Saturday, December 28, 2013

“Just Eat it”? Taking that leap of faith to let go of the diets and the rules.

Just Eat it. Designed by Olle Hemmendorff for Nike.
Just Do It has been a memorable Nike campaign, motivating and inspiring athletes and active wannabees for years now. But I really don’t want to talk about exercise and determination.

Rather, let’s talk about Just Eat It, the image circulating on social media with that very phrase. This expression has crossed my mind—but not my lips—during many a patient session way before the creative graphic emerged. Yes, sometimes I’d like to shout out JUST EAT IT! (or even JUST EAT!), at times when rational discussion seems to get us nowhere. But that’s my emotional—and occasionally frustrated—response.

Personally, I struggle with the just part of the statement. Does it feel like a just to you, as an only? Or merely eat? To the person living with disordered eating, I bet just is the worst possible adverb imaginable. To me, it minimizes the struggle. Just eat it? As in, “it’s no big deal, what’s all the fuss about anyway”. EAT it?! If you could just eat, wouldn’t you?

The hike toward the Hornli Hut, heading toward
the Matterhorn.
My editor was reviewing this piece—by editor I mean husband—and he likened this minimizing to a personal experience he and I have had. You see, I have a fear of heights, and I swear it’s worsened as I’ve gotten older. So now, when we go hiking where the path has narrowed and I can vividly imagine the drop off to my death, I get a bit stuck—think deer-in-headlights kind of stuck. No, not just a bit stuck. There’ve been times when he’s had to talk me through, or physically be there to support me. At those times, he’s clearly communicated the message of “just do it, just get over it”, as in “what’s your problem?” failing to understand that my concern just might be irrational.

No, others really may not get it; fear is often irrational. But somehow reading a draft of this post he did get it. I don’t choose to get anxious at precipitous drops at high elevations. And sometimes the dangers are real. But the risk of stepping outside of your comfort zone to eat (as opposed to the risk of not eating enough), is not life threatening.

I suspect that if you really think about it, you’d realize that you used to eat the very foods you fear will make you fat, or will trigger overeating, with no ill effect. Think back to the time before the rigid rules and diets began, before your eating disorder or disordered relationship with food developed. Sure, you may associate carb restriction with something positive—weight loss perhaps (strictly because it resulted in reduced calories, and not because there’s anything magical about reducing carbs, or fats, or any food or nutrient in particular). 

But you fail to acknowledge that your struggle with binge eating only began with this restriction, with the deprivation. Or, that starting to restrict set you on your path to being unable to nourish your body, to respond to its needs. You hold on to all the ‘good’ you associate with dieting, yet minimize the consequences of your disordered eating on your health—on your mood, on your ability to be social, on your energy level, on your thinking.

There’s a bit of a conundrum we face; by we I mean providers and parents and loved ones alike. I can present all kinds of justification for nourishment—for including carbs, for increasing necessary calories, for adding snacks, whatever—but sometimes that’s not enough. Evidence that food restriction is slowing metabolism may help—such as pointing out that a slowed heart rate or lowered body temperature is a consequence of starvation. Showing evidence that you had previously been both healthy and a normal weight when eating your now feared foods may help, but it doesn’t seal the deal. 

Do you know which are the least read of all these blog posts? They are the ones describing research—the clearest evidence—in favor of normalizing your eating. Few tend to care about the evidence.
No, you can’t always negotiate with an eating disorder.

Sure, it’s easier if you know you can trust me—that I’m not going to mislead you; that it’ll really be okay if you make the dietary changes I suggest. But where’s the proof? Until you actually do it, and see that it really is okay, it’s challenging to trust. You believe that you’re different, that the rules simply don’t apply. And so we’re stuck.

At that point, you need a leap of faith. You need to go on blind faith that it will be okay. It helps to acknowledge that where you’re currently at is clearly not alright—in fact, that you’re quite miserable, if you allow yourself to be honest about how you feel. And it helps if you consider ‘what’s the worst that can happen?’ acknowledging that fear of rapid weight change is a distortion of your thinking; progress on so many levels can start here. Recognize that you don’t have to commit to continuing with this change forever—take it one day at a time, and give yourself the opportunity to back out.

It can be scary getting to the top, but it's worth the effort.
Capu Rosso, Corsica
Sometimes we do need to “Eat it!” or “Do it” giving yourself no option but to not go running, or to cease all purge behaviors, for instance. Sometimes giving your self no option makes the recovery process much easier.

