Tuesday, August 22, 2006

what are you really feeling when you feel "fat"? and other interesting stuff

Cutting-Edge Therapies forEating Disorders by Jessica Setnick, MS, RD
Three strategies that dietitians can employ when counseling eating disordered clients include the apple test, the transitive property of fat, and recognition of the benefits of the eating disorder.

The apple test:
Eating in response to emotions can lead to overeating, compensating, and/or unwanted weight gain. The apple test is a way to help clients distinguish emotional needs from physiological hunger (Note: This strategy is not appropriate for patients who avoid eating.) At the onset of food thoughts or cravings and prior to eating anything that is offered, clients are advised to ask themselves: “Would I eat an apple?” Since apples are usually considered plain but nourishing food, the goal is to determine if you are truly hungry (“Yes, I would eat an apple”) or not (“I would eat a donut, but Iwouldn’t eat an apple”). If clients determine that they would eat an apple, they follow the guidelines provided by their dietitian or meal plan regarding what and how much to eat. If they find that they would not eat an apple, they follow the guidelines provided by the dietitian or mental health professional for identifying and managing emotional needs.

The transitive property of fat:
Because the “language of fat” is spoken so frequently in our culture, we learn to blame our bodies for our bad feelings. To help clients find non-eating disordered ways to cope with their feelings, they must first recognize that they are having feelings. Otherwise, they will continue to feel“fat,” a situation that has only one solution. Each person has a different definition of “fat.” Feeling “fat” indicates that a person is also feeling how he/she believes “being fat” feels. Clients may disagree with that statement and tell the dietitian they are only feeling fat, and nothing else. However, clients are really saying that because theoretically there is a solution to being fat, while there maybe no solution to other feelings. Using this strategy, dietitians can ask clients to walk through the grocery store and when they see a “fat”person (whatever they consider fat), think about what they assume that person’s life must be like. The dietitian might say to the client: “I know you don’t judge people based on appearance, but if you did, what might you think you know about this person? Is he lazy? Unproductive? Ugly? Lonely? Does he eat too much, eat the wrong things, let himself go?“ Whatever you think you might know about this person, this is what you equate with ‘fat.’ If you think that fat people are lonely, whenever you are lonely, you are bound to feel fat. If you believe that fat people are ugly, whenever you feel ugly, you are going to feel fat. Ugly and lonely don’t always have solutions, but when you know your definition of “fat,” you can discuss with your therapist how to handle that feeling, instead of turning to your eating disorder behaviors.”

Recognizing the benefits of the eating disorder:
Because eating disorders are a response to stress, they develop in response to underlying problems. Viewing an eating disorder as solely bad and shameful only makes a person feel worse for having it; the disorder prevents sufferers from finding the ways that it is actually “helping”them. Ask the client: “If you were to view your eating disorder as a solution, in what situations has it come in handy? How has your eating disorder helped you to get what you want, avoid what you hate, or express your true feelings? Your true problems are the very things that your eating disorder has helped you with. Once you have found the things that your eating disorder has helped you with, find non-eating disorder methods to solve them. When you are feeling strong, you won’t need your eating disorder to do your work for you.”

Eating: From Disordered toOrder—“What is Normal”?
by Reba Sloan, MPH, LRD
Many of my eating disordered clients have asked me to define “normal eating.” Whether clients are struggling to be free from the bondage of extreme dietary restraint or wrestling with the drive to binge on food, the goal is to help them arrive at a normal relationship with food, eating, and activity. This involves abandoning the “all or nothing” thinking and discovering a life lived in the “middle ground.”The first task is to help clients understand which aspects of their relationships with food are disordered. Most clients understand from a rational standpoint that their behaviors are imbalanced in this area. The powerful hold of their eating disorder can hinder them from accepting and living out this intellectual truth. Here are a few areas that dietitians can explore with clients in an effort to uncover disordered eating behaviors or cognitions:

Are you adhering to irrational rules regarding food and eating? (ie, “I can only eat 1,000 calories per day.” or “Carbs are bad/fattening.”)
Have your eating practices/behaviors contributed to a disconnect withyour hunger/full/satisfied cues?
Has the way you are eating and the activity you are getting or not getting contributed to “artificial” weight loss or gain?
Does your current relationship with food disrupt your emotional, social, or spiritual life?

After the client acknowledges thatdisordered eating is present, factors that may have contributed to this imbalance need to be addressed. Thisc an include emotional triggers that might cause someone to eat or not eat continually over a period of time, frequent dieting that stems from unrealistic weight or size goals, or living in a social-cultural melee that complicates finding the middle ground withour food, activity, and weight. Thereis no clearly defined crossover point where disordered eating becomes an eating disorder. Even if one does not meet the diagnostic criteria for an eating disorder, disordered eating can destroy peace of mind and quality of life. My experience has been that many clients struggling with disordered eating fit the diagnostic criteria for Eating Disorder Not OtherwiseSpecified (ED NOS). This initial work with a client lays the foundation required for the journey towards “the middle ground” of normal eating. I have come to see normal eating in the following terms:
Eating that does not cause chaos inone’s thoughts and behaviors with food.
A relationship with food that is not guilt- or shame-based.
Eating that is thoughtful and connected, not obsessive.
Eating that is satisfying and enjoyable.
Eating that is flexible, and, occasionally“disordered.”
Achieving normal eating is even harder than defining the term. It is a process that involves a “hammer and chisel” approach. Our job is to assist clients in this pursuit by helping them identify and change faulty beliefs regarding eating, food, and weight, and giving them nutrition advice to encourage variety, balance, and moderation and to promote “style of eating”work that allows for more effective connection to the body’s signals. In a nutshell, normal eating is a result of realistic and practical goals. This might be best summarized by a quote I once heard and have long since forgotten the source: “Moderation in everything, including moderation.”
Reba Sloan, MPH, LRD, is a nutritiontherapist in private practice inNashville, Tenn.

Thursday, August 17, 2006

On a diet?

I recently read the book Eat, Drink, & Weigh Less by Mollie Katzen (of Moosewood fame) and Walter Willett (Harvard School of Public Health). This has to be the first time in my entire life that I looked at a "diet" and thought, "I could totally do this!". The portions are generous, the food is delicious and totally real. No artifical sweetener, no frozen dinners, no convenience food, and the meals look fabulous. The only problem is that I work full time and have a family! The recipes are very time consuming, and for some of the dinners you have to make 3 of them. Perhaps if a I had a personal chef...

I have, however, been eating the breakfast, lunch, snack parts of the plan -- then just eating a mindful dinner with my family. So far, the food has been great and though I can't say I've never been hungry, I definitely haven't had that soul-sucking hunger I got on Weight Watchers. I don't arrive home desperate for anything that looks remotely like a carbohydrate because I'm so ravenous. I'm not sure if this is due to the composition of the meals or due to the fact that they are higher in calories than I've been eating. I've been eating a small breakfast, morning snack, small lunch, and afternoon snack, totally about 1000 calories. This plan has a breakfast of about 350 calories, a lunch of about 400 calories and a snack of up to 250 calories. So it's about the same number of calories, but more at breakfast with only one snack per day. I wish I had the time to cook some of the dinners. Perhaps on the weekends.

Tuesday, August 08, 2006


I posted this on a bulletin board I belong to:

"It's so easy to understand my desire to eat when I'm anxious, upset, bored, etc. The other day I was feeling a lot of anxiety over something-or-other and I thought to myself, "I wish I could just binge instead of feeling all of this!" It's much less difficult to not eat in a situation when I realize why I want to. It's more difficult when there doesn't seem to be any reason beyond greed for me wanting food! "

One of the posters wrote:

"Susan when you describe your "greed" ~ always wanting the biggest piece of cake, etc. It doesn't sound like greed to me .... it sounds like little Susan wants to make positive that she gets her fair share. It sounds like there have been times in life where you didn't get what you needed and that large piece of cake is a form of taking care of yourself"

Another wrote that there will always be more cake and I need to remind myself of this when I want to eat more even though I'm not hungry or when I want dessert even though I'm full after dinner.

I think the "little Susan" theory is a good one. Growing up, we weren't short on food but with six kids we often didn't get "seconds" unless we ate our "firsts" really fast. We weren't allowed to eat between meals, and rarely ate out or had "good" food like pizza, french fries, ice cream, or chocolate. In addition, I used food to soothe my feelings, epecially as I got older.

I indulge (or used to indulge) in other behaviors (besides overeating) that agree with the fear of deprivation theory. My coworker brings in (giant) bagels every Saturday and I don't eat them anymore. When I did, however, I always made sure to rush over to the bag and pick out the one I wanted right away & squirrel it in my locker if I didn't immediately eat it. I used to be the first one in line at every potluck or buffet, and the first to cut into any treat brought by a coworker.
These days I often skip the treat and wait until last to get in line at a potluck. BUT I do still sometimes squirrel away treats, as though I won't be able to get any later. Silly because I could buy or make anything (I'm a good cook, after all), but I still sometimes find myself doing it. If I could figure out how to get past the feelings of deprivation...

I suppose I just need to put up with them. But then again, there's that fear that they will always be there and never go away. The fear that I will feel and feel and feel deprived and a bowl of ice cream will never just be a bowl of ice cream to take or leave. I've tried and tried to tell myself that there will always be more cake. Sometimes it works (especially with cake that isn't homemade). Sometimes though I think that my inner little girl says, "Oh yeah? Well when? You aren't having it now, you didn't have it last week -- exactly WHEN will there be more cake?!?"