Eating in secret and other embarrassing side effects of dieting.

I consulted with a client the other day who wanted to admit something embarrassing. The admission started out like so many others that I've heard: "I've never told anyone this but... when everyone is in bed, sometimes I sneak into the kitchen and eat foods I am not supposed to. I feel out of control, like I cannot stop myself, eat more than I want to and end up feeling panicked and guilty. What is WRONG with me?!" 

While I am thrilled that my clients feel comfortable enough to share these intimate details, I am sad that they feel so embarrassed. I am also angry that, despite the awful consequences of dieting (such as this one), they are still the #1 go-to for people who want to lose weight.  

The reason why eating in secret should not be humiliating is because it happens more often than you think- it is just not something many people talk about. 
I hear these kinds of admissions all the time, mainly because dieting is a root cause. Imagine that! the very thing that is supposed to "stop you" from overeating is the very thing that pushes you to eat in secret. 

Let's explore a scenario that could lead you or someone you know to be ashamed of eating and thus eat in secret:

"Imagine that you decide to follow a popular diet to lose weight. The diet forbids you to eat your favourite foods and many foods your family typically eats. So, instead of eat your favourite meal you prepared for your family, you are choking down your "special" meal of broiled fish and steamed veggies. Feeling deprived & a little hungry but proud of yourself for eating your weight loss meal, you start to clean up. You are left alone in the kitchen and as you put away the pasta, you hear it calling your name. The internal struggle begins: 

After taking a few manic bite fulls of pasta, you figure, "what the heck! I've already ruined my perfect diet day, I might as well go nuts". So, standing at the counter, you finish off the pot of pasta. How could this have happened?! One minute you were being good, and the next you are stuffing your face. "

There are a few things that may have pushed you in the direction of overeating:

1. Feeling deprived & being deprived: it is natural for humans to "want what we can't have" and there is no better example of this than with dieting and food. When we deprive ourselves of our favourite foods or even just normal foods, we often are compelled to eat a large amount of them when they are available. Also, cravings of these off-limit foods tend to increase when we forbid them. 

2. Hunger, both physical and mental: anyone can follow a crazy diet for a little while but over time it becomes harder. If the diet leaves us feeling hungry, then it is a no brainer that we will want to eat more (perhaps when noone is looking and therefore no one can judge us). The mental "hunger" for delicious foods and the need to have pleasure when eating is something that is often overlooked. If every meal is a disappointment, it is not uncommon to eventually go looking for good tasting food. What usually tastes good? forbidden foods! Foods that are not allowed are often perceived as tasting better than if they are eaten without guilt. Remove the guilt and often you remove the sacred status the food holds. 

3. Comments from the peanut gallery. If the people around us are trying to "help" by saying negative comments about our food choices, our instinct is usually to rebel. Hearing things like "you'll never lose weight eating like that!" or "Are you sure you need to eat that?" is embarrassing and angering. A lot of people are compelled to rebel against these attitudes by eating the food they were told not to. This can happen when alone in the kitchen late at night or in your car before you go into the house.

A wise client recently told me that the key to eating less in secret or out of rebellion is to ask themselves this question:

Am I going to feel less stressed if I eat this candy bar? Am I going to feel more satisfied or over stuffed if I finish this pizza? Is eating this cookie going to comfort me or make me feel guilty?

It is ok to to eat something because you are stressed or need comfort. The big question is, are you less stressed and comforted by it? If not, then eating that food won't help the current problem. 

My client realized that they were eating when not hungry and not "getting anything out of it". In their journey to repair their relationship with food and manage their weight, my client brilliantly said to me:

The Dirty Truth Behind Juice Cleansing

written by Jenna West, dietetic intern

If you are trying to lose weight there is no doubt that you have been told about the so-called miracles of juice cleansing. While it is true that "juicing" may lead to rapid weight loss, it may also result in problems with weight management. The fact is, juice cleansing is like every other fad diet and is merely a way for companies to make money while putting consumers health at risk. It is important to note that drinking juice, in addition to an already balanced diet, poses no potential health risk, and can be a good way to incorporate more vegetables and fruit in your diet. The pitfalls of juicing come into play when people start replacing meals with juices as a way to slim down.  Here are 4 pitfalls to juicing:

  

1. Juice contain the same nutrients as a regular fruit except for one major component-fiber

One of the key components of weight management that has long been studied is the addition of fiber to your diet. Fiber can help you lose weight by making you feel full for longer as well as help reduce your risk for many chronic disease such as heart disease. Fruits and vegetables can be a wonderful source of fiber, however when you remove the skin, you remove the fiber. Without the fiber, you will never feel full and who wants to be hungry all the time?

2. Juicing is not the answer for long-term weight management

Juices are low in calories and there is no question that restricting your calories will lead to rapid weight loss. While this may seem attractive to many people trying to lose weight, it can lead to serious weight management problems in the future. When you restrict many groups, your body will initially shed the pounds but when you resume eating these foods (which you will likely do) the pounds pack on even quicker. Not only that but consuming very few calories in a day can lead to a variety of symptoms such as headaches, dizziness, nausea and vomiting (just to name a few). Who would want to experience that?

3. Juices lack essential nutrients which are needed daily

Although real cold press juice does not contain any added sugar, fruits and vegetables contain natural sugar. When you do a juice cleanse, all you are essentially eating is sugar with a few vitamins. The problem is you are not consuming any of the other essential macronutrients such as fats and protein. Eating all the food groups is essential to healthy living, eating a balanced diet and most importantly weight management. Restricting these key food groups can actually make weight loss more difficult.

