The Five Pillars of Good Health

March 22, 2013 By
When we talk about ‘fitness’ or ‘health’ definitions are often blurred. Inwardly the fitness industry tends to focus heavily on body composition, size, and strength, while outwardly our health service and medical industry have real concerns over obesity, diabetes, and the rapidly increasing elderly population.

There is still a major disparity between the two camps, though in reality the two are closely linked. The fitness industry by its nature seems to attract those who are younger and have less interest in the long-term health aspects of exercise and fitness. Through the rise in media surrounding how we look, rather than how we feel, it has become far more trendy to post pictures of six-pack transformations and large muscular physiques than case studies of improved health, daily function, or disease reduction.

Nevertheless, the two need not be mutually exclusive, although it is questionable that we should sacrifice the latter in search of the former. If our clients are truly in search of ‘feeling’ better, we need to take a wider look at their health and know that if they can get those aspects in line, they will not only feel they look better, but also feel better about how they look.

1) Emotional Health:personal trainer liverpool street

The increase in depression, eating disorders, stress-related illness, and dependence on medication is frightening. Our ability to change our habits and improve our health is built on a foundation of being able to emotionally cope with change, and the realisation of the need to do so. Obesity lives at one end of the eating spectrum, while obsessive eating behaviours and eating disorders occupy the other. Both are unhealthy but are all too easily formed. For many who feel a lack of control in other aspects of their life, eating habits can quickly become the anchor to which they attach a need for control. Of course, eating is not the only vice chosen. Alcohol, drugs, smoking, gambling, violence, and promiscuity all form conduits by which people try to find some escape from their unhappiness. For those wanting to make changes to their life, addressing emotional health is the place to begin. Recognising this and then taking steps to improve it is a necessary start to living a life free of unhealthy emotional attachments and destructive habits.

Tip: Many factors affect our emotional health and the reality is that we will all have to deal with difficult and unpleasant situations in our life. Adopting healthy habits and hobbies that bring us pleasure, be that owning a pet or taking up a sport, improve our ability to deal with these situations and minimise their impact on our overall health. Find something you’ve always wanted to try or experience and go do it. Searching out new and exciting experiences is always rewarding. Support this with a diet high in unprocessed foods and vegetables, healthy sleep patterns, and minimising substance/stimulant use that tend to have a depressive effect.

2) Joint Health:personal trainer shoreditch

While working out is often associated with building bigger muscles and improving muscular strength, it is far less trendy or sexy to talk about joint health. However, when our joints start to break down or are injured, the effects are debilitating. This is why we place such a large focus on flexibility when working with our personal training clients. While the benefits of resistance training are plentiful and well-established, it does carry the potential to increase wear and tear on the joints of the body. Of course, this may not manifest itself to some way down the training journey but, when it does, it will be much harder than muscle damage to recover from. Our joint structures turn over far slower than our muscles and once damaged will be hard to repair. Couple this with the effects of age, poor nutrition, and a sedentary lifestyle and the importance of attention to joint health is obvious.

Tip: Bodybuilder Reg Park (Arnold Schwarzenegger’s idol) recognised many decades ago that there was value in taking lay-offs from heavy resistance training loads. While this may be a bitter pill to swallow for those competing in strength sports, it shouldn’t be so hard to swallow for those for whom long-term health is a consideration. Breaks from high volumes of resistance training, coupled with a healthy respect for flexibility and nutrition should provide a recipe that makes weight training a lifelong pursuit. Similarly, so many people ignore the signs of poor joint health and continue to load joints through a fear of ‘letting go’ of their strength training schedule. Stretch tight areas, improve range of movement, and allow rest and recovery when joints start to tell you that they need a break. Activities like yoga, pilates, and tai chi can be a fantastic balance for heavy resistance training.

3) Digestive Health:

The digestive system is a powerful window into our health. Modern research is identifying the role of the various elements of gut health and are even starting to show links between digestive flora and obesity, plus we all know the effects that stress, anxiety, or excitement can have on our stomachs. Our digestion can also suffer when confronted with foods that provide a greater challenge than it was originally designed for. Diets high in wheat, gluten, refined/processed foods, all increase the burden on the gut to effectively break down and absorb nutrients, which can affect everything from our mental health (95% of our serotonin is found in the gut) to simply cramping our social life when suffering from bloating and stomach ache. It isn’t just our diet either that can cause digestive problems. Prescription medication often has detrimental impacts on gut health, ranging from the damage caused by NSAIDS to our stomach lining to the effect of antibiotic use on digestive flora.

Tip: If you suffer from poor gut health, an elimination diet can be a useful way to determine what causes you problems. Taking out key troublemakers such as high wheat foods can often have an immediate impact on improving digestion. Often including foods like pears, nectarines, and prunes can help smooth digestive transit along with a good intake of water. Try to avoid using over the counter medication where possible, in particular known gut irritants like Ibuprofen.

4) Metabolic Health: personal training shoreditch

With so many of our clients attending regular health screenings and operating in high stress environments it would be foolhardy to be ignorant of metabolic markers of health. From aerobic capacity through to blood lipid levels, these tests can provide insights into the possible risk of long-term health problems. It is a shame that these medicals give little attention to measures of inflammation and blood triglycerides, which to me would seem more pertinent as the paradigm surrounding heart disease risk gradually starts to shift. Aside from that debate, blood pressure, waist circumference, and resting blood glucose provide an excellent insight into our clients health and we have consistently seen these drop markedly in our clients with a bit of attention to diet, a reduction in alcohol intake (note total abstinence not required), and the addition of some cardiovascular exercise, which our clients enjoy both the physical and psychological benefits of despite its vilification in recent times by countless fitness experts and personal trainers.

Tip: Metabolic markers of health can often be considerably improved with simple and easily sustained changes to diet, lifestyle, and exercise habits. Reducing alcohol on several days of the week, lowering sugar and starch intake, taking some exercise over the weekend, and managing stress all combine to have a powerful effect on improving health.

