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

My Mother’s Day Advice.

From the MFA, Boston, MA

I’m not your mother. But the mother in me wants to share some motherly thoughts. Won’t you indulge me in this on my annual holiday? 

Yes, I yearn to do motherly things like feed you—knowing full well that moving past your eating issues and your eating disorders takes way more than my cooking. I fantasize that I can have you all over for a meal and you can eat it and enjoy it without compensation, without unhealthy thoughts and behaviors. That you can see how safe it is to eat. If only it were this simple.

So instead I’m sharing some nurturing guidance, whether you are 20-something or in your 50s.

Indulging at a favorite cafe with my
mom and my son.

Words from your non-mother (when not acting as the Tiger Mom)

• Give yourself permission.
• Be forgiving.
• Treat your body as you would expect your child or your sister should treat herself. Respect its limits—don’t exercise when your body isn’t up for it. And please fuel it.
• Be realistic. Setting the bar too high with unrealistic expectations is a recipe for disaster. You will never be able to healthily sustain such changes.
• Slip. Then pick yourself up.  Yes, it’s unrealistic to believe that slips don’t happen, that they shouldn’t happen, that you should know and do better. So move on. The real test of a slip is your ability to stand back up and move forward. Real progress is having fewer slips that are less severe. Real progress is being able to learn from your slips and work on prevention for next time—without beating yourself up.

• Find a Mom. No, it doesn’t have to be your mom (don’t forget—I said be realistic!) Rather, explore your resources, your supports, and ask for help. Yes, you can do it.

Are you my mother?

• Hope, even if you don’t yet believe, that recovery is possible. Because this old Mom knows that it is.
• Trust that things can and will get better. Gotta love Ingrid Michaelson’s song Gonna Be OK for the inspiration.
• Appreciate what you do have—what’s in place in your life, as well as with your eating. Check out Noa’s Homemade Religion which truly moves me to appreciate.

Enjoy, dear readers! And please let me know you're reading!

Reaching Your Peak: Guidance to Keep You Moving Forward

My favorite place to hike: Franconia Ridge, NH

I love to hike, but I need to tackle hikes that are achievable. Hike Everest next Friday? That’s crazy! It’s so out of reach for my fitness level, for this time frame, and for my psyche, that I think, “why should I even bother to start training? I’m just not gonna make it”. But if I set realistic goals—attainable heights allowing for modest changes in elevation, I’m golden. Yes, small steps forward really work.

Now if I’m getting a bit fatigued on a hike or even a bit fearful, and I just feel like stopping, I’ve got to consider my options. Is it safe to hover, unprotected, unsupported, ¾ of the way there? Will I be left feeling like a failure because I turned back? Or can I pace myself as I continue up, perhaps accepting less change in elevation each hour, staying the course until I reach my goal? Of course, I have to continue to refuel to enable me to think sensibly about my options!

Gorgeous below, winter conditions at the peak.
Even successful recovery has its surprises.

As I near the peak my pace quickens. And then, at last, I reach it. I can survey the beauty at the top, shifting my perspective. And I can appreciate my achievement.

As for the descent—there are rocky times, to take this analogy further. And for me at least, there are plenty of slips. Truly, I struggle more with the downhill part of my hikes, perhaps due to my fear of falling. But experience proves I can do it. That I can pick myself up and keep moving. 

The view and the feeling from the top make it all worth it all.

“And what does this have to do with me”, you’re wondering?

Stopping Midway On the Weekends

You worked so hard all week, Monday through Friday, staying on track with your eating. For some, this means sticking, more or less, to a meal plan. For others it requires respecting hunger and responding appropriately, distinguishing hunger from a range of other eating triggers.  You pushed past the challenges of social eating. And you countered your unhealthy thinking which leads you astray. You know, the thoughts of “I’ll just get back on track tomorrow” or “So I skip a meal—so what?” Or “What the heck, I’ve already messed up—I may as well keep going since I’ve already blown it!”

So you cut yourself some slack on the weekends. You deserve it, right? What’s a couple of day’s off going to matter? Or maybe you’re just tired of working on your eating, or controlling your activity or your behaviors. As one teen patient expressed, “I’m not about to have this take over my life”, with “this” referring to his time-consuming recovery.