4. Juices are so expensive!

Juices can vary in price but are normally around 10 dollars a bottle. If you are cleansing and drinking six of them a day, that is 180 dollars for three days! Most people would agree that spending that much on juice is outrageous. Juicing is obviously a lot cheaper when you own your own juicer, however the average consumer does not have their own juicer and is forced to spend a ridiculous amount of money on juice!

Juice cleansing can be very harmful for the body and the problem is that they are being advocated everywhere from fitness centers to yoga studios. When you hear your super fit yoga instructor discuss his or her recent juice cleanse, there is no question that you may be tempted to do one as well. However, all bodies are different and react differently when drastic dietary changes are made. If you are looking to lose weight successfully and for the long-term it is important to speak to a registered dietitian who understands the consequences of rapid weight loss and can help you figure out a healthy weight loss solution. Juicing is not the answer! 

Wording carries a lot of weight!

Have you ever found yourself wanting something you can't have- seemingly only because you can't have it? Have you ever found yourself eating more food than you wanted after being denied it - maybe because you wanted to take back control over your own decisions? If so, then you are not alone.

People want to see themselves as being in charge of their own decisions and behavior. Threats to their freedom of choice can motivate them to restore their sense of freedom and self-determination by acting against the rule as soon as possible. This is why having a coach or spouse be the food rule enforcer can lead to eating in secret. This may seem innocuous or silly to some, but for the person who is secretly rebelling it can be quite a guilt trip and feel shameful.

This is a phenomenon called "psychological reactance"- reacting to a rule (that infringes on your freedom of choice) by breaking the rule to feel back in control of making decisions. One obvious problem with this phenomenon is that setting restrictions or rules can backfire and actually increase the unhealthy habit. So what are health professionals and campaigns to do when advocating for healthy lifestyle changes!?

Due to reactance, dietitians and other health professionals have had to change their tone and way in which they give advice in order to connect with clients and better meet their needs. Long gone are the days when clients needed information on the topic at hand and many of them are coming to sessions having already researched what they want to know. Our role had morphed into more of a facilitator or coach to help keep the client motivated to make the changes they want to make. Recent research suggests that this more "gentle" approach is not only what the client may want but what they need to make changes.

The reactance phenomenon was recently studied and you can read the article here. The researchers looked at the difference between making eating-related rules as suggestions versus restrictions.
So, for example, stating 'you should not eat unhealthy food' versus stating 'it is best not to eat unhealthy food, but ultimately the decision is up to you'. See the graphic to the left for more examples.

Results of this study indicate that "ironically enough, a restrictive rule may actually increase intake of food in situations where the rule is no longer in place or cannot be enforced". The explanation they gave was that a restrictive rule evoked psychological reactance and participants ate more of the unhealthy food once the rule was no longer enforced.

They also examined if both ways of giving advice are effective in discouraging unhealthy behavior. Some professionals believe that a more flexible and gentle approach won't push the client enough to make changes and follow rules. This study showed that both kinds of statements were equally able to discourage the unhealthy behavior. Therefore a suggested, more gentle rule does not minimize the problem behavior and may ultimately be a more practical alternative to a restrictive rule.

A great summary was written by the researchers: "a suggested rule still discourages consumption of a certain food, but it leaves the ultimate decision about eating the food up to the individual".

SO next time you feel yourself rebelling against a rule- you may be catching yourself in the act of psychological reactance. Take a step backwards and try rephrasing the advice you were given to be more of a suggestion than a rule.

When "do no harm" can mean NOT talking about dieting

There has been much controversy in the nutrition and weight management world about the sometimes harmful role professionals can play when trying to help a client lose weight. Since doctors carry so much weight (so to speak) with their advice, it is extremely important that they give useful, easy to understand and sympathetic advice. By sympathetic I mean advice that takes into consideration their clients as people (not just bodies) who have limitations, feelings and are probably doing more for their health than they see. Obviously, it is also important to that doctors know their limitations in knowledge and make referrals. Knowing your limits can be harder than you think especially if you come from a background of an "all knowing" profession like medical doctors. This is where a lot of my frustration stems from- the "all important god" that is better known as your doctor who gives harmful and often wrong advice on weight loss. One big argument is the fact that the hippocratic oath may suggests that bad weight loss advice is unethical by actually doing harm to their clients.
Before I go further, I must state that not all doctors frustrate dietitians or give harmful advice to their clients. Unfortunately, I only hear the sad stories from my clients.

Recently I had a few clients who were (and I quote) "traumatized by what my doctor told me about the need to lose weight". I can only guess that the doc's goal was to motivate the client to lose weight (little did he know that she is already doing many things to try to lose weight...did he even ask her?). However, I wonder the usefulness of stating that "[she] would be better off as a drug addict than addicted to food". Yes- that is a direct quote from the client quoting her doc.

Firstly, being obese is vastly different than being addicted to food (which is not a well supported theory amongst eating disorder professionals) so he first assumed she was addicted to food (again, not a diagnosis as popular as say, binge eating) and secondly that being skinny while doing drugs is better. Is that really based on science? Will that advice really help her lose weight? All that encounter did was make that day the "worst day of [her] life" (another actual quote). Was that advice ethical considering she may turn to unhealthy ways to lose weight such as diet pills, fasting, or very low calorie diets? All of which may lead to binge eating, skewed relationship with food and body hate.

