Should You Put Your Teenager on a Diet?

stock-photo-74105099-unhappy-teenage-girl-sitting-on-floor-looking-at-bathroom-scalesI still remember that day I was sitting around a long conference table in the Endocrinology department at the children’s hospital where I was just hired to help develop a weight management program for teens and children. There were several nurses, a few endocrinologists, myself, another dietitian and my manager. They had decided the children would keep food logs as well as track their calories. I was so glad I was there to enlighten them about that! I explained that counting calories was a very bad idea as this would not only lead to more focus on food, they would likely gain weight, not lose, and even worse could develop an eating disorder. I explained that even the thousands of adults I had worked with over the past 2 decades were never successful with counting calories, and the only ones who were good at it had eating disorders. Phew, now we can move on (I thought).

No luck. They basically ignored all I said, and my manager was fuming. I was flabbergasted.  So the other dietitian and I decided we would gather the research articles refuting this approach, and share it at the next meeting. We did just that but again, no luck. Although I was floored, I had faith they would learn their lesson when it all unfolded.

I was right. When it came time to teach the classes (parents would come as well as the child and siblings if they wanted), the first step was to share their notebooks. These were also brought to individual sessions with the nurses and dietitians. Lo and behold, almost none of the participants did it! Or if they did they were so obviously inaccurate, it was almost funny. Guess what? It took at least 2 years if my memory is correct but eventually they eliminated the calorie counting (Thank God!). The great news is they eventually hired a full time psychologist who had lots of experience with eating disorders and weight issues, and who went on to change the entire program to be more evidenced-based, and focus on health (and not dieting).

Anyway, I picked this topic to write about this week after getting my monthly newsletter from the weight management “practice group” I belong to in the Academy of Nutrition and Dietetics (AND). It included an article entitled “Alternatives to Calorie Counting: Consideration for Pediatric Weight Management”. The article mentioned the AND Position Paper’s recommendations that “treatment plans for managing pediatric overweight should emphasize multi-component, family based programs, which combine nutrition education, physical activity, and behavioral strategies….alternative approaches to calorie counting should be implemented for this population as a means of self-monitoring nutrition decisions”. The article summarized exactly what these “alternative approaches” were.

The author (Giselle Willeford, MS, RDN) does a great job of summarizing the research describing the detrimental affects of having kids or teens count calories (increased focus on food and eating, increased risk of eating disorders or further weight gain). Here is a brief summary of the “alternative to calorie counting” that were described:

  1. Traffic Light Approach: this method (originally developed by Leonard H. Epstein) calls for dividing foods into 3 categories, Red, Yellow and Green. Green foods are things like vegetables and fruits that you can help yourself to (low calorie and low fat). Yellow foods are those foods that have more calories and that you need to be careful with portion sizes (chicken, rice, etc) but are still healthy. Red foods include sweets, fried foods etc. that you should try to limit and/or decrease in your diet. I am NOT A FAN of the “Stoplight Diet”. Although it sounds simple enough, I have seen first hand the damage it can do. I have had several very young children (age 8, 9) that took this diet to heart. They were those really “good” students who got all A’s and did not want to disappoint their teachers, so when they got the message that red foods should be decreased, they stopped eating them altogether. The patients I saw lost weight when they should have gained, stopped gaining in height, with great repercussions to their family relationships (“she won’t come out for pizza with us anymore”, or “he only will eat the “green” foods so we can’t go out to eat anymore, it is driving us crazy!”  These children were on the verge of developing serious eating disorders and actually were at risk for stunting their growth if they kept it up. The good news if I have been successful with helping these kids because they just needed to hear another authority figure (“The Dietitian”) tell them all the reasons it was ok to drink milk and eat cheese and even pizza again. My recommendations: skip the traffic light approach. Traffic lights are for cars.
  2. Plate Visuals: this is an easy tool to use for those who can’t read or write, so it makes sense to use it with children and teens. You might be familiar with the colorful diagram, and if not see the website: My Plate The visual shows half of the plate with “colors” and this means half your plate should be fruits and vegetables. A quarter of the plate is for “meats” or protein food and a quarter of the plate is for “grains”. The dairy is on the side and that is your serving of milk. There are some things I really like about “My Plate” for education. It is simple and the message is about adding in and not as much focused on taking away. I have used to demonstrate how much fruits and vegetables we need if we want to be healthy. The downside is that some kids, especially picky eating teenagers, really struggle with vegetables because they don’t like the texture or the taste, and so through most of their life refused them. Parents in turn, sometimes just stop making them with the unfortunate outcome being nobody in the family has been exposed over time to vegetables and so nobody eats them. When you show a teen that plate, they tend to feel bad, and like a failure because there is no way they are going to get to that amount of colors on their plate (unless you count brown or yellow, you know, french fries, macaroni and cheese, Doritos). I don’t like making teenagers or even adults feel guilty, so instead we work on increasing exposure and sometimes start with more fruits. Check out the website for more information.
  3.  Portion Sizes: this method uses your own hand to estimate portion sizes. So a “fist” might be a serving of rice. I am not especially irritated by this method, however what if you want 2 fists of rice? I guess the awareness that you are having 2 servings is ok, but then again, will it trigger guilt and overeating? This method traditionally has been used with diabetics, who really do need to follow a special diet with balanced amounts of carbohydrates, so for these folks, it could be very helpful.
  4. Hunger and Satiety Cues: this of course, being the “non-diet” approach for kids and teens, is my favorite! It teaches strategies to help individuals pay attention to their body signals. For younger children, it is called the “Trust Model” promoted by Ellyn Satter (see Ellyn Satter Institute for specifics). This model describes the “Division of Responsibility” with a focus on the parent’s role of buying healthy foods, determining structured meal times, not catering to kids but allowing them to eat as much or as little as they want at a meal. This teaches children to trust their hunger and fullness mechanisms and promotes a healthier relationship with food and eating. With teens, it becomes tricky because sometimes, after over 10 years of being restricted by parents, an abnormal focus on food (such as sneaking food) has developed (survival!). It may require some counseling for some teens who have a significant “disconnect” between their hunger and fullness related to parental restriction. If your teenager sneaks food or binge eats, or restricts and alternates with binge eating, don’t ignore it. Get help by a therapist who specializes in eating issues.

So the answer is: NO do not ask your teenager to count calories. If they are using some app on their phone to track their food intake, pay attention. Instead, work together to find healthy recipes and meals, go grocery shopping to pick fruits and vegetables your children will eat, have taste tests with new ones. Shut off that TV during meals, sit at the table, don’t allow kids to nibble all day, and instead plan for snacks where kids sit down and enjoy it (not in their rooms, nibbling for hours in front of a computer…..who is going to want to try squash when dinner time rolls around?). Consult with a dietitian regarding strategies to make your environment healthier as well as ideas for healthy but yummy meals. But don’t focus on calories or dieting in your home. Instead, focus on EVERYONE being as healthy as they can be. Enjoy eating out, ordering pizza once in awhile, going out for an ice cream cone. Set an example by living the kind of life you want your child or teenager to live. Remember, kids do as you do, not what you say. If you count calories and diet, your teenager will too. If it hasn’t worked for you, it won’t work for them.

Sugar: New FDA Recommendations and What it Means to You

sugar-cube-1325425 The recent  FDA News Release is a bit of a mixed blessing in my mind. I am a big believer in educating yourself about foods, health, fitness, etc so that you are making smart choices regarding your health. At the same time, I think people sometimes get confused with too much information, and end up making drastic decisions which are not smart. I have already seen people freak out about sugar in an unhealthy way. I fear the new label regarding a “Daily Value” for sugar may have the potential to at least confuse people, and at worse, cause some to start eliminating foods.

The proposed goal is for us to limit added sugar to no more than 10 percent of our daily calories, according to the guidelines. For someone older than 3, that means eating no more than 12.5 teaspoons, or 50 grams, of sugar a day (this is based on an average intake of 2000 calories……from age 3 and above, we all eat an average of 2000 calories a day…..supposedly). You can see where I am going with this. I am not a huge fan of math. Definitely not a fan of using it on a daily basis, for instance to figure out how to calculate my daily allowable added sugar.  What is going to happen to those teenagers, especially athletes (who, by the way, need much more than 2000 calories a day)? I can tell you from my experience that many teens and even children start eliminating foods when they have been educated in an inappropriate way about nutrition by well-meaning schools and other adults. The story goes like this: child learns about healthy eating in school, he learns which foods are bad (“red” foods in some programs) and so stops eating them. As a result, weight loss occurs, growth stops, moods change, the brain is no longer fueled appropriately, digestive systems are disrupted, it is a mess. Sometimes, an eating disorder results and therapy is needed.

