Confessions of a 40-year-old Physician

February 1, 2010

Gastroenterologist Robert E. Kramer on his uphill battle to stay fit for the long run.


It was 2007, I was 36 years old, and I knew that I had run out of excuses.

As a faculty member in pediatric gastroenterology at The University of Miami, directing the pediatric obesity program, I had spent years advising patients about the importance of regular physical activity in maintaining physical and emotional health. It was a cause I truly believed in and was able to articulate passionately.

And yet it was something that ironically remained missing from my own life. At 6 feet 2 inches and 192 pounds, my BMI was below 25 (if just barely), so I was rarely questioned about my own personal commitment to physical fitness.

The reality was that, besides occasional bike rides and soccer in the backyard with my daughter, I had no physical activity to speak of. It was something that, through the years, I had always assumed I would get around to. There always seemed to be such convincing reasons why now was not the time. First there was the ridiculously hectic life of a pediatric resident. Then the frantic pace of fellowship and a newborn baby at home. While starting academic practice and having two children under 5 at home, the rationalizations for deferral were even more convincing.

So there I was at 36, having been recruited back to Denver, taking a position at The Children’s Hospital where I had done my fellowship. One reason I had taken the position was to improve my lifestyle - with my kids now 7 and 2, I wanted to live in a healthier environment, with less call, more support, and less stress.

Each day as medical director of our adolescent obesity clinic, I espoused the importance of breaking out of the pre-contemplative phase of behavior change into the active phase. Six months into my new position, I finally called myself into action.

I decided to start running. The only time available to me was in the early morning, before the family troops had been roused. On a cold, dark morning in February, I woke at 5 and groggily started my first run in my new life of fitness. Using a $5 pedometer I bought at Target I plotted my progress. After a relatively short time I was able to run a full mile without stopping. I got myself up to three times per week and steadily worked up to four miles per run. I had traded in my measly pedometer for a digital GPS unit that tracked my heart rate, elevation, miles, and calories. And I felt good.

Although I didn’t have a weight problem, I saw my weight drop to 175 pounds. I had to buy new clothes and people noticed a difference. Most importantly, I felt the difference. On the days that I ran, by the time I got to work I already felt like I had accomplished something great for the day. I ate healthier, was more focused, and had more patience with my kids. I felt better about my role in my obesity clinic because now I was actually walking the walk.

I knew that in the running world I was still just a neophyte, logging a mere 12 to 15 miles per week. I remained in awe of my 60-year-old neighbors who were running full marathons. Yet the whole culture of fitness in my family began to change as well. I ran a few 5Ks with my now 9-year-old daughter. We began biking as well and have trekked as many as 12 miles at a time. I have been coaching her soccer team for the past three years and include a healthy run at the start of every practice.

By 38, I proudly realized that I was a runner. I had finally accomplished what I had put off for all of those years. I was in the best shape of my life and felt truly healthy. I set up a morning routine three days per week. Wake at 5, run four miles in the basement on my treadmill while watching CNN and listening to my iPod, make a fresh fruit smoothie, and take a shower - all before anyone else in the house woke. I thought I finally had the motivation issue licked.

Now, at the precipice of 40, I’ve found that it remains a constant struggle. A tough month of clinical service, a manuscript that needs late-night revisions, a hint of some iliotibial band syndrome in my right leg, and a new puppy at home, and suddenly I’m not a runner anymore. Despite all of the wonderful benefits that I have personally experienced from regular exercise, when that alarm clock rings at 5 a.m., I still have to fight that nagging question, “Do you really want to do this?” I know that if I just get myself up I will always be happy I did.

In the end I’ve learned an important lesson. Living a healthy lifestyle, day after day, month after month, will always be a lifelong struggle. It helps me relate to my patients, who often face even greater obstacles than I do in their bid to be healthier. I keep reminding them that lifestyle change is a marathon, not a sprint.

As for me, I’m back up to 12 miles per week. I’ve thrown in some abdominal crunches and free weights for good measure, and I’m winning the battle with the alarm clock - on most days anyway.

Robert E. Kramer, MD, is an assistant professor of pediatrics at the University of Colorado Denver in the Section of Pediatric Gastroenterology, Hepatology, and Nutrition. He is the director of endoscopy and the medical director of the Adolescent Obesity Clinic at The Children’s Hospital.

This article originally appeared in the February 2010 issue of Physicians Practice.