Sugar makes you fat?

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As a teenage cross-country runner, I believed that if I cut out dietary fat, I would reduce my body fat stores and therefore increase my speed. Besides, many other people around me were demonizing dietary fat, too. In those days, low-fat and no-fat were all the rage. The food industry was more than happy to capitalize on the fad, thus leading to grocery store shelves filled with fat-free products like SnackWell’s cookies, thereby perverting the notion that we were all on the right track to health while simultaneously enabling our disordered eating.

Unlike actual scientific evidence, popular-culture nutrition is fickle. The Atkins diet was hot while I was in nutrition school, but by the time I became a practicing dietitian, going gluten-free was the in thing to do. Hardly any of my patients back then actually knew what gluten was and where it was found, but they erroneously believed they had eliminated it from their diets and boy did they feel better.

Scarce are the people who fear dietary fat now, and these days fewer and fewer people seem wary of gluten, but now sugar is in pop culture’s crosshairs. This past weekend, Joanne played in a charity tennis tournament where she encountered a sponsor who was touting his sugar-free sports drink. “Sometimes people need sugar,” she reminded him, and also threw in that she is a registered dietitian. Offering a rebuttal that lands squarely at the intersection of pseudoscience and weight stigma, he offered, “Sugar makes you fat.”

Regarding the latter, I approached him by myself to see if he would make a similar comment to me, a male in a thinner body, but he did not seem interested in engaging me in conversation. “So, your product is essentially made to rival drinks like VitaminWater Zero?” I asked, but he just walked away. In fairness, he might not have heard me, as many players and staff around us were making quite a bit of noise.

With regards to the factual accuracy of his claim – or lack thereof – no, sugar does not make you fat; that is not how weight regulation works. Body weight is the result of many different factors, including, but not limited to: genetics, environment, medical conditions, and lived experience (for example, history of weight cycling). Eating and physical activity behaviors are of course part of the equation, too, but contrary to popular belief, our weight is largely out of our hands. In fact, a presenter at a conference I attended last year stated that weight is 90% as genetically determined as height.

Besides, Joanne was correct; people do need sugar. Your doctor most likely measures your blood glucose, a kind of sugar, at your annual physicals. If that number reads zero, you are dead. Even if it merely slips below the normal range, you are probably lightheaded, lethargic, and having difficulty concentrating, all symptoms of not having enough circulating sugar to fuel your brain and other organs.

While the rate of the reaction depends on the food in question and one’s individual body chemistry, our systems eventually break all carbohydrates – from sprouted ancient grains to neon gummy bears – into simple sugars. You can get a sense of this by chewing a piece of bread or cracker longer than normal. The sweetness increases the longer you chew because the salivary amylase, an enzyme in your saliva, is already breaking down the long carbohydrate chains into sugar.

Besides, creating a sports drink without sugar is somewhat head scratching. On one hand, I guess it makes perfect sense, just as fat-free cookies back in the 1990s sounded like a great idea, too. Both are cases of smart food manufacturers taking advantage of nutrition fads to satisfy consumer demand and thereby earning themselves quite a profit. Always remember that a food company’s priority is their income, not our health; product prevalence is only a gauge of demand, not the state of nutrition science.

Sports nutrition, in particular, is an area where the fear of sugar is hurting athletes. Carbohydrates and fat are the main sources of fuel during athletics. Even the leanest marathon runner has enough fat stores to provide sufficient amounts during their event, but our carbohydrate stores are much more limited, as we only tuck away small quantities in our liver and muscles in the form of glycogen. If we do not replenish our carbohydrates during exercise, we pay the price, as I can attest from personal experience. As a long-distance cyclist, only twice in my life have I failed to complete rides that I set out to do. The first was when I fell off my bike in Montana and fractured my spine. The other was a few years later when I was temporarily experimenting with a low-carb diet and became so fatigued that I could not make it home.

Much more recently, I went for a 21.2-mile training run in preparation for next month’s Newport marathon and consumed nearly two liters of Gatorade out on the road. Thanks in part to the approximate 112 grams of sugar keeping my energy up, I had a great run and could easily have kept going for another five miles had it been race day.

Back when I was a fat-avoiding teenager, my mom saw the red flags of disordered eating and brought me to a dietitian who explained to me that, contrary to popular belief, dietary fat was fine to consume and that cutting it out would hinder, not improve, my running. Now that I am on the other side of the counseling table, hopefully I can give you similar reassurance about sugar.

You have seen memes and headlines suggesting that sugar is toxic and maybe you have questioned if you have a sugar addiction. Perhaps sugar-free products sound like the path to salvation and virtue. Attempting to cut out sugar might feel like the right next step, especially when so many people around you are going down that road, but I caution you against such pursuits. Remember, soon enough our culture will be demonizing another nutrient, ingredient, or food group. Better to establish and retain a healthy relationship with food and let the fads fall by the wayside.

“Too Fat” vs. “Too Thin”

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Those of us who have had an eating disorder know firsthand that while recovery is possible, the road can sure be difficult. The eating disorder voice is powerful and can make people do and say things they otherwise would not express if their bodies and minds were in healthier places. A woman who is struggling mightily to recover from anorexia nervosa posted on a message board criticism of her treatment team for saying that being “too thin” is problematic while being “too fat” is okay. Does she have a point?

