Which One Really Needs Help? Call the Doctor!

Even Mica was disturbed by this!

I know, I know—I’ve got another 5 days before my expected post is due, but I just can’t wait. I can’t let Laura’s painful experience go unaddressed. If you haven’t read it, please do so now. But brace yourself—you’re gonna get angry.

It’s not unusual for me to hear and read about inappropriate statements and suggestions that medical providers make. Actually, we all can manage to say stupid things—I know I’m no exception.  (Really, no need for those that know me personally to comment on this statement!) But today I heard two doozies—Laura’s tale and a patient’s story.

I don’t know Laura—except, that is, from her blog comments. What I do know about her is that she has made extraordinary progress in her recovery from anorexia. That she can now enjoy pizza! That she gets it—and she follows through with healthy, normal, eating behaviors. That’s she’s worked hard to put all the disordered thoughts aside and use her wise mind to justify doing the right thing. That she, like many others, have needed to use self-talk to move from the myths, the misinformation, about nutrients and foods and weight. Ahh, she’s done so well. I don’t even know her, but I am so proud of the work she’s done, of how far she’s come!

And then someone she respects, her MD, albeit inexperienced with eating disorder, totally sideswipes her. The respectable doctor projects, I suspect, her own mishugaas—about weight control, about carbs, about fats. Our wise Laura knows better—but of course when the white coat-clad MD begins her critique of Laura’s intake it’s simply devastating.

Yes, you can eat the whole panini if you're hungry!

What I read in this comment is not that it triggered her eating disorder; she concludes by stating that this doctor just didn’t work out. (Hooray for Laura! Time to change doctors—or get her to close her mouth and withhold absurd and inaccurate assessments of Laura’s intake!) 

But, I suspect, it’s the profound sense of disappointment in her doctor, and perhaps in our crazy food-and-weight obsessed society, as a whole. Laura appropriately acknowledges that there are absolutely no grounds for this doctor’s comments—she has zero evidence to conclude that Laura is struggling with her weight, or unhappy with her intake or struggling with eating disorder behaviors. 

Perhaps if she had asked more open ended questions—you know, like “How’ve you been feeling about your eating these past weeks?” or “What concerns would you like to address about your recovery?”, she could have prevented this damage. It would make a lot more sense than projecting that there’s a problem, simply because Dr. Dieter has perhaps struggled with her own weight and her eating!

Hats off to you, Laura, for having the sense to air your feelings and get support—and for sharing your reaction with the doctor. Hopefully, she’ll learn from her mistakes. And hopefully, you’ll find an MD that really gets it!

As for the patient story? Nothing too unusual that you haven’t heard before. It’s a case of an MD who looks at a 20-ish patient and tells her that her weight should be about 50 pounds less than it is—which would bring her to a place she has never seen on her growth curve. It would bring her BMI to a percentile lower than ever before, even since grade school! Fortunately, this young woman appeared to have a good sense of self, knowing darn well that this MD’s goal was crazy.

If she is appropriately nourished and growing
along her curve, must we make her weight
an issue?

But what if she took the doctor’s orders to heart and began to fight her body on what was normal? To push activity to an obsessive level and to restrict her intake to a point that was neither healthy nor maintainable? What if she had the genetic predisposition for an eating disorder and all it took was the encouragement of a doctor to set the ball rolling—given her own frustration with her recent weight increase and being told her BMI was in the obese category? This woman was more fit than most people I know and had no health issues. She ate healthily and exercised. And there likely was an underlying medical explanation for her recent unexplained weight gain, yet to be determined.

See the problem? Do they even realize the power of their words?

Do you even realize the power of yours? If you are on the receiving end of poor advice, do share your concerns. Consider another opinion from someone you trust. Or do like Laura did—contact the MD and respond. And if you need to, move on—and reach out for support.

Feel free to share your own horror stories, or simply to express your opinions.

Thanks for reading.

Tackling Pizza/ Junk Food/ Disordered Thinking

Pizza was the focus of several conversations this morning. And we weren’t discussing ordering lunch. The subject was challenging foods, and pizza was mentioned during more than one patient session. And I didn’t bring up this potentially triggering topic.

