Eating Disorders: I Had No Idea

This week is National Eating Disorders Awareness Week and the theme this year, announced by the National Eating Disorder Association (NEDA) is: I Had No Idea. I've had friends in the past who were dealing with an eating disorder and have had the pleasure over the past six months to get to know a lot of new people with eating disorders as they seek treatment at the clinic where I work as a dietitian. Sticking with the theme of "I Had No Idea", here is some information about eating disorders you might find surprising.

Definitions. There are several different ways to define an eating disorder. There are official definitions in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM 5).  Then there are more fluid definitions that indicate a broken relationship with food, regardless of current or past weight.

Food on the Brain. Jessica Setnick is an RD who has a training curriculum called Eating Disorder Boot Camp. In it, she states that people with anorexia nervosa spend 90-110% of their day thinking about food. I use this as a quiz question when teaching medical residents about eating disorders: who spends the most amount of time thinking about food, people who are on a diet, people with bulimia nervosa, or people with anorexia nervosa? Last week I had the first group get it right - most guess that it is people on a diet. Sadly, it is those who are eating the least who are thinking about food the most.

No One Image. When you think of a person with an eating disorder, does an image of a skinny female model with her ribs poking out pop into your head? Frail women are often portrayed as the image of a severe eating disorder. But in reality, this disease spares no one and affects people of all genders, race, shapes, and sizes. We're seeing an increase in our clinic of patients who had been told they were overweight or obese and began to lose weight, which everyone around them applauded, not knowing that they were doing so in an unhealthy and potentially dangerous way.

Mental and Physical. There is almost no part of the body or mind that an eating disorder will spare.

Whether you know someone who has been officially diagnosed or just someone who struggles with self-esteem and has a disordered attitude towards food, take a moment this week to think about them and what they might be going through.

Why You Should Meet with an RD

A Registered Dietitian (RD) is a healthcare provider who specializes in nutrition; how food affects your body and how your body reacts to food. Like some other medical specialties, it can be confusing to know whether or not you need an RD or could benefit from meeting with one. To help figure this out, the Academy of Nutrition and Dietetics put out an article, What a Registered Dietitian Can Do For You. Here is an excerpt to help you better understand whether or not an RD can help you:

The highest level of nutrition counseling. Anyone can call themself a nutritionist, but only a registered dietitian (RD) has completed multiple layers of education and training established by the Academy of Nutrition and Dietetics. In addition to holding a bachelor's degree, an RD must fulfill a specially designed, accredited nutrition curriculum, pass a rigorous registration exam, and complete an extensive supervised program of practice at a health care facility, foodservice organization or community agency.

Personally tailored advice. When you see an RD, the last thing you'll get is one-size-fits-all diet advice.  After learning about your health history, favorite foods, eating and exercise habits, an RD will help you set goals and prioritize. Follow-up visits will focus on maintenance and monitoring your progress.

Guidance navigating food allergies, sensitivities and intolerances. When you suffer from conditions such as celiac disease, food allergies or lactose intolerance, it's easy to be overwhelmed by what you think you can't eat. That can translate into a boring diet and may even lead to nutrient deficiencies. An RD can teach you how to read food labels so you’ll know which ingredients to avoid and a help you find substitutions to keep your diet balanced and tasty, too.

A weight loss program that really works. Fad diets may sound like the quick ticket to weight loss, but they rarely work for very long. A registered dietitian will partner with you to develop a safe, effective weight loss plan that you can stick with for the long haul. 

If you're convinced that now is the time for you to see an RD, contact me for an appointment today by e-mailing eatdrinkandbeactive@gmail.com or calling 617-431-8006.

What's Getting in Your Way?

As I was rinsing off the salt-crusted soles of my running shoes tonight, I realized how warn down they are. A quick calculation and I realized that I've probably been wearing the shoes longer than the recommended 300 miles. I also remembered that every time I've put them on recently I've been a little bit grumpy about the way that they feel. Have they ever explicitly stopped me from going out on a run? No. But "old, warn shoes" are one thing that I could write in my list of the barriers that I feel get in my way of being as active as I could be.

