3 Characteristics of a Healthy Body Positive Group Coaching Program

Untitled drawing-12I’m happily back home after a weekend presenting at the Body Positive Fitness Alliance Affiliated Professionals Workshop, and I want to share with you guys some of the characteristics of healthy coaching programs. I don’t mean just programs that deliver health, but also programs that ARE healthy, programs that will support not only the clients who participate in them but also that will remain strong and viable themselves. This was really the focus of the weekend – how not only to build a program that will support the mental and physical health of the client, but also that will continue to grow and evolve in a healthy and sustainable way.

I shared more than 3 characteristics at the workshop (and you’ll have to take the next one to learn the other characteristics, heh), but I felt like these three were a great place to start for anyone looking for a good program to participate in, or trying to build a program that will serve their clients in the healthiest way.

Number 1: Evidence, evidence, evidence

Or, as I more affectionately refer to it, EVIDENCE OR GTFO. Why is evidence so important? For a couple different reasons:

  • clients deserve recommendations that we know work, not recommends based on the coach’s ego. The coach’s recommendations should be sound, tested, and evidence-based. When a coach diverges from the evidence and starts creating programming based on their own opinions and preferences, they are putting their clients’ health at risk, all because they believe they know better than all the scientists and doctors and physiologists who establish science-based recommendations. Don’t hire the coach who thinks they know better than the entire scientific community. Don’t BE the coach who thinks they know better than the entire scientific community.
  • when pseudoscience and woo are allowed to take root in a group, they create confusion and chaos, and ultimately undermine the credibility of the coach. The coach can begin to prevent this by creating evidence-based programming – but there is more to it than that. Pseudoscience (much like a virus) can be introduced to a group by group members. If the coach hasn’t created a culture within the group that challenges baseless claims, that pseudoscience-virus can fester and spread among the group members. The coach can ‘immunize’ the group against pseudoscience by teaching their clients how to spot bad science and logical fallacies. The best way for a coach to keep their coaching groups healthy is to promote (and teach, if necessary) critical thinking within the group.

If the words ‘critical thinking’ and ‘evidence based’ feel clinical and cold to you, it’s time to re-frame. You’re not alone, by the way – lots of people have a hard time reconciling the concepts of warm and fuzzy body-positivity with science-based terminology. But body positivity IS evidence-based! The research continues to show that empowering and supporting people is the best way to encourage long-term positive behavior change. Evidence and body positivity go hand in hand. To be evidence based, a program must be body positive. To be body positive, a program must be evidence based.

Number 2. All bodies are good bodies.

We talk about this one a lot. Because we get a lot of pushback from popular culture for it. Many people, people still stuck in Diet Culture, people who’ve invested their time and emotions in Fit 1.0, think ‘All Bodies Are Good Bodies’ means that we all just give up on self improvement. That we stop trying to get better at things, that we stop practicing behaviors that improve our health.

It means exactly the opposite, though. It means: YOUR body is awesome and worthy of self care. No matter what your body looks like or can do, it is worthy of self-care. You are valuable, your body is valuable, and it’s worth caring for in the best possible way, and we are here to meet you exactly where you are and help you pursue YOUR goals for YOUR body.

All Bodies Are Good Bodies means we work on our self talk, AND WE ALSO work on the things we say about OTHER bodies. We are kind and compassionate when we talk about and to ourselves, and we are also kind and compassionate when we talk about other people’s bodies. Celebrating one body doesn’t mean denigrating another. We can all be awesome. ALL bodies are awesome. And worthy of care.

A coach can foster a culture of compassion toward all bodies by modeling self care for themselves. And by teaching clients to treat themselves with respect and compassion. They can also foster that culture by not making derisive comments about celebrity bodies, or bodybuilder bodies, or skinny bodies, etc. And they can address those kinds of comments when they’re made by clients as well. A group culture in which all bodies are respected will help everyone in that group feel respected and supported in striving for their goals while ALSO appreciating their bodies for what they can do today.

Number 3: Eyes on your own plate.

“I would never eat that.” “That’s a lot of food!” ” What did you eat to lose weight?” “People who eat [insert any food] don’t care about their health.”

We here in western culture LOVE to judge the food choices of other people. We love to tell people what we eat and why it makes us superior. We love to look down our noses at people who eat things we believe are unhealthy. We love to make sweeping judgements about people based on their food choices. We love to endeavor to eat in ways that we believe signify that we are smart, healthy and more informed than others.

We are obnoxious.

If I’ve learned anything from running an online coaching community, it’s that when people start talking about what they eat and don’t eat, things go to hell quickly. People either forget or don’t know how important context is, that people make food choices for perfectly valid reasons that may not be obvious to other people.

The best way to keep a coaching community from devolving into shame and judgement about food is to simply make the topic off limits. “Eyes on your own plate” is actually a formal rule in all my groups. Group members worry about their own food and no one else’s. And each group member can feel safe from the judgements of others, because there is an expectation that each member will focus on their own diet and no one else’s.

“What you eat is your business and no one else’s” is a common refrain in my groups, and the result is a safe place for members to give and seek support without fear of being judged or told they’re “Doing it Wrong'”.

