Margaret is in her 20’s, almost done with law school, an A student with a promising career ahead of her. Debbie is 54 years old. If you saw her you might think she’s got it all together for a woman her age. She is a smart dresser, hair always perfectly in place and she has energy galore. Pedro, on the other hand, is only 17. Tall and handsome with a shy smile who is the star swimmer for his high school. One of the “cool” kids, you would think he must be enjoying every minute of his teenage years. Robert is a 62 year old man, recently retired with his wife and known for his super fit physique. He still works out at the gym several hours a day and everyone knows him there.
What do all these individuals with seemingly a lot going for them have in common? They all are suffering from a disease that often goes unnoticed……until their world collapses. These completely different people all revolve their lives around “ED”. Short for “eating disorder”. ED does not discriminate between sex, race, religion, social class or sexual orientation. But people suffering from an eating disorder often have similarities in the debilitating affect on their lives.They likely wake up every single day of their(sometimes what feels like a) facade of a life thinking about food. They may weigh themselves daily with goal weights they have been obsessing about for weeks in Pedro’s case, or years, in Robert and Debbie’s case. When the number on that scale goes up, they have a really bad day. They may record every morsel and calorie they consume in a food diary, on an app, or in their minds. They starve, they binge, they purge, they are exhausted and feel like crap. And yet, even when they reach that initial “goal weight”, they still are not happy. So they lower it. Nobody seems to notice at first because our culture just loves it when people lose weight. Comments like “you lost weight! You look so good!” just fuel the fire. Our cultural focus on bodies makes it really confusing and hard for someone to stop the often dangerous behaviors they have fallen into. Even if someone manages to avoid serious medical and physical consequences (for a while) the psychological and emotional drains on a life are not always apparent to the outsider. But the person with the eating disorder often becomes depressed as they lose previously treasured parts of their lives (socializing, family gatherings, jobs, relationships) all because ED demands it of them. It becomes really hard for the person with an eating disorder to face food at social gatherings, to listen to comments and questions from family members expressing concern over weight loss and often sickly appearance as the disease progresses. Opportunities are lost, sports scholarships are taken away, dropping out of college and leaving a job, even relationship fall-outs happen because of ED. Sometimes, binge eating leads to excessive weight gain. Unfortunately, with the focus on childhood obesity, even children aren’t immune as they get the message at a very young age that the number on that scale really matters, and it is up to them to do something about it. The bottom line is appearance and body size of a person with an eating disorder are never the same, yet assumptions are made because of this, and this is a big mistake.
Every year during the month of February, the eating disorder community of health care professionals, those who suffer(ed) with eating disorders and the people who have been affected by them make an effort to educate us all. This year, National Eating Disorders Awareness Week is February 26th through March 4th. The theme or message is “Let’s Talk About It”. This is such a great message because the fact is, the earlier an eating disorder is identified and treated, the more chance there is to prevent it from getting worse, or to beat it. We need to talk about the fact that it is a confusing world with our focus on, and fear of fat. We get confused about what is important. Is it more important to be thin or should we just focus on being healthy? How do we fight the cultural ideal and still feel good about our bodies? And most important, we need to talk about the fact that nobody is immune, and no, you can’t tell if someone is suffering just by looking at them. Eating disorders strike children, teenagers, college kids, middle-aged and older adults. Fat, thin or in-between, rich or poor, educated or not, no matter what nationality or culture, you can’t tell what someone’s life is like or how miserable they may be.
Or, you may wonder about yourself. Is your obsessive calorie counting really a problem? Do you say to yourself “well, I do need to lose weight” and think your diet is just “healthy?” but you do feel drained from thinking about it all the time? Is it a problem that you feel guilty for missing the gym? Do you constantly think about your bulging middle-aged tummy and have started cutting out foods to fix it? Do you have an eating problem you are starting to worry about? To help you answer these questions, or to at least lead you in the right direction, why not take the free screening offered by the NEDA website (National Eating Disorder Awareness). Go ahead and take the free screening Get Screened, or share with any friends and/or family members who may know loved ones they are worried about. Remember, the earlier this debilitating disease is identified and treated the better chance for recovery. Don’t wait. It’s time to talk about it.
I was not surprised when my doctor told me I needed to take a calcium and vitamin D supplement after a recent bone density exam. Being at the age where bone density starts to diminish, and being a dietitian on top of it, I was fully aware that my intake of calcium was sub-optimal. But time flies by, doesn’t it? No matter how much I know about nutrition, somehow here I am. Although I do believe in good nutrition I have never been a fan of thinking about it too much (unusual maybe for someone in my field of work).
“I chopped down a corn stalk yesterday!” my patient (I will call Susie) said as she sat down for our session. She had binge eating disorder, and was in the habit of restricting her intake severely during the day, then after work she would pull into the drive-through of several different fast food establishments on her way home. First for several double burgers, fries and giant milkshake. Then, Dunkin Donuts for a bagful of donuts and large coffee drink. She would gobble this down with predictable feelings of guilt and remorse afterwards. No matter how much resolve she had the next morning (“that’s it! I am starving myself today, I don’t deserve to eat. I will make up for it. And today, I won’t do it” ) by the time 5 pm rolled around, her starving body screamed at her and her conditioned brain went into automatic pilot. Her car just seemed to turn automatically into that darn entrance with the sign that said “Drive-Thru Entrance Here”along with the giant yellow arrow to be sure you do not miss it.
Eating 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.
I 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.
“What percentage of my diet should be carbs? What about fat? and how much protein do I need?” I get this question all the time and usually give the same answer: do you really want to think about that every day? The point is, even as a dietitian who is somewhat good in math I would never want to calculate these figures on a daily basis. Even using an app. But many people are confused about this, they hear things at the gym, their marathon running friends are carb loading, or maybe they saw a magazine headline at the grocery store check out. Not to mention goals of losing weight, which usually are part of the motivation to find the best combo of macronutrients that could be the magic answer.
Have you ever tried salami on a cinnamon raisin English muffin? Add a slice of provolone and some mayo and amazingly, it is not half bad. That was the only thing I could put together from the fridge for my bag lunch for work one day last week (or was it the week before?). My dad was very ill and did not have long to live, so all of us spent as much time with him and my mom as we could. Grocery shopping was not the priority at the time and so salami and cinnamon was it.
I was at a lovely outdoor graduation party yesterday and happened to walk in on a conversation that was going on between a sweet young man in his 20’s and my husband. “She’s a dietitian, you should ask her”. Apparently, this healthy-looking but thin young man was trying to gain weight. He had been a runner in high school, now worked out but not as much, sharing that when he was lifting he was able to put on some weight. I went into my spiel about “listening to your body”, explaining how our natural set-point makes it difficult to change (our genetics) and that even if he tried to eat more or add protein shakes (what he has tried in the past), it would be hard to maintain due to the fact that it requires way too much thinking and also, just as with dieting, your body tends to compensate and do what it needs to so you will go back to where you are supposed to be. “But what should he eat? He doesn’t know!” my husband says. I looked at this guy and he says “he’s right, I don’t really know”. Oy. How did eating become so complicated for even a twenty-something year old male? I kind of understand, it makes sense that women, especially older women who have spent a life time dieting and not being happy with their bodies continue to try one diet after another, end up on and off restricting and overeating, but this just felt odd to me. I just wanted to say “Just eat what you want!” It struck me at that moment that people who don’t know much about nutrition and really do care about their health (and body size, which always seems to be the motivating factor to look into nutrition) really don’t know where to begin.