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

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

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

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

But first, about Rachel—the latest victim 

My summary of The Biggest Loser.

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

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

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

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

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

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

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

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

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

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



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

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!)

Role modeling with the Lean Cuisine diet. Who needs the reality check?

Adorable, yet strikingly painful. 

                              (If a video doesn't appear above, click here)

Young, school age children, sharing their observations about their moms’ and their dads’ eating. These are strictly their observations, without judgement— except for the stink of some of the cleansing pepper drinks they refer to. The contrast made by Lean Cuisine is that eating their frozen dinners as a strategy for weight loss—that is normal!

Well isn't it? Not unless you are a 4'8 woman, non-competitive athlete. To have one of your main meals of the day, your lunch or dinner, coming in under 300 calories is hardly adequate for most anyone. Yes, even though it does contain some carbs. And the suggestion that it, in itself, is a meal, an adequate meal, is quite problematic. Who do you blame when you are left feeling hungry after this meager intake? No one but yourself, no doubt. Calling it an appropriate meal replacement is misleading, unless you add a glass of milk, a fruit, a salad with some oil and vinegar or nuts, for instance.

We know all the Lean Cuisine eaters in this YouTube video have families, including kids—young, impressionable, school age kids. So let's think for a moment about dinner time in these homes. "Here, sweetie, you can eat the chicken dinner I made for the family, I'll just eat my (inadequate, 300 calorie) frozen meal. You know, because I need to lose weight." Or "You deserve to eat this great tasting meal I've made, but not me—I'm too fat!" Or maybe, "Why don't we all live on Lean Cuisines, so you can have control over your portions too; because I don't really trust that I or you can manage when there is more than a limited amount of food in front of me!"

Fast-forward several years and let’s imagine these innocent kids as adolescents. Do they feel entitled to eat an adequate plate of food? Or do they, like many a patient I've heard from, feel limited by the messages they heard from their parents (yes, parents, because dads put forth much of the same diet shtick so to speak). Like Dana, she may struggle to ever eat more than half a sandwich—that's how much her mother allowed herself. And like Allie, she might be counting her calories, limiting them to the boxed frozen dinner amount that her mom thought was right.

What do these kids end up taking from this? That their frozen-diet-dinner-dependent moms are the sane ones, as the video implies? Or that their moms and dads (and maybe them, too, when they’re grown ups) dislike their bodies, and certainly can't trust themselves, their ability to eat enough, their body's signals, their ability for their body to be forgiving if they ate a bit too much one day. They learn that normal family dinners are things other people can have, but not them. This is just the price they have to pay to lose weight.

Are you stuck in this place? 

Are you the adult child of such a dieter, who never learned to trust her own eating? Or simply struggling as of late, desperately dieting, relying on prepackaged foods and calorie-restricted meals? Consider cooking--see the recommendations made by "Thursday's patient" to ease the process, or check out Food to Eat for more support, with its 25 recipes in an easy to manage format, justifying the merits of each dish and its nutrient content. Serving sizes are suggested, but are by no means restrictive. Suggestions to enhance the meals are provided, along with sections to help you get out of your own way--to change your perspective about food and respond to your needs. And check out the links below, including sample recipes.

Kudos to Lean Cuisine for pointing out how crazy our culture is, with moms and dads filled with body loathing following all sorts of nonsensical diets. If only they can see that their video stopped short of pointing out the irony of their own product.

http://dropitandeat.blogspot.com/2010/08/size-matters-but-not-how-you-think.html

http://dropitandeat.blogspot.com/2011/03/normal-eating-taken-too-far.html

http://dropitandeat.blogspot.com/2011/02/who-or-what-decides-how-much-you-eat.html

http://dropitandeat.blogspot.com/2010/11/honor-thy-hunger-and-thy-fullness.html

And from Food to Eat: 

http://dropitandeat.blogspot.com/2010/11/pecan-pumpkin-pancakes-you-can-feel.html

http://dropitandeat.blogspot.com/2010/10/how-to-cook-healthy-meal-before-eating.html

Weight Management Gelato Style

The first time I traveled to Italy I was 19. I recall marveling at marble fountains, being seduced by sculpture and impressed by massive stone architectural creations while touring through Rome and Florence. But perhaps as memorable as Michelangelo’s larger than life David (http://bit.ly/nyY9rx), with which I fell in love, was the smooth and creamy gelato. Twice daily I would indulge in such intense flavors as nicciolo (hazlenut) and espresso, midday and late evening. 

