Quasi-Recovery

Qausi-Eating Disorder Recovery Dandelion Pic

A previous post, Is Full Eating Disorder Recovery Possible?, brought up a lot of questions about a common challenge for people pursuing eating disorder recovery that I want to talk about today: partial recovery. I actually like the term qausi-recovery because the word “qausi” can mean both “almost but not fully” as well as “seemingly but not actually”. Though sometimes we are aware we are only partially recovered, other times, we think we are fully recovered when we’re not actually 100 percent there. My personal journey fell into the latter category. 

When I relapsed, I had been free of eating disorder behavior for 8 years and believed I was recovered. Slipping back into old behaviors took me by surprise because I didn’t think I was in danger of a relapse since I hadn’t really struggled with my eating disorder for so many years. I didn’t understand why it happened for a while, but eventually came to realize that all those years, I had really been in quasi-recovery.

Some might not agree, and that’s understandable. Part of the difficulty with this topic is that there is no one definition for recovery. Everyone defines it a bit differently, so for our discussion here, I wanted to clarify what I mean by recovery.

What is Full Eating Disorder Recovery?

From a clinical perspective, we would use the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) to see if a person still meets any criteria for an eating disorder. The three most-known are anorexia nervosa, bulimia nervosa, and binge eating disorder. However, many people don’t meet all the criteria for these disorders, but could still be diagnosed with an eating disorder known as Other Specified Feeding and Eating Disorder (OSFED).

OSFED is diagnosed when a person has feeding or eating behaviors that cause clinically significant distress and impairment, but do not meet the full criteria for any of the other disorders. While some people start out with an OSFED diagnosis, some start with a different diagnosis and are later diagnosed with OSFED when they no longer meet criteria for anorexia, bulimia, and binge eating disorder. Some examples include:

  • Someone who has restored weight to a “normal” range but continues to significantly restrict
  • Someone who binges or binges/purges but not as frequently
  • Someone who doesn’t restrict caloric intake anymore, but has become overly conscientious about eating only “healthy” foods (now known as orthorexia

Anyone who still meets the diagnosis criteria for an eating disorder is still not recovered. I imagine most people would agree with that. But does not meeting criteria mean you’re recovered, as I was those 8 years? Perhaps from a clinical perspective, but I personally believe recovery goes beyond a clinical definition. For me, recovery from an eating disorder is more than just abstaining from eating disorder behaviors—it involves a real healing of the relationship with food and your body. 

What Quasi-Recovery Can Look Like

Some signs you might not be fully recovered from your eating disorder include (and during my qausi-recovery stage, I could check several of these boxes!):

  • Eating more than you did before but still not consistently honoring your hunger and/or eating an appropriate amount
  • Eating more foods than you did before but still labeling food as “good” and “bad” and avoiding “bad” foods much of the time
  • Having anxiety around food
  • Using exercise to “earn” or “make up” for what you eat
  • Having food rules about what, how much, or when you can eat
  • Continuing to hate your body and/or fear weight gain

How to Push Through Quasi-Recovery

Being honest with yourself about not having fully healed your relationship with food and your body is an important place to start, if you’re not there already. It’s equally important to believe that full recovery is possible. Don’t settle for believing that this is the best it can be for you, though I understand those feelings as well. I have vivid memories of saying through sobs that I would never be able to make peace with my body and therefore food, even though I wasn’t using explicit behaviors anymore. 

But recovery is about rooting out eating disorder thinking just as much as it is about quitting behaviors. So keep doing that internal work to challenge all the eating disorder/diet culture mentality that continues to drive food anxiety and fear of fatness. Here are some great books I recommend:

Read these and other anti-diet, fat-acceptance books and follow fat-positive, intuitive eating accounts on social media (sign up for my newsletter and I’ll send you a list of influencers!). Then unfollow, cancel, or otherwise disengage with people and content that continues to keep you in bondage to food issues. What we surround ourselves with influences us in a MAJOR way. Finding community with people who promote true body acceptance and food freedom is vital in changing your mindset. It made all the difference for me and I hear the same from so many others.

Final Thoughts

Based on my own experience and those of my clients, qausi-recovery is a common stage for many people with eating disorders. So if that’s where you find yourself, that’s totally okay. Please don’t feel like a failure or get discouraged. The journey to full eating disorder recovery is not a straight line, and it’s certainly not easy. Especially considering how disordered our culture’s relationship with food and bodies is! You CAN get there. It might be cliché, but it’s true:

Progress, not perfection, dear one.

Please reach out to me if there’s anything I can do to help you in your journey. If you’re ready to start therapy with me, you can schedule an appointment online.

Much love,
Cherie signature

I’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, OSFED, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

Is BMI Useful?

Because much of our health system revolves around BMI (body mass index), our BMI is supposedly a big deal. I get asked questions about what exactly is BMI, what does it really measure, and is it valid. Today I want to tackle those questions.

First, let’s start by defining BMI, which is a person’s weight divided by their height squared. According to the National Institute of Health (NIH), “BMI is a measure of body fat based on height and weight that applies to adult men and women.” Ok, so that’s questionable, but we’ll get into that later. I think a brief history lesson on the origins of BMI and the campaign against “obesity” is useful in helping understand BMI’s usefulness for us today.

How BMI Was Developed

BMI was introduced in the early 19th century by a Belgian mathematician (not a physician!) named Adolphe Quetelet to define the statistical norm of human beings, i.e., “the average man.” Quetelet himself said that his index should not be used as a measure of individual health.

Nevertheless, later in the 19th century, U.S. life insurance companies began using it to classify individuals as a way to determine what to charge prospective policyholders. These Metropolitan Life Insurance Company height-weight tables were used to define “ideal” weights for almost a century and helped popularize the idea that weight is a determinant of health.

In 1972, researcher Ancel Keys and colleagues tested several indices of body fat and compared those results to actual measurements of body fat taken from skin calipers and underwater weighing. They concluded that Quetelet’s index was superior to other indices of body fat, and proposed the formula be termed body mass index (BMI). Even then, Keys et al. admitted that BMI does not accurately represent a person’s body fat percentage. Yet another warning that people largely ignored.

Changes in the BMI Categories

In 1985, the National Institutes of Health (NIH) published a paper summarizing their Panel’s definition of “obesity” and its health implications. The NIH grouped “overweight” and “obese” together as a BMIs ≥ 27.8 for men and ≥ 27.3 for women.

Then in 1998, the NIH once again changed the definitions, not only differentiating between “overweight” and obese”, but also significantly lowering the cutoff to be medically considered fat. Now, for both men and women, a BMI greater than 25.0 is considered “overweight” and a BMI over 30.0 is “obese.” An estimated 29 million people went to sleep “normal” one day and woke up “overweight” the next day.

CNN summarized it well when they reported that “Millions of Americans became ‘fat’ [that] Wednesday — even if they didn’t gain a pound — as the federal government adopted a controversial method for determining who is considered overweight.”

Flaws with Using BMI

It Doesn’t Really Tell Us About Fatness

One of the most obvious flaws with the BMI is that, as Keys et al. admitted (even while supporting its use), BMI doesn’t actually measure body fat. This where the NIH definition I mentioned earlier isn’t quite accurate. The calculations make no allowance for muscle mass, bone density, and other factors that can highly influence a person’s weight.

