Lessons About Eating Disorders

What I Learned at the AED Meeting

I’ve exceeded my 1 week limit between posts, but I’ve got a really good excuse—I’ve spent the past 4 days at the Academy of Eating Disorders (AED) Annual Conference. So I thought I’d share some personal and hopefully meaningful observations about eating, recovery, and miscellaneous thoughts:

• Day one, 4 hours of workshop, and what did they serve at the refreshment break? Coffee, tea and water. Period. And I wanted calories. Food. I was hungry. Half a day learning about a treatment for anorexia and I couldn’t find anything to eat! But it only got better from there—really.



One of several courses eaten at Barley Swine

• I spent a large percentage of my 24 hours each day doing 2 things—learning about eating disorders and planning and arranging to eat—where to go, whom to go with, and what to order, to name a few. And I must say, Austin Texas has some fabulous food! My top picks?  Barley Swine and La Condesa—simply divine!

• Another evening we were 8—two in recovery from anorexia with 3 RDs, 2 therapists and a mom/eating disorder advocate—all eating out together. Can you even imagine? From my perspective it was fabulous. How about a round of applause for those recovering, brave enough to endure such a dinner?
• People appeared better in person than they had on the web. No, I’m not speaking of their physical attributes. But in person, their energy and warmth radiated, adding a whole level of beauty that truly got missed on line. Thoughts were shared and clarified without misunderstanding—it sure helps when you have more than 140 characters to explain yourself!

• Two of the diners are bloggers that I had a somewhat rough start with in the virtual world. Carrie and I, as I recall it, had long ago debated the implications of viewing eating disorders through the lens of biology, much as a conference panel debated labeling eating disorders as brain disorders. While Laura helped shake up my thinking on Family Based Treatment, yet supported my perspective about the important role for dietitians, typically omitted from this therapy.

Carrie, Cate and I before dinner.
(We didn't look any different after dinner, though!)

• Conflict leads to learning and change. If we all stuck with our same ways of doing things we would never grow and develop. We would perhaps feel safe, but would truly stifle our potential, our recovery even.
• Cate and I met for the first time, in spite of feeling I have known her forever. We met through this blog and we have inspired each other to change as well. And you’ll soon hear details about our upcoming book!

Dessert shared with another RD

Meaningful messages from the AED meeting

Connection

Connection helps recovery. A family member, treatment provider, friend, an internet-mentor—even one strong connection can make a difference. And involving your partner shows great promise, based on the research by Cynthia Bulik, PhD and Donald Baucom, PhD. So if you haven’t begun to share with your significant other, or no one knows your struggle, perhaps it’s time to change that.

Hope

“You’re the first person who ever told me I can recover”, I’ve been told far too many times. It is unfortunate. Recovery happens (a bumper sticker, perhaps?), but it doesn’t occur passively. It certainly takes work, your hard work, and a great deal of time. And there are slips, which you must prepare yourself for. Because slips happen (ok, another bumper sticker?) I hope those of you outside the states get the reference to a US bumper sticker—Shit Happens—it would be much funnier if you did!

So if your provider tells you that you can’t recover, then it’s time to find a new provider.

Blame

Blame is useless. Your mother didn’t cause your eating disorder, nor did your ex-boyfriend. Sure, environment can play a role in the development of eating disorders (just as perhaps your genetic predisposition and your personality type may have contributed). But it is most ineffective to focus on “why did I get this condition” or to blame yourself asking “what’s wrong with me, why can’t I change?” We all want answers, but the truth is, what we really need are solutions. And blame is clearly an obstacle to getting there.

Eating disorders are serious

I liked Laura (Collins) Lester-Mensch’s suggestion that we refer to eating disorders as treatable brain disorders. Sounds so serious, no? Even a bit scary—and rightfully so. Eating disorders need to be taken seriously. One in 10 people die from their eating disorder. And delaying treatment only makes the challenge greater for recovery. While we don’t know whether the brain is involved from the start of the eating disorder or as a result of the eating disorder, here’s what remains—the brain is involved, and nourishing it aids in recovery of the disordered thoughts, mood changes and of course, the physical consequences. The brain is not static—it is flexible, plastic, and changeable.

