The Tipping Point

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You probably heard about Gina Kolata’s piece in the New York Times earlier this month detailing commonplace weight regain among Biggest Loser competitors, but you may have missed Dr. Sandra Aamodt’s excellent follow-up piece in which the neuroscientist shares research showing just how unlikely long-term weight loss is for any of us, not just the show’s former contestants.

While this information might be news to some of us, data showing commonplace weight regain among people who attempt to lose it has been available for quite a while, yet it has not garnered much mainstream attention despite years of efforts from researchers, advocacy groups, activists, and practitioners around the world, including myself.

Regardless of what our goals are, nobody wants to hear that they are probably unattainable, which partially explains why the myth of weight loss has survived. Unfortunately, yet understandably, people are reluctant to listen when receiving a message they do not want to hear.

The problem, however, runs deeper. The notion that we can lose weight and keep it off if only we try hard enough has taken on “everybody knows” status. We hear it in our fitness centers, around the proverbial office water cooler, up in the bleachers at Little League games, and at spring cookouts. The message is so commonplace that we do not stop to question its validity.

Doctors, dietitians, and other healthcare practitioners can inadvertently contribute to the mess. We are human and vulnerable to the same “everybody knows” paradigm too, and sometimes we take treatment guidelines at face value without looking into them for ourselves.

Lump the green version of myself in there as well. I shake my head with embarrassment and shame at some of the advice I doled out early in my career before I knew better, and I wish my profession as a whole would get up to speed.

We see the “success stories,” the people in our lives who were able to lose weight and keep it off, at least so far. The Massachusetts State Lottery website features pictures and stories of its recent million-dollar winners, but their enticing smiles do not change the reality that the most likely outcome of buying a ticket is financial loss.

Children observe their parents looking critically in the mirror, associating guilt and virtue with eating and exercise behaviors, and oscillating between rigid restriction and binges. The torch of dieting and weight obsession passes to the next generation.

If the myth of weight loss dies, so do the $60,000,000,000-per-year diet industry and the privilege enjoyed by the thin in a culture thick with fat shaming and weight stigma. They keep the fantasy alive and have plenty of incentive to make sure we continue to feel bad about ourselves.

Cognitive dissonance is a powerful force to overcome, not just for laymen, but for everyone. Given the strong headwind, I am pleased to see this information finally receiving the widespread attention it so desperately needs.

Ms. Kolata and Dr. Aamodt certainly deserve credit for their parts, but so does everybody who has ever made an effort to get the word out – practitioners and researchers who risked career suicide, activists for whom death threats are a daily way of life, and patients who have stood up and demanded evidence-based care – as they have also contributed to what I hope is finally the tipping point.

He Said, She Said: Weight Watchers – Helping You Lose Since 1963

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He Said

We believe that people should have the freedom to choose whichever healthcare paths they wish to take, independent of whether or not we would recommend their selected treatment plans. Disclosure and transparency are corollaries necessary for building a foundation that supports patients as they make decisions regarding their own care. Today’s approaches are likely inferior to healthcare’s future toolbox, and part of what separates respectful collaboration from a sales pitch is candidly discussing both the pros and cons of available options so patients can make informed decisions. We are not afraid to admit “I don’t know” when that is indeed the most appropriate response. None of this makes us exceptional or great, but it does make us honest.

For a look at the flip side, consider Weight Watchers®. A magician once explained to me his secret: misdirection. He gets you to fixate on his right hand so you entirely lose track of what his left hand is doing. Weight Watchers uses ads emblazoned with their “Because It Works” slogan to capitalize – literally and figuratively – on your desire to lose weight while they hope you forget to ask for their definition of “works.” The large font in their television ads demands so much of your attention that you miss the fine print resulting from the Federal Trade Commission’s (FTC) action against Weight Watchers in 1997 that declared they must concede that “For many dieters, weight loss is temporary.” In reference to the commonplace weight regain that prompts clients to re-enroll in the program time and time again, Richard Samber, Weight Watchers’ former financial director, explained, “That’s where your business comes from.” Weight Watchers is profitable, in other words, because it can successfully create short-term weight loss and make you believe that their long-term failures are actually your own.

