What Working at the USDOT Taught Me About Nutrition

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After graduating from Tufts with a double major in mathematics and English, I took a job working as an Operations Research Analyst for the U.S. Department of Transportation (USDOT). Underworked and painfully bored, I generally hated my time there, but I did work on some interesting projects during my three years. Once I pivoted and went back to school to study nutrition, I realized in hindsight that working at the USDOT had taught me more about nutrition than I ever would have expected.

The USDOT assigned me to the economics analysis division, a group in which I felt very much out of place because I had no background in economics. My father half-jokingly suggested that I just imagine sticking a dollar sign in front of every figure to make the projects feel more relatable to what I was already familiar with, as statistical analyses and mathematical modeling were already in my wheelhouse. 

One of the first projects that I worked on was in the realm of intelligent transportation systems (ITS). An example of such a system is a traffic light that senses an oncoming car and changes to green, as opposed to a system in which the lights change according to a timer regardless of the cars in the vicinity. Back in high school, one of my friends was sure that some of the lights in town would turn green for him if he flashed his high beams at them, but that is not how the technology worked, at least not back then. Rather, ITS in those days utilized sensors embedded in the road which cars would trigger as they approached an intersection. My friend correctly noticed that the light quickly turned green as he approached, but he misunderstood the mechanism, and all his high beaming was for nothing. A parallel exists between that and the gluten-free diet that was so popular when I first began working as a dietitian. Sure, some people genuinely must avoid gluten, but back then the diet’s popularity far outpaced its legitimate need. Yet we had people swearing that they felt better, particularly with gastrointestinal distress symptoms, once they eliminated gluten. Some of that was unquestionably a placebo effect, but some of it was a misunderstanding of the mechanisms at play. We now understand that for many sufferers, the trigger is not gluten, but rather FODMAPs, which are subsets of carbohydrates that can cause issues for some people. Gluten-containing foods, it turns out, tend to be high in FODMAPS, so following a gluten-free diet can help people to feel better, but the culprit is not the gluten itself, but rather the FODMAPs that come along for the ride. 

Some of our work focused on mathematical modeling of the trucking industry and specifically looked at driver and company violations. It was during this project that I learned that approximately 20% of truck drivers randomly tested at weigh stations were driving under the influence, a horrifying statistic that crosses my mind pretty much every time I see a truck on the highway. We also learned that many companies knowingly command their drivers to intentionally exceed the volume of hours that they are legally allowed to drive continuously, as it is more financially favorable to pay the fines for such violations (that is, if they even get caught) than it is to obey the law. In essence, knowingly keeping drowsy drivers out on the road and flaunting the law is good business. Remember this the next time you are in the grocery store and notice an influx of products geared towards whatever diet fad is hip and trendy at the moment. Some consumers take prevalence as validation that the fad must have sound evidence supporting it, but such an assumption could easily be – and probably is – false. Food manufacturers are trying to make money, and they are happy to capitalize on a trendy demand to increase profits regardless of the science behind such a demand. They are not looking out for our health any more than the trucking companies that keep sleepy drivers out on the road.

Even though I spent the entirety of my time at the USDOT housed in the economics analysis division, eventually managers from other divisions began using me for their projects, including a few that were working on a mathematical model of the alternative fuels industry. Going into the project, I knew very little about alternative fuels, but I picked up knowledge as I went. Much of what I learned involved the downsides of these fuels and the problems that had not yet been solved. For example, one fuel was so unstable that a fender bender could cause a vehicle to explode. Another fuel was so expensive that hardly anybody would be able to afford it. Another would save tailpipe emissions but cause massive pollution at the plant where it was made. Decades later, we have seemingly solved or mitigated some of these issues, as we have electric cars all over the place now, but as one of my colleagues said to me at the time, “Alternative fuels are alternative for a reason.” Keep that in mind when it comes to alternative, functional, or holistic medicine, including the approaches to nutrition that they tout. If their guidance was as safe and effective as they want you to believe, it would not be alternative; it would be mainstream. 

Earlier I mentioned that I was underworked. One of the problems that the USDOT faced was that tasks were unevenly distributed, so while some people sat at their desks reading the newspaper, others stayed late and came in on weekends to meet deadlines. My sense was that some of the middle managers overseeing me were still developing their delegation skills, and to be candid, I – a young guy fresh out of college – probably did not do enough to earn their trust. Finding time for lunch was rarely a problem for me, as I had an abundance of time on my hands, but some of my colleagues struggled to even utilize the brief lunch break to which they were legally entitled. The experience gave me an appreciation for how practicing self-care (finding time for lunch, physical activity, adequate sleep, etc.) can be a significant challenge for people who work demanding jobs and perhaps have long commutes and other obligations besides their occupations. 

One particular colleague who fit the above description told me that he took a multivitamin to make up for the convenience foods upon which he heavily relied. No judgment whatsoever, as I know he was up against a lot and doing his best to take care of himself in challenging conditions, but I remember how confidently he erroneously believed that a little pill was making up for everything that was missing from the rest of his diet. Fast forward to the present days of biohacking and supposedly “nutritionally complete” food products like Huel, and I see people making the same mistake. Just as my co-worker’s multivitamin lacked sufficient nutrients, such as fiber and phytochemicals, to make up for what his dietary pattern was missing, a bottled meal replacement product is not going to cover all the bases that a wide variety of actual food would touch. As I said though, no judgment; we are all doing the best we can.

When I decided to change careers and wrote the personal statement for my nutrition school application, I only briefly touched on my experience at the USDOT before quickly adding, “I do not believe that anybody is hard-wired for any specific field or career . . .” and continuing on to other topics. Had I realized at the time how much I had already learned about nutrition by working at the USDOT, I certainly would have said more.

The Pride of Quitting

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Earlier this month, a longtime friend of mine set out to walk from Mexico to Canada. An ambitious goal, for sure, but he has achieved similar accomplishments before, so completing this international walk seemed like a realistic challenge for him. He performed the necessary physical training, prepared for the logistics, headed to Mexico, and began. Unfortunately, what was to be a months-long endeavor ended just a few days later in southern California due to a persistent leg injury. Man, what a bummer. Like I told him though, I was more impressed that he stopped than I would have been if he had continued on while hurt.

Dealing with injuries early on in a big adventure is something that he and I have in common, but I made a different choice. In 2006, he and I set out from Seattle with some other friends to ride our bicycles to Boston for charity. On the eleventh day, I fell off my bike in Montana and fractured my spine. That diagnosis came much later, way after the window of opportunity for the breaks to heal on their own had closed. All I knew at the time was that I was in a lot of pain and that the muscles around the injury had seized up to the extent that pedaling a bike was temporarily impossible.

But I also knew that ending my trek early would have been unbearable. Virtually everybody in my life – family, friends, classmates, professors, and co-workers – knew that I was going on this trip, and the shame of having to tell them that I stopped early was more than I could handle. At that point in my life, which was a challenging time for me personally, I felt like my self-worth was contingent upon completing the trip. I feared how I would have looked to others and felt about myself if I had quit.

Beyond that, I was immersed in a no-pain-no-gain exercise culture that glorifies pushing limits and disregarding physical indicators of distress. I still am. And so are you. Our work-till-you-drop capitalistic society praises people who show up sick, substitute caffeine for adequate sleep, and forgo lunch breaks. New England Patriots fans wear shirts emblazoned with a former coach’s famous “no days off” mantra. A singer on the radio tells us, “My body tells me no / But I won’t quit ’cause I want more.” The same spirit bleeds into how we approach physical activity.

And sure, sometimes we get away with it. We play through an injury that eventually heals. We show up to the office all week hopped up on DayQuil and then recover over the weekend. Twenty years ago in Montana, I got a massage, remounted my bike, and finished our ride to Boston. We get away with such choices until, well, eventually maybe we don’t. Our society is pretty good at quickly moving past cautionary tales, but I still remember a tennis teammate who had to get his ankle fused after continuing a match on the sprained joint, a local woman who kept working with the flu until it proved fatal, and my two spinal fusions.

Listening to and honoring our body’s signals is a counterculture act of rebellion, which makes exercising intuitively more complicated than it otherwise needs to be. By stopping his trek early, my friend demonstrated courage, strength, discipline, patience, responsibility, and self-confidence. If I had those same qualities back in 2006, I probably would have taken a taxi to Glacier Park International Airport and found a sedentary way to enjoy the summer while recovering from my fall.

Genetics

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My birthday was last month. It was not a momentous birthday or one that held a lot of meaning, but, nonetheless, I turned a year older. The day after my birthday, some of my friends on my tennis team gave me some goodies to celebrate: a balloon, a beautiful bouquet of flowers, and a delicious cupcake. While I count these ladies as friends, I would not say that we are the kind of friends that know everything about each other. We know about each other’s lives marginally but not deeply. One of these tennis friends wanted to guess how old I was and I obliged. When I told her, she was in disbelief, as she had thought that I was a decade younger than I am. “Your skin is amazing! How do you keep it in such good shape?!” she commented. And then she proceeded to ask me about my skin care routine and all the ways that I was keeping my youthful skin. The honest answer that I gave her was “genetics.”

I have always had “good” skin since I was young. I did not get tons of acne breakouts as a teenager, and I do not have many wrinkles now. But this is not due to any beauty regimen or skin treatments. Yes, I cleanse my face and I moisturize. I wear sunscreen, drink water, do not smoke, and rarely consume alcohol. But other than that, I do not do anything special. The only thing I can attribute my skin’s youthfulness to is my mom’s genes. She is going to be 83 this year, and her skin is still in really good shape. My youthful skin is mostly due to luck.

This interaction with my tennis friend got me thinking about genetics and weight. We are all born with a specific genetic makeup that is a major determinant of our physical features. According to one research paper, the author found that genes account for 40-70% of the variability in body mass index (BMI). Other research has found that genetic influence on BMI can be as high as 75-80% for some individuals. Genes have been found to affect body composition by way of appetite and satiety signaling pathways, metabolism (resting energy expenditure), and fat distribution (where one’s body stores or does not store fat). This means that there is a genetic predisposition for our bodies to gravitate towards a certain weight range and distribution. We all know people who, no matter how much they eat or move their body, their weight is always in the “slim” range. And I’m sure we know people who, no matter how much they eat or move their body, their weight is always in the “large” range. In the scheme of things, weight is largely outside of our control.

My impression is that most people are not aware of or choose to ignore the fact that while environmental factors and behavioral factors do play a role in weight, the main determinant of our weight is our genetics. Yes, some people can temporarily lose weight through dieting, but as we know, 90-95% of dieters regain all or most of the weight within five years, with one to two-thirds of them gaining even more weight than they had lost in the first place. We also know that weight cycling, or losing and regaining weight repeatedly, results in more weight gain over time, not to mention the numerous health risks including, but not limited to, higher overall death rate and an increased risk of dying from heart disease. Of course, there are outliers, or people who have lost a significant amount of weight and kept it off for over five years, but they are the exception, not the rule. Fighting one’s biology is almost always a losing battle. At the end of the day, your body weight is going to land where it is mostly predestined to land, even with extreme habit manipulation (e.g., restriction, exercise, medication, and surgery).

Instead of fighting our biology and trying to make our bodies fit what society feels is acceptable, we could save so much time, money, and energy by accepting our bodies for what they are and taking care of them in ways that feel good.

Hunger/Fullness Scales: Helpful or Counterproductive?

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One of my patients is reading The Fuck It Diet, by Caroline Dooner, for the first time, and I am rereading it to refresh my memory so the two of us can discuss it. This book has become one of my go-to volumes for patients who are interested in reading about intuitive eating. Do not let the title fool you; while The Fuck It Diet is indeed a casual, informal, and humorous read, its substance is generally on point. Sure, sometimes I take issue with what the author writes, but that is true pretty much anytime I read anything, including my own writing, as my typical reaction to revisiting my blogs from last decade, last year, or even last month is wishing that I had better expressed myself.

Having said that, one of the upsides of The Fuck It Diet is that Ms. Dooner directly addresses the pitfalls and misunderstandings that people commonly encounter while traveling down the intuitive eating path. For example, she points out the tendency for people to warp intuitive eating into yet another diet. “Most of us think that if we can just ‘eat intuitively,’ we will eat like a bird and become naturally thin and happy versions of ourselves. So many of us try to heal our eating without changing our relationship to weight [italics are the author’s own emphasis] as well. Ignoring how closely our feelings about eating and weight relate to each other is our big mistake.”

While I completely agree with Ms. Dooner on that front, one of our points of divergence is the use of a hunger/fullness scale as part of relearning how to intuitively eat. For those of you who are unfamiliar with what a hunger/fullness scale is, essentially it is a numerical continuum, sort of like a ruler, where the number at one end represents extreme hunger, the number at the opposite end represents extreme fullness, and all of the numbers in between represent more moderate degrees of hunger or fullness. Different versions of the hunger/fullness scale exist with most of them utilizing a 1-10 scale on which 1 represents extreme hunger and 10 represents extreme fullness. 

Ms. Dooner is seemingly not a fan of hunger/fullness scales. A couple of quotes stood out to me. “But again, true intuitive eating does not happen by rating your hunger on a rating scale . . . . You do not need a hunger scale to learn whether you are hungry or not.” On one hand, she makes some good points, and I think I understand where she is coming from, as some people do turn intuitive eating into a sort of hunger-and-fullness diet in which they set rules that their hunger must reach a certain number for them to eat and that they must stop eating when their fullness reaches a particular number. Also, sometimes people do become hyperfixated on the number as if a precise bite exists at which ending the eating experience will yield the perfect level of satiety. If someone is utilizing their hunger/fullness scale in one or both of these ways then, yeah, the scale is doing more harm than good. 

On the other hand, some people do find a hunger/fullness scale to be a helpful tool for relearning how to intuitively eat. Probably the most helpful aspect of utilizing a hunger/fullness scale is, strangely enough, just taking the time to construct one. Rather than giving people a scale that is already completed, I prefer to start with a bare-bones outline and help them to flesh it out based upon their own experiences. After all, while some commonalities may exist regarding how we feel a given level of hunger or fullness, we also have individual differences. For some people, sitting down to create their own scale is the first time that they give much thought to what hunger and fullness feel like in their body. The extreme ends are usually the easiest points to describe while the intermediate points are more challenging, but that is absolutely fine because it creates a learning opportunity to go forth and pay attention to what those levels feel like. 

Use of a hunger/fullness scale gives us a shorthand that makes discussing hunger and fullness easier and also enables a person to more efficiently check in with their body. We could say that someone is of great or more than average height especially relative to their width, but isn’t it just easier to say that they are tall? And isn’t taking paper money with us easier than carrying around the gold that those bills represent? Similarly, assigning a numeric value to represent a more complex description of a level of hunger or fullness simplifies the process of thinking about and discussing hunger and fullness.

Ms. Dooner makes some great points, which is why I love her book and oftentimes recommend it to patients, but some people are able to constructively make use of a hunger/fullness scale without falling into the traps that she discusses. When considering whether or not to utilize a scale with a particular patient, I will typically raise for discussion the pitfalls that Ms. Dooner points out so we can gauge how confident we are that the patient in question can avoid them. From there, we mutually decide if we want to use a hunger/fullness scale or if we should follow Ms. Dooner’s lead and skip it.

Real, Authentic, Unapologetic Cookies

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Nearly 25 years ago, I bought a bag of Whole Foods semi-sweet chocolate chips that had a cookie recipe on the back. The purchase came at a time of transitions in my life, as I had just left the metropolitan area that had been home for my entire life and relocated to the countryside, a move that necessitated quitting my job without knowing what the next step in my career would entail. Anxious and with time on my hands, I filled the gaps in between job searches and informational interviews with tennis, volunteer work, marathon training, GRE studying, and baking – especially the aforementioned cookie recipe, which I cut out, saved, and committed to memory.

At this point in my life, I was also still dealing with what I understand in hindsight was PTSD related to my first back surgery, and I was very worried about my health. Pretty quickly, I began to alter this recipe by substituting ingredients that I believed made the cookies “healthier.” What began as small tweaks grew to radical warps. White flour was out, whole wheat flour was in. Nuts and dried fruit replaced the chocolate chips. Olive oil and brown rice syrup stood in for butter and sugar, respectively. Sometimes I ground up flax seeds and threw those in as well.

While I fooled myself – temporarily, at least – into believing I was still baking cookies, the reality was that I was essentially making pancakes but calling them by a false name. Nothing against pancakes, but they are not going to hit the spot if what one really wants are cookies. Since each, umm, “cookie” provided minimal satisfaction, I would eat a bunch of them at once in an effort to make up for diminished quality with quantity. Those of you experienced with diet foods can probably relate to the state of feeling overly full yet insufficiently satisfied.

My next career move ended up being a return to school to study nutrition, and some of my early courses reinforced that my recipe substitutions were on the right track. However, nutrition education comes with an unexpected twist. The basic courses oversimplify complex topics and present a fictitious level of certainty. Only later do students discover that the early lessons were not quite accurate, that the truth is murkier, more nuanced, and riddled with outstanding questions. This is why some people who only learn the basics know less than they realize.

As I progressed through my schooling, I came to appreciate that good health is never guaranteed no matter what, when, or how much one eats. Whatever cookie ingredients I use are small drops in the ocean of the myriad of factors, only some of which are in my control, that determine my health. Besides, who was I kidding, whole wheat olive oil “cookies” taste gross. So I stopped baking them.

While I continued to make recipe substitutions, the tweaks I was making by the end of nutrition school were entirely different than the ones I was making at the beginning. For example, I could turn them into double chocolate cookies by slightly reducing the volume of flour and adding some cocoa. Through experimentation, I discovered that Cadbury Mini Eggs are great in place of chocolate chips, but candy corns are not because they liquefy in the oven..

My relationship with the cookies is so different now than it once was. Because they hit the spot, I feel satisfied with less, so I can eat two or three, enjoy them, and get on with my day, as opposed to eating a whole batch of the pancake versions and still feeling like I am searching for something. Because they actually taste good, I can share them with other people. Shortly after Joanne and I began dating, I endeared myself to her by leaving some cookies in her vestibule while she was home sick. Whenever a new family moves into our neighborhood, I greet them with cookies. Imagine the impression I would make if I brought them the pancake version instead.

Most importantly to me, I bake the cookies for and with our daughter, who I hope is learning that one does not need to alter cookies beyond recognition in order for them to be acceptable. Cookies – real, authentic, unapologetic cookies – are welcome just the way they are.

Lessons from the Food Pantry

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Shortly before winter break, our daughter came home from elementary school with materials she received during an educational event regarding a local food pantry. While I look through everything she brings home, I was particularly curious about these materials because issues of community nutrition have long been important to me. On one hand, I was glad she learned that food insecurity exists and that society has resources in place to assist people who are struggling, but on the other hand, I had some concerns about specific messages contained in the materials. 

By way of background, I have taken an interest in community nutrition ever since I was given an eye-opening homework assignment a couple of decades ago. My professor tasked me with going to the grocery store to research prices and to use the information to design a diet that would nutritionally satisfy the Dietary Approaches to Stop Hypertension (DASH) diet while also financially satisfying the Thrifty Food Plan’s allowance of $4.37 per day. Unfortunately, I failed, as the closest I could come was $4.77 per day, still $0.40 over budget. If I could not do it despite my nutrition knowledge and mathematics degree, then how is someone with less education in such matters supposed to figure it out?

