Diet soda causes weight gain?!

What do you think? Does drinking diet soda cause you to gain weight or not?

Too much diet soda?

This is an old story; the media has summarized some studies done several years back concluding what many of you might fear—something with no calories can make you gain weight. But a look behind the sensationalized headlines showed something else.

Yes, there was a link; more people who drank diet sodas were higher weight. But did drinking diet soda causeit? And were you able to take in this correct conclusion and hold on to it, or do you still fear diet soda?

Oh, this is dangerous. I am notadvocating for diet soda consumption! There’s no nutritional merit—no calories, no vitamins or minerals—and it may even have some negative effects. Namely, it may mask your hunger, making it more difficult to trust your need to eat. And large intakes of colas—regardless of type—may pose other consequences such as impacting your bone density. 

But really my intent was not to discuss diet soda. Rather, I’m highlighting this example to prove a couple of points.

Causation vs. correlation

Wasting way too much time on Facebook the other day, a post by a local, experienced dietitian caught my attention: 

“Very interesting research about vitamin D's potential for significantly slowing MS. Adds to the body of research linking higher vitamin D levels with reduced risk for MS.”

The comment was, on the one hand, harmless enough. The dietitian was referencing a recent article—just an abstract, really— presented at a recent medical conference. The abstract summarized the study findings fairly, stating that average, baseline blood levels of vitamin D link with disease symptoms and severity. Those with a lower average level of vitamin D at the start of the study had a worse disease outcome than those that started with higher blood levels.

This may seem subtle to you, but it’s not to me. The RD’s comment about the “potential for vit D to significantly slow MS” is not, in fact, what the article stated. It merely showed a connection, a correlation. Perhaps there’s something about people with MS that utilizes more vit D when there’s more active disease. Or maybe low levels are simply a marker for more disease activity. 

Nowhere did the study state that supplementing with vit D improved the prognosis. I don’t tend to look at the half empty, but I simply didn’t see the hope for vit D’s potential, at least not in this study.

Maybe it’s splitting hairs. I mean she did, in fact, refer to this as a link. But what troubles me—along with the image on the post showing supplements, is what’s implied and therefore what we end up believing. No, vit D supplements have not been shown to reverse or improve the health of those living with MS. But wouldn’t we all like to believe that a magic pill could do that for us—for our MS, for our cancer, for our anorexia, for our weight struggles?

But besides the false hope, there’s the issue of our getting sucked into believing that correlatedequals caused. No, diet soda doesn’t cause obesity. But those living with obesity may be more likely to select diet beverages than those who are average weight.

Similarly, maybe you gained a lot of weight when you moved from a gluten free to a regular diet. That doesn’t mean that non gluten free diets cause weight gain. Rather, it may be that while being mindful of your intake—like you do on any diet—you may have seen a weight shift—but not because of what the diet was. But then when you regain the weight, you cling to the belief that the gluten free (or carb free, or fat free or whatever diet) was the reason for your weight loss, and therefore subsequent regain. The regain may have been about overeating following deprivation from denying yourself foods you enjoyed—and not a result of some magic involved with the ingredients you omitted.

Unfortunately, misinformation sticks. And trying to scream and shout that information is wrong only solidifies it as fact.  Misinformation can be dangerous, keeping us stuck in our ways, and preventing us from trusting ourselves. And conflicting info in the media confuses us and leads us believing that nothing we do makes a difference.

So instead, I ask you to question what you read. And challenge educated individuals in the health field about the articles and flashy news snips.

Focus on the facts, and work with your team for concrete ways to counter your unhealthy thinking. I hope this blog helps to set you on a healthy path!

Body Wraps, Toxin Removal and More: What I Learned at the Gym Today

I'd much rather be hiking...

It's hard enough starting at a new gym. Generally, I dislike going to gyms, preferring instead to enjoy a long bike ride, a hike or a cross-country ski or snow shoe when weather permits. But living in New England, there are times, like now, when conditions are simply not favorable for either of those activities.

So off to the gym I went, attending my first spin class of the season, at a new gym with a new instructor. And I could barely get through it. No, I am not that out of spin shape—although those cycling muscles certainly needed a workout. Rather, I was feeling my blood pressure rise as I sat through the marketing pitch and endless misinformation by this supposed promoter of health—the spin instructor.

I'm still headachy from it, so in truth, I am blogging to air my annoyance and frustration.

You know me be now—I am not shy to share my opinions, particularly those I feel strongly about. But this was a challenging setting. Jane, I'll call her—no, Barbie better suits her—stood before the class of about 35 cyclists confidently spewing her crap. Misinformation spilled from her mouth with no objection from the group, until I, a newcomer there, just had to speak up. But it was hardly the forum to debate in, and my rebuttals could be endless if I countered every outrageously false claim about weight loss.

