The Sliver People

Image result for thin slice of cakeEating behavior has fascinated me for years. Maybe because of my Italian heritage and the tendency to “cook enough for the army, the navy and the marines” as my mom would say…..coupled with my discovery of the research on “restrained eating” and learning about the link between dieting and binge eating. Added to my years of working with people with eating disorders and weight concerns, I have a great appreciation for the complexity of eating, food, and why people do what they do. So I love when people tell me stories about food and eating. Last week at work one of my co-workers told me a story about a family dinner and how something a relative (great aunt) said that kind of bothered her.

It was a celebration and cake was being served. My friend, her son and her daughter were enjoying a piece of cake at the dining room table while this aunt sat on the couch watching. “Look at you all, stuffing your faces!”she said in a way that was kind of negative, as if she were witnessing bad behavior, or behavior to be ashamed of. My friend went on to tell me about this aunt who appeared to be criticizing them for eating cake. Apparently this person is someone who always resists the dessert…..she “does not eat sweets”. She has “willpower”. And she seems to look down on those who give in.

But then, here is the weird part, the question my friend had: she refuses to take dessert EVER…..but then eventually, every single time, after shaming everyone else, sneaks back for “just a sliver”.

OH! I knew exactly who my friend was talking about. She sounds like “The Sliver People”, I said. We both burst out laughing, describing what we see when people try not to eat something they really want but for some reason don’t allow themselves to have. After a good amount of giggling at the term we just coined, I went on to share my theories of The Sliver People. Now remember, these are just my theories (which are influenced by research on cognitive restraint and dieting behavior as well as what lots of my patients have described to me about the way they think and feel about food).

So what is it with the Sliver People? My theories:

  1. They have a “good food-bad food” mind set. Sweets are bad, dessert is bad, cake is bad, so nobody should be eating it. If you eat “bad” food, then you, by association are being “bad”. You have no “willpower”. You are weak.

My Response: if you like it, it is GOOD. If you have cake for breakfast, lunch and dinner, you won’t feel too good. It’s all about balance and “listening to your body”. If you want something sweet and don’t eat something sweet, you will likely be thinking about food all day. I would recommend eating that darn piece of cake and going about your day.

2. They think cake (substitute sweets, desserts, “bad” food) makes you fat. Magically, one piece of cake can add gobs of weight.

My Response: the scientific fact is that one average piece of cake may have a few hundred calories (except my sister-in-law Michelle’s Mocha Marsh mellow 90 million layer cake she enters into baking contests which she manages to cram in a bit more melted butter and cream I am guessing that makes her a champion baker)….anyway, it takes much more than a piece of cake or one dessert to have any effect on weight, even Michelle’s. When you eat more calories than your body needs, it knows what to do. You don’t have to count. Think about it. When you eat a bigger meal than normal, something very strange happens: you no longer feel hungry, imagine that. You can go longer than an hour without thinking about food. So if you eat the cake and it is more than you normally eat, your appetite on its own will keep you in balance (if you learn to listen and trust it). Not easy for some people.

3. They have been dieting most of their lives. They are on a diet still. Cake is not on the diet.

My Response: when people “go on a diet” and eat only certain foods while eliminating others, we know they eventually have to “go off” the diet. Dieting and food restriction lead to food obsession and disordered eating, often binge eating. When dieters give in and have even “just a slice” feelings of guilt often follow. That is why restrained eating and dieting often lead to depression (in addition to the negative effect of starvation and inadequate energy intake on our brains and mood). I know I will never convince people to stop “dieting” or looking for that magical eating plan that will transform their bodies and their lives….but I won’t stop trying. Instead, if you focus on “healthy eating” and living, then having a piece of cake for dessert at a family celebration does not disrupt anything. It just adds to life’s enjoyment and moments we should be cherishing, creating memories together, savoring every single thing that is good…and I call that “healthy”.

4. They really aren’t hungry,but want to taste it. Their belly is full, but they know they won’t get this chance again (how often do you get a chance to try an award winning 9 million layer cake?).

My Response: I think it is “normal” eating to listen to your body, and if you know you can’t fit an entire piece of cake comfortably into your belly but want a “sliver”, it’s not a big deal. Chances are the person who takes just a bite because they want to taste it are probably not even noticing what everyone else is eating. They certainly are not being judgmental about anyone who decides to eat an entire piece. They are just eating what they want and not what they don’t want. Maybe they may take a piece “to go”. There is nothing wrong with that, honoring your body and staying in tune with it is something we all should be working on, that is if feeling good is your goal.