The assignment helped me to appreciate the impacts that financial limitations and food availability can have on health. The simple truth that people can only buy what they can afford and is accessible to them sounds so obvious now, but it took studying community nutrition for me to really get it. When I rode my bicycle from Seattle to Boston that summer, I made a point to visit the grocery stores on the Native American reservations that I passed through because I wanted to understand the options available to the residents of these relatively isolated communities.

During my dietetic internship in Boston, I spent time working on a roving healthcare van that stopped in some of the more impoverished areas of the city. We gave out condoms, took blood pressure readings, performed blood sugar checks, and answered nutrition questions for anybody who visited. During our breaks, my preceptor took me around the neighborhoods to visit restaurants, food pantries, and grocery stores. We talked with some of the regulars who relied on the pantries, and I was struck by the realization that food insecurity is not some abstract notion in textbooks or a relic of a bygone era, but rather a present challenge for many people in our own city. Many years later, I remain conscious of this reality, and I was glad to hear that our daughter’s class learned about what I believe is an important topic.

Unfortunately, some of the materials she received reinforce a dichotomous view of food that is damaging, oversimplified, and – quite honestly – unnecessary. For example, one exercise in a workbook invited her to take stickers of various foods and to sort them into “healthy food” and “junk food” bins. Another exercise asked her to draw a picture of a “healthy” meal. 

The food pantry’s materials reflect how our society generally views and talks about food, but while this kind of language is common, it is also problematic. These kinds of dichotomies warp how kids see food and set them up for potential issues as evidenced by the large number of patients who can trace their disorders back to something like this. 

How “healthy” a given food is depends on context. Bananas are commonly known as being a significant source of potassium, which might make them helpful for somebody with hypertension, but perhaps less helpful for someone with renal disease, so onto which bin should my daughter affix a banana sticker? Because a myriad of factors – medical, cultural, personal, social, financial, etc. – influence our eating, absolute claims about any particular food are going to apply to some individuals while completely missing the boat for others.

Besides, while food pantries are essential, teaching nutrition to school children seems like an unnecessary and sabotaging step towards fulfilling their mission. Imagine the sad irony of being a kid in class whose family struggles to make ends meet and being told by a food pantry – maybe even the very food pantry that you and your family rely on – that a food you and your family utilize to survive belongs in the “junk food” bin. How is that child going to feel, and what are they going to do, next time their family serves a meal or snack featuring that food?

So I reached out to the food pantry in question and communicated my concerns. As a preliminary step, I emailed our daughter’s teacher. She shared my concerns and strongly encouraged me to directly contact the food pantry in question, which I did. In my message to them, I explained that I was neither angry nor was I judging them, but rather I was reaching out in the spirit of constructive criticism and a willingness to help. To their credit, they responded quickly and with an open mind. They requested that we schedule a time to talk so they can learn more. Similarly, I hope our conversation will help me to better understand what they are trying to achieve by their inclusion of nutrition talk in their student materials. Perhaps we can devise a plan together to reach those same goals in a way that mitigates the risk of inadvertent harm.

Surviving the Holidays in the Ozempic Era

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November is here, and that means the holiday season is upon us. I always feel ambivalent about this time of year. On the one hand, I do enjoy spending time with family and friends that I don’t see very often, and Thanksgiving foods are some of my favorites. On the other hand, seeing family and friends whom I haven’t seen in a while can be somewhat nerve-wracking. Even though Jonah and I are very firm in our HAES and fat-positive beliefs, many of our family members are entrenched in diet (or “health”) culture, so naturally there will sometimes be triggering conversations.

As we approach Thanksgiving, many of my patients are concerned about interacting with family members and friends who have started taking GLP-1s over the past year for weight loss. As I am sure you are aware, these medications have skyrocketed in popularity over the past few years, with seemingly everyone under the sun taking them. The pharmaceutical companies and the government are making these drugs more available and affordable than ever before. According to the Journal of the American Medical Association (JAMA), about 12% of American adults have tried a GLP-1 for weight loss, with 6% using them currently. Obviously, the drug is most widely prescribed to treat Type 2 diabetes, but JAMA also reports that of the people who are taking GLP-1s for weight loss, approximately 22% of people classified as “obese” or “overweight.” As of 2024, the US population is over 340 million people, so that means that about 20 million people in the US are currently using these medications. 

Given this information, it is quite possible that one or more of your friends and family members will be currently taking GLP-1s when you see them for the holidays. Considering Thanksgiving is traditionally known for the abundance of highly palatable and “special” foods (in addition to being thankful to be with our loved ones), there is also likely to be some awkwardness and possibly even some very triggering conversations and food situations occurring. The main purpose of GLP-1s is to decrease the user’s appetite by greatly slowing down digestion. This means that most individuals who use these medications are either not hungry at all, or when they do eat, they feel fuller much faster, leading them to not eat much.

My patients who are not taking GLP-1s are concerned that they will feel “gluttonous” in comparison to their GLP-1-taking friends and family members. Some of my patients report feeling anxious to even eat “normally,” as it will be uncomfortable to watch their loved ones on these medications hardly eating at all. This anxiety makes sense to me. Since the beginning of humanity, food has been a way for us to connect with each other, to show love, to carry on traditions, and to nourish each other. In my opinion, it feels unnatural (and honestly sad) to try to enjoy a Thanksgiving meal with people who are unable or unwilling to eat.

Virgie Tovar, a fat activist who writes about fat acceptance, anti-fat bias, and diet culture, just recently published a newsletter piece on her Substack about getting invited to a “GLP-1-Friendly Thanksgiving,” which is both hilarious and terrifying at the same time. The invitation she received included a “menu” for the Thanksgiving party that included everything but traditional Thanksgiving fare, including “mini protein bombs,” “high-fiber dips with spinach and white beans,” and “anti-bloat snacks with oatmeal and probiotics.” It goes without saying that Virgie politely RSVP’d no to this invitation, and just the thought of a Thanksgiving centered around these diet culture foods gives me anxiety.

In addition to the food restriction and awkwardness that may occur, some of my patients are scared to see how much thinner their friends and family members have become since taking these medications. All of these patients believe in bodily autonomy and that everyone has the right to take these medications, but it doesn’t change the fact that when family members/friends lose a lot of weight intentionally, it can be jarring. We live in a fat-phobic society, and it feels like the anti-fat sentiment is lately at an all-time high. Existing in a larger body (and not pursuing weight loss or engaging in diet culture) can feel like a radical act. It is hard to spend time with friends/family who have made it clear that they don’t want to look like you anymore, that being in a larger body is something to be ashamed of and avoided at all costs, all under the guise of “health.” Of course, none of my patients would ever comment on anyone’s body or what they are eating (or not eating), but it doesn’t take away from the discomfort that can arise during these get-togethers.

So, what are we supposed to do about this? About eight years ago, I wrote a blog about surviving the holidays when your friends/family are stuck in diet culture. I still stand by everything I wrote in that blog, obviously, but I wanted to add to it because of the huge impact GLP-1s are having on all of us (not just those taking the medications). If you are having a hard time being around folks who are restricting/not eating/talking about weight loss, or demonizing foods, you can choose to not engage. That could look like pardoning yourself from the table and taking some space, changing the conversation to a different topic, or even talking to family members/friends ahead of time about your concerns. I hope that all of our readers can survive (and even enjoy) this holiday season amidst the GLP-1 craze. Happy holidays!

4,000 Laughing Smiley Faces

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While I am rarely on social media these days, I used to be a Facebook regular, both for professional utility and personal entertainment. One day, Facebook presented me with a prank video of a relatively thin weightlifter pretending to be a health club custodian and shocking more musclebound exercisers by easily lifting their heavy barbells. 

Maybe I watched the video because when I was a personal trainer, I used to perform custodial duties when I was not busy with clients, and I was curious to see a fellow gym janitor featured in a video. Or maybe I took the time because way back in my college weight room, other students occasionally offered confused looks or comments when I lifted more than they expected. Regardless of whatever my reason for pausing my scroll on the video was, I watched it. We know the way these social media algorithms work is that once you watch one video, you can expect a downpour of similar videos to soon come your way. Sure enough, this faux custodian has several other videos that quickly showed up in my feed, and while the exact circumstances seem to vary, the punchline is always the same: shocked onlookers in disbelief that someone so small can lift such heavy weights. 

That got me thinking about other life experiences I have had in which size-based expectations of an athlete turned out to be off base. As far back as eighth grade science class, I learned that strength is a function of more than just muscle mass. For example, the location of where the distal biceps tendon attaches to the radius bone influences mechanical advantage, which means that a relatively scrawny person with a more advantageous attachment point might be able to curl more weight than a more musclebound individual with a different attachment point. Technique also matters, which is why the sixth grader I played tennis with shortly before the pandemic could hit the ball so much harder than I could. 

Back in 2013, I competed in the U.S. Mountain Running Championships (The event was open to everybody, so please do not mistake me for some elite mountain runner.) and finished after scores of men who were older and/or heavier than me. Sure, age and body mass influence running ability, but so do factors such as mechanical efficiency, VO2 max, health conditions, racing strategy, nutrition, sleep, training, tapering, and even footwear.

