Unintended benefits

A little while ago, I was reading an AP opinion piece in the newspaper, titled Disease prevention often costs more than it saves. I was skeptical about its premise, but then I read the article, and the details bothered me more. The example used is that of relying on a personal trainer/lifestyle coach to prevent diabetes.

It's a terribly poor example, and whoever Carla Johnson is, I am sad to report that she appears to be neither a mathematician nor a health expert. True, the annual cost of diabetes is about $4100 initially (ref - note, however, that it rises over time) and we are, hypothetically, spending $5400 or $6300 a year to prevent it (note: The article says "$5400" but also says that for every person that this sort of treatment works for, it fails six others, and seven times $900 is $6300, not $5400). So on diabetes, we're saving $600-700 or so per person per year with this program, hypothetically, if each year of the program leads eventually to 1/7 of one year free from diabetes for one person.

However, the health benefits of having someone sort out your diet and exercise problems are not limited to not getting diabetes! Diabetes is the big-ticket item, sure. But is it the only thing? Obesity is linked to many other health problems. What the article author should instead be comparing is the cost of the program - which we expect would be discontinued after the first year or so if it were not making a difference - to the average increased cost of being overweight and not exercising, not just diabetes.

And then there's the other side of the question of cost effectiveness: We have not only a significant portion of the costs being repaid in saved diabetes bills, and much (quite possibly all) of the remainder being repaid in other medical bills; we have additional years of healthy productive life, fewer sick days, etc. Direct medical costs are only about half the total price tag of obesity (ref) and so, even hypothetically paying $900 a year indefinitely for personal lifestyle coaching is, on the scale of a national system, a good idea. After all, we're looking at an expected average positive payout at that point.

So the example is quite poorly considered. Is there a valid point to the op-ed piece? Well, yes. An ounce of prevention is not always worth a pound of cure, and it's worth actually checking to see if it is. But a valuable moral of the story is that you have better be very thorough in weighing the costs of everything being prevented. Narrow focus on particular kinds of costs while ignoring others is how we wound up with this system in the first place.

Why does the calf trick work?

There's a little trick I use to guess someone's fitness at a glance. It doesn't work with everyone at all, but I have learned you can't just go by size or visible flab. What seems to work is glancing down at the calves. You look at how big the calves are relative to the rest of the body - and in my experience, that does a remarkably good job with skinny people, fat people, and everybody in between.

Yes, skinny people can be out of shape. I know, I know - it's the appearance that matters, so often, but there's so much more to fitness than size.

Fact of the matter is that most forms of aerobic exercise - and the most intense forms of exercise, period - involve moving the whole body, and that comes down to actually using your leg muscles. Some guys work out their upper body heavily without getting into shape - but very few people, aside from dancers, work heavily on their calves specifically. If they do calf-specific exercises regularly, odds are they're doing exercises for most parts of their bodies.

And that's why it works so often. Doesn't work for someone paralyzed from the waist down, or with muscular atrophy in their legs, but for most people, overall level of physical activity is tied to calf muscle use. Most people who sit down all day and don't walk much are desk-bound and out of shape.

What working at a weight loss camp did to me

Yesterday, I noted that I once (twice, actually) worked at a weight loss camp. It amazes me how often that experience turns out to be relevant to the topic and hand; it also had a truly remarkable impact on my life.

Before I worked at camp, I was absolutely terrified of the idea of working with children. It wasn't going to be pleasant, or something I would be too competent with. Children were something you tried to avoid getting stuck with. My surprise was that I actually had fun, and my second summer there, Ira told all the other counselors that I was a fantastic counselor. Before working at camp, I was ambivalent about the idea of having children in the future; after working at camp, I decided it would be nice to have kids of my own at some point.

Before I worked at camp, I didn't think about my weight. Nothing like working at a weight loss camp to suddenly make you conscious of your weight and give you a touch of paranoia about weight management. Most of us counselors also picked up very funny food issues during the summer, since we could eat freely so long as the campers surrounding us for most of the day didn't see it. I ate about three times what the campers did.

Before I worked at camp, I had no idea how sleazy people could be. Ira himself meant well, but had some old bad habits and a couple of associates widely criticized by the counseling staff; the people running the Patterson school, however, were the real eye-openers. Ira's buddy (partner, the first year, I think; later, Tommy became his business partner, and Tommy was a much more upright guy) may have been an eBay-flipping online poker addict with an eye for quick-get-rich schemes, but the people running the Patterson school? Complete sleazeballs, made every one of us involved look like saints even on our worst days.

And the school was just falling apart around us. Talk about a badly managed property. I learned a lot of practical lessons in maintenance and repair. Not to mention the second year, I had some nice hands-on experience in pool chemistry and how to operate a pool.

