Friday, March 29, 2013

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 should be.
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?

Monday, March 18, 2013

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 you suggest?” 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 Tavern is not going away anytime soon. I just need to remember that.

Wednesday, March 6, 2013

Weight Loss and Recovery—Can they Coexist? Is Recovery Even Possible After So Long?

Remember Maggie who lost over 150 lbs.?

She’s experienced them all—she’s been labeled with anorexia, bulimia and BED (binge eating disorder)—now an official diagnosis in the new DSM-5, the manual of mental health diagnoses. And she’s been categorized as obese. She did not seek treatment for her disorders early in her history, when recovery is known to be more likely. Yet she’s done it, she recovered. And she didn’t truly start the process until she was in her 60’s.

Hooray for Maggie! Recovery is possible!
I'm writing about Maggie, once again, to offer hope that recovery is possible. Because it is. And because you may believe that even if you did recover, that you would never maintain it. And that it’s not even worth starting on the path, because you just might fail. There. I’ve said it. Now let’s move on.

About Maggie, present day.

This lovely, now 74-year old woman with a long history of eating disorders, has maintained her consistent recovery—and then some. If you haven’t read about her history through Feb 2011 in the link above, please read it now to appreciate where she’s been.

First, the stats. As of today, Maggie's weight is down from her initial weight of 387 pounds (back in 2002 when we started our work together) to 212 lbs. Yup, that's 175 lb. decrease. Most notable, though, is that she achieved this through healthy measures, normalized food intake, a move from binge eating and without disordered behaviors. I don’t think you’ll find the Biggest Loser winners accomplishing such behavioral goals, given the crazy-extreme measures they take on the show.

But let's look at the markers of health that really matter: her A1c, the measure of blood sugar control over a three month period, is now normal for this diabetic woman (it was out of acceptable range even for diabetics, previously). And she is no longer on the blood sugar-lowering medications she had relied on twice daily. All of her lipid measures (think cholesterol) dramatically improved, too. ‘Maybe it's the meds?’ ‘Don't statins do a great job at that?’ Well, her statin dose was cut in half. And statins do little to nothing to improve HDL, the 'good' cholesterol—yet hers improved significantly. As did her triglycerides (down 150 points), also not attributable to her medication! At 212 pounds, her cardiac risk ratio is lower than most individuals’ by far.

Maggie eats more than she ever recalls allowing herself to eat at any other time in her life—aside from pregnancy. She consumes regular meals and snacks daily. She does a water exercise program a couple of times per week—she's even overcome her anxiety of being in the water, with the assistance of a great therapist.

It's a lot of hard work, and you might get off course.
But you'll be glad to get there in the end.
It's been neither a few months, nor a whole year. Rather, it's been 11 years since we started our work together. Yes, it's a process (although not this long for everyone, I'll add). But Maggie only started her journey when she was 62, after about 50 plus years living with disordered eating and beliefs about what she deserved to eat and how to nourish her body.

Patience, dear readers. You can’t expect to undo a decade or a lifetime of unhealthy thoughts and behaviors in a couple of months.

Maggie’s next step is to believe that she's just fine as she is—high BMI and all; that weight loss shouldn't be the focus. It’s not so easy, though, given that her whole life her worth was tied up in the number on the scale. Even when those who constantly criticized her appearance were gone, she picked up where they left off with her own negative self-talk. It seemed the damage was done.

But can’t she still lose weight?

If she continues with her eating on course, and she feels well, and her weight continues to decrease—there's no problem with losing more weight, as long as her thoughts are kept in check. But I'm emphasizing that the goals that really need to be met, have been: she's taken control of her health, she's more fit than she's been in years, and she's eating more adequately than ever before. There's no binging or deprivation, and no compulsive exercise. And she feels well—physically and mentally. So we’ll just need to proceed with caution, because weight loss is a slippery slope for triggering eating disorders.

I hope Maggie will check out this blog (she has given me permission to write about her again, with her name change of course!) And I anticipate she'll see from your comments how she has inspired you and others to not give up and to have hope that change is possible. Yes, recovery really is possible.

Please share your thoughts with us!