The Dieting Game: Can You Really Ever Win?

hungry man and burgerI have two questions for you. Question #1: Do you know anyone who followed a diet and lost weight? I bet you do, because ALL diets work. Yes, I said that. And NO, I don’t believe in dieting, but they DO work…..initially. If you ever tried one, then you know. That is why I often hear “I am going back on the Atkin’s Diet (insert Weight Watcher’s, Zone Diet, Hollywood Diet, etc) because I lost a lot of weight on it last year, it works”. Yes, all these diets “work” because they provide less calories (energy) than you were eating before (if you follow the restrictive guidelines spelled out in whatever plan). Voila! You lose weight.

Question #2: How many of those individuals that you know who were “successful” in losing weight continue to maintain their weight loss a year or two later? I am guessing there aren’t too many. Research predicts this, past experience proves this, yet, millions of people continue to support the diet industry (or continue to repeat the same diets over and over). Even worse than gaining back weight is falling into a destructive eating disorder, another fall-out of starting on a restrictive diet. If you are reading this and thinking “hey, I actually lost weight and have kept it off!” then you, my dear, are the exception. Hopefully, you are one of the lucky ones who made some positive changes in your lifestyle as a consequence of starting your diet; and hopefully, none of that disordered thinking that goes along with most diets did not stick.

I have known people who started exercising at the same time as dieting and learned they actually loved moving. They end up becoming yoga fans, or loving the gym or zumba, and enjoying every minute. Even when they give up the diet, they have successfully incorporated something healthy into their lives that is helping them have a healthier lifestyle (and body). Sometimes, people who are forced to learn to cook healthier because their diet calls for different foods realize they actually enjoy some of the healthier meals. They may learn how to shop smarter and eat out less and end up eating healthier in the end, even though they give up their weight loss diet. Again, these people are the lucky ones who have taken something positive from their restrictive diet and are able to move on and incorporate a healthy habit or two. But this is the exception rather than the rule.

Unfortunately, for most people, this is not the outcome of following a strict weight loss diet. Instead of loving the new exercise regime they started, they give it up immediately because the only reason they started it in the first place was to lose weight. And since they are off the diet, they of course are off the exercise. To them, exercise still feels like punishment, so why would they continue?

As far as learning and incorporating some healthier cooking and eating habits, most dieters end up missing the foods they have been restricting so much that they tend to overeat them once they give up their diet. They avoid salads like the plague. They go right back to the easier life of picking up fast food or eating whatever is quickest. They go back to that “all-or-nothing” thinking (and eating) because in the back of their minds, they know another diet will come (so why not enjoy it all now, right?).

If you are a dieter, but not one of the lucky ones who has evolved into a healthier lifestyle, and just can’t imagine life without another diet in your future, what other options do you have? How about a reality check?

The reality is that YOU are not like anyone else. Over the years I have learned that our bodies (and weight) are affected by so many complex factors that only focusing on eating/food/exercise is like taking a toothpick to chip away at an iceberg. You really need to get to the bottom of it. We all have our own “big picture” of what affects what we eat, how we live and what we are, and these factors can be supportive of health or non-supportive. What kinds of things am I referring to? I group these contributing factors into three categories:

  1. physiological
  2. behavioral
  3. psychological

If you do not address each of these areas then evolving into a healthy happy lifestyle is next to impossible. Although some diet programs attempt to address things like behaviors, positive thinking/emotional eating and metabolism, they typically only scratch the surface, and they tend to be “blanket” approaches. We are all different and what works for one may not work for another.

So where to begin? Instead of judging yourself (I notice people often beat themselves up emotionally when they fall off the dieting wagon) I recommend a “detective” approach. It means more of a problem-solving, discovery model of moving toward change rather than a judgmental approach. In other words, you just want to gradually figure out, step by step, by trial and error, how to move into a lifestyle that is better for your body (and mind and soul for that matter). For example, let’s start with #1: Physiological.

