Pages

Showing posts with label Alcohol. Show all posts
Showing posts with label Alcohol. Show all posts

Monday, February 27, 2012

Advice for Your Doctor for NEDAW


Call me crazy, but I’m tempted to respond to a doctor’s closed-ended questions in ways that would knock his socks off. When he asks me about alcohol, for instance, he frames it something like this “you don’t drink much, right?” Or perhaps to assess risk of STDs he suggests “just one partner—you’re married, right?” Well, yes, he’s right, but would I ever say anything other than what he’s led me to believe is the only acceptable answer possible?

Isn't it time to get the support you need?
This brings me to the important topic of educating your healthcare team, your doctor, in particular, about how to truly support you. In honor of National Eating Disorder Awareness Week (NEDAW) (here in the States) I thought that health care providers could use a bit of awareness, to hopefully make your visits, and your life, a bit less stressful. Please consider adding your own two cents to the comments—then pass it on to others—and your providers! While this is prompted by NEDAW, I’ve included recommendations that are worth sharing regardless of whether you struggle with an eating disorder, disordered eating, or simply are outside of what the BMI chart says you should be.

Unsolicited Advice From One Healthcare Provider To Another

On weighing your patient

Please weigh patients with their back to the scale. Have them remove all layers possible—most individuals, regardless of their weight, want the weight to reflect what’s real. Weighing with shoes, heavy belts, and jackets doesn’t contribute much valid information. Oh, and have them empty their pockets!

That said, some do want to misrepresent their weight—so less is always better—with regards to clothing. And have them empty their bladder first!

A poker face and restraint from commenting is wise. That is until you’ve gotten to assess their weight in context. Imagine if you said to an overweight patient—“great, you’ve dropped a ton of weight” only to realize that they had a rapidly growing cancer? 

Weight change must be evaluated relative to behavior. Someone who lost weight (regardless of how appropriate you thought it was for them to drop some pounds) may very well have gone about it the wrong way. 

Consider this—they may have been starving themselves, resulting in messing up their periods, their metabolic rate, their mood, their sleep, their thoughts, their relationships.  This is nothing to offer positive reinforcement for. There is nothing healthy about losing weight this way. Perhaps they are compulsively exercising, or dehydrated from purging or laxative abuse. No, weight would not be a good measure of health then.

Similarly, your patient with a high BMI might have simply maintained her weight. But she feels well, is active and fit, and is healthy by all measures. Maybe she has even turned things around, if her weight had previously been climbing. Sure, you can explore other risk factors, such as quality of her diet—as I hope you would do with your slim patients, too. But if all looks good, perhaps you can accept that her stable weight is just fine for her.

Perhaps if she’s been climbing in weight that might warrant some probing about recent lifestyle changes—stressors, activity, diet—to help with better self care and disease prevention.

And if your underweight anorexic patient has increased his weight, please similarly temper your response! While you may be delighted, he (or she) may not be. It’s a mixed bag, gaining weight, even for those who are trying to gain weight. There’s the healthy side of them that really wants to recover. And then there’s the eating disorder voice that sees weight gain as a failure, as a “you can’t do anything right”, pulling them back to restricting again. It’s more valuable to elicit a sense of what they are thinking and feeling about the change. How does it fit with what they expected? What are the benefits of the changes they’re making? Focusing on the behaviors that contributed to the weight shift is more valuable than discussing the weight itself.

If your patient isn’t doing well, rest assured that they are as frustrated—even more so, really—than you are. The impact is far greater on them than on you, that’s for certain.

Hooray! You got your period back!

It’s not healthy to lose one’s period due to such factors as anorexia, restrictive eating, or compulsive exercising. We all know that. But while getting a period back is a good sign, it is not always well-received by patients. For some, getting a period equals “I must be fat now”. For others, it means they are done with their efforts to change their eating and behaviors. And that may be the worse thing for them to conclude.

Periods may return before weight is restored and before behaviors are normalized. Or they may come back after 4-6 months after stabilizing in a healthy range. Or they may never have disappeared, as was the case of a patient of mine who conceived 5 children through her years living with anorexia. The point? Consider where your patient is at before you rejoice in their body’s normalizing their periods!

