Category Archives: Exercise

He Said, She Said: Sports and Nutrition

Posted on by
Reply

He Said

Leading up to this month’s Newport Marathon, I solicited advice from colleagues around the world as well as fellow marathoners regarding fueling strategies that might help me to avoid the nausea that plagued me in earlier endurance events.

The suggestions I received were all over the place: Eat boiled potatoes with salt late in the race. Pack maple syrup in a fanny pack and drink it periodically along the course. Eat bananas, orange wedges, gummy bears, white bread, salt bagels, or jelly beans. Drink Gatorade, Pedialyte, flat beer, coconut water, Nuun, Skratch Labs, or mix the latter two together.

As I sifted through the various suggestions, I realized I was looking at a great example of the intersection between the hard science of nutrition and intuitive eating. During endurance events, we need to replenish fluids, carbohydrates, and electrolytes, but how we do that must be individualized based on what works for each one of us; thus we need the gamut of ideas. How we determine what works best for us is by trying various approaches based upon sound nutrition guidance and personal history, paying attention to how each trial makes us feel, and basing new iterations largely on firsthand experience.

Sometimes we, as patients, have a tendency to defer entirely to our practitioners. We see comfort in directives. “Just tell me what to eat,” a patient may say. In reality, a collaborative approach tends to be much more effective in part because determining the best path involves the patient’s input and experiences. Hydrating with a particular beverage may seem great on paper, for example, but if it disagrees with the patient’s system, then we need to form a different strategy.

Patient input is one of the most significant differences between textbook nutrition and nutrition in real life, which is why Joanne and I strive to create an atmosphere of collaboration and equality at our practice. Only our patients know how various foods make them feel, so we focus on building intuitive eating skills in part so they are able to recognize and communicate these experiences.

Leading up to the marathon, I treated every athletic endeavor as an opportunity to experiment and gather data regarding how various foods and fluids made me feel. One of the drinks I tried during a tennis practice failed to hit the spot whatsoever, but better to find that out during a casual hitting session than during an important training run or the marathon itself. Another beverage worked really well once I was actually running but made me jittery beforehand. Some foods gave me cramps and made me feel sluggish whereas others settled better than I expected. All of these outcomes, even if they were not what I had hoped, represented important data.

As a result of my experiments, I knew exactly what I was going to eat and drink come race day. Breakfast consisted of white toast with peanut butter, honey, and sliced banana with orange juice and Nuun Active. Between breakfast and the start of the race, I drank Gatorade and water until a half hour before the start, at which time I downed more Nuun Active. During the race itself, I consumed Gatorade and bananas from the aid stations as well as Nuun Energy and salted pretzels that I brought with me. Worked like a charm.

If your takeaway from this column is that you should adopt my own specific food and hydration plan during your own athletic events, then unfortunately you have missed the point: the importance of individuality. As I downed the last of my Nuun Active before the start, my friend with whom I ran the race strapped small vials of maple syrup to her waist, a fueling technique that she knew from experience would work for her. If she and I had swapped strategies, both of us would probably have felt awful. We are all different, so figuring out what works best for you is a process that involves both guidance from a professional as well as your own input based on firsthand experiences.

 

She Said

From a young age, I participated in a variety of team sports, including soccer, softball, and volleyball. While I truly loved playing these sports, my family was a tennis family, in that tennis was a sport that we all learned to play as children and enjoyed playing together. As I got older, I played tennis less and less, usually just hitting the ball around for fun with my family on vacations or with Jonah on a public court during the summer. But about 3 years ago, I decided to get back into the sport that I had enjoyed so much in my youth, so I joined several local women’s tennis teams.

While my overall experience on these teams has been overwhelmingly positive, whenever the topic of food or weight comes up, I have noticed some troubling trends. Whether it is one of my teammates or one of our opponents, a number of these women exhibit quite disordered ideas about food and weight.

When I was new to one of my teams, I remember one of my teammates asking me what I do for a living. After I told her that I work primarily with individuals struggling with eating disorders (EDs), she jokingly commented, “Oh, I so wish I had an eating disorder! I just can’t seem to lose these pesky 10 pounds!” I was very quick to correct her and explain how dangerous and life-threatening EDs are and that they are not simply something that someone can choose to engage in or not to lose a few pounds.

