Is this really the best we can do?

Day three of the #DDdailygratitude challenge and already, I’m inspired to share one of my posts in a longer blog form! Unfortunately, the motivation stems from all of the frustration and anger that ultimately turned into my gratitude for the day.

I’m scheduled for a resting metabolic rate test (also known as an oxygen uptake exam, or an indirect calorimetry test) next Friday, but I need to get pre-authorization because many health plans won’t cover the exam. I have been at a weight plateau since April despite working out regularly and monitoring my diet, and so my doctor wants to do this test so that we can better calibrate my nutrition. Basically, we’re checking to see the rate at which my body burns calories while I’m completely at rest, to make sure that my metabolism is behaving the way it should be. The results of this test will help me to make sure that I’m eating enough to support my energy output in my workouts, while still maintaining an appropriate calorie deficit to get my weight down.

The pre-authorization turned into a circus. Aetna couldn’t authorize the test without the appropriate CPT code. The doctor’s office didn’t know it, and billing had to transfer me four times before they could answer my question. Spoiler alert: the Google result for the code was correct and I could have saved myself a whole lot of hold time. When I called Aetna a second time, they gave me a benefit policy code to look up, but basically told me “We won’t cover this, unless your doctor says it’s medically necessary.” However, they couldn’t tell me what “medically necessary” means. Last I checked, the very act of referring me for the test could be considered my doctor deciding this was medically necessary… but I digress.

I looked up the benefit policy to better understand what was going on, and that turned out to be a very, very bad idea. You can find it here in full, if you’re interested. Basically, I would qualify for weight loss medication, no questions asked, but they won’t cover this test because it’s still considered “experimental” or “investigational” for weight loss. Mind you, the benefit goes on to acknowledge that medication works in conjunction with calorie restriction and exercise, and also that weight loss from medication is usually temporary…. but it has the studies to back it up, so it’s all good in their book. However, this test apparently isn’t considered sound science, so Aetna’s having none of it.

A quick PubMed search turned up an article titled “Indirect Calorimetry: A practical guide for clinicians,” which

“Measurement of energy expenditure is the most accurate method to assess energy needs. Indirect calorimetry remains a gold standard in measuring energy expenditure in the clinical settings… To achieve the highest quality of patient care, we should strive for patient-specific nutrition support regiments. Indirect calorimetry offers a scientifically-based approach to customize a patient’s energy needs and nutrient delivery to maximize the benefits of nutrition therapy.” [Nutr Clin Pract. 2007 Aug;22(4):377-88]

Meanwhile, a systematic review of energy expenditure studies, published in Obesity Reviews in 2012, turned up this endorsement of using indirect calorimetry to get more accurate information for patients:

“Today, many health professionals including dietitians typically use prediction equations because of ease of use, low cost and decreased participant burden, but emerging evidence is reflecting great disparities between predicted and measured energy values… The level of inaccuracies of prediction equations that are commonly used in clinical practice may potentially impact patient outcomes… As health professionals seek to improve their quality of service and provide appropriate nutrition care to prevent clinical morbidity and mortality, measuring energy requirements through IC [indirect calorimetry] may be the direction of the future.” [Obesity Reviews, 13: 753–765. doi:10.1111/j.1467-789X.2012.01000.x]

(In case you’re wondering, this is what happens when you’re someone who is naturally curious, who enjoys learning about interesting topics, who believes in doing the research on her own health, AND who also happens to work in academic publishing. Doctors either love me or hate me. There’s no in between.)

So, basically, I was in a really bad place when I called my doctor’s office for the third time today. I had a phone number from Aetna, and I needed my physician to call and make the case for medical necessity, so I’m not on the hook for $200. And that’s when today’s moment of gratitude stepped in.

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The woman I spoke to this third and final time was so kind. She took down all of my information, and she reassured me when she let me know that she processes requests like this all the time. My doctor is at a conference through Monday, so she told me she’d share the message then, and she also promised to follow up with me herself Monday afternoon, even if she didn’t yet have an answer, just so I’d know where things stood at that point. She listened. She cared. It was so unlike every other conversation I had experienced so far today, and I was so grateful to her, I burst into tears. (What can I say? It’s been a long week.)

