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New Clinical Report From The American Academy of Pediatrics on “Preventing Obesity and Eating Disorders in Adolescents”: What You Need to Know Before Your Teen’s Next Checkup

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medical-doctor-1236728At first I thought “hooray! finally!”when I saw the report from the AAP (American Academy of Pediatrics). They are finally doing something to counteract the horrible way weight has been addressed with kids and teens. But, after reading the paper, it struck me that a lot is left unsaid. In particular, how are you going to help parents do the right thing? How does this translate into action? So, I have a bit of advice for parents who have been made to feel like a failure because their kid has not lost weight. I have a few words to share that I hope will help you at your next doctor’s visit. I want you to be armed and ready.

The new AAP report is meant to “address the interaction between obesity prevention and EDs in teenagers” and to “stress that obesity prevention does not promote the development of EDs in adolescents”. I believe we need lots more research to be able to be sure this is not true, as I have seen first hand children and teens who have developed disordered eating behaviors after a health class. Anyway, the good thing is the authors do bring out the point that many overweight teens actually do end up developing an eating disorder when they start trying to lose weight. Pediatricians and parents tend to celebrate the weight loss, often failing to realize the teen actually now has an ED. This delays the identification and treatment of the eating disorder, and sometimes it is entirely missed. The point is stressed that focusing only on weight increases the risk of this happening. This is extremely important in my opinion, I have seen it happen often. And when the ED is finally diagnosed, it can be harder to treat than if it were detected earlier.

Anyway, the paper reviews both the behaviors that are associated with obesity and eating disorders, mentions the use of “Motivational Interviewing” by health care professionals in the treatment of weight issues, and finally briefly discusses six points for pediatricians to consider in order to address weight and prevent EDs.

First, the following behaviors were associated with both “Obesity” and EDs” in teenagers:

  1. Dieting: defined as “caloric restriction with the goal of weight loss”, in a nutshell, research shows that dieting actually increases the risk of weight gain, and not loss. It also increases the risk of developing an eating disorder.
  2. Family Meals: eating meals together as a family promotes a greater intake of fruits and vegetables and a healthier diet; eating family meals was preventative of eating disorders.
  3. Weight Talk: any talk about weight, even a parent’s weight increases the chance that a teen will actually gain more weight 5 years later, and also increases disordered eating behaviors such as extreme dieting…..talking about weight, NOT GOOD.
  4. Weight Teasing: family weight teasing may lead to both weight gain, binge eating, and extreme weight control measures
  5. Healthy Body Image: 1/2 of teen girls and 1/4 of teen boys are dissatisfied with their bodies, and even more in overweight teens. Body dissatisfaction can lead to disordered eating behavior.

Second, the paper briefly mentions the “use of Motivational Interviewing” (MI) to counsel families of overweight children. I am a passionate believer in the use of MI, which is founded in “empathy”. In other words, it is an empathetic approach to helping people change behavior. I have attended every MI seminar I could in the past because I have seen how the typical approach to helping people change does not work. I will never forget the mother who came back to me for follow up with her teenager who had gained a lot of weight, had developed some health issues, and had seen the endocrinologist. “He made me feel like a terrible mother! I will never go back!” This mom and kid had done so much work and had made some good changes toward a healthier way of eating. His labs actually had improved! Yet, the doctor was looking at the lack of weight loss (which is never my focus, I was so happy his blood sugar was now normal). Anyway, I convinced her to go back because he really did need to be followed, and instead, I called the doctor. I gently informed him that he might want to know that this family was upset with how they were treated. He said “how do you deal with it?! They never do what you tell them to do!” I went on to tell him about how motivational interviewing has helped me so much. I told him I never tell people what to do, instead I treat them as experts in their own lives, and I try to find out what their motivation is. Then I ask them what they need and how I can help, and we work together on their goals, not mine.  To make a long story short, I sent him some articles, apparently he read them because at their follow up, he actually treated them differently (so they told me) and I received an email from him stating “this MI has changed my life”. I am sure it has probably changed his patient’s lives, too!

The point though, is that MI is not easily learned. It takes working with expert trainers, being observed, practicing again and again and getting feedback from peers. You can’t learn it in a day. I was surprised that this endocrinologist hadn’t even heard of it. I am not confident that this new paper  will result in everyone using it. But I am hopeful.

Finally, the paper discusses six points for pediatricians to consider in order to address weight and prevent EDs:

  1. Discourage dieting, meal skipping and diet pills and instead encourage a focus on healthy eating and physical activity. The focus should be on healthy living and NOT ON WEIGHT. YAY!
  2. Promote a positive body image, and especially do not focus on body dissatisfaction as a reason for dieting.
  3. Encourage more frequent family meals.
  4. Encourage families not to talk about weight but instead to talk about healthy eating and being active to stay healthy. Do more to facilitate this at home. My add in: Please don’t talk about exercise as a way to “burn” what you just ate.
  5. Find out about bullying and address it.
  6. Carefully monitor weight loss in adolescents who “needs to lose weight” to ensure they do not develop the medical complications of semistarvation. I need to translate this one to what I hope they mean: don’t ignore it when a teen seems to be losing too much weight, even if you think they needed to lose weight. It could be an eating disorder.

So, what does this mean to you, the parent? My advice is this:

  1. Ask yourself how you are treated by your child’s pediatrician. Are you told what to do even if you were not asked any details about what you are doing now? Do you leave feeling like you were shamed, or that you just don’t want to go back? If so, that may be an indication that your doctor does not know about motivational interviewing….or they do, but don’t know how to use it, or maybe just are too busy to learn. I recommend asking them. You deserve to be treated with empathy and respect, and your doctor should be the best he or she can be.
  2. Follow the advice above. But, if you need help, ask your pediatrician. It is really easy to tell people to “eat more meals together”, but that is kind of hard when dad is home at 8 pm, Johnny is at football practice until 7 pm, mom is picking up Suzie at daycare at 5 pm……you get it. So, if you need help or guidance, don’t feel bad. Ask for some resources.
  3. Don’t ignore weight loss. If your teen is losing weight, don’t ignore any red flags. If they are skipping meals, losing hair, running to the bathroom after meals, exercising too much, complaining about their body, or any other drastic changes in their social life, don’t ignore it. Tell your pediatrician.

The bottom line is, this is progress. But, it may not change much unless we all are aware and make it happen. FYI, it is noted at the beginning of the Clinical Report paper that “The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate“. In other words, your doctor will do what they feel is best depending on the patient. And it is important to treat each patient as the unique individual that they are.

However, I believe we all should be treated with respect and empathy, as we most definitely are the experts in our own children’s lives.

Check out the paper here: Preventing Obesity and Eating Disorders

 

3 Steps to Eating Mindfully:Which One Are You Neglecting?

On By jodietitianIn UncategorizedLeave a comment
My hungry husband at Faneuil Hall, Boston

The other day I found myself standing at the kitchen counter, wolfing down some leftovers. I was in a rush to finish packing for a weekend trip, and I was in one of those “multi-tasking” modes. You know, if you can figure out how to do two things at once, try doing three. So there I stood, with the small TV that is stuck in our kitchen wall closely watching the path of Ermine (or was it Hermine?), the hurricane that was maybe going to hit us as we had our yearly outing with good friends in their boat down the Connecticut River. A hurricane would be bad. So I was standing there shoveling this yummy salad down my throat,and it suddenly struck me that I was not even tasting it. And I LOVED this creation, which was a random modification of a kale goat cheese salad I make often (if you ever go to Bricco’s Restaurant, their kale salad is the one I tried to copy…..I got pretty close!). It is a delicious blend of chopped kale, fried chick peas, garlic, red onion, olive oil, balsamic glaze and crispy bacon bits. Anyway, I kind of combined this salad with another bean salad recipe I make with black beans, corn, carrots, etc. and boy, was it good. I should have enjoyed it, but instead, I was just rushing it into my belly so I could move on.

