WTF is “lifestyle change” supposed to mean anyway?

lifestyle changeIf you’re like me, you’ve heard the term “lifestyle change” thrown around quite a bit. For example, it was used plenty of times in the comments on my recent post, My Breakup with Exercise. People are always saying things like, “It’s not about dieting, it’s about making a lifestyle change.” But oftentimes one person’s “lifestyle change” is another person’s diet, and vice versa. So WTF does “lifestyle change” actually mean?

Growing up, I first heard my parents use the term to describe a family friend and the healthy changes she made many years ago. Even then I was confused because her story began with everyone’s favorite diet company, Weight Watchers. Even though she no longer follows the program, she continues to practice some of their tips and tricks to maintain her weight, like tracking what she eats, looking for foods high in fiber, etc. A relative told me about a coworker who “doesn’t diet” but just has “plus days” and “minus days”; if she had a “plus day,” she’d compensate by having a “minus day.” To me, this all still sounds like dieting because it involves monitoring your food intake, following food “rules” or restrictions, and placing value judgements on foods or eating habits as being “good” or “bad.” Of course, you might not agree, and that’s okay.

Although the intention is usually good, telling someone to make a “lifestyle change” is problematic because everyone’s understanding of what that means is different. For example, it could mean switching to sugar-free versions of your favorite foods, or it could mean never eating artificial sweeteners ever again. Those of us who struggle with weight and body image often understand the term to apply to eating and exercise behaviors, but for others it could refer to quitting smoking or taking up a meditation practice or switching to paraben-free bath products.

The beauty of the term, though, is that it can mean whatever you want it to mean — whatever makes sense to you.

At it’s most basic level, a “lifestyle change” means making changes to support one’s personal wellness. Did you know that there are actually seven different dimensions of wellness?

  • Physical wellness can include fitness, diet and nutrition, sexual behavior, substance use or abuse, medical care, and sleep.
  • Intellectual wellness can include the pursuit of knowledge, awareness of current events, and the expression or experience of creativity.
  • Emotional wellness can include stress management and relaxation, as well as self-awareness, self-acceptance, and mental health.
  • Social wellness can include interpersonal relationships, social justice, and community service.
  • Spiritual wellness can include your value or belief system (including but not limited to religion), and finding personal meaning, hope, and optimism.
  • Environmental wellness can include the protection and conservation of natural resources, as well as the health and safety of animals, humans, and our own bodies.
  • Occupational wellness can include job satisfaction, work/life balance, and financial security.

It’s helpful to consider of all of these dimensions because it reminds us that neither our worth nor our happiness nor our “wellness” is defined by our appearance, our fitness, or our diet. Part of figuring out what making a “lifestyle change” means to you is figuring out what dimensions of wellness you want to pay more attention to–recognizing that each are equally valid and important in your personal pursuit of health and happiness.

Last year I taught a course on leadership and we used a ranking activity to help students think deeper about their own values. (Mad props to Steve R. for the activity!) I modified it and I think this version could be helpful in terms of figuring out what “lifestyle change” you might be interested in. Below are 50 different things that could be part of making a healthy “lifestyle” change, in no particular order.

 Weight management

 Fitness/ Strength

 Smoking

 Religious belief & practice

 Community Service

 Finances/debt management

  Job satisfaction

 Inner Harmony

 Environmental conservation

 Social Justice activism

 Hope/Optimism

 Stress management

 Animal rights

Being active

  Nutrition

 Vegetarian diet/ vegan diet

 Mindfullness/ meditation

  Sleep

 Creativity/ Creative expression

 Sexual pleasure/sex life

 Family relationships

 Social life/ friendships

 Avoiding processed foods

 Career Advancement

 Romantic relationships

 Pursuit of knowledge

 Alcohol use/abuse

 Medical care

 Sexuality/ gender identity and expression

 Self-care/ Self-compassion

 Awareness of current events

 Political involvement

 Mental health

 Avoiding artificial sweeteners

 Body image

 Reducing intake of chemicals in bath/beauty/cleaning products, etc.

 Intuitive eating/mindful eating practice

 

 Self-acceptance

Avoiding artificial growth hormones in meat/dairy

 Drug use/abuse

 Community engagement

 

Experiencing new things/places

Eating less sugar/high fructose corn syrup

 JOY!

FUN!

