Tag: diet

How diabetes nutrition education “inadvertently” encourages disordered eating

~ Green Apple Dietitian ~ 1 Comment

Over 10 years ago, my mom was diagnosed with diabetes. She was referred to a diabetes educator who taught her about foods that affect blood glucose levels and those that don’t. The educator recommended a carbohydrate intake of 45 grams of carbs for meals and 15 grams of carbs for snacks. She didn’t keep up with carb counting but always ate a wide variety of foods, and is one of the healthiest eaters I’ve ever known.

Last year after my mom’s second knee surgery, she lost a noticeable amount of weight. It made sense the weight loss was the result of healing and her dedication to physical therapy. However, during a follow-up procedure, the anesthesiologist reviewed her chart and noticed her blood glucose was consistently above 200. After a 6-month checkup, her A1C was 9.5. When she was first diagnosed, excessive weight loss was a symptom of hyperglycemia and her recent weight change signaled high blood glucose once again.

Weight loss is not a reliable measure of good health. Rapid and significant weight loss can indicate an underlying issue. If eating habits and medication haven’t changed, it’s crucial to consult a healthcare practitioner for an evaluation.

My mom’s doctor, again, referred her to a diabetes educator. She received the same carb-counting education as before, including the proverbial cut-a-banana-in-half speech. Bananas sold in stores are usually larger than what’s recommended on diabetes exchange lists. Patients are encouraged to eat one half and save the other for later. From a behavioral health perspective, how the patient interprets this advice is important. Do they see it as increasing food variety, or an opportunity to consume fewer calories?

If the diabetes educator is unaware a patient is struggling with an eating disorder, the advice may encourage food restriction. If this patient is encouraged to eat half a banana, this validates disordered thinking, “Eat less food so you don’t gain weight.” The eating disorder doesn’t care about diabetes or the patient’s health, only the fear of weight gain. Without screening for and addressing disordered eating, diabetes care is like a band-aid that comes off in the water.

Diabetes educators teach patients about foods that raise blood glucose. The goal of this education is to improve their diet, so it trends within a healthy range. But unfortunately, traditional carb-counting diets put food into distinct categories like eating disorder thought patterns. In simplistic terms, the carb-counting diet has 2 major lists of foods. 1. Foods that don’t affect blood glucose. 2. Foods that affect blood glucose. 3. The eating disorder will see them as good and bad foods while sifting through them to find safe foods that won’t cause weight gain. The result is usually less food intake while raising the risk of malnutrition.

Eating disorders aside, carb-counting diets are not easy to follow, especially when preferred foods are not available. Science proves behavior change is difficult. Not everyone will adapt well to a new diet as people tend to move toward what’s expedient. When feeling stressed, some patients might stop seeking treatment altogether or seek unproven alternative care treatments that can make diabetes worse.

After her appointment, what my mom said later that day is something I hear all too often in my practice, “I don’t know what to eat.” While revisiting the education booklet at home she said, “I’ve forgotten about the carbs. I should get back to that.” Yet she was confused about the difference between a carbohydrate and a protein. Her desire to change perceived incorrect eating behavior insinuated by the diet was evident. She also wasn’t happy with the idea she couldn’t have her oatmeal for breakfast when it was suggested she try to eat something different in the morning.

In my mom’s case, carb-counting education disrupted her healthy relationship with food by causing her to second-guess her choice to eat a banana and oatmeal. Later, she began giving away foods she loved because she believed she could no longer eat them.

As a dietitian specializing in disordered eating, I’ve observed how a carb-counting diet can overwhelm some folks more than it can help. It encourages perfectionistic dieting behaviors that are difficult to follow in real-world situations. The diet requires the patient to learn a lot of information in a short amount of time. There are numerous ways a patient can misconstrue what they’ve learned at first. For example, a newbie to carb counting may decide to “avoid” instead of “balance,” and take an all-or-nothing approach. Then the language becomes, “I can’t eat that, it has too many carbs,” which sounds just like a punishment for bad behavior.

