Qnexa and “Magic Bullet Syndrome”

For the first time since 1999, the FDA Advisory Board has recommended a weight-loss drug for approval.  The drug, Qnexa, has been a hot topic in obesity for a few years now, after it was turned down by the FDA back in 2010.  Like many other weight-loss drugs before it, it causes a bevy of side-effects, including heart problems and birth defects like cleft palette.  On the other hand, it has the highest effectiveness of any weight loss drug thus far, boasting a 10% reduction of weight over the course of a year—more than enough to reverse many health problems linked to weight.

One of the most frequent arguments against treatments like Qnexa, Orlistat (the last drug approved by the FDA), or even various forms of bariatric surgery is that the treatments attempt to create “magic bullets” that kill the proverbial werewolf named Obesity in one fell swoop, with no effort on the patient’s part.  As one blogger on Blisstree.com puts it, “We’re still not teaching people how to take responsibility for their bodies if giving pills is the answer for obesity. As anyone who has lost weight knows, there is no easy fix. It takes a lot of hard work and a total restructuring of their lifestyle. Giving people a pill to do this is just setting them up for failure.”

Many members of the media, health professionals, and others like to discuss modes of weight loss that do not depend solely on diet and exercise as an attempt to find an “easy fix” for obesity. The general assumption with this argument, of course, is that the individual just isn’t trying hard enough to get healthy on her own.  She’s taking a shortcut when the rest of us are stuck in traffic during rush hour.  Little does she know, that shortcut will most likely have a detour on it that actually brings her back to where she started, or worse, maybe spits her out on a road even a few more miles off path—she may lose weight while on the drug, but because she never learned to take care of herself properly, it will creep back on. Serves her right, we believe as we sit in traffic, thinking she could get out without all the suffering we’re going through.

Take the latest “shortcut,” Qnexa, a combination of the appetite suppressant phentermine and the anti-convulsant topiramate.  Phentermine was part of the ill-famed Fen Phen, a popular weight loss drug that caused many heart problems to outweigh the benefits of the weight loss and get the drug pulled from the market.  Topiramate, as the brand name Topamax, has been used in the treatment of binge eating, migraines, and bipolar disorder for years now.  While it, too, has appetite suppressant qualities, the actual usefulness of the drug seems to stem from the fact that it ­­­causes the urge to binge to disappear; in other words, this isn’t a drug for just anybody looking to lose weight, it’s a drug for people with actual issues with binge eating (eating more than a thousand calories at one time, more than twice a week, for at least six months). Individuals prescribed Topamax have been all shapes and sizes because binge eating affects all sorts of people; it’s not an obesity-specific treatment. In the process of getting Qnexa approved, the company producing it had to outline safeguards such as means of monitoring patients using the drug as well as ways to limit access to the drug.  Essentially, it’s not meant as a drug for anybody who needs to lose some weight, but instead as a treatment for folks who, even when attempting to maintain healthy habits, find their eating uncontrollable often enough that it’s inhibiting their efforts.

This last bit is the hardest to empathize with, as well as the most difficult to judge the validity of.  How do you tell when a person really cannot control her urge to eat, and when it’s just a “lack of motivation,” so to speak?

I first heard about Topamax well before the Qnexa crisis; I was seeing a therapist for binge eating.  I wasn’t obese, had talked to enough specialists to come to discover that a) I apparently missed my calling, and should have gone to school for my MSW rather than my MFA b) I have a remarkably healthy view of my body and taking care of it and c) I have a remarkably good grasp on pretty much all non-medication treatments for bingeing.  That is, I can eat my regularly-spaced nutritious meals and snacks, I can exercise, I can recognize when I’m lonely and need to talk to a friend or when I’m stressed or haven’t slept enough or just plain bored.  After a few sessions of trying to pull apart triggers and break down all the thought processes and causes and what-have you that could lead me to fall headfirst into more chocolate than I’d like to admit, he said to me, “You know, I really don’t think you need therapy.  I think it sounds like a chemical imbalance.”  And then he brought up Topamax, how it had been a miracle for a couple of his other patients who could tolerate its side effects.  “Worst case scenario, you stop taking it,” he said.  “But it might give you the opportunity for the rest of what you’re doing to take hold better.”

Long story short, I did a whole lot of research and didn’t go that route.  The drug has too many terrifying side effects (loss of memory, strange tingling in the extremities, changes in the ability to taste certain foods) and I wasn’t entirely sure I was that desperate yet.  For me, dealing with bingeing was nerve-wracking because I was doing everything RIGHT.  When I had a therapist tell me to stop before a binge to pat my arms and legs to bring me back into the moment, even if it meant looking like a moron standing in the middle of a sidewalk, I—well, I didn’t do the patting thing, but I thought about it, and thought, This is when I’m supposed to pat myself like a moron.  Pat, pat.  Pat, pat.  Then went on my merry way to the candy aisle at Walgreens.  (I talked about it to couple other therapists later, and they thought it was a silly idea, too.)  (Lord, this account makes me sound like a therapy whore.  I like chatting and self-reflection.  Okay?  Don’t judge.) After all that, it was a compelling argument to have one pill fix whatever was causing my brain to undermine my efforts for self-care.

Reading patient reviews opened my eyes to the entire idea of why people take drugs like these—compulsive overeating can be downright debilitating. For the people who didn’t find the side effects overwhelming (and even for some who did), the medication turned off the compulsion to binge so they could do everything they were supposed to—eat their healthy meals, go exercise, etc.  When you’ve been living in a state of complete lack of control, the promise of normalcy, at whatever cost, can be really tempting. 

Now, there is plenty of evidence we live in a culture that thrives on efficiency, from assembly-line cars to fast food drive-thrus and beyond.  But I’m not entirely convinced that we’re doing obesity treatment—medical and otherwise—justice if we call any attempt at this point an “easy fix.” You see, we like to talk about these treatments as though they’re shortcuts, but, going back to the driving metaphor, they’re meant to be a way to help the individual get from their dirt road in rural Iowa to the highway in the first place.  Then she gets to sit in traffic, like the rest of us.

So, yes, an attempt at reducing obesity-related illnesses and health risks without actually working on living a healthy lifestyle is impossible, but we need to stop viewing obesity treatment as a stand-in and more as a stepping stone.  And by “we,” I don’t mean the just the folks undergoing obesity treatment, I mean the rest of our society as well, particularly the people in the mode of talking about diet and health and weight loss.  There’s not much of an argument in saying that a person won’t be able to have a healthy lifestyle if they don’t put in the effort: of course not.  We’re also likely not going to have some Soylent Green-like substance to help nourish ourselves without thinking about what we put in our bodies.  The question is in how we judge the amount or quality of effort an individual puts into maintaining healthy habits, and how we view their level of control.

Of the clients I’ve worked with who are working on major weight loss and have undergone or are considering undergoing major therapies—diet pills, weight loss surgery, or otherwise—none have used the singular treatment as a “quick fix.”  Now, granted, I haven’t been training quite long enough to see a complete cross-section of the population, and, of course, if they’re in the gym with me, chances are they understand the importance of the whole “stepping stone not magic bullet” concept because they’re working on building up an exercise habit.  Yet I’ve also met with countless women who, because of their weight, feel invalidated in the gym—they don’t believe they’re as talented athletically as they actually are, they feel self-conscious around their thinner peers, they worry about the quality of the exercises they’re doing (ie, “I bet you make your thinner clients do harder stuff than this.”).  Part of me wonders if this magic bullet syndrome of our culture—this judgement of the means of how people make themselves healthy—has actually made it much harder for overweight individuals to build healthy habits.  Rather than being able to feel happy with making steps in the right direction, they instead must live with the knowledge that others are vocally judging the quality of their efforts. 

Health and fitness professionals like the blogger on Blisstree argue that we need to understand that medical obesity treatments are no magical bullet, that weight loss is a long and difficult challenge with or without a pill for help.  Yet the majority of people undergoing these treatments probably understand better than anyone else how difficult living under the stigma of being overweight is and understand how difficult changing lifestyle habits is.  Thus, perhaps rather than aiming this message at those undergoing the treatment, the health pundits should take to heart the message themselves and empathize with how difficult developing healthy habits are, even with Qnexa.

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Putting your best butt forward (Or, Motivating by appearance:The good, the bad, and the ugly)

There have been a few inspirational photos floating around my coworkers’ Facebook pages lately, showing off how strength training rather than long stints of cardio can transform a woman’s body with impressive results.  You see, no matter how much the media tells women that lifting weights does not, in fact, turn you into the Hulk and does get you that much closer to being a bad-ass like Michelle Obama and Ellen (see: Best Video Of My Life), many, many women get scared by the prospect of picking up moderately heavy objects and moving them around. 

