Tag: eating disorder

Trying to Lose Weight? 5 Reasons You Should Never Have a “Goal Weight”

On By jodietitianIn Uncategorized5 Comments

Mannequins head“I want to look like a supermodel” she said. Her answer to my simple question of “how can I help you” threw me. “Have you ever seen a supermodel?” I asked. “No” she said. “Then how do you know you want to look like one?” was my response. She was a young woman who needed some nutrition guidance, referred to me by someone who was worried about her eating habits. Although I loved her brutal honesty, I had to regroup to figure out what direction to go with this. Before I did anything I needed to find out much more. Oh, and she had a very specific weight in mind that she felt would accomplish this goal.

As is usually the case, when someone is bent on focusing on such a specific physical goal, there usually are other matters going on. I was relieved to hear that she had a therapist so I proceeded to find out more regarding her eating and exercise habits before I rushed into education and explaining why wanting to look like a supermodel was not a reasonable goal. To be clear, although this is a true story, it could be anyone I have seen over the past 30 years (and although I am changing a bit of the specifics as I usually do, her eating and lifestyle are not unusual and could be anyone’s). It was her statement about the supermodel that was a bit more direct than any I have heard, as usually people don’t come out and admit this. Somehow, deep down, I am guessing most of us understand this is not a smart goal and would never say it out loud.

The funny thing is when I asked her if she had ever actually seen a supermodel, she said “no” but then asked “have you?” I answered yes, because I had worked with a male model years ago who gave me lots of details about the unhealthy behaviors the models did before a shoot. Basically, they would starve and dehydrate themselves to look “cut” and then when the work was done, the binge eating began. Clearly, the image you saw in the finished photo was not the image of a body that was natural or that could be maintained more than a week or two (without serious consequences, such as hospitalization due to dehydration which happens often). Or worse. Yes, there are many people who are naturally super-tall and super-thin, and there may indeed be models who eat normally. In his situation however, this was not the case.

Anyway, it was her honest statement that motivated me to write about the insanity of having weight goals. I realized that so many people go blindly on their way getting themselves into ridiculous, stressful, self-esteem damaging lifestyles that sometimes go on for years, all because of a stupid “weight goal”. I hate numbers in general, and when it comes to a fluid, changing, living body, something that will never be static, never be the same day to day, I dislike the use of numbers even more. What baffles me sometimes is how a person decides on the magical number. In many cases, people pick a number from their past. “When I was in high school, I fit into size ‘x’ and I weighed 140 pounds, so that is what I should weigh”, or “I read that ‘famous model/actress so and so’ is my height and weighs ‘x’ so that is what I should weigh”. And on and on. For most of the people I have seen, there is no way to reach that magical weight and live a life in any healthy, sane or even safe way.

You might be wondering “what is the big deal? Why not have a definite goal in mind?”  Here are the 5 reasons to forget about weight goals:

