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.

The Struggle Is Real

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The following is a guest column by one of Joanne’s patients, Ashley, a 28-year-old female. We sincerely thank her for sharing her story.

Processed foods.  Whole foods.  Organic.  GMOs.  Good Foods.  Bad foods.

When did all of these labels become so powerful? When did we stop listening to what our bodies wanted to eat, rather than what the media deemed appropriate? If you are a person living in this country, my guess is that your food intuition got drowned out somewhere in your childhood/adolescent years. For many, once we gained the wherewithal to understand the outside world and the messages being thrown at us via TV, radio, internet, we were no longer allowed to listen to our bodies and were told the “right” and “wrong” ways to eat. Or maybe you are one of the rare people that maintains a healthy, nonjudgmental relationship with food. If so, please don’t change your ways; you are unique and courageous.

Let me start by saying that I have been in recovery from a restrictive eating disorder for about three years. At the height of my eating disorder, I felt as though I could not escape the judgmental voices in my head that were only amplified by the outside messages I was receiving. I have never been considered an overweight child or adult, but at a young age, I became hyperaware of my food habits and developed an overwhelming fear of being fat. Growing up in an affluent town, where the pressure to succeed in every way, shape, and form became the standard, maintaining a “thin” ideal was the only way I felt I could succeed, as I did not believe I was successful enough in my studies at school. I was very studious and maintained As and Bs, but this was not comparable to the others around me in high-level AP courses with perfect scores. With this frame of mind, I turned to food restriction in the hope that if I couldn’t be the smartest, I would strive for the “perfect” body instead – whatever that even means.

I later learned that food would become a perceived source of control for when anxiety took hold in my life. Generalized anxiety, with a bit of obsessive compulsive behavior, is a genetic component of my brain chemistry that I inherited; it is a feature I share with others in my family. This seems to be a common theme amongst those with eating disorders, and thus I am not unique in this. My life became consumed with thoughts of food, body image, and the fear of becoming fat. I never thought I was dieting, just “eating healthy.” Striving to increase fruit and vegetable intake, and getting physical activity, in and of itself is a great thing. However, it is commonly a gateway mindset to disordered eating. What most people don’t understand is that an eating disorder is not something that is chosen or easily reversed. A lot of people have said to me “just eat,” or “you have nothing to worry about; you’ve never been overweight.” Trust me, I would not choose a life full of counting calories and innate voices telling me that if I maintain my thinness, I am a better, more beautiful person. That is an insurmountable amount of pressure to be put under, so no, I did not choose to think and act this way. Of course, an eating disorder, while potentially deadly in its own right, is not necessarily a terminal disease, and for that I am very grateful, but that does not mean my story is any less important or challenging. It is a taboo social/mental health issue that we don’t often discuss (until most recently), but I would like to put an end to that. Many of us suffer in silence with voices telling us that we are not thin enough, or that if we put on weight, we will not be loved. I myself did not have the discussion with many of my closest friends until a year or more into recovery.

I can tell you that although I have come a remarkably long way in my journey to recovery, these voices never go away; they only get quieter. I have come to terms with the fact that this may be my own destiny, but that doesn’t necessarily mean food has to run my life in a negative fashion. It has been embedded into our brains as a society that there is a certain way to eat, and not to eat. For some reason, food has gained a moral power, and we are judged on character by what and how much we eat on any given day. For those of us who have struggled with any form of eating disorder, it feels nearly impossible to ignore the flood of messages we receive on an hourly basis regarding food choices. For some, it may be easier to block these harmful messages out, and for that, I am envious.

By nature, I am an easy target for the influence of what I refer to as “Ed” (as in Eating Disorder), the alter ego voice that reinforces negative and irrational food thoughts and behaviors. I was an insecure child growing up in a high-pressure minicosm within a larger society that places increasing value on the “thin ideal.” Trying to navigate the steps to recovery has felt impossible at times in the modern-day era, where food and body size remains a constant topic of conversation. This hyperawareness of food is a fairly novel phenomenon. The seemingly harmless recipe blogs found on Pinterest, fitness blogs, and health research articles have grown in numbers, highlighting the fact that food obsession has become the norm. There have been periods in recovery where I had to deactivate my Facebook account and/or unfollow certain websites in order to regain my sanity and focus on what works for MY body and holistic self. The number of conflicting (and often untrue) facts and opinions on the “best,” “healthiest,” “clean” diets, available at our fingertips is more harmful to achieving a “normal” food mentality than we realize. Even something as seemingly innocent as family, coworkers, and friends asking what I was having for lunch or dinner, or what was in the lunch I brought to work. The analysis and chatter regarding food trends and health is inescapable, and when I took a step back and became aware of it, I recognized my OWN disordered comments with others. I became more sensitive to asking others about their food habits, or how I complimented them, such as the common, well-meaning “Wow, have you lost weight? You look great!” The number of disordered messages that this single statement holds is often overlooked, as weight loss is praised and often equated with beauty.

