Stop Complimenting Weight Loss

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On the surface, complimenting someone’s weight loss seems like a benign and positive affirmation, but there are a number of reasons why doing so is problematic.

First and foremost, unless we have been told by the individual that their weight loss was intentional, we really have no clue as to why someone is losing weight. It could be due to illness, grief, or depression. It could also be as a result of an eating disorder (ED). Many of my patients say that comments about their weight loss when they were in the throes of their eating disorder fueled the disorder and made them feel like they had to keep up their disordered behaviors in order to keep their body “in check.” This goes double for patients with anorexia who are in larger bodies. These individuals often go undiagnosed with an ED because their weight loss is seen as a positive thing, never mind that they are engaging in extreme restriction and over-exercise to achieve this loss.

While I was never formally diagnosed with an ED, I myself remember when I was a teenager and engaged in very disordered eating and exercise habits and ended up losing a significant amount of weight in a short period of time. Despite the fact that I had lost my period, had very little energy, avoided going out to eat for fear of having to eat “junk” food, and overall felt awful and obsessive, I got compliment after compliment from family, friends, and even from my doctor. I even remember my doctor saying to me, “I don’t care what you are doing to lose the weight, just keep doing it!” I cringe just thinking about it!

Another reason to stop complimenting weight loss? It inherently implies that there was something wrong with the person’s body before they lost the weight. Think about it – do we ever comment on someone gaining weight in a positive light? Nope. These weight loss compliments also imply that being smaller or skinnier is better than being larger. The truth of the matter is that bodies come in all shapes and sizes, and they all deserve respect. Placing smaller bodies on a pedestal reinforces the idea that people in larger bodies are less than. This is weight stigma, and it has been shown to negatively affect us not only psychologically, but physically as well. Furthermore, since we know that 95-98% of intentional weight loss attempts result in weight regain, the silence when someone regains the weight they lost can be deafening.

Finally, and possibly the most important reason, is to stop modeling this behavior for our children. Little ones are like sponges, and from a young age, they are acutely aware of our society’s dislike of fat people. One study found that children aged 6 to 11 hold considerable negative attitudes towards their heavier peers, being more likely to describe these “overweight” peers as “mean, stupid or dirty” than average-weight peers. Other studies found that “nearly a third of children age 5 to 6 choose an ideal body size that is thinner than their current perceived size” and that “by age 6, children are aware of dieting and may have tried it”. When we compliment another’s weight loss, we are telling our kids that to be smaller is better and that being fat is a bad thing.

What can we do instead? Don’t comment on another person’s body. Full stop. If you feel compelled to give a compliment, try complimenting the person’s kindness, humor, intelligence, or other attributes not related to body shape or size.

The Kids Are Alright

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Weight Watchers, I won’t call you by your new convenient moniker “WW” designed to try to fool the public that you aren’t all about the weight. You might try to kid yourself into thinking that you are just about “wellness” and that the goal of weight loss is just a byproduct of a “healthy lifestyle change.” Nope. It’s just the same crap in a slightly different package. Any way you slice it, the only thing you care about is your bottom line, not helping your customers get healthy. If you really understood health, you would realize that a lifetime of weight cycling, weight stigma, and self-loathing are far more damaging than just staying fat. 

Weight Watchers continues to spread the lie that intentional weight loss is attainable if you just try hard enough. And if you fail at maintaining your weight loss, you, not the diet, are to blame. Bull. If your program worked, you’d be out of business. Even your former financial director Richard Samber stated as much in an interview, explaining that repeat customers are “where your business comes from.”

Where is the evidence that Weight Watchers “works” anyways? The company is famously close-lipped around their long-term success rates. In fact, they cannot demonstrate that anyone, save for a measly tiny percentage of dieters, can keep off the weight they lose for more than five years. And those who do manage to keep the weight off often use disordered eating and exercise behaviors to do so.

Intentional weight loss endeavors, whether they are through Weight Watchers or any other diet or “lifestyle change,” fail 90-95% of the time. Yet our medical community continues to push weight loss on fat patients, telling them that they are at risk of death if they don’t lose the weight. For myself and many other fat people, going to the doctor can be an anxiety-inducing experience, as we are often met with weight stigma and advice to stop eating so much (even if that’s not what’s going on). Many fat people I know just avoid going to the doctor altogether to avoid this weight shaming. Is that health-promoting behavior? I don’t think so.

The notion that weight loss is achievable and maintainable is one of those common beliefs that is put forth by diet culture. Diet culture tells us that being fat is inherently unhealthy and unappealing, that those of us who cannot lose weight are lazy, inept, unintelligent individuals who just aren’t trying hard enough. Diet culture glosses over all of the research that shows how and why our bodies fight like hell against losing weight. Diet culture ignores the facts that repeated dieting and yo-yoing is actually much more physically harmful than just maintaining a higher weight and that shaming fat individuals is not helping anyone but is taking a toll on all of our health and well-being.

