Nutrition and Fitness Professional, LLC

Weight Loss Counseling, Vegetarian, Vegan, & Sports Nutrition, plus Fitness Training Services and Body Fat Assessments

Posts Tagged overweight

Checking Benefits for Nutrition Counseling–How, Why?

Feb 17

Posted by Joey Gochnour, BS, BS, MEd, RDN, CSSD, CSOWM, LD, NASM-CPT in Healthcare | No Comments

Unfortunately, it isn’t obvious on many health plans that you can see a licensed dietitian, the healthcare professional trained in working with people to reverse many of the leading causes of disease and death in the US, such as cardiovascular disease and diabetes.

Many plans did not cover this service until recent years or after the Affordable Care Act’s mandates for coverage for obesity and those at risk for diet-related disease.

Now, many plans do cover, but it hasn’t made it to common knowledge or insurance benefits packets.  It isn’t in the automated phone message system either.  You have to speak to a customer service representative by calling the number on the back of your insurance ID card.

Perhaps if everyone knew about it, there would be too much business?  I’m not sure why it isn’t advertised with your insurance.  It is cheaper to see a dietitian a few times a year outside of the hospital than to have bypass surgery in a few years with associated hospital fees.

How to check nutrition counseling benefits:

  1. Turn over your insurance ID card and call the number.
  2. Choose Medical.  Not dental or behavioral health
  3. Supply your insurance ID and date of birth.  If given these ahead of your visit, we can sometimes help verify benefits if not busy.  You should check yourself so you can hear it for yourself.
  4. Eligibility and Benefits.  Sometimes you have to select “office visit” or “outpatient service” or “specialist.”
  5. State “nutrition counseling” into the voice system–you probably won’t hear it in a list of automated services
  6. Ask about CPT codes 97802, 97803, 97804 (individual initial, individual follow-up, group, respectively).
  7. Ask if you need a referral or preauthorization for the service.  Only some plans require this.
    1. Referrals can take a few days to a week to get from your physician’s office and may or may not require you visit your Primary Care Physician (PCP) first for a visit.  If you schedule a visit and cancel in less than 24 hours because you “just find out” you need a referral, you will still be charged a missed visit fee for reserving business hours. It is the patient’s responsibility to be aware of his or her plan’s rules and only reserve professional time when ready to have the service rendered after plan requirements are met.  We accept and bill your insurance as a courtesy and are aware of many plans that require referrals from experience, but not ALL plans in existance!  Sometimes plan rules change year to year.  Remember, it is YOUR plan, so know the rules for it!
    2. Preauthorization can take a day or two.
      1. If you don’t have a referral or preauthorization prior to your visit and your plan requires it, the service will be denied, and you will be responsible for payment.  We will aid in preauthorization requests, but will only confirm referrals if notified your plan requires them.  Referrals must be on file with the insurance company if your insurance company requires a referral.  Informal physician referrals are not required to be on file with the insurance company if your insurance doesn’t require a referral for the service.
  8. Ask if there are any excluded ICD-10 diagnosis codes (some plans only cover diabetes or kidney disease, others cover dietary counseling and surveillance, e.g. Z71.3 code, others cover obesity and overweight codes).
  9. Get a confirmation reference number for the call and restate your understood coverage back to the representative.  If preauthorization or referral is required, get the additional preauthorization and referral number.

We do our best to check benefits for patients with plans we are not familiar with as well, but this needs to be a joint effort to limit surprise fees that we do not like issuing nor you like paying, including late cancel fees or self-pay fees for services that would be denied due to no referral or preauthorization.

Self-pay is going to be more expensive than insurance coverage, and you should always be prepared to self-pay even if 90% (yes!) of our patients receive coverage when they properly check their benefits and follow the rules on coverage.

If you cannot make your appointment, you can reschedule at no penalty if done >24 hours of your visit by emailing or calling and leaving a message.



Share on FacebooktwitterredditpinterestlinkedintumblrmailFacebooktwitterredditpinterestlinkedintumblrmail

Tags: , , , , , , , , , , ,

Repeal of ObamaCare and Possible Effect on Your Nutrition Counseling Benefit

Feb 6

Posted by Joey Gochnour, BS, BS, MEd, RDN, CSSD, CSOWM, LD, NASM-CPT in Healthcare, Personal Experiences and Opinions | No Comments

At the time this is written, it is still too early to tell whether or not the replacement for the Affordable Care Act will result in the loss of coverage for preventative healthcare services or not.  President Trump has stated that some parts of the healthcare law will remain.

What worries me, as a practice and business that highly uses insurance-based nutrition counseling benefits, is that the loss of the mandate will mean insurance companies could cut their coverage for the services I do unless you have a formal physician referral for a specific medical condition.

Currently, most people do not know (and your insurance company is very evasive in letting you know) that you MAY (about 80% of my clients) get 100% coverage before you even meet your (enormous) deductible for preventative nutrition counseling, unless you have a grandfathered plan from before the Affordable Care Act.

Specifically, I can use a preventative code as a dietitian for preventative services with many insurance plans that results in no copay or coinsurance (yea, too good to be true, right?).

As a licensed dietitian in private practice, I am not allowed to diagnose any specific medical condition and am restricted to using a preventative code or a BMI code (because it is a calculation) to support coverage for nutrition counseling.

This allows individuals to just see me to work on their health rather than having to go do extra work and get other diagnosis codes from their physician, which may be subject to copays, coinsurance, your (huge) deductible, and cost to see your physician for the diagnosis (which also costs money!).

If ObamaCare is repealed, then I sincerely hope that the clause that allows coverage for nutrition services (CPT codes 97802/3/4 medical nutrition therapy) with a preventative ICD-10 code remains for a few reasons:

  1. Individuals who are overweight or obese without a formal diagnosis of a comorbidity (medical condition) face a financial barrier to getting on track with the professional who can literally reverse their condition without drugs or surgery.  Removing this barrier can be a huge boon to getting people in the door who need to work on themselves before they use a cop out excuse like “it is too expensive.”  Individuals WANTING to make a change to their diet and exercise habits needing legitimate information need all the support getting into my office they can get (a whole other blog post on the swamp of misinformation non-degreed fitness professionals give out about weight loss that you probably already self-pay for in personal training sessions).
  2. America pays more for the disease than the prevention.  Small fires are easier to put out than blazing forest fires.  This is a metaphor to saying overweight is easier to treat than type 2 diabetes, surgeon fees for coronary artery bypass, chronic kidney disease dialysis procedures, and pharmaceuticals for band-aid-fixing diseases that can be cured with lifestyle change.  Supporting the healthcare professional, through health insurance, that facilitates lifestyle change is supporting a registered dietitian and exercise physiologist (me).
  3. If my practice dwindles due to the repeal of the Affordable Care Act, I promise you that isn’t because everyone is healthy all of a sudden.  It is because there would not be coverage.  Even though the price of my services is inexpensive compared to what your surgeon or primary care physician costs, many people feel they are already paying for healthcare with their premiums, so they should not have to pay a dime more.  One of the major ways to have more coverage for services is if your premium is higher, to my knowledge.
  4. Loss of coverage for nutrition services would be a step backward in fighting many of the health problems that are easily treated by diet, exercise, and lifestyle changes.
  5. In appeal of Trump’s love for small business owners, as a small business owner, I have spent my blood, sweat, and tears slaving over my private practice for the past 3 years learning how to facilitate coverage for my services through health insurance for the benefit of helping clients and making a living myself.  By no means am I getting rich doing this.  I still work 7 days a week with a part time job seeing clients with my business and through an employer.  I have good success with the clients I do see (they let me know, or I see it myself).  I deserve to not have what I have built over 3 years burnt down just through a change in government administration.  I deserve to not have the rug pulled out from under my feet.  Not enough people are even using the benefit yet, nor is it advertised well enough through your health insurance company (probably because they think they lose money in the short term).

I agree the healthcare law is not perfect.  As a small business owner who is single, male and over age 26, I pay for my own health insurance through the Exchange without a husband or wife with a full time job with benefits a spouse can get on.  It is one of my biggest expenses next to paying for office space in Austin.

