Name-calling Has Its Place: BED is Now Named as a Distinct Eating Disorder. So what’s in it for you?

What’s in a name?

Perhaps it sounds like an existential question, but if it doesn’t have a name, does it even exist? Labeling Binge Eating Disorder (BED) what it is—a painful struggle living with frequent overeating large amounts of food—makes real the impact on mood, thoughts, energy level, physical wellbeing and hopelessness, to name a few. 
Living with Binge Eating Disorder when it was not yet recognized as a diagnosis, you might not have felt sick enough or eligible to be treated, because it just wasn’t taken seriously enough by those around you. 

Being added as a condition all its own validates this not-uncommon eating disorder whose sufferers live with their secret relationship with food, silently and ashamed.

Like adulterers you may sneak around family members and friends consuming large quantities of food—rarely lean protein or vegetables, I’ll add—but typically those foods and nutrients deemed forbidden. Yes, adulterers, as you carry on a relationship you may fail to acknowledge, cheating only yourself.

You eat quickly, masking the empty packages for fear of the response. “Who finished the cookies?” you dread hearing. You may eat salads or nothing at all in the workplace or with others, then stop at the convenience store or the fast food drive in and eat more than a day’s worth of calories, before even getting home. And then perhaps eat dinner as if nothing had ever happened. There may be a short-lived thrill preceding the binge, but a lingering guilt-filled regret to follow.

I should be mindfully eating? 

Binge eaters rarely taste their food, nor do they enjoy it mindfully—from the accounts of my patients over the past 26 years. They eat cakes and cookies and ice cream, but they don’t consume them with permission—their own permission, that is. They may be quite unaware of what and how much they have eaten. And although there are exceptions, they rarely truly enjoy what they are binging on—although the experience may be quite pleasurable—in the short-term. Friday’s new patient diagnosed with BED would never come in for a follow up—that much was certain—if I dared to suggest he’d have to give up his nightly, longed for ritual of binge eating. Yes, making change takes time—and hard work.

Why oh why do I do this?

You may find yourself eating impulsively, wondering why, even though you know better, you can’t follow through with your intended control over food. 

Let’s start with one basic fact. You are not stupid. It is not for lack of knowledge that you maintain your binge eating pattern, but likely because it meets some needs.  It may temporarily numb you, a drug of choice for some, or may help manage your anxiety. Or it may be triggered by impulsivity, even greater in those who get too hungry and those who struggle with impulse control—like those with ADHD. Now don’t get me wrong. I’m not endorsing binge eating to meet your needs. Rather, hopefully providing some insight so you can begin to move from the place you are stuck.

Binge eating typically, although not always, follows deprivation and food restriction. Ever notice that your binging is worse after dieting or fearing you will be without food? 

Thoughts like “I’ve already blown it so I may as well keep going”, what I call the what the heck effect, adds flames to the fire, contributing to continued overeating. Or you may preplan a binge—a very much-controlled binge, counter to the uncontrolled binges often described.

“What’s your point?”

I just sent a family member a link to a popular press article about a parallel situation- trichotillomania (compulsive hair pulling) is also now added to the new DSM-5, the mental health manual of diagnoses. In response to the link, the trich sufferer responded, “So what’s your point?” So let me clarify for all. The point is, if you are described in these posts, then you deserve to have your condition acknowledged and treated. And that includes getting support from a mental health professional (one who’s trained in CBT, Cognitive Behavioral Therapy). And for BED sufferers, adding a Registered Dietitian who specializes in eating disorders is essential as well.
It takes time to shift your eating pattern and your thoughts, and to find alternative ways to manage things that cause distress, but recovery is possible. 

