Just Drop It and Eat: BED

Showing posts with label BED. Show all posts

Sunday, February 2, 2014

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 normalBMI 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 Citytoday 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!)

Monday, August 12, 2013

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.

Sunday, June 9, 2013

The 'Life’s Too Short' Diet

Perhaps a little something with that coffee?

Do you fear you’ll be dealing with eating issues in your next decade—when you’re in your 30s, or 40s, 50s or beyond? Yearning to just be normal again? (Again—because at some point in time, perhaps way back when you were a child, you lived free of all these food concerns, never counting calories or giving a thought to when and how much you consumed). Wrestling to release your self from the hold of anorexia, binge eating or bulimia, and the preoccupation with your weight and the diet du jour? Ready to be free of carb and fat phobia?

Scared? No surprise. You don’t yet trust the next step, but know it’s time to change. Seemingly damned if you do, damned if you don’t change your relationship with food.

There comes a point, a tipping point, when you realize that the cost-benefit of staying stuck is not in your favor. Don’t be fooled into believing that you’ll be happier if only you weighed a few pounds less, because it’s simply a moving target. And the toll that restrictive eating and disordered behaviors takes on your body and your mind is a steep price to pay—even if you thought you’d be happy. It’s not worth the ruminating, the fatigue, the loss of social activities, the isolation, or simply the risk. It’s not worth living with your secrets.

While I no longer struggle with an eating disorder (although my past history of restriction and binge eating was shared in Food to Eat), my tipping point crystalized soon after my diagnosis with MS. It hit me that I didn’t know what tomorrow would bring. (Brilliant, huh? Nobody knows what tomorrow will bring! We could be hit by a car or by lightning, heaven forbid.) The awareness that I could lose my ability to walk, or bike or go up the stairs in my home at absolutely any time highlighted for me that the time was now. I needed to start acting like life is short—because it is. I needed to carve out time for me and for my needs and to seize the moment. Putting off travel was no longer an option. Taking care of my body—including minimizing my stress level—was essential. Continuing to eat well and stay healthy—to take charge of the variables I can control—was essential.

So to my readers who want to challenge their status quo, consider the following—life’s too short.

Life’s too short:

To count your calories, fearing you’ll run short while still hungry for more food;
To jump on the gluten or milk free, low carb, or fill-in-the-blank-freediet when you have neither celiac, gluten intolerance nor milk tolerance issues;
To live in your head, ruled by diet rules about when and how much you’re allowed to consume, disconnected from your body and its signals;
To view foods solely as nutrients, versus the tasty, pleasurable part of your intake they are;

Do you believe this?

To eliminate categories of foods—yes, even cupcakes and desserts—even if they have little nutritional value;
To spend the majority of your waking hours consumed by your weight, or size of your hips/thighs/butt/stomach or muscle mass;
To deny your hunger for the sake of dropping some weight;
To omit those foods necessary to support your health and any diseases you may live with;

Yes, another one of my weekend breakfasts...

To fail to attend to your body’s needs for fuel, for moderate activity (if you’re healthy enough to do so) and for kindness;
To ignore the needs of your soul, denying yourself time for you and embracing your needs for fulfillment;
To consistently override your fullness because you feel you’ve blown it and you don’t deserve to feel better;
To abuse your body through unhealthy behaviors, including food restriction, binging, purging, and excessive exercise.
To wait until you feel deserving to enjoy the food you eat with all your senses.
To wait until Monday, or January first for change, or until you’re taken through the emergency entrance.

The only thing missing is Enjoy.

So assess your thoughts and your actions. And ask yourself “What do I need to change to improve the quality of my life?” Truly somethingis in your hands to change.

Because life’s too short.

Thanks for reading—and for sharing your thoughts.

Friday, May 31, 2013

Name-calling Has Its Place: BED is Now Named as a Distinct Eating Disorder. So what’s in it for you?

What’s in a name?

Perhaps it sounds like an existential question, but if it doesn’t have a name, does it even exist? Labeling Binge Eating Disorder (BED) what it is—a painful struggle living with frequent overeating large amounts of food—makes real the impact on mood, thoughts, energy level, physical wellbeing and hopelessness, to name a few.
Living with Binge Eating Disorder when it was not yet recognized as a diagnosis, you might not have felt sick enough or eligible to be treated, because it just wasn’t taken seriously enough by those around you.

Being added as a condition all its own validates this not-uncommon eating disorder whose sufferers live with their secret relationship with food, silently and ashamed.

