Author Archives: Jonah Soolman

Dry Drunk

Posted on by
Reply

We are sincerely thankful to our current and former patients who took the time to answer the survey that we distributed last month. The answers, which I will probably discuss more in the future, were insightful and helped us to better understand what we can do to help people going forward, which was the whole point of the survey.

Some families and former patients emailed me directly with feedback and updates, and I particularly appreciated these messages, some of which came from people I had not seen in well over a decade. Being a dietitian is tricky work in some ways, one of which is that I work with someone for a finite period of time before they go off on their own, and only occasionally do I learn how they fared after our time together ended. But I wish I knew more often, both because I actually care about my patients and hope they are doing well, and also because having some knowledge of their outcomes helps me to evaluate the work we did together so I can potentially do things better in the future.

Given that, these updates – which, when taken together, built a sort of unscientific longitudinal study – feel as valuable as a pile of gold. Some former patients are thriving, which was the best possible news, while others are still struggling to one degree or another. The rest are, well, I guess I am not really sure, which brings me to this . . .

Somewhere in the neighborhood of a decade ago, I attended a continuing education event at the Multi-Service Eating Disorders Association (MEDA). During a break, I was talking with a colleague who specializes in both eating disorders and addictions, and whatever it was that we were discussing inspired them to ask me if I was familiar with the term “dry drunk.” No, I was not, so they explained that the term refers to an individual who has ceased a problematic behavior – such as abusing alcohol – but has not yet dealt with whatever is going on underneath that led to said behavior; thus, the underlying issue shows itself in a new and different way. Their explanation reminded me of the arcade game Whac-A-Mole: hit one mole down and another one pops up. 

Some of my former patients seem to possibly fit that picture, and I want to explain why, but I need to be careful. On one hand, I need to be vague enough to protect patient privacy. On the other hand, I have to be specific enough for readers to get the gist of what I am saying. Maybe the best way for me to put it is that some of these individuals have chosen paths that require a heavy focus on their eating and/or appearance in ways that neither scream recovery nor struggles, but rather suggest that perhaps the issues that brought them to me years ago have since bubbled up into something new.

Maybe that means there is still work to be done, that the ongoing existence of underlying issues calls for further treatment. Then again, maybe it means that for some people who have a history of an eating disorder, disordered eating, or body image challenges, channeling – rather than doing away with – what was once a negative into something questionably positive is enough to constitute a degree of recovery.

My gut is telling me that I have some learning to do in this realm, that I could benefit from doing some reading, talking with colleagues, and sitting with my own thoughts. Meanwhile, I am profoundly grateful for the updates that prompted me to reexamine the fundamental question of what it means to recover.

The Floor Is Lava

Posted on by
Reply

Those of you who have been following our blog for a while and have long memories may recall that I occasionally bristle at false and misleading motivational quotes. First in 2014 and then again in 2019, I wrote about two such quotes, each of which suggests that we have more control over our outcomes than we really do. The latter quote was posted on a message board outside an elementary school, which especially bothered me, as I thought of all young readers now primed to blame themselves when some aspect of their lives turns out differently than they had hoped.

Strangely enough though, an experience at another elementary school has me reconsidering my stance. This summer, our daughter has been using the area playgrounds to push the boundaries of her newly discovered confidence. She was always capable of more than she realized, I thought, and now she has discovered this for herself. Slides that she used to look at with fear have become some of her favorites, and she darts across monkey bars that she would barely even try before.

One of her favorite playground activities is playing The Floor Is Lava. The game motivates her to use her creativity and try new movements in order to make her way between pieces of equipment without touching the ground. If she got carried away and actually believed that touching the ground would burn her, her loosened grip on reality would of course be an issue, but so long as she remembers it is just a fun, inspirational, and imaginative game, no problem.

A day after watching her play The Floor Is Lava, I walked by the fitness director’s office at my gym and saw a quote she put up that read something along the lines of, “Push harder than yesterday if you want a different tomorrow.” Immediately, I thought of counterexamples, situations in which someone pushing themselves harder than the day before could cause a setback rather than progress, such as someone recovering from illness or injury, or an athlete in need of a recovery day after a particularly demanding exercise bout. 

