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Tuesday, August 30, 2011

Powerless?

I’m typing this from my office computer, where I still retain power after Hurricane Irene.

But last night I dreamed that I lost the power to speak. I could hear and listen, I could see, ‘though I have no knowledge of taste (as I didn’t eat anything during this brief period). I was in unidentifiable, unfamiliar surroundings, but somehow did not feel uneasy. Even experiencing this loss felt familiar, like when I temporarily lost sensation in my left arm, due to MS, and was unable to dress myself. Powerless.

In the morning, the windows were open, and I felt the cool, dry air across my skin. I saw the beam of dust particles shimmering in the morning sunlight. And I heard my voice as I said goodbye to my husband, as he departed for work. Ahhh, all was well—my body was fully functioning.

The electric and telephone, however, remained non-functional. But all was not lost. I could drive to work, and get in touch with the world from there.

Even in the absence of modern life’s distractions—cut off from the Twitter tweets, the endless email, and the more pleasant indulgences of good music and movies, I had had to simply be. I had to give serious thought about what to grab from the fridge (I needed to act quickly to prevent the cold air from exiting). And I needed to sit and eat mindfully, by daylight or by candle.

My mind was freed for creative thought. Yes, 3 posts were written (by hand, I’ll add) yesterday.

Don’t get me wrong. Losing power has its downsides. I was hoping to bake those rugelach (http://dropitandeat.blogspot.com/2010/12/minding-your-eating-managing-your.html) to send to my son, but couldn’t without a working oven. And when the hot water that remained in the water tank was all gone, I wouldn’t be rejoicing in the cold shower. And for some, the consequences, no doubt were more dire.

But sometimes these little reminders are so valuable to remind us of what power we really do have. My body still functioned, even though the electric was dead. My brain filled the void, when it had free reign to create. There was much I could do, and enjoy, in spite of the temporary loss of power. And just doing nothing, an option I never consider, was now possible; imagine giving yourself permission to do absolutely nothing!

Some things are out of our hands, like the electrical service into my home. But sometimes we simply need to take charge of our situation—to find creative solutions, to appreciate what we do have that works, and to shift perspective.

And, we need to appreciate that we always have the power to speak and advocate for ourselves.

No, we’re not powerless at all.

Thursday, August 25, 2011

So You REALLY Think I Can Keep This Up?



The verdict is still out, but I’d bet on Sally’s success. Over the past 12 months, this formerly mid-200-pound woman has lost 54 pounds, since we began our work together. But she’s done that before, without my help. In fact, she’s lost weight faster in the past, each of the past three times, even. These previous diets yielded a weight loss of 70 pounds, I’m told. Yes, in each of her decades of life, she managed to lose, and then to regain, approximately 70 pounds.

Back then, after about a year, she’d slip into old habits. She’d get bored with her eating routine, overeat, and then feel like a failure, letting the “What the heck effect” take over.  So I probed Sally, given her one-year anniversary working with me, to summarize what has changed, why this time is different. And here’s what I heard.


Clothes

Of course you’d expect her clothing size to change, with a more than 50-pound weight loss. But this time, she discarded her “fat clothes”. No sense holding on to things you hope never to need. But equally important, she tossed her unrealistically small sized garments. Sure, they were outdated. But she also recognized the importance of setting realistic goals, and living in the present, and appreciating her self and her body where it’s at, even as she continues to make changes. Sally has purchased a few new outfits that she feels good wearing. But she hopes to purchase some new items as she continues her progress. One step at a time.


Guilt

It’s hard to release yourself from feeling guilty after eating “treats”, particularly if you lived most of your years believing that you were not entitled to eat them. Overweight? You might believe you don’t deserve to eat ice cream; the stares alone, from strangers even, might convince you of that. Even if your weight were never out of range, you might have absorbed messages of caution around foods you’d love to indulge in. So perhaps indulgences occurred when your watchful parents or spouse or siblings weren’t around.

Sally stated that while she did have sweets before, while losing weight, she would always be thinking that she should be having a carrot instead. Hmmm, cake or carrot, cake, or carrot.  Which would you choose? Now, she includes sweets, as part of a healthy diet, and with a lot less guilt. She doesn’t limit them to when she is alone, or driving, or eating mindlessly. Now she can put a dessert on a plate, sit down with it, with or without others present, and enjoy it. Really enjoy it. Now she bakes, sometimes modifying a recipe, while still allowing for a satisfying and delicious product. She no longer awaits vacations to include the foods she enjoys. Instead, she chooses what she likes—but eats in portions more appropriate for her body’s need.