I hated to tell him, but that is absolutely what he needed to do—to have recovery take over his life. Yes, for right now, eating needs to be elevated to the number one priority. In addition to medical appointments, there is nothing more important than focusing on meeting your body’s needs.

You want to be present to assist your kids or an ailing parent? You’ve got to nourish yourself first. You want to feel well physically and take control of your health—to have more energy, to regain your fitness, to prevent a wealth of consequences from a poor diet? (Regardless of what side of the scale you weigh in at). Then you’ve got to shift priorities.

Sure, I know it’s more challenging for most of you on weekends. There’s the lack of structure, the shift in sleep schedule, and the need to be flexible. There’s the social eating, and perhaps drinking. And the fact that everyone’s needs may come first on your days off. Slips will, of course, happen.

But consider the consequence of a bigger slide. Recurring slips on the weekends mean you’ve got to work even harder to get back on track on Monday. View Saturday and Sunday as opportunities to check out, and you will slip into viewing your week in black and white terms; you’ll be eating in two phases—“on track” or “off track”, “in recovery mode” versus “off recovery mode”—far from the moderate sensibility we are striving for.

You’ll feel more discouraged with this repeated process, taking one step forward and two steps back. You’ll continuing to think you’re working so hard, while failing to acknowledge that you’ve lost a lot of ground on your day’s off.

It's a lot easier with support along the way!

There’s no checking out for the weekends. There’s no stopping half way toward recovery, or toward normalizing your relationship with food. It can’t be a 9-5 job. And if you give in to this downward pull, it will only make things more challenging. You’ll have to psyche yourself to start the process again, to begin the climb from the start. You’ll be investing a lot more resources—both time and mental energy. And ultimately, you’ll have a lot more ground to cover!

Really, it’s a lot easier to move slowly to the top, with a few supports along the way.

Thoughts? Please do share!

What Your Healthcare Team Needs to Know About Your Non Compliance.

Compliant |kəmˈplīənt|

Adjective

1. inclined to agree with others or obey rules, esp. to an excessive degree; acquiescent : good-humored, eagerly compliant girls. See note at obedient. (From the New Oxford American Dictionary)

A picture of NON-Compliance. Only a biscuit will
motivate him for action.

It’s rare that I have the opportunity to chat with a medical student, a soon to be doctor. But this past weekend I was fortunate. Mike, a bright, articulate, and lovely guy of 28, is nearing the end of his fourth year of his medical education, currently doing his internal medicine rotation. He attends a top medical school in New York City. And you know me. I just had to ask him, this soon to be practicing doctor, a few pressing questions, while strolling along the brownstone lined streets of NYC. Here’s how it went.

LL: “So how much nutrition education do you get throughout your training?”

Mike: “About 5 hours total, in my four years.”

LL: “And what kinds of nutrition topics do you cover?”

Mike: “The greatest focus is on all the vitamins and minerals and their deficiencies—scurvy, beriberi, Wernicke-Korsakoff, to name a few.”

LL: “Wow, so the bulk of your nutrition education is spent studying conditions that we rarely see in our country.” (scurvy is a vitamin C deficiency, beriberi a thiamin deficiency rather uncommon in these parts), with the exception of Wernicke’s which we do see in severe alcoholics (also from a thiamin deficiency).

Further along in our conversation Mike shared his frustrations regarding nutrition-related illness:

“Patients tend to be non-compliant. You know, they don’t do what we tell them, what they need to do to help themselves.”

What does your doctor need to hear from you in
this limited time?

And with that comment, I had to hold back my biting tongue. (He really was a lovely fella, and a friend of my son, so I took a breath and went for the patient response.) Yes, it is frustrating to feel that people could help themselves if only they would follow what you tell them to do, if they would just do it. We discussed the fact that the average length of a typical doctor’s visit is maybe 17 minutes, start to finish; during the length of three songs on your iPod, your doctor needs to assess your medical situation, answer your questions, figure out how best to convey information to you about your condition, educate you and direct you to resources. Sounds easy, no?

Clearly something gets missed in these limited length visits. How can providers expect patients to change when they haven’t even probed to see what obstacles are keeping them stuck?

For better “compliance”, doctors need to better assess patients’ readiness for change. And then provide them with correct information and useful resources to go forward.

Laziness Keeping Her From Exercise?

Maybe there's another reason she (he?) stays where he's at?
And no, I didn't pose them when I too this picture.

