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    Archive for the ‘emotional eating’ Category

    You Ask, I Answer: Bariatric Surgery

    lapbandWhat is your opinion on bariatric surgery? I have lost a lot of weight by eating less and exercising more, but it took me a long time and I still struggle at times.

    I recently spent some time working at a bariatric center where they do procedures on adults and teenagers and it got me thinking about the issue.

    Just wondering where you stand on the growing popularity of this weight loss solution.

    — Maria (Last name withheld)
    New York, NY

    I certainly appreciate the need for surgical intervention with morbidly obese patients.  In many instances, it’s a matter of preventing an untimely death as a result of an overworked system that can no longer handle the amount of effort and work it takes to sustain itself.

    My concern, though, is for patients who do not simultaneously seek out help for their compulsive behaviors, thinking there is solely a physical component to their weight issues.

    A few years ago, actually, reports surfaced of many post-bariatric-surgery patients developing a gamut of addictions following their bariatric surgeries — from gambling to alcohol and drugs.  Depending on who you speak to within the field of bariatric surgery, anywhere from 5 to 30 percent of patients develop some sort of addiction shortly after receiving treatment.

    One problem, as you may imagine, is that research on this issue is fairly limited since the procedure itself is fairly new.

    That said, I can’t say I am at all surprised.  Too often, we forget that, for the vast majority of individuals, compulsive eating has deep, emotional roots.

    Bariatric surgery has its merits, but it must be part of a multi-prong approach that also examines psychological issues and foundations.

    It frustrates me that so a large percentage of conventional medicine practice fails to acknowledge the mind-body connection.  Detaching the emotional from the physical is, in my mind, an erroneous way to deal with medical concerns.

    If someone binges almost uncontrollably out of emotional issues dealing with self-sabotage and self-hatred, bariatric surgery does not tackle the root of the problem.

    The weight will be lost, but the emotional scarring that leads to the destructive behavior will simply be transferred somewhere else.

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    Survey Results: Hunger & Satiety

    The latest Small Bites survey dealt with the issues of physical vs. emotional hunger as well as recognizing satiety (a healthy feeling of fullness.)

    The results were pretty evenly spread out:

    Very well, always: 5%
    Very well, most of the time: 35%
    Somewhat well: 34%
    Not well at all: 24%

    I find this to usually be the most difficult hurdle for many people to jump over in their quest to achieve their healthy eating goals.

    After all, you can have the healthiest diet in the world (meaning, full of nutritious foods) but if your hunger and satiety recognition mechanisms are off, you can still end up overconsuming calories and gaining weight.

    These behaviors — and, in many cases, patterns — can be very frustrating to change largely because they stem from years of conditioning.

    I think a variety of factors can make it challenging for people to recognize their hunger level.

    For one, too many people assign themselves strict eating times.

    They may be hungry at 11 AM (say, two and a half hours after breakfast) but if they are meeting a friend for lunch at noon, they think, “Ah, might as well hold out. Don’t want to ruin my appetite!”

    WRONG! Part of being an active participant the hunger game is listening to your body’s cues.

    If your body is demanding a few nibbles at 11 AM, go ahead and provide them.

    This is not to say you now have a pass to eat two Entenmann’s donuts or half a stack of Pringles.

    However, if your next meal is in an hour, keep hunger at bay by snacking on an ounce of nuts (remember, an ounce is approximately 24 almonds – quite a bit!)

    Those 140 calories will keep you satisfied until lunch, making it easier to have one roll, rather than three, from the bread basket.

    What if the snack fills you up more than you think, and by the time you meet your friend you are only hungry enough for an appetizer? Then simply order an appetizer.

    Don’t order an entree just because your friend does and, well, you don’t want to “make her look bad” or “insult him.”

    Sharing lunch with a friend is about communication, catching up, and enjoying yourself. THAT should be your focus. Not second guessing yourself or putting your needs aside just to “look” good.

    The worst thing you can do is ignore your hunger. The trick is to feed your body foods that are filling and satisfying without breaking the caloric bank.

