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.

Obsessive Workouts and Protein Powders: How Concerned Should We Be?

Reactions to the NY Times article and the Pediatrics study on teens and muscle-enhancing behaviors.

I'm bothered by something I read. "Compared with a sedentary lifestyle of video games and TV, an obsession with working out may not quite qualify as a health hazard", as stated in last week's NY Times article. While the article brought to light the silent struggle many boys deal with—or rather, don't deal with—their obsession with weight training, dietary modification and steroid use to achieve the 'perfect' body—it failed big time in educating readers about when to be concerned, and what we can do to prevent this unhealthy trend. But this is not just about boys—the Pediatrics article identified that girls, too, are taking steroids and more frequently protein shakes to increase muscle mass while pushing activity.

Yes, teens, both boys and girls, have become more focused on increasing their muscle mass. "Strong is the new skinny" is a current sentiment; neither being healthy nor slim is good enough. The bar has been raised necessitating increased muscle mass to change one's appearance. And the price they pay is far greater than suggested in the Times' quote above.

Lean and muscular, yes, but nor much of a sex drive!

But how big a deal is it if a teen—or an adult—takes a supplement or pushes their training to change their appearance? The actual study, in my humble opinion, did little to differentiate unhealthy disordered behaviors from more innocuous ones. What's the issue with weight training to increase muscle mass, any way? What's the harm in your taking a protein shake to bulk up your muscle a bit? (Steroid use is another story, and that is well addressed in the Times article.)

If you're like twenty-three year old Nathan, it's quite a big deal. He relied on the gym-endorsed protein powders, "to promote muscle growth". All things high in protein were considered safe—if they were also very low fat. Despite my urging to reduce his exceedingly high protein intake, and to liberalize his intake of fats and carbohydrate, his kidneys began to fail, struggling to filter the extraordinarily large load of protein waste products. His thoughts were all consumed with when he'd be able to get to the gym and when and what he'd be eating next.

But this is not solely a male thing, as the Pediatrics study shows. Girls, though, are more likely to modify their diet, while boys will increase their gym training to 'meet their needs'.

And what if it were high in carbs?

Like Karen, you may be spending more and more time at the gym while restricting your intake, ultimately finding it too stressful to live life with school and work demands, along with your rigid workout regimen.

Certainly, drinking protein supplements is not itself a cause for alarm. But relying on shakes in lieu of real food is. It impacts our ability to socialize, to be flexible in eating situations and to get all that we need nutritionally. A diet devoid of fats and carbohydrate will be deficient in much-needed nutrients, and typically in calories. A sense of deprivation often results, accompanied by obsessive thinking about food and eating and weight.

As for the workouts, where do we draw the line about what is healthy and safe, and what is excessive? If you're in a community of triathaloners, marathon runners or iron men/women, a few hours at the gym will seem inconsequential. 

But is it driven by a preoccupation and distortion that anything short of a few hours will leave you fat or unfit? Many of my patients believe falsely that working out is always a good thing. Nothing can be further from the truth. When intake is inadequate, working out not only won't build muscle mass, it will help break down muscle to convert it to fuel! And when net intake is substantially less than need (either because of very high activity or low intake) metabolic rate slows down, so you burn fewer calories 24/7. Certainly not what you intended!

Surprisingly, there was no mention of the low testosterone levels that result in males, similar to the drop in hormones seen in females with anorexia. Tell this to those boys and it might motivate for change. Sex drive drops, facial hair diminishes and risks to bone density increase as well. For boys in their growing years—which might last until 18 or 19 years—the consequence may be stunted growth. And the opportunity for catch up is lost once the bone growth plates have closed. Most boys and girls do care about their height, but do they realize this may result?

And what messages are we conveying to our kids with their school BMI screenings? Are we faulting them for their high BMI (which will remain high as muscle mass increases and height fails to increase)? Or are we fairly looking at an increasing BMI percentile for that individual as a possible marker for unhealthy behaviors—be it steroid use resulting in rapidly increasing muscle mass or binge eating? Are we presenting being obese as so horrific that even if their behaviors are healthy, we tell them they need to lose weight? Is a drop in BMI in an overweight child healthy if they starved themselves or compulsively exercised to get there? 

