Tag Archives: wellesley dietitian

Intuitive Eating

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Thanks to a colleague’s tip, one counseling technique I sometimes implement is a one-on-one book club of sorts where a patient and I read a book together that is relevant to his or her care. Recently, I have been reading Intuitive Eating with a patient who is working hard to overcome decades of approaching eating from the vantage point of dieting and to build a new relationship with food.

He has impressed me by how open-minded he is to a new way of looking at eating and by how candidly he has shared the thoughts, questions, and concerns that have come to mind during his reading. Now about a third of the way through the book, he reports that he sees himself in many, but certainly not all, of the case studies that the authors present. However, the idea of not depriving himself feels scary. Specifically, he notes that he loves having dessert, but that he is better off skipping it because one brownie so easily turns into four. Besides, he says, health must come into the picture somewhere, so there must be a “but . . .” caveat to the notion of not depriving oneself. He is waiting for the other shoe to drop.

His concerns are common among people who are at the early stages of putting aside the dieting mentality and learning intuitive eating. He is right that we certainly consider health. After all, I am a licensed health care practitioner. Before we take into account the hard science of nutrition though, we have to address the emotions that affect eating.

Sure, physiological mechanisms exist that yield pleasure when we consume foods that are high in fat, sugar, or salt. You are alive to read this because these mechanisms gave your ancestors an evolutionary advantage and they passed them down to you. However, the reason that one brownie turns into four has less to do with physiology and more to do with the morality that gets attached to them.

When we experience guilt for eating a particular food or virtue for abstaining from it, these emotions block us from being able to truly experience and honor the internal cues that our bodies give us regarding our eating. We eat the first brownie, feel guilty for having done so, and say “screw it, today is ruined” and then reach for three more. In essence, the idea of not depriving ourselves feels scary because in our minds it translates to opening the flood gates. In other words, brownies all day, every day.

In reality, that is not how the body tends to operate. When we strip away the morality of food and see our choices on a level playing field, we discover that the appeal of previously-forbidden foods drops considerably. Some days we may want an apple for dessert, other days we may not feel like dessert at all. And what if we go through the question tree of asking ourselves are we hungry, how hungry are we, what texture/temperature/color food do we want, do we feel like something salty, savory, or bitter, and how much of that food do we really need to be satisfied, and we determine that a brownie will indeed do the trick? Then we find the best brownie we can get our hands on, eat it slowly, enjoy every bite, stop when we are feeling satisfied, and know that we can have another one whenever our bodies are asking for one.

Ideally, the hard science of nutrition comes into play after this sort of relationship with food is established. We can talk about the advantages of one kind of cereal over another, or one kind of yogurt over another, or what have you, but we have to take into account the human element. Whole wheat bread is probably a better choice for someone with high cholesterol than is white bread, for example, but if forcing down the whole wheat because it has a better nutritional profile on paper is going to trigger some sort of overeating in search of satisfaction, then he or she is probably better off just having the white bread in the first place and getting his or her soluble fiber someplace else. On the other hand, if the two breads are pretty much equally enjoyable, then sure, he or she is probably better off with the whole wheat.

Learning to eat intuitively involves taking a leap of faith that we can largely trust our bodies to tell us what and how much to eat. Reestablishing that trust involves dialing down the noise of guilt and virtue that makes our internal signals difficult to hear. If you find yourself consuming piles of brownies, or none at all, consider whether or not you are truly listening to your body.

You Are Not Tom Brady

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Leading up to today’s Super Bowl, a Boston television station aired a piece examining how Tom Brady, the quarterback of the New England Patriots, eats. The segment teaches us that among other eating behaviors, Brady does not consume any added sugar or processed foods and he abstains from alcohol.

Celebrities often influence our own behaviors, which is the driving principle behind sponsorship deals. Lump me in there as well. When Andre Agassi, my all-time favorite athlete, was endorsing Nike, much of my workout apparel bore the “Just Do It” slogan. Later in Agassi’s career when he signed with Adidas, the logo on my sneakers quickly changed from a swoosh to three black stripes.

