Tag Archives: weight loss

The Potato Diet

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A couple of decades ago, a nutrition professor told me that one of the reasons she loves being a dietitian is because when people hear what she does for a living, they are interested and want to talk with her about the field. In contrast, most practicing dietitians I know dislike talking about their work, so much so that some of them purposely shade what they do, such as saying, “I work in healthcare,” or “I am a therapist,” in order to discourage follow-up questions. It’s not that these dietitians hate their jobs or anything; rather, they do not want to get sucked into irritating conversations during their free time.

Personally, I have found that quickly adding that I specialize in eating disorders tends to keep at bay the annoying questions and commentary that are more likely to arise when I simply say that I am a dietitian and leave it at that. My approach, while usually successful, still has its failures, as evidenced by an experience we had last month in a Puerto Rican swimming pool.

Joanne and I were on the island vacationing with our daughter, and we ended up in conversation with another couple who were also enjoying the hotel pool with their son. Upon hearing what we do for work, the father began talking about a favorite dietary approach of his: the potato diet.

Given that the potato diet is actually a real thing, let’s talk about this guy’s diet of choice. According to him, the potato diet consists of eating nothing but potatoes and supplementing with vitamin E because, according to him, potatoes – when eaten in abundance – contain sufficient amounts of all nutrients except for vitamin E. He also claimed that the diet “works” without ever defining what constitutes success in this context, although he did make mention of a celebrity who supposedly lost a significant amount of weight on the potato diet, thus suggesting that “works” means something along the lines of “will cause someone to lose weight.”

Okay. So, according the USDA’s nutrient database, a generic large russet potato, including its flesh and skin, is said to provide 292 calories. For a generic person who needs 2,000 calories per day (and many of us need more), that means eating nearly seven of these large potatoes a day. Putting aside the feasibility of that for the moment, would seven potatoes per day really contribute enough of each nutrient besides vitamin E? Let’s take a look.

The low end of the recommended carbohydrate range is 45% of total calories, so the person needing 2,000 calories per day would need at least 900 calories, or 225 grams, of carbohydrate from these seven potatoes. Because potatoes are densely packed with carbohydrates, they would easily exceed this minimum. Check mark.

What about protein? Estimated protein needs are based on body weight, activity level, and medical conditions, so let’s say that the person in question weighs 130 pounds, is generally sedentary, and has no medical conditions that would influence their protein needs. The low end of their protein range would be about 47 grams per day. Their seven potatoes would contribute 55 grams, so check mark again. If the person is heavier, more active, or has higher protein needs for any other reason, this check mark is probably replaced with a red X.

How about fat? The low end of the recommended fat range is 20% of total calories, so this person would need at least 400 calories from fat, or approximately 44 grams. Their seven potatoes only contribute a couple of grams total, so a huge red X here.

Unfortunately, the low fat content spells trouble for the fat-soluble vitamins. Russet potatoes do actually contain some vitamin A and K, but too bad the dieter’s body will be unable to absorb it due to the lack of dietary fat. The same would be true with vitamin D if the potatoes actually contained any, which they do not.

The seven potatoes do contain enough vitamin C to stave off scurvy, and the thiamin content is enough to prevent beriberi disease, but the lack of vitamin B12 would likely cause fatigue and, if sustained long enough, possibly anemia. We could go on, talking about other micronutrients, phytochemicals, and other nutrients, but you probably already realize that the potato diet is not a great idea if the goal is any semblance of health.

But what if the goal is not actually better health but rather, say, weight loss? (And remember, weight and health are not synonymous.) Personally, I imagine that the first couple of potatoes on day one would taste great, but by potatoes six and seven, I would already be sick of them. In subsequent days, I would probably be so tired of them that I am not sure I could continue to stomach all seven even if I was still hungry. Restricting variety to just one food carries the likely intended side effect of restricting one’s intake overall, and while restriction does not always lead to weight loss, sometimes it does, at least in the short term.

And isn’t that really what the potato diet is? Just another fad diet to bring about short-term weight loss that will likely be regained plus more? Instead of focusing on our daughter and having a good time, we had to spend a portion of our vacation talking with this guy about this nonsense. See, this is why so many dietitians hesitantly offer some version of, “Umm, I work in healthcare,” and then try to change the subject.

Weight Loss Wagering

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When I began working on this piece, I was trying to remember when I first learned about the idea of betting on weight loss and what my reactions to the concept were back then. As far as I can recall, I think it was around 2009 or 2010, and I believe I was intrigued, as this was at a point in my career when my work was centered around instigating weight loss (or its close cousin, improved body composition) and the assumption that of course such pursuits lead to better health. So, if wagers could be a useful tool in my proverbial toolbox, I wanted to know about it.