For example, a person with higher muscle mass, such as an athlete, will have a higher weight even compared to someone with the same amount of body fat who has a lower muscle mass. Same for bone density. Also, even some who support the use of BMI are calling for the formula to be changed, criticizing the current formula for what they believe is a tendency to exaggerate thinness in short people and fatness in tall people.

It Doesn’t Really Tell Us About Health

First, let’s keep in mind that the data used to create the BMI scale were based primarily on Caucasian men. Why does that matter?

Well, because people of different sexes, ethnicities, ages, etc. are… well, different. It’s overly simplistic and rather ignorant to assume that a white man is the same as an Asian women. I would think the failings of a one-size-fits-all approach would be pretty obvious, especially given our current concern about diversity, but apparently not.

For example, on average, women have a higher percentage of body fat in relation to total weight than men do, but this does not necessarily mean more health risks. Studies published by the Endocrine Society indicate that because black people tend to have heavier bones and therefore weigh more than white people, the BMI overestimates fatness and health risks for black individuals. And on the other end of the spectrum, according to the WHO, the BMI underestimates health risks for Asian communities, which may contribute to underdiagnosis of certain conditions.

Is BMI Valid?

So Does Being at a Higher BMI Mean You’re Unhealthy or At-Risk for Diseases?

Not necessarily. First, let’s take a look at the supposedly-indisputable evidence that being at a higher BMI is bad for your health.

A Closer Look at the Research that Says Being “Overweight” is Bad

As I covered in a previous post, Can You Be Fat and Healthy?, while there is research that associates higher BMIs with certain health conditions, we don’t really know that higher weight causes those conditions. I’ll say it again and again: correlation does not equal causation.

Even the previously-mentioned NIH paper (1985) defining and vilifying “obesity” states that: “The distribution of fat deposits may be a better predictor of mortality than BMI.” And my personal favorite: “The mortality and morbidity related risks of obesity are influenced by concurrent risk factors such as smoking.”

Well yeah, of course it is. That sounds like a complete ‘duh’ statement, but I don’t think it is considering the disproportionate amount of attention that’s placed on weight. And smoking as a confounding factor is just the tip of the iceberg. There are a lot of factors that are considered determinants of health. Some of those factors include:

  • Genetics
  • Age
  • Sex
  • Ethnicity
  • Activity level
  • Stress levels
  • Mental health
  • Sleep quantity and quality
  • Personal behavior, such as sexual activity and even things like handwashing and oral hygiene
  • Amount of social support and social interactions
  • Socioeconomic conditions, such as poverty
  • Access to medical care
  • Availability of resources to meet daily needs, such as educational and job opportunities, living wages, or healthful foods
  • Alcohol, cigarette, and other drug use
  • Traumatic experiences
  • Social norms and attitudes, such as experiencing discrimination
  • Exposure to crime, violence, and social disorder
  • Environment, such as the presence of trash
  • Exposure to toxic substances and other physical hazards

This isn’t an exhaustive list, but hopefully you can see even considering just these factors, it’s incredibly difficult in research to account for all the possible variables. Much of the research about “obesity” doesn’t level the playing field by making sure all these things aren’t influencing the data negatively toward people with higher BMIs.

For example, a study found that people in the U.S. who live in the most poverty-dense counties are those most prone to being at an “obese” BMI—it showed “obesity” rates to be 145% greater than affluent counties. Now, we know that poverty reduces life expectancy and quality of life, and increases the risk for a number of health issues. Other studies have indicated that socioeconomic factors were found to be the most important predictors of death by all causes.

And yet, we’ve downplayed the poverty issue (along with all the other confounding factors) and have decided weight is the main issue when it comes to health. Based on the U.S. Census Bureau’s 2017 estimates, there are an estimated 39.7 million Americans living in poverty. If we truly care about health, perhaps our efforts would be much better spent on the “war on poverty” instead of “obesity.”

There is another issue with some of the studies that seemingly indicate being “obese” is bad for your health. Let’s consider what researchers often consider “healthy” from a metabolic standpoint (because there’s no standard definition, it can be a bit subjective). Typically, it would be individuals who exhibit good health markers such as appropriate levels of blood sugar, triglycerides, high-density lipoprotein (HDL) cholesterol and blood pressure without the use of medications. So the question is… can thin people be “unhealthy” and fat people be “healthy” according to these types of metabolic markers?

Yes, absolutely.

But too often in studies that (supposedly) show “healthy obese” people are still at higher risk for disease and death, the “healthy obese” people are defined as individuals who have no more than 1 metabolic risk factor—hypertension (high blood pressure), for instance. That is problematic because hypertension alone increases the risk of death.

Do you see how misleading that is? The results seem compelling until you look closer and realize the “healthy obese” people weren’t actually healthy to begin with so their conclusion is inherently flawed.

A Look at the Research that Says Being “Overweight” Can be Okay, Sometimes Even Healthy

Contrary to popular belief, the studies associating higher BMIs with negative outcomes aren’t the only research on the topic. There are, in fact, a number of studies indicating being “overweight” is a protective factor for many health issues, meaning that for who people do get a certain condition, they are less likely to die from it if they are at a higher BMI. This phenomenon is referred to as “reverse epidemiology” or the “obesity paradox”.

For example, “obesity” has been associated with improved survival in patients with certain types of cancers as well as some chronic diseases, including congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), chronic kidney disease, and more.

A landmark study by Flegal et al. revealed that compared to being at a “normal” weight, “overweight” is associated with lower death rates by all causes. Unless you’re already into the Health At Every Size® (HAES) movement, you likely have never heard about that research. It doesn’t exactly fit into our normal fear-mongering paradigm about weight.

Though this study did account for some confounding variables such as smoking and pre-existing illness, this research has been criticized by some as not accounting for other variables. I think they did a pretty good job on that level, but again, we have to acknowledge how complex all the variables are when it comes to studies on health and the difficulty in isolating the one variable being studied. So perhaps there’s validity to that argument. But you have to admit the irony of such criticism. These critics are applying a standard of scientific rigor only to the research they want to discredit, while blatantly ignoring the same issues in the research supporting their preconceived ideas.

In 2018, researchers at York University’s Faculty of Health published a study comparing several groups, including individuals who were:

  • “obese” with no metabolic risk factors
  • “obese” with a metabolic risk factor
  • “normal” weight with no metabolic risk factors
  • “normal” weight with a metabolic risk factor

This is a more fair comparison than other research with “healthy obese” people who weren’t actually healthy. The conclusion of this study was that “obese” people with no metabolic risk factors do not have an increased rate of mortality over “normal” weight people without risk factors:

“We found that a person of normal weight with no other metabolic risk factors is just as likely to die as the person with obesity and no other risk factors…This means that hundreds of thousands of people in North America alone with metabolically healthy obesity will be told to lose weight when it’s questionable how much benefit they’ll actually receive.”

Final Thoughts…

Sadly, though our culture prides itself on being science-based, a whole segment of the research on weight and health is completely ignored while the other segment of the research is misinterpreted. Then those misinterpretations are treated as indisputable.

That’s how powerful and destructive fat bias is. It’s bad enough that we’ve marginalized fat people in the beauty industry, but now we also do it in the LAST places it should ever happen—in science and medicine.