Like adulterers you may sneak around family members and friends consuming large quantities of food—rarely lean protein or vegetables, I’ll add—but typically those foods and nutrients deemed forbidden. Yes, adulterers, as you carry on a relationship you may fail to acknowledge, cheating only yourself.

You eat quickly, masking the empty packages for fear of the response. “Who finished the cookies?” you dread hearing. You may eat salads or nothing at all in the workplace or with others, then stop at the convenience store or the fast food drive in and eat more than a day’s worth of calories, before even getting home. And then perhaps eat dinner as if nothing had ever happened. There may be a short-lived thrill preceding the binge, but a lingering guilt-filled regret to follow.

I should be mindfully eating?

Binge eaters rarely taste their food, nor do they enjoy it mindfully—from the accounts of my patients over the past 26 years. They eat cakes and cookies and ice cream, but they don’t consume them with permission—their own permission, that is. They may be quite unaware of what and how much they have eaten. And although there are exceptions, they rarely truly enjoy what they are binging on—although the experience may be quite pleasurable—in the short-term. Friday’s new patient diagnosed with BED would never come in for a follow up—that much was certain—if I dared to suggest he’d have to give up his nightly, longed for ritual of binge eating. Yes, making change takes time—and hard work.

Why oh why do I do this?

You may find yourself eating impulsively, wondering why, even though you know better, you can’t follow through with your intended control over food.

Let’s start with one basic fact. You are not stupid. It is not for lack of knowledge that you maintain your binge eating pattern, but likely because it meets some needs. It may temporarily numb you, a drug of choice for some, or may help manage your anxiety. Or it may be triggered by impulsivity, even greater in those who get too hungry and those who struggle with impulse control—like those with ADHD. Now don’t get me wrong. I’m not endorsing binge eating to meet your needs. Rather, hopefully providing some insight so you can begin to move from the place you are stuck.

Binge eating typically, although not always, follows deprivation and food restriction. Ever notice that your binging is worse after dieting or fearing you will be without food?

Thoughts like “I’ve already blown it so I may as well keep going”, what I call the what the heck effect, adds flames to the fire, contributing to continued overeating. Or you may preplan a binge—a very much-controlled binge, counter to the uncontrolled binges often described.

“What’s your point?”

I just sent a family member a link to a popular press article about a parallel situation- trichotillomania (compulsive hair pulling) is also now added to the new DSM-5, the mental health manual of diagnoses. In response to the link, the trich sufferer responded, “So what’s your point?” So let me clarify for all. The point is, if you are described in these posts, then you deserve to have your condition acknowledged and treated. And that includes getting support from a mental health professional (one who’s trained in CBT, Cognitive Behavioral Therapy). And for BED sufferers, adding a Registered Dietitian who specializes in eating disorders is essential as well.
It takes time to shift your eating pattern and your thoughts, and to find alternative ways to manage things that cause distress, but recovery is possible.

How do you change and move from being a binge eater? Five areas tend to need to be addressed. You’ll need to:

Eat enough calories throughout the day. Guidance from an RD can be quite helpful here.
Watch your eating pattern to avoid long periods without eating. Excessive hunger leads to excessive intake. Think about a pendulum; swinging to one extreme results in an equal swing in the opposite direction. We are looking to be swinging in a much more narrow range!
Move toward mindful eating. Start by separating eating from distractions, such as TV, reading, computer, driving, phone use. Keep food in the kitchen or dining room only. And try to use your senses when eating. Yes, you deserve to experience and taste what you eat.
Once you are preventing excessive hunger and mindfully eating, it’s time to reintroduce foods you view as ‘forbidden’. Remember that if you are listening to your hunger and eating when you need the fuel, you are no worse off for choosing something you really enjoy eating—be it ice cream or chocolate chip cookies. But keep in mind that while you’re working on liberalizing your ‘forbidden’ foods, work on…
Distinguishing physical hunger from emotional eating triggers, such as stress, reward, depression, anxiety, the need for self-punishment.

Now that it is a recognized condition, it’s my hope that MDs will no longer direct their overweight patients for lap band or gastric bypass surgery, never inquiring about or addressing the underlying problem behaviors. Perhaps the medical community will also begin to distinguish those who are overweight yet healthy—yes, they do co-exist—from those that are struggling with their thoughts and behaviors.

What I like most about this new diagnosis it that it puts the focus on your behavior, not your body weight. Now let’s hope that the medical community begins to ask the questions to open discussion about eating behaviors so that you and others can get the support and direction you need to recover.

Check out these older posts on binge eating and related themes:

Many more posts on the subject can be found by clicking on the relevant labels on the right of the blog.

I'd love to hear from you! Thanks for reading.