  1. Your body has a “Set-point” weight range it will fight to keep. I think of my father who was living proof of the meaning of “set-point” weight range. He was someone who I believe truly listened to his hunger cues and ate what he wanted. Being a traditional Italian and growing up with salami, sausage, fried peppers, Parmesan and fresh Italian bread he knew nothing about calories or nutrition. This is not why he ate. He ate the foods he loved and the meals my mom cooked. Every Sunday was pasta, meatballs, sausage, bread and sauce. He would sit there for what seemed like an hour and devour and savor his meal. He wasn’t big on sweets most of his life unless he craved something, then would have a good serving. His weight never really changed. How could this be, when he never spent a minute trying to figure it out? Set-point.
  2. You can ruin your set-point if you diet. I will never forget a patient I had years ago who had an eating disorder and would restrict then binge eat. She was in the health field and she understood what was going on when she did this however she had it stuck in her mind that she should weigh 125 pounds. She weighed 135 pounds. She had reached her goal at times through extreme behaviors however these could not be maintained due to the triggers for binge eating that resulted from her restrictions. She dropped out of treatment and I had not seen her in years. About 5 years had passed and lo and behold, she returned. The reason she returned she said was “I don’t want my set-point to go any higher”. She weighed 145 pounds (still within a normal weight range for her, but 10 pounds above what had been her norm). She knew it was her disordered eating behaviors that affected her natural set-point weight. All because she would not accept her natural body weight. When you have to experience extreme hunger every day in order to stay at a certain weight, then this is not your set-point weight range. And if you are binge eating then alternating with strict dieting as a result of wanting to be a certain weight, then you are at risk for ruining your natural set-point.
  3.  When you focus on a number you get disconnected from your body’s natural signals. Most people who have a weight goal in mind weigh themselves on a regular basis. When they jump on that scale and it does not move, they tend to jump up the restriction (“I am going to be good today”). What happens is they become more “cognitive” and less “intuitive” with their eating. They “figure out” what they should have for lunch and eat only the amount they believe will result in weight loss. What happens instead is they most likely do not eat enough calories, fat or carbohydrates. This imbalance triggers the brain to step up the appetite, and especially cravings for those particular foods that are being restricted. The cravings kick up a notch. Finally, whatever the trigger the dieter breaks down and has “just one” but then, that “just one” leads to another and another…..and another. The body is smart and won’t shut up until it is in balance again. The problem is the mind takes over and leads us to binge because we “are going to start tomorrow”. And the cycle of disconnection begins. Does this lead us to our natural and healthiest body weight range? No.
  4. That magical number has nothing to do with health. The issues of health and “obesity” has been argued before, with those saying weight is related to health. The reality is that having a healthy body is much more complicated than a number on the scale and has much more to do with lifestyle (and genetics of course). If you have a goal weight in mind, as you can see, the behaviors people tend to engage in do nothing to enhance their health. In fact, the opposite is likely true. Dieting to lose weight rarely contributes to health. If being healthier is something you care about then if you focus on restricting and losing weight you are missing the boat.
  5. It is only when you let go of that magical goal weight number that you will be able to actually move in the sane direction of achieving a healthy (and happy) you. I don’t try to talk people out of wanting to feel good about the way they look.We all want that. But, from what I have seen, most people who diet to lose weight and are successful (for a while) do feel good about themselves at first. But if they don’t get off the yo-yo diet cycle and regain that weight, they do not tend to feel good about themselves at all. If, however, they stop focusing on that number and instead begin the road of truly reflecting on their health habits (which yes, do include healthier,not perfect, eating) then the journey can begin. This is a long journey and is not predictable like a diet. There are no promises. It is about exploring your lifestyle and identifying the things that are doing you in.  Do you notice yourself mindlessly eating in front of the TV at night? Do you hate to cook so Chinese and pizza are a daily thing? Do you work late and struggle to fit in any kind of physical activity? Are you up until 3 am playing video games? Do you eat out of stress because you hate your job? Or, are you in a dangerous spiral of self-abusive disordered eating habits that you are yet to get help for? These are the types of things that need to be addressed that NO one diet can fix.

 

If any of this rings a bell, I hope you think long and hard about picking some random magical goal weight. Instead of wasting the energy doing unhealthy and impermanent things to get there (a place that probably has nothing to do with the real you), consider going in a different direction for once. Learn what healthy eating and healthy cooking is. Take the time to reflect on your lifestyle, and start with even one thing you want to change. Educate yourself about what it means to have a healthy lifestyle. Talk to friends you know well and trust, who you think manage to live this way and you might find out some strategies that might work for you, too, in this busy world. Work on intuitive eating and pay attention to all of the messages your body gives you every single day. Make your mistakes, feel yucky, but then learn from them. Over the months and years, guess what I have seen happen when people do this? They often just naturally land within a weight range that is truly natural for them. They do this while enjoying eating and good food, and living life to the fullest.

For more information on the negative impact of dieting, check out: Has Dieting Ruined Your Metabolism?

 

 

 

When Your Thighs Change Size Overnight (or do they?)

