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Monday, June 27, 2011

To Be Skinny, Do Skinny People Stuff!

Confession: I am a huge Dave Ramsey nerd. He is a finance celebrity of sorts who encourages people to get out of debt. His wisdom and encouragement has helped millions of people pay off financial mistakes. One of his “pearls of wisdom” that has stuck with me is, "If you want to be poor, do poor people stuff. If you want to be wealthy, do rich people stuff.”

So, what does that have to do with a blog on weight loss? Recently, I received an email from a physical therapist colleague of mine. She is thin, even after having a couple of kids. However, she admits keeping weight off has been a struggle. Despite this challenge, she finds it upsetting when obese friends, patients, and co-workers make comments such as, "Oh, you wouldn’t know how tough it is…..you’re thin!” She feels the comments are not fair. “It doesn’t come easy," she says, "I choose to work out over lunch while others sit, and I go for jogs in the evening while others watch American Idol.”

As PTs, we are aware of obstacles patients face with limited ability to be active because of their medical conditions. However, she makes a very good point. Some have a protective mechanism built in that makes the assumption, if others have been successful it must have been easy. However, there is a very simple principle that will make your journey easier: To be skinny, skinny people do skinny people stuff.

So what is skinny people stuff

Skinny people move. When others choose to do sedentary activities like watch tv or sit and enjoy a prolonged lunch with friends, that is when my friend gets in some exercise. Most of my obese friends know they should exercise regularly, they just have a hard time finding time. However, increased physical activity has been correlated with lower BMI*. In younger subjects this was even more predictive than most food intake differences. 1 The decision needs to be made to find the time to be active. Start where you are at, and do what you can do. The goal is not to run a marathon today. The goal is to do a little bit more than yesterday. Here are some suggestions:
Wake up 30 minutes early. If you are worried about getting enough sleep, skip David Letterman.
Before eating lunch, take a brisk walk around your work place. It may cut into your eating time, but maybe that is a good thing.
If you must watch American Idol, develop a routine and get off the couch while you watch. Do some calisthenics and abdominal exercises while you watch the “boob tube”.
Start working out with your significant other or a friend. Interestingly, those who are thin do have a higher tendency to have an active spouse.4

Skinny people don’t diet. They don’t obsess about food the way obese people often do. According to a 2005 study published in Obesity Research, successful weight maintenance was associated with relatively fewer attempts at weight loss. 2 Think about your diet history. Are you guilty of doing the HCG diet to drop a few quick pounds before swim suit season, or a few weeks of the Atkins plan to fit in that wedding dress, or the office Biggest Loser contest to win a couple hundred bucks?
Skinny people love desserts, but they indulge in them occasionally. They usually do not clean their plates, and they often share a restaurant meal with their significant other. Skinny people may have a slice of pizza or two, but they don’t regularly go to Pizzarama’s all-you-can-eat buffet. The point is, people who are thin eat what their body needs for energy.2 As the cliché goes, they “eat to live, they don’t live to eat.”

Skinny people are ok with hunger. Doesn’t it feel like when you get a little bit of a stomach growl it feels like a 5-alarm emergency? But at worst, it is a distraction. The big secret is, a little tummy gurgling at 3:30 in the afternoon never resulted in death at 4:00. On the contrary, hunger pangs are often a sign of boredom or habit. I mentioned this in my last blog, but a signficant predictor of successful weight management is restraint. 2 I know it is frustrating when a thin friend at work says they are just going to have a bite of an indulgence, and then actually do it. But, if those who struggle with weight would start copying that behavior, they would likely start seeing the pounds come off. I am not saying to starve yourself and eat a 1000 calorie diet. I am talking about those daily indulgences that keep us from achieving our goals. Something I remind myself when faced with temptation is, "Nothing tastes as good as it feels to be in shape."

Skinny people are creatures of habit. In a 1999 nutritional study, it was shown that eating a high variety of entrees, carbs, condiments sweets and snacks coupled with a low variety of vegetables was associated with increased body fatness. However, less variety of the fatty foods while eating a large variety of veggies predicted the least amount of body fat. 3 So, ever notice that thinner people tend to have similar lunches day after day? I have. It may seem mundane but real change will come when you start treating food as fuel, not as your major source of fun.

This is by no means an exhaustive analysis. I am sure if you imagine Jeff Foxworthy in your head saying, “You might be a skinny person if you……(insert hilarious response here)” you’ll come up with all sorts of observations. In fact, that is how I want you to start thinking and then model those behaviors. It won’t be easy, and we are programmed from a very young age to follow the path of least resistance.

I was reminded of this the other day. My three-year-old's swim instructor called the house to inform us he was ready to move up to a more advanced class as the skills were now all too easy for him. We excitedly went to tell him the good news and were perplexed when he didn’t have as jovial a response as we anticipated. After he thought about it for a moment he replied….”but I like easy!”

