Tuesday, October 30, 2012

Record Keeping to Change Your Perspective--And Your Eating

I'd LOVE to eat your food record, but I'm really not that hungry!
“My dog ate my food record.” “Oh, I left it at work.” “I know what I eat, I don’t need to write it down.” And finally, the very honest and most insightful comment I’ve heard, “I just couldn’t bring myself to do it. Because if I don't write it down, then maybe it didn't happen." This, perhaps, sums up why, in spite of knowing that food record keeping is recommended, it is often not done. But of course you know I can't just let it go at that! 

First, let me clarify. A food record, generally speaking, is a journal of what you ate including the quantity of food, and when you ate it. A valuable food record also includes some other critical information—your perceived hunger when you begin eating, your thoughts and your feelings—both physical and emotional. Noting where you ate is also quite useful, as we’ll discuss in a bit. Oh, and if food was consumed but eating disorder behaviors followed, that should be noted as well.

And calories? In my view, these have no place in your food record. “But don’t they count and impact my weight?” Absolutely. Yet counting them is not my idea of a healthy way to change your relationship with food and normalize your weight. We are trying to get out of your head—away from your over-analyzing what's acceptable to eat—and into your body, aware of its signals to eat and to stop eating. A goal of record keeping is to help you learn to rely on these signals so you can trust your body—I know you're not there yet—but this is a great way to start.

Why all the fuss about keeping a food record? Why do Dietitians like me recommend it and why do so many struggle against doing it? 

Accountability, compassion and shifting perspective

If you know that someone is going to be looking, you certainly think twice about what you eat. Now you may think that you already are painfully aware of what others think about your eating. And that recording only makes you obsess more about what you're eating. But writing it down in the way described below does something different. It allows you not to hyper focus on the meal you overate or the fact that you ate when you think you didn't need to. Rather it allows you to look at the bigger picture. Truthfully, this is where having another set of experienced eyes makes all the difference. 

Just saw this in NYC--can you imagine?!
Most of my clients find that my perspective on their eating  helps them to be less critical of their eating. They see that their overeating followed too long a span of time, or that their recurring hunger makes perfect sense, given the large volume of food devoid of adequate calories they were consuming.

Recording allows you to distinguish between physical hunger vs other eating triggers. Recognizing that you weren't hungry helps you to realize that something else contributed to your eating. Seeing that you were hungry but didn't eat, forces you to ask yourself what your intentions of restricting were.

Recording the food you've eaten also takes it out of the closet, so to speak. It legalizes eating. And hearing someone like a Dietitian react not in the way you'd expect—rather, acknowledging how delicious the brownie might have been, or that you only had 3 versus the whole package of cookies, or that you seemed to have needed to eat when you did and it was great that you entitled yourself to do so—get the idea? These messages help to counter the negative assumptions you have about your eating, and may help you feel more justified to eat in a balanced way. No, not the way you think you should be eating—full of restrictions and deprivation, but a more human way of enjoying food.

Would you sleep or do other things on your kitchen table?
(Ok, you don't need to answer that.)
Identifying the location you eat in is also quite important. Do you only eat when driving—where no one can see—not even you? Do you do a lot of eating in your bedroom late at night? Must you eat your food alone, out of the watchful eye of family members?

And what do you choose to eat? Do you limited your selection to diet foods, light in calories and in satisfaction? Do you include a range of nutrients including fats, carbohydrate and protein—or tend to shy away from one or more of these groups? Do you allow yourself to really eat what you like—not just to eat it, but to see it and take it in with all your senses?

Sure, there are some of you that feel so overwhelmed that recording feels like just another chore—which it is. And some of you feel you just can't get organized to remember to write things down. But largely most readers may prefer not to know—not to see it, not to acknowledge what you've eaten—at least on the days you didn't think you ate as you should have—and so you don't record.

If you're serious about shifting your relationship with food, get yourself a notebook you can keep in the kitchen. Or do you live with your smart phone at your side? Check out a fabulous free app, Recovery Record, which leaves off the nutrition details common to so many apps, but appropriately includes the thoughts, feelings and behaviors that so influence your eating, and how you feel about yourself. Then get started. And be sure to share this info with a professional experienced in this area—not the gym trainer who may have a slightly different way of seeing things.

