Weight loss and the Biggest Loser: What you really need to know about the NY Times article

Patients, Facebook friends, and friends of friends contacted me in horror after reading the NY Times article on the Biggest Loser. Weight re-gain is inevitable. Most if not all of it.  And metabolic rate is screwed too. The control you believed you had? Doomed to dissolve. The hope you were given that you'd finally made it to your goal size or weight—or were getting closer—shattered. Overweight, obese, underweight or average size—the feelings knew no size boundaries. Fear. Anxiety. Hopelessness. Panic.

The pain of regain extended well beyond the 14 Biggest Loser contestants studied and their loved ones. It was felt by those of you who shared their struggle and their joy and sought inspiration from this outrageous, extremist show. 

The NY Times summarized the research: by 6 years after the show’s end, all but one participant studied had either regained some weight or gained beyond their starting weight; 4 contestants are now heavier than before they tortured themselves with this unsettling weight loss regime.

I know how you're feeling.

Nearly all have slower metabolisms now than at program’s start—over 600 calories less on average— with the biggest loser, Cahill at a loss of 800 calories burned per day; he now has to eat 800 calories less per day to maintain the same weight compared to at the start of the program. Many reduced their weights enough to improve their health, but the struggle to maintain the loss was constant and painful—physically and psychologically.

Where’s our anger at this abuse?

Four to 6 hours daily exercise was commonplace, with Cahill reporting 7 hours/day while on the show. Two or more hours included intense cardio workouts. And their intake? 1000-1200 calories was not unusual—an outrageous restriction even if the obese individuals were sedentary. That’s right. Just breathing or being at rest they would lose weight at that calorie level given average heights and starting weights. The degree of starvation was shameful and irresponsible. A set up for failure for sure. And did I mention there are now reports by participants of taking stimulants (provided to them by the program) to accelerate the weight loss—like ephedra and Adderall? 

It is simply abusive to lose weight the way they were directed to for the public’s entertainment. The extreme calorie deprivation resulted in a hormonally induced hunger and subsequent binge eating. No doubt, great shame and embarrassment resulted from their regain as they blamed themselves for their “failure”. Unfortunately, people replicate this self-abuse with crazy diets all the time, believing they can just jump-start their weight loss and then sustain it. Wrong, wrong wrong. 

What can you learn from this Biggest Loser study?

Yes, metabolic rate does slow with weight loss. This is not news. You knew it. You knew that when you were dieting and the weight loss you’d hope would continue simply didn’t happen. Your weight would plateau even though you were doing just what you were doing before. Even though you were “being good”. And so you made an adjustment. You’d eat a little less or exercise a little more or use behaviors like purging. And what resulted? More frustration, less “success” with weight loss. 

It may be time to be more realistic.

And for many if not most of you, rebound overeating or binge eating occurred. Because you’re a failure? Surely not! Because it wasn’t sustainable. Because you felt deprived—hungry, unsatisfied, fatigued, unfocused, vulnerable. Because hormone levels fought against you, as leptin levels—which helps us feel satiated—dropped with weight loss.

While the number of study participants—a mere 14 individuals—was small—the results were enormous. All but one regained significant weight. Yet the big news from this piece was the extent of the metabolic rate drop and the duration that it was sustained—observed when last checked 6 years after the end of the show! Now that’s scary.

What does this really mean for you?

While we don’t have all the answers, it appears that the degree of restriction impacts the outcome. Meaning, more rapid loss, more rapid gain. The “biggest loser”, Danny Cahill, had the greatest drop in metabolic rate—down 800 calories/day. He also regained the fastest, based on the NY Times graph accompanying the article. Deny your body and it’s gonna do what it needs to preserve yourself—it’ll try to slow the engine down, to conserve, to save some fuel for another day, to burn fewer calories. Yes, it does appear proportional. More moderate reductions in rate of weight loss, less drop in metabolic rate. 

Is my metabolism ruined forever?

The degree and duration of metabolic drop reported in the Biggest Loser research is simply not seen in other studies—a drop of 3-5% is more common. And most studies show that this drop reverses with increased food intake. 

Living with anorexia? 

Fear not—you have not permanently messed things up. The famous Minnesota Starvation Experiment demonstrated what those who treat eating disorders know from practice—that metabolic rate rapidly increases with re-feeding. (But continue to starve yourself and yes, your metabolic rate will be suppressed.) It requires a lot more calories than we’d expect for underfed individuals to restore weight. Ask any parent who is helping to renourish their child with anorexia. 