A very tricky component of my recovery process is that I enjoy cooking (and have to say I am quite decent at it). I often justified cooking my own meals because it was cheaper and “healthier.” Now while that is certainly true, I now realize that measuring and calorie counting every morsel of every meal provided me with an immense feeling of control. I continued with these obsessive thoughts and behaviors for over 3 years, and only about a month ago did I literally throw out any form of measuring cup or spoon. Over the past year, I began forcing myself to eat out once a week or more, where I couldn’t count calories or micromanage the ingredients in whatever I ordered. What I have learned in regards to this is that control feels safe, but rebellion is uncomfortable, and progress often does not occur without discomfort.

In my recovery process, the practice of “intuitive eating” has truly given me hope. For those of you who are unfamiliar with this style of eating, it is basically a practice of getting in touch with your body’s needs, wants, cravings, and satiety. Instead of “how many calories are in this sandwich?” or “how many calories have I eaten today?” the focus shifts to “what is my body in the mood for, and how can I create that? What type and quantity of food is going to make me feel nourished and energetic?” I have to say that honoring my hunger intuitively has been one of the most difficult challenges throughout the recovery process, but without a doubt, the most rewarding and satisfying. Eating without internal judgment? I have never known what that feels like or what it truly means. I may never fully recover from my eating disorder and have come to terms with that idea. However, I continue to learn about my body and coping skills in ways that I never thought possible. I will continue to have great days and very anxious days, but overall, I can say with confidence that life is truly brighter when food freedom feels just within my grasp.

“If you’re gay, don’t come home.”

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Joanne and I overhear so much nutrition-related garbage at our health club that I have considered creating a new blog category to chronicle it all, the working title of which is “Shit We Overhear at the Gym.” Harsh, but to the point.

Similarly candid and blunt was my experience at the gym this morning, where the topic of conversation was understandably a departure from the typical diet talk, body shaming, and nutrition myths, and instead focused on the presidential election results.

“My husband told me, ‘Anybody but her [Hillary Clinton]’, but I am really scared, and as a woman I feel so disrespected,” said the woman on the cable machine. Shortly thereafter, I ran into a friend of mine who fought back tears as she talked about what Trump’s election means for her 18-year-old daughter who now fears for her present and future.

Once I finished my workout, I headed downstairs to the men’s locker room where the guys were also discussing the election, but instead of crying they were laughing, making a joke of the whole thing. The sample size is small, granted, but the stark contrast between the male and female reactions illustrates the difference between the privileged and the vulnerable.

A friend of mine, someone I have known for close to 30 years, is the only open Trump supporter in my social circle. Once his candidate was declared the victor, he took to Facebook and gloated. After considering whether or not to respond, I decided to reach out to him in a way that I thought might help him to understand what this election result really means for our country.

When we were teenagers,” I wrote, “your father reportedly said to you, ‘If you’re gay, don’t come home.’ Fortunately, you self-identified as heterosexual, but the threat of not being accepted and welcome in your own home shook you enough that you talked with me about it. A Trump presidency makes America a less welcoming and more dangerous place for Muslims, Jews, Mexicans, women, blacks, gays, and other at-risk groups. The outrage and fear we are witnessing regarding Trump’s election is not about political parties, a change in direction, or disagreement over policies; rather, it is about millions of people with whom you and I share this country waking up today worried for their safety and freedom.

“For your sake, I am glad the crosshairs are not on you, at least not yet. Hopefully neither one of your sons is a closeted homosexual or self-identifies as a woman but is too scared to say so. For the rest of us, whether we are members of one of Trump’s targeted groups or we simply care about the people who are, his election is an ominous reminder that hate and scapegoating are alive and well in America and that history can certainly repeat itself.”

Hate is nothing new and Joanne and I have received a small taste of it. Because we advocate for size acceptance, we are occasionally bullied by online trolls who disagree with our stance that everybody, regardless of their size, is entitled to respect and equal treatment. The flack that we catch is nothing; for some of our colleagues, daily death threats are a way of life.

What is new though is the legitimacy that Trump has given to hate. Hiding behind an anonymous Twitter handle or a white sheet was one thing, but suddenly we had a presidential candidate repeatedly broadcasting his racism, misogyny, and bigotry out in the open on international television, and instead of shutting him down, we elected him. No wonder the women in the fitness center cried while the guys downstairs laughed.

As paradoxical as it may sound, intolerance of intolerance is an important stance for the safety of our community. Employees who spout hate speech at work are likely to be disciplined or fired, our legal system has hate crime laws that extend beyond whatever act is committed, and Germany banned the swastika after the fall of the Nazi regime, just to name a few examples. Regarding the latter, I reminded my friend how things worked out for that country and its people when a man rose to power on the platform that minorities were to blame for the nation’s poor economy and lack of prosperity.

We, as Americans, should be ashamed of ourselves. All of the men and women who have given their lives, either literally or figuratively, in military conflicts and civil actions over the past 240 years in pursuit of freedom and equality, and now a good portion of our citizens are eagerly trying to flush it down the toilet. We are a threat to ourselves and the world. America is an international embarrassment.