But then I remembered The Floor Is Lava, and I realized that maybe these motivational quotes are to be taken with a proverbial grain of salt. In other words, by assessing where they fall on the continuum spanning between reality and fiction, maybe I was missing the point, as they were perhaps never meant to be taken seriously. Their power lies less in their degree of truth and more in their ability to inspire. Sure, such quotes are oftentimes factually incorrect, but if people can keep that in mind while simultaneously using them as fuel to take better care of themselves, one could argue that the ends justify the means. After all, our daughter seems perfectly well aware that, contrary to the name of the game, the floor is not actually lava.

Just tell me . . .

Posted on by
Reply

Many years ago, someone from my personal life sent me a message asking for some exercise advice. They told me they had been doing a lot of walking but felt ready to try some other modes and asked for suggestions. In my response, I asked them what types of exercise they have enjoyed in the past or have been curious about possibly trying. My reply marked the end of what I thought was a budding conversation, as they were seeking a direct and concrete answer, not collaboration. This brief story exemplifies one of the challenges I face in nutrition counseling. Some people – not everybody, certainly, but a lot of people – just want me to tell them what to do, but nutrition is more complicated than that.

Sometimes I think about one of my personal training clients from 20 years ago and an important lesson that she taught me. As we were going about her workouts, I used to explain to her the rationale for her exercise regimen because my assumption was that she wanted to understand so that eventually she would feel educated enough and confident enough to ditch me and train on her own. Wrong. During one of her sessions, she interrupted me and bluntly explained that she did not care and did not want to know. She said that when she goes out to eat, she just wants to enjoy her meal without the chef coming out from the kitchen to explain how they made the food or why they constructed her entree in a certain way. In essence, she hired a personal trainer to deal with matters of methodology so she would not have to do it herself, which is a completely valid choice to make.

In a way, I can appreciate the desire to lean on someone else for making a decision. A while back, I was looking to buy a new graphics card for my computer, but some of the jargon was unfamiliar to me, some of the factors I had to consider felt confusing, and I struggled to weigh the pros and cons of the options. I felt overwhelmed and uninterested in investing the necessary time to get myself up to speed, and I just wanted someone to tell me what to buy so I could make my purchase and get on with my day.

So, I think I get it, but making a rare purchase of a computer part or deferring to a personal trainer are different than asking a dietitian to dictate eating behaviors. As long as my aforementioned client continued to have the financial means, she could isolate all of her exercise to biweekly sessions with a trainer indefinitely and live out the rest of her life without ever learning anything about exercise science. In contrast, someone may eat approximately 20 to 40 times per week, and most likely none of those meals or snacks happen with a dietitian standing over their shoulder. 

Ultimately, people have to make their own decisions regarding what, when, and how much to eat. We make these choices based upon factors that are static, such as self-imposed dietary restrictions or food allergies, and others that are dynamic, such as available options, transient health conditions, and personal preferences. Every food has its pros and cons, and even an attribute that qualifies as a pro for one individual in one context may very well be a con in a different scenario, and vice versa.

One day back when we were still working in our former Wellesley office space, an exasperated patient asked me to just tell him whether he should buy white or whole wheat bread, but even a specific question like that requires a conversation rather than a concise answer. What if I just went with diet culture’s eat-this-not-that response and said whole wheat? After all, that is probably the answer he expected to hear, and he would have appreciated the clear-cut response, but would I really have been helping him? What if the slightly higher price of whole wheat strained his budget? What if its shorter shelf life mattered? What if the extra fiber or higher FODMAP content triggered gastrointestinal issues? What if he found the flavor unappealing? You get the idea.

I want to give my patients what they want. People spend time and sometimes money to meet with me, and my hope is that they leave feeling that the experience was worth their expenditure. Yet sometimes giving them what they want would be doing them a disservice. When this happens, I ask questions and listen so I can learn more about where they are coming from, and I explain the rationale for my approach so they can better understand my point of view too. Sometimes we go our separate ways, but other times we wind up on the same page and move forward together.

