Body Size and Eating Habits: STOP Judging!Please?

little-girl-1430293I saw an article this week on Twitter that really disturbed me. It was about “thin privilege”, and it showed a post with two pictures that went viral….one of a thin young woman getting ready to eat a gigantic burger and fries, and the other of a young (larger size) young lady on the beach. The comments were offensive, I don’t even want to repeat it. The bottom line was that the thin woman was found appealing because she was eating but the larger woman was insulted. It made me think about my own experiences with patients who have spent half their precious lives dealing with these issues.  Feeling embarrassed for eating in front of people, wondering what others thought of them as they ate.

If you have never had any issues with weight then you may not relate, but for those of you who have dieted, or had issues with weight, well, you will get it. We like to pretend all are created equal, but it unfortunately just is not true. In the past year the racists seem to have crept out of the woodwork, and we all understand racism. I am hoping most of us know that the color of our skin or our country of origin does not predict who we are. Even I know (although I like to joke about it) that all Italian women do not love to cook and feed people…just the ones I grew up with. It’s a stereotype. Well, the same thing happens with people depending on their size. We make judgments (out of our ignorance, just as racism is out of ignorance). Most people do not have a clue about how our bodies work and the physiology around body size and weight. We make assumptions about people depending on how they look.

If someone is very large and big we assume they overeat or stuff themselves, they have no willpower. People wonder why they would do something like that, and put their health in jeopardy. How awful.

And then there is that skinny person. They must have willpower to be that thin. They care about their health, they must eat lots of vegetables for sure, and exercise. We really look up to these thin, strong willed healthy people. We wish we could be like them and do that too. Or, we make assumptions about them. They must have an eating disorder, why else would they be that thin? They should just eat a cheeseburger, for heaven’s sake.

Well, guess what. It is all a bunch of baloney. That skinny person you are assuming is healthy might just be living on Coke and chips. Their blood pressure might be horrifying, and maybe they have high cholesterol. They might smoke a pack a day and be out of luck if they need to catch a bus because they can’t run more than 2 feet. Or, maybe their entire life they have tried to gain weight, but they take after dad’s side of the family, all tall and thin and no matter what they eat, they can’t gain weight. They get called names all their lives, made fun of for being too skinny, as if there is anything they can do to change it. They hide under clothes, layers of them so hopefully nobody will notice their skinny arms.

And that obese young woman you have sneered at and wondered why she doesn’t take care of herself? Well, she may have the blood pressure of a teenager, and the flexibility of a yoga teacher. She may eat more veggies in a week than you eat in a lifetime. She may eat less fast food than you. And, I am guessing, she has more willpower in her left pinky than you have in your entire body. Because, if she has experienced what most larger people have, she has dieted in her life. She (or he) probably have given in to the pressure to change. Have you ever tried to follow a diet? If you haven’t because you have been BLESSED with the metabolism and brain chemistry and genetics to be thin then I promise you, just like any human being you would not be able to do it….as long as most larger people have done it. Yes, they diet and lose some weight but BECAUSE IT IS NOT THEIR FAULT their bodies and brains fight against this. For a good article explaining why diets don’t work and what happens to some people’s metabolism after dieting check out:

TIME Magazine article “The Weight Loss Trap”    

So, unfortunately, when weight is lost quickly and then regained often our metabolism lowers and makes it even harder. So that person who originally wanted to lose a bit of weight finds her or himself after the diet with more weight than they started with. What often happens is that person tries to diet again, and the cycle begins. And the judgment from others is even worse. This makes me sad because the weightism from others leads people to diet, regain weight and then some, and then they are subject to even more of it.

I know there are a lot of people who will continue to judge. My hope is to help people be more empathetic by understanding that we are all different. For example, our brains and digestive system are connected by a complex system of neurochemicals that act as messengers or hormones to tell us what and how much to eat. For example, there is a messenger referred to a PYY that tells your brain you are full. Some people release it very quickly and want to stop eating even before they even finished a meal. You know those people, the ones who leave a quarter of a sandwich or who can’t finish their fries (what??!) This has NOTHING to do with willpower, they were born this way. Then there are those with less effective PYY and their brains just don’t get the message. They aren’t full. You wonder, “wow, how did they finish that?” It is not gluttony my friends, it is probably their chemistry. They were born with it. So stop judging. How would you like to walk around feeling starving all the time? It can’t be fun in this world we live in. And sometimes, some people have amazing willpower and have succeeded in ignoring their chemistry and have lost weight but the message eventually wins, and they give in. Think of a time when you really really really had to pee. Like when you are on a road trip in the middle of nowhere. If someone said to you, “you need to have some willpower and wait until tomorrow!” how would you feel? Well, that physiological signal that is telling your brain that you need to urinate is just as strong as the one that tells someone they need to eat something. It is not about willpower. It is about physiology. So we need to stop blaming.

