Over 30 or 40 and Struggling? You're Not Alone!

You carpool, cook and shop. You work at home without pay—childrearing, cleaning, managing the household—and perhaps at your job professionally. Universally bright, you are seemingly well-functioning to those who know you, at least superficially. Yet you’re ignorant about your own needs on so many levels. You’ve successfully gotten pregnant, and produced healthy children. Then proceed to ensure that everyone’s needs get met. That is, except your own. Most of you are in your 30’s, 40’s and 50’s. But some are still struggling into their 70’s. Yes, seventies.

You are my closest friends, from college and beyond, and my local acquaintances. You are my patients recently seeking care, and those struggling for a lifetime. And you are my blog followers from Australia to New Zealand.

And you have all managed to slip through the cracks for way too long, failing to get the help you so badly need, to acknowledge your eating struggle. You’ve successfully deceived family, denied concerns from friends, as well as the medical community, when they’ve had the occasional sense to ask.

In some ways, you are the riskiest ones. You see adult practitioners who are largely uneducated about eating disorders. And so they don’t know to ask the questions. And you certainly won’t volunteer the information. Instead, you get praised for your runner’s pulse and your low blood pressure, and for avoiding the middle age spread.

Usual signs of an eating disorder fall short in flagging you as at risk. Perimenopause or excessive exercise easily ”justify” a lack of menstruation. Low energy? Who wouldn’t be, with changes in sleep patterns associated with age. And besides, you function so well given the juggling that you do!

But let’s be real. We know each other too well. Please don’t minimize your disorder, attributing your eating issues simply to anxiety; selecting diet sodas and choosing a fat-free salad without the bread is a giveaway. And no, eating a breakfast or missing your exercise does not justify meal skipping.

Please don’t tell me it’s because you have a small frame, when you have never before maintained a size zero. And when XS-sized clothes slip off of you. No, there is nothing normal about being a zero.

Please don’t tell me “but I do eat!” when you know as well as I that it takes more than simply eating. Yes, it requires eating enough to support a healthy weight and a healthy body.

I’ve heard you say I’m just not hungry. And I know that’s honest and true. But you fill the voids with coffees and diet beverages. And with food restriction the hunger cues get lost. And so you really don’t feel hungry. And your anxiety, disordered thoughts and body image don’t make it any easier.

Please don’t suggest that you need your exercise to stay healthy and fit. You are only deceiving yourself. Physical activity supports health, but only when you fuel your body with adequate nourishment. Otherwise, you will slow your metabolic rate and suffer the many symptoms I’ve referred to above. And the very muscle you hope to build will be burned as fuel. It takes adequate calories from carbohydrate, protein and fat to fuel your body and maintain health.

Regardless of your absolute weight—even if it is in the normal range—if your thoughts and behaviors are disordered, there’s work to be done! You can be in the normal weight range or overweight while restricting and binging. That is no way to live.

And what impact is your eating having on those you care about, in particular, your children? Do you unintentionally, through your minimal food intake, convey what normal is? Do you role model denial using diet products or guzzling water when you are hungry, versus honoring your body’s cry for fuel? Do you send the message that food is the enemy? Do you set unrealistic goals for yourself as well as your children, suggesting avoidance of pleasurable foods, with lists of good versus bad foods to eat? Perhaps, simply passing on to another generation the very distorted messages you were raised on?

Loved ones read here

If you are a loved one wondering what the big fuss is, consider this. Restrictive eating consumes our thoughts and distorts our reality. It makes us irritable and contributes to depression and anxiety. It leads to social isolation, and contributes to losing one’s voice, so to speak. It’s numbing and protective, but impacts your loved one’s quality of life, and zaps her potential. It can lead to nutritional deficiencies, dehydration, muscle wasting, cardiac and renal issues. And ultimately, it can lead to death. And it impacts not only your loved one, but your children.

What do I do now?
It's not too late to change. I've seen it. It will be challenging, but it can be done. But don't put it off.

First, own it. Acknowledge that you are struggling with nourishing yourself.

Use your resources. Educate your spouse or significant other. Check out websites such as http://www.nationaleatingdisorders.org, www.somethingfishy.org and www.medainc.org, as well as the many other online resources.

Enlighten your MD. She relies on you to share to appropriately guide you.

Seek out a therapist to help you understand why this pattern of eating and thinking is helping you meet some needs. Then learn alternative ways of coping to slowly let the eating disorder go.

See a Registered Dietitian experienced with eating disorders to help you reality check abut your needs compared to your perceptions. Get correct information to allay your fears of change, and the consequences of failing to do so. A good RD will let you work on baby steps, while ensuring you stay safe.


And if you are not yet in the age range I describe, consider the writing on the wall. Where do you want to be in five years? In ten? Please take this post as a wake up call for change.

