#ywm2014 Obesity Action Coalition, “Your Weight Matters” Convention

JOIN ME!  I’m so excited to announce that I will not only be attending the “Your Weight Matters” Convention, but I’m also on the Welcoming Committee! 

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If you’ve never attended a convention before, the Obesity Action Coalition convention is the event to attend!

The Your Weight Matters Convention features the leading experts throughout the country providing YOU with the latest information on topics such as:

  • Weight
  • Nutrition
  • Exercise
  • Weight Bias
  • Emotional Issues and Weight
  • And More!

The Convention also features a wide variety of special events throughout the weekend, which are designed to help you learn more about your weight and health, teach you how to become an effective advocate for change, stick to your exercise routine, eat healthy and most importantly…HAVE FUNTo learn more about the special events featured at the Convention, please CLICK HERE.

#ywm2014 #obesityaction

 

Alcohol. Limits. Self Regulation.

The alcohol is a huge problem.  The way the obesity surgery works is that it makes anyone who has had the procedure more susceptible to alcoholism. Alcoholics are not bad people, but at some point, one has to recognize that the behavior is a problem.  I get a lot of hate for my opinion on this matter, but it’s a very serious issue.  The development of alcoholism is so much easier after WLS. Surgery is an alcoholic, as my surgeon puts it. That doesn’t mean you can’t have a few drinks, but if you are drinking to be able to more easily socialize and have a good time, then priorities are out of check. It’s out of balance if you can’t self regulate.

As a therapist, I see it in my work with bariatric patients. Binge drinking behaviors can be extremely dangerous after weight loss surgery, drama within social circles is only scratching the surface to the problems it can cause. Choose to abstain or moderate your alcohol use (no more than 3 drinks in a 6 hour period), it helps you practice mental strength, establish boundaries and maintain control of yourself. You can learn to live without it. You can overcome social anxiety without libation. Alcohol can lead to making an ass of yourself, screwing up your life (sometimes) and making poor decisions (almost always.) It’s not me judging you, it’s me asking you to respect yourself enough to know your limits, and caring enough to tell you that it may be a problem for you. This is not directed at anyone in particular, it’s just a generalize PSA… Never let a substance run or ruin life.

Stomp Out Self Doubt

Are you someone who has not yet submitted to the necessary task of daily exercise?  Do you put up barriers between you and “THE GYM” because it’s just too intimidating.  Do you tell yourself that people will judge you for being overweight, obese or just “out of place” in a new environment?  I’m here to tell you that you are putting up your own boundaries between better health and yourself.  If you’re still sitting at home thinking that the gym is a scary place, then your fears are running you, not your determination.

I’ll tell you a personal story.  I try not to make too much personal here, but here goes.  I enjoyed the gym, to a point, for the last 8 or so years.  I only went when I felt like it though, which often was every few weeks for a few days, and then I would disappear again for weeks or months, even.  Frustrated, annoyed and downright defeated by continued stalls with weight loss on this journey through pounds I’d lost before, regained and now fought to take off again was enough to convince me that I was not doing enough.  I was not earning my health by haplessly going to the gym with no direction.  I finally made up my mind to do whatever it took to get healthy.

Here I am, a month into personal training, three times a week, and I’m happy. I’m happy that I’ve stuck to my guns and kept up a pace of establishing a continuous habit. I’ve commit to myself and my health.  While it hasn’t sent the pounds flying off, though, an aside, it seemed like that for a moment when I lost eight pounds in three days, the next day the scale bounce back up by five pounds, it has boosted my mood, improved my self confidence, and given me something to look forward to and dread at the same time.  The latter is part of the infinitely unstable relationship I have with this commitment.  I am not yet at a place where I believe I can not live without this healthy habit, I still fear I might stop, get injured or lose hope.  It happens. You work through those emotions and you continue to commit to the habit for your health. I’m sure a few months from now, I will not be able to live without it.

I have a few simple rules for myself.  Feel free to adopt them, tweak them, or make up your own all together. Never skip more than one day at the gym. Commit to an hour a day, at least 5 days a week. If you can afford a trainer, even if only temporary, it will be money well spent. Write down those workouts, learn to use the equipment, and do the exercises properly, then when workout on your own, you have some knowledge of proper use. Drink tons of water.  Never, ever give up.