So now we are increasing our focus on sugar by setting a blanket daily limit that really should not be “one size fits all”. Individual foods will have the sugar content but also a “percent daily value”. For instance,  the example given on the FDA website is “a consumer who drinks a 20-ounce sugared beverage may be surprised to know it contains about 66 grams of added sugar, which would be listed on the label as 132 percent of the Daily Value”. That means that in one drink that person will have consumed 32 percent more sugar than they should have that day. What affect will that have on eating behavior? Will this trigger some people to feel they need to read every label and stop eating anything with any added sugar the rest of the day because they had that soda? This stresses me out just thinking about it.

Don’t get me wrong! I am not a fan of soda or sweetened drinks and also believe in healthy eating. But I believe in educating people about nutrition in a way that makes it doable (which rarely involves much math). The funny thing is I have often used empty soda bottles and other empty sugary drink containers, measured the sugar in them and used for a visual display to help people see what they are consuming. This is always accompanied by more information such as as the message of moderation and having a soda when you want one, but that filling up on 5 cans a day does not leave much room for healthy stuff. You will not feel good. The difference is the focus on health and NOT on restriction or the idea that anything is forbidden.

The bottom line: use the new information to learn about the foods you consume on a regular basis. Being knowledgeable is a good thing. But don’t feel you need to eat exactly the correct grams of sugar or the perfect “daily value” every single day. Instead, stay on the path of caring about your health and doing those things that make you feel your best. Don’t focus too much on the math. Don’t let any food, even sugar, stress you out.

For more stories: Sugar Story

Putting Added Sugar Into Context

Having Your Cake and Eating it too….what to do about “junk food” for you and your family

IMG_7692Let’s face it. Do you really and truly think you should live the rest of your life without having a good old homemade chocolate chip cookie? The cookies pictured here were baked by my mother-in-law for a recent family gathering. I was fortunate to grab some that I packed away in a freezer bag for later cookie cravings. Anyway, after a recent post about childhood obesity and the damaging repercussions about an unhealthy food environment, I got some feedback about how children should not be restricted as this will likely contribute to binge eating, and an increased focus on food.

While I totally agree with the principles of hunger-motivated eating and “intuitive” principles of eating, I also know that it is not as simple as it sounds. My husband has always joked when I have said “listen to your body” because his body says to eat the entire bag of Lay’s! Of course this is not exactly true, and I have never seen him consume an entire gigantic bag of chips, however this is an issue that comes up often when “intuitive eating” and “listening to your body”is promoted. What is a parent to do when a child does appear obsessed with whatever sweets are in the home and can’t wait until he or she can get a hold of it? What is an adult supposed to do when they are dieting and truly craving something sweet? or salty such as chips?

We are a culture of “all or nothing” thinking. You have heard it before….the dangers of being “on” a diet, then “off” a diet. People follow the craziest and most restrictive diets for a variety of reasons, but when, inevitably, they can’t maintain the restriction (usually due to a powerful physiological response to starvation coupled with an environmental trigger, such as exposure to a particular food), well, after they break the diet, everything changes.

After having that cookie, or eating a handful of those chips, total mind games take over. The “all or nothing” mindset kicks in and people lose control (who wouldn’t?)

The problem is that if we want to encourage our children to eat healthy, but also don’t want them focused too much on eating and food, then we need to be careful about the messages we send. We want them to make healthy choices, however, we don’t want them to feel guilty about having a cookie. What is the best advice to promote a healthy relationship to eating and especially, to “fun food”? Here are my 5 Tips for Having Your Cake and Eating It Too….