In addition to misunderstanding EDs and the seriousness of these disorders, many of the tennis women I encounter seem to struggle with diet mentality. A couple of years ago, I remember one of my tennis friends casually mentioning that one of the primary reasons she plays so much tennis is that it allows her to eat whatever she wants. In fact, I have heard this sentiment from other tennis peers, implying that they view tennis first and foremost as a way to burn calories.

At nearly all of my tennis matches, the home team provides food for the visitors and themselves. Depending on the time of the matches, the foods offered can range from simple snacks to pretty substantial lunches. Of course, with all of this food come a lot of shame, guilt, and judgments. I overheard one group of ladies on an opposing team debating whether they would have one of the cookies offered, with one of them declaring that she does not allow herself any “white carbs.” Other times I have seen women eating only salad or protein, as they are “trying to be good.”

Diets are a hot topic at many of my matches and practices. From Paleo to Whole 30 to Shakeology, a great number of the tennis women engage in restrictive eating in one form or another. One of my tennis friends started a cleanse not too long ago because she felt like she really needed to “detox” her liver and other organs. Another friend has been eschewing carbohydrates during the week and only indulging in them on her “cheat days.” As one might imagine, I try not to engage in any diet conversations as they can become quite charged. But when I mention what I do for a living, it seems like many of these women are only too happy to talk to me about food and nutrition.

I really don’t blame these tennis ladies for their disordered ideas about food, nutrition, and weight – they are subject to the numerous fear-mongering messages we all receive from our doctors, from the media, and from our friends and family. Talking about one’s diet or weight has become so commonplace that the idea of not talking about it seems strange somehow. But just think about all of the other things we could discuss! All of the ideas and stories we could share with each other! Wouldn’t that be more fun than talking about how to lose those pesky 10 pounds?

At the end of the day, I try to pick my battles. If someone asks me about my thoughts on dieting or certain foods, I will oblige. I try to be gentle with them around my strong anti-diet philosophy as it can be quite surprising and confusing for many people. When it comes to EDs, I do my best to educate those who ask about them. So far, many of my teammates have expressed interest in the idea of intuitive eating and the non-diet approach, so I have tried to point them in the right direction by recommending books and other resources. If I can somehow help even one of them to ditch the diets and begin to appreciate their body for what it can do (e.g., play tennis!), then I will feel like I have made a difference.

Busted

Posted on by
Reply

Football player Rob Ninkovich announced today that the league has suspended him for four games for taking a banned substance. Ninkovich explained, “Few things are more important to me than my name and reputation. This might call that into question for some, which has me heartbroken. I don’t want to cut any corners. I want to do things the right way, with high integrity, and that’s what I have always wanted to stand for.”

He continued, “Any supplement I’ve ever used was bought at a store. I was unaware something I bought had a substance in it that would give me a positive test because it wasn’t listed [as an ingredient]. One thing I have learned is that if a supplement is not NSF certified there are no regulations that ensure that what is on the label is 100 percent accurate. That is a hard lesson for me to learn at this stage in my career, but I take responsibility for it. It’s a mistake I made and it hurts that I won’t be there for my teammates.”

Patients frequently ask me about supplements, particularly protein powders. Pop culture nutrition is fickle. Not too long ago, we emphasized carbohydrates and feared dietary fat. Today, we are scared of carbohydrates and worship protein. As such, people who are already getting more than enough protein often feel they need even more and turn to a protein supplement.

Protein powders, like other supplements, are largely unregulated. Generally speaking, we have no idea if the contents match the listed ingredients or if the quantities reported on a bottle’s nutrition label are accurate. Back in 2008, I read a study (which I unfortunately cannot find right now) that analyzed actual protein content in various powders and found that most did not contain nearly as much protein as advertised.

Furthermore, as odd as it may initially sound, realize that manufacturers have incentive to add secret ingredients. Competition is fierce; a quick search of GNC.com yielded 512 different protein supplements. Consumers often make their selections based upon the perceived results or testimonials of others. If you are a supplement manufacturer and you want your product to stand out among the rest, to be the one that is perceived as yielding the best results, the one that gets talked about and recommended in the locker room, you may decide it is in your best interest to slip in an unlisted ingredient that produces the desired effect.

Whenever an athlete like Ninkovich gets busted and blames his supplements, the common reaction is to assume they are lying and covering for having purposely taken a performance enhancer. That may indeed be true, but we have to remember that what we often see as an excuse is also a completely plausible explanation.

