Don't wait for an earthquake to shake you into action.

I was talking to a guy from San Francisco this week, and the subject turned to earthquakes. This long-time SF resident and survivor of the big quake of 1989 offered some very practical advice for me to share with my son, a San Francisco newbie, fortunately naïve about the seriousness of going through an earthquake. His focus was not on what to do during the crisis—although that advice is critical as well—but rather what to do before hand. How to be prepared for this challenging situation, because being prepared, as he put it, is the surest way to increase survival.

Imagine that while sitting and discussing such matters my mind moved to you, my dear readers. No, there’s no need to worry about earthquakes for most of you. Rather, the subject of preparedness as a means to ensure survival and minimize damage struck me as most fitting—whether you struggle with an eating disorder or living free of diet rules.

Have a plan, he said. In San Francisco that might mean knowing which are the secure places to hover—the solid doorways and tables to stay under. But before it strikes, he emphasized that it’s critical to have an action plan: to keep cash on hand—because you never know when you’ll need it and ATM machines simply don’t work in these situations. Have a plan for communicating with those you’re close with—because electric doorbells to apartment buildings will fail and telephone lines other than landlines will fail. A transistor radio helps you connect with the world—to reality check what’s going on outside of your own limited space. You’ll need light of course—so batteries and flashlights need to be stashed to access easily.  And of course a supply of non-perishable food as well as water. Decision-making when undernourished will surely be compromised.

Time to come out of hiding and ask for what you need.

You can guess where I’m going with this. Yes, the analogy applies to you who are metaphorically on no greater solid ground. Communication is key to survival, and planning for opening these channels is critical. Can you tell your partner you’re struggling? Can you ask for help shopping and cooking to ensure your health and nourishment? Can you simply say “I need a place to eat dinner tonight?” Can you ask them to keep the pastries off the counter when you are trying to avoid impulse eating? Can you ask for a referral to a therapist or a behaviorally oriented dietician?

Where’s your transistor radio, so to speak, your exposure to the world outside of your own thoughts? Admittedly the cultural media may not be the most fitting reality check for sane thoughts, for diet-free messages, unfortunately. What I mean is that you need exposure outside of your own disorder thoughts—someone that can ground you when you are limited inside your own space. Were you really happier when you were so much thinner? Did staying on that crazy diet truly improve your quality of life? Your mental health? Or are you using magical thinking like the way we recall old boyfriends/relationships, fantasizing about how awesome it all was--when really it was nothing of the sort? Do you think you’ll restrict just for now and then be able to simply normalize your eating? Think again!

Do you have a grounding place to run to—your doctor, therapist, dietician, perhaps even a higher level of care—if your foundation is shaking? Do you have ready to eat food for when resources are tough to come by? A reserve for when, due to all the stress, your ability to organize and think through what’s best to eat may be impaired?

Where will your light come from when the power goes out? Do you recharge with talk therapy, or maybe yoga or meditation? Do you get spiritual support or guidance from wise friends or loved ones?

You may get no warning before the quake, before the shake up to your healthy behaviors and thoughts. So have a plan. Be prepared.

What steps will you take? Please share—we can all use to hear some ideas!

Read more about slips and relapses:

http://dropitandeat.blogspot.com/2011/08/so-you-really-think-i-can-keep-this-up.html

http://dropitandeat.blogspot.com/2011/08/hope-or-despair-only-you-can-decide-but.html

http://dropitandeat.blogspot.com/2011/11/quick-fix-for-your-struggle-with-eating.html

http://dropitandeat.blogspot.com/2010/12/new-years-resolutions.html

Essential Weight Loss Tips? There Has to be a Better Way.

A winter storm has its risks. The biggest? It keeps me home with time on my hands trolling the Twitter feeds and Facebook messages. I read, filter my thoughts, read, filter, read—and then I can’t take it any more and feel the need to speak out. Earlier, I tweeted: ‘The only #cleanse you should be doing is a facial one. You know, soap & water or alternative. GI cleanses are disordered’, after reading an MD’s unintelligent praise of ‘cleanses’ (in quotations, because there’s nothing cleansing except your perception that you are removing those treacherous toxins.)

Then I came upon my professional organization’s tweet, “If you're hoping to lose weight before winter's end, these tips can help!” with this link. http://www.eatright.org/Public/content.aspx?id=6847

It’s hard for me to say just why it annoyed me, but I’ll try my best to explain.