I read and hear from a lot of people who are intimidated by the gym. The preconceived notion that the gym is intimidating is just your fear talking you out of doing something good for yourself. Just do it. Abandon all ideas that people will look at you. I have never had a negative incident at my gym, actually I find everyone to be very nice. The more you go, the more people you will see there. I don’t chit chat at the gym, but there are lots of regulars! I hired a trainer for the next two months, so that’s kept me on schedule and I’m learning about all the equipment and exercises I can do. Once I’ve done a few months with the trainer, I’m going to give it a go on my own.

The gym is not a scary place. Go. Do it. Be there and find the health you deserve. 

 

Ask the Therapist: Change Your Ways for #1

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Why do people tempt me after weight loss surgery by bringing around trigger foods  that I can not cope with having around? This is a question I see in groups and chats all the time. We can not continue to blame others for instances where we the self control to say “no.”   There are certain things we can not control: genetics, environment and the consequences of past discretions and the circumstances they may have caused.  However, we can control our choices in the present to create a healthier, happier future to improve our life expectancy outcomes.

Truth be told, you made this choice to have surgery. As hard as it is to accept that you can no longer live the way you used to live, once you accept this into your actions and do what you know you should do, weight loss happens.  Everyone around you shouldn’t have to change if you are the one who needs to change a behavior.  I know its hard, but we have to take responsibility for our choices. Even if that food is there, you don’t have to eat it. You don’t even have to pay attention to it.  You have the power of choice.

You have to get to a point where the compulsion (a substance, such as food, alcohol or drugs, or action, such as sex, shopping, etc.) no longer controls you.  It no longer provides an escape. You no long need to the escape because you’ve regained control in your life. There is freedom in changing how you do things. Who you make those changes for is you, and only you. How you behavior matters, It is the choice and power you have over a substance or compulsive activity. The higher power is YOU. You maintain control of yourself to do what you know you need to do for YOU. You are the only person in control. This is a power struggle within ourselves to make the right choices, always, no matter what options are presented before us we make the decision to do what we know we need to do. Weight loss surgery is seriously. Living with obesity is risky. Decide how much your health means to you every time you want to be deviant to your cause… make your deviances few and far between… the farther they get between, the better you get at strength, power, and control over your body and mind to attain that driving hunger for control.

But we are human, and we make mistakes…. accept poor choices as mistakes of the past and move forward. It takes a while to get it right. May the force and strength of resistance be with you, and take good care of yourselves, always.

 

Dear Dr. Amen… A Response to your Facebook post, “Obesity is a Brain Problem”

Dear Dr. Amen,

For the last ten years, I have followed your work religiously.  First, as a clinician working with ADHD children, and now as a therapist working with people with obesity.  I respect you immensely.  However, I am concerned about the language and images of your recent Facebook page status.  “Obesity is a Brain Problem,” may have offend people in a way you did not intend.  The headline is an over-simplification of obesity that also carries an unintended message that obesity is mental deficiency.

The use of images of headless people with obesity carries a message of disrespect and dehumanization to those of us who struggle with the disease of obesity. Every person who struggles with obesity has unique causes, be it genetic, situational, and circumstantial reasons behind why we can not lose weight. Recovery from obesity is a constant state of being for many of us. We intimately know the emotional hurt and psychological pain stigmatizing us can cause.

Please respect patients everywhere by considering a change to your language and approach to obesity. We can do more to help people without the shameful headlines and pictures that promote stigmatization. We must first, do no harm. Our words and actions must always treat our patients with respect, and treat obesity seriously.

In recent years, I’ve read the Daniel Plan. I place your work in high regard, as I believe it is an excellent spiritually-focused, medical weight loss program due to its holistic approach to one’s relationship with God and food. Please consider supporting the Obesity Action Coalition (OAC) to remove weight stigma from health care.  I believe your support would be an asset to our mission.

“OAC is the nearly 50,000 member-strong 501(c)(3) National non-profit organization dedicated to giving voice to the individual affected by the disease of obesity and helping individuals along their journey toward better health through education, advocacy and support. Our core focuses are to raise awareness and improve access to the prevention and treatment of obesity, provide evidence-based education on obesity and its treatments, fight to eliminate weight bias and discrimination, elevate the conversation of weight and its impact on health and offer a community of support for the individual affected.” ~ ObesityAction.org

Together we DO make a difference.  