The treatments for someone who is “too thin” versus “too fat” are actually more similar than some people realize. In both cases, the etiology of the person’s size matters as well as whether or not the origin is pathological.

For example, consider two people, each of whom is “too fat.” One person has a healthy relationship with food and physical activity, no significant medical or psychological issues, has always been “too fat,” and comes from a family of people who are of similar builds. Meanwhile, the other person is “too fat” due to binge eating disorder. The former receives no treatment while the latter receives treatment for his eating disorder, not his body size.

Now consider another example of two people who are both “too thin.” One person has a healthy relationship with food and physical activity, no significant medical or psychological issues, has always been “too thin,” and comes from a family of people who are of similar builds. Meanwhile, the other person is “too thin” due to anorexia nervosa. The former receives no treatment while the latter receives treatment for his eating disorder, not his body size.

[Note: Anyone of any size can have an eating disorder, including some “too thin” people who experience binge eating and some “too fat” people who restrict. In reality, we never completely know what struggles someone might have just by looking at them.]

In both cases, whether one is “too fat” or “too thin,” any treatment is targeted at the underlying pathology, if one is present, not at the body size itself. However, for the person who is “too fat” due to binge eating disorder, we let the person’s weight take care of itself as they progress through treatment, as opposed to focusing on the weight. He may or may not lose weight as his disorder subsides, but altering his body weight is not the goal for two reasons:

(1) While being “too fat” is associated with an increased risk of medical woes, causal relationships have not been established, contrary to popular belief. In chapter six of Health at Every Size, Dr. Linda Bacon does an excellent job of explaining the correlations between body weight and the conditions for which weight is often blamed.

(2) While our bodies are relatively adept at gaining weight, they are resistant to long-term weight loss. In other words, interventions aimed at lowering body weight are most likely to result in ultimate weight gain, so in that sense even if the patient’s weight itself is the problem, he is only likely to exacerbate the condition by trying to lose weight.

In contrast, for the person who is “too thin” due to anorexia nervosa, weight restoration is an important part of his recovery. When someone becomes unnaturally thin due to restriction, overexercise, or other disordered behaviors, the body sheds not just fat mass, but also bone structure and tissue from organs, including the brain.

Dr. Ovidio Bermudez, Medical Director and Chief Medical Officer at the Eating Recovery Center, a behavioral hospital for children and adolescents, gave a talk at the 2014 Hynes Recovery Services conference in which he explained, “As a young girl starves herself, or a young man starves himself, and they knock off their sex steroid production, one of the important aspects of that, one of the downstream consequences of that, is that they may also be unintentionally impacting very important aspects of brain development, including neuronal growth.”

When discussing recovery, Dr. Bermudez noted that brain atrophy can be documented just as we can document bone demineralization, and then he continued, “If you stay underweight, your brain size does not recover. So you have to really normalize your weight in order for your brain size to recover.”

Dr. Kim Dennis, former Medical Director at Timberline Knolls Residential Treatment Center and current Medical Director at SunCloud Health, presented at the same conference and explained further, “When a patient with anorexia also says they’re depressed or a parent says they’re depressed, many times that’s not depression. That’s simply what looks like a mood disorder, but it’s based on the fact that their frontal lobes are shrunk, they can’t display affect, they have lower levels of neurotransmitters in their brain, and the cure to that, the treatment to that, is not necessarily Prozac, but it’s food and refeeding.

“Many times patients with anorexia really, really value their brains, and a lot of times you’ll tell someone with anorexia, ‘You’re not thinking straight because you’ve lost neurons. Your brain looks more like a 60-year-old with early dementia than an 18-year-old.’ And they’ll say, ‘I know a lot of anorexia patients might look that way but my brain doesn’t.'”

She then referred to a slide showing a brain with reduced volume due to restriction side by side with a healthy brain. “It’s important for us [clinicians] to realize when we’re working with a malnourished, underweight patient that there’s no amount of CBT (cognitive behavioral therapy) or DBT (dialectical behavioral therapy) or trauma work that’s really going to be effective unless that person’s brain is regrown first. So, first and foremost, food is medicine.”

Left: Normal control. Right: Patient with anorexia nervosa. (Image courtesy of Dr. Kim Dennis and SunCloud Health.)

Sometimes patients ask me to differentiate how my role, as a dietitian, differs from the roles played by other practitioners on their treatment team, namely their therapist. Oftentimes, I explain that eating disorders are mental illnesses that get played out through food. My role is to provide nutritional support during the early stages of recovery and then to help someone form a new and healthier relationship with food as the eating disorder recedes, but the bulk of the recovery happens in the therapist’s office.

For the reasons that Dr. Bermudez and Dr. Dennis explained, the brain cannot rebuild without weight restoration, and without an appropriately functioning brain, therapy – and therefore eating disorder recovery – becomes that much more of an uphill battle.

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.

He Said, She Said: Menu Calorie Counts

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He Said

Nutrition information has its upsides, but the data are only as useful as their interpretation. Context and framework matter; without a solid foundation, food labels and menu calorie counts can do more harm than good.