Whether consciously or subconsciously, the sentiment we tell ourselves is along the lines of, “If those sneakers [or racquet, or sports drink, or watch, etc.] are good enough for him, then they are more than good enough for me,” or perhaps, “If I use those sneakers [or racquet, or sports drink, or watch, etc.] too, then maybe I can play like him.” It is only natural that the same message may extend to our perceptions of how professional athletes eat, but if you are considering emulating Brady’s diet, think again.

With sport being the primary focus of a professional athlete’s life and so much financially riding on performance, they frequently make choices that would not necessarily be prudent for the rest of us. In a recent conversation, a physical therapist pointed out to me how professionals are quick to undergo surgery and rush through their recoveries, while an amateur with the same injury is more likely to opt for a longer, but safer, rehabilitation program rather than an operation.

In other words, the life of the professional athlete is often focused on the here and now while the long-term risks take a back seat. Look no further than how the National Football League dealt with concussions for decades – largely minimizing the significance of brain injuries and rushing concussed players back on the field with little regard for the depression, memory loss, and suicidal urges that often came with retirement – until very recent legal action inspired change.

This philosophy bleeds into nutrition as well. Following rigid food rules comes with upsides for professional athletes, but similar payoffs are unlikely to exist for amateurs. Therefore, while it may make sense for Brady and his peers to follow strict diets, the same does not hold true for the rest of us. In other words, Brady’s diet may serve him at this stage in his life, but if implemented by one of us, the same eating behaviors may be described as orthorexic.

According to the National Collegiate Athletic Association, 6.5% of high school football players will continue the sport in college, and 1.6% of college players will go on to play in a professional league. In other words, only 0.08% of high school football players will ultimately play professionally. The statistics that they report for basketball, baseball, hockey, and soccer are on par with these figures. Given the extremely high probability that student-athletes will have to make their livings in a capacity other than turning pro, they often have backup plans for their lives (well, at least hopefully they do) in the form of academic educations so they have somewhere to turn when school and their athletic careers end.

Similar benefits exist in thinking long-term about nutrition as well. With all due respect to Brady and other professional athletes who are doing what they feel they need to do in order to perform their best, all-or-nothing approaches to eating rarely serve people for too long. When an athlete retires and suddenly the incentive for restriction ends, how will he deal with previously-taboo foods? This is akin to children who grow up in rigid eating environments with strict rules regarding quantities and/or forbidden foods, and then they go off to college and binge on late-night pizza delivery and all-you-can-eat soft serve in the dining hall. Such black-and-white approaches that teach us to ignore our internal cues and rely instead on external constructs will in all likelihood ultimately backfire.

Real life exists in grays, so building healthy relationships with food means both listening to our bodies and being flexible to allow for the complexities and variables that come our way. A professional athlete may have incentive to sacrifice such a relationship and rely instead on external rules because the here-and-now upside is so great, but the rest of us are better off learning a lesson from the 99.92% of high school football players who will never play in the National Football League. In other words, think long and hard before deciding to sacrifice for the here and now, and instead focus on life’s big picture.

Psychology

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At a large family gathering over the weekend, a distant relative asked me about my work. Upon hearing that I am a dietitian, he smiled, leaned in, and asked me one of the most common initial questions that dietitians field, “So, do you practice what you preach?”

Whenever this question comes my way, I experiment with different permutations and phrasings of the same core truth in order to see which version best resonates with people. In this instance, I told him that what I “preach” might not be what he imagines, and that in reality a large chunk of what I do involves helping people to listen to and honor their internal cues regarding hunger, fullness, and food cravings.

His eyes wandered elsewhere as I spoke, and I could tell that this version of my answer was most definitely not resonating with him. When I finished, he reflected back to me, “That sounds like psychology.” He is not alone in his confusion, as other people have reacted similarly upon hearing a summary of intuitive eating. However, reconsider my answer within the framework of the following examples.

When a diabetes educator discusses the symptoms of low blood sugar with his or her patient, is that psychology?

When a physical therapist instructs a patient on how to modify an exercise in response to pain or discomfort, is that psychology?

When a primary care physician listens to his or her patient recount the side effects he or she experienced on a particular medication, is that psychology?

When a personal trainer talks with his or her client about the difference between the temporary discomfort that sometimes accompanies exertion and warning signs of injury, is that psychology?

Of course not, none of these examples are psychology; they are just examples of various discussions that take place between patients and practitioners regarding the feedback that our bodies give us in particular situations.