Is this the best message we as RDs can offer? It’s a message of calories in/ calories out. Pick from all food groups! Exercise! Eat smart (as opposed to stupid, I suppose). Personally, I’d run the other way if I were looking for weight management guidance. It feels insulting to intelligent, well-informed readers. And it fails to acknowledge a couple of major points.

1) Actively dieting is not the answer and 2) eating and activity are not simply information-based decisions.

Were the authors thinking readers would respond with “Wow, I had no idea calories and activity were involved?” or “So simple! I’ll just choose from all the healthy food groups! That should work.” Or “Ohhh, it’s about moderation!”

As for BMI

For some, self-acceptance of a weight higher than the population-based weight and BMI charts is in order. A high BMI based on the population charts may be perfectly acceptable for you, if you maintain a healthy lifestyle. Similarly, a normal BMI hardly defines you as healthy (or normal) if your behaviors aren’t so healthy—if you engage in restricting and overeating, use purge behaviors, including compulsive exercise, have a rather restrictive diet, or poor quality intake.

Perhaps instead of having a “Calculate your BMI” ad on their page, they could include a ‘plot your personal BMI’, to help you evaluate whether you’ve been maintaining a healthy pattern over the years; a high BMI at the earliest ages suggests that genetics may play a role in your weight and size. Just as you wouldn’t expect that your shoulders would become narrower or your eyes would change shape, you shouldn’t believe that your BMI percentile should be changing much. Acceptance of this not-so-minor-point may be the best medicine for many!

But if your weight or BMI have been climbing inappropriately, you could use much better guidance than my national organization provided.

So in an effort to redeem them from the pitiful piece, I’m pulling a few thoughts together. Ask yourself:

Is it legitimate to be concerned about your weight? Has it changed inappropriately? Or are you focusing unnecessarily on your weight, the New Year’s phenomena, when really you are a reasonably healthy and fit person? I caught an episode of Sex and the City today at the gym, and Carrie said a most fitting line: “the problem isn’t with your thighs, the problem is with your head.” (This, in response to her friend kvetching about the size of her thighs and her body image.)

If it is legitimate, explore what’s in place, and what needs to change.

Are you aware of your hunger? Do you allow yourself to respond to it, or are you living inside your head, counting calories, or points, or carbs, for instance?

Do you let yourself get to the point of famished, only to overeat, then regret it, then set more rules again, perpetuating this cycle?

Do you eat beyond a comfortable level of fullness? Do you let your black and white thinking get in the way, suggesting that you’ve already blown it, resulting in you throwing in the towel, so to speak? Some CBT (cognitive behavioral therapy) may be in order.

Yes, there are other ways to self-soothe.

Or do you eat for comfort—because you’ve had a hard day—or as punishment, because you feel you don’t deserve any better? Maybe you’ve simply given up, feeling that nothing you do can even make a difference.

Are you overeating as a rebound to years or months of restrictive, rules-driven eating? Are you overeating only on ‘forbidden foods’? Time to learn how to work those in with permission to eat all foods that you enjoy—not just those foods that fit ever-so-nicely into the food pyramid! “Eat desserts less often”, the Academy for Nutrition and Dietetics recommendation, is hardly the advice you need. Setting more rules is not the answer.

Must we view desserts as forbidden?

Is your eating chaotic? Do you have balanced meals and snacks? Perhaps some help with planning is in order.

And have I mentioned patience? You've been living with your eating behaviors for a very long time, many years, no doubt. Let's not expect that they will consistently change after just a week or two.

Do you set realistic goals? You’re not stupid—of course you know exercise might help if your activity is low (and your intake is adequate). But maybe the obstacle is your belief that if you don’t have 60 minutes to spend, or can’t sustain exercise at 85% of your target heart rate range that it’s not worth doing any activity! 

Perhaps it's time you acknowledge your frustration—with messages from the media and the medical community, with false promises of quick fixes for your weight, with conflicting messages about what’s the right way to eat, and with insulting guidance from those who should know better. Yes, there is another way, which includes self acceptance and insight about the limits of what you can change. And, a shift to understanding how your thoughts and behaviors play a critical role in your eating.

Your thoughts? Thanks for reading (and in advance for commenting and spreading this advice!)

Measuring Progress with Gingerbread & Other Tales of Eating Disorder Recovery

But only if you do your part!

It was the shortest day of the year, the winter solstice, and it was a dark and rainy day here in the Boston area. And I was home sick with a bad head cold. It was enough to put me in a rather gloomy mood, if it weren’t for some bright spots from this past week that lightened my mood. Perhaps they’ll brighten yours, too.