However, I also realize that as someone who is extremely fit, healthy, and barely uses his health insurance for anything except my flu shot and annual physical, I am paying for others who are not as fortunate as me to have the knowledge I do about nutrition and exercise and the desire to live the lifestyle.  And I’m fine with this.  I have no issues with it.  I can budget my money well if others need to use their health insurance more.

I know other young people are not aligned with this idea, and I do see the opinion that they feel they pay too much in premiums for something they don’t use and that as healthy people, they shouldn’t have to foot others’ healthcare bills who don’t care as much about their health as they do.

Clearly this is a complicated issue, and it is good that people can stay on their parents’ health insurance until age 26 and that 20 million more people actually have some coverage, but Americans also do not like paying for each other’s healthcare, and that is also a valid opinion.

I urge you to reach out to your representatives and senators with your concerns about the healthcare law reform.  If you are reading this post, you might care a little about preventative healthcare coverage and/or nutrition counseling coverage.  Please don’t be silent during this time when our voices need to be heard.

When it comes to nutrition counseling, Americans deserve legitimate information from a trained, degree-holding, licensed professional who is an expert on the subject and adept at working with individuals and groups.  Americans deserve the right to avert disease before it starts.  Americans deserve the right to prevent further healthcare costs down the road by taking action to a healthier lifestyle now, and they do not need additional financial barriers put in the way merely as a way to myopically cut costs and keep campaign promises.  Long term, it does not save.  Long term, we lose.

Yes, if you cut nutrition counseling, health insurance companies will save a little bit of money now.  But if you cut nutrition counseling long term, disease rates will go up and healthcare costs go up.  Clearly this is not a simple issue and needs to be considered carefully as a new healthcare law is implemented.

Edit 02/07/2017: A professional colleague alerted me to former President Obama’s recent article published in the New England Journal of Medicine on the possible repercussions and irresponsibility of repealing the ACA without a better replacement that is openly discussed first since posting this yesterday.

Please share or comment!



Share on FacebooktwitterredditpinterestlinkedintumblrmailFacebooktwitterredditpinterestlinkedintumblrmail

Tags: , , , , , , , , , , , , , , , , , ,

Paradigm Shift: Weight Regained After Dieting Is Not Failure

Jan 26

Posted by Joey Gochnour, BS, BS, MEd, RDN, CSSD, CSOWM, LD, NASM-CPT in Diet or Exercise?, Personal Experiences and Opinions | No Comments

I am often surprised by the number of people who claim that diets don’t work.  Perhaps there is a miscommunication on what they mean by that.  If anyone would clarify that for me in the comments, I would love to have a discussion on that.

All diets work.  You will lose weight if you change what you are eating to something with fewer calories.  All diets are rules of eating that get you to change what you are doing from an eating standpoint so as to consume fewer calories in the end than before.  Whether you want to do it with a fancy sounding trending word like a “cleanse,” a “detox,” or “paleo,” or if you want to add fasting into it (such as intermittent fasting), or if you want to do it less radically, the diet will work.  At the end of the week, you ate fewer calories than you did last week.

Not all diets are created equal.  When cutting calories, it is more important to make sure that the calories left that you ARE eating are actually doing something for your health.  You want them to be highly nutrient dense per calorie.  Otherwise, theoretically, you could deplete yourself of some nutrients and develop malnutrition during the process.  Then, how healthy will that diet actually be for you?  If you deplete yourself of nutrients involved in energy metabolism, maybe your body won’t want to lose weight as efficiently at that point.  It’s possible.

This is why it is important to work with someone who knows how nutrients affect your physiology so as to recommend diets that are healthy.  Shameless plug here for registered dietitians, a medically recognized profession that works with nutrition on a daily basis.  These are people to consult if you are planning on changing your eating habits for a goal.  Anyone can call himself or herself a nutritionist and set up shop.

To the main point of this article, however, a criticism of diets is that people gain the weight back.

My response to this?  So what?  Hear me out:

You still lost the weight for some time and learned from the experience.  This isn’t an all or none success thing.  Let’s not throw the baby out with the bathwater.  Diet failure is a highly pessimistic view of the experience.

Yes, it is important to view nutrition changes as things you should accept as long-term, but let’s say you are overweight or obese enough that it affects your ability to perform exercise at a level that you need to maintain your weight.  You will HAVE to go on a diet until you reach a weight at which you can start working out intensely without it killing your joints.

People who say that diets don’t work or that they fail do not understand the behaviors you must do to maintain your weight after you lost it.  The great part about finishing a diet is that you get to eat more food.  You also get to start working out more/harder because you have more energy from all that food you are now eating.

People who regain ALL their weight after a weight loss experience tend to not be progressing in their fitness level while going back to the habits and mindset that brought them to their original weight.  Weight loss requires cognitive restructuring of thoughts on how you view food and your relationship with it.  This is why cognitive behavioral therapy should be a part of the process.  The awesome part about exercise and fitness is that it is EXCELLENT for helping you maintain your weight post weight loss even if the way you view food psychologically hasn’t changed completely.

weight loss maintenance with exercise post diet

Exercise is excellent for maintaining weight lost post-diet.

You know when people plateau with exercise?  Their body has adapted to the stimulus.  This means that their body requires fewer calories during exercise and recovery because there is less breakdown of existing body tissue from that exercise because they are performing it more skillfully.  To get out of that plateau, you have to increase the intensity and get better at what you are doing by adding weight or reps so as to reach an eventual ultimate plateau where your hunger matches your energy expenditure–ie you are able to workout at a level that allows you to eat what you want.  This is the “nirvana” or “enlightenment” of nutrition and fitness, your ultimate goal of having maximized your physical fitness capacity while being at peace with the food required for that body.

If you DO regain all your weight back post diet and made good effort with progression in exercise, then you will just have to diet again and figure out what you were doing last time that didn’t work.  If you think about times of surplus and famine in history, dieting has happened for a long time.   There are times of the year you will be heavier and times you will be lighter.  There is always something you can do about it, so seriously, let’s just not say dumb things like “dieting doesn’t work” anymore.  At least be more articulate about what you really mean.

I get angry when I hear the idea that regained weight means it is a failure, which is stated even in scientific literature.  Yea, if you resume eating exactly like you did before without a change in your exercise habits, of course you will gain all your weight back.  That doesn’t mean the diet didn’t work.  It means you didn’t change the way you view and use food in respect to your activity and lifestyle.  Psychology is a huge part of the process.  Are you adaptable, and do you have grit?

You’re not going to get the weight off though initially without some form of a diet unless you are ok with extremely slow progress.  It is currently thought that achieving weight loss progress quickly builds adherence to the program (link to PDF).

So in short, dieting DOES work, and exercise is what you must progress with after dieting in order to maintain your weight.  Don’t use exercise as a means for weight loss because that doesn’t work, as shown in previous posts.  Use it to maintain your new weight!

Please comment and share!  If you would like to work with me personally, send me an email.

Edit: This article was featured on CureJoy on 02/24/15.  I encourage you to check out their site.  Disclosure: I do not have any financial or other incentive through the company.



Share on FacebooktwitterredditpinterestlinkedintumblrmailFacebooktwitterredditpinterestlinkedintumblrmail

Tags: , , ,

Calorie Recommendations, Dieting, and Exercise

Jan 22

Posted by Joey Gochnour, BS, BS, MEd, RDN, CSSD, CSOWM, LD, NASM-CPT in Diet or Exercise?, Personal Experiences and Opinions, Science Analysis | 2 Comments

Preface

When you’re trying to lose weight, how many calories is too low?  This question seems simple up front, but upon researching for “the correct” answer, I found that it comes down to what is called “clinical judgement.”

There are a variety of ways to assess how many calories you should be eating, called calorimetry, the measurement of calories.  The current best way to find it during one point in time is indirect calorimetry, where an estimate is taken based off of carbon dioxide to oxygen ratio per gas volume.  Direct calorimetry, or where changes in heat are observed in a closed environment, is not practical for humans.

Without indirect calorimetry, the next best way is to look at what you typically eat for a long period of time and find the average caloric intake from food journaling.  Food journaling is one of the best ways to assess your diet and look at what is working and what isn’t and serves a number of purposes beyond just finding the calories you typically eat.