It’s a sad commentary on the state of our health care in this country that I had to jump through so many hoops today, and an even sadder commentary on human behavior in general that I felt so surprised and relieved to finally experience a little kindness.

We’ll see how this all plays out. I’m probably going to move forward with the test either way, just to know exactly where my metabolism stands, but I’d feel a hell of a lot better if it didn’t set me back $200. More to come!

In the meantime, it’s not too late to jump on this Daily Gratitude plan. Thanks to @thedaydesigner for pulling this together, and for making awesome planners – check out their website here. I love that they offer free printables so you can see how the layout works for you before ordering the full planner. I’ve been using their Daily Planner printable for almost a month and I love it, and I can’t wait to order my 2017 Planner!

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Challenge Recap: Day 2

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Day two of the Advocare 24-day challenge is in the books and it was a doozy.

Murphy’s law was in full effect yesterday. Work has been intense for the past few weeks and it all came to a head yesterday for me, resulting in a lot of time spent at my desk with my head in my hands staring in disbelief at my computer screen. It wasn’t great. And that’s all I’ll say about that.

I probably could have handled the work stress if I didn’t also have the stress of a quarterly dermatology check in hanging over my head. Thanks to a melanoma diagnosis in 2012 and a basal cell diagnosis in 2014, I get to visit my derm every three months. Fun! Luckily I love my dermatologist – she’s funny and kind and helps to set me at ease, which is good, because I always manage to work myself into a massive panic before every appointment.

I ended up needing four biopsies. I had identified two spots myself, and the doc found an additional two that she found concerning. She’s almost positive one of the spots is another basal cell that will require treatment, and the other three are atypical moles that they’re checking for melanoma. People. Seriously. Wear sunscreen. SPF is your friend.

So, after three hours at BWH, I left with four bandages, four sets of stitches, four brand new scars. I’ve officially lost count of the number of biopsy scars on my body. And it sucks. I’m really struggling with this. Any biopsy is scary and four at one time really freaked me out and sent me into a tailspin.

And every single cell in my body screamed for emotional eating. When I’m upset, I eat — I binge on things that I know are bad for me, but my brain shuts down and my body convinces itself that the food brings comfort. It’s been a bitter cycle my entire life.

And I didn’t give in last night. I wanted to. I wanted to drown in a bottle of wine and a pint of Ben & Jerry’s. I wanted to order a pizza and eat it alone in my bed while I wallowed in anxiety. But I didn’t do any of those things. I cooked a healthy dinner that fit in with the challenge plan, I drank a glass of water, and I ignored the voice in my head screaming that it wanted potato chips and pity.

It was so. Effing. Hard. 

But I did it. And that feels like the best victory I could ask for.

I’m baaaaack!

Didja miss me?

I don’t have any good excuse for the lack of posting over the past month. Family issues, holiday stress, and a much-needed vacation all kept me away from this blog, and I’d apologize, but the truth is, I needed some time away from everything. I drafted and discarded multiple attempts at a 2015 resolutions post to kick off the year, but it felt disingenuous to share a resolutions post when I truthfully hadn’t yet gotten myself into the right mindset.

The good news? I’ve spent a lot of time reflecting on the things that I’m doing right, and the things that I need to do better, to continue improving my overall health and wellness in the new year. I finally feel like I’m at a place where I can fully redevote myself to the mission of this blog and, by extension, get back into the flow of blogging.

So what do my 2015 resolutions look like? I only have one: Don’t make any resolutions! 

I’m 29 years old, turning 30 in a few months, and I have a life that is super jam packed and constantly evolving. What seems like it’s a good fit right now may not still work for me in a few months, so a year-long resolution feels like I’m setting myself up to fail. I have the best successes when I’ve got a regular forum to check in with someone else – whether that’s a nutritional counselor, a fitness group during a challenge, or just a friend who agrees to be my accountability partner. Those external check ins really help me to refocus on what I’m trying to achieve, so I’m going to approach 2015 similarly.