Maslow’s hierarchy of needs suggests that we, as humans, have basic needs that must be met before we can fulfill more advanced needs. Nutrition has a similar structure. At the base, someone has to have food – period. If food security is an issue, whether it is due to financial limitations, self-imposed restriction, or any other factors, then not much else matters. At the structure’s very top rests the hard science of nutrition as it relates to whatever medical conditions we may have; this is where we might talk about grams, calories, or various micronutrients. In between are issues of eating behavior that often go overlooked and yet are critical to address. Many people want to jump right to the top, but the danger in doing so is that without a solid middle, the structure is likely to fall apart.

Nutrition labels on packaged food can be helpful to someone with a healthy relationship with food and their body, but in the hands of an individual who does not have the solid middle that I previously discussed, the information can be misinterpreted, maybe reinforce a good/bad food dichotomy, and lead to or exacerbate issues like weight cycling and disordered eating.

In grocery stores, at least, we have a certain level of privacy and ambiguity that may mitigate the damage. Few shoppers probably recognize the yogurt in your cart as being higher in calories than its counterparts, and ultimately neither your fellow shoppers nor the cashier know whether that ice cream you are buying is for your kid’s birthday party or for yourself. Such uncertainties can help comfort people who fear judgment from the people around them.

Calorie counts on restaurant menus present a more complex problem. We place our orders in front of friends, family, co-workers, acquaintances, waitstaff, and fellow patrons who are primed for judgment because they – thanks to the menu – know how many calories you have elected to order for yourself.

Certainly, not everyone judges, and some of us are coated with more Teflon than others, but for many people, even the mere fear that the person across the table may be thinking “No wonder you are so fat/skinny/slow/etc.” can be enough to cause problems. The middle layer of the nutrition hierarchy involves making food decisions based on internal cues rather than external constructs. Issues of guilt, virtue, judgment, praise, and fear cloud the picture and make the establishment of this kind of relationship with food that much more difficult to attain.

Of course, restaurant nutrition information can be helpful sometimes – for example, I remember looking at the Bertucci’s website with a patient of mine in search of menu items that would mesh with his sodium restriction – but it can be provided in ways that are cognizant of potential harm. My suggestion: Post nutrition information online, as many chain restaurants already do, and have it available on site per customer request, but leave it off the menus.

 

She Said

When Jonah and I went to Bertucci’s Italian Restaurant the other night, we both realized that the menu had been redesigned (Clearly, we are regulars at Bertucci’s!). In addition to new entrees and different graphics, I was dismayed to see calorie counts prominently displayed above each and every menu item. I remember when the law was passed requiring all chain restaurants to publish their calorie information on their menus, but for some reason I had forgotten about it. (I feel like the law was passed a few years ago and just now is being implemented.) In any case, it was jarring for me to see this information, and it also made me quite concerned for my patients with eating disorders (ED).

Most, if not all, of my clients with EDs have engaged in some sort of calorie counting. Whether tallying up carbs, “macros,” or points, these patients have misused the nutrition information available to them in order to help them engage in ED behaviors. Much of my work with these individuals is around helping them to move away from the counting because it is completely antithetical to intuitive eating.

As Jonah and I have discussed before, intuitive eating is the practice of using one’s internal cues rather than depending on external factors to make food decisions. That means that someone who is an intuitive eater will (most of the time) eat when they are physically hungry and eat what they are hungry for in an amount that is satisfying. It’s about trusting your body to tell you what it needs and then honoring your body’s needs by fulfilling them.

Most of my patients with ED struggle with the idea of intuitive eating because it flies in the face of what their ED is telling them – food is to be carefully monitored and planned, certain foods are bad for you and should be off-limits, you can’t trust your hunger cues, etc. Many of these patients use calorie counting as a way to gain some control, to feel like they know exactly what they are putting in their bodies. One of my patients who is doing quite well in her ED treatment says that she still can’t shake the calorie counting habit, and she notices that this behavior ramps up when she is anxious, stressed, or overly hungry. One could say that calorie counting is a coping mechanism for many people because it helps to alleviate unpleasant feelings by giving them something concrete to focus on.

In any case, I often encourage my patients to ignore nutrition labels as it can trigger their ED. And in many cases, it is possible to (mostly) avoid this information – by purchasing unpackaged foods, buying prepared food from smaller restaurants or stores, etc. However, with this legislation, many more people will be exposed to calorie information at restaurants that they have gone to for years, and it is inescapable. I know that much of the nutrition information for chain restaurants has been available online for years and that anyone could just look up the calories on the restaurant’s website, but that at least takes a bit of effort. If someone really does not want to see this information, they will avoid it, but printing it directly on the menu makes that nearly impossible (short of never visiting the particular restaurant again).

In my opinion, I think that calorie information should be made available if the customer requests it. Everyone has the right to know what they are putting into their body. But it would be great if restaurants could also provide menus without the calorie information in order to prevent triggering individuals with ED or a history of disordered eating. It could make a number of people feel safer in these establishments, and that would make a big difference in many people’s lives.

Politics

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Shortly after we published our March e-newsletter, I received an automated notification informing me that one of our readers had unsubscribed. His given reason: “your political bias – no thanks.”

The only overt political statement we made is that we had followed through on our promise to donate all of the co-pays we collected between Thanksgiving and New Year’s to the Southern Poverty Law Center (SPLC), an organization that fights hate, teaches tolerance, and seeks justice. Huh, I wonder which of those missions our reader objects to the most?