And, as you probably can guess, the concern is never getting too strong or too fast or jumping too high.  Many women shy away from weight-lifting for fear of getting “too big,” and head to the treadmills or ellipticals when they want to shed a few pounds. Now, this not being a blog about the science behind fitness, I’m not going to get into tons of explanation here of why this thought process doesn’t hold much weight (no pun intended).  Suffice to say, though, research has shown that to change one’s body composition to get the look flaunted in Hollywood and most fitness magazines, you have to lift a few weights.   Plain and simple.   You cannot look “toned” without muscle, and you can’t build muscle without doing something to challenge the muscles you currently have. 

Now, let me show you these photos that folks have been talking about:

  

In the break room, I heard multiple people say how great the photos are.  Women should see that the bodies they want don’t come from hours on the treadmill. Maybe this will show women that shorter interval-training-style cardio sessions and strength-training can help get them to goals they’re actually trying to achieve, not just things they “should” care about like bone health and injury prevention.  Let’s be honest—gym-goers care about the things they “should,” but they often care about their looks as much or more.  As a result, any motivational quote, article, or picture that shows women that strength training can make them feel attractive seems like gold to personal trainers.

Now, I’ll be the first to say that the trainers I work with have a great understanding of the importance of motivations beside appearance.  They brag as much or more about their newfound ability to do pull-ups or increasing mobility in this joint or that or increasing their speed on their latest 10K.  And they get the importance of appreciating one’s appearance in the context of one’s own body, instead of some random societal standards.  In fact, they’ve been integral to helping me wrap my head around the idea that appearance can be a positive motivator for people—focusing on improving one’s appearance doesn’t necessarily mean you hate yourself, it doesn’t necessarily mean you want to look like someone you’re not.  Feeling sexy or beautiful or muscular can be another way a woman learns to value herself.

Motivating by appearance, though, treads a fine line.  Take those pictures.  Okay, yes, we’re telling women to get away from their fear of weights and anything but long, slow “fat-burning” cardio.  But chances are, that marathon runner in photo number one actually does have a well-rounded workout routine including strength and shorter interval runs, because, guess what—it’s pretty tough to be a decent marathoner without doing those things as well.  Equating her workouts to just watching television on the elliptical for an hour three times a week isn’t entirely accurate. 

Plus, go into any running advice forum or magazine, and one of the major points made again and again is you shouldn’t take up marathon running if you want to lose weight.  Period.  You take up marathon running because you want to run really far and tell people you can run really far.  Possibly you take it up because you really like pasta dinners before a race.  Whatever.  Point is, people who start marathoning to lose weight or look a particular way usually end up sorely disappointed, and marathoners readily advertise this fact.

So chances are that chick in photo number one did not go into running simply for the hot bod, and therefore it doesn’t make sense to judge her for doing something that doesn’t make her look like a fitness model.  She probably didn’t go into the sport to be judged for her appearance, so why on earth spread her photo around the internet as an “educational” device about how women should get the bodies they want? She decided she wanted a body that runs 26.2 miles.  It’s essentially like a marathoner calling out some random woman whose goal is to look good at her sister’s wedding for not being able to run more than two miles.  Different people want different things from their bodies.

Thus, we end up with the first stumbling block with appearance as a motivator for working out: Oftentimes, we confuse judging a routine based on how it helps a person reach her goals with judging a routine based on how it helps someone look a certain way.  The latter is a subset of the former.  Too often, when motivational materials try to convey the idea that form follows function, that our bodies adapt to the types of stress we put on them and therefore will change in appearance and ability based on the way we challenge them, the message comes out as, “You don’t want to look like that, do you?”  Suddenly, a logical argument becomes body-negative and teaches women that bodies that don’t look a certain way are shameful.

Furthermore, even if the marathoner did go into running to look better, she may actually consider her body type the hottest body type out there.  On the off-chance that everybody viewing the photo agrees that the sprinter is hotter than the marathoner, it’s still not fair to shame the marathoner because her body doesn’t fit others’ perceptions of beauty. The same holds true for the second photo, of the two ladies’ bums.  Think about the people you’re attracted to and the people your best friend’s attracted to—probably a few differences, right?  The first photo implies that one should prefer the sprinter body type, and the second suggests we should all prefer the perky, round bum.   And so we see problem number two with appearance motivators: it’s easy to forget that not everybody idolizes the same body types, and positive appearance goals should stem from one’s own body and values, not others’. 

Photos like these illustrate the main reasons I had a hard time grasping appearance being a positive motivator for so long.  Calling someone unattractive—whether overtly or implied– does not make for healthy motivation.  It teaches the individual who is motivated by appearance to be ashamed by not fitting particular molds.  It can make fitness seem downright futile for those who realize their bodies will never look like the standards set by society.

 

Trip down memory lane:  This is a photo of my track team, freshman year of high school.  It was the only year that I participated in a team sport, because that season I ran out of practice crying about every other day.   That cutie with the red arrows pointing at her is yours truly, age 15.  Notice my shoulders were as broad as those of the linebackers in the next to the last row, despite the fact that everything below my ribcage was a size 3/4.  I hated this photo at the time because it made me realize, no matter how thin or athletic I was, I would never fit into any sort of ideal body type (it’s also hard to tell in this picture, but I was pale-whitish-pink, thanks to my Norwegian ancestry, while everybody else had this lovely golden tan).  Since then, I’ve learned that my shoulders, along with my really large hands and flipper-like feet, make me a formidable swimmer, and I would probably be a damn good football player on a girl’s tackle league, were it not for the aforementioned crying problem and a general lack of hand-eye-coordination (not a requirement for personal training certification, incidentally). 

I suppose this is all to say, I’ve been jaded about appearance motivation for a long while.  Exercising made me learn to appreciate my body for more than what it looks like, made me care or the bits and pieces for what they can do for me rather than whether or not they make me look good in a sleeveless dress or bathing suit.  The feminist in me, the liberal-arts student turned MFA-er, wants to make all women think this way.  I want to yell, You are more than the sum of your parts!

But I work at a women’s gym, and, I have a feeling co-ed gyms are pretty similar in that the majority of the clientele worry about fat loss and getting Michelle Obama arms just as much or more than they do about their LDL/HDL ratios.  (Well, perhaps the men don’t want Michelle Obama arms.  But maybe they do. Have you watched that video I linked at the beginning of this post yet?  Go.  Now.  Why on earth are you still reading?)

So then I grapple with this question of how women motivate themselves with the goal of looking better without turning it into a game of comparison or deeming particular activities off limits simply because they don’t have the desired effect on x, y, or z body part.  From what I’ve learned from my coworkers, part one is accepting and embracing who you are and what you find attractive: robust farm girl with killer arms and quads and freckles or hippy endurance athlete or muscular and compact crossfitter.  Some people want more muscle, some want less.  Some want long, lean limbs with soft definition, some want every vein to pop. Some care more about having an endorphin rush after every workout, some hate feeling sore or tight the day after a workout.  The trick is to stay true to who you are, and to remember that others may value different traits– and neither will be wrong.

The irony of the photos, of course, is that they ultimately are meant as a way of teaching women to think outside the box in terms of their own fitness goals.  The intended take home message is one that I stand behind: don’t limit your workouts because you’re afraid of what they’ll do to your body; you might be happily surprised when you challenge yourself in a different way.  Or, as one of my coworkers’ t-shirts proclaims, Strong is the new beautiful.

The Paradox of Promoting Health

Probably one of the biggest blows to the ego of a young personal trainer starting a new training gig is the realization that the first months of the job only sometimes includes those inspiring moments you see on television of a trainer pushing her client to new limits with grueling strength routines or cardio intervals.  Just as rare before you build up your client-base, are those dreams of helping a retiree overcome some hip dysfunction that’s been preventing her from taking advantage of her favorite step aerobics class or motivating a girl with fifty-plus pounds to lose to get started with a routine and to feel like a bad-ass at the gym, just like the thinner girls.

No, those first few months include a lot of crawling through rows of sweaty, dusty treadmills with bottles of orange-scented cleaner, hoping an exercising member doesn’t chew you out for aggravating her asthma with the aerosol. You realize, among other things, that it’s a miracle Spiderman hasn’t gotten knee pain from his favorite web crawling position, because it’s really not that different from what you’re doing as you swing under the arms of one piece of cardio equipment to the next, and, within a matter of two weeks, your joints have started to make you feel like a grandma.

Don’t get me wrong—you do actually train and work with other people quite a bit: introductory sessions for new members looking to get acclimated, complimentary workshops to show off your skills to potential clients, walking the floor to answer questions about equipment or exercise form.  But, in the process of pulling together a full set of clients to see week in and week out, the new trainer also does a lot of other stuff around the gym in order to have a paycheck until the training commission is enough.  Thus, orange-scented cleaner and visions of Spiderman.