  1. Never withhold food from a child, especially a sweet or dessert, until they have finished the main meal. This serves to reward them with sweets and teach them that something is very wrong with the food they are being served and something is very special about the sweet they are being rewarded for. Instead, let them have the sweet right along with their meal. This bothers many parents because they were brought up back in the day when sweets were used as reward, or withheld for punishment. Many of those brought up this way tend to continue to reward themselves with sweets when they are finally adults and can do what they want. I remember one patient I saw for binge eating. She had gained and lost hundreds of pounds over the years. Her mom used to restrict her to make her lose weight, so when she finally was out on her own, she was all about getting back at her mom and started to use food (sweets especially) as a reward for almost everything. Now as an adult, her mom still made comments about her weight and eating, and it bothered her, even though she was 50 years old.  I remember her telling me after her mom passed away that she still was feeling restricted and it was hard for her to accept now that her mom was no longer alive, she did not have to sneak or get back at her. It still was hard for her as she had been doing this for so long (binge eating sweets). So the message is, beware of restricting sweets or making them special as it will likely mess up your child’s relationship with eating (or if YOU have been restricted, maybe it is time to think about sweets in a different way?)
  2. Pay attention to your child’s reaction around food (and pay attention to your own feelings when food is around). Accept that everyone is different. You may discover that your child has little interest in eating (I see these kinds of kids all the time in the Feeding Team, where children are referred for feeding issues). Or maybe the opposite is true, and your child seems obsessed with food. This sometimes is due to a child’s food intake being restricted, or too much attention placed on a child’s eating or weight. Other times, I have seen it just be that the child simply enjoys food and eating.  Even as an adult, some people seem to be bored with eating (“eat to live”) while others are somewhat obsessed with it, love cooking, love eating, and spend lots of time on it. This is not a bad thing necessarily, however if it is due to previous restriction, or dieting as an adult, then this kind of eating and food obsession tends to come with guilt, not pleasure and enjoyment.  The bottom line is you need to pay attention and accept that everyone is different. If you have a child obsessed with eating for whatever reason, or if you are for whatever reason, then it is important to create an environment where everyone is able to enjoy food and eating, but not be triggered into binge eating. This means having those fun foods on a regular basis because you enjoy them, but not going to Costco’s to buy the mega cookie tray to leave on the counter where there is a child who is not going to be able to stop. Or do what I do, and put them in zip lock freezer bags so you can take out what you want when you want it. No one is deprived and no one is triggered. Yes, I have had patients who are not able to do this as they will binge on them frozen. Know yourself, and do what you need to do to have balance in your eating.
  3. Again, I have said it before and I will say it again. Don’t treat children (or adults for that matter) differently when it comes to sweets, or what foods you allow them to eat. If you want to make sweets or some other fun food (chips, fries) a part of a meal, let everyone, no matter what their weight or body size have it. Don’t make comments like “that is enough”. Let everyone have what they want and need. Encourage listening to your “tummy”. How do you feel? Do you feel satisfied, stuffed, still want more? It is important to help children, and also important for adults to learn how to eat ALL foods in amounts that make them feel good. Not stuffed, not uncomfortable, but good. Satisfied. The only way to do this is to have these foods on the menu.
  4. Talk about being healthy, and not about how “good” or “bad” a food is. I personally think it is ok to educate even children a bit about nutrition. It is ok to say “milk makes your bones strong!” or “this broccoli has lots of vitamins and makes us feel good” or “that has a lot of sugar in it, so we need to brush our teeth so we don’t get a cavity”. But is it not ok to talk about food and weight. Don’t say “cookies are bad for you! If you eat too many you will get fat!” Instead, have cookies as a part of a meal that provides some good nutrition (such as a dinner with meat, vegetables, grains, a glass of milk). It is really amazing how children will not devour all the cookies first as you would expect when they are given in a neutral manner, without judgement along with the rest of a healthy meal. Yes, if you have been restricting sweets, kids will go to them first. But after awhile, they won’t be special anymore. This will work for you, too. Although if you have been dieting or restricting excessively, you may need the help of a dietitian and therapist to guide you. Don’t feel bad if this sounds impossible. For many who struggle with eating disorders, it is. That is why knowing when you need help is important.
  5. Realize as a parent or as an adult, you make the decision about what your food environment will be. You go to the grocery store and you bring home whatever you buy. It is not restrictive or wrong to decide to predominantly have healthy foods in your home. If you know how to cook, healthy meals are really yummy! You are the one to decide if food is left on counters or in cabinets where children can help themselves. Don’t villainize the food, but instead, have it be a part of your normal healthy meals when you really feel it fits (and you want it). We all have our family favorites. When I grew up, ice cream was our thing. We would go every Sunday on long drives in the country and eventually stop at the same farm where they made their own ice cream. We all got what we wanted (I always asked for the green ice cream, also known as pistachio…still my favorite). In my husband’s family it was Grandma Harmon’s cinnamon buns. They are a pain to make, but when my husband does, he makes a lot, and we freeze them. We make them last!