Don’t Ask, Don’t Tell? I Don’t Think So.

If you don’t ask the right questions, you won’t get the real answers. So do ask open- ended questions—different than what my MD thought to ask—to obtain valuable information. If you’re discussing weight or body dissatisfaction, do ask if they’ve used laxatives, or diet pills, or vomiting or restricting—in the past, or currently. Suggest a frequency, in a non-judgmental way. If a patient says she purges daily, follow with a question like “how many times per day?” And when he says twice, follow with “And what’s the maximum?”  Just like if they say they have a couple of drinks, follow with what’s a couple—4? 5? 2? Per day? Per week? Suggest a range of possibilities, without raising an eyebrow.
 
We can only help our patients if we can accurately assess their situation. And, we can’t begin to do so if they feel they can’t trust us. So do your part. Ask your questions in open-ended ways, and be careful how you react. Ask how you can help, what they need from you. Are they connected with appropriate resources, or do they need guidance?

Encourage a follow-up sometime soon! 

Suggesting a 3 or 6-month follow-up visit certainly sends the message that their situation simply isn’t worth your taking too seriously. And as a result, they will undoubtedly convince themselves that really everything is fine, that nothing really needs to change.
And if you don’t believe me, read the comments from those in the know, below.

Thanks for taking the time to read this.

Sunday, November 20, 2011

Taking Charge: Practical Strategies for Enjoying Holiday Eating and the Morning After

Ready to take control?

You, my readers, are a diverse bunch. Some of you are overweight, perhaps higher than your usual and healthy weight. You struggle to have balance in your eating—to eat what you’d like, and to learn to eat just enough. Others maintain their weight in a healthy range, yet grapple with these very same issues. Just because you may look fine, doesn’t mean you’re not challenging yourself to improve your relationship with food. You, too, may be working on legalizing foods, moving from a diet mentality.

Many of you are underweight, as evidenced not only by the scale, but by your body’s function—your low heart rate, body temperature, or hormone levels, resulting from inappropriate weight loss, food restriction or over-exercise. You too may be trying to release yourself from the grips of disordered thoughts and behaviors around food, whether or not it is visible to those around you.

Yet as diverse as you are, it seems most everyone gets challenged around holiday and social eating situations. Social anxiety may add flames to the fire. But I’ll leave that to the therapist bloggers to better address.

Last November, I did a post on recovering after slips, such as after Thanksgiving. Now I’m realizing I’d better address prevention. Perhaps I should have thought of this sooner? It’s not too late! (For those non-US residents, plug in Christmas, Hanukah, Kwanza or any other social eating situations not connected to a holiday celebration—the situation is the same.)

It may seem strange, but regardless of what end of the scale you’re on, or what your personal needs are— weight loss or gain or stabilization—these guidelines apply. Because we all want a sense of control over our situation—to eat what we’d like and eat enough of it—but not too much; to enjoy eating and feel entitled to eat, regardless of our size, in spite of the opinions of others; we’d like to free ourselves, discarding those useless rules around good food/bad food, appropriate times, and inappropriate times to consume food.

So here are my tips:

Maintain normalcy before the gathering.

Don’t skimp on your eating beforehand or you’ll be more vulnerable at the event. All too often I’m told of a client’s attempt to prevent overeating. What do they do? They eat less before the meal out or the function, figuring they’ll save some calories. Then they arrive more vulnerable than anticipated. As a result, their resolve to mindfully select their food, or to pace themselves through the afternoon of eating goes out the window.

The sensory stimulus doesn’t help.  The pleasant aromas and visual displays of appetizers through desserts calls to us. Their strategy backfires, and they feel a sense of hopelessness with getting their control back.

Using your head to maintain the necessary balance
Or like my patient, Shari, you restrict before the event, eat fine or over eat at the event, then restrict again afterwards. Hmm. Does this make sense? Somehow, when you hear it told about Shari, it’s clear how senseless this is. Yet my clients believe that somehow they are different, that the rules don’t apply. They are smart. They get it. I know they do. Yet I frequently have to remind them they are not special; lovely individuals, yes. But not so unique that the system doesn’t apply to them.

Get informed. Ask questions.

