When fat things happen to good people. On being thin, fat, and your false assumptions.

"Such crazy thoughts in that Aussie article!"

Do you think that if only you do the right thing—eat a healthy diet, exercise, get enough sleep—then you will achieve your dreamed of weight, live free of disease and live happily ever after? This, dear readers, is a fairy tale. 

If you believe that eating nutrient packed, low calorie foods is solely responsible for whether or not you get cancer, or arthritis or MS, think again. And don’t be fooled by the preaching of Dr. Fuhrman in his book, Eat for Health, that health equals nutrition divided by calories, period. Health is not such a simple equation. And no, eating whole grain, veggie packed meals won’t protect you from an eating disorder either. 

If you think that eating 'right' ensures thinness, as was recently emphatically suggested in a popular newspaper article in Australia, it is yet another fantasy.

And if you torture your overweight self with the belief that you must lose weight--at all costs, and that your inability to reach target goals based on BMI charts is your personal failure, you’re wrong again.

“What is she thinking?” you’re thinking? Let’s start from the top. 

Eating healthy equals health

Yes, diet can impact many, many health measures. And I certainly encourage a balanced, varied diet filled with a complement of vitamins, minerals, antioxidants, and an appropriate level of fiber, to name a few. Yes, there are correlations in populations that have higher intakes of alcohol and saturated fat, for instance, with increased rates of cancer and high cholesterol, respectively. And a nutrient-rich diet chock full of antioxidants and lycopenes, like those found in tomato-based products, may help stave off such conditions as Alzheimer’s, cancer, and other diseases. But eating a proscribed diet will not guarantee your health. Nor will it ensure happiness, which is not to say I don’t encourage making healthy choices—I surely do. But do not, for a moment, think that if you are fortunate enough to stay healthy (or unfortunate enough to become ill) that it is solely by your hand. Credit your parents for their genes, to start.

Fallacies about thin

And do you know what? Eating well does not ensure thinness either. I see my share of patients who choose the most wholesome foods, but eat in excess—even those nutrient rich, heart healthy foods, like avocado and almonds, lean protein and kale. By excess I mean frequently eating without regard for hunger, and eating past a point of comfortable fullness. And eating well—high quality, nutrient-rich foods—even eaten mindfully and intuitively—may not keep you slim. Yup, it’s a sad truth that many of you don’t want to hear. And in fact, the very act of pushing your body to be a weight it is not meant to be, may put you in worse shape—both physically and psychologically. Just wait until you hear about these studies!

Stay tuned. That’s my next post, based on fascinating research presented at the Renfrew Conference I attended last weekend.

And those who are thin do not necessarily eat well and are often hardly fit by any standard. Do be careful about equating weight with health because they do not always pair up as you’d expect. Individuals may be thin because they are genetically predisposed to be, or they may be thin because, in contrast to what journalist and dietitian Susie Burrell believes—that they “know what to do to control their weight”—they may fall quite short in controlling it appropriately. They may be no better than someone who binge eats for emotional reasons at knowing “how to cope when things are tough”. Don’t be fooled into assuming that thinness is simply a lifestyle choice, a moral higher ground.

And I’d caution her, and you, not to overgeneralize about thin people’s skill at “assuming responsibility for self”. Just spend a few hours in my office; even those without eating disorders may allow anxiety or depression to stand in their way of eating enough. How responsible for self is the person who denies herself nourishment when low energy or headachy—hunger gone too far—or pushes herself to exercise even when she reports constant fatigue, or pain? 

Eat when they are hungry, stop when they are full? Some thin people may. But overgeneralizing about a segment of the population isn’t too intelligent. 

No, I didn't leave the rest over, for the record.

Thin people may self-regulate just fine. Or they may deny their hunger and fluid load or rely on high volume low calorie foods. They may eat nourishing foods, or a diet of junk—just not excessive in calories. Or they may compulsively exercise, hardly resulting in mental health, potentially leading to loss in muscle mass, heart problems and a range of symptoms if accompanied by undernourishment. Really, the only thing you can generalize about thin people is… that they are THIN. You can’t assume they are healthy, or happy, or good at self-care or self-regulation.

And of course the reverse is also true. The only thing you can tell by looking at a fat person is….? Yup. It’s that they are fat. You cannot predict their lipid levels or their blood pressure. You can’t tell whether they’ve never exercised or they exercise too much. And you can’t determine the quality of their diet.

My own parents are perfect examples of this, as I’ve written about previously. 