Joanne and I both want to leave. She says Toronto, I say Canada is too close for comfort and have my sights set on New Zealand. In reality though, running from the problem is no solution and we are not going anywhere. Every generation faces its struggles with hate, but the overall trend moves towards acceptance and inclusion because ordinary people hold their ground, stand up, and demand it.

Gentlemen, the Ladies Do Not Hold a Monopoly on Weight Obsession

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Gentlemen, the ladies do not hold a monopoly on weight obsession. Us guys engage in diet talk and body shaming, too. You know that, right? Maybe not, actually, as such talk is so casual and commonplace that you might not even be aware (consciously, anyway) of its pervasiveness. Consider the interaction I had yesterday evening at the gym with a male acquaintance we will call “Brad,” whom I had not seen in a long while.

Brad walked past me as I was warming up on the Arc Trainer prior to a tennis match. He had just finished a spin class and stopped to say hello. Brad and I first met 16 years ago while taking a core-strengthening class together, but the only place I had seen him in recent years was when we occasionally bumped into each other at the local pub where he eats dinner every Friday.

“You’re in nutrition. What do you order when you go there?” Brad asked with a smirk. Although he did not specifically say so, I knew exactly what he was getting at: He wanted to know if I follow a strict diet or eat freely like a perceived hypocrite, hence the mention of my profession.

Pausing, I considered the various replies at my disposal. On one hand, this was an opportunity to reeducate Brad regarding both the nature of my work and the problems with a good/bad food dichotomy. On the other hand, this was also my free time, and really I just wanted a few minutes to myself to get loose before heading out to the court, not an obligation to broach complex topics when I had neither the time nor inclination to do them justice.

“I order what I want,” I finally told him. “I order what feels like the best choice for my body at the time,” and specifically cited the pizza and nachos, which are my salty favorites to replenish the sodium I lose during long runs. (Note: By no means am I implying that one needs to exercise in order to “earn” these menu items or any other food.)

Then I asked him if he has seen our mutual friend (Let’s call him “Gary.”) who resumed exercising earlier this year after a long absence. “He’s down 40 or 50 pounds,” Brad responded, “He looks great!” Again, I paused and internally debated my next move. At the very least, I knew there was no way I would echo Brad’s praise for weight loss, as I know the damage such extolment causes, especially without fully knowing how or why someone lost weight.

“Weight loss aside, I’m just glad he is taking the time to care for himself again,” I told Brad. Like me, Gary was an avid exerciser, which is how he and I met at the gym soon after I graduated from college, but the burden of his caretaking duties increased as the health of his parents deteriorated and he no longer felt up to working out. His mother and father subsequently passed away in quick succession, which left Gary to settle their estate and figure out what to do with his own life. After everything Gary had been through, I was just happy to see him caring for himself again and returning to the activities he enjoys, including exercise, regardless of his weight.

Unfortunately, Brad did not seem to follow the gist of my sentiments and continued talking about Gary’s weight loss, adding that he has seen Gary do this at least a few times before. By “this,” Brad was referencing Gary’s history of weight cycling: alternating periods of weight loss and subsequent regain. “But not like you have to worry about that yourself,” Brad offered, looking down at my abdomen. “You’re always in great shape.”

Great shape? One of the problems with judging people for their exteriors is that we probably have no idea about the makeup of their interiors, both metaphorically and literally. Too taken aback by Brad’s comment to say anything out loud, I silently reflected upon everything I have been through over the last three years and specifically turned my thoughts to the titanium screws and rods, artifacts from my third back surgery, buried deep inside the midsection of which Brad is apparently so envious.

As is the case for everybody, my size and shape are influenced by many factors, the most significant of which are out of my hands. Among those that are at least somewhat in my control though is my history of never having tried to lose weight, which would have put me on a path most likely to end at, ironically enough, weight gain. In that sense, part of the reason I do not have a “weight problem” is because I never viewed my weight as a problem.

Think about the diet talk and various mentions of body shape and weight that Brad crammed into a casual conversation that lasted just a few minutes. Comments and discussions along these lines are so prevalent that I overhear men talking this way at the health club on a daily basis. Another recent incident comes to mind in which some of my fellow tennis players – adults, no less – bullied another player for the size of his stomach.

The problems with such talk are numerous, including: the reinforcement of the ridiculous, offensive, and dangerous notion that people of certain sizes and weights are more deserving of respect than others; the exacerbation of bullying and unequal treatment that spills well beyond health clubs and into our homes, businesses, classrooms, government initiatives, and doctor’s offices; and the pressure to pursue weight-loss endeavors that most often result in weight gain and worsened health.

Guys, this kind of talk has to stop, and the first steps toward putting it to rest are acknowledging its existence and realizing the harm we are doing to each other through our words.