If, like me, you don’t know much about “Thin Privilege” check out this website which I stumbled upon and liked (it is a feminist website, so if you are not of like-mind you may not like it but I hope you are):Thin Privilege

And next time you find yourself wondering how someone could eat that, or why on earth they can’t finish their meal…..just stop and focus on yourself. Just as I hope you look beyond skin color or race or nationality or sexual preference or religion or any other meaningless definition of someone’s goodness, I hope you look beyond someone’s body size and definitely beyond what someone is eating. Thank you.

It’s Time To Talk About It

No automatic alt text available.Margaret is in her 20’s, almost done with law school, an A student with a promising career ahead of her. Debbie is 54 years old. If you saw her you might think she’s got it all together for a woman her age. She is a smart dresser, hair always perfectly in place and she has energy galore. Pedro, on the other hand, is only 17. Tall and handsome with a shy smile who is the star swimmer for his high school. One of the “cool” kids, you would think he must be enjoying every minute of his teenage years. Robert is a 62 year old man, recently retired with his wife and known for his super fit physique. He still works out at the gym several hours a day and everyone knows him there.

What do all these individuals with seemingly a lot going for them have in common? They all are suffering from a disease that often goes unnoticed……until their world collapses. These completely different people all revolve their lives around “ED”. Short for “eating disorder”. ED does not discriminate between sex, race, religion, social class or sexual orientation. But people suffering from an eating disorder often have similarities in the debilitating affect on their lives.They likely wake up every single day of their(sometimes what feels like a) facade of a life thinking about food. They may weigh themselves daily with goal weights they have been obsessing about for weeks in Pedro’s case, or years, in Robert and Debbie’s case. When the number on that scale goes up, they have a really bad day. They may record every morsel and calorie they consume in a food diary, on an app, or in their minds. They starve, they binge, they purge, they are exhausted and feel like crap. And yet, even when they reach that initial “goal weight”, they still are not happy. So they lower it. Nobody seems to notice at first because our culture just loves it when people lose weight. Comments like “you lost weight! You look so good!” just fuel the fire. Our cultural focus on bodies makes it really confusing and hard for someone to stop the often dangerous behaviors they have fallen into. Even if someone manages to avoid serious medical and physical consequences (for a while) the psychological and emotional drains on a life are not always apparent to the outsider. But the person with the eating disorder often becomes depressed as they lose previously treasured parts of their lives (socializing, family gatherings, jobs, relationships) all because ED demands it of them. It becomes really hard for the person with an eating disorder to face food at social gatherings, to listen to comments and questions from family members expressing concern over weight loss and often sickly appearance as the disease progresses. Opportunities are lost, sports scholarships are taken away, dropping out of college and leaving a job, even relationship fall-outs happen because of ED. Sometimes, binge eating leads to excessive weight gain. Unfortunately, with the focus on childhood obesity, even children aren’t immune as they get the message at a very young age that the number on that scale really matters, and it is up to them to do something about it. The bottom line is appearance and body size of a person with an eating disorder are never the same, yet assumptions are made because of this, and this is a big mistake.

Every year during the month of February, the eating disorder community of health care professionals, those who suffer(ed) with eating disorders and the people who have been affected by them make an effort to educate us all. This year, National Eating Disorders Awareness Week is February 26th through March 4th. The theme or message is “Let’s Talk About It”. This is such a great message because the fact is, the earlier an eating disorder is identified and treated, the more chance there is to prevent it from getting worse, or to beat it. We need to talk about the fact that it is a confusing world with our focus on, and fear of fat. We get confused about what is important. Is it more important to be thin or should we just focus on being healthy? How do we fight the cultural ideal and still feel good about our bodies? And most important, we need to talk about the fact that nobody is immune, and no, you can’t tell if someone is suffering just by looking at them. Eating disorders strike children, teenagers, college kids, middle-aged and older adults. Fat, thin or in-between, rich or poor, educated or not, no matter what nationality or culture, you can’t tell what someone’s life is like or how miserable they may be.

Or, you may wonder about yourself. Is your obsessive calorie counting really a problem? Do you say to yourself “well, I do need to lose weight” and think your diet is just “healthy?” but you do feel drained from thinking about it all the time? Is it a problem that you feel guilty for missing the gym? Do you constantly think about your bulging middle-aged tummy and have started cutting out foods to fix it? Do you have an eating problem you are starting to worry about? To help you answer these questions, or to at least lead you in the right direction, why not take the free screening offered by the NEDA website (National Eating Disorder Awareness). Go ahead and take the free screening Get Screened, or share with any friends and/or family members who may know loved ones they are worried about. Remember, the earlier this debilitating disease is identified and treated the better chance for recovery. Don’t wait. It’s time to talk about it.