Weight Watchers distracts you with their glittery new SmartPointsTM system and hopes you will ignore the long list of previous systems, including the Weight Watchers Program Handbook for Ladies, the Quick SuccessTM Program, the original PointsTM program, and PointsPlusTM, that never worked nearly as well as they wanted you to believe at the time. Weight Watchers is not changing their program because “Now we’re enhancing our program based on the latest science,” as their Chief Scientific Officer, Gary Foster, wants you to believe; nor are they changing their program because they suddenly uncovered data showing its poor efficacy. This is not a case of “When we know better, we do better.” They knew for decades that their program was not working as well as their large print made you believe, but they continued to promote it anyway, and when forced by law to tell the truth, they wrote it so small that you probably missed it.

Despite their spin that Weight Watchers always worked and now they are just making it even better, Weight Watchers is changing for one reason: money. Over the last four years, the company has seen their stock plummet from $85.00 to $6.80 per share as customers and potential customers have turned instead to weight-loss apps or more holistic approaches. To combat the former, they are launching a new mobile app and an expanded coaching program that offers more extensive support outside of group meetings. Their response to the latter involves some sleight-of-hand trickery. “Beyond the Scale” appears to be the new slogan, replacing “Because It Works,” and their company logo has been tightened up to two letters, thus removing the word “weight.” Seeing as they are so poor at creating long-term weight loss, taking the focus off the scale would make sense, but it is just a surface-level marketing ploy. Taking a closer look reveals that weight is still the focal point of their approach.

A Weight Watchers spokeswoman recently told Good Morning America, “People would really spend a lot of time trying to figure out ‘How do I get my Doritos in? Oh, I can do it if I adjust this and adjust that.’ Now it’s not as important for them to make sure how they are getting their Doritos in. It’s much more important for them to say, ‘What am I putting in my body? How’s that going to make me feel?'” Sounds very similar to intuitive eating, or at least a perversion of it warped just enough so at first glance it appears to fit seamlessly with their weight-centered approach.

The problem is that intuitive eating and dieting mix as well as oil and water. In fact, the very first principle of intuitive eating, as stated by Evelyn Tribole and Elyse Resch, is “Reject the Diet Mentality.” Sure, some people pursue intuitive eating hoping to lose weight, but intuitive eating is not designed to be a weight-loss tool, and if someone is unable to at least put weight on the back burner, then he or she will never truly learn to eat intuitively. In other words, having one foot in intuitive eating and the other in weight-loss culture will likely get you nowhere.

Really think about the company name: Weight Watchers. Weight. Watchers. People who watch weight. How is someone possibly supposed to jump with both feet into intuitive eating in the context of weigh-ins and an emphasis on mass? It is fine and dandy for Foster to say, “[Weight] is an important metric, but not the only metric,” but when the scale continues to be the focal point and the most important measure of progress in the eyes of everybody involved, consider the bind clients will find themselves in if and when becoming more proficient with intuitive eating is at odds with the scale. With the attention still on weight, how long will it be before the newly developed intuitive-eating skills are abandoned in favor of old-fashioned restriction?

Weight Watchers launched a pilot study of their revamped program in New Jersey, and 38 of the 40 participants lost weight, including three women whose testimonies of having lost between 18 and 50 pounds were featured in the Good Morning America segment. “We still produce weight loss,” Foster said on the show. Pretty much any kind of restriction will lead to short-term weight loss, so it always blows my mind when companies act like their program is unique in this way. Remember, nobody knows how to produce long-term weight loss in more than a tiny fraction of people who attempt to achieve it. The right hand can attempt to distract you with all sorts of glowing testimonials and a small, short-term pilot study, but none of that suggests that this version of their program will work any better than its predecessors, and you know the left hand is still holding the FTC-mandated disclaimer due to the futility of the program.

Weight Watchers certainly has success stories, and they make sure you never forget it. Group meeting leaders are all former clients who have lost weight and kept it off (at least so far) through a combination of behavior change and a boatload of factors out of their control that happened to work in their favor. Their mere presence is a subtle sales pitch that conveys enticing testimonies of hope and success, making you believe that the next winner could be you if only you continue to partake. Weight Watchers emphasizes seduction over expertise and downplays that leaders do not necessarily have backgrounds in nutrition, exercise science, or anything remotely connected to health, but rather disciplines such as drama that lend themselves to charismatic performance. Why hire someone with solid and extensive qualifications in economics and finances to manage your money when you can instead attempt to follow in the footsteps of some dude who struck it rich on a convenience store scratch ticket?