Screening for disordered eating behaviors can help practitioners become aware of treatments that may do more harm than good. Diabetes educators should create an environment that’s all food inclusive while encouraging patients to consume healthy fruits and vegetables as nature intended. The longer I’m a dietitian the more it seems like this diet inadvertently blames the patient for their diabetes instead of giving them the help they need to better manage it.

DISCLAIMER: The Green Apple Dietitian blog provides nutrition information for education only and is not intended to offer medical advice or cure any health conditions. The content should NEVER be used as a substitute for medical advice, diagnosis, or treatment of any health condition or problem. Any questions regarding your diet and health should be addressed to your specific healthcare providers. Never disregard professional medical advice or delay seeking it because of something you have read on this blog.

Green Apple Dietitian makes no warranties expressed or implied regarding the accuracy, completeness, timeliness, comparative or controversial nature, or usefulness of any information posted or shared on this blog. Green Apple Dietitian does not assume any risk whatsoever for your use of any information contained herein that was posted or shared on this blog in the past, present, or future. By accessing this blog, you agree that neither Green Apple Dietitian nor any other party is to be held liable or otherwise responsible for any decision made, or any action taken or not taken, due to your use of any information presented on this blog website.

How to be healthy if you believe you’re overweight

~ Green Apple Dietitian ~ 1 Comment

We all heard about the war on fat. Every news outlet incessantly conveys to us we are heavier. Obesity is making us sicker. The plethora of diet and exercise advice tells us what to eat and what exercises to do to lose weight. It’s never-ending. The diet culture is solidified the world over. We’re always being lectured, “If we’re not trying to lose weight, we are not behaving healthfully.” But is there a better solution for a healthy life instead of dieting? Shouldn’t the answer include everyone of all sizes?

The problem with telling people to lose weight by eating less and exercising more is that it sets people up for weight cycling. When folks starve themselves to lose weight, the body always fights against deprivation. The body battles hard to get the food it needs to survive. Hunger escalates, and cravings for high-fat and sugary foods weaken our resolve. Instead of losing fat, the body becomes dehydrated, loses muscle, and slows down how many calories are burned in a day. Adding exercise to this only speeds up the process. Inevitably, once dieting stops, the weight returns. Then the blame game starts. “I didn’t have enough willpower. I eat unhealthy foods. I am a failure.”  When a new weight-loss diet comes out, the self-torture starts all over again. For some people, the scale tips a little bit higher each time the weight returns.

What’s the answer?

You won’t find it in another weight loss diet or by listening to someone preach about what you should eat and what you shouldn’t. It certainly won’t be in a place where you feel shame or defeated. The reality is we all come in different shapes and sizes. The reality is when most people diet and avoid foods they love, they become obsessed with failure. They feel bad when they believe they ate too much, then starve themselves only to lose out to a late-night binge. The reality is, weight loss diets don’t work, period.

The solution is already within yourself. Set yourself free. Free from the notion of dieting and weight loss. As much as the diet industry wants you to believe, weight cannot be controlled by manipulating calorie intake. If you’ve dieted before and gained the weight back, deep down inside you know this is true. A healthy body tells the truth when it’s hungry and when it feels full after eating enough food. A weight-loss diet keeps you from honoring that truth while encouraging you to fight those normal healthy signals. Your body’s biological hunger and fullness cues are never judgmental. They just are. But weight-loss diets always say, “you’re not good enough unless you have willpower.” Willpower is meaningless to the body when it’s deprived of proper nutrition. Your body doesn’t know the difference. All it knows is there’s not enough food for it to function properly.

The answer to “what should I eat,” is different for everyone. But if you’re willing to open your mind up to another way of thinking, there are some ways to get relief. It’s not how much we weigh that makes us unhealthy, it’s unhealthy behaviors and thoughts about the food we eat. Then it’s how we act on that negativity.