Now, I’d be remiss if I didn’t plug my own coaching group program here. Habit-Based coaching has become very trendy lately, but I’ve been doing habit-based coaching longer than just about anyone in the business. I was writing about habits before it became a ‘thing’, and in fact some of the people who used to ridicule my approach are now copying it! If you’re looking for a sound, experienced coaching program that embodies the characteristics I’ve talked about here, you can’t do much better than The Habit Project, my joint venture with Sean Flanagan (bonus, we’re running a sale right now!).

If you’re a coach who’s interested in creating the kind of program I’ve talked about here, join us over at the Body Positive Fitness Alliance and attend one of our future workshops. In the future, ALL fitness coaching will be body positive, and you can help us get there (and get a jump on the competition) by getting involved now!


Body Positive Fitness Isn’t Always Rainbows and Unicorns

Untitled drawing-11I think one of the things people are frequently surprised by when they join my Facebook group is that we don’t always tell people what they want to hear. Nor are we unquestioning cheerleaders. This throws people for a loop if they’ve joined under the impression that “Body Positive Fitness” means perpetual cheerfulness and consummate harmony.

I think that general Body Positive culture, and the size acceptance movement (both of which I support) DO tend to be those things, so when one of my coaches calls someone out on their self-destructive or manipulative behavior, things can get uncomfortable.

Body Positive Fitness isn’t always comfortable. Body Positive Fitness is, at it’s core, about respect. Respecting ourselves, and respecting others. And where there is respect, there are boundaries. Run up against those boundaries, and you should expect things to get uncomfortable.

In my last post, I spoke to fitness professionals. This post is for clients. It’s for the people who are curious about this new approach to fitness but not quite sure what it’s all about. This is what you can expect, from the movement and from the Professionals driving it.

Respect For The Client

We, the fitness professionals representing Body Positive Fitness, will treat you with respect. We will respect you as a person, we will respect you as a grown adult, and we will respect your body regardless of it’s size, shape, ability, color, age or gender.

We will respect you as a person. This means we will spend time learning about your goals and limitations. We will create programs for you based on those goals and limitations, as well as your personal preferences, time constraints, and available resources. We won’t dismiss your circumstances by assuming we know what you want to look like or be able to perform. Your program will be what works best for YOU, in your circumstances, and with considerations for your limitations.

We will respect you as a grown adult. Essentially, this means we will be honest with you. Sometimes, being honest with you means telling you that your behavior is self destructive. Sometimes it means telling you that you’ve been given bad information by someone else (Fit 1.0), and it’s keeping you from being successful in your goals. Sometimes it even means telling you that the actions you’re taking will hinder your progress toward your goal. But none of these things means you are a bad person. All of these things happen to EVERYONE, and it’s our job to help you identify barriers to success, and overcome them. When those barriers are coming from yourself, it can be hard to hear. We know that. So we do our best to present compassionate honesty. Being honest with you, even when it’s hard to hear, is one way we respect you. Being dishonest is disrespectful, even when it’s the easier thing to do. Respecting you as a grown adult means we treat you like one. We tell you the truth. We are honest. Because that is how grown adults treat each other.

We will respect your body. Respecting your body means we support you in creating habits that will help you reach your goals. If we recognize that your habits are hindering your progress toward the goal you’ve identified, respecting your body means we will let you know. If increasing your daily step count is one of your stated goals, and we recognize that you’re passing up opportunities to work more walking into your day, respecting your body means we’ll discuss it with you. Compassionately. It also means that if we recognize that you may be struggling with disordered thinking about food or your body, we will talk to you about it and refer you to an appropriate professional. Sometimes this can be a very uncomfortable conversation for both of us – but respecting your body means we place your health ahead of our own comfort.

On the other hand, we will NOT project our own assumptions about what your goals should be on to you. For instance, if you haven’t identified weight loss as a goal, we won’t give you advice on creating a calorie deficit. And if one of us slips up and does something like that, please speak up. Your own goals are what we are here to support. Not our own projected goals.

Respecting Each Other

I mentioned boundaries above. Most Body Positive Fitness interactions will happen in group environments. Creating a culture of respect for each other often means that BPF professionals will have to create firm boundaries that clients will be expected to respect. Respecting those boundaries is a way the clients can support each other. It may not always be easy – sometimes one person in a group may have to compromise their own preferences because they don’t work for the group as a whole. But respecting boundaries is the way we show respect for each other in group settings.

One example of this is the rule in my Facebook group that if a person makes a health claim, they are expected to provide evidence to support it (read my last post about why Body Positive Fitness MUST remain evidence-based). Ultimately, this rule (i.e., boundary) is there to prevent pseudoscience from taking root and spreading within the group. Sometimes an individual will run up against this boundary, make a claim, and not have evidence to support it. That individual may feel they are being treated unfairly by being required to provide evidence – but the rule is there to respect the group as a whole. In this case, an individual has to either compromise (not make the claim), or decide the group isn’t the right place for them. They won’t be able to disrespect the other people in the group by making unsupported claims. Even though that one person may feel like the group isn’t ‘positive and supportive’ to them specifically, in the end, the boundaries and rules are there to respect and support the group as a whole. All the other people in the group, who matter every bit as much as the person in question, will recognize that the group’s boundaries are there to protect them.

Body Positive Fitness group interactions require boundaries, and those boundaries must be designed to respect and protect the cohesiveness and safety of the group as a whole. Individuals within the group can show respect for each other by respecting the group’s boundaries and rules. Sometimes those boundaries might make an individual within the group feel uncomfortable, but that doesn’t make the boundaries ‘negative’ or ‘unsupportive’. That individual might see them that way (as sometimes happens in my Facebook group), but people who can’t see that respecting a group’s boundaries is in itself body positive simply aren’t ready for Body Positive Fitness.

