Triage Method Newsletter - 19/01/2020
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This week's newsletter features our new structure for 2020. Rather than just sending you content we have posted elsewhere, we will be sending an exclusive article in every newsletter. This will be a short article focusing on one specific topic, which should give you something to take action on (or at least consider) heading into the following week.
We hope you enjoy the new structure and, as always, we appreciate your feedback. Everything that we produce is designed to help you, so it means a lot to us that our content actually makes your life better in some way.
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In the last couple of years, the voices of those from the Health At Every Size (HAES) and Body Positivity (BoPo) movements have become louder and louder, gradually infiltrating from the fringes to the mainstream. There are many positives to this, such as raising valid concerns about weight stigma in healthcare, while also encouraging people to look beyond their weight as a marker of health or self-worth. I'm on board!
But, what seems to have happened more recently is that the attempt to add more nuance to the discussion of weight loss has turned into an all-out sabotage on the process of lifestyle change. It would be unfair to say that these voices are the norm, as that's not true, but I have had a number personal trainers and clients worry that they are doing the wrong thing. They're being told that "diets don't work", or that their attempts to improve health
should not focus on weight loss? What's the story?
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The above is a good example of what I am talking about here.
To me, these messages are just as reductionistic and unscientific as those that science-based nutrition folk are often trying to counter. I do not think this is doing anything to move the needle forward, and is not empowering the individual trying to make their life better.
The claim that "diets don't work" is a deceptive one. It is not false IF you specify exactly what underpins the statement, but this is meaningless in the real world when the statement stands alone. One could justify the point by saying something like "for most people, attempts to lose weight tend to fail, as adherence to such practices can be difficult for various reasons, which may vary between individuals". But,
for the general population encountering such a statement, it would seem that this, very simply, states that dietary methods designed to restrict calories simply does not work?
This is, of course, untrue. People often ask for specific research to show that people can sustainably lose weight (generally with the 1-2 year mark being the cut-off for successful maintenance), which, to me, is a classic example of why people hate academics. Most of you know lots of people in the real world who have successfully lost weight and maintained it, and as trainers, many of us have helped to facilitate that process. However, for the sake of keeping
everyone happy, we can find examples in the research of successful weight loss:
The National Weight Control Registry is a US-based registry for individuals who have successfully lost >30lbs (range of 30-300lbs) and maintained it for >1 year (range of 1-66 years). With 10,000+ registered individuals, 98% have changed their food intake in some way to attain/maintain this weight loss. In 2012, analysis was carried out on 2886 individuals enrolled from 1993-2010, finding that, when using a 10% weight loss as the criterion of success, 88% were estimated to be still successful at Year 5 and 87% at Year 10 (Thomas et al. 2014).
Furthermore, there have been other specific studies carried out that shed light on the question of successful weight loss maintenance. For example, here is a summary of the CALERIE trial, designed to investigate the effects of 2 years of 25% caloric restriction: the results of this large, randomised
controlled trial provide evidence that a moderate calorie
restriction-induced negative energy balance improves
multiple cardiometabolic risk factors—waist circumference, blood pressure, HDL-cholesterol, LDL-cholesterol,
triglycerides, insulin resistance and glucose control,
metabolic syndrome, and chronic inflammatory tone—
well below the conventional risk thresholds used in
clinical practice (Kraus et al. 2019).
Similarly, here are the results from the DIETFITS study, which enlightened us on the fact that the specific type of diet is not quite important, but caloric restriction can work quite well over the longer term: In the HLF vs HLC diets, respectively, the mean 12-month macronutrient distributions were 48% vs 30% for carbohydrates, 29% vs 45% for fat, and 21% vs 23% for protein. Weight change at 12 months was -5.3 kg for the HLF diet vs
-6.0 kg for the HLC diet (mean between-group difference, 0.7 kg [95% CI, -0.2 to 1.6 kg]). There was no significant diet-genotype pattern interaction (P = .20) or diet-insulin secretion (INS-30) interaction (P = .47) with 12-month weight loss (Gardner et al. 2018).
