Lean body – getting the results you want

I have been transparent about my battles with negative self-perceptions and body-image. These negative thought patterns go in spurts. I started writing this post late at night – unable to sleep and staring into the dark – wondering what it would be like to be ripped, hard, and lean. How would life be different?

What did I come up with? It would be different in no significant nor substantive way!

Media’s role

But wow. Facebook likes to think it knows what we will “like.” For me, it always recommends systems, supplements, and proteins that promise a lean body. I am active in many health and fitness social media networks and groups – so I get it. But they got me all wrong – and they are pushing the wrong buttons.

Triggered thoughts

I began to think, what if I just try it for a bit and see what is different. Will I have that ripped appearance that I want so badly but won’t starve myself to obtain? Will I remain the same? Will I bloat up?

How I would LOVE a lean body like the one advertised in the image. But at what cost?

I know what it takes

For someone with my genetics, it takes more to achieve the extremely lean look than it does for others. I have mentioned before, during times at my most lean, I felt sickly and exhausted. I couldn’t function! Would it be different if I filled my body with chemicals and manufactured ‘energy’?

The bottomline

And my mind goes on and on – all because of the hundreds of hard, lean bodies I see advertised on Facebook and other social media sites each day. I would delete my social media accounts, but it is a way for me to educate the community and cultivate new relationships and clients.

What messages do these ads send us? Don’t we have enough to deal with?

Follow me on Facebook: Better by Becca – where I rarely – if ever – post lean body pictures. There are plenty of other ways to motivate, inspire, and empower women.

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Managing stress and anxiety in a chaotic world

Many of our difficulties originate with stress and anxiety. Packed schedules, competition in the workplace and social circles, pressures to be perfect, and lack of self-care (e.g., sleep, exercise, healthy eating) all play a part in high stress and anxiety levels.

Those who know me well know that I can suffer pretty severe anxiety. Anything that requires numbers – I will need someone to talk me down out of my anxious state. And nothing makes me more anxious than being late – I become light headed and nauseous. The mind is powerful!

Stress is described as “the psycho-physiological responses of the individual to any influence which disturbs homeostasis.” What does this mean? Physical, mental, and emotional changes to your body’s normal balance. These changes depend on a given individual’s tolerance to stress. What might cause a great deal of stress to me may not elicit the same response in you. And vice versa. Stress can be the result of environmental factors, although illness and nutrition can also play a role. An individual’s reaction to stress can involve aggression and anger or inversely, inhibition, regression, and fear (Moran, 2004).

Anxiety involves a feeling of fear or a perception of threat and it may or may not be specific to a particular situation. Possible symptoms are nausea, loss of composure, reduced motor coordination, and aggression (Moran, 2004). The intensity of anxiety can be directly related to the amount of associated stress and more often than not depends on the individual’s perception.

The following tips can help you while learning to manage stress and anxiety.

  1. Be informed. Ask questions and know your expectations, roles, and responsibilities.
  2. Use imagery. Imagine yourself performing the tasks – flawlessly and with ease.
  3. Maintain a strong social support system. Having strong social support can help you cope with the stress, whether by having someone practice scripts with you – for example before a big presentation – or  by watching a movie to distract you for a time.
  4. Practice physical and mental relaxation. Release tension and clear the mind. Progressive muscle relaxation and guided imagery are two forms of self-care. Treat yourself to a massage. Learn self-massage or tapping!
  5. Communicate. Let friends, family members, and colleagues know how you are feeling and what you are thinking.
  6. Get plenty of sleep. Inadequate rest can lead to fatigue and poor judgment.
  7. Drink plenty of water. Everything suffers – physically, mentally, and emotionally – when the body is not properly hydrated.
  8. Maintain a positive attitude. And practice self-talk. People with positive attitudes tend to approach problems with more hopeful and optimistic views.
  9. Maintain realistic expectations and goals. Having unrealistic expectations can lead to unnecessary pressure and stres.
  10. Celebrate. Recognize goals and milestones that you have achieved!

The bottomline

Everyone of us faces periods of stress and anxiety. Some of us have more serious experiences, but often times we can manage daily situations by implementing one or a few of the above tips.

What tips do you have for managing stress and anxiety?

References

Koslowsky, M. (1998). Modeling the stress-strain relationship in work settings. New York: Routledge.

