Tag Archives: eating disorders

He Said, She Said: New Year’s Resolutions

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You already know that New Year’s resolutions do not typically last, but you have not yet heard our opinions as to why and what you can do about it.

He Said

A few weeks is not yet enough time for most New Year’s resolutions to have fallen apart, but if past statistics are any indication, by the end of the year only 8% of us will have been successful in achieving our resolutions.  The poor rate of conversion from resolution to reality is partly due to the goals themselves, as Joanne will discuss below, but being honest with ourselves about how ready we are for change is of utmost importance, too.

According to the Transtheoretical Model describing behavior change, individuals can fall into any one of five stages.  The preceding link gives detailed explanations of each stage, which I will concisely summarize below.

  • Precontemplation: The person does not see a problem and therefore has no intention of changing.
  • Contemplation: The person recognizes that a problem may exist but feels ambivalent about what to do.
  • Preparation: The person has decided to make changes and is formulating a plan.
  • Action: The person is implementing changes but has not yet maintained them for six months.
  • Maintenance: The person has maintained the given changes for six months or longer.  (Note: Some versions of the Transtheoretical Model also throw in an additional stage, Termination, but often this stage is considered part of the Maintenance stage.)

Classically, the idea is that a person moves from one stage to the next in the sequence in which I listed them, but in reality someone can jump from any one stage to another at any point in time.  The Model is not perfect, but it expresses an invaluable truth: Not everybody is ready to change.

This truth, by the way, is perfectly fine.  Change is a process, as the Model indicates.  When Joanne describes our counseling approach to people unfamiliar with how we work, she often tells them, “We meet our patients where they are.”  She does not mean that literally as if we make home visits; rather, she is referring to their stage of change.  Recognition of said stage is critical to successful counseling.

What do you think would happen if I counseled a patient on the changes he can make to his eating (thereby treating him as if he is in the Preparation stage) while he does not even see a problem with his diet and came to my office only because his doctor insisted he see a dietitian (which suggests he is in the Precontemplation stage)?  He would not feel heard, the session would be unproductive, in all likelihood he would not return for another session, and whatever health condition he is dealing with would remain a problem.

Conversely, if I listen to him without judgment as he shares his emotions and opinions, acknowledge the validity of his feelings and point of view, and discuss his doctor’s concerns with him, he may transition to the Contemplation stage and move closer to ultimately making and sustaining behavior changes that will improve his health.

Alternatively, perhaps after learning more about his condition and the potential consequences, he decides that he will maintain his current lifestyle anyway, at least for now.  It is his life, he can do what he wants with it, and I respect his choice without judgment.  At least he will have had an opportunity to weigh his options and make an informed decision.

Similarly, we each have to meet ourselves where we are at, too.  In other words, when we make New Year’s resolutions, we have to be honest with ourselves about how ready we are to make the given change happen.  The calendar’s flip from December to January does not automatically transition us to the Action stage.  In all likelihood, if we were truly in the Action stage, we would have implemented the change before New Year’s rather than wait for the holiday.  Willpower can only force change for so long.  Whatever was holding us back before New Year’s will remain and ultimately catch up to us after the holiday and bring an end to the resolution.

Instead of setting yourself up for failure by setting a goal that is unfit for your readiness to change, use the New Year as an opportunity to be honest with yourself about your health and how you feel about it.  In other words, meet yourself where you are instead of forcing yourself to take an action before you are truly ready for it.  Reach out for whatever information or support you need.  Consider the following examples:

  • A husband in the Precontemplation stage might give in to his wife’s urging to finally make an appointment with a dermatologist to have his strange-looking mole examined if for no other reason than to appease her.
  • Perhaps a diabetic in the Contemplation stage might decide to schedule an appointment with his doctor to discuss his ambivalence regarding monitoring his blood sugar at home.
  • An individual in the Preparation stage might meet with me to plan specific and achievable changes to his eating that will improve his cholesterol, then go home and discuss the upcoming changes with his family.
  • An osteoporosis patient in the Action stage might continue to use the package of personal training sessions she bought so she can continue learning how to lift weights safely and preserve her bone structure.

Most important, remember that New Year’s is just an arbitrary point, and one need not wait for a new calendar year to start the process of making change.  Said differently, we do not need an exterior cue to trigger internal change.  When we are truly ready, we will make the change happen no matter what date it is.  One of my favorite quotes is from Andre Agassi’s Hall of Fame induction: “ . . . every journey is epic, every journey is important, every journey begins today.”