Doing it for Sally

Sally always had to be accountable when in a diet program. But this time, while she may still care to be a good student and do well at our visits, something major has shifted. “I’m doing it for myself now”, she shared. More than needing to show me a weight loss, Sally is determined to maintain her progress, which impacts how she feels—her ability to move her body, to feel comfortable after a meal, to go clothes shopping.

Thoughts and Actions

With past weight loss there was the before and the after, weigh in periods. Hours prior to that stressful moment, you know how it goes. Those struggling with overweight restrict more, to save face at their weigh in; and those of you struggling to gain, may push out of your comfort zone for those few remaining hours or days before the weigh in. And unfortunately, the weigh in lady would reward you simply for the loss of weight (think Weight Watchers); and similarly, those nurses or doctors inexperienced with eating disorders would reward you for your gain.

No one explored how the weight change occurred, whether through healthy or unhealthy measures; few bothered to ask. Rarely did anyone inquire whether you were struggling with the recent changes, and whether they were sustainable. Progress was measured strictly in pounds lost or gained. Some things, regrettably, never change. You might have changed your actions, but not your thoughts, making the eating behaviors less likely to be lasting changes. 

Unlike many medical professionals and weight loss program leaders, Sally now does know better. She can appreciate that her weight is only one small part of who she is, and how she is doing. She knows that her thoughts and eating behaviors are what’s most important. They built the foundation to support her progress.
In the past, losing weight required pain and suffering—at least as I heard it described by Sally and many others. “Isn’t going to bed hungry a good thing?” a teen patient recently inquired. That’s what she was taught. That was the gold standard. So why should she think otherwise?

At our most recent visit, I heard something I don’t always hear; Sally described how proud she was of how she handled a recent slip. Rather than focusing on what she failed to do, I got to hear the other side, the side that I am usually working hard to get patients to acknowledge. And without any prompting, Sally shared her accomplishment, pulling herself back up after a recent slip. Instead of dwelling on her excessive dinner portion when socializing with friends, and the seemingly unnecessary dessert which followed, in spite of not being hungry, she didn’t beat herself up, as she had for decades past. She described how she was able to put this eating in perspective, realizing she is only human, and move on, which she did just beautifully.

Slipping is not the problem, when it comes to changes in eating behaviors. It’s the ability to shift gears, to see the positive, and to appreciate your ability to continue to move forward. And to learn from our mistakes.

Yes, that’s why I’ll put money on Sally’s success.

Wednesday, August 17, 2011

Diet Rules: In Response to the Diet Pill Disaster

Imagine the disappointment!
Didn’t you want to believe it? “Finally, a diet pill I can endorse! Check out this link”, with yours truly as the sender. Yes, my Twitter account was hacked, or hijacked, as they say. Someone managed to get into my account dispensing a bunch of tweets as if they had come from me. And this was just one of the creative gems they sent. 

Now, if you have been reading Drop It And Eat for a while, I suspect you were a bit skeptical. And hopefully, you even had the wisdom to stop yourself from clicking and perpetuating the myth.

Maybe you even believed it, but knew it would be trouble, a slippery slope, getting into diet pills. You knew it was too good to be true.
Perhaps you feel addicted to hope—hope for a solution to your daily eating struggle—for assistance with binge eating, obesity, or body dissatisfaction, in spite of a normal body size. Yes, at times a pill may seem like the only answer.

But, dear readers, there are no pills, no magic bullets. Never mind meds; there is no quick fix, no special diet to cure our ills, I’m so sorry to say.

How ironic that this violation of my name and of my Followers came when I was vacationing, reveling in the beauty of Acadia National Park with its stunning vistas, by foot and by cycle. And while enjoying the fabulous bakeries, the flavorful oils and vinegars and local restaurant cuisine. And no, I didn’t enjoy the muffins and scones solely on my active days when I was burning it off; I even enjoyed them at breakfast, before the almost 6 hour drive home, sitting on my butt.

How does this fit with good health, you may be wondering? What kind of dietitian are you, endorsing pastries and other indulgences?
I often find myself defending my approach to eating and to weight management and disease prevention to others—to strangers wondering why I’m photographing their lovely loaves, to friends who question my aversion to seemingly healthy fat free foods, even to patients and Followers who wonder if I really practice what I preach. So I thought I’d share a few thoughts following my 5-day vacation in Maine.