One Week in October

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October 15, 2016, Ludlow, Massachusetts

Exactly 941 days after my first spinal fusion and 472 days after my second, I drove west to play a match for my old Amherst-based United States Tennis Association (USTA) team for the first time in a decade.

Over those 10 years, and particularly in the last two as I recovered from my operations, I dreamed of reuniting with them and wondered if it would ever actually happen. Intellectually, I thought it might, as my surgeon was cautiously optimistic about my chances of playing competitively again. My physical therapist was more guarded, however, particularly because the failure of my 2014 surgery reinforced that medical outcomes are rarely guaranteed no matter how certain they may seem on paper. So while in my head I thought I might compete again, in my heart I never really let myself believe it for fear of crushing disappointment.

The team roster has undergone some turnover since I last played for them in 2006, but many men still remain from my first stint and it sure was great to see them again. “You haven’t changed at all!” one of them declared. Well, on one hand, I think of the transitions I have experienced in the last decade: no longer a student, now a licensed healthcare practitioner; no longer an apartment-dwelling bachelor, now a husband, homeowner, and business owner; no longer a spry 20-something, now a balding guy in the twilight of his 30s with three back surgeries under his belt.

On the other hand, I felt at home again, just as I had before, that much was constant, and I think my teammate could see it in my face. If anything, I felt even more confident walking onto the court now than I did back in the day. Just returning to the team was in itself a victory, so whatever else I happened to achieve in the match was a bonus.

Confident and relaxed, I took advantage of an opportunity a decade in the making and destroyed my opponent 6-1, 6-0. As I quipped to my team captain, “Those 10 years of rest really helped!” Most importantly, my back felt great before, during, and after the match, which was particularly noteworthy considering what my body went through just six days earlier.

October 9, 2016, Newport, Rhode Island

My surgeon cleared me to resume running in January and I quickly ramped up my training enough to complete a 10-mile race in late February, but subsequent pain suggested that sticking to shorter distances was probably in my best interest. As the spring progressed, however, I was able to comfortably go for some longer jogs, which had me wondering if running the Newport Marathon in October might be possible. In July, my surgeon reversed his stance on long-distance running, gave me his blessing, and told me to go for it.

Go for it, I almost did not, as I nearly backed out several times on the morning of the race. As recently as two days earlier, I was excited for the event and did not feel the slightest bit nervous, but in the final hours I was sad and anxious, eerily similar to how I felt on the mornings of my surgeries. Driving south on route 24 before dawn, I thought about how easy it would be to take an exit, any exit, turn around, head north, and crawl back into bed. Just continue on to Newport, I told myself. Do not make a decision about the race yet, just drive to Newport, park, and reevaluate.

The parking lot near the starting line was still pitch black when I arrived, and torrential rain and raging winds, the extension of Hurricane Matthew that reached New England, pummeled me as soon as I stepped out of my car. Retreating to my vehicle, I considered pulling out of my space and driving home. Instead, I paused to take a deeper look at my anxieties, which mostly centered around getting sick or injured, and reminded myself of the strategies I had formulated to avoid disaster and maximize my chances of a great race.

Most importantly, I remembered other instances in my life when I felt similarly stressed and apprehensive before significant events, most notably my transcontinental bicycle ride a decade ago, only to be happy that I had followed through. In the early morning hours of June 1, 2006, my best friend drove me to a Seattle beach, my bicycle and backpack in the trunk. Sometimes he reminds me just how petrified I looked as we sat there waiting for the other riders to arrive. Indeed, part of me wanted to curl up in the fetal position in his passenger seat and ask him to drive me back to Seattle-Tacoma International Airport. Out of the 4,024 miles I traveled between Seattle and Boston, the most difficult span was the step out of his car, but I am so glad I took it.

“If you get out and run,” I told myself, as I remembered my bike trip, “in about six hours you are going to sit back down in this car seat with a medal and a tremendous sense of accomplishment.” So that’s what I did: I got out and ran. Around mile 24, I passed by my car and thought about the pep talk I had given myself early that morning. Soaking wet from the storm but excited and still full of energy, I finished the course with the fastest two miles of my entire race.

As was the case regarding my aforementioned tennis match, my back held up just fine during the marathon. “I don’t know if you fully appreciate how impressive that is after all you have been through in the past few years with your back and the surgeries,” my physical therapist wrote in an email. She may be right, as she can speak better regarding typical clinical outcomes than I can, but by no means did I take being able to complete a marathon for granted. Finishing was emotional, not just because of how close I came to backing out of the race that morning, but because for a long time I thought I would never cross another marathon finish line again.

Three days after the race, I returned to my surgeon’s office for a routine follow-up appointment. “I brought something to show you,” I told him, as I reached into my jacket pocket and retrieved my finisher’s medal. “Wow,” he laughed, “That’s amazing!” Back in March, he had gently told me my days of running marathons were probably over. He was right; they probably were.

October 8, 2016, Boston, Massachusetts

Walking from the Hynes Convention Center subway stop to its namesake for the final day of the Cardiometabolic Health Congress, I remembered limping the same route three years earlier, physically unable to continually walk the two blocks without pausing for my back pain to die down.

