New Year’s Resolutions and Weight: Tips for Success (if you really gotta do this)

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It takes a lot of tries to finally grasp that rubber ducky!

I don’t do them. Making  New Year’s Resolutions that is. I don’t like setting myself up for failure. That doesn’t mean I don’t reflect on things at the end of the year….. it just may take me more than the month of January to figure things out. But, tonight is New Year’s Eve and having listened to the “new year’s resolution” chatter already, I am pretty confident there will be lots of people living it up like there’s no tomorrow (as my mom likes to say) until New Year’s Day is over and it’s time to face the music.

Yes, people make resolutions about all kinds of behaviors they don’t like about themselves, usually focused on some health behavior change. Things like quitting smoking (yay), exercising more, eating healthier, losing weight. Sometimes people vow to spend less, save more, get a new job, go back to school, get organized, experience new things, etc. Of course, most new year’s resolutions I tend to hear about are related to wanting to change one’s body. You know, lose weight. It’s not just me, if you google “New Year Resolutions” there are lots of top-10 lists, and right at the top of most of them is “lose weight”.

I am not a fan of dieting and here’s why: As my friends and family know, I have spent much of my career trying to help people focus on health instead of dieting and weight loss. They are surely tired of me saying “listen to your body”, and they joke about it (especially my husband who loves to tell me his body is telling him to eat another cookie). What most of them will never truly understand is the struggle, pain, loss and often tragedy of those struggling with disordered eating. I have been forever affected by the lives I was blessed to share with some true heroes. Young and old men and women, girls and boys, mothers and daughters, who have fought this terrible disease and manage to keep going, and even to thrive despite its grip on their lives. I can’t forget them. And so, that is why when people tell me they want to lose weight, I struggle. Also, I believe in the “Health at Every Size” philosophy, and that someone’s body size, BMI or weight is absolutely no indicator of health despite our obsession with BMI and numbers. However, there are individuals who have been in their natural weight ranges most of their lives but then, due to some gradual but detrimental changes in their lifestyles gain weight that is NOT normal for them….and may affect their health because of that reason, NOT because of the number on the scale. I totally understand why those people would want to lose weight, and although reverting back to their original lifestyles that promoted their normal weight sounds easy, it is not.

So, despite my passion to prevent eating issues, I realize I really should not discount the feelings of others. If there is something that is important to you and you are determined to do it, it is not fun to hear someone else tell you it is a dumb thing to do. Plus, it doesn’t change things. It really doesn’t help.  People are going to diet, period. I have learned to keep my mouth (kind of) shut and let others learn on their own what works for them. Inevitably, life goes on. People lose weight, they may regain it over time (we all know people who say “such and such diet works! I lost 30 pounds on it last year!”). So they do it again, it is comfortable for them. Maybe some people (the lucky ones who don’t fall into a disordered eating pattern) may learn something good (like how to make healthier meals, smarter ways to shop, meal prep ideas, etc).  Do I wish they would avoid giving the diet industry even one more penny…..yes. But that is because I believe the diet industry all too often seems to prey on the insecurity and desperation of people striving to lose weight, and that bothers me. They make money off of the reality that most people are repeat customers due to the simple fact that by design, you start and then end the diet. Unless someone really becomes self-aware and uses the lessons learned in the right way, letting go of the rest of the ridiculousness all too often results in weight regain. For example, counting points (or calories, or carbs) for life just is not normal eating and not possible. I have NEVER seen someone adopt that as a forever lifestyle. So, you pay again. And again. And again. But back to what I said initially, I am not going to try to talk anyone out of anything. Not any diet (unless I know for a fact it is dangerous to that person), not any lifestyle, not any food. I am not an expert on anyone’s life, they are, so they know what is best for them, and they need to travel and learn in their own way, even if it takes a few rounds of it. What I do want to do, however is share what I hope might prevent disordered eating and what might truly help someone adopt a healthier way of looking at dieting, food and weight.

So, if you are one of those people with “lose weight” at the top of your New Year’s Resolution list, here are my tips for you:

  1.  Reflect on your “weight and lifestyle” history. Was there a time in your adult life that your weight was settled in a 5-10 pound range for several years and you didn’t have to pay attention to it? What was your lifestyle like? Sometimes we have even minor changes in lifestyle that eventually affect our health (or weight) such as moving from the city and walking everywhere to moving to the country and driving everywhere. Over time, the decrease in physical activity has an affect on our body. With that said, excessive physical activity isn’t exactly a doable lifestyle either. I have heard people say “in college I only weighed such and such, I want to be that weight again”. Well, in college, if you were on the track team and ran 70 miles a week, or maybe walked across campus day and night, or danced your butt off every weekend, that is not typical! You were probably at an unnatural low weight for you as an adult, and your present weight is more normal and healthy. Instead of thinking you should go back in time and be a certain weight, consider reflecting on your current activity level. Do you get an hour of joyful movement daily? Maybe that should be a focus instead of that number on the scale. So turn up that dance music, join the Y, find a walking buddy, or whatever you need to do to incorporate healthy movement into your life. Or, did your weight always fluctuate? Were you always on a diet, always trying to lose weight? Have you suffered from disordered eating such as binge eating alternating with trying to starve yourself and skip meals? If you have had extreme fluctuations in eating over many years and never got help, I would suggest an evaluation by a therapist who specializes in eating issues (ask your doctor for a recommendation). If, however, you have slipped into some unhealthy lifestyle and/or eating patterns such as eating out every day, drinking lots of soda or alcohol, watching 8 hours of TV a day, staying up way too late then maybe your weight really has been affected by these unhealthy changes and they are worth working on. And yes, although I would be happy because changing these behaviors will make you healthier, they may also help you be at your healthier weight, too (your goal). Bottom line: your weight and dieting history affect everything. Don’t ignore it and don’t compare yourself to others.
  2.  Reconsider your goals. If your diet plan or program makes any suggestions regarding how much weight you should lose (per week or whatever), I would suggest ignoring that. If you think your unique, individual body and metabolism is going to cooperate with anything but its own reality, think again. You will be setting yourself up for disappointment. You will not feel successful if you set yourself up with expectations involving numbers. Our bodies just don’t work that way. Fluid shifts may result in changes in the number on the scale which have absolutely nothing to do with what is happening regarding body composition (muscle vs fat vs water), so why judge yourself on it? The funniest story I can think of is when one of my patients came in after having ice cream the night before, thinking her weight was going to be up. Instead, it was down. “Oh wow, I didn’t know ice cream makes you lose weight!” she said….I had to laugh. The lesson is that your weight is going to fluctuate no matter what. Instead of focusing too much on that, could you consider looking at all the good things you have been accomplishing to be healthier?  Have you been eating more fruits and vegetables? Drinking more water, less alcohol and sugary drinks? Walking more? Sleeping better? Maybe instead of feeling bad because you did not lose weight, stop and think about all the healthy changes you have made. Find something positive. Then move on.
  3.  When your body talks, LISTEN. I was going to word this one “Beware of all-or-nothing thinking”. All too often when people start weight loss regimens they are “on the diet”. This implies something really powerful which many do not understand when they undertake this endeavor. It can be a set-up if you are not careful. I have used the term “diet jail” before. This analogy is pretty easy to understand, and worth repeating. When you start a diet it psychologically places you in “jail” where all the acceptable foods exist. The lean meats, fruits, vegetables and healthy “good” meals that you are going to restrict yourself to are available, and you are expected to eat a certain way as long as you are in there and until you lose the desired amount of weight. Outside of this self-imposed jail is the “bad” food. This is where the chips, ice cream, cookies, chicken wings or whatever else you are trying to avoid are. Unfortunately (or fortunately) our bodies know better than we do regarding what we are missing (again, I’ve talked about this but worth repeating). Since most diets are deprived of adequate fats and carbohydrates, if too restrictive our regulatory systems may send signals to our brains to fix it. This means you just may crave a cookie. Or chocolate. Or chicken wings. Since these are not in the jail (on the diet) where you planned to live for awhile, what is a dieter supposed to do? Often, since it is almost impossible to ignore body signals (have you ever had to REALLY pee on a road trip??) you give in. You break out of jail (or pull over on the highway). That is ok. What is not good is the way you react to this experience. Here is where you can make a change. If like most people, when you do what your regulatory system demands (eat the cookie, satisfy your body’s need for carbohydrates to function properly) you may be inclined to binge or overeat. It is natural to want to hoard something when you are deprived of it. But you don’t live on a deserted island, you are not a contestant on survivor and you really can get a cookie tomorrow if you wanted. Do you feel guilty because you ate the cookie? Guessing the answer for most dieters is “yes”. Well, instead of just accepting your self-judgment, why not try to give yourself some credit for being so intuitive and listening to what your body is trying to tell you? Can you try to eat just the amount of whatever it is to make that nagging thought (need) go away? The reality is that a few cookies (5 chocolate kisses probably satisfies a true chocolate craving) is no big deal. Binge eating IS a big deal because of the way it tends to make people feel (both physically and emotionally). Even then, it truly is a learning experience (“wow, this is harder for me than I thought. Maybe I need to research strategies to prevent this next time). The bottom line, if you are a dieter, this is likely to happen depending on the diet. If you can learn to eat healthier yet still fit in the foods you crave this is a behavior you can take with you for life, long after the diet ends. (Note: this does not apply to those suffering from Binge Eating Disorder, where professional help is needed; this advice is meant for the typical dieter who may overeat just because they broke out of diet jail).
  4.  Don’t give specific foods magical powers. Here’s a news flash: all food are equal when it comes to weight gain. I am not talking “big picture” for surely, if you eat a lopsided diet your appetite may be affected (no protein or no fat or no carbohydrates may affect your appetite and what you crave over time). I am talking day to day, meal to meal, snack to snack differences in food choice. Think of the ice cream girl. The ice cream did not make her lose weight, and if she gained weight it would not have been because of the ice cream. If your diet calls for only fruit for snacks for example, and you have that day when you just can’t look at another apple, having that muffin truly won’t make a difference. Again, it’s that darn smart body wisdom again, telling you what you need. So don’t give food that power. It doesn’t have it. Eating kale everyday or drinking some magic juice also won’t do anything magical. It won’t negate poor sleep or stress or smoking or a sedentary lifestyle. But if you like kale, eat kale : D
  5.  If there is a magic bullet, it is this.  Sleep. If you are staying up past 11 pm or midnight chances are you are going to affect your appetite in ways that won’t make you happy if you are a dieter.  According to one study, ” physiologic evidence suggests short sleep may influence weight gain through effects on appetite, physical activity and/or thermoregulation”- see Sleep Study . In other words, getting less than 6 hours of sleep may put you at risk for feeling hungrier, being too tired to be active and/or affect your metabolism in ways that may promote weight gain that is not normal for you. Clues you may not be getting enough sleep: needing a long nap on a regular basis. Naps longer than 20 minutes or so tend to interfere with falling asleep at night, and so the cycle begins. Do me a favor, do an experiment for a week and don’t nap, don’t take electronics to bed, turn off the TV, avoid caffeinated drinks after noon, avoid alcohol and try to get to bed by 10 pm (if you can). See how you feel.
  6.  Learn Learn Learn. If you look at your “diet” solely as a means to lose weight and change the way you look you are bound to be back where you started eventually. Instead, this may be an opportunity to learn so much about yourself. You may be forced for the first time to go grocery shopping in different isles. You probably have to cook more, and this is a good thing. Most healthy minded people I know have learned to enjoy cooking because in order to eat something both tasty and healthy, you really do need some skills. It does not have to be difficult, the microwave is fine. I know people who may have gone on and off diets but always have a few recipes they kept because they were really good. I suggest keeping a collection of dishes you have tried, maybe fast lunches or crock pot meals. No need to ditch the yummy healthy recipes you will find on this journey you have chosen. I tend to jot things down when I find a recipe I end up loving. I use google a lot! For example “Healthy Breakfast Casserole” gave me my favorite fast make-ahead breakfast for when I have company. “Best Ever Quinoa Sliders” and “Best Ever Gumbo” gave me other favorites. It really can be fun! I jot them down and stuff them in my recipe box (hopefully, you are more organized than I am). But healthy cooking is one thing to learn and keep, learning about yourself is the other great thing. Some changes come easy (maybe you discover yoga and love it). Some changes seem impossible. You may learn you struggle with one thing or another. Maybe it is too hard to break a night eating habit. Maybe you discover you can’t stop eating certain foods in moderation. No matter what happens to your weight, you will learn about yourself. And if you can’t fix it,just learning that you may need some help/support is a life-changing accomplishment.
  7.  If your diet program only focuses on food, be careful. Our eating habits are no simple matter! It drives me crazy when programs or health professionals spit out obvious information we all know without considering the individual experiences of a person. “Don’t eat too much sugar”, “Exercise more”, “Take smaller portions”, “Drink more water”,  “Limit eating out”, etc. etc. etc. What about the person who has tried to be active but just can’t because they were made fun of their whole life in gym class, failing that stupid pull-up test and mile run? What about the person who has been using food for 30 years because for them, it really is the only way they feel better? Or the person who has dieted for years and just can’t get out of that “all-or-nothing” mentality? Or the super picky eating adult who still only eats 3 foods? What about emotional eating, binge drinking, workaholism, stress, hating your job, bad relationships, not to mention health issues such as hypothyroidism, chronic pain, depression, anxiety, fibromyalgia? It is way too easy to give advice, to think you are helping someone by spelling out eating and exercise instructions. But that is just one little piece of the puzzle. If you are determined to use a diet plan, please know that it is not the end-all and there is no shame in needing support for other things you struggle with in life. It is all inter-connected after all.

So that is my simple advice. I have so much more I would like to share but time is short today! We are getting ready for a month on the road, doing some exploring of the Southern USA in January. Being away will give me that time to reflect on the New Year and where I want to go. So far, I will share one thing I have figured out since my retirement in July. I still feel obligated to share my experiences somehow, to hopefully help others. Especially in the world of pediatrics and how weight issues are treated at times in children. I feel the need to get my 2 cents in, so finishing that book, even if it is just published on Amazon, is definitely a goal. Other than that, like most everyone else, I will continue to be grateful for all the love in my life, from family to friends to past co-workers and patients, students and families. ALL are what make me so thankful and feel so blessed.