How do you change and move from being a binge eater? Five areas tend to need to be addressed. You’ll need to:

1. Eat enough calories throughout the day. Guidance from an RD can be quite helpful here.
2. Watch your eating pattern to avoid long periods without eating. Excessive hunger leads to excessive intake. Think about a pendulum; swinging to one extreme results in an equal swing in the opposite direction. We are looking to be swinging in a much more narrow range!
3. Move toward mindful eating. Start by separating eating from distractions, such as TV, reading, computer, driving, phone use. Keep food in the kitchen or dining room only. And try to use your senses when eating. Yes, you deserve to experience and taste what you eat.
4. Once you are preventing excessive hunger and mindfully eating, it’s time to reintroduce foods you view as ‘forbidden’. Remember that if you are listening to your hunger and eating when you need the fuel, you are no worse off for choosing something you really enjoy eating—be it ice cream or chocolate chip cookies. But keep in mind that while you’re working on liberalizing your ‘forbidden’ foods, work on…
5. Distinguishing physical hunger from emotional eating triggers, such as stress, reward, depression, anxiety, the need for self-punishment.

Now that it is a recognized condition, it’s my hope that MDs will no longer direct their overweight patients for lap band or gastric bypass surgery, never inquiring about or addressing the underlying problem behaviors. Perhaps the medical community will also begin to distinguish those who are overweight yet healthy—yes, they do co-exist—from those that are struggling with their thoughts and behaviors.

What I like most about this new diagnosis it that it puts the focus on your behavior, not your body weight. Now let’s hope that the medical community begins to ask the questions to open discussion about eating behaviors so that you and others can get the support and direction you need to recover.

Check out these older posts on binge eating and related themes:

• http://www.dropitandeat.blogspot.com/2013/04/intuitive-eating-is-not-for-youmaybe.html
• http://www.dropitandeat.blogspot.com/2012/11/you-can-pull-it-off-but-it-wont-be-pain.html
• http://www.dropitandeat.blogspot.com/2012/10/whats-point-ive-already-blown-it.html
• http://www.dropitandeat.blogspot.com/2012/09/what-ive-learned-about-food-addiction.html
• http://www.dropitandeat.blogspot.com/2012/10/trying-to-change-your-relationship-with.html
• http://dropitandeat.blogspot.com/2010/11/honor-thy-hunger-and-thy-fullness.html
• http://dropitandeat.blogspot.com/2010/11/morning-after.html
• http://www.dropitandeat.blogspot.com/2012/04/0-false-18-pt-18-pt-0-0-false-false.html
• http://dropitandeat.blogspot.com/2010/12/minding-your-eating-managing-your.html

Many more posts on the subject can be found by clicking on the relevant labels on the right of the blog.

I'd love to hear from you! Thanks for reading.

Dessert Happens

Saturday night. New York City. True story.

I’m out to dinner with my husband while visiting New York City, at a restaurant highly praised by a foodie—friend I’ll call Lloyd. And Lloyd says “you must try the desserts—they’re amazing”, or something to that effect. It’s a 45-minute wait for a seat at the bar (a beautiful, relaxed setting, I’ll add). We share a couple of wine flights—those 3 oz samples, and order our meal.

That part was easy. The arctic char appetizer was divine, surpassed by the two entrees we decided in advance to share. (Basically, I have a hard time deciding and don’t want to limit my options, so I petition my husband that we should share and he generally obliges as he did Saturday. Yes, marrying him was a good decision.) 

Skillfully prepared fish and a butternut squash lasagna—the labels do no justice to their taste. Totally wow, and I don’t use superlatives for food too readily. The bread was similarly fabulous—a whole-wheat sourdough seemingly right from the oven served with sweet butter. Of course I enjoyed a couple of slices as they  were put before me.

I was quite satisfied from this leisurely paced meal. A warm beverage would’ve capped it just fine. But Lloyd’s words hovered. I knew I needed to try dessert. What to do? We started with coffee, a spiced French Press, while the menus sat before us. Okay. Let me just inquire, I thought. So I engaged the bartender/waitperson. “Can you tell me about the lemon curd dessert with chocolate and hazelnut crumble (which sounds so weird I can’t even image getting it but I just need to know!)? And she did. “What would yousuggest?” I prodded further. “This or the apple pie with ice cream?” (which sounded so conventional, I thought). She described them both in glowing terms, then added that the apple pie is the restaurant’s most popular. “Fine, then. We’ll take it. It’s decided.” (My husband, by the way, was somewhat indifferent to having dessert that night.)