Weight Watchers’ latest endeavor, launching an app that targets children aged 8-17, makes my blood boil. In the iconic words of John McEnroe, you cannot be serious, Weight Watchers. Never mind all of the eating disorders that this app will help to create and/or encourage; this app contributes to the weight stigma that plagues our society. It reinforces the idea that being fat is a bad thing and that it must be avoided at all costs. It fosters a feeling of shame in heavier kids, a feeling of being “less than.” 

As a chubby (not fat) child, I was repeatedly told by my pediatrician and my family that my body was wrong. These messages and the messages I got from diet culture led me to develop disordered beliefs around food, exercise, and my body. It wasn’t until I found Health at Every Size that I finally figured out that my body is not to blame. My body doesn’t need to change. Our weight-shaming culture needs to change. And I am honestly scared for the legions of kids and teenagers who are exposed to this toxic culture.

Weight Watchers’ app will teach kids that they cannot trust their own bodies, that their own bodies are damaged or ill-equipped to tell them what and how much they need to eat. This app will create lifelong struggles for these kids, who likely will have a disordered relationship with food and their bodies for the rest of their lives. I cannot even wrap my mind around the amount of psychological and physical damage this program will cause. 

I don’t know if it’s the fact that I have a daughter myself now that this is striking such a chord with me. I fear for her. I don’t ever want her to feel like she needs to make herself smaller to be loved, accepted, or healthy. I don’t want her to spend her life trying to change her body and fear its appetites. I want her to be confident in her body, to trust that it will tell her what it needs, and that her weight is not the measure of her worth. 

So, Weight Watchers, I hope this program fails and you disappear into the ether sooner than later. 

Intuitive Eating and Infants

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It’s been a number of months since I last wrote for the newsletter (8.5 months, to be exact!). As most of you know, Jonah and I became parents last June to a wonderful baby girl named Lorelai. I’ll be honest, the first few months with Lorelai were a blur of diapers, bottles, and swaddles, but once she reached about six months old, things started to settle down a bit. Around this time, on the advice of her pediatrician, we started introducing solid foods. It has been such an eye-opening experience to watch her begin to navigate food, and it has given me a front row seat to what purely intuitive eating really looks like.

Of course, Lorelai was an intuitive eater from the day she was born. When she was hungry, she would cry and would eat until she was satiated. Some days she was seemingly ravenous, and other days she was not so hungry, but she steadily gained weight and thrived. Since she only had one source of food (first breastmilk and then formula), there was no real choice about what she was eating. That’s what happens when there is only one food on the menu! But introducing solid foods increased her options, and that’s when things got interesting.

Lorelai’s first solid food was baby rice meal mixed with formula. When we initially tried to feed it to her, she pursed her lips and seemed truly offended by the spoon. We didn’t want to force anything on her, so we waited before trying again, and eventually she allowed the spoon into her mouth. Her puzzled face spoke volumes as she could not fathom what was in her mouth, never mind how to eat it! She opened and closed her mouth and then proceeded to push the food out with her tongue, causing the food to land on her bib. She didn’t cry or seem upset, just genuinely perplexed about this new development. None of this food made it past her mouth. We were assured by our pediatrician that this was totally okay and normal, as the introduction of solids for the baby is mainly about teaching her food comes in forms other than just liquids. The baby learns to taste and manipulate the food in her mouth and may or may not swallow it. During this time, her formula continued to be her main source of fuel.

As the weeks went by, we continued to try introducing new solids, moving next to baby oats and then adding things like mashed banana and pureed pear. With each feeding, Lorelai became more and more interested in food and started not only to mouth and gum it, but swallow it, too. Her food preferences started emerging at this time as well. From the get-go, she was not a fan of white potato, which she made evident by promptly vomiting it up after a few reluctant bites. Similarly, she votes “no” on pureed peas. Pretty much all fruits are her favorite foods, especially pureed blackberries.

But even in this short time, some of her preferences have changed. When we first tried to give her avocado, she looked at us like we had three heads. She pursed her lips and pushed it away and was not having it at all. We wondered if maybe she could try feeding herself avocado, she might like it better. And that is exactly what happened! Instead of giving her mashed avocado and spoon-feeding it to her as we had done previously, we gave her avocado slices with the peel on so she could hold it herself. To our surprise, one day she picked up an avocado slice and joyfully started chewing on it. It is now one of her staples, and she loves it. The same thing happened when we introduced her to Bambas, crunchy peanut butter snacks that are very popular in Israel. At first, Lorelai was not at all interested in them, but at some point, she began to pick them up and hold them and put them in her mouth, and now she eats them every day and loves them.

