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!)

Someone You Care About has an Eating Disorder – How can you help?

There is no one better suited to write this post than the person struggling with an eating disorder. No, it's not my post; it's a heartfelt, insightful guide from someone really in the know about what those in recovery desperately need from their caring community. This post didn't come easily. It was 'Thursday's Patient's suggestion that it be written, and my invitation for her to write it. And it took guts to put it out there, to stand naked, so to speak, and shout out that help is needed.

Read it and respond--on this post and to your loved ones. Email, FB, Twitter--share it however you'd like. But do share it. Because the more you express your needs, the more you can be supported; the more you withhold, the safer your eating disorder is, maintaining the status quo. Enjoy!

It's going to take more than this to recover. But it's
certainly a start.

Someone you care about has an eating disorder, maybe she is anorexic or bulimic. Maybe she abuses or misuses laxatives, diet pills, diuretics or compulsively exercises. Maybe he eats when he is with you but you are not sure if he eats when he is left to his own devices. 

I know how difficult, painful, and maddening it can be to watch someone you love engage in such unhealthy behavior. I also know that you are aware of and afraid of the risks, both to their health and survival as well as to their emotional well-being. I know how you feel, because there are people in my life, whom I love, who suffer from bulimia, anorexia or ED-NOS (eating disorder – not otherwise specified). They exercise for hours a day, restrict their intake, and/or purge if they perceive that they have 'overeaten'. I get mad, frustrated, scared and sad. And the trickiest part is that I behave the same way - because I also have an eating disorder. And I know what it is like to desperately need support from my loved ones, the people who are mad, scared and sad because of my disease. See the conundrum? I can’t make you understand what having an eating disorder is like but as someone who has struggled with this disease for over twenty years I can tell you how difficult it can be to ask those closest to me for help when I am struggling. 

It's an Uphill Climb 

The door to change may be open, but you just might need support
breaking out.

Eating disorder recovery is a series of ups and downs. We climb the mountain, trip on a stick, land on our asses and sometimes slide all the way back to the bottom (and the slide down hurts). Sometimes we can pull ourselves up, dust ourselves off, tighten our shoelaces and gain elevation back up the mountain. We do this with the help of our providers. These are the people that really do keep us alive and accountable - and they hold the hope for us when we feel like even just standing up (never mind climbing) is impossible. We see them often; as Lori always says, “recovery is a full time job”. Weekly, I see Lori (my trusted rock-star dietician), I see my therapist, and a clinical hypnotherapist to work on issues that contribute to my eating disorder. When things are not going as well as my team would like I may also have to throw in a visit to the medical doctor and a second appointment with Lori. I spend hours and what feels like a million dollars a week. 

Sometimes, despite this high level of support, I'm still a dusty mess sitting at the bottom of the mountain. There are times when we need more. Sometimes that means a higher level of care, and other times it means a higher level of support from the people in our lives.

Needing Support – Not Wanting Support 

"I'm so ashamed asking for help! If only you could read the signs that
I'm struggling."

Have you ever had to ask someone to help you move a heavy piece of furniture? Do you remember feeling like you should be able to manage it on your own? Maybe you tried. You pushed with your entire upper body and it moved a smidgen. You decide you will make more progress if you push at an angle - you shift to the right, you shift to the left. You're sweating. You sit down, put your feet against the wood, bend your knees and push with the strength of your lower body. But all that happens is your own bottom slips out from under you. The furniture has not moved. You have two choices, leave it in the middle of the room or ask for help. 

For me, asking for help during a relapse or a major slip is painful, humiliating, and exposing. I feel like I am admitting failure and weakness (AGAIN). My pride has shriveled. I feel like a source of unending concern, burdensome and unworthy. My friends/family are supposed to love me no matter what though – and my treatment team says I have to call in the troops. So I reach out. For those of you on the receiving end of this plea for support – you might feel lost. You are afraid to say the wrong thing, you want to say the right thing, and you don’t know which is which.

Please know that the eating disorder (often referred to as 'ed') always tries to boss us around. He is an uninvited guest. We try to ignore him and tell ourselves that he lies to us and is not really on our side, but sometimes we might need you to remind us. Even as I write this I am forced to edit out my eating disorder voice. The thing is, he knows that if you follow some of these suggestions, then I won’t be so aligned with him and may not follow through with his demands. My eating disorder is threatened by your knowledge – and if recovery is my ultimate goal then this is a very good thing.

The suggestions below assume that your loved one is asking for support and is motivated to move toward recovery. If this is not the case then it may be that your only choice is to encourage your friend that more intensive treatment is warranted.

  

   1. Think with your heart. It sounds strange to think with your heart; don’t we feel with our heart and think with our brains? But your heart is where your compassion lives and the friend who sits before you, having just revealed what feels like a gaping wound, needs compassion, or she's going to bleed out.