5) Dental Health: 

The last part of this little post is to look at dental health and the emerging data linking heart disease and dental health. I won’t get into all the hubbub surrounding fillings and heavy metal poisoning etc; it’s way beyond the scope of this post and I’m way under qualified to comment on it. However, one thing is for sure and that’s that we only get one set of adult teeth so we had better look after them. Many habits that affect our health negatively can also impact on our dental health causing tooth decay, gum disease, discolouration, acid erosion, and bad breath. All equally bad news, but a very quick and easy way to get a window into someone’s overall health is to look inside their mouth. Stress, anxiety, and stimulants can cause teeth grinding (the official name is Bruxism) which also accelerates the wear and tear on our mouth. In a 2010 study, those participants with the worst oral hygiene routine were 70% more likely to develop heart disease compared to those who cleaned their teeth twice a day. Whether it is causative or simply correlation remains in debate, in a similar way to how we should be viewing cholesterol in reality. However, gum disease (gingivitis) is an inflammatory condition and modern health research is showing us that for many years inflammation has been the elephant in the room when it comes to heart disease.

Tip: Brush your teeth twice daily, preferably with a electric toothbrush and careful attention to teeth, tongue, and gums. Get teeth professionally cleaned by a hygienist twice a year, and avoid habits that damage teeth, such as smoking and fizzy drinks.

So, there you have it. Five pillars of health that when combined give an insight into our overall fitness outside of the now more mainstream measures of BMI, Body Composition, or muscularity. What’s more is that very few of these require much effort to monitor or measure, with the exception of some aspects of our metabolic health that can be easily tested with home kits or via private medicals. Address, and in turn improve in, all the above areas and it is highly likely that you’ll see an accompanying improvement in how you look, feel, move, and function as our body remodels itself to the demands placed on it.

Often health improvement is less of a consideration or motivation for many taking up exercise, but for those clients we see at our City of London studios it will often be a high priority as they notice their decreased ability to cope with the stresses of the modern workplace and lifestyle surrounding it. As with much of our work, simple changes can have profound effects. Tackling the ‘big rocks’ within our clients lives, and strengthening them through intelligently applied resistance and cardiovascular training provides a platform for them to continue to enjoy their work, families, and leisure time.

Filed Under: Blog, Fitness Tagged With: , , , , , , , , , , , , ,

Health in the City: Dreams vs Reality

February 27, 2013 By
Graeme at our latest successful corporate health and fitness seminar

Graeme at our latest successful corporate health and fitness seminar

I recently went back to the city law firm where I gave my first ever talk here on nutrition and training, almost ten years ago and while the faces are different the questions tend to remain the same.

The public now seem more confused than ever, and it isn’t just them – the over-sciencing of nutrition by those seeking to become gatekeepers of information on this topic is making the waters more muddied instead of less. Meanwhile, the obesity bandwagon marches on, with British women on target to be fatter than American men by 2030.

As with most things Occams Razor can be applied to 99% of nutritional and weight loss cases. Very rarely is their problem down to some kind of spurious ‘imbalance’ or a deficiency in some sort of magical amino acid. In fact, all too often it is their psychology that we need to consider ahead of their physiology in all but the more extreme clinical cases involving specific and diagnosed pathology.

Looking at the folks I’ve worked with here in the City for over a decade now I’ve come to a few fairly solid conclusions. These have been borne out by practical experience rather than studying the books, although I’m reasonably confident that current research into the psychology of behaviour change will back most, if not all of them up.

So, in no particular order here are a few thoughts…..
  1. Compliance is everything. Consider this first. The likelihood of someone’s ability to change their behaviour to your recommendations is directly related to their perceived ability to do it. If it all sounds too much like hard work then it isn’t likely to happen at all. Personality type is rarely ever considered, but for example, entrepreneurial and very creative people struggle with organised routines requiring high levels of self control, whereas a highly organised lawyer or trader may seek that exact approach.
  2. Where and how people eat is as important as what and why. The first two tell you a lot about the reasons behind the latter two. Changing diet is about changing habits, eating in front of the TV and social eating are two environments prone to overindulgence, irrespective of actual hunger. Look at where and how people eat first.
  3. Sleep and recovery drive the ability to train and eat well. Without good sleep both our food and training suffer. It builds reliance on sugar and stimulants, reduces work capacity, impairs how we feel and function, and generally makes us feel crap. It is the first and easiest way to break people down by depriving them of sleep. If sleep is poor then fix it first and if prone to long days travelling then build in strategies to help deal with it.
  4. Temptation is the hardest thing to avoid and all too often clients are faced with the temptation to drink and eat when if left to their own devices they probably wouldn’t. Try to build in some solid plans of action for when these scenarios come up “If we go for drinks I”ll keep to non-alcoholic till I’ve eaten” or “I’lll ask for a vegetable option instead of chips or pasta”. Keep away from the unhealthy choices, if there is cake in the office, keep it in the kitchen rather than next to your desk where you are more likely to succumb to a piece (and if you are breaking a diet, you’ll probably go right off the rails and have several).
  5. ‘Dieting’ requires almost constant conscious thought and willpower to maintain, only those with the highest motivation and strictest level of self control are likely to stick to them. Those who fail tend to gain back more weight than they started with. Instead look at simple habits that over the course of a longer period of time (think in terms of months and years rather than weeks) that can be more beneficial. For example, trying to just give up bread consumption can often be achieved and often can bring great results. Once ‘not eating’ something becomes a habit it is much easier to maintain.
  6. Use simple and easy methods of tracking weight and body. No need for complex measurement systems, regularly measure weight and waistline and you won’t go far wrong. Unless you are preparing for a competition – and even then, how you look will be more important than any numbers on a chart. For my clients in the city I am more interested in their blood lipids, resting heart rate, and blood pressure as a guide to their health.
  7. Seek out habits that bring happiness. Dieting is miserable, just ask any pre-comp figure athlete or bodybuilder. Instead look for habits that make you happy and your capacity for improving your food and lifestyle will raise too. Dancing, walking the dog, playing sport, or simply taking a stroll with a friend – they may not burn the same calories as an hour of interval training but they bring many other far more wider ranging benefits (and are a lot more fun too!).
  8. Give yourself a break, you don’t have to eat cake every day but you’re far more likely to stick to your habits if you know that in a couple of days you are out with friends and able to relax and enjoy a piece of cake with them then. This has been proven time and again to be a more effective strategy than total abstinence. It is naive of any trainer working with the population that I do to think that they will live saintly in your absence. They will more likely just hide this information from you, especially if it is received with condescension and a telling-off. Work with what you have got, find solutions WITH the clients that they feel confident and happy to try and over the longer-term you’ll see a progressive improvement in health, fitness, and happiness.

