obesity, diabetes, physical activity, and U.S. geography

i wanted to bring everyone's attention to a report released by the Centers for Disease Control (CDC) on U.S. levels of obesity, diabetes, and physical activity. it provides county-level data, and allows a geographic comparison across the country.

the main link to the report is here:

• http://apps.nccd.cdc.gov/ddtstrs/default.aspx

the part that caught my eye was the selection of maps that allows a visual overview of the relative differences by county in obesity, diabetes, and physical inactivity as percentages by population. the link with the Powerpoint slides and definitions is here:

• http://apps.nccd.cdc.gov/DDT_STRS2/NationalDiabetesPrevalenceEstimates.aspx?mode=DBT

you can see the maps:

• geographic distribution of physical inactivity (darker colors reflect lower physical activity rates, with darkest meaning >32.6% of the population, physical activity refers to some leisure-time exercise)

• geographic distribution of obesity (darker colors reflect higher obesity rates, with darkest meaning >30.8% of the population)

• geographic distribution of diabetes (darker colors reflect higher diabetes rates, with darkest meaning >10.6% of the population)

my comments are as follows:

1. wow. if there was ever evidence for a connection between physical activity, diabetes, and obesity, this is it. this may not prove causality, but the level of correlation is certainly something that warrants further investigation. talk about eye-opening.
2. i'm curious how a map showing geographic distribution of dietary habits (overall caloric intake, consumption of vegetables/meat/etc., breakdown of steamed/grilled/fried/etc.) would look compared to these.
   
3. i wonder what's causing such great differences in physical activity by region. it doesn't seem to be warm weather (e.g., the deep South has very warm weather, but clearly suffers from higher rates of physical inactivity, obesity, and diabetes), so what's going on?
4. there's a trend in American politics of people migrating to areas with populations that share similar values as theirs. i wonder if the same thing applies to lifestyle--that is, if people who enjoy physically active lifestyles are migrating to areas of the country where there are other people who enjoy physically active lifestyles.
5. it would be interesting to see if similar data and maps exist for other countries. i'd like to compare the U.S. with other populations in the world.
6. clearly, some parts of the country are more engaged in physical activity and healthy lifestyles than others.
7. i certainly know where my preference is to live now.

these maps are really interesting. but i also find them really disturbing. seriously, obesity rates above 30%? and i'm guessing it's just not mild obesity, but morbid obesity. how? why?

to me, this shows just how much work needs to be done to improve the health in the U.S. we--and i mean as an athletic community, as a healthy community, as a country--need to be trying encourage everyone, and i mean everyone, to adopt more physically active, more nutritionally beneficial, more mentally and emotionally and spiritually fulfilling lifestyles. because the status quo is just awful. and absolutely unacceptable.

my weak butt

hmmmmmmmmmm...well this is a new one:

• http://well.blogs.nytimes.com/2010/12/21/when-the-diagnosis-is-dead-butt-syndrome/

those who know me are all to familiar with my issues in this area. a few years ago a physical therapist offered her opinion as my chronic recurrences of lower back, hip, hamstring, knee, and calf injuries: my problems, she said, sprang from what she identified as (and i quote): "substantially underdeveloped gluteal muscles." or as a friend of mine rephrased: "a flabby butt."

this was somewhat surprising to me, since i figured as an athlete i'd probably devoted more to this area than most ordinary sedentary people. not by design, but just as a matter of due course in the ordinary passage of training. particularly since i'd done what this article recommends, which was to engage in cross-training (swim, bike, run, but also basketball, tennis, hiking, weight training, etc.). and no one certainly had ever really complained about the inadequate state of my posterior to me before.

despite my protests, however, the physical therapist insisted on her diagnosis, and then proceeded to offer me proof by asking me perform a series of diagnostic movements that subsequently erupted into excruciating pain. nodding sympathetically, she tisked at my groans of agony, and said the pain was clear evidence that my backside was inferior and not up to the muscular development in the rest of my body. the result was a structural imbalance that pulled on the muscles and connective tissues in ways inducing overuse injury.

it's because of her diagnosis that i've dedicated the past few years of my life to a greater regimen of exercises (the usual suspects: yoga, pilates, gymnastics, kung fu, even ballet) involving flexibility, range of motion, and strength in the area that i appear to lack: the gluteus. specifically, the gluteus maximus, the gluteus medius, and the gluteus minimis. both sides.

