Ending the battle on obesity: can we talk about building health instead?

soupHave you ever gone to your doctor and had advice thrown at you without them even asking about the reality of your life? It is unfortunate that most jobs in the healthcare industry now revolve around “productivity”and making a profit. A friend of mine who consults in pediatrician’s offices around the state tells me the poor doctors scramble and stress about their time and seeing patients because their productivity is tracked by the companies that manage them. It is for this reason I believe some doctor visits seem rushed. It is probably why in some cases there is just not time for a doctor or nurse to get the information they need from you to counsel you appropriately. So many people I have worked with have told me they have felt insulted when told to “stop going to McDonald’s!” or “just exercise more” or “cut down on your portions” when the reality is they cooked only healthy foods, they ate tiny portions and they already were exercising. Or, even scarier, the eating disorder patient being told to “keep doing what your doing, your weight is good!” without even asking about the dangerous way the patient lost weight. So, it is not always lack of time, but, sadly, the tendency for people to make judgments about behaviors based on someone’s appearance or size.

A friend shared this great article with me recently that describes what is going on perfectly. In a nutshell, it tells personal stories of individuals and what they go through. It describes our “war” on obesity, and the repercussions of that war. Finally, it suggests changing our focus instead to one of promoting health.

Please take the time to read the entire article, it is worth it. huffington post article

The truth is, looking at our life as a whole instead of just the fat on our thighs (or butt or tummy) just may lead us in the right direction. Taking a look at sleep, stress, nutrition, physical activity, smoking habits, etc. and tackling a little bit at a time brings us closer to feeling good (and yes, probably looking our best, too). It is not glamorous or exciting or as dramatic as fast weight loss and the lure of dieting can be, but the difference is, it may be doable.

Untethered Eating: Exciting….or Terrifying?

Image may contain: people sitting and foodI love the word “untethered”….not sure why, probably because it makes me think of a dog escaping his leash and running free to smell the grass, jump around and finally, being able to be the creature he was supposed to be. Maybe that is why when I arrived at the airport way too early last month on my way to Florida, I ended up impulsively buying a paperback in the airport bookstore. I actually almost always end up buying a book at that bookstore because we are ALWAYS early. Anyway, I ended up purchasing The Untethered Soul by Michael A. Singer because I liked what it said on the back, it was not too long and like I said, I like the word “untethered”.

As I was reading the book, it struck me there were lots of parallels that could be made with the way we eat. I tend to be slanted in the way I look at eating because of my experience with working with individuals with eating disorders and with parents of children who have the dreaded unacceptable BMI. I often react to things very differently than others. When really smart and educated, even insightful and spiritual people fail to react to something that totally infuriates me, I know I am prejudiced against some of our culturally expected natural instincts. Anyway, I know this is why this book struck me so hard in the way it relates to eating, and especially dieting minds.

To see what the book is about check out this description on the Untethered Soul’s website. The bottom line, to me, was learning how to live in the moment verses constantly reliving and regretting the past, and/or spending way too much time planning, worrying about or dreading the future (hhmmmm… do you know anybody who does that with food?). It was about that voice that is continually and always in our heads, barking orders, belittling, shaming and stressing us out. And although it is somewhat different (the book refers to inner consciousness) I have talked about “self-talk” before. It is a common term in healing from disordered eating. We sometimes refer to this nasty voice as “ED” (eating disorder), the one telling us we are fat, we are stupid because we ate something, a cookie will make us gain weight, and on and on. The first step is to start to become aware of that voice.

And that is what struck me about the book message and how it can apply to the way we eat (or try not to eat). Becoming aware of that voice is the first step to a more peaceful relationship with food. Being non-judgmental of that voice, no matter what it says, is also critical. The important thing is to become more conscious of what is going on. Not running from it, not trying to change it, and definitely not judging it. Just sitting with it and accepting it.

After reading the book I started to think about what “tethered” eating looks like. All of the things patients have said to me came to mind. The sad thing is some of the culturally acceptable messages also came to mind (so you can imagine how hard it is to heal from disordered eating when cultural messages about bodies and eating are also disordered……how do you fight the world?).  Some of the thoughts stuck in our heads that keep us tethered might be:

  • You need to lose ______pounds
  • You need to get down to a size _____
  • You need to get rid of that tummy (thighs, butt, insert body part)
  • Carbs are bad
  • You need to be “good” (meaning don’t eat “bad” food)
  • Don’t eat fried foods
  • Sweets are bad
  • Don’t eat after 6 pm
  • Read the label and don’t eat anything with sugar
  • You ate __________ so now you need to burn it up by exercising more
  • Cheese is bad
  • Meat is bad
  • Eggs are bad
  • Cookies are bad
  • Pasta is bad
  • I can’t eat what everyone else is eating
  • I can’t order what I really want in a restaurant

And on and on, you get the message. We are so wrapped up in perfect eating and perfect bodies (whatever that means) that we end up feeling tied up when it comes to food. I actually have witnessed people looking almost like a cartoon when they are faced with food. Imagine a child in front of a bakery counter, drooling over whoopie pies or amazing looking desserts and the mom pulling the kid away, the child’s neck still stretched as far as it can toward that sweet display. Sometimes, that is how people strike me, but there is no leash, no adult pulling them back, they are just drooling and denying themselves something they really want because of the subconscious “tether”.  Then again, at other times when I see someone gobbling something up, it is because they have decided to cut the tie and go crazy (just like the puppy running free, they really let loose). It is a natural instinct I imagine, after feeling tied up for so long. But it has nothing to do with enjoying food in a healthy way (or a normal way). There is nothing intuitive or conscious about either extreme (of restricting or overeating).

If you are someone who is trying to lose weight (or simply trying to be a “healthy eater”), you may be thinking “of course I need to control myself, if I didn’t I would eat everything and gain weight (or be unhealthy)!”.

Probably not, if you stop and think first. Not if you tune in to your true hunger (or your true desire, craving or need). Not if you get to a place of knowing you are truly free, and believing it.

Remember, although I wish everyone with disordered eating could do this and be free, I know it is not that easy. Eating disorders are complex, and getting better is not this simple. Stopping binge eating or recovering from anorexia or bulimia takes lots of therapy , work and medical attention. And although leaning how to “tune in” to true hunger (verses using eating or not eating for something else) may be part of the process to recover, what I am talking about now is directed more toward the “typical dieter” who is simply falling into the trap of thinking eating needs to be perfect, or a certain way in order to affect weight. Those of you with eating disorders need to work with your specialists to do what you need to do for your individual situation. I know you will agree, though, that EVERYONE would be happier and mentally healthier if they got off this crazy perfect eating bandwagon.

With that said, my goal is to give you healthy-eating, dieting, weight watching people a little reality check. Thinking you need to be tied, tethered or whatever to eating a certain way either for a certain time period, or forever is actually preventing you from being the healthiest you can be. Keeping yourself leashed to a specific and narrow way of choosing foods based on Lord knows what not only may affect your physical health, it is likely a drain on your mental health, too. Thinking about every bite you put in your mouth is not only draining, it prevents you from living in the moment and enjoying all that life has to offer. And even worse, it actually keeps you disconnected and less in tune with what your body needs.

But what about our health, you might be thinking? Of course we need to think about what we eat! It is the only way to make healthy choices, right? OK, here is the clincher: it IS a balancing act. You DO need to care about your health (which means caring about your food choices) but, you also DO need to be happy and live life. You DO NOT need to be tethered to anything. How do you do both, eat healthy but be free? THAT is the balancing act.