    A srerving of whole grain crackers, for instance, is a great way to give your body a little something in a 120 calorie package.

    Similarly, a piece of fruit or some baby carrots with hummus can help keep hunger at bay so you don’t have that insatiable need to devour something — ANYTHING! — on your way home from work later that afternoon.

    It is quite a simple formula. The more you ignore your hunger, the more likely you are to overeat and go past your satiety point.

    You can’t expect yourself to recognize a healthy feeling of fullness if you are absolutely starving!

    Another trap for many people? The idea that in certain locations — and situations — you must eat.

    Answer the following:

    How many of you eat a slice of cake at someone’s birthday party at your place of work simply because cake slices are being passed around, regardless of your hunger level?

    I know I have done it before. I distinctly remember a time when I had just finished a very filling lunch and stopped by a co-worker’s going away party.

    Whoever organized the food had gone all out. Cake, cookies, brownies, chips and salsa… it was all there.

    Sure enough, about five minutes after I arrived, the cake was cut, someone handed me a piece, and I dug right in.

    It was actually a little dry, and the frosting tasted like chemicals. After the third or fourth bite, I felt uncomfortably full — and dissatisfied!

    It suddenly hit me. I wasn’t having cake because I truly wanted some, or because I enjoyed the taste. I was having it because somewhere in my mind I thought I was “supposed” to.

    I still remember that event pretty vividly to this day because it truly gave me a different perspective on my relationship with food.

    Now, in social situations, I don’t think about what I “should” be doing or even what everyone else is doing. I simply ask myself: would I be eating RIGHT NOW if I wasn’t in this situation?

    Sometimes the answer is “yes,” but a lot of other times it’s “no.” And if someone asks why I’m not having a slice of cake or one of the catered sandwiches, I reply with the truth, “I’m not hungry right now, thank you.”

    And then there’s the movie theater. Sometimes I’ll snack on some whole wheat crackers and some trail mix (yes, I sneak food in — so sue me!). Other times, though, all I need is a beverage to quench my thirst.

    A few years ago, though, my mind always equated movie watching with popcorn, pretzels, malt balls, and soda.

    This is not to say you can’t enjoy some popcorn or share a chocolate bar with your movie companion next time you hit the multiplex, but the key is in doing that out of actual physical hunger, rather than some ingrained mandate that advertisers have lodged into our minds.

    These check-ins with yourself might initially seem odd and different. In a society so obsessed with consumption, we generally don’t hear the “Ask yourself — why am I craving this right now?” message.

    Once you develop it into a daily habit, though, you have quite a powerful tool in your hand.

    PS: I’ll discuss emotional eating in a future post (later this week.)

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    You Ask, I Answer: Nutella

    Since returning from a recent trip to Paris, I have been craving this [Italian chocolate and hazelnut spread].

    Could you touch on its positives and negatives?

    I feel guilty eating it.

    — Robin Cameron
    New York, NY

    Though Nutella has a cult following in the United States, it is as common as peanut butter in many European countries.

    The ingredients tell quite a tale.

    They are — in descending order of predominance by weight — sugar, modified palm oil, hazelnuts, cocoa powder, skim milk, lecithin, vanilla, and reduced mineral whey.

    Interesting fact: vegetable oils replace modified palm oil in Nutella sold outside of the United States.

    Meanwhile, this is what the nutrition label reveals:

    Nutrition Facts For 1 serving (2 Tablespoons)

    Calories: 200
    Saturated fat: 2 grams
    Sugar: 20 grams (5 teaspoons)

    We are clearly looking at a dessert treat without much redeeming nutritional value.

    That is not to say it can’t be enjoyed in a certain context.

    One tablespoon of Nutella (say, spread over a toasted slice of whole grain bread or some whole wheat crispbread) only adds 100 calories to your day.

    So in that sense, it is possible to enjoy a little Nutella.

    I firmly believe that in order to form healthy eating habits, guilt needs to be taken out of the equation.