Even with her ever-growing repertoire of foods, Lorelai has maintained her ability as an intuitive eater. If we present her with food, even if it’s one of her favorites, and she is not hungry, she won’t eat. And if she is hungry, she will eat until she is satiated and then stop eating, even if there are a few bites left. I have always spoken with my patients about how we are born intuitive eaters, and as we get older, we often lose that ability for numerous reasons (dieting, being told to clean our plate or that some foods are bad for us and aren’t allowed). Much of my work with these patients is around rediscovering their inner intuitive eater and getting back to the time when they explored and enjoyed their food and made choices based on whether they were hungry or not and whether they liked what they were eating. It has been such an amazing experience to watch Lorelai’s intuitive eating up close, and I truly hope she will maintain this ability throughout her lifetime. Of course, I know that I won’t be able to shield her completely from diet culture and its toxic messages around “good/bad” foods, weight, and appearance, but I hope to foster her intuitive eater and help her develop a joyful relationship with food and her body.

Thoughts on Body Image and Pregnancy

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I want to preface this installment of pregnancy thoughts with this: the biggest lesson I have learned regarding pregnancy and body is that not only is every woman’s body different, but every pregnancy is different for each and every woman. What I am writing about in this piece is my own personal experiences, and it is not meant to be generalized to other women’s experiences. There is no wrong way to have a pregnancy and/or a pregnant body!

Thoughts on Body Image and Pregnancy

Some of the earliest advice I got from female friends and family members when they found out about our news was around making sure that I did not gain “too much weight” over the course of my pregnancy. Of course, I feel that these sentiments are rooted in fat phobia and diet culture, but many women also told me that they themselves ended up gaining “huge” amounts of weight during their pregnancies (much more than the medically recommended amount), which led to complications. While I am not a doctor and do not know the intricacies of these women’s pregnancies, part of me wonders if perhaps this “extra” weight gain might have resulted from the rebound bingeing I described in the previous newsletter feature, although it could just be how their bodies responded to pregnancy.

The other thing I have wondered in these situations is if these women give this advice to all pregnant ladies or just fat ones. Given that I have been living in a larger body for a number of years now, I am curious to know if these women are worried about potential medical complications for my pregnancy or, instead, how much fatter I will get. I have not asked these women questions about their intentions, but it definitely has crossed my mind.

Being a fat pregnant person is an interesting experience. For me, my baby belly did not become all that visible until relatively recently. This is partly due to the fact that I tend to dress in loose clothing (that is just my style), so my baggy sweaters and sweatshirts do camouflage my bump. But I also think that starting out as a fat woman, I was not going to have the stereotypical pregnant body that we all see on TV and in the movies. When I used to envision a pregnant woman, I would think of a slender woman who is “nothing but bump,” i.e., lean all over except for the “perfect” round tummy. I feel that we rarely see representations of fat pregnant women on TV or in movies, so that what the “typical” pregnant body looks like has been skewed for many of us. I was big before my pregnancy, and now I just look bigger in my belly area; if you did not know I was pregnant, you might not assume as much.

This “untypical” pregnant body has its pros and cons. On the one hand, I do not like to have a lot of attention focused on me, so not appearing obviously pregnant has helped me fly under the radar a lot, which I appreciate most of the time. One of my good tennis friends told me that she had a tough time during her pregnancies as she is a very private person, and her protruding baby belly made her quite conspicuous. She described how people on the street would approach her and touch her belly and give her a lot of attention that made her uncomfortable. I am sure she would have preferred to have had a bit more camouflage at the time!

But there are also times when I wish that it were more obvious that I am pregnant. In our society, pregnant women are (for the most part) treated lovingly and with respect. If a pregnant woman gets on the T, people will give up their seat for her. Her baby belly garners smiles and warm greetings. I am missing out on that as my baby bump is not prominent, and sometimes that makes me sad. When Jonah and I went on our “babymoon” vacation in March, no one could tell I was pregnant. They knew we were celebrating something, so they assumed it was our honeymoon, and as such, they kept on trying to give us champagne! I was able to laugh at it at the time, but there was also something a bit disappointing about not having my pregnancy celebrated by others.

Another thing that has been super interesting to notice is how friends and family have commented on my pregnant body. While all of the comments have been positive in nature, it also makes me feel uncomfortable when people comment on my body at all. On many occasions, these friends and family members have said, “Wow, I can’t even tell that you’re pregnant!” or “Good for you for not gaining too much weight!” A few weeks ago, the tennis pro at my club actually said, “You look great – you look like you’ve lost weight!” I know he was trying to be nice, but his comment implied that losing weight would be an improvement for me (as in my pre-pregnancy body was flawed). Never mind that pregnant women are indeed supposed to gain weight over the course of their pregnancies; so any weight loss would not be healthy during this time. These types of comments are fat phobic in nature and reinforce the idea that it is okay to comment on others’ bodies. People, please stop doing this! If you must, saying something like “You look great – how are you feeling?” is a much better sentiment to express rather than commenting on a woman’s specific body changes.

I feel like my pregnancy has given me a new appreciation for my body. I had thought that being “advanced maternal age” and fat would have not only made conceiving nearly impossible, but that my pregnancy would be rife with complications. Incredibly (knock on wood!), everything has been going well! I hesitate to write this, but honestly, being pregnant has been much easier than I thought it would be. Aside from some tooth/gum pain (hello, root canal!), hot flashes (sweating up a storm), and fatigue, I have had very few negative pregnancy symptoms. Of course, this could all change in the final month, but for now, I am amazed that my “old” and fat body is handling pregnancy so well. When I think about the fact that I am actually growing a tiny human right now, it seriously boggles my mind! It truly is incredible!