Unless you walk around with an indirect calorimeter on all the time, the device is only so useful because it only looks at your needs based off of one data point in time.

Then we are left with predictive equations like the Mifflin-St. Jeor equation, which is the current most popular equation for predictive energy needs (1, 2).  These give you an estimate for your resting metabolism.  Then you must add an estimate of energy expenditure based on your activity, which honestly is an educated guess.

Predictive equations are great for a population but may not be as accurate for any particular individual.  You can assess your caloric intake on this website or use any online calculator you want.

What is Formally Recommended for Weight Loss

The simple answer is this one-size fits all calorie recommendation found in the Evidence Analysis Library (EAL) of the Academy of Nutrition and Dietetics.  For women, 1200-1500 Calories are recommended for weight loss along with physical activity.  For men, 1500-1800 Calories are recommended for weight loss along with physical activity.

Having completed the Commission on Dietetic Registration’s Self-Study Module for Adult Weight Management, as well as having seen evidence of this during my master’s and seen this in the EAL, we know that exercise is not an effective way to lose weight from a physiological standpoint.  Perhaps from a psychological or sociological standpoint, exercise is helpful because of reinforcement of good habits, including dietary habits.

Granted, we all know someone who has lost some weight with exercise, but having not followed them around to see how exercising changed their diet habits, I am still skeptical.  Some of my clients are very sure that they have lost weight with exercise alone and no diet change, so perhaps the research isn’t as sensitive to this or the particular people it has that effect on.

Exercise calorie deficits vary widely depending on how fit you are and what you do.  It is possible that some populations may be able to achieve weight loss from exercise, but it is a small percentage in the big picture, according to the research.

Below is a graph from some pooled evidence on whether diet or exercise is more effective for weight loss.  Notice how old the study is, yet people are still trying to exercise off their weight.

Diet beats exercise on weight loss

Not a significant difference on weight loss with diet vs diet and exercise.

Very Low Calorie Diets (VLCDs)

According to the 2009 Position Paper of the Academy of Nutrition and Dietetics on Weight Management, a very low energy (calorie = energy) diet (VLCD henceforth), is defined as “800 Calories (or 6-10 kcal/kg) or less per day” and is typically in the form of liquid meal replacement supplements that are fortified with 100% of vitamin and mineral needs.

These are prescribed under the supervision of an MD for people who are obese by BMI or overweight with comorbidities (like diabetes, cardiovascular disease, etc.).  They are supposed to result in rapid weight loss and can help provide encouragement to individuals with the fast results.  They are not recommended without a healthcare professional’s supervision because you REALLY have to make sure you make your calories count in terms of maximizing the nutrition density per calorie.

Some nutrients are of concern.  When you are not consuming a lot of food, electrolytes such as sodium and potassium, which aid in nerve impulse conduction and heart contractions (mainly calcium) can lead to heart arrhythmias.  Gallstone formation is another complication possibly due to less fat in the diet, and bile can concentrate with less gall bladder contractions.

If you are 250 lbs, a VLCD could be as low as 682 Calories or as high as 1136 Calories.  The 800 Calorie number is open to clinical judgment.  If you are 140 lbs, a VLCD could be as low as 382 Calories or as high as 636 Calories.  That said, you probably would not need to be on a VLCD at 140 lbs.

Since a VLCD starts at 800 Calories and requires medical supervision, beware of any diet that asks you to go to 800 or below calories.  The cabbage soup diet is a medically unsupervised, VLCD that does not provide the array of nutrients for meeting nutrition needs, yet people go on it often considering how popular it is.  I haven’t heard of anyone dying on it, but if you have, please let me know in the comments.

The calorie range of 800-1200 Calories seems to be a range of numbers where not much guidance is given in terms of recommendations for healthcare practitioners.  Many physicians fear going below 1200 Calories with patients, but unfortunately, some people just won’t lose weight at that level of calories.

That said, physician education on nutrition is limited to an elective or two during medical school, should they decide to take it and is not standardized across medical schools.  “On average, [medical] students received 23.9 contact hours of nutrition instruction during medical school (range: 2–70 h).”  So asking your doctor how many calories you need may not be the right question unless they actually studied nutrition.

Does this mean a recommendation of 850 Calories is too low?  It isn’t a VLCD, by definition, and would not require physician supervision.  It depends on who is recommending it and for whom.  A smaller person needs fewer calories than a larger person, so 850 may be very low for someone very large while it may be just low calories for someone smaller.

Registered dietitians are trained to make sure the calories count in your diet to avoid health risks while dieting.  Most of us will not even recommend something that low unless the patient has unsuccessfully tried other levels.

Summary

The take away from all this is that figuring out how many calories you need takes some effort.  We can estimate with equations and calorimetry.  Food journaling is the best way to figure out how to make changes to your diet and see where you can improve.

Very low calorie diets (VLCDs) are generally considered to start at 800 Calories and are not recommended unless you are speaking with someone who studied nutrition and have worked with them unsuccessfully trying other less extreme approaches.

Exercise is not considered a good way to lose weight unless it makes you make better food choices.  It will make you fitter and healthier though so should be encouraged.

If you like this post, please comment and share.  If you don’t like this post, please let me know why in the comments.



Share on FacebooktwitterredditpinterestlinkedintumblrmailFacebooktwitterredditpinterestlinkedintumblrmail

Tags: , , , , ,

My Recent Weight Loss Experience: Part 1

Dec 29

Posted by Joey Gochnour, BS, BS, MEd, RDN, CSSD, CSOWM, LD, NASM-CPT in Diet or Exercise?, Personal Experiences and Opinions | No Comments

In an effort to become a better personal trainer and registered dietitian, I decided to embark upon a weight loss journey on November 1, 2014 that ended December 15, 2014.  Granted, I didn’t need to lose weight for any health reasons, but I tend to go on some sort of a reduced calorie modified version of what I currently eat about every year and a half to reset to where I like to be.  Otherwise, I’d just keep gaining weight the way I like to eat and sometimes exercise! 🙂

Because this post got longer than I expected, you can jump to the how I felt when I did it part after the Preface heading, which gives background on my thoughts on weight and rationale for changing my weight.

Preface

Not everyone loses weight because they need to.  It is often a want to sort of thing.  For me, I enjoy being at different weights for different reasons.  Sometimes I like to emphasize the big heavy lifts, and more mass makes me better at that.  After a while, I tend to find it exhausting maintaining that weight, eating all that food, and keeping up my cardio to keep my body fat percentage down.

Add training and nutrition consulting with local Austin clients, working with private client hours on top of that who are not local via telehealth, and developing this website, it can get fatiguing after a while.

I also don’t like to be too lightweight.  In our society, a muscular male physique is valued more than a ripped, agile, and fast male physique.  I also just feel weaker than I can be and don’t emphasize endurance activities in my routine.  Rather, I do them for general health and maintenance.

The perks of being light include: I save money on my grocery bills, I have boundless amounts of energy, I can workout “forever” without getting fatigued, and my strength:mass ratio is probably the best due to these previous qualities.  Strength:mass ratio, ie maximizing your strength for a given body weight, is the way to go if you lift weights, in my opinion, as it takes less time to maintain the results and yields the most functional body type.

If you think about it, for a small framed individual to have tons of weight, be it muscle or fat, it makes the body less efficient at doing anything.  Your organs don’t grow enough to keep up with the body size changes.  Your heart prefers a certain size, your liver a certain size, your kidneys a certain size, and your lungs a certain size.  They just don’t grow like your muscles can, so when you pick a body size to be, understand the pros and cons.

Bigger people are stronger, but lighter people (to an extent…as there is too light) can be more athletic for anything that requires moving the body through space and time.  I prefer the ideal body weight equation over BMI when assessing weight ranges for people, but I look at both models and consider fitness status as well for the big picture.

My belief in the healthiest human body is one that is good at many aspects fitness but also absent of disease or disease risk propensity.  Aspects of fitness include skill based and precision work, muscular strength, muscular endurance, agility, balance, cardiovascular fitness, and body composition.