Anyway, at first I felt bad, as if the loss of a reader indicated a shortcoming on my part. Maybe I had crossed a line of some sort by bringing politics into our work.

On the other hand, fuck that. Acknowledging that nutrition is political and declaring what we stand for is important for our practice’s identity.

Nutrition is science, and science, as recent times have reminded us, is political. A couple of weeks ago, I participated in the Boston March for Science. Take a moment to steep in the ridiculousness that is having to stage a protest in hopes that our current leaders will incorporate evidence into their proposed policies.

Nutrition is healthcare, and healthcare, as Republican efforts to destroy Obamacare have reminded us, is political. Today, the House voted for the American Health Care Act, which – if enacted – will result in the loss of health insurance for millions of people and hasten death for many of our fellow citizens. The American Medical Association has condemned the Act, while I remember would-be patients who were unable to receive treatment because their insurance refused to pay. I think to myself: This is only going to get worse.

Nutrition is cultural, and our culture, as we have known for years, is political. Regardless of her intentions, Michelle Obama’s support for the “war on obesity” made our societal focus on weight that much more glaring. Our current, umm, leader’s objectification of women and admissions of sexual assault, for which millions of voters inexcusably gave him a free pass, are exacerbating matters. In an effort to flee weight stigma and oppression, people run towards a diet culture that damages relationships with food, increases eating disorder risk, and – ironically – promotes weight gain and worsened health.

Politics are not just about which bubbles each of us fill in on election day. Our positions reflect how we move about the world and what we want not just for ourselves, but for our friends, neighbors, strangers, the generations that will come after us, and of course our patients.

Nutrition is political, and our stances regarding the latter are intertwined with how we approach our work. We believe that everybody – regardless of their gender, size, weight, religion, country of origin, wealth, lifestyle behaviors, ethnicity, language, mobility, or sexuality – is deserving of respect, informed consent, and affordable access to evidence-based healthcare as a matter of human rights.

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.

He Said, She Said: Clean Eating

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He Said

The phrase “clean eating” never arose in nutrition school, and the only time I have seen it appear in a peer-reviewed journal article was in reference to behaviors that could be described as disordered eating. That should tell us something.

Pop culture nutrition is, after all, quite different from scientific nutrition, and “clean eating” resides squarely in the former. Given the nature of “clean eating,” let us look in that direction for its definition. “Clean eating is a deceptively simple concept,” according to Fitness Magazine. “Rather than revolving around the idea of ingesting more or less of specific things (for instance, fewer calories or more protein), the idea is more about being mindful of the food’s pathway between its origin and your plate. At its simplest, clean eating is about eating whole foods, or ‘real’ foods — those that are un- or minimally processed, refined, and handled, making them as close to their natural form as possible.”

Unsaid is the prevalent cultural implication that “minimally processed, refined, and handled” foods – “clean” foods, in other words – are healthier than foods that do not fit this description. While the concept of emphasizing foods that are less processed has some merit, the message is so oversimplified and rounded off that it is more problematic than useful.

For someone trying to keep his blood sugar steady, whole grains might be more conducive to achieving this goal than more refined grains would be because the former tend to be higher in fiber and protein compared to their white counterparts, which are stripped of these nutrients during processing (although these nutrients, and others, are sometimes added back via fortification).

In other cases though, foods that are more processed might actually be the better choice. For example, I think of one of my patients, a young woman who had lost her period for many months due to nutrient deficiency, and it was not until we increased her intake of more-refined foods – which tend to be more calorically dense – that her period returned.

What constitutes a healthy choice for someone really depends on the individual, their needs, their preferences, and other factors that are unique to them. One of the problems with the way our society talks about food is the individual gets lost. For example, we talk about foods being “good for you” or “not good for you,” but who is the “you” in question? Almost always, the phrases refer to a monolithic representation of the population that probably does not take into account the unique characteristics that separate each of us from the pack. Talking in generalities has its place (No matter who you are, drinking paint thinner is not good for you.), but way too often that kind of oversimplified talk is misleading at best and damaging at worst.

Consider the good/bad food dichotomy embedded within “clean eating.” Foods unworthy of the “clean” label are, what then, “dirty”? If you have ever dieted, remember what it was like to consume foods that were frowned upon in the context of the diet. Most likely, ingestion of a small amount of a forbidden food triggered overconsumption of said food, not because of any objective qualities inherent to the food, but rather because of the overarching subjective eating experience. We eat a little bit of “dirty” food, figure today is ruined anyway, so we might as well have some more – whether we intuitively feel like more or not – and resolve to start over “clean” tomorrow.

Clean vs. dirty, good vs. bad, sin vs. virtue, these are issues of morality and spirituality that have infiltrated the world of nutrition. Alan Levinovitz, a religion professor who has taken to writing about nutrition in recent years because of the intersectionality of spirituality and food, explains, “It’s terrifying to live in a place where the causes of diseases like Alzheimer’s, autism, or ADHD, or the causes of weight gain, are mysterious. So what we do is come up with certain causes for the things that we fear. If we’re trying to avoid things that we fear, why would we invent a world full of toxins that don’t really exist? Again, it’s about control. After all, if there are things that we’re scared of, then at least we know what to avoid. If there is a sacred diet, and if there are foods that are really taboo, yeah, it’s scary, but it’s also empowering, because we can readily identify culinary good and evil, and then we have a path that we can follow that’s salvific.”