You may or may not get drug tested the way that many professional athletes do, but the uncertainty of supplement contents can still impact you. Might an ingredient, listed or otherwise, interact with one of your medications, make you nauseous, give you a headache, accelerate your heart rate, or damage your liver? You could have no adverse reactions at all, wind up dead, or anywhere in between. That’s the risk.

If you use a supplement or are considering taking one, think about the potential ramifications, and remember that the lesson Ninkovich apparently learned today is actually an important lesson for us all.

An Important Shot Bricked Off the Glass

Posted on by
Reply

If ESPN is going to advertise their story with a provocative before-and-after pictorial of Kevin Love’s body transformation, then let me begin my response by pointing out that the chiseled-armed latter version of Love is arguably a worse player than his earlier, pudgier self.

Sure, now that Love is LeBron’s sidekick in Cleveland rather than the focal point of offense in Minnesota, one might expect some of his numbers to be down. However, his points per game, rebounds per game, and assists per game have all worsened despite nearly identical minutes per game and playing in the midst of what should be his peak basketball years. That’s tough to do. Given that, someone will have to explain to me why we are focusing on his physique instead of his noteworthy and curious decline.

That someone, however, might not be Jackie MacMullan. Normally a fantastic sports journalist, one of the best in her field, she took a shot at an important subject with her ESPN article entitled, “From Kevin Love to Draymond Green, NBA players struggle with food more than you think,” but uncharacteristically threw up a brick.

Her piece begins with a detailed account of Love’s meticulous and rigid eating habits. “Not 10 almonds, not 18 almonds — 14 almonds,” his trainer reports. “Kevin is exactly on point. If he’s supposed to eat every two hours, then on the days when he wants to sleep in, he’ll wake up, eat and go back to sleep.” Even his teammates raise their eyebrows at his eating behaviors, which also include bringing his own food on the team plane rather than “be tempted by a postgame spread that might be high in calories and carbohydrates.”

The aforementioned content and the article’s title set up perfectly to discuss disordered eating, which is sorely in need of more attention and dialogue. “NBA players, in truth, are just like us,” the author writes, before listing various eating behaviors common to both professional athletes and laymen. A glaring omission from her list is that professionals are susceptible to dysfunctional relationships with food, eating disorders, and nutrition myths just like the rest of us. Sometimes abnormal behaviors are so prevalent that we mistake them as normal, and I think the author may have fallen into that trap.

More troubling is that instead of discussing Love’s eating habits as a red flag of concern, the author presents them in the context of his lower weight and improved endurance. Consider the impact this kind of message has on readers. For you parents out there, do not be surprised in the least when you walk into the kitchen and find your teenager counting out his or her almonds.

Furthermore, while Love is no doubt eating in a way that he believes serves him best on the court, we must remember that professional athletes often focus on the here and now while long-term risks take a back seat. The stakes are simply different for them. Professionals put their long-term health on the line for short-term rewards that are unavailable to the rest of us. Love just rushed back on the court from a concussion so he could continue playing in the NBA finals. If you suffered a similar concussion, would you risk permanent brain damage in order to play out the remainder of your YMCA rec league’s spring season? Similarly, readers must understand that following an eating plan as rigid as Love’s is risky and makes little sense for the general population.

The author turns her attention to Oliver Miller, “. . . who at his peak weighed over 375 pounds, ate so much of it [pizza] that the Suns took drastic measures, including hospitalizing him and hooking him up to IV fluids. ‘But then they found out he was ordering Domino’s from the hospital,’ [former teammate Danny] Ainge says. ‘They had to put a security guard outside the room.'” Under a photograph of Miller is a caption reading, “Oliver Miller had to be hospitalized because he couldn’t keep his eating under control. The root of his career-long battle? Pizza.”

Look, I have never met Oliver Miller or viewed his medical records, but whatever was going on with him during his playing days, I promise you that the root cause was not pizza. By talking about pizza, or any other specific food, in this way, the author further propagates the myth of food addiction. When we abandon the diet mentality, uncouple moralization from eating behaviors, break up the good/bad food dichotomy, build intuitive-eating skills, and make trigger foods available in abundance, “food addiction” typically resolves, which is the exact opposite outcome that an addiction model would predict in response to such treatment.

