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Coming Out

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I am officially coming out as fat today. I’ve been thinking about doing this for a while now. This concept might seem laughable to some of you. How can someone come out as something that everyone can plainly see? Take one look at me and my size and there is no question that I am fat, but up until fairly recently, I had eschewed the title of “fat,” something that I never wanted to claim to be.

I would describe myself with euphemisms: chubby, chunky, curvy, plus size. I would try to shrink myself in public, taking up as little space as possible lest someone feel like my body imposed on them. I would keep my gaze down as I passed strangers on the street, a way of showing my own shame and embarrassment for my body. I would dress in loose, baggy clothes so no one would be forced to see my belly rolls. If I went to the beach, I would be sure to wear a cover-up the entire time unless I decided to be brave and go for a swim. Then I would sprint into the water so that bystanders would not need to be assailed by the vision of a fat woman in a bathing suit.

All of this was an attempt not to take up space in the world, to show that I, as a fat person, was aware of my horrible shortcomings and was not okay with being in this body. The world that we live in confirmed these feelings often. Microaggressions would come in the form of friends discussing another friend’s weight gain or loss, family members commenting on what I was or was not eating, and doctors suggesting changing my diet without asking me what my diet looked like in the first place.

Like any “good fatty,” from a young age I would engage in different weight loss attempts to try to shrink myself and be “healthy.” My first earnest weight loss attempt was in my senior year of high school. I had made up my mind that I would finally lose the weight that had plagued me throughout my childhood and adolescence and be thin by the time I started college in the fall. Then I could start my new adult life in a socially acceptable body and everything would be perfect. I dutifully dieted, restricting all the foods that I loved, instead living on fat-free cottage cheese, vegetables, and sadness.

My body began to shrink and everyone noticed. I got compliments, invitations to parties, acceptance. My doctor was so impressed that he told me to “keep going” and “get skinny.” Meanwhile, I had lost my period, become completely obsessed with eating as little as possible, and was a grumpy, exhausted mess. At my worst, I was exercising twice a day to try to break the plateau. I was downing sugar-free candies to prevent myself from snacking between meals. (P.S. Fun fact about those candies: They are wicked laxatives!) I would loathe going out to eat with my friends and family, as I would be faced with all the foods I no longer allowed myself to have. Food and weight were all that I could think about.

When I went off to college in the fall, the wheels fell off the proverbial wagon, and I gained back all the weight I had lost and then some. The weight loss/gain cycle continued throughout college and into my 20s as I tried diet after diet, thinking that this time it will stick. But inevitably, the weight would creep back up, and I would feel humiliated and ashamed.

Little did I know then that my experience was not unique. In an analysis of 31 long-term diet studies, researchers concluded that while individuals can expect to initially lose 5% to 10% of their weight regardless of which diet or “lifestyle change” they choose, the weight inevitably comes back, with at least one-third to two-thirds of people regaining even more weight than they had lost in the first place. Another study that looked at the effectiveness of traditional dietary and exercise interventions for weight loss determined that while there is not much long-term follow-up data in the effectiveness of these interventions, “the data that do exist suggest almost complete relapse after 3-5 years.” And those 3-5% of dieters who do manage to keep the weight off for more than 5 years spend all of their time and energy trying to stay that way, often by using disordered eating and exercise behaviors.

I remember reading an article in the New York Times about nine years ago that focused on the National Weight Control Registry (WCR), a research study that follows individuals who have lost at least 30 pounds and have kept it off for at least a year. The article featured a husband and wife who had lost over one hundred pounds each and had been on the WCR for five years. In order to maintain their weight, the couple engaged in a rigid regimen of diet and exercise. Both of them not only exercised for a minimum of two hours per day, they also weighed and measured every morsel of food they ate, logging it into a food diary. They severely limited not only their calories, but the types of calories they were eating (e.g., low carb, no desserts). The wife herself said, “It’s pretty easy to get angry with the amount of work and dedication it takes to keep this weight off,” but the alternative (i.e., gaining the weight back) was not an acceptable outcome for her.

Part of the reason I made the decision to become a registered dietitian was the hope that I could finally crack the code of weight loss. I figured, well, if I learn about all the aspects of nutrition, I will be able to lose weight, keep it off, and help others to do so, too. Before entering the nutrition program, I had dieted down to a lower weight and thus was obsessively thinking about food and my body. Interestingly, by the time I had completed my dietetic program, internship, and Master of Science in nutrition, I had again gained back all of the weight I had lost. Of course, I was quite unhappy with this development but still believed that I could figure out my weight dilemma eventually.

My first dietetic job was at an eating disorder center where I was a registered dietitian working with residential patients. It was around this time that things started to shift slightly for me. I saw how the patients were treated differently based on their body size. For instance, those patients in larger bodies, regardless if they had been admitted for restriction or not, were put on “weight maintenance” meal plans to prevent them from becoming “too fat,” while those patients in smaller bodies were encouraged to eat more to restore their weights to a “healthy weight.”

Basically, we were prescribing behaviors to one group of patients (restriction for those in larger bodies) that were considered disordered in the other group of patients. This double standard did not sit well with me, but I adhered to the guidelines at the center. At the same time, I was still fixated on shrinking my own body, terribly self-conscious of being a fat dietitian in a field known for a very specific type of person: white, female, thin. I thought to myself, “How will any of these patients take me seriously when they see my body?” I dieted once again during this period of time, and with my own wedding day approaching, I got even more obsessed about the number on the scale.

It wasn’t until after the wedding (and subsequent weight regain) that I finally had enough. This wasn’t working for me anymore, and it wasn’t for lack of trying. I had hit diet rock bottom and knew there had to be a better way. So when I learned of Health at Every Size® (HAES) and Intuitive Eating (IE) at a talk given by a colleague, I was so ready to hear the message that there was a way to live a happier and healthier life, a life where food is not the focus and where I could be free of the chains of dieting.

