Tuesday, February 12, 2019

How can they Both Increase?

A headline in the summer of 2018 caught my eye. Fox News reported Exercise and obesity both on the rise in America. As one who has struggled with weight for decades, and for whom exercise is a hated necessity, that headline screamed oxymoron sentiments. 

The author concedes that the results of a recent study and survey seem internally inconsistent. The story notes, however, that "more adults in the U.S. say they are exercising at the same time more of them are becoming obese." In each instance, the results reflect what people are self-reporting when responding to a survey about themselves. In that regard, perhaps there is reason to consider our own tendencies for truth? At least one expert quoted by Fox suggests we may tend to overstate what makes us look good (exercise amount and height) and understate what makes us look not-so-good (weight, lack of exercise). 

The survey results indicate that "24 percent of adults last year (2017) said they exercise" consistent with "government recommendations." Notably, those recommendations can change, but more on that later. This represented an increase from only "21 percent in 2015." 

In the same survey, "31 percent of adults indicated they were obese last year." That is, they self-reported their perception that they were "obese." And, after decades of on-again/off-again diets, perhaps others join me in the category of people more than a little reluctant to refer to ourselves as "obese," despite what some chart at the doctor's office might say. But, the percentage of Americans self-identifying as "obese" has nonetheless increased. 

The Fox story notes that one explanation of this apparent anomaly is that the data responses "may reflect two sets of people," They characterize these groups as "the haves and have-nots of physical fitness." It contends that perhaps "the people becoming more active are already normal weight." That is, the increase in physical activity is occurring within the portion of the population that perhaps wants, for fulfillment and to prevent future issues, physical fitness; the group that least needs weight loss. 

If that perspective is accurate, then perhaps there is another group of people who are not in a proactive posture. These individuals perhaps have slowly accumulated body mass or adopted sedentary habits. They may find themselves today on the wrong side of that doctor office chart, labelled as "obese" or worse. And, those people may not be exercising as recommended. 

The definition of obese has not changed. And frankly, there are flaws in how we define obese. The Center for Disease Control (CDC) explains how body mass index (BMI) is calculated. It is expressed on that website in the Metric system measures that our teachers predicted would become the accepted normal in America, which predictions, miles later, have proven not so accurate. But, essentially, the BMI is calculated by dividing weight by height. 

The CDC even provides a chart for your use in determining your BMI. Notably, the same CDC that says the calculation is based on "kilograms divided by the square of height in meters" provides a chart that is accessible to the rest of us (Americans), in which height in inches and weight in pounds directs us to our respective BMI. According to this chart, I am "obese." But, so is Dwayne Johnson (the Rock). No I am not comparing myself to the Rock, but just saying I am in good company perhaps. 

As mentioned, the government changed its activity recommendations in 2018. A National Public Radio (NPR) story in November 2018 noted the recent recognition that Americans are burning fewer calories, and that our "sedentary office jobs" are the cause. Sitting, the experts have concluded is not good for us, with some concluding that "sitting is the new smoking." I know a few who have spent hundreds of dollars to modify their workspace to allow standing as an alternative. Stand-up desks have become very popular.

Courtesy Heavy.com 

One workers' compensation community company can be said to have gone "all in" on stand up desks. WorkCompCentral recently reported that Texas Mutual has equipped each workstation in its new headquarters with these desks. This story notes however, that "a spirited debate continues over the benefits" of such equipment. There are studies cited regarding the impact on cardiovascular health, and perhaps the overall theme of that story might be aptly described as "the jury is out" on stand-up desks. Buying some trendy new equipment may or may not benefit us. 

And, the government recommendations for activity have recently changed. NPR reports that the government has "updated recommendations for physical activity." And, with that update, it is likely that the number of people reporting they are exercising "consistent with the "recommendations will increase even beyond "24 percent" in the next survey. That may not mean more are exercising, just that more are able (or willing) to "count" what they are already doing. 

The new guidelines are essentially a recognition that any activity, of any duration, can be beneficial. The new recommendations do not change the overall volume of activity recommended. The government says "adults need a minimum of 150 minutes a week of moderate-intensity physical activity." This essentially meant that you should perform some activity that "that gets your heart rate up," for about 20 minutes daily (average) and that you "do muscle-strengthening activity on two or more days a week." 

