The Graduation Diet.

A Triggering Tale of Graduation Day Goals

Talk about triggering. Last week, Sarah described a conversation she was subjected to at a dinner gathering. Prompted by Amy, pulling her food-filled Tupperware container from her leather bag, the discussion centered around Amy's latest venture. She was determined to lose 15 pounds by her son's college graduation.

Why the fuss, you might ask?  What's wrong with this goal?

So many aspects of this dialogue struck me that I want to share. Let’s start with the goal setting.

If you do the math, with six weeks left until her senior's graduation ceremony, an average weekly weight loss of 2 1/2 pounds is necessary to achieve Amy’s goal. Here’s a quick reminder, for those who've forgotten: it takes about 3,500 calories per week to lose one pound per week. That is, if she were maintaining her weight previously, versus gaining. (For the record, for those of you struggling to eat enough and concerned about taking risks and eating a bit more, it may help to remember that it takes this same amount to gain a single pound. So those cookies, even too much of them, will not by themselves, result in your gaining weight!)

Oops! that's really 8750! Feel free to do
the math! Too lazy to re-photograph!

Back to Amy’s example. If she had been gaining weight, she would need 3,500 fewer calories per week AND a further reduction in calories to account for the climbing weight that was occurring previously. For each of the next 6 weeks, then, Amy would need to create a caloric deficit of 8,750 (3,500 x 2.5 pounds). Divide that by seven days, and you get 1,250 calories daily, which equals the number of calories Amy would need to lose to reach her stated goal. So unless Amy were entering Basic Training or was ending binge eating, that level of deficit simply isn't realistic.

In fact, if she were a binge eater, the last thing I would ever suggest is setting a dramatic calorie-restrictive goal. Think deprivation and the consequences that follow—preoccupation with food, eating and weight, irritability, and fatigue, to name a few. The rebound overeating that results more than overcompensates for the dramatic reduction in calories.

Magical thinking?

What does Amy really hope to achieve by losing 15 pounds by graduation? Will it make her feel better about herself when her son reaches the stage to collect his diploma? Will it cause her social anxiety to disappear? Will it put the focus on her versus her son during this pride-filled day? Will it improve her health? Her mood? Her outlook? Or her sense of self worth? Is it all so that she can enjoy a piece of graduation cake guilt free?

No, it will likely make her irritable and less social. It will focus a greater percentage of her thoughts not on her son and his accomplishments, but on her self--her size, what her lunch is going to look like, how much time before she can get to eat again, and what his roommates’ parents will be thinking when they see her eat.

And how will Amy’s weight loss strategy likely work for her long term? Is her approach—bringing her own food wherever she goes—going to help her manage her weight in the future? Will it teach her how to function in challenging eating situations? Or will it establish foods as good and bad, acceptable for weight loss versus unacceptable?  

In life, she’s going to need to learn to be flexible. She’ll have to figure out how to stop eating when she’s had enough to eat.  And to sit with the discomfort of being full, having eaten more that necessary at times. For long term, cake will need to happen more than once every graduation, with permission, and with enjoyment. 

While I can respect her determination, I would caution Amy, and those of you thinking like Amy, to rethink your goals and your approach to meeting them. The short-term gain (well, loss actually, in pounds) of losing weight, will backfire, leaving you feeling worse. Dramatic changes in eating and activity are rarely sustainable. And they never occur without a cost. The “cost benefit” of your severe dieting will be slanted in favor of too high a cost for the benefit you get; even the pounds lost may not be enough to endure the dramatic change from restrictive eating and the resulting deprivation.

 For those who know that I too have a son graduating from college this year, I can assure you this tale is not autobiographic! No, I am already reserving the restaurant and planning for another fun, and food-filled 48 hours (http://dropitandeat.blogspot.com/2010/11/forty-eight-food-filled-hours-and-yes.html). And, I might add, I’ve been enjoying my delectable birthday cake over the past week. No sense waiting for graduation!

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.

Where Diet Apps Fail. Record Keeping That Shifts Your Perspective

The Wall Street Journal did a piece yesterday on diet apps, those free or modestly priced software programs for phones and mobile devices. Under the bold heading Counting Calories they stated:

“Certainly dietitians and nutritionists would say that keeping track of what you eat every day is a big step toward eating better and possibly eating less. But many of these apps go a step or two further.”

Here’s where their assumption falls short. Yes, tracking your intake makes you more aware and has a known benefit for weight management. But the apps tend to mislead you. In spite of their comprehensive database of foods and nutrition info (from the USDA), they are only as good as you are at honestly and accurately estimating your portions. And it is well established that we simply don’t do a very good job at this. In general, most individuals tend to significantly underestimate their food intake, while those who are underweight and those with anorexia tend to overestimate their food intake.

