Pet Peeves. Just in Time for Eating Disorder Awareness Week.

We will all rest more easily if we air
these 'pet' peeves.

Radio show host, Brooklyn Kitchen store owner and foodie Harry Rosenblum wants to know my food related pet peeves. He'll be interviewing me on March 16th on Feast Yr Ears about eating disorders and recovery with a particular interest in Cate and my book, Food to Eat: guided, hopeful & trusted recipes for eating disorder recovery. Pet peeves. Funny he should have asked; 'Thursday's patient' was just suggesting this for a blog post.

We all have them. Pet peeves are those things that drive us crazy that people and companies say and do that make us want to scream. But most of you don't scream, or even express your outrage. You might be annoyed, infuriated even, but you just keep it quiet and say nothing. Maybe you ruminate about it, or binge eat or don't eat at all. "I'll show them" may be your thinking. So readers, here's your prompt to share those things that piss you off. Ok, ok, not so fast. Let's narrow the focus to food and eating disorder related topics, okay?

I'll start us off with a few.

• People who ought to know better, that assume weight loss is a good thing. Think doctors and nurses. Just 2 days ago a pre surgical nurse interviewing a family member asked if there was weight loss of more than 10 pounds in the past month. Yes, was the reply. "That's great!" she  moronically responded, naive to any underlying vomiting, pain, growing cancer, or depression that might have contributed. Brilliant. Or the pediatrician who praised the boy's weight drop from his high BMI, failing to ask the critical questions that would have diagnosed his eating disorder.

• Food companies that sneakily shrink their packaging, thinking we just won't notice. 1/2 gallon of ice cream? Nope. Now it's just 1.5 quarts (vs 2 quarts). Kashi cereal boxes--same height, just a fraction of the content, with skinnier boxes. Call a spade a spade. Increase the darn price but keep the package size the same. Don't insult my intelligence, please! I'm waiting for them to fill my dozen eggs with just 10. Just you wait. 

Stop insulting my bread.
And please call it bread, not carbs!

• Nutrition misinformation that people can't let go of--belief that gluten, or carbs make you fat. Not so my friends! There's no evidence to support this. It's like global warming for a particular US political party. They hold on to these beliefs in spite of all the science to the contrary. Ughh!

• Food labels that shout out "high protein" or "low fat" or "gluten free" as if we should care. (If you  need to watch your gluten since you have celiac you'd better look for more that the shout out gluten text; you'll need a legitimate stamp identifying foods that have a measured low gluten level through careful factory testing).

• People that think their food choices or diet type raises them to a higher moral ground. Choose to be vegan if you are concerned about the planet or animals or both. But don't wear it like a designer label because quite simply, I'm not impressed.

This is steak. It contains protein.
And fat. And other nutrients.

• Calling food by its nutrient. As in "I'll have some protein with that" referring to meats or fish, for instance. Can't we appreciate and select foods for their other characteristics, too? For their flavor, or texture, their smoothness or crunch? The simple pleasure they give us?

What are your pet peeves? Let's put them out there and circulate them. And maybe we will raise awareness and create change.

The very low sugar, low fat healthy diet—an oxymoron.

Kristen knew to avoid fats—except for those in nuts (which she included in very limited amounts) and certainly those in dairy and oils. Fats are bad. Period. She loves fat free yogurts, but those she omits because of the sugar. Same with milk, which she truly used to enjoy. Now she uses fortified water aka lite almond milk. Seasonal fruits, even the organic stuff—completely stricken from her diet, you know, because of the sugar.  Whole grains—well those have those god-awful carbs so those are out too. Yup, that leaves… lean poultry and fish and non starchy vegetables.

No wonder meal planning is a challenge.

No wonder she struggles to not binge following a day of deprivation.

No wonder her energy level is low, and her thoughts are preoccupied with food and eating.

Why can’t I decide what to eat?