I delved into all of the HAES, body positive, and intuitive eating material I could find online and in various books. I attended workshops and lectures and even spent three weeks at a HAES/IE retreat. I started listening to podcasts, connecting with other HAES and IE practitioners, and before I knew it, my mindset had shifted significantly. HAES and IE spoke to me like no other paradigms or approaches, and once I learned that they are also both backed by scientific research, I was a convert.

During this time, of course I gained some weight after years of losing and gaining (in addition to having a baby), with my body finally landing in the “obese” range, at least for now. It is difficult to be in a larger body for many reasons. Doctor appointments have become more fraught as I brace myself for the weight lecture. Luckily I was able to find a weight-neutral doctor who knows not to talk to me about weight loss, but if I ever need to see a specialist, I know that inevitably my weight will come into the discussion.

Being in a larger body makes it harder to shop for clothes, fit in some spaces, and feel “normal” amongst my mostly slim friends and family. I never had to think before, “Will I fit in this seat?” But now these are things I need to consider. Being a “small-mid fat,” I want to acknowledge that I have much more privilege than those who identify as “large-fat,” “super-fat,” or “infinifat.” The hatred, mistreatment, and oftentimes abuse these individuals deal with on a daily basis make me simultaneously so angry and so sad.

Our diet-obsessed, fatphobic culture makes sure to remind me and other fat people that we are lazy, gross, sloppy gluttons who could be thin if we just tried hard enough and put down the bonbons. The overwhelming majority of people believe that weight is controllable and that if fat people just ate less and exercised more, they could be thin. Most people also believe that the health conditions that are often associated with larger body sizes (such as heart disease and diabetes) are directly caused by weight, even though there are thin people who develop these conditions, too.

While obviously what we eat and how much we move can affect our health, they are a very small part of the picture of overall health and wellness. Access to healthcare, socioeconomic status, oppression, and weight stigma have even greater impacts on our health than just diet and exercise. And just because someone does all of the “right” and “healthy” things does not guarantee that they will never become ill. Society would have us believe that the pursuit of health is a moral imperative and totally within our reach if we just try hard enough. But in the wise words of fat activist Ragen Chastain, “health is not an obligation, a barometer of worthiness, completely within our control, or guaranteed.”

Otherwise open-minded, liberal people who believe in equality and respect for those of different races, ethnicities, sexual orientations, religions, abilities, and gender identities do not consider body size diversity as something that also needs to be respected and protected. This world is not built for larger people, and existing in it can be torturous at times.

In addition to all of this, I still have a great deal of internalized fatphobia that I am constantly trying to counteract with body acceptance. I have had to come to terms that I will never likely be in a smaller body and that this is not the end of the world. At the same time, nearly everyone in my life lives and breathes the same diet culture air we live in, so it’s rare that I am not faced with some fatphobia, diet talk, or weight stigma. It’s like I’m swimming against the current of diet culture nearly 24-7, and sometimes I just want to give up and go with the flow or jump out of the water entirely. But knowing what I know about the lies of diet culture and how miserable my life was when I pursued thinness, I can’t go back.

So I am coming out as fat today to reclaim this word that has been used to taunt me and millions of other people but should honestly be just a neutral descriptor. I am a fat, fair-skinned, red-headed registered dietitian, wife, daughter, sister, friend, and mother. I am all of these things. And I am no longer going to stay in the body shame closet.

Privilege and Cowardice: A Chronology

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“You should have hit her. She’s black.”

It is 1989, and I am a sixth grader struggling to adjust to life at Pollard Middle School. We are in music class. Instead of practicing their piano parts, two boys are sexually assaulting one of our classmates, laughing as they repeatedly grab her breasts and pinch her buttocks despite her best efforts to swat their hands away.

When the brown-skinned girl sees me looking at her, she recoils and asks me if I am going to touch her, too. No, I would never, that is not at all who I am. But she does not know that. The fear on her face suggests that despite her young age, she has already learned to see every boy as a potential assailant. I do nothing. Neither does the music teacher.

Two grades later, I am walking through the science department hallway after school has let out for the day. The corridor is mostly empty, just me, a younger girl, and the two aforementioned boys. One of the latter flinch tests the girl, acting like he is going to punch her before stopping his fist just before her face. She remains silent and does not react. As they walk away, one boy says to the other, “You should have hit her. She’s black.” Afraid they might come after me, I say nothing. I do nothing. I tell no one.

It is November 2015, I am reluctantly attending my high school reunion, and I spot him, the boy – now a graying man on the early fringes of middle age – who spoke those words in the science department hallway. As soon as I see him, I think of these two incidents and wonder how many women and minorities he has harassed, bullied, intimidated, and assaulted over the last few decades in part because I did nothing to stop him.

 

Kicked

It is early spring in 1995, and my time at Needham High School is nearing an end. The best player on our tennis team is a black student who buses between his inner city home and our suburban school as part of the METCO program.

The time he loses every morning and afternoon sitting on a bus is time that I and many of my suburban-dwelling peers can use to study, do homework, seek tutoring or extra help from teachers, participate in extracurricular activities, or even just relax or sleep, all of which help directly or indirectly with our academics and college applications. We have a leg up on him based on proximity alone.

Not only is my teammate a great player, but he is also a super nice young man who goes out of his way to help us with our own games, including teaching me how to hit a kick serve. Meanwhile, I am stuck in tennis purgatory, sandwiched between a varsity roster filled with players better than me and our coach’s policy against allowing seniors on junior varsity. Coach explains to me that after three seasons together, he feels too bad to cut me, but that I should cut myself because I am not going to play. I refuse to do so and remain on the team solely as a practice hitting partner.

My personal and familial responsibilities enable me to spend every afternoon out on the courts, but my teammate has other obligations. He misses some practices, and coach tells him that if it happens again, he is gone. Then he misses another day because he has to give his brother a ride. Coach kicks him off the team, citing a lack of commitment. He cannot be in two places at once. What is he supposed to do? Yet none of his now ex-teammates come to his defense, at least, not to my knowledge.