On By jodietitianIn UncategorizedLeave a comment

Waves, Sand and FeetI have never heard a man complain about the size of his butt. Women, on the other hand, seem to scrutinize almost every inch of their bodies. Their hips are too big, their tummy too fat, their arms jiggle too much. Their neck is getting saggy and so are their breasts. We just can’t win in the body image world (or sometimes it seems). With eating disorders awareness week coming up, and without a week going by when I don’t hear at least one complaint from someone about their physical body, I thought it might be good to write about it. In particular, I was remembering a handout I used to use with my eating disordered patients  called “The Theory of Expando Thighs” by  Karin Kratina, PhD, RD. She is one of the most respected among the eating disorder and body image experts, so check out her website and the resources she provides (and she has a new book coming out soon).

I do want to be clear that although in my work and life I tend to hear more body image complaints from females, males are not immune. Body image concerns are not discriminatory. I bet we all know a man who complains about his abs. But for the purpose of this post, I am going to focus on women.

Anyway, I loved this handout because it was a great visual explanation of what is really going on when we look down at our thighs and it seems they have grown overnight. Sometimes our eyes don’t see the reality.  Can a body part truly change overnight? No. So why is it that sometimes we feel that way? We look in the mirror and feel good. Then, we go to get ready for work, take another look and see something totally different. How does this hijacking of our mind, this total takeover happen?

The reality for most of us is we have so much going on in our lives. Stress at work, children to deal with, families, careers, school, and so many other things to think about. Yet, somehow, the size of our thighs (butt, arms, tummy) take center stage. The need to diet, count calories, lose weight, get these thighs back to normal becomes a priority. You should be trying to figure out what to do when your senior year ends. You should be filling out applications for that new job. You should really call that marriage counselor because for once, you told yourself you were determined to make your marriage better….or to end it.

None of these challenges sound like fun. Who enjoys worrying about getting a job? Who wants to think about the future? And who in the world really wants to see a therapist and delve into something that has the potential to turn your world upside down?

That’s where those thighs come in. And the calorie counting. And the gradual obsession with numbers and food. When you see your thighs as a sudden problem, you get to stress about it. Suddenly, you conveniently have something else to worry about. This is awful, these suddenly huge thighs! Time to diet, count calories, plan menus, etc, etc, etc. Who has time to think about the “real” (difficult, painful) issue. It works. As torturous as it may sound to have your thighs grow overnight, it is much easier to deal with than the real issues.

So, instead of seeing what is actually there, our eyes just might be seeing what is going to enable us to avoid “something”.

I don’t consider myself a body image expert by any means, however I have had the privilege to be educated over the years by my former patients who often had extreme body image distortion. There was no way for me to ever understand how someone who appeared emaciated to me could look in a mirror and see themselves as someone who needed to lose weight. One day, over 20 years ago, one of my patients, a very intelligent professional woman who had suffered for several years with an eating disorder was in for a weekly visit. Her weight was dangerously low and she had been in and out of the hospital. She told me she had had an amazing thing happen. She was in the process of applying for a new job and had to go shopping for a business suit. She first went into a department store at the mall, and no matter how small of a size she tried on, the suits just were too big. She figured it was just the brand, so she went to a different store. The same thing happened. Still, she told herself, it was the store, their clothes just ran big. After several stores, she was finally in the last one, a very expensive store that she was confident would have accurate sizing. She put on a suit jacket and looked in the mirror, and for a second, she said, she saw this emaciated woman swimming in a giant coat…..which was a size double zero. She left the store. This was the first time, she said, that she had ever seen herself as others see her. She said to me, “but, the eating disorder will not allow me to see myself as I truly am because then I would have to eat”. I will never forget that woman and the story she told me. For once, it kind of made sense.

Of course, someone with a clinically diagnosed eating disorder may suffer from the extreme as far as body image. Anyone, however, can get sucked into focusing too much on their bodies and end up wasting a lot of precious time. Whether you are having body image concerns or not, if there is something in your life you are not happy with (job, relationship, etc.) I always recommend getting some help. Life is too short to not be happy. Some things we just can’t control, but if we can, why not try? Even if you are in the worst of positions, and feel stuck and immobile, making that phone call is a step. It counts. You did something. You are moving in a better direction.

