Thursday, October 25, 2018

Case Study: Health Goals


For this case study, I wanted to do a case study of a change that a lot of us attempt to make at one point in our adult lives for another. This is one for healthy lifestyle changes.

I have a few caveats because I know this is a really sensitive topic.

One, I’m not a doctor of any sort.

Second, I’m not a healthcare practitioner of any sort. I’m not a nutritionist, I’m not a personal trainer. This is just my experience.

Third, and this is from my experience, if you’re doing this to work with an addiction, whether it’s food or alcohol or something else, I recommend doing this exercise with a sponsor (if you’re part of a program) or with professional help if you’re seeing a therapist or get a sober accountability partner. That partner needs to be someone who has already accomplished what you’re trying to accomplish with this change.

This exercise is from my personal experience, your experience, your resources and the environment that you’re working with may vary.

There’s certain things, when you’re looking at the scope of this, where this exercise is going to be really good. One – you want to ask if this is going to impact another person. If you’re trying to just, “Hey, I need to drink more water”, (this is) probably not going to impact anybody else. If, however, you’re looking to stop drinking, often there is a very social component around that. If you’re looking to do major dietary changes and you have people living with you or if it’s something where the dietary changes you wish to make…a lot of families have food rituals and you’re going to have to be mindful of those food rituals.

I think it’s worth at least going through this as one pass fairly quickly just to see where you might wind up inadvertently impacting someone else.

The other scope consideration, is this a long term or permanent change? (This is useful even if it is not).Let’s say you’re looking to do, say the Keto Diet for 30 days to take off 10 pounds. I think it’s going to be handy just so that you’re also thinking in terms of how you off-ramp that change or what you’re trying to do. If it’s super short term – “Hey, I think I’m just going to quit coffee for 30 days.” That’s, that’s the only really going to impact anybody if you get really cranky and that’s not going to necessarily be a long-term change.

I think with this exercise, spend the time with it relative to the scope of the impact and the scope of the change that you wish to make. All that said, I’m going to give you my demonstration of what I’m considering right now for myself.

We’re going to go through four passes of this. The first two passes are decision points. We’re going to go through a short term pass and then we’re going to go through a long-term pass.

Then we’re going to say, “Okay, is this something I actually want to do?” If the answer is yes, then we’re going to do two more passes. We’re going to see what we already have.

I think that’s very important to recognize that we already have quite a bit to work with. It makes that change a little less daunting and then what we need, and we’re going to do this in the context of four quadrants. In a lot of the changes that we’re looking at in these case studies or changes that we individually are making, there’s other things that are also impacted. The changes we make do wind up impacting others.

If they impact us, obviously they impact others – sometimes in ways that we’re not really thinking about when we decided to make a change. They impact the relationships we have with others. Oftentimes, if we’re making a change, we do need to set some boundaries with other people or we need to set expectations with other people. Renegotiating how we’re engaging with others. Also, we may be modeling behavior as well.

Then the, Its, which is your mechanicals. Any systems you have in place, any materials that you need, the money that you need.

The change that I’m wishing to make is Go Primal. There is something called the Primal Blueprint that Mark Sisson has created. I’ve played with it before. I think it’s a pretty good baseline.

My why is -I’m trying to get higher energy. I’m also aware that my diet since back when I was doing crossfit has gotten not so healthy. I’m sure that’s having an impact on my energy levels and how I feel on a day to day basis. Also, my clothing starting to get a little tight and I would like to take care of that before I have to go out and buy new clothes. It’s getting tight in the wrong direction. I want to stop that. I’ll be interested to see whether or not that “why” is strong enough to keep me going when things get kind of tricky. I might wind up reevaluating this, but that’s what I have right now.

My goal is higher energy, so as I evaluate the process, that’s going to be my indicator.

My first pass is the short term. Some of the short term things I came up with in five minutes sitting down with this particular section is:

– I need to set stronger boundaries both with myself and others around workouts. My partner is working from home a lot more frequently and, for whatever reason I tend to be shy about working out around other people if I’m not in a gym or in a class. I need to get over myself and just set aside some time and do it.

– I need to start planning meals again. There’s been too many instances recently where my partner and I will sit there and look each other.

What do you want to eat?

I don’t know.

I don’t know. I don’t feel like cooking.

Okay. And then we order out or go get fast food or something.