"What will you be serving?" "What time will we be eating?" It helps having a sense of what to expect. Going to a friend or family’s home? Ask what you can bring—not if you can bring something. Perhaps you'll contribute something you really enjoy and feel good about eating. A lighter dessert? A favorite vegetable dish? An appetizer you’re comfortable eating?

Pre-plan.

It starts with inquiring about what’s being served. For some, it’s necessary to think through your options in advance. If you are dining out, consider checking the menu online, to be less overwhelmed with the decision making during the gathering. Going to family for a holiday meal? Hmmm, they’re serving 6 different starch choices, including mashed potatoes, stuffing, winter squash, sweet potato casserole, biscuits, and pumpkin bread. Which ones can I get at any time? Which ones are my favorites? Which ones should I just pass on, without regret?

Remember, it’s not your last chance to eat.  So if cranberry sauce is a favorite, plan to buy it and keep some at home. Add it to turkey sandwiches or make a turkey with the fixings, even when it’s not Thanksgiving or Christmas.

You don’t need a dog for a doggie bag. Plan to bring a piece of pie, or a package of leftovers for a later time. Perhaps you’ll get hungry again later that evening. You’ll better appreciate the leftovers when you are less full anyway.

Plate the appys.

Enjoy the appetizers. But know how much you are eating. Select what you’d like, and place them on a plate, together. This allows you to take note of what you are consuming. When we are simply grazing on them, without really seeing or acknowledging them, it is much easier to over eat.

Watch the alcohol.
Painting by Russell D'alessio, Bar Harbor, ME
I hope these women had eaten before their martinis!

Nothing decreases our awareness and inhibitions like alcohol. If you can drink responsibly, that’s fine. Best to delay your drinks until after you’ve had some solid food, though.



Be flexible*.

Maybe you decide you’d like something other than what you intended to eat. Or you ate more than you anticipated, even though you tried to be well prepared. The worst thing you can do is to beat your self up. Best to work on moving on. (Yes, it takes 3,500 surplus calories to gain a single pound.)

We may not be able to control senseless comments from those around us at family and social gatherings. And unless we are hosting, we can’t eliminate temptations. But we can certainly take charge of our own thoughts and actions. And in the worst-case scenario, remember it’s only one meal, or one day. So if you ate more than you needed and are sitting with regret, re-visit that old post on the morning after.

* Did you, like me, wish this subheading was left-justified, instead of over here on the right? It's the start of being flexible!

As always, I'd love to hear your thoughts!


Saturday, October 29, 2011

Setting the Record Straight. Shifting Your Perspective Toward Recording.

Here's what she had to eat. Take a look. Then write down your assessment and tell me what you think. You know, as if you were the nutritionist working on helping her improve her diet and her relationship with food.


8:30-9:00

Bread and jam, 2 slices
Freshly juiced red grape and berry juice, ~8 oz.
Coffee with whole milk
------------------------------------------------
Vanilla yogurt with fresh peaches
------------------------------------------------
Semolina cake with plum topping
------------------------------------------------
1 fried egg
Bread and jam

12:30 PM
Medium gelato,

~2:00 PM

Wine samples and bread sticks

3:30 PM

½ a thick cheese and tomato sandwich, on white Italian bread
½ a thick pesto and roasted veggie sandwich, same bread
----------------------------------------------------

Wine tasting, approximately 6 oz, and a few bread sticks

7:45 PM

Cheese samples, approximately 1-2 oz.

8:00 PM

Bread, 2 slices
Large vegetable salad (enough for 2 or 3 people) with olive oil and vinegar
Wine, approximately 5 oz.
Gnocchi and sauce

~9:30 PM
A couple of cheese bites from around the world.


Nectarine with hazelnut chocolate sauce--day two's breakfast!
So what did you think? And have you figured it out yet? The she is me, and you are seeing an entire day of my eating while vacationing in Italy, unadulterated.

I'm not in the habit of sharing my food intake in such detail, in part because what's fine for me is not necessarily right for you. And I don't have a ton of personal experience with recording—the last time I tracked my dietary intake was for a grad school project, a good 25 years ago. But I decided I needed to address the topic of recording because it can have great value.