One of my favorite pizza places in Bar Harbor, ME

“It’s junk food”, one young woman stated firmly.  “Why’s that?” I probed. Silence, she responded, uncertain. “The grease”, was another’s response, in a different session. Seeing all that grease was problematic. For others, pizza equals fast food, convenient take-out—all of which has to be “bad”. For others, it’s about portioning. I mean, how much is okay to eat for lunch? Or, for dinner? “And how do you stop”, others have asked.

For some, pizza is fine if you’ve made it yourself—at least you know just what went into it. For others, it’s okay if it’s organic or whole wheat. For most everyone it’s fine if it can be eaten in control.

So what is it about pizza?

As I sit down to write this piece I recall how shocked I was at age 9, when I overheard the conversation. The birthday-party hostess, my friend’s mother, related to my mother with shock and horror that I downed 4 slices of pizza! Besides feeling full, I can’t say I thought anything of it at the time—that is until I heard her comment. And I can remember many a comment my mother had made about my appetite—that I eat as much as my 6’1” father, for instance—not exactly stated with pride, I’ll add. Yet she failed to recognize that her baseline for comparison was her chronic dieting and self-denial, and that my father could easily have been described as low body weight. And, I was a preteen, growing to a height at the 95^th%ile. Why should it come as any surprise I had a hefty appetite? I was perhaps expending more calories than my non-growing father! Four slices for me was slightly more than appropriate, I recall.

Okay, okay, now that I processed some of that therapeutic history, let’s talk more about pizza and you.

Lessons about eating pizza

It helps to break it down into smaller pieces. Well, I don’t mean that literally. Rather, that it helps to think about what pizza really is to make it easier to digest. The base has three ingredients: flour, yeast and salt. Period. How bad is that?  Not very at all!

Homemade, grilled pizza. Delicious!

And the way most American large size pizza pies (made from a pound of dough) are cut into eighths, a slice is like two slices of bread. And then there’s the cheese. Less than an ounce per slice, at most places (although there certainly are exceptions). 


And the grease? It's simply what you see when you heat up cheese. If you must, blot it. Otherwise, just recognize it as separated cheese. And then there’s an insignificant amount of sauce (which the US school lunch program would like to count as a vegetable serving but is hardly enough to count!)

How does it fit or compare to other meals you might be having? Well, the protein- rich element is much lower—again, for 2 slices, that’s less than 2 ounces—much less than anyone would need for a dinner meal—that’s for certain. So if the grain or starch component is larger than you’d usually eat, just remember that the protein is way less than you need.

How do I eat it in control?

• Don’t serve it from the table! Pizza, in my opinion, smells yummy, and it’s easy when foods smell good and taste good, to eat them beyond a comfortable level of fullness. Keep it warming in the oven. Or simply get a couple slices to go, when you are first starting out. But really you might need more than just 2 to meet your needs. Maybe even 2 ½ slices. Yes, you can cut slices in half! Ask them to do it at the pizza place. Tell them it’s for your baby sister.

• Serve it with other items—a salad, cooked veggies, a glass of milk, a cut up fruit—to help you add some balance and some modest volume to know when you are full.

• Stop calling it junk food! If you label it junk, you think you have done something wrong. And if you think you’ve done wrong, you’re likely to feel ashamed. You may view it in black and white terms, thinking you must compensate for having eaten it. And that will get you into some real trouble!

And what about things that really are junk? You know, they have no redeeming value from a nutrient stand point? About those foods, I say enjoy them. Not 5 times a day. Not with rigid rules like “only on the 3^rd Friday of the month”! No, make them a part of your regular routine, but include them instead of something you typically eat (but that you don’t necessarily enjoy), when you need the fuel, when you are hungry or need to have a snack on your plan.

Don’t approach pizza or any meals feeling ravenous! It is a recipe for disaster. You’ll eat too fast, and will likely eat beyond a comfortable level of fullness.

Allow yourself to have pizza regularly. You need the practice!

So go ahead and enjoy some pizza. Try it topped with fresh fig, sliced pear or pineapple, or maybe artichoke or roasted peppers. And don’t listen to anyone else’s comments about pizza or about how much you’re allowed to be eating!

Let me know how it goes!