Oh, that adorable little guy in the picture reaching for the rubber ducky? My new grandson! At not even 6 months old, he made me realize we must be born with determination. I watched him for hours mastering the skill of grasping for his toy (that is after he took a few months to get the fingers-in-the-mouth skill down pat). His face was contorted from concentrating so hard. His eyebrows furrowed, he looked so intense, he tried so hard. And when he finally got it and found out how to bring it to his mouth, the delight on his face was just awesome. We can do it, too. We can find our balance. It won’t come easy, nothing good or worthwhile ever does. If you are reading this, you surely were successful with lots of things in life (you got the ducky!). You got this, too. Happy New Year!!!!!

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

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

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

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

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

Two Cookies and a Yogurt

Image may contain: foodThe other day I was casually chatting with a young man about healthy eating. When someone finds out you are a dietitian they often have lots of questions. Anyway, this young man said something that really stuck in my head: “I feel like a war is going on in my head” he said when talking about trying to eat healthier. Apparently, he had been trying to lose weight and thought he should totally avoid eating junk food, and, just like everyone else who tries to “not eat” something, it creates a struggle.  But the way he described it as a “war” made me think. I actually could relate to having “wars” in my head with lots of things. We all have ideas of what the “right’ thing to do is, and struggle with decisions on a daily basis. Whether it be about what we should be accomplishing, if we should spend money on something, if we should have another drink, or visit a loved one, or make an appointment for a colonoscopy.

But when it comes to food and eating, what does this “war” mean? What is going on here? Where does it all stem from?

I have my opinion about that war, and where it originates when it comes to eating, and it is complicated. I don’t think we can ever totally come to a conclusion with this as everyone’s experience is different. I know people who grew up with health food nuts (sorry, don’t mean to offend anyone, but I am referring to those who are kind of obsessed with eating healthy foods only…..whatever you consider healthy food….you are talking to an Italian here, I have trouble thinking sausage is not ok). And then there are those who have a different food background with cultures dictating the foods they are exposed to. Or, think about someone who grew up with a weight watcher kind of mom who was always dieting and talking about her weight, jumping on a scale and degrading herself depending on the force of gravity that day. Another common scenario I have seen these days is the truly good and caring parents who have heard from the pediatrician about BMI concerns with their child. These parents unknowingly start thinking they need to restrict their children and scold them for wanting what everyone else is eating. Then of course there is the cultural influence, the final word of what we are supposed to look like. One year big breasts are the thing to have for women and the next year it is all about muscles. Abs always seem to be “in”. The bottom line is how we look at food can be complicated. God bless the untainted soul who somehow is resilient to all of it. Far and few between.

No matter what the contributing factors are as to why an individual may be so affected as to feel at war with themselves when it comes to food, it is helpful to know we are not alone. The experts have been looking into this for many years. There happens to be decades of research exploring this phenomenon of what is typically referred to as “restrained eating”. I have talked about this before as it is a theme that never seems to have disappeared. People don’t seem to stop and re-evaluate, even when they experience the same thing over and over (dieting, losing weight, gaining it back, dieting again). Not sure why, but guessing it has to do with the constant focus and pressure on being the right body size, something that women especially seem to distract themselves with. Although those suffering from eating disorders focus on eating, weight and food for other reasons, I am referring to the “typical” dieter, that person who just simply wants to lose weight. Even for these people, looking at food in a restrictive way eventually can become harmful. The person who starts out just wanting to lose a few pounds often starts to look at food in a different way (once they start dieting). For example, before the weight concerns and dieting/restrained eating started, maybe they were a bit picky about what kind of cookie they liked. They could easily refuse an oreo because they only liked their mom’s homemade oatmeal cookies. Nothing could hold a candle to those. But, suddenly, after 3 months of dieting and avoiding sweets altogether, even fake cookies look good. At a meeting at work, if cookies are on the table, they call out to dieters. The bigger the “war” in a person’s head, the louder that cookie’s voice. The non-dieter, on the other hand, may glance at those cookies and just not want one. Yes, any cookie takes on a different meaning depending on the war in someone’s head.

But is it not just about cookies. According to that young man I was talking to, any “bad” food was a food to be avoided. Once he realized he needed to lose weight he fell into the trap of thinking what everyone else in the world seems to think: certain foods make you fat and other (healthy) foods don’t. The good/bad  all-or-nothing thinking when it comes to food is the problem yet again. Giving any one food this particular power is a mistake. When it comes to health (or even weight for that matter) NO FOOD IN THE WORLD has the power to affect either (well, unless of course it is poisonous, but that is not what I am talking about and I think you know just what I mean).

What I told this young man is the same thing I will tell you. Yes, nutrition matters because eating a variety of healthy foods gives us everything we need to feel good, do what we want and prevent illness. But, it does not have to be that complicated. I believe in working on “mindful” and “intuitive” eating, and listening to one’s body, which is not easy for everyone (especially dieters or those with eating disorders). But, for the typical dieter who is at war with themselves, I have seen it work to free them. I have seen people actually learn to have just one slice of cake instead of half of the entire cake… they did when they told themselves they should not have any, ever. When people are able to tune out the “war” voice, and instead tune in to their true hunger and actually give themselves permission to have it, a funny thing happens. Your body really does not need or want more than a normal amount of anything. It is only when we deprive ourselves, when we restrict and unrealistically tell ourselves we can’t ever eat something that we break down and overeat it. And continue a war that we will never win.

Instead, I suggest you care about your health, make it a priority. Eat your vegetables (experiment with ways to prepare them to make them taste yummy such as roasting). Include protein sources with all your meals because it makes you feel better and last longer. Eat fruits you enjoy because they taste good and are healthy. Buy wheat bread instead of white. But, for heaven’s sake, don’t go to war over something as simple as a food choice. Your body knows what to do if you learn to listen to it. A normal serving of anything will never hurt you. But, if you deprive yourself, you definitely will be more obsessed with food and more likely to overeat and binge on it…..and not feel so good afterward.

Oh, you might be wondering what the heck “Two Cookies and a Yogurt” means. Well, I hate throwing away food, especially cookies. So on New Year’s Eve when my good friends Barbara and Fred had us over, there were gobs of Italian cookies leftover. She offered them to me, and well, you know, I couldn’t say no. They ended up in my freezer and I have been having them with my coffee for breakfast ever since (only 6 left I think!) No, cookies do not comprise a well balanced breakfast however, throw in a Greek yogurt and you are good to go. Well, I am. Everyone is different. Eat what is good for YOU for breakfast.

But don’t go to war over a cookie.



If Diets Don’t Work, What Does?

The Ultimate Diet PlanI made the HAES Pledge. That means I consider myself a “health at ever size” dietitian, someone who refuses to focus on weight and body size, honors diversity and promotes a healthy, sane lifestyle that includes fun movement and intuitive eating. I would love to pretend that everyone cares about their health and not just their weight, however I know this is not true. It does not mean I will ever promote weight loss for the sake of weight loss alone, but I often feel uncomfortable when those around me are doing everything they can to lose weight. Although I know through my experience with patients as well as reading the research on weight loss (there’s lots there) that strict dieting is not the way to go in the long run, I am not one who discounts another’s feelings and goals. That just means that if you tell me you want to lose weight and you are starting a diet, I am not going to lecture you, or tell you to stop wasting your time and to focus on your health instead (and that you are beautiful no matter what your weight or body size). If you are a loving, kind, good, nice person, of course I feel you are perfect the way you are. But you may not feel that way (just because you don’t like your body since you have gained that weight). And although I wish I could make you see the light (that focusing on being healthy is the way to go), I know I can’t.

