Dietitians Unplugged Podcast – Episode 7: Making Peace With Exercise

Cover2Do you hate “exercise?” So do we! Sort of…Episode 7 is here, and in it, Aaron and I talk about how, after making peace with food, we’ve also made peace with our relationship to moving our bodies. We also talk about fitness trackers, our different approaches to getting activity in our lives, and why we actually hate the word “exercise!”

Here is The Atlantic magazine infographic we referred to during the podcast.

 

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The Weight You’re Supposed to Be

Bulldog
I’m on the “Greyhound Body in 30 Days Diet Plan.”

One of the most common reactions to what I write about learning to accept our bodies at the weight they are and taking a Health at Every Size® approach is, “But I’m not at the weight I’m supposed to be…I should be XXX pounds because that’s what I was [when I was my healthiest weight; when I was an athlete in college; before I had three kids; before I developed this knee condition; when I ran marathons all the time].” I totally get it. Lots of us have that utopian time in our lives when our weight was perfect (or so we think in hindsight), our health was optimal, and we were going to live forever…and we so desperately want to get back to it.

 

Even when, intellectually, we know that dieting doesn’t work, that weight loss is typically short-term (<3 years) at best, that even when our own personal experiences tell us that previous weights were not sustainable, we resist in accepting this. I recently read a great term for this: data resistance, meaning no matter how clear the science is on this topic, people still want to believe that long-term weight loss is possible for more than a tiny fraction of people. The propensity for magical thinking is strong in us humans, and weight is no exception.

Let’s roll with it, then. Maybe you aren’t at your optimal weight. Do you want to diet to try to get there? Is that something that has been sustainable for you in the past? If not, why do you think things would be different this time? What happens if, despite all your efforts, you never get anywhere close to your desired weight? How do you live your life then? What happens if the weight you are now is your weight for the rest of your life? I think it’s worth it to have this conversation with yourself, so you at least have some options.

There are also important things to know before you decide what to do next. First of all, despite what we have been told ad nauseam by the diet industry, your weight is not really within your control, at least in the long term. If you’ve been reading this blog for a while, you are well aware by now that intentional weight loss has a 90-95% failure rate over the long haul (>5 years). If you’re new to this blog, head on over to my Scientific Lit page and have a look for yourself.

Your weight is really determined by a combination of your genetics, your metabolism, and your environment (past and present) – and not so much by the weight you actually want to be. Do you have fat parents or family members (genetics)? Have you spent any part of your life restricting calories or foods (environment)? And if so, did you know that your metabolism is probably running slower than if you hadn’t (metabolism, obviously)? Possibly most significantly, if you have made multiple weight loss attempts throughout your life or were put on diets as a child, your natural set point will be higher than what it might have been had this never happened. Unfortunately, we’ve all been fed the calories in/calories out bullshit, and have been taught that calories out are totally within our control, when in reality our sneaky metabolism comes along and adjusts everything to make sure we aren’t spending too much energy, because Lord knows the body loves homeostasis.

So now you’re well-armed with information about the spectacular failure of long-term weight manipulation. That’s all well and dandy, you think, but maybe I’ll be one of the 5% who keep the weight off. Maybe you will be! I was for a long while – before The Diet Monster took over my life and made me more miserable than I had ever been as a fat person. It’s a dicey gamble to make – you might be one of the 5% who manages to maintain long-term weight loss by making it your life’s work, OR you might be one of the 95% who gains some, all, or even more of your weight back, leaving you even fatter than you started. In the words of Dirty Harry, “You gotta ask yourself, ‘Do I feel lucky?” Well, do ya??

“But I’m simply not healthy at this weight.” Hey, you might not be. I don’t know your particular health habits or your lab values. Just remember, though, that weight is not a health behavior; it’s a size. Health at Every Size® does not purport to say that everyone is healthy at whatever weight they’re at; it simply means that whatever weight you are right now, you can start to work toward better health. So maybe your health isn’t great right now – is losing weight truly the only way you can improve your health? What about improving your eating habits or activity level? If you consider yourself too large to exercise, check out The Fat Chick’s webpage for activity for people of all sizes. Plenty of studies show that fitness is a better determinant of health than fatness and recently even more are showing that weight loss in some populations is associated with greater mortality rates.