So please don’t be too quick to assume your fate. How do we know metabolic rate increases in this population? In addition to the Starvation Experiment and inpatient studies using indirect calorimetry—a  measure of resting metabolic rate or calories burned at rest, we also can see it indirectly—from increases in heart rate, body temperature and hormone levels.

I don’t have anorexia. I just diet to lose weight.  What does this mean for me?

“Just dieting” still lowers metabolic rate. If you are as extreme as the contestants, you may need to acknowledge your fate. If you are expecting rapid loss to be maintainable, think again. Torturing your body with hours of exercise each day as many of them did (or any amount, quite frankly, that leaves you starving) and/or restricting your eating and denying your hunger will fail you. 

Banning these? Time to change your approach
 to weight management.

Feeling deprived by omitting foods that satisfy you will lead you nowhere. Besides the reduced metabolic rate, the resulting deprivation leads to binge eating. And binge eating contributes to significant excess in calories and weight regain. Hopelessness follows, leads to the “what the heck effect” and eating recklessly. It all adds up to significant weight regain. And with chronic restricting, there’s also a loss of muscle mass which further reduces metabolic rate.

So now what?

Using more sensible, less extreme, more behavioral approaches to take charge of eating may seem less sexy, but has my vote. An 8 year study on lifestyle change resulted in long term weight loss (in 73% of overweight participants)— but not to the degree you might be hoping for. A 5-10% drop in weight was maintainable without losing sanity, and improved health. 

While the Biggest Loser participants tortured themselves dropping huge amounts of weight, and suffered as it rapidly increased, those with practical lifestyle changes lost less to start and after some initial regain, stabilized for years, suggesting better long term outcomes. The Biggest Losers? The study ended at 6 years, but based on the charts most seem to be likely to continue their weight gain trend.

So what can you do?

• Accept more realistic weight goals.  Modest paced weight loss (assuming weight loss is truly needed) may be most sustainable. 
• A 5-10% weight loss is enough to have a signifiant impact on your health—on blood pressure, blood sugar blood, cholesterol, fitness level and overall well being. 
• Focus on fitness goals. Regardless of your weight, find ways to move more, setting realistic goals.
• Address the quality of your intake for health. Include plenty of whole foods including grains, fruits, vegetables, nuts and lean protein sources—as well as fatty fish. But allow room for other foods you enjoy—yes, that includes cupcakes.
• Work on your eating behaviors, as I’ve addressed throughout this blog (see posts labeled mindful eating and binge eating)
• Cover your ears when your doctor says you must drop to the average BMI if you haven’t seen that place in decades, or ever. Clearly more harm than good will be done.
• Oh, and stop blaming yourself. Take charge of what you can control without physical or mental distress. And take some steps to love yourself as you are.

Thanks for reading. And sorry it's taken so long for a blogpost. Please take the time to share your thoughts--and share this piece with others.

Why I’m worrying about Vyvanse and Binge Eating Disorder

Seeming quick fixes can be so tempting.

This week’s inbox held the following message from an old patient:

“I was watching Good Morning America and they had Monica Seles on, admitting she's suffered from binge eating disorder (BED). They announced a medication they are now using to treat BED, Vyvanse, also used for ADHD. I looked it up and side effects include weight loss. Have you ever recommended this drug for BED? Do you feel it is effective for BED? Can people with BED take this med to lose weight? Do they think if you have BED you must be overweight and this medication can cause weight loss? Which would perhaps (in their minds) solve the bingeing?

That small ED voice that lurks deep from within is screaming 'get me that drug! Get me that drug!' so I can lose weight. WTH?!"

I’m glad she was brave enough to share what she was wondering, as I’m sure she’s not alone in her curiosity. Aren’t you wondering what this means for you?

Let's start by clarifying a few things about binge eating disorder. Most notable about BED is the recurring episodes of binge eating, feeling out of control while binging, and feeling guilt and shame afterward. People of all sizes live with BED, and the experience of a binge may vary. You might eat large amounts of one item—such as a whole package of cookies—or large amounts from a combination of foods. For some, even eating a single bite beyond what they intended may feel like a binge.

There's a way off the roller coaster--appropriately
named the Cyclone.

