Thursday, May 5, 2016

The Biggest Loser Goes Bust!

Erin Naimi, RD, CEDRD

This revelatory piece in the NY Times, by Gina Kolata, has been making headlines all week and has been the major talking point in my office and the hallways as well.

In truth there's nothing particularly revolutionary about the content, but there is something quite revelatory about the conversations it has opened up.

Though there's no new data or science here, what seems to be a revelation (or mostly a disappointment) for people
 is  that truth is being spoken about how truly difficult achieving AND sustaining weight loss really is.
How damaging losing too much weight too quickly can be for your body and soul.
How no matter how hard you try and no matter how committed you are, sometimes biology really does have the upper hand, and that does not
make you weak, it only makes you mortal.

About 5 years ago I received a call from the producers of The Biggest Loser, they were looking for a new dietitian for the show.
I had never been a fan of the show, in fact their tactics seem appalling and humiliating.... so of course I took the meeting.
In my idealistic mind I thought, "maybe I can change their minds and help them see the errors in their ways."  I wanted to get them to see
that what they were promoting (in terms of drastic weight loss) could never be sustained- by anyone, and that furthermore their show
was just a grand display of public humiliation.
I spoke with them about the concept of  Intuitive Eating, how to facilitate real change in people's attitudes towards food, and how to help them feel normal again, (not like
the freaks they make them out to be on National TV).

They seemed  intrigued, one meeting led to another and another, and in the end they wanted sensationalism, they wanted ratings.
"So what if we put all their trigger foods in one room, and just let them go wild, you know like a room full of donuts, and chips, and ice cream...?" one producer asked.
I realized they weren't getting the point, and they would never get the point, because their contestants well beings was really the farthest thing from their minds,
for them, ratings rule.

So now here we are, the truth has been exposed: "The contestants from the Biggest Loser have regained their weight, and then some!"
They too are mere mortals like everyone else in this struggle.
Being on national TV with the most intense trainers and all that public support and exposure still
couldn't help them keep the weight off in the end. And just to add insult to injury, they have now been left with Basal Metabolic Rates
that are now lower than before they went on the show!
"Drastic Weight loss," The gift that keeps on giving!
The science behind it is so simple, and yet so complex that no one has been able to crack the body's code at this point.

Weight loss is NOT as simple as calories in vs. calories out!
It is NOT as simple as having will power!
It is NOT as simple as just cutting out the carbs or exercising more!
It is NOT as simple as cutting out sugar in your diet!

There is nothing simple about our relationships to food.
Each and every person out there who trying to lose weight has a story, has a long history with food that is rarely heard or understood.
To simplify their struggles and endeavors to a simple math equation is not only being simplistic, but it is also being ignorant and insensitive.

I wonder if the show and it's producers will now take a hard look at their tactics and see the damage they've facilitated, season after season.
I wonder if we, as a nation might stop tuning into the sensationalism, trying to live vicariously through these contestants, and stop fixating on finding that magic pill.
Maybe now, when people can see, and read with their own eyes, that there is no quick fix, that maybe drastic weight loss really isn't the way to go.
Or maybe this extreme and excessive focus on Obesity and weight loss in general is whats making everyone feel like a Big Loser!

Thursday, October 30, 2014

Parents:  Let Your Kids Eat Halloween Candy!
Erin Naimi, RD, CEDRD  

Years ago, I had a mom come to me in desperation hoping I could help with her candy-obsessed child, and presented me with her dilemma:

She was raised in a home where candy and junk food were abundant and readily available, and though she was seemingly healthy and had no health consequences as a result of being raised in a sugar-ridden environment, she wanted to make sure she was a healthier influence on her child, than her parents had been on her.

So it goes, in her quest to have a healthy household, she explained that she kept no “sugary foods or junk in the house”, and she tried her best to keep those foods out of her child’s reach whenever possible.   She went on to say, “…but I’m so frustrated, whenever we’re at a birthday party or somewhere where sweets are available, he is the first one at the dessert table! I don’t know what to do!” she exclaimed, with confused desperation.