As a result of his expulsion from the team, I get promoted to the varsity lineup and have an unexpectedly great season – thanks in part to my new kick serve – that springboards me to playing for my college.

It is my senior year at Tufts University, and not only do I get to tell potential employers that I am a collegiate athlete, thus implying that I possess a disciplined work ethic and an ability to function as part of a team, but I can add that I have been named a co-captain, suggesting that I have leadership qualities and the respect of my peers. Can my ex-teammate from high school list either of these accolades on his resume?

 

Being Followed

It is the summer of 1995, and I am a recent high school graduate working my first “real” job at Thunder Sporting Goods in Wellesley, the town in which gun-drawn police forced black Celtics player Dee Brown from his car and ordered him to lie on the ground in a case of mistaken identity five years earlier. Brown, who was originally from Florida, went on to say, “When you think of towns up North and you think of racism, you think of Boston.”

My duties primarily entail stringing tennis racquets and selling running shoes, but on this particular day, my manager gives me a different task. A neighboring retail store down the block called him to report that a black person had just been in their store and was apparently headed in our direction. My manager tells me to follow them around the store to make sure they do not steal anything.

His racist directive shocks me, yet I am intimidated by my boss, my first one ever, so I plan to keep myself busy with tasks in the same general vicinity as the shopper, but no way am I going to blatantly follow them around the store. Not a great plan, but in my 18-year-old brain, it feels like a compromise of sorts. As it turns out, the person takes their business elsewhere and never enters our store.

 

The “Bloody Shirt” Incident

It is 1996, I am a college freshman, and I agree to help a friend paint the set for her drama production. Afraid of getting paint on my nice sneakers, I wear my running shoes. It is late at night by the time I leave the scene shop, and since I have my running shoes on anyway, I decide to save some time and jog back to my dorm.

A policeman working a construction detail yells at me to stop. He sees red on my shirt and thinks I was involved in the fight he heard about over his radio. It is just paint, I tell him. Without getting close enough to me to verify my claim, he takes me at my word, and I continue running into the night. Now I have a somewhat amusing story to tell friends about the time a policeman briefly mistook me for a violent perpetrator. I am white.

 

Daewoo(d)

It is June 1999, and I am a recent college graduate. My girlfriend and I land in Las Vegas with plans to rent a car and drive to Phoenix and then San Diego for a short vacation before I enter the working world next month. The rental agency gives us the choice between two vehicles: a car to which they cannot find the key or a sketchy Daewoo without a license plate.

Somewhere in the Arizona desert, we get pulled over for speeding and driving a car without a license plate. Both policemen are friendly, and as one of them does whatever it is that cops do in their cruisers during traffic stops, the other remains by our Daewoo and jokes that maybe the last D on the car had fallen off, as he has never heard of the make before, but he knows of an electronics company by the name of Daewood.

The only emotions I am experiencing are shame and embarrassment for having been pulled over. Fear for our safety or even a theoretical notion that a routine traffic stop could turn violent never cross my mind. Despite being egregiously guilty of both offenses, we are sent on our way in our plateless car with neither a ticket nor a written warning. My girlfriend is also white.

 

Playing Fields

It is 2004, and I go back to school for nutrition at the University of Massachusetts Amherst. Driven by a fear of failure, I do everything I can to be academically perfect. In general chemistry, I answer literally every practice question in the textbook, even ones not assigned as homework. In organic chemistry, I attend the TA’s office hours, the professor’s office hours, and the on-campus tutoring department’s study groups every single week. My anxiety drives me to attend chemistry classes that I am not even enrolled in, just so I can hear the material presented over and over again.

My work ethic is as solid as osmium, but so are those of many of my classmates. Unlike some of them, I have finances working in my favor. Whereas some classmates have to load up on courses in order to finish the program as quickly as possible rather than rack up tuition costs for additional semesters, I go at a leisurely pace and never take more than four courses in a given semester. Instead of toiling endlessly at a job just to get by, my part-time gigs as a personal trainer and a dietitian’s assistant rarely sum to more than 15 hours in a given week. While our efforts are more or less equal, theirs are spread thinly over several demands whereas mine are more focused. I can afford – both literally and figuratively – to do this because I have personal savings and financial support from my parents.

Upon graduation, I have a 4.0 GPA, a handful of merit scholarships – including one for my achievements in organic chemistry – and an offer to work for free at one of the most prestigious dietetic internships in the country. Some of my classmates are not matched to an internship and are forced to pivot their career paths away from nutrition.

Because of my financial situation, I can accept my placement in the unpaid internship, the name recognition of which helps me to land my first job as a newbie registered dietitian.

 

The Iceberg’s Tip

It is June 2006, and I am in the early stages of a Seattle-to-Boston charity bicycle ride with a small group of other cyclists from around the country.

Riding into Clark Fork, a small and isolated town in the Idaho panhandle, I am shocked to see Confederate flags and pro-KKK signs openly displayed in front of a good portion of the homes.

That evening, the only black rider on our trip and I head to the local laundromat. As we walk, I tell him how surprised and horrified I am to see that such blatant racism still exists in our country, as I thought that we as a nation were past all that.

He explains to me that because I am white, I have the privilege of moving about the world largely ignorant of racism until it is glaring in my face like it is here in Clark Fork.

He is right, I realize. More than any other lesson that I learn about myself or America during our 4,024 miles across the continent, his is the one that sticks with me.

 

Community

It is the winter of 2007-2008, and my internship rotation has me working on a roving healthcare van that travels to parts of Boston that I have previously steered clear of because I associate them with violence. We park in the heart of Mattapan to conduct various screenings, such as blood sugar and blood pressure checks, distribute free condoms, and answer as best we can whatever health-related questions and concerns are voiced by our visitors, virtually all of whom are black.