I am sure that my thoughts about my body will change once I deliver and continue to evolve after the birth and as the years go on. I hope to impart to my daughter the idea that our bodies are truly amazing and are capable of so many wonderful things and that appreciating what our bodies do for us on a daily basis is one of the cornerstones to a happy life.

Thoughts on Food and Pregnancy

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As some of you may know, Jonah and I are expecting our first baby (a girl) in June. While we just recently started sharing this news with our patients, we both have been experiencing the myriad of emotions, including excitement, anxiety, and joy, about the major life change that is about to occur. But in addition to this, I have been acutely aware of both my relationship with food and my feelings around my changing body. I had often wondered how my body would react to pregnancy. Would I feel sick as many of my friends and family members did during their first trimesters? Would I be excited as my bump grew and feel a new sense of appreciation and joy for my body and what it is doing? How would my appetite change? So I thought that I would write a two-part newsletter feature on some of my observations around food and body image in relation to my own personal pregnancy experience. This month, I will focus on my observations around food and pregnancy.

Thoughts on Food and Pregnancy

I am sure I am not the only first-time pregnant person to have had preconceived ideas about how my relationship with food would be during pregnancy. We all have heard about the strange cravings (pickles and ice cream, anyone?), insatiable appetites, and odd aversions that pregnant women are supposed to have. Interestingly, almost none of these applied to me! While of course I had to change certain things in my diet, such as cutting down on the caffeine in my morning cup of coffee (I now do ½ caffeinated and ½ decaffeinated.) and avoiding raw fish (i.e., no sushi tuna rolls), I really did not have to change much at all. Most of all, I have noticed that more than anything, I am slightly more conscious about making sure I get enough vegetables into my day. I have always been a reliable veggie eater, but there are days when I only have one serving for whatever reason, so I have been making an effort to make sure I eat at least 2-3 servings per day. Sometimes that is in the form of cooked broccoli or raw snap peas or baby carrots, and sometimes it comes in a smoothie.

While I have noticed that I have days during my pregnancy when I am super hungry, it is not too much different from my appetite fluctuations as a nonpregnant person. As an intuitive eater pre-pregnancy, I knew that there were some days when I felt like a bottomless pit, and then there were some days when I just did not feel that hungry. This pattern has continued throughout my pregnancy. Just to see if what I felt was going on was accurate, I asked Jonah one day if he noticed that I had been eating much more than usual, and he said, “No, not really.” Don’t get me wrong; there have been some days when I have been ravenous, but honestly, it does not feel that much different than my normal (nonpregnant) hunger cues. One interesting observation that Jonah had was that I seemed to be having less dessert than usual. Let’s be clear – I am not consciously trying to eat less dessert! It just seems that these foods have become slightly less appealing to me than usual for whatever reason. Perhaps the developing baby needs more other stuff!

A number of my friends and family members have described how they felt that pregnancy gave them the green light to eat whatever they wanted in unlimited amounts and that they took full advantage of “eating for two.” One woman recounted how she would have an ice cream sundae every night of her pregnancy. My thought on this is that I bet that many of these women prior to pregnancy were eating in a restrained or diet-minded way (as many women in our culture do). As such, they would not allow themselves to eat certain forbidden foods prior to becoming pregnant, or if they did, they had to do so in very limited amounts. I would be willing to bet that much of their overeating during pregnancy was likely a direct reaction to the restriction they had exercised pre-pregnancy. As we have heard time and time again, one of the biggest contributors to binge eating is prior restriction.  Once the constraints are lifted, the body and mind go all in with the previously off-limit foods. Given that I haven’t eaten in a restricted manner in many years, there was no rebound bingeing for me. I have always given myself permission to eat whatever, whenever in any amount that feels good to me. And that has not changed!

I have not had any strange cravings or strong aversions to certain foods or odors. Once I began to be able to feel the baby moving (around week 19), it was interesting to notice that she would be much more active after I had eaten certain foods. To this day, when I eat foods that are more carbohydrate-based, the baby gets busier in my belly! She also seems to really enjoy breakfast, which I guess might be due to the fact that she has not “eaten” since the night before and therefore is hungry. So apparently, she is tuned in to her hunger cues!

I guess the bottom line to all of this is that my relationship with food has not changed markedly since I have become pregnant. I still eat intuitively, and I still eat a wide variety of foods. I feel very lucky to have been an intuitive eater prior to pregnancy because I feel I am much more relaxed around food than many pregnant women I have known. Of course, over the next two months, things might change; but for now, eating in an attuned manner is working for me.

Next month, I will discuss my thoughts around body changes in pregnancy. Stay tuned!