The common features among sufferers, though, is the guilt, shame and lack of control accompanying the eating. According to the Binge Eating Disorder Association,  "Binge Eating Disorder (BED) is the most common eating disorder in the United States. An estimated 3.5% of women, 2% of men, and 30% to 40% of those seeking weight loss treatments can be clinically diagnosed with binge eating disorder. The disorder impacts people of all races, levels of education and income — including adults, children and adolescents."

Given the shame associated with BED, however, there are likely many more living with the condition than we know.

Medication to the rescue?

Two recent studies were done using Vyvanse—a stimulant used to treat ADHD—for the treatment of moderate to severe binge eating disorder. They were well-done studies— randomized, double-blind and placebo-controlled—with promising outcomes. 

In one study, participants who binged three or more times per week were treated with either a placebo—a dummy pill—or 30, 50 or 70 mgs/day. Researchers saw a significantly better response to the 50 and 70 mgs/day doses compared to placebo in a study of over 250 subjects with a roughly equal number of controls. Improvements included reduction in binge frequency/week, a higher percent of subjects binge free for 4 weeks, and a change from baseline in the Yale-Brown Obsessive Compulsive Scale Modified for Binge Eating—compared to placebo treatment.

Notable, however were a couple of other outcomes. The placebo group also improved, by 21.3 percent (versus 42% in the 50 mgs/day and 50% in the 70 mgs/day treated groups). Meaning, the belief that taking something could help your binge eating was enough to improve binge frequency.

And then there were the side effects. More than 5% of those treated with Vyvanse reported symptoms including “dry mouth, insomnia, headache, decreased appetite, nausea, irritability, heart rate increased, anxiety, feeling jittery, constipation, hyperhidrosis [excessive sweating].” Twelve patients (5%) on Vyvanse reported treatment-related adverse events that led them to stop the study; 5 patients in the placebo-treated group had such negative effects. 

And then there’s this: “CNS stimulants (amphetamines and methylphenidate-containing products) have a high potential for abuse and dependence.” 

If you struggle with Binge Eating Disorder and are tempted by the positive research results, consider the following before you request a prescription. While medications might improve binge eating, so does addressing some underlying eating patterns and thoughts—without the risks of medication. In fact, since the placebo also improved binge frequency by over 21%, it suggests that the power of believing you could change—with some help—is quite strong with BED.

Yes, there's hope without meds for BED!

Need I say more? http://www.annetaintor.com/

Do any of the following scenarios apply to you? If so, medications for BED may be unnecessary.

1. You restrict your calories throughout the day, trying to be “good”. You deny your body the fuel it needs and by later in the day—often late afternoon or at night—you start eating, intending to eat in control. But then it feels like the flood gates open and you just can’t stop. Perhaps you feel like you’ve already blown it, so feeling defeated, you decide to continue to binge. You’re determined to get back on track tomorrow—with restricting. And so the cycle continues.
2. You eat enough calories throughout the day, but your food choices are very limited—including only foods you "should" be eating based on rules you follow; they may be only high protein, or unprocessed or not very palatable. They are foods that you’re okay with, but that don’t necessarily give you much pleasure. Then, when at a friend’s or out to eat and you eat something to appear ‘normal’ or because you really want it, you have serious regret. Later you continue eating because you’ve already "ruined it", but are determined to get back to your very restrictive, healthy food choices.
3. You truly get enough to eat—enough calories and enough of foods you really enjoy. But most of your eating is quite mindless—you eat standing up in the kitchen, while multitasking—while driving, on the computer or on the phone. So you never truly feel satisfied. And it’s worse when food is kept in sight.
4. You eat enough, you get what you want to eat, AND you pay attention to eat mindfully. But when stress if high, or you struggle with an emotion that’s hard to sit with, your knee-jerk reaction is to reach for food for comfort or to numb out. You may even be completely aware of what you’re doing, but the pull is so strong, because in the short run, it helps. But later, you are left with regret.

If any of the above statements apply, then working with an eating disorder dietitian—together with a therapist can really help. Cognitive Behavioral Therapy (CBT) is a valuable, well-studied treatment for BED, and you can purchase self-help workbooks specifically for this condition as well. 

Learn to normalize  your eating!

Yes, binge eating can be resolved without medication. But it requires dropping the diet and rigidity around eating. Really, dieting simply isn't helping.

For those with ADHD who also binge eat, the medication may be helpful to manage impulsivity—which can lead to binge eating. Delayed gratification—redirecting and waiting to notice fullness—can be too challenging, as is moving away from multitasking.

