Maura Flanagan grew up and went to college in Massachusetts, like me, and later moved to Washington, DC for a career with the federal government. As young women, she and I lived in the same dormitory, and our social circles overlapped. Maura was known and highly regarded for her wit, and when you sat down to dinner with her, you knew it would be punctuated with mirth.
After I graduated from college in 1987, I stayed in touch with a few friends. These were the days before social media, and friendship required contact through phone calls, visits, and letters. Time is finite, and there were only so many close relationships I could keep up with. Friends disappeared from my actual circle, and I from theirs, and I also made new acquaintances, especially at work. And there was my family, too.
For me, the best thing about the arrival of Facebook has been the way it makes possible re-connection with distant cousins, childhood friends, and former classmates. A few years ago, I started noticing Maura’s name and thumbnail photo appearing in the comments section of our mutual friend Susan’s status messages. She still had fiery red hair and a talent for original and funny one-liners. We connected.
In many ways, Maura seemed like the Maura I remembered, but in one noticeable way she was changed. In October 2005, she signed up for a program that would help her lose 90 to 100 pounds and improve her health, and she has stayed with it. At my request, Maura and I had a long phone conversation about her weight loss and strategies to maintain it. She described her Type 2 diabetes diagnosis, decision to join a clinic-based weight loss program, and gradual incorporation of new activities and attitudes into her life. I was struck by the thoughtfulness of her approach, honesty about her relationship to her body and health, and persistence at re-shaping her habits and thinking. Jokes were gentle. Here is some of Maura’s story and reflections.
A Type 2 Diabetes Diagnosis as Motivation for Change
Maura has a strong connection to her family, and it was a concern about her mother’s health that inadvertently got her focused on her own. Back in 2005, in trying to overcome her mother’s resistance to seeing a doctor, Maura suggested, “Well, how about if I go? I haven’t been to a doctor in a long time. If I go, will you go?”
Taking this as an opportunity to find a new doctor, Maura made a commitment to get a full checkup, which included “a full screening that’s typical when you start with a new doctor,” as she characterized it. One of the results was unexpected; as Maura told me, “I found out that I had a high blood sugar level, around 222.” Although overweight, Maura had not ever had her blood glucose tested by her previous physician.
Results from the blood screening launched a sober conversation with her new doctor and a frank Type 2 diabetes diagnosis. As Maura recalls it, “He started talking to me about all these different things that I would have to start doing: testing my blood sugar, probably taking medication for it, taking medication for cholesterol. I had high blood pressure too.”
It was “the presence of medical evidence” that made Maura think hard about her weight and its contribution to her health. “It’s what put me over the top to do something pretty aggressive about it.”
In retrospect, there were earlier signs that diabetes was in her profile. “My father had Type 2 diabetes, and he died from a heart attack, which, I believe, even on his death certificate it says diabetes was a contributing factor in his death.” Although the diagnosis had an underlying logic to it, Maura’s feelings were still vivid and intense:
“I started to beat up on myself. Type 2, you think that’s a lifestyle issue. I caused this. I made it happen to me. I should have known better. This runs in my family. Why didn’t I take better care of myself? I spent a lot of time feeling stupid for not seeing this coming. Also, there was a sense of unfairness. Not every overweight person I knew had diabetes so I felt, “Why is this happening to me?” Of course, an endocrinologist explained to me that it has to do with family history. People can get Type 2 diabetes if they’re just a little bit overweight if that’s the way things are in their family. Some people can become quite overweight and they will never have a high blood sugar level. Luck of the genetic draw.”
Maura told me that she cycled through her own thoughts for a while before realizing “It was unproductive thinking, that I just had to move on and address the issues in front of me.” For some health problems, medication was necessary. For others, she realized that she could improve them through behavior changes she could make. “I decided I would take a chance and see if I could reverse some of the damage to my body through weight loss.”
Commitment to a Clinic-Based Program
Maura had previously heard about a weight loss clinic at George Washington University in Washington, DC where she lives. “I think a lot of people do this. I heard about it, and I checked out their website every once in a while.” Before the diagnosis of Type 2 diabetes and neuropathy, however, Maura explains that she had done no more than browse. The program “sounded extreme,” and she wasn’t ready to “pursue” it.
By October 2005, she was finally ready, and she joined. The diet, which is high in protein and vegetables, was prescribed. It began with a liquid fast – mainly a diet of protein shakes — for 16 weeks. Then she transitioned to another 16 weeks, which added some food to the protein-shake regimen. After eight months, by June 2006, Maura had lost about 91 pounds total.
The GWU program is medically supervised, and in the first 16 weeks of the program, Maura saw a doctor every week. Once she added food back in, the visits alternated between a doctor and a dietician. The visits monitored her health and progress, and supported her in the dietary changes she was making.
Paradoxically, Maura found the narrowness of the food plan and the emphasis on protein shakes to be “liberating.” In the pre-weight-loss part of her life, she had often made “poor decisions about food choices.” She explains that by “taking food off the table,” so to speak, the structured diet “was enlightening” to her.