Truth be told, I was utterly confused by her state of confusion.

Wasn’t it obvious that this child’s obsession was rooted in the constant lack of sugary resources he had available to him? Couldn’t she see that if her son had regular access to the “goods” that she kept at bay, that he really wouldn’t care so much about them when they became accessible in other environments?

Though the solution seemed so obvious to me, it took some coaxing to help her understand the repercussions of her restrictive ways.  I soon learned that I would encounter many more perplexed parents who found themselves in a similar quandary- wondering why the no junk food for my child rule was backfiring as evidenced by the innumerable empty candy wrappers found hidden underneath their children’s beds.

In a time where fears about “The Obesity Epidemic” are being rammed down our throats, I guess avoiding sugar might seem like the logical thing to do…. Or is it? As documented by Tara Parker-Pope in her recent NY Times article, The Lure of Forbidden Foods, “studies show that children who grow up in homes with restrictive food rules, where a parent is constantly dieting or desirable foods are forbidden or placed out of reach, often develop stronger reactions to food and want more of it when the opportunity presents itself." The article goes on to discuss how a child (raised in a restrictive household) will work significantly harder to attain the desirable snack foods, compared to a child who readily has access to similar types of foods at home. [1]

So on the eve, of Halloween I am making the plea to all parents, let your kids have their Halloween Candy!  Resist the urge to allow your concern for your child’s well-being force you to make (restrictive) decisions that will backfire and cultivate a rebellious, sugar-sneaking child in the long run. Halloween happens once a year-is meant to be a fun, creative, and celebratory holiday that also includes sugary indulgences, and to restrict a child of that part of it will usually just create more havoc in your household. 
My advice on how to handle Halloween without the havoc:
  1. After Trick or Treating adventures have concluded, engage your child in a conversation about the day as a whole as well as the candy they collected- but don’t make the conversation all about the candy. Ask them about the costumes and decorations they saw.  Did anything scare them? Are they excited about the candy and/ or other things they collected? Did they get what they wanted? Do they even care?
  2. Go through your child’s stash of candy with them. If there are any items that have known allergens that your child cannot tolerate or if anything looks remotely unsafe, remove those together and explain why it’s not safe for them to ingest.
  3. Decide together where the candy will be stored or placed. Do not hide or give away your child’s hard earned candy without their consent- they will either find it- or sneak some out of their friend’s lunch packs the next day!
  4. Use this as an opportunity to teach and model flexible limit setting and how to have “fun foods” in moderation.  You are still the parent and you can help determine how much and how often it’s ok to have the candy, depending on your individual child’s needs, interest, and eating habits.  This is most effective when it’s done collaboratively and your child does not feel like something is being taken away from them or dictated to them. It is absolutely acceptable to say that the candy can’t take the place of meals, but that they can have it as a treat after any or all of their meals- again, based on your discretion.
  5. Don’t panic if for the first couple of days your child shows a keen interest in their stash of candy (especially if it’s something that’s normally restricted from them).  Remember that the novelty effect will wear off.  The less reactive you are, the sooner they will bore of their new-found treasure (I assure you, they will.)
  6. If you have personal concerns about keeping candy in the house because you’re afraid that you may be unable to keep your hands off the goods, please find a way to address these concerns and don’t pass on your issues with food onto your child.

Candy and other fun foods are a part of our reality. Trying to avoid these foods and instilling fear in our children does not give them the tools they need to feel confident and in control of their choices when faced with these foods, as they inevitably will, throughout their lives.  Children who are raised to feel guilty about eating foods they like (whether healthy or unhealthy), grow to be guilt-ridden adults who don’t know how to set reasonable limits and moderate their needs, cravings, and desires in relation to food- that is a big part of what our Obesity Epidemic is about .

Please remember that candy and other fun foods can be a part of a healthful and balanced lifestyle, and a great model of normalcy. Just as no one wants their life to be all about work, school, and chores… we also don’t need our nutritional intake to be all about Kale, Quinoa, and Chia seeds!

[1] Parker-Pope, T. The Lure of Forbidden Foods, New York Times, April 2014.