The more grueling aspect of the position is that during this period, you open and close the club.  In other words, you wake up when the college students next door are stumbling in from the bars so that you can get to the gym at 5 to make sure the BOSUs are lined up in something resembling order and that the jumbo TVs overlooking the cardio floor have the appropriate chick flick and/or strange artsy film playing for the bright-and-early exercisers.   Or, on other days, you wander the hollow shell of the gym at 9.45, internally wondering if the girl doing that strange leg exercise on the stretching mat really is going to stay until The Very Last Minute on a Friday night.  Sometimes, you do both, back-to-back.  (Confession time, because I feel I should mention it here: I never opened my gym, because the train system didn’t start until 5.15 and, at the time, I lived an hour away.  This reduced my stress a boatload. On the other hand, I lived an hour away, so there was no hope of going home between morning and evening clients.  Still, I got it easy, relatively speaking). Some maintain second jobs, to pad their budget a bit, resulting in working 16- to 20-hour days, six or seven days a week.

On the positive side, you get to know the guys at the local coffee shop pretty well, and they slide you free drinks as you discuss the merits of barefoot shoes or tai chi. 

To be perfectly honest, these conditions are actually fairly light compared to what the managers at the gym are going through, who also open and close the club, clean equipment, etc., when the club’s short-staffed, and, when there are enough newbee trainers to help out, spend ridiculously long days at the club doing all that other magical stuff that keeps the company running (the magical stuff seems to include a lot of spreadsheets).  Note, also, that this is not a company-specific problem—from what I’ve heard about other gyms, we have one of the best support systems for our staff, the most checks and balances to keep a person from going crazy during the challenging period of, essentially, starting a personal business.

But, to get to the point, that stress takes its toll on every new trainer.  You, a person who never gets sick, fight cold after cold.  You start craving sugar like nobody’s business, and hit up the Easter candy aisle at CVS or one of the many local frozen treat establishments on a daily basis.  Exercising, previously one of your favorite activities (you made a career out of it, didn’t you?), becomes a chore.  Despite being on your feet all the time, you gain weight, even if you were previously a person who struggled to keep weight on. I’ve heard various iterations of the same story from multiple (if not most) other trainers getting started with their new career. 

We see even more extreme cases of this same situation in the medical industry: One study showed that doctors “working traditional 30-hour shifts who stayed with patients all day and night made 5.6 times as many serious diagnostic mistakes as those scheduled to work no more than 16 consecutive hours.”  Then, exhausted, they’re at higher risk for getting into car accidents on the commute home or becoming ill themselves.  Proponents of the long shifts argue that residents and doctors need to be able to see new patients through the first 12 to 24 hours of care to best judge the treatment plans taken.  Additionally, longer shifts means patients are passed between fewer hands, so they feel better acquainted with their care team.  To uphold the Hippocratic oath, it seems, a doctor has to be willing to sacrifice everything.

I don’t mean to say that personal trainers undergo anywhere near the stress levels that medical personnel do.  But both situations raise a similar question, and that is what is the ideal of health we’re trying to achieve, and at what point is the patient or client’s well-being coming before that of their caretaker/trainer? 

I can’t even count the times that I’ve had a doctor, nurse, midwife, psychologist, etc. tell me she feels like a hypocrite because she lectures her patients on proper self-care, but then never takes the time to do it or herself.  Meanwhile, pretty much every day I watch myself or another coworker snarf down a meal in five or ten minutes between a long string of clients, at least one of whom we’ve probably discussed the merits of proper nutrition and eating slowly to better register satiation. (In one of my past blogging brainstorms, I considered starting a blog about meals that could be gulped down in under five minutes.  Then I realized that plan was probably sign of a larger problem with my lifestyle.)

One of my coworkers recently posted a link to this article on Facebook, discussing the inherent problems with the split-shift, the standard morning-break-evening double shift that trainers work because most clients don’t have time to exercise between 9 and 5.  The author writes, “NOT taking care of yourself and NOT being there for your family and fulfilling those very important roles you signed on to play in your life BESIDES being a business owner, coach, etc. IS the root cause of negative symptoms like burnout, unhappiness, and general dissatisfaction.” The paradoxical result? Putting care of others first, and not care of oneself, prevents one from being as productive or helpful as intended. On the same thread, The New York Times published an article last year about the trend in doctors choosing positions that don’t require such ludicrous hours. Think of it like those safety procedures you hear on airlines: in case of a drop of cabin pressure, secure your oxygen mask before helping someone else with theirs.

The interesting point, however, is not the debate, but that there is a debate at all.

What drives us to perpetuate the belief that a person must put her well-being second to those whose health is under her care, whether in treatment (for doctors) or in preventative lifestyle modification (for trainers)?  The most apparent reason, of course, is obviously that the patient/client is not as well off as the caretaker/trainer—perhaps dying, in the extreme situations of the medical world, or perhaps just unable to navigate the weight room  sufficiently to exercise routinely on her own. In a sense, the rich of health give to the poor of health.  Even ignoring the whole issue that individuals cause more harm than good when fatigued, our systems function under the assumption that it’s okay to negate one person’s health in order to increase another’s. Is it a genuine belief in altruism that drives us?  Is it more capitalistic reasoning, trying to the make the most money out of limited resources?  Most importantly, how much are our efforts to build up health for everyone actually chipping away at the base of support instead?

 

 

The call girl conundrum

One of my clients works as a professional escort.  I’m not going into too much detail here about her specifically, for the sake of her privacy, but most of my fitness-related thoughts these past couple weeks have found themselves returning to her situation—and, perhaps more surprisingly, how the obstacles against her health that her job creates aren’t all that different from those that many of my clients face.

The first time we meet with new clients at my gym, we sit down with them in a small glass cubby smack dab in the middle of the fitness floor.  The Fitness Director and Assistant Fitness Director, my bosses, sit about three feet away at their own desk; it’s cozy and homey like one of those mini-terrariums baby turtles come in when you buy them from a kiosk in the mall rather than a more reputable pet emporium.  Much like a terrarium, there isn’t a whole lot of privacy, although we try to obscure the view with photos and promotional materials. 

We ask the new client a series of questions that, I assume, most people would want someone who’s about to take them through a series of strenuous exercises to ask:  What brings you to the gym?  What are your goals? Have you belonged to a gym in the past?  How active are you currently?  Any injuries or other health concerns?  Etc.  Depending on the answers to these questions, we’ll often freestyle with some related questions, to help us build a bigger picture of what we’re working with.

This girl in particular wants to lose weight.  Ten to twenty pounds—significant, but not extreme.  A common enough number we hear during these sessions.  So, as with most clients in her situation, I asked, “Are you doing anything with diet and nutrition at this point?”

Yes, she was cleaning up her diet at home.  Because she’d lost a large amount of weight in the past, she knew about eating whole foods rather than processed, lean meat, vegetables, etc.  She knew, too, that she did better when she drank less and didn’t smoke pot, because both habits made her more inclined to reach for a frozen burrito in a post-midnight snack.  So if she knew all that, if she’d done it and maintained it before, what was her obstacle at this point?

“My job,” she explained.  “You’ve got these guys, and they’re taking you out to dinner every night at these fancy restaurants, and they’re expecting you to live their fantasies.  And you can’t drink just one glass of wine, because then they’ll think you’re waiting until they’re drunk to take advantage of them.”

Valid point.  So I gave the only advice that I could think of, “So do you know where you’re going ahead of time?  Maybe you could look at the menu online for healthier options?” It seemed ridiculously inadequate as a response.

“Yeah, I try to do that.  Like, last night, we went to this place with this amazing risotto on the menu, and god, I love risotto, but it’s so full of cream and fat.  So I got this Mediterranean fish with tomatoes and olives instead.”  She paused.  “But then we went back to his room, and we’re hanging out and having a great time and we end up getting Mexican food and all this other crap and—” She laughed at the memory. “The amount I ate was vulgar.”

Thus, the question I’ve been toying with in my head since our first meeting: When you’ve made a career out of giving up your own agency to please others, how do you put yourself first in the way that you need to when making healthy changes?  How does the regular advice even apply to you?

Oftentimes, advice about making healthy habits boils down to the simple idea of learning to put yourself first and others second: not so much in the sense of look out only for number one, but in that to get into healthy habits, you have to get past the idea that you’re letting others down when you make room in your life for your goals.  In other words, you have to feel like you can tell your friends that you’re sticking to one cocktail when you socialize without risk of them judging you or feeling like they think you’re not fun; you have to feel like you can ask your partner to take the kids to school three days a week so you can get to that morning spin class; you have to tell Mom that you’re going to lighten up some of the Thanksgiving favorites so you can stick to healthier eating through the holidays.

