Refuse To Regain

The Problem with Eating Clean

B Barbara Berkeley

Virtually all maintainers practice some form of “clean” eating. Whether they are Primarian, Vegetarian, Vegan, Mediterranean or just careful omnivores, POWs have found that they need to keep “modern” foods to a minimum and eat closer to their original human nutritional needs. Here’s the rub. The edible substances which pass for food these days are a far cry from the complex plant matter and healthful animal sources we once knew. Eating closer to the original human diet is easy in theory, but devilishly difficult in practice.

I haven’t had a chance to see the new documentary “Food, Inc.”, but I’ve been reading its companion book for the past week. (“Food, Inc.,” Karl Weber, Ed, Public Affairs Press) I recommend it. The book is essentially a series of essays, each one written by an expert who deals with food related issues. Most of Food, Inc. revolves around agribusiness and our modern methods of food production. Topics include discussions of the corporate forces behind our food, the production of organic foods, the problems created by turning corn into ethanol, the dangers of pesticides, the mistreatment of animals grown for slaughter and many others. There is also a hefty section on the effect of our American food production on world hunger.

Reading this book has given me another kind of food: food for thought. There are so many possible contributors to our modern disease and obesity epidemic. How do the hormones and antibiotics given to animals figure in? What about the growth hormones given to cows to increase milk production? And how’s this for a thought: We may think we are avoiding “fake” foods by passing up the processed stuff, but the food we grow is so uniform, has so little diversity and is grown under such unnatural conditions, that even our fresh food is pretty unrelated to what humans once ate.

Here are some interesting factoids from the book

• About 2/3 of all cattle raised for slaughter in the U.S. is injected with growth hormones. You might think that this practice has been proven safe, but the European Union would not agree. These hormones have been banned by the EU since the 1980s. In fact, the EU will not import any U.S. beef because of its hormonal content.

• Over 50% of large dairy cow herd farmers in the U.S. use recombinant bovine growth hormone to stimulate increased milk production. Safe? Not according to Canada, Australia, Japan and the European Union, all of whom have prohibited its use.

• Most of our food production has been concentrated in the hands of a few very large companies. Powerful lobbyists for these entities have prevented them from being regulated at adequate levels. To quote the book, “ … corporations subject to few external controls are experimenting with our food supply, using chemical additives, hormone treatments, pesticides and fertilizers, and mechanized production methods that represent a revolutionary break with almost 10,000 years of agricultural history.”

• According to the FDA, half of our produce tests positive for some measurable level of pesticides.

In addition, most of our crops are grown in soil that is fertilized with man-made chemicals instead of through a natural process of soil enrichment. Our animal foods come mostly from huge feedlots or poultry operations or fish farms. None of these animals is eating what it would naturally consume and all are raised in highly stressful environments which undoubtedly change the nature of the hormones they produce. An enormous proportion of our fields are devoted to growing corn and soy and the fruits and vegetables which we do grow tend to represent the same varieties over and over. The average produce in your grocery store travels about 1500 miles to get there. Apart from the enormous energy usage this entails, the produce passes through the hands of multiple shippers—each of whom treats the product differently.

Recently, our hospital system decided to sponsor a local farmer’s market on its grounds. While I have been involved in developing this idea, my thoughts about it have mostly revolved around the benefit to local growers. “Food Inc.” has made me think a lot harder about the benefits of eating a wider variety of foods grown in a sustainable way. I also like the idea of being able to talk with the farmers and see exactly how and under what conditions their food is grown. Local produce markets (which also sell animal products like grass-fed beef) are one excellent way of taking back the power over what you consume. The book contains an excellent section called “Questions for a Farmer.” Additional info on this topic can be found at www.sustainabletable.org.

Don and I have also expanded our own vegetable garden this year. There is nary a pesticide in sight, even though the leaves of some of the plants might be a little moth eaten. I am also working on promoting a community garden on our hospital property so that those who want to grow-their-own but lack space can participate.

“Food Inc.” contains a number of useful addresses for getting more information and/or becoming more involved in the movement to improve your food. www.foodandwaterwatch.orgwill link you to a nonprofit organization dedicated to clean water and safe food. www.localharvest.orggives you access to information on small farms and farmer’s markets in your area. www.organicconsumers.orgis the website of the Organic Consumer’s Association, an organization that represents those who buy organic foods and support sustainable farming.