Hannah had not had the easiest time these past several months. Besides her eating disorder, which ranges from anorexia to binge eating, she’s been struggling with depression. Yet after many months of working with her team her progress shined through.  No, I’m not talking about measuring her progress in pounds—her weight fails to reflect the recent progress that’s just starting to emerge. 

Ahh, the feeling of eating and trusting it's going to
be okay...

Rather, I heard her describe for one of the first times, her interest in food—in its taste, and in its texture. I heard her say that she realized that she actually didn’t like some of the things she had been eating, and I heard her talk about her food passions and preferences. Yes, Hannah is finally allowing herself to taste what she’s eating, and to select foods she enjoys the taste of. This is progress!

Then there was Sammie, who bought my book last week—Food to Eat, co-authored with Cate Sangster— and at her follow up visit on Tues. this 20-something-year-old came in all excited. She had prepared about 7 of the recipes, from Cate’s Muesli Bircher to the gingerbread. But more than that, she actually ate them all! (Not all at once, I’ll add!) And she reported loving each and every one of them.

Rye Pixels Copyright. 

She told me about her love of baking—something I knew nothing about—but confessed that she had not previously ever eaten the baked items she labored to prepare. No, not since she’s struggled with her eating disorder. But this week was different. And having broken the ice and done so once, she’s increased her confidence that she could do so again. She trusted, she told me; she felt like she knew what we were saying was true and that it was okay. And it worked.

Are you ready to challenge yourself and break with your routine? Bring a little light into these dark days by challenging yourself and trying something different. I’m attaching the gingerbread recipe—I baked it Friday with the lemon icing and it was divine! But with or without the glaze, you can’t go wrong.

It’s not too late to start to change. All it takes is the first step.

Let me know what you think.

From the recovery cookbook Food to Eat, one of 25 sensible and tasty recipes.

Overeat, Restrict, Over-exercise—Just for now?

It may make you happy for now but...

Dana used to tell me she'd allow herself to eat "whatever", just until the holiday season was over, and then she'd buckle down and resume her restrictive approach to food management again. 

Rob cancelled his November appointments, preferring to wait until after January 1^st to begin to improve his eating and his cholesterol level. And Stacy continued to restrict—in part because she knew that after her next doctor visit in a few weeks, she was going to be held accountable for her actions. Yes, she was going to need to turn her eating around or she'd be finding herself in a rather unhealthy predicament.

If you're like my patients and thinking you'll get by just for now, whether you'll continue to drop a few more pounds before you start normalizing your eating or you continue on your path of overeating, it's time to face the facts—you're not really planning to change. At least, not for long term.

I know, I know, you really do want to change. You may, like Dana, hate how challenging it is to do the simplest tasks, and how incompetent it makes you feel being foggy headed and spacey. Like Rob, you may be savoring what feels like your last supper, your last chance to get it all in before you take your diet seriously and have to give it all up. Or like Stacy, you may fear the consequences of eating enough—even if you know it's the right thing to do, for both your physical and mental well-being.

The truth is, this approach of just for now will do nothing to improve your relationship with food. If you continue to feel like it's your last chance to indulge, then plan to refrain from your favorite foods, you'll find yourself deprived. Sure, you'll do fine for a while—even a few weeks—until you're exposed again, or have a weak moment, a triggering situation. And then once your guard is down you'll overeat, again determined that it will never happen again.

And if you starve yourself or restrict your intake, fully intending to get your self back on track—once you drop the weight, that is—the behaviors that result will be anything but normal.

Putting off change-now that's a big mistake!

If you're serious about change, it can't wait until Monday—or for January 1^st. And when you have a slip, you need to wrestle with it now and learn from it.  Ask yourself  "What happened here and what can I do next time to prevent this from happening again?"  But then you've gotta move on. (I say when not if you slip, because the truth is, slips do happen—so brace yourself.) You can't make it a slide until the first of the year, thinking you've already ruined it.

Please don’t wait until 2013 to resolve to change. Because if you're really serious, the change can and should start now.

I know it's hard, and I know you're struggling. But its not going to get any easier with the passage of time. So use your resources and start moving forward, won't you?

Thanks for reading.

The Consequence of Changing your Relationship with Food.

It Doesn't Have to be All or Nothing

I heard on the radio that the odds of winning this lottery, this multi, multi million dollar lottery, are less than the odds of getting struck by lightening.