Are you one of the “Sliver People”? If so, do you recognize yourself in any of these descriptions? Remember, this is not meant to be a judgement of people who don’t take an entire piece of cake. It is meant to make us all aware of how we have been influenced by a culture that values thinness and weight loss and dieting at the expense of the true meaning of life. To cherish family, friends and celebrate all that we have, all of our blessings as much as we can while we can (if you ask me). To be thankful for all of it, every single day. To miss out because of fears of gaining weight, well, that is just sad.

Oh, and please don’t judge me because I only eat the frosting.

Can YOU Make the Pledge? No Diet Talk for the Next 2 Weeks

IMG_3720The month of December is typically a time of joyful craziness. Young parents are scrambling to get everything on a child’s Christmas list, co-workers are organizing cookie swaps, friends are wanting to get together to make a holiday toast, toy drives and food drives are happening, the malls are insane, and on and on.

But something else is also occurring at this time of year. People are thinking about their “New Year’s Resolution”and at the top of the list is anything to do with losing weight and/or getting fit. Besides all the energy given to the fun stuff, some people are spending a lot of time thinking about and talking about how they want to change their bodies. Sometimes, the talk occurs because of a recent medical diagnosis, such as newly discovered diabetes or hypertension, or even elevated liver enzymes where it is important to make dietary changes. This is not what I am referring to. I am talking about those people who have spent much of their lives focusing on their weight and body size.

The things I hear come out of people’s mouths at social gatherings probably irritate me more than most (such as my husband) because of my work experience with individuals suffering from eating disorders, especially teenagers. Our culture’s focus on bodies has made it acceptable to promote disordered behavior around eating and exercise. Conversations  abound regarding how to lose weight, diet products, and even how to supposedly mold specific body parts into your dream “whatever”.  When young people hear adults (especially parents) discussing these things,  it becomes clear that trying to achieve weight loss and a certain body size is a good life goal indeed. Is this really what we want our children to grow up with as an ideal that is important enough to take up all that time and energy?  It makes me so uncomfortable when an adult is talking about their own body or dieting in front of young adults or children. I typically change the subject, or at lest try to. And it is not just children who are affected by this type of talk. Adults struggling with eating issues and weight are also affected in ways you may not be able to understand. One of the big struggles some of my patients experienced was having to convince themselves to stay on track with their recovery despite what felt like the entire world was doing around them. Why was it important for them to continue eating their meals and snacks when clearly it was alright for everyone else in their lives to restrict and diet? It would take a lot of work to help a patient get grounded again and fight the eating disorder voice that tortured them.

Besides focusing on their own dieting and weight goals, another topic of discussion is OTHER people’s bodies. My husband does not get it (he is an engineer and not at all familiar with a non-diet approach or the great divide in the professional world of weight management). Why would you not tell someone how great they look if you have not seen them in a long time and they lost a lot of weight? Won’t that make them feel good?

The problem is, you don’t know what they did to lose that weight. I have known countless patients who dread the holidays because of the focus on them and their bodies. Again, it gets confusing. For example, a young woman I worked with had finally been successful with gaining enough weight to stay out of an inpatient facility. She had stopped purging for several months but did not gain enough weight yet to restore herself back to her normal weight and was not menstruating. At her holiday family party, those who did not know what she had been through (and was continuing to work on) made the usual comments about how great she looked. Those who knew she had gained weight with much hard work complimented her on that too (also not good as this almost always makes someone who is recovering feel “fat”). Those who knew nothing of her ordeal told her she looked great with all that weight loss and “how did you do it?!”. Ugh. After the holidays and all of these conflicting messages, the work is never easy to get back on track.

With that said, you may know someone who you know for sure had been working hard to change habits and get healthy. Doing things like quitting smoking, taking up physical activity, eating more vegetables and learning how to cook healthier does result in weight loss for some. Instead of focusing too much on their bodies, giving praise or positive feedback for the healthy changes is different (“You must feel so good! You have so much more energy, that is great! Your blood sugar is back to normal, yay!)

So this is what I am asking you to do: Make a pledge.

  • Please pledge to try to recognize dieting and body talk.
  • Pledge to catch yourself doing it.
  • Pledge to stop doing it in front of children or young people.
  • Pledge to try to stop doing it constantly even with close friends.
  • Pledge to (try to) change the topic when others are doing it.
  • Pledge to avoid commenting on anyone’s body, especially someone you don’t know well because you will never know what they are going through and how it will affect them.