You can’t tell someone, like my patient Ellen, who might benefit medically from an increase in physical activity for her blood sugar, cholesterol and blood pressure management, as well as her escalating weight, that she needs to exercise four days per week, 30-40 minutes. Why? Because she associates an increase in heart rate with anxiety, and fears it’ll result in a heart attack. Instead, I had to work on getting her to see that exercise is safe, first and foremost. So I discussed with her doctor getting a stress test done, followed by a doctor’s approval for exercise, to allay her fears. After that, she was able to slowly increase her activity. Now she exercises regularly.

Time To Change The Strategy

 Stubborn and non-compiant--
but who knows what's going on inside his head?

More than one woman I have worked with has shared that her husband has made it clear in no uncertain terms that she shouldn’t be eating what she eats, or weighing the weight she weighs. The result? An “I’ll show you” response—she eats beyond her need, when he’s not around, in part to spite him. Acting like her husband, telling her what to do, judging her by her size, will ensure that her weight continues to climb. Instead, directing such patients to work with a therapist to better communicate with their spouse (and others) and speak up for them selves can help. And enlist their suggestions, their ideas for practical change. That’s a way for providers to successfully problem solve.

And such patients need to be given permission, with practical strategies, to bring food out of the closet. I often recommend that they tell their spouse what to expect—that they will see them eating foods the spouse deems unacceptable for weight management—and they shouldn’t be surprised. And their spouse should withhold comment and judgment, thank you very much. Only then can we expect “compliance”.

Information Can Cause Slips

Health care providers need to check their facts, before being quick to disseminate information. Telling patients “cut out your carbs” is simplistic and unnecessary, including for diabetics. And you can bet it’ll lead to non-compliance. And confusion, as they get bombarded with nutritional misinformation from all ends. It is unrealistic, and not a practical change.

They need to get educated, too, in communicating information with teenage and adult, anorexic girls and young men. Statements like “great job! Your weight’s heading right up there!” or “You need to gain weight or you won’t get your period” can be traumatizing. Or “You’re perfect—don’t gain another pound!” And how many girls couldn’t care less about getting their periods? Telling a 12 year old that not getting a period will lead to osteoporosis? Who cares? They envision old, bent over, great-grandmothers—not something they believe can happen to them in their teen years. But tell them amenorrhea could cause fractures when running or engaging in their favorite sports, requiring them to end participating in sports with their friends—now that may make a difference.

What’s In It For You?

Listening to what patients really do care about, about where their concerns lie, will help motivate change. For some, it’s about hair loss in clumps, or lanugo, hair growth on their arms or face, as their weight has dropped, that concerns them. Or it’s being freezing all the time, as their body temperature has dropped. Or the fear they will not be able to return to soccer, or dance, or field hockey, to name a few.

Sure, doctors and health care providers get frustrated by non-compliance. But our patients are no less frustrated—and they’re angry, and hurt—too. Because they are not understood; because there are good reasons they stay stuck in their unhealthy behaviors. And it is rarely due to ignorance.

Advice For Fellow Healthcare Providers

Compliance shouldn’t be the goal we shoot for. Patients need to be more than puppets nodding and acting according to our commands. (See definition of compliance.) 

They need to be engaged in the process of change, participating in charting their course. We all need supports, guidance, and compassion, not just rules, to begin making change. Oh, and did I mention the need for hope? Certainly, if I don’t believe in my patients, they won’t believe in their own potential for change.

The health system isn’t going to get over-hauled any time soon. Seventeen minutes may seem like a luxury in the future. But if only doctors and other providers would take the time to ask a few key questions. And then? Give up a few minutes of the 17 to truly listen.

Then they can refer to appropriate providers—the nutritionists and therapists experienced in a behavioral approach to change. Only then can they assist their patients in making change, helping us all feel a lot less frustrated.

Taking Charge: Practical Strategies for Enjoying Holiday Eating and the Morning After

Ready to take control?

You, my readers, are a diverse bunch. Some of you are overweight, perhaps higher than your usual and healthy weight. You struggle to have balance in your eating—to eat what you’d like, and to learn to eat just enough. Others maintain their weight in a healthy range, yet grapple with these very same issues. Just because you may look fine, doesn’t mean you’re not challenging yourself to improve your relationship with food. You, too, may be working on legalizing foods, moving from a diet mentality.