About a week before that day in 2013, I went to bed feeling fine, but in the morning I stood up from bed and almost fell over due to a sudden onset of severe pain radiating down my leg. Over the next few days, I hoped the symptoms would resolve as spontaneously as they arose, that I would similarly go to bed and wake up in the morning feeling back to normal. As I struggled to walk from the subway to the convention center, however, reality set in that a rapid recovery was not in the cards and I might be in serious trouble.

Thus began my three-year saga of doctors, injections, medicines, physical therapy, alternative treatments, surgical consults, operations, setbacks, and rehab that led to the present. This road has no end, as I will always have to be mindful of my back, take care of it as best I can, and live with the uncertainty that someday I may run into trouble with it again despite my efforts, but I am very happy and thankful to be where I am today.

He Said, She Said: Sports and Nutrition

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He Said

Leading up to this month’s Newport Marathon, I solicited advice from colleagues around the world as well as fellow marathoners regarding fueling strategies that might help me to avoid the nausea that plagued me in earlier endurance events.

The suggestions I received were all over the place: Eat boiled potatoes with salt late in the race. Pack maple syrup in a fanny pack and drink it periodically along the course. Eat bananas, orange wedges, gummy bears, white bread, salt bagels, or jelly beans. Drink Gatorade, Pedialyte, flat beer, coconut water, Nuun, Skratch Labs, or mix the latter two together.

As I sifted through the various suggestions, I realized I was looking at a great example of the intersection between the hard science of nutrition and intuitive eating. During endurance events, we need to replenish fluids, carbohydrates, and electrolytes, but how we do that must be individualized based on what works for each one of us; thus we need the gamut of ideas. How we determine what works best for us is by trying various approaches based upon sound nutrition guidance and personal history, paying attention to how each trial makes us feel, and basing new iterations largely on firsthand experience.

Sometimes we, as patients, have a tendency to defer entirely to our practitioners. We see comfort in directives. “Just tell me what to eat,” a patient may say. In reality, a collaborative approach tends to be much more effective in part because determining the best path involves the patient’s input and experiences. Hydrating with a particular beverage may seem great on paper, for example, but if it disagrees with the patient’s system, then we need to form a different strategy.

Patient input is one of the most significant differences between textbook nutrition and nutrition in real life, which is why Joanne and I strive to create an atmosphere of collaboration and equality at our practice. Only our patients know how various foods make them feel, so we focus on building intuitive eating skills in part so they are able to recognize and communicate these experiences.

Leading up to the marathon, I treated every athletic endeavor as an opportunity to experiment and gather data regarding how various foods and fluids made me feel. One of the drinks I tried during a tennis practice failed to hit the spot whatsoever, but better to find that out during a casual hitting session than during an important training run or the marathon itself. Another beverage worked really well once I was actually running but made me jittery beforehand. Some foods gave me cramps and made me feel sluggish whereas others settled better than I expected. All of these outcomes, even if they were not what I had hoped, represented important data.

As a result of my experiments, I knew exactly what I was going to eat and drink come race day. Breakfast consisted of white toast with peanut butter, honey, and sliced banana with orange juice and Nuun Active. Between breakfast and the start of the race, I drank Gatorade and water until a half hour before the start, at which time I downed more Nuun Active. During the race itself, I consumed Gatorade and bananas from the aid stations as well as Nuun Energy and salted pretzels that I brought with me. Worked like a charm.

If your takeaway from this column is that you should adopt my own specific food and hydration plan during your own athletic events, then unfortunately you have missed the point: the importance of individuality. As I downed the last of my Nuun Active before the start, my friend with whom I ran the race strapped small vials of maple syrup to her waist, a fueling technique that she knew from experience would work for her. If she and I had swapped strategies, both of us would probably have felt awful. We are all different, so figuring out what works best for you is a process that involves both guidance from a professional as well as your own input based on firsthand experiences.

 

She Said

From a young age, I participated in a variety of team sports, including soccer, softball, and volleyball. While I truly loved playing these sports, my family was a tennis family, in that tennis was a sport that we all learned to play as children and enjoyed playing together. As I got older, I played tennis less and less, usually just hitting the ball around for fun with my family on vacations or with Jonah on a public court during the summer. But about 3 years ago, I decided to get back into the sport that I had enjoyed so much in my youth, so I joined several local women’s tennis teams.

While my overall experience on these teams has been overwhelmingly positive, whenever the topic of food or weight comes up, I have noticed some troubling trends. Whether it is one of my teammates or one of our opponents, a number of these women exhibit quite disordered ideas about food and weight.

When I was new to one of my teams, I remember one of my teammates asking me what I do for a living. After I told her that I work primarily with individuals struggling with eating disorders (EDs), she jokingly commented, “Oh, I so wish I had an eating disorder! I just can’t seem to lose these pesky 10 pounds!” I was very quick to correct her and explain how dangerous and life-threatening EDs are and that they are not simply something that someone can choose to engage in or not to lose a few pounds.