The heavier I get, the more strength and muscle I have, but also the more likely I will have high blood pressure, as it runs in my family.  Moreover, the less likely I will be good at running for any extended period of time over a couple miles.  Think of fueling a Prius vs a Hummer.

I have had either prehypertension or high blood pressure at a few points in my life of high stress, and it is more likely to come on as my weight creeps up.  Being able to squat and bench heavy at that point becomes moot to me.  I’m already a small- to medium-framed individual anyway so won’t set any big records there.

I’m a 5’10” male who likes to weigh between 165-175.  When I was a competitive swimmer, however, I weighed 150 and got my best times at 145 (age 17) when I had diarrhea during a meet that I was shaved, tapered, and wearing a fastskin for.  That experience taught me that losing 10 lbs of water weight (I actually lost from 155 during that meet) gave me collegiate division 1-worthy times for swimming.

I didn’t understand that at the time though, and obviously it is not a healthy thing to do due to the electrolyte abnormalities and possible heart risks with that fast of weight loss while competing at a high level.  But I digress!  Back to weight loss!

There are a few reasons I decided to lose the weight.  I knew the holidays were coming up, and I wouldn’t be able to work out as much or the way I wanted with family.  I also needed a break from working out, in general, to let my body fully repair and heal.  I decided it was a good time to do so.

My weight was creeping up to 182 at a peak but averaged around 177-178.  I carry a lot of water weight that fluctuates depending on the time of day, hydration, how much fiber and sodium I have had, stress levels, and exercise amounts.

I also knew I started lifting really heavy and found it easy, a sign I gained some muscle (and fat), which when working out as many years as I have, I know I don’t make many muscle gain or strength improvements anymore without a significant technique or routine change.

I also was becoming exhausted with less cardio than I used to.  Any extra muscle on my frame size at this point inevitably carries more and more fat.  You can’t continue to gain muscle with a low body fat percentage on a given frame size forever.

How I Lost the Weight–Diet Only this Year*

In the past, I have lost weight by the book.  I did both diet and exercise in the past.  This time, I just did diet only.  The asterisk means that I was still biking to my personal training employed job and still training clients (some who require more physical effort on my part than others, which is what goes with the profession), but I was doing no formal exercise as I usually do to push my own limits.

Usually, I hit all muscle groups heavy a little less than once a week, do high intensity cardio (run or swim), moderate and relaxing cardio (run or swim), bike to/from work, agility and balance and gymnastics skill work using bodyweight at playgrounds with parallel bars and monkey bars, or I’ll count a physical outing like hiking or kayaking as a workout for the day.  These make great date ideas that do NOT involve food…I’ll have to post on that topic another day!

In the past, I did it by cutting my food portions of non-protein calories like carbohydrates and fats down very mildly, as I still wanted to be able to fuel my workouts.  I have a food scale and use measuring cups and live alone, so it is much easier to track.  I believed in sports nutrition by the book in that it was supposed to have that magic 30-min to 2-hr window after a workout when you have to eat, or you lose all your gains!  More on that in another post.

I also still lost about 5-10% of my strength with weight loss, which is inevitable.  I couldn’t do as many reps or sets in the gym, and my high intensity work wasn’t as intense.

In the past, I also would get muscle cramps, tight muscles, and nights where I had to “refeed” the calories I cut that day in order to fall asleep because my body was trying to repair muscles that I wasn’t feeding.  I wasn’t even severely cutting my calories, but to be able to workout at the intensities I usually do, my body needed more calories and wouldn’t relax until it got them.

This time, I went into my weight loss journey knowing I would lose strength and endurance no matter what I do.  Why go through the psychological trauma of seeing your lifts decrease in weight and repetitions when you could just start over at the end?

As a trainer, I see unfit people get fit very quickly.  Losing your gains is not hard to get back.  My clients teach me this when they are gone for an extended period of time and then come back.  It is exhilarating to see, from my perspective, and made me less strict with my own regimens.

When cutting calories, my body doesn’t want to work out intensely.  It is just counter intuitive to push yourself harder while eating less as an already lean individual (for someone who is new or intermediate to exercise, this sentence may not apply due to relativity of ratings of perceived exertion during exercise).

This time, I got NO cramps, I didn’t have to wake up in the middle of the night to refeed myself food I had cut out earlier in the day due to working out raising my calorie needs.  I had no tight muscles.  Muscles shrink during weight loss anyway.  Why try to make them bigger during this phase of your life?  I took my own advice and experience and did it on myself this year.  The weight loss experience was much more pleasant.

I usually eat about 3000 Calories a day at my 175 weight, consisting of 4 meals and a snack.  Normally, I work out 5 days a week doing different activities at various intensities.  When I cut my calories, I started out having 3 meals and a snack.

The first week, I was hungry.  After the first week, I wasn’t hungry and didn’t get hungry for the rest of the experience.  I was able to cut down to 2 meals and a snack after I noticed I was losing weight slower and the fact I was starting to be satisfied on smaller amounts of food.

I probably ended up having about 1500-1700 Calories with those 2.5 meals when I finished my weight loss journey at about 160.  I could probably be more specific since I have my diet in a spreadsheet and could figure out the specific numbers, but that is beyond the scope of this post.

From a sociological standpoint, people were concerned rather than encouraging.  There is a stigma any time you cut weight and are already relatively lean, whether male or female, especially for those not familiar with athletic populations who do this often.

There is a lot of overlap with anorexia nervosa behaviors and effective weight loss behaviors.  I think the difference is whether it becomes a clinical problem of becoming underweight, malnourished, and having a distorted, unrealistic body image.  Another difference is knowing when to stop these behaviors.  There is a difference in knowing which thoughts are rational and which are irrational.

I think a lot of the concern is also self-reflective on those who are concerned about their own thoughts about body image.  Perhaps they want to lose weight, fear the process of doing it, and hesitate to do it.  It is a temporary lifestyle change, after all.  If you associate too much of your daily joy and life-meaning with the act of eating food, then that will be something to think about.

The bottom line of this? I cut calories more intuitively this time.  I didn’t have exercise and all its variability in energy expenditure making things complicated.  I used the intuitive eating technique for knowing when I wasn’t eating enough.

I only looked at my calories afterwards because I’m a registered dietitian and feel compelled to know this sort of information for the sake of my career and to better help clients, the few who actually understand and think in calories.  I have a different idea for ways the general population should better understand food calories in another post.

I overshot my weight goal of 165 to 160 on purpose (on average, as it dipped to 158 depending on the day) because I knew the moment I started eating more and exercising again, I would gain my weight back to 165 very quickly thanks to fluid shifts and storing more carbohydrates again.  Rather than having to restart adapting to fewer carbohydrates as energy again, which can take a while, I just decided to overshoot my weight goal a bit.

Interestingly, whether it is the adaptation to eating fewer carbohydates (due to lower calorie intake), or the fact I wasn’t always having blood diverted to my digestive system, I was much more mentally clear during the process.  Who knows?  The research isn’t out on that yet.  I do like to keep up on ketogenic diets though just for sheer interest in the unknown.  This is not to be confused with ketoacidosis.

Notice mental clarity is the same thing people on that religion of bulletproof coffee report.  I think it is more due to the weight loss and blood to gut diversion being reduced, not the “grassfed pure butter that is good for your brain.”  I would like to see some references for that statement.  Oh right, there aren’t any!

So, that is the end of my weight loss journey (and the midpoint to getting back to fitness).  Once I got to the point of finishing up, I was mildly irrationally afraid of starting to eat more food again and having to get back into shape.  What a pain, I thought.  I could see how people can get stuck on eating less and less food when you have been successful with weight loss.  It is an anorexic thought.

That’s why everyone should have fitness goals.  It’s not optional these days.  You HAVE to exercise to be healthy.  It lets you eat more food and feel great.  Who wouldn’t want that?

Now that it is a week or two back into my old routine, I’m back on 3.5-4 meals a day and am exercising again.  I feel great, lighter (weight didn’t come back instantly or anything), and healthier.  I lost a fair amount of fitness in that I’m not pushing myself to my weights I was pre-weight loss because I didn’t feel that would be safe.