Here are some tips:

  1. Reject any “all or nothing” thinking. Example (my pet peeve, this drives me crazy): sugar is bad, therefore I need to avoid any foods that have a lot of sugar. I need to pick the yogurt with the least amount of sugar (even though I really don’t like it).  I can’t get the one I like because it has 10 grams of sugar. Mine only has 5 grams. Really? FYI 5 grams of sugar is a teaspoon of sugar (15 calories people). So, for an extra 15 calories you are not going to get the yogurt you truly enjoy? NOT THAT CALORIES MATTER but, the point is, 15 calories is only a tiny fraction of your total intake for a day. It is basically meaningless. Eat the darn yogurt you like, would ya!?
  2. Be skeptical of the latest craze. For example, avoiding gluten. If you have celiac disease or a true intolerance, that is one thing. But most of us don’t have this problem, we have no digestive reaction to eating gluten containing foods and there is no reason to avoid it. On the other hand, it is perfectly smart to avoid things that we know are harmful (trans fat, for example), or, if you have a medical condition and need to limit something (such as saturated fat) that is different. But for those of us who don’t have medical conditions, there is no reason to scrutinize every label and every bit of food we eat. With that said, avoiding weird additives and artificial dyes, etc, and preferring natural whole foods is a personal preference and choice, not what I am referring to here (I like real food myself).
  3. Educate yourself about nutrition, but don’t be perfect. I have said it before, it is smart to make healthy choices, to learn how to cook in a healthier way, to plan ahead in order to avoid spending money eating out, bringing lunch to work or school, etc. But just because you know what makes a healthy meal does NOT mean every meal needs to fit some perfect pattern. Being a dietitian is sometimes irritating because I am totally aware of what I am missing in a meal. And I know how my choices may affect how I feel later. I still, though, really do try to practice what I preach. A good example is my recent craving for avocados. For some strange reason, I have been wanting avocados every single day for the past several weeks. Maybe it is the changing weather, with warm weather finally arriving, who knows. Anyway, there have been days where for lunch I just smash that avocado up with some salt on a roll or other bread item and skip the usual protein source (often leftovers) I typically have. I may have other things in my lunch, but they definitely don’t have protein. But guess what? I feel completely satisfied and happy. I know my hair is not going to fall out just because I got 20 less grams of protein for lunch. Yes, I may get hungry earlier in the afternoon than usual, but who cares, that’s what snacks are for. I would rather be happy with what I am eating and truly enjoy my lunch rather than force feed myself a few slices of turkey that I don’t want. So care about your nutrition, but please don’t try to make it perfect.
  4. Make a decision about what you want to eat BEFORE you start eating. Some people are so “out of tune” with what they like, and so accustomed to denying themselves foods that they tend to have an internal war with themselves when they have to pick something to eat. They may want to heat up a plate of that leftover lasagna for lunch, but noooooooooooooooo! That was a splurge on the weekend, and today they have to be “good”. They should have a salad (the last thing they really want). So, as they start to throw together their boring salad, they grab a few wheat thins (they have deemed that as healthy, so that’s ok), then maybe a few grapes (safe too). Maybe a bite or two of cheese as they grab the lettuce out of the fridge. Oh, there’s that lasagna….maybe a cold broken piece of noodle off the top. Finally, after NOT enjoying any of the bites of food they mindlessly nibbled on, they sit down to their bland salad, feeling deprived, but safe. What if, instead, this person stopped for a minute to think about what they really wanted to eat? Maybe they first had to case the fridge to see what was available (smart). They would have discovered the leftover lasagna and made the executive decision that this would be what would be truly satisfying. They get the plate, cut a piece the size they know would be satisfying but not make them uncomfortable, heat it up, and they sit and enjoy their lunch. They leave the table feeling satisfied, not deprived. There is no need to keep going back to nibble because they have actually satisfied their appetite and had a perfectly acceptable, normal lunch.
  5. Slow down. Put the phone down. Turn off the TV. Get a plate (or a bowl). Sit. There just is no way to start to tune in to enjoying your food when you are distracted. If you want to work on being free from restrictive eating and following rules, and you have taken the brave step to allow yourself to choose a meal you really want, then you also need to pay attention to how you feel. It sometimes takes time to learn how much is enough. It is ok to make mistakes (that lasagna person may be satisfied with half of the piece they took, or may find themselves hungry an hour later if the piece was too small). It is a learning process. If you don’t pay attention and tune in to your tummy and how you feel, you will miss it.
  6. Be wary of peer pressure. It is just weird to me how people care what other people are eating (or not eating). When you are truly in tune with your hunger and fullness, and when you start to really know what you like or don’t like it is a great, freeing thing. But sometimes, it does not make sense to others. I think most of the adults I know kind of think they should not eat sweets, so they avoid them like the plague. But when there is some occasion to celebrate, and sweets are available, they just don’t get it that someone may not want any. Something like desserts and sweets  really do lose some of their allure with both children AND adults when they are not made out to be so naughty. Friends or family probably will comment either way, if you eat it or if you don’t (you can’t win, I am telling you!).  If you don’t want something, they will say “oh, you are so good” and if you do take something they will say something else. Don’t let the stupid comments of others make you either eat something you don’t want, or skip something you really do want. The important thing is to eat what, and how much, makes you feel right.
  7. Don’t stop caring about eating healthy. The reality is that a good part of the time we are actually not too picky and don’t care what is available to eat. You may not be on an avocado jag. You may not care if you have the lasagna or a turkey sandwich if that is what is in the fridge. Maybe the blackened salmon on kale salad with goat cheese appeals to you just as much as the chicken wings with onion rings. Why not go with the healthy choice? That is the smart thing to do. But, if you are really wanting the choice that you have previously had rules about, why not take that risk and get what you truly want? The key is to take the time to tune it to how much is satisfying and enough. For example, if a gigantic basket of onion rings (which I love) is placed on your table in a restaurant, having some is satisfying, but eating the entire basket just because they are there leads to discomfort later for most of us. Taking a serving and passing it on is not restricting, it is knowing your body and what makes it feel right.

Untethered eating is not for everyone. For those who have eating issues such as emotional eating, binge eating disorder, or who have other eating disorders or disordered eating behavior, moving to intuitive eating may not be doable on your own (but, hopefully, you are under good professional care and working on it). And for those of you who are dieters, or just trying to eat healthy, but simply can’t imagine taking that step, I hope you at least take that first step: pay attention to that voice. Ask yourself: are you regretting what you ate yesterday? Are you stressing about what you are going to eat tomorrow? Why not at least take a moment to be in the present. Don’t miss out on the simple joy of even one meal or snack you could be enjoying today.

Just like the puppy who breaks off the leash and runs free…..don’t you want to be free when it comes to thinking about food and eating? Just like that puppy who runs around and around and goes wild for awhile, eventually, he plops down and relaxes…..

and so should you.

 

 

The Gift of Good Enough

When my son turned a year old, I made him a Choo Choo Train cake. It did not look like this. It kind of resembled a train “wreck” if you ask me. The frosting was kind of thick and it definitely did not have great wheels. I am not artistic but for some reason, since he was my first (and only) son, I thought he should have a train. When I look back, I realize no matter how bad I felt about the appearance of that very important cake, it was good enough. Now, he lives in a different time zone, and he has a birthday coming up, and I bet he would love to have me there making him a cake and would not care at all what it looked like. And neither would I.

Although this is a “nutrition blog” the idea of “good enough” is relevant. It doesn’t only apply to baking the perfect looking birthday cake for your child. It applies to all aspects of life, and especially to eating (and exercise). I have observed that many people tend to turn to food and eating to feel better about not being “good enough” in some aspect of their lives. I also have seen people avoid eating and starve themselves because they don’t feel “good enough”. Let’s face it, people, women especially, are super critical of their bodies. They are NEVER good enough. I don’t think it is always about comparing yourself to others, but often just being hypercritical of yourself. I have witnessed both women and men be critical of their bodies (but mostly women, probably because we women spend more time on things like appearance….unfortunately). Much of the time the discussions focus on weight loss but sometimes I notice we tend to over-scrutinize body parts. Butts too big or too flat, legs too flabby, arms too thin, chest too small or too big, hips too big or no hips at all. I am always fascinated when I get the chance to people watch on a beach. It is so glaringly obvious how different we all are when it comes to our bodies. Tall, short, muscular or not, round, straight, long legged, short legged, even kids and teens all differ. Dark, light, red headed, brown or black or white haired, curly, straight, bald. No two people look alike. And yet, we still scrutinize as if we can change things, and even worse, when we can’t we blame ourselves.