it's become somewhat of a fixation of mine. almost to the point of neurosis. definitely to the point of self-consciousness. i actually find myself pondering the state of my buttocks. and worse, i actually find myself pondering what other people are pondering about the state of my buttocks. as in: "is my butt flat?"

for a while, i was worried i was becoming paranoid about this. or at least developing a complex. even though the extra attention to my nether rear has definitely managed to improve my struggles with overuse injuries--they're not as chronic as before, and not as severe. although i still find myself wondering if my glutes are sufficient to please the eye, so that they do not bring to mind the discouraging connotations of "flat" or "flabby" but instead bring the resounding reassuring denotation of "round" and "juicy" (because, that is, after all, just way more healthy, right? that's why they had those clothes with the word across the namesake area?).

but this article helps me assuage my worries. apparently i'm not alone with my butt situation. and apparently it's not as embarrassing as i fear. and the article does provide me with some alternative ways to deal with and think about my rear end.

and i mean that seriously (as opposed to just being an ass).

anyways, as always, if the link doesn't work, the full text of the article is at the end of this post.

When the Diagnosis Is ‘Dead Butt Syndrome’
New York Times
December 21, 2010
By Jen A. Miller

My butt, unfortunately, is dead.

“Dead butt syndrome,” the sports medicine doctor said to me after making me go through a series of circus-act contortions that involved swiveling my hip in all directions. His voice was very serious, his tone stern. I wondered if I should start making funeral arrangements for my rear, maybe a New Orleans-style blowout parade?

Hold the tuba. My butt’s not really dead. It can’t be revived with defibrillator paddles, but it can be fixed.

The technical name of the condition I have is gluteus medius tendinosis — an inflammation of the tendons in the gluteus medius, one of three large muscles that make up the butt. It’s a very isolated and painful injury that knocked me out of marathon training in January with stabbing pains in my hip. It’s a symptom related to what running experts hammer at: the need for cross-training and strength training. I was running so much that I told myself I didn’t have time for the exercise machines or weights, so I have no one to blame but myself.

I’ve been running for five years, but I’d never heard of the problem. I ran it by a friend, a former track coach at the University of Pennsylvania, and he was baffled too. I haven’t seen any coverage, though the doctor said it’s fairly common with runners who train for half marathons and beyond. It took him five minutes to figure out the problem.

“A new thought in running medicine is that almost all lower extremity injuries, whether they involve your calf, your plantar fascia or your iliotibial band, are linked to the gluteus medius,” said Dr. Darrin Bright, a sports medicine physician with Riverside Methodist Hospital in Columbus, Ohio, and medical director of that city’s marathon. “In the last five to 10 years, we’ve just realized how much of an important role the gluteus medius plays in stabilizing the hips and the pelvis in running.”

If you think of the pelvis as a cup, the muscles that attach to it, including the three gluteal muscles and the lower abdominals, interact in an intricate choreography to keep the cup upright when you run or walk. If these muscles are strong, the cup stays in place with no pain. If one or more of those muscles is weak, the smaller muscles around the hip take on pressure they weren’t designed to bear.

The cup still stays up, but at a price. First come muscle tears and inflammation, followed by scar tissue in the muscle. If left untreated, this process becomes a cycle that keeps feeding into itself.

“For people who have persistent pain, it’s healing gone wrong,” Dr. Bright said. “That gluteus medius isn’t firing the way it’s supposed to. You’re getting an inhibition of the muscle fibers. It’s kind of dead.”

Some of us run through the pain, which is what I did. And many compensate by adjusting their strides in a way that impedes the gait and can lead to problems in the quads, hamstrings, Achilles tendons, heels, knees, calves, ankles, feet or toes.

“Whether they’re recreational weekend runners up to the elite marathoners, the majority of runners I see have weak gluteus medius and gluteus maximus muscles,” said Dr. David Webner, a sports medicine doctor at Crozer-Keystone Health System in Springfield, Pa.

For about 70 percent of his patients, physical therapy that stretches the muscles in the hip and leg and strengthens the gluteus muscles, along with a temporary reduction in the mileage and intensity of running, resolves the problem. Deep tissue massage, which sends more blood to the area to break up scar tissue, along with strength training may also help to break the cycle of inflammation and scarring.

More advanced approaches include ultrasound guided tenotomy, which uses ultrasound to identify the affected muscles and then “poke little holes in the area of the scar tissue,” Dr. Webner said, or platelet-rich plasma therapy, which involves injections of centrifuged blood products and is what Tiger Woods underwent after knee surgery last year.

