Tuesday, July 19, 2011

Tweet This, Not That.

Time For Some BIG Changes In Our Approach to Managing Our Eating

I used to warn patients “be careful where you get your information”.  There’s plenty of myth-information around, and the last thing you need is to fill your thoughts with more useless, conflicting ideas. Too much information makes us like deer in headlights. And it’s worsened by unrealistic, idealistic, and at times, downright false and unsubstantiated messages from tweets and the media. 
Love the message.
Love their sweet potato tortilla chips too.

Now I’m finding that even credentialed professionals, yes, registered dietitians included, appear to be putting out the most triggering messages. Sure, they tell you to include more fruits and vegetables, and be sure to have a snack before heading out—hard to complain about those tweets encouraging healthy intake.

But there is a constant subtext to the messages that concerns me. They tend to follow a format of “I’m having rice cakes and seaweed for lunch. What are YOU eating? I ran 35 miles in 15 mins. What are YOU doing for exercise? And in the process of giving perhaps well-intentioned nutrition and fitness messages, in my view, they’re potentially doing more damage than good. If I’m feeling triggered, I can only guess what my readers and patients are feeling.

Here’s a list of some recent tweets:

--Ran 6.2 miles in 54 mins. Felt good, wish I did better.
--Just finished 11,000 steps to start the week. What r u doing?
--Popover at dinner was a must : (
--Cravings can hit hard, but if you distract yourself they often pass.
--Kiddie size (soft serve). Always a good choice.

And this is just a taste of what’s out there.

Maybe it’s just me, but here’s what I read between the lines, from these and other daily tweets:

There are good choices, and there are bad choices. Healthy foods are good ones and  sweets are to be avoided. Why the “  : (    “ ?   about a popover for goodness sake? Can we not include popovers as part of our healthy diet? Why is it framed as a personal failing?

Homemade pizza--white flour crust, real cheese. And, yes, there were
fresh vegetables at this meal as well.
Exercise is good. But the amount I’m (and she) is doing is never enough.

Deny your body’s signals regarding pain (still run through it), and regarding hunger (avoid it and maybe it will pass).

One size fits all for portions, regardless of individual need. If I'm very hungry, or am striving to maintain energy balance, why would I always choose the kiddie size?

We should be striving to eat to meet an ideal—whole grain, high fiber, “clean” eating. It appears to be a fatal flaw to include any saturated fat, never mind something fried or made with (OMG) white flour!

And because the messages are so limited in length, the fuller context gets lost. I’d like to believe that if given more than 140 characters these well-educated nutrition professionals would be able to communicate a much more sensible message than what comes across. And did I mention the actual unsubstantiated “facts” which are really just conjecture getting tweeted? False reports of metabolic rate changes and difficulty handling fats, unsupported by research, should not be tweeted and retweeted, becoming urban legend.

It’s not much better than weight loss ads touting dramatic weight loss in insignificant periods of time. Patients often refer to these when stating their unrealistic weight loss goals, only to have me ground them in reality.  They need to be reminded to read the small print, which states something like “results not representative of what any typical human being should expect to see in her/his lifetime”, or something to that effect. You get the gist.

Yes, there's a place for (really delicious) chocolates,
 regardless of your weight.
In other words, you may think yourself into doing poorly; your expectation, albeit unrealistic, is unmet, triggering disappointment, a feeling of hopelessness, and inadequacy, leading to what I call the what the heck effect, continuing the downward spiral.
The continued slip further worsens your sense of hopelessness, and contributes to the inertia to find your resolve again.  It’s remedied using CBT—Cognitive Behavioral Therapy, where thoughts, feelings and behaviors are all connected, and the pattern can be broken.

About Jane

Jane gained about 100 pounds the previous nine years. (Yes, there are meant to be two zeros after the “1”). Admittedly 100 pounds during that time span is rapid weight change. And Jane wasn’t underweight or recovering from anorexia. She was a chronic dieter who struggled with compulsive overeating, with stress eating, and with hopelessness about her climbing weight. She feared the gain was due to her medication, necessary for managing her other health conditions.

But Jane turned things around. Even while continuing on the meds she began to lose weight through our work together. Over the past 5 months she has lost 26.5 pounds. She is eating normal foods, without rigid rules. She is learning to taste her food and to thoroughly enjoy what she eats. And most importantly, she is feeling better—emotionally and physically. The spiraling panic about the direction her body was heading has subsided and her thoughts about food and eating are no longer all consuming (pun intended). From my perspective, this is not good enough.

No, not the amount of weight change, nor the changes in eating behaviors—those are fabulous shifts. What I’m concerned about is Jane’s perspective.

“I know I’m losing, it’s just not coming off fast enough”. 

These are Jane’s words. They give insight whether you, too, are overweight, or you are underweight and working on gaining to a healthy place, or trying to learn to have balance in your eating and your life.
This post applies to all. Jane’s words have less to do with weight loss than with unrealistic expectations and how we respond to them. It has to do with perspective.