So next time you glance in the mirror, and something appears vastly different than the day before, don’t beat yourself up. And please, don’t take any drastic action. Instead, ask if there might be something in your life you could be avoiding….make a vow to work on your health (a very positive and rewarding goal). If you happen to be going through a difficult time, ask yourself if you can do it alone. With Eating Disorder Awareness Week starting tomorrow, make a pledge to start with yourself by loving and appreciating the body you have.

For more resources on body image check out:

Books by Dr. Margo Maine

Pursuing Perfection: Eating Disorders. Body Myths, and Women at Midlife and Beyond (with Joe Kelly) (Routledge, 2016)

Body Wars: Making Peace with Women’s Bodies (Gurze, 2000)

The Body Myth: Adult Women and the Pressure to Be Perfect, with Joe Kelly (John Wiley, 2005)

 

 

 

 

 

 

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

On By jodietitianIn UncategorizedLeave a comment

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.

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

On By jodietitianIn body image, dieting, Uncategorized, weight2 Comments

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……

 

 

 

Do You Live With the Food Police?

On By jodietitianIn UncategorizedLeave a comment

stock-illustration-19467692-policemanI saw a patient today that made me sad. She shared a story I have heard one too many times. The reason the story is bothersome is because the things some people do in the name of caring are so obviously not helpful at all, and actually very harmful. It seems like a no-brainer to me, if that makes sense. By that I mean those simple things, like manners, that everyone should know. Saying or doing something that if you have one iota of intelligence, you would know it is wrong.

But for some reason, people don’t get it.

So I decided to write about it because even if just one person reads this and changes, or reads this and shares it then maybe someone will stop. What I am referring to is the food police. Not the one stuck in your head. The real live one(s) many people live with.

The story goes like this: the teenager, who always played soccer and was thin and fit in high school goes off to college, stops her sports so she could focus on studying and then gains weight. Mom is not happy about this (and neither is the college kid), and mom wants to help her daughter. So she makes comments about what her daughter  is eating when she is home visiting: “are you sure you want that much? Do you think you really need that?” On top of this, her dad and her younger brother have also joined the forces. They watch what she eats and feel they are “helping” her when they comment about those cookies or chips or ice cream sandwiches, “those aren’t for you, they are for your brother, you don’t need them!”

Or consider the young wife who has a few kids, gains weight and no longer fits into those tight jeans. She already beats herself up about this, and knows her husband is not happy. He says he just wants to help and that is why he feels the need to tell her when she has had enough.

What happens when mom, dad, brother and hubby leave? What would YOU do? If there was white chocolate mousse in my house (my favorite, and something you just can’t find easily), and someone said it was “not for me”, I will tell you what I would do. I would wait until they left, or went to sleep, and I would sneak it. Actually, no, that is not true because that would make me feel guilty if I had to lie. I would probably be honest and tell them directly that they better not leave it there because I will steal some!

But most people in this position are not able to be direct and stand up for themselves. They find it hard to say “look, I love chips, so if they are here, I am probably going to eat some, and I would appreciate it if you would mind your own business!” No, what I see is that children and adults alike all do the same thing when they live with the food police. They sneak. They binge eat. They feel guilty. Part of it is that they really do crave the food but much of it seems to be almost a passive aggressive resentful act against those trying to control them.

I remember clearly a middle aged woman who was in one of my non-diet weight management classes many years ago. Her husband was the food police (just trying to help her). She would sit and eat her Special K cereal with skim milk while he scoffed down his bacon and pancakes every morning. Then, she would watch through the window as he drove out of the driveway and around the corner. Once he was out of sight, she went straight to the fridge. She would binge on all of the foods he would not want her to eat. He did not understand why she was not losing weight when she barely ate. She had a lot of work to do with making that relationship healthy and one that would truly support and not control her.