Perhaps viewing eating disorders as treatable brain disorders will allow us to have hope, remove the blame, and inspire us to connect with others without shame to support recovery.

As always, I care to hear your thoughts and reactions to these posts.

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

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Semolina cake with plum topping

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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!

This Time It’s Simply About The Calories

Piedmont: Great Wine, Great Challenges

I’m a snob. I admit it. When it comes to food, it’s got to taste good. Because I intend to really taste it. To enjoy it. To savor it. Every bite of it.

But Thursday, after many long, hot hours biking the grueling hills of the Piedmont region of Italy, we were hungry. Really hungry. The hills took us much longer than expected; we had no idea what it really means to be in shape for riding hills!  And the snacks we carried? We downed those within the first couple of hours.

So we rolled into a tiny town, known for its hazelnut production. Now give me a dessert with hazelnuts and chocolate and I would’ve been just fine. But that didn’t happen—no bakeries in sight. But it didn’t take us long to identify the only eating establishment around. Think retro, stale, cigarette-smoke-filled air luncheonette before it turned quaint and chic.

In our broken Italian we ordered the only Panini that sounded acceptable. Oh, and a salad.  What comes to your mind when you think salad? Fresh, crisp vegetables? A brilliant assortment of colors, flavors, and shapes? Think again. They offered what is known as Russian salad—a heaping mass of mayonnaise, containing diced potatoes, peas and a speck of carrot.  We had it along with the white bread sandwich packed generously with cheese. And I neglected to mention (how could I forget?)—that there were two rolled up sardines with olives. At least they added some color.

Well, I ate at least 90% of this lovely meal. And I hated every bite. (Although given my sweating from the unseasonable heat, the sodium rich sardines and olives were much appreciated.) This was so far from the fabulous cuisine I had heard so much about and had begun to enjoy my first day in the Piedmont (more posts about those meals to follow). The Piedmont, after all, is know for the Slow Food movement http://www.slowfood.com/international/6/faqs, amazing wines (Barolo, Barbaresco and Barbera) and white truffles (these are intense mushroom like fungus, not chocolates, my friends), with their distinctive flavor which embellishes foods with a mere drop of a truffle infused oil.

At this point, exhausted and overheated, depleted of energy, it was strictly about the calories, the fuel. I wasn’t going anywhere without eating this awful meal. I had no other options. I couldn’t find my voice in this language I barely spoke, and I suspect there were no other options, given the appearance of this place. Yes, mayonnaise-laden salad with a bland cheese sandwich was the only answer. Simply non-negotiable. There was nothing else to do but eat it.

Provence, not Piedmont!

What’s the meaning of this post? It’s not about my disappointment, of things not going as planned—that could be a whole other post. It’s not about adjusting expectations, because who could have expected this? Never mind that the biking was a total drag, nothing like our fantasy rides through Provence with climbs we could manage and stunning varied vistas to distract along the way.

No, the meaning is much more literal. Sometimes it comes down to Nike’s message—Just Do It.

For those of you who undereat—I know there are times when you are not hungry, and eating seems totally unnecessary. And when a fat-containing food may overwhelm. Or you question why you have to eat more than everyone else around you. Or the uncertainty of a meal’s content leads you to want to choose the safest route—food aversion. Or the allure of not eating, or restricting, promises a pleasant disconnect which might be so welcomed at this moment.

As for the overeaters and binge eaters (and anorexics, too)—skipping meals or snacks certainly sounds promising. Why take in those extra calories when a coffee will suffice? Because sometimes, you need to just do it. And when you’re feeling hungry even if no one else is, you need to just eat—because you need to begin to listen, to trust your body and its signals. Because you so deserve to be well nourished. Because your size has nothing to do with your need for nourishment in the moment. Yes, you too, need to trust it’s okay, it’s necessary to eat. And that you deserve to eat, regardless of what others’ glances may suggest, in spite of the messages from family members you hear or replay in your head, regarding your need to lose weight. Be in the moment, and trust that you should eat.

A cool drink after a long day of unmanageable hills and bad food!