Holiday Survival Guide

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It’s November, and that means the holiday season is upon us. Many of my patients have mixed feelings about the holidays. On the one hand, these celebrations can be a joyous time with one’s family and friends, full of tradition and connection. On the other hand, these same gatherings can be highly triggering and lead to serious anxiety. Of course, the fact that most holiday celebrations are centered around food can complicate matters even more.

While I love my family and cherish the holiday celebrations we have together, it can still be challenging at times. As I have written about previously, my family does not really understand the principles of Health at Every Size® (HAES) and Size Acceptance. In addition to this, my sister is Oprah Winfrey’s personal Weight Watchers coach and firmly entrenched in diet culture. Needless to say, my family gatherings can be seriously difficult at times!

Over the years, I have accumulated some practical strategies for dealing with challenging family situations, so I thought I would share them with you. Keep in mind that not all of these strategies will work for you, but, hopefully, one or more of them will aid you in navigating these tricky situations and permit you to enjoy the holiday season.

1. Create Safe Spaces

One way that I have found to help my family gatherings be less triggering is to ask my family to refrain from talking about dieting, weight loss/gain, or judgments about weight or food choices during our time together. This can be achieved by sending an email to the main holiday participants ahead of time or making a few phone calls. Another way to achieve this would be to send along some HAES materials to explain the basics. Finally, if you feel uncomfortable reaching out to everyone yourself, you could ask your significant other or trusted family member to relay this information to everyone else.

2. Have an Ally

While this might not always be possible, bringing a supportive friend, partner, spouse, or family member to a holiday gathering can be tremendously helpful. Ideally, this person would be someone who understands/is open to HAES and Size Acceptance and could advocate for you if needed. If your ally cannot be with you at the actual event, making a plan to talk, text, or Skype with them before and after the gathering can also be helpful and make you feel more supported.

3. Take Space

Sometimes despite best efforts, family members or friends will talk about dieting, weight, and/or moralizing food choices. Unfortunately, this is common practice in our society, and many people (especially women) use it as a way to bond with each other. If the conversation turns to these triggering topics, you have every right to get up and leave the table, room, or conversation. Take a walk outside, hang out with your nieces and nephews, play with the family pet, or just find another space and take a few minutes. Sometimes all you need is a few moments alone.

4. Set Boundaries

If a friend or a loved one consistently makes comments about your weight or food choices, you have the right to tell them that this is unacceptable. In the moment, it can feel very difficult to stand up for yourself, so it might be helpful to think of some replies ahead of time. Some examples could include “Please don’t talk about my weight,” “I would prefer it if you didn’t make judgments about my food choices,” or “My food choices are none of your business, so please do not comment on them.”

5. Practice Regular Self-Care

While of course I would recommend engaging in self-care activities year-round, the holidays are an especially important time to do so. Practicing intuitive eating and physical activity, getting enough sleep, and managing stress are some basic ways to take care of yourself. If you are in therapy, it can be helpful to prepare for challenging situations with role-playing, i.e., have your therapist help you practice your responses to difficult family members or friends.

In the end, sometimes holiday gatherings are just about getting through it with as little scarring as possible. Inevitably, Aunt Edna will start talking about her latest cleanse, or cousin Fred will comment on how much weight someone has gained/lost. In some cases, there really is nothing you can say or do to change a family member’s or friend’s thoughts about weight/dieting/food, so the best thing you can do is agree to disagree and move on. Remember that these events are time limited, meaning that they will not last forever. I hope that some of these strategies will be helpful for you during the upcoming months – you can do it. Happy Holidays!

Real Reality

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Some of you may or may not know, but I am a reality TV fan. I know, I know, it definitely isn’t doing anything for my IQ points, but watching these shows is one of my favorite ways to unwind and relax. The ridiculous scenarios and personalities are entertaining and help me suspend my own reality for 52 minutes. Now, while I am not a fan of all reality TV, I have been known to watch some of the “Real Housewives” shows on Bravo, and lately, I have been watching episodes of the “Real Housewives of New York City” and the “Real Housewives of Orange County” (RHOC).

This season of RHOC, one of the storylines is about how Shannon, one of the housewives, has gained weight since the last season of the show. Shannon cries to the camera about how ashamed she is of her body, how “disgusted” she is with herself, and how she cannot believe that she has let herself go. Shannon attributes her weight gain to eating to cope with numerous stressors in her life. In addition to this, the camera shows her family (her husband and daughters) making fun of her weight and urging her to eat less.  Some of the other housewife cast-mates also make snarky comments about Shannon’s weight gain to the camera, saying how she should only be eating steamed fish and vegetables.

On last night’s episode, Shannon goes to see her chiropractor/health guru to help her get her body back to where it was previously. From the get-go, this charlatan, er, um, health guru, is brutal to Shannon about her weight. Without missing a beat, he asks her to step on the scale and berates her when the numbers show that not only has she has gained a significant amount of weight, her body fat percentage is “dangerously high.” He warns her that these numbers are dreadful and that she has nothing to look forward to other than cardiovascular disease, diabetes, and an early death. If this wasn’t bad enough, he then insists that he take photos of Shannon in just a sports bra and capris from all angles to show her how much weight she has gained. With every turn, you can hear this guy mutter “ugh” when Shannon turns for each pose, clearly vocalizing his disgust. And, of course, Shannon ends up in tears, not because she is upset with the chiropractor, but because she is angry with herself for her weight gain.