Thank you! Here’s to a wonderful holiday season and remembering what the season is about……




More Evidence: When it comes to diets, one size does not fit all

beach-1168473Have you ever heard of “glycemic index” (GI)? This is a way foods are categorized depending on the way they affect our blood sugar. Many people believe we should avoid foods that have a high glycemic index because those foods are supposedly likely to trigger a high insulin release which in turn will make us store fat. I am not a big fan of GI or looking at the gycemic index of foods because there is not enough evidence regarding how mixed meals affect us. For instance, if you eat pasta which has a high GI but have it with meatballs, what happens?

Well, a recent Research Study (check out the details) shows that people react differently to different glycemic loads. In other words, one person may be able to eat a certain food and not have any reaction regarding blood glucose whereas another may spike their blood sugar which eventually may lead to weight gain.  We all can’t have lab work to see how our bodies respond to one food or another, however we can accept that a diet may work for a friend, but now for you. Again, if you are grasping at whatever comes across your path as a possible quick fix to your concerns about your weight, remember, you are unique.

With the holidays looming ahead, and people starting to panic about food, eating and weight gain, and thinking about what diet they are going to take on come January 1, 2016, I am hoping you take a minute to get real. There is no perfect diet for you, or for anyone. There is no magical weight or body size that will make you happy.

Instead, what do you think about keeping it simple? What would happen if you decided you would instead focus on feeling good? What does that mean to you? Do you need to work on getting more sleep? Do you need to figure out a way to incorporate some fun physical activity into your life? AKA exercise…..don’t like that word because it insinuates something that is not fun. So you need to make it fun for YOU. Because moving makes you feel good.

What about eating? Eating is more complicated than you would think, and I can say that because I listen to what people eat pretty much every day. And I know how people struggle. Yes, you do need to think about it to a point. If you do not plan, you will not be healthy. Period. If you don’t buy healthy food, you will not eat healthy food. If you do not know how to cook, you will probably need to eat fast food or eat out often, and that will not only be unhealthy (after awhile) it will also make you broke.

So yes, it does take some time and planning to feel the best you can feel, but at least you do not have to waste your time and energy and money on just another diet plan that may not work for you anyway.

Instead, do the simple thing you did when you were 5. Eat when you are hungry. Stop when you are full. Whether it is a ham sandwich or a bowl of ice cream, remember when you just could not finish? or, remember when you needed more? That is intuitive eating, young children have it until adults step in to force them to finish, or restrict them because they did not finish, and then they learn to tune out the natural mechanisms that regulate us every day, every meal, if we would only listen. (Note: those with disordered eating may not be able to do this. If that is you, hopefully you are working with a therapist and dietitian so that you can eventually get reconnected to your natural body signals).

My old college roommate Marion and me at the annual Manchester Road Race in Manchester, CT

So during the next month, over the holidays, try to eat your favorite foods, but listen to your tummy like you did when you were 5. Feel good. Eat enough, but not too much so that you don’t feel good. It’s just food. Go do the fun stuff, like playing football out in the cold, or running a road race with your old college roommate,  because that is what you do on Thanksgiving. We all know people who can’t eat because of a medical condition, or who can’t play football or run a road race. So, if you can, it is the time to be thankful.  Happy Thanksgiving!

Regarding “Clean” Eating….

mopThis women’s face is how I feel several times per week. Have you fallen for the latest weight loss craze? This is driving me crazy!! It angers me when people are taken advantage of because they are desperate to lose weight. How do you define “clean eating”??? And why does it usually involve some type of juice that you need to purchase?? Anyway, try to find some good long term outcome studies on this diet approach, and please share them with me. I can’t find any. The bottom line is any trick to make you eat A LOT less will make the force of gravity on your body less over time (that means you will weigh less). It won’t last. Most of these diets have you do a juice fast or just fruits and vegetables or maybe a “clean” shake for a certain amount of time. You will lose weight as your body breaks down muscle (sorry but the Krebb Cycle prefers amino acids to keep producing it’s ATP’s for energy, not the fat you are hoping it would use). Not to mention the typical dehydration that occurs when your body is breaking down muscle from starvation (because when you break down muscle you need to get rid of the nitrogen through your kidneys, and your body knows to use water to dilute it otherwise your kidneys would be damaged…unfortunately, that happens to some people anyway). And if you are getting way too little calories, your body may be building up toxins in your blood called ketones….that isn’t too “clean” if you ask me.