Hence, we invent a construct of “clean eating” that is based less on science and more on profound issues of humanity. Understandable as this behavior may be, I cannot say strongly enough: Our relationships with food become much less fraught when we remove issues of moralization, sin, and virtue from our food choices and eating behaviors.

 

She Said

Many of my patients with eating disorders (EDs) and/or disordered eating have engaged in “clean eating” at some point in their lives. The practice of eating only unprocessed, organic, additive-free foods that have the highest nutrient value seems to be the diet du jour for many people right now. And I get it – many of us want to live the longest and healthiest lives we can, and one of the ways we can take care of ourselves is by being aware of what food we put in our bodies. Take a look at any viral “food science” article or video online and you will hear doctors, dietitians, and other health care practitioners and researchers telling you that if you eat this one food (or don’t eat this one food), you can expect to live longer (or die sooner) – as if every food decision we make over the course of the day has the power to lengthen or shorten our lives. It makes it seem like we have so much control over our health, that if only we eat the right things, we will never have illness and will live forever. Of course, this is just not true (case in point: fitness guru Bob Harper’s recent heart attack).

Given the oversimplified and misleading fashion in which food-related information is often presented in the media, nutrition must seem like an ever-changing landscape. Sure, the field is evolving just like every other facet of health care, but not as radically or quickly as the public is led to believe. Every month, a new “super food” is unveiled and promises to improve our energy, stave off cancer, prevent heart disease, and so on and so on. Never mind that just a month earlier this food might have been on the “unhealthy” food list (I’m looking at you, coconut oil.). The point is that nutrition is always evolving, and trying to keep up with all of the foods we “should” and “shouldn’t” eat is exhausting. Yet, so many of my patients are obsessed with eating only the most nutritious, healthiest foods. They emphatically believe that some foods are inherently virtuous and clean, worthy of being ingested, while other foods are a waste of money and have no business being called food. And I believe that this is a big problem.

Food is not just fuel. Let me repeat this again. Food is not just fuel. Food is connection; it’s tradition, rituals, and how we care for ourselves and others. Food can elicit some of our most cherished memories (e.g., grandma’s famous chocolate chip cookies), and food can comfort us at times. I know that “emotional eating” has been deemed a problem by many, but really, it’s okay to eat emotionally at times. In fact, it’s completely normal! For people with EDs and disordered eating, sometimes the act of eating food can be agonizing, physically, emotionally, and mentally. I can’t count how many times I have heard some version of the following from my patients: “I wish I didn’t have to eat food, that I could just get all of my needed nutrients from an IV. It would make life so much easier.” These types of sentiments break my heart.

For individuals with EDs or disordered eating, breaking foods up into “good/bad” or “clean/unhealthy” categories is de rigueur. By having clear-cut rules about what is okay and not okay to eat, these individuals feel safer and in control (Of course, we know that really, the opposite is true – these rules control the individual.). In my work with my patients, I try to help these patients challenge their food rules. This might be having them eat a formerly loved food that they have not allowed themselves to eat due to perceived lack of nutritive value. We will also discuss the value of eating a wide variety of foods, that all foods fit, even Oreos. For most of these patients, they feel that eating less-nutrient-dense foods is a waste of time, that they are “empty calories” and have no business being eaten. I have had to justify more times than I can count why Oreos might sometimes be a better choice for a snack than an apple.

What it comes down to is this: Is eating “clean” really improving your life? Aside from perhaps improving some physical health markers, how are the other aspects of your life? Are you able to share meals with others? Are you able to partake in your child’s birthday cake? Are your food rules running your life or limiting it? These questions are what I would ask a “clean eater” to consider.

He Said, She Said: Whole30®

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He Said

Earlier in my career, I worked at a medical clinic where part of my job was to put people on a 28-day “detox” program, when ordered to do so by the doctors, for reasons ranging from digestive woes to problems with fertility. For those four weeks, the patient abstained from gluten, dairy, soy, eggs, peanuts, shellfish, corn, and other foods deemed to inflame the body. At the end of the four weeks was the possibility of reintroducing the forbidden foods in systematic fashion in hopes of determining the impact of each.

If the protocol, rationale, and reasons for use sound familiar to you, that may be because they are all strikingly similar to those of the Whole30® program. “Strip them from your diet completely,” the Whole30 program’s website says of the demonized foods. “Cut out all the psychologically unhealthy, hormone-unbalancing, gut-disrupting, inflammatory food groups for a full 30 days. Let your body heal and recover from whatever effects those foods may be causing. Push the ‘reset’ button with your metabolism, systemic inflammation, and the downstream effects of the food choices you’ve been making. Learn once and for all how the foods you’ve been eating are actually affecting your day to day life, and your long term health. The most important reason to keep reading? This will change your life.”

Oh, Whole30 might change your life all right, but perhaps not in the ways that you hope. Let’s take a closer look at the program and examine three questions that address how the claims and expectations stack up against what really happens when someone embarks on such a journey.

(1) Are the excluded foods (added sugar, alcohol, grains, legumes, dairy, carrageenan, monosodium glutamate [MSG], and sulfites) really “psychologically unhealthy, hormone-unbalancing, gut-disrupting, inflammatory food groups”?