So although you won’t find me trying to convince people they should not feel the way they do, you won’t catch me advising people on how to lose weight. It goes against my principles. You WILL find me trying to educate dieters though, because I have seen it all, I have been affected by what I have seen and I will do whatever it takes to prevent the bad things that can happen from dieting.  And that is what this post is about. If you insist on dieting to lose weight then I want you to be safe, stay healthy and aware of what you are doing. I want you to avoid the typical traps that dieting often sets. I want you to recognize dieting for what it is: a temporary answer. But mostly, I want you to never give up trying to learn what the permanent answer is to your weight and body concerns. And that is different for everyone.

The fact is that some people gain weight and although they may not like it, it is completely natural and does not affect their health. There are others, however, who do gain weight resulting from some unhealthy lifestyle changes or other issues and the weight gain is not normal for them.  Even for these individuals, focusing on dieting and losing weight typically is not the answer. Actually, lots of people gain weight just as a result of their dieting. Either way, I like to believe there is a “normal, healthy weight range” that a BMI or weight chart can’t predict. It is the weight your body is happiest at, the weight you tend to fall at when you are living a relatively healthy lifestyle, sleeping well, enjoying regular enjoyable physical activity, eating regular meals, eating healthy foods as well as other foods when you want them (not starving, not binge eating, not feeling excessively full all the time, or walking around hungry half the time). My goal for you, and the true answer as to how to be the weight you are supposed to be is to do some reflecting and learning.  Here is my advice to keep you healthy, safe and alive and hopefully, in touch with reality when it comes to your weight and health.

  1. Find the REAL answer. What is the actual story about your weight? I find people fall into 2 categories: those who gain weight because they are supposed to and it is normal, and those who gain weight in a sneaky way because they have fallen into a lifestyle that is not supportive of their health or feeling good. An example of the first group is the high school/college athlete who used to run 70 miles a week in order to compete at a high level on the cross country team. After college, they get their dream job and now barely have time to exercise (or maybe they now take a walk every day, you know, normal life exercise) and gain several pounds over time. Their new weight settles in a stable range, yet they can’t fit into their old clothes. Not wanting to buy new clothes in a larger size, they start to diet. This has all kinds of negative repercussions (such as making them preoccupied with food, binge eating, etc). In this case, the weight gain is completely normal with no affect on health, and actually trying to lose weight is the last thing they should be doing as far as health OR weight is concerned. Even though they gained weight, they needed to. After all, running 70 miles a week is not the norm. Who wants to do that forever? Unless you are someone who truly loves running, well, that is different. I believe we all need to do what we love and if competing in road races, running long distance, biking 100 miles is something that makes you happy, then go knock yourself out. But if you are doing it only to prevent weight gain, hating every minute, well, that is no way to live.                                                                                      Or maybe you can’t relate to this at all, and when you look back and truly reflect on your life, you realize some things have changed. This is the second type of person who has gained weight over time.  I can share some stories I have heard from others. Maybe they started a new job after college and now that they are making money they start going out to eat more often. Dinner used to be whatever mom made, but now it is the favorite pizza joint (and they throw in a free 2 liter bottle of Coke, can’t beat that). Or maybe they got married and their entire lifestyle changed. Lots of baking for the new husband who loves his cookies, watching movies together with drinks and popcorn. He is a couch potato kind of guy, so you join him (you miss the gym, but this is fun, too). Over time, you notice your clothes getting tighter, you don’t sleep as well, you get a bit more indigestion than you used to. In this case, the weight gain resulted from some changes in lifestyle that were not conducive to health, and actually contributed to feeling less than great. Figuring out why your weight changed and if it is normal for you, or not, is important. Because then, it gives you a focus. A diet is not the answer. Getting back into your healthier habits is. And it has nothing to do with the weight, but everything to do with how you are living (and feeling).
  2. If you insist on dieting, be aware of the “all-or-nothing” trap. Just because you “fall off” your diet by eating a cookie you then go on to finish the box. If you were needing a cookie, it just means your diet plan likely does not provide enough of what the cookie has. Is your diet low fat, low carb? Then guess what? THAT is what you will crave! a cookie. Or chips, pizza, ice cream….carbs and fat. Who craves grilled fish when they are dieting? Instead, try to take it as a lesson. Learn to listen to these cravings and enjoy what you want in moderation. Instead of binge eating or saying “what the heck” (actually referred to as the “what the hell” effect) and eating everything in sight because “tomorrow you will be back on track”-meaning back on “the diet”, eating some of what you want actually makes the craving go away. You feel better. In fact, when you hopefully go off the dumb diet (sorry, I mean the diet) this will have taught you that you can enjoy both those foods defined as healthy as well as those other foods, and nothing bad will happen. You won’t gain weight. You will just be a normal eater.
  3. Don’t skip meals. You have heard this before. Just today I had a patient come back for a follow up visit. I saw her a week ago because she could not stop herself from excessive snacking at night. Come to find out, she had been skipping lunch and breakfast. By evening, she was out of control. She simply started eating a typical breakfast and lunch (plate of meat, potato, veggie, water, cookie) and then dinner, and lo and behold….no more excessive snacking. Plus, she said, she felt “so much better”. Yes, getting some nutrition during the day does have an impact on your energy level. If you find yourself dragging and exhausted by early afternoon, maybe you aren’t eating enough. And, skipping meals lowers your metabolism and encourages weight gain (but you knew that). Finally, skipping meals really does affect your brain and your thinking. For some, skipping meals a can trigger even more disordered eating. There is no way to know who is at risk, but I don’t want it to be you.
  4. Get enough sleep. You have heard me say it before, I believe in listening to your body and food cravings, but when you don’t get to bed before midnight, and don’t get enough sleep (7-9 hours for adults, it varies) your levels of ghrelin will be elevated and this messenger makes you excessively hungry, and also causes you to crave fat and sugar. It is really hard to eat healthy when this is going on. Not to mention all of the other benefits of a good night’s sleep (feeling better, having energy, fighting illness). Napping doesn’t count, and actually can make sleeping at night even more difficult. Yeah, don’t nap if you can help it..
  5. Stay hydrated. I worry about people who diet because they are at more risk of dehydration as well as hurting their kidneys. When you diet too strictly, you actually break down muscle,which is protein which has nitrogen that needs to be excreted through your kidneys. So water is essential so as not to damage your kidneys. Your pee should be light yellow and you should need to use the bathroom every 3 hours or so. The minimum for most adults is 8 cups of water a day, usually 9 or 10. If you feel dizzy sometimes, this can be a sign of dehydration. The other (less scary) issue with dehydration is that your metabolism will not be working at its best if you are dehydrated. Hopefully, that motivates you to drink that water!
  6. PLEASE don’t connect dieting with exercise. We all need to move, be active because moving in ways we really enjoy is so important to our health. We can prevent heart disease, keep our bones strong, help us sleep, improve our mood, make our muscles strong, help prevent us from falling (especially as we age) and all kinds of other good things, both mentally and physically. Often, when the diet ends, so does the exercise. This does not make sense! Although, if you have the mindset that exercise is only to help you lose weight, then I guess it does make sense. But, in the long run, the real answer? Keeping fun and consistent movement in your life has nothing to do with dieting and everything to do with your mission to have the healthiest body you can have. So when this diet ends, keep on moving.