The OAC is accepting of surgical and medical treatment options to support patients with obesity. Please join the more than 50,000 patients, physicians, and clinicians to speak out against weight bias in healthcare. Today, more than 93 million Americans are affected by the disease of obesity. If you are affected by obesity or care for individuals affected, I ask that you join the OAC today and help to strengthen our voice.

Respectfully,

Nanette W. Adams, M.Ed. N.C.C.

THE LANGUAGE OF A FAT WAR

I often hear obesity referred to as an “ugly” disease or that it is something to be “fought” as though it were a war. These approaches have really infuriated me. The message that it sends to the person with obesity is that they are not acceptable the way they are.  While obesity is a chronic, life-threatening condition. AND losing weight is TOUGH. We are all working against different odds. What is to be obtained from weight loss is not superficial or aesthetics, it’s health! Obesity should not be treated as a battle to be lost or won.  We set people up for defeatists’ attitudes when we stigmatize obesity as a war.  We are not at war against ourselves.

The process to lose weight and gain better health is not aided by use of the terms “battle” or “war.”  These words further stigmatize negativity in obesity treatment. Health changes are a process we find through wellness education and action.  The use of combative terminology sets patients up for resistance. The psychology of resistance is the “phenomenon often encountered in clinical practice where patients either directly or indirectly oppose changing their behavior.”¹ Research research has the idea patients cling to the idea that their disease defines them, and using these defensive terms drive behaviors. 

The most beneficial language we can use to treat patients with obesity in comprehensive obesity treatment programs are positive, education-oriented recognition of prohibitive behaviors, small steps toward change, and an attitude of success. We can not win if we wage war against ourselves. Positive attitudes, appropriate language, accurate education, and unconditional positive regard for individuality is the way. Weight stigmatizing words and images will not work to discourage obesity with a population that has lived with shame and blame throughout their lives. 

We’re not meant to all be size 6′s or 8′s or even 10′s or to have 32 or 34 or 36 inch waistlines. We should strive for healthy behaviors in our nutrition and activities. We have to want to be healthy, and understand what that means. Society needs to stop “fighting obesity” and start “promoting overall health and wellness.” We live in a sick healthcare system. We live in a world of mixed messages from the media about what healthy body images are. If you can’t say and do nice things, media and society, just silence your judgment.

Obesity and Mental Health

I’ve noticed a trend in professional obesity space to clearly state that obesity is not a mental health disorder or diagnosis.  While I definitely believe it is NOT, obesity goes hand in hand with many mental health issues.  Whether it is a precursor or product of weight retention or gain, be it from psychological distress or medical issues placing limitations on one’s ability to be active or metabolic dysfunction due to biochemical and/or hormonal processes, we cannot treat obesity without discussing mental health in the equation.

It is a fundamental element of obesity treatment.  Behavior management and patient compliance go hand in hand.  Some patients will respond well to coaching and motivational interviewing techniques to identify meaningful intentions to promote behavioral changes.  Others may seem more resistant when their psychological state is compromised by circumstantial and organic mental and emotional health issues.

Some patients will require more support, assessment and psycho-pharmaceutical treatment planning than others.  To ignore mental health as part of the equation in obesity medicine is to say that a patient’s emotional being is psychosomatic to the equation.  Where the patient’s emotional health and well-being is the chicken or egg, it cannot be ignored.  Assessment of psycho-social, emotional, and environmental factors contributing to mental health are an essential element to understanding how the patient became obese in the first place.

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I’ve also noticed a trend toward not confronting the psychological distress that weight loss plateaus cause in patients who are putting forth the effort to lose weight and not seeing results.  In terms of scientific research, people often can understand why their bodies are adapting to the changes, or inability to change.  We are created to store fat in the face of famine, so adaptive thermogenesis is a good way of explaining to a patient why their body is resisting shedding pounds.