But using Vyvanse is not without consequences. Decreased appetite may sound appealing but if you don’t know when you’re hungry, it's hard to trust when and how much to eat — making intuitive eating impossible. It may contribute to inadequate intake and food restriction—something those struggling with binge eating may already struggle with. 

Do we need to swap one problem with another?

Further, will doctors inappropriately start prescribing Vyvanse for those who are overweight but not living with moderate to severe BED? Will prescribing seem like the medical quick fix, while failing to address restrictive eating, or deprivation or over-exercising that truly need treatment? 

So, dear readers, please don’t be tempted. But don’t give up hope. Seek out providers that work with binge eating disorder patients because it is in your hands to change.

Other related links you might find helpful:

http://dropitandeat.blogspot.com/2013/05/name-calling-has-its-place-bed-is-now.html

http://dropitandeat.blogspot.com/2013/03/weight-loss-and-recoverycan-they.html

http://dropitandeat.blogspot.com/2013/04/intuitive-eating-is-not-for-youmaybe.html

http://dropitandeat.blogspot.com/2013/03/heres-to-speedy-recovery-maybe-not.html

http://dropitandeat.blogspot.com/2013/04/eating-disorder-recovery-reflections.html

http://dropitandeat.blogspot.com/2012/08/do-or-do-not-there-is-no-try-think.html



http://dropitandeat.blogspot.com/2012/07/forgetting-to-remember-key-obstacle-to.html

Doing what we can to help eating disorders.

I don't know Jean Forney, a Phd student and AED (Academy for Eating Disorders) member studying eating disorders, but she has some very interesting ideas. She recently contacted me requesting I do a blog post on her research. Better yet, I thought--you can do it! I wasn't just passing the buck, but preferred to give her the opportunity to describe her proposal. 

One step in the right direction.

Measuring hormone levels to help predict eating disorder recovery (keep reading for the full description) is not simply about determining how long your eating disorder will last. It may offer insights about biological causes of eating disorders and ultimately to treatments for bulimia, binge eating disorder and purging disorder. 

I post this to offer hope--to show what young researchers are exploring to better understand eating disorders and help the path to recovery. And to offer you an opportunity to personally support the research (see her link at the end). 

The Importance of Physiological Research to Help Eating Disorder Treatment

By K. Jean Forney, M.S.

Eating is both a biological and psychological process. Deciding what to eat, when to eat, etc. - it’s governed by both our mind and our biological make-up. In trying to understand and treat eating disorders, more and more research is focusing on physiological processes to help supplement what we know about the role of the mind and psychological factors in eating disorders.

Two hormones involved in eating come to mind: cholecystokinin (CCK) and leptin. CCK is released from the gut during digestion. It sends a signal to the brain that says “Hey, I’m full!” and leads you to stop eating. Multiple studies have found that CCK is released more slowly in individuals with bulimia nervosa, an eating disorder characterized by binge eating and purging, compared to individuals without an eating disorder. In contrast, the CCK response appears to be normal in individuals with purging disorder, an eating disorder characterized by purging in the absence of binge eating. This led the authors who conducted the study to conclude that delayed CCK response is likely related to binge eating. 

Problematically, when you look at people at one point of time, you do not know if dysregulated CCK response occurred before the eating disorder started, or if it is a consequence of the eating disorder, or a combination of the two.  It also means that we do not know if a dysregulated CCK response makes someone more likely to binge eat and keeps the eating disorder perpetuating itself over time.

The other hormone I mentioned was leptin. Leptin is a hormone secreted from fat tissue. It is sometimes called an “adipostat” because it tells the body how much fat tissue it has. When leptin levels are too low, the brain is told to eat more via a network of neurons, neurotransmitters, and other hormones, and people become more hungry. Leptin levels appear to be lower in people with bulimia nervosa and purging disorder compared to people without eating disorders, and some authors have found that leptin levels are associated with duration of illness. That is, the lower the leptin levels, the longer someone has been ill. It makes you wonder if lower leptin somehow contributes to the eating disorder lasting longer, or if having an eating disorder causes lower leptin levels.

To answer that question, you need to study people at multiple time points.