The reality is that any single diet that tricks you somehow into taking in a lot less calories than you were eating is going to result in weight loss. The problem is that nobody can sustain any particular diet because it is too hard, too boring and just simply not a normal way to live. Instead, the answer is to reflect on the reality of your weight. Have you been at a stable weight and have a healthy lifestyle, but just want to be thinner? Then, I am guessing your body will fight you every inch of the way, and focusing on being as healthy as you can is the sane way to go. If, on the other hand, you have fallen into some really unhealthy habits, have given up some of your past healthier habits (that also made you happy and feel good), then figuring out how to move back into a more balanced lifestyle would be more helpful than another diet (which basically just puts off the inevitable). It is never about some magical number on the scale. There will never be one diet that works better than they all work. But it is about feeling good. There is just something about sleeping well, having energy, feeling good that really helps you feel better about the body you were born with.

In the meantime, if you are on a diet to lose weight, I hope you stay safe, listen to your body signals (they are smarter than we are!), maybe learn to cook some healthy meals while you are doing this, discover some new vegetables or fruits you like. But mostly, I hope you take the time to learn about YOU. When the diet ends, that is when your story really begins.

The Sliver People

Image result for thin slice of cakeEating behavior has fascinated me for years. Maybe because of my Italian heritage and the tendency to “cook enough for the army, the navy and the marines” as my mom would say…..coupled with my discovery of the research on “restrained eating” and learning about the link between dieting and binge eating. Added to my years of working with people with eating disorders and weight concerns, I have a great appreciation for the complexity of eating, food, and why people do what they do. So I love when people tell me stories about food and eating. Last week at work one of my co-workers told me a story about a family dinner and how something a relative (great aunt) said that kind of bothered her.

It was a celebration and cake was being served. My friend, her son and her daughter were enjoying a piece of cake at the dining room table while this aunt sat on the couch watching. “Look at you all, stuffing your faces!”she said in a way that was kind of negative, as if she were witnessing bad behavior, or behavior to be ashamed of. My friend went on to tell me about this aunt who appeared to be criticizing them for eating cake. Apparently this person is someone who always resists the dessert…..she “does not eat sweets”. She has “willpower”. And she seems to look down on those who give in.

But then, here is the weird part, the question my friend had: she refuses to take dessert EVER…..but then eventually, every single time, after shaming everyone else, sneaks back for “just a sliver”.

OH! I knew exactly who my friend was talking about. She sounds like “The Sliver People”, I said. We both burst out laughing, describing what we see when people try not to eat something they really want but for some reason don’t allow themselves to have. After a good amount of giggling at the term we just coined, I went on to share my theories of The Sliver People. Now remember, these are just my theories (which are influenced by research on cognitive restraint and dieting behavior as well as what lots of my patients have described to me about the way they think and feel about food).

So what is it with the Sliver People? My theories:

  1. They have a “good food-bad food” mind set. Sweets are bad, dessert is bad, cake is bad, so nobody should be eating it. If you eat “bad” food, then you, by association are being “bad”. You have no “willpower”. You are weak.

My Response: if you like it, it is GOOD. If you have cake for breakfast, lunch and dinner, you won’t feel too good. It’s all about balance and “listening to your body”. If you want something sweet and don’t eat something sweet, you will likely be thinking about food all day. I would recommend eating that darn piece of cake and going about your day.

2. They think cake (substitute sweets, desserts, “bad” food) makes you fat. Magically, one piece of cake can add gobs of weight.

My Response: the scientific fact is that one average piece of cake may have a few hundred calories (except my sister-in-law Michelle’s Mocha Marsh mellow 90 million layer cake she enters into baking contests which she manages to cram in a bit more melted butter and cream I am guessing that makes her a champion baker)….anyway, it takes much more than a piece of cake or one dessert to have any effect on weight, even Michelle’s. When you eat more calories than your body needs, it knows what to do. You don’t have to count. Think about it. When you eat a bigger meal than normal, something very strange happens: you no longer feel hungry, imagine that. You can go longer than an hour without thinking about food. So if you eat the cake and it is more than you normally eat, your appetite on its own will keep you in balance (if you learn to listen and trust it). Not easy for some people.

3. They have been dieting most of their lives. They are on a diet still. Cake is not on the diet.

My Response: when people “go on a diet” and eat only certain foods while eliminating others, we know they eventually have to “go off” the diet. Dieting and food restriction lead to food obsession and disordered eating, often binge eating. When dieters give in and have even “just a slice” feelings of guilt often follow. That is why restrained eating and dieting often lead to depression (in addition to the negative effect of starvation and inadequate energy intake on our brains and mood). I know I will never convince people to stop “dieting” or looking for that magical eating plan that will transform their bodies and their lives….but I won’t stop trying. Instead, if you focus on “healthy eating” and living, then having a piece of cake for dessert at a family celebration does not disrupt anything. It just adds to life’s enjoyment and moments we should be cherishing, creating memories together, savoring every single thing that is good…and I call that “healthy”.

4. They really aren’t hungry,but want to taste it. Their belly is full, but they know they won’t get this chance again (how often do you get a chance to try an award winning 9 million layer cake?).

My Response: I think it is “normal” eating to listen to your body, and if you know you can’t fit an entire piece of cake comfortably into your belly but want a “sliver”, it’s not a big deal. Chances are the person who takes just a bite because they want to taste it are probably not even noticing what everyone else is eating. They certainly are not being judgmental about anyone who decides to eat an entire piece. They are just eating what they want and not what they don’t want. Maybe they may take a piece “to go”. There is nothing wrong with that, honoring your body and staying in tune with it is something we all should be working on, that is if feeling good is your goal.

Are you one of the “Sliver People”? If so, do you recognize yourself in any of these descriptions? Remember, this is not meant to be a judgement of people who don’t take an entire piece of cake. It is meant to make us all aware of how we have been influenced by a culture that values thinness and weight loss and dieting at the expense of the true meaning of life. To cherish family, friends and celebrate all that we have, all of our blessings as much as we can while we can (if you ask me). To be thankful for all of it, every single day. To miss out because of fears of gaining weight, well, that is just sad.

Oh, and please don’t judge me because I only eat the frosting.

News Flash: You Have No Right To Comment On My Body

HidingIt happened again. Not once, not twice but at least three times this past week. I am so sick of it, it makes me so crazy and yet, sometimes I feel like I am the only one going nuts. How could it be that we seem to allow anyone at all to be as rude as they want to be, and yet it just goes under the radar? No, I am not talking about Donald Trump (although I very well could include him in this rant, since he is a perfect example of what I am talking about). Yes, somehow we have become immune (it seems to me) to knowing what is right and wrong when it comes to what we should or should not say…..about people’s bodies.