 

She Said

Mid-January through the beginning of February is a tricky time for many of my patients.  Their motivation for keeping all of their nutrition resolutions is starting to dwindle, and many people feel like they have failed in one way or another.  What I often find is that many of my patients had set the bar too high in terms of nutrition goals.  They expect too much from themselves and have no other option than to not meet their goals.  Most of these goals are so overly ambitious that it would be very difficult for almost anyone to follow through with them.

So what’s a person to do?

When my patients ask me for help setting nutrition goals, I tell them to think S.M.A.R.T., as in goals that are Specific, Measurable, Attainable, Relevant, and Time-bound. No, I didn’t invent this clever mnemonic; it has been attributed to George T. Doran who wrote a paper called There’s a S.MA.R.T. way to write management’s goals and objectives in the November 1981 issue of Management Review.  But I really like the simplicity of this handy acronym.

Specific goals are those that are clear-cut and unambiguous.  Examples of specific goals could be “I will make a kale smoothie for breakfast…,” or “I will prepare a new salmon recipe…”  Measurable means that the goal must be quantifiable in some way so that you can clearly assess your progress.  This can be accomplished by adding to the above goals; for example, “I will make a kale smoothie for breakfast 2 times….” and “I will prepare a new salmon recipe one night….”

Attainable goals are those that are ones that realistic for you.  If, for instance, you know that making a kale smoothie for breakfast 5 mornings per week isn’t likely to happen (e.g., you often sleep late and don’t have time, you have difficulty going to the grocery store to get the ingredients, etc.), then shoot for something you absolutely know you can do.  In other words, it’s much better to start with smaller goals and then build on them than to start with goals that are too ambitious for you.

Relevant goals are ones that are worthwhile and applicable to you.  If upping your omega-3 intake isn’t that important to you, then don’t set a goal to eat more salmon.  By the same token, if you are already succeeding at one area of your nutrition (say, getting your leafy greens), then maybe it’s time to focus on something else, like increasing your nut intake.

Finally, it’s important that your goals are time-bound, that there is a particular time frame for achieving them.  You could add on to the examples given above: “I will make a kale smoothie for breakfast 2 times this week,” and “I will prepare a new salmon dish one night per week for two months.”  By giving yourself a deadline, you will be more likely to achieve your goal on or before that deadline.

If the above seems a bit much, the one piece of advice I give all of my patients is to keep it simple.  When goals are overly complicated and ambitious, it can be overwhelming.  And be kind to yourself – you are human, after all!

The Real You Is Sexy

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Aerie, the lingerie branch of American Eagle, is going with a “The Real You Is Sexy” campaign for their spring line.  My understanding is that the ads are not retouched in any way and show the models just as they were when the photographers took their pictures.  Aerie deserves credit for this move, but this change alone does not fix the underlying problem.  The greater problem is with us, not the fashion industry.

Reality is more complex than I am about to make it seem, but the basic premise is that we compare ourselves to models, feel pressure to look like them, feel bad about ourselves for not looking like them, and adopt certain behaviors – healthy or not – in an effort to match them.  Other advertisement campaigns that do retouch photos can dramatically alter a model’s appearance making him or her seem flawless.  When such a picture is held up as the ideal, we are comparing ourselves to someone who does not even exist.  As such, who can possibly live up to that standard?  Aerie deserves credit for at least removing this as a factor from the equation.

The larger problem though is that we compare our bodies to others in the first place, and that is not going to go away even if the fashion industry completely does away with retouching.  For example, I work with a patient who watches women leaner than herself pass by in town and feels bad about herself as a result.  No retouching there; she is comparing herself to people she sees with her own eyes.

We do not know what somebody does to look a certain way.  I do not know any of the Aerie models and I have no idea what they do to maintain their looks, but chances are neither do you.  They might look the way they do because they are genetically predisposed to have that figure and on top of it take excellent care of themselves.  On the other hand, they could also look that way due to eating disorders, overexercise, or other unhealthy behaviors.  One of my patients, a former model who is working to overcome anorexia, tells me of the pressure in the industry to gain a certain look at any costs, healthy or not.  If a model gets his or her frame through an eating disorder, are we really to look up to that image as an ideal just because there is no retouching involved?  In that sense, we still should not be using models – retouched or not – for a point of comparison.   