Surely I could’ve passed on dessert. But guess what followed? Fresh baked, flaky apple pie with homemade vanilla bean ice cream, of course.

 AND the lemon curd dessert—gratis, I’ll add! This lovely waitperson felt we really needed to try both—perhaps she felt my decision-making pain when I announced my dessert selection.

Now what would you do?

1.    Thank her profusely, then return the second dessert?
2.    Take a couple of bites, then leave the rest because you had enough?
3.    Eat both desserts—sharing them of course—even though it is completely unnecessary?

So after we completed devoured the two desserts, which were as delectable as our foodie-friend promised, what to do? We didn’t need the extra calories (and thankfully calorie counts have no place on these non-chain restaurant menus!)

Breathe. The meal was over and we thoroughly enjoyed it. This was hardly the best match of intake and need. Rather, fullness had been overridden by desire, by opportunistic eating (when would I get to try their desserts again?), and the like.

What’s the worst-case scenario? Okay, we took in more than we needed that meal. So what? This is more the exception than the rule—our eating is generally quite fitting for our need. Compensation would lead to consequences—restriction results in excess hunger and deprivation and potentially rebound overeating, or at a minimum, preoccupation with eating.

Besides, we thoroughly enjoyed the two desserts, and the whole dining experience. No regrets.

Would I do anything differently in the future? Perhaps. I just might make a point of going there more often, so it doesn’t feel like a now-or never experience. Gramercy Tavernis not going away anytime soon. I just need to remember that.

Cupcakes for control—A healthy strategy for weight management

No need to wait until the holidays for a slice of pie.

What if you ate what you liked? No, not just ate what you liked but accepted it as ok, too? And what if you allowed yourself to eat enough of it? What if you ate as much as you needed to satisfy your hunger?

Imagine you actually notice your hunger. The signal becomes clear to you as your stomach begins to growl. Then you get annoyed, angry with yourself for feeling. You want to deny the hunger.  You start counting down until the right hour has arrived to eat, to justify the fuel your body begs for. You're angry that your body is fighting with you, telling you that you should eat, that you need to eat, while your thoughts fight back. I shouldn't need to eat—I ate yesterday! I ate too much earlier today! I didn't exercise! I don’t want to gain more weight. I don't deserve to eat.

Well I'll tell you what I argued back, in a session earlier this week: "Don’t expect that you can have it both ways; that you can easily stop eating when you've had enough, while not eating when you haven't had enough! Don't expect that you can deny yourself food and still feel well fueled over time. No, that's just not going to work for you." Ultimately, we need to respect our hunger and to get enough.

"But I should choose healthy foods, right?"

If you only eat what you think you should eat, omitting what you'd truly love to eat, you will keep yearning. You'll have the popcorn, then the fruit, then a yogurt and ultimately the cookies. And not just one cookie. And not just a comfortable amount of cookies. Because even though you're eating them, you're thinking and believing you're not supposed to be. So you shovel them down. You neither taste them nor enjoy them. You'd rather not even feel them. Then you set the unrealistic goal that tomorrow (and the day after, and the day after that) you will not eat sweets, or carbs, or white flour, or fill-in-the blank.

It looked beautiful—the low-fat chocolate soufflé that my husband decided to make, prompted by the professionally photographed image on the cover of my nutrition magazine on our kitchen table. But the taste? Yuck. So after one or two bites, I left it. It made me yearn for the rich, satisfying, molten chocolate desserts my friend Amy makes. What a disappointment. (Now that's not to say there aren't great, satisfying yet reduced calorie desserts, mind you. I've got some really good ones in a soon-to-be-released recovery cook book, in fact).