So the bottom line is that it is smart to normalize “fun foods” so they are not so special after all. There is less need to be obsessed with them when they are treated neutrally, and when we get to have them. At the same time, we want to feel good. Therefore, it is smart to have our favorite fun foods as part of our normal healthy meal. It does not mean we need to have these fun foods at every meal. It could be once a day or a few times a week, or even a few times a day. As long as everyone gets the nutritious foods we all need to survive, that is what matters.

Also, it is imperative that we don’t talk about any foods in harmful ways (“this will make you fat”). Instead, talk about how yummy it is and enjoy it. With a focus on a healthy lifestyle (adequate sleep, fun physical activity, balanced healthy eating, relaxation) a normal amount of sweets, chips or other fun foods is fine.

So what is YOUR family traditional fun food?

Who is ED?

eating-disorder-mirror-drawingI first was introduced to ED back in 1996. I had just finished graduate school and took a part time job at an eating disorder program. As a dietitian, my main interest was in health promotion and disease prevention. It made sense to me that it seemed smarter and easier to help people prevent disease if possible through promoting a healthy lifestyle. It is much harder to treat illnesses that may have been prevented. I specifically remember a middle aged man who I met during my very first job as a dietitian in a small hospital. He was admitted after having a heart attack. His lifestyle was not healthy at all (smoking, unhealthy diet, no physical activity). I remember thinking that he should not have been there.

I left the hospital after just one year and changed my focus to helping people be healthy. I worked for WIC (Women, Infants and Children) and loved teaching young mothers about healthy eating. I also did some private practice and that is when I knew I needed more skills with counseling, and went back to graduate school (with a focus on counseling). It was while working on the college campus that I encountered students with “sub-clinical” eating disorders. In other words, they were restrained eaters who dieted yet had not developed an eating disorder yet. I did my research on “cognitive restraint” because I felt if we could stop people from dieting and focus on health instead, we could possibly prevent an eating disorder.

Although working with eating disorders was something I never planned to do, after doing my research, I ended up connecting with many eating disorder professionals and got my job at the eating disorder program. It was here where I was introduced to “ED”.

I got to observe group sessions and then got to run my own. Every patient is different however one of the common connections all of the patients related to was a “voice” that was constantly in their heads. Meet ED. I eventually imagined a little ugly creature sitting on my patient’s shoulders, feeding them thoughts and ideas, rules and insults, misinformation about themselves, food, their bodies, absolutely everything. This voice (ED) would follow them around all day long, into the night. It never stopped. It was a learning process for me as I learned about how this voice contributes to all of the distortions and beliefs individuals suffering from these eating disorders experience.

Here are some of the things my patients have told me ED says (warning, it will make you sad):

  • you can’t have that, it will make you fat
  • why did you eat that? you are worthless, you have no willpower!
  • don’t listen to her, she is lying, she wants you to gain weight
  • white flour is bad
  • meat is bad
  • you can’t eat fried food
  • you can’t have that, it has sugar in it
  • you need to burn that up, when are you going to do it? figure it out, you ate it, now you need to get rid of it
  • you look fine, they are just jealous because you lost weight. You need to lose more. Don’t listen to them
  • you are disgusting
  • you didn’t do enough. You need to do more, more laps, more sit-ups, more more more.

Get the picture? Depending on where someone is in the recovery process, talking about this voice does come up. It is a slow process, but helping individuals fight this voice is critical. Exposing ED for the liar that he is takes a lot of work and energy. Of course, every patient needs therapy to work through their specific issues that led to the eating disorder in the first place. As a dietitian, I focus on teaching the truth about foods, eating, weight, etc. Sometimes, during a visit with a patient who is fighting hard and finally aware of what a “healthy” voice is, ED still weasels his way back in. I admit to falling into the trap of arguing with ED, and then it hits me, and I stop. I have often said to patients “wait a minute, I am not going to engage ED, can I talk to YOU?!” Once I had a patient get up and dramatically rip ED from her shoulder and throw him in the waste basket! She said “I have lots of family celebrations this weekend and I want to enjoy them. ED is not invited!” I will never forget that strong visual.

Another thing people don’t often realize is that individuals with eating disorders are just that. Individuals who unfortunately struggle with this disease. They are not an “anorexic” or a “bulimic”. They are people. I have met the most extraordinary people who have had ED on their shoulders and have had to fight him daily. I have met lawyers, dancers, chefs, professors, soccer players, football players, mothers, aunts, fathers, sons, daughters. I have enjoyed getting to know these individuals and especially as ED fades away and they can be their very interesting, fun, loving, energetic and happy selves again. That to me has been rewarding beyond explanation.