We’ve been working with these approaches for years now at The Foundry, and while we may not specialise in putting people on stage in their swimwear, we do know how to ensure that our clients go to their medicals and achieve results that would look good for people half their age. As with anything, there are universal truths about training and nutrition, but how you communicate these will often need to be measured and delivered differently.

There is no one right-way, though there are many wrong ways. As a trainer, I look for every little win and I am sure to do my best to highlight it and focus on it with the intention of creating a habit. I am also realistic about the lifestyles my clients lead and believe that the first stage to achieving better health is an honest appraisal of current health and a desire to want to improve that, without that well-intended advice is too often wasted.

Filed Under: Blog, Health Tagged With: , , , , , , , , , , , ,

Seven Top Tips For Training In-Season

February 25, 2013 By

find rugby now east londonFoundry Director Graeme Marsh was recently asked to put together his top tips for training in-season by the excellent rugby resource website FindRugbyNow. For the original article, please go to  and please find a copy of this article syndicated below.

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I was recently asked by a new member at our East London training centre, Foundry:east, to take a look at his current training programme, which he had downloaded from the internet.

I was curious as it was the very definition of high volume with over 30 sets of work per workout, but ever the diplomat I asked, “How are you getting on with this?”. He replied, “Man, it is wiping me out. I can’t do anything after it and I’m knackered before the game even starts”.

It wasn’t that it was necessarily a bad training programme. In fact, if he had been a 22-year-old bodybuilder on anabolic steroids looking to add serious mass, then he probably would have seen some good progress on it.

What it did, however, was illustrate perfectly how you need to adjust training programmes during the season to reflect the demands that field training, games, and life in general can have on the body.

Too many amateur players try to sustain a regime that would be draining in the off-season, let alone during it. So, with that in mind here are a few tips for anyone looking to develop their strength and power during the season and how to avoid making some of the most common mistakes.
    1. Do less to get more: It is unrealistic to expect to be able to sustain a high-volume programme during the competitive season. Game and practice time will make recovery from long, high volume training sessions near on impossible for all but the most hormonally blessed players. The actual amount of work needed to develop strength and power is lower than many think, but the intensity is key.
    2. Put your effort where it brings the best returns: To develop or maintain strength concentrate on the intensity of your lifts. The bulk of your time should be spent on movements that target the high-threshold motor units (key for strength and speed) and recruit the most muscle. To do this incorporate a mixture of plyometric movements (jumps, bounds etc), olympic style movements (clean pulls, Snatch pulls etc) with high-intensity loads in the big lifts (below 6 reps per set) as the mainstay of your training. Game and training time should keep pre-season fitness, but if not, keep CV work low in volume and energy system specific.
    3. Let your recovery dictate your training: If you had a hard game, took a lot of hits and played a full 80 minutes then you may need longer recovery before hitting the weights. Similarly if you only had a run out for the last 15 minutes then you may be able to hit the gym monday morning feeling fresh. Be flexible in your week to week planning and adjust what you do to match your ability from week to week. If you feel tired and beat up, take a sauna and then stretch, you’ll feel the benefit and come back fitter and stronger. Too many guys are emotionally attached to their training and determined to keep lifting like a full-time bodybuilder through the competitive season.
    4. Listen to your body and watch for signs of overtraining: Too much work with inadequate recovery will eventually lead to overtraining, which can take a long time to fully recover from. If you start to see weights going down from week to week, every weight (even the empty bar) starts to feel heavy, if sleep is poor and you wake up feeling heavy and tired after a full 8 hours, and you feel performance during the games suffering then you need to check that your training isn’t contributing to this. Don’t be afraid to build recovery weeks in to your training, so few people actually do this for fear of suddenly getting weaker or smaller, where the opposite is more likely to happen as the body gets time to rest and adapt.
    5. Keep things simple: The aim of your gym session is not to try to spend a load of time and effort on pointless ‘sport-specific’ exercises that are currently popular in the fitness media. Wobbling about on Bosu balls or doing the latest ‘functional’ craze is merely a waste of time that could be spent actually getting stronger or stretching and recovering from the weekend’s game. Stick to the fundamental movements of deadlifting, squats, presses, pulls, and rows and you won’t go far wrong.
    6. Put recovery methods in your training: Stretching is practically impossible to do too much of, but it is the most neglected aspect of most people’s training. A lack of adequate flexibility will lead to increased risk of injury, muscle imbalances, and a lack of any real progress in training. Being big and strong is pointless if your hips are so tight that your speed is impacted negatively and your lower back exposed to increased injury risk. The current trend is to only stretch after having done the rest of your training, but this means that stretching is generally done poorly, with minimal focus and therefore negligible results. Ideally dedicate separate time to stretching work as it can be done anywhere, but if time is an issue (which for most it is) we tend to do it first.
    7. Work with a trainer who knows their stuff: If you can then invest in some time with a professional coach who understands how to design training programmes for you that will address the above points. It isn’t rocket science, in fact it is largely common sense. Having a good coach will give you accountability, external feedback, guidance on correct technique, and someone who can monitor your training performance allowing you to concentrate on simply training hard and recovering effectively. Our team at Foundry:east specialise in working with active busy professionals on this, you can find out more at www.foundryfit.co.uk.
 Remember, life isn’t linear and neither is training. Too many factors can conspire to mean that it won’t work out like the magazines, articles, and textbooks say it will.