On a regular basis – at least monthly – I’ll sit down and reflect on how things feel. What’s been going really well? Where have I been slipping up? Am I bored with any aspects of my fitness routine? What can I do to freshen up my day to day activities to keep myself invested in my own journey? I’m also looking into a therapist who specializes in disordered eating and body image issues. The stress of the past few months made me realize that I’m still very much at war with my impulses toward emotional eating, and this isn’t something I can fix on my own. I’m looking forward to the coming months, and to inviting you all along with me as I continue to figure it all out.

What are some goals you’re currently working toward? Do you make resolutions?

Emotional Eating: Why Can’t I Quit You?

Emotional eating has always been my biggest nemesis in the battle to improve my diet. Food has seemingly always been tied to how I’m feeling. Birthday celebrations centered around decadent cakes covered in sugary icing from the local Italian bakery. Stressful periods meant that stopping for fast food could be excused away by my busy schedule. When someone in my family was sick, or after a death, friends and neighbors would come bearing gifts of food – bags of bagels and cream cheese, trays of lasagna, deli platters to feed an army.

Weight Watchers is capitalizing on this right now with their current ad campaign. I have tried their programs in the past and it didn’t work for me, but I know there are a lot of people who swear by the company. Sharing this video is in no way an endorsement of their methods; it is, however, a great piece of advertising and one that hits home with today’s topic.

I’ve mentioned this a few times recently, but my family’s been going through a rough patch lately. My father had surgery last week, and it’s been difficult to keep up with a sense of normalcy with everything that’s been going on. I tend to internalize things like this, which is not to say that there haven’t been incredible displays of support and friendship from the people I care about; I just tend not to talk much about things like this when they’re going on. So, instead, I go to war with the grocery store. Ice cream? Chips? Homemade chocolate chip cookies? All things that were on the patient’s wish list for recovery snacks, and I had zero mental energy to find the willpower to resist adding my own treats to the cart when shopping last week.

So here we are. It’s been a week since the surgery, and I feel gross. I haven’t been eating well, I’ve been drinking way too much wine, and my body is letting me know that it is displeased. My pants are feeling tight, I have no energy, and I can’t find the willpower to get back to my normal healthy eating and exercising routine.

This latest incidence of emotional eating has helped me to see that I need to focus more on the mental side of all of this. I know what I need to do to lose weight and get in better physical shape, and I am totally capable of doing all of those things. What I need to figure out know is how to maintain those habits and not let outside forces shake me to the core. Life happens and I need to learn that turning to comfort foods not only won’t comfort me, but it will make me feel worse in the long run.

I’m making this one of my priorities for the coming year and I’d love suggestions from others who have dealt with this in the past. Any books that particularly worked for you? Techniques to try? Should I just suck it up and try therapy? Advice is welcome, and much appreciated!

Fitnasty for Life
I’m teaming up with Carolyn over at Fitnasty for Life to get #Fit4Fifteen – check out the linkup!

Do you battle with emotional eating? What has worked for you?

Tackling tempation

I don’t know about the rest of you, but willpower and I don’t really get along all that well. More than anything, I really struggle with temptation. If there’s candy in my desk drawer, I’m going to eat it. If I open a bag of snacks, I’m not going to stop after the recommended serving size. At parties, I can’t just try a sampling of the appetizers; I park myself next to whatever is most delicious and munch away. With the holidays coming up, I know that temptation is going to be confronting me at every turn. I’ve committed to both #6W2C and #Fit4Fifteen to help myself stay on track through the end of the holiday season, but those challenges aren’t going to take me all the way on their own. I also need to employ some handy tricks to keep myself on track.

Tip #1: Pre-portion all snacks as soon as you get home from the grocery store. 

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I did my grocery shopping at the new Market Basket in my town last night, and I was super excited to find this Cedar’s Spinach Dip, made with Greek yogurt. Cedar’s is based in the Merrimack Valley, here in MA, and I’m a huge fan of their products. They’ve also been generous donors to the youth conference I volunteer with in the past, so I like to support them whenever I can. At only 50 calories per serving, this is a great thing to have on hand for an afternoon snack with pretzels or cut up vegetables. However, I know that if I were to just start dunking carrot sticks directly in that tub of dip, I’d exceed the recommended serving before I knew it. To ward off any temptation, I picked up small snack size dip containers and pre-portioned out the tub as soon as I got home. The tub contained twelve 50-calorie servings, so I portioned it into six small cups to have at work as an afternoon snack this week.