In addition to misunderstanding EDs and the seriousness of these disorders, many of the tennis women I encounter seem to struggle with diet mentality. A couple of years ago, I remember one of my tennis friends casually mentioning that one of the primary reasons she plays so much tennis is that it allows her to eat whatever she wants. In fact, I have heard this sentiment from other tennis peers, implying that they view tennis first and foremost as a way to burn calories.

At nearly all of my tennis matches, the home team provides food for the visitors and themselves. Depending on the time of the matches, the foods offered can range from simple snacks to pretty substantial lunches. Of course, with all of this food come a lot of shame, guilt, and judgments. I overheard one group of ladies on an opposing team debating whether they would have one of the cookies offered, with one of them declaring that she does not allow herself any “white carbs.” Other times I have seen women eating only salad or protein, as they are “trying to be good.”

Diets are a hot topic at many of my matches and practices. From Paleo to Whole 30 to Shakeology, a great number of the tennis women engage in restrictive eating in one form or another. One of my tennis friends started a cleanse not too long ago because she felt like she really needed to “detox” her liver and other organs. Another friend has been eschewing carbohydrates during the week and only indulging in them on her “cheat days.” As one might imagine, I try not to engage in any diet conversations as they can become quite charged. But when I mention what I do for a living, it seems like many of these women are only too happy to talk to me about food and nutrition.

I really don’t blame these tennis ladies for their disordered ideas about food, nutrition, and weight – they are subject to the numerous fear-mongering messages we all receive from our doctors, from the media, and from our friends and family. Talking about one’s diet or weight has become so commonplace that the idea of not talking about it seems strange somehow. But just think about all of the other things we could discuss! All of the ideas and stories we could share with each other! Wouldn’t that be more fun than talking about how to lose those pesky 10 pounds?

At the end of the day, I try to pick my battles. If someone asks me about my thoughts on dieting or certain foods, I will oblige. I try to be gentle with them around my strong anti-diet philosophy as it can be quite surprising and confusing for many people. When it comes to EDs, I do my best to educate those who ask about them. So far, many of my teammates have expressed interest in the idea of intuitive eating and the non-diet approach, so I have tried to point them in the right direction by recommending books and other resources. If I can somehow help even one of them to ditch the diets and begin to appreciate their body for what it can do (e.g., play tennis!), then I will feel like I have made a difference.

He Said, She Said: Obesity Awareness Month

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He Said

The concept of National Childhood Obesity Awareness Month is flawed in several ways, many of which Joanne covers in her She Said passage. The most glaring issue, in my opinion, is that by promoting the use of weight as a proxy for health, the government is paradoxically distracting from matters of actual health.

Human beings can be healthy at a variety of weights, which is why we cannot draw accurate conclusions about someone’s health or behaviors based solely on their size. Thin folks can have plenty of medical woes. A couple of years ago, I wrote about a slender friend of mine who was diabetic, suffered a heart attack, and ultimately died of cancer. Someone might be thin due to food insecurity, a medical condition, psychological disturbances, eating disorders or disordered eating, or overexercise, just to name a few of the health-threatening issues that might lead to lowered body weight.

With a focus on obesity, not only do we miss an opportunity to identify and assist people at risk for or suffering from these problems, but we actually push them in the direction of trouble. For example, I have recently seen an increase in pediatric patients, including males, with eating disorders or disordered eating that reportedly stemmed from a fear of getting fat brought on by discussions at school or the doctor’s office.

One of my teenage patients recently told me how his pediatrician praised him for having lost weight from one annual checkup to the next after having chastised him the year before, but what his doctor did not know was that my patient had overexercised and restricted his food intake leading up to the appointment for fear that his doctor would again be mad at him if he had not lost weight. My patient’s behaviors brought him further away from health, not towards it, and the poor communication between him and his doctor puts him at risk for improper care in the future. Furthermore, food restriction elevates his risk for binge eating disorder and, ironically, ultimate weight gain.

Trust me, children who are obese already know it. They hear about it on the playground, in gym class, on television, online, maybe in the pediatrician’s office, and from other sources that tell them something is wrong with their bodies and it is their fault. National Childhood Obesity Awareness Month calls even more attention to them and their bodies, thereby exacerbating stigmatization and bullying.

The concept of National Childhood Obesity Awareness Month may be well intentioned, but its fallout is the exact opposite of the desired effect. If we want to improve the actual health of our children, better to promote size diversity and the importance of healthy behaviors, such as fun and appropriate physical activity, for everybody.

 

She Said

According to the U.S. Department of Health and Human Services (HHS), September is National Childhood Obesity Awareness Month. Per the HHS website, “one in 3 children in the United States are overweight and obese,” putting kids at risk for developing health problems such as type 2 diabetes, hypertension, and heart disease. The website goes on to say that childhood obesity is preventable, as “communities, health professionals, and families can work together to create opportunities for kids to eat healthier and get more active.” Some of the strategies that the HHS recommends are nutrition based, such as “keeping fresh fruit within reach” and providing healthier food options at school, and other strategies are focused on activity levels, such as encouraging families to go on an after-dinner walk and incorporating daily physical activity at school.

