The War On Obesity: Preventing Collateral Damage

Mrs. D rushed into my office apologetic. “So sorry I’m late”, she said. “I was held up at the principal’s.” The principal’s? Mrs. D is well into her 30s, and her middle school aged son hardly seems to be one that would cause a visit to the principal’s office. And then the details unfolded.

Mrs. D and her son Sean had unknowingly broken with school policy, committing a public school crime. She had allowed Sean to bike to school. And in spite of the presence of bike racks (which one might think suggested that bikes might be allowed on the premises) biking to school is forbidden.

 According to the principal, if he allowed Sean to ride his bicycle to school, than there might be 100 students who’d want to ride their bikes to middle school. Imagine that—dozens of middle-schoolers getting more exercise, incorporating biking into their daily routine. The school might even need to get more bike racks.

In theory, the principal appeared to understand. But permission for policy change is only granted by a school committee vote. That is, if it were deemed important enough to land on their meeting’s agenda. And the school committee only meets periodically during the school year. So for now, Sean will need to skip his biking to school, lest he break the rules again.

Why the recent interest in biking anyway?

Several months ago, Sean’s school began its own war on obesity. First, they screened all the kids, evaluating them based on their BMI. (for more thoughts on BMI and its problems, check out http://dropitandeat.blogspot.com/2011/02/where-bmi-goes-wrong-lessons-from-cupid.html) Their weight report cards were then sent home. They were not, by the way, accompanied by a fitness assessment, which might have included measurements of strength or cardio fitness.

Concerned and caring mom that she is, Mrs. D responded to her son’s high BMI by seeking appropriate guidance. And so they presented to me.

Remember when kids were allowed to have milkshakes?

Sean has done remarkably well these months since we began working together. He’s eating better and learning to better manage his previously excessive portions, by responding to his physical cues. And he has significantly improved his food choices when dining out; no, he hasn’t given up burgers and fries, but now he might share a single portion of the fries or skip the cheese on the burgers. Those endless sodas at restaurants are now a thing of the past. In addition, this shift toward healthier eating has led to more meals prepared at home—an added benefit for the whole family.

Moving more was also on Sean’s to do list. After brainstorming together Sean and I decided that bike riding would be a fun, manageable activity to help improve his fitness. He began with weekend rides and then suggested biking to school, weather permitting. Yes, Sean was only trying to do well—to eat healthier, be more active and fit, and respond to the school-prompted campaign against obesity in a sensible, practical way. How unfortunate the school was so short sighted about its unhealthy policy.

As a side note, let me tell you a bit about Mrs. D. She has long struggled with anorexia and has also been working with me on her own eating issues. The school’s Get Fit night, together with the BMI materials send home, were nothing short of triggering. While well intentioned, the evening’s focus on eating less and exercising more, a seemingly harmless message, was not a healthy message for someone struggling with food restriction issues. 

One-size-fits-all recommendations can often do more harm than good. Simple nutrition overgeneralizations, classifying foods into good and bad categories only leads to trouble. While the school meant well trying to control obesity, sending the message of eat this, not that teaches nothing valuable.

It’s kind of like the My Plate message stating that we (all) should Eat Less (http://dropitandeat.blogspot.com/2011/06/time-to-clear-my-plate-before-you-get.html) If 50 or 60 % of all kids are overweight, that means that the rest are not overweight, right?

Did all the Get Fit night guests need to be told to eat less? Did they need to have fats identified by their calorie density, without labeling their many benefits? Did they have to be categorizing desserts as forbidden, while failing to teach self-regulation and balance?

Not Sean's favorite, but definitely mine--French macarons.
(the reason why it's taken me so long to get a post done this week)

Hard and fast rules and simplistic messages are not the answer for weight management. A healthy diet includes cupcakes, macarons and chocolate as well as fruits, vegetables, nuts and oils, dairy and lean meats. It’s all about balance. 

Counseling an overweight preteen as well as his anorexic mom forces me to think carefully about what war we really should be fighting. Should the focus be on what foods to include and which to omit from the diet? Should I encourage some foods for a mom, while forbidding those items from the son’s diet? Not a chance. Whether underweight or overweight, the message is strikingly similar—honor your body and respect its needs. And if hunger and fullness awareness feels foreign, trust that you can re-learn them.

Photo courtesy of Sean

As for Sean, his BMI has dropped significantly, as a result of a slow reduction in weight while his growth has continued. He still enjoys his favorite foods, including ice cream and French fries, but is starting to determine when he has had just enough. And this summer, now that he is out of school, he’ll be spending a lot more time cycling, with minimal TV time. That is, when he’s not watching the Tour De France.

Healthy AND Great Tasting? Try My Favorite Barley Black Bean Salad!

I love crock-pot cooking—just not in the spring and summer. I used to love pasta salad, but the vinaigrette and mayo based versions lost their appeal in the 1980's. (Thai peanut noodles, however, I could eat any day of the week!) So when I'm looking for a wholesome, convenient meal or side dish, this whole grain, satisfying summer salad does the trick. If you’re looking to step out of your comfort zone and try something new, give this a try. It’s delicious and won’t disappoint.

You can't go wrong with this recipe for barley black bean salad, and it's many variations. (Okay, maybe you think you don't like beans. But I promise, in this recipe, you're sure to enjoy them.) 

