I’ve Gained Weight. Now What Am I Gonna Do?

Perspectives for those with bulimia, anorexia and those with no eating disorders at all.

"How much weight have I gained since we started working together?", “I want to know." That was the pressing question.

Ellie has been seeing me for several years, for periods at a time. She presented with severe bulimia, purging 3 times per day, every day, after each of the three times per day she allowed herself to eat. Back then, eating and keeping food in was simply not an option. Over time, her purge frequency decreased and she normalized her food intake, ultimately giving up her bulimia. 

Beyond her initial and modest weight increase, her weight has remained stable within a 2-3 pound range over the past many years. And that initial increase can be attributed to two things—no longer living in a dehydrated state and better nourishment.

To me, the better question for Ellie to ask would have been " how much better off am I since I’ve changed my eating?" In spite of the modest weight increase that she had no interest in, what did Ellie get in return?

When confronted with this question, she appropriately retreats from her disordered thoughts which periodically reemerge and readily acknowledges just how far she has come, how much better she feels. She remembers that there's no way she could've taken care of her newborn grandchildren in the state she was in then, or be trusted driving back and forth to their home. No, the price she paid, the few pounds gained, is nothing given what she's getting in return.

Gaining weight is rarely seen as a positive in our culture. Advertisements fail to praise us for outgrowing our jeans.

But for some, that is exactly what needs to happen. Staying at the weight you were at when you were 12  is hardly appropriate when you are 16, 20, or 40 years old. And even if your weight is objectively 'within the normal range' for the population, it may not be in range for you. It drives me crazy when doctors tell their patients that their weight—a  weight that has never been maintainable without an eating disorder because it's too low—is fine, because they are basing it on the charts for populations. Why the double standard? Because if you've always been a healthy larger size and you've lost weight through unhealthy measures, that 'normal range weight' may be anything but normal. Perhaps given your build, your genetics, your muscle mass, your history of athleticism, your body needs to be at a higher-than-average weight. And fighting it to be at a place you've never been will only contribute to unhealthy ways of eating and thinking. For your mental and physical well-being, weight gain may be just what's needed.

Gaining weight without an eating disorder?

Not long ago—a couple of months, maybe—I noticed that snugness around the middle. No, my jeans hadn't just been dried at high heat for too long. And really it was not in my head. Everything was fitting a bit too tightly. (Yes, even the bras.) Not one to weigh myself with any regularity, I suddenly jumped on the scale. I felt the need to reality check, to verify what I was feeling.

Yup. My weight was up.

Save your rush to judgement, please--it has nothing to do with the cupcakes, the chocolates and my homemade, full fat lavendar ice cream. Ok, let me clarify. No "I told you so's" necessary, because I ate all those foods before. But over the months of summer, the balance wasn't perfect, and so my weight crept up. 

Could it be that I was super active through the end of June, training for my fundraising ride, only to reduce my activity precipitously with the heat wave and awful humidity? Perhaps. Could it be that I've been socializing more, sipping on wine with dinner more nights than previously. Perhaps.  Could I have possibly joined my husband for an after dinner snack—just because it looked good and I thought I'd keep him company—more often than I really needed from a nourishment standpoint? Likely. Like you, I'm not perfect.

But the bigger question is what to do about it. If you were me, would you:

1. exercise a couple of hours each day to make up for the previous reduction in activity?
2. reduce your food intake to compensate for the extra calories consumed?
3. seek the guidance of a Registered Dietitian?

Ok. So I'm the RD so  I'd better come up with a fix.

But if you don't fall into the categories described above--those truly needing to gain weight, or those who've gained appropriately as a result of releasing yourself from disordered behaviors--and you find you've gained some unnecessary weight, here's what I'd suggest. Intuitively, it may seem appropriate to make up for any overeating in the days or weeks which follow. But don't do it! Instead, refocus. Get back to the basics, particularly if you've found yourself slipping into old patterns. Have you forgotten the basics? For starters,

Sit. No eating as you walk around the kitchen emptying the dishwasher. No eating standing at the fridge. And no, don't sit at the fridge; seat yourself at a kitchen or dining room table.