It all comes down to what Food and Water Watch calls “Food Sovereignty.” There is no doubt in my mind that those of us who have remade our diets to include fewer calories, more whole foods and more healthful choices have another step to take. We can go the extra mile toward health for ourselves and our families if we give up the notion that all “healthy” foods are equal. Unfortunately, the difficult work or finding clean food must fall to each of us.

The Thin Doc’s Dilemma

By Barbara Berkeley

As a diet doc, it is my job to make people thin. It’s strange then that one of the most persistent obstacles I face in that task is being thin myself.

New patients will often sit through a 1-hour initial evaluation in seemingly rapt attention. We will discuss their ancient genetics, their struggling insulin systems, the importance of making changes that they can commit to permanently. Then, just as they get up from their chair and turn toward the door, they pause.

“But how can you understand any of this,” they say, “You’re thin.”

Of course I launch into a practiced and much-repeated speech. I am maintaining a 20-pound weight loss myself and would be vastly heavier if I had not reversed the process and put a permanent end to it. I live exactly the life and follow exactly the recommendations I make to my patients. In fact, you could even say I am the living lab for the program I preach.

Nevertheless, overweight people don’t trust thin people to “get” it. You may even find this to be true as a maintainer of larger amounts of weight, someone who was quite heavy for most of your life. Once you become thin, you seem to cross an invisible line. Like the rich, the thin are different.

In fact, there may be more of a parallel here than one might think. America is the land of opportunity and it is our fondest dream to accumulate wealth. But once we become wealthy in America, we’ve crossed a barrier. Politicians rail against “the rich” and talk about them as if they are some sort of enemy class.

Those who are still struggling to make it may see the rich as wasteful and uncaring. Achieving the success that we all crave leaves us open to envy and to a desire to tear us down. For people who are overweight, the thin tend to be viewed with similar suspicion.

My own weight and its stability prompts a lot of patient comments. “I’ll bet you never cheat.” “You really don’t have a problem with your weight do you?” “I can’t be like you.” I am a foreigner because I fall on the other side of the thin line.

But there is another facet to this issue. In this week’s NY Times, pediatrician Perri Klass writes about the dilemma she faces as an overweight doc. How does she help kids and their parents when she does not seem to have her own weight under control? She describes her discomfort in being asked by a family to deliver diet advice to their child, advice that she herself can’t follow.

Perhaps there is one positive in her situation: patients may be better able to identify with doctors who share their struggle. That said, it doesn’t instill confidence when the very person who is advising you is unable to follow the suggested guidelines. I have experienced this issue in my own practice. A number of years ago, I hired another doctor to share my workload. Although overweight, she was bright, kind, and seriously interested in working with our patients. Within a few weeks, our clients began to complain. They felt that they could not take this doctor’s advice; that she could not possibly help them. Ultimately, we had to let her go.

Awhile back, I wrote about the “pretzel phenomenon.” I had noticed that when I occasionally bought some pretzels while paying for my gas, the cashier always smiled and made conversation. This did not happen unless I was buying junk food. Being part of the overwhelming mass of America that eats mindlessly confers a certain feeling of guilty membership. When I bought the pretzels, I was a member. It’s not a club that I am part of most of the time, and when I experience one of those moments of welcome, I’m always struck by it.

Where does all of this leave us? Being thin puts us on the outside. Weight loss advice from thin people is suspect. The thin don’t understand and aren’t part of the club. On the other hand, overweight people can’t advise other overweight people because their answers can’t be trusted.

Clearly, in terms of giving weight loss support and guidance, it is maintainers who have the answers. But how to get the message across? I am left with the interesting thought that we need to de-stigmatize thinness. This is rather radical isn’t it? Who would think that the thin are stigmatized! We are always talking about taking the stigma out of being overweight. That’s a good idea. But there is a growing separation, a kind of weight-class warfare, between the fat and the lean. As successful maintainers, we see clearly what needs to be done to stay on the thin side of the line. We can be of enormous help to those who want to cross over. To do this, though, they have to be willing to abandon the club and enter an uncertain new fraternity. Hopefully, a greater emphasis on maintainers and on the joy of the lives they lead will make us less mysterious and more accessible. After all, it turns out that the thin are just like you and me.

Growing a Healthier Apple

By Barbara Berkeley

From 2002 to 2004, the city of New York gained 10 million pounds.

