Change Your Body, Starting at the Top. Shifting Your Thoughts, Not Simply Your BMI.

Was the monkey off her back? I don't think so.

Anna felt desperate for help. This 35-year old had successfully lost weight on her own this past year, down to the average weight for her height, according to standard charts.  She had been overweight, approximately 80 pounds higher than she is now. Now she presents struggling to maintain her current weight for her 5 foot 8 inch frame on just 1200 calories per day. And it wasn't going well. 

She is pleased with her current weight, quite satisfied even, and doesn't want it to change, but feels she is fighting so hard to stay at this place. 

No doctor would look at her BMI and conclude that there was cause for concern. Most would likely praise her for the healthy changes she had made, and perhaps even draw attention to her healthy low “runner’s pulse”.

Do you appreciate what is in place
or see life as black and white?

But I had a very different perspective. Here’s what I saw beyond the scale: she has not gotten a period in over a year, but previously had normal, regular periods; she was feeling more depressed and had reported a significant increase in the percentage of her thoughts spent thinking about food, eating and weight; she tended to be cold all the time, even in the summer, when temperatures reached the triple digits. And did I mention her hair loss?  Her low heart rate, I might add, was not the consequence of a healthy runner's pulse but of a slowed metabolic rate.

As for her diet, I would describe it as rigid and restrictive. Hunger was often appeased with water, food choices were limited, and desirable foods were limited to once per week. Her total intake was way too low, in spite of her sedentary activity level.

What was my advice? Eat more, I told her. (Of course I provided more practical, concrete guidance than that.) And so she did.

At our first follow up Anna described a significant decrease in obtrusive thoughts. Eating more adequately made her feel less compulsive when she did eat. And she felt more satisfied. She had backed off of the water, which was drowning her hunger and is now starting to recognize her body’s signals. I nailed it, she told me. Everything I recommended made perfect sense, and fit with her experience.

Just what are you focusing on?

Of course it doesn’t end here, because these are real stories. At the next visit, just this week, I heard the panic—fears of significant, unnecessary weight gain and body dissatisfaction. Truth is, her weight was up. Yes, instead of being 80 pounds below her highest weight, she was now 78 ¼ pounds less. This minimal weight change which had, by the way, stabilize by our third visit, was the price her body needed to pay to achieve all the positives she was starting to appreciate with a more appropriate intake.

If you can’t recognize the positives you have, you’re simply gonna be stuck.

Yes, this is extreme, but how’s this for appreciating the positives? http://www.nytimes.com/2011/07/09/world/europe/09duley.html?pagewanted=all This recent NY Times article describes a former fashion photographer who decided to try his luck at photographing a war zone. In the process, he became a triple amputee. Horrific. Yet inspiring. He describes the experience post attack, when he realizes that he still has his right arm—and his eyes. Rather than dwell on his misfortune as a triple amputee, this remarkable survivor relishes his potential to continue the work he feels so passionately about, and focuses on what he does have going for him. Truly remarkable.

And what does all this have to do with your weight concerns? Lots. Get a perspective on what you truly value. Put the focus on what is in place and where you are making progress. Don’t beat yourself up about what’s gone wrong, but come up with a plan for change. Thoughts have everything to do with recovery—from anorexia, bulimia, weight struggles, compulsive overeating. Oh, and of course entitling yourself to the necessary nourishment is key, too. Your thoughts will not be clear to allow a healthier perspective unless you are eating well.

What’s the real negative consequence of gaining less than 2 pounds given the benefits Anna achieved? Perhaps it has less to do with the snugness of her jeans, and more to do with something else. But I’ll leave that for the therapist I hope she’ll be seeing.

Dietary Guidelines for Americans, My Way

I just saw this on BoingBoing.  Simple but true. 

This image was created by Adam Fields. 

