Saturday, August 25, 2012

Time for a Diaper Bag-A New Tool For Recovery

No more siblings for this fella!

No, no more babies in my future--unless I become a grandparent too early in my youth. "Two and through", I just overheard a woman say--I second that sentiment! And I've no need for carrying Depends--a diaper of sorts, for adults. This diaper bag is a bit different and it is as essential for me as for you, male and female alike. It knows no age limits--carry it if you're a teen or in your 60s, a single parent or a mom of little ones. It needs to be carried by you--for you--even if you've got no toddler in tow.

This diaper bag allows you to be in control. It holds the snacks you believe you don't need and don't feel you deserve--and it enables you to eat them whenever you need to. This helps you fuel your body any time, any where--whenever you need to. Intuitive eating becomes possible when you can recognize your hunger and are well-prepared to respond to it. It provides you with the essential pick me up to prevent you from dropping down to an unhealthy state physically--and psychologically. Simply placing your snacks into your sack is a very tangible reminder that you need to eat. But it's just the first step.

Choose a bag size that fits your needs!
"Why eat when I can put it off and wait until my next meal?", you might think. Because if you struggle with out of control eating, eating an adequate snack allows greater control at your next meal. It energizes you to help you think straight. It takes the edge off. It keeps you from dipping too low. It helps keep your thoughts straight and prevents major drops if blood sugar and the lightheadedness which follows.
Your diaper bag is a very visual reminder of  your needs. You tote it around as a reminder that you must eat. Yes, even you who are higher weight or BMI, or of normal weight but simply dissatisfied with your body; you, too, need to be burdened by the bag.

Your diaper bag validates that you need to nourish yourself. Would a mother of toddlers dare to leave the house without this tote? Would she leave behind the infant formula or the animal crackers to appease her child's hunger, to honor it, to respect it? Of course not. So why not consider your needs and provide for your own nourishment?

Yes, it's okay to include a portion of your favorites!
Your nourishment isn't limited to the snacks the bag contains. Your diaper bag may include a book or an ipod, or some other distraction from your own thoughts. Perhaps it even has a journal for you to express yourself and air your thoughts, your feeling, your fears.

Carrying your diaper bag is a way of saying you're important and that self care is a high priority, that your needs are as important as those of your children's or the parents you may care for, or your best friend.

Small, but holds the essentials for men or women.
But it's only as good as what you do with it. You've got to make the effort to dip into the bag and actually eat what you've carried. You've got to pull out the coping tools such as the music player or meditation download, and you need to listen to it. You need to change it's appearance and its contents from time to time, so it's harder to ignore it, to forget why you carry it.

Design your own bag or use a simple sack of your choice. But make it all about your needs with the tools to meet them. I know, I know, it's not going to be easy. You've never thought of yourself as number one on the priority list. But it's time for change, isn't it? And if you can't seem to get past doing it for yourself, consider starting by doing it for the sake of those loved ones you care about--your kids, your partner, your parents, your friends.

Please tell us what you've put in your bag. Or how you've created one and used it. See this post for inspiration

Thanks, in advance, for sharing.

Friday, August 17, 2012

“Do or Do Not. There Is No Try.” Think Again, Yoda.

I support mindfully eating these "black and whites" but not the
thinking by the same name.
She comforts with food, rewards herself with food, punishes herself with food. She eats what's served to her by her spouse—even when it's too much and she feels uncomfortably full. Nightly ice cream and dessert are the norm—on the couch, distractedly, while watching TV, simply to numb, barely tasted, never enjoyed. She's a self-described emotional overeater, also treated for depression. And she reports gaining over 20 pounds the past few months.
And then the work began.

Sharon is a 45 year old who first came to see me at the end of May, for weight and blood pressure management. She's had a range of medical issues including cancer, but her greatest distress was her weight and unhealthy eating habits. Her main goal was to lose weight from her high BMI, and to learn to eat healthier. She also suffered from diarrhea, the consequence of a medical procedure, making it more challenging to head outdoors to exercise; or, to even want to exercise at all, for that matter. 

Be positive. Really?

