Putting a Squeeze on a Family Ritual: Starting Bad Habits Early

Sure, it was messy but it was so good!

How sweet! Cute little pouches of pureed food—not for infants but for toddlers to slurp up. Designed for eating on the run, they also help to appease the difficult feeder. You know, when you fear your picky eater might starve by not eating her peas. 

And, they’re convenient for the challenged parent, juggling work and the demands of raising kids. Perfect for soothing the fussy little one while watching TV or simply while riding in the car. Allows for hands-free feeding so you can easily be typing on your ipad or dealing with work issues by phone while productively feeding your little one, too!

Professor Brian Wansink, the fabulous researcher known for his work on environment and eating behaviors may be ambivalent about these, but my opinions are solid. I would never feed these newly popular foods in a pouch (described in the NY Times article Putting a Squeeze on a Family Ritual) to my kids. Never mind that my sons are in their twenties (years, not months, that is). Still, if I did have toddlers, these would be the last things I'd purchase to feed my children.

Now before you leave this page thinking this is irrelevant to you—that you, too, have no young kids to feed, nor care to learn about approaches to feeding toddlers—let me make a point: this has everything to do with you and with managing your weight. You’ll likely learn as much about feeding yourself and self-regulating your own intake as you might your kids.

So what’s my problem, you’re thinking? Let me highlight a few of my concerns.

Distracted eating

Yes, that's a grapefruit he's eating. With a spoon. Not pureed.

Mindful eating enables us to fully appreciate our food with all our senses. And it slows us down. In doing so, we can better appreciate when we’ve had enough, helping to prevent overeating. Distracted eating—eating while on the phone, while watching TV, or even while jumping on the trampoline (an example pulled from this NY Times article) is anything but mindful.  Eating while distracted may lead to overeating. (Although, for those anorexic patients I see, it may enable eating food that wasn’t intended—and that could be a good thing). It is challenging enough to change behaviors in adulthood that perhaps only started recently. I could only imagine what it would be like to shift these behaviors in adults raised mindlessly sucking down pureed food goo.

Regulation of juices, sodas and mush? Not so easy.

It’s well established that we don’t do a very good job regulating our intake of caloric beverages such as juices and sodas. It’s challenging for our body to recognize when it has had enough calories from such beverages, so we certainly need to be aware of our portions. Again, for some needingto increase their intake, this form of nourishment is quite helpful. Less has been explored about the impact on feeding a less-than-solid but greater than liquid calorie diet, such as the slush-from-a-pouch.

Mealtime a thing of the past? Are we really too busy to parent? To nourish our kids with attention, with positive interaction, and with calories and other nutrients?

Even when camping, there's time for meals.

Maybe I’m an idealist, but I cherished the family dinner with my young family. It was a time to connect, to hear about their day, to be present. Sure, when the little ones would toss their food off their tray it would come to an abrupt end. But it was good while it lasted. And it established a tradition that lasted throughout the years (the family eating, not the throwing of food!) It was a time we were all theirs—we were not blogging, texting or talking on the phone. We were simply present—if only just for the mealtime.

If we don’t have time for what may be our most important job—parenting—it’s really a sad state we’re in. An acquaintance recently stated that he had no time to deal with exploring college options for his daughter with special needs—he had some very important business deals that needed his full-time attention! Seems like parents choosing feeding pouches may feel similarly.

Gone is the motivation for change.

Feeding our kids is often what motivates parents to shape up their own diet and eating behaviors. They want their children’s experiences to be positive—to feel good about their body, to be healthy and fit. They care about their little ones’ intake, but had previously not given much thought to their own eating. Having kids can change that, unless of course, family meals are eliminated. Gone is the need for role modeling and healthier eating for parents.

What’s normal and appropriate anyway?

Perhaps because we view smoothies and meal replacement shakes as eating, pouches fit the bill for our little ones. But what about the experience of eating? It’s enough that movies go with popcorn, and we need hot dogs at baseball games. Must we solidify the link from the youngest age, between eating and other activities? Must riding in a car be accompanied by fueling your body? Will they not expect to be eating, mindlessly, once they start to drive? I mean, isn’t that what they’ll have learned to associate with doing whenever they’re in the car?

Neil Grimmer, chief executive of Plum Organics, sees it as empowering children. “It’s on-the-go snacking, on-the-go nourishment,” he said. “It moves with kids and puts the control in their hands.” Seems to me that these days kids have more control in their hands than they need or want—perhaps limit setting would be a more appropriate parenting approach.