The other issue with their use of leaders and celebrity spokespeople to pitch their product is that neither you nor I know for sure what they do or do not do behind closed doors in order to achieve and maintain weight loss. Both parties have incentive to keep their weight in check regardless of the costs. Leaders can lose their jobs if they regain weight, and my understanding is that celebrity endorsement contracts are contingent on continued weight maintenance. Behaviors kept private can range from the privileged (personal chefs, personal trainers, etc.), to the deceitful (employing other weight-loss techniques beyond the Weight Watchers program being credited), to the disordered (ever-increasing restriction and/or exercise, preoccupation with food and physical activity, social withdrawal), to the outright dangerous (very-low-calorie diets, unregulated supplements, eating disorders). Clinically, we have seen many patients whose eating disorders were triggered by competition in a weight-based sport such as crew or wrestling, participation in an appearance-based activity such as gymnastics or figure skating, or employment in a size-based field such as modeling or personal training. While I do not believe we have ever had a Weight Watchers leader or celebrity spokesperson as a patient, it stands to reason that they are similarly vulnerable to the emphasis placed on their weight and the pressure to maintain it.

For 52 years, Weight Watchers has deceived you by knowingly overstating the efficacy of their programs and blaming you for their own failures, all at the expense of your time, money, and health. Do you really want to bet your resources and well-being that the outcome will be any different this time around? You deserve more than smoke and mirrors, don’t you?

 

She Said

While this might be news to some of you, it’s been nearly two months since Oprah Winfrey announced that she has not only become a member of Weight Watchers (WW), but she has also bought 10% of the company and become a board member and adviser. According to O, she decided to join and later invest in Weight Watchers as she has “always struggled with weight” and was impressed by the company’s “holistic approach” to health and weight loss. On Ellen DeGeneres’s talk show (which aired on October 23rd), Oprah reported that she had already lost 15 pounds since August 12th and was truly enjoying the program.

Oy. Where do I start with how sad this whole situation is? I have always been a fan of Oprah, as I have seen her as a strong advocate for women, someone who has been through a lot in her life and who wants to help young girls and women become their true and best selves. While the media often focused (and still focuses) on her weight gains and losses, I was always impressed by her ability to bring people together, inspire, and educate. Oprah is so much more than her weight!

I remember in 2010, I was so excited to see that Oprah was having Geneen Roth on as a guest of her show to discuss Roth’s best-selling book “Women Food and God: An Unexpected Path to Almost Everything.” Roth’s philosophy is that the way one eats is directly related to one’s core beliefs about being alive. She is an anti-diet proponent who posits that by exploring one’s spirit and soul, one can break free from emotional eating, finding balance with one’s relationship with food and one’s body. On the show, Oprah was giving such high praise to Roth and her book, saying how she was inspired to “never diet again” and that this book was a life-changing read for her.

So that brings me to the present day. Really, Oprah? What happened? Because last time I checked, WW is a diet, a set of externally based rules that tells its members what and how much to eat in order to lose weight to become socially acceptable – pretty much the opposite of Roth’s message. As we have written about too many times to count, 95% of people who alter their diet in order to lose weight will regain the weight and usually end up heavier. Weight Watchers is no different – it is a diet! Whenever anyone tries to tell me that it is a “lifestyle,” not a diet, I really have to contain my eye-rolling reflexes. Want to figure out if you are on a diet? Here’s how: Are you purposefully manipulating your food intake based on a set of external (i.e., not internally based) eating rules? Is your main goal of said food manipulation to watch the number on the scale go down? Well, I hate to break it to you, but you are on a diet, my friend. And chances are, even if you do end up losing weight, you will regain that weight and then some.