It is not only our bodies that we want to perfect, it is our eating. I absolutely love those nutrition-innocent adults I know who “just eat”. They don’t read labels, they don’t analyze every ingredient, and they definitely don’t jot it all down in their app. They may be healthy eaters or not-so-healthy eaters, but still, I just love them,probably because in my world it is refreshing to be around people who are not obsessed with it all. Yes, I do preach healthy eating and totally believe in the fact that you do feel better when you tend to eat a variety of healthy foods on a regular basis.But is it really necessary to find that one bar with less than 5 grams of sugar? What if it does have 10 grams but also has protein and fiber and tastes good? 5 extra grams of sugar translates into 20 calories. Do you really think that will matter? Yet, I have overheard people talking about things as minute as this, just to be a “perfect” eater. There are other things people monitor, and actually, some things definitely worth avoiding (such as trans fat). But when we take it to extremes, it just creates stress (not good for health).

Besides bodies, and eating, many people also have unrealistic expectations about exercise. I had a wonderful experience awhile ago with working with a young woman who was not feeling too energetic and thought maybe eating better would help. As it turned out, she was not sleeping well at all. She had recently moved and previously had been working out at the gym for 2 hours a day. Now, she just did not have the time so she stopped. She admitted to being an “all or nothing” kind of person, and said that if she could not do a full 2 hour workout, it wasn’t worth it. I shared with her some recent article I read stating that even 30 minutes of walking daily helped people sleep better. Anyway, I asked if she thought she might be able to incorporate something like that in her life to see if it helped, even though it was not her “perfect” workout. She agreed to try. Only a week later, she came in all energetic and happy. “This changed my life!” she said. Apparently, just adding in the walking helped her sleep which made her feel so much better. We also tweaked a few things in her diet (her snacks and lunch were lacking protein and so she was crashing pretty regularly). After adding in some protein sources and the walking (both doable) she felt much better. The best part of all in my mind was that she was able to do it despite her old “all or nothing” frame of mind. She was totally ready to change from that paralyzing way of life and embrace normalcy. It is not always that easy.

Anyway, I think we all can relate to being somewhat picky about certain things in our lives. We had fun at work the other day talking about all the things we had some OCD (obsessive compulsiveness) about. I just can’t leave dishes in the sink at night (it needs to be empty in the morning). I also can’t be late for anything. I used to have to stop on the treadmill when I was finished (say 3 miles, or 2 miles, but could never stop at 2.5). Now, I stop on some off number just on purpose (2.33 miles, or 2.71 or even 3.2). I do this just to challenge myself and stop being so silly. When I shared that with some co-workers they all cringed. It really bothered one person especially, and she said “Ugh! I could never do that!”

Has anyone every accused YOU of being a “perfectionist”? Can you relate to some of these scenarios? You might enjoy this article on perfectionism in Psychology Today

In the meantime, just for fun, why not challenge yourself? Don’t read that label. Don’t jot it down in that app. Skip the gym and go for a walk. Or stop on the treadmill (or bike or elliptical) on an off number. How does it feel?

And next time you are at the beach, or anywhere for that matter where you are people watching, embrace the beautiful diversity. And remember, “good enough” is a gift you can give yourself.

 

Instilling Fear in Children to Prevent Obesity: Have We Gone Too Far?

Little boy and soap bubblesDo you remember what you were doing when you were 4 years old? Hopefully, you weren’t getting terrified about becoming fat. I hope you were doing what I was doing, making an awesome worm castle out of mud. I loved when it rained and all the worms would come out, more soldiers for my mud castle.

These days, there are other things to think about apparently for our babies….preventing obesity.  We are so wrapped up in our fear of fatness that we are missing the big picture. I can’t share details however can tell you that I was horrified this week when I saw a patient for an eating disorder…..the child was 5. Last year, apparently, this child had seen a puppet show in NURSERY SCHOOL about nutrition and somehow got the message that if you ate the wrong food and got fat, you would die. So the child stopped eating. Granted, most kids might miss this subtle message, but I don’t care. This kid didn’t miss it, and acted on it and lost 10 pounds. The child was diagnosed with ARFID (avoidant/restrictive food intake disorder, a new diagnosis created to include disordered eating without the typical body image concerns). Maybe this kid would have developed an eating issue later in life, who knows, but all I know is that the attempt to prevent obesity with nutrition education of preschoolers is insane.

For those of you with children, I am pleading with you to believe me. I have been in this field for almost 40 years and I have spent the majority of my years working and learning from people with weight issues and eating disorders. I have spent the last decade working with obese kids as well as children with eating issues (such as ARFID) and their families. I am here to tell you that young children don’t need to know squat about nutrition. They also don’t need to think about their weight and should NEVER have access to a scale or worry about their weight. What they really need is role models that are healthy eaters, exposure to healthy foods, especially fruits and vegetables, and opportunities to move and be active and have fun. They also need all of the adults in their lives to accept and love them for exactly who they are, no matter what their body size or weight.

I have shared examples from my older patients I saw in the past. For example, the very intelligent nurse who was a yo-yo dieter, lost and gained the same 50 + pounds over the past 3 decades of her life. She lost her weight through restrictive dieting and she gained it back through binge eating. She finally came to the conclusion that she was binge eating to get back at her mother who restricted her food intake as a child. She became a closet eater because she could not let her mom catch her eating. Apparently, her mother was quite body-image conscious and my guess is she had an eating disorder of her own. Anyway, it was very difficult for this woman to allow herself to eat normally because the fear of fat was instilled in her by her mother. And even though she could cognitively figure it out she struggled with stopping her behavior…even after her mother passed away. Do I think fear of fat helped this woman in any imaginable way? No, it didn’t.

At the other end of the spectrum, we often see infants and children who struggle with weight gain and growth, or who are referred to as “failure to thrive”. We often recommend adding what we call “calorie boosters” to foods, such as melting extra butter into a food, adding in a teaspoon of oil, mixing is some heavy cream to milk, yogurt, etc. I can’t tell you how many times well-meaning parents have returned with their child who has failed to gain weight because of the parent’s fear of adding calorie boosters. Yes, it is great that parents are health-minded, cook healthy foods, etc, but when fat is avoided like the plague everyone suffers. Children need fat for proper brain growth. Saturated fat is a precursor to cholesterol which many important hormones are made of (yes, we need cholesterol!) And children need calories to grow (steamed veggies won’t do it).

Here’s another brain teaser: have you ever had a health issue, or known another adult who has had a health issue and needed to make a healthier choice, yet didn’t? Let me start with a very simple example, constipation. Have you ever experienced this very uncomfortable situation or known someone with chronic constipation that was caused simply by not drinking enough water and not eating enough fiber? “Eat more fruits and vegetables and drink 8 glasses of water a day” the doctor probably says. Do adults follow advice just because they know it is the healthy thing to do? It’s not that easy, is it? If most adults can’t do it then why on earth do we think educating preschoolers is going to teach them to make healthier choices?