While the idea of wagering on weight loss continued to exist, it never really took off or hit the mainstream either, at least as far as I could tell, but it caught my attention again early last month when I noticed that HealthyWage [Note: They seem to use HealthyWage and HealthyWager interchangeably on their website.] was running ads during the US Open tennis tournament. My reaction now, 14 or 15 years later, was quite different than when I first heard about betting on weight loss.

Using weight as a proxy for health – which a younger me left unquestioned and unchallenged for way too long – is problematic in itself, but we have already covered that elsewhere, so I am going to put that aside, as many other topics are going through my mind: Does the prospect of winning or losing money in the short term actually induce long-term behavior change? How do outcomes differ when someone wagers against themselves as opposed to engaging in a weight loss competition against a friend or others?  Addressing these and other questions that I have in mind would be too lengthy for a single blog, but perhaps I will circle back to them one day.

Meanwhile, I want to take a narrower focus and examine a few of the company’s claims and pieces of information that most stood out to me when I spent some time exploring HealthyWage’s website.

Clicking the “Get Started” button on the homepage brought me to a calculator where I could change my prize range by manipulating how many pounds I want to lose, how much money I want to bet each month, and how long I need to reach my weight loss goal. Regarding length, I noticed that the more time I asked for, the higher my prize range, which runs counter to the old adage that trying to lose weight slowly and steadily is more likely to be successful than rapid weight loss, advice that I used to echo early in my career and that some doctors still repeat to their patients. In reality though, this advice is nonsense, as weight loss endeavors will likely fail in the long run no matter how they are pursued. While we can be relatively successful inducing short-term weight loss, the weight almost always comes back in the end. HealthyWage’s algorithm suggests that they understand that long-term weight loss is less likely, as evidenced by their willingness to fork over more money to the people who achieve it and less money to those who quickly lose the same number of pounds.

Going back to the homepage and scrolling just below the “Get Started” button yielded testimonials from three “Success Stories,” including names and locations of three individuals who won between $1,463 and $3,007 via losing 101 to 160 pounds in contests that ranged from nine to 18 months. In addition to their statistics, these profiles also feature before and after photos as well as quotes from the individuals. You know who else posts success stories? The Massachusetts State Lottery Commission, for one, whose website lists hundreds of winners per day across the state. According to a study by Bloomberg, state lotteries “have the worst odds of any form of legal gambling” in the country. To put things in perspective, one is reportedly four times more likely to get hit by an asteroid than they are to win Powerball. Testimonials – whether they are lottery winners posing with oversized checks, Weight Watchers leaders touting their own journeys in front of their groups, or HealthyWage winners – sure are enticing by inducing fantasies of what is possible, but possible and likely are vastly different adjectives.

One question on the HealthyWage FAQ page asks, “Is HealthyWage legal?” to which the company responds, “Yes. Although we use the word ‘bet’ to explain the concept, HealthyWager isn’t gambling in the legal sense because you are in control of the outcome at all times. It’s up to you to lose the weight.” Okay, first of all, suggesting that weight loss is entirely in one’s control is incorrect, reckless, and contributes to stigma. Joanne and I have both had patients who were still fat despite struggling with very restrictive and dangerous eating disorders, and I take issue with the false narrative that someone is whatever size they are solely because of their behaviors. Furthermore, the “at all times” phrase flies in the face of solid evidence showing that weight regain is the norm, not the exception.

HealthyWage can call their service whatever they want, but the fact remains that it is a gambling operation similar to state lotteries, casinos, or any other for-profit entity that invites customers in with splashy hooks and enticing testimonials. When we put our fantasies of victory aside and get back to reality, we remember the basic truth of this industry: The house always wins.

“Food Noise”

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Over the past year or so, a concept has been popping up on my radar: “Food Noise.” It seems like with the growing popularity of the newish weight loss/diabetes medications Ozempic, Wegovy and Mounjaro, there has been more discourse around how these drugs are getting rid of the “food noise” in many people’s brains. Anecdotally, most individuals who take higher doses of these medications report feeling “less obsessed” about food. In fact, they almost stop thinking about food altogether. For many of these folks, this comes as a welcome change, as previously their brains felt like they were constantly perseverating on food and on what, when, or how much they should or should not be eating. People describe feeling relieved to no longer be overly focused on food and the “noise” that their brains create around it.