What Working at the USDOT Taught Me About Nutrition

Posted on by
Reply

After graduating from Tufts with a double major in mathematics and English, I took a job working as an Operations Research Analyst for the U.S. Department of Transportation (USDOT). Underworked and painfully bored, I generally hated my time there, but I did work on some interesting projects during my three years. Once I pivoted and went back to school to study nutrition, I realized in hindsight that working at the USDOT had taught me more about nutrition than I ever would have expected.

The USDOT assigned me to the economics analysis division, a group in which I felt very much out of place because I had no background in economics. My father half-jokingly suggested that I just imagine sticking a dollar sign in front of every figure to make the projects feel more relatable to what I was already familiar with, as statistical analyses and mathematical modeling were already in my wheelhouse. 

One of the first projects that I worked on was in the realm of intelligent transportation systems (ITS). An example of such a system is a traffic light that senses an oncoming car and changes to green, as opposed to a system in which the lights change according to a timer regardless of the cars in the vicinity. Back in high school, one of my friends was sure that some of the lights in town would turn green for him if he flashed his high beams at them, but that is not how the technology worked, at least not back then. Rather, ITS in those days utilized sensors embedded in the road which cars would trigger as they approached an intersection. My friend correctly noticed that the light quickly turned green as he approached, but he misunderstood the mechanism, and all his high beaming was for nothing. A parallel exists between that and the gluten-free diet that was so popular when I first began working as a dietitian. Sure, some people genuinely must avoid gluten, but back then the diet’s popularity far outpaced its legitimate need. Yet we had people swearing that they felt better, particularly with gastrointestinal distress symptoms, once they eliminated gluten. Some of that was unquestionably a placebo effect, but some of it was a misunderstanding of the mechanisms at play. We now understand that for many sufferers, the trigger is not gluten, but rather FODMAPs, which are subsets of carbohydrates that can cause issues for some people. Gluten-containing foods, it turns out, tend to be high in FODMAPS, so following a gluten-free diet can help people to feel better, but the culprit is not the gluten itself, but rather the FODMAPs that come along for the ride. 

Some of our work focused on mathematical modeling of the trucking industry and specifically looked at driver and company violations. It was during this project that I learned that approximately 20% of truck drivers randomly tested at weigh stations were driving under the influence, a horrifying statistic that crosses my mind pretty much every time I see a truck on the highway. We also learned that many companies knowingly command their drivers to intentionally exceed the volume of hours that they are legally allowed to drive continuously, as it is more financially favorable to pay the fines for such violations (that is, if they even get caught) than it is to obey the law. In essence, knowingly keeping drowsy drivers out on the road and flaunting the law is good business. Remember this the next time you are in the grocery store and notice an influx of products geared towards whatever diet fad is hip and trendy at the moment. Some consumers take prevalence as validation that the fad must have sound evidence supporting it, but such an assumption could easily be – and probably is – false. Food manufacturers are trying to make money, and they are happy to capitalize on a trendy demand to increase profits regardless of the science behind such a demand. They are not looking out for our health any more than the trucking companies that keep sleepy drivers out on the road.

Even though I spent the entirety of my time at the USDOT housed in the economics analysis division, eventually managers from other divisions began using me for their projects, including a few that were working on a mathematical model of the alternative fuels industry. Going into the project, I knew very little about alternative fuels, but I picked up knowledge as I went. Much of what I learned involved the downsides of these fuels and the problems that had not yet been solved. For example, one fuel was so unstable that a fender bender could cause a vehicle to explode. Another fuel was so expensive that hardly anybody would be able to afford it. Another would save tailpipe emissions but cause massive pollution at the plant where it was made. Decades later, we have seemingly solved or mitigated some of these issues, as we have electric cars all over the place now, but as one of my colleagues said to me at the time, “Alternative fuels are alternative for a reason.” Keep that in mind when it comes to alternative, functional, or holistic medicine, including the approaches to nutrition that they tout. If their guidance was as safe and effective as they want you to believe, it would not be alternative; it would be mainstream. 

Earlier I mentioned that I was underworked. One of the problems that the USDOT faced was that tasks were unevenly distributed, so while some people sat at their desks reading the newspaper, others stayed late and came in on weekends to meet deadlines. My sense was that some of the middle managers overseeing me were still developing their delegation skills, and to be candid, I – a young guy fresh out of college – probably did not do enough to earn their trust. Finding time for lunch was rarely a problem for me, as I had an abundance of time on my hands, but some of my colleagues struggled to even utilize the brief lunch break to which they were legally entitled. The experience gave me an appreciation for how practicing self-care (finding time for lunch, physical activity, adequate sleep, etc.) can be a significant challenge for people who work demanding jobs and perhaps have long commutes and other obligations besides their occupations. 