Many of you are underweight, as evidenced not only by the scale, but by your body’s function—your low heart rate, body temperature, or hormone levels, resulting from inappropriate weight loss, food restriction or over-exercise. You too may be trying to release yourself from the grips of disordered thoughts and behaviors around food, whether or not it is visible to those around you.

Yet as diverse as you are, it seems most everyone gets challenged around holiday and social eating situations. Social anxiety may add flames to the fire. But I’ll leave that to the therapist bloggers to better address.

Last November, I did a post on recovering after slips, such as after Thanksgiving. Now I’m realizing I’d better address prevention. Perhaps I should have thought of this sooner? It’s not too late! (For those non-US residents, plug in Christmas, Hanukah, Kwanza or any other social eating situations not connected to a holiday celebration—the situation is the same.)

It may seem strange, but regardless of what end of the scale you’re on, or what your personal needs are— weight loss or gain or stabilization—these guidelines apply. Because we all want a sense of control over our situation—to eat what we’d like and eat enough of it—but not too much; to enjoy eating and feel entitled to eat, regardless of our size, in spite of the opinions of others; we’d like to free ourselves, discarding those useless rules around good food/bad food, appropriate times, and inappropriate times to consume food.

So here are my tips:

Maintain normalcy before the gathering.

Don’t skimp on your eating beforehand or you’ll be more vulnerable at the event. All too often I’m told of a client’s attempt to prevent overeating. What do they do? They eat less before the meal out or the function, figuring they’ll save some calories. Then they arrive more vulnerable than anticipated. As a result, their resolve to mindfully select their food, or to pace themselves through the afternoon of eating goes out the window.

The sensory stimulus doesn’t help.  The pleasant aromas and visual displays of appetizers through desserts calls to us. Their strategy backfires, and they feel a sense of hopelessness with getting their control back.

Using your head to maintain the necessary balance

Or like my patient, Shari, you restrict before the event, eat fine or over eat at the event, then restrict again afterwards. Hmm. Does this make sense? Somehow, when you hear it told about Shari, it’s clear how senseless this is. Yet my clients believe that somehow they are different, that the rules don’t apply. They are smart. They get it. I know they do. Yet I frequently have to remind them they are not special; lovely individuals, yes. But not so unique that the system doesn’t apply to them.

Get informed. Ask questions.

"What will you be serving?" "What time will we be eating?" It helps having a sense of what to expect. Going to a friend or family’s home? Ask what you can bring—not if you can bring something. Perhaps you'll contribute something you really enjoy and feel good about eating. A lighter dessert? A favorite vegetable dish? An appetizer you’re comfortable eating?

Pre-plan.

It starts with inquiring about what’s being served. For some, it’s necessary to think through your options in advance. If you are dining out, consider checking the menu online, to be less overwhelmed with the decision making during the gathering. Going to family for a holiday meal? Hmmm, they’re serving 6 different starch choices, including mashed potatoes, stuffing, winter squash, sweet potato casserole, biscuits, and pumpkin bread. Which ones can I get at any time? Which ones are my favorites? Which ones should I just pass on, without regret?

Remember, it’s not your last chance to eat.  So if cranberry sauce is a favorite, plan to buy it and keep some at home. Add it to turkey sandwiches or make a turkey with the fixings, even when it’s not Thanksgiving or Christmas.

You don’t need a dog for a doggie bag. Plan to bring a piece of pie, or a package of leftovers for a later time. Perhaps you’ll get hungry again later that evening. You’ll better appreciate the leftovers when you are less full anyway.

Plate the appys.

Enjoy the appetizers. But know how much you are eating. Select what you’d like, and place them on a plate, together. This allows you to take note of what you are consuming. When we are simply grazing on them, without really seeing or acknowledging them, it is much easier to over eat.

Watch the alcohol.

Painting by Russell D'alessio, Bar Harbor, ME
I hope these women had eaten before their martinis!

Nothing decreases our awareness and inhibitions like alcohol. If you can drink responsibly, that’s fine. Best to delay your drinks until after you’ve had some solid food, though.

Be flexible*.

Maybe you decide you’d like something other than what you intended to eat. Or you ate more than you anticipated, even though you tried to be well prepared. The worst thing you can do is to beat your self up. Best to work on moving on. (Yes, it takes 3,500 surplus calories to gain a single pound.)