 Eating whole grains

 Work/life balance

 Hobbies/skill development

 Gratitude

 Eating local/food sustainability

 

 Intimacy

Okay, here’s the hard part. Here’s the link to download and print it out: Defining your Wellness Values Chart

  1. Cross off the 10 that either a) you’re already satisfied with, or b) that are least important to you right now. (Remember that this doesn’t mean these things are unimportant, just that they are less important to you, right now, than the remaining 40.)
  2. Now cross off 10 more (30 remaining). Give yourself a time limit.
  3. Now cross off 7 (23 remaining). Take a quick break and then come back to it.
  4. Now cross off another 7 (16 remaining).
  5. Cross off 6 more (10 remaining). This is getting tough, huh?
  6. Cross off 5 more (5 remaining).
  7. Circle the most important wellness element to you at this point in time.

I just did this activity and it was really freaking hard, but I narrowed my top 5 wellness elements to: building fitness/strength, improving family relationships, self-acceptance, intuitive eating, and reducing my intake of chemicals, These are the areas I want to focus on to improve my overall “wellness.” So, for me, a “lifestyle change” means working out, accepting myself the way I am, finding more ways to make meaningful and positive connections with my family, listening to what my body wants, and staying away from processed foods and chemicalized bath and beauty products.

The thing about changing your lifestyle is that it has to be something you actually WANT to do. Wanting to lose weight because you struggle with body image is not the same thing as wanting to change the way you eat. For example, the person in that scenario might experience more success and actually feel better by choosing to focus on positive body image and building self-esteem.

Only you know what a “healthy lifestyle” means for you. And if you’re not sure yet, perhaps this activity will help.

Let me know how it goes! I am hoping to try this with my students next year, and your feedback will be super useful.

 

 

My Breakup with Exercise

In November, I met the amazing Ragen Chastain at a conference. She was the keynote speaker and blew the minds of college health professionals about Health at Every Size. During one of her talks she explained that many people are currently experiencing a “bad breakup with exercise.” That phrase was a gift to me – I finally have the  words to describe my fraught and complex relationship with exercise.

I was never an overly active kid. I loved to read, play with plastic dinosaurs, and find salamanders in the woods. I hated gym class. I did not like sports. Nor did I like hiking or cross-country skiing, my parents’ favorite activities. Once I hit puberty my body became soft and pudgy and my dislike of physical activity was no longer just a personality trait – it became a flaw. It became an indicator of my laziness and bad attitude, or at least, that’s how my parents seemed to interpret my spirited protests. I quickly understood that I was being forced to go hiking because I was fat. My mom encouraged me to go to the gym with her. I felt out of place there and embarrassed. My presence in this dark, smelly, scary adult space was punishment for being a fat and lazy kid.

I didn’t touch exercise again until my junior year of college. My university required everyone to take a certain number of gym credits and I signed up for a step aerobics class I had heard good things about. I loved it. The instructor was an athletic female coach who was all about strength and fitness, not about appearance. She wore a giant t-shirt and long, baggy gym shorts. I started coming to the gym a few times a week and doing the elliptical machine, crunches and pushups. I signed up for Pilates and a strength-building classes even though I had already fulfilled my Phys Ed requirements. It felt good. It was a happy time for me. I finally was developing some positive experiences with exercise.

In 2009, I moved to Boston to begin my first full-time job.I got myself a gym membership. I started doing Weight Watchers with a coworker, and religiously tracked every morsel I ate. I signed up for personal training. I went to the gym at least 5 times a week. My sessions at the gym now lasted about 2 hours. I would start with 15 minutes of cardio on the elliptical to warm up. Then I would do 30-45 minutes of strength training. Then I would do 45 mins-1 hour of cardio – rotating between the elliptical, stairmaster, and bike. Then I would stretch for 20 minutes. For a month or two, I added another 15 minutes of ab work each night before I went to bed. I turned down offers to go to dinner or evening events in order to go to the gym. I knew that I needed at least a 3-hour block of time to do my regular workout, shower, and change; there was simply not enough time to do anything else on a weeknight. I had no hobbies to speak of, besides working out. I did this for about a year.