 

Ye, I was in a rush, but promised myself when I got back from the weekend trip, I needed to write about this. If felt important to me because mindful eating, and working on having a healthy relationship with food is one of the messages I hope to send. This means enjoying eating. Shoving food down to get it over with is the opposite of mindfulness. I understand not everyone looks at food and eating as something to be enjoyed, and I chat with people every single day who look at food as “the enemy”. It kind of makes me sad, as cooking and creating healthy but yummy dishes is something I greatly enjoy. I just love sharing what I cook with family and friends, and maybe that is part of my Italian heritage, but being a dietitian definitely affects my cooking, too (“how can I make my mom’s sausage and eggplant but not give my husband heartburn?”).

Ermine missed us, and we sailed down the river easily, and as I joyfully floated one day on a gigantic blow up duck (don’t knock it till you try it) I had time to reflect on how I would describe this eating experience and what bothered me by it. It dawned on me that eating involves three simple (yet not always easy) steps. Each step is important to understand if your goal is to eat somewhat healthy and feel good. Especially if you want to have a healthy-ish relationship to food and eating, and most importantly if you are an emotional or binge eater.

Here is what I came up with:

Step 1. You need to have food available to eat. Now before you say “duh…”, let me ask you this: what are you making for dinner tonight? What are you having for lunch at work this week? What snacks can you have, right now, this minute if you get hungry? Like I said, I love to cook, I know a bit about nutrition, and yet, it is after 12:00 noon and I have yet to figure out dinner, although I have successfully defrosted what looks like 2 gigantic boneless chicken breasts. As for lunches for work, it will have to be leftovers. I am not at all in the mood for grocery shopping. Snacks, well, shriveled grapes and frozen fudge….and the bottom of a chip bag.

The point is, having food available is pretty important because it really does affect what you are going to eat. For those with binge eating issues it can be critical. FYI there are 2 kinds of “binge” eaters. The first kind is the “subjective” binge eater who thinks eating a full sandwich and a cookie is a binge (these are the dieters or even those with disordered eating who don’t allow themselves to eat what most of us might consider a normal meal). The second type is an “objective” binge eater which is someone who truly eats an amount of food most people would consider a large amount, such as the whole box of cookies on top of several sandwiches. Lots of guilt follows an eating episode no matter which type. Many binge eaters have certain “trigger” foods, in other words, when these foods are in the house they can’t resist eating “the whole thing”. Not consuming enough food also can trigger binge eating. It is pretty smart to know yourself, and creating a food “environment” that works best for you.

Besides triggering binge eating, eating healthy and feeling good is next to impossible if you don’t have access to healthy food. I know of some people who just would rather not bother. Maybe they are single or live alone, or maybe the kids moved out and so they don’t cook. Eating macaroni and cheese every night with Pop Tarts for breakfast and take out for lunch eventually will affect your health. Having a bowl of jelly beans on your desk may not be the best idea if you are a mindless nibbler, especially if the dentist is not your favorite person. Yes, paying attention to your food environment definitely affects what you eat and your health. What foods do YOU have available….at home and at work?

Step 2. The act of taking a bite, a forkful, a spoonful or otherwise putting that food into your mouth, chewing and swallowing. The first question is, where are you when you eat and what are you doing? Standing in the kitchen like I was while watching the weather is pretty much the exact opposite of how to eat in a mindful way. Digestion actually does begin in your mouth, so chewing fast and swallowing foods whole will interfere with this. Did you know that savoring your food (really seeing it, tasting it, enjoying it, feeling it in your mouth and chewing it thoroughly) actually has been shown to lead to “sensual satisfaction” and helps you to know you are full? In other words, taking the time to look at your food (not the TV or a book), pay attention to the flavor and texture (is it good? need to add something?) and really enjoying it helps you to be more in tune with your body. Savoring your meal or snack instead of rushing through it makes it more likely that you will eat the amount that you need. Even more important, truly taking the time (more than 2 minutes) to enjoy your food can be a part of the joy of life.

Step 3. Stopping eating. You might find it interesting to know that scientists are fascinated in studying what makes us stop eating. How and why do we “feel full”? What factors contribute to satiety? Everybody knows that eating fast usually contributes to overeating (and by this I mean getting too full, not feeling good physically because you ate too much, I don’t mean the guilt and judgement some people put on themselves because they did not follow their “diet”). We now know there are several chemical messengers that our body sends to our brain to tell us we are full and can stop. We are all different, and some people may feel full faster, but most people need time (about 20 minutes or so) for that messenger to get to the brain to signal fullness. Many factors affect this of course, such as the food we eat, how much fat, protein, fiber, etc. But one of the most fascinating things to me is the “sensory satisfaction”, or how much we actually enjoy the particular food that may affect how satisfied and full we are. Yes, some researchers have found connections. This is just one abstract about how  the sensory aspect of food and how it contributes to feelings of satisfaction and makes us stop eating. Yes, other studies have connected good tasting food with overeating, and we all know that when excessive yummy food is available most of us may eat more than we usually do. The key is finding the balance. Do you expect yourself to live on dry toast, cottage cheese and salad? Are you absolutely bored by the food you make? I have seen people become kind of obsessed with foods they normally deny themselves especially when they try to be “good” all the time…I hate that word, but people use it when they define their eating, so I want to be sure you know what I mean. Eating only and I mean only healthy food. Boring, especially if you aren’t into cooking. Instead, jazzing up your meals, even a little bit can greatly add to your satisfaction. Can you throw some avocado onto that grilled chicken wrap? add some crunchy granola to that morning yogurt? How about a little olive oil dressing in that salad? Make it taste good, and you are bound to feel more satisfied, less obsessed with food, and maybe you even may develop a new hobby…..collecting cookbooks?

Besides being sensually satisfied, tuning in to the ole tummy is also a part of learning to be an intuitive eater. I sometimes use a “hunger scale” (many dietitians do) to help people judge how full they are. It typically goes from 1 (starving) to 10 (stuffed to the gills, extremely uncomfortable). Check out a typical hunger scale HERE.  If you are a mindless eater who gobbles down meals too fast, you may find yourself with indigestion or an upset tummy after the fact. That is one sign that you could benefit from taking the time to slow down and tune in. Practice sitting quietly somewhere, or at least trying to pay attention to what your stomach has to say about a half hour after eating. Are you barely satisfied or are you feeling sick? Both extremes teach you something.

So there you have it. The thoughts I had while floating down the Connecticut river on a duck. I hope you take the time to “digest” some of this, and realize this is not a skill we learn overnight. If you have trouble, just give yourself time. The important thing is doing the reflecting. The rest comes with trial and error. There is no right or wrong, and if you want to live on mac and cheese and Pop Tarts, who knows, you may live a long and healthy life without the fiber….but if you truly do want to feel your best then do your best to work on creating a healthy but enjoyable food environment. Slow down. Tune in.

By the way, we named the duck…Ermine.

Does Your Teenager Have an Eating Disorder? Signs and Symptoms You Should Not Ignore

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scaleThey came to their visit together. Jessica (not her real name) did not want t be there. I let her stay in the waiting area fixated on her cell phone (she made up her mind she hated me, at least that is what her facial expression conveyed). Instead, I took her mother into my individual counseling room to get the story before I met with Jessica. It was one I have heard before. In fact, the entire scenario became predictable. Mom was all over the place, at first angry that her teenager was being so rebellious, she was driving them all crazy. She refused to go anywhere with the family, she hid out in her room, refusing to sit at the family dinner table. Vacations were a night mare. “She used to be such a sweet girl, so happy and care free, she LOVED helping me in the kitchen and really enjoyed going out for pizza with the family, but now she is like someone else. We don’t know what to do”. Next, after the anger, comes the crying. “She looks horrible. She passed out the other day and it was so scary. Yet, she won’t stop this. It does not make sense!”Jessica took to wearing very loose and baggy clothes, and it wasn’t until her mother walked in on her changing that she noticed her protruding ribs and the obvious weight loss. After lots of threatening, Jessica agreed to go to her pediatrician’s and was then referred to us. How did it get to this point, and how did this family miss it?