I won’t be heading back for another Russian salad-filled lunch in the Piedmont. But I’m pleased I was able to fuel up for the challenging ride back. In the end, we enjoyed a lovely meal at dinner, and a refreshing drink just after unclipping from our pedals.

How much should I eat? Using your head, trusting your body.

I just returned from two weeks abroad, 24-7 vacationing with my husband of 25 years (and yes, we still remain happily married). One week hiking in the Swiss alps, one week eating and drinking my way through Italy’s Piedmont and Tuscany regions have left me with so many thoughts to share. So enjoy the photos and commentary in the next several posts, and please share your thoughts and comments with me!

The lovely town center of Bagno Vignoni we pushed our bikes to.

I get it now.

This week I was struck by how much I utilize, maybe even rely on nutrition information to make my eating decisions. Sure, I eat intuitively, and I stand by absolutely everything I’ve told you throughout Drop It And Eat’s many posts. But I had an interesting revelation this week while in Tuscany. Until then, I hadn’t fully realized just how much nutrition info is a part of me, my food choices, my portioning. It came to light in a big way this Wednesday in Italy.

A lovely lunch, except for the 1/2 cup of oil!

Of course I’m aware that information impacts what I purchase. That includes higher fiber cereals, to keep things moving, as well as desserts with real butter, (because of the knowledge that I like the taste); white meat poultry, lower in saturated fats associated with cholesterol levels and cardiac risk, and whole grains for their mineral content, fiber as well as my awareness that I love their chewy texture. And while my awareness of the nutritional content of rich pastries doesn’t stop me from eating them, nor from thoroughly enjoying every bite, it makes me mindful to savor these items and to consume them in modest amounts.

18 euros, about $26 for these two fellas!

Twenty-five years as a nutritionist yet, I take knowledge for granted; I never really acknowledge its impact on my diet. No, I don’t calorie count, or tally my fat grams. And I don’t use a meal plan of any kind. Nor do I weigh my food. 

But at home, nutrition guidance surely impacts my life. When I buy fish, I ask for the amount based on an estimate of the number of ounces our family needs per person; ¾ pound for the two of us is not an unusual request. In contrast, most people I see approach the fish counter saying “I’ll have those two fillets” or “3 salmon steaks for the three of us”, without regard to the portion size.

I know how I like my food prepared; I enjoy good tasting meals with added fats—flavorful oils and butter—but I do add them sparingly, knowing they are calorically dense. Over time, I’ve learned how much rice I need at a meal, and just how much will serve my family, preparing accordingly. When I eat out, as you’d have guessed by now, I’m vocal, requesting foods the way I want it—light on the oil, or with extra basil or cilantro, or with added tofu or vegetables—whatever. Are you cringing just thinking about us dining out together?

Given the price of olive oil I considered getting this oil to go.

So imagine this. I’m in a country where I could barely order off the menu with minimal understanding of what I’m ordering. Culturally, I have virtually no awareness about regional preparation of the dishes. Imagine my surprise when I was served this veggie and cheese plate (right).

Earlier in the day, we ventured into the local fish market to plan for our home-cooked dinner in our apartment. Unlike what I am accustomed to, the fish are sold whole—then weighed, cleaned, and filleted—so we had no idea just how adequate a single fish would be. God forbid we should go hungry! So we ordered two whole fish. The price of 19 euros (approximately $26) should have been a red flag—a mighty expensive dinner for two! But what did we know?

Our home-cooked fish dinner, made with onion, peppers, fennel, capers,
garlic, white wine, and did I mention olive oil?

That evening, after cooking the meal—roasted branzino fish, risotto, cheese and figs—I realized that this meal was truly enough for four people, versus two. I had no knowledge of the food’s weight, the cheese was bought as a round single unit, and we just ate it. Slowly, we sat enjoying our delicious meal, together with a lovely white wine from the region.

And then it struck me. I had felt, at first, handicapped, yearning for my usual knowledge-based cues to assist me that day. How much oil is in this dish at lunch? How many ounces of cheese am I eating? How many people should this fish dinner serve? But I let it go.