When I asked the call girl how likely it was she felt she could tell her clients that she’s trying to live healthier and therefore needs to watch her food and wine intake, she said she felt she could ask her regulars to help support the changes she’s making to her lifestyle.  Still, how much support can she expect? (And nevermind the question of whether the unhealthy habits are necessary to make the subjugation involved in the job bearable, if only because the subject of the rights of professional escorts is too large a topic for a fitness blog.)

These are not professional-escort-specific concerns, though.  Many careers require business lunches and dinners, long days of travel that mean sleeping fewer than six hours at night, and, of course, the motivation to keep doing these things because it’s the best way to pay one’s bills at the moment.  How many women struggle with putting together meals for their families that will please the picky palates of their partners and/or kids?  How many women feel that getting involved in the singles scene means needing to be able to drink a bottle of wine with the latest prospect once or twice a week?

Oftentimes, however, even though the general concept is the same, the behavioral modification needed similar in all situations, individuals have a hard time translating advice to their own lives—whether in seeing how it applies in the first place, or simply in execution. Many women can chirp back on command, “I know that I need to take care of myself and put myself first!” when asked about getting started on a fitness routine, but when pressed about how much time they’re spending on work commitments to the ill-effect on their health, they argue, “ You don’t want me to lose my job, do you? How do you expect me to pay my bills?”

In personal training, we often talk about “cueing” exercises: how do you explain a movement or correction to a person in a way that she’ll be able to reproduce it?  Good cuers have an arsenal of ways to describe a single movement, from visual demonstrations to verbal metaphors to tactile prodding.  Different people respond best to different types of cues. 

Lifestyle modification advice, though, is also a form of cueing.  A new exerciser might respond to the instruction, “Okay, so you’ll feel your scapula travelling down your back,” with, “Sure,” but then quickly realize she has no clue what a scapula is but she feels the front of her arms burning. With lifestyle modification, we say, “Put yourself first,” but, hey, isn’t making sure you have something to hand your landlord at the beginning of the month looking out for your own well-being?

Read fitness magazines or listen to trainers advising their clients, and most of what you’ll hear are the healthy facts we know: Try to get your heart rate up three to five days a week for a minimum of thirty minutes.  Lift weights two to three days a week.  Drink x ounces of water per day.  Fiber and protein usually help people stay fuller, longer.  Fancy Starbucks coffee beverages have a shit-ton of calories and sugar. 

These are the things we discuss because, in part, they are the things that don’t step us outside of our professional bounds into the lands of therapist or doctor or even registered dietician.  But many times fitness professionals repeat these morsels ad nauseam, and wonder why the advice still doesn’t stick.  They’re pretty straight  forward facts, aren’t they?

Unfortunately, if we don’t consider the whole picture—the job restrictions, the family obligations, etc—then we simply can’t give cues that will help the person modify her lifestyle for the better.  In essence, we will continue to talk about scapular movement when the client only knows that she has the back fat that pokes out of her bra and the wobbly bits on her arms and she doesn’t terribly give a crap about the only thing she does feel, which are the front of her arms.  If we talk about it, though, she knows it might be important, so she nods and agrees and continues to overcompensate in the movement with muscles that really should only play a supporting role. If the trainer figures out something’s not right with her movement, then maybe the trainer can tell the client to focus on driving her elbows downwards or patting on the part of the ribcage where the lattisimus dorsi should be working or any number of cues. 
Some will make equally little sense, but one may help.

And no, the question of cueing lifestyle modification isn’t limited to simply rewording advice in a manner that seems applicable to a given client’s life—be she call-girl, corporate exec, or full-time mom—although that plays one part.  The cues need to take into account the individual’s priorities, without judgment.  To get back to the idea of cueing physical exercises, one of my coworkers commented once that trainers will tend to explain exercises based on how our bodies work or compensate—so if usually let my knees cave when I squat, and I have to think about pushing my knees out to keep them properly aligned, my initial explanation for the exercise will include that same cueing to keep the knees aligned, even if the client has other problems related with, say, her body leaning too far forward. Thus, rather than tell a client who spends a third of her work-week on a plane to cut back on the travel so she has more time to exercise, nor can we tell her to simply make exercise a priority and set time aside every day for the gym; we have to work with her to figure out how to translate the advice into tools she can use given her lifestyle.

Of course, I’m still trying to figure out ways to help my call girl, but it does lead me to question whether health and fitness professionals should focus less on the particulars of the advice we give and more on how we give it.

Beware: This exercise might kill you.

The other day, I read a New Yorker article by Malcolm Gladwell about the massive amount of brain damage football players undergo over the course of years of practice.  The athletes often sustain repeated hits to the head with the same level of force as a car crash.  Gladwell likens the sport to dogfighting, because the players have become so loyal to working their hardest and not letting their team down that they put their own well-being at risk.  Much like how a dog that sees its trainer out of the corner of its eye will continue to fight, even with mortal wounds, our professional (and, many argue, high school and collegiate) athletes push themselves through massive brain damage—injuries that cause vomiting in the short term in Alzheimer’s like dementia long-term—in pursuit of victory.

Meanwhile, another article printed in the New York Times last month talks about the hidden peril in practicing yoga.  The supposedly gentle and therapeutic practice can actually lead to more back injuries than it heals, and, in extreme cases cause enough spinal damage to lead to seizures or death. 

On the fitness spectrum, professional football and yoga probably seem like polar opposites.  Part of what’s disconcerting to most who read the New York Times article is that the majority of people live under the impression that yoga is gentle and safe.  With one publication, though, many are second-guessing their choice to practice yoga. For optimal health, it seems best to play it safe, stick with the workouts that don’t have such a high risk of injury.

Who can argue with that?

At the club where I work, all new trainers go through a multi-day intensive course where we discuss the company history, basic sales tactics 101, and standard protocol for introductory training sessions given to all new members.  It’s usually filled with a combination of trainers who are completely new to working in the fitness field and those who’ve worked for years at other companies, and, for one reason or another, decided they needed to switch homes. 

During my initiation, one of the latter, more experienced trainers started a lengthy debate with the woman leading the session about whether the club should have “off-limits” exercises.  Some gyms, it turns out, come up with a list of exercises that trainers should avoid, the logic being that the risk involved with performing the moves outweigh the benefits.  Make sense, given the particular exercise the trainer cited was a Good Morning—a form of deadlift where the individual puts a weighted bar on her shoulder, then hinges at the hip as though she’s bowing to royalty.  It’s killer on the butt and back of the thigh, and, when weights are chosen cautiously, can strengthen the lower back.  On the other hand, it’s incredibly easy to arch the spine too much—and low back muscles are fairly wimpy compared to the big honking leg muscles that are supposed to act as the powerhouses for the move.  Add in the strain the bar can put on the neck and cervical spine, and it’s a wonder anybody would practice the move, right?

Well, no, actually. But to get into the particulars of why is more of a digression than this post needs at the moment.

The woman in charge of the training said that the company trusts its trainers to be able to tell whether an exercise is safe for a client or not.  The seasoned trainer seemed incensed by this argument—that puts a lot of trust in the trainer.  How do you know a truly new recruit will have the know-how to tell which exercises are safe and which are not?

It’s the same argument that comes up in that yoga article, really: can you trust that your instructor will have the ability to keep you safe?  Not a whole lot of certification is needed to teach yoga.  No wonder people are getting hurt in a practice previously considered safe—they’re being led by someone who knows little more than they do about what’s reasonable to expect the body to do. Some of the certifications available for personal trainers are little better than those for yoga instructors.

These points may not seem like they overlap—how is an athlete pushing himself to glory for the success of his team and the approval of his coach, groups who care more for the collective than his individual well-being, similar to your average person putting herself into the care of a fitness professional whose intention is to keep the client safe while aiding her in improving her overall health?

The common thread, though, is this concept of the seemingly paradoxical ability for exercise to both hurt and help.  They all involve the same central question: Does this activity we once thought was healthy actually cause more harm than good?

I don’t think the cultural interest in this question is all that mystifying.  Obviously, we want the activities we seek out—whether they be professional sports that show off the pinnacle of athleticism or the workouts we do to lengthen and better our lives—to not hinder the health and fitness that they’re meant to promote.

No, the interesting point lies in the fact that we readily judge exercises in such black-and-white terms, immediately labeling the activity as hazardous or healthful, not allowing for gray areas.  Walk into my gym on a given day, and you’ll be able to find people who will tell you about the wonders of running and those who will tell you it’s worse for the body than running naked through nuclear fallout. You’ll hear how working out in barefoot sneakers that make you look like a periwinkle-footed monkey will solve all your lower body ailments, and that they can wreck your knees in a hot second. 

When something goes wrong, we blame the exercise, we blame the person teaching the exercise (who, yes, I agree should know enough to keep her clients’ safe), but we never consider those neon-signs our bodies give that many ignore while performing the exercise.  Many have heard the term, “No pain, no gain.”  As many have become aware, this cliché isn’t quite as straight-forward as it sounds—that there’s good pain (muscle soreness), and there’s bad pain, and you better differentiate the two if you want to stay injury-free.