Imagine if...

Yet in my office Patty talked about how winning this bundle of money would change her life, how she wouldn't be able to stay in the same place she's at. People would expect things from her, and in many ways it would add some stress. She spoke as if this change could happen, as if it were real enough to taste.

What would happen if you had a life-changing relationship with food? If you had fully recovered from your anorexia, your bulimia, your binge eating disorder? If you had healthily lost weight to a normal range? 


In some ways, this is so thrilling, so liberating, so refreshing. Like winning millions, it may certainly change things for better. You're likely to feel better, physically and psychologically. It may resolve some stress, allowing you to feel lighter. And it may open up some options. You may be less preoccupied with food and eating, freeing up your mental energy for more appealing thoughts. You may become less isolated, allowing yourself to socialize, with or without food.

Can you allow yourself to enjoy the benefits of change
without fearing the consequences?

Yet in other ways, it's rather frightening. What will I lose if I let go of food, my best friend, as my means of coping?What will be expected of me—by my friends or family members? Will they support me or be threatened by my progress? Will I have to take steps to move on in life, or can I hover where I'm at?

But you're not obligated to change; the choice remains yours and yours alone. If you don't want to move up professionally, that's your choice. No interest in dating? Again your prerogative. Change can be scary, but you can be selective about what you change; you can enjoy the benefits of  feeling better, while staying put in every other area of your life—if you should choose to.

Here's an update on several of my patients you've read about, to make this point.

Ready to tackle whatever comes his way!

Remember Maggie, with her history of emotional and compulsive overeating, unhappy with her climbing weight, her newly diagnosed diabetes and her chronic knee problems? She had struggled with disordered thoughts and behaviors for several decades.  By changing her relationship with food and without disordered behaviors Maggie's weight is down over 152 lbs. Now she chooses to step out of her house more than she had before. Knee surgery is now an option, but she's not quite ready to deal with surgery.

Always fearful of being in a body of water, she decided to get past her fears with the aid of her therapist, and now goes to water aerobics several times weekly. In the past, she could neither face her fears of the water nor of donning a bathing suit.

She's finally content and able to speak her mind.

How about Erin? She's the one who was subjected to the rudeness of clueless, assuming strangers—one in particular, who had the audacity to comment on her eating while she mindfully sat in her parked car, eating her snack when she was hungry—simply following my recommendation to respect her body's signals. She recently brought a giant grin to my face, as she related this story:

“That’ll teach me to eat while driving”, she told the dry cleaner last week, handing him her  food-splattered jacket. Struggling with a recent GI issue, she had some reflux after she had consumed her meal at home, before heading to my office. And while driving, the food decided to revisit. No fault of hers. And so she made a stop at the cleaners and playfully commented about her “inappropriate” eating.

To even be able to joke, to not feel ashamed of her eating, to have the confidence and to choose to speak up—now that's the result of a shift in thinking.

Like Maggie, she too has lost a large percentage of her weight, a total of 101 lbs as of today, yet she remains overweight. She is still not comfortable traveling in planes (the seats are just not comfortable for her) and she doesn't like the uncomfortable feeling of being in Europe where the cars and most people are smaller. But now she has set her sight on a trip, a chance to visit relatives abroad—when she feels she can better manage it physically.  But she's definitely not waiting to start speaking up and sharing her thoughts!

I heard from Daniel after several years—he had worked with me and successfully recovered from his anorexia. He spoke about finding his passions—currently theater and track—and is now applying to colleges. His life is no longer filled with medical appointments, nor with thoughts about calories, “good” foods versus “bad” foods. He finally chooses  to fully enjoy life.

Laura could have fallen back on her binge eating during this stressful time. Dealing with her recent divorce, and the chronic lack of support from her husband, overeating held a lot of appeal. Yet somehow she hasn't slipped. She's gone through challenges for sure. Yet she's well aware that binge eating is a choice, and the risks and consequences are much greater than any short term benefit. She continues to impress me with her awareness and her ability to put fear aside and face her many challenges.

Change doesn't have to be so scary!

I could go on, really I could. There are many, many clients with similar successes. Why share? Because at some point they were all petrified of change. Because in spite of knowing that where you are at is not a place you want to stay, the fear of change can feel paralyzing.

You have choices. And as long as you're in a safe place, medically stable, you can make change one small step at a time. Maybe it's time to take the first step?


You are safe to share your thoughts here! I'd love to hear from you.