Many clinicians may approach the situation by means of “you must be doing something wrong” or “it can’t possibly be that you’re not losing weight when you tell me XYZ is what you are doing” but it makes sense.  Especially for those who’ve chronically been on diets for a lifetime, their bodies have developed maladaptive patterns of weight reduction and regain over time.

We should not avoid talking about mental health, nor should we avoid explaining the phenomena seen in resistance to behavior change or body functions.  It is all collectively a part of the big picture.  As the medical landscape evolves (telephony), we are positioned to offer more services to patients through means of technology, and we should not shy away from developing services that allow for accessibility through telemedicine.  Encourage patients to join reputable support and advocacy services, such as the Obesity Action Coalition, and watch their educational seminars available on their YouTube Channel.

Education is an essential element in growth and promotes change of attitudes and behaviors.  We should encourage progress individually and community-wide. Implementing support, telemedicine, and data management has become easier in this day and age. Integration of services is completely possible.  Influencing decision makers to develop these services and engage patients is a crucial step in changing the obesity trend the world over.

Excuse me while I Facebook my surgeon. 

Humbled Self Actualization

One of my core theoretical orientations in psychotherapy is the work of Carl Rogers.  Rogers’ is known as the father of humanistic psychology, a philosophical orientation based on unconditional positive regard, where the helper shows complete acceptance and support for the human being, no matter what the person says or does.  It is a client-centered approach that centers on an attitude of grace and values the person no matter their actions. Even if therapist does or does not agree with a client’s actions, they should accept the natural value of the person. The main factor in unconditional positive regard is the ability to be able to isolate behaviors from the person who commits them.

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My personal experience with the medical treatment of obesity, I found that physicians did not use this approach.  Often, harsh criticism of my weight made me feel isolated and helpless in the medical setting.  I was not treated fairly, as a patient, but rather as a problem that needed to lose weight.  For many years, I did not go to the doctor.  During my lapband journey, I felt judged and the need to justify why the scale didn’t move.  In retrospect, I know now that it had everything to do with the philosophical approach within the practice, and the attitudes of the professionally I had chosen to guide my journey.  My current surgeon and primary care physicians’ approaches are completely different.  It’s more personal because they understand and are willing to listen without blame. They trust me when I tell them what I eat and how I exercise and still, the scale is not moving.  I don’t feel like I’m not being heard, but the only answer right now is consistent behavior management.

On a community level, I often see people judging others for the decision they make about their care.  Whether this is derived from a belief that so-in-so isn’t doing such-in-such and their behaviors are leading to X-Y-Z, is not my business.  So many people still think that the only way to “cure obesity” is with diet and exercise.  It’s not THAT simple.  It will never be some magic formula (or potion!) that we can drink to make us healthier (or skinnier, for those in it for vanity.)  Believe it or not, many people want to lose weight for the sake of vanity and nothing else.  They are quick to switch from diet plan to exercise routine to power potions as fast as the market can release it.  They may even want to sell it to you so they can make their riches.

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Do not be distracted by these people.  They do not have your best interest in mind.  Visually, they are looking for what’s wrong with you so they can prey on your weaknesses.  They want to empower you to become better (by losing weight!) and they will quickly show you where to sign your check.  Don’t do it.  Look within.  Process all the negative emotions and failed attempts, and realize that you are healthy when you live in the present moment, free of fear.  Your self esteem is built on knowing who you are and accepting yourself today.  All the negative beliefs you have held about yourself can be let go.  You have the power to grow and nurture your intentions, with diligence and persistence.  It shall conquer all things.

 

I write this as a counselor intern with eight years of experience under my belt in the field of therapy,  and as a bariatric patient who is five years post op from Lapband this week, with one year two months post-op band removal and eight weeks post-op vertical sleeve gastroectomy revision—and it’s frustrating.  I’ lost twenty-five pounds in the first month.  My expectations were so much greater, so, yes, I have disappointment in with my current metabolic inefficiency.  I’m disappointed because there has not been one day in the last two months where I exceeded 1500 calories in one day, and most, I did not exceed 1,000 calories.  I exercise.  I focus on getting protein in first.  I am doing all the right things, and I am transparent about it.  I keep my diary in MyFitnessPal open for others to view (just don’t tell me you read it because I don’t want to know you’re diet-stalking me.)