Shouldn't we be screening with questions about thoughts and behaviors, not just BMI?

Are we reinforcing their interest in fitness because we perceive it as healthy—no matter what? Do we share the same distorted views about all things protein-rich being "good" while villainizing carbohydrate-rich grains and fat-rich foods, too? Are we contributing to the misinformation they hold fast to? Why don't we recognize that there is sometimes pathological thinking and behaviors that drive extended workouts and dietary changes?

I don't have the answers.  But I do know that we are influenced by cultural standards of beauty, and that these images have become more and more unattainable. Yes, without steroids, you can't possibly bulk up like many of your weight-lifting role models, nor can you be both healthy and low weight as the air-brushed magazine pics would lead you to believe.

Something has to change. And it can start with you. Add your comment. Share this piece. Counter misinformation and acknowledge unhealthy behaviors—even when society fails to.

Consider these older posts for more information on topics covered in this post:

http://dropitandeat.blogspot.com/2010/07/daily-exercise-is-must-or-so-you-think.html

http://dropitandeat.blogspot.com/2012/03/protein-new-black.html

Are You Still Thinking It’s All About Your Weight?

You’re a mixed crowd, dear readers. You are patients, current and past, local and those I Skype with overseas. And you are Anonymous followers whose identity I’ll never know. You are largely female, but include many a loyal male reader. You cover most ages from late teens to into your 70s. On a recent day you visited from all 50 US states (a first!). And you regularly read from all continents. 

I love this! 

I certainly don’t know you well, except for what you share in your comments and emails. You may struggle with an eating disorder of any variety or strive to maintain your sanity in a world of over focus on food rules and misinformation.

You may be underweight or overweight—whatever those terms have come to mean—and you may or may not have come to terms with the work that needs to be done. You may be simply contemplating change or you may be working on maintenance and relapse management.

Yet here’s one thing I know for sure: your weight is not a valid measure of your progress nor of your effort, of your commitment to change or your need for change.

The past couple of weeks I’ve had many an encounter that convinced me I needed to share these thoughts with you.

Here’s a sampling of what I heard this week:

• She was frustrated by her stabilized weight—it was nothing like those weight loss ads promise! Yet she realized that she is now capable of eating a couple of Oreo cookies. Justa couple—and feeling satisfied. And, she was able to talk about it, as opposed to keeping this info a secret. No more Oreos in the closet.
• There was the realization that food tastes good! From someone who has spent the past umpteen years eating while barely using her senses (similar to how she was living life) this was a giant accomplishment. She now appreciates what she likes, and can follow her preferences. And she can allow herself this pleasure long denied.

• “Do you mind if I eat in our session?” she asked me, as she nonchalantly pulled out her McDonald’s French fries. “I haven’t had time for lunch yet”. Long ago when we started our work together, reliance on a meal plan was absolute and deviating from the plan was a non-option. Food was restricted and binging was common. Think what you might about fast food, seeing this meal enjoyed, and eaten normally, made me happier than I’ve ever imagined a McMeal might!

• He is learning to reframe his actions. Instead of, “I only walked 3 times this week, for only 10 minutes”, I can, with a mere raise of an eyebrow have him shift his focus. “I walked threetimes this week! I’ve started to make walking a priority to help my blood sugar! And it’s feeling good.”
• Black and white thinkers may still struggle with what I refer to as the what the heck effect, that sense of why bother I’ve already ruined it. Yet even their acknowledgement that the thinking is the culprit, not the food item, is a major and necessary shift.
• And finally there was this list I received from Dana just yesterday:

First I'd like to begin with the positive changes I have made since under your care:

    -I'm not starving myself

    -I'm throwing up TONS less

    -I do NOT exercise, ever

    -I incorporate risk foods into my diet

    -ed thoughts no longer consume 100% of my brain

    -buffets are "manageable"

    -I allow myself to eat after dinner

    -I no longer consume bottles and bottles of diet coke/day, just 1 or 2 glasses

    -I only drink 2 cups of coffee/day - not 2 pots

    -I DRINK calories!!!!!!!!