The people who design government dietary guidelines are gagged by the fact that politics and business are so tightly intertwined in this country.  Their advice will never directly target the primary source of obesity and metabolic dysfunction-- industrially processed food-- because that would hurt corporate profits in one of the country's biggest economic sectors.  You can only squeeze so much profit out of a carrot, so food engineers design "value-added" ultrapalatable/rewarding foods with a larger profit margin.

We don't even have the political will to regulate food advertisements directed at defenseless children, which are systematically training them from an early age to prefer foods that are fattening and unhealthy.  This is supposedly out of a "free market" spirit, but that justification is hollow because processed food manufacturers benefit from tax loopholes and major government subsidies, including programs supporting grain production and the employment of disadvantaged citizens (see Fast Food Nation).

Interview on Super Human Radio

Today, I did an audio interview with Carl Lanore of Super Human Radio.  Carl seems like a sharp guy who focuses on physical fitness, nutrition, health and aging.  We talked mostly about food reward and body fatness-- I think it went well.  Carl went from obese to fit, and his fat loss experience lines up well with the food reward concept.  As he was losing fat rapidly, he told friends that he had "divorced from flavor", eating plain chicken, sweet potatoes and oatmeal, yet he grew to enjoy simple food over time.

The interview is here.  It also includes an interview of Dr. Matthew Andry about Dr. Loren Cordain's position on dairy; my interview starts at about 57 minutes.  Just to warn you, the website and podcast are both full of ads.

Wisdom From A Girl Like You

Moving On After Triggering Comments

I’ll never forget the SoHo gallery that July day, about 14 years ago. No, it wasn’t the memorable art, but the chatty 20-something employee there. I stood bewildered at first, in my short black sleeveless dress, with its Empire waist, feeling quite good about myself, I might add. That is, until our conversation. Perhaps it was the heat, but I wasn’t so quick to get her references. "How much more time till the big day?" "How are you feeling?" And finally, "Have you picked out names?"  Yes, I was assumed to be pregnant—but I wasn’t!

And how would you feel?

I wish I could say I hardly remember this event, but unfortunately I do. People can say the most triggering things.

To better address this point, please read the following piece, so beautifully and powerfully written by a very wise patient of mine. Welcome my very first guest author, who I’ll call Molly.

I walk in the cemetery to revel in the peacefulness, to breathe in the lush smell of flowers and mulch, to admire the stately row of hemlocks that borders the “Olde Burying Ground,” coniferous soldiers lined up the protect the granite headstones and perfuming the air with the sharp scent of pine. On that hill, I learned to ride a bike without training wheels; at that pond, I would catch frogs with my sister on hot summer afternoons, our murmurs of excitement swallowed by the thousands of headstones that extended for acres in every direction.

The cemetery was my safe place, a sanctuary away from the challenges of becoming an adult and claiming my space in the world.

It was a safe place. Until a Friday when a caretaker turned off his lawn mower as I walked by and said, “A young girl like you should be running, not walking!” He swung his arms like a marathoner as he spoke, as if that would make his comment funny or clever, as if that would ease the harsh sting I felt, the reprimand, the accusation of laziness, and the stirrings of a familiar voice.

My eating disorder used to make me run every day, rain or shine, and I hated every moment of it. I hated changing into running clothes, no matter how cute they were (and my closet looks like a lululemon store, so great is my quest for cuteness). I hated queuing up a playlist on my iPod that would keep me motivated for an hour. I hated the feeling of my ponytail swinging from side to side like a clock pendulum with every step. I hated when cars went skirting by, strange faces appraising me in the side mirrors. I hated the way my fingers swelled and my nose ran and my thoughts galloped in an endless loop: I hate this I hate this I hate this. Most of all, I hated peeling off my running clothes, stepping into the shower, and thinking, I have to do this again tomorrow. Sure enough, the next day I would go through the same miserable routine.