One way coaches can affirm the group’s boundaries is by calling out manipulative behavior when it arises. This takes some wisdom and skill, and the ability to first recognize manipulative behavior (which is why critical thinking skills are SO important to Body Positive Fitness coaches). Again, this can be uncomfortable for the entire group, but in the end, addressing and challenging manipulative behavior will help everyone in the group learn to recognize the way they, and others, can sabotage their progress. Calling out manipulative behavior in the group ultimately supports every individual’s personal journey. It is a vital skill for Body Positive Fitness Professionals, and is there to support the clients’ goals.

Body Positive Fitness will have uncomfortable moments. This is one thing that sets it apart from more general body positive culture. We expect those uncomfortable moments, and approach them with respect, as adults.

If Body Positive Fitness were rainbows and unicorns all the time, we’d miss opportunities to recognize and overcome barriers to success. We’d lose clients and coaches to the chaos of boundary-less classes and programs. We’d allow people to continue on in self-destructive behavior patterns without understanding why they can’t seem to make progress.

Respect means telling the truth, with compassion. Respect means creating boundaries, and respecting them! Respect means saying things that are hard to say, and sometimes harder to hear. These things are the way we show we respect each other, and respect is the foundation of Body Positive Fitness.





Why Body Positive Fitness MUST Be Evidence Based

Untitled drawing-9The Body Positive Fitness movement is growing. More and more fitness professionals are realizing the value of this approach to coaching, and more and more individuals are being drawn into fitness for the first time by this brand new way of approaching fitness and health. The focus on quality of life rather than appearance is changing the climate of the fitness industry, and it is exciting!

There’s something really important I have to say about it though.


We MUST leave the pseudoscience and woo behind. That bullshit has to stay with the old fitness industry. The Body Positive Fitness industry we’re building needs to be evidence based, and STAY evidence based.

What pseudoscience do you mean, Amber you may ask? There is so much. Oh my god, so much. I can’t list everything, so I’ll share some of the most egregious examples. Fake diseases like adrenal fatigue, candida overgrowth, “broken metabolism”, and leaky gut. Most supplements. All MLM products. Fad diets. So. Many. Fad. Diets.

WHY do we need to leave the pseudoscience behind? Don’t some people like it? Doesn’t it work sometimes, even if it’s not supported by science? Placebo is powerful after all! What’s the harm, Amber'

The HARM is that when we use these non-evidence based products, diets and practices on our clients, we are essentially experimenting on them.

And experimenting on our clients is disrespectful. Come on people! Stop experimenting on your clients!

RESPECT for the bodies of our clients is the core value of Body Positive Fitness. We put that respect into action by grounding our coaching in proven, established, evidence-based practices. We do NOT subject our clients’ bodies to unproven techniques and fantasy-based diets. I mean, best case scenario, nothing will happen. Your client spends a lot of their money on magical pills and potions and nothing happens. Worst case scenario, though, is that you hurt or even kill someone by making unproven, fantasy-based recommendations.

Do you know what drives the use of unproven techniques and fantasy based diets? Ego. The ego of a coach who thinks they know more than the kinesiologists, doctors, dietitians and scientists who develop standards of practice and nutritional guidelines. The opposite of evidence-based coaching is EGO-driven coaching. I see it all around me, douche-bros who belittle women for having the wrong kind of body, coaches who use crystals and herbs to treat their clients’ adrenal fatigue, gurus who tell their fans that they got their abs from isagenix (and not the combination of genetics and calorie restriction that is reality), trainers promoting paleo or low carb or vegan diets…EGO. These coaches are basing their recommendations on EGO. Not evidence.

Sometimes a person will come to my page or group with some beliefs they’ve gotten from a coach or trainer – beliefs that are inaccurate. That carbs are evil for instance, or that paleo is the ideal human diet, or that they have adrenal fatigue, or that they need to buy shakeology to succeed, etc. And they sort of look foolish to the people in the group, because they believe the bullshit they are spouting. But it’s not really their fault. Someone they looked up to, someone they PAID, taught them bullshit. Someone they trusted with their health taught them bullshit. THAT is what Body Positive Fitness MUST LEAVE BEHIND.

People trust us with their health. We can’t teach them bullshit. We can’t make them look foolish. Let ‘professionals’ from the OLD fitness industry do that to their clients. Not us. No.

Body Positive Fitness Professionals need to stick to evidence-based practices. It is the way we put Body Positivity into practice. We respect our clients’ bodies by not subjecting them to unproven methodology. We respect our clients’ bodies by basing our coaching practices on evidence, not our egos. We respect out clients’ bodies by not gambling their health on something that might or might not be true, by not experimenting on them with new fad diets and supplements.

Join the revolution. Leave the bullshit behind. Whether you are a fitness professional or an individual getting active for the first time, there is a place for you in the Body Positive Fitness movement.'?And some day, there will be enough of us to completely shut down the old, ugly, shame and ego based fitness industry of before, and all there will be will be the awesome evidence and JOY based fitness industry of the future.