Moran, A. P. (2004). Sport and exercise psychology: A critical introduction. New York: Routledge.

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Let your challenges lead to growth

I’d be lying if I said that this last year has been anything but hard. It’s funny how looking back on times that I felt were hard – were nothing in comparison. While in this year, I have grown a great deal and learned the value of me, I stumbled, bruised, and scarred along the way.

With each stumble, it has been difficult to remember my strengths and endearing qualities.

With each bruise, thoughts, “Is pursuing your dream really fruitful?”

With each scar, a memory to go along.

Stumbles

I stepped away from a position in management – and this did not fair well. It is not that I do not attend to direction, it is that my superiors should be more educated and experienced than I am – whether it be in fitness, nutrition, business, or management. And I do not do well with micro-management.

I gained nearly 15 pounds – ignoring my self-care. I refocused and the weight came off.

Income – in 2012, I fell below the poverty line. Humbling!

Bruises

I had bruises from walking into furniture. I had bruises from dumbbells, kettlebells, and barbells.

I had bruises on my heart – from haters and opponents who liked to poke and prod.

The good news, bruises are temporary and they all healed on their good time.

Scars

I am left with scars – physical and mental.

The scars on my knuckles – from taking my anger out on the heavy bag without taking the time to adequately wrap them.

The scar to my heart – losing my best friend and mentor.

The scars to my mind – thoughts of failure and disappointment.

The bottomline

I wouldn’t change any of it. It cultivated me into the woman I am today…and amazing things are happening! I look back at each challenge – and I can see how each and everyone of them led me to grow.

How have your challenges led to growth?

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Learning the value of – ME

I am feeling gratitude. I am feeling blessed.

These last few years been rough – but good. I had to throw my plan out the window – the career I was working  for was crumbling under my feet and I had to spread my wings to fly. I took myself across the country to experience the East Coast. I left everything familiar behind. I sold and stored my belongings – packing my life into my car. This experience was priceless.

I met one of my best friends – without her I would be lost.

I met a colleague, with whom I have endless conversations about the demise of our industry and our passions and visions for ourselves. He has been an indispensable resource.

I drove from Wisconsin to New York. Then From New York to Texas. Then Texas to Minnesota. In search of something that I did not know. I ultimately found it in Wisconsin.

Recently, during a discussion with my colleague – who is currently in Ohio, it occurred to me that I was in search of my value. MY value. I had to drive quite a ways, but I found it.

The things I learned

There are countless things that I learned. But there are several that have been ‘life-changing.’ I love how I can look back on my difficult times and see how they are blessings. I can remember dealing with knee pain and surgeries, thinking: why, why, WHY? But today, I am a much better trainer and coach because of that experience. I am much more invested in injury prevention, knowing the struggles of the aftermath. I wouldn’t exchange the years of pain for anything! But, what did my cross-country journey teach me?

I learned how to build and maintain relationships.

I learned to be confident in what I know.

I learned who my true friends are – some of this was very painful.

I learned how to let go.

I learned to enjoy downtime – something that otherwise had made me anxious.

I learned to be slow to talk (ok, so I am still working on this one).

I learned to stand up for what I believe in – this was moreso solidified.

I learned what my dietary needs were – and that I had fine-tuned my body far better than I had realized.

I learned that you can call yourself an expert, and very few will no whether you are or not.

I learned that the people in Texas really ARE the friendliest people you will ever meet.

I learned that I have a strong Wisconsin accent – although most of those telling me this had never met a true midwesterner – so they may be in for a shocker someday.

I learned how to say when enough is enough.

I learned MY VALUE.

The bottomline

I was called back to my home state. The former clients who have been displaced. I could not turn my back to the plethora of opportunities: writing, training, coaching, business development, corporate wellness, and MORE!

What is my value? I cannot quite put it into words. But I know that I offer something that very few do. When asked who my local competition is, I can confidently say: NO ONE. No one else does what I do, how I do it.

And that feels good.

Is body awareness important for fitness results?

Last decade’s trends of yoga, tai chi, and pilates heavily emphasize mind-body awareness. Some could argue it is about the mind communicating directly with the physical body.

Body awareness: Body awareness involves an attentional focus on and awareness of internal body sensations. Body awareness, as we define it here, is the subjective, phenomenological aspect of proprioception and interoception that enters conscious awareness, and is modifiable by mental processes including attention, interpretation, appraisal, beliefs, memories, conditioning, attitudes and affect. (Mehling, et. al, 2011).