    -I allow myself to snack in between meals

    -I can go to dinner with my friends now with very little anxiety

    -I eat in front of people with more ease

    -I can control binges with much greater power

    -I recognize and honor my hunger now

    -I have learned to speak up a little more

    -I am present

    

 I know there's a LOT more to that list, but those were the ones at the top of my head.

Proud Tiger Mom and her cub, taking her
French pastries home after a satisfying brunch.

I feel like a proud Tiger Mom. Really.

In each of these cases, focusing on weight as the end point would have been absurd. In Dana’s case, weight has been around the same for probably a year. Why probably? Because honestly I rarely obtain it. But the times I do, it never surprises me. I’m not blindsided by positive talk without substance. And I ensure my patients are following up with their physicians for medical checks when necessary.

Weight can be stable or in a normal range while binging and purging. It can be stable while restricting followed by rebound overeating. And weight can be outside the “healthy” BMI range with either healthy or unhealthy diet and behaviors. What a disaster it would be then to focus on weight without attention to the damaging behaviors!

Just the setting for enjoying a pastry out!

Weight assessment certainly has its place. A progressive shift in an unhealthy direction (for an individual’s need) is clearly a red flag. But without assessing the underlying thoughts as well as the behaviors, obtaining and focusing on weight is nothing short of damaging.

I'd love to hear how your thoughts and actions have shifted, so please share!

Advice for Your Doctor for NEDAW

Call me crazy, but I’m tempted to respond to a doctor’s closed-ended questions in ways that would knock his socks off. When he asks me about alcohol, for instance, he frames it something like this “you don’t drink much, right?” Or perhaps to assess risk of STDs he suggests “just one partner—you’re married, right?” Well, yes, he’s right, but would I ever say anything other than what he’s led me to believe is the only acceptable answer possible?

Isn't it time to get the support you need?

This brings me to the important topic of educating your healthcare team, your doctor, in particular, about how to truly support you. In honor of National Eating Disorder Awareness Week (NEDAW) (here in the States) I thought that health care providers could use a bit of awareness, to hopefully make your visits, and your life, a bit less stressful. Please consider adding your own two cents to the comments—then pass it on to others—and your providers! While this is prompted by NEDAW, I’ve included recommendations that are worth sharing regardless of whether you struggle with an eating disorder, disordered eating, or simply are outside of what the BMI chart says you should be.

Unsolicited Advice From One Healthcare Provider To Another

On weighing your patient

Please weigh patients with their back to the scale. Have them remove all layers possible—most individuals, regardless of their weight, want the weight to reflect what’s real. Weighing with shoes, heavy belts, and jackets doesn’t contribute much valid information. Oh, and have them empty their pockets!

That said, some do want to misrepresent their weight—so less is always better—with regards to clothing. And have them empty their bladder first!

A poker face and restraint from commenting is wise. That is until you’ve gotten to assess their weight in context. Imagine if you said to an overweight patient—“great, you’ve dropped a ton of weight” only to realize that they had a rapidly growing cancer? 

Weight change must be evaluated relative to behavior. Someone who lost weight (regardless of how appropriate you thought it was for them to drop some pounds) may very well have gone about it the wrong way. 

Consider this—they may have been starving themselves, resulting in messing up their periods, their metabolic rate, their mood, their sleep, their thoughts, their relationships.  This is nothing to offer positive reinforcement for. There is nothing healthy about losing weight this way. Perhaps they are compulsively exercising, or dehydrated from purging or laxative abuse. No, weight would not be a good measure of health then.

Similarly, your patient with a high BMI might have simply maintained her weight. But she feels well, is active and fit, and is healthy by all measures. Maybe she has even turned things around, if her weight had previously been climbing. Sure, you can explore other risk factors, such as quality of her diet—as I hope you would do with your slim patients, too. But if all looks good, perhaps you can accept that her stable weight is just fine for her.

Perhaps if she’s been climbing in weight that might warrant some probing about recent lifestyle changes—stressors, activity, diet—to help with better self care and disease prevention.