So what would I recommend to family members who really do want to help? (You can share this with them if you agree):

  • ASK your loved one how you can help.
  • LISTEN to what they say. Sometimes it is helpful to NOT have certain foods in the home if it triggers someone to binge eat. Binge eating often leads to other disordered behaviors such as purging, and this is not what you want to happen. Little Johnny can have Oreo’s at his friends house or buy them at CVS, if his sister is struggling at the moment, he can live without them at home. Hubby can live without ice cream at home (go out for a cone when you want one! and take your wife if she wants to go too)
  • STOP talking about weight. Or body size. Theirs, your own, your neighbors, Oprah’s, anybody’s!
  • ACCEPT the beautiful person your loved one is that has nothing to do with the force of gravity on their body (which is all weight is, right?)
  • PROMOTE health in your home. Make healthy meals. Play outside. Dance, play games, have fun.
  • TRUST that your adult child or your spouse or whoever will figure out what is best for them. Be an example, NOT the police.
  • IF you notice any disordered eating behaviors, don’t ignore it. Educate yourself (check out NEDA)for some support.

And if you are the one feeling like the criminal living with the food police, consider sharing this post. Blame it on me! If the dietitian admits she would be sneaking the white chocolate mousse….well, maybe they will understand.

Do You Need To Be Perfect?

On By jodietitianIn Uncategorized3 Comments

downloadIt dawned on me this week that one of the most wonderful gifts in life is the ability to not have to be perfect. I was reminded of this on a beautiful sunny Friday afternoon last week. It was one of those picture perfect, almost fall days with a gentle breeze, sunny sky, no humidity and perfect temperature. Once a year I go with one of my best friends to a reservoir near where I live to go kayaking. My husband and I go several times during the warm months but my friend Barbara does not own a kayak and so for the past two years she and I decided to start a traditional and yearly kayak outing. She is retired and I get out of work early on Friday, so last Friday we went on our trip. We packed some sandwiches, the new Lay’s Reuben flavored potato chips and some wine and a camera, and off we went. Since it was a week day we almost had the reservoir to ourselves. We both had our hair disheveled, no make up to speak of, crappy water shoes, faded shorts and tee shirts, and no jewelry (well, except one of the necklaces that I refer to as my kayak necklace, which is made of natural jute and beads that my daughter made for me, and that I love (and do wear other places), but especially love for things I do in nature, like kayaking).IMG_6753

Anyway, we paddled along and stopped at a clearing on the shore to go walk along a path that became muddy, but was beautiful along a bog with reeds and lily pads and frogs. We also had found a spot where we paddled to float near a fallen tree (dubbed Broken Bark Bar) to have our late afternoon lunch/happy hour plastic cup of wine and proceeded to chat about everything. We both agreed we were at a point in our lives where we were so thankful that we were content and thankful to enjoy all the beautiful but simple things in life. We realized how relieved we felt to actually not care about our hair, our make up, or what we were wearing. Life is hard enough as it is. Problems come up with children and family and friends and life in general. It never ends! Imagine the extra strain of having to be perfect. Sadly, I clearly remember all the people I have met who struggle with this on a daily basis.

Just imagine:

Having to do a certain amount of exercise a day. Having to follow a certain diet, and think about every morsel that passes your lips (yes, there are people with dietary restrictions who have to avoid foods for medical reasons, but that is not who I am referring to). I am thinking about those people who forbid themselves things on a daily basis, and truly get emotionally upset when they do not follow their own self-imposed rules. People who invent some body image goal they feel is the only body they could possibly be happy in. It typically is not achievable without mental and physical repercussions, yet they carry on with the delusion that this perfect body will be the answer. Even when they reach their “goal weight”, it is never good enough. One thing I will never forget is the anorexic patient who told me “I finally realize, the only time I get to wear my goal jeans is when I lose so much weight that I have to be hospitalized”.

Can I share what I have learned from those I have seen reach these goals? These are the patients I have worked with over the years, and this is what I have seen: they change their goals once they reach them. It starts with one goal of losing a certain amount of weight, but then, that is not good enough. The weight goal lowers. They reach it and it still does not make them happy. The person who has the goal of doing a certain amount of exercise? The need to run a certain race, then another and another. Well, when they reach their goal, it is not enough. The goal increases. And they still are not happy. The end never comes.