If you want my opinion on the bottom line, here it is:

  1. What snack your child chooses at school, whether they decide to take the cookie at lunch or have the chips with their sandwich will have NO affect on their weight. The calories in one cookie, one bag of chips or a bowl of fruit salad are similar. Yes, the fruit has more nutrients, but hopefully, you are offering fruits and vegetables at home (right?). Having a cookie for dessert or a serving of chips with a sandwich is normal eating. I might predict that if you don’t allow children to eat normally, they may be destined to be that closet, sneak eater when they become an adult and nobody is there to restrict them anymore.
  2. Your 4 year old can’t drive. Therefore, it is you who is doing the grocery shopping (mom and/or dad). What you buy to have in your home matters more than if your child knows which snack is healthier. If you want your child to grow into the healthiest body he is supposed to then having access to healthy foods and a structured eating schedule (3 meals and 2-3 snacks) is what matters more.
  3. Don’t become obsessed with the fat on your child’s body. It just baffles me when a parent worries about a toddler’s “tummy”. Think about it for a minute. A 2 year old, a 4 year old, even an 8 or 10 year old is short. They have lots of time to get taller (hopefully). Do you really think when they are 3 feet tall they have the tummy they are going to have as an adult? Their little bodies are going to change so much as time passes,however much body fat they have today will be different tomorrow. But if you talk about it, point at it or worry about it you run the risk of affecting your child in a negative way (making them worry and stop eating, triggering food obsession and abnormal weight gain or just feeling scared (or sad) that you think something is wrong with them). Their natural little bellies should not be a topic of conversation. Ever.
  4. Your children probably won’t eat what you won’t eat. I have seen many picky eating adults who want their child to eat veggies even though they don’t. Probably not happening. Remember the Rule of Twenty: it takes 20 tries to really know if you like something. Model the behavior you want your child to do, so that means going through the process of taking that bite with a smile. Talking about how good veggies are for you won’t work (we adults know that, yet we don’t care…I still don’t cook beets).
  5. It is ok to talk in a fun way about foods being good for you, but you should not talk about getting fat. Talking about being fat, instilling fear of getting fat, making it seem shameful to have a fat body just contributes to the growing insanity and body shaming and discrimination that permeates our society today. I plead with you to avoid being a part of this problem by accepting your child’s body and your own body without judgement (at least don’t talk about your body insecurities in front of your child if you can help it). This does not mean ignoring health and fitness. It means focusing on health instead of body size and weight. You can tell kids that carrots have vitamin A and that helps you see, that whole grain cereal is good for your tummy and oranges have vitamin C and will help you fight colds. But don’t say “that will make you fat” because that is not true. No particular food makes anyone fat. Learning to eat ALL foods in a normal way (a few cookies, not the entire box) is really important and this may not happen if you villainize a particular food.
  6. Find out what your school does as far as nutrition education. Talk to the health teacher or whoever it is that is doing the teaching. Find out what their philosophy is then voice your concerns if you have any. We need to speak up to protect our children.

Don’t blame yourself if you have done the natural thing a good parent does at times. Sometimes, we do worry about our children and we also want to show the doctor that we care. Often that translates into a parent leaving the pediatrician’s office, having been told their child’s BMI is out of range and so the good parent does something. Unfortunately, what they do is focus on the child which does not work. Instead of ever mentioning weight to a child, we need to look at ourselves. I recommend the entire family focus on being healthier, not just the singled out kid. Everyone needs to get off those devices and get outside to play. We all need more fruits and vegetables. We all need to get enough sleep.

Another sad fact is that healthy food is expensive. One mom told me how much WIC gave her for fresh fruit (not much) and this made me wonder how on earth she was going to increase the fiber in this kids diet. I am addicted to grapes and a week ago noticed that my one bag of grapes actually cost almost 9 dollars. How do people do it? Maybe, instead of funding programs to teach 3 year olds how to pick a healthy snack we should figure out how to help poor families have access to more healthy foods. Maybe we should focus on educating parents on how to cook healthy on a budget.

I am thankful all I had to think about was mud castles when I was 4. I hope you keep your child’s life simple, too. And if you can prevent even just one child from developing an eating disorder, it is worth it.

 

With Age Comes Wisdom(But Not Always When it Comes to Eating)

Image may contain: 1 person, tree and outdoorI think of him as the “Bird Man”. I was only 18 years old and little did I know at the time it was probably because of him that I became a dietitian. I was a freshman at Clark University in Worcester, Massachusetts and he was the graduate student who taught my biology lab. I was a biology major because I just loved the subject and everything to do with how every living thing worked (except the paramecium or amoeba). I had no idea about what I “wanted to be” when I grew up. But I realized I never wanted to be the Bird Man. He studied birds and bird calls (apparently, his thesis was about this topic), and he had us listening to hours of bird tweets, marking down different marks according to how long or short the tweet was. This was not my idea of fun. Anyway, I had no idea at the time that I could have chosen any topic in the field to study, and maybe, it would have been more interesting. Instead, when I consulted with my adviser about changing majors, he asked what interested me. At the time, my best friend at school was a vegetarian, and the food she ate was very different from what I ate. I answered “vegetarianism”. “Well, you should be a dietitian” was his recommendations, and so I changed my focus and transferred to UConn where they had a nutrition program. If I mentioned this story before, I apologize. Age has taught me I am becoming my mother (pictured here, eating ice cream even though she is lactose intolerant).

Anyway, yogurt with sunflower seeds and honey no longer interests me, and if I am honest, I have no interest in vegetarianism either. That was short-lived, but I have no regrets because over the years, I have discovered what truly does fascinate me, and that is behavior. My passion is promoting health and happiness and peace, and being a dietitian , that means peace and happiness with food and eating. Food being such a basic part (and necessity) of life, you wouldn’t think it would be so hard, right? But for many, it is.

When I worked exclusively with patients with eating disorders, I grew to appreciate even more how hard it is for people to change. When I encountered older women or men (in their 40’s, 50’s and one woman I clearly remember in her 60’s), it struck me that age did not necessarily bring wisdom when it came to making healthier choices in life. It was way more complicated. Now, between working more with families who have children with eating issues and even with encounters with your average “dieter”, I am discovering there are many barriers to change and everyone is different.

These are some common scenarios I often see:

  • Your average middle aged person who has gained a few pounds and wants to lose it. They try a certain diet (be it paleo, juice cleanse, Weight Watchers, it really doesn’t matter), they lose weight, and as time passes they gain most of their weight back. But then, despite the fact that they regained the weight, they repeat the process.
  • The person with an eating disorder who is in denial, and despite family and friends expressing concern and worry, they refuse treatment.
  • The person with an eating disorder who does get treatment but still struggles (and often beats themselves up because they are still struggling).
  • The parent with a child who has health issues because of a poor diet yet can’t change their own eating habits.

With all of these situations (there are many more), one thing rings true among them all: despite a good reason to change and despite repeated experiences with failure, change does not happen. Why?

My thought (and experience) is that our expectations are not always realistic. No matter what the situation, we can’t change it overnight. Knowledge, and even age and experience does not translate into change. And guess what……that is ok. The problem is that most people trying to change have little tolerance for making mistakes or for failing. Instead of being accepting of themselves that it is perfectly normal to fail, the self-deprecating dialogue takes over. That leads to a very negative feeling that has the risk of overtaking everything. Feeling negative and berating oneself is not a good recipe for change.

Instead, can you entertain the thought of a different approach to eating? No matter where you are on the eating spectrum (it taken over your life because of an eating disorder, or are you just slightly concerned that what you eat may matter) YOU are the one in control of your thoughts. You may not feel in control of your eating, but there truly is hope.

My suggested steps to change? First, ask yourself these questions:

  1. Reflect. Take time to neutrally (non-judgmentally) think about where you have been when it comes to eating and dieting. Has your road been long, or are you just starting to think about what you are eating?
  2. What does your “self-talk” sound like? In other words, what are you saying to yourself that nobody else can hear? Are you being nice to yourself, treating yourself kindly as you would others, or are you being mean?
  3. How do you feel? Do you have energy galore, or is getting up and moving a battle? If you don’t have energy or you are dragging, do you know why? Have you addressed it with your doctor?
  4. Are there changes in the back of your mind that you really know you need to make for your health’s sake? More sleep, less wine, more exercise, quit smoking, more vegetables? Be honest and make a list. This does not have to do with weight. This has to do with health and feeling good and living longer (hopefully).

THEN, make an action plan:

  1. If your self-talk is negative, write down some “counter-statements”. These are positive things you could say to help put you in a better place. Instead of “I can’t believe I ate that (or did that, or whatever), try saying “nobody’s perfect! at least I am aware of what I am doing! I am working on it!”
  2. If you don’t feel good or have no energy CALL YOUR DOCTOR and get help figuring out why. I know many people who have thyroid conditions, especially later in life that after treatment changed their lives. Depression can also zap energy and will rarely get better without help.
  3. If you are trying to improve your lifestyle to be healthier, but struggling on your own, ask your doctor for a referral (you may need a therapist, physical therapist, sleep study or dietitian…check out Find An Expert to find a registered dietitian in your area.