Oftentimes, though, we set our sights on larger goals, and to our detriment. When we read about brain-damaged football players, we think, Well, duh.  Didn’t they know that was going to hurt them? Of course sustaining multiple car-crash like blows per day will hurt you.  The reason we are so shocked by yoga causing harm is that we let ourselves believe that there is activity out there that doesn’t require the diligence of monitoring our own well-being.  We’ve been taught that we’ll succeed if we just try hard enough, but, the truth of the matter is not everything works in such a succinct pattern. 

Thus, when working harder hurts us, we blame the exercise.  It’s much easier to blame an outside force than to say, Hey, my body just wasn’t made for this.  It’s harder still when you know someone who’s body does seem to be made for the exact same activity—who never gets sore or doesn’t struggle with back or knee pain. Instead, we say, Oh, the exercise will get to her eventually.

Chances are, you’re right: the exercise won’t continue to be the best option for her body, because our bodies change over time, as do our minds (and yes, psychological needs do play a large factor in choosing an exercise routine).  But is the key to avoiding injury avoiding the exercise altogether?  Take the plank, for example: A person holds her body in a straight line, supported by her hands and toes.  Great core stabilization exercise, not necessarily going to cause you injury if you make sure you keep the posture correct (which isn’t too hard, with the help of a mirror.)  Then you throw out your shoulder one way or another.  Go through some PT for the rotator cuff muscles, another set of wimpy muscles located in the shoulder region.  Guess what?  When you’re in PT recovering, that plank ain’t so safe anymore, because it puts a lot of stress on those shoulder stabilizers that may still need to gain strength and flexibility.  Should a gym ban the exercise that was once great for you because now, at this point in your life, it’s not a good fit for your mending body?

Consider the question from the statistical perspective: something that’s safe for the average person does not mean it’s safe for everybody, because, “average” is a derivative of many disparate individuals.  No one is running around with just the arm or leg of a child, but on average, the American family has 2.2 kids.  Some people have five kids.  Some have one.  Some have zero.  “Average” does not mean “this is what most people have.” “Average” means something that summarizes or represents the general significance of a group of different entities.

We discuss the helpfulness and risk of exercise in terms of this average, though. In actuality, we need to consider the variance and standard of deviation as well; in non-math-talk, we need to consider how many people actually fall under the umbrella of risk.  A one-mile jog will feel like nothing to a marathoner, but probably be intensely difficult—yes, even risky—for a couch potato who hasn’t run since childhood. On the other hand, most people probably would sustain brain damage from professional football practice.  In the former situation, there are more outliers to the risk umbrella than in the latter scenario.

Perhaps because of team sports, perhaps because of our cultural interest in success, perhaps for other reasons entirely, we have a collective view of fitness.  This means that, when playing team sports, we take the collective’s well-being and success into consideration over our own.  It means, too, that with individual practice, we judge what’s good for ourselves in terms of what’s “good” or “bad” for the collective—essentially, a person can walk into a strength-training class and assume that every exercise will be helpful for her, even if she has the aforementioned rotator cuff injury or knee problems or a lack of coordination that puts herself and those around her at risk.  Similarly, the chosen exercise may not challenge her enough, and therefore reduce her gains.

More simply, we need to examine our tendency to put others’ opinions ahead of our own needs—whether proving ourselves to a team or push ourselves to a higher challenge—and our tendency to discredit the messages our bodies give because of what we think we should do.  Vomiting after getting hit in the head?  Maybe you shouldn’t do that sport that gets you pummeled so much.  Twinges in your back after that yoga pose?  Maybe you should reconsider your position, or see if there’s a modification that will allow you to get the benefits of the pose while responding to your limitations—even if it means you won’t be able to do something cool or that you feel you “should” be able to do. 

This is not to say one should live without challenge; the only way to improve is to push oneself beyond one’s previous limits.  At the same time, though, we need to consider how we choose our challenges and why. Perhaps the overall lesson is not that one exercise or another is especially risky.  Instead, the danger lies in considering an exercise solely in terms of wins or losses, failures or successes.

Guest Post! Leveling Up

This post marks the first in a once-in-a-while Tuesday guest post series I’ll be publishing on the blog, “What I talk about when I talk about health” (Why yes, I am a creative titler.)  The series aims to open the conversation about how individuals define “health,” how they’ve come to consider or reconsider health in their day-to-day lives, or other such related topics.

The first post is from the incredibly witty and thought-provoking Editor of the Salem Gazette, Sarah Thomas.  Thanks, Sarah!


It’s nearly 3 a.m. I should be sleeping, but I can’t. I haven’t slept in days; I’ve been too busy roaming the countryside on foot, bringing friends and acquaintances exotic delicacies or gifts from far-off lands. Right now, my back is laden with clothes, weapons, and gems – just a few short months ago, I could barely carry a quarter of what I can carry now, but with exercise and determination I’ve become much stronger.

I don’t eat much, these days. Mostly a liquid diet, tailored to my immediate needs, though every now and then I’ll munch a piece of bread or salmon steak. I’ve even tried some bizarre delicacies – cheese made from the milk of mammoths, the thorax of a lightning bug.

Three-thirty. I’ll sleep as soon as I kill all the zombies and wizards in this cave.

***

The life I’m talking about, of course, is my character’s life in video games, in this case my current obsession, The Elder Scrolls V: Skyrim. If your experience with video games doesn’t go much beyond making plumbers rescue princesses, let me tell you that the size and scope of this game is staggering. There are thousands of quests to undertake and choices to make. You can be a two-fisted brawler or an arcane sorcerer, a political partisan or Machiavellian opportunist, a noble hero or a dastardly villain.

The one thing you can’t be, however, is fat.

You can see why; just look at those first paragraphs, the description of a typical day in the life of a Skyrim character. Who’d have time to get fat? Running over mountains, fighting through dungeons, hauling gear, and no food. There’s food in Skyrim — the game’s realism even extends to having functional kitchens, where characters can combine ingredients and cook delicious dishes. But I never use them. There’s too many other things to do.

I bring all this up, you see, because it’s January (well, February by the time you read this) and I, like all columnists, could have my Pontification License revoked if I don’t write about losing weight at least once every January. It’s a journalism classic, right up there with “Is Your (device) Giving You Cancer?” and “Teens: The Shocking Truth!”

I’m not saying that this isn’t a germane topic of conversation for me — after all, anyone who regularly plays video games until sunrise is probably not going to make the cover of this month’s Ribcage Beautiful. And I’ve yet to meet anyone, no matter fitness-obsessed, who could honestly audit their life and say, “You know what? I’m being healthy enough. No need to push it.”

So, like many others, I kicked off 2012 by joining a gym, in this case the Salem YMCA. Before I go any further I want to say that this is a great place. Aside from the amenities (which are impressive — there are two pools, a sauna and a steam room, and lots of classes), there’s a wonderful staff that is always friendly and positive and ready to answer my questions.

But all that can’t really distract from one incontrovertible fact; getting fit in the real world is boring. I’ve been to the YMCA just about every night for three weeks now and we haven’t been attacked by a single dragon. In Skyrim, if my character is running and running and never getting anywhere, it’s because the game is glitched and I have to restart the console. In the real world, it just means I’m on a treadmill.

Those who play video games will be familiar with the concept of leveling up — starting with a weak character and, as they go out into the world and have adventures, gradually making them stronger and more effective. With the way games work, leveling up in the early stages of a game is much easier than later on; the first few times you kill a monster give you much more experience than those same monsters will give you toward the end of the game.

Good leveling ensures that a game is fun from the first moment you start playing. If you find yourself having to do repetitive tasks, unable to kill weak monsters early on, or you just can’t accomplish the tasks the game sets you, it means you’re playing a badly designed game.

With human bodies, the experience of leveling up is basically the exact opposite. In the early stages of fitness, every exercise is less fun and less effective than it will be later on when you’ve made some progress. It’s repetitive, unpleasant, and painfully slow. The first levels are the worst. If my body were a game, I’d be trying to get my money back — and that’s a horrible way to feel about my body, and not at all the way I felt about it before I started “getting fit.”

This is what health is? I ask myself as I pull at the rowing machine, ESPN droning on about some sport with unintentionally hilarious subtitles above my head. This is what healthy feels like? This bites. I’d rather be assassinating Imperial dignitaries.
Clearly, fitness needs a total programming overhaul. Here are my modest, video-game derived proposals.

1) Less science, more treasure hunting. I know there’s lots of research about safe ways to decrease body fat and increase metabolism, but that’s really boring. We should replace all of our gyms with underground torch-lit mazes, which can only be navigated by following the clues on mysterious ancient artifacts. At the end of the maze, there’s a wooden chest full of cruelty-free diamonds and Best Buy gift cards.