In a purely monetary sense, Oprah’s investment in Weight Watchers is brilliant – contrary to its popular “It Works!” slogan, It Doesn’t! The company has admitted that the success rate of its members is embarrassingly low, and much of their research is based on data that was collected over the span of a year. Um, nice try! We all know that weight regain often occurs between 1 and 5 years post-diet. But of course Weight Watchers doesn’t have data that goes that far. What a surprise. The company’s business plan is so clever because it knows that the diet doesn’t work. 95% of their members will regain the weight (blaming themselves instead of the diet, of course) and will rejoin, creating an unending cycle of profit for Weight Watchers.

Listen, I don’t really blame Oprah for making this truly unfortunate decision – she is human, and she is not immune from the body-shaming, weight-loss messages women receive on a daily basis. But I am disappointed that she is choosing to participate in and endorse a company whose sole purpose is to tell women that they are not enough, that their worth should be measured by a piece of metal, and that weight loss is the only way to find one’s true and best self. Oprah, I really expected more from you.

“Real” Science

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Some of you may or may not know that one of my favorite activities is solving crossword puzzles. Not just any puzzles, mind you, but the Sunday New York Times crossword found in the very back of the magazine. Every Sunday, I eagerly sift through my newspaper and find the magazine, ready to start working on the puzzle and figure out all of those elusive answers. This week, as I was thumbing through the pages, I came across an article under the “Well” section of the magazine, which caught my eye: “Mind What You Eat: Can ‘intuitive’ eating be as effective as calorie counting?” written by Gretchen Reynolds. The picture accompanying this article was that of a corpulent, blind-folded man, whose stomach was feeding itself a piece of pizza.

Given the nature of the work that Jonah and I do, I was intrigued to see what Ms. Reynolds had to say about intuitive eating, especially since the idea of intuitive eating is still relatively unknown to most of the general public. As I read on, however, my curiosity turned to disappointment and frustration. The article was riddled with inaccuracies, and, above all, truly missed the point of what intuitive eating is all about.

Although the idea of intuitive eating (also called the “non-diet approach”) has been around for many years, Evelyn Tribole and Elyse Resch, two registered dietitians, brought the topic to the public’s attention in their 1995 book “Intuitive Eating.” In the book, the authors explain the 10 Principles of Intuitive Eating, including such ideas as “Reject the Diet Mentality,” “Honor Your Hunger,” and “Make Peace with Food.” The authors assert that by following these principles, an individual can create a healthy relationship with food, mind, and body. The basic “rules” of intuitive eating are quite simple: eat when you are hungry, eat what you are hungry for (not what someone else or some diet is telling you to eat), and stop eating when you are satiated.

While the book does discuss the likelihood that by eating this way one will reach their “healthy weight,” it is in no way meant to be a diet book or a how-to weight loss treatise. One’s “healthy weight” is not based on the BMI or what popular culture says is healthy – it’s the weight that one’s body arrives at when he or she is engaging in healthy behaviors such as eating intuitively, engaging in pleasurable physical activity, and managing stress.

Since weight loss is not the ultimate goal of intuitive eating, I was confused as to why Ms. Reynolds decided to compare the approach with calorie counting to see which resulted in more weight loss. In addition to this, the article was flawed in a number of ways.

Ms. Reynolds begins her article by saying that intuitive eating has not been studied extensively by researchers. This statement could not be further from the truth! Per the Intuitive Eating website, there have been over 40 studies which have looked at the health benefits of intuitive eating. According to Ms. Tribole who posted her reaction to Ms. Reynolds’ article on her own Facebook page, “last month a systematic review was published on Intuitive Eating with 24 studies, totaling over 9,000 people.”

Ms. Reynolds’ article goes on to discuss a study in which 16 overweight men and women were split up into two groups of eight: one group was assigned to a restricted-calorie diet between 1,200 and 1,800 calories per day, while the other group was to engage in intuitive eating. At the end of the study, which ran a total of six weeks, the researchers found that those in the calorie-controlled group lost more weight than those in the intuitive eating group. Given these results, posits Reynolds, limiting one’s calories is a more effective way to lose weight than engaging in intuitive eating.

Yikes. This article is problematic for a number of reasons. Firstly, the study itself is a poor one to use, as it has an extremely small sample size of 16 subjects and is conducted over a measly six-week time period. Secondly, to draw any conclusions about health outcomes from this study is wildly irresponsible. And thirdly, duh, of course the calorie-restricted group lost weight! This study literally gives us no useful information!

