Tag Archives: wellesley nutritionist

Is the Risk of Foodborne Illness Worth It?

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Almost immediately after posting a Wall Street Journal article entitled “Does Rinsing Fruit Make a Difference?” on our Facebook page yesterday, I got an email from a family member talking about pre-washed salad mixes in the past tense (“What a convenience they were.”) and asking me if I will change my own eating habits because of this article.

When it comes to foodborne illness, risk always exists.  One can take every known precaution and still contract a foodborne illness, or one can grotesquely forgo all food safety guidelines yet not get sick.  The question is not one of risk’s presence, but rather one of risk’s relative magnitude.

Each one of us has to decide for ourselves how much risk we are comfortable taking.  The article talks about the health of one’s immune system as being an element of consideration, but other factors are in play, too: What does one like to eat?  What can one afford?  How much time does one have for food preparation?  What are the realistic alternatives if one forgoes a given food?  Pros and cons exist for eating and not eating a given food, and these must all be considered before reaching a conclusion. 

The answer to my family member’s question is no, I will not be changing my own eating based on this article.  Generally speaking, I do not care for vegetables.  I know, I know, a dietitian who does not like vegetables.  As it turns out, dietitians are people too and we have our own challenges with food just like everybody else.  The modes in which I enjoy vegetables are slim: carrots and peppers dipped in humus, spinach in lasagna, and broccoli and mushrooms on pizza.  In terms of true enjoyment, that’s about it.

Raw salad greens topped with fresh fruit and nuts are moderately enjoyable, but the tipping point is such that convenience is a major factor for me.  Take away pre-washed salad mixes and the likelihood that I will buy whole greens and prepare a similar mixture on my own is very slim.  Therefore, when I weigh their benefits against the risk of foodborne illness, continuing to consume pre-washed salad mixes makes sense for me.

Somebody else might reach a different conclusion for his or her own life and that is perfectly fine.  My case is nothing more than an example; I am not suggesting that others should or should not reach the same conclusion for themselves that I have reached for myself.  Everybody has different needs, priorities, goals, and constraints, which is why Joanne and I feel so strongly about providing individualized nutrition counseling that is customized for each one of our patients.

He Said, She Said: New Year’s Resolutions

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

He Said

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

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

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

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

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

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

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

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

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

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

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

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

 

She Said

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

So what’s a person to do?

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

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

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

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

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

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

Pan-Glazed Chicken with Basil

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Courtesy of Cooking Light’s 5-Ingredient 15-Minute Cookbook.

Ingredients

  • 4 4-oz. skinned, boned chicken breast halves
  • 1/2 tsp salt
  • 1/4 tsp freshly-ground pepper
  • 2 tsp olive oil
  • 2 Tbsp balsamic vinegar
  • 1 Tbsp honey
  • 2 Tbsp chopped fresh basil

Directions

1.     Sprinkle both sides of chicken with salt and pepper.

2.     Heat oil in a large nonstick skillet over medium-high heat.

3.     Add chicken; cook five minutes or until lightly browned.

4.     Turn chicken; cook six minutes or until chicken is done.

5.     Stir in vinegar, honey, and basil; cook one additional minute.

Noms: The Local, Wellesley

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To celebrate Jonah’s birthday, we decided to venture out to The Local, a restaurant that just opened up in Wellesley last November.  Per usual, we went for an early dinner (5:30  pm), so when we arrived, there weren’t many patrons.  Suffice it to say, the place began to quickly fill up, and as we walked out the door at 6:30 pm there were people waiting for tables.  The Local’s menu is divided into clever sections such as “Snack Things,” including warm potato chips and dip and spicy Chex mix, “Mac and Cheese Things,” which allowed the diner to customize his or her mac and cheese, and “Bigger Things,” which was comprised of larger entrees including chicken cacciatore, short ribs, and semolina-crusted fish and chips.  Impressively, none of the appetizers is more than $14 (most were $5-8), and none of the entrees costs more than $19.

To start our meal, we had the fried pickles, which were crispy and delicious and not greasy in the least.  For our main meals, Jonah had the grilled cheese sandwich with a cup of tomato soup, while Joanne had the Atlantic salmon, which came with roasted Brussels sprouts and parsnip puree.  Although Jonah’s grilled cheese was smaller than others he has gotten at similar restaurants, he felt it was the perfect amount of food and was comfortably full by the end of the meal.  Joanne’s salmon was perfectly cooked, and the contrast in flavors among the salmon, Brussels sprouts, and puree was addictive.

While our meal was tasty and uneventful, it appeared as though the couple dining next to us were not happy with their orders.  We overheard them telling their waiter that the steak tips they had ordered were not cooked to their liking, so they sent them back.  In addition, it looked like there were other issues with that couple’s meal, including missing meal components.  Our guess is that since the restaurant is still only about a month old, it is working out the kinks.

All in all, The Local was a pleasant surprise for its delicious food at very affordable prices.  It will surely be added to our favorite restaurants rotation!

The Real You Is Sexy

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

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

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

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

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

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

Confusion

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A friend and I recently got into an email exchange about how rapidly nutrition advice seems to shift and how this often leaves people confused, frustrated, and feeling paralyzed about what to do.

No doubt, guidelines do evolve in response to new research, and in fact the Dietary Guidelines for Americans are updated every five years.  The shifts, while perceived as quite fickle, are much more subtle than most people realize.  However, the reason we perceive nutrition advice to be oscillating like the ever-changing wind is not due to this evolution, but rather because of misinformation.

Take yesterday as an example.  Each day, Joanne and I receive a blast of nutrition-related articles.  For each topic, we are provided with the story geared towards the general public, such as an article in the New York Times or Boston Globe, as well as the research piece or journal article on which the story is based, such as a piece in the New England Journal of Medicine.

Yesterday’s topic read, “Fats and Oils That Can Improve Your Health.”  As soon as I began to read the story, something seemed fishy.  Ghee and coconut oil topped the list of supposedly-healthy fats.  Although alternative medicine touts both of these fats as having health benefits, the research up to this point has not supported these claims.  Therefore, I was surprised to see them headlining the list.  When I got to the bottom of the article, I discovered that sure enough the story was written by a “Holistic Health Counselor,” as opposed to a credentialed and licensed expert in the field.

Next, I read the position statement released by the Academy of Nutrition and Dietetics on which the above story was supposedly based.  The content of the two publications bore little resemblance to each other.  Regarding coconut oil, the Holistic Health Counselor wrote, “This versatile oil goes well with both sweet and savory dishes and boasts many health benefits.  Made up of medium-chain fatty acids, this oil is good for those trying to lose weight because the body can easily use this healthy fat for energy.  A large portion of the fatty acids found in coconut oil are made of lauric acid, which can serve as an antimicrobial, antiviral, and antibacterial, helping to combat viruses and boost the immune system.”  On the other hand, the position statement read, “New food products containing coconut oil and other palm oils (eg, milk, spreads, yogurt) are touting health benefits of MCTs [medium-chain triglycerides, or medium-chain fatty acids].  Given that 44% of coconut oil is 12:0 and 16% is 14:0, and these fatty acids are hypercholesterolemic, consumption of coconut products is not currently recommended.”  Do you see any relationship between these two passages at all?

Omitting a link to the Holistic Health Counselor’s story was a conscious decision on my part in order to avoid further dissemination of misleading information.   If I showed you the article though, you would discover that it is concise, organized into a list with bold headings, and features colorful and attractive photos as well as a head shot of the author.  Compare that to the text-heavy, chemistry-laden, pictureless, 18-page monstrosity that is the position statement.  The former will attract more readers and gain steam and wide circulation due to forwarding to friends, postings on Facebook, etc.  The latter is lost in the dust, only to be read by the likes of me.

Generally speaking, most people never read primary source articles.  They simply trust that the stories they read summarizing said articles do so with a high degree of accuracy.  Unfortunately, just like in the game of telephone, details and facts get lost or skewed with each iteration; the ultimate and initial messages conveyed often do not match.  The mismatch is what makes playing telephone fun and interesting, but in real life the consequences are negative.  A patient comes into my office having read the more popular article and understandably believes the content to be true, but then he or she hears me present the position statement’s stance.  “Have the guidelines already changed?” the patient asks.  “Who should I believe?  What am I supposed to do now?”  No wonder people feel stuck and confused.  Part of our work then becomes to undo this confusion so that the patient can move forward.

In a culture where we have limited time and attention spans, we get a great deal of our news through tweets, scrolling headlines at the bottom of the television, and sound bites.  Media members, fully aware of the small window they have to present an idea and under pressure to break a story first, sometimes sacrifice checking facts and preserving key messages.  The pressure to be first and to accumulate clicks, retweets, and Facebook likes is king while the responsibility to be accurate gets lost in the shuffle.

Somewhere along the line, somebody suggested to me that I should shorten my blogs.  People have neither the time nor attention span for my entries, and who besides my mom reads all the way through to the end?  Shortening my blogs, I am told, could increase our Facebook fans and Twitter followers, thereby making Soolman Nutrition and Wellness LLC more popular.  That could be true, but my position as a source of reliable information is one that I take seriously, and I am not about to sacrifice my credibility for some extra likes and retweets.  Despite today’s be-first-and-keep-it-short media culture, accuracy and completeness are still necessary in order to minimize confusion.

Eating Flowers

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If you are like me, your eating pattern is somewhat repetitive.  Your grocery shopping involves focusing on the usual suspects while consciously or subconsciously dismissing most of the foods in the store due to cost, lack of knowledge about how to prepare them, ethical reasons, bad experiences last time you had them, or a variety of other reasons that can eliminate them from consideration for purchase.

Once upon a time, my shopping trips were so consistent from one to the next that my visits to Whole Foods were showcases of machine-like precision and efficiency.  Within 10 minutes of turning off my car’s ignition in the parking lot, I was buckling my seat belt with a trunk full of groceries in the back.

While routine has its upsides, at some point along the line I realized that I was doing myself a disservice by always eating the same foods.  From a health standpoint, I was missing out on nutrients that were deficient in my regimen.  In terms of enjoyment, I often felt bored with what I was eating.  Food can and should be fun, and as Joanne pointed out, we tend to absorb more nutrients if we enjoy what we are eating.  The grocery store is full of foods that I might have really liked if only I was adventurous enough to give them a chance.

Once I realized that, I decided that each time I went to the store I would purchase one food that was either brand new to me or that I had not had in a very long time.  I tried all sorts of things, some of which probably sound mundane to you, but they were departures from the norm for me: exotic melons, crab cakes, pies, tabouli, strange-looking vegetables I had no idea how to prepare, dairy-free “ice creams,” pumpkin pasta sauce, teff, vegan hot dogs, etc.  Each week I came home with something new.  No, I did not like everything I tried and many of them I never bought again, but there was still value in the experimentation.  I expanded my palette, rediscovered foods I had forgotten, and realized that some foods I used to dislike now hit the spot.

Although I maintained this tradition for years and got a lot out of it, recently I found myself sliding back.  Once again, I gravitated towards particular shelves while ignoring the vast majority of the inventory.  As soon as I caught myself doing this, I reminded myself how much I enjoyed my years of experimentation.  At that moment, I was standing in the produce section in front of a package of edible flowers.  My hesitation reminded me, “I am not someone who eats flowers.”  As I reached for the package and put it in my cart, I thought to myself, “I am now.”

EdibleFlowers

How should one measure health?

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

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

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

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

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

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

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

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

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

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

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

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

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

The Lottery

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Ralph Francois, of Quincy, won $1,000,000 playing Mega Millions. Marjorie Teixeira, Frank DiMascio, and Christine Cummings, of Melrose, Watertown, and Dedham, respectively, all won lottery prizes on the same December day. Stanley Goryl of Smithfield, Francis McPherson of Somerville, Marque Scott of Fall River, Patricia Cannata of Attleboro, and Linh Dang of Dorchester are just a few of the 15 locals who won at least $1,000,000 through the lottery last month. Their pictures, smiling and holding up enlarged replicas of their winning tickets and prize checks, are both evidence of their victories as well as enticements to the rest of us suggesting that we can be winners too.

Despite these testimonials that fill us with hope, most people do not walk away a winner.  Massachusetts lottery players, on average, will only win back $0.72 for every $1.00 they spend on lottery tickets. 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 reportedly is 1,400 times more likely to die in an asteroid apocalypse than he or she is to win Powerball. As if the odds themselves were not concerning enough, playing the lottery can sometimes spiral out of control. A link on the Massachusetts State Lottery’s website directs people to where they can get help for compulsive gambling.

Some people enjoy gambling, including the lottery, and as one of my friends said to me recently, “You can’t win if you don’t play.” Going about it with a sporting attitude for the sake of entertainment and excitement is one thing, but nobody actually believes that playing the lottery will really net a profit, right? Wrong. According to a couple of 2005 surveys put out by the Consumer Federation of America and the Financial Planning Association, 21% of the surveyed Americans believe that winning the lottery represents the most practical way for them to accumulate several hundred thousand dollars. I imagine one would be hard pressed to find a legitimate financial adviser who would suggest that playing the lottery is a sound investment strategy.

Given the time of year with people around me making all sorts of resolutions, the clear parallel between playing the lottery and resolving to lose weight has been on my mind. Joanne and I have written extensively about the chronic failures of weight-centered dietary approaches. Although the exact outcome depends on the specific parameters of the given study in question, research across the board shows that the chances of keeping off lost weight are poor. According to one group of researchers, “Less than 20% of individuals that have attempted to lose weight are able to achieve and maintain a 10% reduction over a year. Over one-third of lost weight tends to return within the first year, and the majority is gained back within three to five years.”

Joanne and I advocate focusing on health rather than weight. In that sense, weight outcomes are only somewhat interesting to us. However, for programs and approaches that revolve around weight, shouldn’t the results at least be better than this?

However, just like people who play the lottery despite the terrible odds of making a profit, we get sucked in by glamorous testimonials, peer pressure, advertisements, and the like, all encouraging us to lose weight. We enter the weight-loss game with the expectation, whether by delusion, misunderstanding, or overconfidence, that we will be the rare exception who comes out on top. “You can’t win if you don’t play,” right?

The difference is that we are not playing a game; we are playing with our health. At best, the weight-loss-weight-regain cycle postpones behavior change that will actually improve our health. More likely, the cycle itself can leave us in a less healthy state, either physiologically, psychologically, or both. Furthermore, just as the lottery can lead to a gambling addiction, weight loss pursuits can lead to serious eating disorders which add a whole new layer of complexity to one’s health problems.

Instead of entering a game that you are likely to lose, leave weight-centered approaches behind and focus on making healthier choices. No, lifestyle change is neither sexy nor rapid. Lifestyle change does not make for good reality television. What it can do though is increase your chances of getting healthy and staying that way.

The Wrong Idea

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

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

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

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