2) One word; danger. Think you can’t possibly run those last five laps? You will if a giant, fire-breathing polar bear is chasing you.

3) No more cars. You have to walk everywhere, carrying everything you own. I’ll start doing this as soon as my boss tells me he’s OK with me showing up to work a month late because I had to help a farmer in Virginia retrieve his family’s ceremonial dagger from a troll-infested cave in Wyoming.

4) Achievements! When I reach my weight loss goal, I don’t want a sticker. I want the Amulet of Mystical Awesomeness, which has been handed down to the most legendary of fitness warriors since the dawn of time, when Lord Nautilus bestowed it on Charles Atlas from his mighty Throne of Rock-Hard Abbery. I’ll also take a commemorative water bottle.

Well, I’ll let you know if any of these happen. In the meantime, I discovered that some of the exercise bikes at the YMCA have little screens that let you race against other bikers. So far, I haven’t been able to beat them, but I’ll keep trying.

Some days, I don’t know if I’ll ever really get fit. But leveling up? That I can do.

The case for spending money on a posh ladies-only gym

I’m going to let you in on a little secret: Way back when I first interviewed for the sales position that started my career at the all-women gym where I train, I realized about five minutes into the tour of the facility it was not a gym I, personally, would have joined.  For one, there was no squat rack.  The lone bench press reached about mid-calf.  I didn’t mind that all the benches and machines were upholstered in purple vinyl, but the lack of dumbbells over 50lbs worried me that it would limit my own advancement in strength.  There was no pool, but two large class studios and one smaller studio filled Pilates reformer machines (which just looked like a set for an S&M porn.  Really.)  For some reason, there were bowls of cucumber slices on ice in the spa area.  I mean, Jesus– there was a spa area.

                Far too fru-fru for my tastes, honestly.

                Part of me even considered it a bit sexist to assume so much about women—that we all wanted candy-colored equipment and dainty weights and long, lean bodies.

                It may not make sense that I ended up working there, or to have stuck around for so long.  But also when I was touring the facility, the Sales Manager at the time brought me by a line of treadmills used for yet another type of classes the club offered.  An elderly lady, probably in her eighties, with glasses the size of tea saucers and clothes far too large for her diminutive stature, walked slowly on one of the machines, her hands gripping the rails.

                “This is Nancy,” the Sales Manager told me.  “We like to think of her as sort of a mascot for the club.”  Nancy was the first member of this location—she’d wandered into the facility twenty years before, when it was still under construction, and was greeted by the company’s owner.  He promptly brought her into his office and sold her a membership.  She often spent hours at a time at the club, packing a lunch to eat in the lounge, attending Pilates classes, and walking on one of the treadmills. Later, the Sales Manager would explain to me that they liked to consider the club a “third place”—you have your home, you have work, and then there’s usually one other place that you gravitate to regularly that is equally important.  The goal of the company was to make their gyms that third place for their members.

                That I could get behind.  The gym had always been where I went to unwind—I first started running in college because I wanted time to just daydream about crossing a space-time rift and becoming an X-Man or winning the Pulitzer or what-have-you, and I felt too damn guilty ignoring my schoolwork with no good excuse.  I wanted to help other women see that it could be a place they could find comfort in as well—that they could see their bodies for what they could do rather than just what they look like, could see exercise as a means of taking care of oneself beyond simply losing weight or following doctor’s orders.

                So I took the job and have since become a huge proponent of women-only facilities, because they offer this sense belonging that coed gyms often don’t afford women.

                In the late ‘90s, over a decade before I started working for the company, our club was sued for gender discrimination—and, many don’t realize, lost.  The guy who sued was known for fighting gender inequality on both ends: in New York, he wrote letters of protest against ladies’ nights at bars, but he also fought for the women in the New York public school system to be able to receive disability when they went on maternity leave.  The National Organization of Women backed his cause, stating that to offer women their own gyms was akin to allowing male-only racquetball clubs, which had long been outlawed.  After we lost the lawsuit, the club officials told all our members that we would be converting to co-ed facilities; we’d hope they would stay members, but we would understand if they did not. 

                The response was overwhelming: the corporate office received mail bags full of letters from members, stating that they would stay with the club, but had the gym been co-ed before, they wouldn’t have joined in the first place.  Long story short, the club used that information as leverage to pass an amendment to the bill stating that it was a matter of public health for women to have a gym where they felt comfortable exercising.

                Now I ask you: What does it mean for us to cater to women’s health and fitness specifically?  How does it differ from serving men? The answer has many pieces, but one in particular sticks out to me, perhaps drew me to the club the most initially when some of the finer details, like the orchids in the locker room or the wide variety of dance classes, did not.

                Months after that initial interview, I signed up another elderly lady.  After she took me through a thirty-minute explanation of her list of medications (“Then I take my Cumidin.  I usually take it with about six ounces of orange juice, before I eat anything else,” “My cardiologist told me it’s okay for me to have three to four ounces of wine, but I’m going to tell you the truth, sometimes I pour myself five,” etc.), she leaned over and said, “So, do you know how old Nancy is?  I told her I’m eighty-seven, but she won’t say a damn word about her age.”  It was a heart-warming experience for me because it made me realize I could remain a gossip far into old age. 

                The moment also illustrates one essential aspect of creating a facility catering specifically to women—that is, there is an underlying sense of community at the gym.  You get to know the other people who show up to Monday night Body Jam or use the treadmill next to yours on Wednesday mornings.  At the coed facilities where I’ve worked out, I may occasionally get a thumbs up from a male gym-goer who saw me manage an impressive squat or deadlift, but at the women-only gyms there seems to be much more conversation: Good job on those lunges. That looks really interesting, could you explain to me why you’re doing it? Are you training for something? Etc. This holds true even when I’ve gone to other clubs in our system, where the members and staff don’t know I work for the company and therefore probably don’t view my presence as an open invitation for conversation (which is usually the case when someone knows you work there).

                Thus, when Nancy’s husband got sick and she spent more time at his bedside and less time at the club, I regularly fielded questions from members about her whereabouts. This focus on community shows up in many of the club features: Each facility offers over a hundred group classes per week, the vast majority of which are packed until nearly overflowing.  We show movies on large screens overlooking the cardio equipment—because even though many of the machines have individual screens, members like watching movies alongside other club goers.  During periods when people find it harder to get in the club, like the summer months, we run complimentary, club-wide competitions where members can track their visits with stamps on jumbo posters we tape up along the entryway to the locker room.

                Yes, there are a variety of reasons that women choose women-only gyms: because there are no men ogling them, because the equipment is more appropriately sized for them, because they can treat themselves with a few moments in the steam room post-workout.  Perhaps it is sexist to pigeon-hole women’s tastes and needs.

                But I suppose what I discovered working at the gym is that in order to feel as though you can work out somewhere, you really need to feel like you fit in there.  During company meetings, our staff is regularly reminded that how long a member stays with the club often depends on how many different pieces of club programming she has become involved with—someone who only comes in to use the elliptical and read People is less likely to stick to her routine than someone who ellipticizes some, takes a couple of classes, does a personal training session here and there, and yes, even uses the sauna or steam room.

 And now there’s research showing that our women-only gym may be on to something.  A recent article in The Huffington Post discusses a program at a church in Orange County where the 30,000 congregation members worked together to develop healthier life habits.  Those who worked together the most in their small groups and with other friends and loved one saw the most reduction in disease risk factors, medication use, and weight.  They also had increased energy, better sleep, and better mood regulation. 

Only about 15% of the population belongs to a gym, and, as you probably know, many of those people don’t use their memberships very much.  The vast majority of Americans, though, are not “gym” people, and I suppose that’s what brought me to my current position: we are not all gym people, but we can all benefit from the sense of community and support that a gym can provide. We just need to find a health community that works for us.  And no, not all gyms do offer such a sense of community—there are many dime-a-dozen exercise mills where people come in, do their time, and leave with little acknowledgement from any other human being.  But if fitness and health professionals are looking to get Americans out of our epidemic of lifestyle-related diseases, then we need to start considering how to bring folks together into cohesive support systems, gendered and otherwise.

Why I’m not giving up my morning coffee, but you should still consider giving up yours

A recent article in the New York Times discusses a new study of the effects of caffeine on young women’s estrogen levels.  I being a) female and b) a bit of a crackhead when it comes to coffee, I clicked on this link before looking at anything else involving things like the presidential race or whatever the hell  is going on in the world right now.

What interested me about the article was not that they found that caffeine affected women’s estrogen levels in an infinitesimal and possibly insignificant amount, but that it affected their estrogen levels differently depending on their race: Asian and African American women saw a slight increase in estrogen levels with moderate caffeine intake, Caucasian women saw a slight decrease. 