One particular colleague who fit the above description told me that he took a multivitamin to make up for the convenience foods upon which he heavily relied. No judgment whatsoever, as I know he was up against a lot and doing his best to take care of himself in challenging conditions, but I remember how confidently he erroneously believed that a little pill was making up for everything that was missing from the rest of his diet. Fast forward to the present days of biohacking and supposedly “nutritionally complete” food products like Huel, and I see people making the same mistake. Just as my co-worker’s multivitamin lacked sufficient nutrients, such as fiber and phytochemicals, to make up for what his dietary pattern was missing, a bottled meal replacement product is not going to cover all the bases that a wide variety of actual food would touch. As I said though, no judgment; we are all doing the best we can.

When I decided to change careers and wrote the personal statement for my nutrition school application, I only briefly touched on my experience at the USDOT before quickly adding, “I do not believe that anybody is hard-wired for any specific field or career . . .” and continuing on to other topics. Had I realized at the time how much I had already learned about nutrition by working at the USDOT, I certainly would have said more.

The Pride of Quitting

Posted on by
Reply

Earlier this month, a longtime friend of mine set out to walk from Mexico to Canada. An ambitious goal, for sure, but he has achieved similar accomplishments before, so completing this international walk seemed like a realistic challenge for him. He performed the necessary physical training, prepared for the logistics, headed to Mexico, and began. Unfortunately, what was to be a months-long endeavor ended just a few days later in southern California due to a persistent leg injury. Man, what a bummer. Like I told him though, I was more impressed that he stopped than I would have been if he had continued on while hurt.

Dealing with injuries early on in a big adventure is something that he and I have in common, but I made a different choice. In 2006, he and I set out from Seattle with some other friends to ride our bicycles to Boston for charity. On the eleventh day, I fell off my bike in Montana and fractured my spine. That diagnosis came much later, way after the window of opportunity for the breaks to heal on their own had closed. All I knew at the time was that I was in a lot of pain and that the muscles around the injury had seized up to the extent that pedaling a bike was temporarily impossible.

But I also knew that ending my trek early would have been unbearable. Virtually everybody in my life – family, friends, classmates, professors, and co-workers – knew that I was going on this trip, and the shame of having to tell them that I stopped early was more than I could handle. At that point in my life, which was a challenging time for me personally, I felt like my self-worth was contingent upon completing the trip. I feared how I would have looked to others and felt about myself if I had quit.

Beyond that, I was immersed in a no-pain-no-gain exercise culture that glorifies pushing limits and disregarding physical indicators of distress. I still am. And so are you. Our work-till-you-drop capitalistic society praises people who show up sick, substitute caffeine for adequate sleep, and forgo lunch breaks. New England Patriots fans wear shirts emblazoned with a former coach’s famous “no days off” mantra. A singer on the radio tells us, “My body tells me no / But I won’t quit ’cause I want more.” The same spirit bleeds into how we approach physical activity.

And sure, sometimes we get away with it. We play through an injury that eventually heals. We show up to the office all week hopped up on DayQuil and then recover over the weekend. Twenty years ago in Montana, I got a massage, remounted my bike, and finished our ride to Boston. We get away with such choices until, well, eventually maybe we don’t. Our society is pretty good at quickly moving past cautionary tales, but I still remember a tennis teammate who had to get his ankle fused after continuing a match on the sprained joint, a local woman who kept working with the flu until it proved fatal, and my two spinal fusions.

Listening to and honoring our body’s signals is a counterculture act of rebellion, which makes exercising intuitively more complicated than it otherwise needs to be. By stopping his trek early, my friend demonstrated courage, strength, discipline, patience, responsibility, and self-confidence. If I had those same qualities back in 2006, I probably would have taken a taxi to Glacier Park International Airport and found a sedentary way to enjoy the summer while recovering from my fall.