A patient of mine recently said, "No spray paint supermarket cupcakes for me—if I'm gonna have them, they're going to be good ones from a great bakery." Yes, even full fat desserts can be a let down at times. Last Thursday I was served some of those tasteless, mass-produced brownies at a function, and I couldn't get past a single bite. I came home, still hungry after the yummy vegetarian entrée I had there, and ate a small bowl of dark chocolate chips, peanuts, and raisins—my go-to when there's no fabulous baked items available. And that hit the spot. I sat at the table, and I enjoyed them.

I'm bragging a bit; I want you to know that it's ok to eat what you like, and to taste it, and truly enjoy it. And that you can leave what you don't like—as long as you're still meeting your needs. (And that doesn't mean leaving what's not 'safe'—that's a very different story. You know who you are.) When I hear patients describing how fabulous something tasted—how much they enjoyed a particular dish or meal—I know they've made progress. That is, if they allowed themselves more that just a bite in a pathological restrictive way that's far from healthy.

Waiting patiently for a satisfying dinner.

When I came home from that 'brownie-evening' out, I noticed that Mica, my dog, had not touched his food. And then I realized. I had placed dry chow in his bowl earlier that afternoon, but had not mixed in his usual and preferred wet food. He was hungry for sure—but you know, dry food alone just doesn't cut it. So he waited patiently for me to return and feed him what he really wanted. And you know what? He even left some food over when he had had enough!

Sometimes when we're hungry we eat for the pleasure, while sometimes it's just for the fuel. When my son was a nursing infant I experienced for the first time eating to live. I often ate simply for the fuel. I got hungry frequently as a new mom juggling my infant's needs and my own and I needed to eat whatever was convenient. I got hungry and I ate anything. Similarly, when I'm hiking or biking I eat to fuel. I'm just looking to get enough, and it's not for the pleasure of eating, but strictly for function. While most other times I eat, in part, for the experience.

Moving forward.

Visions of cupcake vans? Time to allow yourself to eat some!

Does this post resonate? Start noting when you get hungry, and how you respond. Do you honor your hunger and eat? Do you count up your calories to see if you're allowed to eat? Do you check the clock to see if it's acceptable? Put aside those rules and work on responding to your hunger before it gets extreme or you miss your 'window of opportunity'.

Make a list of what you like to eat. And make a list of what you allow yourself to eat. Then start moving things over from one list to the other.

But don't just eat it. Eat it mindfully. Eat it peacefully. Eat it with all your senses. See it. Feel it—the creaminess in your mouth, the granular sugar on the surface. Smell it and hear it. Yes, note the crunch of the chips, the chewy sound of the chocolate caramels. 

And of course taste it. Reallytaste it and enjoy it. Because honestly? It's going to be fine.

Trying to Change your Relationship with Food? A Letter to your Loved Ones May Help

I frequently describe the chat that needs to happen—between those of you struggling to normalize your eating and move away from compulsive overeating or binge eating, and your loved ones. I spend so much time talking about this in patient sessions that I decided to write it down in a letter form, so all of you in this position can use it.

Why such a conversation, you ask? Because in order to start to change your relationship with food, you need to let go of the fear and the shame you’re all-too-familiar with. To do so, it helps to put it right out there to those who will be seeing you eat and may be surprised by what they see. The last thing you need is more judgment—you’re critical enough of your own eating, you don’t need anyone else’s judgment! So read on and test it out at home!

Dear All-who-really-care about me,

While I know you are worried about my health and my eating please realize that you are not alone. Just because I don’t talk about it with you doesn’t mean I am not concerned. In fact, I am actively working to try a different approach to change my relationship with food, so I thought I’d let you in on it.

Remember all those diets you’ve watched me start and stop, those failed attempts to take control with rigid, senseless rules? Those days are over. “What now?” you’re wondering? “You’re giving up again?” you’re thinking? Think again! Here’s what you can expect to see, so brace yourself.