    Guilt over enjoying decadent food accomplishes nothing but making you more vulnerable to extreme dieting, which in turn usually sets you up for bingeing in the future.  Next thing you know, the guilt cycle starts all over again!

    To prevent the risk of starting off with a tablespoon and coming back for 6 more throughout the course of the night, make Nutella a post-dinner treat, rather than a pre-dinner snack.

    Since you will feel fuller after finishing dinner than an hour before you sit down at the dining table, this reduces the risk of trying to quash your hunger with a delectable sweet spread that is fine in certain amounts.

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    In The News: Recession & Health

    Today’s Los Angeles Times features an article suggesting that recession may lead to better health, due to people cutting down on risky health behaviors.

    Although “medical science has accumulated a solid body of research showing that poverty and unemployment lead to higher rates of obesity and more cases of diabetes, asthma, kidney disease, cardiovascular disease, [and] some cancers,” recent economic research is concluding differently.

    “This is about the macro picture, the health of entire societies. And their statistics show that as economics worsen, traffic accidents go down, as do industrial accidents, obesity, alcohol consumption and smoking. Population-wide, even deaths from heart disease go down during recessions.”

    I’m not very convinced — at least not as far as the United States is concerned.

    Although healthy eating can be financially viable, we are talking about a culture where instant access to an inexpensive meal often trumps its nutritional value. Consequently, picking up KFC on the way home or a $1 donut for breakfast is often chosen over spending 10 or 15 minutes in the kitchen whipping something up.

    It also doesn’t help that at many fast food establishments, an additional 50 or 75 cents can increase a meal by several hundred calories.

    My particular concern is that economic recessions — which include higher unemployment rates — can be emotionally taxing.

    And, as is the case with finances, eating is very much tied to emotions.

    The formula is rather simple in my mind — the worse you feel, the worse you eat. And the worse you eat, the worse you feel.

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    You Ask, I Answer: Hunger/Metabolism

    I’ve always welcomed feeling hungry as an indication that I’d run out of easily accessible energy and therefore was digging into my accumulated fat.

    I mean, how can you lose weight without feeling hungry?

    But, I’ve also read that hunger is associated with a slowing of the metabolic rate which suggests I should NOT welcome the feeling, but instead eat something.

    For the sake of argument, suppose I’m disciplined enough not to eat when I feel hungry. Should I eat something or not?

    How much does one’s BMR vary in response to the sensation of hunger?

    I’m 10-20 pounds overweight, (i.e. not obese) and looking for a strategy to maintain my weight or lose a bit.

    — Robert Keyfitz
    Washington, DC

    Hunger is multi-layered concept.

    Firstly, we humans are “special” because our hunger can be motivated both physiologically (there are different theories on this, ranging from low glucose levels to altered body temperature to stomach contractions) and psychologically (reasons not related to the body demanding calories, such as eating to alleviate emotions, eating out of habit, or eating “because it’s time to.”)

    Oh, yeah, animals don’t know what they’re missing — only we Homosapiens run the risk of scarfing down a bag of chips after a lousy date!

    Your question also brings up the issue of weight loss and hunger.

    Since these two are closely linked together, it is very important to have a carefully constructed weight loss plan drawn up by a professional – preferably a Registered Dietitians – who is able to implement strategies to make weight loss more manageable.

    Telling someone who regularly eats 4,000 calories a day to go down to 1,400 overnight — as many popular diets recommend — is a recipe for disaster; yet, because people love quick fixes, they give it a try.

    We know what happens. A week later they are about to lose their minds, drop everything, and go back to their established patterns of eating, without having learned any fruitful tactics.

    So, should you eat something when you feel hungry?

    This really depends on where the hunger is stemming from. Is it physical hunger, or is it masking other underlying emotions (anxiety, depression, boredom, fear, etc?).

    Assuming we are talking about physical hunger, the answer is “yes.” The tricky part involves making the right choices.

    The key is to choose lower-calorie foods that satiate. Remember that protein, fats, and fiber are the three pillars of satiety.