2. Depending on what point in recovery your loved is in, the grocery store can be a major source of anxiety (think being in a room filled with your most feared animal!). In my early recovery days, having a friend with me while grocery shopping was the only way I could make it up and down every aisle and to the register. With someone there I also couldn't get caught in the trap of studying nutrition labels - which could not only take up hours but could lead to me shutting down and walking out of the store without any food.

3. Cook with your friend or prep with your friend, or even just sit nearby while s/he organizes and cooks meals for the week. Your presence is incredibly helpful. A social distraction is always a good way to help get through a stressful situation.

4. Plan for meals together and push through excuses - ed hates this. Your company and the structure you provide just by being there goes a long way. When I left residential treatment my friends and family were ready to have dinner that night and breakfast the next day. They didn't smother me and it wasn't every meal (although some do need this some of the time), but it was consistent support. I was transitioning from residential to day treatment and it was the weekend, we all knew I had to get in every meal and every snack between Friday and Monday morning when I would return to the day program. I was so grateful for their help.

We need support, but we need to move from our complacency!

   5. Do not ignore signs of slipping! I know this puts you in a precarious and uncomfortable place and I am sorry for that – but for me, the longer I feel like I am “getting away” with engaging in eating disorder behavior the worse things get and the louder my eating disorder's voice becomes (“You're fine, see, no one even noticed that you skipped lunch, lost weight, went running, threw away your snack, spilled out your juice”). So, call us out on it, gently but confidently.

6. Ask questions without assumption. I know you don't trust ed, and you shouldn't; but remember that your loved one is in there, too. So ask, instead of accusing (“Is it ok with your treatment team that you joined the gym, went to yoga, walk every morning, eat diet food, etc.”). Asking helps us to feel safe enough to tell you the truth. We don't want to lie to you, but even more we don't want to disappoint you.

7. Keep it Simple Sweetie (my therapist says it all the time) When s/he asks for support don't complicate the discussion. She says, “I'm struggling, I need your support”. You say, “thank you for telling me. Of course I am here for you”. Use the voice that says you care, not the one that says “AGAIN?!” Maybe you are feeling that, but let that be your’s, she can't hold that for you at this moment. Ask, “How can I help?”.

8. Know that your friend is not asking (at least most aren’t) for you to be her therapist, her dietician or her mom. She is asking for your love, patience and company.

9. Check in – for me this sounds like, “How is the meal plan going”, “Are you managing to resist the urge to exercise?” or “How was your appointment with Lori?” or “Does she feel like you are ­­­­headed in the right direction?” or “How is your team feeling about where you are at?”- those last two are really safe because they put the ownership on the provider's opinion rather than your friend – who, let's face it, you don’t always trust. Insert sad face here.

10. Don’t assume that this go at recovery will look the same as the last. Remember that each step toward recovery is different than the one made three years ago, a month ago, or even last week. There are times that we want it so badly but truly, despite our best efforts cannot get out of our own way. Sometimes, we just need someone to hoist us up off our butts, hand us a walking stick and hike beside us as we start back up the mountain.

It's easier to get down when you have some support
and accountability.

11. Make sure we know we are not alone. Having an eating disorder is very isolating - it’s part of the trick of the disease. Recovery can feel equally lonely without the proper support. If you notice that your friend is becoming more isolated please reach out, their eating disorder won't let them reach out to you. Say, “I miss having lunch with you,” or “I noticed I don't hear from you about having dinner together – can we make a plan?” or “Can we talk about how I can help you get back on track by us eating together?” Please don't take it personally (hard, I know) – we want to be with you and miss you, but ed doesn't like when you're around – he knows you’re stiff competition.

12. Do not criticize, blame, or yell. Don't use “you” statements: “You just have to eat,” or “You are acting so stupid”. Do use “I” statements: “I'm afraid the next time you purge you could die”. “I feel like your team should know you started running again” or “I'm worried about you, I’ve noticed you've been eating less”, “I'm worried about how much you’ve been going to the gym”.

13. When all else fails call your mother! In all seriousness, when more intensive treatment is not on the table for your loved one (no matter what the reason) suggest to him/her that they stay with you for a few days (or vice versa if logistics are not a hindrance). If that won't work suggest that s/he stay with family until they are back on their feet. My mom and ed really don't like each other; as a result when she is with me skipping a meal is never an option as I cannot bear being in conflict with her. So, if I need a 'reboot' she will come stay for a couple of days - Lori always knows that when mom's here no meals are skipped or skimped!! 

There are so many 'do's & don'ts' in supporting eating disorder recovery - and just like everything else, they vary from person to person. When in doubt why not just ask your friend how you're doing? Ask him/her if she is finding any of your conversations triggering or unsupportive. Allowing for this openness not only supports her recovery but nurtures your friendship. It's a win/win, right? Writing this forced me to remind myself how important my support people are to my recovery process. I am stubborn...and I often tell my team "I am fine" and "I can do it on my own; no need to involve anyone else". And while sometimes this might be true - everything is easier and more enjoyable with a bit of help and support. 

So, as uncomfortable as this all can be, reach out to your friend/loved one and support his or her journey to a better life.  