Separate. Eating and distractions,  (other than your family which you can't get rid of) should be separate activities. TV watching, texting, reading--these should be separate from eating. (Unless, I'll add, you are struggling to get food in and find that being less mindful is actually helpful--which it often is!)

Eat with your senses. Are you seeing your food and acknowledging what you're eating? Are you experiencing the textures of what you're eating? Are you tasting your food? Doing so will allow you to slow the pace and to feel more satisfied with what you're eating. You'll enjoy the food so much more!

Choose what you enjoy. Are you giving yourself permission to eat what you like, or holding on to rules about what's allowed vs forbidden, in your mind?

Tune in to  your hunger. Don't wait  until you are at the extremes of hunger--if you're starving you are more likely to struggle to eat as described above, and overeat.

Re-explore fullness. Are you eating until you are stuffed? Might a modest adjustment in portions be appropriate? That said, if you start with smaller portions, do give yourself permission to eat again later--after about an hour--regardless of what you you ate before.

Don't panic! And don't take radical steps to 'fix' the problem. Restrictive eating, denying your body's signals and needs, does nothing positive in the long run. It will only perpetuate an unhealthy cycle and make you feel like c!*P!

Breathe. It won't take long to get yourself back on track. But be realistic--if your eating was off course for some time it will certainly take some time for you to be back to your former, healthy self. Radical dietary changes can have radically negative consequences, so do be patient and appreciate the modest improvements as they happen.

Parenting Without Disorder: It's Not Too Late to Role Model

Stir Crazy Grace  August 5, 2013 at 1:46 AM

"Thank you, thank you, for normalizing (re-normalizing?) normal food and normal eating! As a mom, I am also doing my best to give these attitudes to my family. My challenge, besides the fact that I deal with my own food issues, is an overeating spouse who likes to bring the child along on his path. Would you ever address anything like that? How we, with food issues, deal with being responsible in our families for being the provider of nutrition and shaper, to some degree, of the attitudes there? I always look forward to your posts! Thank you!"

I grew up on Whoopie Pies but I prefer a
good scone these days.

Thank you, SC Grace, for asking and prompting this post. It is not too late to change your eating, nor to model a healthy relationship with food, even if you've struggled during your own childhood. So I'll share a bit about my own experience as a child, a young adult, and as a mom.

I grew up on Lucky Charms and Capt’n Crunch for breakfast. Mayonnaise sandwiches on Wonder white bread was my frequent snack of choice which I'd help myself to; I’d pull a chair up to the refrigerator to reach the shiny metal bread box at the top, clad in my Pjs, while my mom slept early am—I was preschool age then. I don't think I was sneaking—although I don't know what she'd have said if she found me climbing above the fridge and eating.

I ate everything, including cooked-to-death canned vegetables—I loved the rubbery mushrooms and the flaccid asparagus spear pieces the best—and fried liver and onions. Really.  Casseroles made with those goopy canned soups—high in fat, saturated fat, and sodium, and low in fiber—these were the norms. And I guess even then I paid attention to how I experienced food.  I was free to eat cookies—and ice cream and cakes—but only after I finished my meal. Somehow that was never a problem for me. I do recall many a comment about what an appetite I had. Yes, compared to sedentary adults who were not growing, my needs, like those of all growing children, were great.

I never encouraged grapefruit--it was just always one of his favorites.
Go figure.

Then my mom went through her dieting jags. I turned to grapefruit and dry toast with black coffee and salads for lunch—just vinegar, please. Fish, cooked dry—and it tasted it—with merely a sprinkle of all-the same-on-everything seasoning. Oh, and plenty of cottage cheese—low fat of course. No fresh garlic, just powdered. No herbs. No tasty olive oil. Minimal pleasure, I’ll add.

Yup, it's me in my college years. (As promised, Cate!)

And when I was college age and gained more than the freshman fifteen, I was told that I could use to lose about 20 pounds. There was no exploration of the why, no guidance on the how. My mom did instruct me to hold my stomach in, however. I restricted my eating at times, and binged at others. I became rigid about how things were prepared (heaven forbid there was something added that I didn't know about) and I even had a short-lived period as a vegetarian.