Eating disorders can happen at anytime, but transitions are especially tough. Back to school, back to college, back to normal life. Simple, predictable, or is it? Not for everyone. Times of transition and change, such as starting a new school, going away to college, new teachers, different friends, all of it can be a challenge for some kids. Times like these can be risky when it comes to falling into the grip of an eating disorder. Couple that with society’s obsession with losing weight and it is pretty easy to understand why lots of eating disorders often go unnoticed until it is almost too late. As a parent, what signs or symptoms should you look for? Some things that you should not ignore:

  • Weight loss. Sounds obvious, but actually, especially in teenagers who are larger or fatter, parents mistakenly tend too think the weight loss is a “good” thing. Even doctors make the mistake of automatically praising weight loss, especially if it brings a child closer to a “healthy” BMI (gag).  That meaningless number does it again…….clouds the judgement of otherwise smart and well-meaning people (parents and professionals alike). The great news is the American Academy of Pediatrics came out with a new report in August highlighting the risk of treating obesity in adolescents with disordered eating as well as the importance of focusing on health verses weight. See this article in American Academy of Pediatrics for the specifics. The bottom line is that we need to get off the losing weight bandwagon, fight the cultural message that everyone needs to be thin, or a certain BMI, and NEVER EVER praise weight loss in a teenager. Yes, there are times when a kid may lose weight. A teenager who is very sedentary who goes away to college and finds themselves having to walk 9 miles a day just to get to all their classes may indeed lose some weight. This is not what I am talking about. But even then, making a big deal about weight loss is never good. Even this kid, if they get lots of attention for losing weight may decide they like the attention, and start doing things to purposefully lose weight (I have seen this happen many times). Don’t do it. Don’t compliment weight loss in a kid. Instead, compliment growing up and being successful.
  • Food refusal. When your teenager has always loved your home-made macaroni and cheese, and even begged you to make it, but now refuses to eat it, NOT GOOD. Unless there is a really good reason for refusing a favorite (recent stomach bug, stomach ache, cramps, etc) don’t ignore this red flag. Should you try to force your kid to eat it, or pressure them to answer you as to why they don’t want it? Like I said, one refusal because they don’t feel good is normal, but a few times in a row is just not normal, however responding with anger is not helpful. Instead, I have found those parents who are able to open up a caring dialogue with their teen have a better chance at getting to the bottom of it. It is important to pay attention to all signs and symptoms so you can then make a plan to address it. Forcing food or anger does not help.
  • Decreased socialization. For a teenager with an eating disorder, any situation that involves food and eating is threatening. You will start to notice they don’t want to go to their friends houses, or to birthday parties, and they especially will try to get out of family functions (those typically aren’t a teen favorite anyway, but they are doubly horrifying because of the food involved). They may lose interest in going to what once was a favorite restaurant and a big treat. They will refuse to eat the family’s favorite pizza on “pizza night”. Red Flag.
  • Loss of menstrual period. Not that you need to keep track of your teenage daughter’s cycle, but if you notice she does not ask you to buy feminine hygiene products the way she usually does, ask. Don’t ignore it as this can be a sign of weight loss and inadequate calorie intake.
  • Obsession with exercise. If you notice your teen going out for long runs, or running both morning and night, or if you notice the bedroom door is always closed and when you walk in she just so happens to be exercising, this could be a sign that something is not right. Yes, being active is good for all of us, but if doing calisthenics is something new and different, and especially if your teenager seems to be hiding it, then this is also a red flag.
  • Going to use the bathroom after every meal. If this has always been normal for your child that is one thing, but if it is a new behavior, it could mean they are purging or throwing up their food. You can check the bathroom for evidenced or you may hear it, but don’t ignore this. Vomiting on a regular basis is an eating disorder behavior and could leads to electrolyte imbalances that can be deadly.
  • Body checking. Do you notice your teenager looking at her body, especially her stomach obsessively? Does she tend to squeeze her arms as if to check for fat? This is a common behavior for people with body image issues and should not be ignored, especially if other signs are present.
  • Obsession with food labels, writing food in a journal, or counting calories. I can’t tell you how many food journals complete with calorie counts I have seen in my life. It is NOT normal. It is NOT a good thing. Yes, there are apps and websites and even the My Plate site has trackers for this. I hate them.This is as far away as normal, intuitive eating as you can get.

So what should you do if you notice any of these symptoms? Remember, your teenager is not doing this on purpose. They can’t stop. It is a very complicated disease and the triggers and causes are different for each person. It is important to be empathetic, kind and loving and to avoid blaming as this will not help. The first step might be to call your pediatrician and share your concerns. They will probably want to see and evaluate your child and may recommend therapy and a visit to a dietitian. Be sure that both specialize in treating eating disorders. Your teenager probably won’t be happy, but you can also get support from the therapist as far as how to handle resistance. The sooner you address the issue, the better chances for recovery. Remember, it does not matter what size your kid is, if they are fat or thin. It is very easy to ignore some of these red flags, like I said, some are so socially acceptable and desirable that it is sometimes hard to see what is going on. Don’t ignore these signs. They won’t go away on their own, and the longer you put off getting help the harder it will be.

There is hope. You can get your old teenager back.But you gotta move fast.

For more information and for great resources, check out the website: Eating Disorders Awareness and Prevention.

The Joy of Feeling Free: Do You Have It?

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IMG_9335They were sitting on the ground in a patch of sandy dirt, huddled together, focused on something that must be really intriguing, I thought. Why else would a 9 year old boy and his 7 year old sister be so content and quiet? As I got closer and peeked over their shoulders I was taken aback. Not what I expected. I was imagining there was some funky looking bug or maybe they had some hand held electronic device that kids these days are obsessed with. But no…..what they were focused on was creating the very best road system for their tiny little match box cars. There they sat, in the sun, all barefoot and dirty, happy and content as can be, just digging imaginary roads. I am guessing it was much more complex that it looked to me, you know how kids imaginations can be. But then again, with all the video games, etc. maybe things have changed. Anyway, I loved it.

This happened at a campground on Cape Cod where my husband and I were staying for a week with another couple. We had the perfect spot, secluded and right on a beautiful lake. Not a luxury vacation, but if you are the camping type, you would have loved it. The week long vacation was very different than the last vacation we took with our friends, a long trip to Italy where we stayed at beautiful places, with great food and good wine and lots of culture. Yes, this was different. No luxury here, nope. Not much culture, although campers might disagree with you, as well as Cape Codders. The “New England” feel is everywhere. But unlike our last trip, we were “roughing it”. No electricity, no running water at our site, the nearest bathroom facilities were a good walk up the hill, and the closest shower was a short car ride away (you could walk it, but you would need another shower by the time you got back).

Despite the lack of usual niceties, we had everything we needed. Two tents, 4 gravity chairs, fire pit, picnic table complete with checkered tablecloth and canopy in case it rained (it didn’t).  We had our “camping kitchen” which provided extra counter space, storage area for pots, pans, paper plates and packaged foods, and then we had our coolers filled with ice and all the necessities to get us through a few days. We were spoiled with our air mattresses (that had to be inflated by running an extension cord into the bathroom, the only place with electricity), and we had 4 kayaks, 4 bikes, a double tube and a spare air mattress that we used as a float. Imagine 4 middle aged adults floating around a lake holding onto each other, a mattress, a float and 4 drinks, giggling as the wind blew this motley crew wherever if felt like. We were in our glory, feeling like kids again. The reactions we got from various people we eventually encountered were funny. Some you could tell wish they could join us. Others, well, kind of eased their children in the other direction.