In short, no, the connection between food and our bodies is not that simple. Taking a step back in order to gain a macroscopic view of life, we see that few of us are comfortable with murkiness and uncertainty, and this overarching theme weaves its way through our relationships with food. Our yearning for crisp delineations leads to an oversimplified good/bad food dichotomy that might make us feel at ease, but really, it is nothing more than the application of scapegoating to nutrition.

Alan Levinovitz, a religion professor who has taken to writing about nutrition in recent years because of the intersectionality of spirituality and food, explains, “It’s terrifying to live in a place where the causes of diseases like Alzheimer’s, autism, or ADHD, or the causes of weight gain, are mysterious. So what we do is come up with certain causes for the things that we fear. If we’re trying to avoid things that we fear, why would we invent a world full of toxins that don’t really exist? Again, it’s about control. After all, if there are things that we’re scared of, then at least we know what to avoid. If there is a sacred diet, and if there are foods that are really taboo, yeah, it’s scary, but it’s also empowering, because we can readily identify culinary good and evil, and then we have a path that we can follow that’s salvific.”

(2) The Whole 30 website reads, “We want you to take this seriously, and see amazing results in unexpected areas.” What about that?

One of the confounding factors, and indeed one of the greatest challenges, with elimination diets is the power of suggestion inherent to unblinded experiments. If someone wants to test if dairy is responsible for whatever symptom is ailing him, he might first cut out dairy, wait for the symptom to subside, and then add back dairy systematically to see if the symptom returns. He knows whether he is pouring himself a glass of cow’s milk or a dairy-free alternative though, and this knowledge can influence the presence or absence of the symptom in question via placebo or nocebo effects.

For example, consider the patients I wrote about a few years ago who told me how much better they felt after cutting out gluten while they – unbeknownst to them – were still consuming gluten in abundance. They expected the exclusion of gluten to produce a positive result, so the mere belief that they had done it created the desired outcome.

By scapegoating the to-be-excluded foods before the program begins, Whole30 builds expectations that their removal will yield positive results. By guiding participants to consider “results in unexpected areas,” the program throws a bunch of crap against the wall, assuming some of it will stick. You may remember that scene in Ghost in which the psychic, played by Whoopi Goldberg, offers name after name until she hits on one that her client – who fails to see through the sham – recognizes and takes as proof of a metaphysical connection to the afterlife. Similarly, the likelihood is that over the course of 30 days, at least one facet of your wellbeing will improve, even if temporarily, and Whole30 is banking on you giving credit to the program when in fact another factor could very well be responsible. 

(3) What happens beginning on day 31 and beyond?

“We cannot possibly put enough emphasis on this simple fact—the next 30 days will change your life,” the Whole30 website reads. “It will change the way you think about food, it will change your tastes, it will change your habits and your cravings. It could, quite possibly, change the emotional relationship you have with food, and with your body. It has the potential to change the way you eat for the rest of your life.”

If your expectation is that after 30 days of abstinence, you will no longer have the taste for or cravings for the foods you excluded over the past month, you will probably be quite disappointed. “A review of the literature and research on food restriction indicates that inhibiting food intake has consequences that may not have been anticipated by those attempting such restriction,” wrote Janet Polivy, a psychology professor at the University of Toronto. “Starvation and self-imposed dieting appear to result in eating binges once food is available and in psychological manifestations such as preoccupation with food and eating, increased emotional responsiveness and dysphoria, and distractibility.”

In other words, you will likely be drawn to the excluded foods more than before the program began and overconsume them. The overeating further reinforces your preconceived notion that these foods are a problem. You may even begin to believe that you have a “food addiction” and eliminate the food again, not realizing that your presumed treatment is exacerbating the supposed problem.

Back in my days of implementing the 28-day detox program, such rebound eating was commonplace, and I had many repeat patients who did the detox over and over again in the earnest belief that the latest attempt would turn out differently than all of the ones that came before it. They blamed themselves when really the program was a setup for failure.

Taking a look at the Whole30 website, I see similar red flags planted to expunge the program of responsibility while erroneously placing the blame for potential failure squarely on the shoulders of participants. “Don’t you dare tell us this is hard. Beating cancer is hard. Birthing a baby is hard. Losing a parent is hard. Drinking your coffee black. Is. Not. Hard. You’ve done harder things than this, and you have no excuse not to complete the program as written,” the site reads. “Don’t even consider the possibility of a ‘slip.’ Unless you physically tripped and your face landed in a box of doughnuts, there is no ‘slip.’ You make a choice to eat something unhealthy. It is always a choice, so do not phrase it as if you had an accident.”

See through the enticing marketing and realize that diets like Whole30 are unlikely to produce long-term positive results and are more likely to pave the way for weight cycling and an unhealthy relationship with food while making you feel responsible for their failures.

 

She Said

While the Whole30 program has been around for a few years (It was created in 2009 by two “sports nutritionists.”), it feels like I have been hearing a lot more about it recently. And since we recently rang in the New Year, there seemed to be a surge of Whole30 talk both inside and outside my office. Many of my patients have asked me about the eating plan that emphasizes eating “whole” (i.e., minimally processed) foods while avoiding dairy, soy, sugar, alcohol, grains and legumes for 30 days and then strategically reintroducing these foods one by one to see how they affect one’s health, energy and stress levels. One patient of mine is getting married this month, and her husband-to-be and many of her family members are following the Whole30 to start “shedding for the wedding.” Go on any “healthy eating” Instagram page and you will find #Whole30 all over the place, with people posting their “clean” meals and extolling the virtues of this way of eating.