Tip #2: Stock your kitchen with healthy, nourishing snacks. 

You know the saying, “Monkey see, monkey do”? In my kitchen, it’s “Colleen see, Colleen eat.” If you keep your biggest temptations on hand, you’re more likely to eat them. Bypass those aisles at the grocery store and resist the urge to add tempting foods to your cart. You’ll tell yourself that you’ll only have those cookies once a week as a special treat, but we know that’s a lie. That ice cream will definitely not be for PMS emergencies only, and I don’t care how much you swear that you’re only buying those chocolate chips as an addition to protein pancakes, we both know those will end up getting eaten by the handful after a bad day at work. Try instead to make sure that you always have plenty of healthy foods on hand that still feel like you’re giving yourself a treat. Avocados are one of my favorite healthy treat foods – adding them to eggs or mashing them on toast feels so indulgent, but I’m getting the healthy fats that my body needs. I also always have apples, hard boiled eggs, and preportioned baggies of turkey or beef jerkey on hand. These are all snacks that are easy to grab and go if I’m in a rush, and they fill me up and satisfy me without destroying my healthy eating plan for the day.

Tip #3: The freezer is your friend. 

I could pretend that my kitchen is a place where you will find only healthy, nutritious food items. This would be a lie. Yes, I do try to avoid keeping tempting foods around, but I’m human, and sometimes a girl needs a Snickers. I keep a bag of fun sized Snickers bars in my freezer at all times. That way, if I decide I really do want a little chocolate treat, I can go for just one bar. The bar needs to thaw a bit before it’s edible (unless I want to break a tooth!) and that time helps me to limit myself to just the single serving, and to be mindful that I’m treating myself to this snack.

Tip #4: Don’t go to holiday parties on an empty stomach.

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I always have a snack before I go to a holiday party. It’s easier to resist all the tempting appetizers if you’ve already got something healthy in your stomach. I might make a half serving size of Shakeology, or I might grab a handful of almonds and an apple. It’s also a good idea to have a full glass of water before you leave for any holiday events, and to keep drinking water throughout the night. Hydrating will help you feel fuller, and it will also keep you from overindulging in the holiday punch! I know that my already weak willpower becomes completely nonexistent after a few glasses of festive sangria.

Tip #5: Plan ahead.

When I go out to eat, I like to read the menu online ahead of time and plan out what I’m going to eat. This gives me time to think about healthy substitutions so I won’t delay my dining companions when we’re all ready to order. It also lets me preview both appetizers and desserts so I can decide where I’d rather splurge. This type of planning can be harder if you’re attending a party hosted in someone’s home, but there are ways around this! Call the host and ask if there’s anything you can contribute to the event. Maybe you can bring a healthy appetizer option, or prepare a side dish that utilizes lots of delicious vegetables without drowning them in butter or cream.

Tip #6: Don’t forget to enjoy yourself! 

At the end of the day, the holidays should be about having a good time with the people you care most about. Don’t get so caught up in trying to make healthy decisions that you forget to have a good time. It’s okay if you slip up. No one is perfect! This is all about finding balance. Set yourself up to succeed by reducing temptation wherever possible, and you’ll find that your slip ups are few far between. And if you do overindulge on pumpkin pie come Thanksgiving, well, at least it’s only one day out of the year. Get up and go for a run the next day, and remember that every day is a new chance to start over and make healthier choices.

What are some of the ways you resist temptation?
Share your favorite tips in the comments!

Fitnasty for Life
This post is my contribution to this week’s #fit4fifteen link up, hosted by Carolyn over at Fitnasty for Life. Make sure to check out some of the other awesome bloggers in the link up – they’ve all got great stories to share!

Finding the why

As I mentioned last week, I’m doing another Six Weeks to Chic challenge at Studio Poise. I’ve done this challenge twice before, once in Summer 2013 and again in spring of 2014, and I’ve been really happy with the results both times. I’m very excited to be kicking off another challenge and looking forward to holding myself to a higher standard for the coming weeks, in the hopes of resetting my habits on the healthier track.