This startling piece of data was one of the arguments used to advance New York’s pro-health legislative agenda. In December 2006, the city banned the use of trans-fats in restaurants and food service products. Trans-fats had clearly been indicted as a risk factor for coronary artery disease and few could argue with their exclusion. Soon, however, with the Big Apple threatening to become the Candy Apple, legislators tackled a more controversial initiative: mandatory calorie counts on menus.

New York City had reason to believe that calorie labeling would be popular. A number of surveys had shown that the public wanted this kind of information. In 2007, for example, a survey of 2,500 consumers had concluded that three out of four supported laws that would compel restaurants to post nutritional information on their menus. In addition, California was working on legislation that would make the entire state subject to menu labeling laws.

From March to June 2007, the city conducted a survey of 7,000 fast food restaurant customers. Their aim was to get a sense of what they bought, what calories were consumed, and what nutritional information they were offered. They found that the mean caloric content of fast food purchases was astonishingly high (see table below). Of particular interest in this data is the fact that some of the highest calorie counts were found in foods that might be considered “healthy”, such as chicken dishes.

Source: Enacting Menu Labeling Policy, Dr. Lynn Silver

Even though some fast food chains provided nutritional information on tray liners, very few people reported having seen it. Only 4% of patrons were aware of having seen any nutritional figures at all.

Data from a survey of Subway patrons, where nutritional info was posted, showed that when people were influenced by calorie counts, they ordered about 100 calories fewer per meal. But how many were influenced? Of 1830 patrons, 1237 said they never even saw the information. And among those who did, see the counts: only about 200 out of 568 acted on the information and changed their order.

Nevertheless, New York decided to go ahead with mandatory menu labeling. They limited the law to chain restaurants with 15 or more locations nationwide reasoning that asking smaller establishments to provide counts would be burdensome. Calorie counts would have to be posted on menus and menu boards and in a font that was at least as large as price. On December 5, 2006, this legislation was approved and became the first mandatory calorie posting law to be enacted in the United States.

Since enactment, the law has twice been challenged by the New York Restaurant Association. Thus far, these challenges have been struck down and the law remains in effect. Here’s what the new menu boards look like:

 

My personal reaction is I LOVE THIS! Information is power. And for those who complain that they would rather have the freedom to choose food without knowing its caloric impact, we can point to the studies that show that those who are not interested don’t even notice these numbers anyway.

But where’s the beef? Has calorie labeling caused any real movement (other than the rhapsodic reaction of diet docs like me)? While it’s too early to tell, preliminary signs suggest that mandatory labeling may indeed already be motivating change. New York City has taken note of a number of shifts in restaurant menus. Dishes are being re-formulated to lower those off-putting digits. Some examples? Between March 2007 and June 2008, a Dunkin Donuts glazed cake stick mysteriously went from 470 to 370 calories; a McDonald’s large fries dropped 70 calories, a Wendy’s chicken club trimmed 110 calories from its count. And there are numerous other examples.

The assumption of health officials promoting calorie labeling is that 10% of customers will purchase 100 fewer calories at each restaurant meal. From this, enormous extrapolations of potential health benefits are made. New York City states, for example, that if these changes work out, 150,000 fewer residents will be obese and 30,000 cases of diabetes will be prevented. Despite my enthusiasm for menu labeling, these predictions seem pretty optimistic. Those of us who treat obesity or who have been obese ourselves know only too well that 100 calories saved in one venue are easily picked up in another. So, it’s not the saving of a few calories here or there that makes me so excited about menu legislation.

What lights me up is the idea that we might FINALLY be making strides toward a culture that visibly supports healthy living. We all swim in a cultural sea, a kind of bath of “normalcy” that surrounds us. It is so all-pervasive that we barely feel it, but it is the air we breathe and the environment that motivates our life choices. Menu labeling is just one small way of beginning the shift toward a cultural sea that tells us that healthful choice is “normal.” Bravo for that.

My Awesome Friend Who Lost 410 Pounds Will Be On TLC on Sunday!

By Lynn Haraldson-Bering

My friend David Smith was interviewed by Matt Lauer yesterday on The Today Show. I met David (pictured here with my friend Shari) when we were on Oprah together in November 2007. His 410-pound weight-loss story almost (almost…) made me ruin my makeup before my own stage appearance. He’s a hard act to follow, let me tell you.

David is one of the kindest, gentle people I’ve ever met, and his personal trainer, Chris Powell, (here in the limo with me on our way to the airport) is as nice as he is gorgeous. His story will be chronicled tomorrow night (Sunday, July 12) on TLC. It is called “The 650-Pound Virgin.” Alas, I don’t have cable, so I’m hoping TLC will make this available online.