Many factors can impact on finding the right routine that works best for you. These include: age, nutrition, sleep, stress, work, relationships, hormonal status, training age, playing position, level of competition, etc. All of these factors can all have an influence and should be considered when designing a training plan. 

 

Filed Under: Blog, Fitness, Sport

Intermittent Fasting (IF) and the 5:2 Diets

November 19, 2012 By

lose weight personal training londonDieting dominates the popular media and it seems like every month the glossy magazines find another celebrity diet fad to report on. From Maple syrup to cabbage soup these are mostly ridiculous, unhealthy, impractical, and almost impossible for anyone with a normal life to follow.

Still, people do try, and they hop from diet to diet like a gym room newbie will hop from training plan to training pan in the hope of finding that magic solution. Most people end up depressed, with digestive and metabolic issues, and often worse than they were when they started out. However, in August, the BBC’s Horizon programme covered an approach to weight loss that is regaining popularity, and not without good reason.  The presenter, Dr Michael Mosley, who seemed in a rather poor state of health for a doctor at the outset, put himself forward as a human guinea pig to trial intermittent fasting (IF) with some remarkable results.

What Makes A Successful Diet?

fat loss personal trainer london

Chronic voluntary restriction of any sort is difficult if not impossible for most and it is generally only the most obsessive and neurotic that can maintain extended periods of dieting. It is no wonder that in diet studies the drop out rate can often be well over 50%.  This is also the reason that initial weight loss typically occurs over the first three months followed by a steady period of regain. In many ways the success of a diet isn’t really measured by how much lose, but about how little of it you put back on.

When it comes to successful weight loss, compliance is certainly 9/10th’s of the law and, as  a trainer, finding the right eating plan to suit your clientele is part of the biggest challenge. The research is clear that the lower people’s own confidence in sticking to an eating plan, the lower their chances of success, so it always merits looking at new (or not so new) ways to approach this and over the years I have experimented with just about all of them.

Quality Over Quantity?

Over recent years the trend has been more towards the quality of food, rather than the quantity, and ‘Paleo’ diets have been the popular weapon of choice. Caveman eating though presented some real problems for my typical client; traveling, socialising, work and family eating meant it was often difficult to maintain a truly paleo style of eating and lapses were inevitable. Without the need to get ripped for a magazine photoshoot or topless stage appearance it can be hard to maintain rigourous dedication to such diets in the face of corporate hospitality, work drinks or a dinner guest’s lasagne.

What’s The Role Of Psychology?

Another challenge of dieting, whether that is Atkins or Ornish, is the need for every single food choice to become a conscious one, which for most of us is a long way from what really happens. Dieting and weight loss as a process becomes one largely related to our psychology as much as our physiology as it is our thoughts, habits, and behaviours that tend to dictate how we eat.

Jane Ogden’s research at Surrey University discovered that we make most of our choices on food sub-consciously, which would explain why many people simply find dieting itself such a huge cognitive effort. All of a sudden they need to think about every single meal; how many carbs does this have? Is it paleo-compliant? How many calories are in my latte? Does that come with dressing on the side? It gets tiring. Aside from the tedious nature of continuous dieting, recent research suggests that it may be just as beneficial to diet for shorter periods interspersed with periods of maintenance or to first understand the skills needed to maintain weight, before embarking on a long-term diet.

So How Does Intermittent Fasting Differ?

Intermittent fasting (IF) approaches such as the 5:2 diet offer an alternative approach to the typical diet plans that require wholesale changes in how we shop, prepare, and eat our food. IF offers a potentially very simple way to improve our diet and health by introducing periods of low (or in some cases none at all) calorie fasts into the week. Some approaches, such as Fast-5 or Leangains prefer to use a daily format (fasting for 18-19 hours and then eating for the remainder) while others, such as Brad Pillon’s Eat Stop Eat or PhD Researcher Dr Krista Varady’s Alternate Day Fasting (ADF) combine cycles of ‘regular’ days with ‘fasting days’.The 5:2 diet is closer to ADF and E/S/E than the aforementioned methods and uses 5 days of ‘regular’ eating and 2 days of low-calorie ‘fasting’ where calories are limited to around 500-600 per 24 hours (or around 25% of basic daily needs). Eating on regular days is as per normal, and surprisingly early research shows that people don’t tend to binge the day after despite being free to eat as much as they choose. It may well even be that the reduction in ‘need’ to eat healthier means that people choose to eat better options more often without feeling compelled to have to do so at every meal.

More Importantly, What Does The Research Say?

Research is still quite young into these methods (I haven’t been able to find any specifically on the 5:2 format used by Dr Moseley in the BBC programme), with real long-term studies on large groups lacking, but what is there is indeed very encouraging and not just for weight loss but also for a wide range of health parameters including anti-aging and heart health. A thorough literature review and explanation of the science behind IF is well beyond the scope of this blog post although I have posted a few links below where you can find a lot more information if you are so inclined and here is a link to one of the studies authored by Dr Varady herself: http://www.nature.com/oby/journal/vaop/ncurrent/pdf/oby201054a.pdf

However, for the people that I train the real appeal of this style of diet is in the simplicity of it and the ease of application. Fasting days can be set up according to travel, work, and social schedules, and the reduction of emphasis on eating ‘clean’ at every single meal throughout the week increases the client’s belief in succeeding and sticking to the plan.

With many of my clients already eating a good quality of food, the biggest challenge has often been how to get them to eat (and drink) a little less and IF offers a possible solution to that challenge. Like any diet there will be those who try to take it to greater extremes, fasting for longer, eating less, combining it with another diet, etc and while I encourage you to experiment yourself with this I’d advise you stick to the simple 5:2 format to start with, and ensure you eat adequately on your ‘normal’ day. With exercise, it depends on your training goals to some extent although I will always prefer training fasted and aiming for a good meal post-training than the other way around. How and when you train will dictate how you set this up, along with your lifestyle and work etc. The ADF studies all began their fasted days at midnight but you may wish to move these times according to your training times or work shifts, the key is the 24 hour window on an intake of around 25% of your daily base calorie requirement.