I found myself literally screaming at the television screen during this above scene – I was horrified and sickened by it. If this is not one of the most blatant examples of fat shaming that I have ever seen, I don’t know what is. This “health guru” told Shannon that she is less than human for having gained weight, that if she doesn’t “shape up,” she will end up dead before the end of the week, leaving her in tears. And then he made sure she knew how “gross” and “unappealing” she looked while taking her “before photos.”

I think the thing that most upset me about this scene was how it portrays an actual reality for many people living in larger bodies and how they are treated by “health professionals.” I can’t tell you how many of my patients who are “overweight” or “obese” have been subjected to ridicule and abuse from their providers. Several of my patients have been denied fertility treatment until they lose weight, while others have been told that even though their labs and vitals are perfectly normal, their weight will “catch up” with them and lead them to inevitably develop diabetes or heart disease. Even though there is a mountain of evidence that supports Health at Every Size®, that behaviors are more important in determining health outcomes than the number on the scale, doctors, nurses, chiropractors and the like still believe in the weight-centered paradigm and beat their patients over the head with it. Not surprisingly, these fat shaming instances make people of size reluctant to get medical treatment, and in turn can result in even worse health outcomes. Fat shaming is never okay and when perpetrated by health professionals, it’s honestly a form of malpractice.

In any case, after watching the scene with Shannon and her “health guru,” I had had enough. I am no longer a RHOC watcher and I hope that eventually the show will catch on that this storyline is doing so much more damage than good. It is teaching millions of women that they should be ashamed of their bodies if they gain weight, that weight and health are synonymous, and plays into the “obesity epidemic” rhetoric we have been subjected to for the past two decades. Not only that, it could inspire eating disorders in many of its viewers as they will learn that the number on the scale is the most important thing and eating only steamed fish and vegetables is acceptable behavior. Please, Bravo, get your heads out of your asses. This reality show is too real in the worst possible way.

Veganism

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Veganism has been gaining some traction in the diet world lately. While it sounds harmless enough and even “saintly” to forgo meat, chicken, fish, eggs, dairy, honey, gelatin and the like, I have found that the client’s motives behind going vegan are quite important to figure out when meeting with them initially, as sometimes they can indicate some disordered eating.

For some people, the draw of veganism is purely moral – they do not feel right about taking life (or products) from any animal. In other cases, environmental concerns top the list of reasons why someone might choose a meatless diet because meat production has been found to contribute to pollution via fossil fuel usage, water and land consumption, animal methane, and waste. And of course, there are those who really do not enjoy the taste or texture of meat/fish/poultry/pork and their products. In all of these examples, the individual is making food decisions based on personal preference. Everyone has the autonomy to choose what foods to feed themselves, as that is part of being a human – we can choose what we eat.

What concerns me the most about veganism is the zeal with which some vegans talk about their diet. I don’t want to generalize to the entire vegan community because I know many vegans who do not behave this way, but I have been struck by how many celebrities, actors/actresses, “health experts,” and social media personalities have seemed to paint veganism as the only moral and healthful way to eat and that those who are not vegan are less than/going to an early grave/behaving immorally or selfishly, etc. This is very problematic for me because I believe that shaming others about their food choices is detrimental to their health mentally, psychologically, and physically – not to mention that not everyone can afford to follow a vegan diet due to socioeconomic status, the availability of fresh produce, and other factors.

Another concern I have with veganism is how it can sometimes indicate an underlying eating disorder (ED). Many of my patients with EDs have tried to eliminate whole groups of food from their diets, and for some of them, going vegan is just another variation on that theme. Of course, it is often difficult to suss out what is really going on when someone goes vegan, but if it coincides with increased preoccupation with weight, rigidity or secrecy around food or eating, and other signs of trouble, it is worth taking note of it.

Going vegan is not for everyone. About a year ago, I was working with a young woman who identified as a vegan. She said that it felt like such a part of her identity that the alternative (i.e., eating animals or animal products) seemed impossible and undesirable. This young woman was part of the vegan community, and she strongly identified with the morals and values of this group. For her, it was as much a lifestyle as it was a way of eating. At the same time, however, she complained of physical symptoms, including lack of energy, dizziness, weakness, difficulty concentrating, and weakened immune system, and she wondered if perhaps her vegan diet wasn’t working for her body. After much discussion in my office (Mind you, I did not encourage her to eat meat, just to weigh the pros and cons.), the patient decided to try to reintroduce meat into her diet to see if it made a difference in her physical symptoms. Over the course of a few weeks, she began to slowly add in some animal products and found herself feeling much more energized, clearer, and healthier overall. Of course, there might have been a placebo effect at play here, and we can’t be sure that simply adding back in some meat/animal products “cured” her, but the difference was startling. Despite this, the patient felt very conflicted about giving up veganism because it would mean losing a huge part of her identity. In the end, she decided to continue to eat meat occasionally, essentially becoming a “flexitarian” – someone who sometimes chooses to go meatless but other times will eat meat. This compromise seemed to work best for her physiology.

