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.

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.

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.


Should you worry about a picky eater?

picky eater cartoon

Growing up in an Italian family where food was a big part of most celebrations and meal time an important time for families to be together, I have no memory of anyone who suffered from picky eating. So when I started to work on the “Feeding Team” at a children’s hospital, I was very surprised by the children that were brought in to be evaluated. The team consists of a Psychologist, Occupational Therapist, Speech and Language Pathologist and Dietitian who all play a role in evaluating the patient. The team evaluates issues with chewing or swallowing, texture and sensory issues, behavioral issues and of course nutritional deficits and growth adequacy. A common scenario is the toddler whose parents are concerned because he only eats 5 foods. These limited food choices vary from child to child however we do see many children refusing most meats (except for chicken nuggets!), all vegetables, most fruits and sometimes even dairy. Of course every child is different, and the reasons for the picky eating and food refusal are different also. It could be a sensory issue the child was born with, or maybe a choking incident which left the child fearful of eating some foods, or a history of reflux and feeling bad after eating. Whatever the reason, the parent’s reaction is often predictable: pressure the child to eat! It feels like the thing to do if you care about your child, they need to grow, right? How can they be healthy if they don’t eat?

Sometimes parents are so afraid for their child they may actually force feed them! You can imagine the child’s reaction. This does not lead to a pleasant feeding experience! It is more likely the child will dig in his heels and become even more resistant. The affect on health if left untreated (and if parents do not learn appropriate ways to deal with this problem) is the child may grow up to continue to eat just starches, no fiber, inadequate protein, vitamins and minerals and end up not having the healthiest body they could have had. Even worse, their relationship to eating and food can develop into a disordered one.

What should you do instead of forcing? First, tell your pediatrician or doctor about any extremes in your child’s eating. They should be able to refer you to a specialist for an evaluation (such as an Occupational Therapist who specializes in feeding issues, or psychologist or feeding team). Or, you can educate yourself as there are plenty of great books on the topic. One of my favorites is by Kate Samela, MS, RD, CSP who is an expert on the topic. Check out her book “Give Peas a Chance: Give Peas a Chance by Kate Samela, MS, RD, CSP

Another expert, Anne London, MS,RD has a wonderful website with great resources. Check it out at: PetiteNutrition

Finally, check out Ellyn Satter’s Website which is filled with great information on helping your child develop a healthy relationship to food and eating.

So if you child won’t eat his vegetables, don’t worry. It is most likely a phase. But if he starts to eliminate more and more foods over time and eventually entire food groups, don’t ignore it! You can help your child be the healthiest he can be!!

Should You Have A “Cheat Day”?

donut vs apple and womanWhen I hear a person say “Saturday is my cheat day” I gotta be honest, it pushes my buttons. To most people it sounds like a harmless thing, but to me it is a red flag. An alarm goes off, triggering this irritating feeling throughout my body. I try not to react, it is a conscious decision on my part to ignore it if I am overhearing a conversation in the elevator of the hospital where I work part time, or somewhere else where there really is not time to get into it. Otherwise, such as a party or other informal gathering where women especially tend to chat about what they are doing to change their bodies…. I always take the opportunity to educate people about Health at Every Size, and how focusing on being healthy verses being thin is a much more sane goal. Then I may ask what they mean by”cheat day”. Inevitably, it means following some type of “healthy” eating plan or dieting throughout the week, then allowing themselves to overeat any of the foods  they have denied themselves during the week on Friday or Saturday, and often again on Sunday.

What bothers me about this approach to eating is that it ignores all of the principles of “mindful” eating, and about “listening to your body” . It gives food so much more power than it deserves. It makes me think of how back in the day (and actually still today unfortunately) food is used as a reward. For example, “if you finish your spinach, you can have the cookie”. What does that message send? It says “something is very wrong with spinach, and something is very special about cookies”. I wish food was never treated this way. If you are really honest with yourself, you have to admit, that sometimes fresh vegetables or a great salad or roasted garlic with asparagus is extremely yummy. And an Oreo cookie could never substitute for that taste. If however, one were to hold that Oreo up as a reward, then it might be different. Over time,we might become conditioned to look at that sweet in a different way, and want it even if we really didn’t want it! If we really were mindful and not conditioned to think some foods were good and some foods were bad (that we could only eat them on a “cheat” day) and REALLY listened to what our bodies wanted, then we would not even need a “cheat” day. We would eat in a mindful way, cooking meals that were healthy and that we enjoyed, because we want to feel good, have energy and live a long and healthy life. But that means enjoying the fun foods too, the ones that are important to us, in our culture, our family traditions or socially. Having a homemade blueberry muffin at Grandma’s house or sharing a favorite dessert when out with our old college roommate,or Grandma Harmon’s favorite cinnamon buns that you only get once in a blue moon. It may not be a Saturday or a “cheat” day, but it may be and should be just part of normal life. Monday, Tuesday, Wednesday, Thursday, Friday, Saturday, Sunday….I hope everyday you listen to your hunger, and fullness, and enjoy healthy eating, have energy, and never miss an opportunity to enjoy a serving of a special food that you enjoy. Heck with “cheat” days. Enjoying life is living, not cheating.