    Note, though, that it is not necessary to have all three of those nutrients present in one food to feel full.

    Let me give you an example.

    A low-fat, low-protein, fiber-free food like pretzels is a terrible choice, as it takes quite a bit of them (and, thus, quite a bit of calories) to provide a feeling of fullness.

    However, something like oatmeal (prepared with some skim milk) provides plenty of fiber and protein. Those 200 calories will leave you fuller for much longer than 200 calories worth of pretzels.

    In order to keep metabolism running steadily, I recommend going no more than three hours without eating.

    Again, though, this means having small snacks in between meals, not meals in between meals. A large triple chocolate shake from McDonald’s may keep you full for several hours, but it also adds 1,160 calories to your day.

    Going long periods of time without eating a single morsel of food not only decreases your metabolism, it also makes you more prone to binging.

    One of the best weight-loss/maintenance strategies you can implement is to be in control of your food intake.

    This means respecting your hunger and satiety, making deliberate choices, and supporting your eating with some structure (i.e.: not letting yourself go more than 3 hours without eating).

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    You Ask, I Answer: Low Calorie Diets

    What would you say is the minimum substantial amount of total calories you should eat to lose weight?

    Are 800 calorie diets really that bad?

    I was told that if you eat below 600 calories, your body goes into starvation mode.

    But if you stay from 600-1000, then you’re guaranteed weight loss?

    I just want to figure out what I’m doing wrong and fix it.

    I recall you saying that’s the wrong way to go but then why do so many dietitians and weight management centers recommend this ?

    — Janie (last name unknown)

    New York, NY

    Low calorie diets (those going below the minimum daily recommended intake of 1,200 calories) are a terrible idea.

    I take issue with the entire concept of a “diet.”

    If you go on one, you will inevitably go off it. And then what?

    Most likely, old habits return — along with the weight you initially set out to lose.

    What I recommend is a metamorphosis towards improved dietary patterns and relationships with food.

    I want to point out that this should always be looked at as a work in progress, and a process that isn’t consistently moving in one direction.

    An emotional setback or particularly stressful time, for instance, might have you reverting to old dietary patterns or seeking out high-calorie, sugar-laden comfort foods.

    Not surprisingly, in a society where we are basically told that if we do not get what we want in 7 days or less we might as well resign ourselves to the fact that we are failures, this thinking doesn’t exactly dominate the mainstream media.

    Instead, people are told that in order to lose weight, they must:

    Believe that food does not make them fat (The Secret)
    Not eat brown rice and chicken in the same meal (Suzanne Somers)
    Get a colonic every 2 days (Kevin Trudeau)
    Drink a hideous mix of maple syrup, lemon juice, and cayenne pepper (Hollywood fast).

    And so on and so forth.

    If any dietitian, weight center, or book recommends that you eat less than 1,200 calories a day, RUN – do not walk – away.

    Going below this figure poses several problems.

    From a weight loss perspective, metabolism slows down (especially since the thyroid gland slows down production of thyroxine, a hormone that plays a major role in metabolism), lean mass is lost, and muscle tissue is broken down in order to create glucose.

    So, when you return to your normal caloric intake, you will undoubtedly gain weight because your body is no longer as efficient at burning calories.

    Going below 1,200 calories is also problematic from a health perspective.

    With such low caloric intakes, it is extremely difficult to obtain necessary nutrients from food, including fiber, calcium, iron, and potassium.

    Sure, there are always supplements, but healthy compounds like polyphenols, lignans, and certain antioxidants are exclusively found in foods, not pills.

    What always strikes me as odd is that many times I see people who normally consume 2,500 calories start a 1,200 calorie diet overnight.

    Completely unnecessary.

    If that person were to simply slash 500 calories each day, they can enjoy 2,000 calories on a daily basis and kick-start weight loss.

    You mention not knowing “what you are doing wrong.”

    I am assuming you are having a difficult time losing weight.

    I do not know your individual circumstances, but by reducing your caloric intake (say, by 300 calories each day) and increasing your physical activity, you should begin seeing slow, steady results.