It took a few days, but we got into the swing of things. As usual, I packed too many clothes. I pretty much lived in my bathing suit (the one I kayak in, which is basically shorts you can wear in the water with a modest bathing suit top that could double as a halter top. Really comfy yet practical). And my 5 dollar Old Navy flip flops. Never wore a pair of earings, no make-up needed (no mirrors anyways). I washed my hair twice, why bother when you will be jumping in a lake every day? Yes, it was a wonderful feeling. Feeling like a kid again. Simple and Free.

Even when it came to eating, things were different. First of all, I have a new appreciation for my automatic coffee maker…..you know, the kind that grinds the beans and has the coffee ready a few minutes before the alarm goes off? We did have coffee, we made sure of it, but it was no easy task. First of all, I was always up first. Even though we rarely knew what time it was, my body knew it was past 6 am so I woke up (our cell phones kept dying, no way to charge them consistently). If you have ever used a camping type stove, you know they run on propane. So you have to hook it up, then open the stove which clanks and clicks, and then use a lighter to start the thing, and finally, fill the pot with water. We had the old fashioned stove top percolator, so it always took awhile. When it came to meals, we were all on different body clocks so that took some doing. I like something sweet when I first get up, so one day I took my bike on the bike trail down to a wonderful French bakery called something like “Eat Cake for Breakfast”. Ok! There usually is a long line but not at 8 am. Everyone was happy with the treats I brought back that day. We were so random with our meals, without schedules or clocks it was truly natural eating. Buying the exact food we wanted (I NEEDED fried scallops, my husband NEEDED fried clams, my friend NEEDED ice cream). We ate what we wanted. We savored the specialties of the Cape which included lots of fish and home made ice cream and of course those Cape Cod potato chips. We all brought food too, and the meals we created at the camp site were sometimes funny….but delicious. We doctored up leftovers to be resourceful. One of the last nights I created a dish made with ratatouille, leftover grilled chicken, fresh corn scraped from leftover corn on the cob and grated cheese. Everyone loved it. I made a sangria with leftover fruit and red wine along with some bruschetta from Italian bread that was getting stale. After this wonderful meal we rushed to the bay to watch yet another sunset and play our lawn game, Kubb, Check out this link which can also be played on the beach : ) We blasted our music (old Beatles tunes one night), sipped our drinks, laughed as the sun disappeared and the moonlight took over. Walked barefoot, back to the car, another wonderful night spent without jewelry or make-up, shoes or clocks, TV’s or computers. Just the sky, the water, the sand, the stars, fire and friends.

I am not going to lie. That first real shower felt good. Sleeping in my own bed was awesome, and it was especially great to have a bathroom within walking distance. But since coming back to reality, and after chatting to a few family members and friends about my trip, it struck me how fortunate we were to have the ability to enjoy ourselves despite the lack of structure or predictability, the absence of technology or schedules for anything, from eating to exercise to reading and sleeping. We may have joked about those stairs up the hill leading to the bathroom, and how crazy it was to have to drive to take a shower, but the reality is we loved having an excuse to be kids again, to feel free, and to be free. We obviously can’t live this way every day (you really do need to wash your hair and wear shoes). But, how structured and predictable do we really need to be? Do you find yourself panicking if you can’t eat what you think you should? Do you get bothered if things aren’t perfectly clean and in order? Are you imprisoned by needing everything in your life to be on a tight and predictable schedule? Do you ever give yourself permission to let things go “just because”? Do you allow yourself down-time to reflect, or simply to just walk barefoot and feel the grass against your feet, and the sounds of nature to fill your head instead of the sound of television? Do you get to play mindless games like Left Right Center, or do you feel guilty when you are not productive?

Yes, this morning, being that it is my last Monday morning off in a long time, I am truly feeling thankful. I am appreciating that I can let go and be mindless, eat whatever, do whatever, live without a mirror or make-up or jewelry, not wash my hair, have French cookies for breakfast and not care. I don’t mind admitting I love my bed! and my own bathroom! But sometimes pushing your comfort zone makes you appreciate all that you do have even more. And sometimes, not accomplishing anything is a wonderful thing. Can you do it? How free are you?

Here’s my challenge: pick a day, just one day this week that you don’t have a “to-do” list. Eat whatever you want. Do whatever you want. Wear whatever you want. Let yourself be free. Just one day.

Just One More Mile: When Exercise is Anything But Healthy

On By jodietitianIn Uncategorized1 Comment

1620926_998862783473172_7494305765083366545_nHave you ever been at a crossroad in life when you just did not know what was going to happen next? I clearly remember the summer of 1979, a time of change for me. As I look back at how I coped back then, I have realized I may have been on the brink of something very dangerous.

I had just returned home from finishing my dietetic internship in Nashville, Tennessee. I had been away at college for 4 years, and then a year away for my internship, and for once in my life, it did not feel right to be home with my parents and younger siblings. I couldn’t quite explain it, but pretty much everyone got on my nerves. I had applied for a few jobs, but in the mean time, I needed to find a way to cope with everything. As you may know from a post a few weeks ago, in college I had taken up jogging when I quit smoking, and it literally changed my life. I continued my running down in Nashville (it was hot!) but only did a 2-3 mile loop around the hospital grounds and Vanderbilt campus. This has always been just enough for me to relax and meditate, and easily fit into my life.

But when I came home that summer, something happened. For some reason, I felt like “challenging” myself. My younger sister Fran also was into jogging, and we had lots of fun running and talking. Our loop was only a few miles and was perfect. Being my little sister, who was very sweet and agreeable (she still is), well, it was easy to convince her to add on a mile. When we first ran 5 miles, I remember, we both felt pretty awesome. Wow, look how strong we were! I wonder how much longer we could run? Before you knew it, we were up to 7 miles. Then 8. Finally, only once in my life, I did 10. It was a drizzly day, I vaguely remember, and it took me a very long time. But at least now I could say “I ran 10 miles!”

Yes, it felt very cool, and we both felt proud of ourselves until something weird started to happen. It wasn’t enough. If for some reason we only had time to do 5 miles, I remember feeling a sense of guilt and inadequacy. I couldn’t understand what was happening, but somehow this running that started out as fun and good was turning into something that was, well, getting a nasty grip on me. And I did not feel like I could control it, yet I did not recognize what was going on. Thank goodness, that phone call finally came. I got a job! It was out of state, so I would have to move into my own place in Massachusetts. I was so relieved!

Then, the funniest thing happened. I found a place, found the local High School track, and after work went to jog. For some reason, I no longer had to compete with myself. Now, 3 miles was enough again. What happened? I felt content, proud of myself for getting a job, and excited about this new life I was entering.

Looking back, I now know what happened. I was using running as a distraction from my feelings of fear. It may have been fear of change, fear of failure, fear of rejection. Maybe I was not smart enough to get a job? Maybe nobody would want me! It was terrifying. But I did not feel that at all at the time. That is because I found a way to numb myself. I took something that was once a blessing in my life, something that made me feel good and helped me cope by relaxing me, something that was not harmful to me at all, and turned it into something that had the potential to destroy me.

To be clear, there are many people who are very stable, happy, and healthy, and who are marathon runners, but the difference is, it adds to their lives. This is not what I am talking about. Real athletes don’t feel guilty about taking a day off, and they aren’t trying to escape from their real feelings. It is only when something like running serves to distract someone from dealing with life that it can become unhealthy. When we don’t deal with our feelings and pretend all is good in our lives when it really isn’t, well, something eventually is gonna give. Day to day life is not very fun when all you think about is something that is getting you nowhere.