– I also need to plan the workouts and then actually go do them. I found that if I go into the gym or if I even work out here with a plan or have a really concrete idea of what I’m going to get accomplished that day, I’ve been a lot more inclined to get it done. That’s just me.

I need to remind myself that I am fit and healthy. I’m getting close to 50. I think I’m doing okay, but I need to keep reminding myself with that. The mindset I need to maintain is that I do what I say I’m going to do and I execute my plan.

That said, I do reserve the right for myself to execute that plan imperfectly or change the plan if my energy levels are really, really low that day. I have a couple of chronic issues. I need to be willing to be flexible but still maintain the discipline of, “Okay, if maybe lifting heavy weights isn’t going to work for me that day because my joints are bothering me, maybe doing yoga.” Getting very clear. Again, I’m after higher energy, and it’s (also) getting very clear about what the intention is for that (higher energy).

I’m in the It (quadrant). I’m gonna look at this as how this impacts other people, whether I want it to impact them or not. A big person this impacts, frankly, is my partner because I do a lot of the cooking and if I’m doing a diet, he’s either going to have to cook for himself or be cool with going along for the ride.

One of the changes – we’ve been eating a lot more pasta these days. Bread and that sort of thing. I know the Primal Blueprint is not very crazy about that stuff. He’s going to be seeing a lot more meals without grains. One of the other things that I need to do, and I’ve put this in italics because it’s something I need to ask or it’s something I’m not terribly certain of – I need to go get more information, is I do need to ask him about the impact of just setting aside time for workouts and setting aside space and privacy for workouts.

I don’t think it’s going to be a big deal, but I don’t want to make that assumption. This tells me I need to go ask some questions and that’s a good thing. We want to surface what questions we need to ask. Where we’re not entirely certain of information.

In terms of the We, it’s how I’m interacting with other people and how I’m modeling for other people. One of the things that we need to do, so with Ryan, I need to negotiate time and space for workouts and again, as we put together that contract with each other, maintain that. I’m also negotiating meals. I do want him actively involved in this process. It impact him. I don’t want to do two meals. He’s really good at fending for himself if what I’m making is not to his liking, but I just as soon have him be a partner to this process.

Friends and family. Again, there is a social component. In my family in particular, and maybe yours too, we’re super into food. I know that sharing with them what I’m doing and why (will be important). I’m very fortunate to also have a very supportive family and very supportive friends. Just let them know, ask for help, see what comes back. That way I’m not getting inadvertently sabotaged. I also get feedback, too. I know that there’s been some changes where friends have not necessarily been all that supportive and that’s good to surface. Uncomfortable, but good to surface.

You’re also bringing out risks as well, particularly if there’s particular friends that might cause you problems.Let’s say a relationship with some of your friends are all about being drinking buddies and you decided to quit drinking. You’re going to learn real quick about what the foundation of that relationship is. Knowing that you’re going to surface that – it’s good to be prepared.

Also with friends and family, one of the things about food and a lot of cultures, (and I know the food with my family and maybe yours, too), is that you may have someone who cooks your favorite thing because they know that’s your favorite thing. It’s an expression of love. There’s a couple of ways to handle this, particularly if you’re dieting and you’re on a diet that has some restrictions. One is selectively eat what is offered. Maybe not take as much as usual. Then, on your own time, go, “Okay, how am I going to accommodate this?” The other is, you know, “Hey, I love you. Maybe there’s a better way we can do this.” Again, that’s up to you.

I know my preference, based on my values is – if my Mom makes me German chocolate cake. I’m having a slice of German chocolate cake. Your choice, but that’s my selection.

Then finally the Its. This is all the systems. Groceries – what do you need to shop for in any diet or health plan? (Diet and health plans are typically) good about giving you a grocery list. For me it’s “Eat real food, minimized process things.” Go around the circumference of the grocery store. Meal prep. I know short term I’m going to need to get a lot more disciplined about setting aside an hour for meals and meal prep, usually in the evenings. What I need to add to that, as I’m looking at this again, setting aside time and planning for things to eat for breakfast and lunch.

I do work from home. For those of you who are working in an office, making sure that you’re setting aside time for meal prep, for lunch. For eating out, identifying friendly restaurants. I think that’s really handy because sometimes you just flat out don’t feel like cooking. Knowing that you’ve got some go-tos that support the lifestyle change you are wishing to make is very, very helpful. I’m very fortunate. I live in a major metropolitan area with really good restaurants. Some of you may not be so lucky. Just identify what you’ve got to work with.