I think one of the more subtle things I got from working at camp was a self-image boost. Even the most athletic of the other counselors wouldn't be able to jump as high or run as quick a mile; it's hard to get too down on yourself when the kids look up to you, your boss thinks you can do anything, and you're rapidly finding out that you can teach things you've never taught before.

How you can gain weight while burning calories

As you may or may not know, in addition to being a student of physics, I worked for two summers at a weight loss camp. And so it was that I thought to apply thermodynamics to what was happening to my campers.

Some campers would lose weight steadily; others would have slow and fact points; in the long term, they all improved dramatically. And yet, when you use weight to try to measure your fitness, things tend to fall flat a little more often, and you see quirks.

As BMI measures it, I hit the "overweight" marker at 184 pounds - at which point my body fat percentage is still quite healthy. If I drop to 170 pounds (BMI 23, still in the upper half of "normal") my body fat percentage is dangerously low. I would probably drop dead before hitting the "underweight" BMI (136 pounds).

The quirk here is lean body mass. I have a relatively high lean body mass; my campers, universally, were increasing their lean body mass as well, strengthening muscles they didn't know existed, drinking plenty of water, etc. And at the most extreme end of it - you can be burning through calories and still adding just a little bit of mass as you reshape your body. I've seen it; I've also seen, on weighing day, how terribly discouraged campers get when they discovered they lost little to no weight that week.

Hidden in that news is the amazing improvements they made in their fitness. They can now hike further, lift more, swim more quickly, and they may even have lost an inch on their waistline. And when we're worried about our appearance, it's that - not the proxy of total weight - that makes the difference when people look at you.

So if you're working out hard and watching your diet, and yet you just don't seem to be losing weight, cheer up. You're still probably improving your health and appearance.

Beauty tips from the furball

Many of you may not have realized I have any interest in cosmetology. Truth of the matter is, I'm interested in everything, and so, here it is - what I know about cosmetic care.

Keep those pores clean and that body free of toxins!

For flushing out the skin regularly, and purging your body of toxins, what works better than a nice long workout followed by thorough rehydration? Sweat pores are tiny and everywhere, and when you're adding and removing a few liters of water, anything water-soluble is likely to go with it - along with some dead skin, dirt, and body oils.

In fact, I now believe that particularly harsh and sour body odor is the result of not having sweated enough recently. I've noticed it with myself - if I haven't done a solid workout lately, I'm going to smell pretty sour the first time I break a sweat. Go on, prove me wrong - take up a regular exercise regimen and tell me you don't feel better about yourself. Or stop, and tell me you think you smell nicer.

What, me smell?

Personally, I'm not fond of scents. Unscented deoderant for me, please - and if I can't find that, a palmful of baking soda works quite well to mute the natural smell. If you must, please be subtle... some of us have sensitive noses, others are allergic, and I, at least, remember some terribly irritating people in high school who wore much too much scent, so I have poor associations with that.

The idea is to smell nice - something that will blend into your deoderant, your surviving natural scent (yes, you still have one), and in all probability your shampoo, conditioner, body wash, soap, lotion, and any other products you use, rather than overwhelm everything. In my humble opinion, one should not to smell like perfume. Your scent will tend to improve with exercise and regular showers, of course.

Yes, showers!

Nothing beats regular doses of epidermal water. Nothing! I go in for at least one shower a day. I recommend it - it's nice, pleasant, helps wash gunk and dirt off your skin, and usually makes you smell better, even if you don't use anything scented. I also have the vague feeling that making your skin soaking wet might moisturize it, too.

Myself, I have very curly hair. I've found it actually looks best with a combination of chlorine and sun bleaching plus regular combing in the shower using copious amounts of conditioner. Following the advice posted in this livejournal group, I've found that using large amounts of cheap conditioner with no sodium laurel sulfate really works. For me, anyway; for those of you with other hair types, I recommend reading around in there. Amazing stuff.

And then... fashion?

No, let's not go there. There are many things I detest about men's fashion, and this entry is positive! If, perhaps, a little sarcastic here and there.

To run like a girl

The other day, this phrase popped into my head. She's running like a girl. Then I shook my head. What was wrong with me?

But there wasn't anything else for me to say. "To run like a girl" was the phrase that directly captured what I was seeing, never mind that girls who run regularly usually don't run that way. Somehow, to run inefficiently, in that peculiar style with the forearms flailing out to the sides, the upper and lower body rotating sideways in opposition to each other, is to run like a girl.

If I just say her running form was bad, it could mean any number of things, but "to run like a girl" somehow captures that specific bad form. Which I, of course, last remember seeing done by a boy. Oh, to live in a language where the idioms are not gendered. What can I say that captures what I saw more specifically than She had poor form without reinforcing sexist beliefs?

And have we yet reached the point where little girls and little boys both participate equally in sports that require them to learn how to run?