I know. We all like easy. Making real lasting change is very, very hard. But it can be done! There will be costs involved. It will surely be slow and very frustrating. However, what seems impossible just takes a while.


BMI- body mass index. a ratio between rate and height that is a measure of obesity and an indicator of overall health. A BMI  greater than 25 is indicative of obesity. Those with a BMI of 22 are shown to have the low levels of illness. This scale is a good general tool for average individuals but is flawed when measuring those with high levels of muscularity. BMI is very easy to check. BMI calculators are readily available on the Internet by simply doing a search for BMI calculator.
1. Wendell, et al. Dietary intake and physical activity of normal and overweight 6 to 14 year old Swiss children. Swiss Medical Weekly. 2007 July 28. 137 (29-30): 424-30.
2. Vogels n, et al. Predictors of long term weight maintenance. Obesity Research. 2005 Dec; 13(12). 2162-8.
3. McCrory MA, et al. Dietary variety within food groups. Association with energy intake and body fatness in men and women. American Journal of Clinical Nutrition. 1999 March. 69(2). 440-7.
4. Davison KK, Burch LL. Lean and weight stable. Behavioral predictors and psychological correlates. Obesity Research. 2004 July. 12(7). 1085-93.

Monday, June 20, 2011

Are You In Or Out- Why Some Succeed and Others Fail at Long Term Weight Loss

What motivates some people to get on the path to personal fitness and achieve long term success? This topic has probably been debated for as long as there has been deep-fat fried food. As I examine my own successes and failures and speak to others with combat experience in the bulge battle, I have come to believe that there is much more to successful weight and fitness management than dedicating ones self to counting calories and power walking, especially if the individual is plagued with a chronic illness or orthopedic condition.

I believe that to achieve success in a wellness program, it is advantageous to have some strong stimulus that will jump start the program and to have the proper behavioral mindset from the outset. In other words, we have to be so fed up with the condition we are in that we are truly ready to make a change.
The first time I thought about this was several years ago when I was treating an elderly man for an orthopedic injury who was in particularly good shape. In questioning him I learned that he had always been around the same size with some fluctuation. When I asked him what his secret was, he told me very simply..... "well, every time my pants got tight, I realized I needed to stop eating so much." This was profound to me that something as simple as not wanting to buy a new pair of pants could be one's "trigger" for pushing away the plate. It made what is so complicated for myself and others so simple. 
In contrast, there are many others who can pass one obesity milestone after another without reaching the "tipping point" as Malcolm Gladwell put it, to actually motivate them to a lasting healthy lifestyle. What is the difference between those who succeed and those who fail?
There is evidence-based research on this topic and the various findings are pretty interesting.
First, it helps if you are willing and able to take on the physical activity necessary to achieve results. One of the greatest predictors of weight loss failure is the belief that one cannot do more physical activity than they are right now 1. The fact is, everyone of us, with few exceptions, can do more. A patient with hemiplegia can get on an arm bike, a woman with MS can spend a little more time doing water walking, and an overworked dad can get up 20 minutes early to get on the treadmill. Those who truly think otherwise when initiating a weight loss program can be reasonably certain of one thing: failure. As well-known trainer Tony Horton says, "Stop saying 'I can't' and replace it with 'I currently struggle with'!"
Second there are several behavioral traits of individuals who achieve long term success in their weight loss program.
In a recent study of 225 middle aged women they found that those who achieved weight loss for at least two years usually:
  • had flexible cognitive restraint. That means that when faced with the opportunity to make good decisions regarding their nutrition and exercise, these women make them. They don't get the cheese on the burger. They eat half of the bread when they get a sandwich. They take the stairs instead of the elevator. Day in and day out, they make good choices.
  • they were disinhibited. In other words, they really don't care what others think. They do what is best for themselves and continue pursuing their goals.
  • they had exercise self-efficacy and exercise intrinsic motivation. They loved to exercise, saw the benefit of it, and didn't need some external force pushing them to do it. 2
I think that last trait is the key. It is so simple and cliche' but true. If you love it, you'll do it. So are you intrinsically motivated because you want it for yourself? Or are you exernally motivated to lose the weight to please someone else or just to achieve some short term goal. Are you in or are you out?
Recently, my wife and I started an exercise program incorporating yoga. We get up very early to do downward dog, tree pose, and vinyasas. I have noticed it has made my back and neck feel less pain and I feel more functionally flexible. I see some real benefit! My wife, Susan, however, just feels like it is messing with her chi. When we are supposed to be calm, intense and focused, she is irritated, bitter and distracted. If you had to guess, who do you think is more likely to continue doing yoga 5 years from now? My guess is Susan is much more likely to be on an elliptical machine or doing tai-Bo than in the yoga crane. However, she is rather fond of the corpse pose, so she will probably still be doing that position all night for many years to come.
The point is, initially focusing on counting calories and "dieting" may help you lose a few pounds, but you will have a struggle achieving long term success. Those who keep the weight off and truly achieve wellness find enjoyment in the process even if it sometimes makes them cry; and learn to love the activity, even if it hurts. 3
So, again I ask, are you in or are you out? Check your attitude, be honest with yourself about what motivates you and make the decision. A friend who I just saw after a long absence and has lost over 100 lbs in the interim said this when I asked him how he got started:  "I asked myself, if not now, when?" We all would do well to ask that same question.
1. Kong, et al. Predictors of success to weight loss intervention program in patients at high risk for diabetes. Diabetes Research Clinical Practice. Nov 2010.
2. Teixeira PJ, et al. Mediators of weight loss and weight loss management in middle aged women. Obesity. Apr 2010.
3. Teixeira PJ et al. Exercise motivation, eating and body image variables as predictive of weight control. Med Sci Sports Exerc. Jan 2006.