And if your underweight anorexic patient has increased his weight, please similarly temper your response! While you may be delighted, he (or she) may not be. It’s a mixed bag, gaining weight, even for those who are trying to gain weight. There’s the healthy side of them that really wants to recover. And then there’s the eating disorder voice that sees weight gain as a failure, as a “you can’t do anything right”, pulling them back to restricting again. It’s more valuable to elicit a sense of what they are thinking and feeling about the change. How does it fit with what they expected? What are the benefits of the changes they’re making? Focusing on the behaviors that contributed to the weight shift is more valuable than discussing the weight itself.

If your patient isn’t doing well, rest assured that they are as frustrated—even more so, really—than you are. The impact is far greater on them than on you, that’s for certain.

Hooray! You got your period back!

It’s not healthy to lose one’s period due to such factors as anorexia, restrictive eating, or compulsive exercising. We all know that. But while getting a period back is a good sign, it is not always well-received by patients. For some, getting a period equals “I must be fat now”. For others, it means they are done with their efforts to change their eating and behaviors. And that may be the worse thing for them to conclude.

Periods may return before weight is restored and before behaviors are normalized. Or they may come back after 4-6 months after stabilizing in a healthy range. Or they may never have disappeared, as was the case of a patient of mine who conceived 5 children through her years living with anorexia. The point? Consider where your patient is at before you rejoice in their body’s normalizing their periods!

Don’t Ask, Don’t Tell? I Don’t Think So.

If you don’t ask the right questions, you won’t get the real answers. So do ask open- ended questions—different than what my MD thought to ask—to obtain valuable information. If you’re discussing weight or body dissatisfaction, do ask if they’ve used laxatives, or diet pills, or vomiting or restricting—in the past, or currently. Suggest a frequency, in a non-judgmental way. If a patient says she purges daily, follow with a question like “how many times per day?” And when he says twice, follow with “And what’s the maximum?”  Just like if they say they have a couple of drinks, follow with what’s a couple—4? 5? 2? Per day? Per week? Suggest a range of possibilities, without raising an eyebrow.

 

We can only help our patients if we can accurately assess their situation. And, we can’t begin to do so if they feel they can’t trust us. So do your part. Ask your questions in open-ended ways, and be careful how you react. Ask how you can help, what they need from you. Are they connected with appropriate resources, or do they need guidance?

Encourage a follow-up sometime soon! 

Suggesting a 3 or 6-month follow-up visit certainly sends the message that their situation simply isn’t worth your taking too seriously. And as a result, they will undoubtedly convince themselves that really everything is fine, that nothing really needs to change.

And if you don’t believe me, read the comments from those in the know, below.

Thanks for taking the time to read this.

Healthy At Every Size?

Read first, then decide.

Today I saw a 12 yr old girl, I’ll call Gabrielle, whose weight was off the charts. She was referred by her doctor, supported by her concerned parents. And here's what I told her, because I believe it to be true.

Her place on the weight chart is likely the right place—for her. Since the age of 2 yrs she has paralleled this curve at just above the 95^th percentile, (in spite of being only 5 ft tall, much shorter than average), resulting in a very high BMI. She is an active, healthy girl—more active than most thin girls and boys I see, with no apparent suggestion of health issues. She eats well—appropriate portions, as I'd expect for her need, a healthy balance of foods, including those I'd call "junk" food, and she eats the same when she is alone and when with others. In other words, she’s got a healthy relationship with food. Most importantly, she feels good about herself, and the last thing I wanted to do was add mental health issues to any perceived, but non-existent risk of physical health issues.

Gabrielle is one of several patients I’ve seen recently, fitting this description. Some individuals are larger than average size, some smaller, kids and adults, males and females. And we should not assume that’s a problem, as several bloggers are sharp to point out. Health At Every Size, The Fat Nutritionist and others enlighten those who don’t know better, who don’t ever question their assumptions, that large people can be healthy, fit, and in fact happy.

End of story? 