Do you emphasize the half or the full?

One of the recent goals we've been working on has been to identify some positive changes she has experienced between our visits. I must admit—this is where she really fails! Getting Sharon to credit herself for anything positive is like pulling teeth. 

She keeps my expectations low—she prepares me to expect little from her, with her self-deprecating words. And with her persistent focus on what's not in place, I’m forced to reality check and remind myself just how well she is progressing. Here’s a window into our session:

I praise her for beginning the process of contemplating exercise, by exploring the on demand cable exercise programs—first, just watching them, then moving to participate for the half hour session. But she replies, “yes, but I only did it once.”

I acknowledge that she got back to the gym after a long hiatus, and what does she respond? "I got there only three times”. “That’s three times more than last week!” I add. She rebuts "but I only did the bike", as if the 45 minutes on this piece of equipment didn’t even count, because, as she stated, "I planned to go more and I didn't". 

I remind her how she has been diligently recording her food, identifying her hunger and her eating triggers. But she replies “but I didn’t get to record for a couple of days”.

I noted how impressively she followed through with bringing lunches from home, but she admitted that she didn’t eat them every day—because it wasn’t always what she felt like eating.
“Wow, you’re paying attention to how things taste, to what you feel like eating—that is progress!” And she admitted defeat. She was being too hard on herself; it’s something she’s long struggled with. She began to describe how thirty plus years ago, when she was only a teen, she heard something she has never let go of. It was this: 

“Do or Do Not. There Is No Try.” The perfect philosophy

Precontemplation: Not even ready to consider thinking about
going for a walk.
—for a black and white thinker, that is. On or off, good or bad, dieting, or binging—hardly an approach I can endorse. Instead, I educated her about Prochaska’s Stages of Change Model, a theory about the process of changing behavior, which is much more nuanced than that of Yoda. This model acknowledges that behavior change is an ongoing process, and that there needs to be appropriate pairing of recommendations to one’s readiness to shift where they are at. So for Sharon, a non exerciser, her move to find an exercise program on TV, and then to choose to watch it to get more comfortable with the idea, was an absolutely appropriate shift—much more so than if I had instructed her to go from zero to 60 minutes per day of running several times per week. That would have set her up for absolute failure. Or if I had suggested she had to prepare a lunch from home every day—and eat it—when she hadn’t even made shopping a priority.

Prochaska’s Stages of Change model describes 6 stages that individuals go through—not necessarily in a straight line or in one direction. They may even hover in one stage for a while—until they are ready to move on. The stages include pre-contemplation, contemplation, preparation, action, maintenance, and relapse. Yes, there’s even a relapse. This guy knew what he was doing, didn’t he? He spent a great deal of time studying smokers and drinkers and others as they tried to shift toward healthier behaviors. And the resulting model has informed us about what works for clients dealing with changing their eating and activity—as well as their expectations for change.

See where this is going?

Contemplation stage: "I'm thinking about getting up
to eat my dinner, but I'm just not ready yet."
If Sharon keeps expecting to change by leaps and bounds when she is just contemplating action, she will continue to be disappointed. And if she thinks that slips don’t happen—that relapse has no place—then she is equally wrong. But if she can more compassionately acknowledge that there is a process going on and that action is only one visible step in that process—then she will have success. Setting unrealistic goals is a self-fulfilling prophecy. Yes, you will be a failure if you set yourself up for failure.

Back to Yoda.

I’ll admit it—I’ve never been a Star Wars fan. And this quote Sharon shared does nothing to endear me to Yoda. But then I watched this other movie clip that went beyond that short, all-or-nothing statement. 

Forget what you learned.

Yes, with all the misinformation and craziness out there, this one I can endorse! It’s funny that it’s stated in the same frame as the more well-known quote above. And, I suspect, it simply gets missed.

Yes, Sharon, it’s time to forget the diet rules and the self-destructive thinking. It’s time to forget the failures you’ve come to expect and to hold on to the hope.

And I do expect to see a list of positives from you—at least when you are ready to accept that you are truly doing well.

Friday, August 10, 2012

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!