Friday, December 27, 2013

Quality vs Quantity: From Leather Boots to Weight Loss

There's a growing problem in our country.  It's a problem that afflicts most of the developed world.  It's the reason for which you have to replace your bedroom furniture every couple of years, processed food is cheaper than locally-sourced grub, and why you see the same crappy content all over the web whether it's on Facebook, Twitter, Reddit, or LinkedIn.  
Our society values quantity over quality.

Last weekend, I traveled to Fredericksburg with my lady, my mom, and my sister (three different people) to visit my late father's family for Christmas.  Virginia is loaded with antique shops, and there's a 50% chance that we'll stop if we pass one on the road.  When you walk through an antique shop with my mother, it's both frustrating and educational.  I simultaneously feel impatient and inspired by her elaborate description of "what to look for" in fancy china or quality woodworking.  My mother has had the advantage of being raised in the fifties and sixties when our society valued quality over quantity. Here is the problem: contemporary society has flipped a switch, and now we value quantity over quality.

George Ziermann (featured in the video above) has been making shoes for over forty years.  From watching the video, you can see that  he slaves over each and every pair of boots that he puts on his store shelves.  When a company says that they've been around for 150 years (see Frye boots), you are bound to get a good product, as they otherwise wouldn't have survived this long competing against cheaper alternatives.  Likewise, any rational human being would agree that hand-stitched, American-made pants are probably going to last longer than whatever junk you can buy at Wal-Mart.  

The Seasoned Pro Is a Dying Breed
I've got to take off on a tangent for a minute - hang tight.  My father was a unique man.  He was bored by engineering school, opting to drop out and join the navy where he learned how to fix aircraft.  After leaving the service, he started an HVAC company called Riley Mechanical right around the time he met my mom.  Over a few decades, he became the best in the city at diagnosing and fixing air conditioning and heating systems.  

On one occasion in my late teens, we were sitting in the main dining room of a local restaurant, and the owner came to our table to greet us.  He asked how our meal was, and my dad interrupted him, asking "Did you recently have some construction done on the property?" "Why yes, sir," the restauranteur replied, "Just last week."  "Ask the guys to check the orientation of the fuse in your main breaker.  Your air is circulating in the wrong direction." The restauranteur was baffled, "If you're right about this, Mr. Riley, you've got a new client."  Until the day he died, that business owner supplied my dad with more business than his small company could handle.  

There is something special about a true expert: they don't need to publicize.  Thirty years ago, when my dad was establishing his HVAC business, social media and the internet were merely an idea brewing in Al Gore's spunky young mind.  My dad's practice was built on word of mouth.  He provided a higher quality service than his competitors, and his clientele valued that.  They valued his approach in the same way that my mother values craftsmanship when examining tables in antique shops.  This is something that we're largely lacking in the marketplace today.

What Do HVAC Repairmen and Physicians Have in Common?
Up to this point, you're probably nodding along in agreement.  Now let's talk about healthcare.  In medical school, we learn diddly-squat about nutrition, exercise, stress management, and the importance of sleep.  There's simply too much to learn in medical school nowadays, and, unfortunately, a lot of what we learn defies clinical and anecdotal evidence.  

For example, you've probably heard that high cholesterol is a recipe for a heart attack.  Well, it turns that that's not exactly true, yet this misinformation is still supported by the American Heart Association despite a paucity of clinical evidence to support statin use in the prevention of heart attacks.  All cholesterol isn't the same, so to appreciate a patient's full risk of cardiovascular disease, you must take into account their comprehensive medical history and the various types of cholesterol present in the blood.   Instead, we are taught to order a basic lipid panel and treat with a statin if LDL is too high.  New cholesterol guidelines encourage physicians to prescribe statins faster than Willy Wonka pumps out gobstoppers.  This is dangerous because statins are critical in synthesizing important compounds in the body in addition to stabilizing cell membranes

As physicians, we are educated in fundamental biochemistry and physiology in order to make rationale decisions, but lifestyle modification isn't incentivized in medicine, so why bother studying extraneous materials?  The physicians that are willing to step back and take a look at our increasingly rates of obesity, diabetes, and cancer and ask "why?" are the George Ziermanns (from the video above) of healthcare.  If you are one of the few who splurge on quality clothing, boots, or furniture, ask yourself, "Why don't I adhere to this same philosophy in paying for services, especially those meant to keep me healthy?"  Taking the limitations of medical school into account, what if you found out that, in addition to attending medical school, there was a local doctor who dedicated a portion of their free time to reading medical literature and studying these topics as a function of longevity, health, and performance?  How would that sway your selection of a primary care physician?  