Fast forward

Over the years, my own eating normalized. Yes, I realize that's a rather passive statement. I can't quite say how it happened, though, as I never sought help—I never had something one would have known how to label back then. By today's DSM, I'd be labeled a restrictive binge eater.

And then, of course, I became an RD, and after some years, had a family.

Some things will come intuitively--if you let them be.

In spite of my profession, my sons were the least educated of all their classmates in areas of food and nutrition. They didn't know a carb from a fat, and were never taught that they had to finish their 'healthy' food before eating dessert. Ice cream was an acceptable snack—when it was eaten in the kitchen, at the table, no TV in sight. French toast, pancakes and waffles with real maple syrup the norm in our home. They did know that Frosted Flakes was more candy then cereal—and they were tuned in to be critical viewers of the media. It never struck me as problematic when my son had a fuller build, appropriate before his adolescent growth spurt.

In their later years of high school and into college the discussions began. They wanted to know if what they were hearing was true—like whey protein for muscle development? And what’s the story about eating late at night? And are refined carbs as bad as they say?

But really, they already knew the answers. They knew from seeing how we ate that a varied diet was appropriate. And they heard that food was something to be consumed both for fuel and for pleasure. They learned that food was neither to be used as a treat, a reward for good behavior, nor to be withheld as a punishment for bad behavior nor for eating too much. And they had learned to trust their bodies.

And now?

I just spent 4 days on a mini vacation with my husband and my 2 20+year old sons, and what I heard and saw only reaffirms this parenting approach.

I learned that my elder son mixes his cereals at work, where he eats breakfast daily on workdays.  Approximately one third is Frosted Flakes, 2/3 regular Cheerios. Or, there's Kashi Heart to Heart—with a bit of Lucky Charms thrown in—for sugar, or maybe even nostalgia, I suspect. And at our local dairy where the ice cream is oh-so-rich and the portions are crazy large, my almost 6'2” boys order a ‘kiddie’—a single scoop—because it’s just as much as they need.

My adult kids enjoy fine food out—and their share of cheap, quick food—but in moderation. Son #2 would choose fresh blueberries or a fruit laden dessert over chocolate any day. And they’re both as excited about the farm-fresh tomatoes we’ve recently gotten as I am. Meals are eaten at the table—eating in the bedroom or the family room is just not happening—at least when they're home; I can’t speak for what happens in their own space.

They might be momentarily engaged with some texting, but for the most part, meals are mindfully consumed. They talk about the flavors—their preference for one vinegar or oil over another—and they choose foods they enjoy. They are foodies—with all that connotes—but mostly it speaks to their appreciation for how food tastes. Both my sons enjoy eating—and cooking.

As for spouses: I could never have raised my kids as I did if my husband countered my messages with talk of 'good foods' vs 'bad foods'. Or if he told them that they couldn't have seconds. Or if he continually prompted them to eat—even if they weren't hungry.

Most important, talk to your partner so you can be consistent in the message you put out there. And when your spouse isn’t on board, address the issue away from the ears of your children. Arguing around food is the last thing you want to be doing. Food and eating shouldn’t be stressful.

Educate your partner—do they get it? Maybe they have no reason to get it, given little personal experience with a food struggle. Or maybe they are so stuck in their patterns that they aren’t too self aware. Perhaps you can make the connections for them. They just might need some direction.

Remember it's not too late to modify your approach—just be consistent with your message. Focus on health and self care, on listening to and respecting one's body, versus targeting a change in weight.

Hope that helps.

Comments are both welcome and encouraged! Thanks for reading.

The Door to Change is Open. Learning about eating disorder recovery from Let’s Make a Deal.

So you long to be at your old weight, the lower size, the place where everything was fabulous? Like the amnesia when recalling an old boy/girlfriend—you know, that selective memory that favors only the good times (not how miserable they made you feel or how unhealthy your relationship was with him/her)—you remember longingly how great it was to be thinner, and you strive unhealthily to get there. Remember how happy you were, how you loved your body then? Don’t you recall how great you felt—physically and mentally? No?

Was it as good as you recall or did you feel trapped?
The door is open for change!