On the surface, I can completely understand how getting rid of the “food noise” can come as a relief for so many people. Constantly thinking about food uses a lot of mental energy and can be exhausting. To be freed from these thoughts can feel like one is breaking out of diet prison. But, as a dietitian who helps folks with intuitive eating, I also have some concerns around this concept. A number of my patients who are on these prescriptions report having no hunger cues whatsoever, that they have to remind themselves to eat, and when they do, they do only want to eat a little and get full quickly. While this might seem like a dieter’s dream, it is in exact opposition to what our bodies were built to do. We are born as intuitive eaters from the start; babies are quite adept at communicating when they need nourishment. It is normal for us to experience hunger multiple times per day, and, in response, to fuel ourselves as the need arises. Hunger is a basic biological function that is vitally important for survival. When hunger cues are removed, we are at risk for undernourishment and malnutrition.

One of the ways that these weight loss/diabetes medications works is by slowing down our digestive process so food lingers longer in the stomach. Unsurprisingly, when our digestive system slows down, we feel less hungry and feel hungry less often, which results in eating less. This process also helps our body to improve its ability to manage its blood glucose. While smaller/moderate doses of these drugs have been shown to be helpful for those with type 2 diabetes to manage their blood sugar, doctors are now prescribing them in much larger doses to “aid in weight loss.” The higher the dose, the more likely it is that one will experience gastrointestinal side effects such as nausea, vomiting, diarrhea, cramping, and bloating, which in turn leads to a decrease in appetite and ensuing weight loss.

Is this (or any kind of intentional weight loss) healthy? I would argue not in the slightest. These drugs are basically making it easier for folks to underfeed their bodies. It makes food restriction tolerable. It can seemingly get rid of the “food noise,” but at what cost? As we have learned over the years, intentional weight loss, especially when it is rapid, takes a huge toll on one’s health and almost inevitably results in weight regain. Weight cycling is a risk factor for many health conditions that the medical community blames on weight, such as cardiovascular disease and metabolic disorders. While we do have plenty of research on these medications and their efficacy in managing type 2 diabetes, the research on using these medications for weight loss is much sparser and of shorter duration. In a way, these weight loss medications feel like the weight loss medications of the past (e.g., Phen-Fen in the 1990s), promising to be the “miracle cure” for so many struggling with weight issues, only to be eventually pulled from the market due to the serious health risks they inevitably cause.

I would argue that for those who are able to eat intuitively – listening to their bodies’ hunger and fullness cues, responding accordingly, and rejecting the diet messages we get constantly in our weight-obsessed culture – “food noise” is not really a thing. Many folks feel like they are “food addicts.” While I certainly want to validate someone’s feelings, the research we have at this point does not confirm that this is a real, physiological issue, such as substance addiction. Much of the “food addiction” research that is out there currently does not account for the subjects’ previous or current dieting behavior which has had a considerable effect. Restriction, whether it is mental or physical, begets food preoccupation.

When someone learns to listen to their body’s cues and feed oneself in accordance with these cues, and when one gives oneself unconditional permission to eat, food preoccupation lessens greatly and, in some cases, disappears. We are supposed to feel hungry several times per day; this is our body’s way of telling us we need fuel throughout the day. Our bodies are constantly giving us cues and feedback, but we are taught that our hunger cues are “wrong” and are not to be trusted.

I will be curious to see how those who are taking these medications will fare in the future, specifically around “food noise.” Many studies have shown that most people are unable to tolerate these medications for more than a couple of years (despite the medical community and drug companies saying that these drugs need to be taken for the rest of one’s life). And for those who continue with these medications, we have yet to see the long-term health effects that they will cause. My hope is that more and more people will come to realize that we do not need to be at war with our bodies and that listening to our bodies’ wisdom is the best course of action.

Thoughts on the New Weight Loss Drugs

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I’ve been meaning to write a blog about the new weight loss drugs for months now, but every time I start, I find myself having trouble with what I want to say, especially since so many of the anti-diet and fat-positive activists I admire have already written such important and insightful pieces on these drugs. For anyone looking for some in-depth research study analysis, I want to point you towards Ragen Chastain, a speaker, writer, and amazing fat activist, in addition to being a certified “statistics nerd” (her words, not mine!). Her Weight and Healthcare Substack is an invaluable resource that takes a hard look at “weight science, weight stigma and what evidence, ethics, and lived experience teach us about best healthcare practices and public health for higher weight people.” Ragen is adept at sifting through the research studies that the drug companies publish to sell the efficacy of these drugs and finding the myriad issues, conflicts of interest, and straight-up bad statistics that these studies exhibit. So please read what she has written on the topic of GLP-1 agonists.