Yes, it's all about balance.
A truly healthy diet:



  • is a way of eating that promotes both physical and psychological wellbeing.

  • indulges the senses with the pleasure of quality—flavors, textures, smells, experiences.

  • involves selecting foods that may be rich, such as the fabulous baked goods from Little Notch Bakery—and enjoying them when hungry (but not so hungry that you can’t savor the flavors and enjoy the food).

  • allows for pastries, and chocolates, and cheeses as snacks or as part of a meal, not as a reward for eating a “healthy” meal. Tuesday, it meant blueberry pie mid-morning, after a lovely bike ride. Wednesday, it included blueberry scones (yes, wild Maine blueberries are in season), a chocolate croissant and delectable carrot muffins at breakfast. Monday, it meant a shared apple tartlet as an afternoon snack.

    Thanks for helping to make my vacation fabulous! 
  • means eating just as much as we need, and trusting that we could always get to the bakery again for another great purchase. Yes, I hit up Little Notch Bakery three times over my 5-day vacation in Acadia—once in each area of the island.

  • also means bypassing fat free spreads on my toast—because I don’t like their taste—and dipping my sourdough, white flour bread in olive oil instead. It entails selecting oils with intense aromas, fabulous flavors and nutritional benefits, like those found at Fiore in Bar Harbor.

  • means choosing a lighter entrĂ©e, at times, because I prefer a less dense dinner after my day of snacking. So it was poached salmon (still a high fat fish, I might add), but in a lighter prep than the other options available.

  • means having what I really want, but eating only as much as I truly need. I was in charge of cutting up the baked goods, served on a platter in bite size pieces for 5 of us to share.

I chose the middle one. What a crust!
I’m not kvetching today, post vacation, about my week’s intake; I enjoyed every minute of it. I did not need to go crazy with my eating simply because I was on vacation, because quite frankly, eating like this is totally normal for me. I eat this way all the time. I buy great breads weekly (if I haven’t made my own with the help of a bread machine), I enjoy delicious cheeses (but am mindful of the portions) and I have my share of baked goods (and clearly you’ve already learned of my love of chocolate!). Really. Just ask my friends and family. But I pass on anything sub par, because I truly want to enjoy what I put in my mouth. I take my food pretty seriously.

Tags from a line of women's clothing. Great, no?
Does this eating approach seem foreign to you? Trust me, there is still hope for change. It takes time to learn that you are allowed to enjoy good food, great tasting, quality food. Yes, whether you are overweight, normal weight or underweight you are entitled to the pleasure of eating whatever you would like. Just be sure to eat the amount that’s right for your body.


That is a truly healthy diet.

Wednesday, August 10, 2011

Hope or Despair? Only You Can Decide. But I Chose Hope.

“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us…” 
Charles Dickens
Taken after surviving my 9th annual 150+ mile bike ride for MS
I barely understood A Tale of Two Cities when I read it as a young teen. Yet somewhere in my memory the very first sentence has stuck.
Ten years ago I experienced 2 years of Hell. The list of craziness included, but I can assure you was not limited to, the following:
My father was diagnosed with lung cancer. He was a non-smoker with no environmental or genetic risk factors that we know of. He died 14 months later, at the age of 68.
My dog died the day after my dad’s funeral.
I experienced double vision leading to a diagnosis of MS 4 months after this symptom.
My husband lost his job and was unemployed for the better part of a year.
I hired a part time secretary who sued me after 6 weeks for a reported slip and fall; suing was apparently her second career.
Does it get more fabulous than this? Provence!
My then 13-year-old son went in for routine elective adenoid surgery, under general anesthesia. He was supposed to wake up after 40 minutes. Seven hours later after being hooked up to a breathing machine he awoke. We learned he had a rare enzyme deficiency preventing the breakdown of the anesthetic.
There is more, really, but I’ll stop here.
Recently, a patient of mine, having heard this list, asked me how I managed during that time. I thought it a strange question at first, especially as her life, to me, seems to include more trauma than any one person can be dealt, and she has done exceptionally well in her recovery from anorexia and bulimia, the very conditions that in many ways helped numb her pain.
The answer is that I feel rather grateful, perhaps because I have chosen to identify all the ways I have been fortunate. Yes, I have MS, but I function better than anyone might imagine, given this condition. The unemployment? I was fortunate that I could increase my hours and grow my business, so we were not in financial distress. And my kids enjoyed having my husband around after school then. My dog of 16 years lived a long, good life.  My father didn’t suffer long. 