I believe that anyone considering becoming vegan needs to really weigh the pros and cons of this decision. Why are you going vegan? Is it because you feel it is morally wrong to eat animals and their products or that it is harmful to our environment? Do you feel like your body works/feels better eating this way? Or are you using veganism as a way to further limit your diet, restrict, and try to manipulate your weight? Are you able to make sure you are getting enough protein, iron, vitamin B12, and calcium (nutrients that are more difficult to get through a vegan diet)? Is this way of eating sustainable for you or more of a hardship? In the end, everyone has the right to decide what and how they eat. But it is always a good idea to consider the factors that go into these decisions.

Emotional Eating

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Last week, I received the following email from one of my patients:

“I wanted to touch base about a concept that keeps coming up in food podcasts/books/articles, etc. The idea of ‘emotional eating,’ and what that even means. I understand that it is the idea of food being comforting and thus using it as a coping mechanism, but isn’t food almost always tied with emotion (happy, guilty, satisfied/pleased, disappointed, etc.)?

“I think this concept is referring to eating when not hungry to deal rather than other ways, but often I hear rethinking if that cupcake in the middle of the afternoon is what you need or to call a friend or go for a walk.’ Yes, I agree that sometimes if I am tired, I will crave these foods, and realize I just need a nap. However, what if I crave a sweet snack in the middle of the afternoon, after lunch, because I am hungry and that’s what I want? To be honest, I don’t love this idea because it feels judge-y. Am I interpreting it wrong?

“Also, on a Friday after a long week, I look forward to a drink, a meal of my choice, and some popcorn in front of the TV. Does that make me an ‘emotional eater,‘ too? I don’t think that is wrong but maybe this is not how I should be coping with stress…? Thanks!”

“Emotional eating” is a buzzword phrase that seems to be everywhere lately. Many of my patients come to me to help them stop “emotionally eating” because they see it as a problem or a failure on their part. I thought it might be a good idea to explain what I believe emotional eating is and what it isn’t and whether it should be seen as problematic or not.

From the time that we are babies, feeding (i.e., via breast milk or formula) is one of the very first ways our parents/caretakers take care of us and show us love. Feeding and eating are primal actions that serve as a way to keep us alive; we depend on our caretakers to help us with this at the beginning. When a baby is hungry, he or she will cry, and the caretaker will provide nourishment to take away the feelings of discomfort from hunger and give the baby satisfaction. This basic hunger-crying-feeding-satisfaction loop happens over and over again and basically cements itself in the infant’s brain that the only way to get rid of one’s uncomfortable hunger is to cry until mom or dad gives the infant nourishment. This way, a very strong connection is forged between food and love as our caretakers are the first ones in our lives who provide both of these necessities to us.

As we grow up, food and eating situations are often connected with emotions. For instance, you might have very strong and fond memories of your grandmother’s apple pie and how lovingly she served it to you on special occasions. Or perhaps you remember how your dad used to make you the perfect peanut butter and jelly sandwich for school every day, cutting off the crusts just so, and how this made you feel loved and special. We collect these eating/emotion experiences throughout our lifetime, and as a result of this, we can elicit some of the above emotions by eating some of the associated foods.

I believe that while eating can often be associated with emotions, it does not necessarily need to be problematic. When most people nowadays use the term “emotional eating,” I believe they are referring to the behavior of trying to cope with negative emotions or situations by eating comfort food in the absence of hunger. In my opinion, someone occasionally dealing with their emotions by eating is not a big deal, but if it becomes a chronic habit that is bringing discomfort or pain and/or not truly helping to assuage that person’s negative emotion or situation, that would be something to be curious about in a very neutral and self-compassionate way. It’s important to realize that feeding ourselves comfort food sometimes even if we are not hungry is one way that we are trying to take care of ourselves. It might not be the most helpful or effective way to give ourselves self-care, but it is a self-care attempt nonetheless.

In response to my patient’s thought that food is “almost always tied with emotion,” I would say that many eating situations are not necessarily connected with emotion. For instance, I had an apple and a piece of cheese for snack today, and while it was tasty and satisfying, I didn’t have any emotions associated with it. I also think one can crave a cupcake in the afternoon for no other reason than it is what they are humming for at the time. It doesn’t have to be emotional.

At the end of the day, “emotional eating” is something that nearly everyone engages in from time to time. In and of itself, it doesn’t need to be a problem, but if it becomes the only way that you cope with negative feelings or situations and it is bringing you distress, it would be worth it to try and develop other coping strategies (with the help of a therapist) to deal with these feelings/situations in a more constructive manner.