What do your barriers look like?

In nutrition counseling we often talk about barriers. Part of being a successful dietitian is helping people to overcome or at least recognize whatever barriers they might have getting in the way of healthy eating. This could be a practical barrier such as lack of grocery stores with fresh produce or it could be something more internal such as feeling sad lately and feeling the need to find comfort in food.

Is there something that you're having a hard time accomplishing? Try making a list of barriers and potential solutions. Here's are a few examples - the first is one of my personal barriers and others I've drawn from patients.

Goal: run more often during the week
Barriers: cold weather, uncomfortable old shoes, darkness
Ideas to break barriers: put together a chart of outside temperatures with appropriate clothes that will keep me warm, buy new running shoes, find friend to run with consistently after work

Goal: eat more vegetables each day
Barriers: fresh produce just goes bad whenever I buy it, vegetables are hard to cook and expensive
Ideas to break barriers: stock freezer with selection of frozen vegetables that I know I like, find Pinterest boards featuring easy vegetable recipes to bookmark for trying each week, buy produce with recipe in hand on the day I know I have time to prepare it to avoid spoilage

Goal: lose weight in order to better fit into clothes
Barriers: gym membership is expensive, family doesn't like 'health' food, low motivation
Ideas to break barriers: find a friend to go for walks with outside on a consistent schedule, try making current favorite family meals using healthier ingredients, put sticky notes with inspirational quotes on car dashboard to remind myself of goal

These are just a few ideas of ways to get into the mindset of breaking through barriers. If you can think up some ideas for overcoming your own barriers, try writing them down. Even if you're not ready to take action yet, looking at your list of solutions can motivate you to take small steps in the direction of your goal! Now I'm off to buy some new running shoes...

94 Years Old and Still Running... on Carbohydrates

If you're a runner or endurance athlete or have ever read up on sports nutrition, you are likely aware of how important carbohydrates are. They give you energy to "go the distance" and are the main source of fuel for an active lifestyle. People have even made a science of carbohydrate "loading," finding ways to pack as much carbohydrate into their body's stores before a big endurance event. I've been reading a lot about sports nutrition lately, in part because I've started a small private practice counseling athletes and also because it's a fascinating topic.

In reading the newly published 5th edition of Nancy Clark's Sports Nutrition Guidebook, she really drives home the focus on carbohydrates for athletes and how your body (and possibly performance) will suffer if you focus too much on protein or go gluten-free for no medical reason without replacing it with enough non-gluten carbohydrates.

It's no secret that carbohydrates get a bad rap in general, but if you're an athlete the cold hard truth is that you need them and they will help you if you use them right. As Nancy emphasizes, carbs don't cause you to gain weight; extra calories, especially from fat, and not enough physical activity cause you to gain weight.

I was reading an inspirational story in Parade magazine recently about Olga Kotelko, a 94 year-old track star. She's broken all sorts of records and is still going strong. Obviously they asked her about her diet, and this is part of how they reported on it:

"She is no stranger to carbs, often having toast in the morning (perhaps topped with cheese and honey) and bread again in her lunchtime sandwich."

I could be adding emphasize in the wrong places here, but when I read that I could just picture some readers across the country thinking to themselves "BREAD?! TWICE a day?!" The way that it is phrased, that she is not a stranger to carbs, seems to imply that eating bread twice a day is excessive. In reality, active people need a whole bunch of carbohydrates in order to fuel themselves properly (the amount depends on the athlete's weight and the intensity of the activity) and no one should ever be a stranger to carbs. Has your relationship with carbohydrates taken a turn for the worse? Consider making 2014 the year you mend that bond - you'll be amazed by what carbohydrates can do for you!

A Chunky as Heck Chicken Soup Recipe

I don't share too many recipes on this blog, but tonight I made a chicken soup (originally billed as a stew) for the second time and it was so good I just had to share it! This is a great chicken soup that can be modified in any way that you want. You can change the flavors, the ingredients, the vegetables, the spices - whatever you like! My favorite part about this is that you cook the chicken in the broth which gives it a delicious, rich flavor and then you shred it. I've had some failed chicken soup attempts where you add little chunks of chicken that are hard to get just right. With this recipe you don't worry about the size, just shred it!