But if you can’t bring yourself to take that leap of faith, or to “Do it”, then eating disorder programs may be the next best thing. Or, for those living at home with family, FBT (family based treatment for eating disorders) may be a great alternative.

Over time, you’ll realize that there’s really no other option for living a healthy life than to maintain the changes you’ve started.
Just saying.

What are your thoughts? Is anyone reading out there?

Saturday, December 14, 2013

Coming Clean: My Biases and What They Mean for You

I’m no different than the rest of you. I too, have my biases—my prejudices, my leanings, my preconceived ideas about what makes sense. They influence my actions, my reading of scientific studies, and they impact my professional recommendations.

I make no apologies; my biases effect what I tell you as patients and as blog readers. Like conference speakers obliged to disclose who profits from their research or their words, I’m giving my full disclosure. Here are some insights about why I lean as I do:

1) I’m biased against the weight loss literature's conclusions. In spite of the dismal research that only a small percentage of overweight dieters maintain their weight loss, I’m biased against these results. Weight loss, and maintenance is not an unreasonable goal—for some people, that is. Yes, I realize that the weight suppression data may suggest otherwise, as mentioned in my previous post.

Yet I’m skeptical about how study participants lost the reported weight and that impact on weight regain. And I’m cautious about who should have been losing in the first place. If someone had been binge eating and normalized their eating, why wouldn’t they lose weight and keep it off—as long as they remained free of binge eating? If you were disconnected from your physical cues, from your hunger and your fullness, but then turned that around, why couldn’t you maintain the lost weight? That is, if your higher weight was not your healthy normal that you had always been. Which gets me to the next point.

Many patients have appropriately lost and maintained significant weight loss. They were not on diet plans—not calorie counting, no categorical exclusions such as “no white flour” or “no carbs”. Rather, they have slowly modified their actions, and their thoughts. And ultimately, their weight adjusted. Read about my patients such as Erin and Maggie.

I fit into the category above. I have lost about 35 pounds since graduating from college—35 pounds that were not a part of my usual size. My weight had always been in the normal range—I had never experienced weight issues until college, when my yo-yoing began. Dieting, binging, denial of my needs failed to bring my weight back to normal. But changing all that did. I do not work to maintain my weight at this point, but I continually embrace honoring what I feel like eating, and responding to when I need to eat.

2) I believe that you know best about yourself—until your disordered thoughts, your restrictive rules, your lack of trust in yourself take over. Yet I believe that deep down you really know just how much you need to eat—just like when you were a young child before all this craziness began. It’s just so damn scary!

3) I’m biased against light products and diet packaged meals. No, they are not simply better than not eating (shout out to Thursday's patient—thanks for inspiring this!) Why? Because they mislead you! Tricky Weight Watcher’s meals and Lean Cuisines? Sneaky Arnold rounds? Indeed. 

First, they may look like they’re supposed to be enough. The light bread (that has half the calories than the regular bread) looks like a full sandwich. But then when you’re hungry from eating what amounts to only half a sandwich, whom do you blame? You only fault yourself, believing that it should’ve been enough, that you’re the one with the problem. Not so, my friends!

As for the frozen meals, I must say that in all my (50) years I’ve never eaten a diet frozen dinner, so my bias does not come from my experience having them. They just look like not enough to me—or for anyone. Admittedly, you can add a glass of milk, and a fruit or a dessert and it may be just fine. But somehow I don’t suspect that’s what you intend to do.

4) I’m biased against omitting what we enjoy eating. I believe that sweets and all things that taste good have a place in our diet. Maybe it’s because I personally eat things I like, including baked goods and good chocolate quite frequently. Excessively? Mindlessly? Not usually. Not when I’m driving or watching TV. Ok, sometimes the popcorn comes down to the family room (notice how passive that statement was?) while I’m watching TV—there, I’ve said it. Maybe it’s because I see the consequence of banning them, of making them forbidden, that I fight for making them available.

5) Yes, I’m biased against eating disorders.  Eating disorders lie. Which is not to say you are a liar. Have you lost me yet? They distort what you perceive you’ve eaten—yes, you overestimate your calories if you are under eating, and you may minimize or exaggerate them if you overate—it can go either way. 

Eating disorders mislead you into thinking that a yogurt is a meal, or that a black coffee, or even a latte is an appropriate means to respond to your hunger. They don’t volunteer information—I have to ask, and beg and probe to get a full and honest response.