Likely not! What was that disordered relationship with food really like? How great did/do you truly feel and function? Perhaps, as I hear from so many...

• Your mood was off. Depression crept in, as did anxiety. Thoughts might have become obsessive. As a result, you were not truly present. Rather, your thoughts were racing, removing you from engaging in conversation and interacting in a healthy way.
• You were emotionally removed—perhaps that was helpful—but not feeling the negative stuff also meant not enjoying the positive experiences either. Were you missing the connections with friends and family? Did you miss out on those early years of your children’s lives, or the later years as your parents were aging? Present, but in body only?
• You were dragging, deprived of energy from truly getting enough fuel throughout the day. Maybe you made up for it later, but that didn’t help you function throughout the day. Ok, so the coffees or diet Cokes gave you that caffeinated illusion that you were energized, but the headaches and preoccupation about your next meal surely told you otherwise.
• The lightheadedness and fatigue were bad enough. But the disturbed sleep during the night might have been more than you bargained for.
• You hated feeling cold all the time, especially when nobody else was.
• And having to attend all those appointments—with your doctor, your therapist, psychiatrist, and that darn nutritionist. Bad enough to have to take all that time, and copays, but having to be held accountable every visit? Uggh!

Yes, there is another way...

• The missed periods (for you women) were a bit worrisome, never mind the impact that would have on your bone density.
• It was so challenging and overwhelming planning meals and trying to be social, when so much centers around eating!
• Your thoughts became so distorted.
• And you felt so trapped and helpless.
• You were not even happy then, as you were still striving, against your body’s best interest, to lose more weight.
• It was like living two lives. The one everyone else saw. And then the real you, the you you struggled with.

Let's make a deal

Remember that old TV show, Let’s Make a Deal? I guess it still airs, but decades ago when I last watched it here’s what I remember. There were three curtains, and behind each one there were items—some desirable and some, so-called zonks. Contestants would have to make a decision to trade what they were shown behind one curtain with the unknown contents hidden behind

Have you read all the posts this cup mug is on? Just checking!

another curtain. They had a chance to reneg on their decision—offered money to trade back, still site unseen— restoring the hope and promise of possibilities behind the alluring curtain—which of course could turn out to be a worthless dud.

This show somehow seems like eating disorder recovery itself. In spite of knowing that we are living with a zonk, which in the grand scheme of things has so little value, it is challenging to trade for the virtually unknown. Virtually, because we have all but forgotten how much better, how much more value that former non-disordered self had.

If you’re stuck in a pattern that you know isn’t working, why not take the risk, so to speak, and try what’s behind a different curtain? Could it really be much worse that what you are living with now? You knew what the other curtain held—the benefits of listening to your body, of nourishing yourself, body and soul. So why not make a deal and trade up?

Maybe you won’t like all the offerings behind a curtain. So toss or trade back the parts you could do without. Perhaps you'll need to learn to tolerate some parts of the package that aren’t your favorites—you’ll learn how to make due. Yes, with support and experience you can become more accepting of the full package.

"How do I start?"

Ready to trade up? Make a list of what you dislike about your current situation—physically and emotionally. What is it stopping you from doing? What harm is it doing? What would you be able to do if you didn’t have this disorder? What was it like without it?

And what positives do you get from your disorder? A strange question, perhaps. But on some level you must be getting something positive from your current situation. It may be your drug of choice, or allow you to not have to make decisions about your future. There may be all sorts of positives you attribute to your disordered lifestyle.

Now put them together. Bring them in to discuss with your health professionals—your therapist, dietitian, or MD.

Do the math, adding the pros and the cons. Then make your voice heard and make a deal. Yes, it’s time to peak behind the next curtain.

From Senna to Weight Watcher’s Dinners: A warning to dieters and disordered readers!

Yes, the list continues, as I promised. I admit it’s a strange compilation, yet these items are pulled together because of a common theme—they mess with your head. They mislead your thoughts and your body. And I want you to be on guard!

