The ABCs of Weight Loss

Pacman eating dots
Pacman goes on a diet.

I was sick at home a few weeks ago and my appetite (along with my energy, my throat and my good humor) was shot. I didn’t feel like eating anything in particular, but I was still hungry and I knew I needed to put something on my stomach. I did what any sick person with no sense of smell and a craving for carby, starchy, sweet and/or cheesy foods would do – I picked and pecked at random selections of food for three days straight.

And suddenly I remembered ABC. If you’re a dieter, and maybe even specifically a Weight Watchers alum, you will know what ABC stands for. WW Leaders would chant this weekly to their loyal followers, reminding us why we might not be reaching our goal weights. “ABC – All Bites Count!” they would decree, and we’d nod our heads in unison.

Another way of saying this was “If you bite it, write it.” It means that literally every little bite you take must be logged into your journal. It means that no bite of food, no matter how innocuous seeming, no matter if it was a whole bite, or a half bite, or a measly nibble, should go unrecorded, because surely it will be that one bite that will take all your weight loss efforts down. Unless we stopped to figure out the points value of one quarter of an Oreo cookie and write it down, surely that one unrecorded bite might be the gateway drug to actually satisfying our appetites, and that would be the death knell of our weight loss. One cannot have a satisfied appetite and lose weight, we all knew that.

That’s how it eventually got for me, caught in the frenzy of weight loss and weight maintenance: seemingly innocent crumbs of foods here and there could not could not go unaccounted without worrying about how they would affect the scale the next week. And god forbid you end up getting sick, or divorced, or have a loved one who dies, or you lose a job, i.e. real life stuff…because those are prime pecking situations, and you are seriously not going to want to record anything when any of these happen (which explained why so many people dropped out when major life events occurred. Because you cannot diet and lose or maintain weight and still have a real life that can accommodate important stuff.)

And then there are those times, like at a party, when you have one bite, then another, and another and another and you think, “Oh what the hell, too many bites to remember, might as well go for broke,” and you eat so much that your belly hurts and you feel the shame of going so far off your diet that you’ll surely have to starve the rest of the week to make up for it.

What no one ever tells us is that even if we manage to write every single bite, we might not be happy or satisfied with either our eating OR our bodies. No one ever tells us, “95% of people who write down all their bites still regain most or all of their weight within three to five years after losing weight,” even though that is what all the current science tells us. No one seems to want to acknowledge that even if you are a super-bite-writer, a significant chunk of your life might be sucky because all you can think about is how you’re going to avoid the bites you might have to write. Because even if you are one of the miraculous 5% who maintain their weight loss longer than five years, your whole life will be dedicated to this one task.

Let’s be honest: having to account for every single bite you put in your mouth – whether it is “working” or not – is a fucked up way to live.

So although I was sick and sniffly and kind of miserable, I was really grateful for one thing: I didn’t have to worry about any of the bites. I could give my body the energy it was asking for, no questions asked, no bite-writing required. I’m going to stick with intuitive eating and eating competence because for me, that is eating well and enough and guilt-free. No more ABCs for me.

Dietitians Unplugged podcast – episode 6 available now!

Episode 6 is called “Clean Eating or Toxic Ideas?” and we had so much fun talking about this subject.

Listen on Libsyn or iTunes. Give us a review on iTunes if you like us — this helps to spread the non-diet love to more people. Check out our Facebook page for our latest episode and news and more weight neutral, HAES® friendly podcasts!

Fat at the Doctor: A Very Real Problem

Thinker, by August RodinI went to the doctor recently and this is the cheeky summation of how that went down:

Me: “I’m here for a totally not-fat-related-but-most-definitely-stress-related problem I have that I need to make sure isn’t something more than I think it is. I think the problem may resolve soon because my stress is decreasing due to my new less stressful job that I get to walk to vs. my previous unbearable commute… but in the meantime can you please tell me I’m not dying of something horrible even though it seems innocuous?”

Doctor: “That’s great that you’re walking to work. Maybe we’ll see that weight come down now.”

As much as I write about this stuff all the time, as much as I am abso-fucking-lutely okay with my body, this turn of conversation stunned me into momentary silence. How the hell did this turn into something about my weight? Especially when I had refused to even get on the scale this visit??

Make no mistake: weight bias is a real thing in health care. Scenes like this (and much worse) play out for fat people in doctors’ offices with alarming frequency, and often with more serious consequences. Sometimes visits to the doctor by fat people end in something like, “We will not provide this treatment for you until you lose weight.” Or, “The treatment for this fat-unrelated condition is to lose weight.”