Remember, any “mistake” you make is really a gift in disguise. It gives you insight into where your barriers and challenges are. You just need to take the time to reflect on what leads you down that path and be kind to yourself as you keep trying to find a better way. It may be that you need to seek help to get you to where you want to go, and remember, it will never be perfect. The path there is never smooth, but that’s ok. As long as you keep going. And learning. And accepting.

So what would I have been had it not been for the Bird Man? I have thought about this. I maybe would have been a Master Chef, or Master Gardener, or maybe a sommelier on a Caribbean Cruise Ship…..Maybe it’s not too late.

Summertime Smorgasbords: How Do YOU Deal With Too Much Food?

Image may contain: foodChili Dip with Nacho chips, chicken cream cheese roll ups, guacamole layered dip with olives, cheeseburgers, hot dogs, grilled chicken, pulled pork, bean salad, corn salad, pasta salad, fruit salad, tortellini salad, cannoli dip with cinnamon chips, homemade macaroons dipped in chocolate, brownies, sugar cookies, chocolate chip cookies, rice krispy treats, cheese cake, Death by chocolate, peanut butter bars, every kind of chip imaginable…..oh, and wine, beer, sangria and water. What do you put on YOUR plate????

That was only part of the food that arrived at our pot luck picnic this weekend to kick off the summer season. Needless to say, the chatter regarding food and eating was unavoidable.  My own daughter was comically stressing about what to choose when the desserts were out. “I’m so full!!! But that looks so good!!” Since she is not a baker and is also very frugal, yummy desserts like these don’t often come her way. I think she felt like she should take advantage of the situation and eat a bit of everything. Yet, she was already full. I simply suggested taking a plate of everything home…..that way, tomorrow, when she was hungry again and eventually in the mood for something sweet, she would be very happy. She thought I was brilliant : ) Such a simple suggestion, yet I am guessing a lot of people might not do this, thinking it was maybe rude to ask to take something home? Yet, I do it all the time for the simple reason being that I am not a fan of tummy aches. Sometimes, you just have to be assertive to take care of yourself….

My daughter’s reaction to my simple suggestion of taking some dessert home made me realize that these summer celebrations, while mostly fun and something we all look forward to, can be stressful to many. That day the dieting/food chatter was impossible to avoid. Some comments my daughter and I overheard:

  • “I didn’t eat today so I can have this”
  • “I am going to do an extra workout at the gym tomorrow morning to burn this up”
  • “I have been good all week”
  • “This week already has been bad, I might as well enjoy it today because after Memorial Day I am starting my diet….again”
  • “I can’t make up my mind what I want to eat, there is too much!”
  • “Get this dip away from me!”

And I am guessing that some people were having their own private thoughts about food and eating they may not have spoken out loud. When I worked exclusively counseling individuals with eating disorders it made me much more aware of how food-filled celebrations like these were absolutely scary. Typical thoughts from my patients were: Will someone be pushing food on me? Will anyone make a comment about what I am eating (or not eating)? Will I gain 5 pounds if I eat something fattening? Yes, everyone is different when it comes to how they handle exposure to such an overwhelming amount of food choices, and it can be emotionally (and physically) draining depending on your relationship with food.

In general, in my career as well as in my daily life I have encountered a few different “types” of individuals when it comes to eating and health, and their reactions to something like my Memorial Day picnic would all be different. For example:

  1. The so-called “normal” eater: this person encompasses a wide variety of people. Picture the active young adult male (or female) who doesn’t know much about cooking, likes to eat and totally appreciates free food. This guy may not care much about how he looks as far as body size, but has the innate ability to listen to his body signals (or, really doesn’t think twice about overeating or feeling way too full). He tends to take exactly what he likes, enjoys his plate of food and may throw out what he can’t finish. He then runs off to play lawn games with friends. Or, picture the middle age or older person who no longer is as fit as they used to be, but never dieted and doesn’t know what a calorie is. They may talk more about their digestive habits than food and body size. They tend to grab food they enjoy but avoid the things they know give them digestive problems (as we age, for example, some of us can’t digest milk as well as we could before). Or maybe fried foods does not sit as well as before, so passing over the bacon chili dogs with cheese is not because of calories but because of the desire to avoid the uncomfortable repercussions.
  2. The “restrained eater”: this person does not have a clinical eating disorder (meaning they may not meet all of the criteria for a diagnosis) however they probably spend a lot of time thinking about food restriction, calories, etc. They are very weight-conscious and weigh themselves often to be sure they are not gaining weight, or because they are trying to lose weight. The way a restrained eater behaves at a picnic depends on which mind set they are in at the moment. If they are determined to be restrictive, they may choose only “safe” lower calorie foods (such as the grilled chicken and salad). They might be experiencing some inner turmoil because the food choices available are especially appealing to someone who tends to restrict them on a daily basis. They may actually break down and have something, but the guilt they feel after eating triggers a repetitive and negative, blaming message inside their heads. Or, they may overeat once they have “blown it”, knowing that days of restriction will follow. Yes, restricting intake and dieting is associated with binge eating. It may not make sense to a naturally intuitive eater why on earth someone would eat so much as to feel ill (sometimes referred to as a “food hangover”). The person who has never dieted won’t get it, but those who have put themselves in “diet jail” understand that you gotta eat while you can, because inevitably, the dieting days will start again. The bottom line for restrained eaters is picnics can be challenging.
  3. The eating disordered person: without going into detail, someone with an eating disorder (anorexia nervosa, bulimia or binge eating disorder) faces challenges beyond most people’s comprehension. They may have some great strategies to cope with these overwhelming situations if they have received treatment and this can help get them through it all. Sometimes, the hardest part for them is the scrutiny of others. That is why I make it a point to never comment on what someone else is eating (or not eating). It is none of my business. So please, do me a favor and keep your eyes on your own plate. Intentions may be good (they usually are from caring family and friends) but I promise you, unless your loved one personally asked you to be the food police, don’t do it.
  4. The “healthy eater”: this person may not be extremely restrained, but they prefer healthier types of foods. They may know little about calories and may not care about their weight at all. But they like good, wholesome and also delicious food. I know a lot of people like this (some may be referred to as “foodies”). They love to cook and discover interesting ways to make kale or beets. When you go to a party and there is that one unusual salad that you just can’t get enough of (and yet it’s main ingredient is vegetables), this is the person who likely brought it. Just this week I had a salad made of shredded broccoli, dried cranberries, walnuts (I think) and poppy seed dressing that was to die for. I also had a fresh corn salad with blueberries and cucumbers (go figure) that was also an unusually delicious combo. Besides enjoying cooking healthy type foods, these are the people who don’t eat much processed foods, not because they are worried about gaining weight but because they would rather make it themselves and know what is in it. I admit to being somewhat of a dessert snob in my old age (I can now taste the chemicals in a Twinkie). It needs to be homemade to taste good to me. Anyway, at a picnic these types of people may tend to be a bit selective but it is not the same as the “orthorexics” who will only eat super-healthy foods to the point of eliminating many fats, carbohydrate foods, etc. and who stress about eating perfectly. Normal, healthy eaters who prefer healthy food don’t waste a lot of time making their decisions about what they want to eat……they just may pick the more wholesome and homemade options (they really don’t miss the hot dog because they don’t enjoy them). But they won’t be passing up that homemade guacamole.
  5. The weight-conscious “healthy eaters”: these are people who have what is often referred to as “normative discontent”. They may be weight-conscious and try not to overeat, but they are going to enjoy themselves. As I may have written in another blog, in our culture it is difficult to not notice or care about body changes or weight gain as we age. Working on eating healthier and exercising but in a way that does not make you stressed out and does not affect your life in any big way is a different story than the restrained eater who feels guilt after eating. Still, focusing on weight in any extreme way (where it leads to meal skipping or restriction after a picnic or party day) may be a red flag. While it is reasonable to want to have a stable body weight as you get older, if too much energy has to be spent thinking about eating and food choices, or if guilt with eating enters the picture that is a different story.