And the blessing in disguise was with learning of my son’s pseudocholinesterase deficiency. This enzyme has only a couple of functions—to break down this anesthetic and to break down cocaine. In other words, had my son of middle school age decided to experiment at some time in his life with, let’s say, cocaine (not a terribly crazy concept), we learned he would have died of cardiac arrest. So 7 hours on a breathing machine resulted in the advance warning that perhaps saved a life—if he had ever chosen to try cocaine and we had not chosen to have this elected procedure. Yes, I was rejoicing.

Chagall painting, ceiling of the Paris opera
I doubt that I’d be able to find the strength to survive the trauma of the 3-limbed amputee, mentioned in my recent post. And I certainly don’t share my history for the sake of getting empathy or pity. Truth is, many of you have survived worse situations. 
But perhaps you’ve done so using your old friend—food, or eating disorder behaviors. And I must confess—those do work—but only temporarily. Eating large quantities of food can make you feel drugged, detached, numb. It can allow you to feel that you’re in charge—that you can eat—and do—whatever you choose. Except that then you’re left feeling awful. You can be healthy and still eat whatever you like to eat (don’t you believe that by now after 90 or so blog posts?). You just can’t eat without tuning in to your body and its need, your hunger.
Alternatively, you can surely restrict your food intake, or get rid of your food, can’t you? Don’t get me wrong—I’m not recommending this, of course! But when things get tough it can be very appealing to stop feeling, to lose the sensations of hunger and of emotions. It’s like disappearing, right?
But there’s a price you pay for coping this way. You miss out on life, on relationships, on connections with people. You place yourself at risk. You cause yourself harm physically, emotionally, psychologically. You stay stuck in an unhappy cycle. You put your life on hold. Helpful, perhaps, but just for a moment.
This is what I found after a long day at the office!
Life isn’t always easy—I’ll be the first to agree. But perhaps you can shift your perspective? Or maybe utilize other coping skills besides the old standbys.
Linda related the following after her MD visit last week:
So it has apparently been 5 years since my last physical with Dr. D. I spent the morning with unwanted anxiety for whatever reason (I just hate going to the doctor!).  I was swept in from the waiting room and within a flash moment I found myself standing on the scale.  Surprisingly, when I saw the nurse begin moving that thingy more and more to the right, I instinctively looked away (go Linda!)
All was well, right?
Nurse Sandy then takes me into the little room and proceeds with the usual routine questions.  She told me how much better I seem, that we all go through "phases"... uh, phases?  And then, with utmost enthusiasm, proclaims loudly "WOW, your weight is the HIGHEST I've ever seen it!!!!"
What. the. hell.
I never intended on going in discussing any weight issues, I even looked away on the scale.  This was a physical, damn it.

So, Dr. D asked me about my weight and has it been stable.  Yup, I told her.  Then I mustered all the courage I had in me to tell her what Nurse Sandy said.  Her response?  Laughter.  Yes, LAUGHTER!
This was not supposed to be funny.  I do not see the humor in this.

Instead of faxing the blood pressures and weight, she wrote it down and handed it to me (so much for the strength of NOT LOOKING AT THE NUMBERS WHILE ON THE SCALE!).  Can doctors and nurses be THAT OBLIVIOUS???

I wish I could undo the damage from all the thoughtless comments you hear.
While I can’t, believe it or not, you can. You could choose to accept the distortion your mind bends it into, or you can fight. Yes, you can counter those thoughts with some healthier reality checks, about what your healthy eating and behaviors are getting you.

This can be a season of hope, or of despair; you can appreciate that you survived another season intact, and are now that much stronger to move forward. Really, only you can decide.






Saturday, August 6, 2011

Diet Solution to Weight Gain Epidemic Revealed!