He further endorses feeding in response to hunger, and I’m all for that! In my mind, that necessitates parents connecting with their children and being aware of their cues. You know, taking note of when they start pushing their food away, when they have had enough. Or providing them with an additional few bites of cheese when they have finished what you served—just to see how much they truly need.  When they’re done, they will make it clear! This is quite different than serving a predetermined 100-calorie portioned food pouch. But the convenience of these foods and their inappropriate use in so many situations far from tunes in to a child’s hunger. See how this might be relevant for you, too?

Grimmer also states “Regular mealtimes just add one more item to the schedule”. Bummer. Now you have to deal with those kids you decided to have! Hain Celestial Group, the company that makes Earth’s Best baby food, sees it as the solution for the child who wants to be independent and self-feed. How about teaching them to use a fork or starting them on finger foods? Toddlers are developmentally ready for more than slush from a pouch!

This old momma thinks it’s time to shift our thoughts about feeding—our kids, and ourselves.

Protein: The New Black

There’s a halo hanging around all things high protein, these days. In fact, even foods not high in protein are labeled as if they are—simply to convince you to buy them! Case in point: which is lowest in protein— Starbuck’s Protein Bistro Box, Chicken and Hummus Bistro Box or their Turkey and Swiss on wheat bread? 

The winner is? Their Protein Bistro Box! Yes, in spite of containing egg, cheddar cheese and peanut butter—a rather disgusting combination, I might add—it comes out the lowest at 13 grams, compared to its competitors at 16 grams and 34 grams of protein, respectively. 

If you are selecting the Protein Bistro because you think all that protein (which doesn’t exist anyway) is going to help with weight management, let me break the news—it’s among their higher calorie meals! And for the record, it's the calories that make the difference. Personally, I’d rather have the lower cal sandwich and add on a mini whoopee pie or cupcake. Maybe that’s just me.

I could have kept this secret to myself. I mean, if you are underweight and struggling to eat more, and protein feels safe, what’s it to me? But here’s the thing. I believe you need to be well informed, that if you are striving to eat better you should have the facts. That goes for those of you who are trying to increase your intake and gain some weight, and it applies to everyone else too. If you are overweight and struggling to lose weight, it’s only fair that you, too, be well-informed. Being well-informed, well-equipped to handle misinformation, allows you to be in control.

So let me set the record straight—there’s nothing magical about protein, about any one nutrient, in fact, that’s going to resolve your weight struggle. And we don’t eat protein. Rather, we eat foods, not nutrients. In those foods there may be protein, but there will also be other macro (large) nutrients, such as fats or carbohydrate. If you assume that protein is good, or safe, it implies that carbs and fats are bad. And you know what I think about these descriptions of good and bad! We need all three macronutrients for health. And no one nutrient will cause weight gain—or weight loss. If only it were that simple.

Adequate protein intake without adequate total calories will still result in loss of muscle mass. Not a good thing! Loss of muscle mass decreases metabolic rate, necessitating fewer calories to maintain your weight.

Excess calories over and above your need for maintenance, regardless of their source—protein, fat, or carbohydrate—will help contribute to an increase in weight.

Yes, it really is about energy balance.

Take it from Harriet

Harriet, an overweight woman, came to see me last week for guidance on weight loss. She’d been working with a trainer recently, at her gym. And given his extensive training in nutritional science (you know, men’s work out magazines and the like) he guided her to do the following: eat virtually no carbs, but push protein—you know, to build muscle and increase metabolism. She was eating as he instructed, whole avocados without the crackers, and limiting her fruit to only grapefruits (3 times per day). Reminds me of the Scarsdale Diet I followed in my teens for no good reason and with no good outcome!

Her energy level plummeted, making her workouts quite the challenge. She reported feeling deprived following her current regimen, and she spent a great deal of time thinking about food, preoccupied with when and what she’d get to eat next. And so she wisely sought out more sensible guidance.

When she presented at her initial session with me, she left with a grin from ear to ear. “Now I can have starches? And other fruits?” She was so excited. At her one week follow up visit, she reported feeling great—greater energy, and so much happier, being able to enjoy foods she badly missed. And, her weight was down. In fact, I had to recommend she further increase her intake to slow the rate of weight loss. It certainly proved the point that carbs weren’t harmful, and large amounts of protein are hardly helpful!

Regardless of your eating struggles, trust that all nutrients are necessary, and safe to eat. Be flexible, to avoid deprivation, allowing you to sustain healthy dietary changes. And please don’t be misled by poorly trained trainers, or misleading food packaging! 

My High Calorie Intake Could Make Me Forgetful?