That said, I probably only lost about 10% of my strength.  I expect to gain about 5% of it back in the next month, depending on soreness and when I can fit workouts in my schedule.  I’ll write Part 2 when that happens.

The whole point of the diet and no exercise thing this year was to better understand what clients feel physically when losing weight, and to prove a point that you don’t need to work out while losing weight because it can take twice as long and be accompanied by all sorts of musculoskeletal annoyances like tight muscles and overtrained muscles.

I also wanted to see if the weight loss process was faster this year (and it was).  That said, Part 2 of the post is to see how long it takes me to get back to full fitness, so I haven’t proved it is faster in terms of maintaining fitness yet.  The first week back I will tell you that I was SORE AS EVER.  I am not sure if the caps emphasize that enough, but I was a bit zealous in starting myself back to about where I should be mathematically speaking in terms of strength losses and cardio.  I also got winded in a half mile of intense cardio.  It will come back in a month.  I’m not worried.

This isn’t the first time in my life I’ve just let a high level of fitness go.  When I quit swimming competitively at age 19, I played 6 months of addicted World of Warcraft gaming.  I lost 17 lbs of muscle then (160 to 143).  No, it wasn’t healthy, but I wasn’t depriving myself of food.  I just wasn’t exercising then nor was I hungry.  So, fitness can come and go.  Your gains are easily reattainable.  Why try to choose two competing goals at the same time?

My opinion is that unless you are brand new to exercise and have to learn a lot of techniques and get into the healthy habit of exercising in order to build your self-efficacy to do exercise competently, then you may achieve physical goals faster and with more satisfaction by focusing on one at a time.  If it is weight loss and you are a very fit individual already, try to diet first.  Seriously, don’t try to increase the amount of exercise at the same time.  You will learn! 🙂

In the future when I lose weight again (after it creeps on again, as it will because the body is a master at caloric efficiency, which I do NOT view as a diet failure as media/science makes it sound…more on that in another post), I plan to do LESS exercise rather than NONE.  I may lose the weight faster with no exercise, but I lost more fitness this time than I would like.

I’ll keep readers updated for my next post (Part 2) in a month or so whenever I’m back at peak condition, hopefully at my 165 or 170 weight.  I really am not too concerned about whichever one it will end up as.  Life happens, so be as fit as you can be for it, and maximize your functional capacity!

Please comment and share!



Share on FacebooktwitterredditpinterestlinkedintumblrmailFacebooktwitterredditpinterestlinkedintumblrmail

Tags: , , , , , , , , , , ,

3 Ways Exercise Can Slow Weight and Fat Loss

Dec 27

Posted by Joey Gochnour, BS, BS, MEd, RDN, CSSD, CSOWM, LD, NASM-CPT in Diet or Exercise?, Personal Experiences and Opinions | 3 Comments

Many people will amp up exercise in an attempt to lose weight because they know the law of thermodynamics that states that calories in must be fewer than calories out.  Knowing this, they will drastically reduce dietary caloric intake by adapting strange diets they won’t be able to stay on for the rest of their life.

At the same time, they start increasing the amount and intensity of exercise they do in an equally unsustainable manner.  Logically, this makes sense, unfortunately, it isn’t as simple as that.

In this article, we’ll discuss three ways exercise can get in the way of your weight loss.

1. Intense exercise and increasing the duration of exercise from what you did before will burn more carbohydrate calories as a primary fuel source, especially during the adaptation phase. Carbohydrates are the energy of intense movement.

All exercise, light to intense, will burn carbohydrates; however a greater percentage of fat is burned in the light to moderate aerobic exercise zone due to a state of metabolic efficiency being reached in carbohydrate burn state where carbohydrate metabolites aren’t overly produced and the slower fat oxidation systems have time to use the products of carbohydrate metabolism.

However, you’re still limited by carbohydrate capacity and aerobic training status (more aerobic enzymes burn carbs more efficiently).  Light to moderate exercise also causes less breakdown of muscle tissue, which is a good thing when thinking about weight loss and brings us to the next point.

 2. Relatively lean and fit people will already be able to push themselves intensely during exercise, requiring more calories on those exercise days than normal to replace glycogen stores (how glucose is stored in muscle) and rebuild lean tissue that was damaged from eccentric muscle activity and acidic denaturation of muscle proteins such as during high intensity exercise (resistance or aerobic-glycolytic).

This means they have higher calorie needs like anyone who has tissue repair needs, yet they’re consuming fewer calories for weight loss.  This leads to overuse injuries and overtraining syndrome, where stress hormones like cortisol increase to raise blood glucose to repair places of inflammation.  Stress, whether physical, physiological, emotional, or mental, and inflammation don’t go well with weight loss, which should be a relaxing, low-stress, anti-inflammatory state.

3. Intense exercise stimulates the body for lean mass gains. This means you GAIN mass, which requires more calories.  You don’t lose weight.  The number will not go down on the scale.  It won’t be a time when your body has calories to spare off your frame.

Some people will argue that the number on the scale doesn’t matter, it’s how fit you are.  This is true to an extent and is in agreement with the current research, as there isn’t much information on what happens to extremely massive people long term who are fit (not a huge segment of the population).

However, if you are extremely massive on a relatively small frame, it would theoretically require a lot more of your heart to pump blood through the extra space in your body, the lungs and kidneys to rid you of the waste products, and possibly increase blood pressure due to increased vascular resistance of blood vessels the heart must pump through.  Whether this is healthy and fit or taxing on organs is yet to be determined.

So in my opinion, excess weight is not good, whether fat or muscle.  You will not be as fast, agile, or aerobically efficient as your leaner counterparts, and your strength to mass ratio will decrease the more massive you get.  People might think you look good though, but that’s a sociological/contemporary phenomenon.

There are many parameters of fitness, including speed, agility, strength, muscular endurance, cardiovascular fitness, flexibility, balance, skill work and precision, as well as body composition.  It’s not always about body composition being the hallmark of fitness as popular culture may have you believe.

Knowing this, I stand by my comment in my interview with Megan Ware that exercise is often a detriment to weight loss if you do too much or too intense of exercise and are already pretty lean, ie near your ideal body weight.

If you are a beginner, you may get more leeway because you are not able to produce as much breakdown relative to the calories you are already taking in.  You also may not be able to push yourself to the intensity that breakdown occurs in your body, which spikes your calorie needs.  If you are spiking your calorie needs, you aren’t able to reduce them much from where you started, so the weight will not come off.

In fact, weight will increase if caloric needs are higher than what you are consuming, at least at first, due to the stress response and water retention.  Weight loss itself requires a consistent DIETARY calorie deficit in an unstressed state, so if you are telling your body to build muscle in your workouts, it will slow you down until it does.

How do I recommend going about fat loss?  It depends how much fear you have about getting out of shape during the weight loss process.

As a trainer, I know how relatively easy it is to get people into shape.  If you fear getting out of shape during the process of weight loss, then you probably are a candidate for a slower, “healthier (as currently recommended)” weight loss.  This will mean spreading workouts out as far apart as possible to limit losses in fitness yet still creating that dietary caloric deficit.

For example, strength training frequency may have to decrease so that you can lower your caloric needs enough to be able to cut the calories.  As your mass comes down, strength will also decrease, so you may have to lower the weight.

High intensity cardio frequency also will have to decrease.  Every time you workout, that increases caloric needs to repair yourself, so you will never truly achieve high caloric deficits necessary for faster weight loss.

If you are not already working out and very fit aka beginner or intermediate exerciser, it is unlikely that the amount of working out that you do will interfere with weight loss, even if strength training.  It is important for beginners to learn to adapt to the behaviors necessary for weight maintenance (ie exercising intensely and regularly) so that when they finish a low calorie diet, they will not regain as much fat weight back when resuming normal eating.

Most people reading this article will be beginners, so I do encourage exercise and diet at the same time for learning and psychological purposes and not because it makes weight loss faster—on the contrary.  For competitive athletes and highly active fitness enthusiasts who weight stall, things are a bit different.