Tune in if you can, especially if you’re feeling down about your body image and skin issues. David gets it. You don’t lose 400 pounds without some skin issues. I hope you find his story as inspiring as I did.

The Tale of Michael Jackson

By Barbara Berkeley

The tragic story of Michael Jackson which has occupied so many media hours this past week fascinates in so many ways. There is the familiar and disturbing theme of the preternaturally talented artist who succumbs to drugs. The horrific back story of childhood beatings and abuse which may well have led to adult confusions about children and sexuality. The mysteries that surround Jackson’s transformation from black to white, from cherubic child to bizarre mannequin.

But for me, the most poignant and instructive theme in the Michael Jackson saga is the undercurrent that appears to have dominated his adult life like a riptide; his desire to remain forever young. In his desperate quest for youth, Jackson slept in a decompression chamber, underwent countless plastic surgeries and created a fantasy empire anchored by a statue of Peter Pan. “I am Peter Pan,” he even said. In the end though, Michael’s desire for eternal youth led him to a life that resembled nothing so much as a Greek tragedy.

Like Icarus who flew too close to the sun on wax wings, Michael Jackson plunged to earth after trying to get too close to immortality. The universe has certain immutable laws. Gravity and aging are two of them. The tale of Icarus has a moral: Despite what we may believe, we are only human beings and as such we are subject to the laws that govern all living things. In his quest to remain ageless, Michael Jackson seemed to move further and further from his goal. He became increasingly distorted until the beauty and youth that he sought seemed to morph into near-grotesque form. The further Michael travelled along the road toward immortality, the more distant he became from his own humanity.

Michael Jackson’s story is not new. In 1890, Oscar Wilde published “The Picture of Dorian Gray,” a gothic horror novel about a beautiful young man who made a bargain with the devil. In order to remain ageless and unchanged, Dorian Gray struck a deal so that his portrait would grow old while he remained youthful. But the cost of the trade was the loss of his soul. As the ugliness of Dorian Gray’s choice robbed him of all goodness, the portrait grew ever more distorted and horrific.

In the light of last week’s events, I have been thinking a lot about aging. As I read Lynn’s last post, I was struck by the desire most of us have for the perfect, ageless bikini body. I also took special note of the many comments regarding the unhappiness caused by sagging skin and other bodily imperfections that remain after weight loss. But this led me to connect these comments with the experience of my own aging. Being in my early 60s, I can tell you that once you enter your 50s, it becomes impossible to avoid bodily changes. The catalogue of things to be unhappy about increases daily. There are the eye wrinkles, the skin spots, the lax muscles and the grey hair. There are the imperfect teeth, the sagging ear lobes and the arthritic fingers. There are all the things that make a deal with the devil seem like a most attractive option. By the time we reach late middle age, we are all completely familiar with the major issue that weight maintainers have faced for quite awhile. In short: we have no hope of achieving perfection (or of regaining whatever perfection we once had).

Thus, we are faced with a Jacksonian choice. We can rage against the damage of the years and let that anger draw us into an endless downward spiral or we can choose a path we can control; the path of humor, acceptance and (perhaps) minor correction. We can straighten our teeth, get a tummy tuck, dye our hair…but with the knowledge that all of this is no more than a bit of touch-up paint on our own particular portrait. We can perfect, polish and show off the good parts and say “so what?”

 to the not-so-good. Is this easy to do in a world that loves perfect bodies and thinks that no one should age past 24? It is not. But there is an easy rhythm to swimming along within nature’s current and a desperate dog paddle for those who decide to strike out against the tide. And what a true bargain we will find in retaining our souls, our essential humanity!

Michael Jackson’s life and death exemplify the extreme struggle that can occur between our outward presence and our internal identity, a struggle that can be fatal in its most extreme forms. I will miss the blazing talent that created some of the greatest music of my generation. One can only hope that Michael Jackson has now found the peace and eternal youth he so ferverently sought.

Bikinis and Maintenance and I Will Never Look Like That

By Lynn Haraldson-Bering

I’d like to welcome the newest resident in Maintenance World: my friend Shari!

I met Shari in 2006 at my former gym, and at first I knew her only as the brunette who monopolized my favorite elliptical. She knew me as the blond who monopolized her favorite elliptical. We were destined to be best friends.