Not only do my clients already feel ashamed and hateful of their bodies, but they have to return to see their doctor for a follow up. It's no wonder that they are scared, anxious, preoccupied about the upcoming visit. I wonder if these feelings will help or get in the way of communication at their next appointment?? It was certainly something that got in the way in talking about nutrition at our session. I was more than happy to discuss the encounter since issues that influence eating is something we discuss (not just diet advice) at appointments. However, I can only imagine how frustrated my paying client felt after leaving our session with little spoken about the topics for which she sought advice.

Weight shaming and weight bias as well as misunderstanding the complexity of weight loss is something that is expected from the masses. NOT from educated health professionals.

My advice to my clients who bring these stories to our session is easier to give than to take- find another doctor. Not an easy task in this city or in Canada. If that's not possible, perhap a firm but polite acknowledgement that things are being taken care of in the weight loss area with the help of another professional, then asking the doctor to get back to what they specialize in practicing.

Think taking the addiction approach to food is best? Think again.

I am so sad to hear of yet another book toting overeating or binge eating as food addiction. In the brief adaptation I read recently in Macleans magazine, I find it interesting that everything the author is describing as addiction can also be considered binge eating. More specifically, the trap of the binge eating and restrictive eating cycle. I am flabbergasted that people continue to chose the "addiction" route versus the mindful eating approach to dealing with a skewed relationship with food. It astounds me because the way in which they are treated are quite different- one being very harsh and relying on "discipline" and the other a more flexible, kinder, realistic way to live. 

Many feelings and thoughts written in the adaptation sound familiar- many of my clients have told me the same things. However, not one of them was able to fully adapt the addiction method without cycling between food restriction and binging. Also, every one of them have found that although addiction is an easier way to think about food, understanding how their emotions and body shame lead them to overeat or binge has helped more in the reduction of binges and cravings for binges. Here is a short summary of the difference between both treatments:

Sure, there may be aspects of the addiction model for treatment that can work for people, but in my experience, clients need way more than this approach to heal relationships with food and their bodies. Cravings are a normal part of life, how we deal with them depends on how we see ourselves (i.e. our weight and shape) and our relationship with food. People who eat intuitively may eat the food they crave, listen to their hunger to determine how much of it that they want and continue to eat according to their hunger for the rest of the day. This may mean they will eat a lighter dinner because they are less hungry. In fact, people who are intuitive eaters get more pleasure and comfort from food than people who eat mindlessly. 
People who do not eat intuitively and eat due to emotions, tend to get less comfort from food and end up cycling between eating for comfort, not being comforted and then eating more because they are ashamed of caving into a craving (which is a negative emotions that can start the cycle all over again). 

If you are looking for more information on binge eating or how to decrease over eating, these books take a more gentle and effective approach :

Eat what you love, love what you eat for binge eating by Dr. Michelle May
Overcoming binge eating by Dr. Christopher Fairburn
Eating Mindfully by Dr. Susan Albers (there is also a companion workbook called Eat, drink and be mindful)

If you are a dietitian looking for more information on the CBT and mindful eating approach to treating binge eating disorder, try these books (of course those mentioned above are a good read too):
A clinician's guide to binge eating disorder by June Alexander, Andrea GOldschmidt and Daniel Le Grange
Nutrition Counseling in the treatment of eating disorders by Marcia Herrin and Maria Larkin
Cognitive behavioral therapy and eating disorders by Dr. CHristopher Fairburn

5 reasons NOT to start a diet this new year

1. Failure is the probable result: most diets fail to help you lose weight or keep it off for any length of time. It is very likely that you'll regain the weight back - if you have managed to actually lose any.  They fail for many reasons- mostly because you are human and diets are made for robots. What I mean is that humans (YOU!) were meant to eat good food, enjoy foods you love once in a while, eat with flexibility and eat with pleasure and occasionally for pleasure. Most diets take all of that away. They quiet your greatest internal food expert (hunger and fullness) and make you focus on an outside "expert" (a meal plan, forbidden foods, pills, etc).

2. You'll always get what you've always gotten and then some:  If you have tried many diets in the past, and they have failed (presumably this is the reason why you want to start another one...), then chances are it won't work. NOT because you've failed or did something wrong, but because dieting is a failed concept. Unfortunately, lack of losing weight may not be your only negative. Most people take their lack of success personally and fell like they themselves are failures rather than blaming the outrageous promises of the diet. Ads for diets are meant to hook you in; promise crazy results with even crazier suggestions of how to cut out food and fun. They are meant to dazzle and prey on people's desperation to lose weight. Shame on them- NOT on you. Perhaps if we didn't regard "being skinny" as the ultimate greatness, they would have less power.



3. There is a good change you may actually gain weight: not losing weight is a bummer. Gaining weight is an even bigger let down. This can be due to a few factors-  they can lower your "metabolism" (slow down the amount of calories you burn), increase your appetite and preoccupation with food as well as disconnecting your from your hunger and fullness cues.

4. They are a waste of good money: there are SO MANY other ways, that are far less costly and more effective to help you make changes to your life and diet. The secret all those diet books, pills and plans aren't telling you- you can do it on your own with a few helpful books or websites. AND you don't have to swallow any nasty shakes or bars. Consulting with a registered dietitian who are the experts on weight management will likely give you weight management tools that will help you for the rest of your life (vs diets that only help for the next few weeks). Just make sure you find one who specializes in weight management and takes the mindful eating/ intuitive eating approach.