We all know that going on a diet results in weight loss for the vast majority of people. The question is: how likely is it that those individuals will actually keep the weight off for a significant period of time? Given that we know that approximately 95% of people regain the weight they lost through dieting, I’m willing to bet dollars to donuts that all of the individuals in this silly little study regained the weight they lost during the first six weeks of the study. In fact, I wouldn’t be surprised if they ended up heavier than when they started!

I guess the thing that bothers me most about this article is how it completely misses the point of what intuitive eating is all about. Intuitive eating is about eating in a way that promotes one’s health, not in a way that is meant to result in weight loss. Ms. Reynolds reinforces the diet mentality of the general public by her assertion that cutting calories is what is necessary to reach a healthy weight. Articles like this one just create more confusion for Jonah’s and my patients, as it backs up the ideas that weight loss should be one’s ultimate goal and that long-term maintenance of weight loss is achievable.

Stocking

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“I have to get rid of these leftovers or I will eat them all.” Sound familiar? The “them” in question could be leftovers from any holiday celebration that includes food, such as Halloween candy, Thanksgiving pie, Christmas cookies, New Year’s Eve hors d’oeuvres, Easter jelly beans, Memorial Day barbecue, or birthday cake and ice cream.

The aforementioned strategy for dealing with such leftovers sounds logical on the surface and might even seem to work for a little while. If the food is not there, you cannot eat it, right? As the never-ending cycle of holidays continues though, the strategy of avoidance reveals its downsides: stress, anxiety, deprivation, reinforcement of an oversimplified and misleading good/bad food dichotomy, and increased risk for episodes of overeating or outright bingeing.

An alternative does exist, one that takes less mental and emotional energy, allows people the freedom to enjoy holiday favorites without going overboard, and makes peace with food. This alternative is stocking, which is a well-known technique among practitioners who help people with emotional eating, compulsive eating, binge eating disorder, and supposed food addictions.

Stocking is the antithesis of quickly ridding the house of holiday leftovers, and it may initially seem counterintuitive. A full explanation of the technique requires more time and space than would be appropriate for this newsletter, but here are the highlights for your consideration.

Uncouple morality from food and eating behaviors

In order to feel more comfortable with stocking, people need to rid themselves of the good/bad food dichotomy and be able to temporarily put the hard science of nutrition on the back burner. Not all foods are the same nutritionally; it would be ridiculous to proclaim that an apple has the same nutritional value as a Twinkie, and I am not arguing otherwise. What I am suggesting, however, is to strip the moralization away from food. An apple is just an apple; you are not good or virtuous if you select it for your snack. A Twinkie is just a Twinkie; you are not bad, guilty, or weak-willed if you choose it instead. Sometimes your body’s cues will lead right to the apple, other times to the Twinkie, and either outcome is okay.

Establish an abundance of food at home

Identifying what food will feel best in your body means little if you do not have a reasonable shot of providing said food for yourself. Therefore, one of the tenets of stocking is to keep a wide variety at home, including foods that are seen as taboo and can trigger overeating or bingeing.

When our body is asking for a food we do not have on hand, we tend to overeat on the foods that are in the house. This can certainly occur with both adults and children, but we especially see this with teenagers who live in food-restricted households. Well-meaning parents might keep foods high in salt, sugar, or fat out of the house because they think that doing so creates a healthy food environment, but oftentimes it backfires. For example, the teenagers overeat on low-sodium potato chips that never really hit the spot while a small amount of regular chips would have done the trick, or they overeat on Newman’s Own fig cookies when really they just want a couple of Oreos.

Select foods based on intuitive-eating cues

One of the logistical differences between those who practice intuitive eating and those who do not is how food selection begins. Standing in front of the open refrigerator or scouring the pantry and cabinets and selecting whichever foods call to you is an external process that differs greatly from asking internal questions about what temperature, texture, flavor, color, etc., food will feel best in your body at that moment and seeing where it takes you.

These cannot be treated as leading questions. In other words, if you have stocked up on, let’s say, Ben & Jerry’s Cherry Garcia, and you are trying to convince yourself that your body does or does not actually want the ice cream, then stocking will not work. Keep an open mind, ask these questions neutrally, and see where your body’s cues take you.