In Conclusion

I could have written an epic on this topic and still not done it justice. I haven’t even looked at other cyclical diet methods or addressed the many potential problems and pitfalls surrounding any diet, that is an entire book in and of itself. However, IF offers a real alternative to the conventional approach to dieting that involves continued long-term calorie restriction and for most, as demonstrated by the patterns of weight regain seen, ultimately ends in failure.

IF also offers a range of other benefits in terms of simplicity and ease of compliance and while it may lack the evidence base of more established weight loss approaches, there is good scope for its future use in appropriate populations. Could IF also encourage unhealthy patterns of eating behaviour such as binging or purging? Perhaps, but there is no evidence, anecdotal or otherwise, to suggest this is the case.

There are already many different methods on how IF is used and the best bet is probably to select the one you will find easiest to integrate into your existing schedule and training plan.

Links:

John Berardi of Precision Nutrition put together an excellent ebook on the topic http://www.precisionnutrition.com/intermittent-fasting/summary
LeanGains and the various musings of the vocal Martin Berkhan can be found here http://www.leangains.com/2010/04/leangains-guide.html
Get yourself a copy of Eat, Stop, Eat here http://www.eatstopeat.com
Watch the BBC programme on the topic here http://www.bbc.co.uk/programmes/b01lxyzc
Filed Under: Blog, Health, Nutrition Tagged With: , , , , , , , , , , , ,

Part 3 – Obesity Crisis – Is exercise part of the problem or part of the answer?

October 17, 2012 By
Much has been written by various experts, journalists, and researchers about the role of exercise in treating obesity and for weight loss in general. Some of it is close to the reality, while increasingly more and more of it is spurious, unfounded, non-evidenced, magic fairy dust rubbish created all too often to sell products, pills, supplements, or training methodologies.
In several articles exercise has even become the pariah of weight loss with some outlandish claims being made about all sorts of negative effects, again without any kind of substantive evidence to back these up. Read these sensationalist headlines with great care and scepticism. However, it isn’t just the Daily Mail behind this, even eminent science writer and author of Diet Delusion Gary Taubes has been quick to dismiss exercise for its effect on food consumption, asserting that exercise simply makes people eat more. An idea that is far less straightforward as it turns out when the evidence is reviewed. Taubes isn’t the only one; John Cloud’s provocative piece in Time magazine rubbished the benefits of exercise (mainly due to his own inability to resist eating a doughnut afterwards), and Emma John (Observer) and Sophie Morris (Independent) have both written pieces with a similar message.
Researching exercise*, its effect on weight loss and applying that research to the general population is a serious challenge. Studies that rely on self-reported data are immediately vulnerable to the sad truth that people tend to grossly overestimate their activity levels, while similarly underestimating their food intake.
Monitoring food intake, energy balance, NEPA (Non-Exercise Physical Activity), and other lifestyle factors makes getting truly meaningful research very difficult. This skews results horribly and may well be a reason that the role of exercise in weight loss has been so understated over recent years. Lab studies have shown a bit more promise but leave us with another problem when it comes to prescription, in that without supervision most people simply will not stick to such rigorous routines and protocols.
It was only a few years ago that the UK fitness industry jumped on the ‘Tabata Training’ bandwagon in an attempt to market a new form of training as being the magic bullet for, well just about everything including weight loss. Of course, Izumi Tabata never even measured body composition in his study, it was a study aimed at improving aerobic fitness using a 4-minute anaerobic training format that involved cycling to exhaustion for 8 x 20 second bouts. This didn’t stop all kinds of ‘Tabata fat-loss’ classes cropping up everywhere replete with misleading and incorrect information that tapped into that human desire to want to achieve more for less. As we will see, while it may be a more time efficient way for trained people to improve fitness, high-intensity interval training is of little use to the obese person. I’d venture that many of those who advocate these protocols have little or no experience of working with the obese population.
Contrary to the journalistic despair at the sheer pointlessness of it all, exercise can in fact positively affect risk factors for health irrespective of weight loss: blood pressure, insulin sensitivity, triglycerides, cholesterol, bone density, mood, anxiety, depression, stress reduction, self esteem, recovery from injury and illness, occupational performance, shorter labour times and improved pregnancy measures, fasting glucose levels, and reduction of chronic pain, have all been shown to be positively affected by the introduction of exercise. A sentiment further echoed by the Cochrane Collaboration report on Exercise for Overweight and Obesity (http://summaries.cochrane.org/CD003817/exercise-for-overweight-or-obesity)  that concluded that:
The results of this review support the use of exercise as a weight loss intervention, particularly when combined with dietary change. Exercise is associated with improved cardiovascular disease risk factors even if no weight is lost.
As we have already discovered in Parts 1 and 2, this subject is far more complex than the media and many of the pundits on the topic would like you to think, and I am about to illustrate that.
Exercise seems to have wildly different responses in different people. Unfortunately this information is often lost by people reporting (at worst) based on the abstract of a study rather than the entire study or (at best) a reporting of the mean data and not the individual results.
Luckily (and you might have just seen this coming) someone spotted this and decided to look a bit closer at the data and what actually happens. Here is a link to the complete study, the full text of which I have sitting in front of me (courtesy of the author himself, Prof. John Blundell). It is well worth a read:
Now, firstly this is a fascinating study with an excellent and very accessible discussion section that I encourage you to read in full yourself. In this study they took a group of 35 overweight men and women and got them doing 5 sessions a week of supervised exercise (in this case various formats of ‘cardio’ ranging from steppers to rowing and treadmills). Sessions were measured individually to produce an expenditure of 500kcal per session. According to energy expenditure vs intake calculations measured at week 0, it was anticipated that a weight loss of around 3.5kg could be expected over the 12 weeks.
Guess what, after 12 weeks the mean weight loss was 3.7kg (+/- 3.6kg) so about as expected. However, when the results were looked at on an individual level things got a lot more interesting. At one end of the spectrum subjects lost as much as 14.7kg of weight, while at the other end several subjects managed to gain weight (albeit very small amounts). Overall though, just about everyone (with the exception of four individuals) lost weight, some more and some less so than others…however, even those who gained weight tended to lose fat and mostly gain lean mass as the below chart from the paper shows, only three subjects in the entire study gained body fat.