I argue that body awareness – particularly as described as proprioception – is essential for all human movement. In fact, we KNOW that it is – watch The Man Who Lost His Body. Therefore, it is not a process specific to these specific schools of exercise.

Mirrors or no mirrors

I am opening a small training and coaching studio. I had no idea how stressful little decisions could become – wall colors, window treatments, signage, decorating, and on! I just want to train and empower individuals! One of the most difficult decisions for me has been deciding if I want mirrors or not. I have decided – no mirrors.

One of the most unique aspects of my training style is training body awareness (proprioception) and teaching individuals how to FEEL what proper positions and movements feel like.

Why do I do this?

If you need a mirror to find your proper posture, in daily living you will need a mirror to be reminded to find that proper posture. I want you to know what it FEELS like and know when you are NOT in proper position and need to re-position.

But why?

Proper posture and positioning can increase your daily caloric expenditure up to 30%. Yes, THIRTY percent. When you are in proper position you move better, feel better, and experience fewer aches and pains. As a result, LIFE is better!

A real-life story

I began my fitness career in facilities with mirrors – watching my form and technique. It never occurred to me to connect to my body and to be aware of what movements felt like. I was young. I had yet to suffer from injuries. And I just wanted to move. In time, I had to deal with my share of injuries (knees and back).

I trained without mirrors from 2009-2012. My movement improved. I became stronger. I became more aware. I did not suffer any serious injuries. My own awareness and fitness improved and I taught my clients the same.

I have been training with mirrors for the last 6 months or so – and I am experiencing more aches and pains. I am about to go back to no-mirror training and we will see if this improves.

The bottomline

Knowing what feels good or bad, right or wrong, is critical to an improved quality of life. There is a time and place for mirrors, but they are far from necessary – and who really wants to watch themselves in the mirror anyways????

Debunking fitness myths

Each day we all talk to people that share stories and it can be difficult to separate facts from fiction. I cannot tell you how much time I spend educating friends and clients on the myths we are confronted with. Many myths about fitness have been proven to be wrong.

I am sure you have heard these statements before:

  • Doing crunches or working on an ab machine will get rid of belly fat
  • Machines provide a safer way to exercise
  • Women that participate in resistance training with weights will bulk up and look like a man
  • No pain, no gain

These are all fitness myths. Each of the above statements has been disproven by scientific evidence.

Crunches

First, simply doing crunches or ab exercises over and over will not alone get rid of belly fat. Doing these exercises will help strengthen these muscles, but they will not show as they get stronger unless you decrease your body fat above the abdominals. You cannot pick and choose where to burn fat. You need to decrease your overall body fat percentage to bring your abs to the surface.

Machines

Next, machines must provide a safer way to exercise. This is not always true. Unless the machine is set up for you to use properly, you may be putting yourself in a bad position creating muscular deficiencies. Working strictly on machines also removes the functional aspect of fitness.

Women & weights

Third, if you’re a woman and you exercise like the man next to you, then you will look like them. This is not the case. Women have 20-30% less testosterone then men. The only way you could bulk up as much as him is lifting far more weights than the average woman and having some sort of chemical imbalance. Don’t be afraid of weights. Resistance training will help you lose weight quicker, and keep it off for a long period of time.

No pain, no gain

Last, we hear this saying more than just in relation to fitness: If you’re not feeling pain, then you will not see any gains. This is far from the truth. There should be some soreness a day or two after exercise due to the muscles repairing themselves. This is a soreness or tightness, it is not a pain. Having pain during exercise could promote lifelong harm to your body. If you feel pain during an exercise, one or two things may be happening. You may have a pre-existing injury, or you are exercising out of proper position. If you feel pain, re-adjust to a proper position and see if it comes back. If the pain stays, go and see a medical professional to fix the problem before it is too late.

The bottomline

Often times it is difficult to decipher facts versus myths. Before believing what you hear, research it to find a good scientific answer. It may be true, but often times in fitness, these myths provide people answers as to why you should not exercise or do certain things – many offer invalid justifications.

And, never hesitate to ask me about what you hear on the street – I will gladly find you the truth.

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Challenge: Strengthen your ‘no’ muscle

Many of us have difficulty saying no. I for one, have GREAT difficulty saying no.