What kinds of things contribute physiologically to your body and weight? Here are a few:

  • Conditions such as low thyroid (hypothyroid),  PCOS (polycystic ovarian syndrome-a condition many women have and don’t know with symptoms such as irregular periods) and genetics all contribute.
  • Lack of sleep affects hormones that cause weight gain and food cravings.
  • Inadequate protein intake or imbalances in macro-nutrients (protein, carbohydrates and fat) may contribute to food cravings.
  • Not moving enough, loss of muscle mass, sedentary lifestyle in general compromises our body’s ability to self-regulate (in other words, active people are more in tune with their hunger and fullness, making it easier to avoid over-or under-eating)

As far as #2: Behavioral, some things that contribute to our not-so-healthy behaviors include

  • repetitive behaviors that have evolved into automatic habits (such as sitting on the couch the minute you walk in the door from work, or stopping in for a donut just because it is on the way to work, or eating in the car, or skipping meals, etc).
  • Non-supportive food environment: purchasing lots of unhealthy foods because it was on sale (hard to resist those buy-one-get-two chips!); leaving food on the counter where it becomes a trigger every time you walk by; not planning ahead for dinners so you have to resort to eating out; going to the grocery store hungry so you end up buying stuff you didn’t plan to buy
  • Clean-plate Club: you were made to finish your food even if you were stuffed because someone is starving somewhere
  • Eating food because it is free (such as when your work provides free pizza or donuts or whatever and you just had your lunch, you are not hungry, but you eat it anyway…because it’s free)
  • You eat food because you think you should, because it is good for you, even though you don’t want it or aren’t hungry anymore (note: some people with a history of disordered eating often do have to make themselves eat according to a meal plan, even when they may not feel hunger. This is critical for them as they may not be connected to their body signals).

And, finally, #3: Psychological

  • You grew up with lots of attention paid to body image, weight, dieting
  • You have used food throughout your life to provide pleasure (after all, you got a cookie when you were good growing up, now you can reward yourself whenever you want to)
  • You have used food and eating to stuff emotions (you are not good at expressing yourself or you grew up repressing how you really felt because it just wasn’t acceptable or permitted); you never received counseling or got help for this or you may not even be aware of it
  • You have dieted so much in your life that you are fearful of being without food
  • You had a parent (or spouse or friend or sibling) who restricted your food or commented on your eating or your body/weight and so you are rebelling
  • You have extremely negative “self-talk”, in other words, you beat yourself up in your mind way too much

These lists are just examples and do not come close to all of the factors that can have an affect on our eating and health. They are probably just the tip of that iceberg, and I am guessing you can think of many more examples in your own personal life. The bottom line message is to accept how complicated and intertwined all of these things become over time, and how difficult and complex it can be to figure it all out. It takes time. It takes more than a diet. So please don’t feel bad if you are one of those people who didn’t last on one. Instead, maybe you did learn something about healthy cooking or grocery shopping, or maybe you discovered you really do like grilled fish or roasted veggies. Don’t give those good things up just because you are not on that specific diet anymore.

Maybe you can use your experience with dieting and only keep what you want.

But then consider putting on that detective hat. Can you ignore what everyone else is doing, and instead start to look at your lifestyle, habits and emotions that are unique to you? Just start somewhere. Maybe you don’t get enough sleep. I promise you if you start getting to bed earlier (before 11 pm) and getting those 8 hours of sleep you will feel better immediately (and likely have less food cravings). Or, if you are tired all the time, or have irregular periods, maybe it is time to get checked out by your physician. You can’t be active or motivated if you are exhausted. You may decide to make a small change such as meal planning instead of eating on the fly. It is up to you, after all, you know your life best.

Can you win at the dieting game? Yes, you can. If you just take what you learn from them….and leave the rest.

 

 

Restrained Eating Vs Intuitive Eating: Finding the Balance

donut vs apple and womanI was not surprised when my doctor told me I needed to take a calcium and vitamin D supplement after a recent bone density exam. Being at the age where bone density starts to diminish, and being a dietitian on top of it, I was fully aware that my intake of calcium was sub-optimal. But time flies by, doesn’t it? No matter how much I know about nutrition, somehow here I am. Although I do believe in good nutrition I have never been a fan of thinking about it too much (unusual maybe for someone in my field of work).