For most clients, recording is the bane of their existence. I say for most, because I have seen that rare person who loves recording. It suits their need to do things perfectly, completely, meticulously, so they follow the recording recommendation to the "nth" degree, including every sip of water and every bite of food they eat.

Do you know how many times I heard "I left my food records in the car" this week? No, you are not alone. They’ve been eaten by dogs, whirled away by hurricanes, and inadvertently used for fireplace kindling. Yes, I have heard it all, the most creative excuses. It reminds me of a NY Times article on North Korean doping (July 17, 2011). Following evidence revealing their soccer team’s use of steroids,

“A North Korean delegation told FIFA (the world governing body of soccer) that the steroids had accidentally been taken with traditional Chinese medicines based on musk deer glands to treat players struck by lightening on June 8 during training.”

You can do better than that, I'm sure.

The egg course--day 2!
More about record keeping in a bit. But first, I want to say a few words about this day's eating, a real day last month in Tuscany.

This is 100% honest. I neither overestimated nor underrepresented my food intake. It is a description of a day we spent in the town of Bra (no, not a typo), the home of the Slow Food Movement and the international, biennial cheese festival which we attended. I don't usually eat quite like this. And I certainly don't drink like this. But we were in one of the most amazing regions for red wines, home of Barolo, Barbaresco and Barbera, and so we did a good deal of tasting.

When you evaluate your intake, please ask yourself  "is this typical?" Perhaps you need to view the day in the context of your usual intake, recognizing that there are always exceptions to the norm.

Here's my take on my day's eating:

The evening before the breakfast at Villa La Favorita
The breakfast meal was crazy. Crazy good. And endless. We stayed at a bed and breakfast called Villa La Favorita  where the breakfast was served in courses. Multiple courses. The broken lines show the breaks between items served. 

Unfortunately, I did not have the benefit of knowing what was coming next, nor how much was coming my way. And the food was wonderful. By the second of our two days there, I knew enough to leave the bread and await the more exciting baked item, to skip the items I cared less for, and to pace myself.

Not knowing what awaits you is most difficult. If you struggle in such situations, obtain as much information about what will be served as you can, so you can prepare yourself. But let's say you didn't, as occurred on day one at the B and B, and you, too, ate more than you needed. What's the worst thing that will happen?



Have you seen enough gelato yet in these posts?
In my case, I didn't get hungry until later than usual. But by 12:30 I needed to eat something. Imagine my pleasure at finding a gelato shop en route to the car! And so I had my second gelato of the trip (see post gelato diet). And it was good. I thought about ordering the small, but had the medium instead. My husband got the small (he is so well trained), but then I shared mine when he was done. So, I think that counts as a smedium?


After a wine tasting in a lovely castle!
 The additional "snack" of some wine (quite little, truly—we paid for these tastings by the sample) and some bread stick pieces resulted in a rather late lunch. It wasn't until late afternoon that we got hungry, quite hungry, in fact. That gelato and wine tasting just didn't cut it. By then I couldn't decide what to eat, and so we ordered two different sandwiches, sharing them both evenly. (It was, perhaps, the best food per euro we had anywhere, in a nothing special seeming little spot.) Thankfully, my husband is accommodating and enjoys similar foods.

Dinner reservations were secured for 8 PM, so we decided to start our cheese tasting before the meal. As for dinner? There was nothing I yearned for more than vegetables! After the preceding week in Switzerland where I ate much less of them than I am accustomed to, I was thrilled to find a large salad as a starter to the meal. It was truly the best part of this meal for me. Then I ate a portion of the gnocchi— although I found them a bit too rich—but had enough room for some more varieties of cheese bites, as we strolled around the lovely town of Bra late night. And did I mention these cheese samples were not low fat?
Bra during the cheese festival 
By the way, my activity for the day was largely eating and wine tasting. There was minimal walking around some quaint medieval towns, but this was not a high output day, by any means. No biking and drinking for me.

What can you take from this?

Get as much information as you need to feel comfortable, and where appropriate, ask for foods to be prepared how you need them. But when the situation prevents that, trust it will be okay—because it will be. And work on being flexible. In the situation above, perhaps I could have asked about the breakfast menu. But it honestly didn't cross my mind. And so in spite of the breakfast being excessive for me, I had what I wanted, and left part of the foods that I was indifferent to, like the egg. It likely was more than enough; I could have had less, perhaps, and felt just satisfied. But I didn't. 