And do start by moving your scale out of site. It is much more challenging to begin to trust yourself when you are being jerked around by that object on your bathroom or bedroom floor constantly.

Thoughts? Comments? I'd love to hear from you.

Thursday, October 18, 2012

What’s the Point? I’ve Already Blown It. Breaking the Cycle of Restrictive & Binge Eating.

What bothered Stacey most was the binging. Sure, the restrictive eating made her feel lightheaded and made it difficult to function. And yes, she was tired—but that was to be expected—it was what she was used to. The preoccupation with her weight, her eating, her food rules—that was all she knew. But then the binges soon followed, along with the need to purge and as this increased in frequency, she began to panic. Which brought her to seek my help.
We began with a behavior chain—a mapping of the sequence of events that Stacey experiences, the link between her thoughts, feelings and actions, which keep her stuck in her disorder. It shows how one link in the chain leads to the next, then the next, to keep the cycle going.

They have no idea how she's suffering.
Her pattern began, like it does for many of you, with deprivation—or simply not eating enough. She often fools herself into thinking that she is having enough—eating regularly, yet consuming insubstantial amounts or very low cal items; or limiting her intake because of not feeling hungry—perhaps because of the large volume of water and coffee she relied on to take the edge off. 

Maybe it seems justified—I mean, she did binge the night before—so it seemed reasonable to her to "get back on track" with her diet mentality. And sometimes even her anxiety makes it challenging to notice her hunger and rely on it. At this point, she simply doesn’t trust her body or herself.

Next, she tends to get quite hungry. Sometimes she actually allows herself to eat enough—knowing she needs the fuel—while other times she overeats. But when she does eat a reasonable amount, she feels so guilty and not entitled to it that she later attempts to restrict.

Patterns can be nice, but not this pattern she's
stuck in.
But once Stacey crosses the line, guess what? She figures “why bother?” and so initially she decides to continue to overeat, thinking she’d already blown it. This leads her to feel disgusted with herself and to lose hope. She continues this cycle for a while until much damage is done—to her intake, to her mood, and to her sense of self-worth. Eventually this leads her, once again, to restricting her intake—to make up for the damage from the day before, to punish herself, to “get on track and take control”.

The scale compounds the problem. Focusing on the number prevents her (and you) from really looking at the problem behaviors. Your weight's climbing? This only increases your panic and impulse behavior to try to seize control--without thinking rationally about what your body truly needs. Your weight’s stable? Perhaps you minimize how damaging your thoughts and behaviors have become, and simply accept them as normal. No, it is not acceptable to spend 90% of your thoughts on food, and eating, and weight. 

And your drop in weight? It may reinforce your unhealthy behaviors, as weight loss can be seen as a positive—even if it is anything but healthy—especially in the manner it is achieved. To me, weighing is generally a lose-lose situation (and I’m not talking about weight) in this situation, before you have learned to trust your body and its ability to self regulate; until you have learned to view your weight as just one variable in the big picture of your health. (So please stop weighing yourself if this applies to you!)

See the problem? In Stacey’s case, as she's eaten less, even with the periodic binging, her weight has been stable. So of course she fears what might happen if she does eat more. In her mind, more food must equal more weight. Yet in reality, there are a couple of explanations for this stable weight despite lower daytime intake. She may be making up the calorie difference when binging (although in her case this did not appear to be happening). 

Or more likely, her metabolic rate decreased to accommodate her low intake. So now she eats less, her body slows the rate at which it burns calories—she feels tired, preoccupied with dieting and sometimes out of control when she overeats—and she fears changing this situation will result in her doubling in size. But this is wrong, wrong, wrong! Because her metabolism will in fact increase again as she normalizes her food intake!

It seems we have a selective memory regarding eating. We focus on the fact that we overate—but we ignore that there was restriction that preceded it; we simply blame ourselves for our "lack of control", or failure to have “willpower”. If we binge and then purge, our memory stays fixed on how much we binged on, so we get annoyed when later on we get hungry and need to eat. How quickly we forget that we have gotten rid of a large part of our food intake, and that feeling hunger makes total sense.

