If you're struggling with your eating you're not alone! Strategies for the holidays and beyond.

These past weeks more people appear to be struggling with their eating. I don't know if statistics support it, and I haven't done a study. It's simply what I'm noticing. So I thought it might be valuable to share what I'm hearing. Because if they're feeling and thinking these thoughts, you just might be, too. 

And I'm hoping that regardless of your type of eating struggle that you'll feel a bit more supported after reading this post. These are not simply holiday eating concerns. Rather, it appears that preexisting concerns get heightened during this time of year.

Setting the record straight

The holiday season may not be the happiest time of the year as the Christmas songs may suggest. There are the common stresses--there's much to get done in limited time, like shopping, meal planning and cooking, perhaps accompanied by a bit of financial concern. Most often these fall on the woman of the house, adding to her usual responsibilities, it seems. You might even have to get dressed up for holiday parties, presenting it's own issues.  And the added stress doesn't make the abundant food challenges any easier. No, you're not alone if you're struggling to eat well this time of year. Here are a few common themes I've been hearing and some guidance to help you through.

 

• Dealing with unstructured time like days off and weekends can be a challenge. Your schedule and your eating can get thrown off leaving you not so confident about what is and when it's okay to eat. But you can always add your own structure. If you wake up late, still make a point of eating within an hour of waking regardless of the time. Be cautious to avoid long intervals without eating, and do include at least 3 meals. Keep snacks handy when you're out and about, to have whenever you might need them--regardless of the hour. Be vocal too-- just because the person you're with doesn't need to eat, doesn't mean you don't need to!

• It's a struggle giving yourself permission to enjoy great tasting foods. And as a result, you lay on the guilt. And feeling bad about your eating truly does nothing positive. You're more likely to eat those desireable foods quickly, when no one is in sight, and with less enjoyment, than if you truly gave yourself permission to taste them and fully take them in with pleasure. Normal, healthy people eat holiday foods including cakes and sweets--and it's ok. Really. And you are no different. In fact, one of the best things you can do is not expect that you will only eat that special food just this once. Because that now or never feeling will only backfire, leading you to want to overeat those foods--whether or not you're hungry.

• It takes 3,500 calories to gain a single pound. That's 3,500 surplus calories, over and above your needs for maintaining your weight. So the impact of some pie or Buche de Noel? Not even a dent. Now's the time to start legalizing the foods you enjoy, but start with just one item at a time. See the blog posts on this subject for more guidance. 

• You feel like you're eating all the time.  Frankly you just might be eating all the time, by which I mean 5 or 6 times per day. Yup, that is absolutely normal. Why pathologize frequent eating, as if it's some problem?  We do need to eat regularly-- for energy, for fuel, to prevent rebound overeating, and to prevent the decreased interest in eating that can snowball into full fledged restricting for those so inclined. Just be sure that when you eat you allow yourself to truly get enough. And ask yourself if you're reaching for food to manage stress, or boredom, or because you've already given up and plan to take control on January 1st.

•  Everyone seems to be focused on weight and dieting and food guilt. You know, the "I really shouldn't be eating this but..." It's really too bad. But you can break from the pack and cut off the triggering chat by redirecting the conversation. Use a simple statement like, "subject change" then ask a question on a different subject. You also might need to turn off the TV for some months til the diet talk subsides. And consider blocking posts from friends with triggering diet and body image talk!

•  You feel ashamed to be seeking help for your eating because you simply don't think you're thin enough to really have a problem, never mind an eating disorder. And that makes it all the more challenging asking for help. Seek guidance from those who specialize in eating disorders; we are well aware that food struggles exist in those of so called normal weight, and that anorexia and bulimia know no weight limits. People of all sizes may struggle with anorexia, bulimia and binge eating disorder. And it is no less serious in those in the "normal" BMI range.

Please know you're not alone. But please reach out for help to those that get it. If you're a parent, check out FEAST. If you're an adult with an eating disorder, regardless of your gender, check out aspire. Look at pro recovery websites linking from this blog, and check out their links too. National and local organizations like the Butterfly Foundation, MEDA, NEDA and others can help direct you for support and care. Virtual supports as well as live supports abound and it's not too late to change your relationship with food--and to recover from an eating disorder.

Wishing you all a peaceful holiday season!

Thinking It's All Your Fault?