This is not okay. Weight stigma is making people sick and even killing people through physical and mental illnesses. Taking the time to educate yourself about the Health at Every Size and body acceptance movements is a great place to start if you haven’t already.

Please reach out to me if there’s anything I can do to help you in your journey. May we all be better people tomorrow than we are today.

Much love,
Cherie signature

Sources
https://www.psychologytoday.com/us/blog/the-gravity-weight/201603/adolphe-quetelet-and-the-evolution-body-mass-index-bmi
https://elemental.medium.com/the-bizarre-and-racist-history-of-the-bmi-7d8dc2aa33bb
https://frac.org/obesity-health
Semega, J; Fontenot, KR; Kollar, MA. Income and Poverty in the United States: 2017. Census Bureau, September 2018.
Levine J. A. (2011). Poverty and obesity in the U.S. Diabetes, 60(11), 2667–2668. https://doi.org/10.2337/db11-1118
Health Implications of Obesity. NIH Consens Statement Online 1985 Feb 11-13; 5(9):1-7.
Robert J Kuczmarski, Katherine M Flegal, Criteria for definition of overweight in transition: background and recommendations for the United States, The American Journal of Clinical Nutrition, Volume 72, Issue 5, November 2000, Pages 1074–1081, https://doi.org/10.1093/ajcn/72.5.1074
Wang Z, Liu M, Pan T, et al. . Lower mortality associated with overweight in the U.S. National health interview surveyMedicine 2016;95:e2424–e24. 10.1097/MD.0000000000002424
Melaku, Y. A., Gill, T. K., Appleton, S. L., Hill, C., Boyd, M. A., & Adams, R. J. (2019). Sociodemographic, lifestyle and metabolic predictors of all-cause mortality in a cohort of community-dwelling population: an 18-year follow-up of the North West Adelaide Health Study. BMJ open9(8), e030079. https://doi.org/10.1136/bmjopen-2019-030079
Hu FB. Obesity Epidemiology. Oxford University Press; New York: 2008.
York University. (2018, July 12). Obesity alone does not increase risk of death: New study could change the way we think about obesity and health. ScienceDaily. Retrieved June 18, 2020 from http://www.sciencedaily.com/releases/2018/07/180712114440.htm

I’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, OSFED, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

Is Full Eating Disorder Recovery Possible?

Is Eating Disoder Recovery Possible

Sometimes clients will ask me if I believe full eating disorder recovery is possible. This is such an understandable question given how difficult recovery is and, for some clients, how long they have been struggling. It’s not uncommon for eating disorder treatment to last years, and sometimes include repeated periods of being in a higher level of care.

Even with all those challenges, my answer to whether full eating disorder recovery is possible is YES.

I believe that because I’ve lived it myself and seen others recover too. And all of us questioned whether it was possible. It felt too hard at times. It was too messy, and we slipped up a lot. And it took much longer than we thought it should, much longer than we wanted it to.

Friend, I promise that is just the reality of eating disorder recovery and none of those things is evidence that you can’t do it.

What about “recovered” versus “recovering”?

There is some debate in the eating disorder community about whether people can be fully recovered without intentional maintenance or whether it is more like always being in recovery… that is, having to intentionally maintain being free of the eating disorder. Many alcoholics describe themselves as being in recovery, even years after they have stopped drinking. It implies a sense of fragility to recovery, as if losing that recovery is always a near possibility. I’ve found this thinking to be common in the 12-step communities.

I personally believe that full recovery without having to intentionally maintain it is possible. That is my experience and the experience of many others I’ve seen. However, I would never minimize the experiences of those who describe themselves in a state of recovery. I certainly have no right to tell them they are wrong. Yet I can’t help but wonder if those people just have settled for a state of qausi-recovery (a topic I’ll write about soon). It’s possible that they haven’t fully healed their relationship with food and their bodies, even though they are free of actual eating disorder behaviors. In the alcohol recovery world, that’s called being a dry drunk.

I have found qausi-recovery to be a very common experience for many people with eating disorders, so if that’s where you find yourself, you’re completely normal in that regard too. It doesn’t mean you’ve failed or can’t do it, it just means there are still some things to work on, things that still need healing. I was in qausi-recovery for 8 years so I know about that in-between place quite well. But against all odds, here I am, now completely recovered.

You can have full recovery too. Just don’t give up.

Please reach out to me if there’s anything I can do to help you in your journey. If you’re ready to start therapy with me, you can schedule an appointment online.

Much love,
Cherie signature

I’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, OSFED, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

Eating Disorder Treatment

Eating Disorder Treatment

Deciding what level of care you need or your loved one needs can be daunting. Today I will give an overview of the five levels of care that are available for eating disorder treatment and describe the type of person who would be a good fit for each level. If you’re still not sure which is right for you, please reach out to me so we can talk about it.

When deciding what level of care is needed, several factors should be considered. Historically, weight was the main determinant, but thankfully, we are slowly moving away from that approach. Now, most treatment providers and insurance companies take into account your overall physical condition, psychology, eating disorder behaviors, and other factors. The American Psychological Association (APA) provides suggested criteria for each level of eating disorder treatment. These criteria include:

  • Medical status
  • Suicidality
  • Weight (as a percentage of healthy body weight)
  • Motivation to recover, including cooperativeness, insight, and ability to control obsessive thoughts
  • Co-occurring disorders, including substance use, depression, and anxiety
  • Structure is needed for eating and gaining weight
  • Ability to control compulsive exercising

Let’s take a look a the levels of eating disorder treatment and how the APA’s guidelines apply to each of them.

Level One: Outpatient: Outpatient treatment includes individual sessions with a therapist and/or dietitian, typically once or twice a week. Outpatient treatment typically last for months to years, and can sometimes include periods of being in a higher level of care. Also, sometimes outpatient care can include group therapy. Outpatient eating disorder treatment is likely right for you if you:

  • are medically stable
  • have at least some motivation for recovery
  • can implement some structure on your own regarding meals
  • are able to at times limit your eating disorder behaviors, including compulsive exercise
  • are not suicidal with a plan or intent to harm yourself

Level Two: Intensive Outpatient Programs (IOP): IOPs usually include about three hours of programming for at least two to three days a week. At this level of care, you would live at home and could probably still work or go to school. Usually, one meal or snack takes place at the treatment center. IOP eating disorder treatment is likely right for you if you:

  • are medically stable
  • have at least some motivation for recovery
  • can implement some structure on your own regarding meals but need a bit of support/accountability
  • are able to at times limit your eating disorder behaviors, including compulsive exercise, but need a bit of support/accountability
  • are not suicidal with a plan or intent to harm yourself

Level Three: Partial Hospitalization (aka Day Programs): Partial hospitalization (PHP) is typically treatment during the day, while letting you still go home at night. PHP is usually 6 to 11 hours a day for at least five days a week, so the majority of meals are at the treatment center. PHP eating disorder treatment is likely right for you if you:

  • are medically stable
  • have some motivation for recovery but are struggling to feel motivated at times
  • need structure and support for most meals 
  • struggle to limit your eating disorder behaviors, including compulsive exercise and need quite a bit of support/accountability
  • are not suicidal with a plan or intent to harm yourself