Are You in Diet Jail?

Idiet jail first encountered the term “Diet Jail” in 1975. I was a biology major at Clark University in Worcester, Mass. I remember clearly working with the lab teacher who was doing his research on birds (he kind of looked like a cool woodpecker). He made me count bird chirps he had taped on a recorder. I decided I did not want to be a biology major because counting bird chirps was incredibly boring. So I met with my adviser who asked me what I was interested in. My best friend Joyce was a vegetarian and ate very interesting things such as yogurt with sunflower seeds and honey, and so I told him, I though vegetarianism was interesting. He told me I should be a dietitian. I did not know what that was, but anyway, I ended up transferring to the University of Connecticut to study nutrition. For my first nutrition class (Nutrition 101) I had to do a  report about fad diets and at the time there were many books out there on the market, including the Atkins Diet. But I found one called “The Psychologist’s Eat Anything Diet” by two psychologists, Dr. Pearson and his wife, also Dr. Pearson.  It changed my thinking in a way that lasted, well, forever. The authors were decades before their times in the strategies they were promoting, before we knew about mindful eating or how our bodies regulated themselves regarding calorie intake, fat, carbohydrate intake, etc. They described what they called “diet jail” where individuals who diet tend to “lock themselves up” in a jail where only the healthy foods exist. In other words, they tell themselves they are only going to eat healthy foods such as grilled chicken, vegetables, fruits, salad, etc until they lose the weight. So psychologically it is as if they “lock themselves up” in a world where only the healthy foods are available (or allowable). But outside the jail are all the other foods, the “bad” foods. The chips, cookies, ice cream, burgers, pizza, you get the picture. All the foods they have determined they are not allowed to eat (while they are on that diet). And so, most people can last a bit in Diet Jail. Yes, they get cravings, but they use their “willpower” and overcome them. Unfortunately, we now know our bodies send out very loud signals when we are not getting enough carbohydrate or fat (the foods that do not exist in Diet Jail!) and so eventually, our bodies drive our brains to give in. Add this physiological drive to an environmental trigger, such as walking into your friend’s home who just baked some homemade chocolate chip cookies, and things change. Your brain, which is triggered by the deficiency in your body, tells you to eat a cookie! It has just what you need, what you have been missing, that fat and carbohydrate! But you can’t have someone throw just one cookie into your jail cell, so you have to step out of the jail to get that one cookie…….the problem is, once you take that bite, your realize you are out there! Out of Diet Jail! And since you know you will go back in (you tell yourself that on Monday you will really start again!) you better eat while you are out here! So you decide to order pizza, and then have ice cream (a lot) because, heck, you are going to start again on Monday. Often a full blown binge results. Because you know this is just this one time. Soon you will be back on track. Back in Diet Jail. Until the next time.

As repetitive as this cycle is in so many people’s lives, they do not seem to stop. The next diet craze offers the next magic scheme. Weight is lost and then regained. Back then we did not know the physiological reasons people were driven to eat but now we do. We know if you restrict you will suffer from “disinhibition” or breaking out of Diet Jail.Often referred to as the “what the hell” effect. It is a very sad and draining cycle.

So why not take those bars down? Why not entertain the thought of changing what you have been doing that is not working? What if you were to start to believe that all foods are equal? No food is good, no food is bad, they all have a place in your life. Yes, we need certain nutrients to feel good, have energy, normal bowel movements, prevent disease, etc. So educate yourself (I will gladly help you!), experiment, enjoy your cultural traditions (yay. pasta fagioli!) but start paying attention to your body. Are you hungry? Are you full? Are you so confused that you might really want to get some help (such as from an eating disorder specialist?). Wherever you are, it is ok, just take some time to truly reflect on your patterns. My hope for you is to enjoy eating, be healthy, and take down those darn bars.