The fuller breakfast meal sustained me, removing the need for an AM snack. (If you are someone following a meal plan at this point, don’t get any ideas about skipping meals or snacks because you don’t “need” them. When your body and your mind are working to keep you healthy and safe, of course you can and will use these cues. But for now, stick with the program and use your meal plan.) Really the gelato met that need—just a bit later than I'd usually need a snack. The source of my calories at 12:30 was hardly relevant, as long as I had enough, and I ate what I wanted to eat. And I enjoyed every creamy bite.
Gotta expect the unexpected! Sculpture from a wine
tasting town in Piedmont

If a struggling client had recorded this day, and was self assessing his intake, here's what they'd likely say, and what I would have countered with:

Client: Nutritionally, this day was way too high in saturated fat, as well as in alcohol calories.
Me: This is quite atypical for your eating. You rarely graze on cheese with such frequency, and you never drink in the afternoon, never mind multiple times in one day. Given the frequency of this type of eating, then, nothing to worry about.

Client: Breakfast is too big.
Me: It may have been more ideal to distribute your food better, spreading this enormous breakfast through the morning. But you couldn't. And so it was. Radical acceptance.

Client: I shouldn't have had the gelato; I should have chosen something healthier.
Me: No, you chose what you felt like eating, and that's appropriate.  And you had as much as you needed. You started to share when you were feeling you had had enough. Perhaps the small gelato dish might have done the trick. Maybe next time you’ll try the small. (Wow, a next time? What a thought!) You never do know how much will be enough, until you explore the options and learn to titrate.

Client: I consumed a lot of calories from beverages, including alcohol.
Me: If you are working to increase your calories, the benefit of beverages (non-alcoholic, I mean) is that they move quickly through your gut, and the feeling of fullness passes fast. But if you’re looking to feel more satisfied from your intake, I'd vote for fruit over juices. Again, it really depends on your need. As for alcohol, it's important to identify the impact drinking has on your awareness and mindfulness of your eating. Some can manage modest amounts, others simply cannot.

Client: I should have limited my dessert to once a week, not twice a day!
Me: Once you set arbitrary limits on your "indulgences" you'll set yourself up for trouble. If cake can only be eaten on birthdays or special occasions, you will certainly find yourself eating more of it on the one and only day you allow yourself to have it. If you are only allowed to eat before 8 PM, you'll find yourself eating a lot more before the time is up. Ultimately, these rules fail you.

Client: I ate so much and should have exercised.
Me: The food doesn't turn to fat because you didn't exercise. While I absolutely do recommend exercise for health and disease prevention, it is essential that you consume enough food to support it. Your body is quite forgiving. A larger intake on some days doesn't result in weight increases that day or that meal. Of course over time, if you exceed your need for maintenance, whether you exercise or not, you will gain weight. And for many of you that really is a good thing! You know who you are.

Benefits of Recording

Recording gives you the opportunity to view things differently, to gain insight, while letting go of the self-criticism and self-loathing. Inevitably my view of my clients' eating is way more compassionate than their perspective. So writing things down and debriefing about it with a knowledgeable provider may truly help shift your opinion of yourself and your eating.

Rather than seeing this as a report card, or a confession, consider yourself a detective, with the goal of uncovering some answers, solving the puzzle of your eating struggle. This helps you break down the barriers to implementing dietary change. Including information such as your hunger rating and other eating triggers, along with the location food is eaten, is enormously useful.

Recording avoidance is common, for individuals dealing with all kinds of eating, regardless of their weight. Record keeping makes us more aware of our eating, which ultimately helps us make change. It's an in your face reality check. And that benefit may be the very reason you may flee from writing down what you eat. It is easier to not confront it. If you don't see it, you don't have to acknowledge it.

But if you don't acknowledge what you are doing, you don’t have to make peace with it. Hence, eating while on the computer, while watching TV, reading, driving, multi-tasking really do the trick to keep you stuck.

If you no longer record, but still consider what you eat, whether you are hungry, or simply satisfying a range of other needs, than putting it down on paper may not be necessary anymore. If that awareness starts to fade, you may want to resume recording.