And what about you? Unfortunately, I hear people mumbling out loud about food, their bodies, what they ate, exercise, etc. in ways that are not always healthy, and sound way too much like ED. He is a villain that somehow has become culturally acceptable (which makes it real hard for those struggling). Remember, prevention is a lot easier than recovery. When you hear a berating, negative voice in your head about anything to do with eating or your body, just try to be aware. Stop ED in his tracks. Say “you are full of it!” If you can’t stop that voice, you may want to consider getting some help. Maybe someday, our culture will normalize it’s view of eating and body size and he will fade away. Until then, I hope you continue to fight the craziness in your own way.

Does Your Child Have Avoidant Restrictive Food Intake Disorder (ARFID)?

picky eater

This article is a must-read for any parent of a young child with “picky eating”. Although it is normal for a toddler to go through phases of being fussy about food, it is wise to pay attention if it continues. I work on a “Feeding Team” at a children’s hospital and before this diagnosis was introduced, we referred to these kids as having “Feeding Difficulties” however now we understand how complex the issue can be! We refer many of these children for outpatient “feeding therapy” to help them overcome their issues. It is sad when physicians and parents don’t worry just because a child is growing well. In time, the result is a teenager who only eats a small variety of foods and whose growth as well as social life has been compromised. And it all could have been prevented with early intervention.

Restrained Eating: is it ever good?

cookie and apple in handDecades of research indicate that “cognitively restraining” your food intake often leads to binge eating and/or disordered eating. Cognitive restraint means using your head to determine what to eat instead of listening to your body. Most people who restrain their eating do it in order to lose weight. They may follow a specific diet and try not to sway from the diet. They may count calories or avoid certain foods altogether (see “Are You In Diet Jail”). They typically weigh themselves regularly. There is actually a “Restraint Scale” consisting of several questions that evaluate the degree of restrained eating.

You may have already heard about this research. I think this can be confusing for many who may say “then does that mean we should not pay attention to what we eat? Aren’t we supposed to try to eat healthy?”

The answer is yes, it is good to care about your health, but that does not mean avoiding any foods or counting calories or weighing yourself. Instead it means using your head to make healthy choices WITHOUT being overly restrictive.  What the research also has revealed is that certain types of “restrained” eating may not lead to problems but may actually be helpful. This type of eating is referred to as “flexible” restraint verses “rigid”. Flexible means just that. You may love the bread sticks at a certain restaurant, however you may also love the entree you just ordered….so you decide you are going to eat one bread stick to save room for what you really love! If you were to “listen to your body” and you were really hungry, theoretically you could eat 5 bread sticks! But then you would ruin your appetite! Is that restrained eating? Well, yes, in a way, however it is also flexible. You are making a decision because you know your body and you want to honor it and feel good. Another example may be planning ahead of time to cook for the week. This does not mean you will not allow yourself to stop for a burger at the drive through, however you also may not want to waste the money, and if you plan ahead and have healthy and yummy foods in your home, you are again being healthy but not rigidly restrictive.

The bottom line is that it is ok to want to be healthy, eat healthy, and yes, you do have to use your head! But being flexible is what is important. Being rigid does not contribute to health, just food obsession, disordered eating and a that is certainly not healthy.


Body Image: Ten Steps to Loving Your Body

daisy feet

A wonderful organization that does so much to support people struggling with eating disorders is the National Eating Disorders Association. On their website, they have a wonderful page on body image that lists “Ten Steps to Loving Your Body“. If you or anyone you know is struggling with body image or eating concerns, check out NEDA and check out this inspirational page: Spread the positive thinking!!! or click on the link: NEDA

When Exercise Isn’t Fun Anymore

kids on monkey bars Remember back in the day when you had recess in elementary school? It was always the highlight of the day, the time where you could run free outside, swing on the swings, play tag, or climb the monkey bars. Then after school, if you were lucky, you were allowed to play kickball outside with your friends until it got dark. Before you ever thought about being active or needing to exercise to be healthy, you were already doing it. But you were having fun!!

