I'm not a big follower of Fat Acceptance or Health At Every Size. Pretty much all I've read is Kate Harding's Shapely Prose and Melissa McEwan's blogs on the subject, although I did snag a few copies of the original "FAT! SO?" back when it was a 'zine. (Doesn't that bring back memories of the 1990's? Imagine, children: we used to have to self-publish things on paper before Blogger!)

Part of this is because I'm not "really" fat. I'm what's usually called a "tweener"--sometimes wearing a 12, sometimes a 14, sometimes a 16 if it's a top and it's fitted. People looking at me wouldn't automatically call me "obese", though that's what my BMI says I am. I feel sort of like I'd be co-opting a valuable movement if I horned in on Fat Rights without really having experienced any discrimination in, say, insurance coverage or hiring on account of my weight.

Another part of it is because the hospital where I work, which I call Sunnydale General (shout-out to Buffy!) does a lot of complex bariatric surgery. I'm talking super-bariatrics, the sort of surgeries done on people who weigh 500 pounds or more, or who weigh 300 pounds and have so many co-morbidities that nobody else will touch them. I've seen the health effects of super-obesity up close, and that makes me (probably unwarrantedly) skeptical about some branches of the FA movement. "Health At Every Size" is a fantastic idea, and it's reality for a lot of fat folks, but it's *not* reality for the people I run across.

That said, I think I might have to get more active. I had a little run-in with my doctor the other day, and am now looking for a primary-care physician.

I went in with a week-long history of right upper quadrant pain that started after I ate one of my bimonthly cheeseburgers (nom nom nom nom). I came in hypertensive, as I always am when I visit the doctor, and fifteen pounds lighter than the last time I visited him.

He did not focus on the hypertension. I got the usual quick lecture about cardiomyopathy and aneurysms before reminding him that my own trending of my blood pressure (at work, away from anything that could cause white-coat syndrome, and yes, I'm aware of how ironic that is) showed that I have perfectly fine, not-concerning blood pressure. My worry was the possibility of a gallbladder problem, and I said as much.

"Well," he returned, "You do have the five risk factors for gallbladder disease." Then, because I am a nurse and he likes to quiz nurses, he asked, "Can you name the five risk factors?"

"Fair, fertile, forty, female, and fat" I returned.

"Yes, especially fat" he replied. "You are far, far too fat."

I am five-foot-two and weigh 173.8 lbs. My body fat is somewhere between okay and too-high, though it's improved since I weighed 188 lbs. I work out three times a week with Atilla and have an active job. I eat mostly whole grains, lean proteins, vegetables (in fact, I have a mostly-vegetarian diet), and stay away from sweets. My two big vices are caffeine and beer. I can outlift, out-cross-train, and outlast nearly everybody else I know. The one thing I can't do is run long distances, though I can maintain an aerobic heartrate for two to three hours at a time without falling over.

I told him all this. I pointed out that my muscle mass is approximately half again what you'd expect for a forty-year-old woman, that my bone density is the shizznit, that all my trends are positive.

Yet he came back again to the same point: "You are far too fat. You must lose more weight."

Dude. I know I'm fat. Why do you think I joined Weight Watchers? Do you think I don't own a mirror? The *point* here is that, although I might be producing and storing more estrogen than is normal (because of that added body fat), I am a healthy individual, aside from some right-upper-quadrant pain and some white-coat hypertension.

The last medical person who expressed concern about my weight fell silent when she removed the drape from my upper body and saw my back. "Never mind," she said, "I see you carry....some muscle."

Not my doctor. He kept harping and haranguing, and I left his office feeling, quite frankly, like shit. I have a training routine that makes even personal trainers turn pale, I eat well, I've lost and kept off more weight than most people can ever manage to do, and yet I felt like shit.

The one good point of the visit was when he took a look at my upper legs as part of the full physical. I have some bruises-turned-scars there (that's the "fair" part), and he asked what they were from.

"Oh," I said, airily, "those are from when I put my neighbor's washing machine into his truck for him."

"Washing machine?" he asked.

"Yep," I replied, "he couldn't get it into the truck bed by himself, so I grabbed the strap and lifted it up there for him."

There was dead silence in the room for a moment. Then he said, "You still need to lose weight. You are far too fat."

I am looking for a new physician once this possible-gallbladder, maybe-it's-a-toomah crisis is resolved. And I might just have to go buy Health At Every Size, just so I have better comebacks for doctors like him.

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(Photo: PerantauSepiLodge)

Spaghetti with tomato loss. Big Mac with a large order of sighs. A balonely and cheese sandwich on rye - extra mayo. Chicken bored 'n bleu. Stir cry. Fish and Dips. Angers and mash (UK and Python fans only).

