The War on Obesity: A War Worth Fighting?

A few days after the FNCE (the American Dietetic Association’s annual conference) dust has settled, I still find my emotions riled up about the very first session I attended. John Foreyt, renowned obesity research and Linda Bacon, Health At Every Size (HAES) clinical researcher and advocate stood head to head to duke out their views on the “obesity epidemic.” John Foreyt staunchly defended his position that the war on obesity is a war worth fighting and Linda Bacon asserted that this war we are waging is ineffective, misguided, and even harmful.

I cannot escape the fact that I write this post from a very biased point of view. I simply cannot give a neutral, objective review of the debate because my feet stand so strongly in the HAES camp. I use a non-weight focused approach in my nutrition counseling and I am a certified Intuitive Eating (IE) Counselor (which means I teach my clients how to respond to internal cues of hunger/fullness rather than dieting).

So, I questioned whether to write this post at all, knowing I don’t currently have access to a recording of the debate and my memory seems to have only held on to the pieces of Dr. Foreyt’s arguments that I found uniformed, inaccurate, and downright offensive. So despite all of this, I sit here writing my two cents, which are heavily influenced by my flawed memory, passion for a non-weight focused approach to health, and personal experience in my own clinical work (and in my own life).

I cannot adequately re-cap the 90 minute debate. But I will recount my top 5 assertions that Dr. Foreyt made that I whole-heartily disagree with. If you are interested in learning more about HAES and Linda Bacon’s perspective, keep reading. I’ll share some fantastic resources at the end of the post.

Top 5 Unscientific, Unsupported, Inaccurate Assertions made by Dr. Foreyt:
1. There are no negative side effects to yo-yo dieting and weight regain (except “some bad feelings like depression for some people.”)

If Dr. Foreyt had properly done his homework, he would have known that dieting is the #1 PREDICTOR OF FUTURE WEIGHT GAIN! See here and here for two examples. And I think it’s a bit crazy for him to undermine the negative mental health consequences that are a by-product of weight cycling. Anxiety, depression, and chronic self-esteem issues are serious concerns. He treated them like nothing more than a pesky skin irritation, when in fact mental health problems are like a deadly form of cancer; challenging a person’s ability to live with a quality of life everyone deserves. We cannot minimize the effects of re-bound weight gain and mental health challenges.

2. Some of your clients will be failures and some will be successes. That’s no reason to stop trying to diet and lose weight. Just keep trying.
Whoa, hold it right there. I cannot stomach the notion that anyone I work with is a failure. But I suppose if there is only one way to measure success that might be the case. If there was a chemotherapy treatment that created more cancer than it eliminated, would we keep using it? No. So why do we keep using the same methods for weight control when the research shows that a weight-focused approach leads to more weight gain? I have learned something magical in my work. When I take the focus off the scale it allows me and my clients to work on core issues which affect body weight, food choices, and self-esteem.

3. Intuitive Eating is a cause of today’s obesity epidemic. Intuitive Eating doesn’t work.
#1 I about jumped out of my chair when Dr. Foreyt stated this. How on earth can he say that Intuitive Eating contributes to obesity when virtually no one in the US practices it?!? Not practicing Intuitive Eating is THE REASON most people struggle with food and many carry more weight than they naturally would.
#2 The principles of IE are often misconstrued or improperly applied. Dr. Foreyt, have you read the book or the research on IE? It is not eating with reckless abandon. No, quite the opposite. It is eating what you want in response to physical cues for hunger/fullness, while attending to emotional needs without using food. I cannot fathom how this can lead to increased rates of obesity.
#3Please see the IE website, where there is research showing the effectiveness of IE.

4. Dieting does work.
Unfortunately, every long-term clinical trial aimed at reducing body weight by placing clients on a specific diet that I’m aware of results in the lovely “J-Curve.” The J-Curve illustrates rapid weight loss, followed by creeping weight gain over time. The LOOK AHEAD trial, led by Dr. Foreyt is an interesting example. Like all obesity research, interventions like a healthier/reduced calorie diet and exercise protocols are given. Consequently, weight decreases but a whole slew of other parameters improve (ie blood sugar, fitness levels, cardiovascular health). What's really fascinating is that the decrease in weight is sometimes quite small, like less than 10 pounds. But the researchers always cite the improved parameters secondary to weight loss, rather than a natural consequence of eating healthier and moving more. Why the focus on weight loss?