6) It’s not your fault—again, that’s my bias. I don’t believe you want to be struggling with binge eating, or purging, compulsive exercise or laxative abuse or restrictive eating. And I’m convinced that I, that we can’t simply wait around until you’re simply ready.

7) I’m suspect when I only hear that everything is always great. And I’m cynical when I hear that everything is always terrible. Your bias, I suspect, is a lack of honesty with yourself.

8) I’m partial to the value of the relationship. I’ve not reviewed the literature on this, but my bias is that you’re more likely to work to change—at least initially—for your soon-to-be-born child or for your young children. And if you’re fortunate enough to have a positive relationship with a healthcare provider, you’ll work for them too.

9) Oh, and regardless of what they tell you, I believe it’s never too late to change. And this bias is based on the many clients I’ve seen, at all ages, at all stages of their disordered relationship with food. Yes, you too can recover from an eating disorder. And you can change your relationship with food. Even now.

So call me biased.

Friday, December 6, 2013

Self-parenting and your relationship with food.

Because you’re more than just dust and ashes.

How long could you have stayed in bed
with this look?
I was lying in bed contemplating this long overdue post, when he started to whine. “I’ll be up soon, go lie down”, I barked to my canine. If he really needed to go out or to eat, I knew I’d hear from him again soon. And so he hunkered down, curling up comfortably in his bed. And I scored one in an attempt to get my needs met, namely more desperately needed sleep.

Only my head was too filled with other things. There’s this post to write, for instance, and food shopping to do, household chores, and… So my need for sleep was bypassed.

And what does this have to do with you?

Get a little help from your friends.
Most of you, it seems, struggle with meeting your needs or are dependent on others to realize your needs. But I don’t mean simply your nutrient needs.

Regardless of your age, you need parenting of sorts. Or call it nurturing. And compassion. And validation. And if you no longer have parents, or your parents don’t rise to the occasion to provide these necessary supports, then you need to find them elsewhere—from your friends, your community, your providers. And you need to provide them for yourself.

Where’s the compassion? 

Can’t we treat ourselves they way we wish others would have treated us? Can’t we say things to ourselves like the supportive words we say (or wish we would say) to our close friends and loved ones? Consider this:

“A person should have two pieces of paper, one in each pocket, to be used as necessary. On one of them [is written] ‘The world was created for me,’ and on the other, ‘I am dust and ashes.’” 
–Reb Simhah Bunim, Przysucha Poland, (1765-1827)
You just might need to give yourself a hug.
I’ve always loved this saying, which emphasizes the need to be neither too haughty and self important nor to minimize your value in the world. The problem, though, is that most clients I see struggling with eating issues err on the side of focusing on the ‘dust and ashes’.

Must you, must we, dismiss the positives, focusing only on our failures? You are not just making excuses seeking to justify your behaviors, when you acknowledge your positives. Understanding informs you where you need to go next, where the barriers need to be broken.

Where’s your voice? 

I realize I have little experience with this one, as I learned a style of communicating that perhaps errs on the side of over vocal. I know, I know, filtering has its benefits. But keeping your thoughts and feelings inside does nothing to aid your relationship with food. It festers (I love this word), defined as eats away, gnaws away, putrefies, becomes infected).

Sure, you can plan what you’re going to eat, and you may follow through. You can organize your eating, and that surely helps. But failing to release those pent up thoughts and feelings only contributes to your struggle with food. Because overeating or food restriction—yes either one—can feel like the antibiotic that remedies the problem. Only the disorder has become resistant to this so-called antibiotic, and is ineffective as a long-term treatment.

The way I see it, communicating is a necessary component of recovery. But if you aren’t yet up for speaking your thoughts, at least express them—through journaling, music or art. Be creative—there’s not a right way to release what you are holding inside.
Not even aware of what you’re feeling? Just starting the creative process may make you aware. Or maybe you need one of these to identify your emotions.

Where’s the self-acceptance? 

Self-acceptance doesn’t mean staying stuck. It isn’t synonymous with accepting that you just can’t change the way things are. Rather, it means accepting what’s in your hands to change and knowing when you need to gather the supports to help you move on. It means setting realistic goals given the trauma work you’re doing, or the crises at home or the multiple hats you’re wearing day-to-day. It means appreciating even a gradual move in a healthier direction, versus viewing your progress as all or nothing.

He's got me at last.And we both really need it.
I think I’ll go snuggle with my dog now. He needs it. And I could use it too on this rainy, dreary day. The laundry and shopping will just have to wait.