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.

Avoidance isn't the answer. It's time to bear hunt.

Recovery is a tricky thing. You may be making progress with your eating—whether you are working to overcome binge eating, anorexia or bulimia—but may be fooled into believing that you’ve truly normalized  your relationship with food. It may feel like you’ve largely recovered; you’ve started to include ice cream (but only when you’re out, never keeping it in the house). And your binge frequency is close to zero. And surely you who’ve been restricting deserve credit for eating more than you used to—at least of the foods you deem good for you.

But consider this:

No, avoidance isn't the answer.

• Is it really recovery when the only way you feel in control is to fill your days with so much activity (no, not even physical activity) that you don't get to sit with your feelings? You work long hours waitressing, take on extra shifts or extend your work hours only to avoid being with yourself. You struggle to allow yourself to feel hungry—fearing you're not trustworthy to respond correctly. You equally fear fullness, that satisfying feeling of truly getting enough. Would you allow your best friend to carry on this way?

• Is it really recovery when you stop binging, only to restrict your food intake? You stick around family or friends because you know you'd never binge in their presence, but you also struggle to eat enough when they're around—and even when they’re not. If your child see-sawed between binge eating and restricting her food intake, would you say “that's just fine”?

It doesn't have to be so scary.

• Is it truly changing your relationship with food when your solution for managing chocolate cake—or your favorite flavor ice cream or bread or peanut butter—is to simply never have it around? You forbid yourself access—just for now, until you meet your weight goal, or maybe believing you’ll resist these for the rest of your life. Would you suggest this to your parent, or would you hope that life could be much better for them?

• Are you really recovering when the only way to nourish yourself (yes, I know some of you struggle with this loaded expression which implies self care in its fullest sense) is by keeping everything the same, limiting your food choices to just a few "safe" foods? Or, by weighing and measuring all of your food? No, not just for now, but forever? What would you say to your partner if he or she kept to the same restricted allowance, an even number of items to be comfortably ritually consumed, day after day after day?

Time to start living again.

• How normal is your eating if you rely on counting your calories, or your points a la weight watchers? Or if you can't release yourself from exercising when your intake exceeds your ideal or your self-prescribed amount?

Can you truly recover? Absolutely!

Full recovery requires feeling—not avoidance of hunger and fullness. Detaching yourself from these physical sensations, like avoidance of all feelings—sadness, disappointment, fear, hopelessness—only prolongs your suffering (while admittedly for a moment it seems like the only way to get through). Avoiding feeling by numbing out with your eating or your not eating, serves a purpose. But let’s not forget that you lose out on life’s positive emotions and experiences, too.

It requires “Going on a bear hunt” so to speak—a reference to Rosen and Oxenbury’s children’s book I loved to read when my kids were very young.

"We're going to catch a big one. / What a beautiful day! / We're not scared. / Oh-oh! Grass! / Long, wavy grass. / We can't go over it. / We can't go under it. / Oh, no! / We've got to go through it!" The family skids down a grassy slope, swishes across a river, sludges through mud and, of course, finally sees the bear…”

It takes trudging through all the uncomfortable challenges—with support, of course—in order to get past your fears. Like the very young kids, you might (at first) run away when you face the bear. But with some work (perhaps there needs to be a part 2 to this classic), you’ll be embracing it and feeling all the better for it.

There’s more to life than yearning for foods you enjoy yet avoid, or regretting the little you did eat. Or struggling after a binge—an inevitable consequence of days, weeks or a lifetime of rigid diet rules, of avoiding eating enough.

You deserve better. Really you do.  I don’t mean to minimize any progress you’ve made. I simply want to urge caution to be on guard for those sneaky eating disordered thoughts and actions. So please consider reaching out to take the next step to push through—to change your thoughts, your feelings and your eating. Push through the tall grasses and the mud. And conquer the bear.

Oh, and please share your thoughts with us!

Thanks.

Speak Up, or You Will Be the Biggest Loser. And That’s Not a Good Thing.

Rapid weight loss is incompatible with mental and physical health. Period.

I beg to differ with Daily Beast columnist Tricia Romano, who believes Rachel Frederickson’s extreme weight loss on the Biggest Loser is none of our business. And I disagree that her weight is just a tad lower than a healthy BMI. And Rachel’s BL trainer Bob Harper is simply wrong when he assumes that “…when contestants leave home ... they are in charge of themselves.” 

Admittedly, I’ve never watched more than a few minutes of TBL—I found it intolerable. Yet the show is unfortunately quite popular. Many of my plus size patients report being inspired, identifying with the desperate contestants, tolerant of the verbal abuse and crazy diet and activity demands. They're smitten by the fairy tale that rapid weight loss through extreme measures works. And that extreme weight loss equals extreme happiness. Let me inform you otherwise; I yearn to protect you from the damage, both visible and hidden, from this diet mentality.

But first, about Rachel—the latest victim 

My summary of The Biggest Loser.

It was a media frenzy as Biggest Loser Rachel Frederickson returned to the show, 45 lbs below her “healthy” weight of 150 pounds when departing TBL. She weighed in at 105 pounds, a 155 pound total weight loss. And the $250,000 reward money was likely the least of the motivators. If you’ve ever known anyone who’s lived with an eating disorder, you know the situation well. It may start with a seemingly reasonable weight loss goal, typically with a common diet. And then once that goal is met, their goal gets reset. “Just five more pounds”, they think. “Then I’ll be happy/ satisfied/thin enough.” Yet for some, no amount of weight is ever quite enough, and the struggle continues. It moves from perhaps a sincere interest in losing some weight—perhaps at the recommendation of their doctor, even—to something completely different. 