We have difficulty setting relational boundaries – unable to say no to friends and often overcommiting ourselves or doing things we do not want to do..

We have difficulty maintaining work boundaries – unable to say no to our boss’s every request, working long hours and bringing work home.

We have difficulty with food boundaries – unable to say no to food that seem to stare us in the face daily or not knowing when to stop.

Read on to learn how I strengthened my no muscle.

Long-term potentiation

As with anything, saying no can become easier with practice. And the more you do it, the easier it becomes. It is like a muscle, use it and it will become stronger. There is an abundant amount of research out there supporting the notion. We call it willpower. Scientists call it long-term potentiation (LTP).

When you practice saying no, you can strengthen the nerve cell connections in the brain – when the connections are strengthened they are potentiated (Amen, 2010). Practicing over time strengthens these circuits and builds what we know as willpower. LTP occurs whenever these circuits are strengthened and practiced and the associated behaviors become almost automatic (Amen, 2010).

My ‘crazy’ experiment

I tested the LTP theory years ago. I had always felt like I had no willpower – prone to binge drinking and eating. I had begun working with a trainer and saw the weight loss benefits. Wanting to see what results I could truly obtain, I quickly modified my diet – strictly following the guidelines that I provide in my meal and snack creation post. At the time, I was having difficulty with giving up my beloved Snickers candy bars. Having read about LTP and that it is possible to increase willpower. I thought I would test it out.

I took a “Fun Size” Snickers bar to work and placed in in front of my computer monitor. At the time, I worked in publishing and sat in front of the computer for 8-10 hours a day. My goal: I will not eat the Snickers today. I sat there all day with the Snickers in front of me. I practiced saying no. Some might argue this was desensitization (it may have been). I wanted to, but I did not eat it!

I set the same goal for the next day.

And the next.

I would tell myself, I did not eat it yesterday and I do not need to eat it today.

This went on for months. More than a year. Eventually the Snickers bar was so old that it wasn’t appealing (although I am sure it has an absurd shelf life) and I threw it away. I had built willpower and the ability to say no.

It was not easy

This brief summary omits the days of stressful deadlines, when I almost ate that bar. I didn’t mention the emotional days, when I wanted the candy bar, but said no. It doesn’t mention my colleagues – who all thought I was crazy – who were nay-sayers and bullied me to eat it.

The challenge

What do you need to say no to?

For me, it was Snickers. At other times, it has been saying no to clients who want to train with me during periods that I am generally unavailable. There was also a time when I needed to learn to say no to alcohol.

I challenge you to think about what you need to say no to. Starting today, you will practice. It starts with 1 day. Then 1 day becomes 2. And if I can do it — so can you.

So tell us, to what are you going to practice saying NO?

References

Amen, D. G. (2010). Change Your Brain, Change Your Body. Three Rivers Press: New York.

Are group fitness classes effective?

I taught two group fitness classes yesterday morning. Back to back. I do this most Saturdays. Out of curiosity, I wore my heart rate monitor this time. First, I wanted to see how high my heart rate got during some of the exercises I selected for the TABATA class. I did not intend for the heart rate to get too high, and it didn’t. Second, I was curious as to how many calories I would burn during two hours of teaching – two classes that I heavily participate in.

When I stopped my heart rate monitor at 2 hours and 2 minutes, I was disappointed: 890 calories. To give you some perspective, my average 45-60 minute workout burns 500-700 calories. Granted, this was not the same intensity, nor designed to be my workout, but it led me to think critically about whether my classes were adequate and appropriate – and about the overall effectiveness of group fitness.

Intended outcome?

Why do most individuals attend group fitness classes? Most have the goal to lose weight. Are group fitness classes targeting that goal? I believe that the answer to this question is complicated – it is both yes and no.

For example, depending on the exercise selection, TABATA can be a effective and efficient workout. I perform this form of high intensity interval training on a regular basis. I design my classes in an equally effective manner (with a lesser degree of intensity). BUT, if a member comes to my Saturday morning class and this is the 8th class she has been to this week, will it be effective? Will the intended outcome be reached? Probably not.