 
Many people love to cite the National Weight Control Registry as an example of permanent/lasting weight loss. Dr. Bacon informed us that weight loss must only be maintained for 6 months in order to be added to the registry, with no clear way to have your name removed if you have re-gained your weight. Dr. Bacon shared a story of a student whose name is on the registry, but has since gained back more weight than she lost and hasn’t been able to remove her name from the list. The weight loss research we have shows the majority of lost weight gained after two years. So the National Weight Control Registry may not be a reliable measure of successful "losers."

5. It’s better to be skinny than fat.
Again, Dr. Foreyt needs to check the research because it actually shows that the life expectancy for a person who is categorically overweight but exercises regularly is longer than someone of a “normal weight” and doesn’t exercise. Having dedicated my career to working with eating disorders, I can promise that it is better to be healthy inside and out regardless of your body weight. Being thin is absolutely no guarantee than you are healthier or “better” by any standards.

Please let me make myself clear. I am an advocate for HEALTH. This means I am an advocate of:
1. Eating a balanced, nutritious diet that includes all foods
2. Eating when hungry and stopping when full MOST of the time
3. Learning to cope with emotions without using food
4. Learning to eat in a way that leaves you feeling energized and satisfied
5. Eating by your own rules and no one else’s
6. Incorporating exercise in a way that keeps your body strong (this can only be done if you are eating well first)
7. Eating guilt and stress free
8. Enjoying and finding pleasure in what you eat and how you move your body

And I believe that this is possible at any weight. I stand with Linda Bacon when she says that “fat” is not the problem, it’s the war on fat that is making us sicker and more miserable.

Finishing remarks:

My regret is that the session left a divided group more divided. If we are going to figure out how to create a nation of healthier people, those of us in the eating disorder field have got to come together and truly dialog with those in the obesity field. And until then, the war will certainly continue.

This is a controversial topic. What are your thoughts?

Linda Bacon's FNCE Handout

Validity of Claims Made in Weight Management Journals

Weight Science: Evaluating the Evidence for a Paradigm Shift

*Picture Source

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Product Showcase: Ak Mak Crackers

Alright, a few days ago I tore to shreds the poor brown rice cake in my product no case post. But I promised to share with you a whole grain cracker that I simply love.

It is the yummy and inexpensive Ak Mak Cracker! They have been around for ages and are available at just about every store. Yes, they are dry and crunchy (so that may be a turn off to some people). But the sesame seed flavor is super yummy.

I don’t mind snacking on them alone but find them to be a much more satisfying snack when eaten:
1. with peanut butter
2. with hummus
3. with turkey and cheese

I think you get the idea. I prefer them when eaten with some protein and fat to add flavor and balance for a more satisfying/longer lasting snack. You can even crumble on salads or soup too.

Do you love Ak Mak crackers? What’s your favorite way to eat them?

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Client Spotlight: Things I Wish For

We all have wishes. Things we long for, dream about, hope of. And I believe that taking care of our minds, bodies, and spirits is a pre-requisite to living a full and abundant life. A life that is full of wishes coming true. This beautifully written client spotlight could not capture these sentiments more completely. Imagine the possibilities when your whole health comes first.

Inside my body, my wishes circle my heart like little fish. Sometimes, when there is extra desire in a wish, that wish escapes from its place and wriggles up toward my throat. The wish can no longer be contained, and it grows so big that it keeps swimming, up past my throat into my eyes, where it finally gets released as tears. There are lots of things I wish for, but there are very few that have the potency to move me to tears. In fact, lately there has been just one, a yearning I feel more deeply than any other—the hunger for more human connection. 

Actually, the word “connection” seems too casual, like something you can achieve with the barista at your local coffee shop as you purchase your daily cup of caffeine. Perhaps what I am talking about can be more accurately termed “bonding,” or “intimacy.” On one level, I want friends - genuine friends with whom I can be myself, and who like me for who I am, not what I can do for them. I want friendships without unspoken rules or contingencies, where communication is direct and honest. For as long as I can remember, I’ve had this longing—for loyal, equal friendships with people who value me as much as I value them. I observe other people in their intimate pairings and I think: I want that. 

Yet the notion of taking direct action is relatively new. My hunger pangs for connection are sharper and more acute than those I felt during the years that I starved myself from food. For such a long time, this appetite for intimacy went unacknowledged, sublimated with a much more easily satisfied fixation on food and body. How relatively easy it was to focus on miles run and calories consumed, rather than on developing intimacy and friendships with other people, people who would surely judge me, deem me unacceptable, and leave. This strategy of displacement worked brilliantly for many years, until, suddenly, it didn’t. 