A Response to the Mayo Clinic's Press Release on Overeating and MCI


UPDATE! Read the response in "comments" from the primary investigator!

Yes I'm distressed!

I'm pretty worked up right now. Could be because the media is suggesting I should eat less, and I don't like it when I'm told to eat less—particularly for no good reason. And maybe it's because I take my mental function seriously, particularly living with Multiple Sclerosis, which can impact cognitive function. So best not to make unsubstantiated claims about what's gonna impact things like my memory unless it comes from good, solid science.

I'm perplexed. Could I really be the only one who sees the great irony in the opening statement of this Mayo Clinic press release stating that higher calorie intake, as self-reported by those with memory loss, ages 70-89, is associated with greater mild cognitive impairment (MCI)? Under the title Overeating May Double The Risk Of Memory Loss  the authors conclude "Cutting calories…may …prevent memory loss as we age." The study suggests that eating "too much" (more than 2,143 calories) may double the risk of memory loss.

Yes, the very people assessed to have the worse cognitive function reported the highest, sometimes extremely and unbelievably high calorie intakes. And as the press release video reveals, we're talking significant impairment (as in “Oh my, I've forgotten I was supposed to fly to New York yesterday" — oops!)

"Vell, I believe I had a couple of chickens, a pinch of shmaltz,
a few spoons of potatoes and a pint of borsht."

It's well established that self reporting dietary intake is full of errors—generally, the underweight err on the side of over-representing food intake, while the overweight do just the opposite. But self-reporting by the cognitively impaired? Is this some sort of joke, an April Fool's prank come early?

Even self-reported food intake using a validated assessment tool has its faults. (As in the Harvard study.) Being validated does not mean that the findings are real, that they reflect what was truly eaten. It merely addresses reproducibility. In this Mayo Clinic study, the only thing that was truly confirmed (as reported in the press release) is the degree of impairment, as assessed by more than one source. So we know participants are truly cognitively impaired, but we don't know with certainty how much they really ate calorically in the preceding year they were reporting on. Quite the population for accurately reporting, retrospectively, the amount they ate!

Maybe, given their MCI, they've forgotten how many portions they really consumed? Or perhaps they forgot that we typically don't report these things honestly.

The Joke is on Us

So here's my beef. The Mayo Clinic's press release, and subsequently the media outlets which picked it up, misled us. Even if my reasoning is off and all of the potential places where the science seems shabby were fully explained in the full study (which is yet to be released) there remains this problem—the media's conclusions suggest causation when at best we have an unexplained association.

The research summary states that higher calorie intake is associated with more cognitive loss (but does not necessarily cause it). So to then conclude, as most every article has, that we should be reducing our food intake, “cut out the chips” even, limiting our calories to prevent memory loss couldn't be more absurd! How unreasonable to manipulate us with these faulty one-liners, these irresponsible conclusions.

The Real Answer May Lie With BMI

The study controls for variables that might otherwise have confounded or confused the results. The researchers appropriately ensured that the finding, the increase in MCI with higher calorie intake, was not the result of such variables as diabetes, stroke, and, important to this argument, BMI. In other words, if I understand the press release and study abstract correctly, the increase in MCI associated with increased calorie intake at the highest intake levels, was not due to BMI. So BMI would not have been similarly increasing along with the cognitive impairment. Or, for that matter, with caloric intake.

So here's where I run into some difficulty. The study is stating that some, manyindividuals ages 70-89 years, are consuming > 2,000 to 6,000 calories daily, if we believe what they self-reported. And this is not linked with increasing BMI? If it isn't, that means people eating a rather extraordinary amount of food have no higher BMI than those at lower intakes. Soooo, if they are eating so much, but don't have higher BMIs, than how do we explain this?

There are several possible explanations. They could be expending more calories from exercise. Yet from the abstract, there was no mention of activity level—a major omission if we are assessing intake and making claims regarding the effects of intake without exploring output. Maybe it's exercisethat's linked with MCI, for goodness sake, as exercisers would need to be eating at higher calorie levels. “Exercise Causes Cognitive Impairment.”  Wouldn't that make for a headline!

Or, maybe there is some other medical explanation for such high intakes without resultant higher BMI. Are they malabsorbing—as in such conditions as celiac disease? This would result in nutrient deficiencies, which certainly may be responsible for cognitive losses.

Or maybe they have some thyroid condition, or cancer, not yet diagnosed, which may account for greater expenditure of calories, and may also impact cognitive function. I am no expert on memory loss—that I can say with certainty. But it appears the researchers have not done due diligence regarding their study and its conclusions.