I think we all have a bit of perfectionism in our lives, or at least unreasonable expectations. I know of moms who need to vacuum 4 times a day (and don’t let their children walk on the carpet….no footprints allowed). I know of women who pick their perfect outfits out of their perfectly organized closets the night before work (I definitely can’t relate). I personally struggle with going to bed if there are dishes in the sink. It won’t happen, I can admit. I just can’t wake up to that. Mornings are hard enough.

So, anyway, at the end of our kayak trip we got ashore, loaded our kayaks, life jackets and oars and drove back, back to reality. We put up our pictures on Facebook, and tucked another wonderful memory away in our hearts. I felt thankful for this friendship with such a wonderful and special woman, a mother who I am sure whose sons would consider the perfect mother, a friend who her many friends would consider a perfect friend, and to her significant other, well, I know he thinks she is perfect, too. With no make up, disheveled hair, faded shorts and tee shirt. I left feeling so very thankful for this beautiful day, but mostly for the realization that I now, finally, can embrace my imperfections and truly not care. Age has helped (one of the perks of getting older!) I only hope and pray that others might take a step to let go of just a little bit of perfectionism in their lives. Care about your health, but there is no need to eat 100% perfectly, or to exercise 100% every single day or to any perfect schedule, or to be any certain body that is not achievable without getting sick or obsessing about food. If you try and try and try…….and still can’t let go of it, consider getting some help. Realizing that you don’t want to have to be perfect anymore is a huge step forward.

For a long time now I have realized being imperfect is my definition of perfect. So consider a new definition of perfection for yourself!

Now if I could only get over leaving the dishes……

5 Reasons You Should Not Skip Meals

On By jodietitianIn Uncategorized3 Comments

stock-illustration-65223149-top-view-of-empty-plate-with-spoon-and-knifeLast week I got together with my three best friends from high school. We all try to connect on each other’s birthdays and so that we are guaranteed to catch up at least four times a year. We usually meet around happy hour/dinner time at a local restaurant in the town where we all grew up. It is always so fun! But as we age, all of the typical discussions regarding how our lives have changed come up, and mostly we laugh a lot!

But this time one of my friends looked absolutely exhausted. She had not slept well the night before and also had not eaten anything all day! It struck me that every time we have gotten together, she is famished because this has been the habit she has gotten into (she us such a caring person that she tends to focus on her family, her family’s restaurant, her own business and never takes time for herself).

I am not one to lecture anyone about their eating habits, but if someone asks me something, I will answer. “Aren’t I burning fat?” she asked. As with most middle aged women, we do gain some weight and the typical person tries to lose it. I then explained how our bodies react to starvation, and not only was it not supportive of promoting a person’s genetically determined body weight, it also could be dangerous at worst, or make you feel crappy (like she was feeling!) at best. Anyway, because so many people are under the misconception that skipping meals is a good way to lose weight, I thought I would write about it.

There are probably lots more reasons (such as the obvious fact that it is next to impossible to meet your nutritional needs by skipping meals), but here are my top 5:

  1. It backfires. Almost everyone has had the experience of not eating enough during the day for one reason or another. Most of the time, dieters do it on purpose, others may just be too busy and not realize several hours has gone by and they missed a meal. The result is the same: a drive to overeat. If you have read any of my previous posts, you know that our appetite and hunger level is intricately tied to numerous regulators. When we do not consume enough calories/energy during the day, we will make up for it. Some make up for it by just automatically listening to their body and eating a very large meal because they are overly hungry! And they feel much better after eating that big meal. Others (dieters/restrained eaters) often feel very guilty when they compensate for not eating enough by eating a big meal, and then binge eat because they feel so bad.
  2. You burn muscle and consequently lower your metabolism. Unfortunately, contrary to what my friend and most people think, you do NOT burn all fat when you skip meals. When we don’t eat for a long period of time, our body has three options to get some energy: protein (from our muscles), carbohydrate in the form of glucose or stored glycogen (we don’t have much energy here, just a few hundred calories, unless you are a trained athlete and your stores may have an increased capacity, but most of us are not trained athletes!), and fat (in our fat stores). Also unfortunately for those trying to lose weight by meal skipping, our bodies draw from all of these forms of storage and eventually may even prefer amino acids (which it can get readily from our muscles). What most people do know is that muscle “burns more than fat” and that is why people who have more muscle need more calories. So what happens when you skip meals and need to burn up some muscle for energy? The next day, with even a fraction less lean muscle, you burn less. Over time, this can have a big negative affect on your metabolism. In extreme situations such as in those with eating disorders who have starved and restricted for a long time, the heart muscle can actually atrophy, causing dangerous health repercussions. The only way to find out if heart damage has occurred is with an echo cardiogram which is expensive. Most patients get an  electrocardiogram which may be normal but does not mean damage has not occurred.
  3. It may increase belly fat and contribute to insulin resistance.  A recent study (May 2015) conducted at Ohio State University revealed that skipping meals not only leads to abdominal weight gain, but it can also lead to the development of insulin resistance in the liver. If youskip meals you might set your body up for larger fluctuations in insulin and blood sugar. The result is more fat gain instead of fat loss. Find the original article in the Journal of Nutritional Biochemistry, July 2015, Volume 26, Issue 7, Pages 721–728 and for a summary of the research results see CBC News Article on Skipping Meals and Belly Fat.
  4. You wreak havoc with your digestive system. One of the biggest complaints I get from people who skip meals is constipation. We all have experienced that uncomfortable feeling at times when maybe we have traveled and our bodies get off track, or we have been ill or maybe ate too much chocolate! It is not a fun feeling, but can you imagine having to feel this way on a regular basis? In addition to constipation, lots of people who skip meals and then eat tend to complain of feeling bloated and gassy, or even having stomach pains. Our bodies just simply like to be in a regular rhythm of eating. Our digestive enzymes get used to helping us digest our meals at regular intervals. When we start to skip meals, eventually these enzymes decrease so we even may stop feeling hungry (many of my patients will ask “why should I eat lunch if I am not hungry? I thought I am supposed to “listen” to my body!” Well, if you have been skipping meals on a regular basis, this is the one time I will say don’t listen to your body because it has been derailed. If this has happened to you then start by adding in a small meal (maybe half a sandwich) and build up to a normal lunch over time. Eventually you will start feeling hungry again and this indicates your body’s metabolism as well as digestive system is getting back to normal. Of course there are other contributors to constipation and digestive issues (food intolerance, inadequate fluid intake, not enough fiber) but going long periods without putting something in your digestive system is not going to help.
  5.  You just plain won’t feel good.    Finally, when you don’t provide your body and brain with the fuel it needs, you just are not going to be in a good mood. You will likely drag, be unable to focus, get grouchy more easily and just simply not be that fun to be with! I have found that most people do not even realize how crappy they feel when they do not eat enough during the day. When they begin to add in breakfast and lunch they are often amazed at how good they feel and how much more energy they have. If I had a dollar for every person that has said “wow, I feel so much better! I didn’t even realize how bad I felt!” I might not be having the time to write this blog because I would be retired and relaxing on my favorite beach on Keewaydin Island.

Just to be clear, I am not promoting weight loss, but instead I am hoping those of you who are always trying to lose weight will stop skipping meals. Why not think about working on a healthier lifestyle instead so that you feel good and can enjoy life. And that involves eating your three meals a day.

Three square meals a day. Funny how good sound advice never seems to change.

The Power of a Cookie

On By jodietitianIn Uncategorized4 Comments

chocolate-chip-cookies-20-1328002This weekend I was reminded of the power of a cookie. I was at a social gathering which was a very joyful celebration filled with laughter, games, children, and great food. As with most summer time picnics that are pot luck, people bring their favorite dishes or desserts to share. Being someone who loves to cook and get new recipes, it is a fun experience for me. I tend to skip the dishes I can make myself (simple potato salad, coleslaw, plain old chocolate chip cookies, etc) and always enjoy trying things where I don’t even know what is in it! For example, there was an interesting quinoa salad with avocado and kale that was amazing (it looked a bit sketchy but tasted great!). Someone made buffalo chicken appetizer balls with a blue cheese dip that I am definitely getting the recipe for. You get the picture, great food, great day, great fun.