And while it is frequently said that eating disorders are about control, the experience of the eating disorder sufferer hardly feels like being in control. Rumination about food and weight and eating consumes thoughts, and normal life comes to a halt. Social activities are put on hold to accommodate diet rules, and isolation becomes the norm. They may be visibly underweight, or appear to be of average or even over weight. Starvation can occur at any size. Really.

As for the Daily Beast writer’s comment “at 5 foot 5 inches and 105 pounds, Frederickson’s is slightly below the recommended BMI. But she’s also small-boned and lithe”, allow me to respond. For her height, midpoint of a healthy range may be 125 pounds by the charts, but at less than 90% of that weight (under 112 pounds), most women lose their periods. As for athletes (she was apparently a world class swimmer prior to her weight gain) a higher weight range is generally expected as healthy, with increased muscle mass. 

Of course there are small boned, women who were always petite, for whom a lower weight certainly may be okay. Weight, as I mentioned, is not the best measure of health. But a significant weight drop below one’s highest weight, referred to by researchers as weight suppression, may have undesirable effects, including precipitating eating disorders. 

Rachel reports feeling fine, but the evidence tells us otherwise. Exercising 3-4 hours per day strikes me as a big red flag for preoccupation with her weight. It’s not her fault, though. The Biggest Loser promotes rapid weight loss and unrealistic goals. We know from a classic starvation study by Dr. Ancel Keys in 1944 that starvation resulting in even a 25% weight loss—much less than her almost 60% drop in body weight—impacts thoughts, moods, sexual desire, and eating behaviors. All that, in addition to the slowed heart rate (no, it is not an athlete’s low pulse), low body temperature, and abnormal menses. 

Three, maybe four exercise classes a day, is her reported activity, while consuming under 1600 calories from a 'healthy' diet. Excuse me? 'Healthy diet' is a term that simply doesn’t apply to this intake relative to activity. I don’t care how healthy the individual foods are, whether they are organic, whole grain, whatever—there’s nothing healthy here. This is a severely restrictive intake for this level of activity.

It’s none of my business, Tricia? On the contrary. I can’t simply sit and watch and not shout out how outrageous and unhealthy this is. I am not, however, faulting Rachel. The Biggest Loser took a vulnerable contestant—perhaps no different than other contestants—a woman who reports emotional overeating resulting in a 100 pound weight gain following a breakup. They turn out an excessive exerciser, who’s restricting her calories and likely quite unhealthy by many measures. 

Call it the flip side of the same coin—first likely struggling with binge eating now struggling to trust her body and her signals and eat to meet her needs. Are we to view this as success? Not in the least. Were her eating behaviors addressed? Was she given strategies for coping versus using food or food restriction or compulsive exercise? Was she guided to learn to trust her hunger and her fullness again, or simply instructed to count calories? 

A former contestant, Ms. Hibbard acknowledges the unhealthy behavior she and others practiced on the ranch, particularly preceding weigh-ins (similar to what Weight Watchers report). Contestants, she claims, “dehydrated themselves through excessive workouts in warm layers of clothing, drank only coffee because it acts as a diuretic and ate little to nothing.” She adds: “I feel I did a vulnerable disservice by not saying on television the night of my finale. ‘I’m sad, and I’m sick from being on this show’”. (http://www.nytimes.com/2014/02/09/fashion/Biggest-Loser-Rachel-Frederickson.html?_r=0)

Hibbard might have been late to speak up. But we don’t have to be silent. The impact of a show like The Biggest Loser is dangerous—to its contestants, and to its viewers. It promises health, while causing harm; and it delays and potentially complicates contestants’ preexisting eating disorders. It shames participants through their weight loss struggle, and turns viewers to criticizing the Loser, like Rachel, for whom continued weight loss may feel out of her hands. 



Don’t accept the promise of rapid weight loss, or believe that extremes of eating or exercising will work. Because they never do.

Self-parenting and your relationship with food.

Because you’re more than just dust and ashes.

How long could you have stayed in bed
with this look?

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

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

And what does this have to do with you?

Get a little help from your friends.

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

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

Where’s the compassion? 

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

“A person should have two pieces of paper, one in each pocket, to be used as necessary. On one of them [is written] ‘The world was created for me,’ and on the other, ‘I am dust and ashes.’” 
–Reb Simhah Bunim, Przysucha Poland, (1765-1827)

You just might need to give yourself a hug.

I’ve always loved this saying, which emphasizes the need to be neither too haughty and self important nor to minimize your value in the world. The problem, though, is that most clients I see struggling with eating issues err on the side of focusing on the ‘dust and ashes’.

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

Where’s your voice? 

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

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

The way I see it, communicating is a necessary component of recovery. But if you aren’t yet up for speaking your thoughts, at least express them—through journaling, music or art. Be creative—there’s not a right way to release what you are holding inside.

Not even aware of what you’re feeling? Just starting the creative process may make you aware. Or maybe you need one of these to identify your emotions.

Where’s the self-acceptance? 

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

He's got me at last.And we both really need it.

I think I’ll go snuggle with my dog now. He needs it. And I could use it too on this rainy, dreary day. The laundry and shopping will just have to wait.