Hunger/Fullness Scales: Helpful or Counterproductive?

Posted on by
Reply

One of my patients is reading The Fuck It Diet, by Caroline Dooner, for the first time, and I am rereading it to refresh my memory so the two of us can discuss it. This book has become one of my go-to volumes for patients who are interested in reading about intuitive eating. Do not let the title fool you; while The Fuck It Diet is indeed a casual, informal, and humorous read, its substance is generally on point. Sure, sometimes I take issue with what the author writes, but that is true pretty much anytime I read anything, including my own writing, as my typical reaction to revisiting my blogs from last decade, last year, or even last month is wishing that I had better expressed myself.

Having said that, one of the upsides of The Fuck It Diet is that Ms. Dooner directly addresses the pitfalls and misunderstandings that people commonly encounter while traveling down the intuitive eating path. For example, she points out the tendency for people to warp intuitive eating into yet another diet. “Most of us think that if we can just ‘eat intuitively,’ we will eat like a bird and become naturally thin and happy versions of ourselves. So many of us try to heal our eating without changing our relationship to weight [italics are the author’s own emphasis] as well. Ignoring how closely our feelings about eating and weight relate to each other is our big mistake.”

While I completely agree with Ms. Dooner on that front, one of our points of divergence is the use of a hunger/fullness scale as part of relearning how to intuitively eat. For those of you who are unfamiliar with what a hunger/fullness scale is, essentially it is a numerical continuum, sort of like a ruler, where the number at one end represents extreme hunger, the number at the opposite end represents extreme fullness, and all of the numbers in between represent more moderate degrees of hunger or fullness. Different versions of the hunger/fullness scale exist with most of them utilizing a 1-10 scale on which 1 represents extreme hunger and 10 represents extreme fullness. 

Ms. Dooner is seemingly not a fan of hunger/fullness scales. A couple of quotes stood out to me. “But again, true intuitive eating does not happen by rating your hunger on a rating scale . . . . You do not need a hunger scale to learn whether you are hungry or not.” On one hand, she makes some good points, and I think I understand where she is coming from, as some people do turn intuitive eating into a sort of hunger-and-fullness diet in which they set rules that their hunger must reach a certain number for them to eat and that they must stop eating when their fullness reaches a particular number. Also, sometimes people do become hyperfixated on the number as if a precise bite exists at which ending the eating experience will yield the perfect level of satiety. If someone is utilizing their hunger/fullness scale in one or both of these ways then, yeah, the scale is doing more harm than good. 

On the other hand, some people do find a hunger/fullness scale to be a helpful tool for relearning how to intuitively eat. Probably the most helpful aspect of utilizing a hunger/fullness scale is, strangely enough, just taking the time to construct one. Rather than giving people a scale that is already completed, I prefer to start with a bare-bones outline and help them to flesh it out based upon their own experiences. After all, while some commonalities may exist regarding how we feel a given level of hunger or fullness, we also have individual differences. For some people, sitting down to create their own scale is the first time that they give much thought to what hunger and fullness feel like in their body. The extreme ends are usually the easiest points to describe while the intermediate points are more challenging, but that is absolutely fine because it creates a learning opportunity to go forth and pay attention to what those levels feel like. 

Use of a hunger/fullness scale gives us a shorthand that makes discussing hunger and fullness easier and also enables a person to more efficiently check in with their body. We could say that someone is of great or more than average height especially relative to their width, but isn’t it just easier to say that they are tall? And isn’t taking paper money with us easier than carrying around the gold that those bills represent? Similarly, assigning a numeric value to represent a more complex description of a level of hunger or fullness simplifies the process of thinking about and discussing hunger and fullness.

Ms. Dooner makes some great points, which is why I love her book and oftentimes recommend it to patients, but some people are able to constructively make use of a hunger/fullness scale without falling into the traps that she discusses. When considering whether or not to utilize a scale with a particular patient, I will typically raise for discussion the pitfalls that Ms. Dooner points out so we can gauge how confident we are that the patient in question can avoid them. From there, we mutually decide if we want to use a hunger/fullness scale or if we should follow Ms. Dooner’s lead and skip it.

Real, Authentic, Unapologetic Cookies

Posted on by
Reply

Nearly 25 years ago, I bought a bag of Whole Foods semi-sweet chocolate chips that had a cookie recipe on the back. The purchase came at a time of transitions in my life, as I had just left the metropolitan area that had been home for my entire life and relocated to the countryside, a move that necessitated quitting my job without knowing what the next step in my career would entail. Anxious and with time on my hands, I filled the gaps in between job searches and informational interviews with tennis, volunteer work, marathon training, GRE studying, and baking – especially the aforementioned cookie recipe, which I cut out, saved, and committed to memory.

At this point in my life, I was also still dealing with what I understand in hindsight was PTSD related to my first back surgery, and I was very worried about my health. Pretty quickly, I began to alter this recipe by substituting ingredients that I believed made the cookies “healthier.” What began as small tweaks grew to radical warps. White flour was out, whole wheat flour was in. Nuts and dried fruit replaced the chocolate chips. Olive oil and brown rice syrup stood in for butter and sugar, respectively. Sometimes I ground up flax seeds and threw those in as well.

While I fooled myself – temporarily, at least – into believing I was still baking cookies, the reality was that I was essentially making pancakes but calling them by a false name. Nothing against pancakes, but they are not going to hit the spot if what one really wants are cookies. Since each, umm, “cookie” provided minimal satisfaction, I would eat a bunch of them at once in an effort to make up for diminished quality with quantity. Those of you experienced with diet foods can probably relate to the state of feeling overly full yet insufficiently satisfied.

My next career move ended up being a return to school to study nutrition, and some of my early courses reinforced that my recipe substitutions were on the right track. However, nutrition education comes with an unexpected twist. The basic courses oversimplify complex topics and present a fictitious level of certainty. Only later do students discover that the early lessons were not quite accurate, that the truth is murkier, more nuanced, and riddled with outstanding questions. This is why some people who only learn the basics know less than they realize.

As I progressed through my schooling, I came to appreciate that good health is never guaranteed no matter what, when, or how much one eats. Whatever cookie ingredients I use are small drops in the ocean of the myriad of factors, only some of which are in my control, that determine my health. Besides, who was I kidding, whole wheat olive oil “cookies” taste gross. So I stopped baking them.

While I continued to make recipe substitutions, the tweaks I was making by the end of nutrition school were entirely different than the ones I was making at the beginning. For example, I could turn them into double chocolate cookies by slightly reducing the volume of flour and adding some cocoa. Through experimentation, I discovered that Cadbury Mini Eggs are great in place of chocolate chips, but candy corns are not because they liquefy in the oven..

My relationship with the cookies is so different now than it once was. Because they hit the spot, I feel satisfied with less, so I can eat two or three, enjoy them, and get on with my day, as opposed to eating a whole batch of the pancake versions and still feeling like I am searching for something. Because they actually taste good, I can share them with other people. Shortly after Joanne and I began dating, I endeared myself to her by leaving some cookies in her vestibule while she was home sick. Whenever a new family moves into our neighborhood, I greet them with cookies. Imagine the impression I would make if I brought them the pancake version instead.

Most importantly to me, I bake the cookies for and with our daughter, who I hope is learning that one does not need to alter cookies beyond recognition in order for them to be acceptable. Cookies – real, authentic, unapologetic cookies – are welcome just the way they are.

Lessons from the Food Pantry

Posted on by
2

Shortly before winter break, our daughter came home from elementary school with materials she received during an educational event regarding a local food pantry. While I look through everything she brings home, I was particularly curious about these materials because issues of community nutrition have long been important to me. On one hand, I was glad she learned that food insecurity exists and that society has resources in place to assist people who are struggling, but on the other hand, I had some concerns about specific messages contained in the materials. 

By way of background, I have taken an interest in community nutrition ever since I was given an eye-opening homework assignment a couple of decades ago. My professor tasked me with going to the grocery store to research prices and to use the information to design a diet that would nutritionally satisfy the Dietary Approaches to Stop Hypertension (DASH) diet while also financially satisfying the Thrifty Food Plan’s allowance of $4.37 per day. Unfortunately, I failed, as the closest I could come was $4.77 per day, still $0.40 over budget. If I could not do it despite my nutrition knowledge and mathematics degree, then how is someone with less education in such matters supposed to figure it out?