Share this post with your supports. And pass it on to anyone you know who might benefit from this wake up call. Spread it on Twitter, Reddit, Facebook, Stumble upon or simply via email.

I do care what you have to say, so please leave a comment!

Lessons About Eating From the Big Apple Circus

Beyond popcorn and cotton candy.

Thanks, Ethan and Sherrie for tolerating my need to photograph!

Controlling popcorn portions? Canning the cotton candy? No, this post isn't going there. Rather, last Sunday's clowns, contortionists, jugglers and acrocrobats  at the Big Apple Circus unexpectedly provided great blog material. I had no plans to do a circus post. Really. But I did take my camera. 

Truly the greatest show on earth!

It raised so many valuable and truly essential lessons about eating and eating disorder recovery, I simply had to share. Yes, much more critical than guidance on high sugar, high salt snack control!

Sticking to your plan 100% versus being flexible depends on your situation.

I'm not into extremes. I'm sure you'e guessed that by now. But if you're the trapezist or high wire act, there is no grey area. You've got to get it right, or else there are serious consequences. If the risk of a hospitalization is looming near, there's little wiggle room regarding staying on track. But if you're the juggler and you drop the cones or batons, life goes on, with less impact. The sooner you pick them up and move on, the less damage will be done. The longer you wallow in your disappointments, the harder it is to get your act together.

And after you slip, remember to pick your self up, with grace.  Slips happen!

And, you'll still get applause. Yes, even metaphorically, in real life.

The sooner you get back on track, the easier, both physically and psychologically. If you see your slip as an irreversible failure and give up, it becomes a self-fulfilling prophecy. The acrobat who repeatedly messed up throughout the first half was clearly losing faith in himself. And as a result, I had come to expect him to fail. But he started the second half with a restored confidence and was amazing. Believing in himself allowed him to turn things 180 degrees. And rather than dwelling on his slips, the audience praised him with the loudest applause at the end.

Be flexible, within your limits. 

Simply awesome!

If you are new to being flexible, don't start with a split! It may be enough of a struggle to take in all that you need to eat, even if you need to stick with only foods that feel safe. As long as you are medically safe, try one small change at a time. For some, flexibility comes more naturally, like for contortionists. Truthfully, no amount of practice and stretching will enable me to put my torso between my legs. But be patient. Learning to eat, sometimes for the first time, really takes time. Even breastfeeding has a learning curve you realize! 

Use your supports

Hooray! I got to chat with Grandma, aka Barry Lubin, my favorite clown
who in spite of all he's gone through continues to make us all smile!

There was such a clever, yet simple, most touching act. One of the clowns, seemingly lacking confidence, pulled out a small box which fit in his hand, with a hinged cover. Whenever there was enthusiastic applause, he'd quickly pull out the box and open it. Through his pantomime, he'd encourage more applause, and when it reached its peak, he'd abruptly close the cover. He had stored the applause, the positive reinforcement of cheers of support in his little box to carry with him. I loved the concept. 

How can we carry the positive messages, the counter to our negative feelings and discouragement when we are away from our treatment team, or our friends and supports? Maybe we could find our own symbolic hinged box.

Set realistic goals

Think tortoise. Sometimes progress is being stable or very slow moving. Sometimes you have to accept that it was enough to give yourself permission to respond to your hunger. But perhaps including new foods will take awhile. Goals will vary with where you are in recovery, how long you've been working at this, and if you've got a tiger mom on your team!

It's ok to be real

Reason to be pleased with himself!

Less sad about his mess-up then his fnger!

Not only is it okay, but to me it seems essential to cry when you're hurting and beam when you're proud of your accomplishments. And sometimes it's necessary to laugh at your self and the absurdity of your thoughts. We need to do a lot more of that.

Expect the unexpected 

A goat riding a horse was a new one for me. Shouldn't rock anyone's boat, so to speak, but neither should adding a serving of carbs or fat, when you come right down to it. Sometimes you'll need to make changes that you never expected to have to make. Like giving yourself permission to enjoy (yes, enjoy) a piece of cake!

Couldn't resist, in spite of the blur from lack of flash!

Personally, I'm glad I allowed myself to to go to the circus for my own pleasure, even at 48 years old without a toddler in tow! (although I did feel compelled to bring along my baby, now almost 20 years). And the Big Apple Circus is just as fun and meaningful as when you're very young.

The Lies They're Feeding You About Your Weight and Health

 And, what you can do about it

Blatant misinformation comes from perhaps the least likely sources, including well-intentioned doctors and the media. Unaware, you continue to be misinformed about your weight, your eating and their impact on your health. Let's take my patient Dave. A pleasant, driven man in his late 60s, Dave takes medical advice to heart. He has a history of high blood pressure, for which he takes medication, religiously. Yet his pressure remains too high. So his doctor told him "You gotta lose weight, Dave, and your pressure will get under control." Reasonable enough, right?