The study’s authors go on to discuss some interesting theories and findings. One finding in particular was that those Non-compensators (those who tended not to increase energy intake in response to energy expenditure) tended to be heavier and fatter at the outset compared to the compensators (those who lost less weight than expected and tended to increase energy intake). One theory being that when exercise threatens lean mass (as it does in those only carrying a few extra pounds…) it drives the need to increase energy intake more than in those with an abundance of excess calories in body fat.

While this notion is an appealing explanation I am not sure it is only the mechanism behind this, although it does make intuitive sense. We do also know that in some people there is a tendency to ‘reward’ exercise by being less active throughout the rest of the day, which can reduce potential weight loss results. This reward mentality does seem prevalent and is a strong driver for the argument that psychology is a prime factor in obesity. Studies looking at eating behaviour, such as those by Jane Ogden at Surrey University have shown how certain environments and situations can influence eating, often unrelated to our actual hunger. Simply eating in front of the television has been demonstrated to increase overeating irrespective of actual reported hunger levels.

What this study does confirm is that in some people doing exercise and losing weight can serve to increase hunger, while in others this response is far less pronounced and in some non-existent. However, this does not mean that exercise makes you fat or even makes you eat more, far from it in fact. Firstly, even in the group who were compensators in this study, most of them still lost weight. Secondly, and perhaps most importantly, these subjects were allowed to eat as they pleased during the 12 weeks. Had their food intake been as strictly controlled and supervised as their exercise routine then I am very confident that the results would have been different (not to mention further proof that exercise does in fact work for weight loss when eating is controlled). Perhaps if this had been taken a step further and the study participants had been counseled on behaviours to avoid overeating, such as not eating in front of the television, then the results may have been even more pronounced. What if their sleep habits had been studied alongside the exercise? Would we have seen further improvements by attempting to improve this given the very clear relationship between poor sleep habits and weight gain?
What the studies are clear on, is that exercise is a key factor in the maintenance of any weight lost and that the addition of it to any dietary regime seems to be an overwhelmingly positive addition given its effects on mood, sleep, confidence, depression, fitness, health risk factors, bone density, metabolic rate, and stimulation of lean muscle mass.
What is capable versus what is optimal?
When it comes to working with the obese population and looking at exercise strategies it is really a case of what people will actually do versus what might be ideal. Given that the biggest benefits to the health of the population come from getting the sedentary folks moving and not from getting the already fit ones even fitter, we should be targeting the obese, in particular those who are totally sedentary, with far different strategies to what we advise an established trainee.
If our target is to address the public health aspect of obesity then a reduction of the continual emphasis on exercise as solely a weight loss tool would be wise and instead more efforts to promote the overall health benefits would be a better option. It seems to me that there are many who are relatively apathetic about their actual weight, but are concerned about their overall mental and physical health and approaches exclusively aimed at weight loss will alienate these rather than include them. Health related goals are also far more tangible and should not be viewed as a by-product of weight loss, but rather the other way around.
In terms of actual protocols, it seems conclusive that a combination of aerobic exercise, resistance training, and diet seems to have the widest reach in terms of overall health benefits and weight loss. Frequency of actual exercise is a key factor in predicting positive outcomes and has a strong inverse relationship with exercise intensity.
If advising someone to exercise who is unsupervised and currently sedentary then simple and achievable is the way forward, there is little need for complex interval training routines or resistance training formats. The less the participant perceives their own ability to complete the routine the greater the chance that they will give up and return to their former weight. In contrast as someone begins to exercise and experiences benefits their capabilities will increase and their perceptions will alter, then the training can be progressed accordingly.
It is all too often forgotten that the sedentary obese person will rarely have the joint and muscle integrity to withstand intense training at the outset anyway and any over-zealous routine could well be injurious, potentially setting the person back further than when they began. Despite this, many shredded fitness professionals (you know the types with their topless pics as avatars and disparaging attitudes towards anyone overweight) like to criticise simple approaches and continue to advise routines online that are inappropriate and show a poor level of both empathy and understanding. Expertise in bodybuilding does not constitute expertise at training obese people.
Although interactions at a biochemical level are complex, exercise has clearly been demonstrated to have a positive effect on those seeking to lose weight. Some types of exercise seem more effective than others, swimming for example has been shown to raise appetite and hunger substantially compared to running.
This effect though may be small in those who fail to give attention to other aspects of their lifestyle, while in others it may be more pronounced, albeit still below what people may be expecting for the time invested. Individual responses to exercise seem widely variable, and while it may cause some to eat more this view simply isn’t born out in the evidence as Professor John Blundell elegantly states in a meta-analysis on the topic:
Only 19% of interventionist studies report an increase in energy intake after exercise; 65% show no change and 16% show a decrease in appetite. Of the correlational studies, approximately half show no relationship between energy expenditure and intake. These data indicate a rather loose coupling between energy expenditure and intake. A common sense view is that exercise is futile as a form of weight control because the energy deficit drives a compensatory increase in food intake. However, evidence shows that this is not generally true.
As part of any nationwide intervention to address the obesity epidemic, exercise is a valuable and, in my opinion, an indispensable aid. By encouraging more sport and play in our young children we can help set a platform by which a healthful way of life becomes normal, without it always being connected to the images of ‘health’ in the media that tend to be only driven by the next skinny model or celebrity diet.
In adults, exercise can bring people together within communities and with the right prescription it can offer everyone a platform to succeed in improving their health and experiencing a better quality of life. It can have a massive effect on improving disease markers and can help with weight loss, although weight loss is not a pre-requisite for the health benefits. The actual what and when of the exercise aspect are very simple, it is getting people to do it and keep doing it that remains the complex part of the equation.
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Part 2 – Obesity, Where Do We Even Begin

October 10, 2012 By

In the first part of this series of articles, we took a look at the real extent of the obesity crisis and its worrying implications on the healthcare system. Even as I sat discussing this in my favourite Shoreditch eatery the other night it boggled my brain at the complexity and difficulty in finding a starting point for dealing with it. If nothing else you should hopefully have realised that the expanding waistlines of the UK population are not going to be fixed by any facile advice, no matter how well intended, to ‘eat less’ or ‘take more exercise’. You should also have realised that the standard (they might not like you to think they are standard, but they really are) mantras of the fitness industry probably aren’t going to do a whole lot of good either, again despite their generally good intentions.

