Thursday, February 28, 2008

Book Report

You may have noticed a new edition to the EWHAED book club (quick, look over on the right!) It's Abby Ellin's Teenage Waistland, a part-memoir, part-reference look at how parents can best help their overweight (and, here, I mean this in the most literal sense--over the "ideal" weight our society has agreed upon, as some of the adolescents Ellin describes, including, herself, are not really fat) teens. In Teenage Waistland, Ellin tackles difficult questions, such as: 1) What should you say/not say about your child's body? 2) How can you respond to your overweight teen who is bullied at school? 3) Should you send your teen to "fat camp?" 4) How about diets? 5) Is losing weight simply a matter of willpower? 6) Why don't heavy teens want to be thinner? 7) What should you do with your overweight teen who eats well and exercises but can't seem to lose any weight?

As for the answers to these questions, you'll have to read the book. And trust me, it'll be a treat--not just because it's chock full of helpful information and case studies, but because Ellin reflects on her personal experiences in a sensitive, yet light-hearted way and because she uses careful and poignant language to make her point and to convey the deep-seated relationship between emotions and our weight. There are plenty of books out there on how to help your children lose weight and/or gain acceptance of their bodies. Ellin, having personally climbed through the fat-camp and diet-fad ranks, can effectively tell us how.

Monday, February 25, 2008

The "Big" One

Several weeks back, I attended a Broadway show with a friend. In between numbers, I whispered to my friend something about one of the cast.

"Which one?", she asked.

"The big one," I replied.

My friend looked at me curiously. "I'm surprised you said that," she said, all-too-familiar with my work.

The show went on, as did our hushed dialogue.

"Why?" I asked, "I didn't mean it negatively. I was just trying to identify her." And, I was, in a sea of tiny, ballerina-bodied cast mates, simply targeting the feature most quick to differentiate. I also could have said, "The one with the long, black hair" or referred to her as the part she was playing, but this was honestly the first thing that came to mind, and when you're talking during a Broadway show, sometimes brevity is key.

For the record, the "big" one was probably as Size 12. She just stood out. And, to me, there's nothing wrong with referring to someone as "big," or "fat," or "large." (I actually much prefer these to "obese" or "overweight.") They're simply descriptors. . . just like long, black hair.

So, was I wrong? Should I have found another feature by which to identify her, or was I (un)consciously working to destigmatize big?

Friday, February 15, 2008

Living & Eating

Master chef Julia Child once said: "Life itself is the proper binge."

I came across the quote recently on a birthday greeting card, and immediately, the wheels started turning--first, IS life really a binge? (Certainly, this is an individual question). And, if it isn't, is this reflected in our eating? If we feel that we're not getting enough out of life, do we compensate by bingeing on food?

Geneen Roth is famous for saying, "We eat the way we live." I wonder, though, do we sometimes eat the way we DON'T?

Tuesday, February 12, 2008

Baby Weight

A while back, a pregnant friend informed me that her ob-gyn had issued some pretty strict guidelines about her pregnancy weight. I was surprised to hear some of her doctor's recommendations and asked this friend if I might interview her for my book/blog; we agreed to talk once she had delivered. Said friend is now the proud mother of a healthy, adorable baby girl, has returned to work (as a psychologist), but still found time to answer the questions below:

1) What foods were you advised to eat, to avoid? Did she propose a daily caloric intake?

She said to avoid fruit (eat it only once or twice a week), avoid the "bread basket" and refined flour. . . . It sounded to me like she was recommending a low carb diet. I was told not to eat any more than I was eating before I got pregnant since I looked "normal" and "thin" (pre-pregnancy). She said that the fetus does not need much in terms of calories.

I told her that I was eating fruit, bread, etc. She said "okay" but encouraged me not to eat more than I was already eating or change my eating habits (except to avoid high mercury fish, more than one serving of caffeine per day, avoid alcohol, etc.).

Another patient that I met in the waiting room (our doctor told her that she was gaining too much weight) said that our doctor told her to eat the following: eggs for breakfast and maybe some yogurt and then salad with protein for lunch and dinner (fruit as a dessert/treat 1-2 times per week). She was told to avoid bagels since they are high in carbohydrates/calories.

2) What did your doctor suggest would be a healthy weight-gain during your pregnancy? What were her concerns about you gaining more?

She said that she recommended to her patients not to gain more than 20-25pounds despite the standard medical recommendation being 25-35 pounds because you don't need more than 20-25 pounds. . . . She explained that any more is "just weight you have to lose."

3) Do you think the above information was correct? How do you think the advice would have differed in a non-NYC population?

Most doctors (even in NYC) suggest gaining 25 to 35, but there is definitely more emphasis on weight gain here. I don't think her advice was very helpful. The way she encouraged her patients to eat (avoid fruit when it is so rich in vitamins, etc.) did not seem helpful. A plan-based diet rich in whole grains (e.g., whole wheat bread) and fruits, etc. is a part of a healthy diet during pregnancy (and always). She is encouraging eating behaviors that are not consistent with nutrition research or standard advice given to pregnant women (especially for someone that may have struggled with an eating disorder). Then again, doctors don't get much nutrition training in medical school.

The average weight gain during pregnancy is supposedly 25-35 pounds (that is what most doctors recommend to their patients). Most people I know gained at least that, often 40 or 50 pounds. To be honest, I don't think you have total control over it. My girlfriends have varied so much! And it did not totally have to do with how much or what they were eating. With respect to weight gain during pregnancy...I think some of it genetic, depends on body type, weight before pregnancy, etc. You can stay active (exercising in moderation) and avoid binge eating, eat healthy, etc. to prevent excessive weight gain but at a certain point you only have so much control.

I felt that her advice was extremely troubling! There seemed to be more emphasis on weight gain than eating healthily. I understand gestational diabetes is a problem and some people see pregnancy as a break from watching their weight (e.g., eating a lot of sweets or high fat foods, etc.) and end up gaining a large amounts of weight...HOWEVER, women already have enough to worry about during pregnancy (the baby, health, body changes, etc.).

I think the advice should should be on health NOT weight gain. It should be to eat as healthily as possible and to eat sweets, etc. in moderation...and to stay active (doing exercises adapted for pregnancy) to promote a healthy baby (first priority) and healthy pregnancy and postpartum recovery. Weight monitoring should be emphasized to make sure the baby and mother are healthy...not as pressure to keep your weight gain low so that you look good afterwards. Patients should be informed that there is a great deal of individual variation, so they should just try their best to eat a healthy diet and exercise in moderation (to feel well and prepare for late pregnancy when it harder to get around & labor & recovery).

4) Did you follow your doctor's guidelines? Did you, at any point, think about switching doctors?

I was quite ambivalent about staying with her. I felt self-conscious and the major goal of each check-up was to check my weight gain (even during visits when she did not bring it up, I found myself bring it up and seeking her approval). I think that if I had gained more than her recommended amount, I would have changed. I seriously thought about it during my second trimester (when I gained the most weight, at the point I had gained 15 pounds) and she suggested that if I wanted to "follow" her recommendation of 20-25 pounds instead of the average 25-35 (30ish), I should slow the weight gain down. She asked me if I was exercising as "vigorously" as before, what types of foods I was eating, etc. She said not to "stress" too much since I was "thin" to begin with if I ended up gaining around 30. She said that if I had been overwieght to begin with, she would have been "upset" that I had already gained 15 pounds.

I did not gain much during the third trimester and she complimented me on it several times, telling me that she was "really happy" with my weight gain. The reality is that everyone's weight gain occurs at a different rate (some people gain more in the middle, others at the end). I don't think it was due to me doing anything to slow my weight gain down.

I ended up gaining 22 pounds. However, I did not really follow her diet advice. I think it was just genetic (similar to my mother during her pregnancies). I ate a decent amount of fruit and bread products, chocolate, etc! I was just mindful of eating everything in moderation (not restricting), trying to eat as healthily as I could) and staying active.