5. They do not get to the bottom of why you have a certain lifestyle: they do not address the reasons why you emotionally eat, overeat, eat when you are not hungry and other hugely important aspects. They may claim they do this but many are too focused on meal plans, counting carbs/points or special products to actually help you explore these habits. Doing mental exercises that help you understand why you eat, why certain foods are chosen over others, and what emotions push you to eat are rarely included. In fact, some diets may actually fuel your emotional and binge eating.

Stop emotional eating (for your sake and your children's)

The more I speak with people about dieting or weight loss, the more I realize that emotional eating plays a huge role. In my defense, I am not the instigator of this topic (and have a hard time talking about it with people outside of the consult room) but it does sometimes feel like an inevitable topic, especially with strangers.

There's the tired cliché about women who are sad, reaching for chocolates to sooth but emotional eating goes much more deep than this. Eating to spite someone (or go against their "helpful" diet advice), eating due to happiness or celebration and eating due to loneliness are all examples.

Stress is perhaps the biggest culprit. Stress from work, home or social life has been a huge influence for many of my clients. It's not always obvious to them but most evening snacking sessions can be due to stress from the day. Making time to reduce stress and have a few moments to breath during the day can help reduce relying on food's ability to calm you down at night. Things like "I deserve this snack because I worked so hard all day" or "because I skipped lunch" or "taxied everyone around this evening" are not uncommon reasons we give ourselves to eat when we are not hungry. It is important to eat foods you love, to eat when you are hungry and to sometimes eat for pleasure rather than necessity. However, eating to reduce stress is a vicious circle, Especially if you are doing it on a regular basis. Most people who are not mindful eaters tend to increase feelings of guilt and anxiety, rather than feel comforted, when eating comfort foods.


Focusing on eating when you are hungry and asking yourself "why do I want to eat" before reaching for food when you are not, is just one way to start being more aware of emotional eating. Of course, the biggest issue with emotionally driven eating is possible weight gain and not being hungry at meals.


Another reason for reducing emotional eating was recently highlighted in a study involving children and parents. It found that offering food to children to soothe their "negative emotions (i.e. sadness, anxiety, etc) was the number one thing parents can do to encourage emotional eating by the child. Unfortunately, the impact of the parents doesn't stop there. The study also suggested that the parent's "emotional feeding practices" (i.e. emotional eating) can influence their children's emotional eating. So it is suggested that there are two ways to reduce emotional eating in children- stop using food to ease their negative emotions (i.e. ice cream to ease sadness or to cheer up the child) and take a look at (and stop) the parent's own emotional eating.

You can read more about this study (Associations between child emotional eating and general parenting style, feeding practices, and parent psychopathology) here.

Saying what no one wants to hear.....weight maintenance

As a dietitian most, if not all of my clients want to lose weight. I would even guess that most people I know want to lose weight. It does not matter the reason, nor does it really matter how much they actually weigh- many people want to change it, regardless of the healthiness of their weight. So, how do I go about suggesting that they should abandon their goals/dreams/hopes? Very carefully.
For some people, maintaining their weight rather than losing weight may be the healthiest option- both for the mind and for the body. This applies both to healthy weight people and - yes- people who are labelled as overweight or obese. Many studies over the last 10 years have shown a weak link between being a fit heavy person and development of diseases. So the age old statement of "I want to lose weight to be healthier" is no longer relevant. The act of losing weight may not have an impact on health if blood pressure, blood sugar, cholesterol levels, etc do not actually improve. This may happen if these risk factors are already in the normal range or if an unhealthy approach to weight loss is taken. Not to mention any psychological issues that can arise from dieting! (guilt, deprivation and shame do not help anyone eat healthier!)
So, how does a dietitian broach the subject that weight maintenance may be the best bet for a client? I have had this discussion a few times recently and despite their differences, each client's situation was eerily similar. My first client was a gentleman who has been struggling to lose weight through exercising more and calorie counting to try to eat less. He has found a nice balance between feeling hungry and eating just enough so that his cravings for certain foods has decreased. With less hunger, he can focus less on eating and more on work/life/family. He has been maintaining his weight for the last 2 months. He feels he cannot dedicate more time to exercising nor can he imagine eating any less (or changing much about his food choices)- but he wants to lose weight. Unfortunately, there is no magic trick I can pull out of my hat for him. Instead of following the same old dietetic approach of offering advice on eating more fibre, less dense foods, etc, I decided to listen to what he was really saying. Reflecting back to him this conundrum and pointing out the facts that he just mentioned (not possible to change exercise or eating),  I helped him come to the conclusion that maybe maintaining his weight right now is the best option. It is a good option because anything else may lead him to further frustration.
The other client was in a similar position except her family and work obligations meant she could not spend any more time exercising. She already was very conscious of what she ate and could not dream of eating less or being more careful.
Neither person was putting their lives in danger by maintaining their weight. In fact, by realistically maintaining rather than unrealistically losing weight and likely putting it back on, they are actually healthier.
Sometimes the role of a "Diet"itian is to give clients permission to maintain weight rather than take jabs at their weight like so many others do.

Protein shakes: helpful or harmful?

Recently I was asked about protein shakes. This question is a common one, especially at this time of year, so I thought I would share it!