Yet when a dietitian engages in a similar discussion with a patient, whoa, suddenly it is seen as psychology. What does it say about how disconnected our culture teaches us to be from our internal signals regarding eating that an approach that encourages us to pay attention to said signals triggers connotations of therapy?

Dietitians are not psychologists, psychiatrists, or social workers (Well, some are, but the vast majority do not hold such a license in conjunction with their dietetic credentials.) and we know our professional boundaries. Discussions of said internal signals are not only within the realm of our work, they are critical to its success.

Just as my relative expected a more concrete and specific answer that would have put some label on my personal style of eating, new patients often expect that a similar external structure, such as a meal plan or a calorie recommendation, will drive their care. Nutrition is not that simple. In fact, long-term success often hinges on paying less attention to external cues regarding what and how much to eat and putting more focus on the internal signals that our bodies give us. Does that sound like psychology to you?

He Said, She Said: Nutrition in Schools

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He Said

Wellness class. The other freshmen and I thought the class was such a joke that if you told then-15-year-old Jonah that in a couple of decades he would wittingly choose to incorporate the word “wellness” into his business’s name, the cognitive dissonance would have rocked his adolescent world view.

Wellness class was gym without the, well, gym. The teachers were the same, but instead of leading us through units of volleyball, basketball, and badminton, they taught us about health and nutrition. The overarching culture, however, was consistent. Gym was the informal time of day, the high school version of recess. It was a time to let loose, move our bodies to one extent or another, and measure ourselves against our peers, both figuratively and, as you will read, sometimes literally. You had better believe the spirit of competition bled into the wellness classroom, too.

Even at 15, I could tell that the school’s approach to wellness was off base. We used to undergo various exercise performance tests (pull-ups, submaximal cycle ergometer, sit-and-reach) as well as anthropometric exams (weight, height, body composition). All of these evaluations happened in front of the group, so we all knew how each of our peers had fared. Gee, sounds like a great plan; what could possibly go wrong?

After the testing was over and it came time for the teachers to gather us together and offer congratulatory certificates to those of us who had what I suppose were good results in the eyes of the teachers or whatever norms against which they measured us, I crumpled up my award in my hands on the spot. Immediately, I felt guilty as if I had disrespected the teachers who had given it to me, but as time went on, I confirmed that my intuition was right.

If the teachers gave some of us certificates based on our body measurements, what kind of message did they send to all of the other students who did not receive such certificates? As a result, how do you think those students felt about themselves and their bodies? Similarly, how do you think their certificate-holding peers viewed them? The teachers indirectly started the bullying by posting their body mass indices and body composition results, thereby publicly shaming them, and other kids were more than happy to pick up the harassment where the teachers left off.

See, here’s the thing: If a teacher is conveying oversimplified and misguided lessons about how we can manipulate our bodies and our weight based on how we eat and exercise, and then they single out the kids whose bodies happen to be larger, the message they are indirectly teaching is that something is wrong with these larger students, that they are not doing enough to take care of themselves, that they are lazy and/or eat too much. And we wonder how weight stigma forms and gets perpetuated.

I still remember two of the largest kids in my class as well as their body composition results. These data should never have been my business to know. What does it say about the culture the school created that these results have stuck with me all this time? That was not wellness.

If we are going to even consider teaching nutrition in schools, we have to scrap the status quo and reexamine fundamental questions of who will do the teaching, what expertise do they hold, what environment will they create, will they reinforce stigma or break it down, and most importantly, what lessons will students actually absorb about their relationships with food, physical activity, and their bodies. If we cannot provide answers that are worthy of their own certificates of satisfaction, then we should not be teaching nutrition in schools at all.

 

She Said

As the holidays have come to a close, it’s back to reality for most of us. For some of my patients, that means back to school. Lately, it seems like I have been hearing a lot about school-based nutrition programs from my patients. Some of these programs are being run in their health classes, while others are part of their biology curriculum or other classes. It got me thinking about the subject of nutrition and school. Should nutrition be taught in elementary, middle and high schools? If so, who should be teaching it to the students? What should the nutrition course cover?