There's Both Too Much and Too Little Online
If you have been trying to lose weight, think about the question that I just posed.  Also, ask yourself why it's not working.  In the digital age, there's a plethora of advice on the internet and literally thousands of Twitter and Facebook accounts dedicated to posting pictures of ripped abs and inspirational messages.  There are an equal number of health coaches, physicians, dietitians, nutritionists, herbalists, yogis, boot camp instructors, etc. that all seem to have the answer.  So why haven't you found success in losing weight?

I'm doing my best to be rhetorical with these questions, because there isn't an easy answer.   Excess weight gain is a metabolic derangement.  Your problem is not that you are fat, lazy, and stupid.  If it were as simple as following a shopping list of "eat this, not that", you would have already lost the weight.  It's hard enough to find the motivation and courage to change your life around, yet, even if you already have the intrinsic motivation to pursue long-lasting lifestyle change, you may also find yourself stuck because, like a bogo sale at Wal-Mart, a lot of health-related services out there are crappy $20 jeans.  What you need is a hand-made pair of dungarees. 

This is where the trouble lies.  A click glance at Twitter will reveal that the majority of the nutrition and fitness content being circulated on the web is fluff, poorly-written, or downright wrong.  Over the past few weeks, I set out to un-follow any account on Twitter that was hell-bent on content marketing for the sake of attracting followers.  In all, I un-followed 789 accounts out of 933 (!!!), all of which were loaded with messages that contradicted themselves in addition to a lot of plain old horse crap about human physiology and biochemistry written by people that haven't done their homework.  This is a big problem, as it's damaging the potential for useful patient engagement by the physicians, dietitians, and fitness instructors that really care about this stuff.  

Poor Quality Is Becoming Ubiquitous
Another area where quantity is dominating quality is our food system.  Reading about biodynamic farming from Joel Salatin, listening to TED talks by Alan Savory, or attending a lecture by Diana Rodgers, you'll be exposed to some unusual ideas about the quality of food.  Their arguments are simple: quality must dominate over quantity if we ever want to break free from our dysfunctional food system.  If you're completely new to this ball game glance over some of my earlier posts, check out Robb Wolf's blog, read anything by Michael Pollan, look into the Weston A. Price Foundation, or simply Google the word "paleo".  The skinny is that our demand for cheaper, more convenient food sources has led to progressively poor quality plant and animals foods that are making us sick.  

Furthermore, in the same way that you can trust Frye to deliver high quality boots thanks to their 150 years of service, the paleo way of eating has been perfected by multiple millions of years by the ultimate product tester: natural selection.  So the gimmick diets you see popping up all over the interwebs?  They're probably junk, and I'd be wary of anybody pushing them on you.  (If you think this is nonsense, I am open to a phone call: 412-477-2142.  Seriously.)  

In no other sector of our society is our insistence on quantity for less dollars more pervasive than the modern food system.  You can vote with your dollar by joining a local food co-op, visiting local farms in person, or taking three minutes to Google "grassfed beef [insert the name of your town]".  I've given you a lot of options in this short paragraph!  But I are curious about weight loss.  Let's get back on track...

