When Johnny Met Rosie--Women in EMS Part 10: The Weight of the World (is on my hips)

Disclaimer: While not EMS-specific, the topic of obesity and physical fitness is a significant one and certainly something many women have interest in. I am not a nutritionist, or an expert in exercise physiology. I have no claim to fame when it comes to fitness. What I am is experienced in all the different ways one can try to lose weight and be unsuccessful at it. Please do not take this article as gospel or any other product/diet testimonial. It represents a journey, not a destination. Do your own research and make your own decisions accordingly.

I am not small—I come from good Celtic stock. My genetic background is tall, broad and fair-skinned, with red hair. Do you know what that makes me? A tall, red-headed broad. I have been various levels of fit throughout my life, but small (and a career as a thoroughbred jockey) has eluded me from about age 14. I would say that at my strongest I could run/bike for miles, could swing hay bales with ease and could leg-press 550 pounds. When I entered EMS I was not small but I was solid, curved and fit enough to do my job.

Twenty years, two kids and a bunch of bad habits later I am still not small…but I am also certainly not as fit as I should be, and have now spent years struggling with an unhealthy amount of excess weight. I could blame a lot of things for it, but ultimately my choices are my own.

There is no big mystery to how it happened; staying healthy with an active EMS career requires discipline and effort. The media’s version of an EMS provider comes to us from shows like “Third Watch”—trim, physically fit, in uniforms tailored to show off our better attributes. However, the same media tool can be used to view us as we more likely are; very often we are overweight to outright obese, and even if we are not overweight the large majority of us are probably not at the peak of physical fitness. In a field that has everything to do with activity and health, how does it happen that very often we are our own worst role models? Let’s look at some of the most common factors which double beautifully as excuses (I know, I use them all the time).

Schedule

Regardless of your role in the field, it is almost guaranteed that your work schedule is far from “regular.” EMS is a 24/7 business and trying to fit it into a 9 to 5 model is often an abysmal failure. Whether it is shifts of 12, 24, 10/14 hours, or any combination thereof, it will usually span both day and night (both if it rotates) and it has a broad spectrum of effects on how we carry out our daily lives. Double or triple that if you have more than one job, which many of us do. What do we get for our ability to be so flexible with our time? Sleep disorders, chronic fatigue, a depressed immune system and horrible eating habits. Go team!

Schedule has a really significant impact on diet for a number of reasons, most of which don’t need to be outlined. For the night people your choices are slim and those that are open, while very often delicious, are far from the healthiest choices out there. For the day people, while your available variety (healthy and not) is greatly increased, very often the increase in call volume—and more simply the locations of eateries—get in the way of obtaining decent food. So if you go for convenient, I don’t blame you; however, in this day and age convenient is rarely synonymous with healthy.

Stress

The great exacerbator, we claim to thrive on it and in many ways most of us do. We function under stressful circumstances that a large majority of people outside of the field feel they could never cope with. That does not mean it does not take its toll along the way. One thing to remember when people talk about stress is that, in and of itself, it’s not a negative term but a neutral one. Webster’s defines stress as “a physical, chemical or emotional factor that causes bodily or mental tension and may be a factor in disease causation.” Sometimes that tension is for our own good—increased vigilance, faster responses and the ability to do and process any number of critical items at once. The rest of the time it goes back to the same things we all worry about—performance, schedule, money, relationships…basically just life in general (compounded by life in EMS).

However, many of us deal with our stress in unhealthy ways (I am not saying anything that you do not know.) If it’s not you it’s someone you know. Whether it’s with alcohol, cigarettes, food or just high-risk behavior in general, we all use stress as a reason for doing it. Studies have shown that stress eating and food addictions are real, that people get the same dopamine and endorphin releases from binging on food or eating “comfort foods” that other addicts get from their vice of choice.

Our field was once described as “90% boredom and 10% sheer panic.” Now, I do not know about the panic part but I would say that is a very good way to describe most shifts. When discussing stress as a general topic, any change from baseline could be placed in that category. Considering the hormonal shifts and adrenaline spikes that can occur from just working a busy shift with a few (or even just one) critically ill patients, it’s no surprise that our systems are flooded with things like cortisol and are completely out of whack.