You know those foods you think I shouldn’t be eating? The foods you and I really like to eat? It’s time to make peace with them, to legalize them. Because now they feel forbidden, and when something feels prohibited I want to eat more of it—just like anyone would. Yes, that’s normal. What isn’t normal is thinking I will never eat cupcakes again—or ice cream, or chocolate, or bread or ‘white carbs’. No, that’s absurd, unrealistic and quite frankly, unnecessary. 

What I’ve been learning from an experienced Registered Dietitian who deals with helping people like me is that it’s not the food that causes the weight gain. No, not the carbs themselves, nor the sugar, nor the fats, but rather how much we eat of them. And I’m learning how to start to take control of my portions of such foods.

First, I’ve got to welcome them back into my diet. You see, when I feel I’m not allowed to eat them, it sets me up for trouble. I feel ashamed if you and others see me eat things, so I’m more inclined to eat them quickly, mindlessly, just because there’s no one around. And trust me, I do. And this goes against what I need to do—to eat them mindfully whenever I’m hungry and choose to eat them.

But I fear the reaction from everyone. So I’m giving you this letter so you won’t be surprised when I sit down at the table and have a couple of cookies. I’ll eat them without distraction and I’ll really enjoy them this way—as opposed to just shoveling them in. Please recognize that I am doing this because I care to feel better and be healthy, so be open-minded. Realize that the diets and restriction have only set me up for problems.

So when you see me at the table eating something you think is ‘bad’, think again. Perhaps you’ll join me and we can normalize our eating together.

Be patient with me--this is a process.  It's not going to get better over night.

Thanks for supporting me and for understanding.

PS: Learn more about my struggle from http://www.dropitandeat.blogspot.com/2012/09/what-ive-learned-about-food-addiction.html

Let me know how it goes!

Putting a Squeeze on a Family Ritual: Starting Bad Habits Early

Sure, it was messy but it was so good!

How sweet! Cute little pouches of pureed food—not for infants but for toddlers to slurp up. Designed for eating on the run, they also help to appease the difficult feeder. You know, when you fear your picky eater might starve by not eating her peas. 

And, they’re convenient for the challenged parent, juggling work and the demands of raising kids. Perfect for soothing the fussy little one while watching TV or simply while riding in the car. Allows for hands-free feeding so you can easily be typing on your ipad or dealing with work issues by phone while productively feeding your little one, too!

Professor Brian Wansink, the fabulous researcher known for his work on environment and eating behaviors may be ambivalent about these, but my opinions are solid. I would never feed these newly popular foods in a pouch (described in the NY Times article Putting a Squeeze on a Family Ritual) to my kids. Never mind that my sons are in their twenties (years, not months, that is). Still, if I did have toddlers, these would be the last things I'd purchase to feed my children.

Now before you leave this page thinking this is irrelevant to you—that you, too, have no young kids to feed, nor care to learn about approaches to feeding toddlers—let me make a point: this has everything to do with you and with managing your weight. You’ll likely learn as much about feeding yourself and self-regulating your own intake as you might your kids.

So what’s my problem, you’re thinking? Let me highlight a few of my concerns.

Distracted eating

Yes, that's a grapefruit he's eating. With a spoon. Not pureed.

Mindful eating enables us to fully appreciate our food with all our senses. And it slows us down. In doing so, we can better appreciate when we’ve had enough, helping to prevent overeating. Distracted eating—eating while on the phone, while watching TV, or even while jumping on the trampoline (an example pulled from this NY Times article) is anything but mindful.  Eating while distracted may lead to overeating. (Although, for those anorexic patients I see, it may enable eating food that wasn’t intended—and that could be a good thing). It is challenging enough to change behaviors in adulthood that perhaps only started recently. I could only imagine what it would be like to shift these behaviors in adults raised mindlessly sucking down pureed food goo.

Regulation of juices, sodas and mush? Not so easy.