First, there's the nutritional merit. It's high in soluble fiber—the same type of fiber found in oatmeal. Soluble fiber causes a slower rise in blood sugar, compared to the same amount of other carbohydrate containing foods. As a result, it tends to satisfy longer. This fiber also has been shown to assist in lowering blood cholesterol levels and help with blood sugar management.  It provides a simple way to combine a range of nutrients into one easy plate, including valuable complex carbohydrate, protein, vegetables, and heart healthy fats. (3 grains, 1 protein and 1/2 a fat serving based on the simple version).

The base recipe is rather light on the fats, but they could be boosted for those in need with additions such as avocado, feta or goat cheese, added afterwards. Extra protein, in addition to the protein supplied by the beans, could be added from diced, leftover chicken or turkey, or from added cheese.

Besides being easy to prepare, it's a convenient way to plan ahead and have a balanced meal waiting for you.

Oh, and did I mention it tastes great?

Barley Black Bean Salad

(serves ~10, 1 ½ cup servings--perfect for a family, but cut in half if you are cooking for 1 or 2)

Ingredients

Pearl barley (not the quick cook)

Black beans, 2 cans, low salt, rinsed thoroughly (if you prefer, you can use dried beans, cooked instead of canned)

scallion, 3-4 large

red pepper, 1 large (more can't hurt!)

cilantro, chopped, ¾ - 1 cup

olive oil, 2 Tbsp.

lime juice, 4 Tbsp.

salt, ¾ tsp

Cook barley. Place 6 cups water in large saucepan and bring to boil.  Add 2 cups pearl barley. Return to boil.  Reduce heat to low, cover 45 minutes or until barley is tender and liquid is absorbed.  Makes about 6 to 7 cups. Rinse cooked barley.

Add rinsed beans and all other ingredients. Mix well.

Refrigerate then serve.

Want to vary the leftover? Consider the following additions:

Diced, fresh tomatoes

corn, fresh or frozen (microwave, then drain first if adding frozen)

green pepper

red onion instead of scallion

crumbled goat cheese or feta

diced chicken

hot pepper flakes

30% Chance of Rain. 70% Chance of Recovery. Beating the odds.

I could get pretty focused on the weather this time of year, particularly on the weekends when I need to be outside biking, and especially the last weekend in June. For each of the past 9 years I've been doing a selfish fundraising bike ride to raise money for Multiple Sclerosis (MS). Why selfish? Because I was diagnosed with this condition 9 years ago. Now, back to the weather.

I'm struck by weather forecasts and how we interpret them. How do you hear “30% chance of rain”? Is it discouraging? For weather channels and websites, it’s represented by a visual image of threatening grey skies with rain. But what does “30% chance of rain” really mean? It means there’s a 70% chance of it not raining. Now doesn’t that sound better?

70% chance of no rain encourages me to get out and ride. I’m reassured there's a good chance I’ll stay dry. Even if there’s a very high likelihood of rain, let's say 90%, it's likely to rain for some time with a good deal of certainty, within a 12 hour period. That is, at least .01 inches. Now when I think rain, I think extremes, like being caught in the rain, not .01 inches of rain. So the weatherman could technically be correct and we might have a high likelihood of rain, but after it rains a bit, that may be it. The rest of the day may be bone dry!

What does the weather forecast have to do with you?

I've been told by many patients that I was the first person to give them hope, to believe that they could change. Yes, like the weather. Even when the odds were against them. And even when they didn't believe in themselves. The fact that someone else had the hope and expectation that they could shift and improve their eating and their sense of wellbeing, made all the difference. There's nothing worse than being given up on, whether you have a long standing eating disorder and your treater has given up, or your supports have tired of hearing that this time will be different. If you’ve struggled to control your weight and your relationship with food your whole life, it can feel like a bad forecast.

Similarly, when I was first diagnosed I remember reading websites about MS, including those reporting the abysmal statistics about disease progression. 85% start off with relapsing remitting MS, the type I'm labeled with, where symptoms can wax and wane. Within 10 yrs statistically more than half of us are doomed to progress to secondary progressive MS, characterized by worsening symptoms and more permanent disability. By 25 years, 90% of us are doomed to be there—or so the stats forecast.

It would have been easy to give in to probability, to feel like my health was not in my hands. Feeling that the odds are against us, can make us give up, to stop trying to take care of ourselves. You may see patterns of eating behaviors in your family, and feel that living with disordered eating is inevitable. Perhaps recognizing that eating disorders are truly diseases may make you feel you have less of a role in recovery. But attitude is everything, combined with a great team you can trust! Personally, I need to focus on the less than 50% chance that I will not progress with a worsening prognosis, the 70% chance of not-rain, versus the 30% chance of storminess.

I believe you can do the same. If you give up it is 100% guaranteed that things won't go well with your eating and ultimately with your health. If you decide that you are a failure at changing your behaviors and your thoughts and feelings, then it will be so—a self-fulfilling prophecy. So I ask you to skip the forecasts and make your own, brighter predictions for your future.

Just one thing I ask—please hope for at least 30% chance of non-rain for most of this weekend, June 25^th and 26^th, as I bike from Boston to the tip of Cape Cod.

Unfortunately the ride does not bring me back to Provence!

PS: And if you feel inspired by this post and want to contribute to my fundraising effort, every dollar or euro will bring me to a greater percent of my goal! http://bit.ly/jNqx09

Thanks for reading.

As always, I am eager to here 100% of what you have to say!