"I had found a basic whey protein shake that was not so expensive, with very few listed ingredients, and was taking that to kick start my metabolism in the morning. I am NOT a breakfast eater, at least not until being up for a few hours, but I could do the shake before leaving work. I was seeing some weight loss results, directly due to that or due to overall better eating habits is not certain. My problem is that the store does not seem to carry that particular one anymore, and so my research into another brand started, and ended in confusion. Do you know of a brand that would suit my needs and not empty my pockets? Or do you have any other advice?"

--Jane

Jane is absolutely right: there are ok and not so ok brands or types of protein shakes out there. 
I think she is going in the right direction with the search for a smaller ingredients list. Some shakes have added fat and calories (they are usually marketed as weight gainers) which most people are not looking for. For regular people who exercise, the type of protein will not be particularly important whereas if you are an elite athlete, then the type of protein will matter. 

To address this issue more generally- my major issues with ptn powders is the cost, the fact that they do not make a balanced meal and the taste. However they are convenient!
 These powders are crazy expensive where as alternatives such as cottage cheese, milk powder, regular milk and even greek yogurt give you the same results (and they have way more vitamins and minerals). The also taste much better. Again, if you are an everyday person who exercises, the type of protein will not make a difference. 

A protein shake made with water or even milk does not make a balanced meal since it lacks 1-2 food groups (fruit and grain products). You can actually make a balanced shake by combining milk, cottage cheese or yogurt (to up the protein content a bit), oats, fruit and even throwing in some sliced almonds. If you really want to use the protein powder, you can add fruit, milk and 1/4 cup of oats to make it more balanced. I would use a scoop that gives the equivalent of 14-21g of protein. Sometimes the companies suggest you add more than that, and there is no need to exceed 30g of protein. In fact, recent research has suggested that it is best to divide out your protein intake over the day into 30g chunks. This helps the body more efficiently use it to help build muscle, keep the immune function running well, etc. 

One last point- Jane mentioned that she wanted to "boost her metabolism". Protein and protein shakes do not "boost" anything. Eating breakfast can jump start your metabolism but there is nothing magical about protein powder. Jane'e weight loss cannot be put down to any one thing. Including breakfast more regularly, spreading calories more evenly through out the day, exercising more or paying more attention to what she eats could all be contributing factors. Protein shakes may help some of these factors come to life but she can make this shake out of real food and get the same results!

Judging those who already judge themselves

Some people believe that judging people who "should" lose weight will help them to make the changes necessary to lose weight. Of course, those people are dead wrong but that is not the point of this post. The point is that judging others is useless since they often judge themselves more than can be imagined. 

This is especially true of people who suffer from binge eating disorder. Having a greater than normal concern for ones weight and shape as well as an over-evaluation of their weight and shape (meaning they feel they have more control than they actually have over their weight and shape) leads to much pain. These negative views of ones body and weight can be quite destructive as well as self-perpetuating. Having what is called a disturbed body image maintains an eating disorder and can actually predict success with therapy in resolving an eating disorder. 

As a dietitian, I rarely work directly with clients to treat a body image disturbance but I do work closely with many amazing psychologist who do just that. However, body image often comes up in nutrition sessions when clients insist they "should" or "must" lose weight. Losing weight before resolving an eating disorder (for those people who have a high BMI) is never recommended but many clients are convinced that losing weight will help increase their self-esteem. The basis for many people with an eating disorder is low self esteem or basing ones self worth on their weight, so does losing weight actually increase self-esteem? No. Surprisingly, despite the many protests from clients, losing weight does not miraculously increase their mood or self-esteem. Instead, dealing with what perpetuates negative thoughts, how to come to terms with ones body and how to enhance positive body image is what helps people feel better. 

Guess what else it helps with? You got it- weight management. Weight shaming, guilt-tripping, judging and all those other negative abuses DO NOT HELP. Loving and accepting ones body and shape helps people eat healthier, move more and just live healthier lifestyles. It may be hard to accept or change the way you think at first, but change is possible! Professional help from a registered dietitian and psychologist speed up recovery from an eating disorder and help you feel happier.

Stay AWAY from this emotion to ease weight loss

I have always been a big advocate that taking pleasure in eating is important for everyone- especially when people are trying to lose weight. At first, some clients find it sounds counter intuitive and they may try embracing the motto eat to live rather than live to eat. HOWEVER, if you are as "live to eat" kind of person, changing this personality trait is a huge task, especially when you are also changing so many other things in your life to try to lose weight. Often, my clients who "love" to eat (foodies!) or who believe they should not want their favorite foods while trying to manage their weight, end up feeling guilty when they eat certain foods (usually high calorie, high fat or high sugar foods).
Some people believe that guilt will help to motivate them not to eat certain foods, however, I have always felt that my clients who are the most guilt-ridden tend to over eat more. There has been a lot of reserach on this topic of reducing guilt to help improve eating habits- and there is another one fresh off the press!

The study found that guilt did not motivate people to change. In fact, people who reported more guilt when eating cake, felt they had less control over their over-eating. They also were less successful at losing weight! Imagine that, the very "tool" some people feel helps them (or should help others) lose weight, actually did the opposite. This is why so many dietitians advocate that "all foods can fit" into a healthy diet, even when you are trying to manage your weight.

You can read the article abstract, Chocolate Cake: Guilt or Celebration? Associations with Healthy Eating Attitudes, Perceived Behavioural Control, Intentions and Weight-loss, here.