The reality is that dietitians and nutritionists are probably at a distinct disadvantage when it comes to “cognitive restraint”, or using your head to figure out what to eat instead of listening to your body. Our training can make it kind of difficult to “listen to your body” or “eat intuitively” which often translates into “eat whatever you want for heaven’s sake”. So, although I was well-aware of my dietary inadequacy, I admit to leaning more heavily into the “eat whatever you want for heaven’s sake” mentality…..which was not too good for my bones apparently.

When you hear the term “intuitive eating” it typically is in reference to dieting behavior and offered as an alternative to stop the insanity of dieting. Yes, billions of people diet to lose weight, and many yo-yo, gaining and losing the same weight year after year (which we know is not good for our health, yet it is hard to give up that hope that this time it will stick). Despite the statistics on the failure of diets, I don’t tell people what to do and will support those who wish to follow some type of guideline because for some people, re-learning how to eat can be very helpful, and yes, it can stick. But this is probably rare, and from what I have seen at least in my patients is when it “sticks”too much it is really disordered eating. When it “sticks” in a non-harmful way is when individuals truly change detrimental habits even when they no longer are following a specific “diet plan”. So, how can you prevent the negative consequences of “cognitive” eating yet also avoid the repercussions of interpreting “intuitive eating” as meaning  “eat whatever you want”? The trick is learning how to do both: be “cognitive”, but also intuitive, gradually interweaving both into your eating style so that you can be both healthy and sane.

The first step is to try to determine if you are a “restrained eater”. Although “cognitive restraint” is often defined by the experts  as “the intent to limit food intake to prevent weight gain or to promote weight loss” to keep it simple, I like to think of cognitive restraint as “using your head to figure out what to eat” despite the signals coming from your body. Sometimes people think too much about food even if it is not because of weight related issues. For example, it is lunch time and you brought a salad. You are absolutely famished, craving a burger but will not allow yourself to go to the cafeteria to get one. You read somewhere that red meat is bad for you so you are not going to eat it. Or, it is 9 pm at night, you are counting your calories and according to your records, you still have 200 calories left that you can eat. You are not hungry at all…..yet you go ahead and pop some popcorn because you like popcorn and you “can have it” since it is just the correct amount of calories. You don’t pay any attention to the fact that you are not hungry. Both situations are examples of “cognitive” restraint, using your head and ignoring your body. Both examples are contrary to “intuitive” eating.

For research, investigators use very specific tools to evaluate if someone is a restrained eater or not. Some of the common characteristics of restrained eaters include, but are not limited to:

  • frequent dieting
  • counting calories
  • self-weighing
  • excessive fear of weight gain
  • guilt after eating
  • food avoidance
  • labeling foods as “good” or “bad”

For our purposes, if you can relate to any of these statements, you may have some characteristics of restrained eating. For those of us who are dietitians or nutritionists, or even those of you who educate yourself about foods and nutrition, you can also fall into the trap of too much thinking about what you eat. I have seen extremes in thinking when it comes to nutrition, with fads coming and going as well as information that is not evidence-based. Some examples include avoiding gluten at all costs, not eating carbs,avoiding foods with added sugar, avoiding processed foods, etc. Some people need to be on special diets due to medical conditions or allergies, or even having a digestive intolerance to a food. Avoiding GMO’s or choosing to eat organic or fresh food is not what I am talking about. It is having an unreasonable fear of foods that on occasion have no affect on health whatsoever. Missing out on eating your grandmother’s famous sticky buns on a holiday because you have chosen to avoid gluten (without evidence of an allergy or medical condition) is restrained eating. Feeling guilty because you “don’t eat processed foods” yet gave in and bought some Girl Scout Cookies to support your niece (plus you LOVE Thin Mints) is also unrealistic. Refusing to eat a meal in a restaurant because you don’t know what they put in it (even if you don’t have food allergies) might be an issue. If what you allow and don’t allow yourself to eat tends to interfere with your social life, well, that may suggest a problem.