Given that the vast majority of my patients are those struggling with eating disorders, I have some mixed feelings about nutrition in school. On the one hand, I think it’s important for kids to learn about how to take care of themselves and the consequences of their lifestyle choices on their health. For instance, it makes sense to me for kids to learn about different nutrients and how they can help them grow and thrive.

But I worry that along with this helpful information, the kids might be learning a whole different lesson. From what I’ve heard, many of these nutrition programs are focused on making sure students maintain a healthy weight and actually scare them about the potential dangers of being overweight. As Jonah and I have written about extensively, health and weight are not synonymous; lifestyle behaviors are a much better predictor of health outcomes. This means that even if someone falls into the “overweight” or “obese” categories on the BMI scale, they are not necessarily doomed to poor health. Similarly, someone who falls into the “normal” weight category might not be healthy. It’s the behaviors that make the difference, not weight.

In addition, kids (and adults) come in a wide array of sizes and body types – we are not all meant to be slender. Genetics are a huge determinant of body weight. And as we have noted many times before, diets (or any program or restrictive way of eating meant to alter one’s body size) fail 95% of the time, usually ending up in weight regain. Oftentimes, I hear that school nutrition programs propagate the false idea of “calories in, calories out” in regards to weight. It’s just not that simple.

Unfortunately, the main message that most of my patients glean from these school nutrition programs is “fat = bad” and “these are the foods to avoid in order not to be fat.” In one case, one of my patients told me her biology professor had her students calculate their resting metabolic rates and then keep a food journal to log their calories to later evaluate if they were eating too much to maintain their weight. Another one of my patients told me that she actually learned about eating disorders from an educational video shown in her health class and that’s when her bulimia started. For someone who has the genetic predisposition for developing an eating disorder, these types of messages and activities can actually trigger them to start restricting.

What’s the solution to this problem? One thought I had is that schools could hire a registered dietitian as a nutrition consultant who is well versed in eating disorders and Health at Every Size®. Perhaps that dietitian could run a nutrition program for the students or train teachers to do so. Ideally, I would think the program should be focused on being weight-neutral, helping students embrace a variety of body types and sizes, and not advocating for restricting certain foods. In addition, maybe it would be a good idea to make nutrition programming an optional part of the school curricula, as some parents might not want their child to learn about nutrition in school. Perhaps the nutrition course could be offered as a voluntary program after school hours for those who are interested in it. I’m not sure what the right answers are to these questions, but I hope that as our society becomes more educated about health and weight, things will change in our schools.

Health at EVERY Size

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In response to my recent post about the calories-in-versus-calories-out myth as seen through the lens of my surgical recovery, someone posted a typo-filled response along the lines of, “You would not have posted this if you had lost weight.” He continued with pretty offensive commentary about people of a certain size not having the right to exist, but I will put that aside for now, not because I condone that nonsense, but because I want to focus on what he said in the quote.

His comment seems to be implying that I had hoped to lose weight and therefore I found a scapegoat for my supposed failure. Not true. We must remember that not everybody wants to lose weight. Some people, whether they are large, small, medium, round, slender, or any other shape, actually like their bodies the way they are. Other people may wish for a different body shape, but they understand that purposely trying to manipulate their form is unlikely to work in the long run and comes with consequences.

The commenter also seems to be assuming that I am overweight based on the fact that I shared my blog on the Health at Every Size® (HAES) Facebook page. To be clear, the name of this approach to health is not Health at Some Sizes and Failing Weight Loss Endeavors and Shame For Everybody Else. It’s Health at Every Size, and people of all shapes and sizes understand its importance in healthcare.

Consider the counterexamples we have all heard before: “He is so skinny, he can eat whatever he wants” and “She is a twig already, she doesn’t need to work out.” These weight-centered opinions have nothing to do with health. Being lean does not guarantee good health, nor does obesity guarantee poor health; behaviors do matter at every size.

Consider doctors who make assumptions about patients based on their weights. Prior to my surgery, a handful of the doctors with whom I consulted made incorrect assumptions about my lifestyle based on my size. Some doctors will decline to run routine tests on lean people based on the assumption that the patients are healthy, and some doctors will similarly decline tests for larger people, blame existing symptoms on weight, and instead recommend weight loss. None of these behaviors are about health, either.