I am running a study that will see how CCK and leptin levels predict eating disorder remission over time. Multiple women with bulimia nervosa and purging disorder have already participated in studies and had their CCK and leptin levels measured through blood draws. I will be interviewing these women, on average, 10 years after they had their blood drawn. Then, we will have some information as to whether or not these disruptions influence how likely someone is to recover from their eating disorder. This is part of a larger study looking at the long-term outcome of purging disorder and comparing it to bulimia nervosa.

Why does this matter? Well, the more we know about the processes that keep eating disorders going, the better interventions we can develop. Perhaps by treating both the body and the mind, we can help people have healthier, happier lives, free from the distress and impairment that eating disorders cause.

To read more about my study or to donate to help support the study, please see my experiment.com website https://experiment.com/projects/long-term-outcome-of-women-with-purging-disorder/Here are some of the articles I gathered this information from, for your interest:
 Keel PK, Wolfe BE, Liddle RA, De Young KP, Jimerson DC. Clinical features and physiological response to a test meal in purging disorder and bulimia nervosa. Arch Gen Psychiatry. 2007;64(9):1058-1066. PMID: 17768271 Monteleone P, Martiadis V, Colurcio B, Maj M. Leptin secretion is related to chronicity and severity of the illness in bulimia nervosa. Psychosom Med. 2002;64(6):874-879. PMID: 12461192 Jimerson DC, Wolfe BE, Carroll DP, Keel PK. Psychobiology of purging disorder: Reduction in circulating leptin levels in purging disorder in comparison with controls. Int J Eat Disord. 2010;43(7):584-588. PMCID: 2891937

Expect another post from me soon!  And please share any thoughts about Jean's research here. Your voice really matters! Lori

Fat and Always Hungry? No, cutting the carbs won't cure your weight struggle.

It’s 10 AM Sunday and quite frankly, I’d much prefer to be leisurely finishing my coffee after my blueberry pancakes-topped with a dollop of vanilla yogurt and heated real maple syrup. But Ludwig and Friedman’s Always Hungry? Here’s Why piece in the NY Times  today compelled me away from my plate.

To start, let’s get a title change, please, let’s say Here’s What We Think based on virtually no research at all. This is an opinion piece stating two doctors’ theories about why we get fat and what we should do about it. Period. But with the sensational image and title you, like most people, will be drawn into more myths about weight management.

Here’s where we agree—and disagree

Do you just eat bread for your meal?

Agree: There are factors outside of your control that may contribute to your size. Genetics and the presence of fat cells exert their influence. Once you have gained to a higher weight with an increase in fat cells, you will be fighting an uphill battle to lose that weight and keep it off—without disordered behaviors.  And it’s not your fault. For more on this see Professor Lowe’s work on weight suppression and bulimia. 

Agree: Metabolic rate slows down with food restriction—that’s indisputable from the research. Obese individuals who have undergone extreme low calorie diets will have a lower metabolic rate as a result of the decrease in muscle mass that results, compared to same weight controls who had not dieted. Less aggressive approaches to dietary activity change tend to spare the muscle loss and help maintain metabolic rate.

Before dieting...

But the authors state that metabolic rate also decreases with weight increase:  “…factors in the environment have triggered fat cells in our bodies to take in and store excessive amounts of glucose and other calorie-rich compounds. Since fewer calories are available to fuel metabolism, the brain tells the body to increase calorie intake (we feel hungry) and save energy (our metabolism slows down).” Yet there appears to be few examples of this cited in the scientific literature, with the exception of a possible rare genetic mutation, not likely the cause of obesity in the greater population.

And the temporary slowed metabolic rate seen with weight loss has been demonstrated to be reversed with weight restoration in the obese (albeit a small sample size studied) and more dramatically in those who are underweight with anorexia, summarized well by Carrie Arnold in ED Bites.  In practice we see dramatic increases in metabolic rate—calories burned and required each day—with weight gain in anorexic individuals at least until they have restored to their healthy state.

Agree: Insulin increases nutrient uptake and in excess causes weight gain. And carbohydrate results in an increase in insulin secretion.

Disagree: Ludwig and Friedman’s leap that foods that increase insulin secretion should therefore be reduced or avoided for weight management is faulty reasoning—unless there is a documented underlying metabolic abnormality. A relatively small percentage of the total population has PCOS or hyperinsulinemia—a faulty regulation of insulin. For these individuals, addressing carbohydrate amount or glycemic load (impact of a food on raising blood sugar) has a positive impact. But there’s no evidence that a low carbohydrate diet is any better at long-term weight management than any other dietary intervention. 

