Sunday, May 26, 2013

The Diet Fix - why everything we know about dieting is wrong

Let's take a break from controversy and talk about the one talk at the WLSFA that I wanted to attend -- one of the things that made it worth the price of attending.

I went to the Dr. Yoni Freedhoff talk expecting a very scientific talk with a lot of references to studies and the like showing how much of the dieting advice we get has been debunked by science. Things like “don’t eat after 7 pm” and “eating fat makes you fat.” His talk was more along the lines of a post I made way, way back when (before surgery even) all about The Dieting Mentality. Only better.

The title of his talk was “The Diet Fix” and it’s also the title of a book that he wrote that was supposed to be published by now but will be published next year instead.

Stop sinning

The main setup was the Seven Deadly Sins of Dieting. Which are:

Hunger

Sacrifice

Willpower

Blind Restriction

Sweat

Perfection

Denial

Let’s take them one by one. I’ll tell you what Dr. Yoni said and then a bit about how this particular sin relates to me personally.

Hunger

"If you aren’t hungry, the diet isn’t working" is how this one goes. But, as Dr. Yoni points out, Hunger is not your friend. Hunger leds to the phenomena that Hyperbole and a Half refers to as EAT ALL THE THINGS:


That’s an actual slide from the talk, by the way.

My own experience is that this is both true and not true. I have found that a lot of my eating is by habit. So, yes, if I let myself get ravenously hungry, I make poor food choices. In fact, I am completely convinced that one of the reasons that WLS has worked so well for me is that it’s much easier to make good food choices when you aren’t hungry all the time.

That said, a little hunger sometimes can be your friend. I mean you can’t experience the wonder of taking a few bites of something and feeling completely satisfied if you never let yourself get hungry.

Also, sometimes my body gets used to a certain calorie level and eating at certain times and will send me signals to get me to continue to eat at those times and those levels even if I no longer am burning the calories to justify it. (Like when I change my workout schedule around to stop working out in Dec to take a break.)

So I find sometimes saying “eh, I think I’ll just be hungry and see what happens” can work for me.

But only sometimes.

So, for me anyway, a little hunger can be Good. If it’s once in a while and I don’t go overboard. Big hunger or continual hunger, on the other hand? Not So Good.

Sacrifice

“No birthday cake for you!” was the subtitle for this one. Except I changed it to birthday pie because, well, PIE! (Never been all that keen on birthday cake.)

As Dr. Yoni pointed out, humans have used food to celebrate since as far back as we’ve got records. The idea that weighing a certain amount means that you no longer deserve to use food this way -- but it’s okay for the rest of us who weigh less -- is a little warped.

Willpower

“Obesity is not a result of a willpower disorder.”

I’ve actually said that in my blog before. And online. And in real life.

Studies have shown that we have a finite amount of willpower. When we use it up, it’s gone until it replenishes. They also show that we can’t really divide it. If we’re using our willpower for one task there often isn’t much left over for something else.

Which reminds me of something I see all the time. People are going through some stress. Maybe a parent is sick and they are caring for them. Maybe they are sick. And they despair -- why am I making bad choices? why can’t I stick to my diet?

It’s because you are caring for a sick person / are sick! You only have so much of what I refer to as “psyche energy” and sometimes you need to use some of it for more important things than losing 10 pounds. Give yourself a break!

That’s what I did with my head. When my head was really, really broken, I concentrated on healing it and with my leftover energy I worked on limiting the damage to my weight -- trying not to gain or not gain too much. Now that my head is only a tiny bit broken and the broken part doesn’t send me Restless Brain Signals that feel like hunger, I am putting a lot more energy into managing my weight and that extra ten pounds has pretty much fallen right off.

Was it scary doing that? Sure. I have DECADES of dieting failure behind me telling me that this ten pounds was going to turn into 100 pounds. But the rational part of me knew that I just couldn’t deal with dieting right then. So I didn't.

Blind Restriction

This is the idea that eating certain foods or types of foods equals failure. I see this A LOT in the online world. People declaring that they will never, ever eat a cookie again! Never! They say things like “I didn’t get my insides cut up in order to eat like that and ruin it all.”

It even happened at the convention. During the Carnie Wilson talk (which I'll talk about in my next blog post), Carnie announced that she hadn't been to McDonalds since her surgery. The room errupted in cheers. I, on the other hand, kind of shook my head and thought "How's that working out for you, Carnie?"

Clearly, eating McDonalds sometimes is not causing me to be a dieting failure. It's not one single choice that leads to dieting failure and not one single food but the sum total of all your choices over time. (Not to mention, you can find reasonable choices everywhere and horrible choices everywhere.)

Dr. Yoni also asked us to keep in mind that food is medication and is does work. Maybe not as well as other medications. But to pretend food is just fuel and doesn’t have these comforting, endorphin releasing powers is to set yourself up in the long run, just like deciding never to use food to celebrate every again is going to set you up.

