This article originally featured in In Cooke's Corner, an opinion collumn in NHD Mag, April 2021. You can read the original copy here: https://library.myebook.com/NHD/network-health-digest-april-issue-162-uk/3265/#page/38
“Never trust an unfit personal trainer” or “Never trust an overweight dietitian”? These surely must mean the opposite, i.e. no person adequately qualified and passionate about food, fitness and nutrition can be anything but the absolute personification of health perfection.
This is the question I wish to discuss in this month’s issue: do we have to hide our flaws and demonstrate a perfectly fit physique in order to be seen as reliable sources of health information in the eyes of ourselves, our peers, our patients and the public?
Now, let’s consider I was within an average range of 6.5% to 8% body fat in my time as a personal trainer and boxer, training two to four hours per day, consisting typically of two to three sessions. I had spent two years at university studying a nutrition sciences diploma and running an online health blog based around teaching the biochemistry and physiology of nutrition, alongside my studying of countless textbooks for my qualifications as a personal trainer.I then did another degree in nutrition while running a boxing fitness service, which required studying for my coaching certifications.
All of the above, I hope, showcases a person with a keen knowledge, passion and pursuit of health and fitness. Yet why do I fight the feeling to this day, that all my qualifications and experience could be entirely disregarded by my clients if they ever knew that I occasionally drink and eat too much, or can be partial to a cigarette?
I used to feel dishonest in not disclosing such behaviours, as although I truly understand my personal flaws to be completely understandable and reasonable, I would not reveal them for fear of being perceived as, “all talk without the ability to practice what he preaches”.
But, as the public perception around health begins to shift, it makes me wonder whether we can showcase our own ‘bad’ habits to our patients, both in person and especially online as, yes, we all have flaws.
HARMFUL HABITS TO HEALTH
If we are the know-it-all experts, why do we still participate in habits harmful to health? Well, according to research published back in 2008, the factors for following high-risk behaviours were listed by the Centre for Disease Control (CDC)1 as:
• innate human defiance
• need for social acceptance
• inability to truly understand the
nature of risk
• individualistic view of the world
and the ability to rationalise
unhealthy habits
• genetic predisposition to addiction
According to Dr Cindy Jardine, Assistant Professor of Rural Sociology at the University of Alberta in the US, who conducted this research: “The results showed that in fact, people have a very realistic understanding of the various risks in their lives. We, as risk communicators (scientists, academics, government agencies), have to get beyond the thought of ‘If they only understood the facts, they’d change’. They do understand the facts, but we need to look at other factors we haven’t been looking at before.”2
Here lies the balance of talking the talk and walking the walk; we know the information, but what factors have we not been looking at before? What if we struggle to follow these factors ourselves?
WHAT DO OUR PATIENTS THINK?
A fantastic piece in Today’s Dietitian asked their reader base of RDs and RNs whether they believed they can be effective nutrition counsellors if they are overweight.
The responses were, of course, mixed, though overwhelmingly in support of the idea that a person’s external appearance alone cannot be used as an accurate predictor of health or knowledge. This was a very insightful article demonstrating how we may be perceived by our peers – but what do our patients think?
Research published in The International Journal of Obesity assessed 358 participants on their likelihood to adhere to medical advice by physicians of varying weight descriptions and found: “Respondents reported more mistrust of physicians who are overweight or obese, were less inclined to follow their medical advice, and were more likely to change providers if the physician was perceived to be overweight or obese.”4
I can understand why this was the case; almost four years ago my very first article for NHD was published: a review of ‘Big Fit Girl, Embrace the Body You Have’ by Louise Green.5
At the time there were large changes happening in the ‘plus-size’ movement and Louise Green was a figurehead for the ‘This Girl Can’ campaign running at the
time.
HEALTH AT EVERY SIZE
Louise Green found popularity due to her status as a plus-size individual with a BMI of 35+ who still participated in regular exercise, proposed eating a balanced diet, and worked with a personal trainer who didn’t focus on losing weight. She went onto become a trainer herself and became popular with clients for the very reason that she was “like them”. She owned what is considered, as discussed above, to be the base of rejecting an advisor and made it her USP.
This continued rise of the plus-size movement was further demonstrated in the ‘This is Healthy’ tagline on the cover of Cosmopolitan back in January of this year, in which women of varying body shapes were featured to showcase that health is ‘not one size fits all’.6
Of course, this caused quite a media frenzy, intended or otherwise, about our considerations of bodyweight and shape in its relation to public health.