The mere suggestion that health is 100% in our hands I take offense to, as would the rest of the population which struggles with MS, and cancer, and ALS, and type 1 diabetes and arthritis and, and and… And I can say the same thing about a target weight or size. I hate to break it to you, but even if you do all the ‘right things’, you may not achieve your desirable, fantasized-about weight. And you know what? It’s not your fault.

Stay tuned for part two, (which I hope to get out within the week), which will address obesity, weight loss, and the risks and benefits of change.

Did this post push your buttons? Did it challenge your thinking? Did it offer some relief? Do let me know what you’re thinking! 

Thanks for reading, and if you liked this post, please share!

Fat enough. Coming to terms with weight when it’s less than ideal.

I don’t know which made me saddest—her sense of vindication when reporting the oncologist’s orders: “I don’t want to see any more weight loss”, or her distress that her weight was up 5 pounds. Or perhaps it was her pride in getting down to the lowest adult weight she has seen in many decades. Ahh, the perks of esophageal cancer!

She’s lived so tormented by her weight, berated by doctors and non-supportive family members to reach for something unattainable, to get thin, from the time she was a pretty, young, school-age girl. “You’re beautiful”, they’d say, “if only you could lose some weight.” Perfect labs and low normal blood pressure were not good enough. No, she didn’t look fat on paper.

And yet her obesity just might have been the source of her potentially fatal illness. There. I’ve said it. Admittedly, GERD, gastroesophageal reflux, is linked with manyfactors, and obesity is just one of them.  But after a decade living on antacids, popping Rolaids like LifeSavers—no pun intended—with a blood sugar approaching diabetic levels, she had gastric bypass. The GERD? Finished! Antacids were no longer a fixture like Kleenex and lipstick in her purse. Yes, she was free of heartburn and indigestion—and her blood sugars dropped to normal. With her 90 pound weight loss came a reversal in symptoms and the promise of a better life.

So it came as a quite a shock last year to learn that she had esophageal cancer. And hers, located at the very bottom of the esophagus near the stomach, was not a result of alcohol or smoking but from many years of damage from acid reflux.

GERD can lead to changes in the cells of the esophagus—between 5 and 10 % with GERD get Barrett’s.  And Barrett’s Esophagus can develop into cancer, with an overall lifetime risk of 5%. 

Could it have been prevented in her case?

Sure, earlier screening by endoscopy to evaluate progression to Barrett’s sooner could’ve helped. And being more proactive with a procedure called ablation to wipe out the changed “Barrett’s” cells would have helped too. 

As for weight loss?

It’s not that she didn’t try. Perhaps she was genetically meant to be a large woman with a high BMI. Still, she could have worked in more activity, walks at least, something, setting realistic, achievable goals. And stress reduction to prevent emotional overeating and anxiety-driven overeating.

Yes, those might have helped her weight and subsequent chronic reflux and possibly prevented her cancer. But in our society it would never have been enough. She would still be viewed as obese, with the stigma we project on that label. Doctors would still say her weight was too high, falsely envisioning the fast food drive-ins she never frequents. (Actually, her meals have been quite healthy and balanced for as long as I could remember.)

In spite of her post cancer, post surgical weight loss of more than 40 or 50 pounds—honestly I don’t know how much exactly—following the doctor’s orders and not striving to lose more weight is quite a challenge. Self-acceptance doesn’t suddenly appear at age 75 when it has been long absent.

So please don’t wait until changing is a matter of life and death. Seek support for working on self-acceptance. And try to see your weight as just a number—not a reflection on your character, nor your motivation, nor your fitness level or your health.

Thanks for reading.

And yes, I've written about this before with a bit of a different focus.

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!

I’ve Gained Weight. Now What Am I Gonna Do?

Perspectives for those with bulimia, anorexia and those with no eating disorders at all.

"How much weight have I gained since we started working together?", “I want to know." That was the pressing question.

Ellie has been seeing me for several years, for periods at a time. She presented with severe bulimia, purging 3 times per day, every day, after each of the three times per day she allowed herself to eat. Back then, eating and keeping food in was simply not an option. Over time, her purge frequency decreased and she normalized her food intake, ultimately giving up her bulimia. 

Beyond her initial and modest weight increase, her weight has remained stable within a 2-3 pound range over the past many years. And that initial increase can be attributed to two things—no longer living in a dehydrated state and better nourishment.

To me, the better question for Ellie to ask would have been " how much better off am I since I’ve changed my eating?" In spite of the modest weight increase that she had no interest in, what did Ellie get in return?

