Dr. Ken Zweig of Northern Virginia Family Practice Associates: “Set goals low”

Set goals low. Changes don’t need to be drastic to show results, and smaller changes are much more likely to develop into new, long-term habits than big ones. This is why most people fail diet plans. A massive change to your eating habits is hard to sustain, but giving up one or two small items […]

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Set goals low. Changes don’t need to be drastic to show results, and smaller changes are much more likely to develop into new, long-term habits than big ones. This is why most people fail diet plans. A massive change to your eating habits is hard to sustain, but giving up one or two small items on a regular basis is much easier. Small changes add up over time. Giving up just 100 calories a day, roughly the equivalent of one chocolate chip cookie, results in over 36,000 fewer calories per year. That’s essentially three weeks’ worth of food!

As a part of my series about “5 Lifestyle Tweaks That Will Dramatically Improve One’s Wellbeing”, I had the pleasure of interviewing Dr. Ken Zweig, M.D.

Dr. Zweig is a primary care physician in Northern Virginia with nearly 20 years of practice experience. He has appointments as an assistant professor at both Georgetown and George Washington University Medical Schools, and remains active in teaching medical students. Dr. Zweig has a particular focus in preventive care and sleep medicine, and is an avid believer in practicing what you preach.

Thank you so much for doing this with us! Our readers would love to “get to know you” a bit better. Can you share with us the story about how you first got involved in fitness and wellness?

As a kid, my family was always very active, and believed in regular exercise. We would go outside in almost any weather, which, in Pittsburgh, was saying something. Also, my older brother was diagnosed with Type 1 Diabetes when I was very young, so the whole family changed to a strict healthy diet early in my life. In addition, as a physician, I’ve seen so many conditions that were essentially cured by just changing to a healthy lifestyle, including a number of diseases that we don’t typically consider “lifestyle-related.” We don’t get much training on diet or exercise in medical school, but after seeing the impact on so many people, I took it upon myself to learn as much as I could, and advocate for a healthy lifestyle to all my patients.

Can you share the most interesting story that happened to you since you started your career?

When I was a resident, a preacher was admitted to my service at the Veterans Administration with a severe Lupus flare. He was miserable, and clearly in a lot of pain. I started him on high-dose steroids, and went home for the day once I finished my work.

The next day, I went to round on him, and found a large crowd of nurses, other patients, receptionists, etc. in his room, spilling out to the hallway. I pushed my way through to see what was going on. I could barely get a glimpse of him through the crowd. My patient was standing on his bed, belting out a beautiful sermon in a loud, cheerful voice that would have lifted anyone’s spirits. He was practically jumping on the bed as he preached. When I finally got a chance to talk to him, he said, “I feel amazing! This is the best I’ve ever felt! Thank you so much, doctor. The angels live in you!”

I thought I was the greatest doctor in the world that day, until the rheumatologist told me that my patient had steroid-induced mania, and we should lower his dose. However, I will always remember him telling me, “The angels live in you,” and will always keep in mind this side effect when I prescribe steroids!

Can you share a story with us about the most humorous mistake you made when you were first starting? What lesson or take-away did you learn from that?

I don’t have a specific story, but when I first started practicing, I was not very confident. We don’t get a lot of training in outpatient medicine as a medical student or resident, so I had to learn a lot on the job. I would see patients in my clinic, then prescribe a medication, order a test, or give reassurance, and then go home for the day. Invariably, later that night, I would second guess my decisions. I would stay up all night worrying, convinced that I killed a patient. I’d call the patient frantically the next morning from my car, rather than waiting until I got in the office, ready to provide my condolences to their family. Every time, the patient would pick up the phone and say, “Hey, doc! Yeah, I’m fine. I feel great today, but thanks for calling!” After multiple recurrences of this, I finally learned that I was better at medical care than I had given myself credit.

Can you share with our readers a bit about why you are an authority in the fitness and wellness field? In your opinion, what is your unique contribution to the world of wellness?

As a primary care physician, I’ve devoted my life to preventive care. Aside from my years of experience, I’ve also learned that just giving patients information is not adequate. Most know what they are supposed to do, they just don’t know how to get themselves to do it. So, many years ago, I decided to focus on learning about behavior change techniques. With the help of my wife, who is a behavior change specialist, I learned multiple ways to help motivate patients, rather than just lecturing them. Medical schools touch upon this, but do not teach it in detail. However, as a primary care doctor, motivating patients to do what they already know they should be doing is the most important skill we can have. And it’s a skill most physicians don’t do well, because they aren’t trained in this. This gives me a unique advantage in preventive care.

None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?

My father was also a primary care physician, and influenced me greatly. However, I’m most grateful to him for what he didn’t do. He never pressured me to go to medical school, and he let me find my own way. During college, I had always intended on going to business school, and even minored in economics. He was always supportive along the way. After a couple of years in the business world, I realized that medicine was probably a better fit for me, and applied to medical school. Again, he was supportive, but always let me choose my own path. He told me repeatedly that I needed to be sure that I was going to medical school because it’s what I wanted to do, not what I thought my parents wanted me to do. Looking back, I realize how important that was for me. Medical school is extraordinarily rigorous, but what kept me motivated was the fact that I had made the decision to attend medical school on my own, and I felt I had to stand by that decision. It was a big factor that helped me excel in medical school and beyond.