Level Four: Residential Treatment: Residential treatment provides 24-hour care for those who are medically stable but still require round-the-clock supervision meals and behaviors. Residential treatment is typically 6 weeks or longer. This level of care is likely right for you if you are medically stable and have a/an:

  • need for supervision to eat 
  • need for supervision to not purge or use other behaviors
  • inability to stop exercising
  • lack of treatment options near home

Level Five: Inpatient Treatment: Inpatient treatment is 24-hour care in a medical hospital. This level is for individuals who are not medically stable and need round-the-clock medical assistance or monitoring (including intravenous fluids, tube feeds, and constant monitoring of vital signs). This is often a necessary level of care for individuals who do not cooperate with treatment protocols at lower levels of care. Inpatient stays can last days to weeks. This is likely the right level for you if you are not medically stable or if you have:

  • unstable heart rate or blood pressure
  • significant weight decline and/or food refusal
  • evidence of malnutrition
  • other psychiatric disorders that would require hospitalization
  • suicidal thoughts with intent to harm yourself

A quick note in case you’re asking yourself Am I Really Sick Enough for Treatment?

I hear this question all the time. Sweet friend, the answer is always “YES!”

Your eating disorder will try to convince you that you don’t need or don’t deserve help. It will whisper lies about things not being that bad, about you being able to handle it, about not looking like you even have an eating disorder…

Don’t listen to any of that or any other excuse your ED gives you. Eating disorders don’t have a “look” despite the stereotype, and people at all weighs can have an ED. And you don’t have to be at the point of needing hospitalization to be “sick enough”. Please, please don’t wait for that point to get help.

You could miss out on spending years of your life with joy and purpose instead of spending them still consumed with your ED. You could do irreparable damage to your body, or yes, even die.

Don’t believe your eating disorder. You are worthy of help and support. Today. Not sometime in the future when things get worse. TODAY.

xo.

Final Thoughts…

Again, I know it might feel overwhelming trying to figure out the right eating disorder treatment for you (or your loved one). If you’re still not sure which is right or if you need a referral to higher level of care, please reach out to me. If you’re ready to start outpatient therapy, it’s easy: schedule an appointment online.

Much love,
Cherie signature

Sources
https://www.nationaleatingdisorders.org/toolkit/parent-toolkit/level-care-guidelines-patients
About Cherie Miller @ Dare 2 Hope

I’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, OSFED, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

Is Noom a Diet? An Inside Look into Noom

By now, you’ve probably seen an ad for Noom because they seem to be everywhere. They’re intriguing to many because they claim to be different than other weight-loss programs, largely in part due to having “psychology” element and also for not involving dieting. When I saw they were offering a free trial, I decided to sign up and check it out to see what it’s really all about. Now that I’ve had an inside look, I want pull back the curtain for you so you can see for yourself how accurate these claims are:

“Noom helps you build healthier habits to lose weight—no dieting needed!”
“Noom: Stop dieting. Get life-long results.”

Here we go 🙂

First, what IS a diet?

To be clear about what a diet actually is, here’s a definition from the Encyclopedia Britannica:

Dieting is regulating one’s food intake for the purpose of improving one’s physical condition, especially for the purpose of reducing obesity, or what is conceived to be excess body fat.

This “food regulation” can take on several forms, including reducing overall food consumed or cutting out specific foods.

So does Noom do those? Yes. And sorta yes.

Cutting Calories

The whole program is built on reducing calories. That’s really not so new, is it? That diet approach has been around for ages! How it works is you say what your goal weight is and if you want to go slow, medium or fast to get to that goal. Then they calculate how long it will take you to get there and give you a daily “calorie budget”. You don’t have to count the calories yourself, but you do have to log everything you eat and their program calculates it for you.

To be honest, my calorie budget was suitable for a toddler. Not a grown woman. Definitely not a woman who is nursing (which was never asked about in the assessment questions, by the way). I blew through my calorie budget by the afternoon. Of course, I wasn’t actually trying to stay within my allowance. To do so would mean eating less and/or choosing different foods (again, the very definition of a diet, amiright?)

Cutting Out Specific Foods

Now, they say that there are no “good” and “bad” foods and you can eat anything. Sounds great! Except that every food you log is coded in a color chart: green foods are thumbs up while yellow and red food should be “limited.” So, I guess technically there’s no cutting out certain foods. But color coding foods and saying some should be limited sure sounds like categorizing foods into good and bad categories. And it sure sounds like a way to make people feel bad about the foods in the red category.

“Get Life-long Results”

This is just a totally baseless claim to make. Their marketing claims that 77% of people lost weight and kept it off for nine months. First off, nine months is nothing in terms of a lifetime. Like every other diet, there is no evidence that it works long-term (meaning 5+ years). Weight loss research typically follows people one year or less, which isn’t a very long time considering most people aren’t interested in losing weight just to gain it back after 12-24 months. That kind of weight cycling is also incredibly bad for your health. (Check out this post to read about the negative health impact of yo-yo dieting.).

Additionally, that 77% success rate they tout is a bit misleading if you don’t know exactly what’s include… or in this case, left out. The study they used was by Chin et al (2016), which looked at data from about 36,000 people who used the app between October 2012 and April 2014. As clinical psychologist Alexis Conason Psy.D. explains:

At the time the study was written, the authors reported that over 10 million people had downloaded the app. However, the study only included people who used the app consistently for six months or more. In other words, the study only included the most successful users. Think about it: If you start a program, use it for a while, and it doesn’t work, what would you do? Would you continue paying each month for a service that isn’t delivering on its promises? No, if you are like most people, you would stop the program. And that is exactly what over 99% of Noom users did.

So, keeping in mind that this study is only looking at the 0.36% of Noom users (out of the 10 million people who downloaded the app) who stuck with the plan for six months of more, let’s see what they found. While actively using the app, over 30% of these users lost less than 5% of their weight. About 24% of users lost 10% of their weight and 22% lost more than 20%. That’s what happened in the short term, when participants were consistently engaging with the app.

At follow-up less than one year after starting the program, researchers had data on 15,376 of these participants (more than half of the sample was excluded due to missing data) and found that less than 10% of participants had lost and maintained 5-10% of their weight. Additionally 11% had already regained whatever weight they initially lost.

But because the millions of people who didn’t keep using the app weren’t even included in this particular study, the conclusion was that 77% lost weight while using the app—again, the stat Noom widely uses in their marketing. It’s actually pretty deceptive once you understand how that number was derived, isn’t it? As Conason puts it, “I guess it sounds better than 86% of users failed our program within a year. Or 99% of people couldn’t stick with our plan for six months.”