If you're like Kristen, you get so over-focused on what you shouldn't eat that you're challenged to figure out what to eat.  Your endless food rules about nutrition, weight and health leave few foods to eat—and enjoy. 

I've lost count of how many patients came into my office these last weeks, stating: "I have no idea what to eat anymore. I just can't decide." These are patients of all sizes and conditions—patients with anorexia, and those with binge eating disorder and bulimia; and those struggling with their climbing weight and obesity in spite of their attempts to eat healthy. And they’re all ruled by unnecessary food rules.

Wrong, wrong, wrong about fats!

Like Kristen you too may be fat phobic, in spite of the updated newest guidelines for Americans 2015, which have removed the notion that total fat should be avoided. Got that? There is no evidence to support a recommendation that total fat should be restricted—neither for weight management nor for health and disease prevention. 

Really? How can this be?

At the 2015 Scientific Sessions of the American Diabetes Association (ADA) there was a wealth of research showing that diets rich in fats from plants sources—with nutrients like mono unsaturated fats (think avocado, peanuts and olive oil)—and in omega 3s (think salmon, sword and tuna in addition to walnuts and flax) help reduce abdominal fat distribution which is the greater health concern than obesity.

And, wrong about carbs and weight gain!

Also at the ADA, extensive research was presented concluding that macronutrients—the protein, fat and carbohydrate balance of your diet—ultimately have no impact on your weight. That's right. Numerous large studies including a well-done Harvard study confirm this.

I know, I know, it’s hard to believe when you’ve already been sucked into the misinformation of carb and sugar toxic diets and fat phobia.

You’ve lost sight of the bigger picture. In spite of eating a diet full of healthy foods including protein sources, fruits and vegetables, grains and fats—your calorie intake can become reduced to the point of providing inadequate calories for your day to day need. You get fuzzy headed, feel fatigued and decision-making about food becomes challenging. Rules and restrictions consume you, so you're at a loss to figure out what you can eat. I mean if you know you can’t eat gluten or that carbs are toxic or fats will make you fat and sugar is poison than what's left? How can you choose what to eat when there's so little that allowed?

Remember when you used to simply eat?

Move from micromanaging your foods.

How can you loosen the reins? Start to shift your thinking from micromanaging your diet. Rather than hyper focusing on each individual food item, on every nutrient or component of your intake, consider the bigger picture.

Consider OJ.

I walk through the supermarket noting the orange juice selection. Remember orange juice, the juice of oranges naturally high in vitamin C (and lesser known for its high potassium and folic acid content)? Only now it’s available calcium fortified. And get it with pulp—it’ll make you think you’re getting more fiber, when in truth there’s no difference. Add omega 3s while you’re at it—just get it with fish oils (quite a disgusting thought, personally). My point? Why are we thinking that one food has to be everything to our diet? Can't oranges or orange juice just provide us with the nutrients it's known for?

Must our pasta be whole wheat and protein fortified or be banned from our diet? What if you started with white pasta—yup, no fiber, all carbs, delicious pasta? You don't need to have the whole 16 oz. of it. By itself it's hardly a balanced meal. But surely you can find a solution to that, right?

Yes, you can add vegetables—for vitamins, for volume and texture, for fiber and satiety. Feel the need for protein at that meal? Add a glass of milk, some cheese, some shrimp or chicken or smoked salmon.  See where I’m going? 

Maybe think even bigger picture. Perhaps some meals are higher carbohydrate, but your protein is met from other meals or snacks?  Maybe you had a Greek yogurt high in protein or some nuts, for instance.

It's time to aim for balanced meals and a balanced day of eating, rather than hyper focusing on some 'perfect', ideal foods and eating style. Imagine even including a baked good simply because you enjoy it, as a snack when you’re hungry—contributing to your energy needs for the day, in addition to the wholesome foods you strive to limit yourself to.

Now that’s healthy eating.

Thoughts? Questions? Does this resonate for you? Are you out there reading? Please share with anyone who might needs some reality checking! Thanks!