A few years after that race, I wrote an article for Boston Baseball regarding Red Sox third baseman Pablo Sandoval and the flak he was dealing with because of his weight. The editor suggested the title, “Leave the Fat Kid Alone,” which I liked because it succinctly captured the point I was trying to make about both Sandoval and the general weight stigma that pervades our culture. Sure, maybe Sandoval did not look the part of a baseball player in the eyes of some, but remember that there were approximately 5,500 minor leaguers (according to the Major League Players Association) toiling in the minor leagues while he was earning millions of dollars in the majors because he possessed skills that most of them – including some with more societally-acceptable physiques – lacked.

Having just logged back into Facebook for the first time in a while, I checked one of the aforementioned prank videos because I was curious to see how my fellow viewers reacted to it. Looking at one specific video, I see that of the approximately 34,000 people who selected a reaction emoji, over 28,000 chose the thumbs up while approximately 4,000 people selected the laughing smiley face. My reaction to the videos? On one hand, I was impressed, just as I am when the elite Boston marathoners zoom by me or when my nephew solved a Rubik’s cube in virtually no time at all. On the other hand, the videos made me a little sad since they are only “funny” because they take advantage of a social stereotype. In other words, take away the onlooker’s astonishment and the humor vanishes. In a healthier culture, they would be nothing more than clips of dudes lifting weights, and what would be funny about that?

I Watched “The Biggest Loser” Docuseries So You Don’t Have To

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I remember when “The Biggest Loser” came on the scene in 2004, a competition reality show that pitted fat contestants against each other to see who could lose the most weight over a period of time, with the winner being crowned the “Biggest Loser” and winning $250,000. Back in those days, I was actively dieting, had lost weight, and was obsessed with diet and exercise, so this show obviously appealed to me. The contestants greatly restricted their intake, exercised to the point of exhaustion almost daily (at the behest of two trainers who bullied them constantly), and as a result of this, they lost weight every week with a ginormous scale displaying their weight loss (or lack thereof) for everyone to see. In the back of my mind, I think I knew that this show was basically teaching the contestants disordered eating behaviors and that the rapid weight loss that was featured on the show could not be healthy or maintainable. But for some reason, I looked forward to it every week as I was still stuck in a diet-culture mindset, believing that fat equaled bad and that we should all be “eating healthy” and exercising to lose weight if we are fat. I watched the show religiously for the first three seasons, but once I went back to school to become a registered dietitian, I started to lose interest, and by 2007, I had sworn off the show.

Despite no longer watching the show, I do remember when a study came out on the contestants after they had completed the show. The study demonstrated that all of them now had “broken metabolisms” with their basal metabolic rate dropping down significantly after losing the vast amounts of weight six-plus years prior. Basically, in order to maintain or try to stave off weight regain, the contestants were working with a metabolism that burned 500 fewer calories than it should be, meaning that they had to restrict even more than that to maintain their weight. This metabolic adaptation, combined with hormonal changes (such as a decrease in the hormone leptin that regulates appetite), made it extremely difficult for contestants to maintain their weight loss. I also remember learning, via social media and even news shows like “The Today Show,” about “The Biggest Loser” contestant who lost “too much weight” and about her jarring appearance at the finale where she looked gaunt and malnourished. The coaches looked on in horror as she, having lost nearly 60% of her starting body weight, made her way across the stage. At this point, I was firmly rooted in the Health at Every Size (HAES) philosophy and knew that this show was not only exploitive and distasteful, but it was also downright dangerous.

In mid-August, a new three-episode docuseries was released on Netflix called “Fit for TV: The Reality of the Biggest Loser.” Eight former contestants, one of the coaches, the show’s physician, and the host of the show were interviewed along with the creators of the show and some other folks. Despite knowing how triggering it could be, I decided to watch it to see if this doc called out the show for what it was, i.e., dangerous fat-phobic garbage, or if it would try to paint it in an overall positive light. Safe to say, the doc was almost as fat-phobic as the original show, claiming that although the show’s methods were drastic and unhealthy, the show ultimately “helped” the contestants (and therefore the viewers) learn “healthy” habits to lose weight. The only good thing about this doc was that they included noted fat activist, author, and podcaster Aubrey Gordon in the interviews and she, of course, was the only voice of reason, calling the show out for humiliating its contestants and the harmful effects that it had on them as well. 

The footage that the doc shows from the original “The Biggest Loser” is honestly disturbing. The “challenges” that the show’s creators dreamed up were often based on humiliating the contestants, especially the food challenges. There was one challenge where the contestants had to build a tower out of “junk” food but could only do so using their mouths. I vaguely remember this challenge from when I originally watched the show, and while I know it made me uncomfortable at the time, this time it made me unbelievably angry. It was so clear that the show’s producers were exploiting these contestants in the hope of their show getting higher ratings and more sponsors. In other clips from the show, we see both of the trainers screaming and threatening the contestants in the gym, telling them that they won’t be allowed to stop exercising until they throw up. The documentary’s interviews with the former contestants revealed how much trauma and pain these experiences caused them. It was gut-wrenching to watch.

