Colleagues of mine, Linda Bacon and Judith Matz, have written a wonderful new article in Diabetes Self Management. It's about intuitive eating, and "stopping the blame game". Learn to eat when you are hungry, eat consciously, and stop when you are full. It really works, even if you have diabetes! Check it out.

http://www.dietsurvivors.com/BaconMatz_Diabetes_EnjoyingFood.pdf

Are Fat People to "Blame"?

There is a current "conversation" among medical professionals about the increase in the number of obese patients, and the stress their size is putting on these professionals. Hospitals and other health care facilities are often not equipped to handle larger size people, and nurses and others feel the physical stress on them is unfair. The idea is these fat people "should just lose weight". After all, isn't it true that fat people are ALL unhealthy and should just eat less and exercise more?

NO, this is NOT always true. There are healthy overweight people, and unhealthy thin people. Being overweight is a risk factor for some chronic illnesses like heart disease and diabetes. It is NOT a guarantee that the overweight person will develop these illnesses.

Here is more on the topic of overweight people and the health care system, from my colleague, Ragan Chastain. See her website at www.danceswithfat.com.

It seems that this is predominantly a matter of "blame". Yes, health professionals might argue, it may be more difficult to work on the elderly or the immobile but they "can't help it". Doctors, nurses, aides and techs may feel justified in complaining about fat patients because they feel that they could "just lose weight". Regardless of the truth of that argument, patients are not treated in hypothetical land and the patient in front of you can't lose weight right now, so a real problem still exists.

I would suggest that the two most important issues here are medical professionals' safety, and patient safety and dignity. Therefore, it's not professionals against patients, it's professionals and patients against a problem and that problem is the fact that hospitals are not properly equipped to deal with the patients in front of them, and are therefore failing to provide an appropriate standard of care and dignity to those patients, and a safe work environment for their employees and contractors.

Rather than turning on each other, I would argue that health professionals and patients should join together and press the hospitals and treatment facilities for the things that they need - equipment, staffing etc. to care for the patients who they have. If patients of size are becoming an increasing issue then that simply speaks to the need to address the problem from the facility level.

As far as weight being a problem that health professionals have to address: My argument would be that even if it would solve the problem, there is nothing yet proven to achieve long term weight loss; and that heaping shame and blame upon people for whom you have no viable treatment option is irresponsible and highly unlikely to result in an outcome of greater health - physical or mental. Excuse the metaphor but it seems to me that the current practice of prescribing caloric restriction is the same as if Viagara were only successful 5% of the time but doctors kept prescribing it and blamed 95% of the guys for not trying hard enough. Not to be cliche but based on the evidence a Health at Every Size approach is much more responsible.

Are Fat People to Blame?

There is a current "conversation" among medical professionals about the increase in the number of obese patients, and the stress their size is putting on these professionals. Hospitals and other health care facilities are often not equipped to handle larger size people, and nurses and others feel the physical stress on them is unfair. The idea is these fat people "should just lose weight". After all, isn't it true that fat people are ALL unhealthy and should just eat less and exercise more?

NO, this is NOT always true. There are healthy overweight people, and unhealthy thin people. Being overweight is a risk factor for some chronic illnesses like heart disease and diabetes. It is NOT a guarantee that the overweight person will develop these illnesses.

Food and Nutrition Conference and Exibition

The Food and Nutrition Conference and Exposition of the American Dietetic Assoc will be held in November in Boston, MA, my home town.
This is the largest conference of Registered Dietitians, and it's always an exciting event. There are thousands of RDs who attend and many interesting topics explored.
Here's the website for the event:
http://www.eatright.org/fnce/
Hope to see you there!

An article from Diana Cullum-Dugan

Diana is a registered dietitian and certified yoga instructor, and inspired colleague. Here's a article from her.

One Drop in the Ocean – One Bite on the Fork

Everyone knows that the drop is inside the ocean, but it is the rare one who knows the ocean is contained in the drop, says Kabir Das, one of the greatest poets of all time. In many cultures, the heart is seen as the container for our spirit. Yet it’s not the physical heart I speak of here, but a space of subtle energy that serves as the doorway to the inner world.
Just as the Universe contains us, our heart space or heart center contains the Universe.
So it is with eating. Huh?
I live by three simple rules when it comes to eating, well mostly, when I’m connected to my heart center.
1. Eat when I’m hungry.

2. Stop when I’m comfortable.

3. Eat whatever my body wants.

Sometimes though, the disconnection between my heart, brain, and stomach is like a little army inside is protecting me from falling into the abyss of self-pity, loneliness and deprivation. The troops say, “Go on, you’re bored, eat some chocolate. You’ll feel better.” Or “Hmmm, lunch time falls right in the middle of a meeting, I should eat more now so I won’t feel hunger.” Or I’m driving home and visions of every kind of food imaginable, Asian take-out, pizza, those delicate little fruit tarts at Whole Foods, hamburgers and tender beef at the local Venezuelan restaurant pop into my head – like, how crazy is that? I’m vegetarian. And I have food at home. Why am I even thinking about driving all over creation in search of food?