Ok thank you for all that. Now let’s move to the main focus of our interview. We all know that it’s important to eat more vegetables, eat less sugar, exercise more, and get better sleep etc. But while we know it intellectually, it’s often difficult to put it into practice and make it a part of our daily habits. In your opinion what are the 3 main blockages that prevent us from taking the information that we all know, and integrating it into our lives?

There’s a concept in behavior change called “self-efficacy.” The concept states that in order for any change to occur, you must believe both that you are capable of making the change, and that the change will result in the desired outcome. Both must be believed, or you will never achieve your goal. For example, if you don’t believe you are capable of ever running 3 miles, then setting that as your goal will never be successful. Also, if you believe that those 3 miles of running will not result in your desired goal, such as weight loss, again you will never be motivated to attempt this change. People who fail in changing habits either set unrealistic goals that they don’t believe they are capable of accomplishing, or they aren’t convinced that change will result in their desired outcome.

Finally, the desired outcome should be measurable and personal. Your doctor telling you to “be healthier” doesn’t have much meaning to most people. But “fitting into my favorite pants” or “keeping up with my kids on their favorite hike” are concrete, measurable goals that have personal significance.

In summary, the three primary blockages that interfere with making the changes we know we should are:

-Setting unrealistic or vague, unmeasurable goals.

-Setting specific behavior change goals you don’t believe you can achieve.

-Lack of belief that the desired change will result in the desired outcome.

Typically, these are blockages we can all overcome.

Can you please share your “5 Non-Intuitive Lifestyle Tweaks That Will Dramatically Improve One’s Wellbeing”? (Please share a story or an example for each, and feel free to share ideas for mental, emotional and physical health.)

I have a lecture that I give that addresses this precisely, entitled “How to (attempt to) Get Yourself to do the Right Thing.” Nothing is foolproof, but these are some non-intuitive steps that can make healthy habits easier to achieve.

  1. Sleep more! This is critical, and likely the single most important behavior change you can make to improve your mood, your health, your motivation, and your overall life. Adequate sleep is the foundation to all other behavior modifications, because when you’re tired, you are far less likely to eat well or exercise. Over 1/3 of all Americans consistently get less than 7 hours of sleep, which is considered the minimum needed for an average adult. Interestingly, if you take a map of counties in the U.S. with the highest rate of sleep deprivation, and place it over top of a map of counties with the highest rates of obesity, they are almost identical, which illustrates the importance of sleep.
  2. Set goals low. Changes don’t need to be drastic to show results, and smaller changes are much more likely to develop into new, long-term habits than big ones. This is why most people fail diet plans. A massive change to your eating habits is hard to sustain, but giving up one or two small items on a regular basis is much easier. Small changes add up over time. Giving up just 100 calories a day, roughly the equivalent of one chocolate chip cookie, results in over 36,000 fewer calories per year. That’s essentially three weeks’ worth of food!
  3. Replace rather than deprive. Most people are not good at depriving themselves, but we accept replacements much more readily. If you try stop having a Coke, and think about not having a Coke, likely you will end up having a Coke if that’s your habit. However, if you have a seltzer instead, your craving for the Coke will be somewhat satiated. If you hate jogging, but want to exercise, try tennis or basketball. In general, try to find something nearly as satisfying or enjoyable as the item you’re trying to replace. Behavior change should not be about suffering, because the change will never last that way.
  4. Measure the process. Whatever goal you set, make sure it’s measurable. “Feeling better” is too vague, but “having the energy to stay awake during movie night” is more specific and quantifiable. Use a system to track your progress, such as getting a Fitbit, weighing yourself daily, or track your calories on your smart phone. For example, studies show that people who weigh themselves at least once a week are more likely to lose weight than those who don’t. Just the act of measuring the process results in better outcomes.
  5. Send your goals out to the world. We are very poor at being accountable to ourselves, but we are more likely to uphold a commitment when we share it with others. Tell your spouse and other family members what you plan to do. Post it on social media. Engage your coworkers. Most of the time, they will all be supportive and encouraging, and may even join you in your efforts. And knowing you have to answer to others can be very motivating. A great tool is to create an “accountability partnership” with a friend or family member, where you commit to send your progress regularly to the other person.
  6. I’ll add a sixth non-intuitive tweak, and that’s “limit alcohol.” There’s a common misperception that 1–2 drinks per night is good for you. However, a recent large study calls that into question, and indicates that even one drink per night can be harmful. Also, alcohol can impair the quality of your sleep, decrease your motivation, worsen your mood and energy, and lower your inhibitions regarding late night snacks. Plus, 1–2 drinks every day adds up to a lot of calories over time. I generally recommend trying to limit alcohol to weekends only. This can be a life-changing shift for some people, especially if they drink regularly.

As an expert, this might be obvious to you, but I think it would be instructive to articulate this for the public. Aside from weight loss, what are 3 benefits of daily exercise? Can you explain?

