by Tom Rifai, MD, FACP

As for many of you, lifestyle medicine is far more than just a profession to me as I not only treat people with major metabolic health issues, maladaptive eating patterns and behavioral health issues, I myself am also “one of them.”

Among other issues, I have been battling binge eating disorder for decades and still today. It is one of my major motivations to be the most compassionate lifestyle medicine physician possible. Before delving into the beginnings of my journey to lifestyle medicine, one “teaching moment” in establishing my “absolutely no judgment of patients…EVER” approach was a brutal early morning awakening of choking on my own vomit after a night of binge eating almost two large pizzas in rapid fashion. For a very critical moment, I truly thought I was going to die. In less than 5 seconds of awakening (but which felt much longer) I was “running” backwards into a wall in my apartment in an effort to dislodge my (not so comfortable) comfort food mix of refined flour, fatty cheese and salt. I don’t remember seeing my life flash before my eyes. Rather, I saw visions of a newspaper article: “Detroit Nutrition Doc Dies Choking on Pizza!”

I have had the benefit (and yes, burden – but I try to look at the bright side) to have been educated by an emotionally traumatic and at times violent childhood blended with a family history of very bad eating habits, much driven by emotional eating. Then there were the two years on anti-depressant therapy (one of those years on two medications combined) and a full continuous year of CBT and psychotherapy at 14-15 years of age.

But no, there really is no full “recovery” from bingeing nor end to “the journey of a lifestyle” in my personal, and professional opinion. At the end of the day I view all of what I have gone through and “suffered” (quotations because suffering = opportunity to learn) as a glorious and worthy battle! And this is the same spirit in which I coach our lifestyle program patients.

I didn’t exactly “get lucky” with a counterbalance of great family genes for metabolic health. Elevated lipoprotein (a), a genetic tendency towards low HDL and insulin resistance are all part of my genetic make-up. Sadly, my beloved youngest brother passed away in January, much driven by frank binge eating tendencies. These have been motivations to be the best lifestyle medicine physician I can be, both professionally and personally.

My father was probably the first strong influence on my journey to lifestyle medicine. Formerly a world class urologist, he currently suffers from self driven type 2 diabetes, dementia, depression and a long history of over and binge eating. While he taught me great things in ethics, value of dedication in education, and the importance of world history, his teaching in lifestyle was the most valuable. I’ll never forget one “sentinel event” around 10 years of age. On a Saturday around 11:30 am, after rounding on his patients (skipping breakfast, of course), I watched him, almost literally, inhale his McDonald’s bag of french fries before our hamburgers even hit the tray at the counter! And then, to shocked audience of me, dad ordered another bag of fries as soon as our burgers hit the tray. It was certainly an indelible, and influential, moment for me. Even as a youngster I knew what he did was not healthy and for whatever (or very good) reason, I can see the image and moment in my mind now as if it happened yesterday. And thanks to that experience, one of my life missions is “breaking the chain” of my family history of bad eating behaviors not only for me but, just as importantly, my two children. I’m proud to say that, almost assuredly due to lifestyle my recent carotid artery intima-media thickness (CIMT) ultrasound was consistent with a vascular age more than a decade younger than my biological age (mid 30’s vs almost 50). Yes, a binge eater with a far less than stellar family history was literally saved by lifestyle (as) medicine. For me, the right attitude is “progress IS perfection”!

My path to lifestyle medicine wasn’t driven by a single “magic moment in time.” I thought would be practicing lifestyle medicine via primary care. However I realized that lifestyle medicine could (and needs to be) a specialty in and of itself. The time required with patients for the highest odds for successful lifestyle change cannot, sadly (at least as our current “health” care system is set up), be effectuated in the current fast paced primary care culture. Hopefully that will change. And while I couldn’t respect primary care docs more (some of my best teachers), I decided to go straight into multidisciplinary care lifestyle and metabolic medicine right from residency. The rest is lifestyle medicine history!