No, neither body wraps nor green
powders will remove body fat.
Sorry!

She endorsed a powder she was selling with her personal testimonial about how she believed it really helped her, as it releases the toxins from the body, those horrible things which fester and cause disease. (Toxins, by the way, are released from our bodies every day, with no need for a product to make it happen.) And it gave her natural energy and promotes weight loss. (For the record, calories are the form of energy we get from foods; a product with no calories has no energy, although you may get a short-term boost from stimulants such as caffeine.) Then I heard her endorsement of the body wraps for sale, which essentially shrink your body a size or so overnight! All without dehydrating you! And finally I learned that you should be drinking half your body weight in ounces of water each day. 300 lbs? That's 150 ounces each day of water, about 5 liters or quarts per day.

So why am I all upset, you ask? Where shall I begin?!

• because while for me it was simply an irritation (and a big one at that), I know how others will be lured by this misinformation, sold products with false claims, sucked into unhealthy thinking and potentially dangerous supplements; more misinformation makes sensible thoughts a challenge;
• because she was speaking to a group of completely normal weight individuals, none of whom could afford to lose weight;
• because no one should be sucking down water or non-caloric beverages instead of eating when they need fuel, simply to mask their hunger;
• because she's setting people up for failure and unrealistic goals, luring them for her personal financial gain, to buy a product, in the case of the wrap, that at best may contribute to a decrease in hydration for a temporary appearance or short-lived sensation of lightness;
• because if we each spoke up every time we heard something we know to be false or inaccurate, then maybe we could make a difference!

Yet another gym promotion. Uggh!

There, I feel so much better now. I think I'll go have dinner, now that I can more calmly and peacefully enjoy it.

Thanks for letting me rant!

Obsessive Workouts and Protein Powders: How Concerned Should We Be?

Reactions to the NY Times article and the Pediatrics study on teens and muscle-enhancing behaviors.

I'm bothered by something I read. "Compared with a sedentary lifestyle of video games and TV, an obsession with working out may not quite qualify as a health hazard", as stated in last week's NY Times article. While the article brought to light the silent struggle many boys deal with—or rather, don't deal with—their obsession with weight training, dietary modification and steroid use to achieve the 'perfect' body—it failed big time in educating readers about when to be concerned, and what we can do to prevent this unhealthy trend. But this is not just about boys—the Pediatrics article identified that girls, too, are taking steroids and more frequently protein shakes to increase muscle mass while pushing activity.

Yes, teens, both boys and girls, have become more focused on increasing their muscle mass. "Strong is the new skinny" is a current sentiment; neither being healthy nor slim is good enough. The bar has been raised necessitating increased muscle mass to change one's appearance. And the price they pay is far greater than suggested in the Times' quote above.

Lean and muscular, yes, but nor much of a sex drive!

But how big a deal is it if a teen—or an adult—takes a supplement or pushes their training to change their appearance? The actual study, in my humble opinion, did little to differentiate unhealthy disordered behaviors from more innocuous ones. What's the issue with weight training to increase muscle mass, any way? What's the harm in your taking a protein shake to bulk up your muscle a bit? (Steroid use is another story, and that is well addressed in the Times article.)

If you're like twenty-three year old Nathan, it's quite a big deal. He relied on the gym-endorsed protein powders, "to promote muscle growth". All things high in protein were considered safe—if they were also very low fat. Despite my urging to reduce his exceedingly high protein intake, and to liberalize his intake of fats and carbohydrate, his kidneys began to fail, struggling to filter the extraordinarily large load of protein waste products. His thoughts were all consumed with when he'd be able to get to the gym and when and what he'd be eating next.

But this is not solely a male thing, as the Pediatrics study shows. Girls, though, are more likely to modify their diet, while boys will increase their gym training to 'meet their needs'.

And what if it were high in carbs?

Like Karen, you may be spending more and more time at the gym while restricting your intake, ultimately finding it too stressful to live life with school and work demands, along with your rigid workout regimen.

Certainly, drinking protein supplements is not itself a cause for alarm. But relying on shakes in lieu of real food is. It impacts our ability to socialize, to be flexible in eating situations and to get all that we need nutritionally. A diet devoid of fats and carbohydrate will be deficient in much-needed nutrients, and typically in calories. A sense of deprivation often results, accompanied by obsessive thinking about food and eating and weight.

As for the workouts, where do we draw the line about what is healthy and safe, and what is excessive? If you're in a community of triathaloners, marathon runners or iron men/women, a few hours at the gym will seem inconsequential. 