What Should I Include When Recording?

Let’s start with what you shouldn’t be recording—calories, fat grams, fiber, and any specific nutrient content. Why? Because that leads to relying on external information, versus internal cues. Internal cues? Hunger and emotions, for instance. Here’s a list of what you ‘d benefit from including:

Don't go by this clock, though!
·         The time you ate
o   This helps you see your eating pattern and understand why you ate as you did. Too long between eating? That will lead to trouble. Eating every hour? Is there something other than hunger driving your eating?
·         Your hunger rating
o   I’ve come to like the scale 1-7 best, with 1 meaning starving and 7 meaning stuffed. But use whatever works best for you, including word descriptions.
·         Your thoughts and feelings
o   This helps you see your obstacles to eating, and to then work with strategies such as CBT (cognitive behavioral therapy) to change them. Food rules and misinformation may come to light, best addressed with your nutritionist.
·         The location food was consumed
o   Does the location support mindless eating? Are you eating in bed for comfort? Would you sleep on your kitchen table?
·         Any other diversions while eating?
o   Distracted eating is mindless eating. For those trying to get their needs met and not know it, this can be useful initially. But ultimately, we all want to be in control of our eating and our weight regulation. So try to separate eating from distractions.

So if you choose to stay stuck, skip the recording. If you want support, and a new perspective, record and share with your providers. Or, self assess as if it were your sister’s or your best friend’s recall; this will likely give you a more compassion perspective. If the only result of recording is more preoccupation with food and eating, and changing your perspective isn’t helping, than please do yourself a favor and don’t record your food. But even assessing these other components, minus the actual food items, can be quite useful. So give it a try.

And please let me know if it was helpful. As always, I welcome your thoughts, comments, reactions, and corrections to my assumptions!

Wednesday, January 12, 2011

Fuller-bodied, Strong and Intense.


Truly the only way.

I like my coffee roasted medium-dark, French press or espresso-machine made. Dunkin Donuts will never do, not even when traveling. I’ll take tea instead, if coffee at friends’ is sub par. Just don’t microwave the water. Yuck!

I like my red wine fruity and flavorful. Full bodied, from any region. Just don’t serve it with fish! For that, a selection of whites will satisfy, thank you.
Dark and intense is my passion for chocolate. Milk and white varieties will get left behind, Lindt or otherwise. Checkout-line varieties will never do, although in my past I loved Peppermint Patties, (although those hardly count as chocolates).

Okay, call me a food snob. I’m the first to admit it.

But it’s like this. If I’m going to eat something, and eat it mindfully, I’m going to taste it. And if I taste my food, I surely want to love what I’m eating. I want to savor the flavors and the textures. 
Every bite should be a pleasure.



A quick fix for dark chocolate, Petit Ecolier, LU France



For me, there is no compromising. I’d rather not eat out, unless the food is superb. Superb generally comes at a price, so I don’t eat out all that often. My husband and I tend to enjoy our own cooking more than the food at most places.

That said, my all time favorite restaurant in the Boston area is Oleana and I would gladly accept an invitation or a gift certificate there any day of the week! Their food is aromatic, texturally interesting, and full of flavorful blends of spices.  The experience is so satisfying, that even if the meals are more substantial (calorie-wise) than I usually prepare, a little goes a long way. Yes, in spite of a multi course meal there Sunday (including a shared Baked Alaska to die for), I was able to comfortably walk out, feeling quite good, I might add.

I believe we have a right to have foods taste the way we want them to. Trying to lose weight? Assuming you need to, ask for modifications to meet your goals—but only if they will also please your palate. If the resulting dish is bland, it will fail to satisfy. And if you only order what you think you should eat, you’ll do fine while out. But once you return home, you’ll be seeking out what you truly yearn for. At a local Chinese food restaurant our family orders everything “light on the oil”. Such cuisines don’t suffer with lower fat modification, given their rich flavor from ginger, garlic, soy sauce, to name a few.
Recipe for the greatest carrot and spice appetizer inside!

