Diet Pill Death Shouldn’t Destroy Your Hope

Won't be long before they're pushing diet pills for him

Weighing In On the Risks of the "Quick Fix"

Another diet pill bit the dust. Last week, the FDA killed the promise of a quick fix for losing weight. They demanded of Orexigen Therapeutics a long-term study for safety, concerned about the possible risk of heart attacks that might result from use of Contrave, it’s new product. Apparently Contrave had already demonstrated success in raising blood pressure, something those with obesity hardly need to add to their woes.

So why a post on this? I am delighted with FDA’s stand, yet alarmed by the details of diet drug and laxative availability and the potential harm to users. Meridia, for instance, another useless diet pill, approved for 13 years, was only recently removed due to a 16 % increased risk of heart attack, stroke and death.

Chai, not Senna tea!

Some weeks ago I was visiting my mother, searching her cupboard for a tea I would like. “Dieter’s Tea” popped out, a product I was unfamiliar with. My mother, of course, didn’t purchase this product, but rather was given it “by a friend”. The box was open, but she had never tried it. No, she had no idea what was in it or how it “worked”. 

So I read the ingredients, and then began to Google. My greatest concern was the Senna. You know, that natural plant substance that helps constipation. Gotta be healthy, right? And here’s one of the many articles that confirmed my suspicion: http://www.livestrong.com/article/121254-dangers-senna-tea/

Because it is over the counter, readily available, comes without a warning, and marketed as a natural remedy, it is most worrisome. Because I know people are seeking a quick fix. And they are not researching the ingredients and their risks while at the supermarket deciding between Earl Grey and Dieter’s Tea.

 So back to Contrave.

At best, subjects lost 4.3 % more weight, compared to placebo, the fake stuff. If you’re 5’4” 175 lbs,, with a BMI 30, you’re considered obese, making you eligible to use a prescription diet drug.

In 12 months, that amounts to just over 1/2 pound additional weight lost per month, 2 ounces more weight lost per week. Wow! Rapid? Significant, even? Enough to justify the cost, either financially or medically? And risk free? Hardly.

Interesting, no?

How much health benefit would you gain from that additional 2 oz. per week?  And self esteem? Would it change how you see yourself? And would it justify the unknown risks? The potential changes in blood pressure and increased heart disease risk?

And how necessary is it anyway to lose weight if we are obese, but fit? Yes, those two phrases can exist side by side!

Some months ago, the promise of a new medication for MS hit the news. A pill, the very first, to offer hope for those of us living with this potentially debilitating disease. The advantages were clear. Swallow daily, or inject daily or multiple times weekly. And the studies showed the medication to be at least as effective as the injectables.

Aren’t you thrilled, friends and family asked, knowing my 8-year history with this illness? Yet all I could think about was the cost. Not financial, as I am fortunate enough to have good insurance coverage. But the risk of this new med, with its list of horrific potential side effects, including blindness and fatal herpes infection, to name a few.

Now if the benefit strongly outweighed the risk, it might be worth it. But, thankfully, I am not debilitated by my disease. I am lucky enough to be able to engage in all activities I care to. And it’s possible that you, at your current weight, may not be debilitated, even if your doctor sees your weight as the number one “disease” for you to tackle. See my point?

We all want a magic bullet, for everything. So we’re drawn to lottery tickets, diet pills, surgical fixes for whatever might hold promise of a better life.

Would a new diet pill really change anything, even, if compared to placebo, it took off 5 % more of your weight? Because that’s enough weight change necessary to get it approved.

Disturbing photo from the MFA, Boston

Finally, those of you at the low end of the scale may cling to the benefits of staying there. The fear of change keeps you focusing only on the positives of where you’re at. Is it really so positive? Is the benefit of your eating disorder really greater than the costs, physically, psychologically, socially?

Reminds me of how we remember old boyfriends (or girlfriends). We longingly recall all the great times, how wonderful it was being together. Until we reality check and remember—I was miserable with him!

