Mindful Eating Gone Horribly, Horribly Wrong

buddha question markA few weeks ago I had the opportunity to go to a continuing education course (gotta get those CEUs!) called “The Science and Practice of Mindful Eating.” I was initially disappointed by the description that focused heavily on mindful eating as a treatment for obesity and stated, “Research shows that mindfulness practices can lead to altered gene expression and neuroplasticity. These and other changes can positively influence resilience, self-regulation, and well-being, which in turn improve weight management efforts [emphasis mine].” You had me until the incredible logic leap to “improve weight management efforts,” but I wanted to hear what kind of evidence they were using to show that mindful eating would lead to long-lasting weight loss anyway, just to ensure that I continue to be as fully informed on the subject as I can be.

There were things I loved about the class. I loved what I learned about meditation and all the wonderful benefits it can provide. I loved the mindfulness exercises which instantly cleared my head and instilled in me a sense of calm, at least for a few minutes (not at all my natural state). I enjoyed the mindful eating exercises, which I have done before, because they are always instructive (yep, still don’t like raisins).

What I didn’t love: the scant evidence they were using to show that mindfulness could produce long-lasting weight loss. The studies were few, the results were minimal, the sample size small, and the duration of the studies were always less than three years – about the time people start to regain weight after any sort of intentional weight loss efforts. And the stigmatizing of obesity throughout the class was bad. I couldn’t help wonder how this stigmatizing affected some of my “obese” classmates who hadn’t ever heard of Health at Every Size®. Would they try mindful eating in the hopes of fixing their “wrong” fat bodies? And when it failed to make them thin, which seems at this point to be the most likely outcome, would they abandon mindful eating for the next diet to come along that promised weight loss?

And then recently I came across this article  about this study, which concluded, “Mindful people are less likely to be obese and are more likely to believe they can change many of the important things in their life.” While the article is careful to initially point out that mindful eating hasn’t been shown to be a “cure” for obesity or even necessarily help people lose weight, they then go on to talk about how mindful eating might help with willpower to make better food choices and stick to an exercise plan which might help one to not become obese. Even though that’s pretty much impossible to determine from this study (the study found that people who scored higher on a mindfulness scale had a lower prevalence of diabetes and obesity, and a higher sense of control over their lives. Period. They didn’t find that fat people were turned into thin ones by meditation).

Although I am no expert on mindfulness, from what I have learned, I think there are wonderful things there. I think mindful eating probably has the potential to help people reconnect with their bodies, improve their relationship to food, practice self-care and maybe even improve health. But I can’t help but think, if you come at mindful eating with the idea the particular outcome must be weight loss, you’ll never even come close to eating nirvana. Mindfulness involves non-judgment, and I can’t think of anything more judgmental than feeling the need to change your weight or shape. I’m imagining second guessing, frustration with the scale, a distraction from the true joy that can be found in eating. A focus on weight loss – an external thing – doesn’t seem mindful at all.

I think this mindful-eating-as-obesity-cure is the tip of the iceberg. It’s an unfortunate side-effect of progress; as the non-diet, Health at Every Size® message spreads, there will be those who want to co-opt the language and the ideas but subvert it into another weight-loss industry money maker. Don’t be fooled. Be a mindful consumer (see what I did there?). If someone is offering weight loss, ask to see their evidence, especially the long-term results.

Check out this great summary of what mindful eating is all about from AmIHungry.com. Stigmatizing messages of weight loss are wonderfully absent.

 

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I’ll Blame My Body

Thinker-damnI was having a particularly bad day, the accumulation of a bunch of things starting to weigh on me, and a few fresh annoyances as well. I had just bought a very nice, expensive bed for the first time in my life – and hadn’t had a good sleep for three days…with at least 27 more days of the trial period (and potentially 27 bad sleeps) before I could exchange it. I was feeling the pressure of saying “yes” to too many obligations that I didn’t feel passionate about. And there was just the general malaise I get occasionally where I feel the world isn’t a great place to be. I needed sleep, I needed solace, I needed self-care. So what did I do?