Self-serve frozen yogurt—It’s all the rage around here—frozen yogurt that has that tangy, original yogurt flavor—just like it’s meant to have. I think that tartness makes people think the yogurt is a free-for-all, with an appeal and halo similar to that of grapefruit; like if it’s tart or sour it must burn fat, right? (Wrong!)  Personally, I do love the flavor, but I don’t love how manipulated I feel when I get into the self-serve froyo shops. These upbeat establishments, all clean and bright and fresh-looking, offer two possible paper containers to use—large and crazy-large, 16 and 24 ounces, in most shops. And you can’t get a smaller dish (trust me—I’ve asked). Why does it matter, you ask? You can take just as much as you need, right?

Well, kind of. The supersized dishes make a reasonable size portion of froyo look pitifully small. So even though you know that it may be enough, you keep swirling it into the cup until it looks more appropriate, until you’ve served yourself perhaps a more generous amount than you need. Even knowing it, we still do it. (Check out Prof. Brian Wansink’s research to learn more about this phenomenon.) Fill the larger cup and you’ll take in more than a generous meal’s worth of calories.

Greek yogurt. It’s the protein thing again. With more than twice as much protein and less carbohydrate Greek style yogurts seem to feel ‘safer’—at least to those of you who have been brainwashed by the Atkins and Paleo diets. Greek yogurts are absolutely fine to include, but unless you are minding your carb intake for diabetes control, I’d suggest selecting the yogurt that you like best—a low-fat standard yogurt (referred to as European or Australian style by some brands now) or Greek—if you like yogurt at all! 

Kale and other super foods. So I like kale—really I do. I like it sautéed with a bit of olive oil and garlic, or used in place of spinach in my lemony lentil dish. But must I make a beverage out of it? Or make it into chips? Must we create 101 ways to eat kale? Not everything we eat must be a superfood. I like my pastries without kale, thank-you!

Juicing: I’m puzzled by the juicing craze—with or without the kale. Must we process our fruits and vegetables, removing their fiber? If you’re gonna have a juiced vegetable beverage, please don’t view it as a meal!

Yes, that's cheese, full fat, at my Mediterranean lunch!

Mediterranean misinformation: The so-called Mediterranean diet is used as a model for healthy eating—high in fiber, olive oil and nuts it’s good for your heart and your health. Walter Willet and others at Harvard even came up with a Mediterranean food pyramid. I’m all for whole grains, unrefined foods, and legumes, which it contains. And can I fault it for the fruits and veggies it includes? Certainly not.

But have you ever traveled to ‘the Mediterranean’—you know, Greece, Southern Italy, Spain and France, for instance? For the record, there’s not simply one way of eating. And the guidelines that American researchers are attributing as Mediterranean hardly fits with what I’ve seen in the Mediterranean. In Italy, they’re not eating whole grain Italian bread or whole-wheat pastas and in coastal France the bread is white baguette. The minimal dairy diet Willett and others created has little basis in the countries of the Mediterranean, where Greeks, Italians and others include yogurts and cheeses, (not low fat, I’ll add) for instance. And have you noticed the croissants in Provence—yes, the Mediterranean! 

Really, it's all about balance. Barely visible are the pastries (right rear)
at our self-prepared breakfast

My point? The so-called Mediterranean diet needs a name change. And while I endorse the core components of this way of eating, don’t feel like you’re unhealthy if you choose true Mediterranean dishes that use white pasta, a crusty white French bread, or some Parmigian or feta. http://oldwayspt.org/resources/heritage-pyramids/mediterranean-diet-pyramid

Senna and Dulcolax—gentle? Have you ever tried them? It doesn’t matter that Senna is natural—that it’s from a plant, that it grows—it ‘s a stimulant laxative that has its risks, as does Dulcolax. Think dependency. Think colostomy. Really. I’m not talking about periodic use when you’re suffering from constipation. But frequent or continued use of senna may make you dependent on laxatives and cause your bowels to lose their normal activity. 

"Laxatives that quickly produce a bowel movement, such as senna (Senokot) or bisacodyl (Dulcolax), are the most abused and dangerous. They stimulate the nerves in the colon.  This causes the muscles of the intestines to contract and push down the contents of the bowel. Over time, the laxatives keep the colon empty. The colon cannot send a signal so that a normal bowel movement can occur.  The muscles of the bowel become weakened because they are not being used.  The body gradually gets used to needing laxatives to produce a bowel movement." http://www.consumer-health.com/services/LaxativesProceedwithCaution.php

If constipation is an issue, discuss with your MD safer types of laxatives—Miralax is one typically recommended. But constipation may be managed with dietary and fluid changes and by evaluating for an underlying cause.