Other Concerns About Noom

Here are some other issues I have with Noom:

  • They don’t flag unhealthy goal weights. Of course, I think part of the problem with these programs and our weight-loss obsession in general is that a person’s healthy weight might be higher than what our culture considers a healthy weight. But that aside, I purposely set my goal weight to be low enough that it would be considered clinically underweight according to BMI. (Yes, I think BMI is horse manure but that’s a fun discussion for another time.) You should know that while the research on the dangers of being fat is questionable, the research about the dangers of being underweight is not. Being underweight is very dangerous medically. Setting an underweight goal should have been a big red flag for Noom. But the system didn’t flag anything and my “goal specialist” didn’t seem concerned. Yikes.
  • They expect daily weigh-ins. Now, I’m against weighing in general, but even if you do weigh, can we agree that doing so every day is excessive?
  • They encourage you to eat foods with more water in them so you get filled up on fewer calories. “Eat and drink more water” is a classic dieting and eating disorder tactic. Does it work in the short term? Sure, it can. Does it work in the long term? No, because no dieting hack does. I only did the app for one day, so there’s no telling what other dieting hacks they would have tried to push.
  • It doesn’t necessarily promote health like they claim. The kind of restriction they are promoting might be so extreme for some people, it would be incredibly not healthy physically, regardless of their current weight. Contrary to popular belief, people in larger bodies can be malnourished. And again, they didn’t care at all that my goal weight was clinically underweight.
  • They don’t screen for eating disorders. I have a huge problem with this, because they claim to be about health. Well, health includes mental health, people. Especially considering eating disorders have the highest mortality rate of all mental illnesses.

Final Thoughts…

Anytime someone is claiming to not be a diet, but wants you reduce calories or eliminate foods, see it for what it is: nothing more than a re-packaged diet. Companies and influencers know that dieting isn’t really en vogue anymore like it was in the 90’s, so now they try to pass diets off as “wellness” and “lifestyle changes” instead. We think we’ve shifted away from weight loss to being healthy… but we haven’t really.

If you’re stuck in chronic dieting or an eating disorder, I’d love to help! Please contact me or schedule an appointment online.

Much love,
Cherie signature

Sources
https://www.google.com/search?q=noom&oq=noom&aqs=chrome..69i57j69i60j69i61l3j69i60.2044j0j7&sourceid=chrome&ie=UTF-8
https://www.britannica.com/science/dieting
https://www.psychologytoday.com/us/blog/eating-mindfully/202005/is-noom-diet
About Cherie Miller @ Dare 2 Hope

I’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, OSFED, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

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5 Myths about Intuitive Eating

Intuitive Eating Myths

If you’re not familiar with intuitive eating at all, you can read the basics about it here. In this post, I want to address some of the misconceptions I often hear about intuitive eating.

Myth #1: Intuitive Eating is a Diet

Intuitive eating is not a diet, although, unfortunately some people approach it that way. Intuitive eating is about having unconditional permission to eat all foods, which requires rejecting diet mentality and making peace with food. The goal of intuitive eating cannot be to lose weight because that will inevitably conflict with listening to and honoring your body.

Myth #2: Intuitive Eating Means Eating Whatever You Want, Whenever You Want

This is an oversimplification of intuitive eating, which does teach having unconditional permission to eat all foods and honoring your cravings, as we’ve already discussed. However, intuitive eating teaches ten principles that work together, so it doesn’t work well for a single principle to be applied without the others.

For example, principle #8 is “Respect your body.” To do that, you have to be attune to how your body feels and what it is communicating to you. If you eat nothing but ice cream,  your body will not function optimally and will tell you so through stomach discomfort, blood sugar fluctuations, or a number of physical symptoms. (Interestingly, research shows the ability to perceive these sensations—called interoceptive awareness—is higher in intuitive eaters.) So the question when considering what and when to eat is not just what will taste good, but also, what will feel good to my body now as well as later?

Additionally, I’d like to point out that because intuitive eating rejects restriction and food policing, cravings for “junk” food typically decrease in frequency and intensity. Studies have shown that intuitive eating typically ends up with people eating a wider variety of foods. Yes, at first, you might find yourself eating a lot of the foods you previously restricted and that’s normal. As the Intuitive Eating book says,

“When you first begin the healing process, you may find that you’re eating more of the foods that you had previously restricted. This restriction has led to deprivation, and you may end up eating more of these foods for a while. Once the deprivation has healed, these foods will take a balanced place in your eating life.”

Myth #3: Intuitive Eating Just Means Eat When You’re Hungry and Stop When You’re Full

While two of the principles of intuitive eating are honoring hunger and fullness cues, that can be more challenging than it sounds. Which is why the other eight intuitive eating principles are just as important! Recognizing and responding to hunger and fullness is complicated if you’re still steeped in diet mentality, aren’t truly satisfied by your food choices, or are habitually using food to cope with feelings.

Intuitive Eating is Not a Diet

Myth #4: There’s No Care About Nutrition with Intuitive Eating

“Honor your health: is #10 of the principles, so definitely, nutrition is a factor in intuitive eating, and is often referred to as “gentle nutrition.” Being attuned to your body while making food choices will naturally lead to some care in nutrition, because while no foods are “bad,” some are obviously more nutrient-dense than others. Our bodies do not feel good eating less nutrient-rich foods all the time, so being attune to our bodies means we will notice that and want more nutritious foods as well. I’ve seen people swear they hated vegetables and they’d never want anything but cookies and cake if they let themselves eat intuitively who actually end up craving sugar less and wanting salads sometimes!

Myth #5: You Will Gain Weight with Intuitive Eating

I think this fear comes from the belief that letting go of food rules means eating high fat and/or high sugar foods all the time. We’ve already talked about how once feelings of deprivation are healed and principles of gentle nutrition are learned, intuitive eaters actually eat a variety of foods. Several studies have associated intuitive eating with having a lower BMI, though please, please don’t take that to mean you’ll lose weight eating intuitively. (Remember, this is NOT a diet and trying to lose weight will always undermine true intuitive eating!)

The truth is everyone will have a unique experience in regards to weight as they transition to intuitive eating. Some will gain weight while others will lose weight, and some will stay exactly the same. It depends on what weight your body wants to be at as well as how responsive you were to your body’s food and movement needs before versus how responsive to those needs you become as an intuitive eater.

Final Thoughts

Intuitive eating really is simple in theory, but it can be hard to put into practice. It’s a completely different relationship with food and your body than most of us have had since we were very young. While it does take time to unlearn diet culture and become an intuitive eater, it’s totally doable! If you’d like to talk with me about learning intuitive eating or have questions about it, please contact me or schedule an appointment.

Much love,
Cherie Signature

Sources
Tribole, E., & Resch, E. (2012). Intuitive eating: A revolutionary program that works (3rd ed.). New York: St. Martins Griffin.
Herbert BM, Blechert J, Hautzinger M, Matthias E, Herbert C. Intuitive eating is associated with interoceptive sensitivity. Effects on body mass index. Appetite. 2013;70:22-30.
Gast, J., Madanat H., & Nielson A. (2012). Are Men More Intuitive When It Comes to Eating and Physical Activity?  Am J Mens Health, vol. 6 no. 2 164-17.
Madden C.E., Leong, S.L., Gray A., and Horwath C.C. ( 2012). Eating in response to hunger and satiety signals is related to BMI in a nationwide sample of 1601 mid-age New Zealand womenPublic Health NutritionMar 23:1-8. [Epub ahead of print].

About Cherie Miller @ Dare 2 HopeI’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

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When Recovery Doesn’t Feel Worth It

Recovery from an eating disorder is incredibly difficult. Not only is the process itself just really hard, but it usually takes a long time and that in and of itself can be challenging. Sometimes it might all feel not worth it.