Things have changed. It seems to me there are few adults that I know who do fun active things because, well, they are just FUN. Most adults, especially those with body image or weight concerns appear to be “forcing” themselves to “exercise” with the intention of losing weight and/or changing their body. Not to be stronger, feel better or have more energy. This typically organized movement (aka exercise) sometimes involves a gym, a treadmill, a video or some other activity that the person does not look forward to (not like the monkey bars back in the day). Yes, there are many people who actually really love to going to the gym and actually have a blast doing their Zumba class. These are not the people I am referring to.

In her book “Body Wars: Making Peace with Women’s Bodies”, Dr. Margo Maine explains that particularly if you exercise excessively it could be a symptom of an underlying psychological condition. If you are not able to solve the issue yourself you may need the support of a therapist. She describes the following behaviors that may indicate a problem:

  • you judge a day as “good” or “bad” based on how much you exercised
  • you base your self-worth on how much you exercise
  • you never take a break from exercise no matter how you feel or how inconvenient it is
  • you exercise even though you are injured
  • you arrange work or social obligations around exercise
  • you cancel family or social engagements to exercise
  • you become angry, anxious or agitated when something interferes with your exercise
  • you sometimes wish you could stop but are unable to
  • you know others are worried about how much you exercise but don’t listen to them
  • you always have to do more (laps, miles, weights) and rarely feel satisfied with what you have done
  • you count how many calories you burn while exercising
  • you exercise to compensate from overeating

So, if any of these description ring true for you, just being aware is the first step. For more information on Dr. Maine’s book which includes many great resources for those struggling with body image concerns, check out this link:Body Wars

And remember, it is never too late to start going to the playground again!!!

Binge Eating Disorder: New Approaches to Appetite Control

ice creamToday I attended a conference presented by Walden Behavioral Care on the topic of Binge Eating Disorder (BED). Dr. James Greenblatt, Chief Medical Officer at Walden and author of the book “Answers to Appetite Control:New Hope for Binge Eating and Weight Management”  spoke about the complicated interactions between our physiology and brain when it comes to binge eating.  There are specific criteria that define a diagnosis of BED and just one of the criteria includes “recurrent episodes of binge eating characterized by both of the following: (1) consuming an abnormally large amount of food in a short period of time compared to what others might eat in the same amount of time and under the same or similar circumstances, and (2) experiencing a loss of control over eating during the episode. Additionally, in BED there is “significant distress” about the binge eating.

Dr. Greenblatt stressed that some binge eaters experience cravings that are physiologically based, in other words, the cravings are a result of your biology rather than just the environment or a social trigger. In fact, some research showed that brain scans of those who scored higher on a “food addiction” rating scale were similar to those of drug addicts.  There was an elevated activation in the reward circuitry in response to food cues. Again, this does not mean that if you binge eat, you are “addicted” to food, but that everyone is different and some people have the physiology that makes it much harder (and it is not their fault).

In addition, disordered eating such as binge eating often co-exists with mood disorders such as bipolar disorder, anxiety disorders, depression and ADHD . In fact, ADHD has been linked to BED (apparently the act of chewing helps to decrease day dreaming brain waves and helps you pay attention). The odds of developing a binge eating disorder is 12 X greater in children with ADHD. Dr. Greenblatt stressed the importance of treating the mood disorder first before the binge eating could be addressed.

Another very important point was regarding the importance of protein. There are over 250 neurotransmitters that send impulses throughout our brains and affect our thoughts, feelings and behaviors, many of these directly affecting our appetite regulatory mechanisms. They are all derived from amino acids. Adequate protein intake is critical, often an issue for some. For example,  vegetarians and vegans may not get enough protein (especially if they are not educated on nutrition) and chronic dieters often have inadequate intakes. And, even if a person does consume adequate protein, it may not always be available, such as in the case of insufficient digestive enzymes or excessive antacid use.

Finally, there was mention of how for a small percentage of people, certain foods substances may contribute to food addiction and binge eating, such as high fructose corn syrup and MSG (he also discussed the gluten craze as well as casein but I may save that for another post!) This does not mean we need to cut out any foods  or that we should never eat them, it just is important to have balance in your life.

The importance of medication (such as mood stabilizers) in some cases was also  mentioned, as well as how medication was not helpful in other cases. The bottom line is that everyone is different, and it is very important to get evaluated by a professional. BED is a serious and debilitating eating disorder, but there is help.

If you are interested in the book which contains a wealth of information from Dr. Greenblatt, check out: