Nutrition and Exercise Return on Investment (NEROI)
Return on investment (ROI) is a commonly used economic term to indicate the benefits (profits/returns) you get back from investing a resource (time/money). I have coined a term that I believe we should be talking about in the health & wellness industry called NEROI: Nutrition and Exercise Return on Investment. To put it simply, NEROI is a measure of how much time you exercise and plan/prepare your food and the positive returns in health that result from your efforts. To help you begin to define your NEROI you need to ask yourself a few simple questions.
Investment
How much time do I spend exercising each week? 0 minutes, 30 minutes, 300 minutes?
How much time do I spend planning meals, grocery shopping, and preparing food? 0 minutes, 30 minutes, 300 minutes?
Return
Am I happy with how healthy I am, physically and emotionally speaking? Am I happy with my progress towards my health and wellness goals?
Take a few minutes to consider your answers to these questions............Most people will probably answer that they can and should be doing more. Even the best trained athletes in the world (professionals) tend to think they should be putting more work into their training and nutrition.
I want you to consider the NEROI questions carefully and follow them up by asking YOURSELF, "how much investment is enough, how much is optimal, and how much is too much for me?"
Clearly, spending 30 minutes on your NEROI is better than spending 0 minutes but is spending 300 minutes better than 30?
Like anything in this world, the answer is, “It depends”. It depends on how much time you have, the resources available to you, what your goals are, and how much it means to you.
Several professional organizations have defined what they believe to be the appropriate amount of exercise to live a ‘healthy’ life. The Centers for Disease Control and Prevention, the American College of Sports Medicine (ACSM), and the American Heart Association (AHA) recommend:
- 30 minutes of moderate intensity aerobic activity on all or most days of the week (5 days) totaling 150 minutes.
- Resistance training should be performed 2-3 days/wk using a variety of exercises and equipment.
Surprisingly, when it comes to our nutrition, there are no professional recommendations on the amount of time per week one should spend planning, purchasing, and preparing food.
What we do have are recommendations on the quantity and types of food we are supposed to be eating (2000 calorie/day example: 6 grains, 2 fruits, 3 vegetables, 3 dairy, 3 protein, limit fats) without any type of roadmap whatsoever on how to achieve these recommendations. It is obvious this does not work, as less than 10% of people follow the recommended nutrition guidelines (1) and only 20% of Americans meet the recommended physical activity guidelines (2).
If you’re like the vast majority of Americans not meeting the recommended guidelines should you simply throw your arms up in the air and give up? Hell no! Let’s consider how much exercise and nutrition preparation are enough, optimal, and excessive.
Exercise roi
When it comes to physical activity and exercise, some people have used the expression, “Just do SOMETHING!” and this is for the most part, accurate.
Figure 1: Morality rates across fitness levels in women and men. Increasing your level of fitness from low to moderate drastically reduces your risk of premature death (3).
Figure 2: Daily physical activity duration and all-cause mortality reduction. Increasing physical activity reduces your risk of dying prematurely, even at a moderate intensity (i.e., brisk walking) (4).
The two graphs above show that when it comes to exercise, the greatest return on investment is going from doing nothing (0 minutes/day) to doing something.
Increasing your fitness from moderately fit to really fit, to super fantastically fittest of the fit doesn’t protect you much more from dying prematurely any more than moving just a little (Figure 1). The least fit people are the most likely to die at a young age whereas those that are just a little more fit (those that move around a bit more) are FAR less likely to die early.
In Figure 2 you can see that increasing your total physical activity (red line) from 0 minutes/day to 15 minutes/day reduces your risk of dying prematurely by ~14%. If you add another 15 minutes/day of exercise you further reduce your risk by ~5% to a total risk reduction of ~19%. Your first 15 minutes yields a 14% risk reduction and your next 15 minutes yields 5% risk reduction. Clearly, your best ROI is moving from nothing to something (although I am not discouraging you from doing more).
nutrition roi
Research scientists and clinicians are constantly trying to identify the types of behaviors that help people lose weight and the types of behaviors that may cause you to gain weight or to regain the weight you lost.
Figure 3: Weight loss ROI by behavior type. The relative importance of each behavior adopted over a 3 year period to weight loss success (Adapted from reference 5).