“Well, I’m just not comfortable at this size.” I understand; moving in a thin body is different than moving in a fat body. While I personally don’t notice all that much difference (I’m lazy at both ends of the weight spectrum!), I also recognize that my weight difference might not be as great as someone else’s and that my experience is not universal (I also developed osteoarthritis in my feet at my thinnest, so even that wasn’t a guard against joint problems). Whether your discomfort is physical or psychological, how much do you think our culture’s prevailing attitudes about weight are influencing your discomfort with your weight?

I used to feel like I had to suck in my stomach, no matter what weight I was. As I regained weight, my stomach was beyond sucking in – I could tighten those ab muscles all I wanted, but that layer of fat wasn’t going anywhere. Sucking in made me feel physically uncomfortable. Not sucking in made me feel psychologically uncomfortable. I felt out of proportion, and I felt like I was being outed by my tummy as a fat person. When I finally acknowledged that how I felt about my stomach had more to do with how the world views fat people and less to do with how I actually felt, I eased up on my expectations of my body. If your feelings of discomfort are 100% physical, consider a HAES® approach in which you could find activities that you are comfortable doing right now, and work your way up from there. Bodies are amazingly adaptable, especially when we are being kind to them.

I wish I could tell you that our brains controlled our weight. That it’s just a matter of trying really hard and you’ll have some satisfying weight loss that lasts forever without totally ruining the quality of your life. My own personal experience, the experiences of all the other people I’ve met in the fatosphere, and the bulk of available science on the subject does not permit me to do so. I can only recommend a kinder approach in which you let your body decide what it will weigh – it will do that eventually anyway – while you find your own way of living as healthfully as you want and can. That will give you a stable weight that is right for you. Because, with this one life you have, how long do you really want to struggle against your body?

Dietitians Unplugged episode coming this week!

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Food is Not Medicine

rxI was at a party once and when a nice woman asked me what I did, I said I was a dietitian. She beamed and clasped her hands together and said, “Oh, that’s wonderful. Food is such medicine, isn’t it?”

I didn’t know how to respond at that moment. I was still recovering from years of restrictive eating, which had at one point taken the guise of “clean” eating, local eating, organic eating all for my “health” – when really I was just finding new ways to restrict for my weight. As I sautéed up a few stalks of chard in as little oil as possible, I would say things to myself like, “I’m gonna live forever!”

Obviously I cringe at that now. Why worry about living forever when the present is so miserable? That was my existence then – taking my medicine in the present in the hope of a longer future. I wasn’t happy then, so I was living as much in the future as possible.

But I couldn’t keep it up. Eating medicine is not as fun as eating food, and turning food into medicine is downright depressing. Food is food; it nourishes us, gives us energy, keeps us alive, and is necessary to our existence. Enjoyment of food is essential and here’s a great example of that: in a study from the 1970s, Thai and Swedish women were both given a traditional Thai meal1; the Thai women absorbed almost 50% more iron from the meal than the Swedish women, who were somewhat okay with the meal but felt it was too spicy. Then the traditional meals for both groups were pureed into mush and eaten. Guess what? Iron absorption for both groups decreased by 70% — even when eating their own traditional food. Why? Probably because for the most part, a pureed meal isn’t nearly as enjoyable as a non-pureed meal, especially if you’re not used to eating it that way. So, yes, enjoyment of your food is integral to good nutrition.

If you’re treating your food like medicine, holding your nose and shoving it in, or in a less extreme version, dutifully eating your “healthy” food but wishing you were having something else instead, you’re doing your body and your mind a disservice. The truth is, for most people, what you eat on a meal-by-meal basis is not as important as how you eat. Having a relaxed relationship to food, providing regular, reliable meals for yourself, allowing internal signals of hunger and fullness regulate your intake, and eating food you enjoy – otherwise known as eating competence  – actually helps you to be your healthiest self in respect to nutrition (I’ll explain more about eating competence in a future blog post). This is because people who approach eating this way tend to get the most variety in their diet, which ensures optimal nutrition.

Now, as a clinical dietitian, I do practice what is called medical nutrition therapy (MNT). There are certain disease conditions for which changing what you eat can help to manage that condition. But there is a big difference between disease management for people with disease vs. disease prevention for people with no disease. Eating low sodium your whole life will not necessarily stave off high blood pressure. Eating no carbs will not ensure you will never get diabetes. Many diseases have a genetic component, and eating a certain way does not guarantee that you will not get a disease. However, if someone is a competent eater, getting a variety of food reliably and enjoying their diet, this is the best disease prevention there is, since, as I linked to above, competent eaters have shown to be generally nutritionally (and socially and psychologically) healthier than non-competent eaters.