But is it driven by a preoccupation and distortion that anything short of a few hours will leave you fat or unfit? Many of my patients believe falsely that working out is always a good thing. Nothing can be further from the truth. When intake is inadequate, working out not only won't build muscle mass, it will help break down muscle to convert it to fuel! And when net intake is substantially less than need (either because of very high activity or low intake) metabolic rate slows down, so you burn fewer calories 24/7. Certainly not what you intended!

Surprisingly, there was no mention of the low testosterone levels that result in males, similar to the drop in hormones seen in females with anorexia. Tell this to those boys and it might motivate for change. Sex drive drops, facial hair diminishes and risks to bone density increase as well. For boys in their growing years—which might last until 18 or 19 years—the consequence may be stunted growth. And the opportunity for catch up is lost once the bone growth plates have closed. Most boys and girls do care about their height, but do they realize this may result?

And what messages are we conveying to our kids with their school BMI screenings? Are we faulting them for their high BMI (which will remain high as muscle mass increases and height fails to increase)? Or are we fairly looking at an increasing BMI percentile for that individual as a possible marker for unhealthy behaviors—be it steroid use resulting in rapidly increasing muscle mass or binge eating? Are we presenting being obese as so horrific that even if their behaviors are healthy, we tell them they need to lose weight? Is a drop in BMI in an overweight child healthy if they starved themselves or compulsively exercised to get there? 

Shouldn't we be screening with questions about thoughts and behaviors, not just BMI?

Are we reinforcing their interest in fitness because we perceive it as healthy—no matter what? Do we share the same distorted views about all things protein-rich being "good" while villainizing carbohydrate-rich grains and fat-rich foods, too? Are we contributing to the misinformation they hold fast to? Why don't we recognize that there is sometimes pathological thinking and behaviors that drive extended workouts and dietary changes?

I don't have the answers.  But I do know that we are influenced by cultural standards of beauty, and that these images have become more and more unattainable. Yes, without steroids, you can't possibly bulk up like many of your weight-lifting role models, nor can you be both healthy and low weight as the air-brushed magazine pics would lead you to believe.

Something has to change. And it can start with you. Add your comment. Share this piece. Counter misinformation and acknowledge unhealthy behaviors—even when society fails to.

Consider these older posts for more information on topics covered in this post:

http://dropitandeat.blogspot.com/2010/07/daily-exercise-is-must-or-so-you-think.html

http://dropitandeat.blogspot.com/2012/03/protein-new-black.html

In Response to Bridal Hunger Games

Preventing the Damage After the Wedding

It's hard to know what disturbs me most about the NY Times article Bridal Hunger Games printed yesterday. Was it the hopelessness of women who don't fit into their ideal image of what a bride should look like—willing to take dietary change to extreme measures to achieve short term “success”? Or my fright at the willingness of MDs and nurses, helping health professionals, whose “first do no harm” mantra has clearly been dismissed? 


Or maybe it's the NY Times itself for creating a piece that seems more like an advertisement for unhealthy weight loss schemes, rather than a balanced report on the pitiful state of our culture and the consequences of being lured into quick weight loss schemes?

Pressure on women for their “big day” abounds, and it's been addressed before on this blog http://dropitandeat.blogspot.com/2011/09/wedding-diet-guaranteed-to-change-your.html. But let's take another look, from the perspective of the newlywed in her post-honeymoon period.

It's now October or November, some months past the glorious wedding day. And as quickly as it was lost using a  starvation strategy—NG tube or HCG, or self-imposed restrictive dieting—her weight has been climbing. Those lovely wedding photos are images of the past, as she is now left with a rapidly gaining yet non-pregnant body. With  her deprivation diet, she began to crave foods like never before. Her thoughts about food and eating were all consuming (pun not intended) and her rigid pattern of restricting has turned into rebound binge eating. 


The more she withholds the calories her body needs, the more she feels stuck in the cycle of overeating and over thinking. Her thoughts become more black and white, as she feels that once she starts, there's no stopping her. She feels hopeless and depressed. And she certainly doesn't want her disgusting body, as she sees it, to be touched. This is hardly the fairytale she envisioned.

In fairness, this certainly might have gone somewhat differently. Perhaps her predisposition to developing an eating disorder, combined with the trigger of dietary restriction and stress leads her to continue her weight loss. Now her periods become irregular and soon ultimately stop. Her libido drops and her irritability worsens, along with depression. She spends way too much time thinking about food and eating and exercise now, and becomes more withdrawn, avoiding social encounters. Hardly wedded bliss.