As I embark on this challenge, I thought about sharing another #MotivationMonday post jammed with Pinterest-worthy quotes and sources of inspiration, but then I realized that I would benefit more from deeper reflection about why I decided to tackle another challenge. For each of the previous sessions, I had a clear goal in mind.

The Summer 2013 session coincided with two weddings. I was motivated to look my best for those events, and participating in the challenge kept me on target while traveling. I even managed to convince some of my friends to rent bikes to ride around Sonoma wine country during one of those wedding trips! We got to see more of the beautiful vineyards this way, and the ride also offset the calories consumed at the vineyards we visited (because you can bet that I wasn’t spitting out those wine tastings!) If you’re ever in Sonoma, I highly recommend this plan – we rented from Sonoma Country Cyclery and had a great time. vineyard bikes

For Spring 2014, the challenge’s conclusion coincided with my 29th birthday. I had planned a big birthday event at Cadillac Ranch and had about 20 friends coming together, so I was super motivated to look and feel my best. I wanted to be in great shape heading into the summer, and that was enough to keep me on target. I loved how I felt after that challenge, and I actually did a pretty good job of continuing to follow the meal plan through most of the summer.

Kindly disregard the wolf wall behind me. My birthday party was at Cadillac Ranch, and this is their standard decor...

Kindly disregard the wolf wall behind me. My birthday party was at Cadillac Ranch, and this is their standard decor…

However, as I head into this challenge, I’m in a very different place. As I’ve previously acknowledged, this fall has been really rocky for me. I’m not maintaining good habits in my diet, I’m not making it to as many classes, and I generally feel like I’ve let my health become less of a priority. I signed up for the challenge to get back on track, but if I’m really going to stick with it, I need to spend some time considering – why do I want to get back on track? 

We all need to find our own why. In the past, I’ll admit, my motivation largely had to do with my physical appearance. I wasn’t happy with how I looked. As I’ve progressed, though, I’ve realized that this is about so much more than the size of my jeans. I’m gaining real benefits from living a healthier lifestyle, and I need to remind myself of those gains so that I can push myself through the times when it’s all to tempting to give up.

So, what’s my why? Good question.

I feel more energized when I’m eating well and exercising regularly. Anyone who knows me will agree that I tend to commit to too many things. I have a demanding full time job, I serve on the board of directors for a youth leadership organization, and I like to fill my free time with adventures, whether that means visiting friends in New York City or trying new fitness classes. It might seem counterintuitive – time spent exercising is time that I can’t devote to these other commitments! – but skipping my healthy habits actually made it harder to keep up with a demanding schedule. I need to take care of my body if I’m going to put such crazy demands on it!

I sleep better when I’m following a healthy living routine. I have had problems with insomnia my entire life. I took ambien for a while, and even did a sleep study a few years back to try to ascertain why I felt tired all the time. When I am exercising regularly and eating healthy meals, I found that my sleep problems basically disappeared. I was falling asleep more easily, I wasn’t waking up multiple times throughout the night, and I felt well rested when my alarm went off in the morning. All that has flown out the window over the past few months. I lay awake for an hour or more trying to fall asleep every night, and I hit the snooze button multiple times every morning because I don’t want to get out of bed. I’m hoping that restoring my wellness habits will also lead to better sleep.

My mental health benefits when I’m taking care of my physical health. The hour a day that I spend working out is one of the very few opportunities I have to unplug and turn off my brain. When I’m on the mat, or riding a spin bike, or shimmying in a Zumba class, I’m not worrying about my clients or thinking about my to do list. I turn everything off and just let myself enjoy the moment. When I don’t work out, I lose that opportunity to tune everything else out, and it has a noticeably negative impact on my overall mental health. Stressful situations impact me to a greater degree, and I had a more negative outlook on life in general. When I’m making healthy choices, though, it has a trickle down effect and dramatically improves my ability to maintain a positive mentality and attitude.