A long time ago, shortly after my first back surgery, my neurologist asked me, “Are you exercising at all?” At the time, I was really offended. I was running, lifting weights, and playing tennis. Didn’t I look like I worked out? However, as time went on and I became more educated, I realized his question was spot on. Some muscular people never lift weights, some lean people never do cardio, and some obese people are more active than all of them but happen to exist in bigger bodies. Making assumptions about one’s lifestyle based on his or her appearance is not about health either, and to my neurologist’s credit, he knew it.

HAES is about focusing on actual health no matter what size we are, hence the name. For more information on the the HAES approach to health, check out the Association for Size Diversity and Health, of which Joanne and I are proud members.

Eating Disorders Are No Laughing Matter

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Last week after a tennis match, I was chatting with some of the women on my team. One of them asked me what I do for a living and when I told her that I specialize in nutrition counseling for eating disorders (EDs), she giggled. After an awkward pause, she said, “Oh, how I wish I had an eating disorder! I can’t seem to lose these last 10 pounds.” The other women grinned sheepishly, but I was not amused in the slightest. Unfortunately, I have heard this sentiment too many times to ignore, and whenever I do, I make sure to nip it directly in the bud.

EDs are not a laughing matter. In fact, they have the highest mortality rate of any mental illness out there, including depression, bipolar disorder, and schizophrenia. EDs are not something I would wish on anybody. They are ruthless, devastating illnesses that not only take a huge toll on one’s life, but also on those around them. EDs are not something that one can just choose to have for a short period of time to “lose the last 10 pounds,” and they are not a phase or a diet. Most of my clients are desperate to not have an ED, as it has robbed them of a normal, happy, healthy life.

I hear jokes about EDs on nearly a daily basis. Turn on any TV show or watch a popular teen movie and you are bound to hear one. Most often, the jokes are in the form of the characters using ED behaviors to lose weight, such as consuming “nothing but Ex-Lax and water ‘til prom!” or not eating anything until feeling faint and then having a piece of cheese. The movie Jawbreaker jokes about having a “Karen Carpenter table” in the cafeteria, alluding to the singer who died of anorexia years ago. These jokes are rampant, and worse, they perpetuate the idea that EDs are no big deal, that it’s cool or trendy to starve oneself or throw up after eating a large meal. Nothing could be further from the truth.

Please, if you hear a friend or a loved one joking about having an ED, don’t laugh. In response to the comment my tennis teammate made above, I made sure she knew that EDs are a serious mental illness and that it wasn’t cool to joke about them like that. Hopefully she got the message, and I hope others will, too.

Day 305: Calories In, Calories Out

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One of my patients and I continually have discussions regarding the myth of weight control boiling down to calories in versus calories out. In other words, expend more calories than you take in and you lose weight. Consume more calories than you burn and you gain weight. Because he has heard this presented as fact for so long from a wide variety of sources, accepting this as a fallacy is difficult for him.

My lifestyle changed dramatically with last March’s surgery. No racing up mountains during my recovery. No running at all, actually. No swimming either. No weight lifting for several months. Certainly no tennis, not even at a recreational level. My high volume of intense exercise was initially replaced with walking, months and months of just walking. Due to a lack of vigorous exercise, my cardiovascular fitness is deplorable compared to what it was not too long ago.

My eating has changed as well. Since I could tolerate more food in my stomach during a walk than, say, a run, the size of my breakfasts increased. While my food choices are almost exclusively vegetarian for ethical reasons, I reincorporated chicken and beef during the first few months of my recovery to ensure that I provided my healing body with the protein that it needed. Since my surgeon reminded me of the importance of calcium in promoting fusion in the bone grafts, I significantly increased my dairy intake, mainly in the form of ice cream.

What I did not do is weigh myself, track my weight, monitor my calories, attempt to quantify my caloric expenditure, or buy into any sort of nonsense about my weight or fitness level saying anything about my value as a person or my competence as a dietitian.

With all of the radical changes in my lifestyle, do you know how much my weight changed from before the surgery until now? Exactly zero pounds. According to the weights that my doctors recorded at my appointments, I am the same weight now as I was before the operation 10 months ago.

If one pound of body fat is worth 3,500 calories (I am not saying this assertion is accurate, but it represents another myth that continues to float around.) and the calories-in-calories-out theory is true, I would have had to have balanced my energy intake and expenditure within less than 12 calories per day on average for the last 305 days. That, ladies and gentlemen, is impossible.