It’s well established that we don’t do a very good job regulating our intake of caloric beverages such as juices and sodas. It’s challenging for our body to recognize when it has had enough calories from such beverages, so we certainly need to be aware of our portions. Again, for some needingto increase their intake, this form of nourishment is quite helpful. Less has been explored about the impact on feeding a less-than-solid but greater than liquid calorie diet, such as the slush-from-a-pouch.

Mealtime a thing of the past? Are we really too busy to parent? To nourish our kids with attention, with positive interaction, and with calories and other nutrients?

Even when camping, there's time for meals.

Maybe I’m an idealist, but I cherished the family dinner with my young family. It was a time to connect, to hear about their day, to be present. Sure, when the little ones would toss their food off their tray it would come to an abrupt end. But it was good while it lasted. And it established a tradition that lasted throughout the years (the family eating, not the throwing of food!) It was a time we were all theirs—we were not blogging, texting or talking on the phone. We were simply present—if only just for the mealtime.

If we don’t have time for what may be our most important job—parenting—it’s really a sad state we’re in. An acquaintance recently stated that he had no time to deal with exploring college options for his daughter with special needs—he had some very important business deals that needed his full-time attention! Seems like parents choosing feeding pouches may feel similarly.

Gone is the motivation for change.

Feeding our kids is often what motivates parents to shape up their own diet and eating behaviors. They want their children’s experiences to be positive—to feel good about their body, to be healthy and fit. They care about their little ones’ intake, but had previously not given much thought to their own eating. Having kids can change that, unless of course, family meals are eliminated. Gone is the need for role modeling and healthier eating for parents.

What’s normal and appropriate anyway?

Perhaps because we view smoothies and meal replacement shakes as eating, pouches fit the bill for our little ones. But what about the experience of eating? It’s enough that movies go with popcorn, and we need hot dogs at baseball games. Must we solidify the link from the youngest age, between eating and other activities? Must riding in a car be accompanied by fueling your body? Will they not expect to be eating, mindlessly, once they start to drive? I mean, isn’t that what they’ll have learned to associate with doing whenever they’re in the car?

Neil Grimmer, chief executive of Plum Organics, sees it as empowering children. “It’s on-the-go snacking, on-the-go nourishment,” he said. “It moves with kids and puts the control in their hands.” Seems to me that these days kids have more control in their hands than they need or want—perhaps limit setting would be a more appropriate parenting approach.

He further endorses feeding in response to hunger, and I’m all for that! In my mind, that necessitates parents connecting with their children and being aware of their cues. You know, taking note of when they start pushing their food away, when they have had enough. Or providing them with an additional few bites of cheese when they have finished what you served—just to see how much they truly need.  When they’re done, they will make it clear! This is quite different than serving a predetermined 100-calorie portioned food pouch. But the convenience of these foods and their inappropriate use in so many situations far from tunes in to a child’s hunger. See how this might be relevant for you, too?

Grimmer also states “Regular mealtimes just add one more item to the schedule”. Bummer. Now you have to deal with those kids you decided to have! Hain Celestial Group, the company that makes Earth’s Best baby food, sees it as the solution for the child who wants to be independent and self-feed. How about teaching them to use a fork or starting them on finger foods? Toddlers are developmentally ready for more than slush from a pouch!

This old momma thinks it’s time to shift our thoughts about feeding—our kids, and ourselves.

Supersized Disaster

Yes, that's a 44 oz individual serving of soda!

I never recommend soda to my patients or my family members. And I cringe when I walk into fast food restaurants (only to use the bathroom, of course) or a movie theater and see single serving cups in the range of 32-44 ounces. It’s obscene. That volume of sugar devoid of other nutrients, consumed at a single sitting is crazy. Our society has a distorted sense of what normal portions are—not just for beverages, but for food as well. The only place I’ve been able to find a true juice glass, a 4 or 6-ounce size, has been at antique stores. Really. So I support NYC’s Mayor Bloomberg’s recent ban on the sale of supersized sodas, right?

Not at all. While the mayor is desperately trying to change a growing trend of overconsumption and obesity, his new policy restricting the sale of sodas larger than 16 oz is absurd on so many levels.