Get Screened

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.

 

New Dietary Guidelines 2015-2020 Released

stock-illustration-65223149-top-view-of-empty-plate-with-spoon-and-knifeThe Eight Edition of the Dietary Guidelines was released this week, The Dietary Guidelines for Americans, 2015-2020. The guidelines refer to three different eating styles, Healthy U. S. Style, Mediterranean and Vegetarian. Please see the link below for all of the details. Please keep in mind the guidelines do refer to preventing “disease”, and they consider “obesity” to be a disease by definition. Those of us who believe in a Health at Every Size approach (HAES) understand that a Body Mass Index in the “obese” range does not mean a person is not healthy. It is all about lifestyle and healthy habits. So please look beyond the lingo and check it out if you want to know some of the details. I recommend using these only as a general guideline (it is good to know if you are not eating enough fruits, vegetables, calcium, etc.) but it would be nearly impossible to meet some of the unreasonable expectations for things such as sugar. I am a dietitian, trained in calculating needs regarding nutrition and I could not spend even one day on trying to calculate if what I ate exceeded the recommended 10 percent of calories from sugar. You do not have to do that to be healthy. Becoming aware of your eating patterns and how you feel (do you snack on sweets all day and crash every afternoon? Then adding in some healthy foods and protein of course will make you feel better!).  You really don’t have to be so specific and add things up like that. Seek the help of a Registered Dietitian Find a Dietitian  for even one visit if you really aren’t sure if you are getting what you need. Here is the link for the new Dietary Guidelines

The Academy of Nutrition and Dietetics (AND) New Position Paper on Interventions for the Treatment of Overweight and Obesity in Adults

scales-1536960I like to share the most recent news regarding anything to do with weight loss or dieting. Every month I receive the Journal of the Academy of Nutrition and Dietetics (AND) which used to be the American Dietetic Association (ADA). It was hard for me to get used to the new name as I am an older dietitian and for a few decades it has been ADA to me. Anyway, the journal always comes because I pay my fees and it has lots of articles, mostly research (not always interesting to me, I have to admit). But I just love when they publish a new Position Paper because many dietitians have reviewed years of research (not the most fun thing to do) and then let us know how we should do our job. As a Registered Dietitian, I don’t have time to do that ( FYI a Registered Dietitian is an RD or RDN, Registered Dietitian Nutritionist, a newer designation I think recently added because people like the word “nutritionist” better than dietitian, and anyone, yes anyone, can call themselves a nutritionist, but only those of us who have gone through 4 years of college as well as a clinical training or internship and then passing a national exam can then call ourselves a “dietitian”). So when you are seeking advice about nutrition you really need to talk to an RD or RDN.

So I love Position Papers because it saves me all that reading of research which I do enjoy but takes time. Anyway, the new Position Paper on treating obesity that just came out was to update the last one of 2009. I wanted to share with you the important points just so that you know what the research says. For many of the questions there is not enough research to prove anything. So I am going to briefly summarize what I think you may want to know. I am a bit disappointed because the non-diet approach was not addressed. I also do not like that weight loss was the focus and we all know that an “obese” BMI (Body Mass Index) does not mean someone is unhealthy. This is where I think it gets hairy. There are so many other factors that are so much more important such as lifestyle, genetics, etc. that affect health. So I just hate that everyone thinks a certain BMI indicates a problem.  What I have seen is that people tend to have a normal weight for them but sometimes their lifestyle and habits change, they may yo-yo diet, or become sedentary, have unhealthy lifestyles, gain weight above what their bodies really want to naturally be, and then yes, there may be health consequences. Dieting is not the answer but identifying those unhealthy lifestyle changes and working on those is the answer. Weight slowly will return to what is normal for them, and then health parameters typically return to normal too. For example, I have seen adults who maintained a certain weight for most of their lives, gone through some life change where they became more sedentary, gained weight, and had an increase in cholesterol level. When they added back their normal activities, eventually they would lose the small amount of unnatural weight gain and blood levels returned to normal.

Anyway, here is the take home messages I think people might want to know:

  1. Reducing sugar sweetened beverages (SSB) does result in weight loss. I am all for decreasing soda in your diet because it really does not add anything. On occasion, fine. But as a daily thing (and I have had patients who get in the habit of drinking a liter a day) well, that is just a bad habit. Have a soda on occasion if you love it, but if it is a habit, it may be a good one to break.
  2. Very Low Calorie Diets (VLCD) did not produce any better weight loss in the long term compared to the typical low calorie diet. I do not promote counting calories at all, or any restrictive diet. However, I know people do it and so I want to be sure you know that going below 1200-1600 calories is never a good idea.
  3. It does not matter if you focus on fat or carbohydrates or anything else. “Macronutrients” are protein, carbohydrate and fat. Many diets focus on restricting “carbs”, or fat or focus on protein. None of these extreme diets work better than just focusing on being healthy. Yes, some of these diets may have some beneficial health benefits (the Mediterranean Diet was mentioned and that it may improve cardiovascular risk factors such as blood pressure, blood glucose and lipids) but that more research was needed.
  4. Eating frequency and timing of eating: as it turns out, there just is not enough research to demonstrate that eating more frequently promotes weight loss. However, there is evidence that eating most of your calories earlier in the day improves weight loss outcomes. And although there is not enough research on breakfast consumption and weight, it does seem to be clear that if you want to be your most healthy weight then you need to eat more during the day. Think about it. I know I have seen many patients who try to restrict all day long and then only end up overeating at night. It makes sense. So eat a good breakfast, enjoy a great lunch, have a snack in the afternoon and then, when you are ready for dinner, you won’t be starving. The research proves this is the best way to have a healthy body.
  5.  Physical activity  was another intervention mentioned, and a very important one. I loved that the paper stated that “physical activity interventions may assist in weight management via mechanisms that are not well understood”. In other words, it is not all about “burning calories” which is one of my pet peeves. I just hate when people are doing something really fun and then say something regarding the calories they are burning. Doing fun things like hiking or swimming or biking or just walking with a friend are so good for you in so may ways. I just want people to embrace the pure joy of moving and how good it feels. Yes, your body will get stronger and you will feel better with more moving in your life. And yes, you may like the way you look when your body gets stronger. But it is so much more than that. The Position Paper did mention some specifics. The recommendation was to encourage 150 to 420 minutes of physical activity a week (depending on intensity and medical contraindications). So that just means 30 minutes, 5 times a week (also mentioned was that 10 minute increments were acceptable), or if you are going for the upper limit, 420 minutes translates into an hour a day. That sounds like a lot to me and I am pretty antsy. My advice: start where you are. Do what makes you happy and feel good.
  6. Reducing “sedentary behaviors” was addressed. This means decreasing things like “screen time” or TV, videos, computer, etc. It appears there is insufficient research to show if this is something we should focus on. From my experience, I like the general recommendations, especially for kids, to limit this to 2 hours a day. I think all of the great technology (which we all love) does make it easier to sit…and sit….and sit…So being aware of how much sitting you are doing is a smart thing. For instance, tonight is the first American Idol of the season. I am taping it. I could easily get addicted ( I love that show!) But I do not want to be tied to the TV and so by recording it I will be able to watch it while doing other things (like folding my laundry this weekend) and can fast forward through the commercials. Enjoy your screens but it is smart to be aware.
  7. Computer based and e-health interventions: the use of the Smart phone was addressed, and the fact that there are many apps that can be helpful in eating healthy. Also, many dietitians are starting to do coaching over the phone or skype or facetime, etc because people really do want the one-on-one individual help but don’t have the time to travel to an appointment. It is the future of healthcare, and dietitians have joined in providing this service. Research is needed to see how effective e-health interventions will be.
  8. It is important to use other interventions such as Cognitive Behavioral Therapy (CBT) as well as increasing mindfulness when it comes to promoting healthy eating. The paper addresses a variety of behavioral and psychological interventions that are helpful and makes it clear that merely prescribing a “diet” is not enough. We need to do more to help our patients.
  9. Medications and Surgery: the paper does address some medications as well as bariatric surgery (gastric bypass, sleeve, gastric banding) and reviews some of the side effects of both. The point is made that dietitians need to work with a multidisciplinary team to support the patient. Medications and surgery are not for everyone. I have to admit to being very opinionated when it came to both of these interventions. I am not a fan. However, after working in this field for so many years, and especially learning more about individuals with metabolic and genetic disorders, I have changed my opinion. I believe everyone is different and we should never judge. I have learned that reputable bariatric programs promote healthy eating and lifestyles first. Surgery is not a magic answer and it is not an easy road. People have to make really hard lifestyle changes.  They can’t have surgery if they don’t make the changes. It is not easy. Anyway, only your doctor knows if you are a candidate for any of these pretty drastic measures. I promote a healthy lifestyle to be the best you can be. But sometimes, people are successful with making changes and it is not enough and they still have health issues that can’t be resolved. Please don’t be judgmental of anyone with weight issues who are just doing the best they can.

The Position Paper also discusses policy level interventions as well as the scope of the dietitian and the importance of working with other professionals to support our patients (such as psychologists, physicians, therapists, school systems, etc.). The bottom line message to me was that we still have a lot to learn. Our health behaviors are very complex and depend on our environment, habits and psychological make up. Our bodies and lives are all different, and YOU are the expert on your own life. Being healthy and feeling your best are good goals to have, but there is no “one size fits all” when it comes to eating.

For more information, visit the Academy of Nutrition and Dietetics website at http://www.eatright.org