Even if Miller was suffering from binge eating disorder, which, as with other eating disorders, is a mental illness that gets played out through food, pizza is still not responsible for his struggles. More importantly, neither you nor I know whether or not he had such a disorder. Hopefully, one of our takeaways from our shameful treatment of Pablo Sandoval over the winter is the lesson that we cannot determine someone’s relationship with food or the presence of an eating disorder based on his or her body size or weight. The notion that we can is yet another myth.

“But it’s not as easy as simply losing weight. Becoming lighter, in many cases, often doesn’t translate into peak performance,” the author later writes. While I completely agree, the article’s subsequent content seems tenuously related at best. She discusses Roy Hibbert, who lost weight upon request by one coach and then put it back on when the Pacers hired a new coach who asked him to regain it, but that was apparently related to differing philosophies in team play between the two coaches, not a change in Hibbert’s performance. A more direct and relevant example would have been to discuss Love’s aforementioned regression despite his body transformation.

The article’s most important passage reads, “Dallas Mavericks coach Rick Carlisle says the one thing he has learned in his 27 years in the league is not to judge a player by his body type. Mavericks guard Raymond Felton, for instance, is more diligent about his diet than Russell Westbrook, yet you’d never know it by a simple eye test.” So true, but these 54 words are drowned out in a 2,910-word article largely about dieting and weight. Besides, in an age in which attention spans seem to rarely exceed 140 characters, how many readers even make it far enough in the article to reach this important paragraph?

While I commend the author for taking on this topic, her article could have been so much more than it is. She could have brought to light the societal prevalence of disordered eating, eating disorders, and nutrition misinformation so widespread that they infiltrate professional locker rooms. She could have explored how the eating habits of star athletes impact the general population, especially minors. She could have addressed the dangers and damage stemming from coupling weight with performance. Instead, she did none of those.

Ms. MacMullan, an important story is begging to be written here, and I believe you can still author it. Please consider grabbing your own rebound and putting up another shot.

Day 795/326: Tennis

Posted on by
Reply

Joanne and I are grateful for everybody who has recently joined us online by liking us on Facebook, following us on Twitter, and reading our blogs. Whether you have been with us for one day or several years, we thank all of you for being part of our virtual community.

For the new folks, let me get you up to speed on a theme that occasionally pops up in my writing: the three back surgeries I have undergone, including two in the last two years, and my ongoing recovery.

Generally speaking, I am pretty guarded when it comes to talking about my own life because self-disclosure can so easily do more harm than good. However, as I headed into my 2014 operation, I decided to make an exception and document my recovery because it can be helpful for patients to remember that while our specific challenges may differ, we are coping with similar themes:

  • weighing the pros and cons of imperfect treatment options,
  • coming to grips with the reality that health outcomes are never guaranteed and only partially in our hands despite our best efforts,
  • mourning abilities or characteristics once possessed that might be gone for good,
  • accepting our new identity and discovering new ways to thrive,
  • other story lines in human existence to which patients and practitioners alike can relate.

Those of you who have followed my recovery know that my ultimate goal is to play competitive tennis again. After playing for my high school and college teams and then in adult leagues, I have been unable to compete for nearly a decade.

On Sunday, 794 days after my second surgery and 325 days after my third, I took a significant step by returning to the tennis court for the first time in three years. Unsure of what my back could handle, Joanne and I began with gentle mini tennis, just tapping the ball back and forth as we each stood at our respective service lines. No pain, to my surprise, so we backed up a little bit more into no-man’s-land. All systems still a go. Five minutes after we got to the court, we were back at our baselines hammering ground strokes to each other almost as if I never had a layoff.

Muscle memory is a crazy thing, as is modern medicine. While Joanne and I exchanged forehands and backhands, my thoughts were with everybody who contributed to my recovery: my surgeon, Dr. Jean-Valery Charles-Emile Coumans, my outpatient physical therapist, Sue Bloom, the inpatient physical therapy and nursing staff at Massachusetts General Hospital (Sorry again for pooping in my gurney, guys!), my friends, and my family, including and especially my wife.

I cannot thank them enough for helping me to find my way back home.

Court

 

An Iatrogenic Condition

Posted on by
4

Joanne and I were watching Shark Tank the other night and I found myself wondering if the negotiations and business analyses might be so bogus that venture capitalists and MBAs get a good chuckle out of the reality show. Maybe real estate agents, general contractors, and interior designers watch Love It or List It and shake their heads. Since these programs cover topics outside my area of expertise, their content could be spot on or largely misleading and I might not know the difference.