Yes, I heard a few stories this week, and have one of my own. And I know these are not unusual circumstances, I know the things I have heard are regular occurrences in many peoples lives. I also know that people don’t always think they are being hurtful when they make teasing or sarcastic comments about someone’s weight or body. Sometimes they think they are funny? Anyway, I have said a lot on the topic of commenting on weight loss, and the possible detrimental affects of giving praise to someone who has lost weight (especially a teenager) since sometimes the weight loss is the consequence of unhealthy starvation or eating disorders. When a teenager is complimented on weight loss it is hard for them to think they should stop. Praise feels good.

No, that is not what I want to talk about again. It is more about how people feel they have the right to say something about someone else’s body. Here are some examples of what I am talking about:

“Geeeez, Suzy, why don’t you just eat a cheeseburger or something?”

“Great to see ya! Put on a few pounds, huh?”

“You look so much better now that you put on a few pounds!”

“What’s that bump on your foot? Why does your toe point out?”

“Gettin’ up there in age, huh? Beer belly and everything!”

“Did you lose weight? Your face looks so sunken”

Get the picture? Does it all sound harmless to you? Most of us know what having “good manners” means. You would never think to go up to someone and say “You have bad breath” or “your face is ugly” or “what a big nose you have”. But yet, it is alright to make comments about how someone’s size ? Or body part? As if it means anything??? Are we all really that brain washed into thinking the size of anyone really matters? Do we all need to have perfect body parts? And why does it matter if someone changes their size? Why do you care if they gained or lost weight? Why the focus on that?

I think I know why. I feel like it is a “global brainwashing”. We are all supposed to think we would be happier if we were a certain size. Our bodies are supposed to look a certain way, and we all should be striving to be that (whatever it is, I think the focus most of the time is on stomachs if you ask me….that is what most of my disordered eating patients always thought about. And that is what most “normal” people I know seem to focus on). Yes, even if you don’t have any extreme eating issues of your own, or maybe you have body image issues that are considered “normative discontent”. Check out this blog on the topic Normative Discontent as well as this video Dove Video. Both are really insightful as to how and why we think the way we do about our bodies, the influences out there that we aren’t even aware of, and why, I am guessing, most of us kind of go along like robots working toward what we are brainwashed to think is important. And why some people think it is A-OK to address people’s bodies in a way that is not only rude, but also NONE of their business.

Granted, some people just don’t give a hoot. You can tell them they look like crap, they look better now that they gained weight (they may agree), or maybe they know they put on a few pounds since high school but they are ok with it, heck, we all gain some weight as we age, it is pretty normal, who cares. But, I am guessing there are some people who are very sensitive to comments about their bodies. I have known people in my life who are genetically very thin. They get made fun of all the time. The comment “why don’t you just eat a cheeseburger” is very hurtful to someone who can’t change their body. Or maybe they are going through something, and they may not turn to food to make them feel better like some people. Some people eat more and it helps them get through stressful times, but some people can’t eat. Telling them to eat a cheeseburger makes me want to smack someone.

So, what would I wish everyone would do instead? To me, everyone is a book. When I was working 40 hours a week as an outpatient dietitian, I did not care if someone was referred to me for “obesity” or an “eating disorder” or “pre-diabetes”. To me, every patient was like a book to be opened. Every person has their own story. And YOU don’t know it. You don’t know why they may have lost or gained weight since the last time you saw them. You don’t know how healthy they are or not by the way they look or their body size. They may have gained 30 pounds but now are doing triathlons (and can kick your butt). They may have lost a loved one and fallen into depression, and lost some weight…….and so do you really think you telling them to eat a cheeseburger is going to help? Stop being stupid.

Instead,if you notice something different that concerns you, why not look at the person inside instead? Re-connect. Find out how they REALLY are. Make time to get together. Then, be supportive. If it is a casual acquaintance that you may not see again for a long time, then why bother commenting on something as meaningless as how much weight they lost or gained? Take the precious few minutes to find out about their kids, their lives, what they are doing, and all of the stuff that matters.

I feel better, now that I have vented. I really wish people would catch themselves before they make a body comment. YOU may think it is meaningless, but you truly do NOT know what the other person is going through. Instead, focus on what really is important in life. And if you think it is your body size, I feel sad for you.

Oh, so my story this week?…a comment about my feet. What was going on with my toe? For some reason, it kind of sometimes turns in to my other toe, and I do sometimes worry that it is some weird neurological thing…but, Really? That is what some people notice I guess… I still wear my flip flops…it literally took me years to get over my not so gorgeous feet….but I really don’t appreciate anyone noticing them, let alone commenting on them. Ugh. So there you have it…some really nice people sometimes just need to say something I guess.

But I hope you don’t.

PS. In the school (for special needs kids) where I work, two of the classes cook on Fridays, then enjoy the lunch they prepare. I overheard a half of a conversation  of a few of the teenagers eating at a table I walked by. I am not sure what happened, but all I heard (out of the mouth of a very sweet guy who happens to have gained a bit of weight) was one comment. He said, very matter-of-fact….”people don’t like to be called fat”. Not sure if someone called him that, but I am going to try to find out.


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

scaleThey came to their visit together. Jessica (not her real name) did not want t be there. I let her stay in the waiting area fixated on her cell phone (she made up her mind she hated me, at least that is what her facial expression conveyed). Instead, I took her mother into my individual counseling room to get the story before I met with Jessica. It was one I have heard before. In fact, the entire scenario became predictable. Mom was all over the place, at first angry that her teenager was being so rebellious, she was driving them all crazy. She refused to go anywhere with the family, she hid out in her room, refusing to sit at the family dinner table. Vacations were a night mare. “She used to be such a sweet girl, so happy and care free, she LOVED helping me in the kitchen and really enjoyed going out for pizza with the family, but now she is like someone else. We don’t know what to do”. Next, after the anger, comes the crying. “She looks horrible. She passed out the other day and it was so scary. Yet, she won’t stop this. It does not make sense!”Jessica took to wearing very loose and baggy clothes, and it wasn’t until her mother walked in on her changing that she noticed her protruding ribs and the obvious weight loss. After lots of threatening, Jessica agreed to go to her pediatrician’s and was then referred to us. How did it get to this point, and how did this family miss it?