While diet can help manage conditions, it rarely cures them. Celiacs can strictly avoid gluten (which they must do) and live a very healthy life, but their condition is never cured by any particular food. People with hypertension can reduce dietary sodium to help manage their blood pressure, but there’s a whole host of other things they need to do too – exercise, manage stress, sometimes take actual medication. And you cannot cure cancer with food (I’m sorry, you just can’t). Food is important and will help keep someone with cancer alive because the body needs additional energy with a catabolic illness and while it receives actual medicine which really can cure. There is a reason we call this medical nutrition therapy and not medical nutrition medicine.

Unfortunately, I’ve seen food-as-medicine go wrong on too many occasions. One of my patients (a meat-eater) with MS was told by his doctor to go vegan to help manage his disease (for which there is some limited evidence). He did so, then gained 50 pounds and developed elevated off-the-charts triglycerides. He went back to his doctor who again said, “Go vegan!” to which he replied, “I already did!” After that, he switched to a different diet style he liked better that still managed to include lots of fresh vegetables, returned to his previous usual body weight, ended up with normalized lipids and generally felt pretty good. I’m not maligning vegan diets; it’s the diet-as-prescription mentality that can be the problem. A diet you don’t love is not good medicine. Too often, because of this food-prescription mentality, many of my patients think they can get good nutrition from a powdered supplement, and then develop all sorts of disordered eating habits to compensate for the actual food they are missing out on.

It’s true that many foods have medicinal properties. Cinnamon may help lower blood sugar in diabetics. Turmeric may have anti-inflammatory properties. Here’s the problem: will you start to sprinkle cinnamon on everything you eat even if it doesn’t taste good? I love turmeric – in a few dishes. A little goes a long way. But studies often show that in order to actually get enough of the medicinal properties of these foods, you usually have to have large quantities of it – more than you’d probably want to eat of anything in a day. Also, what we know about the synergistic properties of foods can so far fit in a thimble. Isolating compounds for their magic properties is reductive thinking at best. Food compounds interact with one another and we’re only just starting to understand this better now. Again, getting a varied diet will help you to get some of everything you need.

I know Hippocrates said, “Let food be thy medicine and medicine be thy food,” and back then that made sense when they didn’t have a lot of actual medicines. But now we’ve got another problem which is a world full of disordered eating, so maybe it’s time to back off this food-as-medicine idea for a while.

So food does not need to be medicine, especiallly in the absence of illness. Food just needs to be food – delicious, enjoyable, varied, reliable fuel for your body – because that’s how it serves us in the healthiest way possible.

1Hallberg L., Bjorn-Rasmussen E, Rossander L, Suwanik R. Iron absorption from Southest Asian diets. Am J Clin Nutr. 1977; 30:539-548.

 

Dietitians Unplugged Podcast!

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! New episode coming soon!

Fat Bodies Are Not Fixer Uppers

fatmouse
Body diversity, yo.

Dear People Who Want to Shrink Fat Bodies:

I think all bodies are awesome – thin, fat, disabled, buff, hourglass, angular, apples, pears, carrots, celery (what, thin people can’t have food body-descriptors?). To my mind, there is no body out there that is not simply wonderful. So it dismays me that there are people who do think that there is a hierarchy of goodness when it comes to bods – with fat bodies on the bottom. They are so distressed by fat bodies that they’ve committed, either personally or professionally, to help make us thinner. To those folks: I know you think you’re doing good, but you’re not, and so…we gotta talk.

I understand that for the most part, you are acting out of the goodness of your heart (even if you are making money from this endeavor). You see how fat people suffer at the hands of a cruel world who has decided that having at least one (but often many more) oppressed segment of society is beneficial in so many ways, especially the money-making way, and you don’t want us to suffer anymore. So you think the best way to end that suffering is to end our fatness. You’ve heard about how fat is killing us all (even though it really isn’t) and you want to save us from death (even though we all die. No matter what.). Because you know (just as we once all knew the world was flat) that it’s just a matter of changing our diets, getting off the couch a bit more, right? Even though if that were truly the case, there would probably hardly be any fat people, since that sounds pretty simple, and lots of us already do it.