So, if patients will reject obese physicians, then why is there such a rise in plus-size and diverse voices for health? And where does this leave us in finding a conclusion to whether we need to be perfect in the eyes of our patients?
Yes, we are walking billboards, but we are also talking billboards, so although first impressions seemingly still do matter, we at least can have confidence in that as long as we are able to demonstrate control over our habits and own the fact that we are imperfect then the public are seemingly still all ears.
Maybe we need to be a little more honest about all of the meals we post on social media, the number of glasses of wine of an evening, and that being an ex-smoker doesn’t mean you are to be avoided at all costs.
We all follow incorrect behaviours. We all have vices. Everyone is aware. Perhaps it is our responsibility to own our dietary and fitness flaws in order to demonstrate to our patients and clients that health is more than how we suffer from dietary weaknesses and instead how we control and mitigate for them.
As always, honesty is the best policy, and being real is far more relatable and reliable than always being right.
]]>Is there anything more irritating than an absurd abstracted attempt to make an alliterated opening line?
I don’t think there is, but why is it they’re so popular in the commonplace health blogs that occupy the main seat of attention in the pantheon of health and fitness information?
These oxymoronic comparisons seem to make up the majority of all opening lines in popular health media. In fact, I spent far too long going back through archives of magazine and blog articles from a variety of low and high profile sites, in an effort to build the narrative for what is now this article, and came to the somewhat obvious conclusion that all such articles are written in a similar fashion.
First comes the introductory prose: the hook – the one magical line that sounds like it was written ‘just for you’ to showcase that this article has exactly the information you’re looking for. This comes in two forms:
However, here comes the drastic turn around, the blessed change in tone that your flabby body and unproductive mind needed to hear; the intonation that there is an incredibly simple solution which has been under your nose this entire time!
This is where we should take a little break (while the blog post and/or magazine article tries to sell you their incredible novel solution), to consider one thing: why is this so d*mn effective?
Like the majority of NHD readers, I was, and always will be, a student of nutrition, dietetics and the sciences.
When I was an out-of-shape teenager, I was sold the world of fitness by poorly referenced articles from popular Facebook pages, believing that Arnold Schwarzenegger and Sylvester Stallone were ‘natural’. All you had to do was “follow this one workout for killer arms”!
My epiphany (which I’m sure is the same for many others), came with checking the references. Of course, I was 14 and somewhat of an idiot judging by school grade performance, but it didn’t take much perusing to come to the conclusion that such references had almost nothing to do with the claims being in the articles I was reading.
Let me give you an example. I could take a snippet of a journal which states “Sulforaphane lowers rate of weight gain by 15% and visceral fat by 20%”, and then write an article all about how you should eat a monumental amount of broccoli every day in order to aid your weight loss, because broccoli is high in sulforaphane.
It’s only science, right?
Well, it pains me to admit that this was, in fact, an area of nutrition advice brought to my attention by a genuine article from a globally distributed magazine… which I happen to work for. Naturally, I was curious, so I dug around for references provided by the editors, along with some jaw-dropping wider reading on the topic and found only one reference relating to this particular article’s claim. The title of the reference was as follows:
“Glucoraphanin Ameliorates Obesity and Insulin Resistance Through Adipose Tissue Browning and Reduction of Metabolic Endotoxemia in Mice” (Nagata N et al. 2017)1
Safe to say, I didn’t find any mention of broccoli.
The logic is simple: glucoraphanin exhibited this acute result in mice. Glucoraphanin is a precursor to sulforaphane. Broccoli is high in sulforaphane. More is always better. So, eat lots of broccoli.
So why - with all the work that organisations such as the BDA and AfN do to help protect the public from misinformation, and with the availability of information at our finger-tips – do such articles dominate the space of health and fitness information?
I am not posing as some kind of investigative journalist out to ‘expose’ the industry. The industry doesn’t need to be exposed. We all know that the claims made are bogus, so, why-oh-why do such articles keep winning attention?
Simply put, they’re interesting.
Why would any average person choose to pick up an article titled “Glucoraphanin Ameliorates Obesity and Insulin Resistance Through Adipose Tissue Browning and Reduction of Metabolic Endotoxemia in Mice”, in order to draw any meaningful conclusions in their life?
Answer? And I cannot stress this enough, it sounds really, really, boring.
In my years as a personal trainer and nutritionist, I started with the greatest intentions of educating my clients on nothing but the facts of nutrition research. I would explain insulin sensitivity and the influence of obesity and subsequent elevated oestrogen levels, etc. However, by the time I’d got to oestrogen levels, they’d completely glazed over and were almost begging to hit the treadmill!