Another thing that happens with Blind Restriction is that people decide that once they eat the Restricted Food that they’ve Failed so they Give Up. They won’t write it in their food diary. They then binge on other restricted foods or at least decide to eat badly for the rest of the day (or sometimes whole weekend). Because they are a failure, so why not?

What I have found is, if you don’t think about food this way, if you think of it as just food, then when you eat a cookie, you think:

“Yum.”

But also maybe something like:

“Well I better not also eat that donut because then I’ll go over my carb count for the day.”

Or maybe

“I’ve been eating a lot of cookies lately, I think I need to start bringing carrots to work again.”

In other words, you make a choice, you measure it against other choices you’ve made recently, and -- if necessary -- you make some adjustments to keep your life in balance overall.

Sweat

This one was about exercise and our attitude towards it. Which is that it should be unpleasant or it doesn’t count. Bonus point if you puke, of course!
Another slide from his talk

This was followed by a mini-Biggest Loser rant. Dr. Yoni hates that show as much as I do and the way they portray exercise is just one reason.

As he points out, if you think of exercise as this unpleasant thing that makes you puke and sweat like a pig and hurts, you maybe ... might not want to do it? (Okay, except for us triathletes. Because we’re weird. But the rest of you normal folks.)

Perfection

This one is my favorite. I see the sin of Dieting Perfection everywhere. This idea that you won’t be able to lose weight unless you are perfect is deeply ingrained. The thing is, we accept that our standards vary based on circumstances for most other things. We don’t have the same standards for behavior (as an example) when we’re on vacation as we do at work. We have different standards at work than on the internet when it comes to the written word, as another. It’s only in dieting that we expect and demand perfection of ourselves at all times.

This reminds me of when I went on my first commercial diet. It was when I got engaged. I weighed around 200 pounds and I wanted to be thin for my wedding. So I joined Nutri/systems and every week I went to the Center and I took that week’s class and met with my counselor and I ate their food and I never cheated. Not once.

I joined in September so that meant I was dieting during what I think of as the Food Season. Halloween, Thanksgiving, Christmas, New Years. And during that time, that incredibly festival of food, I didn’t even have one bite of anything that wasn’t prescribed.

Part of me is kind of glad I did that. Because when people go on about willpower and how obese people are that way because they haven’t got any, I can point to that experience and say “Oh really? Willpower that!” But part of me thinks I was kind of a pill and wonders about my mental health.

Fast forward 20 years. I had my weight loss surgery in September. And three weeks out from it, some dear friends got married. It was during a brief period when gay people were allowed to get married in California and I was very happy for them and of course I went to the wedding even though I was still on soft foods only and mostly on liquids.

I brought a tube of liquid protein with me and figured I’d drink that instead of a fancy drink from the bar and eat what I could from the food that was served.

Then during the ceremony, they passed around a bowl of M&Ms and asked us to share in them because of some symbolism that I can’t remember now, but it had something to do with love and friendship. I panicked for a second as M&Ms were not a soft food and were not in any way on my prescribed list of allowed foods. But there was no way I was going to not participate in the symbolism and snub my friends so I took just one and I let it melt in my mouth so that it would be liquid and not hurt my staple line.

I was happy with my choice and I lost weight just fine even though I sometimes made decisions like this throughout the weight loss phase. I guess I had learned something in the twenty years in between those two diets about not being such a perfectionist!

Denial

This one is wrapped up in the nonsense phrase of "Nothing tastes as good as thin feels." In other words, successful dieting requires us to deny ourselves of everything.

This meaningless phrase is trotted out a lot in weight loss programs. It's always made me cringe. My usual response is something flippant such as:

You've clearly never tasted one of my cake pops. (Or something else I think the person would find yummy.)

What I have noticed, though, is that people say this only when they are high from losing. I've never seen anyone who was in the throes of battling a regain use this phrase to get themselves back on track.

Dr. Yoni referred to something called Post-purchase Rationalization and mentioned that when people lose weight, they are so excited that whatever diet they are on, they will tell you it's the best diet in the world and everyone should be on it. The whole "nothing tastes as good as thin feels" mantra is part of post-purchase rationalization. 

Why is sinning bad?

The problem with these sins is that transgression is inevitable. And that leads to the following cycle:
Transgression --> Guilt --> Shame --> Failure --> Depression --> Despair --> Binge --> Weight Cycling

So Dr. Yoni urged us to break the cycle and stop trying to avoid these sins but instead to stop thinking that we had to do these things -- exercise until we puke, deny ourselves good things, be perfect, be hungry all the time -- and try to live a balanced life that includes healthy eating and healthy behaviors. If we do that, we can get to our best weight.

BMI vs. Health

The next part of the talk was about the relationship between health and weight. I admit I zoned out a bit here. Probably because at this point it's kind of academic for me. I have a weight that's in the "healthy" BMI range. So the message that I don't have to diet to get to this weight to be healthy is somewhat irrelevant to me.