On one of our lunch breaks, my preceptor takes me to Ali’s Roti Restaurant because she wants me to experience a cuisine I do not encounter in the suburbs. We browse a neighborhood grocery store so she can show me the food supply available to the neighborhood’s residents. She points out organ meats and animal parts that I never would have thought of consuming before, but they are commonplace in other cultures. Note how prevalent and cheap the sugary drinks are in comparison to other beverages, she tells me. People can only buy what they have available to them and what they can afford, she explains.

We visit a food pantry, and I talk with people eagerly lined up to receive loaves of bread so old that there is no way I would eat them myself unless I was, well, starving. While I know of the existence of food pantries and understand them in an academic sense, this is my first time really experiencing one and interacting with people who rely on them to feed themselves and their families. I go home and make myself dinner in my fully stocked kitchen.

 

Readings

It is the early summer of 2008, and I have just completed my dietetic internship. A seasoned dietitian asks me to help her at a community healthcare event. People will be coming to us for information and screenings, very similar to those that I performed while on the roving healthcare van.

“If you can’t read someone’s blood pressure,” she says, “just tell them it is 120/80.”

The ethical choice and the one that prioritizes patient care is obviously to disregard her directive, but I feel intimidated by her, and I want to stay on her good side in hopes that she might help me with my job search. Fortunately, I am pretty skilled at taking blood pressure, so I never have to cross this bridge.

For our visitors, the vast majority of whom are black, this community event is essentially their annual physical. I imagine someone coming in for a blood pressure check, giving them a fabricated 120/80 result, and sending them on their way thinking they have normal blood pressure when really they have hypertension that subsequently goes untreated and leads to a stroke.

It is June 2020. I read that blacks are 50% more likely to have a stroke in comparison to whites and I wonder: Is the biology of skin pigment really the causal factor here, or is it everything else that comes bundled with being a minority in a country fraught with social disparities and systemic racism?

 

Praising Adele’s Weight Loss Is Fatphobic

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The following is a guest blog written by “Sarah,” a nurse practitioner in the Boston area, who strongly believes in utilizing Health at Every Size (HAES) and anti-diet approaches in both her personal and professional lives. She has been Joanne’s patient for about six years and is in recovery from an eating disorder.

It is no secret that our current society is obsessed with physical appearance. The perceived attractiveness of a person very much determines how they are valued, respected, and treated. This is especially true in regard to women, and to an even further extent, celebrity women. 

At this point, I am sure most of you have come across recent media stories of renowned singer Adele’s dramatic weight loss. After an Instagram post from Adele of herself in a form-fitting dress, with a caption giving a mention of her birthday and a shout-out to the first responders in the midst of the COVID-19 pandemic, comments swarmed in that had nothing to do with what she actually wrote. Now there were some comments that highlighted the fact that we should be praising Adele for her immense talent and not her appearance. Five or ten years ago, some of these comments would probably not have existed, and therefore that does highlight the progress we have made in rejecting diet culture and in the public knowledge of this movement. However, the majority of the comments praised her new, thinner, more “acceptable” body. 

Now I want to make it clear that I know absolutely nothing about Adele as a human, including her diet or exercise regimen. It is truly none of my or anyone else’s business what Adele decides to do or not to do in regard to her body. Even as someone who fully believes in HAES and is very anti-diet, if Adele did intentionally seek a smaller body, I can’t say that I blame her. Our world is a hostile place for those of us living in marginalized bodies. If you are fat, disabled, trans, poor, non-white, or any iteration of these, you are subjected to discrimination and othering. Therefore, it is no wonder why one would want to attempt to fit into a more socially respected body. 

I would normally say that it is unfair to assume anything about Adele’s means of attaining this new look, but in recent articles, she does discuss a particular diet of a VERY scary low number of calories (*trigger warning) and a rigidly structured exercise plan. Again, it is no one’s business how Adele decides to treat her body, but by the DSM standard, there is no question that she would be diagnosed with an eating disorder. I recognize that this is more of a systems issue, and those who mean well by praising her new body are operating under a fat-phobic structure. While eating disorder behaviors are considered concerning when the individual is thin, these same behaviors are encouraged for those who are in larger bodies. It is what we are taught and how we operate as a culture; it is no wonder that full recovery from eating disorders is so challenging (and oftentimes unachievable).

Now let’s get down to the real issue and meaning behind Adele’s weight loss (which really has not much to do with her at all). Body autonomy is part of the HAES movement, and I fully stand behind this for Adele or anyone else. It is the mere fact that a single picture can prompt so many comments (positive or negative) about one’s body that is the core issue here. 

The focus by others on a changing body, in a positive or negative way, often keeps people from recovering fully. If we lived in a world where a body was just a body regardless of how large or small it became, this would not even be a topic of conversation. Although it is an inevitable fact that bodies fluctuate for various reasons throughout the lifespan, we cannot seem to accept this as a society. Naomi Wolf stated: “A culture fixated on female thinness is not an obsession about female beauty, but an obsession about female obedience. Dieting is the most potent political sedative in women’s history; a quietly mad population is a tractable one.” Diet culture and fatphobia are the prime examples of this. We are taught that our worth depends on other people’s evaluation of us and that how our body looks to others matters more than how it feels to us. Especially as women, we are taught that making others happy is more important than making ourselves happy and that the most important thing is that others will like and approve of us, and therefore it is no wonder that we constantly rely on external validation to prove our worth.

Being fat and/or gaining weight is seen as the ultimate failure, and there is countless evidence of this belief expressed throughout history. We see and hear examples of this in our everyday lives, whether we recognize it or not. It is more common knowledge these days that “diets don’t work,” but we have yet to make significant progress in the idea that one’s body does not determine their worth. That is not to discredit all of the amazing progress that the HAES community has made, and as someone in a straight-size body, I cannot speak to the true experience of someone living in a larger, marginalized body. However, as a woman living in constant recovery from an eating disorder, I can say that the fear of weight gain has held me back in so many ways throughout this journey. Fatphobia truly affects everybody (whether they realize it or not) but is much more pervasive for women. 