As you can guess, I am not a fan of Whole30, or any fad diet for that matter. Not only is it just another way for someone to try to manipulate their food using external rules to shrink their waistline, but it also promotes the “good food/bad food” dichotomy, which can lead to a lifetime of dieting and never having a healthy relationship with food or one’s body. For someone who is predisposed to developing an eating disorder (ED), following a plan like Whole30 could be especially dangerous because diets are often the gateway to EDs. In fact, many of my patients who struggle with EDs have tried Whole30 (or similar eating plans) and have found that it worsened their ED symptoms.

The tricky thing about the Whole30 is that on the surface it sounds good – the authors talk about the health benefits one can expect to reap by following the program and how eating unprocessed foods can improve one’s health and happiness. The plan suggests that there is a “right” and “wrong” way to eat and that if one follows their food rules, they will live a longer, healthier life. In a way, it kind of smacks of orthorexia (i.e., an obsession with eating in a “perfect” manner) to me, which is tricky, as a number of people want to eat “correctly” and view food simply as fuel for our bodies that should always be of the highest nutrient value. It’s not a bad thing to want to eat healthfully and reap the benefits, but I firmly believe that flexibility is key to developing a healthy relationship with food and one’s body. Eating Oreo cookies is not a death sentence, and eating fruits and vegetables will not necessarily lead to you avoiding dying from cancer. What matters is the overall makeup of our diets, recognizing that all foods fit and that sometimes cookies are the right choice in certain situations.

Diets are seductive – they make lots of promises about how you are going to feel, how your body will change, and how your health will improve. They tell you that by following this arbitrary set of rules, you will reach true nutrition nirvana, all of your ailments will subside, and you will become the best version of yourself. Unfortunately, this is rarely the case, and most people cannot follow such strict guidelines for more than a short while, leading them to backlash by eating all of the “forbidden” foods and feeling like a failure. The very nature of diets is temporary, and any results one experiences during the “honeymoon” phase of a diet will likely dissipate once the dieter cannot follow the plan anymore.

I discourage my patients recovering from EDs from trying a plan like Whole30. In my work with these individuals, I am trying to help them eventually learn to trust their own bodies’ wisdom, that their body will tell them what, when, and how much to eat if they listen hard enough (i.e., intuitive eating). Eating in a way that is enforced by a set of external rules, like Whole30 or any other diet plan, flies directly in the face of this intuitive eating philosophy and can derail progress for many individuals dealing with ED. My advice? Skip the Whole30 and find an intuitive eating specialist who can help you rediscover what foods work for your body and promote your health (mentally, physically, and emotionally).

Wins and Losses: Old Habits Die Hard

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The following piece was written by one of Jonah’s patients who wishes to only be identified as a 36-year-old male.

Befitting the New Year, you would think I’d be writing about my resolutions for 2017, but I have a win from this past Thanksgiving that I’d like to share.

A little about me

I was a dancer as part of a performing arts group, and I traveled throughout the world dancing and performing in various venues — some as big as football stadiums and others as intimate as a small conference room. I was very fortunate to have this experience growing up (I began performing at the age of 16 and “retired” at the age of 26.) and feel grateful to have the talent and courage to pursue this sort of lifestyle. I’ve been to almost every U.S. state (excluding Alaska and the Dakotas) as well as various cities around the world — Paris, Amsterdam, Taiwan, Yokohama, Toronto, etc. I loved seeing all the different cities and how different cultures interacted within themselves, with other cultures, and even with their surroundings.

As you can probably imagine, traveling the world was glorious, but it was not easy by any means. I lived out of a suitcase for 6 months at a time; missing family events while I was on tour was the norm; and our sense of “home” was based on how long we would be staying in Anytown, USA. We were also at the beck and call of the directors and the schedules they created. Rehearsals every day, 7 days a week from 9am to 6pm (or some days even later if we didn’t have a show); additional performances that really strained every minute for “ME” time; and when and what to eat (and usually how much to eat) were always decided for us. It’s not as bad as I just made it seem. Like I said, it was quite glorious. It was nice to not think about the outside world — everyday tasks were managed for me. It really allowed me to focus on why I was there: to be the best performer I could be.

Perfection is attainable…right?

Dancing, much like any other sport, is really tough on the mind, body, and spirit. To be the best, you really have to work hard and be committed to the craft (not to mention have good genes and be somewhat of a natural talent). After all, the producers don’t give solos to the 2nd-best dancer. Dancing is also very specific — there is only one correct way to stand in first position. Any slight variation thereof is, well, simply incorrect. One might perfect their skills in other sports (i.e., one might work hard enough to make 9 out of 10 free throws), but in dance, there is always something that can be improved. So the idea of dancing “perfectly” does not exist. Yet, to be accomplished in dance, you constantly strive for this perfection. The struggle to jump higher is real. Turn faster. Turn faster! TURN FASTER! Even though these pressures mainly came from within myself, I became so worried (and obsessed) about being the best that nothing I did was ever good enough. Somehow, I thought I could achieve something better than perfection.