Yesterday, the New York Times exposed the Biggest Loser for some of the long-term harm it does to its contestants and the unrealistic expectations it sets for viewers. Most notably, weight regain is pervasive despite the ex-contestants’ best efforts to keep it at bay.

For myself and other practitioners who use a similar approach to ours, some of the minutiae may have been new to us, but generally speaking, the Times piece went right into our “Yeah, no sh-t” folders, as we have known the show to be fraudulent and problematic since its inception.

Having said that, it occurs to me that for readers whose expertise lays elsewhere, this might have actually been news. If that includes you, and you were surprised to learn about the contestants’ weight regain and struggles, I hope you do not feel gullible. How were you supposed to know?

However, any seasoned obesity or metabolism researchers who found themselves surprised by these results ought to be embarrassed. Data showing commonplace weight regain among people who attempt to lose it has been available for quite a while. Even some of the most ardent weight-loss supporters reluctantly admit that although we have several methods of inducing short-term weight loss, we have no idea how to produce long-term weight loss for more than a tiny fraction of the people who attempt to achieve it.

What we see more commonly, not just in Biggest Loser contestants, but in people across the board who attempt to intentionally lose weight, is ultimate weight regain that often exceeds their baselines.

As an example, consider the following growth chart, which is from a real patient of mine (All information that could possibly reveal her identity has been removed.) Looking at her chart, hazard a guess as to when her parents and doctor first attempted to intervene with her weight. Do you think it was at age 17, when she first came to see me?

Example

No, it was just after age eight, when her BMI-for-age, which was in the 92nd percentile at the time, was deemed a problem. She was naturally a bigger kid, okay, but this fact’s implications have more to do with stigma than health. The focus on weight and a belief that an intervention would help to lower it created an iatrogenic condition. In other words, her weight became a problem because it was viewed as one.

Not only was the diagnosis off base, but the attempted interventions worsened the problem. The first diet produced a slimmer 10-year-old, who subsequently rebounded into a chunkier tween. Based on the research, this was to be the most likely result. As the patient’s teenage years began, subsequent attempts to lower her weight produced similar patterns of weight gain.

They took a child in the 92nd percentile and dieted her up to the 99th percentile, and in the process screwed up her relationships with food, her body, her doctor, and her family, all of which she is now working hard to untangle and fix.

None of that was the child’s fault, nor are the parents to blame, for they were just doing what they thought was right by following instructions from trusted practitioners.

And really, I do not blame the doctor either. Pediatricians and other primary care doctors are tasked with a tremendous responsibility to maintain basic knowledge about a myriad of conditions, everything from sore throats, to sexually transmitted diseases, to early signs of cancer, but this very demand limits them from being experts in any one field, including weight regulation.

The chain of education and direction has to begin somewhere. While these data on Biggest Loser contestants might have come as a surprise to laymen, the researchers who are responsible for the foundation of our healthcare policies should have seen them coming. That it took a New York Times article to wake them up is shameful, but they sure seem to be paying attention now, at least for the time being.

He Said, She Said: Exercise as Penance

Posted on by
Reply

He Said

Data are only as useful as our understanding of them. Food labeling represents an opportunity for education while simultaneously illustrating the tremendous challenge of conveying complex ideas in a space only slightly larger than a postage stamp.

The nature of my work is one-on-one counseling, and as such, public health policy is not my area of expertise, but I can still recognize when those charged with such decisions are barking up the wrong tree. Such is the case with Britain’s idea to indicate the exercise load necessary to burn the calories in a given food.

First, remember that proclamations of calorie content are often flawed. Earlier in my career, I created nutrition labels for a university dining service as well as for cooking software. The labels that I produced reflected my best estimates based on other people’s estimates of generalities. Food manufacturers utilize a similar process to create their labels, and laws that allow rounding further cloud the picture. As the game of telephone teaches us, inaccuracies creep in with each step we take further away from the source.

Second, despite what activity trackers and cardio equipment dashboards would have us believe, estimations of caloric expenditure are similarly problematic. Your soda can may inform you that you need to run for 15 minutes to burn off the calories contained within, but this overgeneralization does not take into account your age, size, body composition, running mechanics, exercise intensity, course terrain, or any of the other variables that impact the energy that you as an individual will expend during a specific 15-minute bout of jogging.