In fairness, all the answers may be in the full research paper, yet to be published. Yes, I requested it, but was only presented with the abstract and the press release; even my questions regarding exercise were ignored.

Even referring to the higher calorie intake as “excessive” or "overeating", leaves me scratching my head—on what grounds? If you are more active than your peers at 75 years old—still playing tennis, walking regularly, golfing in your retirement years, even hiking as I've seen many a 70 and 80 year old do—wouldn't you need to be consuming more calories? Why should they be labeling this higher intake excessive, unless it is resulting in an undesirable weight increase outside of their normal range? But I didn't see this addressed in either the abstract or the press release.

And why should you care?

You, my readers, do not match the profile of the study participants in terms of age. But you are being irresponsibly told that lower calorie intake may prevent cognitive failure. And when it comes from a reputable establishment such as the Mayo Clinic, and sealed as a reality in the written word of such media outlets as the Wall Street Journal, Time Online, and others, you'll believe it.

You'll believe that higher calorie intake is detrimental—regardless of your caloric need. And then another study may arise (like the Harvard study) drawing similarly inappropriate conclusions, and you'll buy into those senseless conclusions, too. And soon you'll be so inundated with all this "science" that you'll be overwhelmed about what you can eat and what you should avoid and how much. See the problem?

What can you do? Don't be too quick to accept the written word as fact. Await a follow up study that might confirm findings. And be careful about where you get your information. Sure, reputable resources are better than sites promoting and selling something, with a financial interest in convincing you of the value of their words. But even seemingly solid institutions and individuals can draw the wrong conclusions. When in doubt, discuss such articles with those capable of shedding some light on the findings.

The unfortunate end result of early publication of scientific studies is a loss of trust. Studies that haven't yet made it for publication in peer-reviewed journals have no place in the hands of the public. Misinformation runs rampant, and as consumers of this information, we are left overwhelmed and confused. And it's a bad state of things when we can't trust science.

This Time It’s Simply About The Calories

Piedmont: Great Wine, Great Challenges

I’m a snob. I admit it. When it comes to food, it’s got to taste good. Because I intend to really taste it. To enjoy it. To savor it. Every bite of it.

But Thursday, after many long, hot hours biking the grueling hills of the Piedmont region of Italy, we were hungry. Really hungry. The hills took us much longer than expected; we had no idea what it really means to be in shape for riding hills!  And the snacks we carried? We downed those within the first couple of hours.

So we rolled into a tiny town, known for its hazelnut production. Now give me a dessert with hazelnuts and chocolate and I would’ve been just fine. But that didn’t happen—no bakeries in sight. But it didn’t take us long to identify the only eating establishment around. Think retro, stale, cigarette-smoke-filled air luncheonette before it turned quaint and chic.

In our broken Italian we ordered the only Panini that sounded acceptable. Oh, and a salad.  What comes to your mind when you think salad? Fresh, crisp vegetables? A brilliant assortment of colors, flavors, and shapes? Think again. They offered what is known as Russian salad—a heaping mass of mayonnaise, containing diced potatoes, peas and a speck of carrot.  We had it along with the white bread sandwich packed generously with cheese. And I neglected to mention (how could I forget?)—that there were two rolled up sardines with olives. At least they added some color.

Well, I ate at least 90% of this lovely meal. And I hated every bite. (Although given my sweating from the unseasonable heat, the sodium rich sardines and olives were much appreciated.) This was so far from the fabulous cuisine I had heard so much about and had begun to enjoy my first day in the Piedmont (more posts about those meals to follow). The Piedmont, after all, is know for the Slow Food movement http://www.slowfood.com/international/6/faqs, amazing wines (Barolo, Barbaresco and Barbera) and white truffles (these are intense mushroom like fungus, not chocolates, my friends), with their distinctive flavor which embellishes foods with a mere drop of a truffle infused oil.

At this point, exhausted and overheated, depleted of energy, it was strictly about the calories, the fuel. I wasn’t going anywhere without eating this awful meal. I had no other options. I couldn’t find my voice in this language I barely spoke, and I suspect there were no other options, given the appearance of this place. Yes, mayonnaise-laden salad with a bland cheese sandwich was the only answer. Simply non-negotiable. There was nothing else to do but eat it.

Provence, not Piedmont!

What’s the meaning of this post? It’s not about my disappointment, of things not going as planned—that could be a whole other post. It’s not about adjusting expectations, because who could have expected this? Never mind that the biking was a total drag, nothing like our fantasy rides through Provence with climbs we could manage and stunning varied vistas to distract along the way.

No, the meaning is much more literal. Sometimes it comes down to Nike’s message—Just Do It.