While I take my freedom for granted, having never lived anywhere that restricted my personal choices, including what I eat, the thought of a law limiting the size of my portions feels, well, un-American. Mark my word; if they try to restrict my purchase of cupcakes after 8 PM, for instance, I’ll start hoarding them at 7. I mean it.

Who decides what you're allowed to eat and how much?

It’s quite a slippery slope. Who decides that Sprite is out, but grape juice is fine? Or that 24 oz smoothies are ok, but soda is not?  Maybe they should halt the sale of those cardiac-inducing hot dogs sold on food carts throughout NY, instead? Sure, there’s nutritional value in the smoothy, but if the driving force behind this policy is obesity and health—why would 24 or more caloric ounces of anything accompanying a meal be appropriate?

Next, will NYC next set limits on who can buy these large caloric beverages? Will we need to weigh-in at the food carts on 5^thAvenue—high BMI? You get the under 16 oz regular soda or the diet one; low BMI? Youmay choose the supersized drinks—but ONLY those drinks with calories—no diet beverages for you. 

Should we perhaps ban the sale of large portions of diet beverages, given that they displace the calories and nutrients desperately needed by those with eating disorders and those simply underweight?

And what about cost? Can we not buy a bottle of soda at the deli to share with others, resulting in a smaller portion and less cost per person? Bloomberg’s ruling prohibits this.

The unforseen consequences

What message does it send if 16-ounce beverage portions—regular or diet—are considered the norm? Our caloric needs vary; for some, 16 oz of juice is absolutely appropriate. For others, it’s excessive for their need. But a law stating that 16 ounces is fine or distinguishing between soda and juice as healthy versus unhealthy creates a hierarchy people will believe is valid—when it’s not. If we are talking about weight management it's about calories, and a Coke is no different than a bottle of 100% juice. 

Should those with high blood pressure be forbidden
 this heavily salted popcorn?

I understand that simply educating the public to improve health is at best challenging. We are impacted by visual stimuli and sensory prompts to eat, as well as our perception--not just information about what and how much is healthy to consume. Prompted by the suggestion that you can size up for only 75 cents more (which I overheard at the movies yesterday), most of us will go for it. If you perceive that you haven’t eaten much you will continue eating, regardless of your fullness. And if you believe that 16 ounces is appropriate--because the Mayor believes it's fine for your health-- you may be more inclined to select the 16 oz size than something smaller.

If they’re going to set rules…

Perhaps there are better alternatives than Bloomberg’s to reduce our excessive intake—if or when it is unhealthy for the individual. How about a pricing policy removing the financial incentive to size up? If ordering the 32 oz soda vs the 16 oz adds $1.20 vs 20 cents, I suspect there’d be more thought before supersizing.

Yes, this is for real. And financially more sensible that the 32 oz
 which was more expensive per ounce!

Or what about a rule allowing individuals to bring their own snacks into a movie—maybe healthier popcorn from home? Or limiting movie-theater food to a specific eating area as opposed to in front of the screen? Can we not go 90 minutes without a feeding? Why are we encouraging distracted eating, when all evidence supports mindful eating helps us better regulate our intake and our weight?

Yes, something needs to be done to improve the health of our nation. But setting arbitrary boundaries on portions, about good beverages and bad, is hardly the answer. And the fallout from this perhaps well-intended policy may only result in more problems.


And I thought I lived in the liberal Northeast...

Tackling Pizza/ Junk Food/ Disordered Thinking

Pizza was the focus of several conversations this morning. And we weren’t discussing ordering lunch. The subject was challenging foods, and pizza was mentioned during more than one patient session. And I didn’t bring up this potentially triggering topic.

One of my favorite pizza places in Bar Harbor, ME

“It’s junk food”, one young woman stated firmly.  “Why’s that?” I probed. Silence, she responded, uncertain. “The grease”, was another’s response, in a different session. Seeing all that grease was problematic. For others, pizza equals fast food, convenient take-out—all of which has to be “bad”. For others, it’s about portioning. I mean, how much is okay to eat for lunch? Or, for dinner? “And how do you stop”, others have asked.