This battle bled into all aspects of my life: from personal relationships and self-confidence to body image and diets. Especially the latter. I distinctly remember a moment during the high point of my career. We were in dress rehearsal, putting together the finishing touches before our big opening night. At this point, we were all dancing 7 days a week for 6 to 7 hours per day. I was in peak fitness. I also wasn’t eating much because there was a portion of the performance where the men had to perform shirtless, and well, I was self-conscience about that since I wanted to look perfect. I mustn’t have weighed more than 130 pounds (I’m 5’10”.). My director approached me and suggested I watch my diet for the next few days because I would be standing next to some of the other men. She glanced over at the skinniest performer. She didn’t need to say the words, “and you are bigger than he is,” as the look was enough for me to really think about what I was doing and, more importantly, why I was doing it.

That moment was so pivotal to my career as a dancer. For me, dancing was like having a relationship with a double-edged sword. I loved to dance and was so passionate to share that with the world. I was enamored by the craft, while being pricked by both ends, as dancing created an environment that allowed me to neglect healthy eating and nutrition choices. I have trouble dealing with and embracing my own body image (The constant critiques towards a dancer are never-ending.); I struggle with the concept of working out to live a healthy life versus exercising to burn calories/lose weight; and even more, I have a hard time figuring out how to tune in to my body to find what I want to eat, when to eat it, and, more importantly, when to stop eating because I’ve reached an acceptable level of fullness.

Now (over 15 years later), my life is completely different. I’m not dancing anymore, so there’s that. I knew I wasn’t going to be able to dance into retirement, so I decided to pursue a different career and won’t bore you with those details now…just know that my life as a world traveler is much less exciting. What is exciting though is that I’m the leader of my own ship. I am in control of how my story goes, and I’ve come to love this freedom in most aspects of my life.

Setting expectations

Years following, I had the hardest time staying “in shape” — I would try any sport that would help me keep the pounds off: yoga, running, triathlons, obstacle course races. And even though all the training helped to maintain my body shape, I was still unhappy with the results I was experiencing. After talking to my sister-in-law about her nutritionist, I thought I’d give it a shot.

You should’ve seen me in my first session with Jonah — looking back now, I think it was quite comical — I came into the office, strong and confident, ready to establish expectations for our future work. I said, “Listen, you can put me on any kind of diet, but I won’t give up my sweets. I love them too much!” I didn’t realize I had the experience all wrong — it wasn’t about the sweets. I would then be educated about the different theories of nutrition, their applications, and the work I had ahead of me.

During our sessions, we would work on binge eating, recognizing fullness, honoring my hunger, and celebrating my relationship with food. We talked about embracing my body image and what that meant for me. We formalized strategies for upcoming occasions where my old habits would challenge my new relationship with food. Most importantly, we didn’t give up my sweets!

So…about that win!

As I mentioned earlier, I have trouble accepting my level of fullness. I went from being told what to eat to complete eating freedom, so you can imagine the binge eating every Thanksgiving, year after year, leaving the dinner table filled to the brim with stuffing, cranberry sauce, and mashed potatoes. You name it, I would eat it — if I didn’t really like the taste — or even if I was already full — or because there was something about missing out on the taste that I couldn’t let go — or because I didn’t want to upset the host by not eating the food they’d so lovingly prepared for us that day.

I wanted this Thanksgiving to be different from previous years, however. This year, I came to dinner with a plan on how I was going to eat during this meal, and I was determined to stick to it! (Spoiler alert: I did!)

Plan of attack

Through my work with Jonah, we were able to formulate a plan, and it was simple (in theory). I was going to take an inventory of the available foods during our Thanksgiving feast. As I walked around, I recognized foods that were appealing to me — I really tried to tune in to my intuitive eating skills — and what foods I could skip out on. I say “in theory” because by doing inventory, I also had to accept the foods that were appealing and give myself permission to eat those foods without guilt (For the record, I love bread and butter…lots and lots of butter.).

The result: I don’t really like all three varieties of stuffing, I don’t need to eat them all, and no one was going to heckle me about trying them all. Most everyone else was too busy serving themselves anyway. This quick walk-through allowed me to really honor and respect my hunger. It gave me the opportunity to carefully select the foods I was so excited to eat — it was Thanksgiving after all.

For the first time I can remember, I left Thanksgiving dinner feeling comfortable in my own skin (and clothes) by not overeating. I am still on the high from this win, and it helps give me confidence going in to whatever meal comes next. It might not be the most exciting win, nor does it mean I am over battling my other eating issues. But it is a “W” in my column.

Don’t get me wrong

I have good days and bad days. There are days where I eat multiple times throughout the day without ever consulting my intuitive eater. There are times when I feel like I really need to get to the gym to burn off that cookie I had earlier. Even though my day-to-day’s nutrition success fluctuates, what I’ve realized is that it’s a work in progress, and I won’t deny myself (and you shouldn’t either) the ticks in the “W” column (the everyday wins). I’ve earned that “W” and proudly display it on my sleeve (Ok, not literally. I am writing this anonymously, so if I wore a “W” on my sleeve, it might give me away.). You should too. No matter how big or small.

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.