In this piece, I am not going to get into the science behind how GLP-1 agonists such as Ozempic and Wegovy actually work. Instead, I want to talk about how these drugs (and the weight loss drugs that came before them) have become such a lightning rod in the discussion of weight. I was a teenager in the 90s, and I clearly remember when the drug Fenfluramine/Phentermine (Fen-Phen) entered the weight loss scene. There was such a fervor about it on the nightly news, and the marketing by the drug companies was intense. It was touted as a “miracle drug” that could “cure” o*esity, and everyone was going to their doctor to get a prescription. I also remember the news stories that came out. Famously, there was one in the Boston Herald about how Fen-Phen was linked to mitral valve dysfunction, pulmonary hypertension, and other cardiac abnormalities. Subsequently, it was removed from the market due to these risks. It took years before people were convinced that the harms that these medications caused outweighed the “benefits” of weight loss for higher weight people.

There has been a seemingly significant theoretical shift in the medical community over the past few years regarding higher weight (the “o” words”) and weight loss. Unlike previous decades, when people were told that their high weight was their “fault” and was caused by their “unhealthy lifestyle behaviors,” many medical professionals are now putting forth the message that one’s weight is largely out of one’s control (true) and is not necessarily due to “unhealthy lifestyle behaviors” (also true). Most physicians acknowledge that the BMI is a flawed measurement and that there are many factors that play into health other than weight (true again). But instead of pivoting away from using weight as an indicator of health, there has been a push by the medical community to classify o*esity and o*erweight as “chronic health conditions” that must be managed over one’s lifetime. In essence, the medical community is saying that while being fat isn’t your “fault,” it is still a problem and one that needs to be managed.

In our fat-phobic, image-obsessed culture, it makes sense why these new “miracle weight loss drugs” are creating such a stir. Higher weight people are being told, “Hey, we know that your weight is out of your control, but we can help you manage your ‘condition’ with these medications!” In addition, there is a lot of pressure on higher weight people to “get healthy” (even if many of them are healthy by every measure other than weight), and losing weight is still seen as something that will improve people’s health. The marketing that the drug companies have put forth is simply astounding. I feel like I can’t watch a TV show, peruse social media, or even read the New York Times without sponsored content popping up about these drugs. Add to this all of the celebrities and influencers who have been publicizing their weight loss “success,” I would be surprised if any person in a larger body wouldn’t be affected. Currently, I am in a small-mid fat, abled body, and I’d be lying if I said that I hadn’t thought about turning to these drugs. I can only imagine how those who are in much larger bodies than mine and/or in disabled bodies are tempted to try them.

The studies that have been put forth by Novo Nordisk (the drug company who makes Wegovy and Ozempic) have shown that while participants lost about two pounds per month over a 68-week time period (during which they were also dieting and exercising 30 minutes per day, six days per week), at 60 weeks, those who were still taking the medication experienced a plateau in their weight loss, and in a follow-up study the following year, two thirds of the weight they had lost was regained. Conveniently, the studies all concluded at the second year of testing, as we know that the majority of weight regain occurs between two to five years post weight loss attempt. Novo Nordisk also reported that taking their medication leads to positive health outcomes, but a closer look at their studies shows that there were no statistically significant improvements in HBA1C (a measure of diabetes), triglycerides, cholesterol, or inflammation markers.

I don’t blame anyone who feels like they need to try these drugs. For some folks, losing 10-15% of their body weight (the average weight loss reported by researchers) could feel like it makes a huge difference in their quality of life. What I find distressing about these drugs is how hard they are being pushed by the media and medical community despite the long list of side effects and potentially harmful health outcomes that can occur. Wegovy has a Boxed Warning (the FDA’s most serious warning) due to it increasing one’s risk for thyroid cancer, acute pancreatitis, acute gallbladder disease, stomach paralysis, as well as an increase in suicidal ideation, among other risks. But it seems that the medical community feels that losing weight is worth the risk to fat people’s lives. That even though folks report nausea, diarrhea, vomiting, constipation, and stomach pain while on these drugs, it’s okay as it is just the price to pay for one to become “healthy.”

I wish that instead of telling higher weight people that their weight is a problem that can be “solved” by taking these medications, the medical community could instead focus its energy on reducing weight stigma in healthcare, as this (along with weight cycling or yo-yo dieting and healthcare inequalities) has been found to have much more of a profoundly negative effect than weight on one’s health. I wish that we lived in a society that didn’t prize thinness so much. And I wish that everyone could see that weight is just another human characteristic that exists on a continuum and that bodily diversity is a real thing, not something that has to be “managed” or “controlled.”