Third, even if the data for calories consumed and burned were as accurate as can be, the implied calories-in-vs.-calories-out paradigm is an oversimplification of the complexities affecting weight regulation and overall health. Our eating and physical activity behaviors do matter, of course, but they are mere pieces in a puzzle mainly comprised of factors that are out of our hands.

Last, the presentation of a tradeoff between eating and physical activity reinforces a commonly held and problematic notion that food choices are worthy of punishment and exercise is our penance. As I recently told BuzzFeed and the Daily Meal, the good/bad food dichotomy, so prevalent in our society, links issues of morality, virtue, and guilt to our eating behaviors and is counterproductive. Nutrition and exercise activity have enough variables already without confounding them further with judgment.

A healthy relationship with food and physical activity means uncoupling moralization from such behaviors, not reinforcing the bond.

She Said

Earlier this month, Jonah and I were watching NECN when a news story came on that made us both cringe. Apparently, Britain is considering creating new food labels that not only tell the consumer how many calories are in the food, but how long the consumer would need to exercise to “burn off” that food. The proposed label would look like this: next to the calories that are listed for the food, there would be two stick figures of a person walking and running. Underneath those stick figures would be the number of minutes that someone would have to engage in either walking or running to negate the calories they consumed.

I find this idea to be highly problematic for several reasons. Firstly, as Jonah and I have written about before, the idea of “calories in, calories out,” is very much oversimplified. Most people believe that if an individual eats an extra 500 calories per day, that individual will have gained a pound of fat after a week. Unfortunately, it isn’t that simple. Numerous studies have shown that everyone processes calories differently, with some individuals getting more calories from the food they eat and others getting fewer calories from the same amount of food, resulting in some people gaining weight and others not gaining a pound.

One such study looked at identical twins and weight gain. Each pair of twins was fed an extra 1,000 calories per day for 100 days while under close observation (i.e., they were confined to a closed section of a university dorm). What the researchers found was that while the twins in each pair gained (or did not gain) the same amount of weight, there was a huge difference between the sets of twins. For instance, one pair of twins gained more than 29 pounds by the end of the intervention, while another pair only gained about 9 pounds. The conclusion that was reached was that some people are more efficient calorie burners, while others are more efficient at storing extra calories.

Aside from the fact that every body processes calories differently, I also take issue with the idea that one should be concerned with “burning off” what they are eating. In my work with people with eating disorders, there are quite a few individuals who engage in exercise bulimia. This means that these individuals will binge and then will try to compensate for the binge by over-exercising. It is a debilitating disease, and I believe that these labels would exacerbate symptoms for these individuals.

Finally, as I have written about before, I believe that exercise should not simply be viewed as a way to burn calories or to “right our wrongs.” Rather, as the Health at Every Size® principles suggest, physical activity should be a way for us to connect with our bodies by engaging in activities that we enjoy. Instead of torturing oneself in the gym to repent for last night’s cake, how about enjoying a walk outside in the sunshine to improve one’s mental, physical, and emotional health? Instead of calculating how many minutes one would need to log on the treadmill to “undo” a cookie, I think it is much healthier to use exercise as a way to feel more alive in our bodies rather than as a weight control tool.

Leave the Fat Kid Alone

Posted on by
Reply

Note: A slightly edited version of this piece appears in the April 2016 issue of Boston Baseball Magazine.

If you are like me, you wonder what the baserunner and first baseman talk about between pitches. When an athlete meets a peer, the dynamic is presumably different from an interaction with a fan that likely centers around adulation and an autograph.

When dietitians get together, chances are that at some point, we will touch on whatever nutrition-related myths and stereotypes are currently damaging our society, such as those reflected in the widespread negative reaction Pablo Sandoval received for his weight upon arriving at spring training.

Consider the following separate, but related, questions:

If Sandoval loses weight, will he play better?

Maybe, but not necessarily.

We look at Sandoval’s physique and dream about the offensive and defensive punishments he could inflict upon the league if only he bore a closer resemblance to Adrian Beltre or Evan Longoria. These fantasies have some merit, as a leaner, smaller, or lighter body can certainly have athletic upsides sometimes.

However, a significant difference exists between an athlete who naturally has a given size or shape versus someone who tries to force his body into that mold. Since weight loss does not happen by magic, we have to consider whether the behaviors Sandoval adopts in pursuit of weight loss would improve his game.