An RD’s lessons from the Harvard Study


Thanks to Right Angle Tutors for use of this photo


Harvard researchers just discovered the cure to the so-called obesity epidemic. Or so you may think from their press release June 22, 2011 and from the media blitz that followed Effect of Lifestyle On Weight Gain, published in the NEJM. Powerful statements linking specific foods and food categories with resulting weight change emerged. And any progress we had made as a society toward a balanced approach to eating, to a move away from rigid food rules, crazy diets, and food paranoia was destroyed. They concluded the following:

  • There are ‘good’ foods and there are ‘bad’ foods 
  • Focusing on specific foods to avoid versus counting total calories is the way to consume less 
  • Changing carbohydrate type is the answer for weight control, by eating less sugars and other sweets
  • Fruits, vegetables, whole grains, nuts and yogurt prevent long term weight gain
  • Do the fruit and nuts get to count as a fruit serving in my chocolate?
  • Potato chips, French fries, boiled, baked, mashed potato, sweetened soda, and meats are associated with the obesity epidemic

The study results and conclusions were further echoed throughout the media. Even Jane Brody, from the NY Times, wrote an article entitled “Still Counting Calories? Your Weight-Loss Plan May be Outdated”, where she states that it is no surprise that French fries led the list of foods that contributed to the greatest weight gain. Yet the Harvard study authors go out of their way to emphasize that the results do not suggest it’s about how many calories per French fry (its “caloric density” or calories per serving)—so why draw the conclusion that of course (high calorie) French fries would be high on the list for causing weight gain?

The authors do acknowledge that, “weight stability requires a balance between calories consumed and calories expended…” (although the media fails to highlight this little detail). Yes, they still agree that weight management comes down to calories. But what they hope to define are the foods which are associated with our over consuming calories, along with possible explanations.

What’s it all about?

Harvard School of Public Health evaluated three separate studies to see how changes in our eating and in lifestyle factors impact our weight gain over time. Researchers evaluated self-reported changes in lifestyle factors (cigarette smoking, exercise, alcohol consumption) in addition to changes in individual foods consumed. They looked at three large groups of participants over a 12-20 year period, reassessing every 4 years. They then drew some conclusions and released them in a Press Release and a professional journal article.

Because weight gain creeps up on us (or at least in this study population of non-obese individuals), the authors suggest it is more difficult to know what’s contributing to weight gain, which averaged 16.8 pounds over a 20-year study period. And so they undertook this colossal venture to find us the answers. Well, at least they tried to.

Before I share my reaction to the studies’ results, conclusions and media frenzy, let me state that I have no financial interest in the National Potato Growers Association (is there one, even?).  Or, I might add, with Coca Cola and PepsiCo. But I do have a vested interest in not propagating diet myths. And it is this fear of public misinformation that drives me to invest the time reading the full research article (all 13 pages), which I suspect many of the popular press’ journalists failed to do.

My conclusions on the Harvard study

Servings

Can you guess how much ice cream I ate? And how much I had
from the container before acknowledging I was eating?
Twenty-five years counseling patients and I can assure you that most people are not very adept at accurately assessing their portions. Sure, we can accurately report how many fruits we consumed, but how many chips? Or how much mashed potato? And I’d bet my serving of French fries differs from yours! Ask a dozen different people and you’ll undoubtedly find there’s a tendency to underestimate portions.

That is, unless you are underweight or anorexic; these populations tend to overestimate portions. And beverages are most notoriously challenging for us to estimate (unless of course they are in a marked can). When I have people measure their drinking glasses at home to determine just how much soda they drink, they are shocked. What they assume to be 8 ounces is typically double that amount.

Prepackaged food items and individual units will naturally be more accurately evaluated—individual yogurt cartons and fruits, for instance. Even grains that we tend to measure may be easier to assess, such as oatmeal, rice and cooked whole grains. These very foods that we are more likely to accurately assess our portions of, tend to be lower in calories. Without a doubt, this could distort the study's findings.

Sometimes a potato isn’t just a potato

How do you make mashed potatoes? I’ve heard of recipes that include a whole stick of butter, and some with only half a stick; there are those that add heavy cream and those that add a splash of milk. What’s my point? Did the researchers have information about the contents of these mashed, boiled, and baked potatoes, before concluding that it was the “refined carbohydrate” that was the culprit here leading to weight gain? The study emphasizes that it’s not about calories per serving. But here’s the problem: the serving size is not measured in the study, and we simply can’t make any conclusions about caloric density, if we don‘t even know the content, never mind the quantity, of what’s really in each portion!