Ingredients:
olive oil
around 2 cups of chopped vegetables such as:
   onion
   celery
   carrot
   zucchini
   mushrooms
14.5 ounce can diced tomatoes (try fire roasted for extra flavor)
14.5 ounce can low sodium chicken stock
1/2 teaspoon of each spice such as:
   thyme
   basil
2 chicken breasts with bones and skin (at both my local grocery store and at Trader Joes I've found this in the Kosher meat section)

Directions:
Heat olive oil in a large pot and saute vegetables for approximately 5 minutes. Add entire can of tomatoes, broth, and spices. Submerge chicken and allow to simmer for about 25 minutes (longer if the chicken breasts are thick), turning chicken and stirring occasionally. Remove the chicken from the pot, allow to cool, and discard skin. Shred or chop chicken and discard bones, then return shredded chicken to the pot. Simmer for 10 more minutes, let cool, and enjoy! Serve atop quinoa, couscous, whole wheat noodles, or with a hunk of whole grain bread.

Good Advice from England

This is a cute and creative video showing how our eating and living habits have changed over time and how that can affect obesity rates.

Less Yellow, More Insecurity

Nutrition-related headlines tend to catch my eye, for obvious reasons. Last week there were two headlines that made all the news sources and got lots of media attention - national, local, and social. These headlines differ greatly but both sparked outrage...

Mac N Cheese to Be Less Yellow!

Millions Lose SNAP Benefits 

So, Kraft has agreed to remove some of the artificial yellow food coloring from it's Mac N Cheese (but only some varieties and not yet). Here is the AP News story which also got covered by such news sources as Perez Hilton who proclaimed "It's a good thing AND a sad thing! But mostly good!" People flocked to their facebook pages and twitter accounts to bemoan the loss of the color yellow, many (it seems) not realizing that the yellow dyes are not being removed from the original Mac N Cheese, just some of the kid-focused shapes like Sponge Bob. Others hailed Kraft for listening to the people and making the product more natural, though Kraft denied that implementing the change had anything to do with a Change.org petition.

I love a good bowl of macaroni and cheese as much as the next person (maybe a little bit more) but thought it was really unfortunate for these headlines to be happening on the same day, and for one to seemingly be getting more attention than the other.

One in seven Americans (47 million people) just lost some of their supplemental food money from SNAP (supplemental nutrition assistance program). Food insecurity is already rampant in America and this decrease in funds just increases that feeling. According to the Food Research and Action Center: 

"The U.S Department of Agriculture estimates that the reduction in benefits amounts to 21 fewer meals per month. Viewed differently, it leaves the average participant with just $1.40 to spend per meal, not enough to sustain health, learning or productive work. And even as these cuts are going into effect and families across the country are trying to figure out how to further stretch their impossibly tight food budgets, Congress is discussing even more drastic cuts to SNAP."

These headlines brought to mind a food drive that my middle school hosted many years ago. The classroom that collected the largest quantity of food got a special prize. The winning group was a class where one boy had gone to Sam's Club and bought a palate of ramen noodles. I'm sure there were a lot of boxes of Mac N Cheese in that drive as well, something else cheap, non-perishable, and to easy to contribute. This connection came to mind because as food stamp benefits decrease, use of places like food banks and other emergency food organizations tends to increase. So maybe the headlines are not so unrelated after all - they could be affecting some of the same people. If SNAP recipients turn to food banks once their supplemental income has run out, what will they find there? Hopefully more than just palates of ramen noodles and still-just-as-yellow Mac N Cheese.

Please consider making a donation to a local food bank during this time or starting a virtual food drive. I won't judge you if you donate ramen or macaroni, but something green (canned vegetables or cash money) might help out a little bit more.

Boston Food Bank: http://gbfb.org/
Feeding America: http://feedingamerica.org/