Yet the calories-in-calories-out ridiculousness is not widely recognized for what it is. Recently, someone posted on Facebook a printout that her doctor gave her containing weight loss advice. “Change your diet,” it says. “Eat 500 fewer calories a day. This can lead to weight loss of one pound per week.”

PrintoutIn nutrition, sometimes a little bit of knowledge is worse than no knowledge at all. The notion that calories in versus calories out dictates weight is nutrition 101, but what they tell you in nutrition 102 is that it is not really true. It has some merit as a general concept, but it should never be taken literally, as weight regulation is vastly more complex than that.

During my recovery, I have moved my body in the ways that have felt most comfortable at the various stages of my healing and consumed the foods that my body seems to be asking for in the quantities that are satisfying. When I have missed the mark by overeating, for example, I do not feel guilty or beat myself up; rather, I look at the episodes as learning experiences to figure out what happened and what I can do differently in the future.

Because of these behaviors, plus genetics and other factors that are out of my hands, my weight has happened to stay the same. If it had changed, would I have cared? Sorry, I know this might be hard to believe in the context of our weight-obsessed culture, but my interest is elsewhere.

My plan is to make my comeback to competitive racing at this June’s Mount Washington road race. This is where my attention is focused. I have five months to ramp up from virtually no running to racing 7.6 miles up the highest mountain in the northeast. Can I do it? We’ll see. But I can tell you this: I am excited and looking forward to the challenge.

Coca-Cola Classic Nonsense

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A pretty hefty portion of session time is spent clarifying misinformation that our patients have absorbed from various sources and assumed to be true. If you are a dietitian yourself, you know exactly what I mean.

It can be frustrating, but the patients are not to blame. If I encounter a post or article about combustion engines, overseas investing, the rise and fall of the Ottoman empire, or any other of the millions of topics in which I am a layman, I might mistakenly assume that what I am reading is correct, too. Without expertise in the subject, how could I possibly be expected to decipher the difference between fact, half-truths, and pure fiction with any degree of accuracy?

As an example of the nutrition-related nonsense that circulates in our culture, consider a post that popped up in my Facebook feed today entitled “This Finally Convinced Me to Never EVER Drink Coke Again. Once You See It, You’ll Understand.”

No way am I going to link to it; the post already has thousands of Facebook likes and I am not going to facilitate more exposure. If you really want to find it, I am sure Google will be more than happy to assist you in your efforts.

The post begins with Coke bashing. “The sugar content in each serving is astronomical, and the acidity can strip metal (coke is often used to de-grease car engines). If you’re a big fan of coke and still need some convincing to quit your bad habit, check out this experiment.”

Look, I am not arguing that Coke is a health food, but good-bad food dichotomies create way more harm than people realize. All foods have their pros and cons. Yes, even Coke has its upsides. Otherwise, why would anybody ever buy it?

“What happens when you drink some coke after drinking milk or eating a dairy product?” They continue, “You’ll be totally disgusted to see what happens in your stomach.” A series of photos then depict a small amount of milk being poured into a bottle of Coke, which is then capped and left to stand for six hours. By the time the hours elapse, the mixture separates into an upper layer of tan water and a lower layer of brown sediment, similar to how Italian salad dressing separates when left to stand undisturbed.

The caption reads “But what is that totally gross thing at the bottom? Is it dirt? Sand? Colon cancer?” They aren’t done. “The coke is so acidic that it denatures the protein found in the milk, causing this chemical reaction.”

According to an article published by the American Society for Microbiology, Coca-Cola Classic has a pH (which is a measure of acidity) of 2.5. You know what else has a pH of approximately 2.5? Your stomach. According to the National Institutes of Health, our stomachs – when empty – have a pH in the range of 1.5 to 3.5 due to the presence of hydrochloric acid, which is a naturally-occurring chemical that our stomachs secrete. Good luck digesting your food without it.

In other words, put protein in your stomach, let it sit there for six hours (which is unrealistic, as the stomach tends to empty much faster than that), and the product may very well resemble the denatured milk protein in the Coke bottle. The authors want us to think that something abnormal, scary, and unhealthy happened to the milk, but that is really not the case.