In fact, I would purchase a scoop regardless of the hour, whenever I had an excuse to pass through the famous square the gelateria occupied. I had purchased it fearing I’d never, ever, see gelato again. It was now or never, as gelato doesn’t travel well in luggage. This, by the way, was the early 1980’s.

During my recent trip, however, I was older and (somewhat) wiser. I had gelato only twice in 7 days. (Okay, I did share some bites of my husband’s on a third occasion, I admit, but does tasting just a bite on those tiny plastic spoons really count?). It was not because I was watching my weight (I was not), but because I trusted this time; I knew it wasn’t my last chance to get this fabulous Italian ice cream. Boston has great gelato, as does NYC, which I visit not infrequently. In fact, you can even purchase some good stuff from the supermarket these days—at least where I live (check out Whole Foods). Or, as I’ve done, you could make it at home with an ice cream maker.

But back then, I harbored many a diet thought. As a teen, I had dabbled in the Scarsdale Diet, and wasted my time at Weight Watchers (Now you understand my vengeful post! (http://bit.ly/gY2653) 

My thoughts about food and eating and my body have changed enormously over these years. At the age of 19 and by the end of college, my BMI was out of range and it was not okay—I was sedentary and hardly fit—and I was rather disconnected from my body’s signals and needs. And I was not a large-size person from early childhood, genetically predetermined to exceed the BMI charts, justifying this above average size.

I’m older and wiser now at 48. On my return trip to Italy, I savored the rich and flavorful, slow cooked meals of the Piedmont, filled with mushrooms and truffle oil—but I didn’t fear it was my last supper; I lingered over multicourse meals, filled with flavors I adore. And I stopped when I had had enough—even though it was delicious. 

I skipped desserts when they seemed unnecessary, but took advantage of the aforementioned gelato when I needed a snack.  I sampled many a local Pecorino cheese in Tuscany and savored the hearty Tuscan Ribollita soup filled with beans, bread and vegetables. We enjoyed divine meals artfully prepared with local ingredients, served by Italians passionate about their culinary art. 

Among the very best meals was at La Coccinella, located in the small town of Serravalle DiLonga in the Piedmont. Fabulously prepared fish, as you can see from this photo. But like the gelato of old, I will never forget the dessert lovingly prepared with local hazelnuts, a delight of textures and flavors I can never duplicate.

I write this not on behalf of the Italian tourism department—no one is advertising for your clicks here. Nor, to brag about my travels I feel fortunate to have taken, along with my husband who enjoys great tasting food as much as I. Rather, it is my hope that this will inspire you. 

You may never care about great olive or truffle oils, perhaps. And traveling may be the furthest thing from a reality for you right now. But enjoying food can start at home, wherever you live. Sure, it may require some prep time (although good gelato, like fine chocolate, could easily be obtained and consumed). It requires you to start asking yourself “what do I feel like eating?”, when you are hungry, not just “what am I supposed to be eating?”, yearning later for the very items you’ve prohibited yourself from having.  It necessitates giving yourself permission to eat now, and again later—even if what you choose to eat later is ice cream. Because when you know you have permission to eat it again, you can stop when you’ve had enough. You’ll begin to trust this is not your last chance.

And after doing this for some time, and really trusting your body, you’ll note something strange. Sometimes, there may be times when you’ve truly had enough gelato, and there’s nothing more desirable than a fresh, juicy piece of fruit. And that’s ok to eat too.

So You REALLY Think I Can Keep This Up?