Stacey has a long way to go. But here’s what she is working on. Rather than blaming herself for her seeming inability to take control, she's working on acknowledging that restricting keeps her stuck in the vicious cycle. And now she is beginning to liberalize her daytime intake, to prevent this unhealthy chain of events from continuing.

She further needs to join the “Clean Slate Club”. Yes, that's the Clean Slate, not clean plate, club. Overate? Binged? What's done is done. Trying to compensate with restricting will ensure you (and she) stay stuck—and that needs to change.  Starting with a clean slate mentality can help. It is more damaging to keep going on the destructive eating path, than to stop now and lessen your losses. It is worse to purge then to sit with the discomfort of overeating. And it is senseless to begin again with restricting, because it is quite clear where that will lead.

A typical breakfast prepared and eaten on my vacation:
fruit, yogurt, honey, baguette and butter and pastries. 
Perhaps you identify with Stacey—who is actually a composite of several patients I have seen this week.  Or maybe you haven't (yet) experienced the rebound binging—and purging—that may result from continued restrictive eating. It is not too late to change, to prevent the potential rebound overeating that deprivation can cause.

Why not start to break the cycle now?

Saturday, October 6, 2012

Trying to Change your Relationship with Food? A Letter to your Loved Ones May Help

I frequently describe the chat that needs to happen—between those of you struggling to normalize your eating and move away from compulsive overeating or binge eating, and your loved ones. I spend so much time talking about this in patient sessions that I decided to write it down in a letter form, so all of you in this position can use it.

Why such a conversation, you ask? Because in order to start to change your relationship with food, you need to let go of the fear and the shame you’re all-too-familiar with. To do so, it helps to put it right out there to those who will be seeing you eat and may be surprised by what they see. The last thing you need is more judgment—you’re critical enough of your own eating, you don’t need anyone else’s judgment! So read on and test it out at home!

Dear All-who-really-care about me,

While I know you are worried about my health and my eating please realize that you are not alone. Just because I don’t talk about it with you doesn’t mean I am not concerned. In fact, I am actively working to try a different approach to change my relationship with food, so I thought I’d let you in on it.

Remember all those diets you’ve watched me start and stop, those failed attempts to take control with rigid, senseless rules? Those days are over. “What now?” you’re wondering? “You’re giving up again?” you’re thinking? Think again! Here’s what you can expect to see, so brace yourself.

You know those foods you think I shouldn’t be eating? The foods you and I really like to eat? It’s time to make peace with them, to legalize them. Because now they feel forbidden, and when something feels prohibited I want to eat more of it—just like anyone would. Yes, that’s normal. What isn’t normal is thinking I will never eat cupcakes again—or ice cream, or chocolate, or bread or ‘white carbs’. No, that’s absurd, unrealistic and quite frankly, unnecessary. 

What I’ve been learning from an experienced Registered Dietitian who deals with helping people like me is that it’s not the food that causes the weight gain. No, not the carbs themselves, nor the sugar, nor the fats, but rather how much we eat of them. And I’m learning how to start to take control of my portions of such foods.

First, I’ve got to welcome them back into my diet. You see, when I feel I’m not allowed to eat them, it sets me up for trouble. I feel ashamed if you and others see me eat things, so I’m more inclined to eat them quickly, mindlessly, just because there’s no one around. And trust me, I do. And this goes against what I need to do—to eat them mindfully whenever I’m hungry and choose to eat them.

But I fear the reaction from everyone. So I’m giving you this letter so you won’t be surprised when I sit down at the table and have a couple of cookies. I’ll eat them without distraction and I’ll really enjoy them this way—as opposed to just shoveling them in. Please recognize that I am doing this because I care to feel better and be healthy, so be open-minded. Realize that the diets and restriction have only set me up for problems.

So when you see me at the table eating something you think is ‘bad’, think again. Perhaps you’ll join me and we can normalize our eating together.

Be patient with me--this is a process.  It's not going to get better over night.

Thanks for supporting me and for understanding.

PS: Learn more about my struggle from

Let me know how it goes!