I understand. I’ve been there and so have many of the clients I’ve worked with. Part of the reason it doesn’t feel worth it, though, is probably because you don’t know what full recovery is like. It’s hard to imagine having peace with food and your body if you’ve never experienced it.

In earlier difficult seasons of my life, I was tempted to relapse back into my eating disorder. If we’re honest, we can admit that our eating disorders serve us in many ways, and that’s another reason it’s hard to give them up. But I didn’t go back to it, because I knew what it’s like to live without an eating disorder and it’s SO MUCH BETTER. Whatever my eating disorder did give me didn’t compare to what it stole from me. Whatever needs it met, I can meet those in healthier, better ways that don’t come at such a high physical and emotional cost.

But if you haven’t been on the other side of full recovery like I have, you might have a hard time even imagining what it will be like. So even though you can’t really know until you get there, let yourself dream. Try to create in your mind a picture of what being recovered might look like for you. Here are some activities that I like to do with clients to help them envision recovery.

Create a vision board. Cut out pictures from magazines (that won’t be triggering) and glue them on a piece of paper or poster board. Include pictures of places you want to go, activities you want to do, foods you want to eat, words that will describe you and your life, etc. Hang it up where you can see it often to help you stay motivated.

Journal about being recovered. Take some time to imagine a day in your recovered life. Visualize in as much detail as possible what you are doing, what you are wearing, who you are with, how you feel about life, how you feel in your body, what hobbies/activities you enjoy, or whatever else you would like to be true for you.

These activities might bring up a lot of emotions. Maybe excitement thinking about the possibilities, or sadness about what you’re missing out right now. It might even bring up anxiety or fear. It’s okay to also feel afraid of the things we want. Even if recovered life seems scary, try these assignments anyway and share it with your therapist, if you have one (and if you don’t please get one!).

Final Thoughts…

Overwhelming emotions, fear of weight gain, loss of identity, and so many other recovery humps make it tempting to give up before you fully recover. Please don’t give up. Reach out for support, give yourself compassion for how hard it is, and remind yourself what you’re working towards.

If I can help, please contact me or schedule an appointment online.

Much love,
Cherie signature

About Cherie Miller @ Dare 2 Hope

I’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

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Can You Be Fat and Healthy?

Can You Be Fat and Healthy?

We are told over and over that people in larger bodies are unhealthy. It’s the underlying assumption that drives the so-called “obesity epidemic” that everyone from doctors to Michelle Obama to Susan on Facebook are ranting about. This assumption about weight and health is so pervasive that most people don’t even stop to question it.

So is it true? Does being fat automatically mean that you’re unhealthy? Or put another way, is it possible to be fat and be healthy?

Believe it or not (and most don’t at first), there’s empirical support for the idea that you can be fat and healthy. Let’s take a look.

What the “Evidence” Leaves Out

First, we have to realize that all the evidence we hear on this topic is selected specifically to support the fat=unhealthy assumption that already exists. It’s human nature to ignore or reject information that doesn’t fit with our preconceived beliefs. So much of the evidence that supports the idea that people can be healthy at all sizes (e.g. Health At Every Size, or HAES®) is not even discussed.

Here is a summary of just some of the data supporting HAES®, as stated by Dr. Arya M. Sharma, MD, DSc (hon), FRCPC. Dr. Sharma is a Professor of Medicine & Past-Chair in Obesity Research and Management at the University of Alberta, Edmonton, Canada, and he writes:

“For one, as reviewed by the authors, a comprehensive search of the literature reveals at least six randomised controlled trials indicating that a HAES approach (focussing on promoting health behaviours and size acceptance rather than weight loss) is associated with statistically and clinically relevant improvements in physiological measures (e.g. blood pressure, blood lipids), health behaviors (e.g. physical activity, eating disorder pathology), and psychosocial outcomes (e.g, mood, self-esteem, body image). None of these studies found adverse changes in any variables.”

Additionally, a government survey indicated that over half the “overweight” adults (51.3%) being targeted were metabolically healthy. There are studies showing that weight and BMI are poor predictors of disease and longevity (see the sources listed at the bottom), and the bulk of epidemiological evidence suggests that five pounds “underweight” is more dangerous than 75 pounds “overweight.”

In another study comparing the HAES® model to a diet approach, though only dieters lost weight, both groups initially had similar improvements in metabolic fitness, activity levels, psychological measures, and eating behaviors.  After two years, dieters had regained their weight and lost the health improvements, while the HAES® group sustained their health improvements.

This is just some of the research behind HAES®, but truthfully, there’s way too much for me to cover it fully here in just a blog post. Please consider additional reading on the topic, which can be found on my Resources page.

What the “Evidence” Gets Wrong

The fact that contradictory evidence gets left out or dismissed is not the only issue. The other problem is that the evidence to support the claim that being fat is unhealthy is just not as cut and dry as we’ve been told. There is literally NO study that has proven being fat causes illness or disease. Some studies show an association between being fat and having certain conditions, but as anyone who has ever studied research and statistics will tell you, correlation does not equal causation. (Say it again with me: correlation does not equal causation!)

For instance, what if I told you that the more ice cream is consumed, the more murders there are. Crazy, but yes, it’s an actual correlation. However, I doubt anyone would claim that eating ice cream causes people to commit murder. You would probably assume it’s either a coincidence or that there is another factor driving both increases. Maybe the heat? People are more likely to buy ice cream in summer months when it’s hot, and perhaps people are also more likely to murder someone because hot weather can make people irritable and temperamental. We don’t really know, but the point is, that in examples like this, we see pretty easily that it would be erroneous to assume correlation equals causation.

Yet that’s what we do all the time with “obesity” studies linking higher weights to certain conditions. We don’t really know that weight causes those conditions, only that they correlate to higher weights. Perhaps there are underlying factors driving both? A very real possibility for that is the emotional stress involved with being in a larger body, especially for those who suffer bullying, discrimination, or even abuse. (It’s well documented that discrimination is a chronic stressor and can increase people’s vulnerability to physical illness.) Another possibility is there’s an underlying physical condition that causes both. Still another possibility is that larger-bodied people are less likely to seek healthcare due to negative experiences with fatphobic medical professionals, and therefore, conditions aren’t caught and treated as early or effectively.

Do you see what I’m getting at? We JUST DON’T KNOW but we sure like to pretend that we do. The truth is that weight, genetics, nutrition, medicine, mental health… all work together somehow and we don’t have it figured out yet (if we ever really will). It’s incredibly complicated! I’m not saying we should stop trying to figure it out, but we definitely should stop blaming everything on weight. A mistaken belief that we’ve already discovered the truth prevents us from searching for the real truth. And our mistaken assumptions end up hurting people of all shapes and sizes in many, many ways, but mostly, of course, those in larger bodies.

Want to Know More?

Check out my Resources page for recommended reading and podcasts related to HAES® and anti-dieting (start with Christy Harrison’s Anti-Diet book or Food Psych podcast if you’re not sure where to start). Or if you’d like to talk with me, please contact me or schedule an appointment online.

Much love,
Cherie signature

Sources
http://www.drsharma.ca/obesity-the-science-behind-health-at-every-size-haes
https://www.buzzfeednews.com/article/kjh2110/the-10-most-bizarre-correlations
https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/discrimination
Gaesser, G. (2002) Big Fat Lies: The Truth About Your Weight & Your Health. Carlsbad, CA: Gurze.
Flegal, KM et al. (2005). Excess deaths associated with underweight, overweight, and obesity.JAMA, 293(15) 1861-1867.
Flegal, KM, Graubard, BI, Williamson, DF, Gail, MF (2007). Cause-specific excess deaths associated with underweight, overweight, and  obesity. JAMA, 298(17), 2028-3037.
Orpan HM, et al.(2009).  BMI and mortality: Results from a national longitudinal study of Canadian adults. Obesity, doi:10.1038/oby.2009.191
Tamakoshi1 A, et al. (2009). BMI and all-cause mortality among Japanese older adults: Findings from the Japan collaborative cohort study. Obesity, doi:10.1038/oby.2009.190
Campos P (2004).The Obesity Myth. New York: Gotham Books.
Bacon, L, VanLoan M , Stern JS, Keim N. Size acceptance and intuitive eating improve health for obese Female chronic dieters. J of Amer Dietetic Assoc 2005;105:929-936.
Wildman RP, et al. (2008). The obese without cardiometabolic risk factor clustering and normal weight with cardiometabolic risk factor clustering: Prevalence and correlates of 2 phenotypes among the US population (NHANES 1999-2004). Archives of Internal Medicine, Aug 11, 168(15):1617-24.
About Cherie Miller @ Dare 2 Hope

I’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

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#ScrewYourBeautyStandards

We are not born disliking our bodies. We are innocent in our self-acceptance until we learn there is a “right” way to look. After that, we evaluate ourselves against whatever ideal we are taught because it is our nature to compare. If we are fortunate, we will grow up in a family that values inner qualities over appearance. Sometimes that can protect us from internalizing the broader culture’s narrow beauty ideal. But it’s difficult to stay immune to all the messages from everywhere else… the teasing from kids at school… the magazine covers with Photoshopped images… the TV commercials pushing their weight-loss products…

And some are not fortunate enough to grow up in families where beauty is recognized in a diversity of shapes, sizes and colors. For too many, the pain starts at home and family opens the first wounds, which are only deepened by peers and the media.

Seemingly from all corners, the message is clear: We aren’t good enough. Not T-H-I-N enough.

Because thin = good and we so reason, therefore, fat must = bad, right? Some will even directly say that it is.

I used to buy into all of it, like so many do. I hated my body long before I developed an eating disorder, and it laid the foundation for me to go down that path. I was so desperate to lose weight, to be accepted, to feel okay for once. I was so mad at myself for not being thin like my friends and the pretty girls I saw in the media.

Thankfully, now I’m recovered—from both my eating disorder and my body hatred. But I’m still angry. I’m angry that we live in a culture that works so dang hard to make us feel bad about ourselves. You can’t go a day without seeing advertisements for products related to weight loss, makeup, hair dye, eye creams, tummy-control pants, and on and on and on. If you don’t feel pretty, thin, or young enough, then they promise to change that if you’re willing to spend enough time and money.

And I mean lots of money. Beauty is a $532 billion industry and is expected to just keep growing. The problem is that every commercial you see isn’t simply trying to sell you something; first, it tries to convince you that you need what they’re selling. It plays on, sometimes even creates, insecurities. The subtle goal is for you to feel bad about yourself so that you’ll then want to buy something that will (supposedly) make you feel more confident.

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While common sense likely tells us that we’re influenced by the media, it never hurts to have some research to back that up—which of course, it does. Indeed, research shows that media influence can lead children and adolescents to internalize ideals imposed by society, which also increases the probability that they will suffer from issues like body dysmorphia and eating disorders. Studies suggest this can start as young as six years old, if not even earlier. We’re talking Kindergarteners, maybe younger!

That makes me angry for every little girl that is harmed by these messages poured into her about her value and what she is supposed to be. I hope that like I have, you’ll learn to turn that anger and disgust that you direct at yourself for not being what you “should” be, and you’ll start getting angry at the diet and beauty cultures instead. Not because makeup is evil or dyeing your hair is inherently bad, but because being sold the idea that you can’t feel good about yourself without those things is wrong. Being told we have to be a certain BMI to be attractive and worthwhile is beyond shallow—it’s destructive and sick, and I will never stop fighting for a better world for my son and daughter.

If you’d like to talk about how to get break free from these destructive cultural messages and finally accept yourself as you are, please contact me about a teletherapy appointment or follow me on Instagram or Facebook.

Much love,
Cherie signature

Sources
http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.572.7007&rep=rep1&type=pdf
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6540021/

About Cherie Miller @ Dare 2 Hope

I’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

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The Effects of Dieting on Your Body and Mind

In my last post, I talked about the diet-binge cycle that results from trying to restrict certain foods or overall calories. I didn’t go into detail about the physical and psychological effects of dieting, so that’s what we’ll discuss today. And there are a lot of negative effects of dieting, despite the widely-accepted belief that dieting is good for your health.

Brain and Hormone Changes

Many dieters restrict carbohydrates, which is a primary source for glucose, but our brains needs glucose to function properly. “If carbs are strictly reduced, the brain will be cut off from its main energy source, which can drastically alter brain functioning,” says Cheryl Mussatto, RD (registered dietitian). “One such change can occur with serotonin, a chemical produced by the brain. Serotonin regulates our sleep cycle, mood and appetite, all of which will be noticeably altered along with experiencing brain fog.”

Also, as Jillian Greaves, RD explains, “If you’re overly restricting carbohydrates, this is a form of stress on the body that can disrupt normal endocrine function.” The endocrine system, responsible for your hormones, is related to many other systems in the body. “This disruption may contribute to cravings, an irregular or stopped menstrual cycle, hypoglycemia, mood swings, anxiety, chronic fatigue, suppressed immune function and thyroid disturbances.” Some studies show that low-calorie diets raise the stress hormone, cortisol, which can have some serious negative health effects over time.

Additionally, our brain is made up of 80% fat and also needs dietary fats to function properly. If you don’t eat enough fat, you may miss out on some of the brain-boosting benefits of dietary fats including better memory, lower risk of dementia and Alzheimer’s, and better focus and concentration. Medical studies indicate that people on diets have slower reaction times and less ability to concentrate than people not on a diet.

Dieting causes your metabolism to slow down to conserve energy and send it right back into building up fat stores. Also, a 2011 study shows that changes to appetite mediators—so-called “hunger hormones”—promote weight regain after diet-induced weight loss. These compensatory mechanisms driving weight regain last for at least one year and could be long-term or even permanent.

Sleep Problems

Some research connects restrictive dieting with poor sleep quality. In one study, even a short period of dieting (just four weeks) resulted in a significant decrease in the amount of time women spent asleep and a greater difficulty falling asleep. Sleep is an important part of health and a lack of sleep can result in inflammation, an increased risk for diseases, and other concerning side effects.

Nutrient Deficiencies

Many important vitamins like vitamins A, D, E and K, are fat-soluble, and your body needs fat to properly absorb those vitamins. Without enough fats, the vitamins you eat can pass through your system unabsorbed and can result in nutrient deficiencies. Also, restricting entire food groups can cut out main sources of important nutrients.

Weight Cycling (aka Yo-Yo Dieting)

Weight cycling describes the pattern of repeatedly losing and regaining weight, often with increased overall weight in the long-term. “Long-term diet research (two years or longer) suggests that most people regain all the weight lost during a diet, whether they stick to the diet or not,” Julie Dillon, RD says. “In fact, many regain more weight than was lost in the first place.” One 2016 study found that repeatedly going through these starvation cycles prompts your body to store more fat, which is likely a survival response against starvation. Also, dieting slows down your metabolism, as previously discussed. “If you follow people over the long term, dieters are more likely than equivalent non-dieters to end up gaining weight over the next 2 to 15 years after the diet,” says Sandra Aamodt, PhD, author of Why Diets Make Us Fat.

Weight cycling is linked with increased insulin resistance, a condition which can develop into type 2 diabetes (T2D). In other words, maybe yo-yo dieting is a more likely cause of T2D than weight itself! Weight cycling also causes other health complications such as higher blood sugar, blood pressure, cholesterol, risk of heart disease, and inflammation. In many cases, acute inflammation is a necessary and helpful human function that can promote healing in response to infection or injury. However, sometimes inflammation is chronic, which can make you feel drained or foggy and harms health, Dillon explains. “Short-term research suggests many diets lower inflammation, but research looking six months out or more shows that inflammatory markers increase.”

Overeating & Bingeing

Weight is actually regulated by our bodies, and each of our bodies prefers to be within a certain weight range, called a set point. “Your brain will defend this amount just like it defends your body temperature,” explains says Stephan Guyenet, PhD, author of The Hungry Brain. As you lose weight, the amount of leptin in your bloodstream drops and sends a signal to your brain to help you fight to bring that fat back (remember those hunger hormones I mentioned earlier?). This is at the heart of why diets don’t work, says Aamodt (author of Why Diets Make Us Fat). “Whenever your weight changes too much, your brain will intervene to push it back to what it thinks is the correct weight for you.” This push-back from your brain is what Guyenet and others call a classic starvation response: your brain responds by upping hunger and cravings.

“In lab experiments, when scientists want to induce rodents to binge eat, the most reliable method for doing it is to reduce food intake until they’re at a lower weight and then expose them to super tasty food, like Cocoa Puffs or Oreos,” Aamodt explains. She adds that in human research, some studies that look at the brain show that this type of junk food activates reward centers even more fiercely in those who have lost weight. And, she says, animal research may suggest that repeated dieting makes the brain more vulnerable to binging behavior even after the diet is done.

Your body prefers to use carbs for a number of basic brain functions, so eating too few of them can cause your brain to fight back. “Cutting out carbs through any low-carb diet (including paleo and keto) can set a person up for binge eating in part because when we don’t eat enough carbohydrates, our body releases a brain chemical called neuropeptide Y,” says Julie Dillon, RD. “This chemical’s job is to tell our body to eat carbs — and eat them now.” When a person’s brain is flooded with this chemical, it can result in an animal-like instinct to go crazy on carbs — attack a plate of brownies or eat an entire pizza, for example. “It can feel like every cell in your body is demanding carbs, which can lead you to feel that you lack willpower,” Dillon explains. “But it has nothing to do with discipline. Rather, this neurochemical is trying to save your body from experiencing fainting, dizziness or worse!”

Body Image & Self-Esteem Issues

You might think that going on a diet would make you feel better about your body, but research shows quite the opposite. A study of college students showed that for men and women, dieting (even diets described as “normal” in severity) resulted in an increased concern with weight and a lower self-esteem. Another larger study showed that both men and women who reported dieting behaviors were less likely to have a positive body image. And of course, I think we are all familiar with the feelings of shame, failure, and poor self-image that happens whenever we “fail” at a diet.

Preoccupation with Food & Eating Disorders

The Minnesota Starvation Experiment, conducted in the 1940s, revealed groundbreaking information about how calorie deprivation affects the human brain. “It demonstrated that a lower calorie intake provokes the mind to overly think about food,” explains Dillon. Even years after the study had ended and participants again began eating a higher number of calories, participants who had been limited to diets of 1,500 calories per day found they felt fixated on food. Some participants even changed their careers, eventually becoming chefs. “Dieting provokes the brain to dream about food and consume thoughts. We believe this is a necessary evolutionary response to not eating enough,” Dillon says. And as we previously discussed, the response to deprivation is often bingeing, which can lead to eating disorders like binge eating disorder (BED) and bulimia nervosa.

But problems can arise even if the body is getting enough calories. Some dieters aren’t focused on consuming fewer calories as much as they are concerned about avoiding certain foods, sometimes entire food groups. Though these types of dieters might start out with good intentions of eating healthy, too often the diet rules progress into rigid thinking about food and disordered eating… sometimes even an eating disorder that has been termed “orthorexia” (orthorexia is characterized by an obsession with “healthy” eating).

Mood Changes

“Research suggests going on any restricted diet places a person at a higher risk for experiencing depression,” Dillon says. Numerous studies also link chronic dieting with increased stress and anxiety. Neither is surprising since, as we learned earlier, dieting affects serotonin functioning. Of the approximately 40 million brain cells we have, most are influenced either directly or indirectly by serotonin. This includes brain cells related to mood, sexual desire and function, appetite, sleep, memory and learning, temperature regulation, and even some social behavior.

Other Problems

  • Some people who diet, especially those on keto, might experience bad breath and even vaginal odor (a side effect referred to as “keto crotch”)
  • Dizziness, light-headedness, and lethargy/decreased energy
  • Decreased sex drive
  • Not eating enough carbs, a primary source of fiber, can lead to constipation, bloating and other digestive issues
  • Social isolation due to not being able to participate in social activities involving food
  • Decreased hunger and fullness cues

If Not Dieting, Then What?

Like me, Aamodt (author of Why Diets Make Us Fat) and other anti-diet professionals advocates for a style of eating called intuitive eating. It’s a non-dieting approach that allows you to listen to your body and nourish it with what it wants (sometimes kale, sometimes a brownie) in the amounts it wants (more or less depending on your hunger). It might sound too good to be true, and while it’s not, there is a catch. Intuitive eating is not just another diet disguised as “wellness”; the goal is not weight loss and that can be a barrier for some who are intent on losing weight.

As I said in my last post, I totally understand that giving up on intentional weight loss is difficult for so many reasons. It can be done though! If you’re interested in learning how to ditch dieting and making peace with your body and food, check out my resources page or please contact me.

Much love,
Cherie Signature

Sources:
https://www.nbcnews.com/better/health/what-happens-your-brain-when-you-go-diet-ncna802626 
https://uhs.berkeley.edu/sites/default/files/bewell_nodieting.pdf
https://time.com/3092086/weight-loss-depression/
https://www.thedailymeal.com/healthy-eating/hidden-side-effects-popular-diets/slide-35 
https://www.webmd.com/depression/features/serotonin#1 

About Cherie Miller @ Dare 2 HopeI’m Cherie Miller, MS, LPC, founder of Food Freedom Therapy™. I offer counseling for chronic dieting as well eating disorder therapy for Anorexia, Bulimia, Binge Eating Disorder, Orthorexia, ARFID, and other eating disorder issues. Contact me here or follow me on Instagram or Facebook.

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