After years of working on recovery, I finally realized that all the attention I lavished on food and body would never be reciprocated, that I would always be alone unless I actively took steps to make room for other people. This new awareness marks one of the many shifts that has taken place inside me since I first made my commitment to recovery. The possibility of opening doors and cultivating relationships at once scares and intrigues me. I look forward to exploring this further.

What do you wish for?

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Crunchy Tofu Fingers

I am not vegetarian. Nor am I a huge fan of tofu. But I do like variety in my diet and am often surprised about the number of inquiries I receive from vegetarians concerned about their nutritional intake. In all reality, eating sufficient protein isn't terrible tricky (vegetarian or not). Great vegetarian protein sources include: beans, lentils, chickpeas, tofu, edamame, nuts and nut butters, dairy and dairy substitutes. Shoot for several servings of the listed foods and you will probably be doing pretty well. If you want more information on plant-based eating, this is a fabulous resource. I hope this recipe will be a fun way to incorporate a vegetarian-based protein even if you're not vegetarian!

I actually got this recipe from a friend's blog. She is vegetarian and I trust her judgement when it comes to good food! So while I haven't tried this tofu recipe myself, if she gives the stamp of approval so do I. Plus, it's a fun kid-friendly recipe if you're looking for that sort of thing. Or if you are still a kid at heart and love to dip things. :)

This meal goes great with green veggies and sweet potatoes. Dip the tofu in spicy marinara sauce for a little kick! And I highly recommend making the time to press your tofu in advance. It makes for much firmer tofu.

Crunchy Tofu Fingers
From Kiwi Magazine

1/2 cup flour
1 teaspoon salt, divided
2 eggs, lightly beaten
3/4 cup panko bread crumbs
1/2 cup Parmesan cheese, grated
1 teaspoon dried basil
1/2 teaspoon dried thyme
1/2 teaspoon dried oregano
1/4 teaspoon dried sage
1 pound extra firm tofu, drained and pressed
2 tablespoons canola oil

Find three medium-size bowls and set them on the counter. Measure the flour and 1/2 teaspoon of the salt, and mix together in the first bowl. Crack the eggs into the second bowl, and gently whisk. Measure the bread crumbs, cheese, basil, thyme, oregano, 1/2 teaspoon salt, and sage and mix in the third bowl. Slice tofu into 8 rectangles by cutting the block into 4 equal pieces, then halving each. Dredge each tofu finger in the flour, then the eggs, and finally the bread crumb mixture. Set aside on a plate. Heat a large skillet over medium-high heat. Add the canola oil, then place each tofu finger flat in the pan. Flip after 3 to 4 minutes. When tofu fingers are crispy, remove from the pan and place on a paper towel lined plate to drain. Serve hot, with marinara dipping sauce.

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#endED Recap with @BEDAorg

Thanks to all that joined our #endED Twitter chat this Wednesday with @BEDAorg as we talked about weight stigma. For those of you that missed it, here were some of the "highlights."

(If you don't know about Twitter, the @ symbol is the way a username is signified on Twitter. The # before a word makes the word searchable in Twitter.)

Q1a: How has #weightstigma affected you or someone you know?
@MarshaHudnall Seems like #weightstigma affects almost everyone I know. Creates dissatisfaction with life and distracts from what's important.
@JanetZimmerman research suggest #weightstigma increases body dissatisfaction and can lead to disordered eating behaviors

Q1b: How has #weightstigma affected your or their own ED journey?
@CounselorMusing Can lead to an increase in stress/anxiety/depression, can harm relationships, and can lead to isolation
@mmarzipan My least favorite #weightstigma aspect is when people ignore the mental health aspect of weight/body politics.
@marciRD Many people invalidate the severity of their #eatingdisorder if they feel they don't "look" a certain way.

Q3 What have you done recently when you recognize a thought that is stigmatizing?
@BEDAorg We must begin to each look within. I have my own stigmatizing thoughts about myself and others at times.
@VoiceinRecovery I catch it in a net & usually say WTF and throw it out. Weird but instant thoughts dont define me. I KNOW what I stand for
@mmarzipan Stop. Process. Think: who is this comment really about? Realize that it's NOT about me. Move on.
@BEDAorg We must begin to each look within. I have my own stigmatizing thoughts about myself and others at times. 