The End Is Near!

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Seven years ago, when I saw Chic in concert for the first time, Nile Rodgers used the interlude in one of their songs as an opportunity to tell the crowd about his recent cancer battle, which he ultimately won. The songwriter and producer explained that receiving the news inspired him to go on a music-making binge, as he figured he only had a short window of time left to express his art.

Earlier today, as I was driving home from the beach with our daughter, that memory crossed my mind. Since she will soon be restarting school, we have been trying to cram in as many daddy-daughter activities and outings – the Museum of Science, the Butterfly Place, farms, the zoo, fruit picking, restaurants, train rides, the aforementioned beach, etc. – as we can before the start of the school year interferes and forces these bonding experiences from frequent occasions to relative rarities. Before we have even left the parking lot of one activity, I am already thinking about the next one and all of the others that I hope to shove into our remaining time before it runs out. We have fun, but part of me is distracted, anxious, and sad as I think about the end.

Deadlines have their upsides because they can push us to accomplish tasks and achieve goals that might otherwise remain unfulfilled, but they bring with them stress and general feelings of unease that detract from the experience.

Life-threatening illnesses and the school calendar are examples of deadlines imposed upon us, realities that we just have to do our best to roll with, but sometimes we needlessly impose deadlines upon ourselves. A person who wants to get married by a certain age may settle because the timing is right even though the partner is wrong. Someone I know recently spent a hot summer evening in the emergency room with heat exhaustion and dehydration because they stubbornly kept hacking away at a tree they really wanted to cut down before dinnertime rather than conceding they should take an additional day to complete the project. When we were adolescents, a friend of mine wanted to bench press a particular weight before a school dance, and he ended up having to fight to free himself as the much-too-heavy bar laid across his chest.

Because this is a nutrition blog, I am of course thinking about the predicaments we can put ourselves and our relationships with food in due to self-imposed deadlines. An obvious example is the melancholy and frantic overconsumption that precedes a scheduled diet. Trying to lose weight before a wedding or another similar function is a common – yet problematic – behavior that is most likely to result in eventual weight gain and increased risk for developing a wide range of health woes. Someone I know severely dehydrated himself on his birthday and spent much of it at the gym because he had set a goal to be at a particular weight by his new age, and while he did survive and recover, he put himself in a dangerous situation for the sake of an arbitrary goal.

Imagine what these scenarios could look like instead without the needless deadlines. No diet on the horizon could mean more peaceful and intuitive eating without the threat of self-imposed food insecurity looming. Foregoing an attempt to lose weight before an event reduces the chances of harmful and discouraging weight cycling and creates space for the person to focus their time and attention on the big day itself and to go into it full of energy instead of depleted. Personally, I can think of more fun ways to spend a birthday than sweating out as much fluid as possible on an elliptical machine.

Time and opportunities are finite resources, and while we never know when they will run out, we can make life easier for ourselves by leaving self-imposed deadlines in the past.

When Family and Friends Lose Weight

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It’s the beginning of summer, and one theme in particular has been popping up a lot lately in my appointments with patients. It seems like everyone’s mother/uncle/friend from college/cousin has gone on a “weight loss journey” since the winter. As you might expect, witnessing your loved ones and/or friends and acquaintances engage in intentional weight loss can stir up a lot of feelings in those of us who are trying to embrace the bodies that we have. Research on intentional weight loss 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. It can be hard to watch others receive the praise and acceptance that often comes along with these “weight loss journeys.” It’s difficult to watch these folks gain more and more privilege while we remain in bodies that often put us at a disadvantage in our fatphobic society. So what are we supposed to do with all of these feelings?

First off, I try to remind my patients that their mother’s/uncle’s/friend’s/cousin’s bodies are not our business. I firmly believe in body autonomy, or as Ragen Chastain calls it, “The Underpants Rule.” In essence, what someone chooses to do with their body is up to them (as long as it is not harming others). Our family and friends will often make choices that we don’t agree with. And those of us who are trying to fight the near-constant onslaught of fatphobia we are fed on a daily basis feel strongly that these friends/family members are doing harm to themselves and perpetuating diet culture. But at the end of the day, we aren’t in charge of others’ bodies. Just like we wouldn’t want someone telling us how to live in our own bodies, we can’t police others.