If you had the time or the inclination to read the Foresight report you’ll also now have an appreciation of how this topic is at best vastly oversimplified, or at its worst how aspects of it are ignored. So many factors (Foresight identified 108 of them) can contribute to obesity in any given population and can often be entirely different across nations.

One of the paradoxes that we can see globally with obesity is its relationship to income. In developed countries like the UK and the US, obesity still remains highest in the lower socio-economic groups. However, in developing countries such as Brazil obesity is seen to rise as people can start to afford to increase food consumption, particularly of sugary, fatty, processed foods. This is particularly prevalent in kids as shown below, but it isn’t exclusive to them. As Brazil’s GDP increased the poorest women went from being the thinnest to the fattest in just 20 years. The speed of that transition is frightening. This has definite implications for strategies to try and prevent the increase of obesity, which I’ll expand on later.

Even the researching of these issues across populations is difficult. Meaningful numbers requires the use of large self-reporting surveys and it is widely acknowledged that people have a habit of overstating things like activity habits while understating nutritional ones. However, in one European country it does seem they are having some success in at least slowing the seemingly inevitable increase in obesity. If you read my first piece thoroughly then you may have noticed that while every country started moving inexorably upwards in the early 90‘s, Finland didn’t and their success with the North Karelia Project, which was actually aimed at reducing heart disease, shows that there is some hope. So, the question now is how we actually go about dealing with it.

What can we do about junk food?

McDonalds largest restaurant in the world was recently built on the site of the 2012 Olympics, right here in London and the signature golden arches of this global food giant have become a common feature on every high street in the UK. The spread of McDonalds into developing markets may well signal the beginning of a shift in those countries own obesity levels as the convenience, speed, and marketing of fast food becomes within economic reach of the poorer parts of the population.

There is even a ‘Big Mac’ index that can correlate the amount of labour hours required to be able to buy a Big Mac with the levels of obesity in that country. The less work required, the fatter the population. It is an indictment on the brand that only a few years ago attempted to introduce ‘healthier’ options onto its menu and whose latest ‘healthy’ addition is somehow classified as one of your ‘five a day’, despite the fact that a 500ml cup contains almost 50g of sugar. Needless to say, as the convenience food becomes even cheaper and even more convenient, less and less people are eating at home. The concept of a family meal now all too often revolves around a trip to the nearest fast food outlet.

Of course, it isn’t just McDonalds who are producing low-cost, high-margin, energy dense, nutrient poor, food for the population. As global demand for food has grown and consumer competition increased, the giant corporates behind food production and retail have striven to increase margins on their foodstuffs, robbing them of nutrients, driving intensive and non-sustainable agriculture practices, and indulging in all manor of nefarious practices. From loss-leading on known-products to blocking food labelling, the interests of these organisations currently sits at odds with the nations health. The brilliant journalist Felicity Lawrence has written about this in her excellent book Not On The Label; I’d urge you to read it.

The question is though, what can we actually do about it? Well, various options have been raised from increasing taxation on ‘junk’ food to restricting marketing and advertising. The latter is a major challenge, given that the food industry spends a voluminous amount on the marketing and brand positioning of their product. The recent Olympic games was a great example with some even suggesting that the games couldn’t run without the support of McDonalds and Coca Cola (both who contributed around £64m), Cadbury (good for £20m) and Heineken (another £10m) to name but a few.

Compared to the government budget on public food education, who in 2004 spent a grand sum of £7m, it is no wonder that the message of the fast food providers is taking precedent. However, this marketing is insidious and in places many of you may not even know exist. Take for example this website http://www.happymeal.com/en_US/index.html#/Games a blatant advertising site (you can tell by the trite warning to ‘kids’ in the top left corner) that is capturing children at an early age to identify with the fast food brand. This site for the nutritional powerhouse that is Reeses Puffs (http://www.reesespuffs.com) is even worse. Hit Mixer and get audibly assaulted with an incessant rap of ‘Reeses puffs, Reeses puffs..’ all set to a hip hop beat….catchy isn’t it? One area the government could target is junk food marketing aimed at children, yet they remain reluctant to do so.

The government did step up in 2009 launching the Change4Life campaign with a budget of £75m (still only 10% of what the food industry spent in 2004 marketing their products) only to pull the plug on it just a year later, rejecting the notion that children needed education and that instead it was the over-40’s men that was a better target. Originally slated to run through to the 2012 Olympics, the Change4Life campaign only made it a year. It is clear that the politicians prefer to see obesity as a social problem and not a government one that can be solved through legislation or regulation. Even the use of a watershed time for junk food advertising is an unpopular strategy with OFCOM highlighting the lost revenues to the broadcaster from imposing such restrictions.

There is little doubt though that the marketing and advertising of these junk food products to kids is at the heart of our obesity problem. Alvin F. Poussaint, MD of Harvard Medical School gives us a stark warning:

“Egregious advertising to children using toys to lure them to McDonald’s for low-nutrient, high-calorie Happy Meals is damaging to the well-being of children and their families. No doubt, it is one major contributing factor in the current obesity epidemic in the United States.”

Introducing taxes and regulations is one of the first arguments from the health and fitness industry but it is a solution fraught with problems and fundamentally it sits uneasily with me. San Francisco tried it, introducing a city-wide ban on giving away toys with Happy Meals. It attracted criticism from the libertarians who dislike this type of ‘nanny-state’ legislation (even the Mayor declared his desire to veto it) and McDonalds sidestepped it easily anyway, charging a token 10 cents for the toy in the price, an amount they then gave to charity. Clever.