When confronted with this question, she appropriately retreats from her disordered thoughts which periodically reemerge and readily acknowledges just how far she has come, how much better she feels. She remembers that there's no way she could've taken care of her newborn grandchildren in the state she was in then, or be trusted driving back and forth to their home. No, the price she paid, the few pounds gained, is nothing given what she's getting in return.

Gaining weight is rarely seen as a positive in our culture. Advertisements fail to praise us for outgrowing our jeans.

But for some, that is exactly what needs to happen. Staying at the weight you were at when you were 12  is hardly appropriate when you are 16, 20, or 40 years old. And even if your weight is objectively 'within the normal range' for the population, it may not be in range for you. It drives me crazy when doctors tell their patients that their weight—a  weight that has never been maintainable without an eating disorder because it's too low—is fine, because they are basing it on the charts for populations. Why the double standard? Because if you've always been a healthy larger size and you've lost weight through unhealthy measures, that 'normal range weight' may be anything but normal. Perhaps given your build, your genetics, your muscle mass, your history of athleticism, your body needs to be at a higher-than-average weight. And fighting it to be at a place you've never been will only contribute to unhealthy ways of eating and thinking. For your mental and physical well-being, weight gain may be just what's needed.

Gaining weight without an eating disorder?

Not long ago—a couple of months, maybe—I noticed that snugness around the middle. No, my jeans hadn't just been dried at high heat for too long. And really it was not in my head. Everything was fitting a bit too tightly. (Yes, even the bras.) Not one to weigh myself with any regularity, I suddenly jumped on the scale. I felt the need to reality check, to verify what I was feeling.

Yup. My weight was up.

Save your rush to judgement, please--it has nothing to do with the cupcakes, the chocolates and my homemade, full fat lavendar ice cream. Ok, let me clarify. No "I told you so's" necessary, because I ate all those foods before. But over the months of summer, the balance wasn't perfect, and so my weight crept up. 

Could it be that I was super active through the end of June, training for my fundraising ride, only to reduce my activity precipitously with the heat wave and awful humidity? Perhaps. Could it be that I've been socializing more, sipping on wine with dinner more nights than previously. Perhaps.  Could I have possibly joined my husband for an after dinner snack—just because it looked good and I thought I'd keep him company—more often than I really needed from a nourishment standpoint? Likely. Like you, I'm not perfect.

But the bigger question is what to do about it. If you were me, would you:

1. exercise a couple of hours each day to make up for the previous reduction in activity?
2. reduce your food intake to compensate for the extra calories consumed?
3. seek the guidance of a Registered Dietitian?

Ok. So I'm the RD so  I'd better come up with a fix.

But if you don't fall into the categories described above--those truly needing to gain weight, or those who've gained appropriately as a result of releasing yourself from disordered behaviors--and you find you've gained some unnecessary weight, here's what I'd suggest. Intuitively, it may seem appropriate to make up for any overeating in the days or weeks which follow. But don't do it! Instead, refocus. Get back to the basics, particularly if you've found yourself slipping into old patterns. Have you forgotten the basics? For starters,

Sit. No eating as you walk around the kitchen emptying the dishwasher. No eating standing at the fridge. And no, don't sit at the fridge; seat yourself at a kitchen or dining room table.

Separate. Eating and distractions,  (other than your family which you can't get rid of) should be separate activities. TV watching, texting, reading--these should be separate from eating. (Unless, I'll add, you are struggling to get food in and find that being less mindful is actually helpful--which it often is!)

Eat with your senses. Are you seeing your food and acknowledging what you're eating? Are you experiencing the textures of what you're eating? Are you tasting your food? Doing so will allow you to slow the pace and to feel more satisfied with what you're eating. You'll enjoy the food so much more!

Choose what you enjoy. Are you giving yourself permission to eat what you like, or holding on to rules about what's allowed vs forbidden, in your mind?

Tune in to  your hunger. Don't wait  until you are at the extremes of hunger--if you're starving you are more likely to struggle to eat as described above, and overeat.

Re-explore fullness. Are you eating until you are stuffed? Might a modest adjustment in portions be appropriate? That said, if you start with smaller portions, do give yourself permission to eat again later--after about an hour--regardless of what you you ate before.

Don't panic! And don't take radical steps to 'fix' the problem. Restrictive eating, denying your body's signals and needs, does nothing positive in the long run. It will only perpetuate an unhealthy cycle and make you feel like c!*P!

Breathe. It won't take long to get yourself back on track. But be realistic--if your eating was off course for some time it will certainly take some time for you to be back to your former, healthy self. Radical dietary changes can have radically negative consequences, so do be patient and appreciate the modest improvements as they happen.