Everyone thought I looked great. I lost 25 lbs and fit into size 8 pants for the first time since high school. For a brief period, you could actually see my ab muscles when I flexed. I could wear really short shorts. I ate mostly processed frozen dinners, raw vegetables, and Greek yogurt (no time to cook). I got compliments from friends, coworkers, and my family. Guys asked me for my number. My parents no longer chided me for my behavior; now they were asking me for tips. They soon signed up with personal trainers themselves.

I was down to 145 lbs, but I was convinced that I needed to get to 125. I believed that was considered “normal weight” or “healthy weight” for a woman of my height. I was excited and happy about the changes I felt and saw in the mirror, but I in no way considered myself “done.” I was in the best shape of my life, but I still thought I was fat. And according to my BMI, I was technically still “overweight.”

This too can be yours! Just eat hardly anything and exercise 2 hours a day for the rest of your life!

This too can be yours! Just eat hardly anything and exercise 2 hours a day for the rest of your life!

Then I started grad school. I was working full-time and taking a full course load at night. Suddenly, there was no time to go to the gym. I had night classes and homework. I still tried to go as often as I could, but if I wasn’t able to complete my full 2-hour workout, it felt like failure. A waste. Moderation was simply not in my vocabulary. My new body was slipping away.

Soon I become so mentally exhausted that I had no room left for tracking Weight Watchers points. I had no time to go grocery shopping. I started living off of cafe sandwiches, takeout, and Red Bull. My beloved trainer experienced some health problems and had to retire. The trainer assigned to replace him was a douchebro jock who kept talking about getting me a “hot bikini body” and I hated him. Eventually, I stopped going to the gym altogether. And, naturally, I started to gain weight. Like so many people, I ended up gaining more than I had lost.

Three years later, I am the heaviest I’ve been in my life. My parents have expressed their concern, and I have pushed back on their well-intentioned but incredibly painful statements with every ounce of spirit in my body; I will not feel like a worthless fat girl again. And no, exercise is not so simple as “Just do it.”

For most of 2013 I was sedentary. I had multiple false starts as I tried to “get back into the gym.”  Each time I returned, there was a new manager at the personal training company who would spot me on the elliptical and approach me, saying “Congratulations on taking the first step towards a better you!” or some bullshit like that.

I wanted to punch them every time. I am already a better me. I have hobbies now. I have friends. I have a life.

Then the manager would encourage me to try personal training because “beginners always need someone to show them how to do things properly.”

“FUCK YOU, I am NOT a beginner,” I would think.

“If you only knew me when…” And then my anger would dissolve into shame. I was embarrassed at failing so spectacularly.

But looking back on it now, I wonder how could I have done anything else but fail. My Biggest Loser-esque workout regime was extreme and unsustainable. Dieting was unsustainable. My abs were unsustainable. And no matter how thin or muscular I got, I always thought I was fat. I always needed to lose more. I was never not unhappy with my body. Losing weight did not improve my body image whatsoever.

In 2013 I vowed to stop dieting forever and began the long process of making peace with my body. Though I was making progress on the eating and body image fronts, I was still having a really hard time with exercise. Friends would say, “Couldn’t you just go to the gym for like 20 minutes? Couldn’t you just take the stairs? That’s better than nothing!” The thought of going to the gym for 20 minutes or taking the stairs was foreign and confusing. How could you do anything worthwhile in 20 minutes? I would never get my abs back by going to the gym for 20 minutes. I would never lose 40 lbs by taking the stairs. It became obvious that thinking of physical activity in moderate and sustainable terms was going to be extremely challenging for me.

I spent a lot of time thinking of ways to get active that would be fun and sustainable. I didn’t come up with any radical new ideas. There was yoga and hiking, which I have learned to like now that it isn’t mandatory and I can choose to do it on my own terms. But I haven’t found a yoga studio I like yet and hiking is difficult to do on a regular basis when you live in a northeastern city. I kept coming back to the gym – the first place I ever really enjoyed exercise.

But I was, as Ragen deftly stated, going through a bad breakup with the gym. The gym had ghosts of my thinner self in every mirror. The gym was full of people who would assume I had never worked out before. And I still never had enough time to do the kind of workouts I felt were necessary. “Do it right or don’t do it at all” would echo in the back of my head.

I took my time. I thought about things. I let myself get comfortable with tenets of Heath at Every Size. I practiced self-compassion. I forgave myself for “failing” and gaining weight. But most importantly, I worked on letting go of the idea that I could someday be 125 lbs or “get my abs back” or achieve the extreme physical transformation I did back in 2010. This has been, and continues to be, the hardest part. There is a very real sense of loss involved in abandoning the idealized, aspirational vision of yourself that’s been in your head since you were a teenager.