Legislating how we buy our food is though a thorny area and I feel that top-down population wide legislative measures are likely to be as unpopular amongst the public as they would be with the food companies themselves. Handing over responsibility for choice in how we eat seems a radical and rather fascist solution and not one I am comfortable with. That said, some regulation over how such nutritionally poor food is marketed and advertised would seem a good step, still allowing free choice, but with limits on how it can be advertised, to children in particular. Obesity is ingrained into our culture, as are the fast food shops on every high street in the UK. If we are to truly reverse the current growing trend of obesity then we need to work out how we can encourage people to make better choices themselves, starting with our educational system.

Organisations like the School Food Trust http://www.schoolfoodtrust.org are trying to make inroads and in pockets of the UK there is certainly some green shoots, but against the might of the food industry it will be a tough task without some stronger support from the government.

Junk food will not disappear from the UK high street anytime soon; it will likely always be popular and some will always exercise their right to eat at these establishments. We have to tackle it from the bottom up, increasing customer awareness of the true ‘health value’ of something with clear disclosure on nutrient and calorie levels, improving food education so that young people can see what goes into these foods and learn how to cook properly, and we must work on offering alternatives that are as easily accessible and affordable, as the low-cost availability of junk food is one of it’s most alluring features.

Consumers do have the power to change it, simply by not eating there; however without the compelling desire not to, combined with the marketing efforts of these major corporations it is a big ask. More money needs to be spent countering the powerful marketing methods these companies use both through popular media avenues as well as front-line healthcare practices.

 

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Obesity, Where Do We Even Begin?

October 3, 2012 By

Where to start?

PART ONE
In 2007 the Foresight programme run by the Government Office for Science produced a report on tackling obesity. It makes for depressing and disturbing reading yet it seems to be relatively unknown in the fitness industry and to have had little impact on shaping government nutritional policy.

The report itself is captivating reading, for example the fact that of the €38 billion (yes, billion) that is directed through the EU’s Common Agricultural Policy the biggest amount, in relation to market value, is awarded to the tobacco industry. If that doesn’t worry you then let’s look at one of the report’s positive recommendations: that school sports fields be preserved and made accessible for communities. This idea was clearly rejected by that annoyingly smug-faced Michael Gove who has driven the recent sell-off of them across the UK, despite coalition ‘promises’ to the opposite. (http://www.guardian.co.uk/politics/2012/aug/17/michael-gove-school-playing-fields).

However, before I get stuck into this blog post, which admittedly could go on a bit, here is a direct link to the report so you can read it for yourself.

http://www.bis.gov.uk/assets/foresight/docs/obesity/06%20part%2002.pdf

Earlier this week I had the opportunity to listen to two of the UK’s leading experts in tackling obesity: Professor David Haslam and Professor Jane Ogden, both who presented very differing viewpoints on the whole calamitous issue. Dr Haslam is a GP and Chair of the National Obesity Forum, while Dr Ogden heads up Health Psychology at the University of Surrey.

Both were entertaining speakers, but it was Dr Ogden’s talk that seemed to resonate best with me. Her compelling research on how and why we over consume food was fascinating. You can read some of her papers here: http://www.ncbi.nlm.nih.gov/pmc/?term=jane+ogden.

It got me thinking that it is worth revisiting this topic with at least the hope of providing some kind of dim light at the end of what is looking to be a very deep, dark, and long tunnel.

Granted, you may well be thinking, why should I care? But you should because the financial impact of this alone was described by Prof. Haslam as a ‘ticking time bomb’ that will take up an estimated 17% of the NHS budget in 20 years time (http://www.diabetes.org.uk/About_us/News_Landing_Page/NHS-spending-on-diabetes-to-reach-169-billion-by-2035/).

Obesity is a one-way ticket to serious illness and disease and yet still we are a country in denial about the true extent of the problem. Short-term politics will never address long-term problems that can only be addressed through policies that will surely lead to the rapid ejection of any incumbent government. This is before we even get into whose responsibility it really is to deal with this. Should we even be relying on the government to tell us how and what we should be eating? I’m not so sure, but more on that later.

The fact is that despite all the wisdom and good intentions of the fitness industry, we are getting fatter. The UK is now the fattest country in Europe, with obesity growing here at a rate that will see UK females fatter than American males by the year 2030. Despite this the fitness industry and sadly most the trainers out there writing their sage wisdom on the topic fail to really understand this problem, what is causing it, and how we can deal with it. In fact, all too often those writing on ‘health and fitness’ seem to be creating more problems than they are solving in their ignorance.

The arguments, articles, books, movies, and musings over the drivers behind these rises though are plentiful and far too many to discuss in this post. They range from the most popular: over-consumption of foods (in particular refined carbohydrates), decreases in physical activity, and economic issues to those less discussed: environmental chemicals that can play havoc with our hormones, poorer sleep habits, and pharmaceutical obesogens. Gary Taubes recent book Diet Delusion did a commendable job in making the argument for refined carbohydrates as being the primary cause of the current obesity epidemic, although I can’t help but feel that it is as much effect as it is cause and that the drivers for this are what we need to understand if we are to effectively deal with it.

As part of the Foresight Report, an interactive map of 108 factors was created (of which only 16 are directly related to food consumption), which attempted to do exactly that. If nothing else, this map shows the total complexity of the problem. Check it out in an interactive format here http://www.shiftn.com/obesity/Full-Map.html.

Still with me? If you are then you will probably by now be realising that the advice we give to relatively lean athletes or exercisers looking to enter contests or sporting events is not the same advice we should be prescribing en masse to the overweight and obese population. Simply telling these folks to ‘eat green vegetables and lean meat’, ‘cut out the carbs’ or ‘have a high protein breakfast’ is not going to work. Atkins was giving that advice decades ago in what has become the world’s highest selling diet book and thousands more since have written books on it (including myself).

Just about every diet strategy has been tried, from low-carb to low-fat, points, blood types, food rotation, carb curfews, cabbage soup, maple syrup, and many many more. Still the obesity line climbs on the charts and graphs.

So what can we do? In the next part of this little series I’ll attempt to provide some solutions, along with the complex ethical and moral challenges each of those presents.

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