The outcome could go either way. We have seen in a variety of sports, including baseball, examples of athletes who played worse after losing weight, in part because over-exercise and/or food restriction left them depleted and vulnerable to fatigue, injury, impaired concentration, nutrient deficiencies, depression, sleeping difficulties, eating disorders, muscle atrophy, and other unintended consequences, none of which are conducive to top performance.

If Sandoval decides to lose weight, will he be able to do so?

In the short term, probably, but in the long run, he will most likely gain it back plus more.

Approximately 95% of people who attempt to lose weight will regain it one to five years down the road, and roughly 60% of these individuals will end up heavier than they were at baseline. Weight regain is common even if someone maintains the behaviors that promoted the weight loss in the first place.

Contrary to popular myth, our weight is largely out of our hands. The calories-in-versus-calories-out paradigm is a gross oversimplification of the complexities affecting weight regulation. While we might be able to manipulate our body size through behavior changes for a short while, biological mechanisms promoting weight regain almost always win out in the end.

If you subscribe to the theory that Sandoval’s weight is affecting his play, what level of performance do you expect out of him in the most likely scenario that he ends up bigger?

What does our treatment of Sandoval say about society?

Fans and media have labeled Sandoval “disgusting,” “lazy,” and “pathetic.” By the transitive property, these derogatory terms apply to everyone who has a body type similar to his.

The message is that fat is to be loathed, that larger individuals are not worthy of the respect enjoyed by the rest of us. We reject stereotypes based on race, religion, ethnicity, or sexual orientation while we inexplicably tolerate those based on body size that are no more accurate than the others, yet are just as abhorrent.

The idea that we can tell how someone eats or exercises based on his shape or weight is a myth. Some people built like linebackers never lift weights, some skinny-as-a-rail folks subsist on fast food, and some obese individuals are more active and have a healthier relationship with food than all of them but inhabit bigger bodies for other reasons.

Weight stigma oftentimes inspires people to sacrifice health for the pursuit of a size. Pressure to be thin leads to dieting, which is a predictor of a variety of problems, including eating disorders. These life-threatening illnesses are so common in Massachusetts that if the crowd at a sold-out Fenway Park represented a random sample of the state’s population, those in attendance with a diagnosed eating disorder would likely fill section 41.

Okay, but professional athletes like Sandoval constitute a different and special class of people, right?

Let’s take a step back and look at the bigger picture. Sandoval is a professional athlete because his talent, practice, and opportunities have coalesced into a skill set that lends itself to strong performance in an activity mankind recently created called baseball and he lives in a culture in which we pay such people to play it for our entertainment.

None of that means he has any more or less ability to manipulate his weight differently from the general population. Sandoval is a product of evolution just like the rest of us, and he has come into being because his ancestors’ physiological mechanisms that resisted weight loss allowed them to survive periods of starvation and reproduce while others perished. In this regard, professional athletes and spectators are all in the same boat.

Fans have every right to feel whatever emotions they may have about a player. If they want to get on someone for not performing, they can absolutely do that. However, I would encourage fans to criticize athletes for lack of production or work ethic directly rather than using body size, weight, or shape as a proxy, as the latter behavior is fueled much more by myths and stereotypes rather than science and sends a dangerous message to everyone who hears it.

BostonBaseball2016-03-27

Objective / Subjective

Posted on by
Reply

Numbers. Nutrition and exercise are full of them. We can tabulate calories and grams, measure portion sizes, count servings, and analyze food journals. Thanks to various electronic gadgets and apps, we can keep tabs on our steps, estimate our metabolic rate, and track other biomarkers.

As a guy who holds a degree in mathematics and used to work as a research analyst, nobody loves objective data more than I do. When I began my career transition and was moonlighting as a personal trainer, I made use of several physical tests – the Rockport walking treadmill, the sit-and-reach, the list goes on – to quantifiably track my clients’ progress over time. My career as a dietitian started off similarly, as I relied heavily upon bioimpedance analysis data, weight, and estimated macronutrient needs to guide my nutrition advice.

Imagine my surprise when, through a combination of additional education and experience, I realized how little these quantitative data actually matter. On the first day of the first nutrition course I ever took, the professor began with a brief survey of the social, cultural, personal, and financial factors that influence eating behavior. In our diet-minded society in which food is thought to be just fuel and any persuasions to the contrary are seen as weaknesses and sources of guilt, we easily forget how important this basic truth really is.