Q4 How can the eating disorders community better recognize and address stigmatization based on size?
@akaMemily I think it's helpful to look past appearance differences & see the internal similarities & shame found in EDs regardless of dx
@BEDAorg #weightstigma interferes in the treatment of eds. In the BED population, the ed is often put aside to focus on weight loss.
@BEDAorg Nurses in study: 31% would prefer not to take care of obese patients, 24% agreed that obese patients “repulsed” them
@BEDAorg There are studies showing that #weightstigmakeeps people from getting proper physical & mental health care
@mmarzipan Q4: not assume that someone of a certain size isnt suffering. Eating disorders manifest differently in people

Q5 How does #weightstigma contribute to body image issues?
@castlewoodtc Neg Body image is deeper than societal prejudice, but prejudice breeds discontent with oneself.
@BEDAorg I feel we cannot talk about body image issues without first acknowledging that weight stigma fuels them.
@MarshaHudnall #weightstigma makes anything outside the societal ideal unacceptable. and the societal ideal is for the most part underachievable 
@BodywiseProgram I think too we need to challenge our own eyes; expand our ideas about beauty to include all sizes/ages/colors...... #weightstigma
@marciRD When a single body size/shape is presented as acceptable, it is easy for false assumptions and negative self-image to grow

Q6 How do we best address those who believe that a person’s worth & will are based on that individual’s size?
@marciRD Make a list of the top 10 things you love abt someone you love. Be surprised if includes size/shape of their body.
@MarshaHudnall Modeling is one of the most effective ways to promote change. "Be the change we wish to see." 

@mmarzipan  Relentless compassion - those people are a product of their experience. Educate, breathe, and remember it's not about YOU

Q7 How do we keep all people-of-size from being bullied and discriminated against in a society that equates thinness and health?
@ScritchfieldRD it starts w/ us - being authentic, we have to use our voices, find our tribes of supporters, and believe in a better world #endED
@mmarzipan We can't. But we CAN create safe, nonjudgmental, loving spaces and live our lives by not buying into the bias.
@BEDAorg After a lifetime, I have learned to accept my body today as it is and each day this opens the door to something new.

Join BEDA during #weightstigma awareness week Sept 26-30. www.bedaonline.com to continue to spread the word! 

Also, check out @VoiceinRecovery's blog carnival on weight stigma. It is an awesome resource.

About #EndED
The goal of #endED is to bring anyone and everyone together who cares about ending eating disorders. My hope is to end the silence and myths about eating disorders, create a place for honest and informed discussion, while offering hope and encouragement. The next chat will be on 10/19 with Michelle May. Find her on Twitter at @EatWhatYouLove!

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#EndED Twitter Chat: Weight Stigma with BEDA

Our next #endED Twitter chat is Wed, September 21st at 8:30pm EST with @BEDAorg to talk about about weight stigma.

You might be asking what exactly is weight stigma? Weight stigma is bullying, teasing, negative body language, harsh comments, discrimination, or prejudice based upon a person’s body size. Weight Stigma is something that shames and hurts many people (of all shapes and sizes) and it is time to spread an awareness of how harmful it is to all and talk about it. 

About BEDA
Binge Eating Disorder Association (BEDA) was founded to help those who have binge eating disorder, their friends and family, and those who treat the disorder. BEDA provides individuals who suffer from eating disorders with the recognition and resources they deserve to begin a safe journey toward a healthy recovery. To learn more about BEDA check out: http://www.bedaonline.com/

About #EndED
The goal of #endED is to bring anyone and everyone together who cares about ending eating disorders. My hope is to end the silence and myths about eating disorders, create a place for honest and informed discussion, while offering hope and encouragement.

RSVP on Facebook and we hope to you join in!

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Product Showcase: Peanut Butter & Co Cinnamon Raisin Swirl

I love peanut butter. So when a client brought me a jar of Peanut Butter & Co's Cinnamon Raisin Swirl peanut butter I was pretty excited. BUT I was not prepared for the DELICIOUSNESS awaiting me. If you like peanut butter, cinnamon, and raisins then you MUST find the nearest store that sells Peanut Butter & Co ASAP. (If you don't like all of those things, they have some other fun flavors which you should check out.)