What I will tell you is this— you are only defeated when you check out of the process and stop doing everything all together. As long as you are still thinking about and processing what you have control of, your head is in the game.  If you throw caution to the wind and just don’t care, eat whatever you want and lose accountability, you’d failed yourself.  I have yet to fail myself.  I still believe that I can lose the weight, and whatever this metabolic dysfunction currently is, I will pull through the other side.  Yes, I am having blood work done again in a week, so checking for any hormonal or thyroid issues is on the agenda.  Yes, I’m exercising my a$$ off.  No, I’m not night eating, grazing or drinking sodas.  I’m just metabolically stuck for a brief (going on 3 weeks) time.  The obesity did not come on overnight (though, that year after the Lapband sure did feel like it at times) and it won’t come off overnight.  I know this.

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All I can do is continually accept compliments from family members and friends alike that I “look like I’ve lost” even though I haven’t.  My sister encouraged me today to take measurements. I am.  My mother reminded me to try on clothes I haven’t worn in 10 months.  Everyone has a piece of advice for me.   Guess what?  I have nothing.  All I have is unconditional positive regard for the process right now.  Whatever is preventing me from losing will eventually pass, and the struggle will move on to something else.  For now, I am going to NOT beat myself up over it, because what good is a therapist who beats herself up over little things she can’t control? This actualization of self brought to you by a very reflective, humble Bariatric Counselor.

The Six Behaviors that Encourage Self Actualization

1. Make choices that progress toward your goals

2. Be honest, humble and transparent in living your life

3. Position yourself to experience life by exposing yourself to new conditions

4. Give up defending your position, and develop the mental strength to resist anxiety

5. Focus on you and what it is you want to become

6. Selflessly concentrate on what you want and allow yourself to enjoy the process

How much weight is too much weight?

When you’ve been obese for a very long time (or all your life), it’s really hard to define a “goal weight.”  Many surgeons are really good about helping patients define a realistic goal weight, but some don’t even bother with a number because it can be so stressful. What’s your answer to this question: “What’s my goal weight?”

Did your surgeon define a goal weight for you?  Mine didn’t.  Sure, my situation is different because I did go to Mexico, and I talk to my surgeon on a weekly basis through direct messaging about everything.  He’s super supportive and he knows that I am going to be on top of everything about my health.  Just this week, I found out from my PCP’s office that my blood work showed I was slightly anemic.  The moment I got that message, I was quick to order liquid iron supplements and start taking what I had left over, as well as increase the amount of spinach, prunes, shrimp, scallops, oysters and almonds in my diet to get those iron levels up ASAP, but I digress…

We’ve never defined a goal weight. Sure, I have a number in mind.  It’s right smack in the middle of the BMI chart, even though I loathe the BMI chart.  It’s my fantasy maintenance weight of 145 lbs.  Will I ever get there?  I don’t know, do I care? Part of me does, but I won’t beat myself up about it if I don’t get there.

Back to the subject of this blog though.  How much weight loss is too much?  What happens when you can’t stop losing?  It can be more frustrating then being overweight because the social dynamic changes.  Before, people were less likely to “seriously discuss” your obesity. But now, being too skinny seems to be an open door to comments and concerns.  What gives?

It’s not uncommon to develop eating issues– distorted thoughts about food and fears of regain– can drive someone who has struggled with food to develop the exact opposite issue– anorexia.  The best way to avoid this is to truly get to the bottom of it.  Develop a healthy sense of normal– find your baseline calorie consumption and balance your life.  Put yourself first.  I never thought I’d have to tell a formerly obese patient to eat more, but it’s happened. Not once, but many times.  The thing is, you can’t go back to eating the way you once did.  We must develop a taste for health– how do you do that?  You become mindful of your consumption and you take care and concern for the food quality you consume.