Over the years, I have noticed that my descriptions have become simpler and simpler, to the point where now I describe things in a sentence and then just tell people what to eat. Is this starting to sound familiar? Tell someone to just eat broccoli to lose weight? Boom! Peak interest!
And right there is the second issue in the language we as healthcare professionals must face: simplicity.
I am sure many of you will already be familiar with the Dunning Kruger effect,2,3 but I shall highlight it anyway.
The Dunning-Kruger effect is a simple graphical representation of confidence in one’s knowledge (Y-axis) over one’s genuine knowledge and proficiency in the same subject (X-axis) (Dunning, D., 2011).
As we can see, there is a rapid spike in confidence despite very little knowledge, with a slow recovery steadily increasing over the course of what is many books, conferences, qualifications and journal entries in order to achieve the same level of confidence in one’s ability as someone straight off the boat.
The Dunning-Kruger effect is a representation of confidence in one’s knowledge. The bias results from an internal illusion in people of low ability and from an external misperception in people of high ability; i.e. "the miscalibration of the incompetent stems from an error about the self, whereas the miscalibration of the highly competent stems from an error about others."2
‘Imposter syndrome’ directly correlates with the Dunning Kruger effect, in that the more you know, the less confident you are in it (Bravata et al., 2019).4 It’s an endemic underlying unease in the position one finds themselves, feeling that they do not deserve to be in said position.
For those who aren’t familiar with all this, here’s an example: I have worked with my fair share of personal trainers who still astound me to this day in how they passed their qualification. I’m not trying to be rude, but I have on multiple occasions been asked what a calorie deficit is and which exercises are ‘best to build big muscles’. This is by qualified and insured trainers, some of whom have more certificates than yours truly.
Yet, the confidence in which they project their information to their clients would run circles around many other, perhaps more competent trainers. After-all, people don’t pay you for what you know, they pay you for what you do with what you know.
The simplicity of the standardised health blog format negates such contradictions. It seems as though it is possible to read a single study, come to a conclusion, and then stand by it with such confidence as to broadcast it in print to almost every country on the planet.
Does a blogger have to read wider to risk any kind of peer review? Is a blogger held to any form of regulatory standard? Is there anyone with any form of qualification present to proofread the blog?
I think we know the answers to those questions. The challenge, therefore, lies uncomfortably with us – particularly those with a far greater knowledge of sulforaphane than me – to contradict such information, without insulting the intelligence of the writer and, most especially, the reader.
This relates to language difference number 3: the relatability of information.
If we insult a magazine as being low quality, we insult the reader as a consumer of low-quality information. Afterall, you catch more flies with honey than vinegar.
More importantly, the informal and conversational style in which magazines and health blogs are written makes the reader feel they are having a friendly conversation with John or Janet by the water fountain, picking up tips from that insanely shredded couple who adorn the magazine covers.
The reader likes John and Janet; he speaks to them every month and they are clearly in great shape; they must know what they’re talking about! They have been with the reader from day one of their fitness journey, and although they say something different every time they speak, this is irrelevant, provided our reader can keep up with them.
This relatable format is a resonating undertone between all consumer magazines. The shredded cover model, the witty hook and description of a relatable feeling, and the simple solution to the reader’s problem in an interesting and easy-to-digest prose. It is all relatable.
If this was an ‘us vs them’ war between health professionals and health bloggers, I wouldn’t be counting any eggs just yet.
And here comes the grand conclusion: are we simply too stuffy in the way we write our information?
It is tough for any industry to be self-critical, but for those working with clients, it is no doubt that telling someone to change their diet or their body, is one of the most personal and challenging tasks a person can take up. It is inherently critical.
We negate this uneasy challenge to criticise a person’s body with our reliance on data, of percentages, measures and graphs. We mask our thoughts in objectivity and professionalism, as we are held in such high regard.
I am not claiming to be an expert, far from it, but I can state from my own experience that being relatable gets you far further as a fitness trainer than just being knowledgeable. And, if you take this prose as it’s written, then perhaps the fitness industry has cottoned onto such points faster than academia has been able to keep up.
Finally, let’s ask the question again: is it high time we meet the readers in the middle with less information, less professionalism and with more human hands?Is this the best for the long run? I highly doubt it. But, if it gets people through the door and asking questions, then that is what we need to grow our influence.
If you enjoyed reading this article, or you hated it and want to debate it, my email is cgrcooke@gmail.com. I actively ask you to get in touch and open a discussion! Alternatively post your comments below…