To further the point, we should not be comparing our bodies to anybody else either.  I discussed with my patient, the one who compared herself to other women in town, that we have no idea what those women do to maintain their looks.  Some of them are probably perfectly healthy, while others might struggle with eating disorders or other unhealthy behaviors.  Some of them are deeply unhappy and live rigid lives in isolation so they can do exactly what they need to do in order to maintain their physiques.  Some of them would laugh if they knew other people look up to them because no matter how great somebody else says they look, they still hate their bodies themselves.  I know all of this because I just described patients of mine.  These problems are much more prevalent than one might think.

It is time to stop comparing our bodies to others.  Weight, waist-to-hip ratio, and other anthropometric measurements do not define us and should not determine our self-worth.  Love and accept yourself the way you are now, not X pounds from now, and focus on leading a healthy lifestyle built on a foundation of balance.

How should one measure health?

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“I really like your blog posts.  They’re really well thought out and are a step above what I imagine normal nutrition blogs are like.  It’s like the philosophy of nutrition or something.  Question, though, when you say this: ‘Joanne and I advocate focusing on health rather than weight.  In that sense, weight outcomes are only somewhat interesting to us.’  I think you’re right, but it also seems challenging to measure one’s health without focusing on weight.  There are very few things a person can do other than stepping on a scale (without regular blood draws and periodic EKGs [electrocardiograms]) to measure their health.  In other words, how do you recommend someone measure their health to see if their health is improving?”

The above email arrived in response to a blog I posted earlier this month in which I compared the slim hopes of winning the lottery to the poor success rate of weight-loss endeavors.  Indeed, Joanne and I do advocate adapting lifestyle changes in pursuit of better health as opposed to taking a weight-centered approach because the latter rarely turns out well.

Furthermore, weight in and of itself is generally not a good indicator of health (although there are some exceptions to this generality, such as for a patient who is recovering from anorexia nervosa).  About a decade ago, I had a weekly doubles game with three other guys.  One player was very lean and clearly had the lowest body mass index (BMI) of any of us.  Was he the healthiest in the group just because he was the lightest for his frame?  After we had been playing together for a few months, I got a call one afternoon saying he had had a heart attack.  I came to find out he was also diabetic.

So if not by weight then, by what should we measure our health?

First, we need to understand that just because a measuring tool is convenient and easy to use does not mean it is valid.  In other words, just because gaining access to a scale and stepping on it are actions that most people can perform does not mean that the resulting data are automatically useful.

You know from my biography that I have an undergraduate degree in mathematics.  For a statistics class project, I analyzed the November 6, 1997 trade between the Red Sox and Rangers that sent Aaron Sele, Mark Brandenburg, and Bill Haselman to Texas in exchange for Damon Buford and Jim Leyritz.  In an effort to determine which team got the better end of the deal, I analyzed the past performances of the trade’s cornerstones, Sele and Leyritz, and determined which metrics were the best predictors of the outcome that ultimately mattered most: team wins.  Some statistics, like strikeouts for a pitcher or home runs for a hitter, are easy to compute and understand, but it turned out that other metrics that were more complex to calculate and comprehend were better predictors of team wins.

While I was in the process of switching careers, I did a similar project in my nutrition assessment course in which I tried to determine which anthropometric measurement is the best predictor of cardiovascular disease.  The results were complex, but the conclusion that I reached is not the point of this blog entry.  The point is that just as I found with the baseball project, the ease of obtaining a particular measurement has nothing to do with the utility of said measurement.  In other words, just because it is easy to count the number of home runs a player accumulates or to step on a scale and find out our weight does not mean that these numbers are great indicators of team wins or our health, respectively.

With that in mind, let us now turn our attention to just some of the ways we can measure health.  This list is far from complete, but it gives a sense of all of the measurement tools healthcare practitioners have at their disposal.

We have anthropometric data, such as waist circumference, waist-to-hip ratio, body fat percentage, and BMI.  We have the numerous biochemical markers that doctors can examine through blood and urine tests, including blood glucose, insulin, total cholesterol , LDL (“bad cholesterol”), HDL (“good cholesterol”), triglycerides, red blood cells (RBC), white blood cells (WBC), and markers of liver health, protein stores, electrolytes, and inflammation.  Clinical indicators include hair and skin quality, finger nail appearance, and tests for hydration status.  Electrocardiograms and blood pressure readings comprise part of a cardiovascular system assessment.  Men and women can screen themselves for signs of testicular and breast cancer, respectively, through regular exams.