Then I agreed, for the first time in my life, to participate in a fundraiser stair climbing challenge. I knew this would force me to get back to the gym, and it did. The stair climb event is two days away, so last week I forced myself to return to the gym for the first time in many months.

Walking in the door was really hard. I could barely finish my first 20-minute cardio workout on the cross trainer. Five days later, I can do 30 minutes without too much difficulty. I think it’s amazing that my body can adjust back so quickly after so long. I am grateful for its strength and responsiveness. I suppress the faint urges to pull my scale out of storage.

This time, I’m trying to commit to realistic goals. 25 minutes. 30 minutes. Mostly cardio, with some Yoga Meltdown or free weights every now and then when I want to work on building strength. No more than 45 minutes per workout, 3-4 days a week.

Workouts that will help keep me active and give me the health benefits I’m looking for, but won’t consume me. Workouts I can squeeze into my busy life without having to sacrifice other hobbies or time with friends. Workouts that have absolutely nothing to do with losing weight or achieving a “hot bikini body.” Those are the kind of workouts I am aiming for now.

I’ll have to wait and see how it goes, but I’ve got a good feeling about this “moderation” thing. Maybe it could work for you too.

Size 14 and that’s okay.

Addressing the sleep deficit, NOT one person at a time

The more I learn about health and wellness, the more convinced I am that sleep is magic.

Not only does getting the recommended 7-9 hours help you feel awake and refreshed in the morning, it also helps regulate your metabolism and improves your memory, focus, judgment, problem solving, and athletic performance.

New and terrifying research links not-enough-sleep (the 5-6 hours most Americans currently get) with weight gain, increased risk of cold/flu, diabetes, cancer, and ADHD-like symptoms. Additionally, not getting enough sleep results in poorer cognitive abilities (lack of focus, concentration, ability to remember what you’ve learned), poor judgment, and impaired driving on par with drunk driving. It’s also correlated with depression, anxiety, and other mental illness.

wE9muBx

When I saw this New York Times post basically summing it all up (and providing links if you want to check out the research) I was ecstatic and all “That’s what I’ve been saying!” Then I read the comments.

“You assume it’s a choice, that people actively choose to get less sleep and, if they want to, can choose to get more. That may well be true of upper class people who can hire others to do their work for them – housework, tutoring, etc. As for me, a middle class shlub, well, I would LOVE to get more sleep. But I am a single mom. I have to get up at 5:30 am for my job. And I have to work or I will land in the street with my kids. ANd I have to stay up at least until 10:30 pm most nights to get this or that child hither and thither, help with homework, and son on. I cannot hire anyone to do any chore– lawnmowing, housecare, homework, driving, shopping, bill paying, college planning for kids, etc etc etc etc. Basically, I work from the moment I get up until the moment I sleep. I have no time to exercise either.”

And it hit me. The sleep deficit is a lot like the obesity epidemic; it is a systemic problem that cannot be solved by encouraging individuals to make healthier choices.

I work with college students who probably could get more sleep if they spent a couple fewer hours playing videogames.

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Shit college students say.

Of course, some of my students work more than the recommended 10 hours per week and can’t choose to sleep more. But in general, I feel okay about trying to encourage them to prioritize sleep over partying or more time on Reddit because they can usually make changes without too much trouble. For the general adult population, however, this really isn’t the case.

The comments on the New York Times post read like a laundry list of reasons why Americans are not sleeping. Parents are kept up by new babies. Physicians-in-training are working 28-hour shifts. People who travel constantly for work (flight crews, journalists, musicians, etc.) are forced to keep irregular schedules in different time zones. Single parents are working full time jobs in addition to the “second shift” just to make ends meet.

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But it isn’t just our jobs, families, and full schedules that are keeping us up. The world has changed. Energy drinks and caffeinated latte drinks are sold on every corner and and marketed either as health supplements or entertainment. We are constantly connected, if not tethered to, our phones, tablets, and the internet — whether it’s for work, entertainment, or connection. A recent study found that the light from backlit screens can disrupt sleep by suppressing melatonin, a hormone that helps regulate our circadian systems. But this is even bigger than a gadget issue.