That being said, I think there is nothing wrong with protecting oneself and setting boundaries around diet and weight loss talk. If you are active on social media and the friend/family member is an active poster of weight loss updates, befores and afters, or touting their new “healthy lifestyle,” it might be time to either snooze them for a short while or hide them from your timeline indefinitely. This can be done by clicking the “unfollow” button on someone’s Facebook profile or clicking the “mute” button on Instagram. By doing this, you are removing the element of surprise from seeing these things popping up on your timeline. It’s hard to look away or unsee some of these posts, so preventing them from appearing on your social media from the start can be helpful.

Another way that you can set a boundary is by being up front with the friend/family member about how their diet/weight loss talk is affecting you. Sometimes I will help my patients role play what they would like to say to the friend/family member who brings up their diet/weight loss. In these types of situations, I encourage patients to try to give their friend/family member the benefit of the doubt. That is, it is very unlikely that they are intentionally causing you harm or distress; they just are unaware of how this kind of talk can be triggering. Here’s an example of how these conversations can be broached: “Hey, I know that you aren’t intending to, but when you talk about your diet/lifestyle/weight loss journey with me, it makes me feel uncomfortable. I am happy that you are happy with what you are doing, but hearing about it is unhelpful for me as I’m working on accepting my body and letting go of diet culture.” If you are struggling with an eating disorder (and this person knows about it), it could be helpful to also say, “Part of my eating disorder recovery is not engaging in diet/weight loss talk as it can make my symptoms worse.”

If after these tactics, the message is still not getting through, it is within your right to limit your exposure to these individuals. This might mean doing shorter meet-ups rather than long, drawn-out hangouts, limiting your time spent at family gatherings, or getting together less often. If this is not an option, you can take space when you need to at these events, excusing yourself from the room or going for a walk by yourself, for example. I also highly recommend cultivating your own “anti-diet” community either online or in person if you are able to. There are many fat-positive folks all over the world, and it can feel less lonely when you are around those who “get it.” Instagram and Facebook can be helpful in finding these people and connecting with them.

At the end of the day, I hope that the one thing you will remember is that just because your
friend/family member is actively engaging in diet culture, you do not have to go that route. You deserve to embrace and live in the body you have, and you do not have to change it. Your body has never been the problem – our fatphobic culture is.

Pancakes

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Some months, coming up with a newsletter topic is unusually challenging. For the last few weeks, Joanne and I were both scratching our heads, as the ideas we had were for research pieces that would demand more time than either of us is able to dedicate at this point in time. Being silly, I facetiously asked our four-year-old daughter what I should write about this month. “Pancakes,” she responded, “Pancakes and maple syrup.” Joanne and I laughed, and I walked out of the room, but I quickly returned and told them I was going to use her idea.

Our daughter’s suggestion reminded me of a quote from one of my earliest patients many years ago, and what the latter said to me felt significant enough that I wrote it down as soon as she left my office. “One day, you will have a baby boy who will love you,” my patient said, “and then he will grow up to hate you. But then one day he will love you again and say, ‘Hey, Dad, let’s go out to breakfast, just us guys,’ and then you will go to Bickford’s, and you will have an apple pancake, too.”

At that point in my career, I was still doing the kind of work that most people figure dietitians do: putting people on diets in the pursuit of weight loss. My prescribed diets were low in carbohydrates, especially grains, and so restrictive of calories that if my patients were living in a different region of the world, the United Nations would have sent cargo ships full of food to help them. While I did not author these diet plans, which seemed concerning to me at the time because of their restrictive nature and the good/bad food dichotomy they established, I did dole them out as instructed, and for that I have nobody to blame but myself.

These diet plans typically “worked” in the sense that my patients lost weight, but rarely – if ever – did the weight suppression last long term. At the time that I left the medical center where I was working and stopped doing that kind of work, I did have some patients who had maintained their weight loss thus far, but I have no idea what happened to them later. Given that most weight regain happens two to five years after baseline, I can only assume that at least some of these patients, if not all of them, regained weight after I was out of the picture.

Diets fail for a number of reasons. Most significantly, the physiological mechanisms that kept our ancestors alive through periods of starvation kick in when we restrict and promote weight regain. Another factor, the one that my patient was trying to make me aware of via her aforementioned quote, is that diets are incompatible with real life. After all, if I were following the low-carb, low-grain, low-calorie diet that I had put her on, I would be unable to both remain on the plan and partake in her breakfast scenario. The dietary expectations I had set out for her were unrealistic, which was exactly the point she was trying to get me to see. Point taken.