I now know that these are reactive thoughts stemming from decades of diet culture brainwashing and the instinctual need to belong as a human. These messages have become even louder throughout the COVID-19 pandemic. Not only are we separated from many of our in-person support systems, dealing with real threats to our health and vitality, but we are relatively stuck at home with our thoughts. Although I do truly believe sitting and ruminating in these thoughts and fears can lead to growth in so many ways, it is also extremely triggering. We have less access physically and maybe financially to certain foods, and this can be triggering in itself.

To add to this, those who suffer from eating disorders and also live in larger bodies are especially vulnerable given the extreme fatphobia that knows no boundaries. There have been countless news articles claiming that people living in larger bodies are more susceptible to COVID-19. Not only is this untrue, but it is incredible healthism and just another example of diet culture profiting from our fears. Attempting to change one’s body size in the hopes of health and immortality has never worked in the past and scientifically never will. It is disappointing that these messages of blame and shame are being touted instead of compassion, inclusivity, and actual scientific facts, especially during this time. 

So how do we begin to change as a culture? By recognizing that beliefs and facts are not the same. By rejecting diet culture and recognizing that our body size or health status has nothing to do with our worth as humans and by treating others with respect and dignity just because they exist. As the wise Ragen Chastain said best: “Health is not an obligation, barometer of worthiness, or entirely within our control,” and this could not be more relevant in our current climate.

Emotional Eating in Quarantine

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Despite the major life disruption that the coronavirus quarantine has been for us personally, Jonah and I are lucky enough to be able to still work, as we are telehealth providers. While all of my patients are struggling in different ways with quarantine, one theme keeps on popping up consistently: “I feel like my emotional eating is out of control.”

Many of my patients are working on becoming intuitive eaters, and the current pandemic is making it extremely difficult for them to heal their relationship with their bodies and food. Living in these strange times is like nothing we have ever experienced before – being confined to our homes, socially distancing, and the near constant underlying fear of illness are exhausting and emotionally draining.

Some of my patients are working on the front lines of the corona crisis, taking care of patients who are severely ill. Some of my patients have lost loved ones to the virus. Others are struggling with the loneliness of isolation. In short, the past couple of months have been really, really rough. And the fact that there is no definite end point for this pandemic, that this state of limbo could continue for months on end, leaves many of us feeling hopeless and trapped.  

So when my patients tell me that they are emotionally eating, I am not at all surprised. Emotional eating in times of stress and uncertainty is normal and, honestly, to be expected. From the time that we are born, food is a source of nourishment and comfort. Food is a basic human need. From the very beginning, whether we start out nursing or bottle feeding, drinking breast milk or formula (or both), food is necessary for survival. It is designed to make us feel satiated and safe. Food is one way that our caregivers take care of us when we are babies, providing comfort when the feeling of hunger arises. This is all to say that turning to food for comfort is a completely normal thing for humans to do – it is programmed in our DNA. And feelings of comfort and safety are paramount to developing love and attachment.

The phrase “emotional eating” has been around for many years, and it always seems to be presented as a negative thing. Many of my patients characterize themselves as emotional eaters and wish that they could stop. In most cases, these patients feel as though they have “no control” around food, that they will overeat on certain comfort foods, and they inevitably feel shame after they do this. Of course, many of these patients are consumed with fears around gaining weight and feel that by engaging in emotional eating, they are likely to become larger.

To me, “emotional eating” is a phrase that was created by diet culture because at the root of it is fat phobia. Our culture is a completely fat phobic one, and one of the underlying themes is that engaging in emotional eating is a dangerous habit; if one emotionally eats regularly, they will gain weight, become fat and be unhealthy, unattractive, and unlovable. Emotional eating is seen as problematic by diet culture, and those who engage in it are deemed weak-willed and less than.

In my work, what I have found is that the amount that a patient engages in “emotional eating” is almost directly proportional to the amount of restriction (both mental and physical) in which they also engage. In other words, my patients who feel like they are emotional eaters and cannot control themselves around food are often the ones who are the most restrictive with their intake.

If you think about it, it makes sense on a biological level. Our early ancestors were often subjected to famine and food scarcity, and in order to survive during those times, their sole focus became about finding food. It is one of our most basic survival mechanisms, and it is deep within our genetic code. When we are deprived of food (whether it be deprivation imposed on us by others/circumstance or self-imposed), our primal brain is designed to focus solely on procuring food. And not just any food, mind you, but food that is calorically dense and will give us quick and lasting energy, specifically foods that are high in carbohydrates and fat. Is it any wonder that many of our “comfort foods” are often comprised mainly of carbs and fat? It is our ancient genetic code’s way of keeping us alive.

This is all to say that when we are in times of stress, anxiety and fear (like during this pandemic), it makes perfect sense that we might turn to food for comfort more often. This behavior in and of itself is not problematic; it is one of the many ways that humans cope during difficult times. Add on top of that feelings of deprivation around food (with many grocery stores running out of supplies and access to restaurants reduced), and it is no wonder that we have food on the brain more often as well. The most important thing we can do right now is not to judge ourselves for “emotionally eating” during this tough time, but to have some compassion for ourselves. We are all just trying to take care of ourselves in the best way we know how.

Welcome to Food Insecurity

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The pasta aisle at the Wellesley Whole Foods on March 13, 2020.

Some of the earliest dietary guidelines emphasized high-calorie foods, like butter and margarine, because so many young men were failing their military physicals due to malnutrition. Unlike some of our ancestors, who struggled through or perished in famines or economic depressions, my generation in this country has been lucky in that we could take our access to food for granted.

Of course, numerous exceptions exist. Needham’s food pantry and the SNAP stickers on supermarket refrigerators are evidence that some of our very own neighbors struggle to get enough to eat. When I visited grocery stores on isolated Native American reservations in middle-of-nowhere regions of Montana and North Dakota in 2006, I was floored by how limited the selections were. Poverty and food deserts are not the sole factors that can limit access to food, as some of my pediatric patients growing up in restrictive households could tell us. Dieters know that food scarcity can be self-imposed.