You don’t understand that maybe some bodies are just naturally fat, or eventually become fat, that the bell curve of bodies tends naturally toward diversity of size and shape and ability (because from an evolution standpoint, that’s a totally helpful thing) and therefore you simply don’t understand why all us fatties are just choosing to be needlessly fat. Perhaps we are just like willful children who need your thinner, wiser guidance. (Also, you might make some money! A LOT of money!)

But here’s the deal – I know almost no fat person who hasn’t tried to turn herself or himself into a thin(ner) person at least once in their lives (fat people who have never dieted aren’t quite unicorns…but they are exceedingly rare in my personal, non-scientific, anecdotal experience). We’ve tried the sensible diets (supposedly Weight Watchers and healthy lifestyle changes) and when those didn’t work (or worked to turn us into crazy people), other diets were tried – some of them more and more extreme as time went by (you go, breatharians!). In reality, if just plain sensible nutrition and exercise (which isn’t all that difficult) worked consistently and reliably to turn fat people into thin people, there wouldn’t be any fad diets at all. But there are. Lots of them. So yeah, we’ve tried them all…and most of us are still fat.

But for the love of all that is kale-infused, if you’re going to make fat people your charity project, at least do the research. (better yet, get a different project). You will find out that most intentional weight loss efforts – like 95% – fail after more than 5 years (and usually by year 3). It is not due to lack of willpower, and the science shows this reliably. In a country that sent people to the moon (conspiracy theorists, stop right there) and invented the iPhone, and where people regularly don’t take vacation, you’re trying to say that we’re simply not trying hard enough? Hogwash. I’m not buying it. People try hard at things all the time, even fat people. If long-weight loss could be maintained by more than a tiny fraction of people, we would have maintained it by now. So you’re not going to make our lives better by making us thin, because there is no real way to make the majority of us thin for the long-term.

How could you help? Lay off the fat phobia, first of all. Consider that there are a lot of ways for people to be happy and get healthy without focusing on weight. Anyone can benefit from eating better – and I don’t mean more restrictively – or being more active, but unless someone has asked for your help, please don’t launch in on a reform mission. No one wants to feel like they need to be fixed, especially by someone who has never walked a mile in their shoes.

Please stop assuming you can tell how or what someone eats just by looking at them. You can’t. And you can’t tell their health status either. Good doctors don’t diagnose by looking at someone by five seconds and making assumptions. You shouldn’t either.

You can advocate to end the stigma and rampant discrimination that fat people face (or any people. No one should ever have to suffer from any kind of discrimination). You can decide to do nothing at all and just leave fat people alone – that in itself will be huge. If you do nothing other than to refuse to speak judgmentally about body shapes and sizes (and that includes thin bodies) you help to shut weight stigma down.

To all our thin and “normal” weight allies – thank you. I love you so much, because you have nothing personally to gain (other than living in a harmonious world full of happiness and rainbows, I guess). To all those who truly don’t give a shit one way or the other whether someone is fat or not – thank you to you, too. You at least aren’t making things worse.

And to those who still want to shrink fat bodies– I hope you find another hobby someday. Because this one isn’t working for us.

 

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!

Why Is Eating Normally So Hard?

cat memeWhen I decided to stop dieting, it felt like the biggest relief ever. I was so tired of trying to trick my body into thinking it didn’t need food, ignoring gnawing hunger pangs, coming up with ideas for meals that tasted great but had next to no calories in it, counting “points,” and acting like the worst thing that could happen to me would be to get fat again (it wasn’t), that the final decision – made after several months of a nutrition class taught by Linda Bacon in which I was introduced to HAES® – felt easy. But the process of learning to eat normally? Not always so easy.

Eating without restriction at first felt scary. This was before I’d even heard of intuitive eating or eating competence,  and I just thought eating normally would happen naturally. I wasn’t prepared for the lingering sense of manufactured food insecurity that drove me to eat quickly and voraciously of portions that were bigger than I was hungry for. I felt way out of control at times.

So I totally get that people can have a hard time with learning to eat normally after dieting. The posts I see in the various groups I belong to on Facebook tell of people struggling with “getting it right” or listening to their bodies with any degree of accuracy. I hear a lot of frustration. Years of dieting can totally fuck with your head and your stomach, and can make this whole process a lot harder.

There are two things that can make this process even harder: Perfectionism and Judgment.