Then, the workout. I need to figure out what workouts I want to do. I’ve always been a big fan of having plans. A lot of people don’t. Also gear check. What do I have to work with, particularly if I need to work out or want to work out from home?

That’s the short term pass.

Now, longer term, because I’m looking at this as a lifestyle shift, there’s some longer term changes I need to make. For those of you who are looking at this more as a short term (change), you know, “I’m trying to drop 10 pounds before my high school reunion,” this is where you look at things like off-ramping. What do you want to do after you finished that really strict diet? This is where I would actually recommend getting a nutritionist to help you because they may be able to help you with that off-ramp process and with longer term changes.

In the long-term, for myself, I know I need to get really good at maintaining those boundaries around workouts, particularly when I get busy.

I’m in a busy time right now because I’m doing a lot of writing which is really sedentary. It’s gotten way too easy for me to decide to stay on the couch and surf the net versus actually working out. I have to maintain those boundaries.

Also with travel. Travel tends to throw my schedule off and I’ve heard it throws a lot of other people’s schedules off in terms of eating and exercise. Determining a plan for what I’m going to do when I travel is going to be key.

Also scheduling. I need to make sure that I set that time aside for meal and workout planning. Considering that part of my day and know if I have a lot of meetings, just making sure that time is blocked and being really disciplined. The mindset is “I’m disciplined and I execute my plan.” The belief I need to maintain is I am fit and healthy.” One of the things that I found really powerful (for me) is reminding myself that I’m already those things. It took a long time for me to get there when I was coming from a place where I wasn’t fit and healthy.

Right now I’m coming from a place where, yeah, I’m kind of fit, but I let things go. I haven’t been feeling that healthy, but reminding myself, “Okay, I am fit and healthy,” I will BE fit and healthy. That’s been helpful. It’s one thing to say internally “I’m fit and healthy” and (feeling like) I’m a shambling wreck. I’m also trying to maintain some integrity too. (Being honest with myself around where I really am).

I think that’s where the power of those affirmations is. If there’s a disconnect between what you’re trying to say to yourself and what you’re manifesting in the outside world, at some point you’re going to want to resolve that disconnect. The disconnect is, “Oh my God, what the heck am I saying?” I invite you to consider maybe other ways to resolve the disconnects. Not, “I’m working on being fit and healthy”, but resolving the disconnect where (you ask), “How do I get to where I want to really display that?” I think that could be really powerful. I’m going to get off my soapbox on that.

In the It section – there’s a couple of things I’m watching for.

One of the things that is worth remembering, and I know this is really valuable for me too, is that the It section is all the behaviors I have no control over. I have no control over what happens outside of the meat case. That’s me, that’s my body. It’s a matter of observing behavior in this section and keeping an ear out. I know that this section for me somewhat incomplete. I may do one more pass, but at this point I need to get cracking on this change. A couple of things I’m looking for long-term: One is to see whether or not Ryan’s inspired to join me in either this or the exercise. He does do some of his own exercise at night. I leave him to it, but I’m listening for that and I just need to make sure I’m open if he decides to go, “Hey Wendy, I’d like to join you.”

Also friends and family. Again, that’s a practice that I need to do. To make sure I stay open and see if anybody wants to join me on this little adventure.

In the We – the we is the relationship I have with others and how we interact. With Ryan, who’s my partner, just maintaining boundaries around me going to work out and also asking for input on meals. Keeping him engaged because that’s the area where he’s really impacted beyond maybe losing a little bit of time as I go pick up iron or move myself around a bit. Then with friends and family, it’s selectively eating what’s offered. That includes desert. Maintaining any boundaries that I need to maintain.

For instance, I’ve been sober for seven and a half years as of this recording. One boundary that I still have to regularly maintain is “don’t drink alcohol. ” Everybody’s gotten pretty good about that at this point. Early on that was none of that was something I had to repeatedly maintain. And you still do, or I still do. That’s a pretty regular boundary I have to maintain, particularly with people who don’t know me really well.

In the Its section – this is the resources and the systems long-term. With groceries, I’m very fortunate in that I have a model and it’s my cousin Mary Beth. When we went to visit her in Oregon, she opened up her fridge and it was this complete wonderland of fresh produce and super fresh foods. My aspiration is to have a refrigerator that looks like hers. I wish I took a picture of it because it was, it looked like something that should be posted on instagram. It was pretty amazing. That’s a long term model.