I wasn’t running because I wanted to, because I enjoyed it. I was running because my anorexia had an iron grip on me, murmuring in its at once soothing and terrifying voice, You fat cow, you disgusting pig, you worthless girl, burn calories, be miserable, take control, run from life. It was my anorexia that forced me to run in January’s freezing rain, the hail stinging my face, turning my cheeks an angry red. It was my anorexia that made me run on the treadmill and obsess about those annoying dots that mark off time remaining and calories burned. (I remember when the emergency stop cord disappeared from the treadmill in my dorm common room at college and I practically cried with relief because the treadmill wouldn’t work without it; then I really did cry when I realized that putting a magnet in its place tricked the treadmill into working, and my anorexia gleefully made the workouts resume).

When I finally entered residential treatment, I learned that the compulsive exercising, in conjunction with severe restriction, had lowered my potassium to what the doctor referred to as “heart attack levels.” In spite of the fact that my period had been absent for six months, and that my body had grown a soft coat of hair to compensate for the loss of body fat, I still believed that running my way to thinness, to perfection, to absolute control, was the only way to prove I was worthy of living.

A girl like you should be doing what's right for you!

After six months of hospitalized treatment, and ten more working with a wonderful outpatient team that brings new meaning to the phrase, “It takes a village,” I am now standing on my own two feet, a college graduate, a proud daughter, a loving sister. And though the ghosts sometimes still haunt me, and my eating disorder still berates me, and life still becomes overwhelming, I am not running away. But I want to, I desperately want to, when uninformed and ignorant comments turn calorie counting and starvation and misery into a glorified ideal.

Eating disorder experts often say that positive body image is the last puzzle piece that falls into place during recovery. But with people saying things like, “You should be running!” or the psychiatrist who skeptically asked, while looking me over from head to toe, “You were anorexic?” I honestly don’t believe I’ll ever get to that place of self-acceptance.

I loathe the phrase, “You look healthy,” because my eating disorder warps it into, “You look fat,” so loved ones who know about my struggle have learned to say things like, “I love seeing your smile again,” or “Í’m so happy we can talk about books again now that you’re able to concentrate when you read.” When I came home from residential treatment, my dad said to me, “There’s a person behind your eyes again,” and I’ll never forget that moment.

But the real world isn’t as educated. Commercials for diet plans and pills are everywhere. Photos of celebrities flaunting their bikini bodies decorate magazine covers. People gossip—who lost weight, who gained, who helped themselves to an extra cookie at the PTA meeting. Random strangers ask why you’re walking instead of running. We constantly evaluate—and praise or mock—people based on food choices, weight, and exercise regimen.

Much better than letting someone's comments derail your progress

That afternoon when I got home from my not-so-mindful walk and burst into tears while trying to eat my snack, I was confronted with a choice: restricting or living. And while my eating disorder was shouting at me, tantalizing me with promises of thinness, numbness, and perfection, the rational part of me got on the phone and scheduled an emergency session with my therapist.

Triggering comments and experiences are an unfortunate reality, but they don’t have to derail everything you’ve worked for. Alternatively, you can never fully know a person’s story, and assumptions can be both dangerous and harmful. That man’s comment could have sent me spiraling back down a road I’ve traveled before (and the destination isn’t a luxury resort). Though I had no control over what he said, I did have control over my response.

A young girl like me shouldn’t be running. She should be living, eating, thriving. And walking—at a slow, mindful place—seems to be the best way to get there. 

Weight Gain and Weight Loss in a Traditional African Society

The Massas is an ethnic group in Northern Cameroon that subsists mostly on plain sorghum loaves and porridge, along with a small amount of milk, fish and vegetables (1, 2).  They have a peculiar tradition called Guru Walla that is only undertaken by men (2, 1):
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Tweet This, Not That.

Time For Some BIG Changes In Our Approach to Managing Our Eating

I used to warn patients “be careful where you get your information”.  There’s plenty of myth-information around, and the last thing you need is to fill your thoughts with more useless, conflicting ideas. Too much information makes us like deer in headlights. And it’s worsened by unrealistic, idealistic, and at times, downright false and unsubstantiated messages from tweets and the media. 

Love the message.
Love their sweet potato tortilla chips too.

Now I’m finding that even credentialed professionals, yes, registered dietitians included, appear to be putting out the most triggering messages. Sure, they tell you to include more fruits and vegetables, and be sure to have a snack before heading out—hard to complain about those tweets encouraging healthy intake.

But there is a constant subtext to the messages that concerns me. They tend to follow a format of “I’m having rice cakes and seaweed for lunch. What are YOU eating? I ran 35 miles in 15 mins. What are YOU doing for exercise? And in the process of giving perhaps well-intentioned nutrition and fitness messages, in my view, they’re potentially doing more damage than good. If I’m feeling triggered, I can only guess what my readers and patients are feeling.

Here’s a list of some recent tweets:

--Ran 6.2 miles in 54 mins. Felt good, wish I did better.

--Just finished 11,000 steps to start the week. What r u doing?

--Popover at dinner was a must : (

--Cravings can hit hard, but if you distract yourself they often pass.

--Kiddie size (soft serve). Always a good choice.

And this is just a taste of what’s out there.

Maybe it’s just me, but here’s what I read between the lines, from these and other daily tweets:

There are good choices, and there are bad choices. Healthy foods are good ones and  sweets are to be avoided. Why the “  : (    “ ?   about a popover for goodness sake? Can we not include popovers as part of our healthy diet? Why is it framed as a personal failing?

Homemade pizza--white flour crust, real cheese. And, yes, there were
fresh vegetables at this meal as well.

Exercise is good. But the amount I’m (and she) is doing is never enough.

Deny your body’s signals regarding pain (still run through it), and regarding hunger (avoid it and maybe it will pass).

One size fits all for portions, regardless of individual need. If I'm very hungry, or am striving to maintain energy balance, why would I always choose the kiddie size?

We should be striving to eat to meet an ideal—whole grain, high fiber, “clean” eating. It appears to be a fatal flaw to include any saturated fat, never mind something fried or made with (OMG) white flour!

And because the messages are so limited in length, the fuller context gets lost. I’d like to believe that if given more than 140 characters these well-educated nutrition professionals would be able to communicate a much more sensible message than what comes across. And did I mention the actual unsubstantiated “facts” which are really just conjecture getting tweeted? False reports of metabolic rate changes and difficulty handling fats, unsupported by research, should not be tweeted and retweeted, becoming urban legend.

It’s not much better than weight loss ads touting dramatic weight loss in insignificant periods of time. Patients often refer to these when stating their unrealistic weight loss goals, only to have me ground them in reality.  They need to be reminded to read the small print, which states something like “results not representative of what any typical human being should expect to see in her/his lifetime”, or something to that effect. You get the gist.

Yes, there's a place for (really delicious) chocolates,
 regardless of your weight.

In other words, you may think yourself into doing poorly; your expectation, albeit unrealistic, is unmet, triggering disappointment, a feeling of hopelessness, and inadequacy, leading to what I call the what the heck effect, continuing the downward spiral.

The continued slip further worsens your sense of hopelessness, and contributes to the inertia to find your resolve again.  It’s remedied using CBT—Cognitive Behavioral Therapy, where thoughts, feelings and behaviors are all connected, and the pattern can be broken.

About Jane

Jane gained about 100 pounds the previous nine years. (Yes, there are meant to be two zeros after the “1”). Admittedly 100 pounds during that time span is rapid weight change. And Jane wasn’t underweight or recovering from anorexia. She was a chronic dieter who struggled with compulsive overeating, with stress eating, and with hopelessness about her climbing weight. She feared the gain was due to her medication, necessary for managing her other health conditions.

But Jane turned things around. Even while continuing on the meds she began to lose weight through our work together. Over the past 5 months she has lost 26.5 pounds. She is eating normal foods, without rigid rules. She is learning to taste her food and to thoroughly enjoy what she eats. And most importantly, she is feeling better—emotionally and physically. The spiraling panic about the direction her body was heading has subsided and her thoughts about food and eating are no longer all consuming (pun intended). From my perspective, this is not good enough.

No, not the amount of weight change, nor the changes in eating behaviors—those are fabulous shifts. What I’m concerned about is Jane’s perspective.

“I know I’m losing, it’s just not coming off fast enough”. 

These are Jane’s words. They give insight whether you, too, are overweight, or you are underweight and working on gaining to a healthy place, or trying to learn to have balance in your eating and your life.

This post applies to all. Jane’s words have less to do with weight loss than with unrealistic expectations and how we respond to them. It has to do with perspective.

Instead of appreciating her progress to date, Jane was focusing on not being good enough. It’s a familiar problem, our not feeling thin enough, smart enough, pretty enough, adequate enough—the list is endless. As a side note, there’s a great book by Sheila Reindl entitled Sensing the Self with a chapter entitled Sensing Enoughness, (if I remember correctly)—a well worth read. This psychologist interviewed 13 bulimic women in Massachusetts, (several of whom were patients of mine, I was told) who recovered. Yes, they recovered. And through her interviews she identifies common features contributing to maintenance of their eating disorders and to their recovery.

Why we never feel adequate enough is better tackled by Sheila and the many psycho- therapists out there. But among the things I hear frequently is a distorted sense of what is realistic. Viewing weight loss ads with their before and after images, and hearing tweets presenting a simple, black and white view of foods, contributes to the problem.

In fairness, there are plenty of valuable tweets out there. Most notable today was retweeted by Doc Samantha from the Dalai Lama:

“If we find we cannot help others, the least we can do is to desist from harming them.”

It’s my hope that this post will inspire readers to set more realistic and achievable goals, and to think before they tweet.

Grilled Vegetable Pasta Salad

Fresh summer salad ingredients: basil, red and yellow tomatoes.

We have a wedding to go to. And not just any wedding. My first born son's wedding. I am mother of the groom. For the first time. Twenty-nine summers ago I cradled this soulful, musical being with new mother innocence and awe, lost in the ocean of this newborn's eyes, starting a journey called motherhood with few tools beyond my willing heart and a deep rooted conviction that I would create for him a childhood unlike my own.

And in many ways I did. I listened with curiosity. I valued his opinion. I gave him paper and paint and books and music. I gave him the time and space and respect to create. We hung together as true companions.

He was always good company.

And still is.

He inspires me daily. We connect through Instagram and iChat. He lives his life as an artist. Creatively. He improvises and honors his intuition. He composes music. Takes killer iphone photographs.

And he cooks.

In fact, he inspired this recipe.

Because he loves to grill vegetables.

His lovely bride is a vegetarian.

So the next time I cook for them- as husband and wife- I think I'll make this vegan pasta salad with smoky grilled vegetables.


Read more + get the recipe >>

Trust Yourself. Except When You Can’t Be Trusted.

6:04 PM

Hi Lori,

 Could I bother you for some support again?? Am *really* struggling with wanting to weigh myself. If you had a moment could you please remind me why this is not a good idea.

Wouldn't it be great if there were a similar warning posted above
your scale? TURN BACK NOW! Or face the consequences!

Here’s what I’ve got:

• It's  too high god knows what I’ll do – and that is not good for my safety
• If it’s where I want it to be or lower then ED is the one telling me how to feel
• I really do want to be rid of all this, and weighing myself will only prolong my recovery
• It will be 13 weeks tomorrow without weighing myself – and I’m proud of that
• I really feel that my recovery only started for real when I stopped weighing

Any other thoughts would be really gratefully appreciated

Thank you

And here was my response last night:

"I think you nailed it, PJ. Weighing yourself messes with your head. Not weighing yourself allows you to take charge a bit. Body mass doesn't change in 24 (or 72 hours) in any measurable way. But changes in weight may reflect bowel function, hydration, menstrual status, fluid retention, to name a few. It takes 3,500 calories per week (above whatever is required to maintain your weight) to gain a single pound, more than that if your metabolic rate is on its way up.