Are you finding that you're using food for something more than nutrition lately? Or maybe it's not really a new phenomenon with you. Maybe you were rewarded/comforted/bribed/motivated with food as a kid and it has morphed into your current diet and mindset. Maybe it's not so much of a stretch for you to equate food with love and comfort. So it shouldn't come as a big surprise that sometimes we find ourselves using food as a coping device for emotions we're not ready to handle and have gotten into a bad habit of suppressing with food. Welcome to the world of emotional eating - population: big and getting bigger.

So how can you tell if your hunger is emotional and not physical? There are some signs that can help make the distinction for you.

- Emotional hunger comes on very suddenly whereas physical hunger is a more gradual build.

- When it's an emotional craving, it is generally for a very specific food. With physical hunger, your range of options is broader - you're just looking to quell the hunger but are not so specific with what.

- Emotional hunger feels like it needs to be sated immediately. It stands in front of the microwave and screams, "HURRY UP!!" Physical hunger says, "Ummm..yeah, I could eat" and then proceeds in an orderly fashion to fix something up.

- Feeling full is never a sign to stop when eating emotionally. You will just barrel right through that stop sign and keep punching that gas pedal. If you're physically hungry, you'll come to a full and complete stop when full.

- Emotional hunger starts from the "neck up" - it's your mouth and mind that are dictating what you eat. Physical hunger relies on the stomach to tell you when to eat.

- Eating emotionally is tied in with, well, an emotion - your boss was a real jerk today, you fought with your spouse, your neighbor's dog is barking non-stop. Physical hunger is tied in with a physical need to nourish the body.

- Automatic, compulsive eating is emotional. If you're eating without thinking, your emotions are running the show. Physical feeding is more deliberate and thoughtful.

- And when all is said and done (or eaten and drunk), there will be guilt and shame after having eaten emotionally. Sure, there's that itch that's been scratched right away but then we experience real negative emotions for having overdone it - again. Physical hunger recognizes that you're eating to survive and as such, there are no feelings of shame or guilt. Eating is as necessary as sleeping and breathing.

Even the most psychologically evolved of us can lapse into eating emotionally once in a while but if eating turns out to be your main coping device, you could be headed for trouble; especially when the foods tend to be more of the unhealthy variety. I can personally attest to never having overeaten carrots or kale. In addition, eating when it is non-physically necessary can also add up to a lot of excess calories consumed which in turn lead to...anyone? Anyone? Bueller?...becoming overweight.

The good news is that you can do something about curbing this feeling feeding frenzy. I used to visit a nutritionist until my health insurance changed and it wasn't covered anymore. Apparently this insurance company's take was that it was better for me (and more cost effective to them) to continue on cholesterol reducing statins rather than pursuing a preventive solution to my problem, but I digress. The nutritionist suggested that when the impulse to eat arose suddenly (a sign of emotion-driven hunger) I should ask myself whether or not I physically felt hungry. Was my stomach growling? Had it been hours since my last meal? If the answer was no, she told me to avoid food for ten minutes, to "sit with the emotions" and try to identify what was really driving this hunger. She also advised that the emotions may not be readily available right away, which I found to be true, but that they were there. It took a lot of sitting still and really thinking about things until the emotions slowly came to the surface. Once I could recognize the underlying emotions, I was better able to short-circuit the unnecessary grazing to help soothe those emotions and learn to deal with them head-on.

She also suggested that once I recognized the onset of emotional hunger, I should try to distract myself with another activity like reading, knitting, talking on the phone, etc. (Cooking or baking is not recommended, Forrest.) Another idea was to keep a journal to record my hunger and the related emotions to figure out what, or who, was behind this urge. Identifying and avoiding emotional triggers can be very helpful in defeating emotional eating.

Stop letting the clock dictate when you're hungry was another smart tip from my nutritionist. If the clock says noon but you're not hungry yet, don't force the issue. Eat when you start to get a little hungry - whether that's before or after The Stated Meal Time. She cautioned against letting the hunger get too far ahead of me, though, in which case I might start tearing apart the kitchen like a ravenous dog, consuming vast quantities of food and Alpo. Planning meals ahead of time can help diffuse the stress of being hungry and clueless.

There's also a terrific author by the name of Geneen Roth who has written extensively about emotional eating with a real "been there, done that" approach should you want to explore the emotional connection to food more extensively. She also writes a monthly column for Good Housekeeping magazine.

How much of the time do you think your hunger is being driven by emotion? And what, if anything, are you doing to correct that?

