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!

24-Day Challenge Prep

Time to face facts: This summer has been an absolute disaster when it comes to my fitness levels. Don’t get me wrong, it’s been an awesome summer, but the very things that have made it such a blast are also the cause of my fitness failures. Vacations, BBQs and nights out with friends have done a number on me, and it’s time to get back on track.

On a friend’s recommendation, I’ve been using Advocare Spark and Joint ProMotion for a few months now. The joint health supplement has really made a big difference in how my knees have been feeling during half marathon training, and Spark is just plain awesome. I feel about nine thousand times better after hot yoga or an intense spin class if I remember to sip a serving of Spark beforehand. So, based on my success with these products, I decided to give their 24-Day Challenge a try.24DayChallenge-Logo

I didn’t just blindly stumble into this. My friend Katrina adores Advocare and convinced me to do this challenge with her. She plans to use the challenge structure to help her get ready for her wedding next year, but swears that it’s also the perfect solution to help me get back on track with my goals. Since I like what I’ve tried so far, I’m going to give it a shot. I like that I can pick and choose what to order for this challenge; since I already have Spark on hand, I omitted that, and I also didn’t bother with the Meal Replacement Shakes, because I have my own protein shake mix that I prefer if and when I decide to swap a smoothie in for a meal. We’re also dragging a few of our other friends along with us for this process, because complaining about meal prepping is easier when your best friends are along for the ride (and yes, this means that you’ll be seeing the #bestfriendscleanse hashtag popping up all over our social media accounts).

We’re planning to get the challenge started on Monday, September 14, so I’m in full prep mode.  (This also means that if you’re interested in joining us, you can – click here for more information on the challenge!) I wanted to share some of the prep tools I’ve purchased recently that will make it easier to succeed in the challenge.

small lidded containers

Small lidded plastic containers: Yes, these are usually used for jello shots. Yes, I purchased a 500-pack earlier this summer. Yes, this is a big contributing factor in needing to do the 24-day Challenge. HOWEVER, these little guys are also a great tool to help prep supplements throughout the day! The Challenge includes detailed instructions for when to take the various supplements – morning, afternoon, evening, bedtime, etc. These little cups are a great way to prep your supplements for the whole week, and they’re the perfect size to toss in your gym bag or purse.

Plastic deli containers: Amazon Prime, you are a god send. I ordered these in the 8oz and 16oz sizes. At $15 for 36 to 40 containers, it was a great deal. These containers make meal prepping so much easier! The containers are dishwasher and microwave safe, although I personally prefer to transfer my food out of the plastic before microwaving it.

3 partitionPartitioned meal containers: The round containers I mentioned are awesome for snacks, but for lunch or dinner, it’s nice to be able to portion everything in a single container. These reusable containers are awesome. The largest partition is a good size for veggies, and the two smaller partitions can hold grains and protein.

Passion Planner: I swear by my Passion Planner for staying on track. I use it for my job, for planning workouts, and for setting weekly goals. You can buy a manufactured planner, but the creator of this amazing tool has also made the PDF template available FOR FREE. I love me some free stuff, y’all! For the duration of the challenge I’m going to be adding meal prepping to the roster of duties that my Passion Planner helps me with, and if all goes well, hopefully this will be a habit that sticks with me after the challenge ends.

I am really excited to get started with this challenge, and can’t wait to report back on how it’s going!

Full disclosure: I signed up as an Advocare Distributor in order to get the 20% product discount. The Advocare product links included in this post are affiliate links. If you’re interested in becoming a Distributor, contact me and I’ll be happy to answer any questions – the discount is pretty sweet, and if you think you’ll be ordering products regularly, it’s definitely worth it!

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!

Time to Focus

Okay, time for me to come clean: October was a really difficult month for me. I had my first serious backslide, and I ended up gaining about 5 pounds over the course of the month. I can blame a lot of things – I was giving in to stress-eating cravings, I skipped workouts, and family issues took center stage. I could beat myself up over this, but I’m being honest and trying to keep a positive perspective. My efforts at fitness and weight loss aren’t a temporary change; they’re habits that I’m building for a healthier life in the long term. Realistically, things aren’t going to be smooth sailing for the rest of my life, and learning to recover from difficult periods is an important part of this journey.

I’m embracing a few strategies to help me regain my footing. I know that as we head into the holidays, this isn’t something I can do alone. So, I’ve created a group on Facebook where friends can turn to each other for inspiration and support. This isn’t a challenge group; there aren’t any points and the only prize at the end will be how we feel about ourselves. I really just wanted someplace where I could honestly say, “I’m struggling today and I’m really craving a bag of Doritos,” and there would be support to help me through it. If you’re interested in joining, leave a comment below and I’ll happily add you to the group!

I’m also excited to participate in another Six Weeks to Chic program at Studio Poise. I’ve done #6W2C twice before and have had really fantastic results both times. It helps to remind me about ideal habits and get back into a routine, and I think doing this over the holidays will help me to avoid the normal holiday weight creep. Best of all, this time around there’s a challenge built in – and you know how I love me some healthy competition!

I’m really excited about the ladies on my team – they’re great friends and will be excellent motivation to help keep me on track. Being able to text them when I’m struggling or schedule classes with them for extra accountability will definitely help me past this bumpy point!

Finally, I’m trying to mix it up more. I love my at-home workouts (shout out to Body Pump, which I am LOVING!) and I am still loyal to my Poise classes, but I think I need to have greater variety to help jump start my weight loss again. I’m trying a new spin class this weekend at Sweat Cycling Studio in Wakefield, MA, and if I like it, I’ll probably buy a class pack to make spinning a regular part of my fitness routine again. I’ve also started scheduling lunch workout dates with coworkers. We have a great new gym that’s free for employees, but I never take advantage of it. Having someone else committed with me will make sure I leave my desk and get in an extra workout! Today we’re trying this resistance band workout from Lean it UP. I’ve got this pinned on my Pinterest page, and I’ll report back on how it goes!