Maintain the inventory of foods at home, especially of triggering foods

Maintaining the abundance of food in the household is an important element of stocking. If the supply dwindles, you might feel like you need to hurry up and eat a particular food while it is still around. Should you ever run out and then buy it again, the food regains its luster. If you are stocking Doritos, for example, maintain a supply of, say, ten large bags at home. As soon as you finish two bags and are down to eight, go out and buy two more.

Be patient and use a neutral voice

Initially, you may find yourself eating certain foods when your body does not actually want them, but as you keep up the practice, eventually your trigger foods will blend in with all of the other foods in your pantry and no longer sparkle the way they do when they are brand new to the house. Until then, abstain from judging yourself harshly for eating episodes that do not go as you would have liked. Remind yourself that you are still in the early stages of the process and you are learning. With a neutral voice, examine what happened so you can respond differently when similar circumstances arise in the future.

Enjoy your new-found peace with food

Imagine how different your experience with leftover Thanksgiving pie would be if you routinely kept slices of pie in your freezer for whenever your body wanted them. Contrast the fretting you feel about the remaining Halloween candy to the relaxed liberation of always having a few bags of peanut butter cups in the pantry year-round.

For the stocking technique to be successfully implemented, foundational work to dispel nutrition myths, break up the good/bad food dichotomy, and uncouple moralization from food choices is necessary beforehand. Because this process takes time, it is probably too late for the stocking technique to be much help for you this Thanksgiving unless you have already been working on these prerequisites.

The cycle of holidays will continue though, so if you get started now, you might find you have a much more relaxing and enjoyable experience with this February’s Valentine’s Day chocolates than you would have if you continued down your current path.

The, umm, “power” of carrot cake

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CarrotCakeOn Valentine’s Day, I surprised Joanne by baking her a carrot cake. Just over one week later, I realized half the cake was still in the refrigerator. Although we liked it, we both felt like we had had enough. The cake was getting old and we did not want to take up freezer space with it, so we pitched the remaining portion.

In posting this, I risk the inherent danger of misunderstanding, so let me be clear: Moralizing foods or eating behaviors is a harmful practice that I do not endorse. Carrot cake is not “bad” or “unclean” or a “guilty pleasure,” nor did I “fall off the wagon” when I baked and ate it. We are not “disciplined” for leaving some, nor would I have been “good” if I had never made it in the first place.

Our carrot cake exemplifies a nutrition strategy that Joanne and I oftentimes use with our patients. We often hear people tell us about their trigger foods, i.e. foods they feel must be completely avoided because a little inevitably turns into a lot. They are addicted to these foods, they say, or perhaps they blame themselves and cite a supposed lack of willpower.

The presumed solution is to abstain from these foods at all costs, but the downsides of this approach include missing out on favorite foods, a low likelihood of long-term success, and reinforcing the notion that these foods are taboo, which only serves to make people want them more.

We find that doing quite the opposite works better: Keep large quantities of said trigger foods on hand at all times and give ourselves permission to eat them whenever we want. Patients sometimes bristle when we raise this idea. If we believe a food has control over us, then having it available in abundance feels scary. Furthermore, giving ourselves permission to enjoy it whenever we feel like it sounds ridiculous and counterproductive to the pursuit of health.

I know, I know, we’re crazy, but think about it: Granting ourselves unconditional permission to eat a particular food does not automatically mean we are actually going to eat it regularly or in vast quantities. We may be surprised to find how sharply our desire for a previously-taboo food can drop off once we give ourselves unconditional permission to consume it.

We couple this approach with building intuitive-eating skills, which involves learning to ask ourselves questions about how hungry we are, what food do we really want at the moment (what temperature/color/texture/flavor/etc. do we really feel like), and what quantity of the identified food do we truly need to feel satisfied. If we ask ourselves these questions in a neutral, open-minded, and non-judgmental fashion, the answer is only sometimes going to be the previously-taboo food.

When it is, then we eat it slowly, enjoy it without guilt, and get on with our day. We stop when we have had enough, not when we are overly stuffed, because we know we can have more if and when we want it. The food, in essence, is demystified. Cookies are just cookies. Potato chips are just potato chips. Bread is just bread. We only experience their power over us when we operate in a paradigm that gives them power. When we remove moralization, judgment, and strict rules from the model, the sham of power is exposed for what it is and supposed addictions resolve. The carrot cake is forgotten as it blends in with all of the other foods in the fridge.