I love peanut butter for a lot of reasons:

• The smooth, rich, creaminess is like a little heaven on my tongue
• It pairs nicely with so many things: apples, bananas, crackers, oatmeal, waffles, marinades, soups, dressings, smoothies, and cookies
• The natural blend of protein and fat makes it a stellar partner with carbs like grains, fruits and veggies giving your snack or meal staying power!

Tip: as the temperatures cool and oatmeal starts to sound appealing, try mixing your favorite PB spread in your oatmeal. It's delicious and will keep you full for much longer than the oatmeal alone. Add some fruit and your set for a balanced, energizing, and comforting meal.

Are you a peanut butter lover too? What's your favorite way to eat it?

Note: If you have a peanut allergy, I apologize. I hope I didn't make you feel left out. I'll try to pick something next month that is allergy free. :)

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Grateful

Today marks a tragic day in America’s history. However, 9/11 is also a day that causes me to think about gratitude. So I felt inspired to share a piece of gratitude from a client of mine. I’ll be honest, when I’m in a sad or downright rotten mood, making a list of things I’m grateful for isn’t my first go-to activity. So it may be handy to have gratitude lists around all the time. You never know when you may need them the most! Below is an example of a writing exercise that relates to body image, but you can of course use the idea in any way you choose.

I’m grateful for my hair which dries naturally curly and doesn’t require a blow dryer to get ready.

I’m grateful for my eye sight which allows me to explore the beauty of the world.

I’m grateful for my shoulders which carry my heavy backpack day in and day out.

I’m grateful for my heart which pumps sure and strong when I run to catch my bus or am practicing yoga.

I’m grateful for my arms which allow me to hold my niece and nephew.

I’m grateful for my hands which are my tools for all of my creative energy.

I’m grateful for toosh which is nice and padded and allows me to feel comfy even when sitting on the ground (plus it’s awfully pinchable!).

Do you have any body parts that you feel particular grateful for? Why?

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Exercise: How to "make it count"

 * In order for my exercise "to count" it has to hurt
*In order for my exercise "to count" I have to do it 6 days a week, for at least an hour
*In order for my exercise "to count" I have to feel worn out after
*In order for my exercise "to count" I can't eat anything "bad" after

Ok, do any of the above statements sound vaguely familiar? When you see it written down, doesn't it looks somewhat abusive? Many people create totally unrealistic expectations of what their exercise should look like. And when they don't live up to those expectations, it's thrown out the window all together!

The Center for Disease Control has posted exercise guidelines for healthy adults. It states that in order to reap the health benefits from exercise, try to aim for 30 min of moderate exercise most days (not all) of the week. THIS INCLUDES: walking, riding a bike, doing water aerobics, mowing the lawn...perhaps hula hooping?

NEWS FLASH! You do not have to rake your body over the coals to benefit from physical activity. So lets let go of unrealistic, black and white goals around exercise.  Your best bet to "making it count" for the long run is to find exercise that you not only enjoy but can sustain. 

**Note: I tell all of my clients that a pre-requisite to any physical activity is consistent, adequate nutrition.

What are you feel-good exercise tips?


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Summer Salsas

 As August is coming to a close, I had to share with you two of my favorite summer salsa recipes. I guess I just can't let go of the idea of an endless summer. :) Pair these tasty salsa with corn chips, burritos, or burgers. They're a yummy way to incorporate fruits and veggies into your meal. Enjoy!



 Black Bean and Nectarine Salsa
Source: Today's Diet & Nutrition July/August 2008

1- 15 ounce can black beans, rinsed and drained
1 nectarine, chopped, about 1 cup
1 tomato, seeded and finely chopped, about 1 cup
1 serrano chile pepper, seeded and finely chopped (wear gloves!)
1/3 cup finely chopped red onion
1/4 cup chopped cilantro leaves
1/2 tsp grated orange zest
1 T fresh lime juice
Salt & black pepper to taste

In a mixing bowl, combine all ingredients and toss with a fork. Season with salt & pepper.


Mango Salsa
Source: Vegetarian Times June 2008

2 mangoes, peeled, pitted, and diced, about 2 cups (How to cut a mango)
1 large yellow bell pepper, finely chopped, 1 cup (I also do red b/c it's pretty)
1/2 cup finely chopped red onion
1/4 cup chopped cilantro
2T lime juice
1 red jalapeno chile, finely chopped
1/2 tsp. smoked paprika

Toss all ingredients in a small bowl. Season with slat and additional paprika if desired.

What's your favorite summer recipe?
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