The verdict is still out, but I’d bet on Sally’s success. Over the past 12 months, this formerly mid-200-pound woman has lost 54 pounds, since we began our work together. But she’s done that before, without my help. In fact, she’s lost weight faster in the past, each of the past three times, even. These previous diets yielded a weight loss of 70 pounds, I’m told. Yes, in each of her decades of life, she managed to lose, and then to regain, approximately 70 pounds.

Back then, after about a year, she’d slip into old habits. She’d get bored with her eating routine, overeat, and then feel like a failure, letting the “What the heck effect” take over.  So I probed Sally, given her one-year anniversary working with me, to summarize what has changed, why this time is different. And here’s what I heard.

Clothes

Of course you’d expect her clothing size to change, with a more than 50-pound weight loss. But this time, she discarded her “fat clothes”. No sense holding on to things you hope never to need. But equally important, she tossed her unrealistically small sized garments. Sure, they were outdated. But she also recognized the importance of setting realistic goals, and living in the present, and appreciating her self and her body where it’s at, even as she continues to make changes. Sally has purchased a few new outfits that she feels good wearing. But she hopes to purchase some new items as she continues her progress. One step at a time.

Guilt

It’s hard to release yourself from feeling guilty after eating “treats”, particularly if you lived most of your years believing that you were not entitled to eat them. Overweight? You might believe you don’t deserve to eat ice cream; the stares alone, from strangers even, might convince you of that. Even if your weight were never out of range, you might have absorbed messages of caution around foods you’d love to indulge in. So perhaps indulgences occurred when your watchful parents or spouse or siblings weren’t around.

Sally stated that while she did have sweets before, while losing weight, she would always be thinking that she should be having a carrot instead. Hmmm, cake or carrot, cake, or carrot.  Which would you choose? Now, she includes sweets, as part of a healthy diet, and with a lot less guilt. She doesn’t limit them to when she is alone, or driving, or eating mindlessly. Now she can put a dessert on a plate, sit down with it, with or without others present, and enjoy it. Really enjoy it. Now she bakes, sometimes modifying a recipe, while still allowing for a satisfying and delicious product. She no longer awaits vacations to include the foods she enjoys. Instead, she chooses what she likes—but eats in portions more appropriate for her body’s need.

Doing it for Sally

Sally always had to be accountable when in a diet program. But this time, while she may still care to be a good student and do well at our visits, something major has shifted. “I’m doing it for myself now”, she shared. More than needing to show me a weight loss, Sally is determined to maintain her progress, which impacts how she feels—her ability to move her body, to feel comfortable after a meal, to go clothes shopping.

Thoughts and Actions

With past weight loss there was the before and the after, weigh in periods. Hours prior to that stressful moment, you know how it goes. Those struggling with overweight restrict more, to save face at their weigh in; and those of you struggling to gain, may push out of your comfort zone for those few remaining hours or days before the weigh in. And unfortunately, the weigh in lady would reward you simply for the loss of weight (think Weight Watchers); and similarly, those nurses or doctors inexperienced with eating disorders would reward you for your gain.

No one explored how the weight change occurred, whether through healthy or unhealthy measures; few bothered to ask. Rarely did anyone inquire whether you were struggling with the recent changes, and whether they were sustainable. Progress was measured strictly in pounds lost or gained. Some things, regrettably, never change. You might have changed your actions, but not your thoughts, making the eating behaviors less likely to be lasting changes. 

Unlike many medical professionals and weight loss program leaders, Sally now does know better. She can appreciate that her weight is only one small part of who she is, and how she is doing. She knows that her thoughts and eating behaviors are what’s most important. They built the foundation to support her progress.

In the past, losing weight required pain and suffering—at least as I heard it described by Sally and many others. “Isn’t going to bed hungry a good thing?” a teen patient recently inquired. That’s what she was taught. That was the gold standard. So why should she think otherwise?