Not to mention, don’t you have to eventually eat something? Then what? Have you learned anything about yourself? Have you identified some unhealthy habits you may have had and are you magically now able to change them? Probably not. If I could have a dollar for everyone I knew who lost weight on a plan like this, but then gained it back, I might have retired by now. This latest fad is nothing new, just like the low carbohydrate diets, the low fat diets, the high protein diets, and on and on, it just delays the inevitable work your really need to do.

I’m good with vegetables and fruits in your diet. But this is way too much thinking and that is something we know people can’t sustain over time. Why not simply work on adding in these healthy foods to your diet and continue working on listening to your hunger and fullness, recognizing when you are eating when you are not really hungry, taking time to move your body because it is fun and feels good and also contributes to your health? Stop all the “cognitive restraint” and focus on health. There  is no such thing as clean eating.

Vegetarian Diets….the question is “why”?

veggie burger

Why on earth would a dietitian even question a vegetarian diet when it seems like such a healthy way to eat? Eliminating all that saturated fat in the form of meat from your diet has to be a good thing, right? And when you think of vegetarians, don’t you get a vision of someone munching on a giant salad?

Well, let me give you a reality check. Having been around the block a few times (meaning I have been a dietitian for over 35 years),  I have encountered my share of vegetarians. When someone tells me they are a vegetarian, or a vegan, I do not make any assumptions about their diet or their intentions. But what I have found is that the reasons people become vegetarian are not always clear. I have noticed that people turn to a vegetarian diet for a few different reasons. In fact, I have encountered 3 types of vegetarians over my long career as a nutritionist (my experience only, I can’t speak for everyone). The people I have worked with or have known in my life tend to fall into the following categories:

1. The True Vegetarian: This is the individual who truly has a strong empathy for animals. They just are not comfortable with consuming them.  They may have had meat in their lives but then, they change and make a decision that they do not want to eat meat any longer. There are different types of vegetarians, those who are ok with eating dairy or eggs or fish, but not meat. I remember my daughter as a teenager getting very upset when the rodeo was in town, and she actually joined a group who stood on the corner and protested. This led her to looking into protecting animals and she decided to stop eating meat at the time. I also have a best friend who is vegetarian, is a great cook, and who also is all about protecting animals (it is a passion with many vegetarians I have come to know over the years). They eat everything, just not meat. I have to say, not all of those I have met who are true vegetarians are healthy eaters like my friend. Many people (especially teenagers who love their kid-foods) tend to live on noodles and chips, still vegetarian, but no vegetables involved!

2. The “I want to be healthier” Vegetarians“: These are the people I have encountered who may have developed some health issues such as high cholesterol, and decided they are going to “cut down on” meat consumption. The reason they want to change their diet is because being healthy is important to them. They may have an occasional meal with meat, but otherwise they believe eating less of it is healthy.

3. The “I am pretending to be vegetarian because it is a good excuse to eat less” Vegetarians: Unfortunately, I have worked with many people over the years with eating disorders who start out with “vegetarianism”. They start eliminating foods, and becoming a vegetarian is kind of a good “excuse” for the eating disorder to NOT EAT. This type of “vegetarian” is different in that they typically refuse to eat the normal vegetarian standbys such as peanut butter, nuts, beans, etc. They may say they do not like salad dressing, olive oil, trail mix, granola or nut butters. This is always a “red flag” to me. Most of the “True Vegetarians” I know rely on nuts and peanut butter for protein and have no problem with pasta and rice and beans and all the other food needed to round out their diets. Not to mention delicious Tofutti Ice Cream!

So what is the bottom line? If you or someone you knows decides to become vegetarian, always ask “why?” If it is to be healthier, or because you care about animals, then you can definitely meet your nutritional needs with some guidance. Vegan diets are a bit harder in that you may need supplemental iron, vitamin B-12 and calcium, and also you need to know how to get protein in your diet (I recommend seeing a Registered Dietitian to be sure-check out and “Find a Dietitian”). But if you know someone who just started being a vegetarian, is losing weight, who no longer eats potato chips (those are vegan!) then don’t ignore it. It could be an eating disorder just beginning.

For more information from the Academy of Nutrition and Dietetics, check out:

Should you count calories?

calorie labelI was a little concerned when restaurants started to post the calorie content of menu items. I have to admit, I am a bit torn between the importance of educating people about nutrition and my mission to prevent disordered eating and promote a healthy relationship to food. My friends and family often argue with me when I say “listen to your body”. My husband says “my body told me to eat the whole thing!”.