People don’t gain weight due to a single factor nor do they lose weight due to a single factor (gluten, saturated fat, omega-3s, antioxidants; none of them work alone or will ruin your diet). Generally speaking, there isn’t one behavior that will make, or break your health (outside of smoking maybe). The pie chart above was adapted from the results of a 2004 research study (5) showing the behaviors most and least beneficial to maintaining weight loss over a three year period. As you can see, not all behaviors are weighted equal (Figure 3). Some behaviors, such as establishing a “meal rhythm” are more helpful than “rigid control of eating”. The graph above is by no means an all inclusive list but it helps us to identify some of the behaviors most (and least) helpful in maintaining weight loss.
The line graph below (Figure 4) is another way of viewing behavior modification (nutrition) return on investment and has been adapted from the results of the same study discussed in the paragraph above (5). The vertical, y axis, shows the percentage of weight loss participants who were successful at maintaining their weight loss three years after the study’s end. As you can see, even adopting “1” new nutrition behavior lead to a 20% success rate in keeping their weight off. With the addition of each new behavior (ie: flexible eating, coping with stress, etc) these individuals were able to increase the likelihood of maintaining their weight loss after 3 years. In this study, the adoption of each additional positive behavior increased the participant’s chances of weight loss success; that is until you reach “5” new behavior modifications, at which time your ROI levels off.
Figure 4: Weight loss ROI by the number of behaviors adopted. The number of healthy behaviors adopted over a 3 year period and weight loss success (Adapted from reference 5).
The fact that the participants received “less bang for their buck” may seem like bad news but it is actually great news. Individuals adopting “8” healthy behaviors were not any more successful in maintaining their weight loss than those individuals adopting “5” new healthy behaviors! This tells us that you don’t have to be perfect to achieve and maintain weight loss success, but you do need to select a few new healthy habits that suit you well and be really good at maintaining those behaviors.
Take home message
You don’t have to be an avid runner, extreme weightlifter, or Whole Foods connoisseur to live an active, healthy lifestyle and you don’t have to be perfect in your nutrition and exercise choices to have a great NEROI. Exercising for as little as 10 minutes/day and taking time to plan and prepare your meals will go a long ways towards improving your health. Your meals don’t have to be perfect and they don’t have to be a salad, low-fat dressing, and chicken breasts. As we saw in the pie chart above (Figure 3), planning the meal (meal choice) and eating consistently (meal rhythm) provides a great nutrition ROI.
We live in a society of extremes (marathons, ultra marathons, extreme sports, supermodels, etc.) where everyone seems to be “the best” at something and we often feel compelled to emulate them. Trying to be like them is not realistic or achievable for 99% of us, me included. I’m not a professional athlete so why would I train like one? Instead of focusing on what we can’t do (train like a professional athlete), let’s focus on what we can do. There is no doubt that losing weight, maintaining weight loss, eating healthy, and maintaining a consistent exercise routine is hard work. But it can be done and it starts with setting small, achievable goals. Although tempting, lofty, magic, cure-all, easy short term fixes do not work in the long run (Nutrisystem, Slimgenics, hcG, low carb, etc).
Going forward, I suggest you determine a level of nutrition and exercise that you’re comfortable with and can consistently maintain, create a plan to execute this level of nutrition and exercise, and give your plan 3-4 weeks to start to see your results (NEROI). If you’re happy with your NEROI, keep up the good work! If you are not seeing the results you would like to see, revisit your plan and see what you can change or do better. It is important to remember that “consistency is king”. If you are not consistent and fail to adhere to your plan, you will have no idea whether your new program really worked and you will have to repeat the test all over again.
Please refer to EBNC's current and future blog posts in which we will talk more about HOW TO CREATE your nutrition and exercise plans. Knowing how to create the right plan for you is the first key to success.
References:
- Krebs-Smith SM, Guenther PM, Subar AF, et al. Americans do not meet federal dietary recommendations. Oct 2010 J Nutr. 2010;140(10):1832-1838.
- CDC Press Release. One in five adults meets overall physical activity guidelines. May 2013. Accessed Feb 26, 2015.
- Church TS. The low-fitness phenotype as a risk factor: more than just being sedentary? Obesity. Dec 2009; 17 Suppl 3:S39-42.
- Wen CP, Wai JP, Tsai MK, et al. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. Lancet. Oct 1 2011;378(9798):1244-1253.
- Westenhoefer J, von Falck B, Stellfeldt A, Fintelmann S. Behavioural correlates of successful weight reduction over 3 y. Results from the Lean Habits Study. International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity. Feb 2004;28(2):334-335.