If you can relate to this story, or if you find yourself compelled to exercise for the wrong reasons, remember, the first step is realizing you have a problem. I was fortunate in that the dynamics in my life just happened to let me slip back into normal life. Once I left, my sister also went back to a normal lifestyle. This is not always the case. If you have been struggling with this issue, or find it hard to stop, seek help. Don’t let the years slip by. You are not alone, as our culture admires unhealthy behaviors such as exercise addiction, so getting out of something that is culturally acceptable takes some doing. I always recommend even just one visit to a therapist or psychologist to at least get a professional opinion if you think you might be using exercise to distract yourself from life. That way, at least you are taking a step. That one little step can be life changing……and get you farther in life than any marathon ever.

 

 

More Than “Bedside Manner”: How Your Doctor Influences Your Health…or Not

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medical-doctor-1236728Do you dread your yearly visit to the doctor? An acquaintance of mine recently shared how frustrated she gets with her physician. Her blood pressure is great, her labs are fine, she has energy galore and a healthy lifestyle, yet, the doctor insists on focusing on weight. The unbelievable part though is how little information this doctor actually gathered about my friend’s lifestyle. No, he did not ask about her concerns or her struggles. He had no idea she had been actively eating healthier, spending less time eating out and more time cooking healthy meals, was being more active and had decreased her stress level by changing jobs. No, he was making assumptions based on the number on the scale. Even though this friend had indeed lost some weight from some subtle changes in her lifestyle (not going on a diet, just making changes that resulted in normalizing her blood pressure, and the slight weight loss was coincidental). When my friend went to this visit she was actually very happy about her improvements in health parameters, but left feeling insulted and inadequate….like she was still doing something wrong.

It is a common scenario. Typical visits to the doctor often involve some type of health education and probably recommendations. Health professionals such as physicians, nurses, dietitians, and others have lots of knowledge in their heads, and they know what is best for us regarding what we need to do to be healthy. Typical advice:

  • You need to lose weight.
  • Cut down on sugar.
  • Cut down on fat.
  • Exercise more. At least 30 minutes a day.
  • Drink more water.
  • Drink less beer.

My question is: Do they REALLY think we don’t know what we are supposed to be doing? The problem is not in the “knowing”, the issue is with the “doing”, or the motivation to change. So the wise doctor or other health-promoter should probably consider focusing on how to assess motivation to change, how to identify the obstacles and how to help their patients to do what they need to do instead of simply telling them what to do and then scolding/judging them when they can’t do it.

Lo and behold, there actually is an approach to helping people change behavior called “Motivational Interviewing”, or MI.  This approach was originally used in the treatment of addictions, specifically alcoholism. But experts have learned that the empathetic and empowering approach of MI is also beneficial to many other fields where behavior change is key. Now, doctors, nurses, dietitians, therapists and others are getting trained because they want to help people achieve their behavior change goals, and they know from experience that the old-school approach (telling people what to do, shaming, scolding, etc) does not work.

Is your primary care physician trained in MI? Granted, some people are just naturally empathetic, and have the skills to motivate people to change. But, most of us use our instincts and do what comes naturally, and unfortunately, we are often wrong. What is wrong with emphasizing how forgetting your insulin is going to result in severe damage to your body? I know of one endocrinologist who threatened a young teen who had pre-diabetes that “if you don’t lose weight and get your blood sugar under control, we might have to chop off your foot!”. Do you really think that helped that kid leave with motivation to eat healthier? The opposite actually tends to occur. When we scold, shame and threaten, people actually become even more resistant. It doesn’t work. They don’t change. So if you leave your doctor’s office feeling shamed, guilty, bad or afraid, or even worse, you don’t want to ever return, well, chances are they may not be on top of their counseling skills.

Instead, when you leave your doctor’s office, you should feel heard. Your doctor ideally should be asking you some open-ended questions that require more than a yes-or-no answer. For example, instead of ” are you eating healthier?” a better question might be “tell me about the things you are doing to eat healthier, and what your obstacles are”. This type of open-ended question allows you to go through some details of what you have been doing or what your struggles are. Then, instead of the typical answer, or response of telling you what to do (“you need to eat more fruits and vegetables”), a more helpful response would be reflecting back what you said, and checking to be sure you were understood. For example, “so you have decreased eating out, but you still struggle with eating more fruits and vegetables because they are expensive and you don’t really like them, did I get that right?”. This type of reflective response shows empathy. There is some research demonstrating that patients who go to a doctor’s visit where they felt empathy actually leave and are more likely to be successful and compliant with recommendations verses those that were merely told what to do. We are all different, our issues are different, our lifestyles, and our readiness to change health behaviors, and being treated with empathy goes a long way to facilitate change.

So what does this mean to you? The most important thing in my opinion is to get regular health care.  When someone does not go back for follow up health care only because they were treated poorly, were shamed or blamed or otherwise disrespected, that is a tragedy. The repercussions can be great. Imagine developing hypertension and never being treated for it merely because you did not go back to your doctor.

If you can relate to being treated this way, I strongly recommend looking into finding a doctor who actually knows what motivational interviewing is. There is plenty of research involving the use of MI in a medical setting, and the benefits of treating patients with empathy. Talk to friends who love their physicians. Do some research into different practices, or just come out and ask directly. Don’t miss getting preventive care just because of the way you were treated. There are plenty of wonderful health care providers who have the skills to get you the help or support you need to be the healthiest you can be. Your health is too important to ignore. For more information on MI, check out the website: Motivational Interviewing

Remembering a Day That Changed My Life

On By jodietitianIn Uncategorized1 Comment
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Your future is in your hands

It was a cold and drizzly fall day,the year was 1976. I had agreed to meet my friend Joe outside in the parking lot of the condominium where we lived off-campus at The University of Connecticut. At the very last minute, I found myself changing my mind. I did not want to do this. What if I couldn’t do this? I was feeling insecure and afraid, but yet, when I agree to something I hate backing down. My motto is “you never know until you try”. For instance, I tried golfing once, I tried to get on a horse, and I tried skiing. People seem to love these things, and I wanted to understand why. After getting kicked by the horse and breaking my leg in two places as well as my ankle on the bunny slope, well, I can say I tried. Golf didn’t work out either. It was kind of like baseball for me, I just could not hit the darn ball.

So there I stood in the drizzle, waiting in my new Nike sneakers and windbreaker. He finally shows up and starts talking, giving me such encouraging words, describing what we are going to do and how we are going to do it. Joe was a physical fitness major and he knew what he was talking about. I had recently quit smoking cigarettes, and I needed something else to help me deal with life in general. After chatting with him the days before, I agreed to give running a shot. He was here to help me, and to guide me on my very first “run”. He had mapped out our route, which simply was a half mile to the end of the street and back, totally an entire mile. He guided me through some simple stretches, and then we started. Can I do this?

I literally felt like a fish out of water. Just a few months ago, I could barely walk to class without running out of breath (and would light up a cigarette once I finally got to sit down and catch my breath). It had been awhile since I smoked, and I actually was feeling so much better (I did not realize how bad I felt until after the fact…..when I had much more energy and realized this is how I am supposed to feel! this is how people who don’t smoke feel very single day).  I also need to share that my roommate Marion at the time was my inspiration to even consider this. She was a runner, and loved it, and although I did not understand why, I wanted to be like her! So Joe and I started out on this country road, and I started to run as fast as I could (isn’t that what you are supposed to do?) but he stopped me. He showed me how to pace myself, and trust me, it was VERY SLOW! So slow, in fact, that it actually felt GOOD. I could breathe. My legs felt strong. I could do this.