In either case, there is hope. Food intake can be normalized and health, both mental and physical, can be restored. But the best thing would have been prevention—avoidance of these crazy, unhealthy diets which can cause this whole scenario to snowball. So if you're lured into believing that you'll be happier dropping weight for your wedding day, please think again!

But back to the article and all my issues.

Where the Medical Community Goes Wrong

Ok, so apparently the nurse tells the patients about the FDA risks about the procedure. Great. But action speaks louder than words. If a provider wearing a lab coat tells you he/she does this all the time and promotes it as a solution to your problem, don't you think it's fine to do? Won't you allow your unhealthy, irrational thoughts to buy into the “treatment”, forgetting the risks? 


Who ARE these providers, willing to inject patients with a hormone while supporting extreme starvation of 500 calories per day, a deficit of at least 1000-1500 calories daily for most moderately active women of average height? Or those willing to subject healthy women to a feeding vehicle reserved for the severely ill unable to consume enough food orally—cancer patients, anorexics, to name a few—simply to make a buck? And the nerve to call it “nutritionally balanced” when it is devoid of carbohydrate, and induces ketosis and self-starvation! 

And yes, the quoted Dr. Shikora gets it right—but regrettably fails to acknowledge that discomfort is the least of the problem; he acknowledges with what I suspect is a bit of sarcasm that having a tube shoved down your nose is “not always comfortable and pleasant”—perhaps because he hears more complaints of discomfort following the gastric bypass surgery he is well-known for performing.

And while Dr. Aronne wisely suggests that waiting until there's little time left for change (resulting in taking extreme measures) is not the best strategy, I'm still left questioning this assumption:  that brides need to lose weight for their wedding! Perhaps if the focus were not on losing weight for a dress or for a day's appearance, I'd be okay. If weight had been climbing as the soon-to-be-bride had become sedentary or had turned to stress eating to manage at her new job, I could certainly see room for change. Addressing her unhealthy behaviors to help her gain control of her emotional overeating, to strategize about alternative coping measures, or to learn to distinguish hunger from other eating triggers—these I could support. 


Helping the soon-to-be-bride feel better, I certainly endorse. But that's not what the article encouraged. Maybe it's me, but this seemed like a sensational article about how to lose weight rapidly, without appropriately highlighting the very serious consequences.

So if you're feeling hopeless about your weight, don't be lured by promises of quick fixes—wedding, or no wedding. Consider the consequences of your actions both on your thinking and your general well being, not just on your weight now but in the future. 


And if you're ready to make changes, be sure they are reasonable to live with—not just for a week or two, but for life. No eating plan that severely restricts calories or omits whole food categories fits this description! 

Shame on these doctors who promote such weight loss programs. And shame on the NY Times for such an unbalanced perspective of the costs of such measures. You could easily buy a new dress at Kleinfeld's for the future cost of an eating disorder program, and the cost of your time at the therapist, doctor and dietitians' sessions to undo the damage from these diets. 


Fitting into your grandmother's dress, or society's expectation of your wedding day appearance, is no justification for messing with your head, and your body.

You’re invited to celebrate!

 

What if you allowed yourself to have whatever you wanted to eat? Good cake (my personal favorite), great bread (ok, maybe that’s my real favorite), quality ingredients like aromatic extra virgin olive oil?

What if you allowed yourself to feel like queen or king for the day—every day? Not to shun your responsibilities at work or at home, of course—but to see yourself as special? If you allowed yourself:

• the power to speak your mind, to ask for what you need?
• the right to take control of your health?
• the ability to eat in the presence of others, foods they don’t think you should be eating?
• the chance to act as if you’re deserving of pleasure—of time for yourself, of adequate nourishment, of enjoying what you’re eating, or getting enough sleep?

Imagine if you thought, if you truly believed that your body is worth taking care of. Then you’d consider the consequences of your actions, when you are thinking about restricting your food intake, or eating despite feeling stuffed, or doing harmful things to your body. Then you might exercise—but not excessively—and you might limit yourself to activities that you really enjoyed.

Imagine if you knew and trusted that there will always be another serving of ice cream tomorrow—that you don’t have to get it all in today. How would that change your thoughts and the amount of ice cream you might eat?

Dear readers, give me a gift today. Take this day— just today to start— to do something nice for your self. Allow yourself to eat something you don’t, in your own mind, believe you’re allowed to eat. Carve out some time, just a wee bit, even, to enjoy your space or to do something you enjoy, just for you.

It’s my birthday today, and I’d like you all to have that gift.

I already eat what I want every day of the year—in amounts that make me comfortable—for the most part. I respect my body—skipping my workout when I’m feeling the need, getting more sleep when my body urges it. Ok, the sleep part’s not always so easy for me! And you probably have learned by now that I don’t struggle much with making my needs known.