At our most recent visit, I heard something I don’t always hear; Sally described how proud she was of how she handled a recent slip. Rather than focusing on what she failed to do, I got to hear the other side, the side that I am usually working hard to get patients to acknowledge. And without any prompting, Sally shared her accomplishment, pulling herself back up after a recent slip. Instead of dwelling on her excessive dinner portion when socializing with friends, and the seemingly unnecessary dessert which followed, in spite of not being hungry, she didn’t beat herself up, as she had for decades past. She described how she was able to put this eating in perspective, realizing she is only human, and move on, which she did just beautifully.

Slipping is not the problem, when it comes to changes in eating behaviors. It’s the ability to shift gears, to see the positive, and to appreciate your ability to continue to move forward. And to learn from our mistakes.

Yes, that’s why I’ll put money on Sally’s success.

Weight Watchers Beware!

Ecstatic to freely eat bananas, for the first time in years—this was the sentiment at Thursday’s meeting. Finally able to select salmon—previously too pricey by their point system—this made them rejoice.

Most of my readers care little about Weight Watchers. But I’m writing this post because whether we realize it or not, whether we are “Weight Watchers” or not, their messages infuse into our culture and into our beliefs. They impact our thoughts about what’s acceptable to eat for health and weight management, whether they are myths or truths. Hearing some myth-information recently, I decided I needed to cut it short, before it spreads. I also wanted to point out a side of diets that most lose sight of—the damage they do.

Unlike those in attendance at their meetings, their cheerleaders who are pleased with their program and their successes, I get to see another perspective.

No Lifetime Membership for Sharon

Sharon came to see me for the first time this week, having never struggled with her weight. That is, until the past few years when it began to slowly climb.  That led this smart, level-headed woman to Weight Watchers. She followed their plan 100%, yet still gained weight. Encouraged by their new program, she figured maybe the old program just wasn’t for her. Two weeks into the new Points Plus system, she arrived frustrated and distraught in my office, and for good reason.

Sharon’s climbing weight made perfect sense to me, and with the recommendations we discussed I am confident she will turn things around. But I mention her because of how she changed as a result of the Weight Watcher’s diet.

Her whole life, she ate what she wanted, in moderate portions. She’d have ice cream at night—when she felt like it—but only as much as she needed. She had wine with dinner some nights, but just a glass, and she listened to and trusted her body. And it worked for all of her 38 years. Only recently, the balance wasn’t there.

Enter Weight Watchers. Her weight continues climbing, and now she is thinking about food all the time. She avoids the normal foods she always had, the moderate portions of foods she truly enjoyed, opting instead for lots of fruit (free on the new program). She moved from trusting her body, which had always worked for her, to trusting the program. And even if it had worked, it has totally impacted her relationship with food, and her ability to be normal. And this can happen with any diet, not just Weight Watchers.

So I went to a meeting. Yes, I decided to put on my journalist’s hat and collect information. I wanted to be fair and not misrepresent their program, to hear it from the horse’s mouth, so to speak.

Lori goes incognito

They were prepared to sign me right up, on line, and at the meeting. It didn’t matter that my BMI was in the normal range (I do have issues with using BMI, but we’ll take that up at another post). No one questioned the appropriateness of my joining, in spite of my normal weight. I could only imagine the damage done, if an eating disordered individual, also in the normal weight range, showed up. The messages, in my estimation, run counter to those supporting a healthy relationship with food.

Here’s what I saw and heard. Upon checking in, your progress is assessed. Behaviors? Thoughts? No, no, simply weight. Progress is measured solely in pounds. It doesn’t much matter how your weight changed.  No, the group leader isn’t inquiring whether you binged, then restricted all week, or if you purged before the meeting. You are praised simply for the weight change.

Now hopefully, those of you dealing with eating disorders or even weight management, in another setting, have experienced a different approach. When you see your team, progress should be measured not only by weight change, but by improvement in your thinking and preoccupation with eating and weight, by changes in your vital signs, and your energy level and sense of well-being.  Weight may not change one week, but we may see breakthroughs in how you cope with challenging situations without relying on food and disordered behaviors.

