By Dr. Karen Reznik Dolins, EdD, RD, CSSD, CDN
published in the Scarsdale Inquirer
The forty-something woman came for her first appointment asking if I could help her to change her relationship with food. She told me that she had been struggling with food, body weight, and body image since about the age of 11, those dreadful pre-teen years when the female body is changing, peer pressure is intense, and we’re trying to figure out who we are. Thirty years later, despite running 5 miles a day regularly, she was unable to achieve a weight she felt good at and unable to control her eating demons. While intellectually she understands that she shouldn’t think in terms of “good” and “bad” foods, she still finds herself slipping back into this engrained habit. She feels that sugar is a trigger for her, and that if she has one cookie she’ll want a dozen.
This woman, who we’ll call Amy, wasn’t obese. In fact her body mass index (BMI), a calculation used to separate a healthy weight from an unhealthy weight, barely put her in the overweight category. Yet she spent a good deal of her waking hours thinking about food and what she should or shouldn’t eat. She was successful in her career and had a rewarding family life, yet her inability to conquer her food issues dealt blows to her self-esteem.
Amy is characteristic of many women, and men, who I see in my practice. Tendencies towards weight gain in their early years can lead to dieting behaviors which morph into an abnormal relationship with food. These individuals often struggle between wanting to control their eating behaviors, knowing that overeating makes them feel bad, and feeling that being in control means being rigid and feeling deprived. As a registered dietitian/nutritionist, my job is to help them sort out these issues and create a way of eating that fits them, a diet that is energy-balanced and healthful so they can achieve their weight and fitness goals while also allowing them to develop a normal relationship with food.
One definition of “normal eating” which is widely used was written by nutrition expert Ellyn Satter:
“Normal eating is going to the table hungry and eating until you are satisfied. It is being able to choose food you like and eat it and truly get enough of it—not just stop eating because you think you should. Normal eating is being able to give some thought to your food selection so you get nutritious food, but not being so wary and restrictive that you miss out on enjoyable food. Normal eating is giving yourself permission to eat sometimes because you are happy, sad or bored, or just because it feels good. Normal eating is mostly three meals a day, or four or five, or it can be choosing to munch along the way. It is leaving some cookies on the plate because you know you can have some again tomorrow, or it is eating more now because they taste so wonderful. Normal eating is overeating at times, feeling stuffed and uncomfortable. And it can be under-eating at times and wishing you had more. Normal eating is trusting your body to make up for your mistakes in eating. Normal eating takes up some of your time and attention, but keeps its place as only one important area of your life.
In short, normal eating is flexible. It varies in response to your hunger, your schedule, your proximity to food and your feelings.”
Amy’s inability to have a normal relationship with food led to disordered eating. Different from an eating disorder such as anorexia or bulimia, she shares with many others a confusion about how strict a diet should be. Those with disordered eating don’t understand the balance between eating healthy and “fun” food. They believe they have a lack of self-control if they don’t consume only the healthiest meals and snacks. They restrict what they eat, and often restrict the wrong foods at the wrong times. Many have obsessive thoughts about food and eating, and the cost to their health and well-being can be significant. Disordered eating is characterized by restrained eating and accompanied by rigid cognitions and self-esteem that is tied into the amount of food consumed. The individual with disordered eating may fight to limit food intake during the day, often feeling hungry and tired until finally losing their “willpower” during late afternoon low-energy periods and digging into the cookie bag. He or she may avoid certain food groups in the belief that they contribute to excess body fat. Eating starchy foods, often a target due to its association with weight gain, may lead to berating oneself and a diminished sense of self-worth. As a result, the restricted eater goes through the day feeling hungry, often light-headed, irritable, and having difficulty concentrating, yet afraid to eat.
Healthy eating is a balancing act. Those who struggle with body weight need to understand their energy needs – the amount of fuel they need for normal body functioning as well as any additional needs due to physical activity. They need to learn how to provide food (fuel) throughout the day to avoid highs and lows. Thy need to understand that eating too little is just as detrimental to body weight as eating too much. And they need to be kinder to themselves, allowing themselves to eat for pleasure as well as for nutrition.
Anyone hoping to achieve a healthy way of eating would benefit from the following recommendations:
- Emphasize whole grains, fresh fruits and vegetables, as they provide carbohydrates to fuel the brain and muscles along with the vitamins and minerals needed to metabolize them. In addition, the high fiber and water content of these foods make them more satisfying than more highly processed choices. Include at least 3 servings of fruit (1 medium sized or ¾ cup = 1 serving) and at least 1 cup of raw or cooked vegetables.
- Limit portion sizes and reduce mindless eating. Pay attention to when you feel satisfied, and stop eating before having a sensation of uncomfortable fullness.
- Reduce fat intake by avoiding fried and sautéed foods. Stick with grilled, broiled, or stewed dishes. Hidden fats are found in muffins, cookies, candy, and ice cream. Salads can be high in fat if the dressing is added in the kitchen. Ask for it on the side and limit to 1-2 tablespoons.
- Watch out for supersized portions of sweetened drinks. Whether it’s soda, fruit drinks, teas, coffees or lemonade, these can add hundreds of calories.
- Include low-fat dairy products for an excellent source of carbohydrates, protein, vitamins and minerals.
- Include lean meat, poultry and fish while avoiding fattier ribs, burgers, bacon and sausages. Beans can be substituted for animal sources of protein.
- Limit alcohol as it adds calories and makes mindless eating more likely.
- Always include breakfast. This meal, whether preceding a workout or work, is essential to fuel muscles and brain after an overnight fast. Going without food in the morning starts the day with an energy deficit that will result in an unfavorable hormonal response, making this meal not a place to “save” calories. Meals can be planned that are quick yet nutritious (yogurt, fruit, cereal, whole grain toast with cheese).
- Limit the amount of time that passes between meals and snacks to no more than 4 hours. For the time-challenged, (and who among us isn’t), this is often best accomplished by carrying a snack pack (home-made trail mix, dry cereal, fruit, nuts, string cheese).
- Be sure to fuel workouts by eating by including pre-workout and recovery meals or snacks.
(Download in Tip Sheet form here: At Peace With Food)
As for Amy, understanding the amount of fuel she needed and how to balance it throughout the day removed some of the anxiety from her food choices. She was gradually able to move away from a good or bad food mentality, to accept that chocolate tastes good and that giving herself permission to enjoy it prevented her from binging on it. She now does a better job of fueling her workouts, and feels more energized throughout the day. There are certainly some days when she eats better than others, but that’s normal, isn’t it?