So I’m asking for what I want on this birthday. I want to make a difference. I want to feel that something I’ve said has helped you shift your own thinking and change some behavior for the better. I’d love you to treat yourself today—not just on a birthday (if that even happens)—in a way that helps you move forward in your goals.

At least make a wish and set your sights on your direction today!

And please share your experiences in the comments!

Advice for Your Doctor for NEDAW

Call me crazy, but I’m tempted to respond to a doctor’s closed-ended questions in ways that would knock his socks off. When he asks me about alcohol, for instance, he frames it something like this “you don’t drink much, right?” Or perhaps to assess risk of STDs he suggests “just one partner—you’re married, right?” Well, yes, he’s right, but would I ever say anything other than what he’s led me to believe is the only acceptable answer possible?

Isn't it time to get the support you need?

This brings me to the important topic of educating your healthcare team, your doctor, in particular, about how to truly support you. In honor of National Eating Disorder Awareness Week (NEDAW) (here in the States) I thought that health care providers could use a bit of awareness, to hopefully make your visits, and your life, a bit less stressful. Please consider adding your own two cents to the comments—then pass it on to others—and your providers! While this is prompted by NEDAW, I’ve included recommendations that are worth sharing regardless of whether you struggle with an eating disorder, disordered eating, or simply are outside of what the BMI chart says you should be.

Unsolicited Advice From One Healthcare Provider To Another

On weighing your patient

Please weigh patients with their back to the scale. Have them remove all layers possible—most individuals, regardless of their weight, want the weight to reflect what’s real. Weighing with shoes, heavy belts, and jackets doesn’t contribute much valid information. Oh, and have them empty their pockets!

That said, some do want to misrepresent their weight—so less is always better—with regards to clothing. And have them empty their bladder first!

A poker face and restraint from commenting is wise. That is until you’ve gotten to assess their weight in context. Imagine if you said to an overweight patient—“great, you’ve dropped a ton of weight” only to realize that they had a rapidly growing cancer? 

Weight change must be evaluated relative to behavior. Someone who lost weight (regardless of how appropriate you thought it was for them to drop some pounds) may very well have gone about it the wrong way. 

Consider this—they may have been starving themselves, resulting in messing up their periods, their metabolic rate, their mood, their sleep, their thoughts, their relationships.  This is nothing to offer positive reinforcement for. There is nothing healthy about losing weight this way. Perhaps they are compulsively exercising, or dehydrated from purging or laxative abuse. No, weight would not be a good measure of health then.

Similarly, your patient with a high BMI might have simply maintained her weight. But she feels well, is active and fit, and is healthy by all measures. Maybe she has even turned things around, if her weight had previously been climbing. Sure, you can explore other risk factors, such as quality of her diet—as I hope you would do with your slim patients, too. But if all looks good, perhaps you can accept that her stable weight is just fine for her.

Perhaps if she’s been climbing in weight that might warrant some probing about recent lifestyle changes—stressors, activity, diet—to help with better self care and disease prevention.

And if your underweight anorexic patient has increased his weight, please similarly temper your response! While you may be delighted, he (or she) may not be. It’s a mixed bag, gaining weight, even for those who are trying to gain weight. There’s the healthy side of them that really wants to recover. And then there’s the eating disorder voice that sees weight gain as a failure, as a “you can’t do anything right”, pulling them back to restricting again. It’s more valuable to elicit a sense of what they are thinking and feeling about the change. How does it fit with what they expected? What are the benefits of the changes they’re making? Focusing on the behaviors that contributed to the weight shift is more valuable than discussing the weight itself.

If your patient isn’t doing well, rest assured that they are as frustrated—even more so, really—than you are. The impact is far greater on them than on you, that’s for certain.

Hooray! You got your period back!

It’s not healthy to lose one’s period due to such factors as anorexia, restrictive eating, or compulsive exercising. We all know that. But while getting a period back is a good sign, it is not always well-received by patients. For some, getting a period equals “I must be fat now”. For others, it means they are done with their efforts to change their eating and behaviors. And that may be the worse thing for them to conclude.

Periods may return before weight is restored and before behaviors are normalized. Or they may come back after 4-6 months after stabilizing in a healthy range. Or they may never have disappeared, as was the case of a patient of mine who conceived 5 children through her years living with anorexia. The point? Consider where your patient is at before you rejoice in their body’s normalizing their periods!

Don’t Ask, Don’t Tell? I Don’t Think So.