But at Oleana, I’d rather have a richer prep of an exotic entrée, eat it mindfully, and stop when I’ve had just enough. Then I get to enjoy the leftovers another day. (This does require asking for a second plate when ordering your food. Otherwise, the delicious meal before you will be consumed in no time, before you’ve thought to put some aside.)

If you are struggling with anorexia, just eating out may be a great accomplishment. Order foods however you need to, to be able to enjoy the meal and not be anxious. Regardless of what others may think. Just be sure to meet your nutritional needs when you get home, if necessary. Ultimately, though, wouldn’t it be nice to be flexible and have foods without analyzing their content?

Look closely. It's made of roses! MFA, Boston, MA.
The message here? Be assertive. Ask for what you need, and what you want. Not just regarding dining, but in life, I might add. And work on choosing foods you really enjoy, not simply foods you think you should be eating. You can't simply cross your fingers and hope all will go well.

I’d love to hear your thoughts!

Hope you enjoy whatever you’re eating tonight.

Note: if you are following a special diet for medical reasons follow the recommendations of your medical team. 

Sunday, December 19, 2010

Weight Watchers Beware!

Ecstatic to freely eat bananas, for the first time in years—this was the sentiment at Thursday’s meeting. Finally able to select salmon—previously too pricey by their point system—this made them rejoice.

Most of my readers care little about Weight Watchers. But I’m writing this post because whether we realize it or not, whether we are “Weight Watchers” or not, their messages infuse into our culture and into our beliefs. They impact our thoughts about what’s acceptable to eat for health and weight management, whether they are myths or truths. Hearing some myth-information recently, I decided I needed to cut it short, before it spreads. I also wanted to point out a side of diets that most lose sight of—the damage they do.

Unlike those in attendance at their meetings, their cheerleaders who are pleased with their program and their successes, I get to see another perspective.

No Lifetime Membership for Sharon

Sharon came to see me for the first time this week, having never struggled with her weight. That is, until the past few years when it began to slowly climb.  That led this smart, level-headed woman to Weight Watchers. She followed their plan 100%, yet still gained weight. Encouraged by their new program, she figured maybe the old program just wasn’t for her. Two weeks into the new Points Plus system, she arrived frustrated and distraught in my office, and for good reason.

Sharon’s climbing weight made perfect sense to me, and with the recommendations we discussed I am confident she will turn things around. But I mention her because of how she changed as a result of the Weight Watcher’s diet.

Her whole life, she ate what she wanted, in moderate portions. She’d have ice cream at night—when she felt like it—but only as much as she needed. She had wine with dinner some nights, but just a glass, and she listened to and trusted her body. And it worked for all of her 38 years. Only recently, the balance wasn’t there.

Enter Weight Watchers. Her weight continues climbing, and now she is thinking about food all the time. She avoids the normal foods she always had, the moderate portions of foods she truly enjoyed, opting instead for lots of fruit (free on the new program). She moved from trusting her body, which had always worked for her, to trusting the program. And even if it had worked, it has totally impacted her relationship with food, and her ability to be normal. And this can happen with any diet, not just Weight Watchers.

So I went to a meeting. Yes, I decided to put on my journalist’s hat and collect information. I wanted to be fair and not misrepresent their program, to hear it from the horse’s mouth, so to speak.

Lori goes incognito

They were prepared to sign me right up, on line, and at the meeting. It didn’t matter that my BMI was in the normal range (I do have issues with using BMI, but we’ll take that up at another post). No one questioned the appropriateness of my joining, in spite of my normal weight. I could only imagine the damage done, if an eating disordered individual, also in the normal weight range, showed up. The messages, in my estimation, run counter to those supporting a healthy relationship with food.

Here’s what I saw and heard. Upon checking in, your progress is assessed. Behaviors? Thoughts? No, no, simply weight. Progress is measured solely in pounds. It doesn’t much matter how your weight changed.  No, the group leader isn’t inquiring whether you binged, then restricted all week, or if you purged before the meeting. You are praised simply for the weight change.

Now hopefully, those of you dealing with eating disorders or even weight management, in another setting, have experienced a different approach. When you see your team, progress should be measured not only by weight change, but by improvement in your thinking and preoccupation with eating and weight, by changes in your vital signs, and your energy level and sense of well-being.  Weight may not change one week, but we may see breakthroughs in how you cope with challenging situations without relying on food and disordered behaviors.