More to the point: the study illustrates that one food or substance can affect two people in totally opposite ways. 

There’s a recipe for crockpot chicken stew that’s been circulating through the gym recently.  One of my close friends put it together, and I’ve watched her throw the ingredients in her crockpot countless times. Now, she’s a great cook—she regularly makes lunch or dinner for the two of us, and it’s always spectacular in the way that you try to go home and recreate it but it’s just not the same.  (This is not a one-sided friendship.  Sometimes I cook, too—usually things I don’t actually know how to make, like steak, and then I ask for advice [cough cough] and she conveniently helps out and whoops!  Looks like somebody ended up in charge of making dinner again.)  (I’m a lovely friend.)

Her crockpot chicken soup, needless to say, has been a hit with everybody who’s replicated it.  There’s the usual chicken and celery and carrots, but there’s something magical that happens with the addition of sweet potatoes and bones and—Oh my God, people are saying, this soup is so satisfying.

Except, of course, it’s the one thing I don’t find at all filling. I can take a bigger serving, add extra chicken or fat or sweet potatoes, and, plain and simple, I will not feel like I’ve had a meal. It’s not just my friend’s recipe, either. I’m enchanted by this whole idea of soups and stews and crockpots, and regularly try to convince myself that this chili or this kale and white bean soup will be the comfort food meal for me.  But it never is.  I long for something more and, after the first or second time, start dreading the meals that include the soup and wishing it wouldn’t be wasteful to just toss the damn stuff.

How a body processes caffeine and how much a person likes soup differ in that the former is biochemical and the latter is arguably a matter of preference, but they both illustrate that how our bodies and minds respond to food is very individual.  We see this often with food intolerances, but if you talk to your friends, you may find other things as well—some people have to have a fair amount of fat or protein in their meals to feel satiated, while others may need some carbohydrates to keep them from turning into a groggy, disoriented mess.

Yet every year, new health plans come out touting that this food regimen is the key to real health.  Some call themselves diets (South Beach, Atkins, Dukan), some are touted as lifestyle changes (eating Mediterranean, Paleo, or vegan), but all imply that one style of eating trumps all others. 

I’m sure you get where I’m going here: if our bodies and minds respond to food so differently, then how can one plan or lifestyle stand out above the rest?  It’s a question that’s come up before, and I like how Michael Pollan responds to the concept of following a particular eating lifestyle in his book Food Rules: “Eat more like the French.  Or the Japanese.  Or the Italians.  Or the Greeks.”  He explains: “Any traditional diet will do: If it were not a healthy diet, the people who follow it wouldn’t still be around.”   Oftentimes we focus on a specific regimen as being the best when it actually just one of many that gets rid of some of the trash in our day-to-day eating. 

But my main point isn’t simply that people need to find the healthy lifestyle that works for them rather than following the latest trend.  Instead, I’m interested in how cyclical our definition of “healthy eating” is.

When I was growing up, my whole family got to a point where we were struggling with our weights.  My mother went the route that’s generally advised by doctors and nutrition experts, which was to change our current meals and snacks for the better and to teach my brothers and I about making healthier choices.  I picked up some invaluable practices at this point that I’m seriously thankful to have as an adult—I don’t struggle to get enough fruits and veggies in my diet, prefer whole grains to white, prepare most of my meals from scratch—and, more importantly, these things are actually what I prefer and enjoy the most. 

But in the process of figuring out what was healthiest, our family went through countless iterations of “the best” diet.  Sometimes it meant we ate a lot of tofu, for a long while we were vegetarian (my parents still are mostly vegetarian, actually), but there were times where we were eating lots of protein and few carbs, and there were times where we lived without gluten or casein, and there were times when our cabinets overflowed with Omega 3 pills, buckwheat, coconut oil, or xylitol.

Working in the fitness industry, I’ve seen this same fascination with others—focusing on “super foods” or reducing grain intake or following anti-inflammatory eating plans.  You can see the shift in how processed foods advertise themselves; current foods tout that they’re “All Natural!” when before they may have low-sugar or low-fat (Remember how Snackwells cookies shifted from being low-fat, high-sugar, to higher in fat and lower in sugar when Americans became more carb-conscious?).

It seems like many of us view health in the way that others view technology: we want the latest, the best.  And yes, there is a great motivation to live the healthiest life possible; we’ll last longer with a higher quality of living for however many years we do get on this plane of existence. 

Our fascination with latching on to the latest trend stems from our cultural fascination with maximizing profit and being as efficient as possible—what will get us the most results, and how do we streamline the process to get the most results for the most people?

Ironically, however, our manner of one-size-fits-all healthy living is really only a stone’s throw away from the same environmental factors that have caused the rising rate of ailments caused by excess.  Just as we’d rather buy a sandwich on the go than make a meal from fresh ingredients at home, we’d rather try out a pre-packaged program for health than take the time to figure out what our bodies need specifically.  Because these programs rarely work one hundred percent for anyone, we continually “fall off the wagon,” and then search for new evidence of a different lifestyle or diet that would work better.  Sometimes we place the blame of our fickleness on the changes in research, on new evidence that refutes the past lifestyle that didn’t work. 

If our fascination with efficiency and profit is both causing our general habits to become more unhealthy and keeping us from developing healthy lifestyles that are maintainable, then perhaps the issue is larger than the foods we eat or how much or little we exercise.  Perhaps we need to shift our entire perspective on living, to stop trying to be so efficient. By trying to make our everyday lives quick and to the point, the shape of our lifespans have followed suit. If we want to live longer lives, then we must do just that: take the time to find the things that we specifically enjoy and need, be it caffeine or career.

Is your workout attire affecting your health?

“What should I wear?”: It wasn’t the most common refrain I heard when I started as a Membership Advisor at the gym where I now train (That was, bizarrely, “The whirlpool’s cold again. Can you fix it?” I learned a fair amount about plumbing in those days.  Practical life skills, really.), but it came up often enough.

Usually, the person posing the question would be a woman in her forties or fifties, entirely new to gyms or only having belonged to co-ed facilities by technicality, never entering the centers after signing the initial membership contract.  Occasionally a younger girl would ask, if she hadn’t frequented a school gym or her family hadn’t belonged to the Y when she was growing up.  Sometimes the question regarded sports bras, or types of sneakers, but many times it was simply whether wearing a t-shirt from a recent trip to Hawaii would be okay instead of seeking out the latest in designer fitness tank tops.

I never thought about gym fashion much before working at our club.  My favorite exercise attire is some form of men’s basketball shorts and Fruit of the Loom ribbed a-line tanks (the kind you buy in bags of four).  I’m a classy broad.

So at first, when I heard my coworkers talking about Lulu Lemon versus Lucy versus Athleta, it was just another manner of girls being girls.  Sex and the City meets the fitness industry and what have you. Some would couch it in terms of practicality—one group exercise instructor would soliloquize on how her Lulu pants from five years ago had the same elasticity and color as those she purchased recently.  Others just liked how certain pants make their asses look. One of the most recent ongoing discussions between the trainers and the corporate office has been whether we can incorporate legwarmers into our uniforms (Verdict: Yes, if they’re black, and not in the summer.)

Truth be told, though, attire is an integral part of gym experience, and not just in the sense of keeping up with the Jones’s.  And there’s something to be said that, particularly for women, clothing inadvertently impacts our health—for many, it affects how we feel when we workout, and thereby how well and how often we perform.

Perhaps the best way I can explain it is with this anecdote: a year and a half ago, we got a new trainer, a strikingly beautiful woman whom we lovingly nicknamed “our Polish Barbie.”  When around her, men have this compulsive need to stare or even talk to her—she’ll walk through a bar and you’ll see a line of heads turn as she passes, or men who normally keep their game face on and don’t greet others will shout hello to her or tell her she has nice glasses when they pass her in a hallway (side note: She’s also an extremely talented coach and possibly a marketing genius. That thing adults tell you as a kid about people who are good looking being able to get by on their looks so they don’t have to be smart or try hard? Lies. Damn lies.)

 Anyway, point is, girl is pretty.  When she started working at our gym, she often talked about how freeing working at our club was—in part, because she didn’t have to worry if she made her clients deadlift with their butts facing a room full of guys, but also because she knew she could wear the clothes she wanted to wear.  As one of the people who lobbied for the ability to wear legwarmers to work, she’s someone who enjoys dressing up, even if her “business attire” is workout gear.  At the coed gym where she used to work, however, anything besides baggy t-shirts and sweats were viewed as an invitation by the male clientele to flirt with her. She couldn’t wear her favorite clothes and be taken seriously as an athlete training in the gym.

