s that time of the year. The message is loud and clear: We should be happy. We’re all happy! Right?
 
Unfortunately, this is not always the case. Depression is a medical condition that affects one in 10 Americans, which equates to approximately 31 million people. Depression doesn’t have a season, and the holidays can be particularly difficult for those with depression. The good news is that having an emotionally rough time in your life is not a medical condition in most cases. Consider the following criteria to determine whether your feelings of depression should include a visit to your physician or to a mental health professional. 
 
According to Mental Health America, the country’s leading nonprofit dedicated to helping all people live mentally healthier lives, this time of year can be as much about anxiety, depression and stress as it is about joy:

Many factors can cause the “holiday blues”: stress, fatigue, unrealistic expectations, over-commercialization, financial constraints and the inability to be with one’s family and friends. The demands of shopping, parties, family reunions and house guests also contribute to feelings of tension. People may also develop other stress responses such as headaches, excessive drinking, over-eating and difficulty sleeping. Even more people experience post-holiday let down after January 1. This can result from disappointments during the preceding months compounded by the excess fatigue and stress.
 
 
What are the symptoms of depression? According to the Centers for Disease Control, they are:
 

• Little interest or pleasure in doing things
• Feeling down, depressed or hopeless
• Trouble falling asleep, staying asleep or sleeping too much
• Feeling tired or having little energy
• Poor appetite or overeating
• Feeling bad about yourself or that you were a failure or let yourself or your family down
• Trouble concentrating on things, such as reading the newspaper or watching television
• Moving or speaking so slowly that other people could have noticed, or the opposite: being so fidgety or restless that you were moving around a lot more than usual

Depression is potentially disabling and can cause severe family and relationship problems and even loss of income. If these symptoms occur for two weeks or longer and they begin to interfere with managing everyday life, it may be more serious than just "feeling down."  

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The Cost of 'Taking a Break' for the Holidays

I’m writing to you as a card-carrying SparkPeople member today!  I’m in my third year of maintenance so I’ve learned a few things about both losing and maintaining weight loss.  The year is drawing to a close and I think it’s appropriate now more than ever to discuss what it means to "take a break." 

The first few weeks of losing weight are exciting.  You are ready to get rid of the extra pounds that you carry and you are motivated.  Your reasons are personal and many of you may be motivated by extrinsic factors.  Counting calories, points, or whatever your system is easy and you are exercising with consistency.  The pounds are flying off (mostly in the form of water weight) and your clothes are starting to feel looser.  You may even start to get some compliments that provide even more fuel to keep going for yet another day.  But (I know you saw this coming), after some time that “new diet” feeling starts to wear off and you start to struggle.  Most people hit the first rough patch within the first two weeks.  It may take others a couple of months before they start to lose steam and start to wonder why they can’t go back to doing things the "old way." But, there comes a time when you will struggle to stay on track and the lure of returning to your old habits seems almost impossible to resist.  There is even some evidence that suggests your own body is sending out hormones to try to convince you to return to your old ways!

If you started your journey at SparkPeople, you are well-aware that what we are not proponents of diets.  Diets, as commonly defined, have a start date and an end date.  The end date of the diet signifies the day that you begin to return to your old habits thus also signifying the date you begin to regain the lost pounds.

But, let’s be realistic here.  It’s not possible to keep your motivation and willpower strong at all times.  There will be times, usually during stress, that you need to focus on more pressing matters.  There will be illnesses, job changes, relationship problems, financial problems, etc.  These stressors, in many cases, will erode your willpower and motivation and will make it more difficult to stay on track. 

What are your options during these difficult days? You can go with the “all or none” mentality and choose "all" to stay on track or you can choose "none" and go back to your old habits.  Alternately, you can choose a middle ground.  What I want to highlight today is the danger of choosing “none” and “taking a break” and to give some examples of what it’s like to choose somewhere in the middle. 

Giving up and “taking a break” is probably not the best choice to make.  I’ve heard many people say that they are “taking a break” and will resume living a healthy lifestyle after a certain date.  It’s not uncommon to hear someone say that they are going to start again “after the holidays.” 