For those of you who undereat—I know there are times when you are not hungry, and eating seems totally unnecessary. And when a fat-containing food may overwhelm. Or you question why you have to eat more than everyone else around you. Or the uncertainty of a meal’s content leads you to want to choose the safest route—food aversion. Or the allure of not eating, or restricting, promises a pleasant disconnect which might be so welcomed at this moment.

As for the overeaters and binge eaters (and anorexics, too)—skipping meals or snacks certainly sounds promising. Why take in those extra calories when a coffee will suffice? Because sometimes, you need to just do it. And when you’re feeling hungry even if no one else is, you need to just eat—because you need to begin to listen, to trust your body and its signals. Because you so deserve to be well nourished. Because your size has nothing to do with your need for nourishment in the moment. Yes, you too, need to trust it’s okay, it’s necessary to eat. And that you deserve to eat, regardless of what others’ glances may suggest, in spite of the messages from family members you hear or replay in your head, regarding your need to lose weight. Be in the moment, and trust that you should eat.

A cool drink after a long day of unmanageable hills and bad food!

I won’t be heading back for another Russian salad-filled lunch in the Piedmont. But I’m pleased I was able to fuel up for the challenging ride back. In the end, we enjoyed a lovely meal at dinner, and a refreshing drink just after unclipping from our pedals.

Beyond Calories. Learning To Embrace Food For Pleasure

From my seat in the kitchen I could only see his butt. But I could hear the probing of his snout, which piqued my curiosity. Then his head emerged, his eyes beaming at mine. After catching my glance he guided me with the movement of his head, pointing toward the 25-pound bag of kibble.

Waiting patiently for his favorite biscuits.

What could he want, I wondered. He has food in his bowl. He repeated this gesture talking to me without my comprehending. But then my husband got it (he speaks dog better than I do). He wants the fresh, new dog food, he realized. The  stuff in the bowl was from the end of the last large bag and it’s just not what he wants.

So my husband opened the new bag, a new variety in fact, replacing the previous batch. And he chowed down (my dog, I mean, not my husband).

Yes, even my dog Mica has absorbed the lessons living in this household. Maybe the quality of the older food was sub-par, or perhaps it was the allure of something new. But for some reason, he was triggered to sniff out something more desirable, and make his needs known to us.

Milanos, one of my favorite cookies.
But I prefer the mint variety to the orange!

There’s meeting your needs for fuel, the most basic in the hierarchy of eating needs. But then there’s eating to satisfy on other levels— to have what you really desire, to enjoy the flavor and textures of great tasting food, to avoid limiting food choices to shoulds.

Admittedly, it is challenging at first. 

It requires:

• Taking a leap of faith, a bit of risk taking. Ask yourself “What’s the worst thing that can really happen?” When you realize that the risk is quite miniscule, you’ll likely find it’s easier.
• Taking baby steps. Maybe a single component of the meal (or of your day) may change at first. It may be varying the portion of your dinner entrée or finally ordering a favorite sauce—perhaps on the side, to begin with.
• It may mean choosing to step out only with people who know and understand your struggle, who you know will be supportive.
• It involves asking for things the way you want them, when eating out. Trust me, you are not the first to assert yourself when dining out! And with the exception of buffets, the food isn’t prepared until you order. So no great hassle to accommodate you.
• It requires feeling entitled, deserving of the pleasure of eating. This allows you to find your voice to vocalize what you’d like and how you want it.

When my mother comes to visit from out of state we often dine out for a dinner. Time after time, this is how it goes:

Me: “So what do you feel like eating tonight?”

Mom: “Oh, anything. I don’t care. Whatever you guys feel like. I’ll do anything”

Me: “Really? Anything? You’d be equally happy with Thai food as with Indian? Seafood or salad would satisfy as well as steak and fries? Gooey cheesy Mexican will work for you as easily as sushi and miso soup?”

No, it’s not easy being my mom. I long to hear a passion for food, an interest in truly enjoying a meal, not simply a need to ingest food and limit her calories until she’s full. Like you, I need to be patient.

You'll rest better once you start enjoying what you eat.

At this point, perhaps you’ve progressed to listening to your hunger and honoring it, to noting your fullness, and trusting there will always be a chance to eat again—when you should need to. Now consider this next level, beyond simply meeting your needs for fuel. Challenge yourself to step out of your safe place, slowly moving to truly enjoy what you eat. And release yourself of the guilt of not following rigid diet rules, set either by others or by your irrational self.

Because life is too short to diet.

Diet Solution to Weight Gain Epidemic Revealed!