Sh*t Tennis Ladies Say

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As some of you might know, I am an avid tennis player. After a very long hiatus (like 25 years long), I started playing competitive tennis in several different leagues three years ago. It has been so wonderful in so many ways – I love that I get to play a sport that is not only physically enjoyable, but is also a fabulous social network as well. My tennis teammates are some of my closest friends and I adore them.

That’s why sometimes it feels particularly upsetting when many of them speak in anti-fat, pro-diet, disordered ways about food, weight and body shape. All of these women are intelligent, well-spoken, kind-hearted people. All of these women are liberal, open-minded and generous. And nearly all of these women have either made negative comments about their own bodies, commented on others’ bodies, and have engaged in any number of diets/disordered eating patterns. It is truly mind-boggling. I have decided to write about a few of these comments partly as a way to vent, but I also feel like they can be valuable learning lessons for our readers.

Tennis friend: “Oh my goodness, did you see X on the tennis court today? She has lost/gained a ton of weight– doesn’t she look great/terrible?!”

Why these types of statements are problematic: 1) We have very limited control over our weight – our genetics are the key determinant of our body size. And while we can lose weight in the short-term, nearly 95% of dieters regain the weight, with many of them gaining even more weight than they had lost; 2) There could be a number of explanations for someone’s weight loss/gain – are they going through chemotherapy for cancer treatment? Did they recently have a traumatic life event that significantly changed their appetite? Are they on a medication that is causing them to bloat/lose their appetite? 3) These types of comments reinforce the idea that the most important thing about a woman is her physique. We are so much more than our bodies!

Ways that I choose to respond to comments like these:

“I really prefer not to talk about others’ weight – every body is different and unique.”

“Commenting on others bodies makes me uncomfortable – you really never know what someone is going through. She could have a medical condition we are unaware of.”

“Hey, how about we focus on her tennis game rather than her body shape/size?”

Tennis friend: “I’m so hungry.”

Me: “Oh, I have a granola bar in my bag – would you like it?”

Tennis friend: “Oh, no. I’m dieting.”

Why this is problematic: As Jonah and I have written about too many times to count, diets don’t work long term. When we restrict our intake and actively disregard our bodies’ hunger cues, our body goes into starvation mode. This results in a slowing of metabolism, decrease in energy, and heightened awareness and obsession with food. When you feel hungry, that is your body’s way of telling you it needs fuel. It is not a weakness. It is a necessity, like breathing air and drinking water. Not only that, once someone stops dieting (because the inherent nature of dieting is temporary), that person will likely overeat on high-fat/high-carb foods (which are your body’s preferred macronutrients in times of scarcity), and with their slowed metabolism, the weight will pile back on. Unfortunately, many women engage in this yo-yo dieting, which a number of studies have shown to be more damaging to one’s health than just maintaining a higher weight.

Ways I choose to respond to situations like this one:

“Being hungry is your body’s way of telling you it needs food. I guarantee you will feel so much better if you a eat something. I also bet you would have so much more energy to play tennis!”

“It sounds like you have been on quite a few diets over the past year. I know it’s hard to believe, but it is possible to eat in a non-restrictive way and be healthy.”

“Did you see Serena’s last tennis match? She was eating a snack on the changeover. I think she’s onto something!”

Tennis friend: “My knees/ankles/hips are killing me. If I could just lose these 20 lbs, I know that would fix the problem.”

Why this is problematic: As I wrote about several months ago, focusing on weight loss to cure physical ailments is not the right approach. Yes, biomechanically speaking, weighing less might help one’s knee pain resolve, but there is no guarantee of that. Not to mention, many people of all shapes and sizes have knee/ankle/hip pain (even thin people!). As we age, we tend to lose cartilage, and this often leads to joint pain. Sorry folks, but getting old is unavoidable! There are many ways to help joint pain that don’t involve weight loss (such as quad strengthening exercises for knee issues, medicine, wearable braces). And finally, even if someone were to lose weight to help their knee/ankle/hip pain, it is still highly unlikely they will be able to keep off that weight for any significant period of time.

Ways that I choose to respond to comments like these:

“You know, there are plenty of other strategies to use that could help your ankle pain. I would recommend talking with your doctor.”

“When I had knee pain, I started seeing a physical therapist who gave me a bunch of exercises to try to strengthen my quads – would you like his/her contact info?”

“While weight loss might initially help, it’s nearly impossible to keep off the weight, and it is likely that you will end up gaining more weight in the long run. Maybe you could find some other strategies to deal with the pain?”

At the end of the day, I really do understand why so many of these women make comments like the ones I shared above. And I also know that these comments are not just limited to the suburban female tennis playing community. We as a society have been brainwashed by the media, our doctors, our family and friends to think that it is right and normal to comment on other people’s bodies, to believe that what we choose to eat (or not eat) makes us virtuous or sinful, and to view weight loss as something that is easily achieved and maintained (all of these things being plainly false).  I just wish that we could change the conversation to one about things that really matter, like the state of the world, what we are passionate about, how our families are doing, etc.  Focusing on our bodies and what we put in them is terribly myopic. How much we could achieve if we just changed our focus.