Now that I am a dad myself, I have greater first-hand life experience to reinforce my theoretical understanding. Numerous times over the last few years, I have eaten foods I was not in the mood for because sharing an eating experience with my daughter was more important to me than eating exactly what I wanted. For example, the food at Chick-fil-A rarely sounds good to me, and I certainly would have preferred something else for dinner last Tuesday night, but I took her there because she loves it, she asked me if I would take her, and I prioritized making her happy and sharing one of her favorite meals over eating what I really wanted.

If I was on some diet plan that restricted foods like Chick-fil-A, such as the plan I had given to the patient in question, I would have had to choose between breaking the diet or missing out on a family bonding experience. When I was a young adult and somewhat orthorexic, I prioritized “healthy behaviors” to the detriment of other important areas of my life. After turning down plans with friends so I could exercise after work and go to bed early, some of them began to distance themselves from me and stopped extending invitations. My insistence on only eating food I had brought from home kept me from joining co-workers for lunch, and my rapport with them weakened. If you have ever been on a diet yourself, consider the ways in which sticking to the plan came at the expense of other facets of your life. My guess is that if you look back, you will find examples in your own life similar to the ones I just described.

Furthermore, remember how you felt when you inevitably deviated from your diet. In Reclaiming Body Trust, authors Hilary Kinavey and Dana Sturtevant succinctly describe the pattern of dieting with a diagram that they entitle “The Cycle.” At the 12 o’clock position, the circular diagram begins with “The Problem,” which then leads to “The Shame Shitstorm” at three o’clock, followed by “The Plan” at six o’clock, then “Life” at nine o’clock, and then back to “The Problem” as the pattern indefinitely repeats. Delving into the particulars of these positions is beyond the scope of this blog, but the overall pattern is one to which many of us can relate: We identify a problematic eating behavior, feel bad about it, desperately grab for a plan that will supposedly rescue us from ourselves, abandon the plan when it proves itself to be incompatible with life, and the cycle repeats.

If a diet puts us in a position to choose between (A) sacrificing important parts of life, such as sharing a bonding experience with our kids, in order to remain on the plan, or (B) breaking the diet and perpetuating a cycle of shame and unsustainable attempts to deal with our problems, then perhaps dieting and living a full life are simply incompatible.

Blaming the Victim

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Perhaps you caught last month’s news story about a tech CEO who was hit by a car and killed crossing a street in Acton. He was a friend of mine from college. The driver took away a leader from a company, a husband from a wife, and a father from two young daughters, and severely derailed the trajectory of their own life in the process.

Some of the details omitted from the published story include that he was crossing the street to meet his wife for dinner and that the driver hit him while he was in a crosswalk. Try telling that to the internet trolls who left some ignorant comments suggesting that my friend may have been looking at his phone or crossed without looking.

Their comments got me thinking, and I remembered that blaming the victim is largely about fear. Admitting that we have limited control over our fates is scary, so much so that some of us find some comfort in assuming that a victim must have made some error and brought their end upon themselves.

Looking back, I experienced some of this myself with my three back surgeries. When I had the first operation to remove a tumor, some people questioned how I could possibly have developed one and suggested that I must have grown up under high voltage wires or that I did not take care of myself. No, my environment was fine, I was an athlete, and I had a balanced diet (by adolescent standards). When I had my first spinal fusion, some people assumed I must have done something stupid in the weight room to necessitate the repair, but no, it was really just the fallout from a freak accident and residual structural issues from the tumor. The next year, when I had to have a second fusion because the first one did not work, some people figured the surgeon must have screwed up or that I did something wrong with my rehab. No, sometimes surgeons do everything right and the patient can look on paper like the ideal candidate to heal well, and yet, in a small percentage of cases – including mine – problems still arise.

Our health is no exception to the reality that our outcomes are only somewhat in our control. We live in a culture that blames “overweight” people for their size, that if they only were disciplined enough to eat less and exercise more that they would be thinner, while the reality is that long-term weight regulation is largely regulated by factors unrelated to our behavior. We look at scary diseases and hope we can ward off morbidity and mortality by creating and avoiding dietary demons, yet people of all ages and behavior profiles still get sick and die.

A few days after my friend was killed, my daughter and I had a close call ourselves while I was walking her to school. We got to a crosswalk, I hit the button to activate the flashing yellow lights, the cars in both directions stopped for us, and we began to cross. Before we could make it across, an SUV pulled out from the school’s driveway. Perhaps the driver saw the stopped cars and thought they were waving her in. Regardless, without looking in our direction, she turned onto the street towards us and hit the accelerator. I started running, and it was a close enough call that I arched my back in order to avoid the corner of her front bumper. When I glanced back at the driver, she looked horrified. As we continued on our way, the driver repeatedly yelled to us, “I’m so sorry!”

