A resident reached out: "I'm concerned about gaining weight, being sedentary, and becoming unhealthy in school and training. What can I do?"
It's completely normal to be concerned about our health as we navigate through school and training. We all know that studying is often a sedentary activity, and the lack of sleep can disrupt our hunger hormones (leptin and ghrelin), potentially leading to weight gain. The demands of long hours can leave little time for exercise or meal prep, and the stress can take a toll on our health. You're not alone in these struggles.
Here are some tips that helped me stay as healthy as possible:
(And please remember that while I'm a doctor, I'm not your doctor. Before making any changes, talk to the clinician who is caring for you, especially if you have other medical conditions).
1. Make studying and charting more active
A standing desk was one of the most practical and effective investments I made for my health. And here's the best part: you don't need to spend a fortune on this--you can even DIY it by stacking up books or boxes. I recommend putting a rug or mat underneath it to make it more comfortable. If you want to take it a step further, you can consider adding a walking tread.
Another affordable option was a stationary bike at a second-hand sports store for about $250. I removed the handlebars and slid it under the desk, creating a makeshift exercise bike.
I now have "active meetings," during which I cycle or walk. I also use this as a tool to stay active while reading, studying, and charting. With this change, I've been able to walk a few miles a day when otherwise I would've been sedentary. (I'm walking on my tread while I write this right now!)
2. Eat healthy foods without spending time meal prepping
There's little time for chopping fruit or vegetables in school and training. While on clerkships in medical school, I started bringing a lunch bag with me and threw in raw, unchopped vegetables and fruits. I still do this for clinic. Here is what I keep in my bag to this day for both clinical work and the car ride home:
A large water bottle, a mug, matcha powder, and herbal tea bags
Mixed nuts (in residency, I also kept a jar of nut butter with me)
A metal butter knife, fork, and spoon
Whole fruits and vegetables (typically a whole avocado, multiple apples, clementines, pears, bananas, a package of blueberries, raspberries, or blackberries; sometimes I throw in a bag of baby carrots, raw snap peas, or anything I have in the fridge)
Leftovers (rarely). If I happen to cook or have leftovers from a family or work event, I'll throw them in, too. However, trying to keep them cold and then find a place to heat them was unpredictable in training (plus it took time), so I rarely did this.
Popcorn without all the junk on it
Dried (unsweetened) fruit. Read the packaging and ensure there's no added sugar. Dried fruit can be high on the glycemic index, so I would consume it in moderation. My favorites are dried, crispy apples, pineapple rings, mangoes, raisins, prunes, and dates.
I also highly recommend grocery delivery and displaying your produce on the counter. When you're running out the door, take 30 seconds to throw it into your bag and amplify your intake of plants. Investing in plants will pay off in dividends.
3. Get creative to fit in exercise in the hospital
Here are a few ways I found to be active while on the hospital service or on call as an internal medicine resident:
Set a timer for 30 minutes and do stairs. If I got called or paged, I'd pause the timer, address the issue, and get back to exercising if possible. Sometimes, I could fit in 30 minutes during the night, but other times, I could not. Give yourself grace.
Use the hospital gym. I wish I could say I used the hospital gym more while on call, but it wasn't close to the team room, and I often needed to stay closer to my patients and the team. But if it was a slow night, sometimes I would walk on the treadmill, cycle, or lift weights.
Go for a walk. If you have a break in clinic patients or on call, take a quick walk around the hospital, inside or outdoors. If I'm caught up on notes in the clinic and a new patient doesn't come, I'll go for a brief walk outside. Figure out what is beautiful (and safe) on your campus. A river walk? A small park? A green space?
Use a blanket or yoga mat for exercise. In a call room or team room (by yourself), you can take a blanket and use it as a makeshift mat (or bonus points for bringing your own yoga mat--I rarely did this). You can stretch, do yoga, pilates, or some strengthening exercises.
Use a standing desk. Some hospitals have these, others don't. Most are in the hallways. Consider taking a break from the team room and writing notes outside the room or down the hall while standing. You can also get some leg lifts in if it's a low-traffic area and you don't mind people sometimes looking at you strangely. (I use a standing desk in the hallway of my clinic and sometimes get in some leg lifts, although I definitely get some strange looks sometimes, but I don't mind).
Wear comfortable shoes or tennis shoes to make exercise easier. Scrubs also lower the threshold for exercise, so wear them when you can.
But what if I sweat or smell bad?
I worried about this, too. I'd often keep an extra set of scrubs in my bag, an extra undershirt, bra, underwear just in case, and deodorant. You'll likely have access to a shower if you're on call. If your hospital has a gym, you can also shower there.
Finding time to shower or change clothes on a busy service is challenging. Most of the time, I kept the same clothes on, applied another layer of deodorant if possible, and returned to work. If I had a break later (depending on the shift length), I'd change my clothes then.
If you start to sweat while exercising, you can also take a break or do something easier for a while. This can help make exercise more realistic while at the hospital.
4. Prioritize your sleep as much as possible
You probably know by now that I talk about sleep a lot. I don't believe in sleep deprivation in training or practice. It affects patient safety and negatively impacts our health.
That being said, here are ways to help prioritize sleep as much as possible when on long study sprints or during busy clinical services:
Tips to help you fall asleep: keep the bedroom quiet, dark, and cool (<68F). Take a warm bath 1-2 hours before falling asleep. Limit screen time before bed (read a book instead). Wear cotton socks to sleep.
If you're studying, make sure to take time to sleep. You can't retain any learning if you're not sleeping. Get at least 7 hours to hold onto that information you've been working so hard to learn. Don't buy into the nonsense of pulling all-nighters or skimping on sleep to study more. You need sleep for problem-solving, memory recall, and learning. It's non-negotiable.
After a long shift or night shift, use black-out curtains or a sleep mask. Limit caffeine as much as possible. And don't drive if you're exhausted. Catch up on sleep when you can, and when you have negotiating power, choose a job where sleep deprivation is not a significant component.
If you have kids, this is another layer of complexity. I feel you. We can talk more about how I was able to maximize rest after having a kid in medical school.
5. Consider intermittent fasting
In my training, I frequently reached for intermittent fasting as a tool to help maintain my weight. I still do this often. It's not right for everyone, and if you take medication or have medical problems, make sure to discuss it with your medical team.
I typically do 18-24 hour fasts a few times a week. This usually involves finishing dinner by 8 p.m., having black coffee or tea the following morning, and eating again in the afternoon or evening. I've found that I'm pretty busy clinically in the mornings, and the time flies by.
Keep yourself well hydrated so you don't get constipated while fasting. Drink water, unsweetened tea, black coffee, or herbal teas.
6. Avoid fad diets or supplements promising weight loss
I don't recommend extreme or fad diets. Most of the data is on eating whole, plant-based foods, limiting processed foods, sleeping enough, and staying active. Don't waste money on supplements or shakes that promise weight loss. Some of them can cause arrhythmias or liver failure.
I recommend Dr. Michael Gregor's book "How Not to Diet." It's a great resource on the science of maintaining a healthy weight. He recommends consuming plenty of fiber, eating primarily plants, consuming foods low on the glycemic index scale, getting rid of added sugar, eating beans, lentils, and chickpeas, starting a meal with plants first, and other high-yield strategies.
I hope these tips help you stay healthier as you navigate school, training, and practice.
Peace,
Laura
___
Remember that while I am a doctor, I'm not your doctor. This is not medical advice. Before making any changes to your health, be sure to discuss it with your medical team.
Comments