In addition, while individual foods and their glycemic index—the amount they raise blood sugar (and therefore subsequent insulin levels) may seem valuable, practically speaking they have less impact.  You see, we generally don’t eat single nutrients like carbohydrate. Rather, we eat mixed meals, containing protein, fat and carbohydrate. And in this combination, the impact on insulin levels that even the white potato might have if eaten solo is minimized with that piece of chicken and the added olive oil or nuts in the salad.

This banana chocolate pastry has plenty of fat to lower its glycemic load!
(From Tartine Bakery, San Francisco)

And did you know that many of the villainized desserts have a minimal impact on insulin levels? Peanut M&Ms aren’t much different than lentils (see glycemic load—the best measure of blood sugar impact which considers portion) and cheesecake made in it’s full fat recipe will no doubt come in quite low as well.

I don’t share this to promote a diet full of low nutrient, processed foods. Rather, to make a point. Viewing foods as good and bad will do nothing to help you manage your weight—nor your mental health. In fact, there’s plenty of evidence that feeling deprived by denying yourself foods you enjoy leads to rebound overeating.

The authors also state “what if it’s not overeating that causes us to get fat but the process of getting fatter that causes us to overeat? Unfortunately, I think they have oversimplified their hypothesis.

Sure, having more fat cells may contribute to our struggle if attempting to lose weight. But it’s not simply a macronutrient issue. Being larger presents more challenges for being active; larger individuals report being subjected to fat shaming while exercising—presenting its own challenges.

Rebound binge eating following starvation—think dieting—has been well documented as well. All or nothing thinking—what I call the “what the heck effect” results in overeating when you believe you’ve already blown it.

After...

Our over-scheduled lives with multiple competing needs don’t help us either. Multitasking while eating makes us less aware of what we are consuming and contributes to overeating. And the larger the containers or plates we are eating from, the more we will over-consume (see Prof.Wansink's extensive work on this).

Time and money constraints add flames to the fire—we take little time to plan, shop and eat mindfully. In fact, our cognitive ability is compromised by these stressors and worsened when we diet. Perceiving that we won’t have enough food to meet our wants or needs, referred to as scarcity creates a range of secondary effects. Poor decision making, impaired ability to organize and follow through and hyper-focusing on the immediate benefits without considering the long term consequences of food choices are well researched and described in the fascinating new book, Scarcity.

Unrealistic goals set by national organizations  and by ourselves adds to the problem. If 150 minutes per week plus 2 days of muscle strengthening/wk is unattainable, why bother?

Further, the food industry isn’t all bad. (And no, I am not a paid consultant to any food company!) They are the ones who bring us the convenience of precut and cleaned vegetables and canned, high fiber, low glycemic legumes. They allow us the convenience of reheating frozen brown rice and quick cook barley. And they have given us a range of milks in every fat percentage we could ask for, and yogurts of every style—Greek and higher protein, sweetened, full fat, real sugar, artificial sugar and no added sugar. But many of the choices remain ours.

So what’s the solution to our climbing weights beyond a healthy range?

• Move away from dieting and that sense of scarcity.
• Set realistic goals for change—be it frequency of a home-cooked meal or a visit to the gym.
• Begin to work on behaviors; separate eating from distractions, and delay seconds (see older posts on this blog for help)
• Include a range of foods and nutrients. Include high fiber, whole grains and legumes, fruits and vegetables, nuts and healthy oils; protein-rich foods such as poultry and fish, and less frequently red meat; low fat milk and yogurt and modest amounts of cheese.
• As part of a balanced meal, by all means enjoy your rice, breads and pasta, too. And you know my stand on baked goods! All or nothing approaches to dietary change will get you nowhere.

Thanks for reading and for passing this on via FB, Pinterest, Twitter...

Coming Clean: My Biases and What They Mean for You

I’m no different than the rest of you. I too, have my biases—my prejudices, my leanings, my preconceived ideas about what makes sense. They influence my actions, my reading of scientific studies, and they impact my professional recommendations.

I make no apologies; my biases effect what I tell you as patients and as blog readers. Like conference speakers obliged to disclose who profits from their research or their words, I’m giving my full disclosure. Here are some insights about why I lean as I do:

1) I’m biased against the weight loss literature's conclusions. In spite of the dismal research that only a small percentage of overweight dieters maintain their weight loss, I’m biased against these results. Weight loss, and maintenance is not an unreasonable goal—for some people, that is. Yes, I realize that the weight suppression data may suggest otherwise, as mentioned in my previous post.