For the rest of us, the panic surrounding COVID-19, the associated hoarding of supplies, and the resulting empty shelves have inducted us into a sensation that so much of the human race has known, but we were too privileged to experience it firsthand.

Welcome to food insecurity.

Whether or not our food supply chain is actually at risk for significant disruption, the mere perception of a threat is enough to trigger feelings of food insecurity. We see the pasta shelves and potato bins empty, the milk section vacant, frozen produce nowhere to be found, and other typical supermarket staples gone, and we feel a visceral reaction that we had better get what we can while we can. Hence, we hear stories of people making purchases that in other circumstances would make little sense. For example, one of our patients was at Costco and ended up buying a gallon of mayonnaise, a condiment she does not even typically use, just because she could get her hands on it in the midst of the frenzy.

We can understand why. Dieters know that restriction, or the mere threat of it, triggers overconsumption. Thematically, little difference exists between someone loading up a shopping cart with whatever items they can and a person who overeats on the weekend while telling themselves, “Diet starts Monday.”

When it comes time to eat, the veil of food insecurity might compel us to finish all that we have served ourselves, lest we “waste” food by leaving it uneaten. My suggestions are to understand the source of these feelings and to validate them, but also to realize you still have a choice and remove moralization from whatever decision you make.

Keep in mind that we have in our lineage ancestors who survived extraordinary circumstances and may have attempted – for better or for worse – to instill their survival skills in us. For example, my grandparents, who grew up during the Great Depression, used to pressure me to clean my plate. As another example, one of my patient’s grandmothers is a Holocaust survivor and made it through her horrific ordeal by eating whatever she could whenever she could because her next feeding opportunity was never guaranteed; like my grandparents, she pressures my patient to eat more than he can comfortably consume, too.

In terms of what to do about potential overconsumption, there is no blanket answer that is right for everyone. Instead, I encourage people to be aware of the dynamics involved in their eating decisions, including any pressures and threats related to food insecurity that might be at play.

Consider the role that stress might have in your eating decisions and know that – contrary to what diet culture tells us – emotional eating is an understandable and relatively benign response to these troubling times. We all have to deal with our stress somehow, and each of us has a different toolbox of coping strategies. Before you feel badly about eating extra in an effort to soothe yourself, remember there are people in your neighborhood reacting to their stress in much more destructive fashions, such as shooting heroin or beating up their spouse. Eventually, we can expand our repertoire of coping options so that eating is just one of many choices we can make to de-stress.

Ultimate decisions matter less than having taken the time to thoughtfully arrive at them. Weigh the pros and cons of whatever options you face while understanding that none of them is likely perfect, choose the one that in balance feels the most right to you, and know that you are neither guilty nor virtuous for whatever choice you make.

Keep in mind that these times will not last forever. Quarantines and social distancing directives will end, restaurant dining rooms will reopen, and grocery store shelves will be fully stocked once again. When they do, be on the lookout for residual behaviors that may date back to your days of food insecurity, as we know from our ancestors that such behaviors can stick around long after the threat is gone.

No Bargaining Needed

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About a month ago, I was watching one of my usual TV shows when a commercial came on for Ore-Ida French fries. Normally, I would skip ahead using my DVR fast forward button, but something made me pause. The commercial starts with a young girl and her father sitting at the family dinner table. The girl has a plate with broccoli on it. She pushes it away with a look of disgust on her face, her father pushes the plate back in front of her, and this gets repeated a couple of times until dad whips out three crinkle cut French fries in his hand. Immediately, the girl smiles, takes a bite of her broccoli, and then happily grabs the French fries. Meanwhile, the voiceover narrates: “Is mealtime a struggle? Introducing Ore-Ida Potato Pay. Where Ore-Ida Golden Crinkles are your crispy currency to pay for bites of this [broccoli] with this [French fries]. When kids won’t eat dinner, Potato Pay them to. Ore-Ida. Win at mealtime.”

Um, what now? Wow. Now, as the mother of a toddler who isn’t the most adventurous or enthusiastic eater, I get that parents often struggle at mealtimes with their kids. As parents, especially parents of young children, we are the “gatekeepers” of meals and snacks, deciding what food will be served and when. There is a lot of pressure on parents to make sure their kids are getting just the right amount – not too much, not too little – of nutrient-dense foods to ensure optimal health. Even prior to birth, mothers are reminded to eat as nutritiously as they can to give their developing baby the best chance of being healthy. This concern continues with infants, as many parents struggle with figuring out if breastfeeding, bottle feeding, and/or formula works best for them. And as these infants grow and eventually start eating solids, the worries about getting enough nutrition while avoiding “empty calories” commence. It’s stressful to be in charge of what your kids are eating (or not eating)!

As Jonah and I have written about previously, we believe that Ellyn Satter’s Division of Responsibility (DOR) is the best way to help one’s children become competent intuitive eaters. In short, the DOR states that parents or caregivers decide what food will be served, at what intervals food will be served, and where food will be served. Children, on the other hand, are in charge of eating (or not eating) the offered food and how much they eat of said food. Parents/caregivers are encouraged to offer a wide variety of foods at meals and snacks, including not only “nutrient dense” options but also foods that the general public might consider to be “fun foods” that are high in sugar, fat, and/or salt. When using these strategies, children learn to trust their hunger and fullness cues, develop their palates, and learn to eat in a satiating and enjoyable way. They also learn that foods don’t have moral value; for instance, broccoli isn’t inherently superior to French fries, and all foods fit.

Clearly, bribing your child to eat their vegetables (or other foods they don’t want to eat) with “fun foods” is the exact opposite of the DOR. This teaches kids that they can’t trust their own bodies to tell them what and how much to eat. It teaches kids that the only way to eat broccoli is to choke it down in order to earn French fries. It takes all agency away from the child and turns the parent/caregiver into the food warden. Instead of helping kids try and figure out what foods they enjoy (which could include broccoli!), this technique basically punishes kids for having preferences. It can and will create even more stress and power struggles around mealtimes.