Loved one on a diet? What their shakes and weight loss mean for you.

Your spouse or partner (or best friend) goes to the doctor and is told to lose weight. And they do. You're pleased for them—on some small level that is—believing perhaps that weight loss is in their best interest. Maybe you’re concerned about how sedentary they've become or about their risk with climbing blood sugars or cholesterol levels. You know how sluggish they’ve been and surely you’d care to see them feel better both physically and mentally. But mostly you're not so pleased. Sound familiar?

Whether you're recovering from an eating disorder or trying to break from the diet mentality and release yourself from diet rules it has "triggering" written all over. To quote my dear friend in recovery from an eating disorder "why is that he's allowed to diet and I can't?" "Why must I be the one in the family who models appropriate eating behaviors, while he restricts his grains and sucks down liquid supplements?"

It's simply not fair. They can do crash diets but you can't. Or shouldn't. Right?

I mean, how well are they really doing?

Not quite. If your loved one is following a fad diet, resulting in rapid (albeit short term) weight loss, be careful what you're longing for. The result is subsequent weight gain that exceeds the loss in most cases. And in the meanwhile, they’ll be dealing with increased irritability, fatigue, and preoccupation with food, eating and weight. Is this really what you want? You've been there before I'm sure. The fantasy of slimming down (through unhealthy measures) and morphing into a new and improved happier being is simply fantasy. You know better. I know you do.

But what about those loved ones that are changing their habits for better, resulting in their losing weight? They’re moving from TV watching while eating and starting to taste their food. They’ve started to portion their food, better reflecting their need for fuel. And their knee-jerk reaction to stress and perceived failure and depressed mood is no longer to reach for food. These changes I certainly support.

Consider that you too can focus on your behaviors. Are you eating mindfully? Respecting your hunger and your fullness? Including physical activity that's enjoyable and not compulsive, that supports your mood and well-being?  Yes, those are actions you too can take, providing you nourish your body adequately (and are medically stable and cleared by your health care provider.) Shopping and preplanning meals and snacks might help, too.

What would you tell a child who says that it isn’t fair that their friend gets to eat a different amount than they do? No doubt you’d acknowledge that we each need to meet our individual needs—based on height, weight, muscle mass, physical activity and genetics, for instance.

For some that might mean eating less, while for others eating more. For some that means figuring out how to move more, while for others it demands respect for your need for fueling your body to enable the privilege of movement. Some of us are more vulnerable to restrictive eating, triggering more eating disorder thoughts and behaviors. While others can exercise modest restraint—delaying seconds and shifting the balance of foods on their plate, for instance.

Perhaps it's time to communicate to help support each other.

But would I endorse a fad diet that appears to promise great outcomes—even based on the short-term results you might find alluring—for anyone? No! I would have a heart-to-heart with your loved one to explain why that approach is not constructive. Not because you feel threatened by their weight loss, but because you sincerely care about their well-being and you know where restrictive diets lead. (And for the record, the macronutrient content—whether high protein or low fat or low are high carb—has no bearing on weight loss. Really. So do set the record straight!)

Their weight loss may not seem fair. But neither is the price of restrictive eating, of feeling like you're on a diet. You've been there. You know better. It's a short term high, and a terrible drop after that.

Remember how you enjoy your freedom, your right to eat the foods you love and give you pleasure. Remember that trusting your body to eat enough enables you to think clearly and decrease preoccupation with food. Remember how bad it feels when the rebound weight gain follows the severe food restriction, the dieting that’s looking so appealing.

You're an adult and you can do what you'd like. But do you really think another diet is going to make things better? Now please go talk with your loved one.

What doctors must know about eating disorders.