What about “Intuitive Eating”? The basic principles of intuitive eating can be found on the website Intuitive Eating. Basically, learning to be more intuitive with eating means getting re-connected with your natural body signals, rejecting the “diet mentality” and relearning how to trust your body’s natural wisdom. This sounds simple, but it is downright scary for many. “If I let myself eat what I want, I will gain 50 pounds! I will live on cookies and ice cream!” or so the thinking goes. To be honest, from what I have seen in former patients, the process of moving into a more intuitive eating style is different for every single person and depends on their unique eating/dieting history. I have seen people do exactly that: live on ice cream for a week. If you have lived for several decades denying yourself certain foods and suddenly the bars come down, it is almost instinctual to dive in! But a funny thing tends to happen. You honestly and truly DO get sick of ice cream. Suddenly, grilled chicken looks very appealing. The wisdom of your body really does win out in the end. But the path is not always simple or easy (which is why I always recommend anyone who has a history of dieting and is tired of it seek the help of a therapist and a dietitian, preferably both who have experience working with individuals with eating issues). Some people do fine on their own, after reading the book Intuitive Eating by Evelyn Tribole (Author), Elyse Resch (Author) they can gradually make the changes they need to free themselves and move into a healthier relationship with eating and food.

The question is, how do we be both “intuitive” and eat what we want while listening to our natural body signals (and trusting them) yet also be “cognitive” in a way that helps us make smart and healthy decisions about eating? I feel ignoring nutrition is a mistake. I like the term suggested with intuitive eating called “gentle nutrition”. The reality is, if we eat a variety of all of the food groups (meats or protein foods, fruits and veggies, grains or starches or other carbs, dairy and fat) we tend to crave less. Imbalances trigger cravings. Remember the chemical messengers our bodies have to tell our brains what we are missing?  For example, serotonin levels drop in our brains when we don’t get enough carbs and trigger us to want sugar or sweets (survival!). Yes, our bodies are pretty darn smart that way. Eating well also makes us feel well. Learning what makes you feel your best (with foods that you actually really enjoy) is key. One example I often give is eating adequate protein to avoid that afternoon blood sugar crash. Without it, you will almost be guaranteed to run out of energy and be excessively hungry which is really irritating when you are at work and there is no fridge to run to. So planning to include your favorite yummy protein packed lunch is not what I call excessive “cognitive” restraint, but smart and enjoyable eating. Yes, you do have to think about it. But over time, you start to find your favorite, doable, somewhat healthy meals and snacks that taste good and make you feel good. You may make mistakes, you may change your mind (we all get burnt out on foods, even our favorites) and so you experiment with other meals and foods. The key is to keep learning through trial and error. You do have to educate yourself a bit about nutrition (the basics, not fads, even the My Plate government website is helpful for basic nutrition info if you can promise me you will ignore the weight loss focus of some of the links). Once you get a basic idea of how to balance meals to feel good and meet your basic needs, experimenting with cooking is also helpful. Last night I took my mom grocery shopping and made her favorite black bean and corn salad. She just loves it, and to watch her tasting it, you would have thought she was eating something amazing (to her it was, to me it is just bean salad, good, but not lobster salad which is much more amazing if you ask me). The point is, good food should be yummy, too.

For those of you interested in the reasons restrained eating often leads to increased hunger, you may enjoy the research article  Cognitive Restraint and Appetite Regulating Hormones which describes a connection between ghrelin, the “hungry” messenger and dietary restraint. Despite the leaps and bounds we have made in understanding how what we eat affects our brain chemistry and appetite, there’s lots we still don’t know. All the more reason to work on a better connection to the natural wisdom of your body.

One more thing. Clearly, knowledge about nutrition does not translate into action. I was well aware that I probably was not getting enough calcium in my diet (the ice cream in my morning coffee, yogurt and grated cheese on everything was not enough). Don’t be like me and wait for something to happen. I did purchase that supplement. Now I need to remember to take it : O

One step at a time.

Weight Watchers: The Good, The Bad and The Ugly

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

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

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

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

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

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

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

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

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

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

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