Regarding “Clean” Eating….

mopThis women’s face is how I feel several times per week. Have you fallen for the latest weight loss craze? This is driving me crazy!! It angers me when people are taken advantage of because they are desperate to lose weight. How do you define “clean eating”??? And why does it usually involve some type of juice that you need to purchase?? Anyway, try to find some good long term outcome studies on this diet approach, and please share them with me. I can’t find any. The bottom line is any trick to make you eat A LOT less will make the force of gravity on your body less over time (that means you will weigh less). It won’t last. Most of these diets have you do a juice fast or just fruits and vegetables or maybe a “clean” shake for a certain amount of time. You will lose weight as your body breaks down muscle (sorry but the Krebb Cycle prefers amino acids to keep producing it’s ATP’s for energy, not the fat you are hoping it would use). Not to mention the typical dehydration that occurs when your body is breaking down muscle from starvation (because when you break down muscle you need to get rid of the nitrogen through your kidneys, and your body knows to use water to dilute it otherwise your kidneys would be damaged…unfortunately, that happens to some people anyway). And if you are getting way too little calories, your body may be building up toxins in your blood called ketones….that isn’t too “clean” if you ask me.

Not to mention, don’t you have to eventually eat something? Then what? Have you learned anything about yourself? Have you identified some unhealthy habits you may have had and are you magically now able to change them? Probably not. If I could have a dollar for everyone I knew who lost weight on a plan like this, but then gained it back, I might have retired by now. This latest fad is nothing new, just like the low carbohydrate diets, the low fat diets, the high protein diets, and on and on, it just delays the inevitable work your really need to do.

I’m good with vegetables and fruits in your diet. But this is way too much thinking and that is something we know people can’t sustain over time. Why not simply work on adding in these healthy foods to your diet and continue working on listening to your hunger and fullness, recognizing when you are eating when you are not really hungry, taking time to move your body because it is fun and feels good and also contributes to your health? Stop all the “cognitive restraint” and focus on health. There  is no such thing as clean eating.

What is “HAES”?


I have a few simple questions to ask before I explain what HAES is:

1. How many people have you known who have “gone on a diet” specifically to lose weight?

2. Have you ever known someone who has gone on a diet and who has lost weight and kept it off? I am not talking about the person who took up a sport or quit smoking and adopted a healthier life style. I am talking about someone who followed a specific “diet plan” such as a low carb diet or meal replacement diet or counting calories or points kind of diet.

3. Have scientists discovered the one diet that works to help people lose weight and keep it off? Of course we know researchers have been looking into this, since people have been struggling with trying to lose weight for a long time. The “obesity epidemic”is always in the news. So have they found the one diet that works?

Not sure of your answer for question #1, but for #2, I am guessing the answer is NO, and for question #3, I will tell you the answer is NO. What most of the public does not know (because who would be interested in the research over the years regarding dieting except someone like a dietitian?) is that many researchers have been looking into dieting behavior for decades. In fact, when I went back to graduate school and did my research on “cognitive restraint” back in the ’90’s, I was angry! I could not believe the world did not know that the “experts” already knew many of the reasons dieting did not work! But then I realized, it is about the diet industry combined with desperate people wanting to lose weight.

I was not the only one who was angry. There now exists a split among health professionals working with people with weight issues (actually, the split has been there for many years but only recently gaining attention). Thanks to the more recent research and new groundbreaking books (see below) by Dr. Linda Bacon, the “Health at Every Size” Movement  has now been brought into the public eye and the movement is gaining momentum.. Those of us who believe in promoting health instead of some perfect weight, are no longer alone. Yes, there are still doctors, nurses and dietitians who will put someone on a diet (boy could I tell you some horror stories). So it is important to ask any professional you are working with which side of the fence they are on. Are they familiar with the HAES Approach? If not, they may be a bit behind the times. Or, they may still be influenced by a society who values a certain physical appearance instead of health.