The interviews with one of the trainers who agreed to participate in the doc were pretty eye-opening. While being shown clips of himself from the original “The Biggest Loser” screaming and berating one contestant in particular, he laughs and says “oof, that was bad,” but in no way does he seem remorseful about this abuse, and he is extremely nonchalant about the emotional and psychological damage he caused. The other trainer, who declined to participate in the doc, was even more brutal to the contestants, and she was found to be giving her team members caffeine pills as a way to stave off their appetites and burn more calories, despite there being a mandate that no caffeine was allowed. I’m amazed that no one died on the show, although one woman came close during a physical challenge. She had pushed herself so hard during a running race that she collapsed and ended up being medevacked to the hospital with rhabdomyolysis, a serious condition that can result in death.

The main physician on the show was interviewed as well, and he gave a lot of mixed messages. On the one hand, he maintains that he tried to give the contestants sound medical and nutritional advice in order to help them “healthfully” lose weight. He said that he disagreed with the trainers’ techniques and feels like the contestants were harmed in many ways. But he also says that it was an “inspiring” project and that it was all worth it for the contestants to be “healthier” than when they started. He should have played a much larger role in the original “The Biggest Loser,” medically supervising the contestants to make sure they were safe, but his appearances did not make for “exciting reality TV,” so he was often in the background.

Nearly all of the interviewed contestants said that looking back, they are bothered by a lot of things that happened on the show, and they also are so deeply immersed in diet culture to this day. Two of the interviewees admitted that they are taking GLP-1s to help with the “food noise,” and most of the contestants have regained the weight and then some. It was just painful to see how the producers of the show felt little to no regret about how they literally harmed and exploited fat people to make as much money as possible. I guess it should come as no surprise that at the end of the docuseries, the overall message was that “The Biggest Loser” did some pretty messed up stuff, but the ends justified the means when the contestants lost weight and “got healthy.” For myself, the doc brought up a lot of memories for me around how I used to feel about my body and how deeply entrenched I was in diet culture. And at the same time, it highlights that even now, in the woke year of 2025, people still believe that fat people deserve the shame and abuse that happens to them in the name of reaching thinness.

The Privilege of Intuitive Eating

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While my time working in food service was mostly limited to academic teaching restaurants and hospital cafeterias, I learned that some businesses monitor the food that customers leave on their plates and interpret the observations as feedback for what the patrons thought of their orders. The less food remaining, the more the customers enjoyed it, is the general theory. This summer, I thought about that each afternoon as we opened our daughter’s backpack to see what portions of her snacks and lunches returned home from camp unconsumed.

We packed her an array of snack options each day without any expectation that she would eat them all, but we wanted her to have choices so she could select something that sounded good to her. Sure enough, each day she ate at least one of the snacks, but lunches were a different story. Providing multiple snack options was easy because they were all shelf-stable items that required no preparation; if she did not feel like eating a particular snack one day, it could stay in her bag until a different day when she did. However, the lunch options she said she wanted were perishable and took time to prepare, so sending her off to camp each day with multiple lunch choices was impractical. Thus, when a lunch returned largely uneaten, that got our attention because it meant she did not have much of a meal. 

If she just was not hungry at lunchtime, that would be fine, but our concern was the possibility that she was hungry but did not want the packed food. So we tried a bunch of lunch options, all of which she said she wanted, only to see them return home virtually or literally untouched. Eventually, I realized and accepted that she simply was not very hungry come lunchtime, and it became sort of humorous that she would request a specific lunch option only to not eat it.

As I chuckled at her uneaten food, I reminded myself of our luck and good fortune, and how being able to practice intuitive eating is a privilege. We did not mind if food came back uneaten and went down the garbage disposal, but what if that was the extent of the food that we could afford, and the choice was either to eat it or go hungry? Over the years, I have met people in our community who experience food insecurity, kids who either eat their free school-supplied breakfasts and lunches or have nothing all day, and families who accept what the food pantries have to offer or deal with barren kitchens.

Intuitive eating is embedded with privilege. Going through the matching process to choose one food over others requires having options available. Choosing when to eat necessitates having enough autonomy to be able to make such a decision. Ceasing to eat when comfortably full demands confidence that another opportunity to eat will arise again soon. Any of these privileges go out the window, and so does intuitive eating, at least to an extent.

However, subtle opportunities might still exist to utilize our intuition even in times when privilege is sparse. Buying dried legumes in bulk can be a thrifty way of obtaining protein, and with the prices of each bean being so similar to each other, we could choose the one that we most enjoy. A small array of cheap spices can impart somewhat different flavors on the same food for more variety in tastes. Free school meals include choices, such as chocolate or unflavored milk, and possibly different entree options. Foods that are shelf stable or at least function well as leftovers can be finished later, thus reducing the pressure to eat past the point of comfortable fullness.

The extent to which each of us practices intuitive eating is based at least in part on our circumstances. The laugh I got out of seeing our daughter’s uneaten lunches come home each day was a privileged reaction, and someone in different shoes might understandably have a very different reaction.