Thursday, October 16, 2014

What The Dying Really Regret

by Kery Eagan

Patients often only appreciate how truly wonderful their bodies are until they realize that they will lose those bodies.

Editor's note: Kerry Egan is a hospice chaplain in South Carolina and the author of "Fumbling: A Pilgrimage Tale of Love, Grief, and Spiritual Renewal on the Camino de Santiago."
(CNN) -- "I know I'm supposed to hate my body," the patient said in her soothing Southern drawl.
She pushed away her lunch, a brown lump and pile of orange. Her son spent a lot of money to have low-fat, no-sodium, no-sugar, low-calorie meals delivered to the house while he was at work and she was home alone.
They looked like piles of wet rocks.
"I really could die happy if I was allowed just one more bite of caramel cake," she said with a sigh. The woman was dying of cancer, and I was her chaplain. "I don't suppose you have any?"
"No, sorry. But why are you supposed to hate your body?"
"Well, Kerry," she looked incredulous that I even asked and laughed. "Because I'm fat!"
She ran her soft hands over her ponderous breasts and her mounding, cancer-ridden belly. She spilled over the sides of her recliner. "I've known that since I was little." She examined the crocheted blanket on her lap.
"Everyone told me -- my family, my school, my church. When I got older, magazines and salesgirls and boyfriends (told me), even if they didn't say so out loud. The world's been telling me for 75 years that my body is bad. First for being female, then for being fat and then for being sick."
She looked up and this time tears trembled along her bottom eyelids.
"But the one thing I never did understand is, why does everyone else want me to hate my body? What does it matter to them?"
There are many regrets and unfulfilled wishes that patients have shared with me in the months before they die. But the stories about the time they waste hating their bodies, abusing it or letting it be abused -- the years people spend not appreciating their body until they are close to leaving it -- are some of the saddest.
Because unlike the foolish or best-intentioned mishaps, the terrible accidents, the slip-ups that irrevocably change a life, this regret is not a tragic mistake. It's intentional. It's something other people teach them to feel about their bodies; it's something other people want them to believe.
Sometimes, it's based on their allegedly unattractive physical features. They might be ashamed of their weight, their body hair, their thin lips or droopy eyes.
But this body hatred can also come from a religious belief about the sinfulness of their bodies. It isn't always the media and peer pressure that create this shame; sometimes it comes from a pastor or Sunday school teacher, or lessons at home that begin at birth and seep in along with mother's milk. Some women grow up thinking that their very existence in a body that might be sexually attractive to someone else is cause for shame -- that their bodies make bad things happen just by existing.
Either way, the result of the messages is the same: They lived their lives thinking their bodies were something to tolerate at best, something to criticize, to despise, at worst -- a problem they could never correct.
Too often, it's only as a patient realizes that he or she will lose their body that they finally appreciate how truly wonderful it is.
"I am going to miss this body so much," a different patient, many decades younger, told me.
She held her hands up in the dim light that seeped through the sunshade on the window. She stared at them as though she had never seen them before.
"I'd never admit it to my husband and kids, but more than anything else, it's my own body I'll miss most of all. This body that danced and ate and swam and had sex and made babies. It's amazing to think about it. This body actually made my children. It carried me through this world."
She put her hands down.
"And I'm going to have to leave it. I don't have a choice. And to think I spent all those years criticizing how it looked and never noticing how good it felt -- until now when it never feels good."
It isn't just health that they wish they had appreciated. It's the very experience of being in a body, something you likely take for granted until faced with the reality that you won't have a body soon. No matter what you believe happens after death, be it an afterlife, reincarnation or nothing at all, the fact remains: You will no longer be able to experience this world in this body, ever again.
People who are dying face that reality every day.
So they talk about their favorite memories of their bodies. About how the apples they stole from the orchard on the way home from school tasted, and how their legs and lungs burned as they ran away. The feel of the water the first time they went skinny-dipping. The smell of their babies' heads. The breeze on their skin the first time they made love outside.
And dancing. I've heard so many stories about dancing: USO dances during World War II; shagging at South Carolina beach houses; long, exuberant nights dancing at roadhouses and discos and barns. I can't count the number of times people -- more men than women -- have closed their eyes and said, "If I had only known, I would have danced more."
While these wishes and regrets are sad for each individual, they raise questions about how we all live our lives.
What does it mean that so many voices out there insist that the body is something to despise because it is too fat, sinful, ugly, sexual, old or brown? That we teach each other, in thousands of blatant and quiet ways, to think we are shameful? That our bodies are something to be overcome, beaten into submission or to be despised?
How do these voices telling us that we are supposed to hate our bodies affect our notions of how we care for the sick, disabled, elderly, children, mothers, soldiers, workers, immigrants, men and women? What we believe about our bodies affects how we treat other bodies, and how we treat each other's bodies is how we treat each other.
"You know what, Kerry?" my cake-loving patient asked as she ran the sleeve of her nightgown across her eyes. "Even though I was fat, even though I got pregnant when I was wasn't married, even though I've had this cancer for 20 years, and I haven't had any hair in years ... I don't hate my body. They were wrong, and they always have been.
"I thought I was going to die for so long, I figured it out. And that's why I've been happy anyway. I just need to figure out how to get some caramel cake into the house."