“Previously, food was something I didn’t think too much about at all. Like a lot of people who have problems with their weight, I tended to pick up whatever was handy… and that would make me feel full. I would just go out and grab a sandwich at lunchtime and then just have something out of the freezer at dinnertime. I enjoyed everything that I had for meals, but I didn’t really have any sense of proper portion control.”
After she started eating “real food” again, Maura relied on Calorie King, recommended by the clinic, for nutritional information on food she ate at home and food she ate in restaurants. She reports that, when she started to look up foods on the website, “I was really shocked.” Her eyes were opened to the calorie counts of favorite meals and sandwiches she had been eating at her go-to restaurants and fast food lunch places. “Without being aware of it,” Maura recounted, “I was very attracted to that type of calorie-heavy food. Whenever I made food choices, I’d just go after taste.” She also realized that foods billed as “healthy,” like salads, are often problematic. Maura has learned that the benefits of greens and vegetables are “offset” by “all the dressing, croutons, and cheese.” She now avoids the extras, and sticks to balsamic vinegar in place of fat- or oil-based dressings.
After Maura completed the weight-loss portion of the program, she “went on maintenance,” and adjusted back to eating regular food full time. She lost another nine pounds at the beginning maintenance, which lasted two years.
Maura stays in touch with the GWU program, which is now the National Center for Weight and Wellness, run by Dr. Scott Kahan, and checks in weekly. She still sees a dietician there and belongs to a support group that works on the issue of emotional eating. She explains that the frequent contact with the clinic staff, who have treated her with great understanding and compassion, has been essential to the effectiveness of the program and her new knowledge about nutrition.
The Place of Mindfulness in Lasting Health Changes
After she lost weight, Maura realized she needed new sources of motivation in her life. In an exploration of new activities, she went to an introduction to meditation that was sponsored by the Smithsonian Associates program and conducted by a doctor from the Benson-Henry Institute at Massachusetts General Hospital in Boston. The program was in a huge auditorium, filled with people, and Maura doubted she would be able to meditate for even a few minutes in such an environment. But, “lo and behold,” she says, “I was really able to relax even though I was in a room full of people.” Maura bought the doctor’s CD at the end of the session, started to use it on what she calls “a semi-regular basis,” and her practice of mindfulness began.
The method that she learned and continually returns to involves a basic body scan and body visualization. In her own practice, Maura emphasizes the body scan: “You concentrate on the various parts of your body. You think about them, try to identify tension, and then release tension in that spot.” Sometimes she accomplishes this by “breathing into” the muscle tension, in her lower back for example, and then breathe out to release it.
The meditation techniques have been particularly helpful in coping with the discomfort of neuropathy in her feet, which was diagnosed when she began the GWU program.
“There was a time when I was waking up a lot in the middle of the night from bad cramping in my feet, to the point where my toes would almost lean back. It almost looked like I had an elf shoe on, you know what I mean? I was pretty miserable, and I thought, “I don’t know if I can stand this anymore.” I wondered if I needed medication for neuropathy, which I wasn’t thrilled about, because I know they’re antidepressants. I’m not actually depressed, so I’d prefer not to try them. I started to meditate again. For whatever reason, it loosened my legs up a bit, and I don’t have the cramping at night like I used to. When it does happen, on rare occasions, I know how to concentrate on the muscles in my feet and legs, and I can actually relieve some of that tension that builds up there. I can go back to sleep.”
Meditation and mindfulness have been helpful in her work life, too. During her bus commute, she listens to a meditation app called Headspace, and it has taken the stress out of commuting both to an from the office. At work, she has occasionally brought her portable stereo to work and invited anyone in her office to meditate with her at lunch in a conference room. On Sundays, she often makes time to go to a two-hour meditation group at Insight Meditation in DC.
Mindfulness has also helped Maura be more in tune with her physical self. The diagnosis of Type 2 diabetes itself, and the necessity for ongoing care, also prompted her attentiveness.
“It’s really important to get a lot of feedback, to see how you’re doing, and diabetes involves regular checkups. Having feedback from medical professionals on a regular basis becomes really important, and this makes it important for me to get more in touch with how I feel. For example, if I had a meal and then a few hours later I start to feel some pain in my hands or my feet, I have to really notice that and perhaps think about, “What did I eat?” Maybe I shouldn’t have eaten quite so much or that combination of foods? It makes me consider much more the signals that my body is giving me.”
Those of who live with either Type 1 or Type 2 diabetes know the burden that the illness may present to us. Maura remarks, with wry humor, that “Before I was diagnosed, I felt that I lived my life from the neck up, in a sense.” Diabetes, and her approach to it, have helped her notice, accept, and take care of her body more actively than she did before.
Note: In part two of this feature story on Maura Flanagan’s health changes, she discusses her commitment to experimenting with new activities, changes in her social relationships, and advice and encouragement for readers contemplating diabetes-related behavior change.