That’s what they’re thinking, isn’t it? And likely you believe it too. Whether you’re fat or thin, healthy or unhealthy, fit or not, we need to place blame. It’s too hard for us to accept what’s not in our hands to control. We blame your weight on your eating and your diseases—even when there may be no link; we unfairly blame the parents for their child’s eating disorder; and we yearn to believe that it was your actions that caused your disease. Here are just a few examples of this I’ve recently encountered:

• "You’re too fat and of course you must eat poorly. And you’re lazy, too. Shouldn’t you be moving that 350 plus pound body around better—faster, longer, more gracefully? Your knee problems, your reflux, your high blood pressure—they’re all caused by you, don’t you think?" It doesn’t matter that you were an overweight baby and a chunky child—cute then, but not for the adult you. No, it bothers us to see people outside the “perfect” range. 
• The first question they ask is “Was he a smoker?” And the answer is no. Not a smoker nor a drinker yet my father died from primary lung cancer which spread to his liver. And no, there were not even asbestos or environmental factors. And my relative’s recent diagnosis of stomach cancer—rarely seen in the US but common in Japan—where they tend to be slimmer, I might add—was not caused by her weight nor her diet—those pickled, fermented and smoked foods associated with this cancer are not in her repertoire of foods regularly consumed.
• I was sent many an internet, urban legend article on diet soda and multiple sclerosis after my diagnosis of MS. They were well-intentioned senders. They just wanted to find the answer, to find a cure. Never mind that the best research facilities still don’t have a cure, and that I can count on one finger how often I drank a diet beverage over the past months. But they thought they were being helpful. Wouldn’t it be great if I had caused my MS, and then I can equally easily undo it?
• It’s the families, isn’t it? You know, that cause the anorexia? Wasn’t her mother always dieting? What about the home environment? Didn’t her sister also have an eating disorder?

Randomness is difficult to accept. If there’s no cause and effect, it means we can’t do anything to protect ourselves from all the bad things that may befall us. It means we have no control over the future of our health, of our survival, and of the risk to those that we care about. It leaves us feeling way too vulnerable.

We want to place blame. If her cancer was caused by her weight or her gastric bypass surgery, then it won’t happen to me. If his cancer was due to smoking or asbestos, then I am safe. Cut out the diet sodas and I’ll be free from risk of neurological disorders. If mothers cause anorexia, then I can change how I parent and prevent my child from getting it.

If only life were this simple. An eating disorder is complex, and can’t easily be caused from environmental influences. It likely involves a genetic predisposition, some triggering event, and environmental support to maintain it. Yet that doesn’t mean that parents are helpless. They may help prevent an eating disorder in a high risk individual by keeping eating on track and preventing the dieting that all too often results in an eating disorder. And they can certainly actively support their child’s recovery!

My MS and the ALS of a dear relative will not be cured with nutrition or weight change. But we can take control of our stress and maintain the health of the functioning bodies we do have. We can eat well to feel well—and yes, that includes cupcakes in addition to whole grains!

As for the myth that your weight is responsible for all evils? Reread this old post!

All hope is not lost. Even conditions we didn’t cause, we have a role in repairing. Yes, even the cancer. Getting the best treatment team and following the recommendations of your medical team is key. Reducing stress and keeping a positive attitude are critical remedies as well.

So when the conversation goes down that path of placing blame, politely educate the naïve inquisitor. And when you’re thinking it’s all your fault, think again.

On my list of "to dos"!

But don’t free yourself from the responsibility of taking action, of taking control of your health in all the ways that you can. And whether you have a terminal illness or a progressive condition or are 100% healthy, start living like you don’t know what tomorrow will bring. Because the truth is—you don’t. 

Thanks for reading. As always, I’d love you to share this if you liked it. Now there’s some action you can take!

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^th Avenue—high BMI? You get the under 16 oz regular soda or the diet one; low BMI? You may 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...

The Consequence of Changing your Relationship with Food.

It Doesn't Have to be All or Nothing

I heard on the radio that the odds of winning this lottery, this multi, multi million dollar lottery, are less than the odds of getting struck by lightening.

Imagine if...

Yet in my office Patty talked about how winning this bundle of money would change her life, how she wouldn't be able to stay in the same place she's at. People would expect things from her, and in many ways it would add some stress. She spoke as if this change could happen, as if it were real enough to taste.

What would happen if you had a life-changing relationship with food? If you had fully recovered from your anorexia, your bulimia, your binge eating disorder? If you had healthily lost weight to a normal range? 