Eating more on exercise days and less on non-exercise days is a great way to maintain your weight once you have lost it. This teaches a sustainable habit of balancing caloric intake with exercise expenditure while still eating a balanced, varied diet with all the food groups. You just modify the quantity of dietary intake while minimizing stress on the body, the essence of weight loss.  Weight maintenance is a different strategy than weight loss, however.

Unfortunately, exercise alone is pretty ineffective at resulting in weight loss.  I’ve seen it on the personal training side in both obese and lean individuals while also getting weight loss success in non-exercising clients who only seek nutrition counseling.  If an obese person does not modify caloric intake consistently below needs, they won’t lose weight.  If a lean individual over exercises and cuts calories, they will not lose weight but will just deplete glycogen stores and risk injury.

Weight loss is a complex process of creating a consistent dietary caloric deficit and maintaining light to moderate activity for the purpose of general health and circulation in an unstressed physiological state.  It is important to consider the calories relative to the exercise, as too few calories coupled with exercise doesn’t get you there faster.  Counter intuitively, it gets you there slower.

It is also not a linear process.  As you lose weight, your calorie needs decrease even more, so you may have to cut calories more to lose even more weight at the same rate or decide to be happy at the current weight while increasing lean mass body percentage with intense exercise (so you can eat more for a while before resuming the weight loss journey).  However, you will lose some lean mass with any weight loss, especially if already very fit.  The body has to stay proportional.  Super hero action figures are plastic toys, after all.

Please comment and share!



Share on FacebooktwitterredditpinterestlinkedintumblrmailFacebooktwitterredditpinterestlinkedintumblrmail

Tags: , , , , , , , ,

Personal Training: Problems in An Unregulated Yet Needed Industry

Nov 9

Posted by Joey Gochnour, BS, BS, MEd, RDN, CSSD, CSOWM, LD, NASM-CPT in Diet or Exercise?, Personal Experiences and Opinions | 2 Comments

Personal trainers are the experts on how to get healthy, fit, gain muscle, and lose weight.   Or so much of the public thinks who didn’t do their research.  Unfortunately, MOST personal trainers are given WAY too much undeserved credibility.  A quick Google search will show you how many certifications are online.  Freelance personal training, which is what most trainers do who hope to make it their career, doesn’t even require a certification unless you want liability insurance.

Do most clients ask their trainers if they have liability insurance or a certification?  No.

Do most clients even know what certifications are worthwhile?  No.

Do clients even want to put that much trust in someone who got a certification on a weekend online?  Apparently.

Do you even want to trust someone who got a certification from one of the more reputable sources (ACSM, NASM, ACE, NSCA, Cooper), which requires a testing center, when they don’t even have a formal education in the subject?  Apparently.

Do you trust them to take care of your diabetes, hypertension, orthopedic concerns, cardiovascular concerns, understand what medications limit exercise, etc?  Apparently.

What if you get light headed during training…then what should your trainer do to help that problem and explain it to you?  Are you being taught myths and fads or evidence based techniques?  Why are we doing this exercise?  

Apparently, YES, people do trust people with weekend certifications to know all this information.  The industry proves this due to how many successful fitness “professionals” there are without any education.  The industry is driven by charisma, unfortunately.  This is ONE big problem with the industry.  The number of barely qualified people doing the work far outnumbers those with formal education on what they are doing.

Does your trainer have a degree in kinesiology, exercise science, biomechanics, exercise physiology?  Have they ever taken an anatomy class?  You would think these would be requirements, but they aren’t!

In other fields, non-professionals doing the work of the professionals is not NEARLY as much of a problem.  Companies won’t hire you unless you have a degree in the subject and there aren’t many freelancers who think they can do better than they could do at a company.  You wouldn’t trust any other medical provider to operate on you or otherwise care for your health without formal education.  You wouldn’t trust someone without a JD to give you legal counsel.  Why is it any different with exercise science and nutrition?  People will accept information from ANYONE in this field!  Mantras like “everyone is different” and “it works for me/Cameron Diaz/Dr. Oz/Oprah/Arnold” dilute real knowledge and wisdom when we need it most as a nation.  The number of charlatans drowns out the true professionals.

A second problem is the fact that the lay public thinks personal training will make them lose weight.  It doesn’t make you lose weight.  If that were the case, personal trainers would be rail thin due to all the activity they do every day.  Exercise changes your body composition.  It doesn’t change your weight, and if you’re overweight, you’re not going to change your body composition enough to look like your trainer without nutrition changes.  If anything, you will gain weight because exercise stimulates your appetite due to the muscle breakdown.

You would do better spending your money on a registered dietitian if your goal is weight loss.  Weight loss is one of the biggest issues in America today, and people have the misinformation that exercise causes weight loss.  Most uneducated personal trainers will not know it isn’t the exercise but diet that causes weight loss, and if they do, will they tell you and risk losing you as a client to a registered dietitian?  Probably not because exercise is always good for everything right?  Wrong.

People give WAY too much trust to trainers on topics like nutrition.  Did you know that some people, such as registered dietitians and those with a bachelor’s degree in nutrition, are much more minimally qualified to counsel on nutrition issues?  These include: weight loss and weight gain, cholesterol, hypertension, performance nutrition, and many other nutrition-related issues.  You shouldn’t trust your trainer on nutrition unless they have a degree in nutrition and/or are a registered dietitian, which is someone with a degree who has been accepted into a competitive 1200 hour supervised practice program and proved their efficacy that they know what they are doing.  Not all nutrition majors get into these programs.

A third MAJOR problem is the financial disparity between employment and freelance personal training.  You cannot make a living at most places that employ personal trainers, especially since the Affordable Care Act (thanks Obama).  Some places prevent you from working more than a certain number of hours so that they don’t have to pay you benefits.  Now, the health and wellness specialist, the personal trainer, has to pay for his or her own health insurance.  Most commission places pay anywhere from 33% to 50% to 60% maximum of your client income, expect you to do the sales, and they don’t reward you for being a good trainer or getting results.

The only reasons you would get a pay increase are more certifications, more formal education, or more experience, but it isn’t enough of an increase to make the education cost-effective (but does make a better trainer and decrease risk of injury to the client and ability to achieve client results).  Plus, most of the fitness industry certifications are stupid.  I don’t think I need to get a certification on how to use a kettlebell, battle ropes (lol), vibration training, or TRX after having degrees.  Seriously?  Interestingly, getting a kettlebell certification is a similar increase in pay as a degree at many gyms.  That’s just ABOMINABLE, isn’t it?

Other gyms sell packages of sessions and don’t pay the trainer the rest of the sessions if the client doesn’t finish them with the trainer.  So if you do a good job and your client learns what they are doing ahead of time, they will stop seeing you because you’re a good teacher, and they think you’re pocketing the rest of the sessions.  WRONG.  The trainer just doesn’t get paid because he/she didn’t work the hours.  Additionally, most places make you do all the scheduling, so if you’re not working with a client, you’re playing scheduling whac-a-mole with all your clients times so that you aren’t working 12-15 hour days while sitting around for hours between clients.  If someone cancels repeatedly, you may or may not get paid for reserving that time slot.

Considering the fact that pay at employed training isn’t enough to make a living, many personal trainers end up having to “under the table” train, ie they squat at various gyms that did not hire them, stealing potential clients and not paying for the equipment they use.  Many gyms don’t think you’re training if you’re “working out with” the client–this is one of the stupidest policies I’ve ever seen in my life.  If an extremely fit guy is working out with someone not even at the same level, you think he’s doing it for free?  He’s just doing it out of the kind service of his heart?  You, as a gym, are ok with the liability of that?  Ok then!

This is also unfair to those who are employed legitimately at those gyms because these freelance trainers can charge what they want and not give half their gross to the employer (and a chunk to the government).  Some even only accept cash and then don’t report it on their taxes.  These trainers are taking business away from the gym.  Because it is the responsibility of management and not the other trainers to report “squatting” trainers (definition 3), they often get away with what they are doing.  Management has these policies to avoid confrontational events, but if management doesn’t enforce it, employed trainers just have to watch it happen and have to bite their tongue.