So, where are we going with this?
The point here is that these messages are as much about ideology as they are about science. The example given above is not a personal issue, as she could produce fantastic work otherwise; this is simply an example which was shared to thousands of people via other channels and has the potential to mislead. These ideas are becoming more widespread, despite their lack of rigour, so I want to make sure that you appreciate the nuance.
True:
- Caloric restriction is difficult to adhere to (lots of things are difficult, but this shouldn't detract from the fact that something does or doesn't "work").
- Excessive restriction (e.g. regarding specific foods as off limits) may be more likely to produce disordered eating behaviours / compromise your relationship with food.
- You do not need to cut out certain foods in order to lose weight.
False:
- Diets don't work.
- All restriction should be treated equally.
- Weight loss is not a valid goal for someone to have.
Ultimately, you can do what you want, but don't let people walk all over your experience by telling you that something doesn't work. It's deeply confusing for people who are having success with their dietary practices, and serves to make dietary changes seem a lot more catastrophic than they actually are. Sure, losing weight is a challenge, but catastrophising about it does not make it any easier.
Thank you for reading. I hope you enjoyed this article, and let us know if you have any feedback, or if you'd like to argue against any of the points I have presented.
- Gary McGowan
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If you want to check out more of our recommended resources, visit the link below, where we have archived all recommendations from previous newsletters.
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Podcast Ep.93 - Progressive Overload Methods
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In this episode, Paddy and Gary get together once again to discuss progressive overload. This follows on nicely from the last couple of podcasts on programming variables. In particular, they discuss the merits of progressing weight vs sets vs reps, leaving you with plenty of practical take-home points for your training planning.
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Q&A - How To Be A Fit Student
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In this episode, Gary talks about living a fit life as a student. Not only that, but he discusses the importance of accepting some trade-offs in order to live life on your terms. This is a must-listen for students and busy people with multiple goals in life.
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Overfeeding & Underfeeding - Finding the Right Strategy
by Paddy Farrell
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Hip Adductors - Muscle Function & Exercise Tutorial
by Gary McGowan & Paddy Farrell
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Anaerobic Energy Provision - Glycolysis, Lactate & More
by Gary McGowan
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Dietary Fat - How Much Do We Need?
by Paddy Farrell
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Lucia Hughes - Powerlifter & PhD Candidate
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Here is what she had to say about the coaching process:
“Back in June 2019 when I decided to hire a coach, there was no question about who I would go with – it had to be Gary.
Having never competed before, I came to Gary with the prospect of competing at not one, but two powerlifting competitions before the year was out. And although Gary would not consider himself a powerlifting coach, he did not shy away from the challenge.
For the first competition we made the wise choice to use it as a “warm up” meet and all programming was done with a longer term goal in mind. This allowed me to not put myself under too much pressure, as well as assessing exactly how I react on the platform. It was an extra bonus that we came away from the meet with a win.
Coming into the second competition, my first IPF meet, Gary increased the specificity of my program which peaked all three of my lifts very nicely. From August to November I actually added 32.5kg to my total. However, more importantly, Gary was always on hand to offer guidance on my competition prep and no question ever went unanswered. He also took the time out of his busy schedule to come up to Galway to handle me on the day of my competition. This is something that I am so grateful for as it
really made the day a lot less stressful and nerve-wrecking.
Besides all the strength gains and competitions, Gary has offered guidance in all aspects of my life. After starting a PhD in September things got a bit hectic but he was always there to help manage the stressors in my life. We placed less emphasis on the number on the scales and more emphasis on general health and wellbeing (obviously the scales had to be closely monitored when coming into competition, but he made it easy to make it to the required weight class). On the other hand, I have
learned so much by working with Gary whether that be about training, nutrition or what works best for myself. And for this, I can’t thank him enough.
After 6 months of working with Gary I could not recommend his service enough. Hiring a coach is an investment in yourself, your health and overall well-being. If you are in the position to do so, I would 100% recommend you to do so. Don’t worry about your level of fitness, Gary welcomes everyone with open arms.”
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