You are worth more than your weight in pounds (or kilos). Also, not weighing yourself may increase your anxiety. Be sure to acknowledge that and add some stress reduction (non-exercise focused) activities to help you cope."

This isn’t to say that nobody should weigh herself. It really depends on what your issue is and what kind of place you are in.

A 2005 study from a Brown University psychologist showed that regular weighing was associated with better maintenance of weight loss in an obese population of women. Perfect! I think I’ll start daily weighing, I bet you’re thinking. Not so fast, not so fast.

Lot's of steps before you reach your goals.
Is it worth it?

Weight management isn’t the only outcome we should be addressing. What about the impact, not on pounds, but on perceptions? Are you grounded enough that if the scale changes, yet you know in your heart you have been sticking to your goals and feeling in control of your eating behaviors, listening to and respecting your body, that you will be able to dismiss it as a senseless measure?

Or will this trigger more negative thoughts about your self, more obsessive thinking, and a sense of failure? If you are in a good place—grounded enough to roll with the scale fluctuations, which are sure to occur—you may be fine weighing your self. But please don’t make this decision on your own. Consult your supports.

First ask yourself “How will I feel if the results aren’t what I am expecting?” Am I truly more anxious not knowing my weight, or knowing it? Will it be destructive for me? If the answer is honestly no, then try the following.

Before getting on the scale, do a bit of a self-assessment. Ask yourself:

• Have I been honoring my hunger and eating when I need to?
• Have I been stopping when I’ve had enough, or when I’ve had what I think I should have based on unhealthy food rules I’m holding on to?        
• Am I respecting my activity goals, and listening to my body?
• Am I being honest with myself about my actions?
• How am I feeling? What positive changes have I made that I need to acknowledge?

And finally, have a plan before weighing. What do I know and plan to do differently, as a result of my self-assessment?

What can you take from my correspondence with PJ?

Here's the view from the top. Worth the trek? 

Like PJ, you probably have more sense than you realize. But if you are struggling with trust and feeling more vulnerable to your unhealthy behaviors, take a few pointers from her.

• Acknowledge you are struggling. 
• Whether you are working on weight restoration or are overweight and trying to lose weight and improve your relationship with food, be realistic. Change isn’t linear. In other words, there will be ups and down, progress and slips, moments of strength and times of hopelessness. That’s what recovery really looks like.
•  Reach out and ask for what you need. Not everyone around you is supportive, however (I’m sure you can provide plenty of examples for us!) So call, email, text, post an S.O.S. to those you feel you can count on.

Focus on what is in place. And make a plan for changing what needs to be changed.

Thanks, PJ, for allowing me to share this! 

Please add your thoughts and experiences to the comments. Looking forward to hearing from readers.

Simple Food: Thoughts on Practicality

Some people have reacted negatively to the idea of a reduced-reward diet because it strikes them as difficult or unsustainable.  In this post, I'll discuss my thoughts on the practicality and sustainability of this way of eating.  I've also thrown in a few philosophical points about reward and the modern world.
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Gluten-Free Cherry Almond Muffins

Whole grain, gluten-free, dairy-free... and luscious.

It hit me today as I was walking my morning walk. I've been sugar-free for two months (I even looked it up, just be sure). Eight weeks without sugar. Eight! Ocho. Huit. Osiem. The first week was the toughest. Sugar detox is not for wimps, darling.

Read more + get the recipe >>

How Does My Brain Look? Personal, Random Thoughts About Beauty.

Ashley, @ Nourishing the Soul wrote a beautiful piece this week, entitled Why I Get Tired of “You Are Beautiful”www.nourishing-the-soul.com/2011/07/why-i-get-tired-of-you-are-beautiful. 