Friday, May 30, 2014

One day, in retrospect, the years of struggle will strike you as the most beautiful.
                                                                                               -Sigmund Freud

I woke up before dawn this morning with thoughts of a former client (who I will name Sarah) on my mind.  I was concerned about Sarah, not having heard from her for the past several months, knowing that the last time we had contact she was deeply entrenched in the throes of Anorexia Nervosa and Bulimia Nervosa, and on her way to another treatment center as a last ditch effort to save herself from the chronic battle she had been fighting for more than two decades.   As I started drifting back to sleep I thought, “I need to email Sarah, and see how she’s been doing lately….”

When woke up a couple of hours later there was a text message on my phone  asking if I had heard the news?
Sarah was dead.  
The funeral was this morning.
Unfortunately, my inspiration to reach out to Sarah had come a day too late.

I was deeply saddened and angered, but not shocked by the news.  While working with her over the last several years, I sometimes wondered and feared whether or not this day would ever arrive- the day when I would get the news that she lost her battle and we lost what was once a sweet, beautiful, charming, bright, loving soul.

In the past 15 years+ of doing this work, this is the second time I’ve received news of a client’s death. It doesn’t feel easier or less sad for me.  Each life lost to addiction is a devastating and unnecessary; it could have been avoided.

Eating Disorders can be deadly. I know we hear this all the time, but I don’t know if people really understand it.  People- young, vibrant, intelligent, loved people- die from the complications of Anorexia and Bulimia. It is true, it is real, and it is not worth it. Whatever pain, suffering, discomfort, shame, angst  you are feeling, turning to addiction in the form of drugs, alcohol, eating disorders is not worth it.
It is not worth putting your precious life on the line.

I know this is easier said than done.

When in the grips of any addiction, pulling away, getting help, and just tolerating the tsunami of feelings seems as unimaginable and unreasonable as stepping into the mouth of an actual Tsunami.
I write this tonight, not only as a plea to the individuals who are struggling to: reach out, get support, and not give up! I also write this with profound admiration and appreciation for all those who do fight the fight, and tolerate the unbearable discomfort(s) that beckon them to step back into the ease and seemingly effortless comfort of their self-destructive behaviors.

 Keep up the fight, because you are in fact fighting for your life.

I wish Sarah would have had the chance for that that “one day,” that day when all the years of her struggles would have seemed to her as the most beautiful.

Friday, May 23, 2014

Thursday, April 24, 2014

The Lure of Forbidden Food- NY Times
by Tara Parker-Pope

"...studies show that children who grow up in homes with restrictive food rules, where a parent is constantly dieting or desirable foods are forbidden or placed out of reach, often develop stronger reactions to food and want more of it when the opportunity presents itself."

Monday, April 21, 2014

Food Shaming- Women's Health Magazine
Why shaming one another about food is the new form of bullying.