So, let’s look the caloric toll and add up what might happen between November 1 and January 1 if you decide to “take a break.”

The numbers used here are simply estimates of calorie needs and expenditures.  Please do not get caught up on them because your body is not a calculator.  SparkPeople has wonderful trackers that enable you to figure out your personal caloric needs based on your level of activity.  However, I am using these generic numbers to illustrate the caloric differential of weight maintenance vs. losing vs. gaining.  The caloric differential of what your body needs vs. consumes is ultimately the key and the point of the following examples.

Our sample SparkPeople member is:

• an extremely motivated obese female
• actively losing 1-2 pounds a week
• on 1,500-calorie per day plan
• exercising five times per week burning 300 calories per session

Her (sedentary) basal metabolic rate: about 2,000 calories per day (the calories needed to maintain her current weight).  

Her deficit: about 5,000 calories per week

• 500 a day from diet X 7 days = 3,500
• 300 calories X 5 days a week from exercise = 1,500
• That equals her about 1-2 pounds per week on average weight loss (3,500 calories=one pound lost but remember that your body is NOT a calculator)

Result:  If she continues her lifestyle change from November 1 through New Year’s she could lose about 12-13 pounds of fat and will be down a dress size for the new year!

Now, let's see what happens when she “takes a break” for the holidays. 

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Living the Lifestyle during the Holidays

It's that time of year again. Staying on track during the holidays is challenging, but it can be done.  I’m entering my fifth holiday season as a SparkPeople member, and I’m looking forward to conquering it! There will be many articles coming out in the next few weeks about avoiding holiday weight gain.  
 
Instead of concentrating on avoiding holiday weight gain, my goal is to maintain consistency with my diet and exercise program throughout the holiday season.  I do plan to splurge on special occasions.  The problem with maintaining consistency is that there are so many special occasions between now and New Year's Day!
 
Why is weight gain during the holidays a yearly topic? Weight gain during the holidays is an important contributor to the weight gain "creep"--that is, the extra pounds you gradually and slowly add without noticing. Just about everyone thinks that you have a license to indulge during this time of the year!
 
When I started my lifestyle change in 2007, I started out sprinting.  I was tired of being morbidly obese and I breezed through the 2007 holiday season with ease. There were no false starts.
 
I was on a mission and my mission was to reach my goal weight. That’s not to say I didn't hit a few bumps: I binged on Halloween candy that year, declaring it to be a "cheat day," and I pretty much did the same on Thanksgiving.  Otherwise, it was smooth sailing. 
 
I started out at 292 pounds on July 23, 2007, and by Thanksgiving 2007 I was in the 230s.  But, I was motivated and nothing was going to stand in the way of my goal. 
 
Unfortunately, the new penny feeling of a "diet" wears off.  I knew that I was trying to change my life, but I had started to tire of trying to be perfect.  Fortunately, I had already become very attached to SparkPeople and its principles and was attempting to focus on the long haul, not the quick fix. 
 
My weight loss was pretty steady during that phase.  By the 2008 holiday season, I was a sleek 158 pounds, but I was already a little battered and bruised.  I had faced and beaten burnout a few times already.  I had conquered many hard questions about my motivations and I had felt the pain of defeat. Still, I got back up and dusted off my knees after every fall.   Despite those battle wounds, I held steady through the holidays and got down to 150 pounds in early January. 
 
The next holiday seasons didn’t go as well as the first two.  I fought hard battles during the 2009 and 2010 seasons.  I gained for the first time during the 2009 season and had to go back to the basics after New Year's to get back to my maintenance weight.  I pretty much did the same during the 2010 holiday season.  So, is this a pattern?  Am I destined to be a yearly victim of the holiday weight-gain tradition?
 

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News Flash: Maintaining Weight Loss is Hard (There's Proof--and Hope!)

It’s not your fault you can’t keep the weight off!