For a long time, when I was not fat, I had forgotten the shame of being fat and going to the doctor. My first weight-related medical care incident occurred when I was 15 years old (and 20 pounds less than what I weigh now) and my doctor told me I was getting too fat (except he didn’t say the word “fat”) and that I needed to lose weight (and then offered up no further solutions). My mom was livid on my behalf (for reasons that only made sense to me much later in life, she was always worried I would develop an eating disorder), and I always wondered if she gave that doctor a talking-to, because he never brought it up again. My response was to refuse to be weighed at any appointments after that and thankfully, I didn’t go on a diet in my teens, a behavior that is well-known to have disastrous consequences, from the development of eating disorders to fucked up weight regulation lasting into adulthood.

Flash forward 30 years. Things are not better. In fact, thanks to rampant fat phobia, healthism and weight-based discrimination, weight bias in health care is a bigger problem than ever. I have worked in health care for the last three years and have witnessed this first-hand. Patients who need life-changing operations are being denied these operations based on their BMIs – and nothing else. In medical rounds, we discussed a dialysis patient with perfectly acceptable metabolic labs, who is by most standards healthy (aside from not having working kidneys) who won’t get a new, functioning kidney for one reason – his weight doesn’t fit into the completely arbitrary “normal” category on the BMI. People have been denied knee surgeries unless they can lose weight (read more about the topic of being fat and knee injuries here and here). A woman posted on my Facebook page that her doctor wanted to treat her muscular dystrophy with a 100-pound weight loss because he felt her muscles simply wouldn’t be able to accommodate her weight – despite the fact that weight loss is a catabolic process and will contribute to diminished muscle mass. Oh, and despite the fact that the science shows that the most probable long-term outcome of weight loss is eventual weight regain. Need more examples? Read here.

More than a few times, I was mortified by the utter disdain and lack of compassion shown by medical professionals for fat people who needed real, compassionate medical care. One skeptical doctor I know said, “I really don’t think weight bias is a big deal when there are so many other problems that are worse.” Well, yes, I suppose if you are not fat, this weight bias thing isn’t as big of a deal for you. But the existence of other problems does not diminish this problem. This is one of the big problems.

Now that I am technically “obese” (after having given up dieting in favor of a healthy relationship to food and my body), I don’t weigh myself again, not because I’m ashamed of my weight, but because the act of getting on the scale for so many years was fraught with anguish that I don’t wish to relive. I know generally what I weigh and I told my doctor my estimate when she asked. And that’s when, minutes later, she started haranguing me about losing some weight.

Once I had recovered my senses, I said to her, “I really don’t work on weight anymore. I just try to eat nutritiously and exercise and let my weight be what it will.” Still, she insisted, she felt my weight would decrease by walking to work more. She acted as though I hadn’t exercised a day in my life before this (I exercise regularly). I asked her if she had ever heard about Health at Every Size® – she hadn’t, but said it sounded fine when I explained to her. Then she apologized for offending me about my weight, and I had to explain that I wasn’t offended, but that I simply wasn’t interested in pursuing my weight as a health outcome. And that was that.

So I got off easy that day: I don’t have a life-threatening condition, and I am not large enough to attract the truly terrible treatment other larger people receive regularly. Although god forbid I need knee surgery some day in the future.

This clearly needs to change. We need doctors who are aware of the evidence around weight and health, or at least willing to hear it in the first place. We need doctors who are aware of their own bias against fat people.

Not everyone wants to be an activist, but I do encourage you to fight for your right to real, unbiased health care. If you’re looking for a fat-friendly physician, check out this list. If you already have a fat-friendly physician, consider adding yours to the list, because it’s not nearly long enough yet. For my part, I make sure I talk to every medical professional who will listen about HAES®.

This free eBook Dealing at the Doctor’s Office by Ragen Chastain of the blog Dances with Fat may be helpful if you are dealing with these kinds of problems. Ragen’s blog is chock-full of information about being fat at the doctor’s (and I’ve already referenced some of that material here), so if you are looking for more on this topic, I suggest heading over there.

Let’s not stop fighting this together until everyone has the same access to medical care that everyone else does.

 

Dietitians Unplugged podcast – episode 6 available now!

Episode 6 is called “Clean Eating or Toxic Ideas?” and we had so much fun talking about this subject.

Listen on Libsyn or iTunes. Give us a review on iTunes if you like us — this helps to spread the non-diet love to more people. Check out our Facebook page for our latest news and more weight neutral, HAES® friendly podcasts!