While I actually applaud the strategies put forth by the HHS to improve kids’ health, I am saddened to see the focus be on body size. Thanks to Michelle Obama, childhood obesity is at the forefront of the American consciousness. Kids are being weighed and measured at school and then later sent home with a health report card telling them whether they are at a “healthy” body mass index (BMI) or are in the “overweight” or “obese” categories. Even though the medical community as a whole willingly acknowledges that the BMI is woefully flawed as an indicator of health status, it still condones its use in determining the health of our kids. Time and time again, studies have shown that behaviors rather than weight are a better determinant of health, but unfortunately, this is not being reflected in current policy.

My greatest concern is the effect that focusing on childhood obesity could be setting up kids to develop eating disorders (EDs). I cannot tell you how many preteens who have stepped into my office had been sent home with their BMI report card and then developed either extremely disordered eating or an actual diagnosable ED. What often happens is that the parents become alarmed at their child’s negative BMI report and will start to impose harsh diet restrictions and exercise ultimatums. I had one patient whose father promised her and her sister iPads if they both lost weight. Not only would he limit their access to “junk” food, he would make them run laps around their neighborhood after dinner every night. As a result of this, the patient developed a very disordered relationship with food and her body. This story is not unique, unfortunately. I have heard it too many times to count.

So, I have a few issues with the HHS’s focus on obesity. First of all, I don’t believe that we should have schools be weighing and measuring kids and sending them home with a BMI report card. Instead, the child’s pediatrician and parents should be the gatekeepers of the child’s health. Every child has their own unique growth charts – some trend on the higher end of weight for height, while others trend on the lower end of the chart. In other words, some kids are just meant to be in bigger bodies, while others are meant to be in smaller bodies. These body sizes do not tell us anything about the child’s health unless there are major changes in either direction. For instance, one would expect a child trending on the 85th percentile to stay at that percentile. If there was a sharp drop to the 50th percentile, that would be cause for concern. Similarly, if a child was trending on the 50th percentile and then jumped up to the 90th percentile, that should also be looked at. One body type is not inherently healthier than the other – every body is unique.

In addition, I think it is so important to not speak negatively about a child’s weight. Kids are like sponges, and they pick up on everything. Talking with one’s child about how their body works and teaching them how to take care of it is one thing, but telling a child that they are too big and need to lose weight is extremely damaging and can set the child up for years of negative body image and a life of disordered eating. Many EDs start when a well-meaning parent tries to teach their child to diet and use exercise to burn calories. In fact, there are a number of studies that show that when children are put on restricted diets, they will often end up being heavier adults.

Also, I think that if a parent has concerns about his or her child’s weight, they should talk with their child’s pediatrician separately (i.e., not with the child in the room). Instead of telling the parent that their child simply needs to lose weight, it would be wonderful if pediatricians did not just make an assumption based solely on the child’s weight that the child is engaging in unhealthy behaviors. If it is determined that the child is in fact not practicing healthy lifestyle behaviors, it would be best if the doctor just focused on helping the child develop these healthy habits (perhaps by referring them to a registered dietitian or other health care provider) and measure the child’s progress by their weight.

Given that, I don’t think that National Childhood Obesity Awareness Month is helpful at all in helping our kids lead healthier lives. By teaching them that weight is synonymous with health, we are doing them a major disservice. Perhaps September could instead be called National Healthy Habits Awareness Month? Just a thought.

Busted

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Football player Rob Ninkovich announced today that the league has suspended him for four games for taking a banned substance. Ninkovich explained, “Few things are more important to me than my name and reputation. This might call that into question for some, which has me heartbroken. I don’t want to cut any corners. I want to do things the right way, with high integrity, and that’s what I have always wanted to stand for.”

He continued, “Any supplement I’ve ever used was bought at a store. I was unaware something I bought had a substance in it that would give me a positive test because it wasn’t listed [as an ingredient]. One thing I have learned is that if a supplement is not NSF certified there are no regulations that ensure that what is on the label is 100 percent accurate. That is a hard lesson for me to learn at this stage in my career, but I take responsibility for it. It’s a mistake I made and it hurts that I won’t be there for my teammates.”

Patients frequently ask me about supplements, particularly protein powders. Pop culture nutrition is fickle. Not too long ago, we emphasized carbohydrates and feared dietary fat. Today, we are scared of carbohydrates and worship protein. As such, people who are already getting more than enough protein often feel they need even more and turn to a protein supplement.

Protein powders, like other supplements, are largely unregulated. Generally speaking, we have no idea if the contents match the listed ingredients or if the quantities reported on a bottle’s nutrition label are accurate. Back in 2008, I read a study (which I unfortunately cannot find right now) that analyzed actual protein content in various powders and found that most did not contain nearly as much protein as advertised.