Free yourself from the weight loss dialogue

What are you saying to yourself when it comes time to eat? Do the words, “I need to lose weight” or “I can’t have that,” come out of your mouth often? How many times a day do you say these words? How many times do you hear people around you say it? As a dietitian, I hear these words all the time. Even in a casual conversation with people of all sizes. Big and small. Fat and thin. I don’t believe most folks realize how much they use weight loss language or select foods they believe won’t make them fat. It’s a diet mentality.

Stop and pay attention. Are you eating to control your weight? Are you limiting foods that taste good because they aren’t healthy enough? We often don’t think about how we talk to ourselves and how it reinforces our behaviors. Increasing the mindfulness of the words you say to yourself will give you a cue on how you treat yourself. You might realize it has nothing to do with your weight. Let go of the diet mentality.

Next time you sit down for a meal, chose language that is self-compassionate. Be more empathetic toward your food cravings. We all have them. Part of healthy eating comes from the enjoyment of food and feeling satisfied after a meal. These good feelings aid in digestion. Express gratitude for the food that is available to you. Eating should be a completely neutral event.

If while you’re eating someone brings up the topic of weight loss, or criticizes your weight, remember you have the choice to change the subject. As a grown adult, you don’t have to be a part of it. Stay away from conversations that make you feel guilty or shame afterward. Everyone will always have their own opinion about food, but they are not the expert on your body’s health, you are. You don’t need to be fixed. Chances are what they are saying about you is how they feel about themselves. Move away from the diet mentality.

Always consider where the source of nutrition talk is coming from. Anyone who is properly trained in nutrition will not get on a soap box and tell others how to eat unless they are given permission. Be skeptical of what you hear. Ask questions first.

Free yourself from the mantra of weight loss

If you take an observational approach, you’ll see how the weight loss industry renews itself to keep the cycle going. They already know diets fail and that’s how they make money. They sell hope. Diet companies don’t want you to think in the present moment, but in a made-up future, that doesn’t exist for anyone. You don’t need to lose weight to live the life that you want. No matter what size you are, you deserve everything life has to offer.

There’s a sense of freedom that comes with the understanding that these companies know there’s always someone out there, hopeful, that the next diet will finally help them lose weight and keep it off. People who still haven’t figured it out yet. But they are willing to keep trying and failing and trying again.

Free yourself to eat in the present moment

When sitting down to eat, chose foods that will satisfy hunger in the present, and not a perceived notion of future weight loss. We don’t always know exactly what we are going to eat at any given meal, especially when we’re away from home. It’s best to choose a wide variety of foods in all the food groups that will completely turn off your body’s hunger until the next meal.

Never eat less with the idea you’ll eat more later. Don’t fight your hunger. It’s not a battle that you have to win. Deprivation sets the stage for overeating, always. Every meal is important. You deserve to enjoy your food and to eat enough to feel satisfied. Treat your body kindly and it will take care of the rest. That’s the truth no matter what size body you live in.

DISCLAIMER: The Green Apple Dietitian blog provides nutrition information for education only and is not intended to offer medical advice or cure any health conditions. The content should NEVER be used as a substitute for medical advice, diagnosis, or treatment of any health condition or problem. Any questions regarding your diet and health should be addressed to your specific healthcare providers. Never disregard professional medical advice or delay seeking it because of something you have read on this blog.

Green Apple Dietitian makes no warranties expressed or implied regarding the accuracy, completeness, timeliness, comparative or controversial nature, or usefulness of any information posted or shared on this blog. Green Apple Dietitian does not assume any risk whatsoever for your use of any information contained herein that was posted or shared on this blog in the past, present, or future. By accessing this blog, you agree that neither Green Apple Dietitian nor any other party, to be held liable or otherwise responsible for any decision made, or any action taken or not taken, due to your use of any information presented on this blog website.