Joanne and I keep lots of play foods on hand, much of which we never touch. We have apple crisp ice cream that I bought this past fall in our freezer and Halloween candy in our pantry. We have unopened trays of Newman’s Own cookies and stashes of frozen pastries I made from scratch. We still have Valentine’s Day candy – from last year’s Valentine’s Day.

And none of that makes us “good” or indicates “willpower” or “discipline,” nor are we “bad” or “weak” or “guilty” when we do enjoy these foods. By having play foods on hand at all times, we find that we actually want them less. Remember, carrot cake is just carrot cake. Sometimes it hits the spot, but other times we might just want, well, a carrot.

Intuitive Eating

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Thanks to a colleague’s tip, one counseling technique I sometimes implement is a one-on-one book club of sorts where a patient and I read a book together that is relevant to his or her care. Recently, I have been reading Intuitive Eating with a patient who is working hard to overcome decades of approaching eating from the vantage point of dieting and to build a new relationship with food.

He has impressed me by how open-minded he is to a new way of looking at eating and by how candidly he has shared the thoughts, questions, and concerns that have come to mind during his reading. Now about a third of the way through the book, he reports that he sees himself in many, but certainly not all, of the case studies that the authors present. However, the idea of not depriving himself feels scary. Specifically, he notes that he loves having dessert, but that he is better off skipping it because one brownie so easily turns into four. Besides, he says, health must come into the picture somewhere, so there must be a “but . . .” caveat to the notion of not depriving oneself. He is waiting for the other shoe to drop.

His concerns are common among people who are at the early stages of putting aside the dieting mentality and learning intuitive eating. He is right that we certainly consider health. After all, I am a licensed health care practitioner. Before we take into account the hard science of nutrition though, we have to address the emotions that affect eating.

Sure, physiological mechanisms exist that yield pleasure when we consume foods that are high in fat, sugar, or salt. You are alive to read this because these mechanisms gave your ancestors an evolutionary advantage and they passed them down to you. However, the reason that one brownie turns into four has less to do with physiology and more to do with the morality that gets attached to them.

When we experience guilt for eating a particular food or virtue for abstaining from it, these emotions block us from being able to truly experience and honor the internal cues that our bodies give us regarding our eating. We eat the first brownie, feel guilty for having done so, and say “screw it, today is ruined” and then reach for three more. In essence, the idea of not depriving ourselves feels scary because in our minds it translates to opening the flood gates. In other words, brownies all day, every day.

In reality, that is not how the body tends to operate. When we strip away the morality of food and see our choices on a level playing field, we discover that the appeal of previously-forbidden foods drops considerably. Some days we may want an apple for dessert, other days we may not feel like dessert at all. And what if we go through the question tree of asking ourselves are we hungry, how hungry are we, what texture/temperature/color food do we want, do we feel like something salty, savory, or bitter, and how much of that food do we really need to be satisfied, and we determine that a brownie will indeed do the trick? Then we find the best brownie we can get our hands on, eat it slowly, enjoy every bite, stop when we are feeling satisfied, and know that we can have another one whenever our bodies are asking for one.

Ideally, the hard science of nutrition comes into play after this sort of relationship with food is established. We can talk about the advantages of one kind of cereal over another, or one kind of yogurt over another, or what have you, but we have to take into account the human element. Whole wheat bread is probably a better choice for someone with high cholesterol than is white bread, for example, but if forcing down the whole wheat because it has a better nutritional profile on paper is going to trigger some sort of overeating in search of satisfaction, then he or she is probably better off just having the white bread in the first place and getting his or her soluble fiber someplace else. On the other hand, if the two breads are pretty much equally enjoyable, then sure, he or she is probably better off with the whole wheat.

Learning to eat intuitively involves taking a leap of faith that we can largely trust our bodies to tell us what and how much to eat. Reestablishing that trust involves dialing down the noise of guilt and virtue that makes our internal signals difficult to hear. If you find yourself consuming piles of brownies, or none at all, consider whether or not you are truly listening to your body.