Wait? What did you just say? I don't have to lose weight to be healthy? But everyone knows that being obese is unhealthy!

Actually, it turns out "everyone" is wrong. Or at least not quite accurate. If you just plot weight vs. mortality, yeah, the heavier you are, the greater your risk of dying. But individual risk isn't that straightforward. If you get more sophisticated in your plotting and start separating out your obese people into categories by what deseases they have, that the relationship between obesity and mortality isn't that straightforwards. 

According to something called the Edmonton Obesity Staging System, if you are at stage 0 or 1 when it comes to certain health factors, you don't have an increased risk of dying even if you are obese. But, if you are stage 2, you do. So that means people like Mr. Mac with their obesity-related diseases -- your high blood pressure, your family history of heart disease, your Type II diabetes, and all the other stuff he's got -- do benefit from losing weight. It does increase their chances of living longer. But someone like me -- who had pretty much no obesity-related diseases -- wasn't at big risk of dying just because I was obese.

I did actually see some health improvements and I may have eventually developed some obesity-related diseases other than my high blood pressure (which I still have to watch my sodium intake or see it creep back up) but I was definitely not in the "at risk of dying just because I was fat" category when I decided to have surgery. So I guess it's a good thing I had weight loss surgery to improve my quality of life more than my health! 

You can read more about how BMI isn't the best indicator of health and the Edmonton Obesity Staging System here.

Comparing Weight Loss to Qualifying for the Boston Marathon

The next part of the talk was all about the Boston Marathon. I loved it!

Dr. Yoni compares losing weight to deciding to qualify for the Boston Marathon. He says he likes to run but he's slow. Some people are naturally talented and qualifying for the Boston Marathon is possible for them. Some people could do it but they'd have to devote their entire life to it, maybe even end up alienating their kids and getting divorced. Others, no matter what they do, will never qualify.

He says that, if you could do it if you devoted your entire life to it, once you qualify, you'll probably ease up on your training and get some of your life back. You may never run that fast again. You may stop running after you do your race. If you will never qualify, no matter how hard you train, at some point you'll give up.

Dieting is like that. Some people can do it. Some people can do it if they devote all their energy to it. But, eventually they have have to devote some energy to the rest of their lives and the weight comes back on. Others never get there no matter how hard they try and eventually they stop trying.

If you want to read the entire explanation, Dr. Yoni has posted about it. It's a fun read and, if you are someone who has never had much of a weight problem but will never qualifying for the Boston Marathon, it might help you understand where people who struggle to lose weight are coming from.

As for me, I used to fall into the "I can qualify if I devote my life to it" category for weight loss. I've lost a bunch of weight several times. I never kept it off though because I couldn't devote my entire life to it for the rest of my life. I also eventually gave up just like those people who qualify only by great heroic effort and then never run that fast again.

I guess I could have accepted that, but I wasn't happy with the quality of my life at that weight so I did something to change what bucket I'm in and now I can easily manage my weight by paying attention. I qualified for the Boston Marathon! Of weight loss anyway.

Next year I want to qualify for the real Boston Marathon though. We'll see, but I think I have a shot. Don't be jealous, Dr. Yoni. :)

Your Best Weight

This part of the talk was a repeat of a couple of blog posts that I'd already read. But it was all awesome and bears repeating:

Your best weight is whatever weight you reach, when you're living the healthiest life you actually enjoy.

Some people talk about your Happy Weight vs. your Ideal Weight. I've talked about this before too. However, I've decided that this terminology is off. I think the idea that there is some "ideal" weight that you could reach if you wanted to is a mirage. There is no such thing as an "ideal" weight, I've decided. There are a bunch of different "ideal" weights for different goals.

For example, the ideal weight to height ratio for climbing while cycling is 2 pounds per inch of height. That makes my ideal weight 122. Which is exactly what I weighed this morning! My ideal weight for looking great on the runway is 109 though. (Yes, I look emaciated at that weight.) But my ideal weight for endurance racing isn't a weight at all, but a range based on body fat % vs. lean body mass.

So it's not ideal weight vs. happy weight. It's happy weight vs. arbitrary insurance chart weight.

Some other points:
  • If you can't happily eat any less, you're not going to eat any less. 
  • If you can't happily exercise any more, you're not going to exercise more. 
  • If you don't like the life you're living, you're not going to keep living that way. 
  • If you accept your personal best at everything else in life, why not weight? 
  • If you can't use food both for comfort and celebration, then you're on a diet that ultimately you're going to quit. 
  • Simply tolerating your life isn't good enough.
And finally: weight that is lost through suffering always comes back!
All in all, it was a great talk and even though I'd heard a lot of it before, it was good to see it all in one place and I did learn some things -- like about the Edmonton Obesity Staging System -- and I got to think about some things in a new way such as some of the different sins and also the whole Boston Marathon metaphor, which really spoke to me.

I just hope I did the talk justice in my transcription and asides.
Post a Comment