In summary, be an accountant. Look at the list of benefits of staying where you are, in terms of weight and behaviors. Then give some serious thought to the negatives, the risks. And hopefully the risk of taking diet pills, laxatives, and cleanses in addition to your own unhealthy actions, will be reconsidered.

As always, I'm eager to hear your opinions!

I didn’t throw away the leftovers.

Managing social eating situations

Cheesecake, with a side of fresh fruit for breakfast. 25 years of marriage and my husband has internalized my eating philosophy. It was a happy sight.

The homemade Grand Marnier cheesecake joined the butter cookies, rugelach, chocolate cake, biscotti, brownie, chocolate chip cookies, cheese, pizza, pasta in peanut sauce and other leftovers. 

No, I did not purge the rich pastries and appetizers, (enough to serve the 40 people at my home last night plus another 40)—not through exercise, and not into the trash. I did share some—there were lots to go around—but admittedly I held onto my favorites to enjoy for many a snack in the future. 

There were indulgences a plenty, accompanied by a wine tasting, a fundraising event (self-serving, I might add, for MS) I planned and cooked for between writing posts.  

And as I reflected on the evening of food and festivities I realized there was a lot to share about eating in social situations.

Maybe I’ll restrict before the event!

Oh, you should know better by now, if you’ve been reading my blog for awhile! But most people think that’s the best thing to do. They figure they should eat less in advance, knowing they will likely be tempted to eat more than usual. As a result, they arrive at the gathering or restaurant quite hungry, with little control over their eating. And so they overeat. Alternatively, they limit their choices to shoulds—you know, eating what looks appropriate or feels safe in the moment—then start overeating upon returning home. 

Or, the more anorexic among you may find you restrict in advance of the event, eat minimally, and then feel bad about something you’ve eaten, while not really excessive, and, eat minimally later on. As we both know, none of these strategies help you manage your eating and weight, regardless of your eating issue.

As for me? I started this weekend morning quite typically-with homemade French Toast (made from the leftover Challah shown on previous posts). I did my usual routine activity, had my usual meals and snacks. True, activity was slightly higher rushing around my kitchen, but that’s about it.

It’s hard to mindfully eat when you’re also the host. Hard, in fact to fully enjoy the event, even. But I chose what I really love (an amazing and easy to prepare walnut/pomegranate/roasted red pepper dip on bread, peanut noodles, and my husband’s homemade sushi.) 

I skipped the Root Vegetable Soup (I’ve been eating it for weeks). I loved my cheesecake, but skipped the other desserts (besides the fruit, which I hardly consider dessert).

There’s something about trusting that the food’s going to be there. No, I’m not going to make such a lavish spread any time soon. But I will, as always, give myself permission to eat the leftovers whenever I am hungry. Yes, even as I watched my husband doing, even at breakfast!

But won’t I double in size following your approach?

Apparently not. Here are some key points to help keep you on track:

   •  Choose what you really like eating. But eat only as much as you need.

   •  Allow yourself to eat more food later if you get hungry. Now is not your last chance!

   •  Eat normally before the social gathering! Don’t skip meals, fluid load or over exercise. Really!

   •  Ask for a goody bag! Bring some leftovers home for another meal or snack, allowing you to fully taste and enjoy them mindfully, and to prevent overeating.

   •  Eat your usual, adequate meals the next day. Even though you may be tempted, do not over exercise or under eat to compensate for the day before.

   •  Trust me. Take a leap of faith with this approach. And once you see how well it works, how much better you feel physically and mentally, you’ll start to trust yourself. 

And that’s the goal.

Lessons from the Tiger Mom

A Nutritionist's View on Achieving Success

Twice last week I was accused of acting like a Tiger Mom. Interestingly, the accusers were not my own flesh and blood. Rather, they were two patients, independently, who described my Tigress-like approach in my sessions with them.