Image courtesy of Real Body Stock Fitness Photos

Thinness and Asian Culture, with Jen Lam

On this past Sunday’s youtube show, I sat down with my friend and colleague Jen Lam, to discuss Thinness and Asian Culture. Jen has been helping me moderate Eating the Food for several years, and is also a member of the Fit 2point0 leadership team. She’s pretty freaking amazing, and has a lot of wisdom to impart. I’m so grateful for her influence and leadership as part of our team.

New Years Resolutions with Nia Shanks!

I sat down with Nia Shanks yesterday to talk about New Years Resolutions. We discussed better ways of making changes. We ended up talking for 30 minutes, so cue this video up to play while you’re doing a quick New Year’s workout this week!


Our next Habit Project On-Ramp is enrolling this week. If you’re interested in a habit-based approach to weight management and health, get your name on the email list to get first dibs on our Facebook and iPhone app groups.

An Inside Look at Herbalife (and Every Other MLM)

Yesterday I sat down with Laura from Surf City Fit Club, as part of one of my side project’s Fit2point0’s youtube show. Laura used to be an Herbalife ‘Coach’ and gave me an inside view of the training she got (or more specifically, DIDN’T get) in order to give her clients fitness and nutrition advice as part of the Herbalife program.

Laura is now training to be a fitness professional through an actual accredited fitness certification institute.

Here ya’ go.

Thank you for watching! Be sure to check out the Fit2point0 Facebook page here.


Are you looking for a coaching program with real coaches who actually ARE trained in fitness and nutrition, and who won’t EVER sell you shakes? Check out my coaching program, The Habit Project', with my coaching partner Sean Flanagan, here. We have a new group enrolling in January!


Cognitive Dissonance, Or: How People Convince Themselves That Dude Didn’t Lose Weight Eating McDonalds

Imagine that you believe something very strongly. That “fast food makes you unhealthy and fat”, for example. And then someone comes along and presents you with some evidence that conflicts with that strongly held belief. Lets say that they present the case of a man who lost a large amount of weight and improved his health markers eating nothing but fast food, for instance.

In the above scenario, you would experience an uncomfortable sensation called “Cognitive Dissonance”. Cognitive dissonance is a state of anxiety that occurs when one is confronted with evidence that conflicts with one’s deeply held beliefs. In order to resolve this anxiety, one must either determine that the evidence is false, or examine and change one’s beliefs.

The scenario I presented is, of course, true. There really IS a guy who lost a bunch of weight and improved his health markers eating nothing but fast food (McDonald’s specifically), and it really has throw the internet into a fit of cognitive dissonance. The point of the article I linked is that the guy maintained a calorie deficit and lost weight. Losing weight itself improved his health markers. As the inevitable snowball of cognitive dissonance happened, I sat back and watched, and chuckled a little, because the mental gymnastics people put themselves through to rationalize away evidence never changes. Because, of course, for most people, it is easier to try to rationalize away the evidence than it is to examine and change their beliefs. I’ve written about cognitive dissonance before; the ways people are trying to rationalize away the McDonald’s dude’s weight loss are no different than the ways people have tried to rationalize away my weight loss success in the past (read the post I linked there to read some of the ways, it can get hilarious).

I’ve rounded up some comments from Facebook about the dude-losing-weight-eating-McDonalds story, and am sharing them here (names redacted, of course), explaining the ways people are attempting to rationalize away the evidence they’ve been presented with so they can preserve their belief system.

First, we have the “It only worked because his diet was so bad before” folks.

The message here? The McDonalds diet only worked because his diet was so horrible before that McDonalds was an improvement. It wouldn't work for ME, because my diet is already good.More on the "his diet must have been horrible before" theme.

Then there are the Concern Trolls who are supposedly worried about his health:Screen Shot 2015-11-10 at 12.00.06 PMAnother "I didn't read the article, and I'm going to choose to believe McDonalds made him unhealthy so I don't have to examine my belief system".

Neither of these people bothered to read the article in which it was noted that in addition to losing weight, all his health markers improved. Perhaps they purposely avoided reading the article, subconsciously worried that they’d be confronted with more evidence they’d have to try to explain away. Again, these people are telling themselves a story so they can continue believing their narrative in spite of being faced with conflicting evidence. They are rationalizing the evidence away.

These next few are random examples, I’ll explain them individually.

"I can't be bothered to read the article, so I'm going to choose to believe he only ate salads, which I could never do. And besides, [insert something Food Babe told me that has no basis in fact]."“If I read the article, I might find out something I don’t want to know, so I’m going to choose to believe that he lost weight because he only ate salads, and not because he maintained a calorie deficit. Oh, yeah, and McDonalds is poison! I read it on Natural Avocado Babe News!”Screen Shot 2015-11-10 at 12.28.40 PM

“I’m going to choose to believe that he lost weight because his gastric system is messed up, and not because he maintained a calorie deficit.”

"I'm a lady. It would never work for me."

“I’m going to choose to believe that this only worked because he is a man, and not because he maintained a calorie deficit. It would never work for me, because I am a woman.”

I'm going to choose to ignore the entire point of the article - that he created a calorie deficit, which yes, ANYONE can do - and play the old 'everyone is different' card, with a side of the irrelevant 'some people can't exercise' trope."

“I’m going to choose to believe this could only work for a small segment of the population (ignoring that EVERYONE will lose weight in a true calorie deficit).”

The exercise bit is legit – some of his improved health markers could be attributed to exercise. But his weight loss was attributed to the calorie deficit he created, which everyone can do.