Dinner included delicious goat cheese with black truffles. Lunch featured
the regional specialty of Pecorino, a sheep's milk cheese.

While I didn’t have the concrete information I usually rely on, I still had my experience—my knowledge of just how much I usually eat, which allows me to maintain a healthy weight. And I retained my internal knowledge—the physical signals that told me when I had had enough food and was satisfied.

When I reflected on this day, consuming ½ an Italian bread (no, I am not exaggerating), cheese, and god-knows-how-much olive oil in my lunch, I realized that I hadn’t gotten hungry throughout the afternoon; in fact, I seemed to have skipped my usual afternoon snack, inadvertently.

Trust

So it still comes down to trust. If you’re maintaining a healthy weight, your usual portions will suffice. Need to gain or lose? Modify your portions accordingly. Eventually your physical signals will resume, so you can finally distinguish physical hunger from all the other reasons you do or don’t eat.

If you speak the language, then speak up! Ask for foods the way you’d like them, and request a doggie bag for leftovers. And trust that all is not lost (gained?) if a meal is different from your norm. I personally would never choose to use half a cup of oil on my veggies, even good tasting extra virgin olive oil, but as I told my husband at lunch, “at least it’s good for my coat!”

I got more of an upper body workout than I bargained for.

In the end, in the two weeks I had had much more wine than I ever consume, significantly more fats of all types, more meals out, and more frequent desserts. Swiss chocolate is divine, and there were times we had some with breakfast. I biked less than planned, walked more than expected (including walking the bikes in terrain I couldn’t manage), and was generally more active than usual, especially given the length of our hikes. 

Sometimes, all we can do is to laugh at the situations
we encounter!

And for the record, my weight is exactly the same, as it should be, as I’d expect. But most importantly, I enjoyed it all, even playing with the leftover oil-soaked food at lunch. Because life’s too short to diet.

Out of Into the Mouths of Babes. Weight management without the rules. 

Ok, so my baby is 20 (years, not months) but as a parent I can still appreciate it when kids say the darndest things, especially when it relates to food regulation.

This past weekend we visited our son at school and indulged him with a lovely Japanese meal out. To be fair, he would have felt more indulged by a home cooked meal, but logistically that just wasn't happening, so dining out it was. Together with my husband, we ordered an assortment of appetizers including delectable sushi. And then it came to ordering our entrees. Now in the past, even the somewhat recent past, I vividly recall the eye rolling and comments when I would place my order. I would feel my sons cringe as I'd politely inquire about the food preparation, frequently requesting a meal "light on the oil", with less ghee at an Indian restaurant or easy on a rich and creamy sauce.

It's what makes me comfortable--I prefer the taste, and it allows me to dine out and feel physically comfortable afterwards. I'd prefer to have it my way than to simply avoid delicious tasting entrees and fine cuisine. So I bit my tongue and stifled my chuckles when my son ordered his noodle-based dish, requesting of the waiter "can you make that light on the oil?"

And there was no prompting from me, I might add; my terriaki salmon order with white rice and vegetables was rather straight forward, necessitating no modifications for my satisfaction. 

The way my son described it, he was so tired of the richness of the frequent meals out that he wanted to eat something that felt better.

Later, he described his recent experience dining at the local burger joint in his college town. He ordered a burger and fries meal at lunch. Sooo, you're thinking? Well, my 6'1" slim and fit son ordered the kids' meal as opposed to the regular portion, and, he added, it was more than adequate. He knew that with restaurant portions tending to be quite excessive, that a kids' size would better meet his needs. Okay, perhaps the fact that he had only $20 left in his campus bank account may also have been an influence. Nonetheless, I was struck by this awareness and ability to self regulate even in restaurants, even after leaving the world of his nutritionist mom behind. And from what I've observed of restaurant portions, his selection was quite wise.

Yes, this is a child raised with chocolates, cookies, ice cream and home baked goods. He was never limited by others regarding how much he ate or what choices he was allowed. The only deprivation he might have experienced is a lack of fast food, as that has never been part of our family repertoire.