Furthermore, as odd as it may initially sound, realize that manufacturers have incentive to add secret ingredients. Competition is fierce; a quick search of GNC.com yielded 512 different protein supplements. Consumers often make their selections based upon the perceived results or testimonials of others. If you are a supplement manufacturer and you want your product to stand out among the rest, to be the one that is perceived as yielding the best results, the one that gets talked about and recommended in the locker room, you may decide it is in your best interest to slip in an unlisted ingredient that produces the desired effect.

Whenever an athlete like Ninkovich gets busted and blames his supplements, the common reaction is to assume they are lying and covering for having purposely taken a performance enhancer. That may indeed be true, but we have to remember that what we often see as an excuse is also a completely plausible explanation.

You may or may not get drug tested the way that many professional athletes do, but the uncertainty of supplement contents can still impact you. Might an ingredient, listed or otherwise, interact with one of your medications, make you nauseous, give you a headache, accelerate your heart rate, or damage your liver? You could have no adverse reactions at all, wind up dead, or anywhere in between. That’s the risk.

If you use a supplement or are considering taking one, think about the potential ramifications, and remember that the lesson Ninkovich apparently learned today is actually an important lesson for us all.

Hold Off On Time-Delayed Eating

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You may have caught a recent New York Times piece entitled “Time-Delayed Eating Leads to Better Food Choices” in which the author writes, “A series of experiments at Carnegie Mellon University found that when there was a significant delay between the time a person ordered their food and the time they planned on eating it, they chose lower-calorie meals.”

Dr. Eric VanEpps, the post-doctoral student who led the research, elaborates, “If a decision is going to be implemented immediately, we just care about the immediate consequences, and we discount the long-term costs and benefits. In the case of food, we care about what’s happening right now – like how tasty it is – but discount the long-term costs of an unhealthy meal. [When we order a meal in advance], you’re more evenly weighing the short-term and long-term costs and benefits. You still care about the taste but you’re more able to exert self control.”

Self control, unhealthy, lower-calorie . . . Based on the language Dr. VanEpps uses and the undercurrent of a good/bad food dichotomy, time-delayed eating sounds like yet another dieting tool right up there with drinking a glass of water before sitting down to a meal, consuming caffeine to stave off hunger, or not eating after a certain time of evening. We all know by now that dieting rarely works, right?

Regarding the research at hand, two of the pieces discussed in the New York Times article are hidden behind pay walls except for their abstracts. While I can only comment on what I am able to read, the information available to me leads to many important follow-up questions.

What happens when the time comes to eat and the food you ordered long ago does not meet your intuitive needs in the moment? Will you eat it anyway? If not, what is plan B? If you do eat it, might you consume more of it than you really need in an attempt to satisfy yourself through sheer quantity? Will you overeat by beginning your feeding with your pre-ordered food only to follow it up by eating something else that you actually want?

Consider a personal example. A little over a decade ago, I went through a phase where I was modifying cookie recipes in all sorts of ways in an effort to make them “healthier”: nuts and dried fruit instead of chocolate chips, oil instead of butter, whole wheat instead of white flour, reduced sugar, etc. These changes sounded good in theory, but who was I kidding; these “cookies” were only cookies by name and bore a stronger resemblance to pancakes. They never quite hit the spot. When you want cookies, no amount of pancakes will satisfy. Either I ate the healthier cookies by the batch in an effort to quell my cookie craving, or I chased them with traditional baked goods anyway. Now that I make normal cookies full of butter, sugar, white flour, and chocolate chips, I only need to eat one or two in order to feel satisfied.

Consider the short-term and long-term ramifications of time-delayed eating. If you just consumed a meal you did not really want but ate anyway, what happens at the next meal, or later that evening? How do you eat the next day? The next week? The next six months? The restriction/binge cycle of dieting suggests that sooner or later there will be consequences somewhere down the road.

One of my patients is coming off a serious health scare and has completely revamped his way of eating over the last year. On the weekends, his family maps out exactly what they will eat each day of the upcoming week and then they shop only for the ingredients necessary to implement their plan. When Thursday evening rolls around and the dinner entree he scheduled five days earlier no longer sounds appealing, he eats it anyway. He may not love it, but he can tolerate it.

Right now, he does not mind taking a utilitarian approach to his eating. So far, it seems to be working for him, and who knows, maybe it always will, but as his dietitian I have to think ahead to what might happen in the coming months and years as the fear associated with his medical incident subsides and leaves him with a different picture of motivation than the one he holds today. In other words, how long can one tolerate eating foods that may seem healthy on paper, but on the enjoyment scale are only meh?

Similarly, I encourage you to consider the aftermath you are likely to have on your hands if you try time-delayed eating and find yourself trying to reconcile the food you pre-selected for yourself and what you actually want to eat in the moment. If the research teaches us anything, it’s that such discrepancies are a virtual certainty to occur.