Screen Shot 2015-11-10 at 1.37.18 PMTricky! This person is pulling a complete non-sequitur! The article wasn’t about how McDonalds sources it’s food, it was about losing weight via a calorie deficit, and if this commenter had actually read the article they were responding to they would have seen that the author actually EXPLICITLY said “I’m sure someone is going to claim I’m telling people they should eat McDonalds every day”. Ha. Ha. Ha.

This is what’s knows as deflection. Putting someone’s opponent on the defensive using a periferally-related but ultimately specious argument to distract attention from the REAL subject (weight loss via calorie deficit). The person who made this comment didn’t want to confront the fact that dude-lost-weight-eating-fast-food, so they tried to distract themselves, and everyone else, by changing the subject.

Screen Shot 2015-11-20 at 9.02.27 AMThis is the one that bothers me the most, because upon first reading it sounds almost reasonable (unless you’ve been reading my blog for a while, in which case you probably know exactly how I’m going to respond to it).

Here’s the thing. Yes, there will always be people doing that. And you know what, dear commenter? You don’t need to worry about those people. You only need to worry about your own body and your own plate. In fact. Stop worrying about other people’s bodies and plates. Because it’s not doing anyone any good, and in fact it’s PART OF THE PROBLEM. It may even be PART OF YOUR PROBLEM. See, I doubt you have a perfect body or body image, or a perfect relationship with food. If you did, I don’t think you’d be running around Facebook judging other people’s bodies and diets. So, back off of other people. Eyes on your own plate.

The only person who’s body, and diet, is your business is YOU.

You see what this person has done? They’ve distracted themselves from the affront to their belief system by shifting their attention to judging other people. A handy trope we see all too often in our culture. Can’t examine their beliefs while they’re busy condemning the behavior of others!

To wrap up…

We are human, and it is hard to change our beliefs. We are usually very emotionally attached to our beliefs. But being able to examine our beliefs critically, and to change them if they can’t stand up to that examination, is a sign of intelligence and strength. It’s also really vital to achieving a truly healthy relationship with food, and to improving your body image. If we can’t be honest with ourselves, we can’t ever really start moving past the stories we tell ourselves that keep us trapped in our cycles of disorder. Being unable to examine beliefs in THIS scenario will keep people from understanding that it is calorie balance that determines weight, for example. They will go on believing that it is ALL about fast food/food quality, and not understand why they may not be losing weight on their 100% organic diet.

It’s hard and frequently painful. But learning to think critically about our belief systems is such an important part of growing stronger as individuals.


Subscribe to my newsletter!

* indicates required

So Meat Causes Cancer Now? Dr. Kern Explains.

Guest post by Dr. Joshua Kern

Forward from Amber: pretty much everyone has written about the ‘MEAT CAUSES CANCER OMG’ news from the World Health Organization last week. You know me, I like to put things in perspective for you guys so you don’t have to run out and completely overhaul your entire diet and lifestyle if it’s not totally necessary. For this one, I asked my friend and coaching partner Dr. Joshua Kern to take a look at the study and provide some perspective and, well…balance for you. At the end I’ll list some of my own blog posts on other media-hyped-up health news reports like this one. So now, without further ado, Dr. Kern’s post. Enjoy!


Recently the World Health Organization released a report about processed and red meat and rates of cancer. You probably saw some coverage of it in the media.

The viral nature of both the mainstream media reaction and the science-minded backlash to the 'meat causes cancer' news following this report have been fascinating to witness. I think the strong emotions this report provokes make a pretty good case study on the reactionary nature we have when it comes to health in Western nations. As a culture we’ve become obsessed with health, as we've realized that we probably aren't doing it right. But despite the answer being pretty basic (eat more vegetables, exercise more, and eat enough to support healthy activity and weight – so simple, yet so hard to implement) we are always looking for 'it'- that singular piece of news or supplement which will finally get us down the road to health. I feel like the reaction to the WHO report is no different.

Many bloggers have already covered this report, some with a balanced and science-minded view but some quite biased in favor of various diet ideologies. I saw a great piece by examine.com that looks at the science of the article and ends with a very commendable and moderate summary:

'But all that being said, the evidence is mostly observational or mechanistic in nature. Due to the practical impossibility of running multi-decade controlled trials, the increased risk from eating different amounts of red meat is not really known. In this case, as in many others, moderation may be key.''?

I don't think I need to beat the dead horse that this report is based on pretty low-quality evidence that shows correlation only, not causation. A diet high in processed meat also tends to be low in vegetables and fruit and associated with a lifestyle high in other risk factors for cancer. So with the type and quality of evidence in this report, there is no way it can 'prove' it's the meat that's the issue, and yet most media coverage of it stated that a link had been proved between processed and red meat and cancer. It’s been a reaction typical of how our culture treats questions of health and lifestyle.

I'd like to spend a moment putting the reported increase in risk in context. I don't know if we can blame 'increased risk' hysteria on low science literacy of the media or the people reading it. I suspect both. We humans tend to make decisions based on fear, not fact.