Remember those bagels described in a previous post? (http://dropitandeat.blogspot.com/2011/01/why-carbs-got-bad-rep-and-what-you-can.html)  With no knowledge of their 7.5 oz weight (he rarely reads these posts and this knowledge would not have been a deterrent) nor of their calorie content, my other son found them impossible to comfortably consume, at least topped with cream cheese.  And last summer, I remember him (also 6'1" healthy and fit, I might add) ordering a kiddie size ice cream at our local, full fat dairy ice cream stand. Yes, he knew that the small serving (measuring approximately 2 full cups) was beyond his need.

No, not my son, but a happy cupcake maker
in NYC, who enjoys his cupcakes!

Let me clarify that these are healthy young men without disorders. They eat all kinds of foods and enjoy great desserts. One stays active through the year with recreational sports, one only seasonally when he trains for a bike event, and both use their legs for local transportation around their campuses.

Neither sets rules about calorie limits, nor restricts his intake to 

certain hours of the day. There is nothing unique about them, other than that they were raised perhaps without nutrition rules. 


In fact, in some ways, at some points, I felt I had failed to educate them, to teach them nutrition basics; we talked little of nutrition and dietary requirements, and I often felt that their classmates were more well-versed in diet basics. Until I realized that in fact I had taught them--by example, through what was served, through watching me enjoy my chocolate snack or my rugelach(http://bit.ly/iOoR2L), and by modeling balance both in and out of the home. And, by providing an atmosphere devoid of negative messages about my body and of theirs. 

"That's just fine," you may be thinking, "but I wasn't so fortunate to be raised in such a household! Now what am I supposed to do?"

 Well, let me confess-- neither was I. There were plenty of messages about weight and weight loss needs in my childhood home, and food was pushed for the sake of avoiding wrapping up leftovers. Stating that I was full was generally followed by encouragement for dessert, although in the next breath the command to "hold your stomach in" was frequently stated. I never really understood how one is supposed to hold their stomach in while still breathing…

A Picasso at MOMA, NYC

My patients, also, are rarely so fortunate. They present feeling hopeless and out of control with their eating. Or, so rigidly controlled by their disorder, fearing that acknowledgment of their body's signals will open the flood gates and cause a non-stop food frenzy. But over time, with guidance, they begin to trust the process, and their bodies. They are shocked that they can keep a 1/2 gallon (actually, they're 1.75 quarts now, unfortunately) of their favorite ice cream around and it will last more than the night! They learn that after the initial leap of faith where they break the rules, and choose foods that satisfy, that they can begin to trust their bodies. But at the start, no one believes it. They all believe they are different, that their bodies don't follow these same laws of nature.

Managing your eating is in part intuitive and involves listening to your body and its signals. But that assumes that the signals are present. If you've been severely restricting, you will require more structure to get this system working. If your hunger is not present, if you struggle with anxiety or depression, or are on meds which may impact appetite, then you too will need more structure to start. 

A Matisse at MOMA, NYC. A print hangs in my main office.

But besides the intuitive part, there are strategies like those mentioned above that help with comfort around eating and weight regulation, regardless of the direction your weight needs to go. 


To summarize:

• Ask for what you need. When dining out, choose restaurants that will accommodate your preferences, without rolling their eyes! Feel free to request sauces on the lighter side or on the side.
• Request a second plate. For those simply overwhelmed by the quantities of food, the second plate allows you to take control of your portions. For those struggling to lose weight (who actually need to), this separation can help you reorient to what a reasonable portion is.
• Give yourself permission to eat again later, if you need to--if it's in your meal plan, or simply if you're hungry--regardless of time of day.
• Work on tasting your food and enjoying it with all your senses. Sometimes with eating disorder recovery, there's a focus on simply getting through the meal. But ultimately, wouldn't it be great to enjoy the food?
• How many years have you been struggling with your eating? Your thoughts and behaviors will not change overnight, even if these guidelines seem so sensible. So be kind to your self and be patient, and appreciate any changes you experience, rather than just focusing on weight changes. Appreciate the change in energy level, strength, weight preoccupation, mood and sense of hope you may now have.

Hoping this post doesn't trigger anyone.  And, that my sons are not reading this and rolling their eyes!