If you don’t ask the right questions, you won’t get the real answers. So do ask open- ended questions—different than what my MD thought to ask—to obtain valuable information. If you’re discussing weight or body dissatisfaction, do ask if they’ve used laxatives, or diet pills, or vomiting or restricting—in the past, or currently. Suggest a frequency, in a non-judgmental way. If a patient says she purges daily, follow with a question like “how many times per day?” And when he says twice, follow with “And what’s the maximum?”  Just like if they say they have a couple of drinks, follow with what’s a couple—4? 5? 2? Per day? Per week? Suggest a range of possibilities, without raising an eyebrow.

 

We can only help our patients if we can accurately assess their situation. And, we can’t begin to do so if they feel they can’t trust us. So do your part. Ask your questions in open-ended ways, and be careful how you react. Ask how you can help, what they need from you. Are they connected with appropriate resources, or do they need guidance?

Encourage a follow-up sometime soon! 

Suggesting a 3 or 6-month follow-up visit certainly sends the message that their situation simply isn’t worth your taking too seriously. And as a result, they will undoubtedly convince themselves that really everything is fine, that nothing really needs to change.

And if you don’t believe me, read the comments from those in the know, below.

Thanks for taking the time to read this.

Saying Goodbye to Your Jeans—A New Perspective on Progress

I bought a new pair of jeans yesterday. For me, trying on jeans is right up there with going for a new bathing suit. No, not particularly positive. In fact, while I love fashion, shopping for clothes and shoes is never anything short of depressing. I can’t find my size shoes in stores (9 1/2 AAAA), and those in catalogues are often fashion failures. My shoulders are broad and my arms long, making well-fitting tops and jackets impossible to find. I’ll stop here; I think you get the idea.

I needed a new pair of jeans. Somehow, a few years ago, I had convinced myself to purchase a pricey pair of dressy jeans, and now I knew it was time to move on. Why? Because every time I put them on, while they looked fine, I was less than comfortable. Maybe knowing the phrase muffin topping had an impact—I just couldn’t get past that visual. And wearing them kept me from fully enjoying my dinners out and my socializing.

So I selected a new pair from a boutique with a limited but fabulous selection of clothes, and picked them (drum roll please) based on their fit and comfort. Yes, they were a size larger than my last designer-type jeans, in spite of my weight remaining the same over these years. And so I bought them.

Jeans were a topic raised in many patient sessions last week. (You thought I only talked about food, eating, calories, I suppose?) Marie, who has struggled with obesity and binge eating disorder for many years, reported her approach to moving on. She was ridding her closet of everything over size 20, as she now comfortably wears an 18, having lost, I forget exactly, but somewhere near 60 pounds (while enjoying such foods as cookies and bagels, I’ll add). The size 20s are really a just in case—I don’t think she truly trusts that her progress is for real, in spite of it being over a year and a half of consistent behavior change with resulting weight loss.

Even more notable was the message I received from Dana, describing the emotions of parting with her old jeans, her anorexic jeans, a remnant of her anorexic self. After discussing her decision to discard a stack of unhealthy-sized jeans, she followed up her session with this note, (excerpted with her permission, below):

“I must tell you that when I pulled down my street from my appt with you, the trash truck was at the house before mine... and as I pulled into my garage I watched in the car mirror the big claws grabbing the trash can to empty it into the truck.  My jeans.  I did it.  Lori, I totally did it.  I successfully threw them out.  I'm feeling so mixed about this enormous sudden decision to get rid of those jeans.  I'm so glad I told you I did this, as I originally wasn't going to tell anyone because to me it signifies weakness... I will never fit into those jeans again... I will never be as disciplined as I once was for so many years... I will FEEL now... there will be no more dismissing life... no living in a state of fog and numbing out... no more living passively...I must now be present in life. 

I didn't want to tell you (or anyone) about throwing away the jeans because I feel like I'm a failure and I'm giving up.  Logically I know this not to be true... but the emotional level is a whole other thing.

This feels a little overwhelming right now.  Never did I imagine it would stir this much emotion.  That pile of jeans symbolized so much - probably more than I can comprehend.  All these years (I guess of progress and agonizing work) it took me to build that pile.  The rejects.  What does it mean for me now? The only descriptive phrase I can come up with is sink or swim.  I made the decision to get rid of that pile of jeans that are unhealthy sizes for me.  This means I forfeited the chance to fit back into them, ever again, because they are no longer in my possession.”

“Right this minute I am in the midst of surrendering to better health at a bigger size.  I feel weak, but I also feel a pull to try.  The challenge is to learn how to accept this larger size as a new way of life...”

“I don't like the size I am, but then I was never happy with the size of those jeans I just threw to the garbage...”