Look, I get it. I, myself, have had to curb my instinct to try to push more “nutritious” foods on our daughter when all she seems to want to eat are the high fat, salty or sugary foods. I want her to be healthy! I don’t want her to have nutrient deficiencies! But I also have to remind myself that intervening in her side of the DOR is overstepping my bounds and that by putting some foods up on a pedestal and pushing them on her, I would be teaching her that foods are either “good/healthy” or “bad/unhealthy.” Instead, I want her to know that all foods fit and that I trust her body to tell her when it is feeling more in the broccoli mood or in the French fry mood. I know that she will eventually get plenty of messages around food from her peers, teachers, and TV, but I hope that by instilling the principles of intuitive eating and DOR early on, I can prevent her from getting sucked into diet and wellness culture.

Immunity Boosters?

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If you are like me, you have noticed the seemingly greater-than-normal prevalence of illnesses circulating this winter, and perhaps you have suffered some of them yourself, too. No wonder people are looking for foods, nutrients, and supplements that can help them get or stay well.

So which ones help? Well, admittedly, this piece has taken a very different shape than I expected it to when I first started writing. It would be straightforward, I figured; just research the most popular immunity boosters and summarize which ones work and which ones do not. However, my expectation stemmed from having fallen into the trap of oversimplification that so often affects how our culture sees foods.

In reality, there is nuance, as I quickly remembered, and the moving parts are numerous. To suggest blanket statements about effectiveness is a variation of the oversimplified good/bad food dichotomies that are so prevalent in our culture, yet they are nonsensical without specific context.

Consider some of the variables:

Effectiveness

What does “boosting” our immune system really mean? Our immune systems are comprised of various structures and mechanisms, so when one talks of “boosting” the system, what specifically is supposedly being increased and by how much? Furthermore, do we really want to turn the dial up on our immune systems, which theoretically could result in an autoimmune disease?

When people say they want to boost their immune systems, really what they are expressing is a desire to get over an illness faster, or experience a sickness milder than what they otherwise would have, or avoid getting sick in the first place. However, these three goals are different from one another, as are the bacterial and viral invaders that exist in a wide array, so any potential immune system booster could differ in effectiveness in achieving each of the three outcomes for each of the numerous potential illnesses. Therefore, a study that demonstrates biological responses to garlic does not tell us much about bottom-line effectiveness, but rather paves the way for further study.

Dosage

The administration of a potential immune system booster has within it its own set of variables, including how much, how frequently, and which delivery method. Further complicating matters is the potential for dosage variation from person to person.

A study on vitamin C found that plasma levels of the vitamin measuring 100-200 mg/day were required for effective prevention of potential infections, but how many oranges must one consume to reach such serum levels? One, five, maybe more?

Population

Effectiveness and dosage may depend on age, weight, physical activity, hydration level, health conditions, or any of the other factors that vary from person to person. Zinc, for example, has been shown to significantly reduce the duration of cold symptoms in adults, but not children.

Risks

Looking to a food, nutrient, or supplement to help fight off an illness has potential downsides. Zinc can cause nausea when consumed orally, and it can trigger a copper deficiency if taken excessively because the two minerals compete for the same absorption sites. Meanwhile, more subjects taking echinacea dropped out of double-blind prevention trials than those taking placebos due to adverse effects. Because supplements are unregulated, we have no way of knowing if the bottle of echinacea that we purchase even contains the herb as advertised.

Somewhere out there lies a truth, but discovering it is a more difficult proposition than some realize. With so many variables at play, designing and conducting informative studies is a monumental challenge. We need large bodies of well-constructed research and replication of results from one study to the next with similar parameters, and all of that takes time, money, and effort.

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

Dr. Levinovitz’s words remain true regarding ailments ranging from the coronavirus to the common cold. Nobody wants to hear that the answers are complex, nuanced, or blatantly unknown when they are anxious and looking for control over their fate.

In order to fill the void, in step those looking to gain notoriety or money. In the eyes of desperate people, the accuracy of an answer seems far less important than being able to provide one. This dynamic likely explains why so much of the misleading and biased information online regarding immunity boosting stems from commercial websites.

So which foods, nutrients, and supplements actually do help us to have shorter and milder illnesses or help us to avoid getting sick altogether? Truthfully, I have no idea. Now excuse me while I go take my elderberry syrup.

WHETHER U BELIEVE U CAN OR CAN’T ONLY SOMEWHAT MATTERS!

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“Anything is possibleeeeeeeeeeeeeeeeee!” Kevin Garnett was already one of my favorite basketball players long before he came to Boston and helped the Celtics to win the 2008 championship, but his famous post-victory line made me cringe. No, Kevin, while I understand you were excited and trying to inspire, empower, and motivate, let’s be real: Anything is not possible.

The message board outside Needham’s Mitchell Elementary School triggered a similar reaction when I passed by it earlier this month. “WHETHER U BELIEVE U CAN OR CAN’T YOU’RE ABSOLUTELY RIGHT!” What are we teaching the children in this town, I questioned, and I am not even referencing the problematic grammar that seems to acquiesce to the texting generation.

As someone who was raised on The Little Engine That Could, I can appreciate the power of motivational messages that encourage children to believe in themselves, show courage, and put forth their best efforts. After all, sometimes we sell ourselves short and assume something is out of our reach, when really we could have grasped it if only we took a chance and tried.

However, the little engine’s famous mantra is “I think I can,” not “I know I can,” and the difference of just a single word reflects a broad and important truth: While we can control our behaviors to an extent, outcomes depend on more than just our actions and are often subject to factors that are out of our hands.

Competitive runners learn that time is more in their control than placement, as the latter depends on who else is racing. For example, I may go into a race fully believing in my heart that I can finish in the top ten, but if the Kenyan national team shows up to run, all the self-belief in the world is not going to overcome my competition’s skill. Even finishing time, which is more in one’s control than placement, is still subject to exterior forces, such as weather, that can slow down the entire field.