We made it to the end of the country street and turned around. I will NEVER FORGET how I felt when we got close to the end of our “run” and I could see our condo complex. I am going to make it, I thought. We reached the parking lot and I felt something shift inside of me that changed me forever. I loved that feeling so much, that feeling of success and accomplishment, it changed my “definition” of who I was, and who I wanted to be. I think we all have our own self-dialogues going on in our heads, thoughts nobody else can see about ourselves that eventually create who we actually are. Sometimes the thoughts are self-deprecating. “You are so lazy! You can’t do that!”

Yes, I can. And I did.

After that, I looked at myself in a very different light. I loved the idea of feeling good, and being healthy and fit. THAT is who I wanted to be. NOT someone using cigarettes to deal with stress. But, I definitely needed something, and the reality is, when we give up a “habit” it is almost always necessary to substitute something else. In my case, it was running. It became my new “habit”. It stuck. For years. Over time, I increased my distance and my usual runs became 2 or 3 miles. I did not run fast, but I loved running longer. It gave me time to think and meditate, solve problems, plan and dream. As I got more fit, running was just as relaxing as sleeping. I started to do road races and loved the camaraderie of other friends who had discovered the same joy I had.

Over the years, my running habit has shifted along with my life. It is funny, but I think because I always ran after classes (4-5 pm), that is the time my body seemed to crave movement throughout my life. To this day, after work, I just can’t wait to move. My body just craves it. I went through phases of running longer distances, but now prefer walking and slow jogging. I can day dream on a track, on the side walk or even on a treadmill. It doesn’t matter to me, just let me move. It can be kayaking on a local reservoir or mowing the lawn. I just need to move. If you have ever taken a few minutes to watch young children outside, they usually can’t stop moving. I think it is innate in us to move our bodies in ways that are fun and enjoyable. When we put unrealistic goals and numbers and expectations on it all, well, to me the fun is gone. Maybe that is why people “hate exercise”?

The benefits to my life thanks to Marion and Joe are too many to count. Because of this life-changing experience, I can enjoy vacations as much now, at my (older) age as I did in my 20’s. I can hike up Red Rock in Sedona, or down the Grand Canyon. I can walk for miles up and down the cobblestone streets of Cinque Terre in Italy. I can walk almost the entire town of Venice, never tiring. I can enjoy all of the bike trails on Cape Cod, explore the cliffs of Gay Head, garden for hours, walk all over the lively North end of Boston and still dance the night away. Yes, that day changed my life.

Since that day, I also became passionate about promoting health. I felt it, the way this simple act changed my life and my identity, and I wanted everyone to feel it, too. With every patient I have ever worked with, this has been my goal. So many people focus on how they look, and not on how they feel. They focus on the number on the scale, they judge themselves for that, and the self-talk and dialogue in their minds do nothing to help them be who they are supposed to be. People “try” but unfortunately, not everyone has a “Marion” for inspiration, or a “Joe” in their lives who can guide them in such a gentle and self-loving way to be the best they can be. To just start. One foot in front of the other. One pedal around the block. Dancing to even one favorite song.

Unfortunately, not every has the physical ability to enjoy all kinds of fun movement. I know many with joint issues, back pain, muscle issues, and other ailments that will always impact them. I am so grateful to be blessed with a body free of pain, and know that many do suffer. If you can move without pain, you definitely are blessed.

As I was writing this blog, my husband walked in and asked me to read what I had written so far. So I did, but as I started to read the 4th paragraph (“We made it…..”) I could not continue. I got choked up. That is how powerful that experience was, that is how important to my life. It took me by surprise, how strongly I felt, but then again, life-changing shifts in self-identity can do that.

I hope you take a minute to stop and reflect on your own self-thoughts and the dialogue in your head. Do you have unrealistic expectations when it comes to “exercise”? Do you call yourself names? Use the “L” word? When it comes to moving, to be clear, I definitely do not think everyone should be running! I have absolutely no advice on what anyone should do as far as physical activity. YOU are the expert on that. YOU know what you love. Some people absolutely love competition, enjoy running fast, getting stronger and stronger, keeping track of times, and amounts of weights they can lift, how many reps they can do, etc. The bottom line is, they enjoy it. It makes them happy. If what you are doing is not enjoyable, or does not make you happy, that is a different story. I just hope you look at moving in a different light. If you look at it as a means to an end, it may be hard to enjoy. If you instead can find something that has the capacity to be one more thing to enjoy in your day, a fun way to move your body (think kids, think hula-hoop, think fun, think freedom), well, that may be something you keep in your life for as long as you live.

So, that is the story. A day that changed my life, who I am and is part of why I have a passion to help people be healthy. Not perfect. Just healthy. I don’t want to be the only one on the dance floor when I’m 80.

 

 

Were You “Bad” Today? And Why is it so Hard to be “Good”?

On By jodietitianIn UncategorizedLeave a comment
Chef’s Salad: Good or Bad?

My daughter was visiting yesterday and was telling me about a weird conversation she had with a woman in line at Subway. After going to the gym she had decided to run in to get a grinder (she is like me, we hate spending money on food we can make ourselves) but sometimes saving time is more important. So she ordered her grinder and the woman behind her says “oh you are being so good!” Huh? “you got vegetables on yours!”……”but I like vegetables on mine….”my daughter said.

The woman goes on to say something about the fact that my daughter had on work out clothes from coming from the gym. That made her “really being good” in this woman’s eyes. The discussion led to this stranger sharing that she had been “bad” for almost 3 years, had not exercised but was just starting again. She was going to make herself eat vegetables, too. But not today. Today she would be bad.

I know I have talked about the language of dieters, of the moral judgement (of oneself) depending on if certain foods are consumed, or if food is “burned off ” with self-induced and not-too-fun “exercise”. But this lingo means so much more if you ask me. It is another one of my triggers to shake my head and feel sad, angry, not sure what. This language goes back decades, and is so ingrained in our culture that when you don’t buy into it, YOU are the weird one. YOU don’t get it, don’t fit in, aren’t normal. Of COURSE there are bad foods and good foods, people tell me.

I can debate why any food you can name is “good” if you happen to like it. “Good” is just a word and can mean different things to different people. To the dieting woman at Subway, “good” meant eating vegetables and exercising. To me, good means something very different. If a food tastes good to me, well then it IS “good”! If you want to talk about how different foods contribute to your health, that is a different story. I happen to believe that since all foods have energy (calories) they are good in at least that respect. If you were hiking in the woods with no food or water, and stumbled upon a picnic basket with Twinkies and Koolaid, I’d call that pretty good.

No, the problem is not just in your interpretation of the words, it is how they make you feel. It is the emotional response you get (and often the behaviors that follow) when you have this judgmental belief system. It ruins people’s entire days. Entire weekends. Entire vacations. The word “good” and the word “bad”. It reinforces the belief that we need to restrict ourselves of certain foods if we are to be healthy (meaning thin in many people’s minds). Most people believe that if you eat certain foods then you are likely to gain weight, and if you eat other foods, you will be thin. I can’t tell you the number of comments I have gotten depending on what someone sees me eat. A friend of mine once commented “You must have a good metabolism! You eat so much candy!” when in reality, I happened to buy a bunch of penny candy while on vacation (it brings me back to my childhood, when we had a corner store that really truly sold penny candy….that cost a penny). So when I happen to go to a store that has Mary Janes and squirrel nuts and caramels, I always buy a few. It just struck me funny how a small little candy is supposed to make you “fat”. I don’t have a high metabolism. I just really enjoy that candy and the reality is a piece of that candy has less calories than an apple. But I am sure if I ate 3 apples, nobody would comment.

The other thing that often baffles me is what different people consider “bad”. To some of my patients, rice was bad. To others, rice was “safe”. Potatoes can go either way I have found. Some people think they are “fattening” however some don’t. So depending on who you listen to, potatoes can be good or they can be bad. Same with rice, and bread, and olive oil, and nuts. It is pretty confusing.