First, readers should realize that exercise is typically only mildly successful for weight loss, unless you do a lot of exercise (i.e., 30 minutes or more five days/week of intense exercise) or combine it with calorie restriction. Exercise increases our appetite, and gives many people a justification to eat poorly, so I generally don’t recommend exercise alone for weight loss. With that said, exercise is fantastic for your body and mind, regardless of whether you lose weight or not.

Also, most people know that exercise can reduce the risk of heart attacks, strokes, and other conditions, so I’ll focus on less obvious benefits.

First, exercise can make you smarter. Regular exercise improves focus and memory. In fact, regular exercise has been shown to increase the size of the hippocampus, the part of the brain that is responsible for storing memories.

Second, exercise can reduce chronic pain. Treatment for chronic back pain, fibromyalgia, or arthritis routinely includes regular exercise. Exercise has been proven to lower your perception of pain.

Finally, exercise improves your mood and builds resilience against stress. Exercise can work as well as medication for treating anxiety and depression. I strongly encourage regular physical activity for anyone who sees me for these conditions.

In other words, besides making you healthier, exercise improves your quality of life. Who wouldn’t want that?

For someone who is looking to add exercise to their daily routine, which 3 exercises would you recommend that are absolutely critical?

Ideally, we should all do stretching, strengthening, and aerobic exercise regularly. Stretching prevents injury, improves flexibility and prevents post-exercise pain. Strength training also can prevent injury, and improves bone health. Aerobic exercise can prevent diabetes and heart disease, and improve mood.

However, in my opinion, the best exercise is the one you’ll do. Movement, in any form, is the most important factor. Swimming is a fantastic exercise, but if you can’t swim, or don’t have access to a pool, that recommendation does you no good. I always tell patients to do what you can, and do what you like (or least dislike). If you don’t exercise regularly, then ten minutes a day is ten minutes more than nothing. Five-pound weights are five pounds more than just your arms. Walking is less aerobic than jogging, but is still far better than sitting on the couch and eating ice cream. To paraphrase Nike, “Just do something.”

Is there a particular book that made a significant impact on you? Can you share a story?

There’s a book called “Positive Intelligence” by Shirzad Chamine, which has had a big influence on me. This book provides simple steps you can do every day to improve your mental fitness and overall happiness. I had never truly understood the concept or importance of mindfulness until I read this book. It helped me be more present in the moment in virtually any situation, rather than focusing on the past or future, which is where our anxieties lie.

I found a great side benefit from the practice of positive intelligence (called “PQ” for short). One of the exercises Chamine asks you to do is be more aware when you’re eating. Feel the texture of the food in your mouth, notice how it feels on your tongue, and try to pick out individual flavors. I started doing this, and found that I enjoy food more! I eat more slowly, and really experience the flavor of my food. There are a lot of other positive benefits that this work has brought me as well.

You are a person of enormous influence. If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂

I would call my movement “Get More Zzz’s, Please!” Sleep is often underappreciated in its impact on overall health. After 20 years of practicing medicine, I have realized that being a primary care doctor means really being a sleep doctor. Most of the conditions I treat can be prevented, improved, or resolved with more sleep alone. And, unlike medication, increased sleep not only treats most conditions, but also makes you feel better. Again, most adults should aim for at least 7 hours of sleep per night at a minimum, and likely 8 hours per night on a routine basis.

Can you please give us your favorite “Life Lesson Quote”? Do you have a story about how that was relevant in your life?

My favorite quote is, “There’s no such thing as bad weather, just bad gear.” I love winter weather, and will bike, hike, or ski in just about any climate, as long as I’m prepared. My patients often use “bad weather” as an excuse not to exercise, but I always remind them that people live in Antarctica. As long as you have the means, you can get gear suitable for any condition.

Most importantly, good gear may have saved my relationship with my wife! Skiing is my favorite activity, and I wanted to share this activity with her. We were skiing early in our relationship, and she got very cold on the first day. “This isn’t fun for me,” she said, which felt like a dagger in my heart. “My feet are so cold, they hurt. My socks just aren’t keeping them warm.” I replied, “So get better socks.” She looked at me as if I had said the most profound statement in history. Ninety minutes later, she had battery-powered socks on, and we stayed out skiing all weekend. We’ve been together ever since, and have had many exciting outdoor adventures together (all with appropriate gear, of course!).

We are very blessed that some of the biggest names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world, or in the US whom you would love to have a private breakfast or lunch with, and why? He or she might just see this if we tag them 🙂

This may be cliché, but I’m a huge fan of Elon Musk. There are a lot of billionaires in the world now, especially in the technology space, but he’s the only one of which I am aware that has been incredibly successful trying to make the world a better place. I think most other billionaires look for opportunities to make money, and build their businesses around that concept. Elon Musk looks for opportunities to better humanity, then builds a successful business around that. He is also clearly a believer in the concept that “there is always a way.” I respect that, and applaud him for his achievements.

What is the best way our readers can follow you online?

I blog on our website — www.nvafamilypractice.com. You can also find me on LinkedIn to follow my blog series OunceofPreventionMD

Thank you for these fantastic insights. We wish you only continued success in your great work!

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