In some ways, this is so thrilling, so liberating, so refreshing. Like winning millions, it may certainly change things for better. You're likely to feel better, physically and psychologically. It may resolve some stress, allowing you to feel lighter. And it may open up some options. You may be less preoccupied with food and eating, freeing up your mental energy for more appealing thoughts. You may become less isolated, allowing yourself to socialize, with or without food.

Can you allow yourself to enjoy the benefits of change
without fearing the consequences?

Yet in other ways, it's rather frightening. What will I lose if I let go of food, my best friend, as my means of coping?What will be expected of me—by my friends or family members? Will they support me or be threatened by my progress? Will I have to take steps to move on in life, or can I hover where I'm at?

But you're not obligated to change; the choice remains yours and yours alone. If you don't want to move up professionally, that's your choice. No interest in dating? Again your prerogative. Change can be scary, but you can be selective about what you change; you can enjoy the benefits of  feeling better, while staying put in every other area of your life—if you should choose to.

Here's an update on several of my patients you've read about, to make this point.

Ready to tackle whatever comes his way!

Remember Maggie, with her history of emotional and compulsive overeating, unhappy with her climbing weight, her newly diagnosed diabetes and her chronic knee problems? She had struggled with disordered thoughts and behaviors for several decades.  By changing her relationship with food and without disordered behaviors Maggie's weight is down over 152 lbs. Now she chooses to step out of her house more than she had before. Knee surgery is now an option, but she's not quite ready to deal with surgery.

Always fearful of being in a body of water, she decided to get past her fears with the aid of her therapist, and now goes to water aerobics several times weekly. In the past, she could neither face her fears of the water nor of donning a bathing suit.

She's finally content and able to speak her mind.

How about Erin? She's the one who was subjected to the rudeness of clueless, assuming strangers—one in particular, who had the audacity to comment on her eating while she mindfully sat in her parked car, eating her snack when she was hungry—simply following my recommendation to respect her body's signals. She recently brought a giant grin to my face, as she related this story:

“That’ll teach me to eat while driving”, she told the dry cleaner last week, handing him her  food-splattered jacket. Struggling with a recent GI issue, she had some reflux after she had consumed her meal at home, before heading to my office. And while driving, the food decided to revisit. No fault of hers. And so she made a stop at the cleaners and playfully commented about her “inappropriate” eating.

To even be able to joke, to not feel ashamed of her eating, to have the confidence and to choose to speak up—now that's the result of a shift in thinking.

Like Maggie, she too has lost a large percentage of her weight, a total of 101 lbs as of today, yet she remains overweight. She is still not comfortable traveling in planes (the seats are just not comfortable for her) and she doesn't like the uncomfortable feeling of being in Europe where the cars and most people are smaller. But now she has set her sight on a trip, a chance to visit relatives abroad—when she feels she can better manage it physically.  But she's definitely not waiting to start speaking up and sharing her thoughts!

I heard from Daniel after several years—he had worked with me and successfully recovered from his anorexia. He spoke about finding his passions—currently theater and track—and is now applying to colleges. His life is no longer filled with medical appointments, nor with thoughts about calories, “good” foods versus “bad” foods. He finally chooses  to fully enjoy life.

Laura could have fallen back on her binge eating during this stressful time. Dealing with her recent divorce, and the chronic lack of support from her husband, overeating held a lot of appeal. Yet somehow she hasn't slipped. She's gone through challenges for sure. Yet she's well aware that binge eating is a choice, and the risks and consequences are much greater than any short term benefit. She continues to impress me with her awareness and her ability to put fear aside and face her many challenges.

Change doesn't have to be so scary!

I could go on, really I could. There are many, many clients with similar successes. Why share? Because at some point they were all petrified of change. Because in spite of knowing that where you are at is not a place you want to stay, the fear of change can feel paralyzing.

You have choices. And as long as you're in a safe place, medically stable, you can make change one small step at a time. Maybe it's time to take the first step?


You are safe to share your thoughts here! I'd love to hear from you.

Who or What Decides How Much You Eat? Taking Back Control of Your Eating.

Last weekend I attended a diabetes conference in NYC (Yes, that explains the delayed post!). And although most of you don't have diabetes, there's so much valuable info to share with you.

First, I learned these experts know nothing about the feeding needs of the sedentary. Yes, sedentary program attendees, myself included, get hungry while simply sitting in a chair for a span of many hours. So with breakfast at 7:45, I was ravenous by the 10:15 coffee break. Now usually, when we say coffee break, we mean something more than simply a caffeinated beverage. Like, maybe we’d expect a mini pastry or muffin, or some fruit? Perhaps the Diabetes Association was using us like lab animals, exploring the impact of low blood sugar on us.