Not quite. The key word is can be. While we cannot and should not assume that an individual’s weight is causing them medical or emotional problems, there are overweight individuals who are not healthy or comfortable at their size, for whom weight loss may help. I question the belief that striving to lose weight, in all cases, is bad. And I am not talking fad diets, mind you.

I am not simply projecting here. I speak on behalf of the patients I have seen over my 25 years of practice. Just as we cannot assume that they’re distressed at their current weight, we cannot assume they are very comfortable or healthy at their state of health and size either.

There are kids, and adults, like Gabrielle described above—always large, but healthy and fit. Many are self-accepting, many self-loathing, perhaps due to society’s discrimination and learned messages they need to unlearn. And I do my best in my sessions to convey this very message, that they are just fine as they are—their eating, their activity and their weight. I am not addressing these “Gabrielles” in the remainder of this post.

Rather, I am speaking about those for whom obesity, or the degree of obesity they are living with, is not their norm, the men and women who have gained weight outside of their comfortable and usual weight range. This includes individuals struggling with compulsive overeating, as well as those without any emotional baggage. It applies to those who no longer take time to meet their needs for exercise, or who might have suffered an injury, which forced a decrease in activity, without adjusting their food intake. I’m describing those who don’t know how to prepare a healthy meal as well as those who eat many meals out, juggling the modern life of working and parenting, soccer practices and carpooling. And those who minimally eat throughout the day, only to eat excessively at the end of the day.

I am not judging them, merely conveying what I hear from them day in and day out. They put off travel because airplane seats feel too tight, and European cars fail to accommodate their size. They want to be off the medications they now take daily, for hypertension, high cholesterol and joint pain. They want to be free of their sleep apnea and their heartburn. 

Sure, there are plenty of normal weight people, thin even, who also develop such conditions (count me in—thin with high blood pressure). But as a population, increased weight increases the odds of developing such conditions. The damage to their knees may be already done, but it is easier to move a body with a lower mass versus carrying surplus weight, particularly when you’ve got pain.

I’m not picking on the obese. If you read any of my posts you’d clearly see my philosophy. Similarly, I do not believe there can be health at every size at the low end of the spectrum. While not all slim individuals have eating disorders, (some are naturally thin, always were and always will be) I can tell you that a low body weight that contributes to loss of menstrual periods, low body temperature, a very low pulse, distorted thoughts and preoccupation with food similarly would benefit from a change in weight. 

And if you think these individuals are immune to society’s judgment, think again. There is equally little sensitivity to those struggling with weight issues on this side of the spectrum. Yes, sometimes the very people who preach size acceptance are all too quick to dismiss, insult and disregard the opinions and insights of someone who is thin, simply because they are thin.

A rabbi friend once said jokingly “Anyone who is more religious than me, is a fanatic. Anyone less religious, a heretic.” Sometimes that’s how I think we all behave around the issue of weight. It’s fine if you are my size, but thinner or fatter we accuse of needing to change and have a difficult time accepting.

Ultimately, the primary focus should not be on losing weight. Yes, even for those who truly care to lose weight, for whom a high BMI was not the norm. Rather, they need to address their behaviors and experience tangible benefits—a sense of accomplishment, having set a realistic goal and achieved it; better sleep; better endurance; better concentration; less irritability by honoring their body’s need for fuel; and a better relationship with food. As these changes occur, weight loss also follows.         

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     

Where do you fit in all of this?

Does your activity need to be addressed? Are you even at a healthy enough place to be exercising? What modest goal can you set that you’ll be able to achieve?

Do you allow yourself to eat when you need to? Or do you push this to the limits, thinking you are too fat to be eating? Everyone, 

regardless of her size, needs and deserves to eat throughout the day.

Do you give yourself permission to eat foods you enjoy? Do you even remember what those foods are? Or are you so stuck following everyone else’s rules (including your own), absorbed from years of dieting and denying yourself?

Yes, allow yourself to eat whatever you’d like—no single food makes a person fat. And have it when your body needs it—when you are hungry, any time you are hungry. But learn to have just as much as you need (do read through the many older posts that address this topic).