Meal prep, maintaining that one hour of meals and meal prep and eating out. One of the things I need to do long-term is determine the system. Particularly when I’m traveling, being able to (determine at a) glance, “Okay, is this something that’s going to support the lifestyle I’m trying to develop or not in terms of my health?”

Then for the workout, determining what’s working and what’s not. There’s a little bit of metrics and when, because I know that my why is higher energy, it’s keeping an eye on whether or not when I leave those workouts I’m energized and keeping track of how I feel a day or two later. One of the things that I’ve noticed for myself is that things that I used to do 10 years ago – I used to do Crossfit. I used to really heavy weightlifting. Unfortunately when I overdo it, it kills me. I may feel fine afterwards, but then a day or two later I feel like I’ve been run over by a truck and it’s not the “I’ve worked out, my muscles are sore,” run over by a truck. It is like existential exhaustion. So I have to be very mindful about how I push myself.

It’s that level of evaluation in terms of evaluating what’s working. That’s going to going to be a long-term thing for me. Now that I’ve done in the short term and the long-term, I can make a decision. In this particular instance, my decision is yes, but I also know that I’m going to need to break it down a bit.

The next step, now that I’ve decided “yes,” is to figure out what I have to work with and what I’m going to need. The first pass is what I have to work with. What resources do I already have available?

The important part of this resourcing is – I’m trying to bridge the gap between my current state and my desired state. I’m very grateful in that I’ve been exercising and sort of toying with healthy lifestyle changes now for the better part of 11 years.

Thankfully I’ve got some prior knowledge to work with. In this case, some of the resources I’ve had to work with include: I’ve actually done Paleo for … I think I managed to make it 17 days. I have an idea of where I’m going to get derailed. I also have an idea of some of the hazards and risks. Paleo is really great for people that it works really great for. I wasn’t terribly successful and the only reason is because I wound up losing weight way too quickly. I was a shambling wreck at the end of it. One of the coaches I was working with the time saw me after 17 days (and told me to stop.) Don’t do anything that’s going to endanger your health. A lot of people are very successful on Paleo diets and it’s worth trying just to see whether or not that’s something you can maintain.

I have had a steady work out program for now over 10 years. It’s been a little more touch and go the past few years, but I do know that I can do that. For many of you – exercise is pretty lame. I think it’s a matter of finding, (this is probably gonna sound really trite,) something you enjoy or just moving around. I would recommend finding an exercise coach for this. Particularly one who’s really good with the types of issues that you’ve had. Don’t try to find someone that’s like,”We’re gonna power through things.” You don’t want that type of coach. (In my personal experience and opinion. Some people need people to push them. I need someone to ratchet me back. Get what YOU need.)

I do have some familiarity with the Primal Blueprint, Primal eating and Primal lifestyle. I have the books so I can get more knowledge. Thankfully, I can also cook. A lot of people can’t and may not be terribly interested in cooking (which is absolutely cool). There are services that provide meals. That may be something worth resourcing.

(Then there is) mindset. I am disciplined (most of the time). I do what I say I’m going to do. I execute on my plan. Maintaining that mindset is going to be really key for me because this is an area that I know, from my past experience that I start making excuses.

In the It area – again, this is how this impacts other people and this is where I’m really looking at who are my allies and who will help me with this. Thankfully, Ryan’s very supportive. He encourages me to get out. When I first started working out, he had some really grave concerns about what I was doing. He’s seen the results. He’s (now) really supportive. Plus he gets the, uh, “added bonuses.”

Then friends and family – I’m looking for the ones who are open and supportive and aren’t like, “Oh, what do you think doing?!?” Finding the allies among them.

Then some of the We – in terms of the (romantic) relationship, I think with him, you know, he is supportive. I just need to make sure I talk to Ryan first. The other thing that I know with my friends and family that they’re already doing is that they are keeping an eye on me and so it’s really important that I ask them, “Hey, as I go through this, please keep an eye on me.” I know from my Paleo experience that I do need to ask them to please note whether or not they see any significant behavioral changes, particularly if I’m starting to be really nasty to people. If I seem really drawn out. If I seem really skinny (and I’ve had that happen as well. In my case – getting too skinny is a bad sign). I know from my experience I need to have people keep an eye on me as I do this. Your mileage may vary.