Shari is who I blame and thank (depending on the day) for telling me the Oprah show was looking for weight-loss success stories – people who’d lost in excess of 100 pounds through diet and exercise. I wrote a letter to the show, forgot about it, and then six months later, we were on a plane to Chicago. No way was I doing that scary bit of TV without her. 

Shari became a lifetime member of Weight Watchers at her meeting last week after losing weight for the final time. Shari’s been up and down the scale (sound familiar?) many times, but has embraced this time as her last time because…well…she “got” it. You all know what I mean.

Here’s what Shari had to say about the whole losing weight/maintenance thing:

Lynn: How much did you lose and how long did it take?

Shari: I started at 140.5 and weighed 113.5, as of this morning. I am 4'11" tall, so every pound shows. I have nowhere to hide extra weight.

My total loss so far is 27 pounds. I'd like to lose maybe 3-5 more. It has taken 22 weeks to get this far.

Lynn: What was “different” this time and how do you know this is your last time down the scale?

Shari: It feels different this time because I didn't give up the foods I love. I learned to eat them responsibly. I learned to control my portions. I lightened recipes by switching to whole grain and reduced fat versions of ingredients. But I didn't give up anything.

I've lost weight, only to regain it many times in the past. The difference is that none of those temporary successes was livable for me in the long term. I accomplished my previous losses by eating too few calories with too little variety to be sustainable. My stints of being super strict about what I was allowing myself to eat were eventually followed by binge eating with reckless abandon. Likewise, in my super strict mode, I would exercise like a maniac for a period of time and then burn out.

I know this is my last trip down the scale because I have finally learned that I don't need to be an all or nothing girl. I really can eat whatever I want...in moderation, and I have found a sensible level of exercise that keeps me feeling healthy and fit without being overwhelming.

I'm nervous about maintenance only because I recognize it as my weak area. This time, however, I have better tools, I have a support system, and I have the knowledge necessary to eat responsibly. And you can bet there will be a bikini picture of me hanging on the fridge to motivate me through the winter!

Speaking of that bikini photo…here it is. When I asked her for an “after” photo and she sent this, she wrote, and I quote, “OMG, I can’t believe I’m doing this!”

I’m pretty sure the baby blue jay I photographed in our lilac bush last week was thinking the same thing: “What am I doing?” He sat there for at least an hour looking nervously at all the other birds and bees and wildlife as his parents brought him food. His fuzzy grey down was molting over his lovely blue feathers. I took this photo through my bathroom window, so it’s not the best shot ever, but hopefully you can see the “new” him emerging underneath.

None of us can really know why lies underneath as we shed pounds. I was thin a few times when I was younger, but I was just that: younger. My skin was younger, my muscles were younger, my breasts and thighs and tummy were younger. Then they were introduced to gravity and cellulite, and as I got bigger and smaller and bigger again, my body got confused, and the things that bounced back before didn’t this time, and so I am who I am…nowhere near bikini presentable, but still presentable.

This is why Shari’s photo is so powerful to me. We’re both at goal, but we look so different. Shari has the body type I will never have without years of surgery, if that’s even possible. I’d love a few curves, but I’m not built that way. That’s a fact I can accept and move on from. It’s the excess skin thing that still bothers me, like a gnat flying around my head. Years of such extreme weights has caused me to have such sad, flappy skin. But before you think this is a “poor me” post, it’s not. I just sometimes need to mourn the loss of elasticity that could have been mine if I’d taken better care of myself in the past. I just wish there was a way to get that message across to young women today. Alas, so many more people are obese now than ever.

I smiled when I got Shari’s reaction when I told her my perspective: “About the body type thing,” she wrote, “I would love to have long legs like yours, so I guess we're even. I will never have them. Could never have them. Surgery does not exist that would make it possible.”

This leads me to ask you: Is anyone reading this truly and completely satisfied with their body type? I am once I talk my way through it, but it sometimes takes a lot of talking over the course of a lot of days. While I’m much more comfortable with my body than I was when I first got to goal two years ago, and especially more than I ever was when I was overweight – not because I was overweight, but because I over-analyzed every one of my faults, including the physical ones – I still compare and contrast myself with other women.

So tell me. Do you do this? Not do this? Also, do you have maintenance advice for our newest resident? If there’s one thing I’ve learned writing this blog for more than a year is that we have a lot more in common than not, so as always, I look forward to your responses.