Where to turn when extreme dieting (ultimately) fails

Although I help people every day manage their weight, I also work with people with eating disorders. My counseling techniques do change depending on my client but one thing always remains the same: extreme dieting is bad. Understanding the difference between normal, everyday improvements with eating and extreme dieting can be tricky. Explaining this difference to anyone who does not have a skewed relationship with food (and even to those with this problem) can be a challenge.

Extreme dieting is a problem for so many reasons since both physical and mental health is compromised. Unfortunately, a new trend is emerging where dieting is called "lifestyle change" or "healthy eating", but the rigid rules of dieting are the same. Here are a few key points to help you decided if you are following an extreme diet:

Does your diet or "lifestyle change" involve delaying eating? this could mean fasting, delaying eating as long as possible during the day or many hours between meals.

Are you restricting the overall amount you eat? this likely means you are tracking calories and trying to eat under a certain amount. Generally, if you do not have an eating disorder, this can be done safely as long as you aim for a realistic amount- at least 1500 calories per day. Anything under 1200 is considered extreme.

Are you avoiding certain types of food? maybe this is due to their high fat or sugar content, or for some so-called "proven" reason that claims it leads to weight gain. In general this is not an issue if you are cutting down on certain foods and savouring them once a week rather than 7 days a week. However, when these foods become outright banned or forbidden, then the diet becomes extreme. The slippery slope to "yo-yo dieting" or developing an eating disorder may not be far away when this banned food list grows.

So what are the alternatives to extreme dieting? Try a mindful eating or intuitive eating approach. They have been proven to be just as successful (if not more successful) as other traditional weight management techniques. These approaches are more gentle and zen and allow you to develop skills that will help you for many years to come to manage your weight versus a diet plan that tells you what to eat and only works when you follow the strict plan.

Check out my suggested readings for some great books on mindful eating!

Acceptance or: How I learned to stop worrying and embrace my shape

If you are unhappy with your weight, raise your hand. 

If you are planning on accomplishing that really cool/fun/amazing thing after you lose 5lbs, raise your hand. 

If you feel ashamed or disgusted by your body, raise your hand. 

Unfortunately, in my line of work, many of my clients would raise their hand if asked these questions. Perhaps it is because I am sensitive on the issue, but I feel that too many of my friends would also raise their hand.
So you can imagine how happy I was to see this article come to light:  Adults with Greater Weight Satisfaction Report More Positive Health Behaviors and Have Better Health Status Regardless of BMI.
This study helps to prove what I (and many other dietitians) have been trying to explain for years- hating your body does not help you to eat healthier or be more active AND loving your body does not perpetuate unhealthy habits. One way to look at it is that negative thoughts or emotions (example: I hate my body) lead to negative outcomes (example: I might as well not even try). Where as positive thoughts and emotions (example: I accept that my natural BMI is 27) lead to positive outcomes (example: I can allow myself to enjoy a few cookies every once in a while but try to enjoy fruit everyday).
Why is "weight dissatisfaction" a problem? It was reported in this study that people with greater weight dissatisfaction reported more dieting, yo-yo dieting, consuming fewer meals, and being less active. All of the these things get in the way of the very thing these people want to do: which is to manage their weight.
One thing that has to be kept in mind when trying to manage your weight is the fact that we have less control over our shape and weight then we think or are led to believe. This over-evaluation of our ability to eat less, exercise more and to control our weight often leads to strict diets or very restrictive eating. Both of which lead down the slippery slope of further disappointment, body shame and even disordered eating.
The Canadian Obesity Network has done a lot of work in the area of "weight bias" or judging someone based on their weight. Weight bias is certainly a contributor to body shame and hopefully with time is something that will decrease with more awareness.

skinny is the OLD "healthy". Welcome to 2013!

Study upon study has proven that it is more important to focus on living/eating healthy rather than just "being skinny" for healthy living. One major issue that perpetuates the misconception that skinny = healthy is the fact that other health professionals (doctors, nurses, etc) often focus on weight to help decrease risk for certain diseases or disease progression. Although it is true that excessive weight (if all other aspects of lifestyle are disregarded) may put certain people at risk, there are far more aspects to look at when evaluating a persons health. Perpetuating the idea that higher weights translate into unhealthy lives is also the result of weight bias in non health professionals.
On a similar note, ff you or someone you know can relate to the questions below, you may want to consider learning more about disordered eating (check out ANEB Quebec for more information):

I think that people who are thinner than me are happier and have a better life?
I am extremely afraid of getting fat?
I have difficulty maintaining an appropriate weight for my age, sex, and height? (a BMI between 20-25).

If the above facts don't change your mind about weight versus health, consider this: other studies have proven that people who focus on health and healthy living while making changes to their lifestyle (i.e. an overall improvement in their eating and activity habits) actually lost more weight than those people who only focused on losing weight. Imagine that! While not focusing on the numbers and the scale, people actually made more meaningful changes! This along with the fact that those people who "love" their bodies, accept their shapes and have higher self esteem tend to live healthier lifestyles (compared to those who have low self esteem and are unhappy with their shape/body) are great example that positive health goals can lead to positive changes.
So let's recap- focusing on healthy living rather than a specific weight (or losing weight) may lead more naturally to weight management and accepting and respecting ones body also leads to healthier living....perhaps the concept that thinking negatively (believing you have no willpower, are not motivated enough, are not good enough, not worth it) may actually lead to "negative" results.