In fairness, the palpable anger I feel from those who blog about fat acceptance is understandable. They have been mistreated by our society, including those that should know better, such as the medical community. They include those, like Gabrielle, for whom weight loss may be inappropriate. They are repeatedly told to change, when change is truly not necessary.

But let’s not over generalize. There are also those overweight individuals who would like nothing more than to be accepted for who they are but have medical conditions that may be assisted with weight loss. And they deserve to be supported on their journey to a healthier place.

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.

Change Your Body, Starting at the Top. Shifting Your Thoughts, Not Simply Your BMI.

Was the monkey off her back? I don't think so.

Anna felt desperate for help. This 35-year old had successfully lost weight on her own this past year, down to the average weight for her height, according to standard charts.  She had been overweight, approximately 80 pounds higher than she is now. Now she presents struggling to maintain her current weight for her 5 foot 8 inch frame on just 1200 calories per day. And it wasn't going well. 

She is pleased with her current weight, quite satisfied even, and doesn't want it to change, but feels she is fighting so hard to stay at this place. 

No doctor would look at her BMI and conclude that there was cause for concern. Most would likely praise her for the healthy changes she had made, and perhaps even draw attention to her healthy low “runner’s pulse”.

Do you appreciate what is in place
or see life as black and white?

But I had a very different perspective. Here’s what I saw beyond the scale: she has not gotten a period in over a year, but previously had normal, regular periods; she was feeling more depressed and had reported a significant increase in the percentage of her thoughts spent thinking about food, eating and weight; she tended to be cold all the time, even in the summer, when temperatures reached the triple digits. And did I mention her hair loss?  Her low heart rate, I might add, was not the consequence of a healthy runner's pulse but of a slowed metabolic rate.

As for her diet, I would describe it as rigid and restrictive. Hunger was often appeased with water, food choices were limited, and desirable foods were limited to once per week. Her total intake was way too low, in spite of her sedentary activity level.

What was my advice? Eat more, I told her. (Of course I provided more practical, concrete guidance than that.) And so she did.

At our first follow up Anna described a significant decrease in obtrusive thoughts. Eating more adequately made her feel less compulsive when she did eat. And she felt more satisfied. She had backed off of the water, which was drowning her hunger and is now starting to recognize her body’s signals. I nailed it, she told me. Everything I recommended made perfect sense, and fit with her experience.

Just what are you focusing on?

Of course it doesn’t end here, because these are real stories. At the next visit, just this week, I heard the panic—fears of significant, unnecessary weight gain and body dissatisfaction. Truth is, her weight was up. Yes, instead of being 80 pounds below her highest weight, she was now 78 ¼ pounds less. This minimal weight change which had, by the way, stabilize by our third visit, was the price her body needed to pay to achieve all the positives she was starting to appreciate with a more appropriate intake.

If you can’t recognize the positives you have, you’re simply gonna be stuck.

Yes, this is extreme, but how’s this for appreciating the positives? http://www.nytimes.com/2011/07/09/world/europe/09duley.html?pagewanted=all This recent NY Times article describes a former fashion photographer who decided to try his luck at photographing a war zone. In the process, he became a triple amputee. Horrific. Yet inspiring. He describes the experience post attack, when he realizes that he still has his right arm—and his eyes. Rather than dwell on his misfortune as a triple amputee, this remarkable survivor relishes his potential to continue the work he feels so passionately about, and focuses on what he does have going for him. Truly remarkable.

And what does all this have to do with your weight concerns? Lots. Get a perspective on what you truly value. Put the focus on what is in place and where you are making progress. Don’t beat yourself up about what’s gone wrong, but come up with a plan for change. Thoughts have everything to do with recovery—from anorexia, bulimia, weight struggles, compulsive overeating. Oh, and of course entitling yourself to the necessary nourishment is key, too. Your thoughts will not be clear to allow a healthier perspective unless you are eating well.

What’s the real negative consequence of gaining less than 2 pounds given the benefits Anna achieved? Perhaps it has less to do with the snugness of her jeans, and more to do with something else. But I’ll leave that for the therapist I hope she’ll be seeing.