What makes this worse is so many of these barely qualified trainers do it as a hobby on the side and charge a fraction of the prices you must set if you need to make a living in the industry if you are a full-time trainer.  The amateurs are in a freelance, unregulated market, charging less against fully educated, real professionals.  These amateurs who do it as a hobby lack any experience or education.  Anyone can have a great body, but education makes you know the principles behind why it works and how to assess what other people need and teach other people what they are doing that is or isn’t working in a way that they will understand.  These trainers don’t know (or care in some cases) if their training style is healthy long-term.  Some trainers can be extremely enthusiastic but not know a thing about what they are really doing.

People often gravitate to what the cheapest trainer charges who looks good.  Well guess what?  You get what you pay for.  In many cases, this is eye candy.  Chances are the “ugly” or not overly muscle bound trainer knows what he/she is doing more if they are successful.

You might ask, then, what makes someone with a degree different than someone who just has the bare minimum?  The public thinks we’re here to just “give you a workout and tell you what to do,” and often doesn’t even take our profession seriously.  They think it is about leisure.

There are different techniques of training that yield different results.  Strength training is different from bodybuilding, which is different from endurance training.  Flexibility, agility, fat loss, muscle gain, and strength gain all are different training techniques.  Injuries require alternate techniques than uninjured people and have contraindicated exercises.  Diabetics need to know how exercise will affect their metabolism and how to deal with that.  Sometimes counseling techniques are needed to elicit behavior change.  It is impossible for any one trainer to be excellent at all styles of training, even with a degree, but the degree should give them an idea of where to start at  least.

A trainer with a degree in kinesiology will know a more comprehensive way of working out the body so as to not neglect underused muscles that get injured later on because the person didn’t strengthen the neglected muscles while progressing in their program.  The trainer with the degree thinks by anatomy and muscle actions, letting those needs dictate the training program than having a pre-made, one-size-fits-all workout of the day.  Speaking of generic workouts, many new and uneducated trainers think that you have to burn someone to the ground to train them.  This style only works with a certain population of well-fed individuals who want muscle gain who don’t want any specific training adaptations and are fine with not being able to use their affected body parts for days after.  This sort of training also carries a high risk of injury, such as rhabodomyolysis, which is when muscle cell integrity fails and spills contents (myoglobin) into the blood, which can cause acute kidney failure.

That’s not the point of training.  The point of training is to increase your lifetime functional capacity.  One of the most pointless adaptations is to be able to do something 10-15 times in the long term.  Where in life is this useful?  It’s currently a popular training style because people think that’s how many times you have to do each movement.  Granted, I do recommend somewhere in this range for beginners who are still learning movements and want lower risk of injury during the learning phase, but staying in this repetition range long term when you’re not an endurance athlete is nonspecific training.  The point is to get better at something.

Trainers who aren’t educated won’t know what energy systems and adaptations that produces other than it might make you socially look good for whatever body type is trending right now in the magazines and media.

In summary, the lack of education and low barrier to entry to credibility to the fitness field, the dilution of true professionals in the field, and the business structure of the freelance vs employed environment make the personal training industry a hot mess during an obesity crisis in the US.  Obesity is not fixed with physical activity yet people think it does, and registered dietitians are not even recognized as the key to weight loss on many health plans while the public thinks personal training is the way to do it.



Share on FacebooktwitterredditpinterestlinkedintumblrmailFacebooktwitterredditpinterestlinkedintumblrmail

Tags: , , , , ,

Paradigm Shift: Away From Idea of Exercising to “Burn” Calories

Oct 27

Posted by Joey Gochnour, BS, BS, MEd, RDN, CSSD, CSOWM, LD, NASM-CPT in Diet or Exercise?, Personal Experiences and Opinions | No Comments

If you follow health news, there are often articles that discuss how much exercise it will take to burn off a cheeseburger.  The motivation behind these articles is to dissuade you from having that cheeseburger, logically at least, because it supposedly takes a “5.6 mile hike” required to “burn” it off.

When I see these articles, I get the good intent.  Most people without a science background don’t get the E=mc2 concept that matter and energy, or Calories, are the same thing.  Most people don’t think in Calories or have a very good abstract idea of what they are.  It’s pretty simple though in terms of what you need to know for nutrition: fat has 9 Calories per gram, alcohol has 7 Calories per gram, protein has 4 Calories per gram, and carbohydrate has 4 Calories per gram.  Fat is, thus, considered an energy-dense nutrient due to the high concentration of calories per unit of mass (grams).  Add up your Calories from each nutrient previously listed, and that’s your Calorie score.

However, every time I see these sorts of articles, I feel like I am banging my head against the wall out of frustration because they miss the teaching point.  I also don’t think these comparisons are very effective.  Here’s why:

1) A 210 lb male uses more energy to move about each day and to live than a 115 pound female, so the “5.6 mile hike” isn’t even accurate for most people anyway.  Who is this specifically targeting, then?  I can’t tell you that answer, as I was never taught.  If you know, please comment below.  Does this “5.6 mile hike” refer to a small female or a large male?

2) Exercise breaks down muscle.  If you are doing muscular endurance exercise, maximum strength training, cardiovascular training, sprinting, flexibility, or anything physical, including walking, you are breaking down muscle.  That is how you move.  Energy is released as heat and as locomotion.  So, depending on the type of exercise you perform, your body’s response is to rebuild that muscle back to normal and supercompensate it with either more energy storage or protein storage as well as create more mRNA for enzymes that favor the types of exercise you do.

Definition: mRNA is basically an intermediate between DNA and protein expression in the body.  They call this the “transcription” process of DNA in school (ie, DNA to mRNA; mRNA to protein is called “translation”).

3) People who are choosing the cheeseburger, even with this information do not make the right choice and are very aware it is not the right choice. People sometimes eat for reasons other than nutrition, such as social eating, emotional eating, rebellious eating, convenience eating, lack of time or poor planning, etc.  So it doesn’t matter what logical information you put on the product.  Perhaps a better campaign would be “talk to a friend instead of eating this cheeseburger alone.”

So what’s my point?  Any time you create breakdown in your body, it has to rebuild.  If you don’t let your body rebuild, either because you are over-exercising or not consuming enough Calories for that exercise, it creates a stress response that basically slows down your metabolism until your body DOES rebuild itself.  The stress response can include elevations in cortisol, which raises blood sugar.

The exercise you did tells your body to actually store weight in the form of muscle.

Wait, muscle?  That’s good right?

It is for some of the population.  However, what about people who are already overweight or obese and have a lot of muscle and a lot of fat?  Now is not the best time to be building muscle because you will not be losing weight.  In fact, it may slow your weight loss progress by slowing the speed at which the pounds come off!  Any excess weight on your frame increases the work your heart has to do to pump blood around your frame.  Your cardiovascular system just gets more inefficient the larger you are for your frame size, muscle or fat.

That said, exercise at any size helps improve overall health dramatically, so if you’re not at a good point in life to make better food choices, exercise will prevent you from experiencing many of the negative effects of being overweight or obese.  It can reduce blood pressure, increase HDL cholesterol, improve blood sugar sensitivity (attention diabetics!), acutely reduce symptoms of depression or anxiety, improve circulation, lubricate joints to reduce joint pain, and many, many other benefits beyond the scope of this post.

“But who cares about weight?  Shouldn’t we just care about lean mass?  Doesn’t muscle weigh more than fat?”  (Actually, a pound of muscle and a pound of fat weigh the same.  Muscle is more dense though and takes up less volume.)

Yes, to an extent.  But from a metabolic efficiency standpoint, frame size is important to think about if you do not want to be carrying around a lot of fat mass with your lean mass to mask how hard you work out.  No one will see your muscle striations if they are behind a lot of fat.

So, in summary, exercising to “burn” off Calories is not a good idea.  You will end up gaining weight over time, albeit muscle weight.

Instead, think of exercise as Calories you need to consume on top of the minimum amount of Calories you need each day.  If you don’t consume them, your body slows down your metabolism until it makes that energy available to remodel your muscles with what it has.  This is basically a state of “over-training” or “weight loss stalling.”  They are pretty similar metabolic states, in my opinion.  If you exercise and don’t eat, your body slows down.