Weight Watchers frozen dinners: Italics intentional, because the content of these frozen packages falls short of a dinner meal for anyone. ‘Feel fuller, longer with these delicious, satisfying meals’—that’s their tag line. They’ve got to be joking. With dinners ranging from 140-290 calories, how can anyone feel full longer?  Longer than when not eating? And adding the couple of grams of fiber will hardly do the trick to satisfy your nutrient needs! No wonder you don’t feel satisfied after eating this and other such frozen diet dinners, such as Lean Cuisine or Healthy Choice.

My intern, Kristen Sementelli, a graduate student in nutrition, added a few of her favorites, too:

Hungry Girl: Hungry Girl puts together cookbooks full of recipes that are low calorie in order to “help” people cook meals and snacks that promote weight loss. Her book “Hungry Girl 200 Under 200” is a compilation of recipes under 200 calories. This includes breakfasts, lunches, dinner, and a variety of snacks. While this calorie range may be appropriate for snacks, so few calories are not only inadequate for dinner, they encourage overeating later in the day leading to unhealthy eating patterns and even weight gain. On top of that, the ingredients she uses are processed and artificial. There are dozens of reduced-fat, fat-free and sugar-free ingredients used, such as reduced-fat peanut butter, which happens to be another pet peeve of mine.

Reduced Fat Peanut Butter: Perhaps it sounds like a good alternative to regular peanut butter. The problem is that peanut butter is full of monounsaturated and polyunsaturated fats, the healthy fats that help lower cholesterol. The reduced fat PB only eliminates 0.5 g of saturated fat, but gets rid of 3.5 g of the healthy fats. To replace the fat taken out, additional sugar, salt, and other ingredients are added, so the calories remain the same. And frankly, it just doesn’t taste good.

            

(Personally (Lori here), I choose a natural peanut butter made from peanuts and salt. Just be sure to blend the oil on top—don’t dump it out—then refrigerate.)

Vegetable Chips: With claims like “one full serving of vegetables in every serving” it’s hard not to be tricked into thinking vegetable chips are better for you than potato chips. Looking objectively at the nutrition labels of Terra brand vegetable chips and Lay’s potato chips, there is little difference between the two. Lay’s chips have only 10 more calories per 1 oz serving, 1 extra gram of fat, and only .5 g more saturated fat. Terra vegetable chips have slightly less sodium and 2 extra grams of fiber, but Lay’s potato chips actually have one more gram of protein than the vegetable chips. There is no difference in vitamins and minerals, and the ingredient list is practically identical except for the choice of starchy vegetable for the base. If you enjoy vegetable chips it’s fine to have them in moderation. Just do not be tricked into thinking they are better for you than potato chips. 

(Lori: Oh, and did we forget that potatoes are vegetables? And that micromanaging your calorie intake will get you nowhere? Just saying...)

Spinach Wraps: You see the word spinach on the packing and think “this must be healthy.” Plus, it’s green! How could it not be? If you dare to look at the ingredients, you’ll see spinach isn’t even on there. There is only a small amount of spinach powder and blue and yellow food coloring. I compared FlatOut’s Garden Spinach Wrap with their whole wheat wrap to find that the whole wheat wrap is higher in fiber (by 5 grams!) and protein, at the same time as being lower in total fat and sodium. The garden spinach wrap is only 2% higher in vitamin A, calcium, and iron, which is not a big difference. Your best bet would be to stick with the whole wheat wrap, and maybe add some spinach inside.

(Lori: Or enjoy a sandwich on some delicious bread; I never did see the appeal of wraps except for with hummus.)

Thanks for letting us air. Hopefully, you’ll be a bit more critical when exposed to product claims, and you’ll start to choose foods you enjoy, too.

Since this is getting so long, I’ll leave you to figure it out: what’s my beef with light soy milk and gelato. Please share you own pet peeves, too!