The message I wanted to send today is that the summer fun has only begun, and my hope is that you will find a way to truly enjoy it at the same time as you honor your health, both physical and mental. That means accepting the person who YOU are and reflecting on your relationship with food. Do you find yourself feeling excessive guilt after eating at picnics? Do you starve or restrict before a party, then overeat and feel awful? Or, do you embrace and enjoy the great variety of foods you don’t ever get to have (because, honestly, who has the time to scrape corn off a cob for a blueberry corn cucumber salad?) If you find you really don’t enjoy these fun summertime food-centered events, try to figure out why….are you trying to be too healthy? are you afraid of gaining weight? Do a reality check. One meal or one day honestly has little affect on health or body weight. If you work on intuitive eating and listening to your fullness, you truly can eventually figure out a way to enjoy the entire event, food and all.

And, remember, you can always take home a doggie bag : )

 

Do We Need to Measure Body Fat in Children?

Children 3Because I am a member of the Academy of Nutrition and Dietetics (AND) as well as the Weight Management Practice Group, I receive regular emails and updates from them, many very informative. But this week I was floored by one that advertised this: “Join us for our November Pediatric Weight Management Webinar: Measuring adiposity in children – what’s the best method? 

Really? OK, is it me, or is this crazy? Am I missing something? To make it clear, I am not referring to evaluating body fat to determine level of malnutrition. I was fortunate to receive training from the hospital where I work in diagnosing malnutrition based on different criteria. It is the thought of using various methods to determine body fat in children that you already know you are going to treat for “obesity”. Yes, I get it, those people who equate perfect weight with perfect health. The whole “obesity epidemic” and those who worry about kids health because of this (as if weight alone or even body fat is the cause of disease, it is not). When I worked full time at an outpatient children’s hospital, yes, there were children with pre-diabetes and hyperinsulinemia or Nonalcoholic steatohepatitis (NASH) who had gained too much weight (according to their individual growth charts, they had veered off which was not normal for them). But focusing on the body composition of a child like this does nothing but continue to label and villainize the poor child even more. The problem is inevitably not the weight, it is the lifestyle change that led to the abnormal (key word=abnormal) weight gain. You cannot, I repeat cannot know if a child’s weight is “normal” or not just by looking at them. Or weighing them.You absolutely need to see their growth chart.

I have ranted on and on about reasons I am not a fan of BMI (Body Mass Index, determined by calculating out a number based on weight and height). Just as a reminder, this number is meaningless when it comes to measuring muscle mass verses fat mass or even water weight so that athletes who tend to be heavier due to all that muscle often have BMI’s in the “obese” range. I am sure I have told the story that always sticks in my mind of the little boy who was about 10 years old and referred to us for “obesity”. How I went to the waiting room to find a very fit looking young man with a very worried look on his face. How when I asked his mom what brought them here, he blurted out “I have obesity. Am I going to die?!” It absolutely broke my heart. I just came out and told him (after looking at his growth chart and seeing that he had been plotting along a certain percentile for weight and height since he was an infant) that his doctor made a mistake. “Your doctor must have forgotten to look at your growth chart! You are fine!” Phew. He literally wiped his forehead as if he just escaped a close call. Come to find out, he was an athlete and very competitive in more than one sport, and he was as healthy as any kid could be. BMI, obesity, see why I hate the terms?

Anyway, after looking into the research a bit, it seems we are more obsessed with getting the “numbers” right instead of figuring out how to actually help people. I was trained decades ago to use the triceps skin-fold method of determining body fat. I hated it because I never felt I could get it right (“am I pulling out muscle or skin or fat? this doesn’t feel right”). Maybe it is just me, but I just never felt confident in it (and have never used it). There are other methods to determine body fat, and I am guessing many people have seen (or own) those scales that supposedly can tell your body fat in addition to the force of gravity on your body. I remember my son telling me back when he was a high school athlete that he was 80 percent fat because his friend’s mother’s scale said so. I just laughed and thankfully he just shrugged it off because it was blatantly inaccurate. But still, I am imagining a lot of people believe those scales and are thrown into a self-deprecating tizzy every morning. But according to that upcoming webinar, we dietitian’s and other health care professionals should be not only paying attention to body fat but learning the best way to measure it.

So now all I can imagine is adding one more invasive scary thing to an already traumatized and singled out chubby kid. It is bad enough to be openly labeled by your trusted pediatrician but then to have someone pulling and squeezing calipers on your body, or measuring your waist or running a weak electric current through you to see how fat you are because we don’t already know by your weight or BMI we just figured out, no,we need to do a few more things to your poor innocent body to see just how horrible you really are. Oh, and at the end of your visit, don’t you feel like going home and eating your vegetables?

OK, I get it, and we all know that a certain kind of body fat is more dangerous. And it is not the fat on our thighs…. for a good explanation as to why experts are concerned, see this article Body fat Types. While we can’t ignore the fact that increasing visceral fat does affect our health, I just don’t get why we need to measure it because in the end, aren’t we still going to have to figure out how to help people? Does it really help to tell someone what percentage body fat they have? And when it comes to children, why on earth do we need to subject them to anything like this? If we are talking about your otherwise healthy child going to the pediatrician’s office for a yearly visit, if BMI is useless, why would this add anything helpful at all? In the end, it boils down to what kind of lifestyle a parent is able to provide for their child. Right? I understand time is very limited at the doctor’s office, and they really need to cover a lot. I have heard the stories, and that is what affects my opinion. From what I hear from parents, most doctors really don’t have time to get the details of what their barriers are as far as achieving a healthy lifestyle. So they just have to resort to handing out the typical advice: Don’t buy soda. Limit juice to once a day. Limit screen time to 2 hours or less. Get 60 minutes of physical activity. Make half your plate vegetables and fruit. Eat at the table. Have family meals. Well, that is great if you have the means and ways to achieve these goals. But lots of families I know just can’t do this. They may not have the income to afford those veggies and fruits and that giant jar of chip/Cheetos/pretzel mix for a few dollars at Walmart will feed your 3 children for longer than 3 apples. Maybe grandma is watching your children after school in a neighborhood where you can’t safely go for a 60 minute walk, and so video games really come in handy. Does your pediatrician ask about these things? The good news, at least in Connecticut, is that some pediatricians are hiring dietitians who actually do have the time to find out all the details of a family’s life and who then can help with the barriers. Yes, these doctors must understand that achieving a healthy lifestyle is more complicated that the healthcare experts think. We are not all created equal and our lives and resources are not the same.

That is why I keep hoping the madness will stop. We will eventually get it that focusing on BMI is not helpful at all. Did I get it wrong, or didn’t the American Academy of Pediatrics just come out with the paper on focusing on health and NOT weight loss? I shared it a few posts ago. I was happy. So then why am I getting these emails about measuring body fat in children? Even if we figured out a way to accurately and in a noninvasive way know what a child’s body fat was….would it change our intervention? Aren’t we supposed to just be focusing on promoting health? Then how can this help?

Frankly, I don’t care what someone’s body fat is. I want to help people be healthier. Whether someone has a lot of the dangerous kind of fat, or the other kind of fat, or no concerns about fat at all. I think we all could benefit from doing all the things we can to be healthier. More sleep, less screen time, less stress, more family meals, more fruits and vegetables, less McDonald’s, more water, more fun movement…..more sanity.

I won’t be attending that webinar. No offense, dietitians, I know the intentions are good. I know the goal is not to humiliate children, and we all say we need to focus on families and parenting, but from my experience, kids are smarter than you think. If you talk about their BMI and then start pinching their arms with calipers, they will get the message, no matter what you say or how you say it. Is it really necessary?

I say no. How about handing out free hula hoops? Now that sounds like progress….compared to calipers.

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

 

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.