    If this is not the case, I recommend having your thyroid checked by an endocrinologist.

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    You Ask, I Answer: Low Calorie Diets

    What would you say is the minimum substantial amount of total calories you should eat to lose weight?

    Are 800 calorie diets really that bad?

    I was told that if you eat below 600 calories, your body goes into starvation mode.

    But if you stay from 600-1000, then you’re guaranteed weight loss?

    I just want to figure out what I’m doing wrong and fix it.

    I recall you saying that’s the wrong way to go but then why do so many dietitians and weight management centers recommend this ?

    — Janie (last name unknown)

    New York, NY

    Low calorie diets (those going below the minimum daily recommended intake of 1,200 calories) are a terrible idea.

    I take issue with the entire concept of a “diet.”

    If you go on one, you will inevitably go off it. And then what?

    Most likely, old habits return — along with the weight you initially set out to lose.

    What I recommend is a metamorphosis towards improved dietary patterns and relationships with food.

    I want to point out that this should always be looked at as a work in progress, and a process that isn’t consistently moving in one direction.

    An emotional setback or particularly stressful time, for instance, might have you reverting to old dietary patterns or seeking out high-calorie, sugar-laden comfort foods.

    Not surprisingly, in a society where we are basically told that if we do not get what we want in 7 days or less we might as well resign ourselves to the fact that we are failures, this thinking doesn’t exactly dominate the mainstream media.

    Instead, people are told that in order to lose weight, they must:

    Believe that food does not make them fat (The Secret)
    Not eat brown rice and chicken in the same meal (Suzanne Somers)
    Get a colonic every 2 days (Kevin Trudeau)
    Drink a hideous mix of maple syrup, lemon juice, and cayenne pepper (Hollywood fast).

    And so on and so forth.

    If any dietitian, weight center, or book recommends that you eat less than 1,200 calories a day, RUN – do not walk – away.

    Going below this figure poses several problems.

    From a weight loss perspective, metabolism slows down (especially since the thyroid gland slows down production of thyroxine, a hormone that plays a major role in metabolism), lean mass is lost, and muscle tissue is broken down in order to create glucose.

    So, when you return to your normal caloric intake, you will undoubtedly gain weight because your body is no longer as efficient at burning calories.

    Going below 1,200 calories is also problematic from a health perspective.

    With such low caloric intakes, it is extremely difficult to obtain necessary nutrients from food, including fiber, calcium, iron, and potassium.

    Sure, there are always supplements, but healthy compounds like polyphenols, lignans, and certain antioxidants are exclusively found in foods, not pills.

    What always strikes me as odd is that many times I see people who normally consume 2,500 calories start a 1,200 calorie diet overnight.

    Completely unnecessary.

    If that person were to simply slash 500 calories each day, they can enjoy 2,000 calories on a daily basis and kick-start weight loss.

    You mention not knowing “what you are doing wrong.”

    I am assuming you are having a difficult time losing weight.

    I do not know your individual circumstances, but by reducing your caloric intake (say, by 300 calories each day) and increasing your physical activity, you should begin seeing slow, steady results.

    If this is not the case, I recommend having your thyroid checked by an endocrinologist.

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    Say What?: It’s not April 1 Yet, Is It?

    Down in Mississippi — one of the most obese states in the country — three members of the House of Representatives have come up with what they believe is a solution to the obesity epidemic.

    W.T. Mayhall, Jr. (R), John Read (R), and Bobby Shows (D) have drafted Bill number 282.

    Its proposal? Make it illegal for state-licensed restaurants to serve obese patrons.

    They are under the illusion that the Department of Health would not only agree with this idea, but also provide them with specific criteria to determine who falls into the obese category.

    You can view the actual bill here.

    There are so many problems with this, I don’t even know where to start.

    From a social standpoint, this is a terrible idea. An obese person can no longer be able to go out to dinner with friends or family?

    While restaurants often serve mega-size portions loaded with calories, unhealthy fats, and sodium, they are not the direct cause of obesity.