I was angry, just as I was when I heard my friend died. I was angry at both drivers, and I was mad at our society that normalizes and enables careless driving. However, beneath my anger was fear. We live in a world in which someone can do everything right and still have things go very, very wrong, which is horrifying, and we attempt to shield ourselves from this fear by assuming that victims brought their fates upon themselves.

“As long as you’re healthy . . .”

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“Health.” It’s a simple one-syllable word with a deceptively simple definition: “the state of being free from illness or injury.” What I have come to realize over the decade-plus that I have been practicing nutrition therapy as a registered dietitian is that health means many different things to different people. Health is not black or white, but a million shades of gray. But the wellness industry (diet culture’s shapeshifted cousin) would have us believe that health is not only easy to define and simple to identify, but also easy to achieve, if we just try hard enough. Well, sorry, it’s not that simple.

When I was a preteen, I remember feeling like my body was wrong, too big, taking up too much space. My mother and I would go to my pediatrician appointments, where my doctor would hem and haw about my weight. I had always trended on the 95th percentile on growth charts, and every year my pediatrician would comment on it in a concerned way. My mom would echo these concerns at home, gently reminding me that my doctor was worried for my health. When I would cry to my mom about being in a larger body than my peers, she would always come back to this statement: “You are a beautiful girl. We could make some changes to how you eat and exercise. I just want you to be healthy.”

“I just want you to be healthy.” These words ring in my ears as they have been spoken to me in different iterations throughout my life. From concerned college friends after I had gained a significant amount of weight during my freshman year (post diet, of course): “We are just worried about your health.” From my first adult PCP when I was 22 years old: “We just want to make sure you are healthy.” From my mom when I announced that I would be going on a low-carb diet at age 25: “as long as you’re healthy!”

Everyone seemed to say that my health was the most important thing and that being healthy meant being in a “healthy-looking” body. When I actively engaged in dieting, restricting, tracking every morsel, weighing myself multiple times a day, exercising even when I didn’t feel like it or was sick or injured, eschewing lunch outings with friends, losing my period – during these times, everyone marveled at how “healthy” I was. “It’s so nice to see that you are finally taking care of yourself!” my family would crow. “Keep going, get healthy!” my doctor cheered. Little did they know the personal hell I was living in. But at least I “looked” healthy. Or at least my body fit the social norm for what we collectively believe is healthy, i.e., it was no longer considered fat. But inevitably as the weight would come back on, the concerns for my health would resurface.

When I finally gave up on dieting and learned about Health at Every Size® and intuitive eating, I was ready to hear the message. At last, I didn’t need to micromanage my intake and output. I didn’t need to obsessively count and weigh and measure. I didn’t have to give lunch outings with friends a second thought. It was like a freedom I hadn’t felt since I was a child, before I was told that I had a body that was “wrong.” I began to realize that health is not one-size-fits-all and that it looks different for different people. With individuals who have chronic illnesses such as celiac disease or cystic fibrosis or those with physical disabilities such as paralysis or amputation, they would never be able to achieve a state of being “free from illness or injury.” How about the millions of people who deal with depression or anxiety? Are they unable to achieve health as well?

I feel that we need to change our beliefs and expectations around health. In my opinion, health is a multifaceted amorphous concept that is not always attainable. It is also something that changes during our lifespan for a multitude of reasons. Even if we engage in all of the “health-promoting behaviors” we have been told to do, there is no guarantee that we will be healthy. In addition, there is no moral requirement for us to engage in these behaviors. As the wise Ragen Chastain so eloquently states: “Health is not an obligation, a barometer of worthiness, completely within our control, or guaranteed.”

The wellness industry loves to prey on our fears of illness and death. It purports to give us the answers to living longer, healthier lives. All we need to do is buy their program, supplement, or detox, and we can unlock the secret to immortality. It’s a brilliant marketing scheme that swindles millions upon millions of people every year. What if we decided to care more about our mental health and wellbeing? What if we made healthcare accessible to everyone? What if we eradicated weight stigma from the medical field? What if we decided that health doesn’t look the same on every body and that this is okay? My guess is the wellness industry would lose billions of dollars. Worrying about and obsessing over our “health” is most definitely not good for us. I wonder when our society will figure this out.

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.