 

Teens and Eating Disorders: 5 Mistakes To Avoid if You Are a Parent

cropped-img_1418.jpgI will call her Jessica. She was one tough cookie, starting from the day her mom brought her in for her first visit with the dietitian. She was 16 years old and referred by her pediatrician for weight loss and a possible eating disorder. I could tell from Jessica’s demeanor and angry face that she would rather be having her toenails pulled out than be here. I met with mom first (I have learned that having both parent and teenager in together almost always turned my otherwise very pleasant counseling room into a war zone). Anyway, Jessica’s mom filled me in on the fact that her daughter did not want to come today. Mom wanted to prepare me for a very bad visit. I let her tell the story of why she was there, and just as with many parents I have seen, the feelings  transitioned from anger to sadness and eventually tears. A newly diagnosed eating disordered teenager is ….well…..so difficult for me to even put into words, because I just can’t imagine how painful it is to watch your son or daughter fading before your eyes. I also know it is scary  for a teenager when they are being taken over by this deadly disease. So when a parent finds out their teenage child has an issue with their eating, what they do can be critical.

With today being the very last day of February, Eating Disorder’s Awareness Month, I thought it might be helpful to share my experiences with the intent to help parents understand just a little bit about what is happening when their teenager seems to be falling into the grip of disordered eating. Let me make it clear that from my experience, every single parent I have ever met who has brought their teen to come see me for help are always caring parents who love their children and only want the best for them. But most of them don’t understand what is going on, and their reactions to their teenagers behavior are often not helpful.

So here are just 5 things I wanted to bring to the attention of any parent who may have to struggle through this with their teenager:

  1. Do not ignore weight loss.

You know how it is when you see someone everyday….sometimes small changes go unnoticed. Sometimes, when teenagers are wearing baggie clothing (which is very common in people with body image concerns) we just don’t realize a significant weight loss has occurred. And sometimes, if a teen is a bit on the larger size, she may get attention for losing weight. Parents sometimes feel happy and proud when weight is lost. They don’t want their daughter to be overweight, the importance of avoiding obesity is all over the media, why wouldn’t they be happy? The problem is (and I see this all the time, when people don’t stop to think) sometimes weight is lost in a way that is not healthy at all, and even dangerous. Sometimes kids skip meals, teenagers stop menstruating (a huge red flag) or even may suffer from dizzy spells and fainting. Parents need to investigate when a teen loses weight, not condone it, not praise it, but find out why. If someone cuts out soda, or takes up a healthy sport and is enjoying life, still eating with the family and eating normally, then there may be no issue at all (but PLEASE don’t give too much attention to the weight loss, instead support the healthy lifestyle as that is a good thing, and has nothing to do with weight). Be sure to take your teenager for regular doctor’s visits and ask to see the growth chart. Ask your doctor to explain it, and if your teen is falling off the growth chart, or not gaining weight, find out why. If your daughter stops having a period, or starts skipping periods, tell the doctor. But do not ever ignore weight loss in a teenager.

2. Do not make the dinner table a war zone.

If your teenager used to love your mashed potatoes and now does not want them, don’t make an issue out of it (at first). But if you notice they no longer want other foods they used to love, and insist on only grilled chicken and salad, don’t ignore it, however don’t start pressuring them at the table. The dinner table needs to be a happy place for everyone in the family. Plus, it will not work, and will most likely cause your teenager to avoid the dinner table altogether. Instead, seek out the help of a professional. Tell your pediatrician about the sudden food refusal and ask for some references for therapists who deal with eating disorders. Tell your teenager that you are worried about her eating and that she does not eat the way she used to. I explain it as an “assessment” so that is sounds less threatening. It is just to be sure everything is ok. Or, you can start with a dietitian to be sure your teenager is getting what she needs nutritionally. Sometimes, kids go through phases when they want to eat healthy, or experiment with vegetarianism, etc. and they just need a professional (and not their mother) to explain why it is ok to eat pizza or potatoes, or ice cream, or whatever because it all contributes nutrition. I have had many teens show a sign of relief that someone who “knows” gave them permission to eat ice cream again! They happily go back to mom’s potatoes. But if they don’t, typically the dietitian can also help along with the pediatrician in finding a therapist who has expertise in eating disorders.

3. Do not ignore your instincts.

Besides refusing foods they used to like, are you getting a feeling that something is just not right? Do you catch your teenager in telling little “fibs”that may not seem significant, but make you think something is up? For instance, your son says he is going to eat with his friends at the pizza joint after school, yet when you see his friends later that week, you hear them ask where he was….is he finagling his way out of meals? Or, has your daughter started a new routine, where for some reason, after eating she always has to run to the bathroom? Could she be vomiting after meals? Or have you caught your teen checking out their tummy in the mirror? Of course this can be totally normal, but if it is coupled with other “red-flag” behaviors such as food refusal, and your instincts are telling you something is wrong, don’t ignore it. Ask questions. Let your teenager know you have concerns and are wondering what is up.

4. Do not think your teenager is purposefully trying to drive you crazy.

One of the first things I always say to a parent whose teenager is newly diagnosed with an eating disorder is “they are not doing this on purpose”. Parents get very angry (at first) when their previously happy eat-you-out-of-house-and-home teenager no longer will even sit at the dinner table. Teenage years are not always the easiest as it is (having had 3 of these I can say from experience). The purple hair, the pierced eyebrows, the roller blades, loud music, protesting the rodeo……teenage years are a time of transition, so throwing in body image issues and disordered eating into the mix certainly has the potential to create some explosive scenarios.  But when it comes to an eating disorder, trust me, no one, not even a teenager, wishes the torturing mindset that comes with the disease upon themselves. What has helped me tremendously in understanding what those with eating disorders are going through is the concept of “ED”. ED is what I imagine as a monstrous little creature sitting on your teenager’s shoulder, muttering the most horrible and distorted demands into their heads that they just can’t ignore. “Don’t eat that! It will make you fat!” “Don’t listen to her, she wants to make you fat!” ” You need to skip dinner, you ate lunch, or you will get fat!” “You don’t deserve that, you were bad all week” And on and on and on. All day. Every meal. After every bite. So when your teenager has a fit, and gets mad at you, and yells and swears, just know it is not her or him. They are under the influence of something very powerful and not in their control. Not yet, until they get help. Which brings me to the last point….

5, Do not think you can go it alone.

It really is hard to commit yourself to doing what you need to do to get help. These days, we are all so busy. Both parents work, and there are more single parent households relying on only one income. Teenagers are involved in sports, getting their driving permits, there are proms to go to, it is endless. But, if ED gets control, none of that will matter in the long run because he can get such a grip on a person’s life that it will only get harder and harder to shake him off. Not only health,but lives are at risk.  No matter what it takes, rearranging work time, finding a therapist who has evening hours, getting into a program, the sooner you get help, the better. Check out the National Eating Disorders and Awareness site at NEDA for more information on eating disorders. Your teenager does not have power or control over what is going on with their eating or their body image. But you CAN help your teen by getting them help. Trust your instinct as a parent. If you think something is wrong, you are probably right.

You might wonder why I chose the beautiful photo at the beginning of this post. It is from a kayak trip down the Connecticut River, off the town of Essex. To me it symbolizes what I have learned an eating disorder is to many patients: it is something they turn to in order to deal with something else in their lives. It is a “life preserver” such as those thrown into a river when someone can’t swim.They need to learn to swim before they can let go. But there is so much to look forward to, like the beautiful sunset in the distance. They will get there.