Eating disorders can happen at anytime, but transitions are especially tough. Back to school, back to college, back to normal life. Simple, predictable, or is it? Not for everyone. Times of transition and change, such as starting a new school, going away to college, new teachers, different friends, all of it can be a challenge for some kids. Times like these can be risky when it comes to falling into the grip of an eating disorder. Couple that with society’s obsession with losing weight and it is pretty easy to understand why lots of eating disorders often go unnoticed until it is almost too late. As a parent, what signs or symptoms should you look for? Some things that you should not ignore:

  • Weight loss. Sounds obvious, but actually, especially in teenagers who are larger or fatter, parents mistakenly tend too think the weight loss is a “good” thing. Even doctors make the mistake of automatically praising weight loss, especially if it brings a child closer to a “healthy” BMI (gag).  That meaningless number does it again…….clouds the judgement of otherwise smart and well-meaning people (parents and professionals alike). The great news is the American Academy of Pediatrics came out with a new report in August highlighting the risk of treating obesity in adolescents with disordered eating as well as the importance of focusing on health verses weight. See this article in American Academy of Pediatrics for the specifics. The bottom line is that we need to get off the losing weight bandwagon, fight the cultural message that everyone needs to be thin, or a certain BMI, and NEVER EVER praise weight loss in a teenager. Yes, there are times when a kid may lose weight. A teenager who is very sedentary who goes away to college and finds themselves having to walk 9 miles a day just to get to all their classes may indeed lose some weight. This is not what I am talking about. But even then, making a big deal about weight loss is never good. Even this kid, if they get lots of attention for losing weight may decide they like the attention, and start doing things to purposefully lose weight (I have seen this happen many times). Don’t do it. Don’t compliment weight loss in a kid. Instead, compliment growing up and being successful.
  • Food refusal. When your teenager has always loved your home-made macaroni and cheese, and even begged you to make it, but now refuses to eat it, NOT GOOD. Unless there is a really good reason for refusing a favorite (recent stomach bug, stomach ache, cramps, etc) don’t ignore this red flag. Should you try to force your kid to eat it, or pressure them to answer you as to why they don’t want it? Like I said, one refusal because they don’t feel good is normal, but a few times in a row is just not normal, however responding with anger is not helpful. Instead, I have found those parents who are able to open up a caring dialogue with their teen have a better chance at getting to the bottom of it. It is important to pay attention to all signs and symptoms so you can then make a plan to address it. Forcing food or anger does not help.
  • Decreased socialization. For a teenager with an eating disorder, any situation that involves food and eating is threatening. You will start to notice they don’t want to go to their friends houses, or to birthday parties, and they especially will try to get out of family functions (those typically aren’t a teen favorite anyway, but they are doubly horrifying because of the food involved). They may lose interest in going to what once was a favorite restaurant and a big treat. They will refuse to eat the family’s favorite pizza on “pizza night”. Red Flag.
  • Loss of menstrual period. Not that you need to keep track of your teenage daughter’s cycle, but if you notice she does not ask you to buy feminine hygiene products the way she usually does, ask. Don’t ignore it as this can be a sign of weight loss and inadequate calorie intake.
  • Obsession with exercise. If you notice your teen going out for long runs, or running both morning and night, or if you notice the bedroom door is always closed and when you walk in she just so happens to be exercising, this could be a sign that something is not right. Yes, being active is good for all of us, but if doing calisthenics is something new and different, and especially if your teenager seems to be hiding it, then this is also a red flag.
  • Going to use the bathroom after every meal. If this has always been normal for your child that is one thing, but if it is a new behavior, it could mean they are purging or throwing up their food. You can check the bathroom for evidenced or you may hear it, but don’t ignore this. Vomiting on a regular basis is an eating disorder behavior and could leads to electrolyte imbalances that can be deadly.
  • Body checking. Do you notice your teenager looking at her body, especially her stomach obsessively? Does she tend to squeeze her arms as if to check for fat? This is a common behavior for people with body image issues and should not be ignored, especially if other signs are present.
  • Obsession with food labels, writing food in a journal, or counting calories. I can’t tell you how many food journals complete with calorie counts I have seen in my life. It is NOT normal. It is NOT a good thing. Yes, there are apps and websites and even the My Plate site has trackers for this. I hate them.This is as far away as normal, intuitive eating as you can get.

So what should you do if you notice any of these symptoms? Remember, your teenager is not doing this on purpose. They can’t stop. It is a very complicated disease and the triggers and causes are different for each person. It is important to be empathetic, kind and loving and to avoid blaming as this will not help. The first step might be to call your pediatrician and share your concerns. They will probably want to see and evaluate your child and may recommend therapy and a visit to a dietitian. Be sure that both specialize in treating eating disorders. Your teenager probably won’t be happy, but you can also get support from the therapist as far as how to handle resistance. The sooner you address the issue, the better chances for recovery. Remember, it does not matter what size your kid is, if they are fat or thin. It is very easy to ignore some of these red flags, like I said, some are so socially acceptable and desirable that it is sometimes hard to see what is going on. Don’t ignore these signs. They won’t go away on their own, and the longer you put off getting help the harder it will be.

There is hope. You can get your old teenager back.But you gotta move fast.

For more information and for great resources, check out the website: Eating Disorders Awareness and Prevention.

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.


Carbs, Protein and Fat: How much?

buffet-variations-1321243“What percentage of my diet should be carbs? What about fat? and how much protein do I need?” I get this question all the time and usually give the same answer: do you really want to think about that every day?  The point is, even as a dietitian who is somewhat good in math I would never want to calculate these figures on a daily basis. Even using an app. But many people are confused about this, they hear things at the gym, their marathon running friends are carb loading, or maybe they saw a magazine headline at the grocery store check out. Not to mention goals of losing weight, which usually are part of the motivation to find the best combo of macronutrients that could be the magic answer.

As far as recommendations that would provide a “balanced” diet here is the general guide:

Carbs: 45-65%          Fat: 20-35%               Protein: 10-35%

Many are surprised that our diets should be at least half carbohydrates, with all the low carb diets out there, it may not make sense. Remember, everyone is different and it is important to consider your own health history, metabolism and body. There are some patients I have worked with who respond differently to carbohydrates (such as those with PCOS or polycystic ovarian syndrome) and balancing carbs with protein is important to prevent increases in insulin. And for the average person who wants to maintain a certain level of blood glucose, including protein in a meal definitely helps. It is more about balance and less about avoidance or restricting.

But what if you really did want to figure out what percentage of your diet is protein for example? I do know people who eat a lot of protein thinking it will help them build muscle (just yesterday at lunch a young twenty-something year old teacher had two bunless cheeseburgers on his plate….nothing else). You first would need to know the total amount of calories you ate in a day (nothing I would ever recommend doing, but just to demonstrate how ridiculous and irritating it would be), let’s use 2000 calories as an example.Then 10% of this would be 200 calories. That means 200 calories as a minimum should come from protein. Since protein has 4 calories per gram, that means 200 divided by 4 is 50. So the answer is 50 grams of protein is 10 percent of calories from protein in a 2000 calorie diet. An ounce of meat has 7 grams of protein, so 7 ounces of meat would just about meet the 50 grams. But protein also comes from other foods, even cereals and grains, dairy, beans, nuts and pasta have some protein. See why it would not be too fun to try to figure out? Even for one day, pretty irritating. So what should you do if you want to eat a healthy balanced diet?

I did do a brief review of the research regarding macronutrients and health as well as weight. To put it simply, I could not find any new breaking news regarding macronutrients and weight. Low glycemic index diets do not result in more weight loss as far as current research (that means low carb). The one macronutrient mentioned as affecting both health and weight was fiber. There were several studies that suggested a high fiber diet was beneficial for both health and weight. This means more fruits, veggies and whole grains. Now that is not exactly a newsflash, but does reinforce a “health” approach to eating verses a “weight loss” approach or trying to limit a certain food group. That is why the government came up with the simple “My Plate” illustrating half the plate as “colors”, or fruits and vegetables, a quarter of the plate whole grains and a quarter of the plate protein food, as well as dairy on the side. The message I like to send is variety, not restriction. I don’t think it is “dieting” to try to add more fruits and vegetables to your meals. If you throw strawberries in your salad or an apple in your lunch bag, it makes sense because you enjoy them. This kind of move toward healthier eating does not seem stressful to me. It does not take too much thinking (too much thinking about eating is not health promoting, and tends to add stress which is NOT good for health). If you don’t take the My Plate idea too far (you don’t have to have the perfect plate every meal), then it is a good general and simple guide.