An RD’s lessons from the Harvard Study

Thanks to Right Angle Tutors for use of this photo

Harvard researchers just discovered the cure to the so-called obesity epidemic. Or so you may think from their press release June 22, 2011 and from the media blitz that followed Effect of Lifestyle On Weight Gain, published in the NEJM. Powerful statements linking specific foods and food categories with resulting weight change emerged. And any progress we had made as a society toward a balanced approach to eating, to a move away from rigid food rules, crazy diets, and food paranoia was destroyed. They concluded the following:

• There are ‘good’ foods and there are ‘bad’ foods 
• Focusing on specific foods to avoid versus counting total calories is the way to consume less 
• Changing carbohydrate type is the answer for weight control, by eating less sugars and other sweets
• Fruits, vegetables, whole grains, nuts and yogurt prevent long term weight gain



Do the fruit and nuts get to count as a fruit serving in my chocolate?

• Potato chips, French fries, boiled, baked, mashed potato, sweetened soda, and meats are associated with the obesity epidemic

The study results and conclusions were further echoed throughout the media. Even Jane Brody, from the NY Times, wrote an article entitled “Still Counting Calories? Your Weight-Loss Plan May be Outdated”, where she states that it is no surprise that French fries led the list of foods that contributed to the greatest weight gain. Yet the Harvard study authors go out of their way to emphasize that the results do not suggest it’s about how many calories per French fry (its “caloric density” or calories per serving)—so why draw the conclusion that of course (high calorie) French fries would be high on the list for causing weight gain?

The authors do acknowledge that, “weight stability requires a balance between calories consumed and calories expended…” (although the media fails to highlight this little detail). Yes, they still agree that weight management comes down to calories. But what they hope to define are the foods which are associated with our over consuming calories, along with possible explanations.

What’s it all about?

Harvard School of Public Health evaluated three separate studies to see how changes in our eating and in lifestyle factors impact our weight gain over time. Researchers evaluated self-reported changes in lifestyle factors (cigarette smoking, exercise, alcohol consumption) in addition to changes in individual foods consumed. They looked at three large groups of participants over a 12-20 year period, reassessing every 4 years. They then drew some conclusions and released them in a Press Release and a professional journal article.

Because weight gain creeps up on us (or at least in this study population of non-obese individuals), the authors suggest it is more difficult to know what’s contributing to weight gain, which averaged 16.8 pounds over a 20-year study period. And so they undertook this colossal venture to find us the answers. Well, at least they tried to.

Before I share my reaction to the studies’ results, conclusions and media frenzy, let me state that I have no financial interest in the National Potato Growers Association (is there one, even?).  Or, I might add, with Coca Cola and PepsiCo. But I do have a vested interest in not propagating diet myths. And it is this fear of public misinformation that drives me to invest the time reading the full research article (all 13 pages), which I suspect many of the popular press’ journalists failed to do.

My conclusions on the Harvard study

Servings

Can you guess how much ice cream I ate? And how much I had
from the container before acknowledging I was eating?

Twenty-five years counseling patients and I can assure you that most people are not very adept at accurately assessing their portions. Sure, we can accurately report how many fruits we consumed, but how many chips? Or how much mashed potato? And I’d bet my serving of French fries differs from yours! Ask a dozen different people and you’ll undoubtedly find there’s a tendency to underestimate portions.

That is, unless you are underweight or anorexic; these populations tend to overestimate portions. And beverages are most notoriously challenging for us to estimate (unless of course they are in a marked can). When I have people measure their drinking glasses at home to determine just how much soda they drink, they are shocked. What they assume to be 8 ounces is typically double that amount.

Prepackaged food items and individual units will naturally be more accurately evaluated—individual yogurt cartons and fruits, for instance. Even grains that we tend to measure may be easier to assess, such as oatmeal, rice and cooked whole grains. These very foods that we are more likely to accurately assess our portions of, tend to be lower in calories. Without a doubt, this could distort the study's findings.

Sometimes a potato isn’t just a potato

How do you make mashed potatoes? I’ve heard of recipes that include a whole stick of butter, and some with only half a stick; there are those that add heavy cream and those that add a splash of milk. What’s my point? Did the researchers have information about the contents of these mashed, boiled, and baked potatoes, before concluding that it was the “refined carbohydrate” that was the culprit here leading to weight gain? The study emphasizes that it’s not about calories per serving. But here’s the problem: the serving size is not measured in the study, and we simply can’t make any conclusions about caloric density, if we don‘t even know the content, never mind the quantity, of what’s really in each portion!