    Someone can never set foot in a restaurant and easily remain obese.

    Supermarkets offer a plethora of unhealthy foods (donuts, ice cream, potato chips, frozen pizzas, candy bars) anyone can purchase and have available at their homes around the clock.

    Add years of physical inactivity as well as no access to nutrition education and other resources, and you have the perfect breeding ground for obesity.

    Remember, too, that obesity often has a strong psychological component behind it.

    Food — and the accompanying extra weight — serves as a type of shield, or emotional security blanket, to hide behind.

    Banning obese people from restaurants is absurd and does not tackle the real issues.

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    Oklahoma City’s Challenge

    The only times Oklahoma City is mentioned in the context of nutrition and fitness is when it tops lists of unhealthiest, most overweight, least fit, and top fast food spending cities.

    In 2007, Fortune declared it the “fast-food capital of America.”

    Mayor Mick Cornett saw all these developments as an opportunity and created the “This City is Going on a Diet” program.

    The goal is to have Oklahoma City residents lose a collective 1,000,000 pounds between January 1, 2008 and December 31, 2008.

    This figure is recorded and monitored by the program’s official website, where people register and track their weight loss.

    The website offers links to several weight loss programs and local fitness centers and also informs visitors of upcoming walks and marathons.

    Two thumbs up for offering behavioral modification resources (ranging from Overeaters Anonymous to smoking cessation programs) and recognizing that a healthy lifestyle entails more than simply the foods we choose to put in our mouths.

    I do wish, however, that the nutrition resources offered more than links to weight-loss companies.

    When it comes to weight management, nutrition education and literacy is crucial. How about a section on how to read labels and identify whole grains, for instance?

    The wordsmith in me isn’t too content with the word “diet” being used in this program.

    It makes me think of a short-term thing people go “on”, only to then go “off” on. It doesn’t fully communicate the concept of integrating healthier life-long habits.

    I’ll chalk it up to needing a cute catchphrase, since the website is responsible and does not advocate crash diets or insane regimens.

    By the way, be sure to take a look at this map of obesity in the United States over the past two decades. Scary!

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    You Ask, I Answer: Weight Watchers

    I was [talking to a friend today about] how fad diets don’t work, because you deprive your body of calories for a short time, and the weight comes back on. But [she] was saying she does Weight Watchers, and she doesn’t consider it to be a ‘fad’ diet because she’s lost weight and kept it off, and eats balanced meals.

    I’m torn, because Weight Watchers seems like a big ol’ scam to me. What do you think?

    — Anonymous (per writer’s request)

    I agree with your friend — Weight Watchers is most certainly not a “fad” diet.

    What I like about Weight Watchers is that, above all, they stress calorie and portion control. Additionally, their famous “point” system (used to determine how many calories you should be taking in) is determined by taking into account a variety of factors, including weight, age, and physical activity level.

    Unlike many fat diets, the Weight Watcher program does not suggest anyone eliminate entire food groups from the diet or deprive themselves.

    Their belief — which I agree with — is that there is no such thing as “good” or “bad” food. Instead, you should strive for balance and watch your calories and portions. THAT is the key to successful and permanent weight loss.

    Banning flour or sugar for life is not only impractical, it also does not guarantee permanent weight loss (you could get extra calories from fats or sugar-free candy and still gain weight).

    Additionally, Weight Watchers recognizes emotional patterns and support systems as crucial pasts of a successful weight-loss system.

    I also like the idea of meetings — at least initially — as a way of providing supportive environments for people. At the same time, I am glad they now offer an online program to people who dislike — or are unable to attend — meetings.

    My only “concern” with Weight Watchers is that they now sell a lot of processed products (cupcakes, muffins, cereals, etc.) that, while low in calories, drown out what I believe is the better suggestion of “eating close to nature”.

    As an occassional treat, they are suitable choices, but I find them to be loaded with preservatives and very artificial tasting.

    If anyone were to ask me what popular “diet program” I would recommend, Weight Watchers would be one of my top choices, hands down.

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