Often patients come in proudly displaying their high tech proof that their eating is in range. But a closer look reveals that their approximation of their portions was far from the mark, making this seemingly perfect app anything but.

More importantly, any nutrition professional that’s worth seeing is looking far beyond calories and counting. We are evaluating patterns of food intake, hunger ratings, and eating triggers such as stress, anxiety, boredom, misinformation, emotions, self-weighing and other influences. And for long-term weight management, we are looking at clients’ perceptions of their eating and the negative and positive impact that has on subsequent meals and snacks.

Take a look at what I read on Sharon’s food record last week:

“I hate eating breakfast! It makes me hungrier the rest of the day.”
“Weighing myself—a big mistake!”
“I am so fat and shouldn’t have eaten so much this week.”
“I’m starving.”
“I blew it. May as well keep eating.” 

“What’s wrong with me? Why can’t I stop eating?”
“I feel awful and super fat!”
“Binged. Not even hungry, just want to eat. I’m stressed and feel fat anyway.”
“Ate a small salad and feel even fatter.”
“Triggered by therapy. It always makes me want to binge and purge. I know it’s wrong but it helps me relax.”
“I don’t want to eat but I just can’t stop thinking about food.”

Now what do you imagine Sharon’s food record looked like? Full of true binges, out of control, excessive feeding frenzies? Multiple items, or very large quantities of a single item, like cookies, ice cream, even cereal? Forbidden foods, generally, but not necessarily. In fact, her eating may have been fully ‘controlled’. It may have even been planned, a not uncommon occurrence. She may hate it, but plan to binge anyway, perhaps with the intent of getting rid of it. Or not.  The eating feels out of control, but ironically it is something she may have very much decided when and how to do.

But that was not what I read on Sharon’s food record last week. Her pages were filled not with surplus calories from binges, but with voids—calorie-free diet beverages, salads with fat-free dressings, coffees and “light” products. More than a report about her food, it revealed the most about the distortion in her thinking.

And had we only looked at an app’s analysis, perhaps the totals wouldn’t have appeared too bad. But the pain and the struggle keeping her stuck in this cycle would certainly be overlooked.

Identify with Sharon? Hoping to get past this place, but petrified, so you stay stuck? Consider this: If keeping things the same isn’t working, you may as well take the risk and try something different.

Now, back to Sharon’s comments.

Why the full feeling? If you’ve gone through a period of severe restriction, or have been purging, you likely are experiencing fullness when eating. And it’s not just in your head. These behaviors result in slowed movement of food through your digestive tract. It takes longer for food to move through, so yes, you will feel full longer. But the feeling passes, doesn’t it? Take note of how long the discomfort lasts. For most, it starts to feel better after about 40 or 45 minutes.

Why so hungry? Could be that the fullness was a temporary fix, not due to adequate or excessive calories. A 2-liter bottle of Diet Coke will make you feel full, stomach full. You’ll likely feel bloated, with a distended stomach. Yet it contains no calories. No fuel to serve your body. And so the feeling passes and then you’re left starving.

Or maybe you purge and then get hungry again later. You’re so focused on how much you ate, that you minimize that you got rid of much of your food. Of course your body is looking for fuel and signals that you are hungry!

Perhaps you really ate frequently throughout the day. But how adequate were those meals or snacks? Did they only look adequate? Were the portions large in volume, but low in substance? Did you omit fats from your diet, leaving you hungry soon after eating?

Aren’t you being unfair, expecting to subsist on so little, and beating yourself up when that strategy fails you?

Sharon has a long way to go. But at least now she is including food, multiple times, in the daytime. This is a giant shift from her old pattern of going all day without eating, followed by a binge and a purge. At least now she manages to get through some days with a more adequate intake, with neither a binge nor purge. At least she is seeing her potential. At least she is starting to shift her perspective.

Yes, these photos were taken by me, in my kitchen. But not while eating!

Her thinking does remain distorted—in part because she is still starved. Small changes won’t cure that immediately. Sharon’s got to push herself further out of her comfort zone to start to see things more clearly. And she needs to learn other ways to tackle her anxiety, versus sticking with what is familiar—her eating disorder.

As for those apps—if they truly want to have an impact and “go a step further”—they should allow for self-reporting hunger levels, moods, distractions while eating and thoughts. Then users could bring them to their visits with an experienced professional. And yes, an RD with a behavioral focus would be a great place to start!

Perhaps you have a different perspective? Care to share it? Please leave me a comment below!