The heart center is the midpoint between Heaven and Earth so it’s said. It’s also the link of your awareness to and compassion for your body. When disconnected, eating spans the space of emptiness inside, it stuffs down and suppresses the emotions, sensations and thoughts that pervade that moment in time – feelings you really don’t want to feel. When connected, you feel love for yourself, an intimacy that is comfortable, clean, soft and open and you’re content. When centered in the heart space, the great spiritual emotions like compassion, forgiveness, gratitude, and joy arise from the heart.

Next time sans hunger you go off in search of emotional fulfillment through the vehicle of food, stop. Close your eyes. Breathe the breath of compassion into the space of the heart. Connect to your own fullness. Listen to your inner teacher. If you still want to eat, go for it. Mindfully and without judgment. Enjoy it to the fullest.

Foods that “Hum” and Foods that “Beckon”
Have you ever experienced a strong craving for a certain food or meal? The feeling can be very strong. You may think of it often over a few hours, days, or even weeks. It can feel as if it’s vibrating in your body in the same way that humming vibrates the bones around your neck and chest. These are foods that are “humming” for you. You may have noticed that these taste particularly terrific when you get to eat them.
By contrast, a food that is “beckoning” you is one you weren’t thinking about before you saw, smelled or even tasted it. Some examples are passing a bakery and smelling baking cookies or bread, smelling chicken roasting as you shop for groceries, or an office mate who drops a piece of candy on your desk as she passes by. In these situations, you may not have been thinking about these foods, but you may just eat them because they are in front of you. These are foods that beckon you.
For some people certain foods hum very often and others only occasionally. In my case, salad hums almost every day. I really like the juicy, vegetable tastes and textures, especially with protein foods like meat, poultry and fish. I always choose a vinaigrette dressing because the combination of the oil and vinegar, veggies, and protein food tastes especially terrific to me.
If you know you are hungry, it’s a chance to determine if any particular food is Humming for you.

Choose Foods That Hum to You!
Why is this so important? If you are hungry, and you eat what “hums” for you, you will need less. I know this sounds impossible, but it’s really true!

Exploring Your Beliefs About Food

I find that people have very interesting ideas about how food works in their lives, and what they expect to be able to change about their relationship with food. Some of my clients tell me that they want to have perfect “control” over food, and NEVER eat anything they consider unhealthy. And they feel really badly about themselves when they don’t follow this rule. I hear things like “I was eating really healthy, and then I had that cake and that just ruined everything.”

Is this realistic? Is anyone absolutely perfect about what they eat? I think the answers to these questions is NO. And what would be a perfect, healthy diet, anyway? Some people think that never eating sweets or junk food or too much fat or sugar makes for a perfect diet. Others believe that never eating between meals makes for perfection. I once heard Oprah say that being hungry made her happy because she could feel the fat being sucked out of her thighs. And, of course, we need lots of fruits, veggies, and whole grains to be perfect. So many rules!

Now, remember that I am a dietitian, and it’s true that fruits, veggies and whole grains are a part of a healthy, balanced diet. But such a diet also includes one’s favorite less healthy foods, in moderation, and in balance with these basics of a good diet. Any most important, eating what you really, really want to be eating is most important. If you are allowed those “forbidden” foods, they lose their power, and take their place as part of your repertoire of possible foods.

Teaching College Students about Nutrition and Diet

I'm a teacher at Northeastern University in Boston, MA. My students are studying to be health professionals in a variety of specialties, in nursing, physical therapy, exercise physiology, and pharmacy.

My courses include material on obesity and weight management, as well as eating disorders and disordered eating. It is fascinating to listen to students' responses to these topics.

I always include a "health at every size" slant on these subjects, since I believe that restrictive dieting does not work. Instead, I encourage my clients to learn to tune in to their bodies and find out when, what and how much they need to eat. As a dietitian, I encourage whole, fresh, "healthy" foods, but all foods fit into a healthy, normal eating pattern.

Some students express the very strong conviction that people should just "shape up" and force themselves with DISCIPLINE to eat fewer calories and exercise more to lose weight and keep it off. They fail to understand that some people just store calories more efficiently, and the goal for all people should be eating mostly healthy, whole, fresh foods, and moving our bodies in ways that feel good.

I teach both my students and my clients that the goal of eating should be to leave you feeling satisfied, healthy, and strong.

How responsible is government for our personal health decisions?

Here's a link to a New York Times article by Dr. Sandeep Jauhar in which he discusses the idea that people with good health habits should pay less for health insurance than those with poor habits.