“Just a lot of feelings around this.  You're right, maybe it is sort of like mourning…”

Wow. I am so impressed with her action, and her newfound ability to communicate her thoughts and feelings around this. In the past, these would have been masked with either binge eating or restriction. She couldn't have done it without the clarity that comes with nourishment, and, of course, with good counseling. 

 Clearly there’s much more to purging the jeans and buying a new pair. It’s about accepting change, and believing that it’s okay. It’s about trust, that you really have progressed, and you can continue to stay the course. And it’s about getting comfortable, physically—choosing sizes and styles that are appropriate, allowing your self to simply feel good. Maybe it's time to clear out your old jeans.

Your thoughts?

The Hyperbole of Weight Gain—The Problem With Relying On How You Feel.

Do you think she struggles with her size?

“We’ve got a big problem here”, she said, in a most unsettled way. “I’ve gained like 85 pounds”. I’m like a great heifer, no, a large female milking cow—whatever they are called”.  I am F-ing fat, and I can’t fit into my pants, and it’s not good. I’m eating, and now I’m hungry when I wasn’t before, and it feels like I just can’t stop.” Kara was able to sarcastically acknowledge that no, it wasn’t 85 pounds, but certainly 35 or so added pounds gained this one-week period between our sessions.  All while trying to increase her intake, to gain some weight gradually, following a period of weight loss from her already-too-low place.

Hyperbole, and then some, right?  Yet this true story from the past week speaks to a feeling, one that was anything but exaggerated. And I write this to point out how feelings could lead us astray in our attempt to get healthy. Kara’s session was not unlike others I’ve had in my career—in this past few weeks, even—counseling patients struggling with eating disorders and disordered eating.

Following the outburst, I acknowledged that her feeling like she had gained a million (or 35) pounds was real. Yes, it feels different, eating more than her abysmally inadequate diet of past weeks. Her food choices—lots of high fiber whole grains, fruits and vegetables—make it all the more challenging. Their large volume and relatively few calories don’t fit with a need to increase calories. Yet she feels as if she’s eating a lot, too much, in fact.  Oh, and the large coffees throughout the day didn’t help, either.

What’s worse is that once she started to eat more, she got hungrier. As is expected, metabolic rate, and along with it hunger, increases with an increase in food. So while metabolism slows with restriction, it picks back up with refueling. Research confirms it continues to increase (your metabolism, that is) until you hit a healthy weight range. (By the way, it’s also possible to be at a normal weight, eating pitifully little, resulting in a slowed metabolism. Increasing food, in this case, increases metabolic rate and weight may not increase, as calories increase along with metabolic rate.

But even if you know it, it feels scary having your hunger return. “What if it never stops increasing?” “Will I always be hungry, even though I’m trying to eat more?” “Will I ever be able to control my intake once I start eating more again?” The panic mounts.

Don't you just feel like staying this way sometimes?

If you respond to your hunger and honor it, it settles down—if you are eating enough. Sure, you’ll get hungry later—maybe 2 or 3 or 4 hours—and you’ll need to respond to that hunger as well. Otherwise, you may find yourself overeating, having restricted before. Until your signals start working for you, you may simply need to eat on a schedule—eating every few hours.

Back to Kara.

I weighed her. And she did gain weight. But it was only ¼ pound, to be exact. She assumed my scale was broken. I assumed she was serious, since that’s how she sounded. And what concerned me most, was my inability to reason with her in that moment; you can’t reason with someone who is irrational, who is simply responding to her feelings.

 It’s just like trying to reason with a young, underfed child; a malnourished individual is incapable of sensible decision-making and rational thought.

Somehow Kara came to her senses. Perhaps it helped being heard. Maybe the increased eating this week was a boost, allowing her to move from her stuck place, to hear the wisdom of my recommendations. And, finally trusting that rationally, she wasn’t having enough to eat, enough calories, to support her body’s needs.

Perhaps having me acknowledge how difficult, and scary, this whole process is, helped ground her in reality, helped. Rarely do providers describe the negatives of recovery, but I was honest with Kara and acknowledged that it sucks to have to feel.  Being numb—from restricting, binging, disconnecting, really works. It can be quite challenging to start to be present and to feel things you’d rather not be feeling.

Sometimes we really see ourselves
as distorted as this tape measure.

In past years, prior to more intensive treatment, there was no reasoning with her. It’s like a recent 24 year old male patient of mine who couldn’t get past his own food rules, and maintained his vigilance around raw foods, unprocessed foods low in fat, that never provided enough calories for his 6’2” frame. This bright young man was anything but reason-able, rational. That was all lost. It was all about how he felt. At that point, all I could do was recommend a higher level of care, to re-nourish him and restore his brain to allow him to think and act sensibly. Only then can we begin to successfully work together and move forward in recovery.