Here is an excerpt taken the HAES website at http://www.haescommunity.org/  :

“Health at Every Size” is based on the simple premise that the best way to improve health is to honor your body. It supports people in adopting health habits for the sake of health and well-being (rather than weight control). Health at Every Size encourages:

  • Accepting and respecting the natural diversity of body sizes and shapes.
  • Eating in a flexible manner that values pleasure and honors internal cues of hunger, satiety, and appetite.
  • Finding the joy in moving one’s body and becoming more physically vital.

  • and from Dr. Linda Bacon: “Health at Every Size is the new peace movement.”

    “Very simply, it acknowledges that good health can best be realized independent from considerations of size. It supports people of all sizes in addressing health directly by adopting healthy behaviors.”

    If you are tired of dieting and ready to focus on health instead of some magic number on the scale, check out  Health at Every Size: The Surprising Truth About Your Weight by Linda Bacon, PhD and her most recently released book, Body Respect (http://thebodypolitic.biz/bodyrespect/), co-authored with Lucy Aphramor

  • And be sure to check out the HAES website at http://www.haescommunity.org/

Vegetarian Diets….the question is “why”?

veggie burger

Why on earth would a dietitian even question a vegetarian diet when it seems like such a healthy way to eat? Eliminating all that saturated fat in the form of meat from your diet has to be a good thing, right? And when you think of vegetarians, don’t you get a vision of someone munching on a giant salad?

Well, let me give you a reality check. Having been around the block a few times (meaning I have been a dietitian for over 35 years),  I have encountered my share of vegetarians. When someone tells me they are a vegetarian, or a vegan, I do not make any assumptions about their diet or their intentions. But what I have found is that the reasons people become vegetarian are not always clear. I have noticed that people turn to a vegetarian diet for a few different reasons. In fact, I have encountered 3 types of vegetarians over my long career as a nutritionist (my experience only, I can’t speak for everyone). The people I have worked with or have known in my life tend to fall into the following categories:

1. The True Vegetarian: This is the individual who truly has a strong empathy for animals. They just are not comfortable with consuming them.  They may have had meat in their lives but then, they change and make a decision that they do not want to eat meat any longer. There are different types of vegetarians, those who are ok with eating dairy or eggs or fish, but not meat. I remember my daughter as a teenager getting very upset when the rodeo was in town, and she actually joined a group who stood on the corner and protested. This led her to looking into protecting animals and she decided to stop eating meat at the time. I also have a best friend who is vegetarian, is a great cook, and who also is all about protecting animals (it is a passion with many vegetarians I have come to know over the years). They eat everything, just not meat. I have to say, not all of those I have met who are true vegetarians are healthy eaters like my friend. Many people (especially teenagers who love their kid-foods) tend to live on noodles and chips, still vegetarian, but no vegetables involved!

2. The “I want to be healthier” Vegetarians“: These are the people I have encountered who may have developed some health issues such as high cholesterol, and decided they are going to “cut down on” meat consumption. The reason they want to change their diet is because being healthy is important to them. They may have an occasional meal with meat, but otherwise they believe eating less of it is healthy.

3. The “I am pretending to be vegetarian because it is a good excuse to eat less” Vegetarians: Unfortunately, I have worked with many people over the years with eating disorders who start out with “vegetarianism”. They start eliminating foods, and becoming a vegetarian is kind of a good “excuse” for the eating disorder to NOT EAT. This type of “vegetarian” is different in that they typically refuse to eat the normal vegetarian standbys such as peanut butter, nuts, beans, etc. They may say they do not like salad dressing, olive oil, trail mix, granola or nut butters. This is always a “red flag” to me. Most of the “True Vegetarians” I know rely on nuts and peanut butter for protein and have no problem with pasta and rice and beans and all the other food needed to round out their diets. Not to mention delicious Tofutti Ice Cream!

So what is the bottom line? If you or someone you knows decides to become vegetarian, always ask “why?” If it is to be healthier, or because you care about animals, then you can definitely meet your nutritional needs with some guidance. Vegan diets are a bit harder in that you may need supplemental iron, vitamin B-12 and calcium, and also you need to know how to get protein in your diet (I recommend seeing a Registered Dietitian to be sure-check out http://www.eatright.org and “Find a Dietitian”). But if you know someone who just started being a vegetarian, is losing weight, who no longer eats potato chips (those are vegan!) then don’t ignore it. It could be an eating disorder just beginning.

For more information from the Academy of Nutrition and Dietetics, check out: http://vegetariannutrition.net/