Mashing up contradictions feels like locking feuding family members into a small space to work out their differences. Without a referee it seems unlikely useful dialogue will flow. In this case, striving to satisfy my medical provider’s nudge into a “lifestyle program” (diet group) for health reasons (“obesity is linked to diabetes, heart disease, Covid-19”) while holding onto my well-researched belief that the Intuitive Eating/HAES path best complements my values and sticks with basic science (as we currently know it), I opted to merge two paths. Sometimes stepping back hones perspective, so that’s what I did.
The doc and I have the same overall goal: good health. The word “health” carries some sticky connotations, though. Ironically, “healthcare” organizations don’t have consistent definitions and many of those demonize fat humans without providing science to support their bias. For me, achieving a state of overall improved health means (1) gaining strength and stamina so I eliminate painful knee days (I can live pain-free with OTC medication in limited doses, but prefer not to use these), (2) Getting back to some basic hiking or at least periodic oceanside walks or garden strolls, (3) Improving my evolving self-care practices around stress (less) and sleep (more), and (4) Paying more attention to gentle nutrition so my blood-test related health markers remain “normal.”
While a mashup of programs sounded easy enough, I discovered I had some bumps to iron out when I attended the “lifestyle program” orientation two weeks ago. I don’t expect this journey to flow like a mountain stream in spring. I expect obstacles and realize where the “lifestyle program” and Intuitive Eating/HAES guidelines diverge. Back to that in a minute. First, here’s how the orientation went.
Virtual attendees were congratulated for connecting with the “lifestyle program” and the moderators described their credentials. I noted the folks who moderated included a registered nurse, a registered dietician, and a licensed social worker. All had more than 5 years of experience and, in general, seemed pleasant and enthusiastic.
During the opening a moderator noted “many people” in this “program” lost 30 to 50 pounds during their year-long participation. The “lifestyle program” components included improving daily habits, healthy eating, and increasing physical activity. In theory, these fit my goals as well. I took the time to write out my personal goals related to the daily habits and physical activity components. For healthy eating, I’d already decided to gently implement the Healthy Plate.[i] The “program” also uses this model.
“This program is not about dieting but making a lifestyle change,” the primary moderator said a dozen times during the presentation, though the rest of the dialogue seemed a hodgepodge of typical Diet Culture advice laced with a few “program” components. For example, the list of forbidden foods like sugar, juice, and alcohol. The Great Success Story featured someone who finished the “lifestyle program” a few months ago and kept the weight off for several months, so far. No data is kept on the success of the program in helping participants retain weight loss. This isn’t unusual. Long term weight loss retention (even as long as 2 to 5 years) is rarely tracked because it discourages participants.[ii] Study after study shows dieting (by any name) has a very poor success rate.[iii]
Sample contradictory comments from my notes: “This is not a diet. No measuring or weighing of foods. Does that sound like a diet? No.” “However, measuring is required the first few months” or if people run into problems (I assume slowing weight loss). And, again, “This is not a diet. This is a lifestyle change.” Then, the “program requires keeping a food log and eating 3 meals and 2 snacks” at specific intervals. Other requirements: using small plates, limiting sugar free beverages except water, and a specific number of specific-sized servings of protein, starch, fruit, vegetables, water, fat, and dairy products daily in order to stay within “the calorie limits per day” based on gender and height. Again, “this is not a diet.”
Out of curiosity I did a quick online search for “healthy eating.” Of course, every self-proclaimed “expert” has opinions, but the WHO website notes “Evidence shows the benefits of a diet high in fruit, vegetables, legumes, nuts and grains, but lower in salt, free sugars and fats, particularly saturated and trans fats.”[iv] What struck me as absent: the protein and dairy food categories that obsess us in the USA.
In the end, the program goal (“each participant will lose 5% to 7% of their body weight”) and my personal goal differ since I have no goal related to a number on a scale. Another “program goal” for each participant involves attending weekly sessions for several months and then engaging with program staff periodically for coaching after the training.
The wrap up lacked a positive tone. The speaker asked, “Why did you gain weight?” I wrote in my notes: Set point trashed by too many diets? I waited to share and crickets in responsetold me folks took this as a rhetorical question. The speaker commented, “Quite a few of you – I know your names – are back because you didn’t have a plan to retain your weight loss.” Two things struck me: the audacity of not even considering for a moment that the program could be the problem, and the cruelty inherent in fat-shaming people who showed up. The moderator offered a quick reminder that the program required eating every 4 hours. I understand the diet-culture rationale for doing that, but I’ve eaten by-the-clock and adherence kept me out of touch with my body while it strengthened the notion the brain should rule the heart and gut with reason and discipline instead of working in a partnership. Since I’ve gotten really good at recognizing hunger before I’m ravenous – a real improvement for me – I don’t want to sacrifice that. When I respond to hunger by eating, I easily stop when I’m satisfied. When I wait for a specific time, I’m often ravenous and end up over-full.
The final component introduced: daily weight logging at home with a mandatory weekly check-in of weight or weight loss and exercise minutes completed. Many things are reported to the referring MD and noted in the patient chart, including failure to check-in with weight, failure to attend training, and I’m guessing other potential failures that remain unstated at this time.
After the orientation, I signed up for the rest of the series. In the 2 weeks before the next workshop, I completed two workshops on improving sleep and a stress reduction workshop. I took advantage of an opportunity (through my volunteer work) to sign up for the Headspace app and, through my medical insurance, to sign up for CALM. Both apps help me in different areas. Headspace meditations work for me. CALM has some nature sound tracks that I find very soothing. I also started a yoga for stress relief class and bookmarked two short trainings related to flexibility and strength training.
And where is the time for these activities coming from? So far, a combination of less focus on social media (I took Facebook off my smartphone) and a big reduction in time spent on the news (from checking 6 news sources to 2). It’s a process, a transition, and though it’s a leap of faith, I have a sense it’s going to work out even when it feels a bit like 2 steps back. Blazing a new trail is worth the effort.
[ii] Take some time to search weight loss retention statistics. I couldn’t find a program that kept weight loss and retention data beyond 52 weeks (1 year). Some keep limited info on limited populations but the final statistic (based on all who entered the program) doesn’t appear. In a VA “MOVE” study, 45-50% of participants dropped out after the first meeting. Across commercial weight loss groups, ~40-50% seems average. Accurate statistics require looking at every person who starts the program, not just those who finish.
[iii] For one easy-to-read summary, look at Anti-Diet by Christy Harrison, MPH, RD (pages 85-90)