One example of this is the absolute fear of hormone replacement therapy that’s ingrained already in American culture since the Women's Health Initiative study was published in 2002. When I have very uncomfortable menopausal women as patients and suggest that we consider hormones, you'd think I was recommending cyanide pills to them. The fact is that this fear is because of a very, very small increased risk of heart disease which was misrepresented somewhat in the initial paper and in the lay media. Something important to understand about that big study was that the average age of the women was about 75. They were taking women who had been menopausal for an average of 25 years and putting them on hormones, and that's the study that created all this fear and hysteria. If you are 50, your risks and physiology are pretty different from someone who’s 75 years old. So right off the bat, how can we know if anything about this study applies to an early menopausal woman with crippling hot flashes?

The actual risk of hormones increasing cardiovascular disease in the study was quoted widely as '29%'. This is only sort of true – that number is based on a hazard ratio of 1.29. The absolute risk was very small, because even the women in the hormone group had so few heart attacks! The total number of women in the hormone group had a .37% incidence of heart disease in a group of 10,000. The placebo group had an incidence of .30%, which means the actual absolute increase in risk was .07%. I personally would make very few medical decisions about myself based on absolute risk increases that low. In fact, with some reanalysis, that increase in risk wasn't felt to be statistically significant, meaning that there's a very good chance that finding was related to random chance. Yet many people still make decisions about hormone replacement based on the fear generated by the misrepresentation of low-quality data from one study. For more information on the reanalysis of that paper view this: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1630688/

With that example in mind, let's turn our attention to the increased risk reported in the WHO report about meat. This PBS article is pretty typical of the types of reporting that people were reading and then freaking out about eating meat.

From that PBS article:

'That meta analysis found that colorectal cancer risk jumps by 17 percent for every 100 grams (3.5 ounces) of red meat consumed each day. Meanwhile with processed meat, colorectal cancer risk increases by 18 percent for every 50 grams (1.7 ounces) eaten each day.''?

Before we jump on the 'OMG increased risk!' bandwagon, let's objectively look at what that even means by putting it in perspective. Again, I'm ignoring the fact that this report doesn't actually prove an increased risk. It indicates a correlation, and the authors of one of the biggest studies used to create this WHO report actually state,“In the large prospective cohort of American Nurses (NHS), it was estimated that women who consumed high amounts of red and processed meat, did not exercise, had a low folate intake, and had a consistent excess in body weight.” http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0020456

Ignoring those other factors and pretending that this is a real effect purely from the meat, we are going to take these numbers at face value. The baseline risk of an average person for developing colon cancer is about 5% in their lifetime. By eating one hotdog per day every day of your life you increase that risk to 5.9%. That's what these numbers say. I'd argue that everyone knows that eating one hotdog per day is probably not optimal for health, but even if you did eat one every day, the overall increase in risk seems pretty small to me. Should that keep you from ever eating a hotdog? That's for you to decide. I'll continue to eat a few hotdogs a year when I go to a ballgame because that's what I do when I go to a ballgame.

To put this increase in risk in further perspective, what's the increased risk of developing colon cancer if you have a family member who had colon cancer? That's one of the biggest known risk factors. The increased risk of that is more like a true doubling from 5% baseline risk to 10% baseline risk. To me that's a truly significant increase in risk, but it still means that if one of your parents had colon cancer you still have a 90% chance of NOT getting colon cancer (though I still recommend all adults follow colon cancer screening guidelines anyway).

I hope that helps put this report and the reaction to it in some perspective. This is why I don't change my diet every time a headline comes out that claims 'this kills you' or 'that saves you'. I think a recommendation to eat more fruits and vegetables and get more exercise is one of the things I can really get behind, because the level of evidence is pretty overwhelming that it improves health. It's just not sexy because it's so'moderate.


Dr. Joshua Kern went to medical school at University of Washington. He practices Family Medicine in a small town in southern Idaho where he does a little of everything including colonoscopy, delivering babies, and inpatient medicine. He runs a residency and trains family medicine doctors and medical students. He’s an assistant clinical professor at the University of Washington.

He lives with his wife and three children. He also is a lifter of heavy things, and author of the blog Go Maleo. He’s my partner in moderating my Facebook group Eating the Food, a friend, and an all-around awesome person.




Body Composition: ‘The Last 5 Pounds’, or How to Deal With Problem Areas

Originally posted September 19, 2012

Almost daily I get a question along the lines of ‘Help! I don’t need to lose any more weight, but I’ve got this (belly/thigh/butt/arm/back) fat that just won’t budge!’.

We all have that ‘last’ bit of stubborn fat that just won’t respond to dieting. The first thing I want you to consider is that maybe it’s not as bad as you think. Our bodies need a little bit of fat reserve to function optimally, and for most of us that last little bit is all in one stubborn spot. For many people it’s the belly. For me, and lots of other women, it’s the hip and thigh area. For some people it’s the arms or upper back. Everyone has ‘that’ spot, and it annoys us, but the reality is that in the vast majority of cases it’s not a health threat, so from a health perspective you can let go of the pressure to lose it.

Doesn’t make it much better from the aesthetics perspective though, right? I hear ya. So today I’m going to talk about body recomposition. Here is exhibit A. Two pictures of me at the same weight, but different body compositions:

There’s 2+ years between these pics. This is not a fast process! Patience and consistency is key.

Screen Shot 2013-07-26 at 8.42.32 AM

170 in both pics.

I was actually in pretty good shape in the first picture, I was competing in triathlons and eating a healthy diet and had recently begun weight lifting. But I had just come off 18 months of losing weight, so while my fitness had improved, the calorie deficit I’d been maintaining had prevented me from adding any appreciable muscle mass (you need a calorie surplus to build muscle mass). So the result was a healthy weight but a higher fat-to-lean mass ratio (I have no idea what my body fat percentage was but it was probably in the 22-27% range). I was not unhealthy in any way, so hopefully no one will interpret these images as casting aspersions on my less-lean self, or on anyone who looks like my less-lean self. I had a healthy awesome body then, as I do now.

In any case, there I was at 160 pounds, a weight at which I’m comfortable, so I stopped losing weight and turned my focus to body recomposition. “Body composition” in it’s simplest terms, is the ratio of fat to lean mass your body is at. Building muscle requires a different dietary approach than losing fat does, so I changed the way I was eating. I ate more calories. Instead of eating at a calorie deficit with the goal of losing weight, I began eating at maintenance, or even a small calorie surplus. As always, I made sure I was getting plenty of protein (I aim for about 1 gram per pound of body weight per day) and adequate fat, so it was really carbs that I increased to bump up my calorie load (note: I’m not saying that my way is the best or only way (find what works for you), but there a popular mythology that carbs make you fat, and as you can see from looking at the second picture, eating more carbs definitely did NOT make me fatter, in fact, it made me leaner). My weight fluctuated about 5 pounds either way over time, so I wasn’t exactly 160 on the nose every day in between the two photos, and what was probably happening was that my body was very organically cycling between building muscle and burning fat, but the end result was that over time my body mass shifted from fatter to leaner. Fat cells don’t turn into muscle cells, what happens is that as muscles get bigger, fat cells get smaller as your body burns off the fat inside them.

You can see from the pictures that I carry/carried a lot of my fat on my thighs. As I built muscle all over my body, the fat on my thighs burned off, because that is where the fat was. So building up my arm, back and core muscles was just as much a part of making my legs leaner as working my leg muscles was. The message I’m attempting to convey here (however inelegantly) is that you need to work your whole body, not just the body part that bothers you. Bigger biceps means less belly fat. It’s true! Add a pound of muscle to your shoulders, and assuming your weight stays the same, that means there’s a pound less of fat on you, and if your fat is on your belly, that’s where it will come off of.

So how do you know it’s time to stop trying to lose weight and focus instead on body recomposition? Here’s my tips:

1. You’re at, or close to, a healthy weight, even if it’s higher than you wish
2. Your weight loss has stalled and simply won’t budge no matter what you do
3. Your eating habits are solid, you’re getting accurate hunger and satiety signals from your body, and you’re able to eat to your appetite without gaining weight
4. All of your health markers are normal and you feel good

Alternately, here’s some signs you may be at a weight that’s simply unsustainably low, and gaining some lean mass may be of benefit:
1. you’re able to maintain a low weight, but must be overly restrictive with diet
2. you need to do lots of cardio to keep from gaining weight
3. you frequently feel hungry and struggle with compulsive eating
4. you struggle with fatigue
5. you recover slowly from workouts

In both of the above scenarios, shifting your focus away from fat loss, and toward increasing lean mass, may be what your body needs in order to continue making progress.

So how do you do that, you ask? Well, here’s some jumping off points:

1. Eat at LEAST maintenance calories. Finding that target will take some trial and error, but the calculator in my Calorie Primer post can give you a good target window. Keep in mind that if you’ve been undereating or restricting carbs for a while, you’ll see an initial ~5-10 pound bump in weight almost immediately when you increase your calorie intake, as your body replenishes it’s glycogen and water stores. IT’S NOT FAT, so don’t panic.
2. It’s ok to go over maintenance calories by a few hundred, especially on days after workouts, your body needs the extra calories to build muscle mass.
3. A healthy female body can gain about 2 pounds of lean mass a month under optimal conditions, so if you keep any weight gain around this level you can be confident that you’re gaining mostly lean mass. If you gain more than that, IT’S OK, but more of it will be fat. Again, IT’S OK. Gaining a little fat along with muscle won’t kill you, you can always lose it later (if you want. You may be surprised at how nice that extra fat looks when it’s over a foundation of added muscle!).
4. Get plenty of protein! I generally recommend aiming for 1 gram per pound of your goal body weight, or just 100+ grams a day. Get protein from food if you can, but a protein supplement isn’t going to derail you and can help bump up your intake if you’re having trouble getting enough from food alone.
5. Carbs are great! Unless you have an active metabolic condition that necessitates a specific diet (in which case you should be working with a medical professional and not getting your nutrition information from blogs) don’t restrict carbs. They give you energy for workouts, and nutrients and calories your body needs to create new muscle mass. As always, get them from mostly whole foods, but IT’S OK TO MAKE ROOM FOR TREATS in your daily calorie target!
6. Don’t restrict fat either. Most people do well getting 20-35% of their calories from fat.
7. EAT, and don’t feel guilty about it. Your body NEEDS fuel to meet your daily obligations, to recover from workouts, and to build new muscle mass. Some days you will feel like all you do is eat. Enjoy!
8. Experiment until you find what works best for you. I do great on tons of fruit, others go for sweet potatoes or bacon or coconut. There isn’t one right way, and trying to do it someone else’s way will ultimately not be as effective and sustainable as finding YOUR best way. You don’t have to ‘get it right’ on the first day. Pay attention to how your body feels and functions in response to what you eat. Keep a log so you can start to see patterns.
9. LIFT. Do a full body resistance routine at least twice, preferably 3 times a week. Alternately, some people prefer to follow a body part split routine, which is effective as well, but I’ve found to be a little more time consuming. It really is up to you what you prefer. Both styles will give you good results. For more on weight lifting styles and specifics, check out my Taming the Weight Room program.
10. Take regular rest days. Your body needs rest to recover properly. Low intensity cardio is fine on off days, but take at least one, preferably two, full rest days a week.
11. Say no to guilt, shame and restriction. Has it worked for you in the past? No? Then you don’t need it.

And last but not least, know that most people are too busy focusing on their own ‘problem areas’ to focus on yours. So don’t kill yourself trying to perfect them. It’s not worth it, you’re valuable and lovable just the way you are.

Body Positivity: it’s SCIENCE, bitchez

To be clear: the 'bitchez' I refer to in the title of this post are, quite specifically, the fitpro douches running around the internet ridiculing fat women and conflating 'loving yourself' with 'being lazy'. This particular brand of internet warrior isn't able to understand the ways that self-care and self-improvement intersect, and sees any expression of gentleness or graciousness as weak and lazy. They think that 'body acceptance' means 'promoting obesity' and are happy to tell anyone who utters the words that they are fat, weak, lazy and undesirable. This fitpro's general philosophy is 'mock and ridicule the fatness away'.

Untitled drawing-20

Oy, the internet can be an ugly place.

So today, I'm going to tell you how scientific evidence supports body positivity.

First, let's acknowledge this: the current cultural paradigm of shaming fat people in an effort to get them to lose weight isn't working. We can see that. We can FEEL that (as the majority of us are actually the targets of that shaming, and it hasn't worked on us). Not only is it not helping us lose weight, it appears that it's actually making us FATTER.

A recent meta-analysis revealed that people who perceived themselves as overweight (even if they weren't) were more likely to GAIN weight over time than people who didn't. The researchers said they couldn't be sure whether the weight gain was due to habitual overeating or a cycle of crash diets followed by regain, which is a cycle most of us are all too familiar with. Diets make you fat. According to Eric Robinson, one of the study's authors, 'The widely accepted finding is that these types of diets don't work in the long run and the debate is over how much of a harmful effect they have,' he said. 'Weight regain is going to happen.' (source). Earlier research has shown that adolescents who are weight conscious tend to gain more weight over time than those who aren't; this research shows that it's a phenomenon that affects people over the entire lifespan, and not just during adolescence. Dieting and weight preoccupation during adolescence also predicts weight gain, not weight loss, a finding that is echoed throughout the literature.

So, perceiving oneself as overweight predicts weight gain; what about how others perceive us? Over and over, research shows that weight discriminations and fat shaming predict weight GAIN, not weight loss. Angelina Sutin, assistant professor at the department of behavioral sciences and social medicine at Florida State University College of Medicine showed that overweight people who experienced weight discrimination were more than twice as likely to become obese than those who didn't. Jane Wardle, Professor of Clinical Psychology and Director of the Cancer Research UK Health Behavior Research Centre at University College London, had similar findings: weight discrimination was significantly associated with weight GAIN and the risk of obesity.

When you consider that our culture, and fitness culture specifically, fixates myopically on obesity and weight loss, frequently to the point of ridicule, it is no wonder that so many people are overweight and obese. The way we approach weight management is designed to promote weight gain. Clearly, our preoccupation with weight, fat and dieting is making us fatter, not thinner. We are doing it wrong.

So, how do we do it better? More and more researchers, doctors and fitness professionals are realizing that focusing on people's weight is not the answer. A growing movement is afoot, one that focuses on positive, health promoting behaviors like daily physical activity, quality sleep and diet improvements rather than fad diets that eliminate foods and food groups.

I've written at some length about how self-compassion promotes successful behavior change. Actual scientific evidence shows that the people who achieve the best habit change outcomes are the ones who afford themselves the grace and compassion to make mistakes, have bad days, seek out community support and practice positive self-care, self-talk and self-acceptance (I will link my own posts on this topic at the end of this post). According to Angela Sutin, 'We should not be classifying people as overweight and giving them a label that has a stigma attached to it, but enabling people to make healthier choices.' And Eric Robinson says 'The way we talk about body weight and the way we portray overweight and obesity in society is something we can think about and reconsider. There are ways of talking about it and encouraging people to make healthy changes to their lifestyle that don't portray adiposity as a terribly deviant thing.' (source)

Finding an activity you ENJOY is KEY to successful habit change. Enjoyment = Self-Care.

Finding an activity you ENJOY is KEY to successful habit change. Enjoyment = Self-Care.

Body positivity, self-acceptance and self-compassion. Those fitpros I mentioned at the very beginning of this post may see these things as weak and lazy, but the evidence says they are important contributors to the achievement of positive habit change. Body positivity is actually evidence based, and predicts improved health and weight outcomes. That's why self-compassion and body positivity are central to my own coaching program and philosophy. I follow the evidence, and the evidence leads to compassion, grace and self-care. Perhaps that is why our Habit Project clients see long term results, and the fitpro douches I mentioned above just stay in their endless parade of circle jerk douchery with each other.

Got something to say about this? Join the discussion on Facebook!

Read more of my posts on this topic:
The Science of Self-Care
The Real Key to Weight Loss Success
Moderation is Evidence Based
Nurturing Self-Compassion
Self-Compassion is the Cure for Extremism
Self-Compassion and Others