Friday, October 25, 2013

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 many factors, 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.

Thursday, October 24, 2013

How Not to Be a Shrinking Woman

I don't know Lily Myers, whose YouTube clip follows, but I know lots of 'Lily Myers'. She is strong and powerful as she describes her mother and herself and the culture which helped to shape her, for better and for worse. She is painfully aware of eating disorders and the grip they can have on us.

Please watch it. But don't blame your mothers, or your grandmothers, just as you can't blame them for the cancer and diabetes genes they pass on to you.!

And make your voice heard--please don't keep silent, waiting for all the others to share their seemingly more important thoughts.

What did you think of her poetry?

Monday, October 14, 2013

Reasons to believe in recovery? Take this simple, anonymous online questionnaire.

Perhaps you CAN rise above the clouds.
I don’t know the Harvard psychologist Dr. Sheila Reindl, but I have recommended her book Sensing the Self, many, many times over the years. It’s filled with wisdom about recovery from bulimia, honed from Reindl’s extensive interviews with 13 recovered women. (Not bulimic? Please read on! There’s something here for you too!)  Maybe I was attracted to it having learned that several of the pseudonym-ed women were actually past patients of mine, shared with a therapist who contributed these cases to the book. 

Or maybe that it meshed research with patient stories, extracting the essence of the recovery process into meaningful chapter themes. Personally, I hate reading books about recovery (but I read this at the insistence of a patient). That likely has mostly to do with the fact that I discuss recovery almost 40 hours a week. Do I really want to engage with strangers’ stories on my down time? I don’t think so.

Yet I likely suggest it because I believe it may help readers with recovery. Just as I recommend Schaefer’s fabulous Life Without Ed and Arnold’s blog ED-Bites—long before it became chock full of valuable research interpreted into a language we can all understand.
I don’t know if reading recovery stories truly makes a difference in the recovery process—for better or for worse. But I’d like to find out! Because I’d like to have another tool available to help support recovery.

Can recovery stories show us the way?
Enter Lisa Dawson, an Aussie PhD candidate who has the very same goal and is doing the research to find the answers—and I really hope you will help! You may remember her name from previous research I referenced. Here’s the description of her research:

Researchers at the University of Sydney are interested in whether reading stories of recovery are helpful for current sufferers of anorexia nervosa. People aged 18 years or over who have anorexia nervosa or an eating disorder similar to anorexia nervosa are invited to participate. This study is conducted entirely online so anyone in the world can participate. Participation involves completing questionnaires on two or three occasions and reading five short stories about recovery. We are very interested in receiving your feedback about the helpfulness of the stories.

The study has been approved by the University of Sydney Ethics Committee and all aspects of the study, including results, are strictly confidential. We are hoping to have as many people as possible take part in the study. If you are interested in participating then please contact Lisa at
So if you have a few moments, please email Lisa to learn more. And say hello for me!

Thanks for helping. Oh, and PLEASE share this any way you can!

Monday, October 7, 2013

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 cause it? 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 not advocating 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 correlated equals 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!

Tuesday, October 1, 2013

Now I Need Some Help!

I know, I know, I’m way overdue for a blog post. The next real post I’ll be putting up this week—I promise.

But first I need your help. I’m working on a presentation entitled From Meal Plans to Weighing Patients: Knowing When and How to Change Direction Based on Patient Readiness for an upcoming eating disorder conference, the Renfrew Center Foundation Conference. And I’d like you to have a voice!

This is for all of you—whether you’ve struggled with Binge Eating Disorder, bulimia or anorexia—or don’t quite meet the criteria for any of these.  (And, family member-readers feel free to add your 2 cents, too). Consider a brief response to the following:

  • What words or actions by a health care professional helped you/your loved one shift toward change?
  • What advice would you like to share with healthcare providers so that they don’t repeat the mistakes they made in your/your loved one’s treatment? Specifically, regarding being weighed, providing nutrition recommendations, setting limits on physical activity, or involving family in treatment.
Thanks in advance for your wisdom.