Life experience has taught me that someone using the language of certainty, such as the verb “will,” when discussing outcomes that are only somewhat in their control is a red flag that the person has lost some touch with reality. One of my first jobs as a dietitian was at a startup medical clinic that boasted that they would expand to 50 locations across the country and build a headquarters complete with a farm and even their own medical school. The leaders disapproved of and took exception to pragmatic questions about the feasibility of their stated goals and used language of certainty when discussing the company’s future. A few years after I left the company, they went out of business completely, having expanded to a total of two locations.

My gripe with the quote outside Mitchell School is not technical, unlike the guy who used logic and mathematics to pick apart the semantics of Wayne Gretzky’s famous quote; nor is it theoretical, as if I were overly worried about a potential impact that may never come to fruition.

Rather, my concerns are based on real experiences I have had with my patients, including children, who cite these sorts of motivational quotes as justification for putting themselves in harm’s way. This most commonly occurs in the context of a desire to lose weight, as some children have told me that they believe they can lose weight and keep it off if only they try hard enough.

While I admire their self-confidence, which will likely serve them well in so many other areas of life, weight regulation is the wrong place to assume that belief in oneself and hard work is enough to get the job done. The truth is that while numerous methods of inducing short-term weight loss exist, nobody has demonstrated an ability to produce long-term weight loss in more than a small fraction of the people who attempt to achieve it.

Some research has found “almost complete relapse” after three to five years, other data are more specific and suggest 90% to 95% of dieters regain all or most of the weight within five years, while other research has found that between one third and two thirds of people end up heavier than they were at baseline. Research in adolescents has found that dieters were three times more likely than non-dieters to become “overweight,” regardless of baseline weight.

To suggest that the people who regain weight simply did not believe in themselves ignores the reality that behaviors play only a small part in weight regulation while factors out of our hands, such as genetics and our gut microbial population, are largely responsible. As an example, consider folks with atypical anorexia nervosa who can implement life-threatening levels of restriction without experiencing weight loss.

Unfortunately, striving for weight loss is not a benign pursuit in which the worst-case scenario means that one simply returns to where they started. Research has shown that weight cycling – repeatedly losing and regaining weight – is associated with numerous health problems, including a higher overall death rate and an increased risk of dying from heart disease, regardless of one’s baseline weight.

Teaching self-confidence is important, but I think we can do better than overly simplistic messages that children can – and will – take literally to their own detriment.

Stop Complimenting Weight Loss

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

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

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

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

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

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

Intuitive Eating: An Introduction

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This article originally appeared as a guest piece in the Progress Wellness newsletter.

What the heck is intuitive eating? We often hear the term, but what does it mean, how can it help us, what are its common misconceptions, and how can we begin to put it into practice?

First, some context: In our society, we are often taught that we cannot trust our bodies and that we need something external from ourselves to guide our eating. Hence, we have calorie counting, tracking apps, points systems, lists of foods to eat and those to avoid, meal plans, and other tools that tell us what, when, and how much to eat.

Intuitive eating, on the other hand, is a system based on the reality that contrary to popular belief, we can actually trust our bodies to guide our eating decisions. Internal signals give us information regarding our hunger and fullness, what foods will hit the spot at any given eating occasion, and how much of those foods we need to feel satisfied. Think of how much better water tastes when we are thirsty versus when we are already well hydrated, for example. Someone with anemia might not know that red meat is high in iron; they just know that a hamburger sounds mighty fine.

In contrast to external tools, intuitive eating tends to be a more peaceful and satisfying way of making decisions regarding what, when, and how much to eat. Not only that, but clinical trials have also found that intuitive eating is associated with improvements in physiological measures (blood pressure, blood lipids), health behaviors (eating and physical activity habits, dietary quality), and psychosocial outcomes (body image, self-esteem).

Whereas diet culture has rules and judgment, intuitive eating offers guidelines and flexibility, and it encourages neutral curiosity when events do not transpire as one would hope. Some people turn intuitive eating into the “hunger and fullness diet” by believing that they must eat when they reach a certain level of hunger and must stop when a certain level of fullness is attained, but such action is an oversimplification and misuse of the skills. If someone practicing intuitive eating ends up overly full, rather than beating themselves up for it and judging themselves as bad or undisciplined, they will just explore what happened to see if perhaps next time they might want to make a different decision.

Some people use intuitive eating as a weight loss tool, but doing so is a mistake. While some individuals will lose weight when they eat intuitively, many will not. By focusing on weight loss, people are likely going to end up disappointed and also stunt their development as intuitive eaters.

We are born intuitive eaters, and internal eating cues still reside in virtually all of us. Even if we fear our signals are gone, more likely they are simply buried by years of disuse, and we can uncover them and put them to use once again.

As a first step, when you are considering eating, take a moment to ask yourself, “How hungry am I right now?” You can imagine hunger and fullness existing on a linear continuum with extreme hunger at one end and extreme fullness at the opposite end. Ask yourself where on that continuum you are. Keep in mind that this is never to be a leading question, and your answer has nothing to do with permission to eat. You are simply gathering data and trying to notice the signals that your body gives you.

As a second step, if you have decided you are going to eat, rather than jumping to immediately see what your options are, take a moment to first look inward. Ask yourself if a particular flavor (sweet, salty, spicy, etc.) would hit the spot. Similarly, consider temperature (hot, frozen, chilled, room temperature, etc.), texture (crunchy, smooth, liquid, etc.), and even color. You might not have answers for all of these questions, but even knowing one of them (Temperature tends to be easiest for most people to discern.) can give you some direction. With your answer(s) in mind, now survey your choices, whether on a restaurant menu or in your own pantry or refrigerator, and try choosing the food that most matches your identified criteria.

Most people who are looking to become intuitive eaters need more help than can be found in a blog. Consider seeking the help of a registered dietitian who specializes in intuitive eating, and remember to be patient, as it can often take six months to a year, or even longer, of work and practice before your intuitive eating skills once again take their natural place as your default decision-making tools.