Food selection may be a marker for more conscientious eaters

A colleague once said “if she’s eating rice cakes for breakfast than she’s not too serious about gaining weight”. Point well taken. Those who take the time to cook whole grains, such as brown rice, quinoa and buckwheat, are not likely to be the frequent diners at McDonald’s. Perhaps we could say the same for yogurt and low fat dairy eaters. Does anyone start drinking skim milk because of the taste? Eating these foods may simply identify those people who care about their health and the direction of their weight. Weight change may have nothing to do with the individual food itself.

Lifestyle changes they should have assessed

In their next study perhaps they should look at variables that truly impact our weight. Here are a few questions for their next questionnaire:

• Do you eat your potato chips right out of the bag, or do you measure them? 
• Do you have a second and third portion immediately or do you wait to see if you are still hungry? And if you wait, how long do you wait for? 
• Do you reach for food when you are hungry, when your body needs fuel? Or do you find yourself reacting to a triggering conversation with a loved one with some sweets or chips? 
• Do you eat the chips mindfully at the table, without distraction, or are they consumed while driving, watching TV or at the computer screen?

Trust me--these cause weight gain. That is, when you eat them
right from the bag without attention to portion!

These behaviors have everything to do with our weight change. We are less accurate assessing our food intake when distracted. And our mindfulness about hunger and satiety likely gets lost as well. Not eating with all our senses can make us feel like we haven’t yet had our needs met, and so we keep seeking, looking for more food to eat.

Secrets hidden in the Study that nobody advertised

Meat

For all of you Zone Diet and Atkins followers believing that more protein is good and carbs are bad, think again. This study showed that over time, meats, both processed and unprocessed types, were associated with weight gain. So if you are still stuck in the need for more protein for weight management, heed the warning. But remember, this is based on self-reported portions, a potential flaw in this study!

Dairy

So it’s notable to me that yogurt and low fat dairy products as a category (adjusted by age) significantly link with decreasing weight over time. Why notable? Because Walter Willett, one of the study authors, has never been fond of supporting milk consumption. In previous presentations promoting his Mediterranean Oldways Diet Pyramid, he spoke strongly against inclusion of milk and milk products. 


Never shy to ask my questions at conferences, I pressed him on this subject some time ago. His response fell short. He emphasized that some have intolerances to milk, and generalized about milk’s high fat content. And what about low and non-fat diary? And what about Lactaid milk for the intolerant? The majority of the population does not have a milk allergy, so why such an omission of dairy for the general healthy population? Let’s acknowledge that low fat dairy and yogurt are valuable, based on this study’s data.

Diet Soda

There was no meaningful association between diet soda intake and weight change over time. Drinking it isn’t likely to cause weight loss. And contrary to previous media hype, diet soda won’t result in increasing weight either. But it certainly doesn’t add anything nutritionally to your intake. And, consuming it may displace some milk, which definitely does have its merits.

Exercise

Exercise itself didn’t link with weight change, but a change in exercise level did. One more time?

If you’ve been doing the same amount and intensity level of physical activity over years, what happens? Well, think back to when you first started to exercise. It was quite a workout. But after doing it consistently for a while, it got easier. And with greater ease, you weren’t working as hard. And when you weren’t working as hard, you were burning fewer calories. And if you were using up fewer calories, over time, even if your eating remained the same, you would gradually gain weight. For the under eaters and over exercisers among you, let me remind you that you are not at any advantage if you continue to restrict you calories, relative to your need, while exercising. You, too, will suffer, ultimately breaking down the very muscle you aim to increase, and slowing your metabolic rate.

Still reading? Here's the take home message!

So what have the Harvard researchers really taught us? To be critical readers of the media, and of research, for starters. To recognize that studies like these are merely looking at associations, between weight change and changes in foods, and in lifestyle factors. We still don’t know why the link between potato products and weight gain. Maybe if we controlled for serving sizes and preparations we’d see a link with caloric density and weight gain. But maybe not.

Is it me, or do you see a smiley face in my husband's sushi?

I support inclusion of whole grains, fruits and vegetables and yogurt in our diets. But I also know that there’s a place for white, refined carbohydrate sources such as pasta, rice and low fiber French toast. And do I need to emphasize there’s a place for chocolate?

It may be, with more information, we will find some valuable links about foods and their impact on our fullness, affecting our weight over time. But I’d be a lot more cautious, and the media ought to be too, about labeling foods as bad versus good, perpetuating the myth information that causes us to stress eat. 

Calorie Counting? Calorie Restricting? Or Simply Calorie Observant?

I had two wake up calls this past week, regarding the calorie content of foods.