Yet I’m skeptical about how study participants lost the reported weight and that impact on weight regain. And I’m cautious about who should have been losing in the first place. If someone had been binge eating and normalized their eating, why wouldn’t they lose weight and keep it off—as long as they remained free of binge eating? If you were disconnected from your physical cues, from your hunger and your fullness, but then turned that around, why couldn’t you maintain the lost weight? That is, if your higher weight was not your healthy normal that you had always been. Which gets me to the next point.

Many patients have appropriately lost and maintained significant weight loss. They were not on diet plans—not calorie counting, no categorical exclusions such as “no white flour” or “no carbs”. Rather, they have slowly modified their actions, and their thoughts. And ultimately, their weight adjusted. Read about my patients such as Erin and Maggie.

I fit into the category above. I have lost about 35 pounds since graduating from college—35 pounds that were not a part of my usual size. My weight had always been in the normal range—I had never experienced weight issues until college, when my yo-yoing began. Dieting, binging, denial of my needs failed to bring my weight back to normal. But changing all that did. I do not work to maintain my weight at this point, but I continually embrace honoring what I feel like eating, and responding to when I need to eat.

2) I believe that you know best about yourself—until your disordered thoughts, your restrictive rules, your lack of trust in yourself take over. Yet I believe that deep down you really know just how much you need to eat—just like when you were a young child before all this craziness began. It’s just so damn scary!

3) I’m biased against light products and diet packaged meals. No, they are not simply better than not eating (shout out to Thursday's patient—thanks for inspiring this!) Why? Because they mislead you! Tricky Weight Watcher’s meals and Lean Cuisines? Sneaky Arnold rounds? Indeed. 

First, they may look like they’re supposed to be enough. The light bread (that has half the calories than the regular bread) looks like a full sandwich. But then when you’re hungry from eating what amounts to only half a sandwich, whom do you blame? You only fault yourself, believing that it should’ve been enough, that you’re the one with the problem. Not so, my friends!

As for the frozen meals, I must say that in all my (50) years I’ve never eaten a diet frozen dinner, so my bias does not come from my experience having them. They just look like not enough to me—or for anyone. Admittedly, you can add a glass of milk, and a fruit or a dessert and it may be just fine. But somehow I don’t suspect that’s what you intend to do.

4) I’m biased against omitting what we enjoy eating. I believe that sweets and all things that taste good have a place in our diet. Maybe it’s because I personally eat things I like, including baked goods and good chocolate quite frequently. Excessively? Mindlessly? Not usually. Not when I’m driving or watching TV. Ok, sometimes the popcorn comes down to the family room (notice how passive that statement was?) while I’m watching TV—there, I’ve said it. Maybe it’s because I see the consequence of banning them, of making them forbidden, that I fight for making them available.

5) Yes, I’m biased against eating disorders.  Eating disorders lie. Which is not to say you are a liar. Have you lost me yet? They distort what you perceive you’ve eaten—yes, you overestimate your calories if you are under eating, and you may minimize or exaggerate them if you overate—it can go either way. 

Eating disorders mislead you into thinking that a yogurt is a meal, or that a black coffee, or even a latte is an appropriate means to respond to your hunger. They don’t volunteer information—I have to ask, and beg and probe to get a full and honest response.

6) It’s not your fault—again, that’s my bias. I don’t believe you want to be struggling with binge eating, or purging, compulsive exercise or laxative abuse or restrictive eating. And I’m convinced that I, that we can’t simply wait around until you’re simply ready.

7) I’m suspect when I only hear that everything is always great. And I’m cynical when I hear that everything is always terrible. Your bias, I suspect, is a lack of honesty with yourself.

8) I’m partial to the value of the relationship. I’ve not reviewed the literature on this, but my bias is that you’re more likely to work to change—at least initially—for your soon-to-be-born child or for your young children. And if you’re fortunate enough to have a positive relationship with a healthcare provider, you’ll work for them too.

9) Oh, and regardless of what they tell you, I believe it’s never too late to change. And this bias is based on the many clients I’ve seen, at all ages, at all stages of their disordered relationship with food. Yes, you too can recover from an eating disorder. And you can change your relationship with food. Even now.

So call me biased.