Something similar holds true for the women I mentioned in the opening, on a more basic level—knowing what to wear at the gym makes them feel less like an outsider, more like they belong.  These same women often say, “I’m just not a gym person,” and regularly going someplace that you feel clashes with who you are is near impossible.  You wouldn’t expect a person who feels out of place drinking and dancing to go to a club to meet their significant other; when you aren’t a “gym-person,” you end up with the workout equivalent of sipping a vodka tonic in a corner while watching twenty-somethings grind their crotches on one another—you lazily ellipticize and watch Kardashians. Walking into a classroom full of LuluLemon pants and tops when you’ve got your hubby’s old shirt on can make you feel like leaving before the warm-up starts.  Knowing what to wear can make you feel like you at least fit in partially.

Plus, others argue, the right workout gear can create motivation in and of itself. Rachel Cosgrove, one of the fitness gurus who regularly designs routines for health and fitness magazines, tells her readers to stop wearing baggy sweats to the gym so they can more closely gauge how their bodies transform—both in how their clothes fit and what they see in the mirror.  Think of it as “dress for success” in the fitness arena.

Ultimately, clothes become representative of the larger question of how one becomes comfortable in the gym environment.  But then we run into a follow-up question: do the latest in fitness fashions further the rift of those who belong and don’t?  Fitted pants and revealing tanks can make someone with body image issues more self-conscious, setting her up in between a rock and a hard place: wear clothes that make her feel uncomfortable, or feel like an outsider when she wears something that doesn’t feel too showy?  And even for those without body image issues, the hefty price tag of most designer togs may be prohibitive, creating a conflict of class.

If something as simple as getting dressed can raise so many issues, what else is affecting women’s ability to make a place for themselves in the gym?

 

 

Hate Exercising? Join the Club

One of my clients tells me every time we meet how much she hates our workouts (despite, you know, having trained for nine months and having told me she only stays at the gym for me). It’s a nerve-wracking statement nonetheless, in part because you don’t want a person to despise the things you do with them three hours a week.  Plus, with a desk job that keeps her stuck on day-long business trips and fourteen-hour meetings, a new relationship that gets her side-tracked nutritionally, and the usual health risks that come with excess body fat and a sedentary lifestyle, she needs the physical activity. 

Still, I don’t really think there’s a point to doing a form of exercise if you hate it.

Hear me out: I am not saying that you should avoid all cardio if you hate getting your heart rate up, or it’s a-ok to skip strength training if counting reps bores you and you’d rather be on the elliptical watching The Wire.  But there are a number of trainers and other health professionals who create a dogma out of what types of exercise you should be doing for optimal health.  Fitness magazines are constantly showing off the latest fad, be it CrossFit or ballet-barre-what-have-you or non-seizure-inducing yoga. On the other end of the spectrum, I’ve heard colleagues denounce everything from morning runs to Body Pump. 

Now, maybe it’s a question of target audience.  When you’re talking to someone who has been working out regularly for a while, then discussing the semantics of “the perfect exercise routine” is probably a little more likely to create the desired effects, since the person may actually enjoy exercising for the sake of exercising and be at a place where they geek out and get excited by modifying what they do. 

But 60% of Americans don’t meet recommended daily activity requirements, and 25% get none at all.  This group, folks like my client, is the one that needs help getting into a routine period, and worry about the fine tuning later.  One of the blogs I read regularly belongs to Yoni Freedhoff, a bariatric doctor who’s helped many people make lasting changes that improve their health; he explains the matter very well: if you don’t like a change you’re making to your lifestyle, chances are you won’t keep with it.

Back to my client: What does it mean when she, like many Americans, “hates” to exercise?  In her case, I become particularly confused because, despite all other factors in her lifestyle, she’s very athletic.  She was active growing up and has the fluency of movement that comes with that early introduction to exercise.  Without much thought, she can perform various feats of balance, speed through complicated agility drills, and lift weights that dwarf the ones other women use.  On the off chance I underestimate the level of challenge in an exercise I give her, she’ll let me know, because she doesn’t want to slack and has no fear of strenuous activity or discomfort.  So why, if she’s so talented at exercise, does she dislike it so much?

In part, I know, it’s because she first associates exercise with weight loss.  She’s put on enough body fat over the years that, now in her thirties, she’s on track for serious health issues if she sticks with her mostly-sedentary lifestyle.  At risk of making this blog sound like a broken record, it seems that the lack of enjoyment comes, in part, because she’s choosing her exercise based solely on what she’s supposed to do to shed pounds—even though she prefers things like playing in team sports and going for hikes.  And while, yes, it is important to consider the effect excess body fat has on disease risk, it seems like it would be hard for anybody to stick with a program if your main purpose in doing it is because you see it as a way to fix something that’s “wrong” with yourself. 

You know what it reminds me of?  I had this friend in college who was interested in the same guy as me; he and I ended up dating, and she would make comments to me like, “Well, I see now that he and I couldn’t date, because people usually end up with partners who are about as attractive as they are, and he really isn’t that attractive.  Like dates like and all that.”  Needless to say, we didn’t stay friends much longer after that.  If you wouldn’t hang out with a person who calls you ugly, why would you spend your time doing an activity that makes you think about how fat you are?

 I could tell myself that the friend was invaluable to talk to about school stuff, or good to go to for advice about what to wear, but, ultimately, there’s only so many passive-aggressive comments you can take before they override the benefits of the friendship.  Similarly, I can tell myself that working out will make it easier to get to my third floor apartment in my walk-up, or I’m doing it to protect me from the heart disease that plagues my family, but if the primary reason I’m doing it is because I think I’m fat and don’t want to be fat anymore—and, worse, I sort of feel like this thing with my weight is a losing battle because I’ve always thought I was fat—those other points will get drowned out. 

Studies have shown time and again that exercise is imperative for improved health, although it may or may not lead to weight loss. But what drives our fascination with finding a routine that is most effective—whether in burning fat or developing long, lean muscles— and is this quest for the best really helping us?

As personal trainers, we’re told to help our clients reach SMART goals: specific, measurable, attainable, relevant, and timely.  Basically, you don’t say, “I want to have more endurance,” you say, “I want to run the entirety of a 5k by the end of summer.”  The stickler here is this concept of attainability: running a 5k may be an attainable goal for, say, a woman who’s been walking regularly with little spurts of jogging here and there; it may not be attainable for someone who recently tore all the ligaments in her ankle and is relegated to an air-cast for the foreseeable future.

An attainable goal, then, is finding a routine that will sound almost as appealing as sitting at home watching the latest episode of Chopped and harassing the cat with a laser pointer—even if that routine means going to Zumba class three nights a week, when a program involving strength training, cardio intervals, and corrective work would be “better.”  You break everything down into manageable steps for the best overall success.

Yet there is a “go big or go home” school of thought with goal-setting, and it seems to be where the hatred of working out can creep in.  If someone’s trying to alter multiple habits that tie together, some health professionals argue that it’s best to attack them all at once.  The theory is that if you tend to drink excessively, smoke, and nosh on bar food all at once, it’ll be near impossible to break one habit without giving up the other two. Others say that if you set the goal high—exercising five days a week—you’ll achieve more than if you set a more modest goal, even if you don’t get as far as you’d hoped.

And thus, many, many people exercise because they “have” to rather than they “want” to—they set up their Mount Everest-size goal of “becoming healthy” by exercising in the best way possible.  And, honestly, a significant portion of them do stick to their routines for years on end.  Yet why does this mentality of “well, you just have to suck it up and do it” work for some people, but not for others? In one of her early advice columns, Hungry Girl Lisa Lillien, a blogger who’s made a niche out of developing low-cal recipes for junk food, told a reader, “I feel your pain. I, too, HATE to exercise. But while I hate to exercise, I force myself to do it. A lot. Because it’s the key to losing body fat or maintaining weight loss when you want to splurge and eat the foods you love. To get myself through tedious workouts, I try to make myself forget what I’m doing.”

Perhaps this mentality stems from the general work-a-holic tendency that drives America.  Making sure to exercise to stay healthy isn’t that far from making sure you have a job, paying your rent on time, or doing anything else that’s generally expected of you.  You may not like it, but that doesn’t mean you won’t do it, because you enjoy some of the consequences—having money to spend on collectible Lego people and groceries, having a place to store said collectible Lego people and groceries, or, with exercise, not getting sick all the time and having more energy and sporting killer guns. 

But then we come back to those like my client, who know they should work out, but can’t stay motivated—because we have too many things we should be doing.  Oftentimes, exercising falls low on the priority list, and changing priorities can be as difficult as changing religious beliefs.

Which is why we need to spend more time focusing on the message that it’s okay to choose exercise based on pleasure.  If you enjoy it, then it is something you will turn to when you want to have fun.  It will be something you make time for, like all those shows you have DVRed, to help you unwind after a stressful day at work.  It becomes a habit in and of itself, not “successful” or “failed” based on a scale or tape measurer, and, thus, you get one step closer to being healthy.