5) What did your doctor have to say about you losing the baby weight post-delivery?

Not much, thank god. But if I had gained more weight, I am sure she would have! If there's anything else, please let me know! Thanks so much, Stacey

Thanks, G, for sharing your story. . .

Thursday, February 07, 2008

Raising an E.D.-Free Little Girl

An old college friend and I recently caught up at another friend's celebration. She expressed interest in my life (and I hers) and then, around midnight, she asked, "So, how do I raise my daughter so that she doesn't develop an eating disorder?" One of my occupational hazards--being asked to provide meaningful psychological commentary in a social situation, second only to the "Are you analyzing me?" concern. . .

And, here, to the best of my recollection, appears my short, adlib list, dedicated to my old friend's adorable toddler, but applicable to all of our little girls:

1) Throw out your scale.
2) Talk about foods with regard to how they can nourish her body, rather than their effects on her weight.
3) Encourage physical activity for the sake of health, rather than weight control.
4) Don't judge your body in front of her--don't say negative things about your body or even glance in the mirror in a critical way.
5) Focus on all of her strengths outside of her body, but make it a point to tell her how beautiful she is.

Any others you'd like to add?

Monday, February 04, 2008

Penn & Teller Weigh In

This weekend, a friend alerted me to the latest season of the Showtime series, Penn & Teller. According to the show's site, in Season 5's premiere, "Obesity":
Penn & Teller reveal truths about the Obesity epidemic. A visit to an Obesity conference exposes the uncomfortably cozy relationships between the medical establishment, the diet companies and the weight loss industry. An advocacy group for overweight people tells us about the hardships and discrimination brought about by their weight. Plus, the first-ever Penn & Teller 'Fat Guy Olympics.'
Penn, a la Paul Campos, introduces the topic quite bluntly: "The obesity epidemic is bullshit." He and Teller (I'm never quite sure how Teller earns his keep, though he does jump on a treadmill at some point during this episode), debunk the obesity myth by visiting "The Annual Meeting of the Obesity Society" in 2006, sponsored by, as they point out, the drug companies that make diet pills, where a bunch of (usually) thin researchers suggest that curbing obesity is simply a matter of controlling diet and exercise. P & T note that if the equation were that simple, none of these researchers would have a job!

P & T actually interview Paul Campos, Professor of Law at the University of Colorado, and author of The Diet Myth. Campos weighs in on the "obesity epidemic," suggesting our nation's collective weight is a sign of economic development instead, and offering three of myths that support the "science" of obesity:

1) Weight is a good proxy for health. (Campos suggests, in fact, that we really don't know anything about a person's health, judging by her weight.)
2) Going from fat to thin can improve your health.
3) We know how to produce long-term weight loss in populations.
P & T go on to tackle the BMI, battling the notion that one need be a certain height and weight (not one's natural weight, of course) in order to be considered healthy. The 6'6", 310-pound Penn suggests, in jest, that, according to the BMI charts, he should weigh 124 pounds and be 5'4". The next thing we know, he's lying prostrate on a table, as a man with a chain saw prepares to remove his lower legs. Comedy aside, the point is well-taken: Asking a man of his size to lose large amounts of weight may be as preposterous as asking him to shrink in height.

P & T interview a Professor Oliver, who suggests that we're wired to be obese (and promiscuous, to boot). Penn then challenges the all-too-common "willpower" argument: "If you have the willpower to overcome several million years of evolution, cool. More for the rest of us."

The show also interviews Glenn Gaesser, Ph.D., author of Big Fat Lies: The Truth about Your Weight and Your Health. Gaesser suggests the diet industry is notorious for "blaming the victim," suggesting that dieters fail, not the diets themselves (if you just would have stuck with it, you know?). Gaesser goes on to warn, as many of us realize, about the dangers of yo-yo dieting and suggests that fat people who exercise regularly are healthier and have a lower mortality rate than thin people who don't.

As Penn concludes: "Is our knee-jerk 'horror of obesity' out of whack with reality? Fuck, yeah!"