In an active field like ours you would think that it would force us to be in better shape, but the reality is that you can be as active or inactive as you choose and usually get away with it. Hang back enough and the task will get done whether you’re helping or not. There are often enough hands for the more manual tasks and in many areas, the flat-out need for physical agility does not always present itself on a majority of a calls. So it is easy to just sit back and let it go.

This piece isn’t about all the whys really, it’s what can you do about it. You really cannot pursue a line of topics focused on women without bringing body image and being weight conscious into it. Whether you claim it is as a result of society, media and culture, or simply internally generated, the reality is there’s more focus on our size than there is our shape and many of our behaviors (good and bad) are a result of that attention.

Like many of you, at one time or another I’ve tried most types of diet regimes. I’ve done the Jenny Craig, the older version of Atkins, the Cambridge and any variety of short-term media favorites in between. I’ve lost the weight and then gained it back. I found a good routine a number of years ago—I was working out religiously six days a week and eating a decent diet. I lost sixty pounds and was happy with my results. Then I got pregnant with my daughter. Now I am not using pregnancy as the excuse, because it wasn’t. What it did do, however, was stop me from exercising. At week 17 my daughter firmly planted herself in my pelvic floor, which brought most walking/running to a screeching halt. And just like any other habit, once it broke it was so difficult to get back going again. It was just much easier to fall back on my old habits, so I did—much to the detriment of my waistline.

My pregnancies left me with a couple of other souvenirs as well; one is the imminent threat of Type II Diabetes and the other was a mildly enlarged heart (just two more things for me to strategically hold against them when they’re older). Combine that with having passed the big 4-0, and with the weight that I put back on, and let’s face it, I’m a time bomb. Then I got promoted at work, which removed me from a full-time road position. All new stressors and much less opportunity for hard physical exertion while at work. Without the threat of another call hanging over my head, eating became more of an expected enjoyment and less of a luxury.

I wasn’t ready to be put out to pasture and the gravity of my situation wasn’t lost on me (if you read this column then you know that, ladies, gravity is not your friend). My next stop was Weight Watchers. It has excellent online tools and frankly the point system is a piece of cake. Combine that with portion control and it’s really a no-brainer. I have friends who have had tremendous long-term success with WW. So I threw myself into it and ended up struggling with the same 15 pounds over the course of a year. Up, down, up, down—very frustrating, but what I learned is while points work, the qualities of those points were not the same for everyone.

So back to the drawing board it was. Books, websites, message boards, interviews with friends who had success and then going back to reading even more. What was apparent was that I could no longer go into this thinking about going on a diet. That’s a short-term mindset and what I needed was something that would be long-term —lifelong, hopefully. During this research period I came across the new version of the Atkins Diet. Since the death of Dr. Atkins his framework was updated and reworked by Drs. Phinney, Westman and Volek. In this very easy read, and supported by all the reading I did after that, there were changes I was looking for specific to me. The idea of being insulin-resistant is something that had surfaced during my pregnancies and I could have looked in a mirror when I read these articles. Again I am not here to promote any one process over another, so I am not going to expound on the information I learned. Please, go do the research yourself and see what fits your body type and lifestyle.

The rules are pretty simple: no processed food whenever possible, no sugar, low carbohydrate, moderate fat, high protein and plenty of water. In order to accomplish this we gradually changed our household over to follow at least some of these tenets. My children can tell you what is or isn’t allowed for Mommy (which makes them painfully effective police). Our quality of food has gone up and we make conscious choices on where and what we buy. We read every label. This year we invested in a local farm—it’s called CSA (community sustained agriculture). You buy a “share” and for the growing season you get a weekly share of whatever is harvested. You know where your food came from, it’s organic and it makes you learn how to cook with new things. You can find your own CSAs at www.localharvest.org .