I have wondered where this all started, and from the decades of research on binge eating and “disinhibition” I know that it most likely has come from our dieting mind-set. It may have started with the labeling of foods by Weight Watchers of “legal” and “illegal” way back in the day (they don’t do that now, now you have points….still, crazy if you ask me. TOO MUCH THINKING). But probably before that, depending on the fad diet of the year. No wonder everyone is so confused. One year fat is the “bad” food and the next year “carbs” are bad. Why don’t people ever stop and wonder: how is it that bad food keeps changing?

My suggestion is this: have you entertained the thought of thinking about health? If you have, then is the obstacle that you just don’t like “healthy” food? Consider this: you may be so obsessed with unhealthy food mainly because you have been trying to avoid it. If you let yourself have it in moderation when you really truly wanted it, do you think you would want it so much? Or, maybe you truly have never developed a taste for healthy foods. There are so many people who grew up on canned vegetables and Mc Donald’s burgers. I have worked with many families who really have not tried fruits and vegetables because they did not grow up with them. I also have worked with people who just don’t know how to cook, and so spaghettios and Ellio’s Pizza are mainstays. We know that exposure to healthy foods (such as fresh fruits and vegetables) over time really makes you eventually love them. We call it the “Rule of 20” which means that if you keep trying something (say broccoli) that it takes 20 exposures to really know if you like it or not. Research actually has mostly focused on children, and it could take as little as 10-15 tries. The bottom line is, that you just can’t know unless you keep trying. I am on my 7th try of beets, and I still don’t like them. I won’t give up though. Thirteen more tries…over time.

The other problem is, we do get used to certain types of foods, and our bodies actually learn to crave them. For example, eating really high fat, fast foods on a regular basis can actually affect your body in a way that makes you tolerate them more and crave them more. But when you eat lower fat foods, or if you never eat fast foods, you may find you get a stomach ache when you do eat them. I am not saying we should never ever eat fast foods or high fat foods. But I do think it is important to take a look at your overall habits. If you never ever eat fruits and vegetables because you think you don’t like them, then you might want to just consider starting to try them. NOT because they are “good” but because we know eating more of them makes us healthier. You can still have those burger and fries, but learning to also like a salad on the side is a huge step toward being healthier. Experiment with cooking vegetables different ways. Read cookbooks or check out cooking websites for new and interesting ways to make vegetables. Just because a dish is “healthy” or “good” does not mean it does not taste fantastic! My favorite thing to do is experiment with cooking healthy foods and coming up with something amazing. For example, last night I made “ratatouille” which is sauteed garlic, onions, peppers, eggplant, squash and zucchini in diced tomatoes. But added some spicy turkey sausage, shredded carrots, several herbs from my garden, some leftover red wine and grated Italian cheese. I melted some mozzarella on top, we had rice and adobo seasoned grilled chicken. It was heavenly. Good? I’d say! and not because it was healthy, but because it tasted wonderful!

Here is my challenge to you: for one week, can you catch yourself when it comes to talking about food? When you go to eat something “bad” can you re-frame your words? Instead, say “this is yummy”. Try to tune in to your body and hunger and eat an amount that makes your tummy feel content. No need to stuff yourself, because you are not being “bad”. You are enjoying something that tastes good to you. Also, instead of avoiding something that you never eat unless you are “dieting” and being “good”, can you try it anyway? have a yummy salad. Try a new fruit. Don’t miss out on exposing your taste buds to good food just because you are “off” your diet. Who knows…..you may discover a new favorite. Stop labeling food. All foods are equal.

Well, except beets maybe. But I won’t give up.

Oh, and that chef’s salad in the picture? It was good!

New Study Links Positive Effects From Calorie Restriction: Why I Hate News Blurbs

On By jodietitianIn Uncategorized1 Comment

 

Green BeanI literally stopped in my tracks the other morning as I was walking out of the kitchen to go get dressed for work. The first thing I do when I get up in the morning (after pouring that critical first cup of coffee) is turn on the small television that is in our kitchen so that I can listen for the weather and traffic. Like most people, I have my routine that gets me out of the door on time. But that morning, the words I heard caught my ear and I had to listen. “New AMA Study shows calorie restriction has positive benefits!” Oh brother, here we go, giving people another reason to diet. I listened to the brief details (how much can you pack into a 2 minute blurb?) and learned that apparently decreasing your calorie intake by 25 percent can improve your mood, quality of life, sleep and sexual function. Really? I didn’t have time to check into it but knew I had to as I like to be prepared when someone asks me a question about things like this. Most people just automatically believe what they hear and that is what troubles me.

So I searched and found a summary of the study, see AMA Study To read the entire study you have to pay for the article unless you are a member of the American Medical Association (which I am not) so instead I just read the abstract. What I learned from working with many researchers in graduate school is that we need to consider many factors when it comes to study conclusions. We need to be critical. This is not easy, especially if the research is in an area where we are not experts. The field of nutrition and health is a complicated one because so many factors influence our health (and our weight). So I always look at a study and try to decide how much it means, if anything in the real world. I like to look at some of the obvious things, such as the number of subjects and the kind of people who were involved in the study as well as the length of the study. In this study, the 220 subjects were “nonobese” and “healthy”.  The subjects were divided into 2 groups: “calorie restriction” (CR) or “ad libitum” (AL). The measures were taken over 2 years (initial, one year and 2 year) and the results are based on “self-report”, in other words, people answered questionnaires. We know there is always a degree of error in self-report measures as people often answer the way they think they are supposed to. We also can’t know all of the confounding factors, such as the other influences in peoples lives that might have had an effect (a new job, a new baby, getting married, etc.). There are so many factors that affect mood and energy level. To believe that simply decreasing calorie intake can have all these benefits is wishful thinking. Even if after many replicated studies (which is always needed to really show cause and effect) do you really think it would be easy to figure out how to decrease calories by 25 percent? That is a lot! How is nutritional status affected? What if someone decides to cut out milk to achieve this goal? What happens to their bone health over 10 years? Do you think you will be in a better mood if you have osteoporosis? When you can’t get up and walk without pain? Maybe I am being a bit sarcastic and extreme, but the point is, it is never ever that simple.

Unfortunately, the people who heard this news blurb and may react to it are probably the ones who are already dieting and restricting to lose weight. In particular, I worry about those with eating disorders who are looking for an excuse to restrict. Remember, there is always opposing research that shows the exact opposite. In this case, you probably don’t have to do a literature search to know (but there is plenty of evidence there) that starving yourself or excessive dieting is more likely to lead to depression, not being happy. It is more likely to decrease your quality of life, especially if dieting and weight obsession become your focus. People I have worked with who have struggled with eating disorders have often lost so much. Having to take time away from college, or your family to be admitted to the hospital due to dehydration or starving, not being able to participate in activities you always enjoyed just because you don’t eat enough, even not being able to drive (I have seen it). Losing friends because they just can’t be around you any longer and watch you do this to yourself. ….this is the reality of calorie restriction.

Instead,  when you hear a news blurb that briefly shares a dramatic result such as this one, stop and think about how different we all are. Our lifestyles are unique, our dieting history and relationship to food is unique, and most importantly, our genetics are ours alone. Reign yourself in and refocus. What were your goals again? To feel good and be healthy and enjoy life to the fullest (I hope).  What are YOUR obstacles and barriers? Are their habits you have that you know might be affecting your health? Stress from work (need a new job?) Stress in your relationship (need some couples therapy?) Smoke too much (need some help here?) Drink too much (do you need to get help, or work on your habits?) Too tired to be active (time to see the doctor for that physical you keep putting off?) Live on fast food (time to start learning how to cook?)

Achieving health and happiness is not always simple. And even when you do achieve it, trust me, a wrench will be thrown in from time to time, such is life (as my mom always would say).

Decreasing your calories by 25 percent?…..not this girl.