Let’s start with Perfectionism. When I hear people talk about learning to eat more intuitively, so many are beating themselves up for “slipping up” and eating too much, or not “getting it right.” As former dieters, we may have felt our “success” depended so much on being perfect, getting the diet right, and never falling off the proverbial wagon. Isn’t that why everyone blames people for diet failure? They didn’t stick to the diet, they weren’t perfect enough, and therefore they didn’t achieve the results. Even though we know this isn’t a personal failure – that the state of dieting is a completely unnatural one, that nearly everyone fails at weight loss over the long term, and that it has nothing to do with willpower – we often persist in this idea that if we had just done it perfectly enough, it would have worked out differently. So even when we give up dieting, I think we suffer from residual perfectionism. Normal eating is just a new thing to perfect. But really, it isn’t. I Ellyn Satter’s definition of what normal eating looks like:

 Normal eating is going to the table hungry and eating until you are satisfied. It is being able to choose food you like and eat it and truly get enough of it – not just stop eating because you think you should. Normal eating is being able to give some thought to your food selection so you get nutritious food, but not being so wary and restrictive that you miss out on enjoyable food. Normal eating is giving yourself permission to eat sometimes because you are happy, sad or bored, or just because it feels good. Normal eating is mostly three meals a day, or four or five, or it can be choosing to munch along the way. It is leaving some cookies on the plate because you know you can have some again tomorrow, or it is eating more now because they taste so wonderful. Normal eating is overeating at times, feeling stuffed and uncomfortable. And it can be undereating at times and wishing you had more. Normal eating is trusting your body to make up for your mistakes in eating. Normal eating takes up some of your time and attention, but keeps its place as only one important area of your life. In short, normal eating is flexible. It varies in response to your hunger, your schedule, your proximity to food and your feelings.

Notice she didn’t say anything about normal eating requiring perfection? There is room here for a lot of mistake-making. So make those mistakes and learn from all of them!

That leaves Judgment. It begins with wishful thinking. It’s like somehow even though dieting didn’t work to make us thin, we hope normal eating might. We are dismayed that when we start to listen to our bodies, they actually start to gain weight (for some, at least). I went through this myself. I felt betrayed that normal eating meant I might gain weight –that wasn’t right, was it?!? Intellectually, I knew that I had been suppressing my weight with dieting, and that weight gain might be natural – but emotionally I felt destroyed. Surely if I just learned to eat “normally,” I would have a “normal” sized body? (Those were early days and my ideas about what constituted a normal body were still dictated by crappy, oppressive cultural ideals.)

So we look at our bodies that seem out of control and decide that it probably has something to do with our new way of eating, which also feels completely out of control. We start to apply the brakes to our eating here and there. We try to eat a bit less, or eat more healthful foods than we want, or we go the other way and binge because we’re so stressed out or starving again. All of this behavior stems from the judgment we’re putting on our bodies and what we think they should or shouldn’t be doing. Next thing you know, eating normally doesn’t feel good at all, and it’s now not any easier than dieting was. Thanks judgment, you judgey asshole!

Despite being freaked the hell out, I decided to roll with the wisdom of my body, if only for one simple, driving reason: I could NOT go back to dieting. The mere thought of more restriction made me want to cry. And I wanted to be authentically me, not someone who lived in fear of what my body actually was when I satisfied my hunger in a totally normal way.

That decision was the key to me finally clicking with normal eating. I decided to not worry about nutrition (a challenge when you’re in the middle of a dietetics program), eat foods I felt like eating as much as possible, experiment when I wanted, and just tune into what my gut was telling me without stressing about whether I got it right or not. That last part was key – it didn’t matter if I wasn’t getting it right. And then one day, after a lot of reading* on the subject and experimentation, it felt like I was getting it right more often than I was wasn’t. And yeah, I still make lots of mistakes. Sometimes I eat too much, sometimes not enough. Whatever. I’ll get it right the next day. Or the day after that. I trust my body to make up for the mistakes.

If you’re in the middle of this process, have a stern talk with Judgment and Perfectionism. Thank them for whatever they’ve given you, and then kiss them goodbye. They don’t have a place in your diet-free life anymore.

*My favorite non-diet how-to-eat resources are:
Intuitive Eating by Tribole and Resch
Any book by Ellyn Satter but especially this one and this one
The Diet Survivor’s Handbook by Matz and Frankel
Overcoming Overeating by Hirschmann and Munter

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!