What my husband is referring to is most likely the “trigger” that yummy food is to most of us (and not true hunger, something not very easy to tune in to for many). We are all different in the way we respond to food and eating, and not everyone is able to “listen to your body” because they have a unique eating, weight, dieting, genetic history that no one can understand except themselves. So what does counting calories have to do with anything? Why would I have any concerns with labeling calories on menu items? Should you count calories to have a healthy weight?

My answer: The Top 5 Reasons you should not count calories:

1. It is hard enough to work on the task of paying attention to your hunger and fullness, so when you attach a number to a meal or snack, you are almost guaranteed to become “disconnected” to your true body signals. Imagine you have determined you need a certain amount of calories for the day, and by evening you feel full after your last meal and do not want that pm snack you are supposed to have. Should you force yourself to eat it? or what if the opposite happens and after your dinner with the specified calories, you are still hungry? Do you forbid yourself a snack and think about food all night long? What if you made a mistake, which leads me to reason number 2.

2. You will not be accurate! The calories posted on many packages and menus may not be accurate! Check out this interesting video about a small experiment in NYC regarding this topic. WARNING: this video only looked at a few foods and most had more calories than stated on the package or menu. The reverse is also likely, where menu items have less than stated. The message is, nobody is held responsible for accuracy! If you are obsessive already about eating and calories, this video may be triggering and you should skip it.

3. It encourages obsessive thinking about food which can backfire. When you use “cognitive restraint” such as counting calories, you become MORE focused on food, not less. Research shows that people who are overly restrictive tend to be more likely to binge eat. Even worse, this behavior is more likely to lead to disordered eating patterns.

4. Counting Calories does not translate into healthy eating.  As I said earlier, although I believe in “listening to your body” I also believe it is good to want to be healthy. That may mean learning about nutrition, healthy cooking, what your body needs to feel good, etc. If you only look at calories, you are missing the boat.

And Finally,

5. Counting Calories is not fun and really interferes with your social life! Not only is it harder to go out to eat once in awhile with friends, even family celebrations become a chore instead of something that should be enjoyed as one of the most wonderful parts of life. Not only that, people who are restrained eaters (such as calorie counters) tend to be more depressed.

So the bottom line is: it is ok to educate yourself about nutrition, but calorie counting is not a great thing. You can’t avoid seeing the calorie count on the menus, and if you get indigestion every time you get that certain giant burger, well, seeing the calories may help you understand why….but your tummy will tell you that, you really didn’t need to know the number after all : )

The Milkshake Study


About 40 years ago, a landmark study was conducted that launched the research investigating why diets fail. This important study is sometimes referred to as “The Milkshake Study” (Herman CP, Mack D. Restrained and unrestrained eating. Journal of Personality. 1975;43:647–660). In this experiment the researchers administered a “Restraint Scale” questionnaire to determine who the dieters were (restrainers) and who the normal eaters were. They then had subjects participate in what the subjects believed was an ice cream tasting where they were to rate the ice creams. They were given either one milkshake “pre-load”, two milkshakes pre-loads or no pre-load and then told to eat as much ice cream as they wanted or needed to rate them. What was expected was the more milkshakes a subject consumed before the tasting the less they would probably eat (because they were already full, right?). But that is not what happened!

Instead, the researchers found that those individuals who were highly restrained (dieters) actually ate MORE ice cream with the more milkshakes they had before they started tasting! They hypothesized that dieters who constantly restrain their intake tend to become “disinhibited” after they break their diet boundary (sometimes referred to as the “what the hell” effect). This study triggered many more years of research into “cognitive restraint” and its negative consequences (binge eating being one).

Unfortunately, most people are not aware of this vast body of research, and so the diet industry has been able to continue making its billions. The good news is that finally a “Non-Diet” approach to weight management has been researched and proven to be effective in promoting health. Keep posted for more information and resources to come!!!

Feeling “Full”

boy with cake

Back in the day when I was young, I am guessing it was easier to know if you were “full”. These days I find many of my patients are very confused about this. Now that we know a lot more about the physiological contributors to feeling both hungry and full it is easy to figure out why back then people didn’t struggle as much.