I think not.  Now only 8 or 10 pounds above his college weight (pretty good, I'd say, given his age), here's a little secret about Dave’s blood pressure--it was elevated even when his weight was at its lowest, back in his early 20's, when his weight was just fine. Oh, and did I mention Joe's fitness level? Despite being in his seventh decade of life, Dave runs 6-8 miles, 5-6 days per week, and he's been doing so for years.

Great art. Terribly high sodium content.

From Dave’s perspective, his referral to me was a blessing in disguise. He's learned that his sodium intake was way too high—3-4 times the recommended level for those with hypertension. Reducing his sodium intake may have much more of an impact than simply losing weight. To focus on his weight was simply foolish, as his weight, historically has had no bearing on his blood pressure. If he put his energy into losing weight and then his blood pressure remained high (as I'd expect given his history) he would feel like a failure. Changing his food choices, however, reducing his very high sodium intake would increase his odds of normalizing his pressure.

Thinking it's all about sodium? Not so fast. Here's a bit more personal story. My father, when he was in his 20s developed high blood pressure, as well as pre-diabetes. He was a normal (actual rather slim) weight, and was active, as he walked everywhere. His father and grandfather before him had Type 2 Diabetes, although I am unsure about their blood pressure. When I was in my 20s I had my first bout of hypertension, which I blamed on the crazy level of stress at my first job. But in fairness, even years later, I still have high blood pressure.

My Dad, 26 who survived his diabetes
and high blood pressure and died of lung
cancer (no, he didn't smoke)

Managed with diet? Exercise? Isn't that what you'd expect from a dietitian? Not so! For the record, I am in a normal weight range, and I watch my sodium. My eating (besides the cake you so often hear about) tends towards freshly prepared food, with lots of fruit, vegetables, grains, and nuts, and my fair share of my favorite oils (olive, walnut and truffle). And yes, I am active. So basically, my healthy diet, normal weight and exercise have done nothing for managing my blood pressure. Thank goodness for meds! But perhaps my healthy lifestyle, in spite of my genetics, may be helping to prevent diabetes.

Me & Mom in NYC

And then there's my mother. I won't mention the dreaded O word, but let's just say that her current BMI qualifies her for gastric bypass. Oh, and that's even after the procedure was done some years ago. And even at her highest weight, prior to her surgery, her blood pressure and cholesterol were always perfect. She actually eats rather well, but does no regular exercise. She does have knee problems, perhaps due to years of carrying the extra weight, perhaps not. Did I mention I also have knee problems?

Now don't get me wrong. I am not suggesting that obesity has no impact on your health, physical and emotional. That is simply false. It increases the risk of Type 2 diabetes, high blood pressure, and cardiac risk. It also contributes to knee and joint problems and has been associated with breast cancer. It presents challenges when people are trying to travel--renting small European cars, for instance, sitting on airplane seats—and in dealing with social stigma and job discrimination. I certainly support making practical, realistic changes to feel better on all levels—eating healthier, being more fit, lowering your stress, getting more sleep. But the focus should be on the impact of those lifestyle changes on your quality of life now, today. If you're motivated simply to lower your blood pressure, you may be disappointed if the outcome isn't as expected.

Not fitting for everyone.

It's like the many clients I see who report a history of starting to exercise. After a short time, they fail to see the weight loss they were expecting for any number of reasons. And so they stop exercising. They forget that there were clear benefits they experienced from exercise—lower stress, better sleep, better mood, greater energy, to name a few. But with a singular focus on exercise to drop pounds fast, they had failed. And so they stopped exercising, giving up all the benefits they were getting from it. How quickly they forget.

Try to change what's in your hands to change, to feel better and to potentially lower your risk of and from chronic disease. And it helps to focus on the imminent changes—those immediate benefits you can see, and feel and experience—not just the benefits far in the future. Those, too, are important, but it’s much harder to motivate for those off-in-the-distance benefits that you can’t even feel.

But if in the end you need to add a medication to keep you healthy, accept (without guilt) that you have done your part, and continue your healthy lifestyle changes because of all the benefits it brings you. This applies to those who are overweight, as well as those with restrictive eating disorders. You need to do your part, in addition to using all available resources as well.

Biking and fundraising for MS with a little help from my friends.

While perhaps unrelated to the weight struggle, I will share one more personal piece. Nine years ago this month I experienced my first symptom that led to my diagnosis of MS (multiple sclerosis). This unpredictable disease is not caused by lifestyle changes, and does not run in my family. Yet while diet and exercise neither cause nor cure MS, they can certainly allow me to stay healthy on all fronts. I don't live with the illusion that my actions will cure my disease, but I can appreciate that I feel well doing what I am doing, and taking control, in a healthy way, of those aspects of my health I can control.

Thanks to Quincy Carole for a past comment, prompting this post!

Thanks for reading.