My husband held out at first, until he saw how I was doing. Now he’s doing even better than me (you know how men are with this stuff, they sneeze and five pounds falls off). For the children we simply insert better choices into their repertoire whenever possible: whole grain breads, fresh fruit always on hand, balanced meals. Yes, we still let them have junk, but it’s controlled. I do not want them to feel deprived and that they have to pursue it as a forbidden food.

Did it work? Well, the first week was really difficult. It’s true what they say about having to detoxify from carbohydrates and sugar—by day four I was miserable and ready to ditch it. But change is not easy and I wanted to see this through, so I stuck it out. At the risk of sounding like a spokesperson I’m glad I did. My energy level went through the roof; I had no more afternoon brown-outs and can go consistently through till bedtime. I don’t get hungry, or at least not that gut-punching hunger. When I’m hungry it’s simply time to eat. I sleep through the night, which I haven’t done for ages. I’ve had chronic pedal edema since I had my daughter—that was gone within four weeks. No bloating, no gas and no feeling like there’s a rock in my stomach after I eat.

As time went on and I got used to it, so did my body. My palate changed, all my old stand-by comfort foods do not have the same appeal to me any longer. Sweets taste TOO sweet, and the pizza or pasta I would normally dive into tastes different. They also make me physically sick, especially if I try to eat the same amount I used to. I actually crave salads and vegetables, especially if I’ve been traveling and have gone without for a while.

My husband and I have learned new ways to prepare different foods (there are fantastic resources out there). He makes a killer low-carb waffle (yes, it can be done), and we learned how to make our own pestos out of stinging nettles and salads out of amaranth. If you had told me a year ago that I would routinely eat shirataki noodles (tofu & yam flour) and drink almond milk because I like it, I would have laughed in your face.

In the meantime, as we were feeling better and learning how to manage hunger and cravings another interesting thing happened—the weight started to come off. As of this writing I am down 48 pounds from my heaviest, and my husband is down 62 pounds.

So if you’re struggling to get those extra pounds off, all I can say is that if this old lady can do it, so can you. But if you haven’t succeeded in the past it’s time to rethink your approach. Here’s my advice:

PLAN: Do not just say “I’m going on a diet tomorrow.” Don’t rush it; plan it out—DO YOUR HOMEWORK. Look at what you eat, when you eat and then why you eat. Look at what you’re drawn to, what your cravings are. Then start doing your homework and find an eating style that fits into something you can do. Read the message boards, check the reviews on the books and look at it from more than one angle. Find some solid resources. There are great websites out there—www.livestrong.com, www.fatsecret.com, www.weightwatchers.com are just a few where you can find articles, charts, recipes and other resources.

PARTNERS: Even if they aren’t joining you on your journey, enlist the people closest to you as back-up. Discuss it with your spouse, children, your partner or your team. Explain what your rules are. Sure some will try to sabotage you, but in the end you may find they’re a great motivation. And you might influence their behavior without even trying. It can be difficult to keep eating badly when your partner isn’t. My co-workers have been great; they help however they can, from modifying recipes to finding exercises to do. One of my girlfriends is a marathoner who plans to drag me through my first 5K in the spring, at my side every step.

PREPARE: Learn to make your food in advance. We do not always do this, and unfortunately our food options at work are simply not ideal or always in our control. If you bring it with you, then that takes those choices out of the equation. Yes, it takes you more time to get ready for work, but the benefit outweighs this. READ EVERYTHING that you’re eating—learn about labels and how to decipher them. You will figure out recipes that you like and that work best for your schedule. On average I eat much better than my co-workers, practically gourmet, and I do not spend a fraction of the money that they do. The people that I know who have been successful do this religiously, they do not go anywhere without a cooler or lunch bag. Not to work, classes or when traveling. By doing the same thing I not only control what I eat, but it’s good for my budget as well. I’m rarely seen without my green cooler.

PHYSICAL: Changing your eating habits is not enough, even if you have great success in the beginning. It’s only one component of your overhaul—you need to move to get those muscles in shape, so do it. Don’t want to join a gym or find a class? Then take a walk or ride a bike. Do it with friends, so you can pretend an activity isn’t exercise. I know friends that do entire stretching routines using the truck, followed by lifting regimes with the equipment. Make the best with what you have.