Real Pro vs Faux Pro
As a physician, dietitian, or health coach, if you want to have any meaningful impact in a patient or client's life, you need to take a step back once in a while and ask yourself, "Am I simply chasing the dollar by pandering to the digital world or am I putting out a quality product?"  If you're putting out multiple podcasts or blog posts every week, when are you finding time to work with patients or clients?  If you're blogging all day, when are you developing the experience required to develop weight loss or health care strategies for sick people?  If you just opened your practice, from what experience are you deriving the expertise required to write a well-researched book?  If you aren't putting out original ideas, you are saturating the web with junk.  Quit it.  Your content marketing is discouraging thousands of people who are failing to see positive results because they are being blasted daily with bad advice that you've promised will work.

The point I'm hoping to convey is that not every company out there is going to have the answer to your weight loss woes.  There's a huge difference between a health coach looking to get rich through content marketing and a health coach that rolls around restlessly at night because they can't seem to figure out the precise mechanism behind a particular client's weight loss plateau.  Likewise, that which sets apart a good mechanic from a bad mechanic is that the former is a student of their trade.  They offer comprehensive service to ensure that your HVAC system or Oldsmobile is running optimally.  

Mechanical repair not part of your vernacular?  How about Crossfit?  It's increasingly easy to become a certified Crossfit coach these days, but the certification printout on the wall doesn't necessarily translate into quality coaching.  The majority of Crossfit-certified trainers were simply gym-goers who were decent at doing the movements, so they coughed up money to Crossfit HQ to get a piece of paper.  Remember what happened when Michael Jordan took up coaching?  These trainers will be of no more help at transforming your body than the bro that swipes your fob upon entry to L.A. Fitness.  Don't get me wrong, I don't mean to rile any feathers in the Crossfit world.  I have gladly paid top dollar for help from Crossfit coaches who were true experts at biomechanics and personalized instruction.  Still, I urge you to apply the same criticism to fitness or health coaching as you apply when assessing food or furniture quality.  There are no quick fixes to your health.  It takes hard work from both you and your coach.  Don't be fooled by content marketing or gimmicks that suggest otherwise.

Value Quality When Purchasing a Product
Our country needs to look in the mirror and ask: "Where is my dollar going?"  When people say that "every purchase you make is a vote", heed their advice.  Everything that we see wrong with the world is secondary to rewarding greed and being unwise with our votes.  Unfortunately, we live in a world in which the resources that you require for survival are locked away, and you have to work your butt off in order to tap into those resources.  The mighty dollar is your ticket to attaining new stuff or useful services.  It's entirely your decision if you choose quality over quantity, but you get what you pay for.  

In today's digital world, quantity seems to be winning out over quality.  You as the consumer have the choice.  If you have been struggling with weight loss (or any other health problem for that matter) think about your specific needs.  It will only force us to become better coaches, physicians, or instructors if you, the consumer, demand a high quality product.  Think about the ideal health coach or physician with whom you want to work.  Whether you're buying a car, bookcase, or some quality time with an expert in nutrition/weight loss/olympic lifting/guitar it's the same decision: spend your money and time wisely.  

Find real experts with original ideas publishing thoughtful writing specific to your problems online.  If you really want a good product, invest your resources in a product created by somebody that is equally invested in helping you.  Find a health coach that is busy making and correcting mistakes in their management of clients' weight or health woes.  A cookie-cutter approach isn't going to work for you long-term.  You need a customized approach, and that takes time to develop.  Furthermore, a solid health coach isn't going to simply give you a shopping list or tell you which blood tests to request at your next doctor visit.  They're going to dig deep and suss out the true underlying problems.  That's what you are paying for; demand nothing less.

If you want to lose weight, you also need to have patience.  High quality food doesn't grow overnight.  Likewise, you can't expect to reach your weight loss goals overnight.  A quality health coach understands this. The right coach for you - the one that will truly help you lose weight - is someone that is diligently working to improve the quality of their product, which often times doesn't correspond with their number of followers on Twitter.  

Quality > > > quantity.

Nathan Riley is a 2014 MD candidate at Temple University School of Medicine.  He writes about food, movement, sleep, relationships, and stress in order to bridge the gap between his patients and evolutionary theory and clinical evidence. You call follow him on Twitter @BeyondtheMD.  He can be reached at  You can also connect with him on Google+. 

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