Think of the exercise first, and then think of what you have to do to from a dietary standpoint to replace what you lost during the exercise.  Again, if you don’t replace what you lose, your body will slow you down until you do.  Don’t think of it as “eat the cheeseburger” then “I have to punish myself by abusing my muscles this many times.”  It’s not even the exact same molecules of energy from the food.  If you haven’t trained to store more energy in your muscles, that cheeseburger just goes to your waist, and if you’re not trained to expend large amounts of energy during exercise (as very fit people can), then you won’t “burn” that food off.  You’ll just break your muscles down some.

Yes, exercise burns some Calories, but it is not significant enough to eat pretty much any food you want.  Food choices are paramount.



Share on FacebooktwitterredditpinterestlinkedintumblrmailFacebooktwitterredditpinterestlinkedintumblrmail

Tags: , , , , , ,

Why Fat Shaming Must Stop if America is Going to Lose Weight

Sep 16

Posted by Joey Gochnour, BS, BS, MEd, RDN, CSSD, CSOWM, LD, NASM-CPT in Diet or Exercise?, Personal Experiences and Opinions | No Comments

A study posted on Medline this past week about fat shaming not motivating people to lose weight, possibly even causing more weight gain is the impetus for this blog post.

People who are overweight and obese are intimately aware of their body type.  Telling people that they are overweight or obese adds insult to injury.  I can definitely relate to not being in control of what’s going on in life in quite a few ways, but one of the ways I’ll share here in a blog post, as I realize I’m posting on the internet for everyone to see, so we’ll start with how I look.  Maybe another day I’ll disclose other more personal ways I’ve not been in control of my life in the past.

When I was balding in at age 22, people would tell me I was balding.  Guess how that made me feel?  Sad.  Scared.  Worse.  Angry at family genes.  I had different coping mechanisms than many people adapt, as I didn’t become an alcoholic or get on drugs.  Since then, I’ve come to terms with being bald and owned it.

I went through stages of feeling embarrassed, wearing hats, growing my hair out, shaving it off, growing it out again, trying Propecia, stopping Propecia because of side effects, trying a different style, shaving it off again, wearing hats, and then just stopped caring.  It took me half of my twenties to come to terms with what the gene pool dealt me, especially when you want to date in your twenties.  There’s really no cure for baldness because there’s nothing wrong with being bald physically.  I am accepting of it now and am a stronger person from having dealt with that already in my life.

Back to obesity.  People who are overweight or obese know that they are overweight or obese.  They may or may not have tried multiple diets already, obsessively weighed themselves, thrown the scale out, bought another scale, hired a personal trainer who beat them into the ground, still didn’t lose weight (because physical activity doesn’t actually help with the parameter of weight loss itself), etc.  It’s a sensitive subject.  Clearly, telling people that they are overweight doesn’t help.

Now let’s talk about a darker issue that judgmental people who fat shame may not be aware of.  How did obese people get obese?  How did overweight people get to where they are now?  Have you ever sat down and got to know someone who is overweight or obese?  For many people a few extra pounds is not what I’m talking about.  I’m talking you’re 50+ pounds overweight and it’s still going up.  You’re out of control of your life.  It’s not as simple as saying “stop eating, and eat more fruits and vegetables,” which is what many people think I do for a living–if only it were so easy.

It’s not as simple as telling people to go exercise more, while I, as the trainer-dietitian, am silently judged by others while working with an overweight/obese person for not pushing them during a personal training session and instead spending time by sitting down and talking.  If you read to the end of this, you’ll understand why I, as a trainer-dietitian, am talking instead of acting as a drill sergeant for a workout.

Our society is not one that is forthcoming with sharing vulnerable emotions, and different people have different ways of coping.  If you’re feeling rock bottom depressed, so anxious you can’t sleep, or so mad you think you’re going to bust a blood vessel in your head and have your eyes turn black Dark Willow style, many people have not been taught how to deal with these emotions.

Many people do not want to feel these emotions anymore, having felt them for enough time in their lives.  Some people have been taught to hide their emotions all life.  This is not uncommon in societies that promote an overly masculine male ideal, in cases of emotional abuse where a child was told they were not allowed to feel emotions they were having, or had to curtail their emotions for the sake of another, among MANY other reasons.

Some people will abuse alcohol to not feel emotions, which as common as alcoholism is, this is not uncommon.  Some people will engage in legal and illegal drug abuse.  Some people will get “addicted” to video games as an escape.  Some people will abuse sex and become “sex addicts.”  Whatever their poison is, they all lead to escaping painful emotions and become habit.

Others are able to reach out to others in a healthy way and share emotions in a supportive environment, but this is not as common for a number of reasons, including lack of supportive environments, a person is far enough gone that they are unable to perceive that such environments exist, or they have never had the experience in life of a supportive environment and were never educated on the benefits of one.  If you’ve made it this far in this post, you’ll see that overweight/obesity can be pretty dark subjects.

Let’s look at compulsive overeating and binge eating.  Did you know that carbohydrates, in particular, can play a role in brain chemistry?  They can alter the dopamine/serotonin ratio in the brain.  Excessive carbohydrate eating can produce a calming feeling, which results from increases in serotonin.  This is exactly what someone who is feeling uncomfortable emotions needs: a calming feeling.

The overeating solves that problem, since society did not solve it for them.  Society failed to provide them that comfort.  They feel calm and comfortable again…temporarily with the carbohydrate overeating.  Unfortunately, food has calories, which lead to weight gain if eaten in excess of what the body physically needs (not emotionally needs).

Add insult to injury, people shame people who overeat instead of figuring out what is going on with the person.  This can lead to even more overeating in a feedback cycle.  Additionally, people who overeat can get into the habit of using food for comfort.  Now, the very thing that gives them comfort is shamed, and they often shame themselves for using food as comfort even when others may not overtly.

The morale of this story is this: overeating is not a logical process.  It is more an emotional process.  People who are overweight or obese KNOW this and aren’t stupid.  They especially will not be wanting to share a vulnerable aspect of their lives with you after you demonstrated that it is unsafe for them to do so.

Overweight and obesity are our problem as a society as well as an individual’s problem, so rather than turn up your nose and shame the person, I encourage you to reach out and connect with them.  We shouldn’t have needed a scientific study to tell us this.  Overweight/obese shaming is one of the last socially acceptable ways to discriminate, and this must stop.

Please comment and share!



Share on FacebooktwitterredditpinterestlinkedintumblrmailFacebooktwitterredditpinterestlinkedintumblrmail

Tags: , , ,

Exercising for Weight Loss

Jun 26

Posted by Joey Gochnour, BS, BS, MEd, RDN, CSSD, CSOWM, LD, NASM-CPT in Diet or Exercise? | No Comments

Personal training, ie pure physical activity without diet changes, is not an effective way to see weight loss in a client.

Clients are often allowed to check “weight loss” as a goal with exercising for most personal training services, which are generally cheaper than my services as a registered and licensed dietitian.  It is frustrating having to compete for weight loss clients against personal trainers who may not know that weight loss is only achieved with diet changes, especially considering the lack of education of a personal trainer in approaching dietary changes with people.

Scientific studies1,2,3 and my experience in training people who have not made any diet changes in spite of significantly increasing their physical activity capacity demonstrate that there must be a dietary caloric deficit in order to lose weight.

Sure you will become healthier on the inside, gain some lean mass and thus reduce body fat percentage (without weight loss), and your clothes may fit better from exercise (or you may have to buy new ones because the old ones no longer fit), but to see the number go down on the scale, you need to change your eating habits. Moderate aerobic exercise is great for increasing HDL cholesterol and improving blood sugar sensitivity.  Resistance training is also great for building bone density, strong muscles, coordination, and improving blood sugar sensitivity.  However, exercise alone will not make you lose weight!

  1. Int J Obes 21: 941-, 1997.
  2. Int J Sports Nutr 8: 213-, 1998.
  3. Am J Clin Nutr 54: 56-, 1991.

 



Share on FacebooktwitterredditpinterestlinkedintumblrmailFacebooktwitterredditpinterestlinkedintumblrmail

Tags: , , , , , ,