PATIENCE: There’s one thing I’ve found doing all the research and with my personal practice, and that is true and sustained weight loss just does NOT come quickly. As much as I would love for it to be faster, it isn’t. As my doctor so lovingly put it, “You’re over 40 sweetie—welcome to it.” I lose approximately 2 pounds a week, which I am told is pretty ideal if I want to keep it off. So I keep at it. I choose a side salad instead of an appetizer, vegetables instead of potatoes, I put real cream in my coffee and I skip the dessert. My reward is to put uniform pants on where the insides of the pockets don’t show and the waist is a number size I haven’t seen in a decade.

We just navigated through the diet danger zone known as the holiday season, some of the most decadent weeks of the year. With my regained fortitude “go on a diet” doesn’t have to be a 2012 resolution.

For 2011 my best moment was when the cardiologist said to me, “You’re down 40 pounds and your numbers are great, what have you been eating?!?”

My response was, “Bacon.”

(My next goal is “Couch to 5K,” and I’m looking to run my first 5K in the spring. Check back with me in a few months to see if I actually manage it.)

"Wealth of Health" Waffles
Source: "Real Food, Real Easy" by George Stella

Ingredients:
Non-stick cooking spray
1/2 cup soy flour
1/4 cup bulk sugar substitute (i.e. ,Splenda)
1/2 tsp baking powder
2 large eggs
1/3 cup heavy cream
1/3 cup water
1 tsp vanilla extract

Steps:

1. Spray electric waffle iron with nonstick cooking spray and preheat.

2. In a large bowl, combine all ingredients until a thick, but smooth consistency is reached. (If the batter is not smooth and more like a thick dough, add small amounts of additional water until smooth.)

3. Pour 1/4 cup batter in the center of the waffle iron and close the lid. Cook for about 5 to 6 minutes, or until steam is no longer visibly coming out of the sides of the iron. Repeat until batter is used up. (Note: 1/4 cup is the perfect amount for a smaller waffle iron and should make about 6 waffles. Larger irons will require 1/3 cup batter, 1/2 cup for Belgian-sized.)

4. Serve hot with butter, or with your favorite toppings, such as fresh fruit, whipped cream or sugar-free syrup. These waffles are already sweet and do not need much help. You can mash up some berries as a topping, or add cinnamon for a cinnamon toast flavor.

Yield: 6 waffles
Serves: 3

Per Serving:
Calories: 150
Fat: 9g
Protein: 11g
Fiber: 1.5g
Net Carbs: 6g

Plan of Attack

So what goes in the infamous green cooler on an average EMS work day?

• Diet soda/drink of choice
• Empty 24oz Nalgene bottle with drink mix packets (Crystal Light, 4C)
• String Cheese
• Small container of nuts (pistachios, almonds, or walnuts—sometimes seasoned or flavored)
• Sugar-free Jello
• Salad—either one large one or split into two if I'm doing a long day. Quality lettuce, zucchini, cucumber, fresh mushrooms, a little tomato, cheese, and occasionally a protein (meat, small shrimp, hard-boiled egg). Dressing is Newman's Olive Oil or Creamy Caesar.
• An omelet with vegetables and cheese in it made the night before.
• Separate meal of meat & vegetable (baked chicken/pulled pork/seafood with broccoli/green beans/cauliflower). This goes in if I'm doing a 24, or is substituted for the salad.
• Emergency Atkins bar, one that's really high in protein and can be pocketed for a meeting or long drive.

Tracey A. Loscar, NREMT-P, is the training supervisor in charge of QA at University Hospital EMS in Newark, NJ. Contact her at taloscar@gmail.com. She is also a member of the EMS World editorial advisory board. To hear more from Tracey on the issue of women in EMS, listen to the September 2010 edition of the EMS Squadcast, a podcast series dedicated to discussions relevant to the world of EMS today.