The new recommendations maintain those overall goals, but abandon restrictions for workout duration. Essentially, "the old message was you needed at least 10-minute bouts of aerobic activity for it to count toward the goal of 150 minutes." The "new guidelines conclude that all movement that helps you stay physically active is important." Thus, before walking counted if you stayed with it for ten minutes, and now strolling to the water fountain counts. It is astounding how many steps people take in a day, even seemingly sedentary folks. The popularity of fitness monitors and even cell phone apps is raising awareness of that activity. 

The goal, according to NPR is to change attitudes about activity. The hope is that people will take the stairs and skip the elevator. That they will periodically take a short walk "around the block." The hope is that activity would be more integrated in our daily routines, to our individual and collective benefit. 

The NPR article quotes a study about the cost of medical care associated with sedentary lifestyles. and the figures are compelling: "$117 billion in annual health care costs." That comes close to $400 per American per year. An interesting study cited on TheRichest reported the top ten physically active nations, including: The Netherlands, Burma, Mongolia, Cambodia, Greece, Malawi, Benin, Comoros, Mozambique, Bangladesh. TheRichest noted that this "list largely consists of countries with low income per capita that have more active lifestyles due to the exerting physical nature of their everyday work." 

But, there is also some evidence of economic impacts driving some behavior in the area of commuting. TheRichest report concludes that The Netherlands activity may be related to oil shortages 50 years ago, that resulted in "a cycling craze that has only grown ever since." Similarly, it notes that "the gulf between bike and car sales was more pronounced in Greece than anywhere else in Europe." Discussions of other nations included on this list make references to the physical demands of work in those nations. Overall, the the outcome of TheRichest analysis is not inconsistent with the NPR connection between American obesity and "sedentary office jobs." 

Despite that link, exercise is not the be all and end all of body weight. The FoxNews article concludes by reminding that "unhealthy eating has a lot to do with obesity." Therefore, the recommendation is for "a change in diet" as well as exercise. Without that change in diet, the increase in activity may not produce lower body mass. The government recommendation (as revised) for activity remains, but perhaps our individual disinclination for altering our calorie intake frustrates our best efforts in exercise? 

As with many things, it is probable that there is not "an answer." The solution to each of our personal challenges may be different because each of us is different. Seriously, is anyone suggesting that The Rock is not in good shape? Therefore, the BMI analysis with which we are seemingly enthralled may not be the best tool for measuring our status or personal progress. And, though the "have and have nots" analysis may be worthy to some extent, there seems significant foundation nonetheless for some introspection not only about how much we eat, but what we eat. 

By now, too many of us will have broken their new year's resolution. Business Insider says that 80% of us fail by February. And, not surprisingly, there is support that "getting in shape" is the most popular new year's resolution. Thus, a great many began 2019 with the commitment to improve fitness, and a great many of those have already not lived up to their own expectations or aspirations. But, perhaps the healthy course is not to wait for next December to make a new resolution? Instead, why not resurrect the 2019 resolution now? As a side note, I have kept my resolutions so far, and will report on that in December (earlier if I fail). 

This can be rational and reasonable. A recent Tweet from the @RxProfessor (an Atlanta resident and well known workers' compensation commentator) reinforced the seemingly simple message of the new Federal Guidelines.


His simple message: if arriving at Atlanta Hartsfield, is to walk from terminal to terminal instead of taking the shuttle train. This is akin to the hope expressed above that people would take the stairs. Instead of grand plans for gratifying self-improvement (grandiose goals or unrealistic eating commitments) why not accept some more realistic expectations: 

(1) increase activity, however and whenever you can; 

(2) eat less each meal, and focus on what is in the produce department (fruit, vegetables, nuts, etc.); 

(3) accept that we will all fail (miss a day of exercise, eat a decadent desert, overdo, under do), but that we can all get back on track the next day rather than waiting for resolution time for the next year; and 

(4) Remind yourself that The Rock is on the wrong side of the BMI chart with you and don't be so focused on the BMI, the weight, the number of minutes in the workout. 

Focus instead on doing better. Not radically perhaps, but merely doing better. Incrementally, we have decreased our national activity level. Incrementally, we have seen increasing obesity. We will not immediately reverse that trend, nationally or personally. We will reverse this trend, if at all, incrementally. Strive to do more, to eat less, and to eat better. Know that the benefits may be incremental, and take a long view of expecting results and improvement. Just do better, that is resolution you can keep. Do it persistently, even if not necessarily consistently, and it will benefit you.



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