One of my patients recently told me that his wife purchased a diet book that emphasizes the glycemic index and she would like the two of them to begin eating in accordance with the author’s guidelines. Objectively, the glycemic index, which is a measure of how quickly various foods raise blood sugar relative to a standard (usually white bread), makes some sense. If a food breaks down more slowly, we stay full for longer, eat less, and consequently lose weight. At least, that is what the book’s author wants its readers to believe. Just aim for the low-number foods on the glycemic index chart and we are all set.

Right around the same time my patient told me about this book, another patient relayed to me an experience he had regarding hamburger buns. His parents typically made burgers on whole wheat slider buns that he thought were okay – not great, not awful, but okay – and he normally ate two or three burgers as the meat from the normal-sized patties jutted out beyond the rolls’ perimeter like a UFO. For reasons that remain a mystery to my patient, his mother decided to make burgers on normal white buns one evening. In contrast to their whole wheat counterparts, these white buns hit the spot. He had one burger, felt satisfied, and stopped eating. Turned out that for him, the white bread, which is sky high on the glycemic index, was actually the better choice and kept him from overeating.

The more I work with my patients, the more I am reminded of how the subjective is often of greater importance than the objective, that the qualitative usually trumps the quantitative. Numbers still have their place, for sure, but they really only play a supportive role. This, I have learned, is one of the most significant differences between nutrition on paper and nutrition in real life.

Healthcare For Some

Posted on by
4

IMG_1199

Yesterday I ran the Five College Realtors 10-Miler, which was my first event since last summer’s surgery and my first road race since September 2013. My time was well off my personal record for this course, which I set the last time I ran it in 2007, but I have been through quite a lot in the last nine years so expecting to pick up where I left off would have been unrealistic. Besides, it was just great to be able to race again regardless of what the clock said.

As I have written before, I owe a debt of gratitude to everybody who has helped me recover over the last two-plus years, but at the same time I think others who do not receive the same level of care from their own support systems, including their medical teams.

When I went to my primary care doctor in late 2013 complaining of back pain, I received orders for x-rays, an MRI, and a CT scan, referrals to see a physical therapist, a physiatrist, and multiple surgeons, and a collaborative discussion about the pros and cons of complementary treatments, such as acupuncture, chiropractics, massage, and neuromuscular therapy. Subsequently, I received a topical medication, oral medicines, injections, and referrals to more surgeons. Ultimately I required an operation, and then another one, more scans, and physical therapy that continues to this day.

When my “overweight” patients go to their doctors complaining of back pain, more often than not they report receiving one intervention and one intervention only, one that research shows is only achievable for a tiny fraction of the people who attempt to attain it and may not improve their condition even if they do: a directive to lose weight.

Are we not all deserving of thorough, collaborative, evidence-based healthcare, or just those of us who are thin?

Day 662/193: Collaboration

Posted on by
Reply

534151_10153919414528623_7249577384166283513_n

Thanks to a great medical team, a supportive family, a generous bone donor, and a boatload of titanium, my spine is now the healthiest it has been in years. My surgeon gave me clearance last week to resume running. Not since 2013 have I been able to step outside and go for a jog.

In addition to expressing my gratitude for everybody who has aided me, I also want to thank myself for everything I have done to help my own cause. While doing so is admittedly not the most gracious of moves, danger exists in giving the impression that we are to solely look outside of ourselves for help. Although health outcomes are never guaranteed or entirely in our control to achieve, patients who come into my office, fold their arms, lean back in their chair, and direct “Just tell me what to eat” rarely do as well in the long run as those who collaborate and take a more active role in their own care. Nutrition may be my area of expertise, but my patients are the experts in their own lives, so the highest likelihood of success comes from working together.

Anyway, my two favorite races are the Mount Washington Road Race and the Five College Realtors 10-Miler, the latter of which is coming up late next month. The other day, I mentioned to my physical therapist that I am interested in running it this year. Given that she tends to be my foil, a voice of caution and conservatism who brings reason and sensibility to my ambitious ideas, I figured she would tell me that the 10-miler made more sense as a 2017 goal. Surprisingly, she thinks the likelihood of me being able to race it next month is high. Whoa. We talked about training for the event in the context of my continued surgical recovery and together we developed a plan. In other words, we collaborated.