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Oh gosh that looks so fun.
Photo:Martineric

I've never seriously considered training for a marathon. I understand you have to run 26 miles... all in a row! On the same day! Here in Slackerville, that just ain't gonna happen.

Yet every now and then, from the depths of my subconcious, a sinister voice pipes up. "Go for it," the voice says, sounding all sexy and seductive. "It would be so cool to run a whole marathon and cross that finish line and feel so proud of yourself!"

"Shut up, sinister voice," I'll say, (or lets pretend I would, as I'm not actually schizophrenic). "Don't be stupid! Training for a marathon is hard! Not to mention the whole getting up early thing, and the lines for the porta potties..."

"But you'd get to brag to all your friends that you ran a marathon! Plus think how many cupcakes you could eat if you were running all those miles!

"Wait... Cupcakes?"

But I've never taken Sinister Voice too seriously. Given my lifestyle (lazy) and my fitness goals (modest) and my time management skills (nonexistent) and my knees (crappy), a marathon would just be a doofy waste of already-hard-to-come-by motivation.

And yet, Sinister Voice would always return another day to nag me again.

It seems like if you run at all, the idea of a marathon is always sort of hanging out there, poking and prodding at you. Of course in the old days, it was this freakishly hard-core thing to do, and it was easier to dismiss. Then it got to be a much more mainstream goal. Heck, even spoiled celebrities run marathons now, and if they can drag their over-scheduled, undernourished butts 26 miles to the finish line ... why shouldn't I give it a go?

Because I don't want to?

Actually, I'm still mad at the stupid Greek guy, Phidippides, who started this whole "marathon" business 2500 or so years ago. Why couldn't he have dropped dead after, say 5 miles? Or not dropped dead at all? Then they'd never come up with this arbitrary measure of fitness that I keep trying to pretend I don't care about.

However, after years of bickering with the Voice, I've noticed a curious thing lately... Silence.

That persistent sense that I should be aspiring to run a marathon? It seems to finally be slipping away. Hooray!

Now this is not to say that running a marathon (or a bunch of them or whatever) is not a great goal for plenty of runners. If you train properly, and pay attention to injuries, and have the spare time so that it's not gonna mess up the rest of your life... I say go for it!

But if you, like me, have been looking for reasons to say "screw it" to the whole marathon temptation, here are few suggestions for talking yourself down.

1. Consider your immune system. As Charlotte pointed out in a recent post over at The Great Fitness Experiment, intense endurance exercises actually makes you more vulnerable to bugs than moderate exercise, not less.

2. Watch out for heart trouble. Fitsugar recently discussed the issue, and there's a good rundown of some of the risks in this Men's Health article. Bottom line: they're not sure if it's permanent or temporary damage that marathon running does to your heart, but your at far less risk of ticker trouble if you're running at least 45 miles a week before competing in a marathon.

3. Jenn at Fit Bottomed Girls is not letting the stupid scale get in the way of her marathoning goals. But I gotta say: I'm more shallow than she is. If I found, as she has, that marathon training was increasing hunger significantly, and it was leading to weight gain? I'd want to be damn sure it was extra muscle or I'd say the heck with the extra running.

4. Running a marathon does not necessarily lead to long-term fitness. This Wall Street Journal article discusses the all-too-frequent phenomenon of eager runners working up to completing a marathon and then, due to burn-out, deciding to hang up their sneakers for good.

5. Fitness is not just about endurance, and "more" isn't necessarily better when it comes to cardio. If you hang out at Mark's Daily Apple at all, Mark is pretty darn convincing about the futility of trying to meet all your fitness goals by overdosing on cardio. Sure, some is good, but more isn't necessarily better! And it's not just the Primal people--more and more we seem to be getting the message that there's a crapload of different stuff you need to do to be fit and healthy. Are you going to be able to keep up on your strength training and balance training and High Intensity Intervals and flexibility and functional fitness and breathing and core etc, etc, etc, if you're doing marathon training?

6. All that pounding can exacerbate injuries. For me, it's my knees; I know I'd be risking my ability to run at all if I insisted on putting in the kind of miles it takes for marathon training. Now plenty of people run marathons while dealing with chronic injuries, and have no problems at all. But others put race deadlines ahead of common sense and end up trashing their knees, hips, feet, back, or whatever because they couldn't chill and take the necessary recuperation time.

What about you guys? Training for a marathon? Tempted? Or No Way in Hell?

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I don't call her Attila for nothing.