Last week a patient thanked me for letting her express her darkest, most disordered thoughts. After I listened, I rebutted. She had to hear my counter argument. She needed to see the pros and cons of her feelings—her feeling that she needed to drop some weight, in spite of being in the low end of a healthy weight range, in spite of the consequences on her body, her thinking, and her mood. She accepted my guidance, feeling liberated, and applied it in the days which followed. Because she was healthy enough, like Kara, she was able to come to her senses. Her thoughts helped change her feelings and subsequently her behaviors, and she is turning things around. Nice work!

If you are stuck on how bad your body feels, take a breath, and do a reality check. Is the change as major as it feels? And if so what are the benefits of eating more?  Being numb may feel safe, and change can be overwhelming, but what are the consequences of staying where you’re at, in your unhealthy place? With a supportive team and the right level of care, it’s not too late to move forward.

Change Your Body, Starting at the Top. Shifting Your Thoughts, Not Simply Your BMI.

Was the monkey off her back? I don't think so.

Anna felt desperate for help. This 35-year old had successfully lost weight on her own this past year, down to the average weight for her height, according to standard charts.  She had been overweight, approximately 80 pounds higher than she is now. Now she presents struggling to maintain her current weight for her 5 foot 8 inch frame on just 1200 calories per day. And it wasn't going well. 

She is pleased with her current weight, quite satisfied even, and doesn't want it to change, but feels she is fighting so hard to stay at this place. 

No doctor would look at her BMI and conclude that there was cause for concern. Most would likely praise her for the healthy changes she had made, and perhaps even draw attention to her healthy low “runner’s pulse”.

Do you appreciate what is in place
or see life as black and white?

But I had a very different perspective. Here’s what I saw beyond the scale: she has not gotten a period in over a year, but previously had normal, regular periods; she was feeling more depressed and had reported a significant increase in the percentage of her thoughts spent thinking about food, eating and weight; she tended to be cold all the time, even in the summer, when temperatures reached the triple digits. And did I mention her hair loss?  Her low heart rate, I might add, was not the consequence of a healthy runner's pulse but of a slowed metabolic rate.

As for her diet, I would describe it as rigid and restrictive. Hunger was often appeased with water, food choices were limited, and desirable foods were limited to once per week. Her total intake was way too low, in spite of her sedentary activity level.

What was my advice? Eat more, I told her. (Of course I provided more practical, concrete guidance than that.) And so she did.

At our first follow up Anna described a significant decrease in obtrusive thoughts. Eating more adequately made her feel less compulsive when she did eat. And she felt more satisfied. She had backed off of the water, which was drowning her hunger and is now starting to recognize her body’s signals. I nailed it, she told me. Everything I recommended made perfect sense, and fit with her experience.

Just what are you focusing on?

Of course it doesn’t end here, because these are real stories. At the next visit, just this week, I heard the panic—fears of significant, unnecessary weight gain and body dissatisfaction. Truth is, her weight was up. Yes, instead of being 80 pounds below her highest weight, she was now 78 ¼ pounds less. This minimal weight change which had, by the way, stabilize by our third visit, was the price her body needed to pay to achieve all the positives she was starting to appreciate with a more appropriate intake.

If you can’t recognize the positives you have, you’re simply gonna be stuck.

Yes, this is extreme, but how’s this for appreciating the positives? http://www.nytimes.com/2011/07/09/world/europe/09duley.html?pagewanted=all This recent NY Times article describes a former fashion photographer who decided to try his luck at photographing a war zone. In the process, he became a triple amputee. Horrific. Yet inspiring. He describes the experience post attack, when he realizes that he still has his right arm—and his eyes. Rather than dwell on his misfortune as a triple amputee, this remarkable survivor relishes his potential to continue the work he feels so passionately about, and focuses on what he does have going for him. Truly remarkable.

And what does all this have to do with your weight concerns? Lots. Get a perspective on what you truly value. Put the focus on what is in place and where you are making progress. Don’t beat yourself up about what’s gone wrong, but come up with a plan for change. Thoughts have everything to do with recovery—from anorexia, bulimia, weight struggles, compulsive overeating. Oh, and of course entitling yourself to the necessary nourishment is key, too. Your thoughts will not be clear to allow a healthier perspective unless you are eating well.

What’s the real negative consequence of gaining less than 2 pounds given the benefits Anna achieved? Perhaps it has less to do with the snugness of her jeans, and more to do with something else. But I’ll leave that for the therapist I hope she’ll be seeing.