Fortunately, I didn’t need to take it that far. I’m lucky — the pain has ebbed with physical therapy and changing one of my weekly runs to a cross-training workout.

“Those runners who do multiple types of exercising are less prone to have weakness than runners who do just running,” said Dr. Webner. “Triathletes who come into my office don’t have as much weakness as just solo runners.”

So I’m biking. I row. I sweat through elliptical workouts at the gym.

And I no longer have the feeling that a pin is stabbing my hip every time I drive. I can sit for more than a half hour without pain. And last month I ran the Amish Bird-in-Hand half marathon, and felt no more discomfort than you’d expect to endure running 13.1 miles through the hills of Pennsylvania Dutch country.

To keep my rear alive, I must be vigilant about continuing to strengthen my lower abdominal and gluteal muscles. Last week, I slacked off and the pain came creeping back.

Is it annoying to have to focus so much on these muscles to run? Absolutely. But if it’ll revive my butt, it’s worth every leg lift and crunch.

playlist: Valentine 2011

i've decided to do things differently this time.

seriously.

ordinarily, i'd be dreading this time of year. for reasons too many and too great and all too familiar for far too many of us (for some perhaps more than others, but for all certainly to some degree).

but i've decided to do things differently this time.

this time, i've resolved myself to face this Valentine's with a more positive outlook. no denial, no disparagement, no disavowal, no disgust. no chagrin, no fear, no hiding, no fuss. no intense workouts to burn myself out for the day. no blackout from all media to close myself from the world.

no, this time i've resolved to open up. this time i've resolved to accept. this time i've resolved to embrace. and enjoy. and imbibe. and yes, even welcome. all that the day may bring me.

because, you see, i've come to an understanding regarding February 14, and it's one that resolves this day of its schism in asking me to celebrate the one thing i do not have.

the understanding is this:

love is intangible. for all the concrete expressions we seek in actions and words and things that we think can show love, they are all ultimately just that: expressions. conveying the message of a deeper meaning that we cannot define and cannot describe but which we can only identify as an abstract idea whose presence we have come to name as love.

as an intangible, as an abstract, as an idea, love is inexplicable. incredible. indelible. invisible. untouchable. unpredictable. uncontrollable. unknowable. unimaginable.

it just is.

as a result, it asks that we go beyond proof and accept its existence as a matter of faith. in other words, it asks us to believe.

even for those of us for whom there is nothing to believe.

but it's important that we believe.

because love, for all its ethereal qualities, is without question one of the most powerful forces in creation. with love, creatures great and small have found themselves motivated and empowered to achieve the greatest feats ever known in measure far exceeding their own making, with consequences that have reverberated far beyond themselves in space and time. with love, mountains have been moved, rivers have been altered, civilizations have been changed, history has been rewritten. with love, the earth and the stars and the sea and the heavens have all become known by name. with love, eternity has become changed.

with love, life has been made.

and that makes love profound.

and that makes love divine.

and that means that love, even as much as it may not be the secret of the universe, is one of its greatest, most fundamental, most sacred truths.

and so if we aspire to become more than what we are, if we endeavor to surpass the measure of our making, if we hope to realize the majesty that lies within the reaches of the heavens, then we need to celebrate the truths which will lead us there.

and we should believe.

even for those of us for whom there is nothing to believe.

and oh yeah, the playlist. here, have one on me:

marc cohn: true companion: http://www.youtube.com/watch?v=sp6zoc84NcU


john hiatt: have a little faith in me: http://www.youtube.com/watch?v=7aYxMuLb3h8


