Friday, July 29, 2011

Change Your Body, Starting at the Top. Shifting Your Thoughts, Not Simply Your BMI.

Was the monkey off her back? I don't think so.

Anna felt desperate for help. This 35-year old had successfully lost weight on her own this past year, down to the average weight for her height, according to standard charts.  She had been overweight, approximately 80 pounds higher than she is now. Now she presents struggling to maintain her current weight for her 5 foot 8 inch frame on just 1200 calories per day. And it wasn't going well. 
She is pleased with her current weight, quite satisfied even, and doesn't want it to change, but feels she is fighting so hard to stay at this place. 
No doctor would look at her BMI and conclude that there was cause for concern. Most would likely praise her for the healthy changes she had made, and perhaps even draw attention to her healthy low “runner’s pulse”.
Do you appreciate what is in place
or see life as black and white?
But I had a very different perspective. Here’s what I saw beyond the scale: she has not gotten a period in over a year, but previously had normal, regular periods; she was feeling more depressed and had reported a significant increase in the percentage of her thoughts spent thinking about food, eating and weight; she tended to be cold all the time, even in the summer, when temperatures reached the triple digits. And did I mention her hair loss?  Her low heart rate, I might add, was not the consequence of a healthy runner's pulse but of a slowed metabolic rate.
As for her diet, I would describe it as rigid and restrictive. Hunger was often appeased with water, food choices were limited, and desirable foods were limited to once per week. Her total intake was way too low, in spite of her sedentary activity level.
What was my advice? Eat more, I told her. (Of course I provided more practical, concrete guidance than that.) And so she did.
At our first follow up Anna described a significant decrease in obtrusive thoughts. Eating more adequately made her feel less compulsive when she did eat. And she felt more satisfied. She had backed off of the water, which was drowning her hunger and is now starting to recognize her body’s signals. I nailed it, she told me. Everything I recommended made perfect sense, and fit with her experience.
Just what are you focusing on?
Of course it doesn’t end here, because these are real stories. At the next visit, just this week, I heard the panic—fears of significant, unnecessary weight gain and body dissatisfaction. Truth is, her weight was up. Yes, instead of being 80 pounds below her highest weight, she was now 78 ¼ pounds less. This minimal weight change which had, by the way, stabilize by our third visit, was the price her body needed to pay to achieve all the positives she was starting to appreciate with a more appropriate intake.
If you can’t recognize the positives you have, you’re simply gonna be stuck.

Yes, this is extreme, but how’s this for appreciating the positives? This recent NY Times article describes a former fashion photographer who decided to try his luck at photographing a war zone. In the process, he became a triple amputee. Horrific. Yet inspiring. He describes the experience post attack, when he realizes that he still has his right arm—and his eyes. Rather than dwell on his misfortune as a triple amputee, this remarkable survivor relishes his potential to continue the work he feels so passionately about, and focuses on what he does have going for him. Truly remarkable.
And what does all this have to do with your weight concerns? Lots. Get a perspective on what you truly value. Put the focus on what is in place and where you are making progress. Don’t beat yourself up about what’s gone wrong, but come up with a plan for change. Thoughts have everything to do with recovery—from anorexia, bulimia, weight struggles, compulsive overeating. Oh, and of course entitling yourself to the necessary nourishment is key, too. Your thoughts will not be clear to allow a healthier perspective unless you are eating well.
What’s the real negative consequence of gaining less than 2 pounds given the benefits Anna achieved? Perhaps it has less to do with the snugness of her jeans, and more to do with something else. But I’ll leave that for the therapist I hope she’ll be seeing.


  1. This is a helpful reality check. At one point in my anorexia, my weight reached a plateau because my body had adjusted to the daily caloric intake I allowed myself. Instead of (rationally) thinking that perhaps I wasn't eating enough, I simply restricted more. Rather than valuing how I felt (irritable, cold, depressed), I valued the number on the scale. It's a difficult cycle to break; when you're malnourished you can barely think, never mind think logically, and nourishment is important for clearer thinking (which you don't realize when you're malnourished). Having an outside opinion (perhaps from a wonderful RD like you, Lori) is incredibly helpful in breaking away from self-destructive behaviors and placing more value on inner health, rather than outer appearance.

  2. This is a very interesting story. My first response is to naturally assume that this scenario wouldn't translate into my situation. Or that you have simply used a fictitious story to illustrate your point - but I know you well enough to know that this really will be a true story. And that someone's weight really did stabilize despite her increased intake. And more importantly her thoughts really were starting to quieten down.
    It must have taken a great amount of courage and trust in you for Anna to take that leap and increase her intake - I hope she continues. I'd love to hear another update of her progress at a later date.

  3. What an incredible story of getting the whole picture and understanding what was really happening to Anna. Anna was very brave to trust you, and do what you requested. I think you hit the nail on the head, Lori, and Anna benefited from your advice. Perhaps you even saved her life! I sincerely hope she continues to improve and get healthier. Thank you for sharing this with us. It helps us to take another look at our own lifestyles and evaluate our behavior, helping us to improve too.

  4. So I realize that this link is exactly relevant to this particular post however if you haven't seen this Lori you might find it interesting. A friend sent this to me and I am interested in your take on it.
    I'm not sure if you follow this blog but it has some interesting points. In that same vein though the author is not a professional just is sharing his personal experiences. Like all things on the internet it should be researched and discussed before implementing any of his "rules"