If you are interested in more specifics regarding dietary recommendations, see Dietary Reference Intakes however please keep in mind we all have different needs, and not everyone eats or needs exactly the same amount of a nutrient. These are general recommendations.

The Academy of Nutrition and Dietetics also has a position paper (2002) on the topic called Total Diet Approach. Although it mentions the outdated Food Pyramid it also describes a way of eating where “all foods can fit” and again, stresses the importance of focusing on health without trying to be perfect. If you like a food, any food, you need to fit it in. It is the average intake of nutrients over an entire week for instance that matters. So even if you eat twinkies for all three meals one day, it does not matter….over time.

Bottom line: keep it simple. Learn from listening to your own body. Good old boring common sense…….





Eating “What You Want”: Easier Said Than Done

IMG_5635I was at a lovely outdoor graduation party yesterday  and happened to walk in on a conversation that was going on between a sweet young man in his 20’s and my husband. “She’s a dietitian, you should ask her”. Apparently, this healthy-looking but thin young man was trying to gain weight. He had been a runner in high school, now worked out but not as much, sharing that when he was lifting he was able to put on some weight. I went into my spiel about “listening to your body”, explaining how our natural set-point makes it difficult to change (our genetics) and that even if he tried to eat more or add protein shakes (what he has tried in the past), it would be hard to maintain due to the fact that it requires way too much thinking and also, just as with dieting, your body tends to compensate and do what it needs to so you will go back to where you are supposed to be. “But what should he eat? He doesn’t know!” my husband says. I looked at this guy and he says “he’s right, I don’t really know”. Oy. How did eating become so complicated for even a twenty-something year old male? I kind of understand, it makes sense that women, especially older women who have spent a life time dieting and not being happy with their bodies continue to try one diet after another, end up on and off restricting and overeating, but this just felt odd to me. I just wanted to say “Just eat what you want!” It struck me at that moment that people who don’t know much about nutrition and really do care about their health (and body size, which always seems to be the motivating factor to look into nutrition) really don’t know where to begin.

I started to share a few websites I thought might be helpful about nutrition as far as basic facts (such as how much calcium an adult needs, protein needs, etc) and I tried to convince him to let his body determine how big it is going to be once he finds an eating pattern that he is happy with along with a healthy lifestyle (which he already pretty much had). But I left that conversation feeling as though I really didn’t help him much. I also got a bit of a reality check when my husband commented “people can’t eat what they want, they are not dietitians, they don’t know!”

If you can relate to any of this, I hope to give you another way to solve the puzzle of being healthy and at the same time, “eating what you want”. In another post, Humming and Beckoning Foods I mentioned a book I read decades ago called “The Psychologist’s Eat Anything Diet” which I now feel was way ahead of the game because the science behind what the authors were recommending was not yet discovered. We now know our brains are regulated tightly by many neurotransmitters, or messengers when it comes to eating. We now know the physiological reason why when people cut out carbs they may end up craving sweets (which often leads to binge eating them). Anyway, even though we know this, people continue to diet and restrict because they really want to lose weight.On top of this, if you are someone who wants to be healthy, eating “what you want” is a scary proposition because you may fear (as my husband thinks) you would live on corn dogs. And that would not be good.

The truth is, although it is not easy, you could do both (eat what you want and also be healthy). One exercise I remember from the book was taking the time to really think about what particular food you wanted. You were supposed to wait until a “meal time”, in other words, you were not supposed to mindlessly nibble all day, you needed to get to a point of physiological hunger (such as lunch time). This alone would be a very hard thing for many people to do, since random snacking is common. Mindless snacking without hunger is a behavior many of my past patients needed to work on since this was not conducive to the “intuitive” eating they wanted to learn. Mindless eating is disconnected eating. So this exercise forces you to be “mindful” in that you really have to check in to see if you are hungry. Then, when you get to the point of hunger, instead of automatically making what you think you should have, or eating food just because “it is there”, you are supposed to really think about what you want. Do you want something cold? Hot? Salty? Crunchy? Sweet? The healthiness of the food was not what you were supposed to think about. When you chose your foods (let’s pretend it is a tuna fish sandwich), then you are supposed to put it on a plate (or in a bowl?) , sit at a table without distractions (no TV, cell phones and tablets and all that weren’t invented yet, but none of that kind of stuff), and eat. Paying attention to the taste, texture and pleasure of the food you were eating was key. Funny how now we know that for our “fullness” messengers to get to our brain to tell us we had enough, we need to look at our food and pay attention. Mindful eating is how our bodies function best.

This type of exercise is not easy for those who have a “good food/bad food” mentality. It might be scary and uncomfortable for some people, especially those with eating disorders to do an exercise like this, and that is why therapists often supervise these kinds of experiences (and if you are interested in working on mindful eating, but have an eating disorder, you should ask your therapist about it). For chronic dieters, or those struggling with mindless eating, it might be helpful to think about really paying attention to how often you don’t let yourself “eat what you want” but never do enjoy what you eat.

So is it true that if you eat just what you want that you might want to eat corn dogs everyday? The tricky part is combining “eating what you want” or “intuitive eating” with healthy eating. Ask yourself: how often do you REALLY have a food craving? Is it every single meal or snack? Probably not. By food craving, I mean that urge for something that is not in your presence at the time (so not those donuts you saw when you walked into the break room, that is a “trigger” or “beckoning” food and not a true craving). The more imbalanced your diet, the more cravings you are likely to have. If your serotonin levels drop because you avoided carbs all day you might find yourself craving pasta every night. However, if you eat a variety, then you may have less cravings. This is where educating yourself about healthy but yummy cooking and nutrition come in. I believe that it is good to know about eating healthy, simple things like including more vegetables and fruits that you really enjoy because we know they promote health (different than forcing yourself to eat broccoli every night, instead discovering you love garlic roasted asparagus or kale salad with goat cheese-my new favorite, I am talking yummy). Learning that you need protein to keep your blood sugar stable, so you don’t get cranky by 2:30 pm in the afternoon is good to know. There are many resources out there on general nutrition (unfortunately, most of them are obsessed with obesity, weight loss, etc), so try to ignore that lingo and pick out what you need to know. My favorite book as far as learning about getting in touch with your hunger and what/how to eat is Intuitive Eating so check out the website for more great information to help you on the way to “eating what you want”….but being healthy, too.

Just to clarify, if have any predisposition to heart disease, or genetically inherited hypercholesterolemia or hypertension, or diabetes, or any other condition that requires a special diet, then you really do need to think about what you eat. We are all different and all unique in our health needs, as well as our eating style, cultural preferences, dieting history, emotional eating, disordered eating, or any other issue that may affect our health. But tuning into your body instead of ignoring it can only help.

And my body says go get another cup of coffee : )

No, it is not an easy task, but if you are not happy with your current eating style, why not try?