Picture from Equilibre.ca

"Diet talk" DARE

What if for just one day, we vowed to stop the "diet talk". We stopped talking about how much we want or need to lose weight. Stopped mentioning how fat we felt or how guilty we feel about eating this or that. What if we avoided reading magazines that promote unhealthy body images and diet foods? I think that if we stopped the diet talk and self negotiating "I can eat this now if I exercise or restrict later" that we would discover a whole new world. A world where it would be easier to make healthy food choices since they were not forced upon us. Where fun foods would be less tempting since they were always available and no longer illegal. I think that any fears  about going over board on calorie dense foods would slowly melt away since we would now have a wider selection of food to choose from.
I think we would start to appreciate our bodies and the uniqueness of them if we only stop picking their flaws apart. Nothing positive can come from a constant bombardment of negative body talk. And this negative talk we all think will help us eat better and move more....well it turns out beating ourselves up doesn't actually help us to change for the better. Studies have actually proven that those who have a better body image regardless of their size live a healthier lifestyle (by choice, not by fear of getting fat).
Just imagine the influence we could make on others around us if we stopped enabling them to dis their body or eating habits. How many times have you been sucked into a conversation trying to one up each other in the bad food you ate or how your legs are so much more big then their belly!? Bonding with one another by bashing ones body is not a bonding moment I ever want to have again.
So, my dare to you is to join me and just for one day, be kind to your self and your body, refuse to body check in the mirror, enjoy eating the food you love and try to think only is it I've thoughts about you self. You may be surprised how addictive it can become!

The KEY to eating less is...

PORTION SIZE.
It may be one of the more difficult things to change about the way you eat (and is certainly one of the less glamorous), but it is one of the most efficient ways to eat fewer calories.
Step one: understand just how big your current portion sizes are which must come before determining what to cutting down on. To do this, you have a few options: start measuring out what you each with measuring cups OR use something that is always handy.... like your own hand!

Portion sizes are the most basic concept on which the “healthy versus less healthy” universe is based. No one food is evil since it’s really the portion of the food that counts. However, this is one of the least understood technical info in the nutrition world. It’s not complicated and certainly anyone can learn basic portion sizes! 

Since your hand is in proportion to you overall body size, it's a great reference tool on which to base your food needs.

Check out these simple ways to use your hand to estimate portion sizes, no matter where you are or what you are eating.
(please note that a fist is generally = to one cup)

Weight loss and the Macguffin

What does the Atkins diet and Skyfall have in common? or to be more broad, what does any action or spy movie have in common with diets? A Macguffin.

These movies have very similar structures: you have a good guy, a bad guy and the reason why they have come face to face. This reason, the thing that differentiates one movie from the next, is called the Macguffin. How can we sit through countless bond films and still be entertained, is the slight difference between each movie. 

The same can be said for diets. They usually promote certain foods (the "good foods") while vilifying others (you guessed it, the "bad foods"). The Macguffin is the "catch" on how this diet is different from the others. All of these fad diets are low calorie- it's the way that they get you to restrict your calories that is different (or the "macguffin"). They may not state outright that the diet is low calorie, they are more likely promote some "miracle" food or supplement that is the "trick" to weight loss.

The reason why diets are not a healthy or smart way to lose weight, is the fact that they are not sustainable. They are designed to work only in the short run and can only really be followed for a few weeks or months. 

Also, they can recommend eliminating healthy foods, such as milk and alternatives, fruit and whole grains. I suppose you could say they all have the same unhappy ending: weighing more than what you weighed when you started dieting. 

Here are some popular diets and their Macguffins:

Atkins diet: good guys = protein and fat; bad guys = carbs (fruit, grain products, other starchy foods).  

Paleo diet: good guys = protein and fat; bad guys = carbs (grains, dairy, other starchy foods).

South beach diet: good guys =low glycemic index foods, good fats; bad guys = high glycemic index foods and bad fats like saturated and trans fats. Certainly less restrictive than other diets but low calorie never the less. 
Montignac: good guys =low glycemic index foods; bad guys = high glycemic index foods. Oh and lots of complicated food combing to limit what you can eat.
Eat right for your blood type: good guys = "depends on your blood type"; bad guys = "depends on your blood type". Basically, each blood type will be limiting certain foods to get calorie intake down.  

Many of these diets have common bad guys and good guys, only proving that creative labeling foods as good and evil is not the best strategy to manage your weight. 
It's funny how, despite having all of these diets, that there still is an "obesity epidemic" in most countries. Perhaps it is because they do not work? or because they are not "the answer"? 

Quebec has an interesting site to visit regarding diets and weight loss plans. Here is an interesting pamphlet if you are considering taking on a diet. 
Equilibre is another great site for more info. 
If you are a health professional, joining the Canadian Obesity Network is free and their website is great!

Stick to your New Year's resolutions with this easy app

It’s that time of year again- the holidays are behind us and life is getting back to normal.  But if you’ve already broken your new year’s resolution to eat better and exercise more, don’t worry, you’re not alone!  Even though they were set with good intentions,  your goals may not be practical or easy to sustain.  Setting realistic resolutions and planning on how to carry them out with the help of a registered dietitian can help you salvage your resolutions and get you back on track.