I blamed my body.

After so many years of knowing that it is not my body’s fault when I have a bad day, of knowing intellectually that the body is merely a quick and easy stand-in for dealing with non-body problems and bad feelings, of knowing that just two days ago I had no problems with my body, in fact liked it quite a bit in my cute summer sundress in the middle of a hot SoCal February; even as an advocate for body positivity and self-acceptance…I blamed my body.

I stood in the mirror, second mirror in hand, checking out the back of my hair, which I discovered was in need of a haircut (but not really; sometimes I also blame my hair). The inner running commentary took off as my eyes drifted down to my butt (too big, wrong shape), then the width of my back (too wide, droopy folds); then I turned sideways to attack my chin (weak and disappearing), and then full frontal as I assessed the belly (bigger than it ever used to be). After that mental beating, my problems went away and I felt fantastic about my life. JUST KIDDING! My problems still existed, I didn’t feel better, and in fact I felt a hell of a lot worse!

It happened, as it often does, too quickly. But after a time, I said to myself, “Those things are not the problems. The problems are the problems.” Knowing at least that much, I can at least stop myself from going on a loathsome diet and instead deal with the actual issues.

Why do we do this? Why is our body the punching bag on which we try to resolve problems that have nothing to do with it? It probably doesn’t help that we live in a culture that continues to weigh women’s worth by their appearance. (Need proof of that? A male friend of mine recently saw Caitlyn Jenner at Starbucks and said, “She had no ass.” The same person who was once lauded for being an Olympian is now judged solely for her perceived lack of ass. Welcome to womanhood.)

There are times when my body has presented real problems. I have foot problems that two surgeries have not resolved. I have overly tight calf muscles that seem to be wreaking havoc everywhere else in my legs. My particular reaction to chronic stress and fatigue is acid reflux and to become itchy all over. I have digestion issues that extreme dieting may or may not have caused, and which now prevent my total enjoyment of a lot of meals. These are real body problems, and they sometimes get me down, but unlike with my fake-body-problems, I know the solution is some TLC and R&R (and sometimes an ice pack or Pepto-Bismol) and I give it to myself.

How I used to resolve my fake-body-problems? I would try to make my body disappear by going on a diet.

I wish I had known this body-as-problem-solving-substitute was a thing, and a thing that I was doing. I might not have gone on extreme diets that messed with my metabolism and probably gave me chronic tummy troubles – real body problems. I might have faced relationship problems head-on, or even recognized bad or unsatisfying relationships for what they were. Instead, I insisted that a smaller body would be the remedy for everything – and when it wasn’t, the problems were still there, and I had to fix them while I was hungry. Not the easiest thing to do.

Occasionally my real problems still get me down. I might still walk around feeling unattractive when this happens (I’m working on getting a new mental reflex) but I know that it has nothing to actually do with my body. And that’s a relief. It frees me up to feel my feelings, fix the problems I can fix, make peace with the problems I can’t, and wait to feel a bit better. That’s what real self-care is all about.

What did I eventually do to tend to my tattered psyche? I cooked, because I love to cook and it calms me and grounds me like no other activity. Knowing I can still feed myself and my family reminds me that on the most basic level, I can still take care of myself.

What do you do to care for yourself in tough times? Feel free to leave your thoughts in the comments!

 

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The Verdict Is In: The BMI is a Poor Predictor of Health

bmiRecently a new study was published on something most of us have known for quite some time: the BMI is not an accurate or reliable predictor of health.

But here’s what the latest evidence reviewing the effectiveness of BMI in diagnosing ill health found: it grossly overestimates the number of “unhealthy” people whose BMIs are in the overweight and obese categories.