When I was a personal trainer, I used tests like the eight-repetition maximum bench press, Rockport walk, and sit-and-reach to assess my clients’ fitness and track their changes over time.  In my realm of nutrition, dietitians will sometimes use tools, such as a 24-hour recall or food frequency questionnaire, to assess the health of one’s food intake.  Aside from one’s intake of fruits and vegetables, for example, one can track other health-related behaviors themselves, such as physical activity duration and frequency as well as usage of tobacco, alcohol, and recreational drugs.

Health is not just about the physical; emotional and psychological health is also important.  This is not my area of expertise, but I am sure psychologists and psychiatrists have ways of screening for and assessing the magnitude of conditions ranging from depression to schizophrenia.

With all of these different tools we have for assessing and tracking health, the criteria that one uses has to be individualized, which is why it is important to talk with your healthcare team about how you should track your own health.  For example, diabetics may measure their health in part by monitoring their blood sugar at home and keeping their A1C under a benchmark value set by their doctors.  A patient with a family history of cardiovascular disease may monitor his health in part through periodic blood lipid level checks and self-monitoring of blood pressure at home.  A patient with celiac disease may monitor her health in part through bone density screenings and tTG blood tests.  A patient with a history of skin cancer may measure his health in part through routine screenings with the dermatologist.

The permutations of how to measure health are endless and must be customized with the help of your doctor and any other healthcare practitioners who are on your treatment team.  Just because weight is easy to measure does not mean one should put much stock in the number or even track it at all.

The Wrong Idea

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In addition to the many patients I see for eating disorders, I often have individuals come to see me for help with weight loss. This goal is completely understandable in the current context of our society. Most of us have been told by numerous sources that weight loss is essential for health, and only if we are at the “right” weight will we live long and healthy lives. And up until about five years ago, I would have agreed with this assumption.

But, as I have written about in many other blogs, I’ve had a paradigm shift. There is more and more scientific evidence out there that weight and health are not inextricably linked. In fact, it is completely feasible for someone to weigh considerably more than the BMI and weight charts tell her to and to be perfectly healthy. In contrast, I have seen countless patients in my office who are at their “ideal” weights, yet are using extremely unhealthy measures to stay there and have numerous health issues as a result.

Therefore, I am concerned when the New Year comes around, as I know that our office will become busier than ever with people wanting to lose weight. I’m afraid that prospective patients will have the wrong idea about what I will and will not do. As a registered dietitian, I am knowledgeable about nutrition for health promotion. This means I can provide nutrition education for my patients and help them figure out ways to establish some healthier eating habits.  While these healthier eating habits may lead to some weight loss, weight loss will not be the inherent goal of our work together. If any weight loss occurs, it is just the byproduct of the lifestyle changes one instills. It isn’t the primary goal.

Maybe 2014 will be the year that we can all start taking our eyes off of the scale and instead focusing on making healthy lifestyle changes instead.

Be Your Own Best Friend

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It’s the holiday season, a time to spread joy and love to those around you.  Many times this takes place in the form of buying gifts, baking, and cooking for those we care about.  It often involves telling our friends and family how much they mean to us, how loved they are.  This is the time of the year when we show our appreciation and care for others.

So, in the midst of spreading all of this happiness to others, who often gets neglected?  You guessed it – you!  Not only do we often forget or put off taking care of ourselves, many of us are pros at talking especially harshly to ourselves.  Many of my clients have an inner monologue that goes on a continuous loop.  These thoughts include things like, “I can’t believe you missed that workout today – you are so lazy!” or “You have to stop eating like such a pig” or “You are a disgusting, fat person who has no self-control.”

Now, would any of us talk to our best friends the way we talk to ourselves?  Of course not!  Pretty soon, we wouldn’t have any more friends!  Then why do we think it’s okay to talk this way to ourselves?  Whenever a client tells me about her latest bout of self-hate talk, I ask her to think about what she would say to her best friend if the friend was saying these hateful things about herself.  Common answers to the above hate talk include, “You’ve been so tired and run-down lately, it’s probably a good thing you skipped that workout.  You need the rest!” and “You are not a pig!  We all overeat sometimes, and it’s not the end of the world,” and “You are a beautiful, smart, and loving person – self control has nothing to do with how wonderful you are!”

Let’s break the cycle of negative self-talk and start talking to ourselves in a more positive way.  When we are kind and gentle to ourselves, we are more likely to take better care of ourselves, too.  Imagine what a difference that would make!