It is my hope that this post has given you some hints on how to do just that. Lastly, if you are suffering with an eating disorder, remember that you are not alone. Reach out to someone who cares about your well-being, show them this post, their support might be just what you need to get to the top of the mountain.

Thanks for reading,

“Thursday’s Patient”

“Just Eat it”? Taking that leap of faith to let go of the diets and the rules.

Just Eat it. Designed by Olle Hemmendorff for Nike.

Just Do It has been a memorable Nike campaign, motivating and inspiring athletes and active wannabees for years now. But I really don’t want to talk about exercise and determination.

Rather, let’s talk about Just Eat It, the image circulating on social media with that very phrase. This expression has crossed my mind—but not my lips—during many a patient session way before the creative graphic emerged. Yes, sometimes I’d like to shout out JUST EAT IT! (or even JUST EAT!), at times when rational discussion seems to get us nowhere. But that’s my emotional—and occasionally frustrated—response.

Personally, I struggle with the just part of the statement. Does it feel like a justto you, as an only? Or merely eat? To the person living with disordered eating, I bet just is the worst possible adverb imaginable. To me, it minimizes the struggle. Just eat it? As in, “it’s no big deal, what’s all the fuss about anyway”. EAT it?! If you could just eat, wouldn’t you?

The hike toward the Hornli Hut, heading toward
the Matterhorn. 

My editor was reviewing this piece—by editor I mean husband—and he likened this minimizing to a personal experience he and I have had. You see, I have a fear of heights, and I swear it’s worsened as I’ve gotten older. So now, when we go hiking where the path has narrowed and I can vividly imagine the drop off to my death, I get a bit stuck—think deer-in-headlightskind of stuck. No, not just a bitstuck. There’ve been times when he’s had to talk me through, or physically be there to support me. At those times, he’s clearly communicated the message of “just do it, just get over it”, as in “what’s your problem?” failing to understand that my concern just might be irrational.

No, others really may not get it; fear is often irrational. But somehow reading a draft of this post he did get it. I don’t choose to get anxious at precipitous drops at high elevations. And sometimes the dangers are real. But the risk of stepping outside of your comfort zone to eat (as opposed to the risk of not eating enough), is not life threatening.

I suspect that if you really think about it, you’d realize that you used to eat the very foods you fear will make you fat, or will trigger overeating, with no ill effect. Think back to the time before the rigid rules and diets began, before your eating disorder or disordered relationship with food developed. Sure, you may associate carb restriction with something positive—weight loss perhaps (strictly because it resulted in reduced calories, and not because there’s anything magical about reducing carbs, or fats, or any food or nutrient in particular). 

But you fail to acknowledge that your struggle with binge eating only began with this restriction, with the deprivation. Or, that starting to restrict set you on your path to being unable to nourish your body, to respond to its needs. You hold on to all the ‘good’ you associate with dieting, yet minimize the consequences of your disordered eating on your health—on your mood, on your ability to be social, on your energy level, on your thinking.

There’s a bit of a conundrum we face; by we I mean providers and parents and loved ones alike. I can present all kinds of justification for nourishment—for including carbs, for increasing necessary calories, for adding snacks, whatever—but sometimes that’s not enough. Evidence that food restriction is slowing metabolism may help—such as pointing out that a slowed heart rate or lowered body temperature is a consequence of starvation. Showing evidence that you had previously been both healthy and a normal weight when eating your now feared foods may help, but it doesn’t seal the deal. 

Do you know which are the least read of all these blog posts? They are the ones describing research—the clearest evidence—in favor of normalizing your eating. Few tend to care about the evidence.

No, you can’t always negotiate with an eating disorder.

Sure, it’s easier if you know you can trust me—that I’m not going to mislead you; that it’ll really be okay if you make the dietary changes I suggest. But where’s the proof? Until you actually do it, and see that it really isokay, it’s challenging to trust. You believe that you’re different, that the rules simply don’t apply. And so we’re stuck.

At that point, you need a leap of faith. You need to go on blind faith that it will be okay. It helps to acknowledge that where you’re currently at is clearly not alright—in fact, that you’re quite miserable, if you allow yourself to be honest about how you feel. And it helps if you consider ‘what’s the worst that can happen?’ acknowledging that fear of rapid weight change is a distortion of your thinking; progress on so many levels can start here. Recognize that you don’t have to commit to continuing with this change forever—take it one day at a time, and give yourself the opportunity to back out.

It can be scary getting to the top, but it's worth the effort.
Capu Rosso, Corsica

Sometimes we do need to “Eat it!” or “Do it” giving yourself no option but to not go running, or to cease all purge behaviors, for instance. Sometimes giving your self no option makes the recovery process much easier.

But if you can’t bring yourself to take that leap of faith, or to “Do it”, then eating disorder programs may be the next best thing. Or, for those living at home with family, FBT (family based treatment for eating disorders) may be a great alternative.

Over time, you’ll realize that there’s really no other option for living a healthy life than to maintain the changes you’ve started.

Just saying.

What are your thoughts? Is anyone reading out there?