Our circadian rhythm, which is how our body knows when to sleep and when to wake, is informed by both light and temperature. Darkness and cooler temperatures let our bodies know it’s nighttime, and therefore bedtime. So what happens to our circadian rhythm when we live in consistently temperature-controlled environments? And about that darkness thing? Yeah. We don’t really have that anymore. Just check out these NASA images of the world at night.

Captured in 1994

Captured in 1994

Light pollution projected growth

Light pollution projected growth in 2025

So basically our artificial environment is  really screwing with our circadian systems, and we wonder why no one can sleep? Some scientists are even concerned that light pollution is killing off wildlife.

Animals need sleep too.

Animals need sleep too.

It’s no wonder that the New York Times post, which encouraged readers to get more sleep and discuss the issue with their doctors, made some people angry. For so many of us, sleep is simply outside our realm of control. Before I’ve made the argument that our obesity problem should not be addressed through individual behavior change because it is a systemic problem that can really only be solved through systemic changes to our environments and our policies. When we try to treat obesity as if it were simply an individual problem, it manifests as shaming people for things beyond their control. When we consider that sleep and weight are inextricably linked, it’s not surprising that the same thing happens when we tell people they need more sleep.

And, just like weight shaming can cause people to develop eating disorders or depression/self-esteem issues that lead to further weight gain, warning people about the health risks of sleep deficit can actually make the problem worse:

“As a law school graduate studying for the New York Bar and planning an impending move to NYC–without yet a job, praying to find one in public interest law–I lie awake every night, worrying.  But at least now I know all of the harmful things that are happening to me.”

“Constantly counting the number of hours of sleep I got each night hasn’t been good for my mental health either. It’s like counting calories. It made me obsessed. So I stopped.”

“One thing that would help me sleep is not being constantly told how awful it is not to get it.”

The Health Belief Model of behavior change tells us that if you scare people about a health issue without providing a clear solution for how they can prevent or treat it, they are not going to respond well. Telling folks the dangers of not getting enough sleep without providing realistic solutions will cause them to feel like it’s hopeless and shut down. This issue cannot be solved by telling people to try to get more sleep.

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So how can we address the sleep deficit at the systematic level? In college health we have an advantage because we have a fair amount of control over the environment our students inhabit. We have the ability to provide a campus that encourages and supports healthy behavior. We can close down our libraries, gyms, labs, and campus centers at 10 pm. We can ban 8 am classes to let our students sleep in later. We can mandate quiet hours in our residence halls. We can ban Red Bull and 5 Hour Energy from promoting their goods on campus. It’s a little more complicated in the real world.

tumblr_inline_mmq91iJGyJ1qz4rgpWhat could some of those systemic changes look like? Is it even possible to regulate light pollution in urban areas? How would we accomplish that? We could tax the crap out of energy drinks like we tax cigarettes. We could create similar disincentives for 24-hour service availability. For example, in Spain, most businesses are closed during siesta in the afternoon. People simply have to run errands another time, and they make it work. We could also place stricter regulations around the “full time” (read: eligible for benefits) work week, reducing it from the standard 4o-45 hours to something closer to 35. (Again, a lot of Europeans do it this way.)

But beyond regulation, true systemic change requires a culture shift. We need to foster a culture that doesn’t reward employees for putting in extra hours, or make anyone feel like they need to put in extra hours to keep their job. In industries where it’s possible, like in most office jobs, we need to institutionalize flex time and let workers telecommute in order to snooze that extra hour it would take to commute. We need to change the norm from one where we lie in bed with our phones checking email to one where that kind of behavior is uncommon. We could stop creating reasons for people to stay up late, like scheduling evening events earlier and no longer airing popular TV shows after 10 pm.

But this kind of societal change takes decades and requires tireless efforts from public health folks and other advocates. Perhaps the first step of that work is recognizing that the sleep deficit is bigger than you and your insomnia, her and her new baby, or him and his ridiculous work schedule. For those who can make the choice to sleep more, doing so will definitely improve their health. But the focus of public health messaging and health journalism should not be to scare or shame people who, for whatever reason, can’t get enough sleep.

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TL;DR sleep zombie friends?

What I’m really trying to say is that the only way to really address the issue is to treat society’s sleep deficit as the gigantic, systemic, clusterfuck of a problem that it truly is.

Goodnight.

Goodnight.