1965_corvette_stingray_by_danielsundahl-d6bjl0zImagine your body is a car.  It’s not just any car, it’s a vintage, rare 1965 Blue Sting Ray Corvette.  However, this is your only vehicle, so you drive it every day and you must keep the car finally tuned and give it only the best fuel.  Maintenance is done only by the best mechanic that knows the car inside and out.  You just don’t put crappy fuel in your prized possession.   You keep your engine clean and your vehicle well maintained because you want it to last forever. You don’t overfill the engine with gas, nor do you underfill it. Fine tuned machine…

More people need to take this approach to their bodies.  When we become mindful, we are able to know without getting on the scale, what, within a reasonable range, that scale should say.  I’ve been trying (unsuccessfully) to move away from daily weighing.  While I know that eventually, I want to develop that spidey sense to “just know” that I’m in my five pound range, while I go through this “revisionary-weight loss again” phase, it’s my way measuring how much more work I need to do to get to where I want to be.

If you find yourself losing too quickly, there could be medical issues involved as well.  Stay on top of everything.  Keep track and monitor your body by logging and journaling daily.  Often, when someone is diagnosed with a serious illness, medical providers insist that they keep a journal and monitor everything.  It can help pinpoint what’s going right or wrong in your diet and/or exercise regime.  It is a healthy compliance activity that doesn’t hurt anyone, but could make all the difference in the world.  If you’re ambitious, you might even want to take note of moods, feelings, and behaviors that could be linked back to what you’re eating.  That’s the ultimate in mindful eating– knowing your reactions to certain dietary inclusions.

While I don’t have any hard and fast solutions to stopping weight loss, I know telling someone to “eat more” and “don’t exercise” is not the appropriate response.  The appropriate response is “Let’s figure out what you’re doing” and work on a solution tailored specifically for you to get this new issue under control.  Treatment plans are not cookie cutter, one size fits all, in my book.  If a clinician hands you some cookie cutter “Do This!” Handout, they are not listening to your individual needs.  We are all different, and we all have different work to do to find and keep a new normal, stable weight and mind.

He could have kept going, but… he forgot to just be awesome

From the Facebook Status Updates File, Today:

“I’m unexpectedly rescheduled for Saturday only at office this week… what do I do? Plan that 4th workout for Friday afternoon to make my 4 days in a row… this thrills me. I need to learn how to make this thrilling feeling of going to the gym a lot a “permanent condition” again. It can not be that burn out from 5 years ago prior to WLS/band has finally swept itself under the rug to allow me to emotionally move on and work through those frustrations? Meh. Or just finally my personal protests no longer are controlled by a desire to do nothing, no longer in favor of laziness or haplessly letting gym time be sucked into a vortex of apathy…”

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Now that I’m personally making much better strides to going to the gym (again), I have these glimpses of people’s experiences in the gym that I witness daily.  Last night, I walked into the gym, put myself stuff up, and noticed a man (who was obese) jumping rope.  There was no judgment here, actually, I find myself cheering people in my head when I see them doing good things for themselves.  As he was jumping, the more counts he said, the more excited I got for him.  It was a rogue cheering section in my brain, and he had no idea.  Then, he stopped at 30, but it was what he said when he finished that bothered me.

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“I could have kept going… but I stopped.”  While a personal trainer might respond to that with encouraging yet biting sarcasm like, “Well, then why didn’t keep going?” The therapist in me thought, “It’s okay to take a break, rest and then do it again, if you’d like!”  Of course, this conversation all went on in my head, but here, I am recanting the thoughts for you, dear readers, because I believe it’s important to acknowledge that stopping does not mean quitting.  If you stop to rest, you’re only saying I need a break right now.  However, when you stop to rest and someone else assumes you won’t start again– well, knowing that can be detrimental to your ability to get back up and keep going, eh?

There is a lot of power in the way we use out words.  We hold the power to initiate change in our lives every single day.  When someone says you won’t do something, don’t listen to them.  Don’t feel guilt for taking a pause or rest in your efforts.  You can pick right back up where you left off as soon as you feel well enough to do so.  Because that’s what this is about… Going At Your Pace.  Yours alone.  Not mine, not hers, not theirs, just yours.

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My tag line on my personal journey Facebook Page is “Nanfit: Moving at the Speed of Awesome.”  Because you know what?  My awesome speed is way different than your awesome speed.  My awesome speed varies every day.  So does yours.  Heck, sometimes, my awesome is not so awesome, but other days, I prove myself better than the day before.  So, what I’d like to say to that guy at the gym is, “Your cheering section silently awaits for you to keep going as soon as you are ready for another set of reps. Until then, Be Awesome!”