Just to recap, the BMI is your weight in kilograms divided by your height in meters squared. It was developed as a way to compare weights in large populations, not a medical diagnostic tool. People in the 18-24 range are considered “normal weight” while people in the 25-29 range are considered “overweight” and over 30 are “obese.” To give you an idea of how arbitrary these ranges are, they were all adjusted downward in 1998, upon recommendation by the NIH Obesity Task force, despite all the available scientific evidence that actually pointed toward raising the ranges. According to one Task Force member, “We were pressured to make the standards conform to those already accepted by the World Health Organization” (Health at Every Size, Linda Bacon). And the International Obesity Task Force who recommended to the WHO the cut-off of 25 for the normal weight category received funding from pharmaceutical companies who made diet drugs. So the ranges are, you know, totally scientific.

It’s totally shocking, then, that this simple math equation, whose ranges were defined more by politics than by science, doesn’t totally tell us everything we need to know about a person’s health, right? That was sarcasm, by the way.

I’ve written before about how problematic it is to rely so heavily on mathematical equations in relation to our bodies, especially when it comes to weight. There’s a ton of stuff we still don’t know about weight regulation (witness the continued insistence on weight loss for health when it’s been shown over and over to not work long term for most people) and while we mostly have the same parts and general bodily functions needed to live, there can be a lot of variability from person to person.

So what this study found was that using BMI alone, “an estimated 74,936,678 US adults are misclassified as cardiometabolically unhealthy or cardiometabolically healthy.”

Oops!

This is not surprising, but now we’ve got yet more evidence to back it up. Yes, it’s one paper. Let’s get some more research behind this so we can finally put the BMI as a health measure to death. In fact, want to help? I just found out about the ongoing study called Health Registry of Obesity (HERO) by the same study authors of the above-mentioned BMI paper.

By the way, I don’t believe that good health is a measure of worthiness or an obligation, so if you are fat and unhealthy or thin and unhealthy, you have the exact same rights to medical care and everything else that healthy people do, without being penalized. I am interested, however, in stopping the lie often perpetuated that fat=unhealthy and thin=healthy. People are being denied important, life-changing operations (kidney transplants, knee surgeries) simply because they are in the wrong BMI category, despite otherwise good health. (Ironically, no one hesitates to perform bariatric surgery on fat patients. Hm….). This needs to stop.

I know many doctors; most of them want to do the right thing (at least the ones that I know), but usually they are under pressure to move fast and work cheaply. The BMI represented a cheap, quick shortcut to preventative health care for them. But now we know it’s bunk. And we have real, useful tools at our disposal: blood pressure, blood sugars, lipid panels, insulin resistance, c-reactive protein (a measure of inflammation in the body). These are the indicators that the study authors used, and they are what our health professionals should be looking at before they declare us sick or not sick. Because this is not only a huge problem for fat people who are over-diagnosed and prescribed an intervention that fails 95% of the time, it’s a huge problem for the normal-weight people who are not being diagnosed at all.

My guess is, this paper won’t be the end of the BMI in medical care. It’s probably going to take a lot more scientific study (much of which already exists), head banging, fist wringing, and just plain shouting to get through a resistant medical establishment. But it’s a good step in the right direction.

 

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Dietitians Unplugged Episode 5 -Weighing in on the Dietary Guidelines

Cover2The 2016 Dietary Guidelines for Americans came out earlier this year and Aaron and I let you know what we think. Are they words to live by…or just another prescriptive diet? Do we even need the Guidelines?  What drives the rational for how Guidelines are formed? Listen to us discuss these questions and more from a Health at Every Size® and Intuitive Eating perspective.

 

 

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I’m Hungry…So My Body Must Be Broken

Stomach_diagram_feedme
It’s actually pretty simple.

“I’m so hungry…there must me something wrong with me.”

“I’m so hungry…it makes me want things I shouldn’t eat.”

“I’m so hungry…it’s really sabotaging my weight loss.”

I have heard all of these statements, and variations of them, A LOT. The only one I rarely hear among the general population these days is, “I’m so hungry…I really must eat now.”