Those of you who really know me would have been so proud! I work hard to filter my thoughts, when they’re inappropriate, and to think before I speak. I could be sharp tongued, at times, when something really pushes my buttons. But at this 7:30 meeting I asked some naïve-sounding questions, and truly tried to listen to the answers. And I bit my tongue really hard.

It’s not about the calories? It’s about eating for health? Really?

“Can you tell me about the new point system?” I asked. “We’ve learned so much about weight loss,” the meeting leader replied. “It’s not just the calories, it’s the macronutrients,” she tells me, “the protein, fat and the carbs, besides the fiber, that determine your points.” Hmm. Has anyone taken basic biochemistry? Or maybe just high school biology?  Those calories in foods come from (drum roll please) those very macronutrients—protein, fat and carbohydrate.

Let me remind you that energy balance and weight regulation is about the calories. In a large Harvard study, they again showed us that weight change is the same whether following a low carbohydrate or low fat diet, by one year’s time, calories being equal. And similarly, for those on the other side, the weight gain is no worse regardless of which component of your diet you increase, calories being equal. And then there’s my favorite Dr. Haub study (see previous post).

What is true, is that certain food choices may make us more full in the short term. But this is not the wisest choice. We may find ourselves in situations getting too hungry, when that volume from liquid and fiber they promote, passes. That doesn’t help us sustain our bodies and our energy. And if we are struggling to recognize hunger and fullness, lots of water and water-filled foods will only mask your ability to listen to your body and its needs.

“It’s about promoting choices based on what we know about eating for health, so we encourage whole grains and less processed foods”, I was told. “It’s not about calories.” And yet, the unprocessed, whole grain brown rice has the very same point value as white rice. To me that would send a message that they are equal, no? And why is a glass of wine so high in points? Science does, in fact, support a glass of wine. And dark chocolate, I might add. Have they not seen that science?

Cocoa and chocolate, concentrated sources of polyphenols, have received much scientific interest and study. In fact, health benefit evidence regarding cocoa and chocolate were reviewed by the Dietary Guidelines for Americans Committee (2010). This session will review the cocoa bean's composition as well as the population-based and dietary intervention studies supporting the cardiovascular health benefits of consuming cocoa and chocolate. (from the American Dietetic Association 2010 conference guide).

Yet Karen, the leader, said “have the fruit first and that may satisfy. Then if you really need it, have the crap.” No, she didn’t use those words exactly, but that was what was implied. You know, “good food” first. In other words, don’t have what you really feel like.  Yet ultimately, after yearning for what you really want, you’ll eventually end up eating it having consumed both the calories from the fruit and the calories from the other item.

Not a diet?

Their materials work hard to convince us that it’s not a diet, but a lifestyle. They’ve got to be joking!  You’re given a plan, a number of points, and ways to count foods. And you’re encouraged to have all your points. There is little focus on self -regulation, eating what you need, as just as much as you need, based on your hunger and fullness. How can they not call this a diet?

They do, apparently have a plan that has you listening to your body, but that plan was largely dismissed at this meeting. And to truly be supported in that approach, an approach I completely support, it takes time, and exploration of eating triggers, and stress management tools, and one-on-one guidance.

So here’s the thing. There’s a place for sensible guidelines. These just weren’t so sensible. Adding structure to our day’s intake helps us not get too hungry, and I certainly support regular meals and snacks. And if you are at a place where you mask your hunger (with anything form large volume, low caloric-density items to coffee and diet sodas) than listening to your hunger with be a challenge—for now.

For those of you who don’t listen to your body’s hunger and deny your needs, a meal plan may have its place—for now. You should re-learn the tools to self manage, to listen to your hunger and your fullness, and trust them. Move out of your head, away from all the rules and information you’ve picked up. Work on becoming mindful—of what you eat and how it tastes. And tune in to what is making you eat—or stopping you from eating, in spite of hunger awareness.

That’s the work we have before us. And counting points isn’t going to resolve it, or improve your relationship with food.

It’s my hope that none of you need a lifetime membership. Let’s work on making changes that can change our relationship with food and our trust in ourselves, to help us for a lifetime.