Tuesday, June 14, 2011

The Genesis of Critical Transformation

Critical Transformation 1

As I start this blog to be read by countless 10s of people, I am sure, it may be best to explain what this blog is, who is it's intended audience, and what the heck "critical transformation" is.

First, most simply, this is intended to be a fitness blog. Outside of my own family and Christian faith, it is probably the topic in which I am most interested and, dare I say, passionate.

Second, to be more specific about the intended audience, I should specify that I would most like to focus on people who feel their fitness mountain to climb is insurmountable. Therefore, it may deal as much with psycho-social as well as physical issues related to fitness.

 Many people know what their triggers are with relation to their personal health degradation, particularly if they grew up thin or, at least, active. The "I started getting this way when...." admission. Perhaps it was when you had that second child, your knees started giving out, you lost your job, your mom died, or a myriad of other circumstances and excuses when things went downhill. However, what is done is done. What I want to figure out is what will be the reverse trigger for you and how can we deal with our circumstances so they are no longer the wall that is preventing you from getting healthy and staying healthy.

For me, weight has been a bit of a struggle since I was a child. The main memories that remind me of my childhood obesity are my brother's name calling, my dad's well intentioned criticisms ("You see that fat woman over there? He would taunt, "that's what you're gonna look like!), and the label on my "husky" Sears corduroys. The reverse trigger for me was (at that time) when I was sitting on my butt watching tv, and this triathlon came on called the "Escape from Alcatraz". I watched these incredibly fit people swim over a mile in the ocean from Alcatraz island before biking and running through the hills of San Francisco. It seems rather benign, but that moment was my inspiration. Over the next several months, I lost enough weight that it was a complete transformation. I don't remember how much weight I lost, but it shocked my friends at school when I returned for my 8th grade year and was almost unrecognizable. It probably disappointed the bullies who could no longer create their desired humiliation with fat humor. 
 Incidentally, I had never gotten to do Alcatraz until this year, 2011. It was one of the most gratifying emotional and physical goal completions of my life.

Though I have had other periods of weight gain, there has always been some sort of trigger that was my mental line in the sand that I refused to cross. 

 Most recently, about a year ago I was getting close to 220 pounds and for some reason checked my body mass index (BMI for short). Seeing in black and white that I was obese was disturbing. Around that same time, I was talking with my wife, Susan, on the phone about what I had eaten that night on the road and she said something simple but profound...."Stan, you KNOW how to make good choices"!

She was right. I am a physical therapist, I have a ton of education and experience in healthy living, and yet, I was making the choice to do the things that would make me fat. That was enough. 
 Over the past year, I have lost about 50 pounds. In the early months I had to constantly remind myself to just make good choices. This "reverse trigger" theory is one of the things I want to research and address, so that I can help you find yours.

Finally, I want to tell you about the term"critical transformation". For a while I have been thinking about this blog. I want to use any knowledge I have gained in my PT education to assist in the fitness of people with difficult medical obstacles (such as diabetes, cardiovascular disease, major chronic orthopedic issues, etc). I had been wanting to come up with a name for this area of focus. Recently, there was a commercial on tv advertising a new reality show. The host is a guy who helps morbidly obese people with their weight loss. He said he specializes in "critical transformation". That was it! My Eureka moment that gave me a title that clearly states the focus of intent for this blog. So, both of You reading this can now applaud! Thank you, thank you very much. I'll be here all week, and hopefully beyond. I hope you will be to. 

Please email me your ideas for topics and issues you need addressed, and I will do my best to help. For now, if you are in need of a "critical transformation" be on the lookout for your trigger. What weight will you not allow yourself to go above? Is it time to no longer have to request a belt extender on an airplane? By the time of the London Olympics do you want to complete your own marathon instead of just watching one on NBC? Then, let's  accomplish your goal together.