Taking Stock

Every now and then it seems that I go through a bit of a renaissance when it comes to the world of nutrition.  Just like the science of food, my knowledge is ever-changing and new information leads to new beliefs. I never abandon my old beliefs but a new layer is added to them.  Consider my own evolution:  As a student I thought weight loss would be my main focus, helping others shed pounds would be my contribution to the nutrition world.  As a dietetic intern, I thought maybe I'd be better served by working as a dietitian for those admitted in hospitals, working with doctors and other healthcare providers to help the acutely ill to recover and play a role in helping them get better.  But then as I became a working RD, I read Intuitive Eating (IE) and that added a profound new understanding about eating which made me realize that my place is better served in the outpatient world helping individuals learn to change and improve their relationship with food.  Layer that with the belief in Health at Every Size® (HAES®) and that focusing on health rather than weight is an important factor in helping people change their behaviors.  And layers continue to be added like what I've learned about Blue Zones and weight stigma.

So here I am, like an onion, with all these layers, some new and some old.  So today's post is sort of a "taking stock" of where I am.

Here are some of the current beliefs.

1. At my core, I believe in IE as a model for eating.  It is a fundamental belief that is at the heart of my practice.  What I take most from IE is the notion that all foods are equal and that I will continue to try to not label foods as good or bad.  My neutrality towards food is not how most of the world of nutrition functions.  We labels things in black and white and with that we add a moral judgement to foods.  That judgement transfers onto us when we eat those foods we've labeled and that clouds our ability to pay attention to internal cues of hunger and fullness.

2. Next, I believe that we are doing a disservice to our country by continuing to fight this ongoing "War on Obesity." This way of addressing the issue of weight is incredibly stigmatizing and potentially damaging, especially when it's focused on our nation's children.  When there is a war, there are winners and losers.  Lose weight and win, stay heavy and lose. Black and white, no middle ground. What a horrible message to send to our children.  And how do we define winning anyway--losing weight? And at what cost?  With such an intense focus on weight, we perpetuate a diet mentality that sabotages our ability to trust our internal cues.  This focus on weight blinds what our real focus should be, healthy behaviors and not healthy weights.

3. Just like the name of this blog, I believe in moderation and balance.  I know there are many dietitians who disagree with me but for me and my practice, I find that moderation is possible.  And when I say moderation, I mean that all foods can be a part of your diet, without judgement, because again, that is how we really make peace with food and begin to tune into what our body tells us.  But this is an area where I begin to struggle, because the term "moderation" has been co-opted by big food companies. This leads me to my next belief:

4. There are things inherently wrong with our food system.  I believe that we rely heavily on overly-processed foods that have allowed big food companies to exert a strong control over our daily food choices.  I don't like the way foods are marketed to kids and I don't like how my professional organization is sponsored by big food companies. I struggle with the nuances of IE at times like this because even though I don't label a candy bar as good or bad, I still don't want it marketed towards my kids and I don't want it used as a reward for their good behavior.

5. Despite what seems to be popular belief, I refuse to demonize sugar.   Sugar is not the root of all our nutritional problems and to think that if we just go sugar-free we'll fix the problem is overly simplistic and setting us up for future problems. That's part of the reason that I won't go see the movie "Fed Up". The other reason I won't see the movie is because of how it addresses childhood obesity and my fear that we are stigmatizing our nation's children.

6. I am not a food elitist, (and to call someone that is rude) but I think that we should be eating more whole foods and spending more time in the kitchen.  Cooking more meals at home helps us connect with our food.  Connecting with food helps us appreciate where our food comes from.  With that respect we might learn to eat with a deeper understanding and eat slowly, paying attention to hunger/fullness/satisfaction.  That doesn't mean I never eat at In 'N Out, it just means that it's not somewhere I go every night, every week or every month.  It's a "play food" that my family will eat on occasion because we enjoy it.  That is moderation.

7. I'm sick of the constant flood of new diets and religious-like zealotry of nutrition beliefs about food.  If I really stay true to my IE roots, then my body dictates my food choices and I tune into that. So if I want to eat more organic, locally sourced food because that's what makes me feel better, then bully for me!  If your body says to eat gluten-free because you think that you feel better because of it, then good for you.  Either way, my diet is my business and I'll be happy to respect yours as well.  That being said, I do have one caveat: if you are going through each different diet plan--one after the next--with the goal of losing weight, then that's where I have an issue because when our diet mentality drives our food choices, we lose sight of the big picture and ignore really listening to what our bodies are telling us.

8. I believe that children are naturally intuitive eaters and that if we, as parents, just take a step back and help foster that skill, many of the food issues we deal with as adults might never be passed on to our kids.  I believe that using a division of responsibility with feeding kids is vital to helping children learn to trust their own bodies internal signs of hunger and fullness.  It's my responsibility to plan a balanced meal with "play" foods and "growing" foods and it's my kids' responsibility to eat, choosing whatever is on the plate and how much of it they choose.

9. Lastly, I believe that we are diverse in our body size and in our eating habits.  As a private practice dietitian it is my goal to provide an environment where my clients can learn to trust themselves around food, to accept their body, to become confident in their cravings, to help them learn what moderation means for them, to help them feel confident around food, to find the joy of movement and to learn to stop worrying about food and enjoy life.