The idea is one of personal responsibility, and the government's responsibility to "pick up the pieces" when individuals don't comply with medical advice. It turns out that it's just not that simple, of course. As Dr. Jauhar says, "When people advocate the need for personal accountability, they presuppose more control over health and sickness than really exists."

We like to think that if we each just worked harder at "good" health habits, all of our chronic health problems would be eliminated. If people just ate "better", exercised, didn't smoke, and had less stress, we would have less obesity and overweight, less heart disease and less diabetes, and therefore lower health care costs. It turns out that's not really true. Changing one's diet and exercise doesn't necessarily result in weight loss. The system is much more complex than that, and much messier! Americans want THE ANSWER to complex problems, tied up in a neat bow. The problem of personal responsibility when it comes to health habits is much more complicated than that.

http://www.nytimes.com/2010/03/30/health/30risk.html?ref=health

Submit Your Comments
to the
First Lady's
Childhood Obesity Task Force

The First Lady, Michelle Obama, has established a task force as part of her childhood obesity initiative and is seeking recommendations on the following goals:

(a) ensuring access to healthy, affordable food;
(b) increasing physical activity in schools and communities;
(c) providing healthier food in schools; and
(d) empowering parents with information and tools to make good choices for themselves and their families

To submit your comments to the task force, and for more information about the obestiy initiative, please visit http://www.regulations.gov/search/Regs/home.html#documentDetail?R=0900006480abe53d

What do you think about these ideas? They are great, but....let's be careful we don't stigmatize "overweight" kids. Let's remember that all shapes and sizes of bodies are OK, and can easily be healthy with good food and exercise. Where your body "lands" is where it's supposed to be. We need to help kids ACCEPT others' differences in shape and size. Stigmatizing and making fun of larger people is just rude, mean and makes things much worse for them.
How would you like it if people made fun of something about you that is "different"?

Fascinating article in NY Times re: Prejudice against fat people

Paul Campos and Marilyn Wann wrote a terrific oped piece on fat prejudice last week. Here's a link:
http://www.nydailynews.com/opinions/2010/0308 2010-03-08_fatties_its_time_to_fight_back.html

This is not a new idea, but one that's gaining traction in the "real" world. How is it that hating fat people is still OK? It's assumed that if they "just" ate better and exercised more they wouldn't be fat. It also assumes that fat people are by definition unhealthy. Nothing could be further from the truth!

It is quite possible to be fat and healthy. Surprised? Friends and family members of mine have believed that fat=unhealthy. These are otherwise very intelligent and educated people. I want to dispell these ideas!

BTW, it is NOT true that fat people all eat badly and don't exercise. That's certainly true for some, but for many it's just the way their bodies work. Would you hate people with blue eyes? Or all white (black, latino, Asian) people? I sure hope not!

Best way to lose weight?

There's been a lot in the media lately about making small changes in what you eat and how you exercise to maintain your weight and/or to lose weight. Michelle Obama has been talking about this in terms of children and overweight and obesity. Is it true that small changes can stimulate weight loss? Perhaps not. Here's an iteresting article in the NY Times.
http://well.blogs.nytimes.com/2010/03/01/in-obesity-epidemic-whats-one-cookie/?emc=eta1

The Great Weight Debate: Is It OK to be FAT??

Here's a great piece, with video, from Nightline, discussing if you can be healthy and still overweight or fat. Great video, too. Check it out.
http://abcnews.go.com/Nightline/FaceOff/weight-debate-fat/story?id=9911743

Check out "The Fat Chick"

This is a great site by a fat woman who helps other "people of size" learn to exercise and improve their health, all the while loving it. A very entertaining and interesting site.
http://www.thefatchick.com/About.html

More People are Giving Up Dieting

What a relief! News that more people are quitting dieting, because it doesn't work for most of us. It's often just a cycle of losing and gaining the weight, which is NOT good for your longterm health. Actually the "yo-yo" effect is more damaging to health than being a healthy overweight person.

http://www.boston.com/news/nation/articles/2008/09/21/interest_in_dieting_slims_down/

And YES, you can be overweight and still be healthy. Health professionals now think about "metabolic fitness", which means that your blood pressure, blood sugar, and blood lipids such as cholesterol are in normal range. This also refers to your cardiovascular fitness, including heart rate and ability to exert yourself.

Diets are often just not the answer.