Desired results far too uncommon

I have been in and out of my fair share of gyms. When you are a group fitness instructor, by default you end up filling in at what seems to be every workout facility within a 30-mile radius. And unfortunately, I have seen very few members achieve their desired results. Weight loss. Improved fitness. Very few group fitness programs will get you this results. Even more disheartening, is that I would see the same faces over and over – watching some individuals attend 8-10 hours of classes a week – with no results. Sadly, most of these individuals are overtraining. Some are undernourished due to extending periods of dieting and/or yo-yo dieting. Most are frustrated and at a loss for what else to do.

Solution

It is pretty simple. While I am not a proponent of many group fitness classes, I will not suggest that you forgo the classes. I will recommend the following:

  1. Attend NO MORE than 4 group fitness classes a week. Most group fitness classes target the same muscles, energy systems, etc. and miss the same muscle groups, form, technique, and energy systems.
  2. Research your instructor – ONLY take classes led by degreed and certified professionals. This one may be tough. There are some good instructors out there who do not have degrees, they have been fanatics for years and they bring good energy and great intentions. But generally speaking, you want to work with someone who has been trained to manage situations as they arise – providing variety that is safe, efficient, and effective.
  3. Work with a qualified trainer first. While working with a qualified personal trainer long term is not always financially feasible, it is in your best interest to invest the time and money into a few (3-12) foundational sessions with a trainer. A qualified trainer will teach you form and technique that the group fitness instructor simply is unable to provide in the setting (some know your form is off but are not able to correct form on every person every hour). With this investment, you will gain valuable knowledge that you can bring with you and ensure that you get the most out of your workout.
  4. Wear a heart rate monitor. Sweat is not indicative of a good workout – however most group fitness class attendees use sweat as the measure of whether the workout was good. It is not the only indicator. Neither is soreness the only nor the best indicator of a good workout. What else can you measure? Your heart rate. Target heart rates are highly individual – for more specifics please contact me personally.
  5. Change? If you have been going to the same class for years – it is time for something new!
  6. Give it your all. Some times a group class can become social hour. While this is not all bad, remember why you are there and give it 100%!

The bottomline

Not all group fitness classes are bad. These classes can be a great way to build community support and accountability. But if you are a regular attendee, be honest as to whether you are getting the results for the time and energy you put into the work. If you go to classes every day, and are not getting the results you desire, you may be overtraining – or simply inefficiently training.

I love group fitness classes – that is how I got my start. (It is also the reason I suffered overuse injuries and eventually elected to have surgery.) Follow the 6 recommendations above and you can get the most out of those classes!

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Muscles = You must be a bodybuilder?

It is really funny actually. I cannot tell you how many times I have been asked if I am a bodybuilder. I have been asked by roommates. I have been asked by strangers at the mall. I have been asked by strangers at gyms where I workout. I have been asked by strangers at gyms where I work. I have been asked by men, women, boys, and girls.

My friend Emily gets asked this as well. Neither of us looks like a bodybuilder. It has become a bit of a joke between us.

You must be a bodybuilder

I have narrowed it down to the fact that we are women, with muscle, who look like we know what we are doing in the gym. This accounts for the comments in the gym. And more than knowing what we are doing, we are not afraid of the heavy weights and are actually drawn to them – I would much rather do 4-6 reps of heavier weight than 12-15 reps of less weight. And for some reason, people associate heavy weights with bodybuilding – when bodybuilders actually use lighter weights for the bulk of their training.

I have determined that the everyday individual’s logic is:

If you know what you are doing in the weight room and you lift heavy weights, then you are a body builder.

Can you offer me any insight?

I am not a bodybuilder

When I let myself dwell on the comments, I can get down on myself. I have shared much about my battles with body image, and comments can trigger rampant thoughts. Out of season, bodybuilders often carry a significant amount of subcutaneous fat – a result of the considerable amount of calories required to build muscle and support the training regimen. I think, I know my body carries some subcutaneous fat, and I am okay with that – but how big do I look? 

There was a period in my life when I thought I would train for a competition. That season of thought has long since passed – there is no need for me to purposefully harm my body and risk significant metabolic damage. For what result? To stand mostly naked, in insanely high heels, and holding uncomfortable poses on a stage in front of individuals who are judging me? I will pass. While I like goals, and my body would likely adapt well to the physical training, I have no desire to put myself in the position of being judged based SOLELY on my appearance.

Thanks, but no thanks.