Three times a week (give or take), this pleasant, charming, fit young woman invades my house with a variety of weird things packed into a rolling scuba bag and proceeds to make me do exercises that are almost always guaranteed to make me cry.

Herein, the best of the bunch. You can do them with fitness balls and barbells if you have such things, or with a cat and some soup cans (if your cat is patient), or with nothing at all. Ready?

(Disclaimer: be sure to check with your inner Slacker before attempting any of the following exercises. Those with back, hip, lung, bicep, head, or fourth-toe problems should see a doctor before beginning this program. Offer subject to local and state taxes and licensing. Do not use while bathing. Never point at your own or another person's face.)

Exercise One: The Frog-Hop

Grab a ball. The ball we use is a seven-pound, sand-filled thing, but I suppose you could use any old ball (except maybe one of those super-bounce ones). Or you could use a shoe. Or your purse. Just make it something that you can toss that'll stay (mostly) where it lands.

Start at one end of the room. Assume the squat position.

Toss the ball forward a foot and a half or so. Easy, right?

Now hop, without coming out of the squat, so that your feet are just ahead of the ball. Reach back through your legs (don't break that squat!) and grab the ball/purse/shoe/patient cat you've just tossed. Toss it ahead of you again.

Hop forward. Grab ball. Toss. Hop. Grab. Toss. Hop. Grab.

About four reps into this, your butt will begin to burn. It will continue to burn for a couple days afterward as well. We (who's this "we"? I mean *I*) do six laps up and down the room with about eight hops per length.

Exercise Two: Ball *#$&* Passes

For this, Attila brings out my big fitness ball. I hate that thing.

Lie down on your back on a relatively padded surface. (We use a foam step, but you could double up a towel.) Place the Hated Fitness Ball between your ankles. Kinda big, ain't it?

Stretch your hands above your head.

Now bring your body up into a V-shape and pass the ball from your ankles to your hands. Make another V-shape and pass it back to your ankles. Repeat. Nineteen more times.

For this one, I do three sets of twenty, though by about the ninth rep on any given set, it looks more like I'm imitating a dying frog than a graceful Pilates babe.

Exercise Three: Combo Curl Thingies

Grab a pair of barbells or a couple of soup cans. Stand with your feet shoulder-width apart. Curl your weights up, just like you're doing a regular barbell curl.

Now press straight up into a shoulder press.

Lather and rinse nineteen more times. Do three sets. Realize, about fifteen reps into your first set, that although this seems like a simple, easy exercise, it in fact shreds your shoulder muscles more efficiently than almost any other move.

For extra added frustration and whining, combine this move with a simple squat. Curl up as you squat down, then stand up as you do the shoulder press.

If you want to get *really* fancy, you can do it on one foot, or while standing on a balance board, or while surfing. I have tried none of those things, but they seem kinda cool-sounding in my uncaffeinated state.

Putting this all into context: it's rare that Attila makes me attempt all three of these moves in one session. Normally I do a heavy leg workout one day a week, and the rest of the week is combined core and upper body. Frog-hops fall into the "heavy leg workout" routine, and I might do either one or both of the other two on any core/uppers day.

Have fun with those, if you end up trying them. And pray Attila doesn't read this blog. She'd probably make up new stuff to punish me for giving away her secrets.

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Does the title of this post lead you to think that there's one simple thing you can do to prevent cancer and keep your bones strong as you grow old?

Sorry about that. It's actually two different "secrets"--the reason they're crammed together in one post is that I was reading the New York Times health section, and these two articles about preventing cancer and building healthy bones both caught my attention.

Note: whenever I discuss health articles from the New York Times, sensitive readers should be warned--there will likely be cursing involved.

@#%$&!!

Because while the New York Times is a great source for news, I hate their health section. They're the ones, remember, who said exercise won't keep you healthy. And their writers seem to revel in casting doubt on my long-held beliefs about the rewards of proper nutrition and plenty of exercise.

If the New York Times were my only news source, I'd be on a cupcake, cheeseburger, and champagne diet by now, and the only exercise I'd get would be scratching my head over their crossword puzzles. Sometimes the studies they cite are convincing; other times they seem to ignore tons of contrary research in order to take a controversial stand and get people riled up. Either way, I find it annoying to have to rethink things all the time. I have a tiny brain and it gets tired easily.

So wanna know what surprises they had in store about preventing cancer and building bones?

Preventing Cancer: Forget Healthy Living

Yep--they say that eating less fat and lots of fruits and vegetables and whole grain fiber, losing weight, and getting lots of exercise won't really do much to prevent cancer. In terms of healthy living, the only lifestyle choice things they had good things to say about were quitting smoking and, if you're a woman, steering clear of estrogen after menopause. (Well, I imagine if you're a guy you should steer clear of it too).