We may not be able to control senseless comments from those around us at family and social gatherings. And unless we are hosting, we can’t eliminate temptations. But we can certainly take charge of our own thoughts and actions. And in the worst-case scenario, remember it’s only one meal, or one day. So if you ate more than you needed and are sitting with regret, re-visit that old post on the morning after.

* Did you, like me, wish this subheading was left-justified, instead of over here on the right? It's the start of being flexible!

As always, I'd love to hear your thoughts!

Trust Yourself. Except When You Can’t Be Trusted.

6:04 PM

Hi Lori,

 Could I bother you for some support again?? Am *really* struggling with wanting to weigh myself. If you had a moment could you please remind me why this is not a good idea.

Wouldn't it be great if there were a similar warning posted above
your scale? TURN BACK NOW! Or face the consequences!

Here’s what I’ve got:

• It's  too high god knows what I’ll do – and that is not good for my safety
• If it’s where I want it to be or lower then ED is the one telling me how to feel
• I really do want to be rid of all this, and weighing myself will only prolong my recovery
• It will be 13 weeks tomorrow without weighing myself – and I’m proud of that
• I really feel that my recovery only started for real when I stopped weighing

Any other thoughts would be really gratefully appreciated

Thank you

And here was my response last night:

"I think you nailed it, PJ. Weighing yourself messes with your head. Not weighing yourself allows you to take charge a bit. Body mass doesn't change in 24 (or 72 hours) in any measurable way. But changes in weight may reflect bowel function, hydration, menstrual status, fluid retention, to name a few. It takes 3,500 calories per week (above whatever is required to maintain your weight) to gain a single pound, more than that if your metabolic rate is on its way up.

You are worth more than your weight in pounds (or kilos). Also, not weighing yourself may increase your anxiety. Be sure to acknowledge that and add some stress reduction (non-exercise focused) activities to help you cope."

This isn’t to say that nobody should weigh herself. It really depends on what your issue is and what kind of place you are in.

A 2005 study from a Brown University psychologist showed that regular weighing was associated with better maintenance of weight loss in an obese population of women. Perfect! I think I’ll start daily weighing, I bet you’re thinking. Not so fast, not so fast.

Lot's of steps before you reach your goals.
Is it worth it?

Weight management isn’t the only outcome we should be addressing. What about the impact, not on pounds, but on perceptions? Are you grounded enough that if the scale changes, yet you know in your heart you have been sticking to your goals and feeling in control of your eating behaviors, listening to and respecting your body, that you will be able to dismiss it as a senseless measure?

Or will this trigger more negative thoughts about your self, more obsessive thinking, and a sense of failure? If you are in a good place—grounded enough to roll with the scale fluctuations, which are sure to occur—you may be fine weighing your self. But please don’t make this decision on your own. Consult your supports.

First ask yourself “How will I feel if the results aren’t what I am expecting?” Am I truly more anxious not knowing my weight, or knowing it? Will it be destructive for me? If the answer is honestly no, then try the following.

Before getting on the scale, do a bit of a self-assessment. Ask yourself:

• Have I been honoring my hunger and eating when I need to?
• Have I been stopping when I’ve had enough, or when I’ve had what I think I should have based on unhealthy food rules I’m holding on to?        
• Am I respecting my activity goals, and listening to my body?
• Am I being honest with myself about my actions?
• How am I feeling? What positive changes have I made that I need to acknowledge?

And finally, have a plan before weighing. What do I know and plan to do differently, as a result of my self-assessment?

What can you take from my correspondence with PJ?

Here's the view from the top. Worth the trek? 

Like PJ, you probably have more sense than you realize. But if you are struggling with trust and feeling more vulnerable to your unhealthy behaviors, take a few pointers from her.

• Acknowledge you are struggling. 
• Whether you are working on weight restoration or are overweight and trying to lose weight and improve your relationship with food, be realistic. Change isn’t linear. In other words, there will be ups and down, progress and slips, moments of strength and times of hopelessness. That’s what recovery really looks like.
•  Reach out and ask for what you need. Not everyone around you is supportive, however (I’m sure you can provide plenty of examples for us!) So call, email, text, post an S.O.S. to those you feel you can count on.

Focus on what is in place. And make a plan for changing what needs to be changed.

Thanks, PJ, for allowing me to share this! 

Please add your thoughts and experiences to the comments. Looking forward to hearing from readers.