Food selection may be a marker for more conscientious eaters

A colleague once said “if she’s eating rice cakes for breakfast than she’s not too serious about gaining weight”. Point well taken. Those who take the time to cook whole grains, such as brown rice, quinoa and buckwheat, are not likely to be the frequent diners at McDonald’s. Perhaps we could say the same for yogurt and low fat dairy eaters. Does anyone start drinking skim milk because of the taste? Eating these foods may simply identify those people who care about their health and the direction of their weight. Weight change may have nothing to do with the individual food itself.

Lifestyle changes they should have assessed

In their next study perhaps they should look at variables that truly impact our weight. Here are a few questions for their next questionnaire:

  • Do you eat your potato chips right out of the bag, or do you measure them? 
  • Do you have a second and third portion immediately or do you wait to see if you are still hungry? And if you wait, how long do you wait for? 
  • Do you reach for food when you are hungry, when your body needs fuel? Or do you find yourself reacting to a triggering conversation with a loved one with some sweets or chips? 
  • Do you eat the chips mindfully at the table, without distraction, or are they consumed while driving, watching TV or at the computer screen?

Trust me--these cause weight gain. That is, when you eat them
right from the bag without attention to portion!
These behaviors have everything to do with our weight change. We are less accurate assessing our food intake when distracted. And our mindfulness about hunger and satiety likely gets lost as well. Not eating with all our senses can make us feel like we haven’t yet had our needs met, and so we keep seeking, looking for more food to eat.

Secrets hidden in the Study that nobody advertised

Meat

For all of you Zone Diet and Atkins followers believing that more protein is good and carbs are bad, think again. This study showed that over time, meats, both processed and unprocessed types, were associated with weight gain. So if you are still stuck in the need for more protein for weight management, heed the warning. But remember, this is based on self-reported portions, a potential flaw in this study!

Dairy

So it’s notable to me that yogurt and low fat dairy products as a category (adjusted by age) significantly link with decreasing weight over time. Why notable? Because Walter Willett, one of the study authors, has never been fond of supporting milk consumption. In previous presentations promoting his Mediterranean Oldways Diet Pyramid, he spoke strongly against inclusion of milk and milk products. 


Never shy to ask my questions at conferences, I pressed him on this subject some time ago. His response fell short. He emphasized that some have intolerances to milk, and generalized about milk’s high fat content. And what about low and non-fat diary? And what about Lactaid milk for the intolerant? The majority of the population does not have a milk allergy, so why such an omission of dairy for the general healthy population? Let’s acknowledge that low fat dairy and yogurt are valuable, based on this study’s data.

Diet Soda

There was no meaningful association between diet soda intake and weight change over time. Drinking it isn’t likely to cause weight loss. And contrary to previous media hype, diet soda won’t result in increasing weight either. But it certainly doesn’t add anything nutritionally to your intake. And, consuming it may displace some milk, which definitely does have its merits.

Exercise

Exercise itself didn’t link with weight change, but a change in exercise level did. One more time?

If you’ve been doing the same amount and intensity level of physical activity over years, what happens? Well, think back to when you first started to exercise. It was quite a workout. But after doing it consistently for a while, it got easier. And with greater ease, you weren’t working as hard. And when you weren’t working as hard, you were burning fewer calories. And if you were using up fewer calories, over time, even if your eating remained the same, you would gradually gain weight. For the under eaters and over exercisers among you, let me remind you that you are not at any advantage if you continue to restrict you calories, relative to your need, while exercising. You, too, will suffer, ultimately breaking down the very muscle you aim to increase, and slowing your metabolic rate.

Still reading? Here's the take home message!

So what have the Harvard researchers really taught us? To be critical readers of the media, and of research, for starters. To recognize that studies like these are merely looking at associations, between weight change and changes in foods, and in lifestyle factors. We still don’t know why the link between potato products and weight gain. Maybe if we controlled for serving sizes and preparations we’d see a link with caloric density and weight gain. But maybe not.
Is it me, or do you see a smiley face in my husband's sushi?


I support inclusion of whole grains, fruits and vegetables and yogurt in our diets. But I also know that there’s a place for white, refined carbohydrate sources such as pasta, rice and low fiber French toast. And do I need to emphasize there’s a place for chocolate?


It may be, with more information, we will find some valuable links about foods and their impact on our fullness, affecting our weight over time. But I’d be a lot more cautious, and the media ought to be too, about labeling foods as bad versus good, perpetuating the myth information that causes us to stress eat.