He Said, She Said: Weight Management

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Weight concerns are one of the main opportunities for improvement that bring people to our practice. Our approach may ring true for you or elicit skepticism.  Either way, we invite you to share your reactions and questions on our Facebook page.  Also feel free to contact us directly if you prefer to voice your questions in private.

He Said

“Weight Management.”  According to my business cards, that’s what I do.  Because weight is such a loaded term that quickly brings to mind so many thoughts, feelings, and expectations, coming up with concise language that accurately reflects my approach is a challenge that I am still trying to settle.

Indeed I do help with weight management, but not in the direct fashion that some people might expect.  We know from working with patients, collaborating with our colleagues, and reading the research that weight-centered approaches to losing weight almost always fail.  That’s the irony: The more we emphasize and focus on weight, the harder it tends to be to keep weight off.

This fact is hardly a secret.  In October, I wrote about a conference I attended where presenters showed that over 20 diets resulted in the same pattern of weight change: sharp initial weight loss followed by gradual and steady weight regain.  A few years back, I had a telephone interview with a commercial weight-loss program that was interested in hiring me.  A study they had posted on their own website showed that approximately 85% (I forget the exact number.) of their clients regained their lost weight after one year, so I asked the interviewer what strategies they had developed since that study to help prevent this rebound.  She said they realized that clients are unable to successfully transition off of the commercial meal replacements and must stay on them for life.  This is very similar to the diet drugs on the market, which also must be taken for life or else the weight will come back, as well as commercial weight-loss programs where leaders tell clients they should be prepared to be lifetime members if they want to keep the weight off.  Sounds like a great business strategy.  As you can imagine, I did not get the job, which was fine by me.  Philosophically, we were not a good fit.

It may come as a surprise to learn that the healthcare community is still uncertain to what degree weight in and of itself matters in terms of health.  The folks who officially declared obesity a disease state this past summer can cite research supporting their view.  The “Health at Every Size”® supporters, who argue that health and body weight are independent, have supportive research as well.  Personally, I have been talking about the concept of “Health at Every Size” for a decade, long before it even had that label.  As a guy whose BMI labeled me as overweight despite a very low body fat percentage, excellent labs, and solid athletic capabilities, I could see firsthand that weight was not necessarily a good indicator of health.  Lest you think that the unimportance of body weight is a fringe theory or an excuse that overweight individuals use to stay that way, my energy metabolism professor, a lean and athletic guy himself, taught us the same concept back when I was studying nutrition at a large state university.

Clearly, there is still much that we need to understand about how important weight is when it comes to our health, but how much does this question even matter?  On one hand, determining the importance of weight is of course important from a public health standpoint.  In order to best help people be healthy, we need to understand the factors at play as well as their roles.

Speaking pragmatically, however, the importance of weight is largely irrelevant.  We know from epidemiological data that overweight and obesity have become more prevalent, not more scarce, over the years.  Closer to home, even if you have not tried to lose weight and keep it off through various permutations of food restriction and/or overexercise without long-term success, you at least know several people who have.  When Joanne and I listen to our new patients share their histories, tales of weight lost and regained are par for the course.  Society as a whole has been acting under the assumption for decades that weight matters, yet this assumption has not helped us to get any thinner.  In fact, quite the opposite is true.

If we remember that weight-centered approaches almost always fail, the only alternative is lifestyle change.  Even more radical approaches, such as bariatric surgery and lifetime medications, have to be coupled with lifestyle change in order to be effective.  There is just no getting away from it.  Whether weight matters or not, or whether somebody wants to undergo a radical approach or not, the bottom line is that lifestyle change is still necessary in order to improve health.

What constitutes healthy lifestyle change is based more upon one’s baseline than it is on some idealistic vision of what one should be doing in theory.  The efforts and constructs of lifestyle change are usually limited by other factors (e.g. time, finances, personal preferences, etc.) rather than by guidelines, so in a sense guidelines do not even matter all that much when it comes to helping people in real life.  The idea is just to start wherever you are and move towards better health one small step at a time. 

More specifically, instead of gravitating towards a particular mode of exercise because it burns the most calories per unit of time, find ways of being physically active that are fun and agree with your body.  You will be happier and more likely to make the activities long-term habits.  Instead of counting grams and calories, restricting your intake, and cutting out whatever food group is being scapegoated this week, learn to eat mindfully and listen to your body’s hunger/fullness cues.