One of the best ways proven to help you eat healthier and consume fewer calories is to track what you eat. Luckily, in the year 2013, it has never been easier!  Using a food journal app on your smart phone or tablet makes it quick and easy to write down what you eat.  Searchable online databases now include everything from generic foods to brand name restaurants so everything can be added with the click of a button. Guess work with calories is frustratingly inaccurate and often pushes people to stop tracking their eating.  Finding the right app eliminates any guess work.

How can tracking what you eat help? Simply being more aware of what you are putting in your mouth can help you eat better. It forces you to be more accountable for your choices and think twice before making rash decisions. Accountability is a big driver towards actually changing your habits and sticking to your health goals.

Food tracking can help you see unhealthy patterns in your eating such as skipping meals or not taking time out to enjoy them (for example “I thought I eat breakfast on most days of the week when in fact it’s more like 2 times per week...”).  It also forces you to be more honest with yourself about the amount you eat (for example “Where did all the cookies go?  I swear I ate only two last night!”).

Of course, food tracking does require you to be somewhat accurate with your estimations of portion sizes if you want a true picture of your eating habits. This is where it can become time consuming. However, there is a very easy tool you can use to guess portions- your hand! The palm of your hand is about 3oz, your fist is about 1 cup, two fingers about 1½ oz, and your whole thumb is about 1 tbsp. Start with this easy trick and if you want more details, use measuring cups to get a better eye for amounts.

An online site or app tallying what eat can help you make healthy choices throughout the day. This is the real advantage over old-school hand written journals. You can immediately know how much you have eaten and compare it to what your body requires for the rest of the day.

Also, rather than labelling foods as good or bad, tracking will help you understand which foods are dense in calories and which ones are less dense. This way you can chose what you want to eat based on the portion sizes you want to consume. If you are really hungry, eating a small handful of nuts may not satisfy you enough, so you may turn to lighter foods such as fruit or yogurt to add volume.

Start with the intention of tracking your food for a few days to get the ball rolling. It may feel easier to start small then aspire to track a whole week. Once you get an idea of where your habits stand in comparison to your needs, you can start aiming at truly personalized healthy eating habits. 

Check out these interesting online sites to get you started: www.eatracker.ca or www.myfitnesspal.com

Is sleep the missing factor for weight management?

As most health professionals who work in the weight management field already know, the simple advice of "eat less, exercise more" is far removed from the complicated answer to weight loss. New research suggests there is another major fact that can influence your risk for gaining weight and it has nothing to do with how much or little exercise you do or food you eat (well...at least not directly related...): SLEEP.
We all know that lack of sleep is detrimental to our health but does it influence our weight?

Apparently, for adults, if you sleep less than 6 hours a night, your risk for being obese is raised by a factor of 3.8 (compared to adults who slept 7-8hrs) and in one study, this was the greatest impact on the participants' weight. Other impacts on weight included a high dis-inhibition behavior (one meaning is interpreted as overeating in response to external cues, or cues not related to hunger. External cues include other people eating or ads on TV), low calcium intake and high hunger behavior.
Other studies have shown that over 9hrs of sleep are also associated with more likelihood of weight gain. Therefore, it is recommended that adults aim for 7-8hrs of sleep per night.

However, if you were thinking about catching up on sleep a few nights of the week while skimping on other nights, think again. Other studies have shown that when you are sleep deprived (say 4hrs of sleep), your body produces hormones and signals that increase hunger and appetite. One study showed that the sleep deprived participants ate 559 more calories the day following 4hrs of sleep.

Sleeping less increases hormones that increase hunger and appetite, not to mention that when you are awake longer you have more opportunity to eat AND if you are tired, you are less likely to exercise.
So if you are trying to lose weight keep in mind that sleeping fewer than 7 hours can impact compliance to a lower calorie diet! And if you are trying to maintain your weight, increasing sleep to 7-8hrs per night can limit fat gain over time.

References: 
Brondel et al. Am J Clin Nut (2010)
Chaput et al. Int. J Obes (2011)(2006)
Chaput and Tremblay. Physiol Behav (2007)
Tremblay, Mathieu, Chaput. Obesity (2009)
Spiegel et al. Lancet (1999)
Spiegel et al. Ann Intern Med (2004)
Chaput et al. Sleep (2008)
Chaput et al. Obesity (2009)
Arlet et al. Ann Intern Med (2010)
Schmid et al. Am J Clin Nut (2009)

"Successful" weight management

Many studies have proven that the best source of motivation for lifestyle changes is seeing success and feeling like your efforts are making a difference. However, many of my clients "see" or perceive their successes differently and too often with a skewed view.

Defining the success of anything involves multiple factors. For example,  a "successful" business not only means it is making money, but also that they have loyal customers, the employees are happy, and the company is growing. "Successfully" raising children not only means they are kept alive until the age of 18, but that they can critically think for themselves, are respectful, healthy, etc.
So why is it that defining success for weight loss is often only based on the number of pounds you lose? Like in the examples above, there are other factors to consider such as your health, happiness, self esteem, waist circumference, relationship with food and ability to plan and prepare healthy meals.

Defining success as a change in the numbers on a scale does not show you the whole picture. It does not acknowledge all the time and efforts put into meal planning, prepping, recipe searching, extra time spent exercising or reading labels.

So, next time you feel down about your lack of change in your weight despite all the hard work you've done, make a check list of all the other accomplishments you want to carry out to lose weight. Go through the list and focus on accomplishing these tasks- seeing all the boxes checked will help to boost your motivation and keep you on track.