I recently got a call from my mother who told me, “I just saw something on the news about why it’s hard to maintain weight loss! I know you’ve been struggling, so will you find it and check it out?”  I told her I saw something about it already and thanks for checking in on me.  I had seen various headlines with similar titles such as “It’s not your fault that you can’t keep the weight off!”  I briefly checked them out and thought, “That doesn’t help me!” and moved on with my day.  But, later on I was thinking about the messages these headlines sent to the millions of hopeful but overweight people of America.  

Seeing a headline like that telling me, “You now have an excuse for gaining back your weight loss!” makes me cringe.  Here I am, trying to maintain a greater than 100-pound weight loss and now I’m hearing that my body is trying to sabotage my efforts?  I will get back to my take on the news after I tell you a little bit about the study. 

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What You Really Need to Know about Breast Cancer

For decades, October has been recognized as National Breast Cancer Awareness month. This is the time of year when the familiar pink ribbons and, in more recent years, pink in general becomes more prevalent in our communities and in the media. Why does breast cancer awareness get so much attention?

Breast cancer is the most commonly diagnosed cancer in females worldwide.  In the United States, breast cancer is the second most common cause of cancer-related deaths in women (after skin cancer) and is the number one cause of death in women ages 40 to 59. What this means for you is that most of you either know someone directly or indirectly affected by this potentially life-threatening disease. In fact, one in eight women will be diagnosed with breast cancer in their lifetime, according to government statistics. 

The Importance of Early Detection

Before we learn about what you can do to protect yourself against breast cancer, I want to stress the importance of early detection. How to prevent breast cancer will be the focus of many discussions regarding breast cancer this month, but despite your best intentions and lifestyle modifications, you or a loved one may still develop the disease.  

Many of the most significant risk factors for developing breast cancer are not in your control: family history, sex and age. I want you to understand that if you have these risk factors, you are at a higher risk of developing breast cancer but that the presence of risk factors will not predict if you will get breast cancer. The best weapon that we have in this fight so far is early detection.  

Thanks to early detection, many women go on to live long lives. Do monthly self-exams and get your screening mammograms. Screening mammograms typically start at age 50, but some women may need to start earlier based on medical or family history. Please check with your physician by age 40 to determine your screening requirements, as it will be different for every woman. Early detection is crucial to survival. In my opinion, every discussion about breast cancer needs to start with this critical reminder. 

Now that we have some very important business out of the way (early detection, self-exams, mammograms!) we can discuss some of the risk factors from breast cancer and what you can do to modify your risk of developing the disease.

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The Skin Condition That's a Dark Sign of What's to Come

Before I started medical school, I noticed something strange about the skin of some of my family members, the ones who were overweight or obese, like I was then.
Various folds of skin--on the neck, arms, and legs, among other places--I noticed their skin was darker and thicker. It didn't look the same as the rest of their bodies. I wondered what it was, what caused it--and whether I would also get it.

This dark, leathery skin is quite common, and you may even have this condition yourself. You might have brushed it off as a skin imperfection and thought that there was nothing that you could do about it. Would you believe that this condition can lead you to the diagnosis of medical disease?
 
Before we talk about what it can help diagnose, let's talk about motivation, one of my favorite topics. In my opinion it doesn’t really matter where your initial motivation for weight loss comes from. Vanity, a desire to fit in, trying to find a partner, hoping to get a better job--all of these reasons are fine.  But, these are “extrinsic motivators.”  What happens when you lose the weight and you meet these goals? What is going to keep you coming back?  Educating yourself about the effects of obesity is one tool that you can use to prove to yourself that the lifestyle changes are worth it, that you must be willing to stick to it for the long haul. 
 
One of the best things that you can to do to keep yourself coming back to SparkPeople (and reaching your goals) is to do things that motivate you and will withstand the test of time, such as your health.  So, I hope that you will take a moment to learn about something that you may have never heard of and something that may inspire you to continue reach towards and meet your goals. 
 
Let's let acanthosis nigricans, that skin change I mentioned earlier, be one of those motivators.  

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