As a result of these changes, weight loss does oftentimes occur, and when it does, it tends to stay off, but it may or may not be the magnitude that you, your friends, your parents, your partner, a BMI chart, society as a whole, etc. would like.  Therefore, part of establishing a healthy lifestyle means learning to love and accept yourself the way that you are and severing any link you may have between weight and self-worth.

It is really about putting forth your best effort to be healthy while still maintaining balance in your life.  This is what I help people to do; that is what I mean by “Weight Management.”

She Said

Well, we are closing in on the end of 2013. Inevitably, after the ball has dropped and the New Year’s celebration has ended, many people start to think about their New Year’s resolutions.  What’s at the top of the list for most people?  Weight loss.  Every January we become inundated with new patients looking to us for help with their weight goals. Most of them have tried every diet and eating program in the book (losing and regaining many pounds in the process), but they are certain that this time things will be different. This time I will find the perfect diet, most people think to themselves.  This time I will have more willpower, and I will lose the weight for good!

I truly understand why so many people want to lose weight.  Every day we are bombarded by messages about our weight. Whether it is from doctors, the media, family, friends or partners, the message seems to be that it is desirable to be thin and it is bad to be fat.  Those who try to lose weight through dieting are to be admired, while those who are fed up with diets are viewed as weak-willed and lazy.  Fat is not only disliked but also feared.  According to a 2006 study by the Rudd Center for Food Policy and Obesity at Yale University, nearly 50% of the 4,000 people surveyed said they would rather give up a year of their life than be fat.  The same study found that 15-30% of the respondents would rather become unable to conceive, be depressed or become alcoholic than be obese. 5% would rather lose a limb. 4% would rather be blind.

Given most people’s dislike and, in some cases, fear of fat, it makes sense that weight loss is on the forefront of many of our patients’ minds.  But as much as I understand our patients’ feelings, focusing all of our energy on losing weight and fighting obesity by dieting restrictively and exercising excessively hasn’t helped anyone reach and maintain their goals.  I mean, if these methods really worked, would we still have a billion dollar weight-loss industry?  Of course not.

It is time to take the focus off of weight and put it on health.  As I’ve blogged about many times before, health and weight are not synonymous.  Numerous studies have shown that when talking about health, it is lifestyle behaviors that make the difference, not just weight loss.  When patients come into my office with the sole goal of losing weight, I try to help them shift their view to one that is health-focused rather than weight-focused.  By implementing healthy lifestyle changes such as eating intuitively, being more physically active, and dealing with stress appropriately, one’s weight will often settle into a “healthy weight range.”  This weight range might not be what the media or the BMI chart says is desirable, but it is one that is sustainable and will result in the best health outcomes.

To a large extent, our individual genes determine where our weight will settle.  There really is not much we can do about that.  But what we can do is work on becoming the healthiest person we can be, regardless of what we weigh.  By honoring our body’s hunger and fullness cues, being active in a way that is enjoyable to our body, and accepting and appreciating our body where it is now (not 20 pounds less than now), we will truly reach our health goals.  Now that’s a resolution worth keeping.

 

Extreme Disappointment

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In general, I don’t watch reality weight-loss shows. I used to. Biggest Loser was one of my favorites. I was always in awe of how many pounds the contestants would lose each season, many of them shrinking to half of their starting size. But, ever since I became a dietitian, I view these shows in a much different light. Shows like My Big Fat Revenge, Biggest Loser, and Extreme Weight Loss promote dangerous messages about weight management – namely, that fat people are inherently unhealthy and that the only way to be healthy is to lose copious amounts of weight quickly by drastically restricting one’s calories and exercising like a maniac.

Despite my dislike of these shows, I do (rarely) catch an odd episode from time to time. Many of my clients watch these shows and take what the “experts” say as gospel, so it helps if I am in the know about the latest and greatest gimmicks these shows use, so I can help re-educate my clients.  

Last night, I stumbled across an episode of Extreme Weight Loss that truly disturbed me. In this episode, a 23-year-old woman named Alyssa was the individual who was chosen to undergo a year of restrictive eating and over-exercising courtesy of trainer Chris Powell.  The episode started predictably enough: initial weigh-in tears, a loss of 100+ pounds over the first 3 months (Phase 1), and the inevitable struggles to lose weight during Phase 2 (months 3-6).  

