Over the last 20 years, I have experienced several pivotal moments that have reshaped me as a doctor, mentor, and person.

After a 12-hour work shift, on a cold winter evening in 2016, I was lounging on a couch, dabbling mindlessly on social media. I am an administrator of a social media wellness group and have a scheduled routine of browsing through the posts, adding actionable comments and resources to keep the members motivated.

On my homepage, I came across a post that read: “I would like to dedicate 300,000 steps on the anniversary of my younger brother’s first death anniversary. I am running short on the steps.”

The comments to this thread in support and pledges counted into the thousands. I pledged 20,000 steps. Routinely, my work generated about 5,000-9,000 steps, and I did not have a plan to achieve the steps in the short four hours left in the day. So, I pulled myself up from the couch and walked. I had to complete 20,000 steps.

So, I walked. I walked in circles around the kitchen; I walked up and down the two flights of stairs like I was on a mission. I stepped as I served dinner on the table. I stepped as I read my kids fables. I stepped when I cleaned the dishes and when I fed the fishes.

But I was still 5,000 steps short. It was about 10:30 p.m. and past my regular bedtime. I glanced at the post and our stepping tribe had achieved 300,000 steps. Victory.

At that moment, I was ready to quit. But something changed, and the desire to continue walking transformed into a mission to step with "no excuses." I was no longer responding to a pledge, but I was being accountable to myself.

My mind was racing with thoughts, but I kept stepping and completed the remaining 5,000 steps. The next morning, I had achy legs and a fresh perspective.

The pledge for 300,000 steps came from the member’s need to share her grief and projecting her sorrow positively. She had lost her younger brother in a massive heart attack a year before this post. His death inspired her to begin a healthier lifestyle.

My life experiences with my own family and their weight-related medical conditions was an eye-opener for me. But in the middle of the night, it took a stranger’s request for help to clinch my decision to continue stepping when no one was looking. However, being accountable is not merely an idea of determination and hope — it also entails implementing a successful strategy. Strategy lies in creating a culture of accountability by taking ownership, being firmly grounded, and acknowledging that despite the monotony of a single activity, it is an “all-time” thing.

Being answerable to an accountability buddy such as a physician, a friend, or a virtual group also has strategic benefits. Increasing physical activity in the wake of obesity is a solution to a global problem, and many individuals turn towards a social support system, like a social media group. Knowing this need and utilizing it to help patients is of strategic advantage. Identifying a social tribe with a collective mindset enables a spirit of camaraderie, accountability, and sustainability that can help both our patients and us maintain healthy lifestyles.

Physicians working in the field of obesity and related co-morbidities should harness the power of an encouraging social support system for patients who are starting a lifestyle change. I believe that living a healthy lifestyle is an individual choice and responsibility; however, using sustainable means to motivate oneself is a strategy. A well-established social group has a mix of excited new users and trained experienced champions, who can coach the groups when the novelty wears off. Fitness groups promoting walking and physical activity support energy expenditure.

Some intentional research, undertaken the morning after walking the 20,000 steps for the first time lead to the following realizations:

• Twenty steps on an average burn one calorie.
• The 10,000 steps per day guideline came from extrapolating this out. The impact of 10,000 steps each day for seven days works out at around 3,500 calories burned over a week, which is the number of calories required to burn 1 pound of fat.
• Walking workstations showed that about 2,000 steps a day increased calorie expenditure by 100kcal/day.

 When encouraging a patient to begin the fight against obesity, we must acknowledge the struggle that patients encounter and support them. We must encourage them to identify their accountability buddies, be it virtual or real. We must promote increasing simple physical activity in addition to lofty exercise goals. 

Together, one small step (or 20,000 steps) for an individual can begin one giant leap in our fight against obesity.

Nita K. Thingalaya, MD, BCMAS Dipl ABOM, is a Board-certified Internist, who specializes in Medical Affairs and Obesity Medicine. She practices telehealth and hospital medicine. She is currently the Medical Director in Healthcare Utilization. Her diverse experience in clinical research, utilization, and informatics make her a leader in Medical Affairs. The article is independent of her affiliations past or present. Dr. Thingalaya is a 2019-2020 Doximity Fellow.

Illustration by Jennifer Bogartz