Those of you who really know me would have been so proud! I work hard to filter my thoughts, when they’re inappropriate, and to think before I speak. I could be sharp tongued, at times, when something really pushes my buttons. But at this 7:30 meeting I asked some naïve-sounding questions, and truly tried to listen to the answers. And I bit my tongue really hard.

It’s not about the calories? It’s about eating for health? Really?

“Can you tell me about the new point system?” I asked. “We’ve learned so much about weight loss,” the meeting leader replied. “It’s not just the calories, it’s the macronutrients,” she tells me, “the protein, fat and the carbs, besides the fiber, that determine your points.” Hmm. Has anyone taken basic biochemistry? Or maybe just high school biology?  Those calories in foods come from (drum roll please) those very macronutrients—protein, fat and carbohydrate.

Let me remind you that energy balance and weight regulation is about the calories. In a large Harvard study, they again showed us that weight change is the same whether following a low carbohydrate or low fat diet, by one year’s time, calories being equal. And similarly, for those on the other side, the weight gain is no worse regardless of which component of your diet you increase, calories being equal. And then there’s my favorite Dr. Haub study (see previous post).

What is true, is that certain food choices may make us more full in the short term. But this is not the wisest choice. We may find ourselves in situations getting too hungry, when that volume from liquid and fiber they promote, passes. That doesn’t help us sustain our bodies and our energy. And if we are struggling to recognize hunger and fullness, lots of water and water-filled foods will only mask your ability to listen to your body and its needs.

“It’s about promoting choices based on what we know about eating for health, so we encourage whole grains and less processed foods”, I was told. “It’s not about calories.” And yet, the unprocessed, whole grain brown rice has the very same point value as white rice. To me that would send a message that they are equal, no? And why is a glass of wine so high in points? Science does, in fact, support a glass of wine. And dark chocolate, I might add. Have they not seen that science?

Cocoa and chocolate, concentrated sources of polyphenols, have received much scientific interest and study. In fact, health benefit evidence regarding cocoa and chocolate were reviewed by the Dietary Guidelines for Americans Committee (2010). This session will review the cocoa bean's composition as well as the population-based and dietary intervention studies supporting the cardiovascular health benefits of consuming cocoa and chocolate. (from the American Dietetic Association 2010 conference guide).

Yet Karen, the leader, said “have the fruit first and that may satisfy. Then if you really need it, have the crap.” No, she didn’t use those words exactly, but that was what was implied. You know, “good food” first. In other words, don’t have what you really feel like.  Yet ultimately, after yearning for what you really want, you’ll eventually end up eating it having consumed both the calories from the fruit and the calories from the other item.

Not a diet?

Their materials work hard to convince us that it’s not a diet, but a lifestyle. They’ve got to be joking!  You’re given a plan, a number of points, and ways to count foods. And you’re encouraged to have all your points. There is little focus on self -regulation, eating what you need, as just as much as you need, based on your hunger and fullness. How can they not call this a diet?

They do, apparently have a plan that has you listening to your body, but that plan was largely dismissed at this meeting. And to truly be supported in that approach, an approach I completely support, it takes time, and exploration of eating triggers, and stress management tools, and one-on-one guidance.

So here’s the thing. There’s a place for sensible guidelines. These just weren’t so sensible. Adding structure to our day’s intake helps us not get too hungry, and I certainly support regular meals and snacks. And if you are at a place where you mask your hunger (with anything form large volume, low caloric-density items to coffee and diet sodas) than listening to your hunger with be a challenge—for now.

For those of you who don’t listen to your body’s hunger and deny your needs, a meal plan may have its place—for now. You should re-learn the tools to self manage, to listen to your hunger and your fullness, and trust them. Move out of your head, away from all the rules and information you’ve picked up. Work on becoming mindful—of what you eat and how it tastes. And tune in to what is making you eat—or stopping you from eating, in spite of hunger awareness.

That’s the work we have before us. And counting points isn’t going to resolve it, or improve your relationship with food.

It’s my hope that none of you need a lifetime membership. Let’s work on making changes that can change our relationship with food and our trust in ourselves, to help us for a lifetime.

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