But what fun would it be, and more importantly how many Facebook likes would their piece get, if the authors concluded it with a lesson on digestive system physiology? Instead, they played the fear card. “This is so gross, I can’t believe I put this stuff in my body. Please share this with others, everyone needs to see this.”

No, not really. As it turns out, I don’t think anybody needs to see it.

Really, Giada?

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Recently a news story came across my radar about Food Network chef and TV personality Giada de Laurentiis. According to an article by Fox News, a source on de Laurentiis’ show Giada at Home insists that the real secret to how Giada maintains her size 2 figure is not by “eating in moderation,” as the chef has often stated. Instead, the source reports that Giada refuses to actually eat any of the food she prepares on her show. But what about all of the scenes in which she takes a bite of the delicious food she prepares during the show? According to the source, Giada has a “dump bucket” on hand to spit out every bite she takes on TV.

Needless to say, I was disturbed to read about this. While I am not insinuating that Giada has an eating disorder, the act of chewing and spitting out one’s food is actually an eating disorder behavior that a number of my patients admit to engaging in. The individual who chews and spits out her food is trying to get the flavor of the foods she deems “unhealthy” without having to ingest the calories.

In every interview with Giada that I’ve read, the subject of her weight comes up. Of course, it’s not terribly surprising that these questions are asked since she is a chef who prepares decadent meals and desserts and yet manages to stay stick thin. And I guess I can’t blame her for her standard answer of “I eat a little bit of everything and not a lot of anything. Everything in moderation.” I mean, who wants to hear that a TV chef actually never eats her own creations on the show? And spitting out one’s food isn’t something that most people would admit to.

It makes me sad that Giada feels the need to do this. Given our fat phobic culture, I imagine she must feel a lot of pressure to stay thin as a TV personality. My guess is that if she actually did eat at least some of the food she prepared on the show, her figure wouldn’t be much different. Genes play a huge role in weight, and eating a few extra bites shouldn’t affect her waistline dramatically. It also makes me think of Paula Deen and how ruthlessly she has been attacked for her weight and “unhealthy” cooking style. I wonder how Paula would be viewed if it was discovered that she also has a “dump bucket.” Would she be praised for her “restraint?”

More than anything, I worry that stories like Giada’s will start a troubling new trend among young girls trying to “stay skinny.” No matter what, chewing and spitting out one’s food for the purposes of weight control is not a healthy behavior. Hopefully this will not catch on as the new weight loss “solution.”

“Beauty Work”

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This morning I read an article on “beauty work,” the digital manipulation of actors and actresses in movies and television to alter their appearances. No matter how rampant this practice may or may not be, the larger point is that comparing ourselves to people we see in any form of media, or even in real life, is never a good idea.

Joanne and I love the town in which we practice. She grew up here while I grew up just one town over and used to work at a sporting goods store a block from where our practice now stands. One of the challenges of our town, however, is the widespread focus on appearance and the negative fallout that this behavior spawns. Because the latter often shows itself in the form of eating disorders and disordered eating, we set up shop here in order to fill the need for help.

Quite often, patients come into my office and compare themselves to others, but the points of comparison go beyond actors and actresses and more often focus on fellow residents they see in the community. No digital manipulation there, but still, what are they really seeing?

Unless someone is completely candid with us, we never really know what he or she does or does not do to look a certain way. How do you know that the person who just lost a tremendous amount of weight is not battling a serious disease? Are you really sure that the friend you admire for being supposedly naturally slender is not struggling with anorexia, or that the co-worker you praise for eating the perfect little lunch is not later secretly bingeing on pizza and cupcakes before purging? Do you ever consider that the super buff weight lifter might be on steroids, or that the gym rat who can seemingly go for hours on the stair climber might be ignoring a slew of overuse injuries?

How sure are you that the person whose body you wish you had is any more happy, satisfied, comfortable, or confident with his or her body than you are with your own? Do you recognize the very real possibility that he or she is looking back at you with envy as well?

We never really know what is going on with someone, whether they are on a movie screen or walking down the sidewalk. Given that someone’s appearance tells us nothing about the person other than what he or she looks like, and given the negative consequences that frequently arise from comparing ourselves to others, how is it ever a good idea to make such comparisons?