Yes, these are them! My sustenance 'til break time.

In any case, I was shocked, and unprepared, for the absence of adequate, calorie-containing snacks to accompany my coffee. And so I relied on the tiny hard candies to get me through until lunch. How ironic. My point? Just because someone else thinks it's okay to not stop and eat between meals, doesn't mean you have to go along with the plan!

Similarly, just because someone else tells you how much you should eat, doesn’t mean that’s right for you. What do I mean? Just because Quaker oats now says that the serving size is either ½ cup dry oats or ¾ cup for their “heart healthy portion” doesn’t mean that that is right for you. Several years ago, Quaker increased their portion from 1/3 cup dry oats, 2/3 cup cooked cereal. Maybe that amount worked just fine. Just because they’ve adjusted upwards doesn’t mean you have to!

Amazing sandwich from Eataly, NYC which I ate too
much of, having not had an adequate snack at break.

Have you ordered a sandwich out lately? Just half of many sandwiches (take Panera, for instance) more closely resemble a full sandwich most of us would prep at home. And eating only half of most burritos filled with rice and beans and guacamole would likely satisfy—except that once we’ve unwrapped it, we’re doomed to finish it.

And if your spouse or mother-in-law usually plates your food, take charge and plate your own food! Then you can’t blame anyone else for how much you’re eating.

Because we eat what’s put in front of us, without regard to how full we are in the moment, and without delaying to see if we really needed the full amount.

Brian Wansink, PhD, presented a fascinating session on his research findings at this conference (see www.MindlessEating.org for more info). This creative researcher developed a strategy to evaluate what factors regulate our food intake, telling us when we’ve had enough. He cleverly designed a feeding study where half the participants were served a bottomless bowl of soup. Yes, the soup was secretly pumped into their 22 oz. bowl, keeping it filled. And what did he find? That people just kept on eating! They ate 73% more soup than those with a finite portion. Yet they didn’t think they had eaten more.

He also interviewed Americans in Chicago, and Parisians, about when they know they’ve eaten enough. Parisians reportedly stopped when they felt full, and when their food no longer tasted good. The Chicagoans, however, made no reference to physical sensations, stating they stopped when their plate was empty, or when their TV show was over. Maybe that’s the answer to the French Paradox. They enjoy their food, including rich pastries and processed breads, but they stop when they’ve had enough.

It’s not that hunger sensations can’t work for us. It’s just that we don’t tend to give them a chance. Remember the titration example? (see  http://dropitandeat.blogspot.com/2010/08/size-matters-but-not-how-you-think.html ) We don’t allow our bodies enough time to take note and acknowledge fullness. Instead, we eat mindlessly, quickly, consuming more calories than we need before putting on the brakes. Then we blame it on the carbs, or the fats, setting rigid rules about what’s acceptable to eat.

The solution? Take charge of your environment, and of your body’s signals. Even if you need to gain weight, you’ll feel better if you are aware of what you eat. It’s not enough to gain weight, but to learn to regulate a healthy weight.

First, find your voice, and negotiate change, when necessary. If you’re out with others and feel hungry, eat a snack you’ve brought or stop for something. Yes, even if you’re the only one who needs to.

Plate your own food, and take responsibility for your own eating. If you're struggling with being overweight, start with a smaller portion than usual, giving yourself permission to have more after 45-60 minutes—if you’re hungry. If you are struggling to gain weight, consider having your grains on a separate plate, which some find less overwhelming.

Use a smaller plate. The size of bowls, glasses, plates, popcorn containers dictate how much we end up eating. Such a simple trick really works! And Wansink and others have the study results to prove it.

Eating out? Have them cut your sandwich or wrap in half, and package each half separately. If you need the second half later, it’s yours to eat then—if you need it! That’s where listening to your signals comes into play.

Limit eating to the kitchen or dining room. Then leave that room and use distraction to avoid the temptation to mindlessly eat.

Control your surroundings. Keep food off the kitchen counters. And keep fruits and vegetables in glass bowls in the fridge where you’ll see them and think to eat them.

And remember. Slips happen! This approach may be new to you, and other factors besides your awareness may impact your eating. Address your stressors and boredom, if they trigger you to overeat.

And set realistic goals. Work on one change at a time, before setting another goal.

As always, I look forward to hearing what you think!