Here’s to a Speedy Recovery? Not So Fast!

Alan came in yesterday and he put it right out there. “I was really disappointed with our visit last month.”, he shared. “I expected to lose more that the 6 pounds given all the work I had done”. More than a pound per week achieved through his modest dietary changes and his move from a sedentary activity level wasn’t enough. Sure he was feeling better—sleeping better, less heartburn, more energy—but still the weight loss wasn’t enough.

Thinking this portion should satisfy? Maybe not!

I wish I could say this was an atypical occurrence. Rather, many a patient, and a parent, present painfully honest about their dissatisfaction. Not with me, I’ll add, but with themselves, their child, their spouse. Really, they struggle to make sense of the reality of changing behaviors with their vision of what shouldbe.

And if you’re like them, it’s not your fault for struggling with this. Ever watch The Biggest Loser? Those who get thrown off the show for not losing fast enough lost 7 or so pounds—in only one week! How about those Jenny Craig and other diet program ads—the ones with those alluring before and after photos with the oh-so-tiny-print revealing for legal reasons, that “results are not typical”? (For the record, losing rapidly will ultimately result in rapid weight increase, preoccupation with food and weight and a host of other consequences).

Perhaps you’re dealing with an eating disorder. These past 2 weeks I’ve watched as my patient’s insurance company repeatedly rejected her pleas for treatment. Alison long struggled with anorexia and bulimia and after much work on the part of her providers (myself included) had agreed to enter a program. I thought that was the hard part. But then the tables turned and she became the one who had to fight for coverage for appropriate care; in the eyes of the insurer, 15 or 20 years entrenched in her eating disorder should surely be remedied in a couple of weeks in a program! Even her providers at the treatment center—no doubt influenced by the regulations and coverage struggles they’ve come to accept—seemed to take that stand, despite her recent slip when left on her own.

You just might encounter some obstacles.

Your difficulties in recovery may be influenced by your unrealistic expectations of the process of recovery or of changing behavior. Like Alan, you may take a “why bother?” approach and throw caution to the wind, sabotaging your progress because you sense you’ve already failed.

Sarah’s parents recently emailed me concerning their anorexic teenage daughter whom I’ve been working with. “She’s been making a point of going out more for dinners and she’d stopped keeping a food record”. Potentially cause for alarm? Maybe. But in Sarah’s case it was anything but. She had make remarkable progress with weight restoration over the preceding months and had been forthcoming about her difficulties—when they occurred. The dinners out? Now that she was more comfortable eating in restaurants and having others prepare her food she was stepping out; it was not an attempt to avoid parental mealtime supervision. And the lack of record keeping? Sarah was working on moving toward more intuitive eating at this point, and we had agreed to move from the daily food logs and exchange list accountability. I am not faulting involved parents in the least. But sometimes change is a good thing, as in Sarah’s case.

Some families expect recovery to be like ER treatment—you come in in a crisis, you get emergency treatment, like surgery or a new medication and you’re discharged to home and fixed. Unfortunately, eating disorder recovery is nothing like this.

So what to do when you live in a world filled with outrageous messages and your unrealistic timeframe for change is far from attainable? Focus on the immediate benefits of the positive changes you’re making, versus dwelling on the disappointments and frustrations. Consider not just the shoulds, as in “I know I’m supposed to be eating better, so that’s good” or “I know that this will help me down the road to prevent heart disease”. 

Don't expect to feel so positive all the time!

Consider the benefits many of my patients shared this week:

• my energy level is so much better

• I’m thinking more clearly

• I’m less preoccupied with what, when, how much to eat and I’ve stopped counting calories!

• my worst fears haven’t come true, in spite of my resistance to making the changes

• it’s getting easier to do the tasks I initially struggled with

• I’m seeing the impact of my role modeling on my young kids

• I was able to have a scoop of ice cream and trust that it would be there if I wanted more later!

• I baked and ate what I baked for the first time in years! (from Food to Eat, I’ll add!)

I also saw improved blood sugars in diabetics—with less than Biggest Loser amounts of weight loss, and I heard from both patients and families about improved mood and decreased irritability.

I realize that the positives, like those described above, may also occur side by side some negative experiences. For those starting to eat more as instructed, the physical sensations can be challenging. And anxiety, for many, is a real challenge and may need to be tackled with support from your therapist and MD. I don’t want to paint an unrealistic rosy picture, suggesting that all you need to do is adjust your thinking!

We’d all like a speedy recovery, as the expression goes. But in order to move there, we just might need to adjust our expectations.

Remember Patience?

Your thoughts?