I know that some of these beliefs might seem in conflict with each other but that is why I struggle.  I guess I'm not very black and white with my beliefs.  I sort of fall in the middle on many issues which can make it a challenge to find an identity as a dietitian.

So here I'll stay in the middle ground, enjoying the world around me and hopefully finding some friends along the way who agree with a little, some or most of what I believe.

Enough With the Otter Pops Already

My wife and I share a lot of responsibility with our twins.  We both work and we've been fortunate enough to have different work schedules so one of the ways we divide up some of the work is that my wife drops the kids off at their preschool and I pick them up.  Most of the time I'm there by 4pm and the vast majority of the time my kids have already had a snack.

Before I go too much further, let me say that our preschool has provided my kids with a very loving, nurturing environment.  They've met great friends, they've had great experiences and developed an early love of Judaism.  But one thing that our school needs to work on is the food they feed my kids.  

We provide lunches for them but the school often gives them snacks.  Since I pick them up I hear mostly about the afternoon snack. If you've ever met my daughter you'll understand why some people call her the "court reporter." She remembers everything and will report back to you anything you want to know about the day's events.  It's not common but there are some days that I pick them up and they have bright blue faces!  The "court reporter" yells, "Daddy, we had popsicles today!" They are smiling, excited to see me and they show me how blue their lips and tongues are.  Of course they're blue, that's what happens when you eat Otter Pops.

I know that some Otter Pops are now made with 100% juice and that they only have 40 calories per pop.  I know that some of you are saying what I've heard before, "Just lighten up." Well to be honest, I will not lighten up when it comes to feeding my kids, thank you very much.  When my kids feces is bright green the next day because of the food coloring in their popsicle, I will not lighten up.

There are plenty of alternatives to the neon glow of an Otter Pop.  Why not make some juice pops with the kids?  My colleague, Sumner Brooks, MPH, RD recommended frozen mango chunks.  I'm sure a handful of grapes or some watermelon would be equally refreshing as a popsicle.

I'm doing my best to raise my kids as intuitive eaters and I believe in the principles I've learned from Ellyn Satter.  My kids have eating habits that I'm proud of and I do not deny them any shortage of play foods inside and outside of our house but in the end the issue is this: when I see bright blue faces when I pick my kids up from school, a part of me feels like the hard work I'm putting in is being unintentionally undermined.  Dr. Yoni Freedhoff said it very well in this article he wrote, "Why is Everyone Always Giving My Kids Junkfood?"

Somewhere along the line, we've normalized the constant provision of junk food to children. It seems no matter how small the ship or short the journey, sugar pretty much christens each and every voyage on which our children set sail. 

There's simply no occasion too small to not warrant a junk food accompaniment. But for me, the strangest part of all is the outcry that occurs if and when I point it out. My experiences have taught me that junk food as part of children's' activities has become so normalized that my questioning this sugary status quo genuinely offends people's sensitivities and sometimes even generates frank anger.

I'm hoping that the status quo will change soon and that my kids will not be supplied endless amounts of sugar and food coloring in the coming years but that might not happen.  I hope that we stop relying on the highly processed food as our go-to snacks for our kids.  I hope that when it comes to treats, we make it from scratch instead of getting it from a box.

What do you think?  Do any other parents struggle with what their kids are fed when they are not with them?

Liquid Calories

When I start talking to someone about losing weight I often start with one big change, avoid as many liquid calories as possible.  It doesn't sound like something that would make a big impact but the fact is it does.

To lose weight, you need to cut calories and one simple way to cut a lot of calories from your diet is to avoid all high calorie beverages.  The typical culprits are sodas, energy drinks and juice.  These beverages can put a serious dent in your calorie budget.  Let's just say you drink a 20 oz. soda, 1 regular Monster Energy drink, and 16 oz of Tropicana orange juice in one day.  Well all of those beverages make up 1/3 of your 1800 calorie budget (which is on the low end of what most men need to lose weight).

Aside from the excess calories, most of these beverages are a huge source of added sugar.  According to the American Heart Association (AHA),

In 2001 to 2004, the usual intake of added sugars for Americans was 22.2 teaspoons per day (355 calories per day). Between 1970 and 2005, average annual availability of sugars/added sugars increased by 19%, which added 76 calories to Americans’ average daily energy intake. Soft drinks and other sugar-sweetened beverages are the primary source of added sugars in Americans’ diets.

The AHA new recommendations for sugar intake is not to exceed 100 calories for women and 150 calories for men.  You can read their full recommendations and findings here.

Other high calorie beverages include coffee beverages like lattes and cappuccinos,  sweetened iced tea, whole-fat dairy, lemonade, fruit punch and of course alcohol.

If weight loss is your goal, try to limit your calories from beverages to less than 100 calories per day.  The Center for Disease Control (CDC) put out a great promotion Rethink Your Drink which will give you some great tips for limiting your liquid calories. 

Remember, you are drinking to hydrate yourself, then nothing does that better than plain, simple water.  But if you must add some flavor, try a squeeze a lemon, using Crystal Light, or choosing diet beverages.  Just be cautious with the amount of artificial sweeteners you use.  Some research has shown that those who drink more diet sodas tend to gain weight rather than lose weight.  Take a look at this great blog post to learn more about artificial sweeteners.

So if weight loss is your goal, take a close look at the liquid calories you are taking in and try to make some healthier choices.