So what are some of the contributors I am referring to? This topic is so complex that I am going to only focus on three:

(1) Balanced Meals: we now know there are messengers that respond to what we eat that communicate to our brain that we got what we needed. For instance, if we do not include adequate protein with our meals, our belly may feel “full” but our brain will tell us we are not satisfied because of a messenger called NPY (Neuropeptide Y). If we do not consume adequate carbohydrate our serotonin levels will fall and likely trigger a craving for something sweet later on. Back in the day, getting “three square meals” a day was the norm (and you were very lucky if you ever got a dessert, and that was probably on holidays and birthdays!). Today, things are different. Family meals barely exist as families tend to be busier, children tend to be glued to computers and video games, and family meals have fallen by the wayside. A typical “meal” for many teens I have seen is a package of Ramen Noodles (not much protein there, more snacking will be needed).

(2) “Sensory Satisfaction”: research has demonstrated that when you eat while distracted (such as while watching the TV or on the computer) you do not get an adequate release of dopamine which tells your brain you are satisfied and can stop eating. Need I say more? With one small TV in the home, 3 channels to choose from, and the remote not invented yet, back then we all ate at the table.

(3) Fitness: studies show that people who are active are more in tune with their hunger and fullness. In other words,one of their fullness messengers (called PYY) works better. Back in the day, there was no choice but to be active. There was nothing to do in the house, so kids played outside. We had to walk 2 miles to school and then back home, etc etc etc.

So, feeling “full”, a very normal physiological function is no longer that easy. Working on having balanced meals, shutting off the TV and sitting at the table sounds like simple advice, but more important than most people realize. And getting outside to play now that spring is here is a good idea too!!


Warm Weather Dieting Woes


IMG_4090Happy Spring!!

Have  you ever noticed how the start of warmer weather gets people focused on dieting? I have been biting my tongue at work these past few weeks as it seems so many people are talking about the crazy eating plans they are starting. The new buzz seems to be a one or two food diet that is supposed to magically “cleanse” your system in a few weeks (a “kick start” as some people refer to it). I usually keep my mouth shut unless someone notices the dietitian sitting at the computer and dares to ask “what do YOU think?”

I love it.

Today I got asked the question, and I gave my answer. The research has connected dieting (any kind of cognitive restraint where you tune out your body signals) with binge eating. And weight GAIN in the long run. Yes, any trick to make you eat a lot less will of course result in weight loss (that good old “kick start” that is supposed to motivate you). Unfortunately, that short term weight loss ends up frustrating people rather than motivating them. They of course can’t keep up that rate of weight loss (and if they did, the loss would be valuable muscle). They end up feeling bad and usually just go back to their old ways.

Instead, what I shared with my coworkers was that it is smarter to take a non-judgmental look at your lifestyle and eating habits. Do you often eat when not hungry just because food is there? Do you have the habit of watching too much TV or sitting in front of a screen for hours on end? Instead, work on listening to your body. If you are hungry for a snack, and you want a cookie, eat a cookie. It is the non-hunger eating that goes against your body’s needs. Sometimes it is our sedentary lifestyles that prevent us from feeling better about our bodies.

I’ve said it before, and I will say it again! Work on being healthier in every way and forget about dieting!!!! In the long run you just might end up being happier AND healthier.

Healthy or Thin?

IMG_2637My guess is these two words get different reactions from different people. It has been my experience over the years that in our culture we assume pretty much everyone wants to be “thin”. And most people equate being “healthy” with being “thin”. Most of us assume if we tell someone they look “healthy” it would be a compliment. Or, we assume telling someone they are lucky they are so “thin” is also a compliment.

What I have learned from my patients is for those with eating disorders, being told you are “healthy” is equivalent to being told you are “fat”. For some of the patients I work with who have trouble gaining weight, being told they are “too thin” is very hurtful, as their body image concerns are often interfering with their lives just as the person who is concerned about being “too fat”.

My goal is to help people see that a goal of “healthy” is the smartest goal. The first step for some is working on their “self-talk” around the word “healthy” and eventually accepting it has nothing to do with your size. For others whose goal is being “thin”, instead changing to a goal of being “healthy” because that may be a goal they can actually achieve (not to mention, a goal of being healthy is also mentally healthier!)

I will always remember a teenage patient of mine who had moved from Africa and had lost a few pounds (still a very normal and healthy weight). Dad brought her in because he was very concerned about this. When I asked about his concerns, he said “I want her to be fat. Doesn’t everybody want to be fat?” He was very serious but I couldn’t help but smile inside. I did have to explain to him that we can’t always control that but I wanted to be sure she was “healthy”. He never came back ; )