Dietitians Unplugged Podcast – Episode 6: Clean Eating or Toxic Ideas?

Cover2Check out episode 6 of the Dietitians Unplugged podcast in which Aaron and I discuss the “clean eating” trend. Is this just another way to eat, a diet, or a new religion? And what are the implications for the kids raised in this dichotomous way of thinking about food?

Here is the article that inspired this blog post. Warning: it includes fat-phobic comments and diet talk.

Other links referenced:
Ellyn Satter Institute
The Blessing Of A Skinned Knee: Using Jewish Teachings to Raise Self-Reliant Children, by Wendy Mogel, PhD

 

Listen on Libsyn or iTunes. Give us a review on iTunes if you like us — this helps to spread the non-diet love to more people. And feel free to like our new Facebook page!

I’m a Guest on the Love, Food Podcast!

IMG_20160309_184311735_HDRHey everyone! Just thought I’d share my geeky excitement – I got to be a guest on Julie Dillon’s fantastic Love, Food podcast!

In this episode, a fat nutrition student writes a letter to food asking if she should go on a diet to better fit the mold of a dietetic student. Have a listen to how Julie and I answer the letter here.

You can subscribe to Julie’s Love, Food podcast on iTunes. Don’t forget to leave a review!

And…

A new Dietitians Unplugged Podcast episode coming very soon! Subscribe on iTunes to get the latest and leave us a review if you’ve been enjoying the podcast!

 

 

The Fat Fear Factor

Big_Fat_Red_Cat
I’m okay, you’re okay.
I was talking to an acquaintance who doesn’t know what I do (this body acceptance/HAES stuff) for at least some of my time, which is why she said to me, “I’m looking for a 1500 calorie diet –  I saw pictures of myself at my nephew’s wedding and I didn’t like the way I looked. What diet should I do?”

Not being paid to treat her, I dispensed with any sort of motivational interviewing sensibility and pleaded, “Oh Harriet*! Please don’t even bother. Diets are horrible and in the end you just gain even more weight back.” She was interested in that, so we talked for a while about what all the science says and how food-and-calorie restriction just leads to crazy-eating and how in the end, almost no one loses weight forever.

But she kept coming back to one thing: I have to do something, because I’m just too big. Being a short, fat, older lady, she most likely receives confirmation, like all fat people, on a daily basis that she has the wrong body, if from nothing more than the near-total absence of fat bodies presented in every form of media that exists (but also probably from a lot more sources). I totally don’t blame her for getting stuck on this. I had talked about listening to our inner cues of hunger and satiety to regulate our eating, but that it probably wouldn’t make her thin. She concluded with, “I’ll try to listen to my hunger and fullness…but I also just need to have portion control,” which, sadly, is really just another way to say “diet.” And I totally get it, because the way she feels about her weight and needing to do something – yeah, I’ve been there.

So what I want to talk about today is not the massive failure of any sort of intentional weight loss effort, but rather the problem of body unhappiness. Because unless we at least explore the reasons for body dissatisfaction, it can be oh-so-hard to even contemplate achieving a peaceful relationship with food.

Why? Look at the above example. Harriet was interested in listening to her internal hunger and satiety cues (and she had a poignant story about childhood hunger that continues to fuel her need to overeat to this day) but she felt she needed to fix her body size first. She couldn’t get past it. She didn’t feel she had the right to exist happily in her body, no matter what her size. And we talked about the reasons for that too: the expectation of women that we always appear “attractive,” the lack of representation of fat bodies in the media, the weight loss industry who continues to perpetuate the idea that permanent weight loss is possible, the medical community who backs up this idea without acknowledging the overwhelming evidence that says that we don’t need to lose weight to be healthy, and society at large which says we need to lose weight to be happy. Everything that she’d ever heard told her that her fat body was wrong wrong wrong.

I think more than ever, thanks to this rampant fat-fear-mongering, so many of us have come to the conclusion that it’s NOT okay to 1. be in a fat body and 2. be happy with ourselves and our lives in that fat body. This is simply wrong.

So this is what I want you to know: you have the right to be happy in your body no matter what its size. You might be miles away from that, but you need to at least know that this is a possible outcome if you decide to choose it.

Permission is a powerful thing. We’re holding ourselves back from a fully-lived life when we feel we lack permission to be authentically ourselves. Your eating will suffer; your happiness will suffer; and your health will suffer.

Becoming happy in your fat body isn’t a quick trip. But you at the very least need the ticket – permission to be okay with your body – to get on board.

 *Totally not her real name