Macarons stacked at La Duree, Paris.Typically French portions!

First, I walked into a local Starbucks and saw a new, and quite adorable, display of mini pastries. Maximum two-bites-sized, these charming micro cupcakes and nano whoopie pies had proudly displayed tags which announced their value, "190 calories".

And how did I feel? Well, quite mixed, to be honest. It was truly a reality check seeing the caloric value of such tiny pastries.  It was nice to see that in a small portion, delicious baked goods could fit as a snack for most anyone, calorie-wise. But how satisfied would I feel with something gone in only two bites, I wondered.

For some of you, it may feel good satisfying your taste from a controlled portion. For others, it might require a box of these cute, but oh-so-small delights. Do you label foods 'good' versus 'bad', 'allowed' versus 'forbidden'? Starbuck's strategy of displaying calories may actually help you, helping you to see that in a small portion, even calorie-rich items can fit in your diet.

Even without the calories listed,
can't you see these are small enough to include?

The second shock

I invited a teen patient of mine to bring in menus from the many restaurants he dines in weekly. Now here's the thing. Nutrition is my field, and I'm not naïve (you've noticed?). And yet when I examined the dinner entrees I was aghast. Single meals, for one person, with calorie counts around 2000! Saturated fat covering 3-4 days' allowance for health, sodium content in the 2000-3000 mg range, exceeding the recommended daily range for even healthy Americans (2,300mg/day, and 1500 mgs/day for those with high blood pressure). And that was just from a single meal.

Yes, even I was shocked. And also surprised by my own response; I was pleased to have that information available! And, to be able to share it with my patient, to enable him to be able to make a well-informed, healthier choice, from the entrees that appealed to him. Or, to be more mindful of his portions of such meals, if he chose to order one.

"But I thought you were against counting calories?"

I am. I am not in favor of adding up calories throughout the day, with a goal of limiting the total to a specific number. And, in doing so, likely deny your physical sensations such as hunger. Imagine you try to keep your intake to some (somewhat arbitrary) level. And by 5 PM you've reached your total. Yet your stomach is growling and you know that your body needs the fuel, the calories. Then what? See the problem? This calorie-counting method for weight control is not a perfect science. Even individuals of the same height will have differing needs. Those formulas that seem to calculate your daily requirement so scientifically are merely estimates, a ballpark figure, nothing more.

As for the calories on menus, here's another true patient story that helped shift my opinion.

I kid you not!

Jamie was a patient I worked with awhile back. She was overweight (without any eating disorder or disordered eating), and wanted to lose weight. Working as a manager at a non fast food restaurant chain, she had the luxury of ordering whatever she pleased from the menu (free, I might add). She just needed some guidance selecting wisely.

She showed me the menu, and unfortunately, there were few items that jumped out as healthy, to support her goal of weight loss. But the pasta primavera caught my eye, filled with veggies, not in a cheese sauce or alfredo. So I started there. As I recall it, this dish was described as containing a light sauce, made with wine. "Can't we just modify their portion of this dish?" I asked.

Not a chance, she smirked. "You know what goes into that dish?" she replied. An entire stick of butter, per plate! Yes, eight tablespoons. In my dreams (nightmares?) I would never have imagined it. Perhaps this sauce was light in color, but it's description failed to inform me of the richness of this meal.

Now if I had seen the menu with the nutrition info, it would have given me a heads up.

From L'Etoile, tops in Madison, Wisconsin!
No camera with me last night at Hamersley's Bistro!

So I'm a bit conflicted. I like having nutrition information available, but I feel it should be our choice whether we want to view it or not. Perhaps we could ask for the labeled menu, if we so choose. Just a thought. What do you think would be most helpful for your goals?

Last night, enjoying a celebratory meal dining in a lovely restaurant in Boston, the last thing I would've wanted to see next to the the pear galette (think buttery pastry) with ginger ice cream and a caramel sauce is the calorie value. Yes, my caloric intake for the day was certain to have exceeded the estimate by any equation. And so it was. I enjoyed every bit of my meal. And I don't eat like this daily. I shared this delectable dessert, and interestingly, was just comfortably full after my meal.

Ultimately, you may find it helpful to observe the calorie info on menus and on labels. It may help you choose between products, to help you meet your goal for weight regulation, particularly when you are just starting out. You may not trust your body just yet. But if you also focus on mindful eating (as described throughout this blog), and start to separate your physical hunger from all the other reasons you eat, you'll do much better. 

If you choose to use it, consider the calorie content as just one aspect of your eating. Choose what you enjoy, and try to use your body, and its fullness, as a guide.