Instead of appreciating her progress to date, Jane was focusing on not being good enough. It’s a familiar problem, our not feeling thin enough, smart enough, pretty enough, adequate enough—the list is endless. As a side note, there’s a great book by Sheila Reindl entitled Sensing the Self with a chapter entitled Sensing Enoughness, (if I remember correctly)—a well worth read. This psychologist interviewed 13 bulimic women in Massachusetts, (several of whom were patients of mine, I was told) who recovered. Yes, they recovered. And through her interviews she identifies common features contributing to maintenance of their eating disorders and to their recovery.

Why we never feel adequate enough is better tackled by Sheila and the many psycho- therapists out there. But among the things I hear frequently is a distorted sense of what is realistic. Viewing weight loss ads with their before and after images, and hearing tweets presenting a simple, black and white view of foods, contributes to the problem.

In fairness, there are plenty of valuable tweets out there. Most notable today was retweeted by Doc Samantha from the Dalai Lama:
“If we find we cannot help others, the least we can do is to desist from harming them.”

It’s my hope that this post will inspire readers to set more realistic and achievable goals, and to think before they tweet.


  1. Wonderful post (as usual)!! So true about how we set ourselves up for the "what the heck effect" by expecting too much,too quickly...Gaining a lot of weight upon release from hospital for anorexia (much of it water...but (needed) fat as well..threw me into sheer panic as I realized, when finally allowing myself to see the numbers on the scale, that I had surpassed my previous "setpoint" and zone of comfort...Trying to "normalize" has been a struggle which is decidedly NOT helped by paying too much attention to tweets..investigating diets which promote the idea of good calories/bad calories and the removal of entire food categories...When you tend to have a "black or white" view of what is "acceptable" it weight, foods, length/intensity of exercise ..etc (as many of us with restrictive tendencies do)..the categorical "slotting" of foods into good or evil categories becomes attractive, almost conforting, because we do need to "think" about our OWN individual needs and desires as much...Thank you for helping us to realize that we are all individuals with very divergent tastes, desires and needs in nourishment...It is very personal and one size (or diet)does not fit all...

  2. What did you think about Jane Brody's recent article in the New York Times?
    Seems to me it reinforces "good food, bad food" theories (and in more than 140 characters).

  3. A commenter on a blog which shall remain nameless posted the following:

    "Then the food recommendations piled up — all kinds of unhealthy things I had banished from my pantry long ago (bread, pasta, meat, chicken, yogurt, cottage cheese, string cheese, etc)."

    These recommendations were made by a dietitian to help the poster lose weight. He or she had not been able to lose weight while on a vegan diet. I don't have any more context than that, but what horrified me is that this person had become totally obsessed with eating "clean" to the point where only plant based foods were acceptable.

    Now, I have nothing against plant based foods. They're some of the best in the world. Nor do I have anything against people who choose to be vegetarians, but in my opinion, this is a case of clean eating crossing the line into full-blown orthorexia.

  4. @Anonymous Funny you should ask. My next post will be addressing her article and the Harvard study directly. (And yes, the message is off base!)

    At least having the awareness that we are influenced by these messages allows us to be on guard! Thanks for your comments.

  5. I sure can relate to having felt like it isn't coming off fast enough/good enough! I agree, ultimately, it is about not feeling "adequate enough"/successful enough. I so appreciate your gentle approach and reminder to be gentle with myself and set realistic expectations. Also, to ENJOY the journey, not feel deprived by it (I appreciate that!)! I think I need not to watch things like THE BIGGEST LOSER, including the "critical transformation"... Thanks, once again, for a thoughtful post.

  6. Lori, I just want to thank you again for dropping by my blog and trying to knock some sense into that odious twit. I'm sure it made to no difference to his testosterone charged brain, but I really appreciated the reinforcements!

    I love your blog, BTW!

  7. As a heavily pregnant lady I can tell you the things I crave most are those that I cannot have. I CRAVE sleeping on my stomach, beer, bleu cheese dressing, sushi and not having to go to the bathroom every 15 minutes. ;) Do I normally crave these things, no. It is simply because the medical community has stated that for various reasons they are unsafe so I avoid them. Does this mean that after I give birth I am headed to the local sushi bar? Probably not. Once they have been removed from my taboo list I am sure the craving for them will also be removed. I think it is such with dieting or lifestyle changes; if something is taboo or off limits it becomes the thing that you most want. It's why I think most people fail at weight loss, we are told that a piece of chocolate cake is off limits when a piece in moderation keeps one from feeling deprived (in my non-dietician opinion) =)

  8. @ Tracey Well stated! Love the analogy.

  9. Its hard work loosing weight but maybe it should be, I will stick with my high fibre diet.

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