There’s more to all of this than the size of my clothes. I’m going to be constantly warring with myself over this. I can’t deny that it feels good to reach for smaller sizes when I’m shopping, and I do appreciate receiving compliments on how I look, but that can’t be my primary motivation for pursuing fitness and wellness. I honestly don’t consider myself a vain person, and I would like to think that I’m not someone who is overly concerned with appearances, but I can’t deny that my own appearance has been a driving force in fitness endeavors for my entire life. This is the area I really want to personally focus on during this challenge – concentrating on my whys and the benefits of wellness and celebrating those, instead of glorifying the size of my jeans. 

To further help with my accountability through the holidays, I’m joining a linkup hosted by Fitnasty For Life, joining with other bloggers as we work to get #Fit4Fifteen. I’ll update this post with the link up when it’s available at the end of this week!

 

So tell me in the comments… What’s your why?

How do you warm up?

I’m leading a Focus T25 Challenge Group on Facebook. We don’t officially get rolling until 8/25 (which means there’s still time to join!) but a few members have already started posting, which is so exciting. I love seeing engaged participants in these challenges!

One question centered around warming up prior to working out. The Focus T25 routines don’t have much of a warm up. Shaun T begins with some lower impact, lower intensity moves for the first 1-3 minutes, but he very quickly gets into the heart-pumping workout that makes up most of the 25 minutes — and it is INTENSE. I am in pretty good shape so I usually find that to be enough for me, but I know that isn’t the case for everyone!

On days when my body just doesn’t want to get going, I like to take my dog for a quick walk or hop on my spin bike for 5-10 minutes of low resistance riding. These activities wake up my mind and my muscles and help to make me feel prepared for the more intense T25 workouts. But I also wanted to find some recommendations that I could pass along to the challenge group, and that I could keep on hand for my own use when traveling.

Why is it important to warm up? Great question. If you aren’t used to working out, you’ll want to ease your heart rate and breathing into the higher-intensity activities. A good warm up will gradually increase your heart rate and help you settle into a strong breathing pattern that you can then maintain through the rest of your workout. You also want to start getting blood pumping through your muscles so that you lessen the risk of injury when you jump into the higher intensity workout. I like these pages on SparkPeople and Fitday for further explanation as to why warming up matters.

One thing to avoid? Static or passive stretching. You might think back to phys ed classes of your youth and think “But I always did toe touches before running laps!” New research actually shows that static stretching can do more harm than good prior to a workout. Static or passive stretching is defined as any stretch that holds a muscle in a fixed position for at least one minute. If you want to stretch, make sure that you’re engaging in active stretching – move through your stretches slowly and try to go a little bit further each time. Start with a very shallow stretch and increase the range of motion as your muscles warm up, but stay moving! For more information on dynamic versus static stretching, check out this great resource from Fitday.

With all that in mind, here’s what I turned up to share with my Focus T25 Challenge Group – and of course I had to get all of you in on the fun as well!

Fitness Blender | Total Body Warmup | 5 Minutes

 

I love Fitness Blender’s YouTube series! Definitely take the time to subscribe to their channel [Website | YouTube]. They have a great selection of free workouts; you can really find anything on their site! This warm up sets a great pace to ease you into the workout mindset. It alternates between cardio and stretching moves, and at only 5 minutes, you can tack it onto your T25 workout without impacting the rest of your daily schedule. I highly recommend this as a “starter level” warm up – if you are brand new to fitness, this is a great place to start, and you can move on to more challenging warm ups as you feel more confident with your body and your fitness level.

POPSUGAR Fitness | Cardio Warmup | 10 Minutes 

 

POPSUGAR Fitness is another fantastic resource [Website | YouTube]. I have a ton of their workouts pinned on my Health/Fitness Pinterest board, because they’re great to throw into the mix when I want to switch up my routine, and they’re also great when I’m traveling or don’t have access to my DVDs. This is a more challenging warmup and not one that I would recommend for someone relatively new to working out. If you’re still close to the beginning of your fitness journey, take this at your own pace, and work on building up to match the same speed as the instructors in the video. I like that the first 5 minutes of cardio will get your heart rate up so you’re ready to keep up with Shaun T, while the second 5 minutes of dynamic stretching really helps to get your muscles warmed up and ready to tackle T25.

GET IT DONE: IN  25 MINUTES A DAY!

Do you warm up before working out? What’s your go-to method to prevent injury and maximize the results of your workouts?