It was a great opportunity to conduct an e-interview with Dr. Danielle Milano.
1. How do you like your job and what are the most exciting things in what you do and what are the main challenges?
I absolutely love what I do. There are very few jobs or careers where you can interact with people on a personal level every day, build long-lasting relationships, and also have a positive impact on the lives of the patient, and by extension, their families also. The main challenges are time and money. Time is a constraint for physicians all over the country. We simply do not have enough time to spend with each patient, in order to give him or her all the attention they need. And, money is a constraint for patients. Especially in East Harlem, our patients are poor. They simply do not have the money to spend on fresh fruits and vegetables, when processed foods are so much less expensive.
2. How do you handle the situations when people come to you with an aim to reduce weight more for the physical appearance than for the healthier lifestyle. How do you steer their thinking towards 'Focus on Health, not on Weight'?
Fortunately, in East Harlem, this is not a problem. There is different attitude. If anything, it is the other way around. People are overweight, or even obese, and think they are at a perfect weight. Some big women in my practice actually want to gain a few pounds. I have to convince them that losing a few pounds would be good for their health, which is no easy feat.
My big women who want to gain a few pounds because they feel they would look better, which is no different than the women at the perfect weight who want to lose a few pounds. This is a never-ending battle, since there is so much pressure from the media to be thin and perfect. All we can do is give people positive reinforcement, tell them that they are perfect just the way they are, and to focus on how they feel. We, as physicians, tend to focus on numbers: weight, BMI, blood pressure. But, more importantly, we need to ask the questions: “How do you feel?” “Can you walk up stairs without becoming short of breath?” “Is your hair brittle and your skin dry?” “What is your energy level?” And, the most important question of all: “Are you happy?”
3. How do you tackle tricky situations when the patient is in the denial mode and does not accept that he/she is heading towards obesity ?
Denial is a powerful defense mechanism. We see it all day, every day, and not just with weight issues. For example, look at the number of smokers with emphysema who continue to smoke. All that a physician can do is to be patient, continue to reinforce the message over and over. The smoker needs to hear it 100 times: “You must quit smoking or else you will develop lung cancer and die.” The obese person needs to hear it 100 times: “You must make lifestyle changes or else you will develop diabetes.” Notice, that I try to stay away from the value judgments about weight. I never tell someone to lose 50 pounds: it is too much of an impossible task. Start with 5 pounds, which is an achievable goal.
So, in short, physicians need to be patient, reinforce the message, and let the patient know that we will be there for them, whether it is for the smoker who asks for help to quit smoking, or for the obese woman wakes up one day, looks in the mirror and says, “Oh my! When did this happen?” They need to know that we will be there for them.
4. Which is the one advice that could be given to everybody - obese or not obese, diabetic or not diabetic - to lead a healthy life?
The most important piece of advice is to exercise. It does not need to be anything fancy. It could be something as simple as going out for a walk every day.
Since women are social creatures, the best advice is to find an activity that you love to do and to find someone you love to do it with. Men might enjoy going to the gym by themselves to lift weights and run on the treadmill, but women won’t do that. We prefer social interactions. So, pick an activity you love, for example, dancing. There are Zumba dance classes all over the country. Find a friend who loves to dance, and go together.
5. How do you see the eating habits of people changing, are they more aware about their health and fitness now or is it the other way round?
People are more aware, but not to the point of doing something about it. For example, people still drink soda, even though high-fructose corn syrup has had some bad press lately. People know they should exercise, but not to the point of getting out there and doing it. Which may account for the popularity of shows like “The Biggest Loser.”
6. What motivated you to write 'Skinny is Overrated' when there are umpteen books available in 'Health and Fitness' space already?
Yes. There are umpteen books on diet health and fitness. But, many of the books are not practical for the average woman on a diet. Some books are too complicated. For example, The Zone is an amazing and healthy diet. But, some people will be turned off as soon as they see the word “eicosanoid.” Some diets are too expensive, for example, South Beach. Again, South Beach is an amazing diet, but I don’t know many people who can afford wild salmon. Other diets are too strict, and people simply cannot maintain it in the long run. Starvation always backfires. So, I set out to write a book that was fun, readable, and most importantly, practical.
7. Why did you think of writing it for American readers only when the issues being handled are common globally. Don’t you think by just making it more generic in diet and food parts, the book could have earned international reach.
You are absolutely correct, but I did not think I could write a book based on the Mediterranean diet for people who live in, for example, East Asia, where obesity and diabetes are a growing problem. But, I do mention in the book that people should connect to their roots. We all identify with our heritage, not though the music or the language, but through the food. If we adopt a diet that our grandparents or great grandparents ate, no matter where you live, we would undoubtedly be healthier.
8. What are your personal goals? Do you have any plans of writing more?
My goals are to continue to educate people about health, and to help people, especially women, find their inner strength. Women have power over what foods they feed their family, and whether there is junk food in the house. Women have the power to determine the future health of their children. This is an enormous responsibility.
Perhaps there will be another book, and it will be entitled “Real Women Eat.”
9. Any case study you would like to share here so that more people get motivation to follow a healthful life?
There are so many to choose from, but this example is short and simply. About a month ago, a new patient came in. Obese and diabetic, she was practically falling asleep in my office during the initial history and physical. At my insistence, she stopped drinking soda. When she returned for her follow-up visit this past week, she was a different person. Bright and happy, and 13 pounds thinner. Although I don’t like to stress the weight loss part, and prefer to stress the health benefit, soft drinks can really pack on the pounds. Since this patient drank so much soda every day, for her it amounted to 13 pounds.
10. What are those two most important things which you would like to change around us so that living healthfully becomes a part of life?
First of all, fresh fruits and vegetables should not be more expensive than processed foods. This would entail changing the way America grows food, the laws, the distribution process, and so on. An enormous feat, but many people are working towards this ultimate goal.
And lastly, if we became a society focused on health, if each of us as individuals were excited and committed to health, we would inspire each other. We are more powerful as a group, than as individuals.
Thanks Dr. Milano for sharing your views here.