Weight Watchers: The Good, The Bad and The Ugly

torpedo-1240955Did you ever experience something that affects you so much that  you remember if forever?  I remember Nancy (not her real name), a sweet middle aged mother who had come to me for help with binge eating (and she wanted to lose weight). If you saw her, you would never know she had any eating or weight concerns. She certainly did not look like she needed to lose weight. She had always been a yo-yo dieter, gaining and losing some weight over the years, but bigger troubles emerged after starting Weight Watchers. She would basically restrict herself before her “weigh ins” when she went to her meetings, which meant eating even less than the diet called for.  All she thought about was the reaction she got after stepping on that scale. She just had to get through that minute. If the number did not go down, she felt like a failure (the fact that they let her into a weight loss program with her weight scared me, but maybe it is different now?). Anyway, Nancy would leave her meeting with relief, proceed to the grocery store or fast food place and binge eat. All day. Because she did not have to be weighed for another week. And then she would purge, feel terrible, depressed and like a failure. But she would be back on track again a day or two later, just to repeat the process. She was stuck in the Weight Watcher’s trap, hold, spell, whatever you want to call it. Unfortunately, Nancy was not the only WW casualty I encountered in my private practice. There were many more. Not all of them developed the eating disorder bulimia, but they all never learned how to eat healthily and happily. Some would lose weight, but then have no idea how to transition to a “real life” without “points”. It was the counting of the points that drove my patients to a place that was not good. After losing weight (by eating less, points, calories, counting carbs, it is all the same) there was no where to turn. What next? The patients I saw did not know and so either gained weight or transitioned into an eating disorder.  Not all people who diet or follow Weight Watchers or count points develop eating disorders. I have known many friends and acquaintances who absolutely love the program. “It works!” they say. Every year, even after they have regained the weight again. Some people even maintain their weight loss for longer. But inevitably (in my experience, with the people I know), the weight is regained, there is a period of living “Outside of diet jail”-how I refer to it. Diet Jail is when someone is following a diet. When they can’t do it anymore, they break out, eat what they want, forget about it for awhile. They eventually remember the “success” (????) with Weight Watchers. They DID lose weight and they felt great. So they start again. I think people believe each time they restart the diet that it will be different. What I have seen (and I can only speak for myself, my experience with patients and others in my life) is that if fails them. They do not learn about themselves in any meaningful way.

Which brings me to something that I really wanted to share with you before you might read it in the news.

You are going to be hearing about a new study on  Weight Watchers  which was published on line in the American Journal of Public Health on February 18th. As with most studies, when they are publicized in the news (usually one dramatic blurb that catches your attention, such as “wine is good for you! chocolate is good for you! Caffeine is good for you!”) we believe it. Because we want to. Most people don’t have any inclination to doubt “research”, it sounds so scientific, it has to be right. So with Weight Watchers, I wanted to fill you in a bit (yes, as you probably noticed, that program leaves a real bad taste in my mouth). The Nancys of the world are the reason I am not a fan. But for now, let’s talk briefly about the study.

The study was conducted by researchers at Indiana University School of Medicine. The objective was to compare WW with another program to find out if it was as effective in promoting weight loss and improvements in metabolic outcomes such as Hemoglobin A1c. It was comprised of 225 subjects (with prediabetes) and was a randomized controlled study (that part is good). The results were good for WW in that their groups had better weight loss and metabolic improvements that were maintained for 6 and 12 months compared to the other program. The negative part (and what people don’t always know) is that the study was funded by Weight Watchers, according to this LA Times Article . The abstract of the research article is available at the link to the Study , and although the entire article is not available unless you are a member or you pay for it, you can clearly see (if you check out the Study link) that two of the researchers are from Weight Watchers. Most would consider this a conflict of interest, and this happens sometimes, but it is ok as long as it is spelled out (and it is). You can make up your own mind, but to me, if a company who is selling a product is involved in the research evaluation the product, as well as the way the article is written, it just bothers me. In this case, the researchers from the university are clearly respected and that helps, but to me, it would have been better if WW were not involved in any way.

The second thing that bothers me is the sample size and length of follow up. Yes, the results were “significant” statistically, but in the real world, 225 people from Indiana is just a start. The study needs to be replicated over and over to really mean anything. And the 12 month follow up is really NOT a long time in the world of weight management. True story: when I was doing some research for a PhD back in the day my adviser would not approve my project unless I did a 2 year follow up. As it turned out, the program that I was a part of was discontinued and I was going to have to start over (ugh). I ended up going back to my normal job and never finishing due to the fact that I just did not have another 2 years. But is always stayed with me, the length of time truly needed for weight management results to mean much (to me anyway, and to many others). It is good news that diet and lifestyle changes can help prevent diabetes and reverse prediabetes. You just don’t need to spend time and money on a program to do it.

Another thing that bothers me about the study is the motivation. According to the LA Times article (link above) Weight Watchers  “was trying to get its system of counseling and motivational goals certified as a diabetes prevention regime by the government, which meant it had to develop data”. I am a little conflicted about this because on a positive note it would be more likely for insurance to cover the program if it is approved, but on the other hand, I hate the thought of even more people counting points.

Which brings me to the real reasons I am not a fan of the program. Years ago, the Weight Watchers program was different,and the issues were different. It was focused on the number on the scale, and labeling food as “legal” or “Illegal”or something to that affect. It instilled guilt with foods, and feelings of failure (especially at weekly weigh ins). But at least back then it was a simple and balanced “diet”, not too overwhelming, and perhaps some people learned they needed to eat three meals a day with all of the food groups included. But now, this point system is just plain overwhelming. I am good at math, but when it comes to food and eating, who can sustain figuring out some mathematical system of adding up points for very long? Yikes. Another REALLY bad consequence is the way the point system contributes to binge eating.  I believe people who count points know they are supposed to spread out their points over meals and snacks. Do you really think a typical dieter or person who tends to overeat or even binge is not going to be tempted to “save up” points when they are going to a party so they can eat more? What does this teach? It is the same bad habit many dieters have: restricting during the day and then overeating later. Does this teach a healthy lifestyle? Do you really think this is going to help someone to get more in tune with their hunger and fullness so they actually learn to prevent overeating and binge eating by just eating “normally”? No. Counting points is just like counting calories (just a bit trickier, a new gimmick, and dieters love gimmicks). It is a form of “cognitive restraint” which I have talked about before. When you use your “head” to figure out how much to eat, you get disconnected from your true body signals. Those signals that help you be the weight you are supposed to be (yes, there are those who are prone to binge eating especially on foods high in fat and sugar, but I am referring to the typical dieter who only became obsessed with food after dieting).

So when the weight is lost, then what? A normal “healthy thinking” person is NOT going to be able to keep counting points. They are not left with much else to transition to. Any person I have ever known who has been successful with weight management has taken the time to really reflect on what has changed in their lives to make them gain weight beyond what is normal for them. It is different for everyone. For some, they gave up a sport when they started working. For others, they started making money and going out to eat and drink more often. Or maybe they took on a new job and stopped going to the gym. Maybe they went through a divorce and became depressed. Or they moved out of their parents home and started to stop for fast food because they don’t know how to cook. It could be mindless eating they have gotten into the habit of (eating in front of the TV or at the computer). It could be a million things that affect our bodies and our health. Counting points, or calories, or even following the Hot Dog Diet will result in weight loss. But that does not mean it “works”or fixes anything permanently. What “works” is taking the time to reflect on your lifestyle, then making the tough decisions as to what changes you want to make depending on what unhealthy habits or lifestyle patterns you have fallen into. You might want to seek out professional help from a Registered Dietitian or even a therapist if your eating issues are rooted in a psychological or emotional issue. You may not see the fast results a diet or diet program can offer. But a year from now, or two years from now, you will be happier and healthier.

In case you did not notice, Weight Watchers recently came out with a television ad with Oprah as the new face of WW. This helped boost the stock at first but just like dieting according the the LA Times article, it did not last long. Check out Dare Not To Diet for some great insight by the experts on Oprah and Weight Watchers.

Anyway, I covered the “bad” and the “ugly, so what about the “good”? I actually think Weight Watchers has some pretty good recipes (I have friends who have brought over yummy healthy dishes, and they were happy to brag “weight watchers recipe!”). I wish anyone who decides to go on the program and count points figures out how to take the good things (like healthy cooking) from the program and leave the rest.  Everyone is different, and if someone loves Weight Watchers, I just wish them luck. We all need to learn from our own experiences.

But please think about it. If you did it before, and regained the weight you lost, did it really “work”?