Mica seems well aware of his many attributes beyond physical beauty.

I read it, then started to type in my comments, only to realize that I had way too much to say to limit to a comment box. Ah, the beauty of having your own blog!

Being frequently told you’re beautiful, or even pretty, is a set up. It’s easy to become dependent on other people’s opinions of you—of your physical appearance, as well as your other attributes. And then if they don’t happen to comment, you are left questioning “Do I look okay?”

If your greatest merit is being attractive, or thin, what will happen if these change? What else will you have to feel good about? Aging will certainly be something to fear, and normal body changes occurring with each decade will be impossible to accept.

If you and others focus solely on your attractiveness, it may leave you questioning what other aspects make up who you are. Are you smart? Witty? Affectionate? Loyal? A good parent or friend? A good writer or cook?

When I was about to graduate from college, I decided it was time to be taken seriously. My full head of attention-getting curly hair needed to go. I wanted to be seen for who I was and what I was capable of, not judged by my exterior. I graduated with the shortest haircut ever. And no, it was not even the style back then. Was it necessary? Maybe not. But at that time it reassured me that people were looking past their first look at my appearance and seeing what else I had to offer.

Summer of 1983, before the haircut.

For a significant part of my early college years I suffered from a common condition known as imposter syndrome. I believed that they couldn’t have really meant to accept me to this top university. My acceptance must have been based on my looks, I assumed. I needed to prove otherwise, that I had perhaps unseen strengths, as I went through college and then ventured into my next stage of life. Perhaps it sounds contradictory, but I needed to modify my appearance in order to get past relying on it.

Consider this.

Must you wait to be at that certain size or have that perfect appearance to like yourself and appreciate yourself? What do you like about yourself—physically and on all other levels? And if your mind's a blank for ideas, ask those who choose to spend time with you. What do they really appreciate about you and find beautiful?

If you don’t like yourself, why would you even bother to take care of yourself—to treat yourself with appropriate nourishment, to respect your hunger and your fullness, to listen to your body’s limits, like when it says you are too tired to exercise (or feel better after a moderate workout)?

And consider what messages you convey to others. Do you greet them with a physical assessment, such as  “Did you lose weight?” or “You look great”. Would you want to have the pressure of such comments on you? And would you even hear them the way they were intended, or project your own thoughts into them? Can’t we greet friends and loved ones with “How are you?” or “I’m concerned about you”, or “You seem so full of life”?

Perhaps if I were into high maintenance I’d grow my hair out again; I’m past the point of fearing that I am just about my exterior. But who has the time and the patience? And besides, the haircut’s already scheduled. Now if only I could accept the spreading silver-grey.

Thoughts? Might I remind you I always appreciate hearing your feedback on these posts, so please comment!

How Does Gastric Bypass Surgery Cause Fat Loss?

Gastric bypass surgery is an operation that causes food to bypass part of the digestive tract.  In the most common surgery, Roux-en-Y bypass, stomach size is reduced and a portion of the upper small intestine is bypassed.  This means that food skips most of the stomach and the duodenum (upper small intestine), passing from the tiny stomach directly into the jejunum (a lower part of the upper small intestine)*.  It looks something like this:
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The War On Obesity: Preventing Collateral Damage

Mrs. D rushed into my office apologetic. “So sorry I’m late”, she said. “I was held up at the principal’s.” The principal’s? Mrs. D is well into her 30s, and her middle school aged son hardly seems to be one that would cause a visit to the principal’s office. And then the details unfolded.

Mrs. D and her son Sean had unknowingly broken with school policy, committing a public school crime. She had allowed Sean to bike to school. And in spite of the presence of bike racks (which one might think suggested that bikes might be allowed on the premises) biking to school is forbidden.

 According to the principal, if he allowed Sean to ride his bicycle to school, than there might be 100 students who’d want to ride their bikes to middle school. Imagine that—dozens of middle-schoolers getting more exercise, incorporating biking into their daily routine. The school might even need to get more bike racks.