In terms of resources, I know that when I go grocery shopping, thankfully I’ve gotten in the habit where a lot of my grocery shopping has been on the fringes. Protein and produce, probably minus the ice cream – maybe not do so much of that. There are some tweaks that need to happen there, but for the most part, if I stay on the fringes, I should be okay. I do already set aside an hour for meals and preparation. It’s just pretty much maintaining that. I do have one restaurant that we go to if we’re looking at each other and neither of us feels like cooking. It’s like, “Eh, let me just go pick up a salad.” We do need to find more and take a look at the places we tend to go and see if there’s anything that we need to maybe focus on more than some of the stuff we tend to eat.

I also have knowledge about workouts. I’ve been very fortunate in that I’ve been healthy enough to have an exercise program for pretty long time. I do have resources available. I just need to pick one. I also have a better idea of what’s working for me these days and what isn’t. I do have books, so I have quite a bit of reference material. I don’t need to go out and buy this. Those are the resources I have now.

Thankfully I have a lot to work with. If all of this is really new to you, that is perfectly fine. We all have to start somewhere.

In terms of needs, again, I did this in the past, this is my experience. One of the things that I think is really important for those of us wishing to make permanent changes is to look at this in terms of small focused steps and gradual changes and really checking how you feel.

I know that the changes that have tended to stick have tended to be ones that were small and I could focus on that and make sure they stuck and then I could add something else. John Berardi, at Precision Nutrition, has a pretty good benchmark. I think it’s you have to have at least 95 percent (confidence) that you could succeed at this. And if you fail, okay, well, let’s make this easier. The idea is to build confidence in your change and to have the change stick. Does it mean I’m going to go from my current lifestyle of sitting on the couch and eating a little more junk food than normal (to a healthy lifestyle in one go)? Probably not. I know that that won’t stick. It’s just a matter of me deciding what those small focus steps are going to be.

I need to go get an (annual) exam. I think it’s recommended anytime you’re planning on significant lifestyle changes and I need to do this for two reasons. One is just to make sure there isn’t anything else going on that I should be aware of. The other is baseline. Getting a much better map of where I’m at now. Again, part of the driver behind this is I have not been feeling very energetic this past year. I have been fighting a little bit of chronic fatigue and I’m still trying to make sure that it’s not something more serious other than just the “existential tireds.” I think that’s really important.

Then I need to maintain a belief that I’m energetic and healthy and that I’m capable of being energetic and healthy. Again. I haven’t been feeling that way for the better part of a year, probably longer, but I think that’s really important.

That mindset of I’m disciplined and execute my plan. I do what I say I’m going to do. These are the things I really need.

In terms of what I need from others. I need to find accountability partners, – particularly in this area. I need to go find a coach again. In the workout area. I’ve been finding that having (a coach), regardless of how the workouts are, having someone that I’ve made the appointment to go see has been incredibly helpful. And recently, as soon as I have not had that appointment, it’s been too easy for me to stay on the couch. I need that. Then, encouragement. Thankfully all I need to do is ask. And that’s where this comes in, is just asking for encouragement. Then also again asking that people keep an eye on me, just to make sure I don’t go overboard…I’ve been known to do that

Resources. I need to schedule regular time for workouts and make sure that those are set appointments that do not get rescheduled. I’ve gotten a little slack about letting other things get in the way of that. I just need to make sure that I set aside regular time for food and workout planning. I used to do this back when I was doing Crossfit and for a couple of years afterward, where every Sunday I’d sit down with cookbooks and my workout journal and plan the week. It was a couple hour process but it was a process I really enjoyed. Again, your mileage may vary on that, but I think having, at least in the early going, some time set aside in terms of what you’re going to eat and the workouts – I found it really valuable and it wound up allowing me the mental space. I wasn’t thinking about “What am I going to have for dinner?” It’s already on my plan. What I plan that week, I need to go do that.

That’s my example of the change planning. This particular pass-through took me about 20 minutes altogether. It probably took me longer to explain this than it took me to do it. My recommendation is to do one pass, let it sit for a day, sleep on it, do another pass, see if you’ve forgotten anything. There’s a few things that come out of this. I know for me what’s come out of this exercise has been that I just need to sit down and do some planning. I need to do some scheduling. I need to go find an accountability partner. My next step is to determine what small change I’m going to make this week to make this real.

I hope you found this helpful. If you have any questions or comments, please feel free to comment on this video or on the blog post. I hope this helps and thank you so much for your help and support.

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