Hatred of Fat People

One of the leaders is the "Health At Every Size" movement is Paul Campos, a professor at the University of Colorado. He writes about our society's fear and hatred of fat or overweight people. In this article he writes about MeMe Roth, the President of National Action Against Obesity. It seems that many of Ms. Roth's behaviors about her own health and her body are indicative of anorexia nervosa. She gets herself a lot of publicity, especially about how lazy, thoughtles, and basically stupid fat people are, and that they SHOULD be able to do something about their "problem". As professionals in this field, we know that much of body shape and size is dictated by genetics, and that HEALTH is really what's important, not body size.
Check out this article: http://www.thedailybeast.com/blogs-and-stories/2010-02-17/leave-fat-people-alone/?cid=bs:archive8

Is there really a crisis of childhood obesity?

http://www.tnr.com/article/politics/childhood-shmomesity

Michelle Obama has declared "war" on childhood obesity, but is there really a big crisis? Paul Campos, a professor of law at the University of Colorado, argues there is no crisis, just a campaign against fat kids.
I agree that if Mrs. Obama's approach to the "problem" of her overweight child worked, there would be NO FAT KIDS! She referred to her daughter's weight (she's chubby)in public, which is a set up for eating disorders. Her approach to changing TV habits and her kids' diets speaks to a desire to improve their health, which, Dr. Campos argues, can do so, but why link this to their weight??

Listen to a Poscast Where I'm interviewed on Intuitive Eating

This company in Australia recently interviewed me on an alternative to dieting to manage your weight. We think of this as a "non-diet" or intuitive way of eating, without restricting what you eat. You simply eat when you are hungry, eat what you really want, and stop when you are full. You can trust your body to tell you when, what and how much to eat!

http://www.foodthinkers.com/2010/01/podcast-weight-management-resolution/

Video on food labels and portion size

Check out this excellent video with William Neuman of the NY Times. He really describes the problem with "Nutrition Facts", the labeling on most food products. Take a look, and I think you'll be surprised at how easy it is to be fooled!
http://video.nytimes.com/video/2010/02/05/business/1247466717641/serving-size-snafu.html?th&emc=th

An interesting piece

Here 's an interesting short article on how people of "Normal Weight" can be fat and unhealthy!
http://watrd.wordpress.com/2010/01/28/even-the-thin-can-be-fat/

Listen to Cake Topple Your Brain!

A Podcast from NPR:
http://www.npr.org/templates/player/mediaPlayer.html?action=1&t=1&islist=false&id=122781981&m=122971033

From the National Assoc to Advance Fat Acceptance

Consider this news bulletin, and think about how we can encourage people to live healthier lives. Is this the way??


Call to Action - Consider Carefully Where You Spend Your Grocery Dollars

Steven A. Burd, Safeway's chief executive says he has set an example for employers nationwide by rewarding employees for healthy behavior. His wellness program requires workers to pay higher insurance premiums if they flunk tests for measures such as weight, blood pressure and cholesterol.

As proof that his plan works, he claimed their health care costs for four years have been held constant. Really? The element of Safeway's benefits plan tying employees' premiums to medical test results was not implemented until 2009, according to Safeway Senior Vice President Ken Shachmut.

John Mackey, CEO of Whole Foods, has a plan for cutting his health insurance costs by giving his employees extra discounts on their company store purchases based on their Body Mass Index (BMI).

Employees with a BMI between 28 and 29.9 will get a 22% discount; those with a BMI of 26-28.9 will get a 25% discount; those with a BMI of 24-25.9 will get a 27% discount; and those below 24 will get a 30% discount. Employees must also meet blood pressure and cholesterol criteria and not use nicotine to qualify. All company employees are afforded a 20% discount on their purchases.

These approaches in company wellness programs are not effective long term strategies. They simply repeat a cycle of stigma and bias in workplaces across America (Puhl et al, 2008). Wellness Programs that encourage and support holistic healthy lifestyle changes independent of BMI are much more effective.

In light of the discriminatory practices of these industry leaders, NAAFA urges our members and all those who believe that discrimination is wrong to consider very carefully where you spend your hard earned grocery budget. We encourage you to support grocery suppliers whose benefits packages benefit all employees equally. We encourage you to support co-ops and farmer's markets for your organic grocery needs. You work hard for your money. Use it wisely to support those who do not promote weight bias and discrimination.

Those of you who wish to express you concerns and opinions to these company leaders may do so at the following addresses:

John Mackey, CEO
Whole Foods Market, Inc.
550 Bowie Street
Austin, TX 78703-4644

Steven Burd, CEO
Safeway, Inc.
5918 Stoneridge Mall Rd.
Pleasanton, CA 94588

Health At Every Size article link

http://www.welcoa.org/freeresources/index.php?category=8

An interesting piece on Health At Every Size

There's a new very interesting report on the website for Wellness Councils of America, called "10 Things You Can Do Right Now". This article is about ways to improve health WITHOUT DIETING. Weight loss and maintenance is NOT the end all and be all of good health. Check out this article at

It turns out that repeated attempts at weight loss increase the likelihood of eating disorders and poor body image in both adults and kids. The focus should be on health at every size!