We’ve attached an enormous amount of guilt to eating and worse yet, to hunger. We think our hunger is to be distrusted, that there is something wrong with our bodies when we experience hunger, and that we must do everything to thwart our hunger: ignore it, fill it with unsatisfying air food, quench it with copious amounts of water or coffee or tea or zero calorie soda (or worse yet an ungodly “master cleanse” concoction of water, maple syrup, lemon and cayenne pepper. Cocktail of champions.). We see our hunger as a symptom of a broken internal system…and that we would only be thinner if this hunger thing would just go away.

Back in the day, when I started dieting, I thought it was just us fat people ruing our hunger in secret. It probably was people of all sizes but everyone had somehow decided to keep it to themselves. Now that everyone, simply everyone, must share the intimate details of their latest weight loss regimen so they can be deemed good and worthy citizens, we know all about it. And because we know all about it…we think it’s the right thing to do. Everyone is suspicious of their hunger…why aren’t you?

I’ve heard it from fat people trying to lose weight and thin people who are secretly terrified to put on weight…I’m so hungry, I don’t know what’s wrong with me. Well, as a very smart person once said on the internet, hunger doesn’t lie (Was it you that said this? Please take credit for it in the comments if so!). If you’re hungry, that’s your body telling you one thing: FEED ME!

It’s so basic, so obvious, you’d think we’d understand this. Even if, on an intellectual level, you didn’t know that hunger means “eat,” it kind of tells your body exactly what to do. If you were raised by wolves in the wilderness and never spoke a word of human, and you got hungry, your body would figure out what to do – it would directly you to eat. It would make even the most unappealing foods – raw badger, or whatever wolves eat – totally appealing. And then you’d eat and your life would be go on.

But back in the “civilized” world (where we are generally not being raised by wolves), not only do we instinctively know we should eat, we have all the science at our fingertips to know that hunger means EAT…and yet we resolve to not eat. Yay, civilized world.

I’m going to go out on a limb and guess that, at least in part, all this started from a collective sense of body dissatisfaction, the idea that our bodies are innately wrong and must be solved (brought to us by the people who have benefited in one way or another from the body insecurity of others). Then came the misinformation that we can not only solve our bodies, but that we should and we must! So if we think our bodies are a problem to be solved, and the solution is possible, and the solution is to eat less, and this means less than we are hungry for, then yes, of course you would learn to see your hunger as the enemy.

And I get it: if you are in one body but feel you should be in another body, you may indeed feel betrayed every time you feel that pang of hunger that tells you to eat just when your diet tells you not to.

But guess what we’ve finally figured out? Our bodies are not something to be solved, and the solution doesn’t even work for very long anyway. Upon starving to lose weight (because simple “lifestyle changes” didn’t accomplish the task), our bodies learn how to use energy more efficiently and store more as fat. They learn how to gain weight on the little we feed them while we are actively ignoring our hunger. You might be able to outrun your hunger indefinitely, but your body will take its revenge down the road, either in the form of weight gain or more intense hunger – take your pick.

To all of those who lament their hunger…your hunger is most likely not malfunctioning*. Your body is not broken. Consider honoring that hunger pang with some food that you love, or that makes you feel good. See what happens. Will you eat until you literally explode? Unlikely. Only the guy in Monty Python’s “Meaning of Life” ever did that but that was just mean, fat-shaming fiction.

It’s time to admit that the body has wisdom. The body decides its own weight, not the wishful-thinking part of the brain that is coerced daily by messages that profit from your body dissatisfaction. Make friends with your hunger, learn how to truly honor it, and it won’t lead you astray.

*Yes, there are some diseases and conditions that can cause excessive hunger. Most of us don’t have those diseases, and that’s not who I’m talking about.

Podcast!

Check out the latest Dietitians Unplugged podcast in which we discuss the misconception that intuitive eating is for weight loss.