For some, pizza is fine if you’ve made it yourself—at least you know just what went into it. For others, it’s okay if it’s organic or whole wheat. For most everyone it’s fine if it can be eaten in control.

So what is it about pizza?

As I sit down to write this piece I recall how shocked I was at age 9, when I overheard the conversation. The birthday-party hostess, my friend’s mother, related to my mother with shock and horror that I downed 4 slices of pizza! Besides feeling full, I can’t say I thought anything of it at the time—that is until I heard her comment. And I can remember many a comment my mother had made about my appetite—that I eat as much as my 6’1” father, for instance—not exactly stated with pride, I’ll add. Yet she failed to recognize that her baseline for comparison was her chronic dieting and self-denial, and that my father could easily have been described as low body weight. And, I was a preteen, growing to a height at the 95^th%ile. Why should it come as any surprise I had a hefty appetite? I was perhaps expending more calories than my non-growing father! Four slices for me was slightly more than appropriate, I recall.

Okay, okay, now that I processed some of that therapeutic history, let’s talk more about pizza and you.

Lessons about eating pizza

It helps to break it down into smaller pieces. Well, I don’t mean that literally. Rather, that it helps to think about what pizza really is to make it easier to digest. The base has three ingredients: flour, yeast and salt. Period. How bad is that?  Not very at all!

Homemade, grilled pizza. Delicious!

And the way most American large size pizza pies (made from a pound of dough) are cut into eighths, a slice is like two slices of bread. And then there’s the cheese. Less than an ounce per slice, at most places (although there certainly are exceptions). 


And the grease? It's simply what you see when you heat up cheese. If you must, blot it. Otherwise, just recognize it as separated cheese. And then there’s an insignificant amount of sauce (which the US school lunch program would like to count as a vegetable serving but is hardly enough to count!)

How does it fit or compare to other meals you might be having? Well, the protein- rich element is much lower—again, for 2 slices, that’s less than 2 ounces—much less than anyone would need for a dinner meal—that’s for certain. So if the grain or starch component is larger than you’d usually eat, just remember that the protein is way less than you need.

How do I eat it in control?

• Don’t serve it from the table! Pizza, in my opinion, smells yummy, and it’s easy when foods smell good and taste good, to eat them beyond a comfortable level of fullness. Keep it warming in the oven. Or simply get a couple slices to go, when you are first starting out. But really you might need more than just 2 to meet your needs. Maybe even 2 ½ slices. Yes, you can cut slices in half! Ask them to do it at the pizza place. Tell them it’s for your baby sister.

• Serve it with other items—a salad, cooked veggies, a glass of milk, a cut up fruit—to help you add some balance and some modest volume to know when you are full.

• Stop calling it junk food! If you label it junk, you think you have done something wrong. And if you think you’ve done wrong, you’re likely to feel ashamed. You may view it in black and white terms, thinking you must compensate for having eaten it. And that will get you into some real trouble!

And what about things that really are junk? You know, they have no redeeming value from a nutrient stand point? About those foods, I say enjoy them. Not 5 times a day. Not with rigid rules like “only on the 3^rd Friday of the month”! No, make them a part of your regular routine, but include them instead of something you typically eat (but that you don’t necessarily enjoy), when you need the fuel, when you are hungry or need to have a snack on your plan.

Don’t approach pizza or any meals feeling ravenous! It is a recipe for disaster. You’ll eat too fast, and will likely eat beyond a comfortable level of fullness.

Allow yourself to have pizza regularly. You need the practice!

So go ahead and enjoy some pizza. Try it topped with fresh fig, sliced pear or pineapple, or maybe artichoke or roasted peppers. And don’t listen to anyone else’s comments about pizza or about how much you’re allowed to be eating!

Let me know how it goes!