This is where things take a serious turn. After Phase 1, Alyssa found that the weight just wasn’t coming off like it had been before. No matter how much she tried to follow the meal and exercise plan, her weight was at a plateau. So, in order to reach her goal of losing another 60 pounds during Phase 2, she decided to drastically reduce her calories even more, at times eating close to nothing. This resulted in rebound binges and subsequent purging. Alyssa developed an eating disorder (ED).

At this point, the show’s producers should have stopped the program for Alyssa, insisted she get treatment for her ED, and take all of the focus off of her losing weight. Instead, Alyssa had a heartfelt talk with Chris and his wife Heidi (who herself struggled with an ED for eight years), and despite the fact that clearly Alyssa needed help dealing with her ED, they continued to encourage her to lose weight and restrict her calories. She was instructed to eat 1500 calories per day while exercising for at least three hours per day to achieve “healthy” weight loss.

At the very end of the program (and after she had completed the program, losing a total of 200 pounds), Chris offered Alyssa a two-month stay at Shades of Hope, an ED treatment center. While at first she rejected the offer, Alyssa ended up going to the program two weeks later, as it was clear that her eating issues were continuing. Why wasn’t this offer made immediately after Alyssa admitted her ED to Chris? Why did they wait until the end of the year to offer her help?

When someone is struggling with an ED, there should be no talk of trying to lose weight, whether it is in a “healthy way” or not. In a sense, the show itself taught Alyssa how to eat in a disordered (re: restrictive) way, priming her for developing an ED. By letting her continue on in her weight loss program, the show did Alyssa a real disservice and gave the message that EDs are no big deal and are just a “phase” that can be dealt with easily. Unfortunately, EDs are not only extremely damaging (and potentially fatal), but they also often turn out to be a life-long struggle, not something to be glossed over.

These shows are not only doing damage to the contestants, but also doing an enormous amount of damage to their viewers. I am hopeful that one day these shows will run out of steam and stop reinforcing the idea that losing weight and the number on the scale are the end all, be all. Maybe someday shows will promote healthy behavior change, without focusing on the numbers. But, I guess that wouldn’t make for scintillating TV.

Meal Enjoyment and Nutrient Absorption

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In nutrition school, I was taught that there were certain nutritional facts that always held true. A calorie is a calorie. If you eat 500 calories less per day for a week, you will lose one pound of body weight. Just because a “healthy” food might not be enjoyable to you or taste good, it is still important to eat it for good health.

Well, there is some interesting evidence that when it comes to nutrition, how much we enjoy our meals may be just as important as what our meals are made of.  In October of 2000, Tufts University Health and Nutrition Letter discussed a study that measured how one’s enjoyment of a meal affected one’s nutrient absorption. In the study, researchers from Thailand and Sweden teamed up to see if cultural preferences for a food would affect the absorption of iron from a meal.

In the first phase of the study, two groups of women, one from Thailand and the other from Sweden, were fed a typical Thai meal. Needless to say the Thai women preferred the taste of the meal more than the Swedish women did. Interestingly, even though all of the meals contained the exact same amount of iron, the Thai women absorbed twice as much iron from the meal than the Swedish women did. In the second phase of the study, the two groups were served a typical Swedish meal with the exact same iron content. In this case, the Swedish women absorbed significantly more iron from the meal than the Thai women did. 

In the second phase of the study, the Thai group and Swedish group were split up into two subgroups. The two Thai subgroups were given an identical Thai meal, but one of the subgroup’s meals was pureed into a mush. Even though both of the meals had the exact same iron content, the women who ate the mushy meal absorbed 70% less iron than the other group. The study was repeated in the Swedish group and the results were similar.

So what does this tell us? Taste and enjoyment matters to nutrient absorption! If you are one of those “nutrition martyrs” who eat foods that you really don’t enjoy just because they are “good for you,” it’s likely that you aren’t absorbing much of the nutrients from those foods. Conversely, even if you are eating a food deemed “unhealthy” by the food authorities, if you are truly enjoying and savoring it, you will be absorbing more nutrients from it.

Now, this isn’t license to only eat “junk.” But, instead of forcing yourself to eat healthy, but not tasty food, how about finding healthier foods that you enjoy? Instead of eating fat-free cheese, which, ahem, tastes like plastic, how about savoring some real sharp cheddar from a Vermont dairy? Instead of munching on low-quality chocolate, how about enjoying a piece of dark chocolate that is full of antioxidants? I am willing to bet that if you start to incorporate more pleasure into your meals, you’ll be happier and healthier.