rosi golan: think of me: http://www.youtube.com/watch?v=6Jl9z9-dFz4


raccoon: love you more: http://www.youtube.com/watch?v=X1I1FNZKaxA


armin van buuren: love you more: http://www.youtube.com/watch?v=Dtw8E85t-w0


david guetta: when love takes over: http://www.youtube.com/watch?v=zudbz4hOcbc


bruno mars: just the way you are: http://www.youtube.com/watch?v=N-ujK7ojtUY


michael buble: crazy love: http://www.youtube.com/watch?v=4iFxwh5LTxU


michael buble: a love song: http://www.youtube.com/watch?v=XdYfB4TzvZU


michael buble: haven't met you yet: http://www.youtube.com/watch?v=1Ecn9aiYkng


placido domingo: nessun dorma: http://www.youtube.com/watch?v=2RdJmqLrsbo


andrea bocelli: ama, credi e vai: http://www.youtube.com/watch?v=UcV-8g2jZIY


florent pagny: lo le canto per te: http://www.youtube.com/watch?v=rQdsCL_g1dM


taylor swift: jump then fall: http://www.youtube.com/watch?v=8lhOpo9qomQ


petra haden: let your love flow: http://www.youtube.com/watch?v=iKHnpwAJ02E

mobility & posture drills

there's been some movement in athletics to training body structure. you see it in the increased attention to exercises that focus on concepts like "core," "stability," or "deep tissue."

the common thread in the various approaches to structure-based training is to develop the finer, sometimes smaller, muscles and connective tissue needed to help stabilize the body as it moves throughout the various ranges of motion required by the athlete. the theory follows a train of logic:

1. good structure is necessary to place the body in the best position to exert force necessary for motion (where structure is "good" if it maximizes the amount of energy expended by the athlete into desired motion);
2. good structure consumes muscular work;
3. underdeveloped stabilizer muscles & connective tissue means that good structure is more dependent on work from the the larger muscles and attention from the mind;
4. larger muscles are used for sports-specific movement, and so the more work large muscles devote to good structure, the less energy they can devote to work for sport-specific movement;
5. larger muscles divided between working for good structure and working for sports-specific movement require attention from the mind, and so consume more mental energy from the athlete.

the implication is that by developing the finer muscles & connective tissue, the large muscles and the mind are freed to expend more energy on the main requirement of sports: motion. as a result, good structure is considered to be important in improving overall efficiency, and thereby improve performance.

you'll see this logic adopted by athletes engaged in programs like "chi running," the "pose method," "functional strength," or even pilates and ballet. a lot of these involve exercises that contrast markedly to most sports training, in that the exercises aren't particularly aerobically/anaerobically demanding or likely to induce total physical exhaustion. this, however, should not be taken to mean that they're easy--in fact, for those people with poor structure, they can be surprisingly difficult, and in some cases downright excruciating.

but in a good way.

to help give you an idea of what i'm talking about, i'll showcase a series of videos from one of the Youtube channels i subscribe to. the channel is SiHunt, and apparently is a coterie of coaches affiliated with Norway's national track & field program (you can check them out: http://www.youtube.com/user/SiHunt ). they have a plethora of really interesting and really useful videos, and i'd recommend you peruse them if you get the chance.

they recently made a few videos devoted to developing finer muscles and connective tissue addressing the hips, the shoulders, and then posture. take a look:

hip mobility: http://www.youtube.com/watch?v=kGsK8gYOYMc


shoulder mobility: http://www.youtube.com/watch?v=G6lVNtWGMiQ


posture: http://www.youtube.com/watch?v=YTlak6mYngc


i should add a little more regarding the theory behind these movements. the premise is that a runner needs to transmit force into the ground for forward motion, and so the more force is transmitted the greater the amount of energy output from the body is translated into forward motion. this means that the forces between the muscles and the ground have to minimize energy loss, or in other words, maximize efficiency.

physics dictates that energy loss in the body is minimized (efficiency maximized) when the body is stiff (it's the same idea behind having stiff springs in a car: the stiffer the springs, the more force is transmitted between the car and the ground).

the issue for humans, however, is to have a body that's stiff but not tight. because in sports, it's imperative that the athlete be able to move. for runners, the runner has to be able to generate turnover with the legs. as a result, the need is for a body that can act like a stiff spring (and hence maximize efficiency) while still being loose (and have the body move).

these exercises are trying to develop body parts crucial for these requirements. they're strengthening the finer muscles and connective tissue tied to joints important for forward motion, while also lengthening them throughout the range of motion in the joint. they make the joints loose, but with enough stability so as to help stiffen the posture to maximize efficiency.

i should note these exercises aren't new. anyone who's taken a ballet or gymnastics will recognize most of these movements--that's because that's where a lot of modern sports scientists have gotten ideas. which, of course, suggests that there's probably room for more ideas in other areas outside of sports.

i've tried these exercises out. i do some of them on a regular basis. they're not easy, especially at the start. but they get easier as the body develops. and they're actually fun, and i've found them to be a good break in the training routine from all the other workouts in the schedule.

i personally encourage everyone to give them a try...highly recommended.