I want your input. I need to hear your voices. For EDAW 2015, I have volunteered to present to two medical residency programs—one in Boston, MA and one in Providence, RI on what doctors need to know about eating disorders.  I've incorporated recommendations from twitter responders and from Aspire, but I welcome more input. Here's what I have to share with new doctors so far:

• Avoid the ‘Don’t ask, don’t tell’ approach. Patients rarely volunteer behaviors they feel ashamed of—bingeing, purging, diet pill and laxative abuse.  So providers need to ask. Nicely. Casually. Non-judgmentally. Include basic ED screening questions at routine visits.

• Early action is not just for college admissions. Eating disorders are best identified early and treated promptly. We wouldn’t simply wait it out to see if blood sugars simply turn around in a patient with type 1 diabetes. Take eating disorders as seriously as you would cancer, or

  

  The time is now for improving medical management
  of eating disorders.

  diabetes, or heart disease. Because like these medical conditions, they cause physical damage, and impact emotional wellbeing. And did I mention that left untreated they can be fatal?
• Relying on size is a seismic mistake. People of all sizes suffer from eating disorders. And because eating disorders in those of “normal” weight are often missed, they may be more chronic and challenging to overcome. Patients with anorexia can have high BMIs; they severely restrict their intake, are ruled by food rules and fear weight gain; their restriction impacts their ability to function, their mood, their blood pressure, body temperature, blood counts and thyroid level, fertility, bone density, and GI function.
• ED sufferers want help. People with eating disorders ultimately want to be free of their disorder. They are not just being difficult. They may also be struggling with depression, anxiety and OCD making recovery more challenging. They are
  
  suffering with their symptoms making day-to-day life unbearable. In fact, the risk of suicide is higher in those living with eating disorders and is a major cause of death in this population.
• Be careful what you ask for. Before recommending that your ‘overweight’ patients lose weight, do some assessing.  Has their weight or weight percentile been normal for them? What behaviors might be better addressed versus focusing on their weight? Diets can be the tipping point, precipitating an eating disorder. Striving to achieve and maintain a lower than usual weight contributes to maintenance of eating disorders.

  

  You can't simply tell by appearance that
  someone is suffering.

• Guys (yes even straight guys) get eating disorders. Seemingly healthy, fit, guys, and overweight boys and men live with eating disorders. Like girls and women, they may restrict and be fearful of gaining, binge eat, purge, and compulsively over exercise. EDs have no gender limits.
• Eating disorders may start in preadolescence, or at age 20, or in the 40s.  Eating disorders don’t expire when kids reach adulthood, or when adults mature. Individuals with EDs may first present for care after decades living with their ED or may have a late adult onset during a transition period in late adult hood.
• Read between the lines and ask the right questions. Please don’t praise a patient’s weight loss. Would you say great job if they lost due to cancer? Do focus on reinforcing healthy actions, not numbers. Rather, ask:
•  "What kinds of changes have you made?" 
• "How do you feel?" 
• "What percentage of your thoughts are spent thinking about food and eating?"
• "How’s your energy level?" 
• "How are you managing with these changes?"And note that healthy eaters are not always so healthy. Ask why your patient became a vegetarian/vegan. Why are they following a gluten-free or low carb diet?

Families play a critical role in
supporting a child's recovery.

• Parents are necessary supports for recovery. Overwhelmingly, parents need to be brought in to assist recovery. And the only thing we can blame parents for when it comes to eating disorders is their genes. 
• Eating disorders are serious mental health conditions. They have genetic, environmental and nutritional underpinnings. They don’t just “run their course” or become “out grown”. They require treatment by experienced providers. ASAP. Waiting may be lethal.
• If you don’t know, please ask! Check out AEDs medical resource guide and this. Seek out providers to collaborate with who are part of national or regional eating disorder organizations like AED, NEDA, iaedp and MEDA.

Please share this with your medical providers. And with your friends. And twitter followers. And with your Facebook friends.

Eating disorders require education and a break from the commonly help practices and beliefs. And you can help make it happen.

Thanks again to those who have already shared their ideas that were incorporated into this post.