I am an athlete – I compete in the game called life

Opposed to bodybuilders, I train for life. I train for getting in and out of the car, impromptu hula hooping contests, unexpected basement demolitions, and so forth. While a bodybuilder may appear strong, most individuals would be surprised by their lack of functional movement and use of those big muscles (this is a broad statement and is not representative of ALL bodybuilders). This falls along the lines that models cannot do pushups – there is an overall disconnect between appearance and reality.

Compliment or insult?

When I have been asked if I am a bodybuilder, sometimes it comes across as a compliment and other times as an insult. The first few times, I let it get to me. Now, I just shake it off. Sometimes, individuals just do not know what to say and that is what comes out.

I love being strong and muscular, so I chose to take it as a compliment every time. And now every time either Emily or I hear it, we laugh and it causes a day’s worth of amusement.

The bottomline

I am not a bodybuilder. None of my friends are bodybuilders. I trained a friend for a figure competition – she is not a bodybuilder. We are strong – and have trained for life and the many obstacles it throws our way.

Further, I am not opposed to bodybuilding or figure training, it is just not for me.

The point is this: not all muscular individuals are bodybuilders. So stop asking us that! (You may give us a complex.)

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STOP rewarding yourself with food!

Rewarding oneself with food leads to an undesirable attitude towards self-treating. The extrinsic reward of food should be replaced with the intrinsic reward of treating yourself well (Lovell, 1994).

I had another conversation with a woman who views ‘treat’ foods as a reward for working out. “I workout so that I can eat that stuff,” she said. I do not know her well, but I know bodies and it is clear that she has never struggled with weight. The problem with this mentality is that the body doesn’t physiologically work that way. If your “reward” is a high fat food, your body does not turn around and use that as fuel for your workout. Further, after the workout, few “treat” foods provide the replenishing macronutrients we need for recovery. You cannot earn your calories.

And unfortunately, a calorie is not just a calorie.

Your relationship with food

Your relationship with food is cultivated from childhood. Unfortunately, parenting strategies that use candy or junk foods as rewards can teach someone at a young age that we can use these foods as rewards. For example, a parent might say, “If you are well behaved in the store, I will buy you a candy bar at the checkout.” (I guess my mom was smarter than I knew because we received Topps baseball cards.)

This has two negative implications: one, it instills a habit of rewarding with food and two, it sets a foundation to desensitization in the brain’s reward pathways (Amen, 2008; Amen, 2010).

Using food to reward exercise

Many of the benefits of exercise go unrecognized, because we too frequently consume food products that overstimulate the reward pathways of our photo (39)brain. By using a food pleasure, we are not allowing our bodies to recognize and experience the natural pleasures associated with exercise – for example, boosted dopamine and serotonin. This is particularly harmful if you reward yourself with rich foods immediately following exercise. Not only do you eliminate the opportunity to experience the immediate benefits of exercise; but also, your mind begins to build an association between exercise and food.

Your brain is powerful, and once that association is made, your physical body will come to expect the reward (in this case rewarding food) following exercise.

Further, we humans are creatures of habit. If you habitually reward yourself with food, your mind, body, and soul will come to expect this consequence. You ask, what is wrong with that? Foods can be addicting – therefore not only are you then going to need to break a habit but you will then need to break an addiction.

NOTE: It is critical to eat as immediately following exercise as possible. But there is a difference between feeding your body’s physiological needs with a post-workout snack or meal and psychologically rewarding yourself with pizza or ice cream. As I said, the brain is powerful.

The bottomline

I could delve into the neurological reasons for not rewarding yourself with food, but those complexities overwhelm the mind. If you want to understand more about the neurological and reward pathways, read Dr. Amen’s books cited below (he does a great job of speaking in layman’s terms).

Similar to training for life with your workouts and physical activities, it is important to eat for life. And there is much truth to the saying – you are what you eat.

Ask yourself – what do you want to be? 

Certainly NOT cheap and fast!

References

Amen, D. G. (2008). Change your Brain, Change Your Life. Three Rivers Press: New York.

Amen, D. G. (2010). Change your Brain, Change Your Body. Three Rivers Press: New York.

Lovell, D. B. (1994). Treatment or Punishment?. European Eating Disorders Review2(4), 192-210.

Wilson, C. (2010). Eating, eating is always there: food, consumerism and cardiovascular disease. Some evidence from Kerala, south India. Anthropology & Medicine17(3), 261-275.

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