But near the end of the night a woman came out to the dessert table looking for a cookie. There had been a few platters of cookies but most of the guests had left and apparently the platters were gone too. She seemed really desperate for a cookie, so I looked around and found a small plate which I showed her. She quickly grabbed one and gobbled it up. I was glad she was happy until a few seconds later when her mood drastically changed. I was thrown when she started to say “why did I eat that cookie? I feel so guilty! I have to fit into my dress next week! What was I thinking!?” I suddenly felt bad for being a part of this, as she was truly upset. But then my dietitian mode kicked in as I tried to convince her one cookie truly would have no effect on her body. It took some time but eventually she seemed to let it go.

It struck me later that reactions like this to a cookie are not uncommon. Have you ever witnessed someone reacting to what they have eaten is such a dramatic way? The reaction is one you might expect from someone who truly did something really bad. The primary feeling is one of guilt. The word “guilty” came up several times. To me, that word is a strong one. It means you did something really wrong, something you regret and don’t want to do again because you feel so bad. How does one cookie make someone feel like that?

Part of it could be the “black and white” thinking many people have about food and eating. Food is “good” or food is “bad”. Who decides what foods fit into what category is the individual and how they define the word as well as how they judge the particular food. To me “good” means it tastes good. To someone else, good means it is good for you, a “healthy” food. So for me, those buffalo chicken balls with the blue cheese dip were definitely good! But to someone else, they may be considered “bad”. Peanut butter cookies may be “bad” to someone who thinks sweets are bad because they don’t consider cookies “healthy”, but to me they are bad because I just plain don’t like peanut butter cookies (sugar cookies however are definitely good).

Another way to explain some people’s guilty overreaction to eating just one cookie might be the “diet jail” I referred to in a previous post Are You in Diet Jail? When people are dieting to lose weight (which often happens when they are getting ready for a specific event, such as a reunion, holiday or wedding, big party, etc and want to fit into specific clothing) they put themselves in diet jail where most normal foods are forbidden. Even one bite of a food that is not in their diet world of foods in diet jail can set someone off.

It also seems like a “perfectionism” kind of approach to food and eating. The word “perfection” is interesting because I think we all have areas in our lives where we strive for it. To my grandfather back in the day, it was his lawn. It was perfect. He would have a fit if a neighborhood dog would set foot on it, and heaven forbid, pee. I remember being very careful as a child when we went to my grandparents home, being sure to stay within the manicured border of the small sidewalk leading to the door. Don’t step on the grass!!

My husband is a bit of a perfectionist when he entertains friends. He spends a lot of time on cutting foods perfectly so the presentation is the way he wants it to be. I, however do not have that kind of patience, and tend to throw it all together. Other people need to have a perfectly organized closet. One woman I worked with had all of her clothes hung up by color, and her shoes all labeled. I, on the other hand, still have sweaters stuffed in my closet mixed in with the sun dresses…never did get around to switching those clothes around. My perfectionism tends to involve being a bit overly concerned that I make everyone happy if they are coming to my house for a get together. It is important to me that everyone has a great experience and I truly do enjoy the cooking and entertaining. It is stressful though to be thinking so hard about pleasing everyone, and I am working on having it be “good enough”.

So maybe that is the take home message. Why can’t everything be “good enough?” Why isn’t your body good enough? Why isn’t your diet good enough?  Not that I promote looking at calories, but the truth is your body certainly does not care if you eat 100 calories from an apple or a cookie, it is probably just happy to have the energy. Yes, you should care about nutrition and getting the nutrients you need, and yes, your health does matter. Assuming you are not allergic to it and don’t have some other health condition such as diabetes, one cookie truly does not have the power to affect your body in any significant way.

So the next time you catch yourself reacting dramatically from eating something, try to stop and do a reality check. Do you really need to waste so much time feeling guilty about something that has no affect on your body or your health? For some, this is much harder than for others. Some have spent months and years with this mindset and it does not change overnight. But even just being aware of your own experience is a step in the right direction. Try not to accept this and instead start questioning yourself. Look at the big picture and all the positive things you do to be the best you can be. To me, being perfect means being imperfect.

And the truth is a cookie has no power at all.