 

Plea to Parents of Fat Kids

On By jodietitianIn Uncategorized2 Comments

lookHave you ever been in a situation where you witnessed a parent doing or saying something to a child that you felt was wrong? Did you say something, or did you bite your tongue? Sometimes, don’t you just want to say “are you kidding me? You did not just say that. Do you not realize how stupid that is???” Well, I have felt that way, many, many times when I worked almost exclusively with “obese” children and teenagers as an outpatient dietitian. I felt like saying not-nice things to parents, siblings. and even other health care professionals (such as the pediatricians who referred them). I just could not believe the stupidity (not a nice word, and I never use it, however it is how I felt at the time). But, it is not stupidity at all as most of the people and a majority of the parents I worked with were very intelligent. Really smart. But when it came to how they treated their children, or how they treated their patients, well, they just were not wise. Not wise at all. And it truly broke my heart…..I wanted to scream, but I couldn’t because, well, I would have lost my job and then I could never help anyone at all.

This is a topic I am passionate about, and I already vented a bit in 5 Things You Should Never Do if your doctor tells you your child is overweight. But I want to take it a step further. I think it was something I saw in a little girl’s face that touched something in me last week, and I can’t forget it. I was leaving the Nutrition Office where I am temporarily covering an afternoon here and there, and as I was walking out at the end of the day I noticed a little girl sitting in the waiting area. She was with her mom, kind of clung to her, waiting to see the dietitian. She was probably 6 or 7 years old and was likely starting the weight management group program (or maybe was already going and just coming for a follow up, I don’t know….but from the look on her face, she looked as if she was on death row). Just to be clear, this “weight management program” does NOT focus on losing weight for children. It is expertly organized and run under the guidance of a very experienced, sensitive and wise psychologist. The focus is on the family as a whole with an emphasis on everyone improving their lifestyle to get healthier. The name of the program has absolutely nothing to do with weight, which is a good thing. The problem is what happens when the child goes home.

Just as with picky eaters, parents of “overweight”or “obese” or “chubby” or “fat” kids (however they are labeled by family, friends, doctors) tend to get treated in an “old-school” way of thinking. For picky eaters, for instance, we learned way back when to make a child “clean your plate”, or “finish those peas” or you won’t get dessert. Just because parents have been doing that for decades does not mean it works or is the right thing to do. We now know this promotes even pickier eating, kids growing up to be adults obsessed with sweets (because when you are 32 you can skip the darn peas and go straight to the dessert). It doesn’t work.

The same holds true for children and weight. The minute the child gets wind that a parent is concerned about his weight or body size, things change. The first mention of “do you really need that?” starts the ball rolling. Sometimes parents start making comments like this after a yearly check up when the pediatrician may mention something about BMI. Sometimes it is just the parent noticing a change in their child’s body. Often times, I have encountered parents, usually those with body image concerns of their own who are the worst offenders. They “don’t want their child to go through what I did” so they are going to make them skinny NOW. Or upper class, professional parents where it is important to portray a certain image, and having a larger size child or teenager does not reflect well on them. Everything needs to be perfect, including everyone’s bodies. I know this sounds crazy, but trust me, I have seen it. These cases especially trigger me and I have to use all of my personal resources regarding counseling skills and self-control to avoid saying something I will regret. What I want to say is “don’t you see how your failure to accept your kid for who they are is affecting their self-esteem? How can you be so shallow?” But I don’t because the reality is these are all good, loving parents who care about their kids. They are doing the best they can. Their intentions are good. The repercussions are really bad though, so I need to say something.

Not everyone accepts what I have to say. I usually try to focus on the research regarding restricting children, or even what happens when adults diet. This almost always leads to more focus on food, binge eating, eating disorders and yes, weight gain. When I ask if they notice any sneaking of food, inevitably the parent says yes. It starts when the child is restricted. So that often opens the door to the parent considering a different approach, such as focusing on health for the entire family. But it still is not easy for parents to change. They truly do want to help their kids, but it is complicated because of the parent’s relationship with food, their own body image concerns and dieting history, their beliefs about weight and healthy, their values, etc.

So what is my plea to parents? First ask yourself these questions:

  1. Do you feel that your child’s body size reflects on you as a parent?
  2. Do you feel you are a failure or did something wrong because your child does not have a thin body like their friends?
  3. Do you make comments about your body, your children’s bodies, other people’s bodies?
  4. Do you weigh your child EVER at home? Do you talk about that number?
  5. Do you allow anyone in your home to talk about another’s weight or body?
  6. Have you changed your behavior toward your child’s eating after a pediatrician visit where you were told something about weight?
  7. Do you forbid one child from eating certain foods but allow others in the home to have it? Do you limit portion sizes for just one child and not others?
  8. Do you force your child or teenager to use a treadmill, exercise bike or other forms of exercise to help them lose weight even if they do not enjoy it?

If you answered yes to any of these questions, my guess is your child or teenager is getting a few messages from you that may harm them, either now or in the future. The messages are:

  1. I am not ok the way I am.
  2. My body size is important in life. That number on the scale defines me.
  3. I should feel bad if I eat certain foods.
  4. Exercise is not fun.
  5. If I lose weight my parents will be happy.

Are these the beliefs you want your kid to carry with them on to their adult lives? Do you carry these beliefs as an adult? How has it worked for YOU?

What is the alternative? It is never too late to create a shift to a healthier relationship with food, eating and weight. You CAN help your children grow up to be the best they can be in every way including body size. You just need to accept the fact that we have absolutely no control on what are bodies want to be (that is in our genes). You can however work on your family’s lifestyle to promote health. You can work hard to accept the goal of feeling good and being healthy instead. Now that is a pretty good message to send to your kids I think. How do you do that? Here is a way to start:

  1. Throw away your scale. Vow to focus on promoting healthy behaviors and not the force of gravity on your body.
  2. Treat every single person who lives in your home the same when it comes to food.
  3. Talk about health, not weight or bodies.
  4. Defend your child. Do not allow anyone at anytime in any place to talk about your child’s body. That means siblings, dad, mom, aunts, uncles, grandma and grandpa.It also includes the doctor. Warn them ahead of time. Tell them you do not want to draw attention to weight. Assure them you are educating yourself about healthy eating and exercise (you can actually ask for a referral to a Registered Dietitian for help with healthy eating, but be sure the dietitian also knows you do not want to focus on weight, just health). Remember, your pediatrician is trained to look at numbers such as BMI and is obligated to diagnose “obesity” however they do not need to talk about it, especially in front of a child.
  5. Do not give your child a “look” when they are eating something, or taking a second helping. They will sense your judgement and it will hurt them. Remember, if you are offering healthy meals and opportunities for fun movement, your child will be fine. They need to learn to listen to their own bodies, and when the emphasis is not on restricting and controlling every morsel they eat, eventually they become less focused on food and eating. All kids are different and it depends on what they have already gone through, as well as their own genetic and psychological make-up. Your job is to set an example of a healthy lifestyle, that is how your children will know what matters. If they see you jumping on a scale every day followed by a reaction from you depending on that number, they learn that is what matters.
  6. Get help. If this is really hard for you for whatever reason, consider getting some support. If you have eating issues of your own, or if you are stuck in a diet mentality, or are afraid of getting rid of your scale don’t give up. I have worked with many women with eating disorders who fear they will somehow pass on their issues to their children. Just their awareness of their own issues really helps.

So my plea in a nutshell is, please let go of it. Let go of our culture’s focus on body size. Let go of thinking you and your entire family have to look a certain way, otherwise you are not a good parent. Instead, embrace caring about health. This does not mean eating perfectly or exercising a certain amount of time every day. It means moving in a direction that feels good and makes sense. If you could have seen that little girl’s face in the waiting room that day, you would understand. Please don’t do that to your child.