Unaware of the Tiger Mom associations, evolved from Amy Chua’s book “Battle Hymn of the Tiger Mother”? Briefly, this Yale Law school professor recently published her memoir on parenting, Chinese parenting, focused on tough love strategies and exceptionally high standards. She writes that “an A- is a bad grade”, and has been known to reject her young daughter’s homemade birthday card, saying “I deserve better than this” throwing it back at her child. She states:

"Chinese parents can do things that would seem unimaginable — even legally actionable — to Westerners. Chinese mothers can say to their daughters, "Hey fatty — lose some weight." By contrast, Western parents have to tiptoe around the issue, talking in terms of "health" and never ever mentioning the f-word, and their kids still end up in therapy for eating disorders and negative self-image. ... "

While I admit to having not yet read the book, it certainly appears that success is measured by how things appear on the outside (such as mastering a musical instrument to perform at Carnegie Hall, as her daughter did at 14). Happiness, and psychological health, however, apparently are of no concern.

Now back to my patients. Neither Jane nor Dana was called names in our sessions. And my focus was hardly limited to external measures of progress, such as weight, for instance. Yet their descriptions of my counseling approach I could only translate as “Tiger”.  And rightfully so.

A literal “Ouch” was uttered, as I strongly linked Dana’s recent eating disordered slip with the very destructive pattern she sees in her mother. I very directly pointed out the inconsistencies between what she stated she wanted to achieve and her unhealthy behaviors. After much time working together, this grade was substandard and for eating disorder recovery, simply unacceptable. I told her I had come to expect better from her. And strict limits were set regarding behaviors that impacted her safety and the safety of those in her care. While her behavior is her choice, I could not support working together unless some clear limits were established, including accountability for medical stability.

As for Jane, who has been working with me for more than a year, she casually described (to an Intern sitting in on our session) my lack of warmth and fuzziness at our initial meeting. Perhaps she even mentioned distant? Can’t remember, or simply blocking it out. But over time, she reported, she saw another side of me. Let’s call it the Koala Mom side.

The Koala Mom, so beautifully and lovingly described by Dr. Amy (http://skepticalob.blogspot.com/2011/01/battle-hymn-of-koala-mother.html) is warm, fuzzy and supportive. She trusts her offspring have the competence and wisdom to do the right thing, to have good judgment, and to be true to them selves. Koala Mom offers a “safe place to escape from the pressures of the world”. And KM wants to build their inner strength so they can cope with disappointments and difficulties when they arise.

Perhaps it’s a bit of a leap, but the parenting role we play as counselors and nutrition therapists cannot be ignored. On the Tiger side, denying you privileges, including engaging in physical activity, traveling, even driving a car, is often essential—for your own safety. And often, few others will step in to set these very necessary limits. And if they did, if might be difficult to hear from those that are closer to you. These limits are set out of care and concern. They are not punishments, merely safety measures, road-blocks to prevent you from detouring into an abyss. I may present what appears rigid, (as described in a phone conversation with one parent today). Yet this very parent, in the same call described how safe and trusting her daughter had become of my guidance.

Yet if I fail to be appropriately nurturing, to be part Koala Mom, to support you in making your own decisions, I am truly sorry. It’s not that I don’t trust you. It’s not that I don’t believe your stated intentions. It’s just that eating disorders are fickle. They don’t always behave rationally and sensibly. Motivated to recover, you’ll come to appreciate this. Like Dana who admits that my direct and seemingly harsh stand, while troubling to hear, was just what she needed. Yes, it shook her up, and got her back on her feet. At least for now.

And so at times, my Tiger Mom side may emerge—seemingly strict, tough, heartless. Tough love, maybe, but with only the best intentions for recovery. But I hope you’ll have absorbed my encouragement and belief in your ability to get through. Perhaps, as patients have reported, believing in you even when you have stopped believing in yourself.

And hopefully you’ll know that you have a voice that I am always willing to hear—even if I don’t always agree what you might be saying.

You won’t always like what I have to say. (Or, the recommendations of your own nutritionist, or therapist, or doctor, if it goes against your unhealthy intentions.) But please consider that this seemingly callous approach is anything but. It comes from truly caring about your success and recovery. And the need to balance the Koala with the Tiger.

I'd love to hear what you're thinking, so please comment!