The fruits and vegetable thing took me by surprise, and elicited the most cursing. I'm certain I've read a number of studies saying that whole grain fiber and fruits and vegetables help prevent cancer. The fiber clears out your digestive system, and the produce is full of all those nifty little antioxidants that will clean up evil free radicals that contribute to cancer. Right?

Well, turns out it's not just the New York Times--everyone seems to be backing down on the diet and cancer connection. As to the ability of antioxidants in fruit and vegetables to prevent cancer--the clinical results now look "inconclusive," according to The National Cancer Institute. Likewise, the Harvard School of Public Health says you should eat your fruits and veggies, but mainly because they're good for heart disease, blood pressure, vision, and gastrointestinal problems like constipation or irritable bowel. As to cancer, "data from cohort studies have not consistently shown that a diet rich in fruits and vegetables prevents cancer in general."

Well, phooey.

What can prevent certain kinds of cancer? Medicines!

According to the article, a generic drug, finasteride, costing about $2 a day, could prevent as many as 50,000 cases of prostate cancer a year. A related drug, dutasteride, (about $3.50 a day), has the same effect.

Likewise, according to the Times, studies have found that taking tamoxifen or raloxifene could cut breast cancer by 50% among high-risk women. Most side effects of the drugs, like hot flashes, were temporary. There was a very slightly increased risk of blood clots and uterine cancer with tamoxifen, but with raloxifene there was no excess uterine cancer, and the clotting risk was 30 percent less than tamoxifen.

Even better, women did not have to take the drug for a lifetime — just five years. And they said the cost for tamoxifen runs about 30 cents a day; raloxifene is $3.30 a day.

So why would doctors and high-risk patients not be jumping all over this to try to prevent cancer? Well, the Times interviewed Dr. Therese B. Bevers, a medical director at a Cancer Prevention Center. She believes that doctors don't want to take the first step — calculating a woman’s lifetime risk of getting breast cancer. Why not? Because that might lead to the next step: "spending an hour or so discussing cancer risk and drug risks and benefits."

An hour or so? Really? When was the last time your doctor spent an hour or so explaining anything? I can't believe doctors can't figure out how to give a brief overview of options in a much shorter time than that. And if it would prevent so many more cases of breast cancer, wouldn't the time be worth it?

Apparently the drugs are a good idea if your lifetime odds exceed 20 percent. (They use the example of a 55-year-old woman who began menstruating early had her first child late, and whose mother and sister got breast cancer. There's an assessment tool here, though they warn you it's designed for medical professionals.)

Equally puzzling, though, is the reaction of high risk patients when doctors do discuss the drug option. According to Bevers, about half the time they turn them down. “The Number one reason I hear is, ‘Oh, I just don’t like to take medications."

Personally, if my risk of breast cancer were calculated to be significantly higher than nomal? I think I'd give the medication a shot.

But no matter what the New York Times says, I'm not entirely giving up on the idea that my bok choy and blueberries and cardio are gonna help me out too.

How to Prevent Bone Loss? Jump!

So the article on exercise and bone loss starts with a disconcerting statistic: a year after fracturing a hip, about one in five people over age 65 will die.

Yikes! I guess I'd really rather not fracture my hip when I'm older.

There is more depressing news, too: a lot of the exercise people used to think would help isn't doing much to build bone density. You need “large forces released in a relatively big burst.” Apparently weight lifting isn’t explosive enough for most people, nor is swimming or cycling. Running can be, although it doesn't work for everyone. Brisk walking helped bone density in older women, but "it must be truly brisk."

What works, they suggest, is jumping--if your bones are strong enough to begin with. “You probably don’t need to do a lot either.” But this recommendation came from... you guessed it. A study of mice.

Photo:armadillo444

Oh wait, not that kind of mice...

It seems that in a Japanese study, mice jumped 40 times a week for 24 weeks and built up bone density, and maintained it by jumping 20 or 30 times a week. (I did not allow myself to discover how they got the mice to jump...I hate animal research and think we should do a lot less of it.)

Anyway, six jumps a day, then down to three or four. Sure, I could add that to my exercise to-do list. And maybe I will someday, if I became convinced that I'm one of those people for whom running doesn't work, and I decide I really need to start jumping too to build my bones.

But just because it worked for mice? At this point, I'm not exactly jumping to any conclusions about humans.

So would you take prescription drugs to prevent breast or prostate cancer if you were high risk? Would you jump up and down like a Japanese mouse to build your bone density?

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