In theory, the principal appeared to understand. But permission for policy change is only granted by a school committee vote. That is, if it were deemed important enough to land on their meeting’s agenda. And the school committee only meets periodically during the school year. So for now, Sean will need to skip his biking to school, lest he break the rules again.

Why the recent interest in biking anyway?

Several months ago, Sean’s school began its own war on obesity. First, they screened all the kids, evaluating them based on their BMI. (for more thoughts on BMI and its problems, check out http://dropitandeat.blogspot.com/2011/02/where-bmi-goes-wrong-lessons-from-cupid.html) Their weight report cards were then sent home. They were not, by the way, accompanied by a fitness assessment, which might have included measurements of strength or cardio fitness.

Concerned and caring mom that she is, Mrs. D responded to her son’s high BMI by seeking appropriate guidance. And so they presented to me.

Remember when kids were allowed to have milkshakes?

Sean has done remarkably well these months since we began working together. He’s eating better and learning to better manage his previously excessive portions, by responding to his physical cues. And he has significantly improved his food choices when dining out; no, he hasn’t given up burgers and fries, but now he might share a single portion of the fries or skip the cheese on the burgers. Those endless sodas at restaurants are now a thing of the past. In addition, this shift toward healthier eating has led to more meals prepared at home—an added benefit for the whole family.

Moving more was also on Sean’s to do list. After brainstorming together Sean and I decided that bike riding would be a fun, manageable activity to help improve his fitness. He began with weekend rides and then suggested biking to school, weather permitting. Yes, Sean was only trying to do well—to eat healthier, be more active and fit, and respond to the school-prompted campaign against obesity in a sensible, practical way. How unfortunate the school was so short sighted about its unhealthy policy.

As a side note, let me tell you a bit about Mrs. D. She has long struggled with anorexia and has also been working with me on her own eating issues. The school’s Get Fit night, together with the BMI materials send home, were nothing short of triggering. While well intentioned, the evening’s focus on eating less and exercising more, a seemingly harmless message, was not a healthy message for someone struggling with food restriction issues. 

One-size-fits-all recommendations can often do more harm than good. Simple nutrition overgeneralizations, classifying foods into good and bad categories only leads to trouble. While the school meant well trying to control obesity, sending the message of eat this, not that teaches nothing valuable.

It’s kind of like the My Plate message stating that we (all) should Eat Less (http://dropitandeat.blogspot.com/2011/06/time-to-clear-my-plate-before-you-get.html) If 50 or 60 % of all kids are overweight, that means that the rest are not overweight, right?

Did all the Get Fit night guests need to be told to eat less? Did they need to have fats identified by their calorie density, without labeling their many benefits? Did they have to be categorizing desserts as forbidden, while failing to teach self-regulation and balance?

Not Sean's favorite, but definitely mine--French macarons.
(the reason why it's taken me so long to get a post done this week)

Hard and fast rules and simplistic messages are not the answer for weight management. A healthy diet includes cupcakes, macarons and chocolate as well as fruits, vegetables, nuts and oils, dairy and lean meats. It’s all about balance. 

Counseling an overweight preteen as well as his anorexic mom forces me to think carefully about what war we really should be fighting. Should the focus be on what foods to include and which to omit from the diet? Should I encourage some foods for a mom, while forbidding those items from the son’s diet? Not a chance. Whether underweight or overweight, the message is strikingly similar—honor your body and respect its needs. And if hunger and fullness awareness feels foreign, trust that you can re-learn them.

Photo courtesy of Sean

As for Sean, his BMI has dropped significantly, as a result of a slow reduction in weight while his growth has continued. He still enjoys his favorite foods, including ice cream and French fries, but is starting to determine when he has had just enough. And this summer, now that he is out of school, he’ll be spending a lot more time cycling, with minimal TV time. That is, when he’s not watching the Tour De France.