The assignment helped me to appreciate the impacts that financial limitations and food availability can have on health. The simple truth that people can only buy what they can afford and is accessible to them sounds so obvious now, but it took studying community nutrition for me to really get it. When I rode my bicycle from Seattle to Boston that summer, I made a point to visit the grocery stores on the Native American reservations that I passed through because I wanted to understand the options available to the residents of these relatively isolated communities.

During my dietetic internship in Boston, I spent time working on a roving healthcare van that stopped in some of the more impoverished areas of the city. We gave out condoms, took blood pressure readings, performed blood sugar checks, and answered nutrition questions for anybody who visited. During our breaks, my preceptor took me around the neighborhoods to visit restaurants, food pantries, and grocery stores. We talked with some of the regulars who relied on the pantries, and I was struck by the realization that food insecurity is not some abstract notion in textbooks or a relic of a bygone era, but rather a present challenge for many people in our own city. Many years later, I remain conscious of this reality, and I was glad to hear that our daughter’s class learned about what I believe is an important topic.

Unfortunately, some of the materials she received reinforce a dichotomous view of food that is damaging, oversimplified, and – quite honestly – unnecessary. For example, one exercise in a workbook invited her to take stickers of various foods and to sort them into “healthy food” and “junk food” bins. Another exercise asked her to draw a picture of a “healthy” meal. 

The food pantry’s materials reflect how our society generally views and talks about food, but while this kind of language is common, it is also problematic. These kinds of dichotomies warp how kids see food and set them up for potential issues as evidenced by the large number of patients who can trace their disorders back to something like this. 

How “healthy” a given food is depends on context. Bananas are commonly known as being a significant source of potassium, which might make them helpful for somebody with hypertension, but perhaps less helpful for someone with renal disease, so onto which bin should my daughter affix a banana sticker? Because a myriad of factors – medical, cultural, personal, social, financial, etc. – influence our eating, absolute claims about any particular food are going to apply to some individuals while completely missing the boat for others.

Besides, while food pantries are essential, teaching nutrition to school children seems like an unnecessary and sabotaging step towards fulfilling their mission. Imagine the sad irony of being a kid in class whose family struggles to make ends meet and being told by a food pantry – maybe even the very food pantry that you and your family rely on – that a food you and your family utilize to survive belongs in the “junk food” bin. How is that child going to feel, and what are they going to do, next time their family serves a meal or snack featuring that food?

So I reached out to the food pantry in question and communicated my concerns. As a preliminary step, I emailed our daughter’s teacher. She shared my concerns and strongly encouraged me to directly contact the food pantry in question, which I did. In my message to them, I explained that I was neither angry nor was I judging them, but rather I was reaching out in the spirit of constructive criticism and a willingness to help. To their credit, they responded quickly and with an open mind. They requested that we schedule a time to talk so they can learn more. Similarly, I hope our conversation will help me to better understand what they are trying to achieve by their inclusion of nutrition talk in their student materials. Perhaps we can devise a plan together to reach those same goals in a way that mitigates the risk of inadvertent harm.

4,000 Laughing Smiley Faces

Posted on by
Reply

While I am rarely on social media these days, I used to be a Facebook regular, both for professional utility and personal entertainment. One day, Facebook presented me with a prank video of a relatively thin weightlifter pretending to be a health club custodian and shocking more musclebound exercisers by easily lifting their heavy barbells. 

Maybe I watched the video because when I was a personal trainer, I used to perform custodial duties when I was not busy with clients, and I was curious to see a fellow gym janitor featured in a video. Or maybe I took the time because way back in my college weight room, other students occasionally offered confused looks or comments when I lifted more than they expected. Regardless of whatever my reason for pausing my scroll on the video was, I watched it. We know the way these social media algorithms work is that once you watch one video, you can expect a downpour of similar videos to soon come your way. Sure enough, this faux custodian has several other videos that quickly showed up in my feed, and while the exact circumstances seem to vary, the punchline is always the same: shocked onlookers in disbelief that someone so small can lift such heavy weights. 

That got me thinking about other life experiences I have had in which size-based expectations of an athlete turned out to be off base. As far back as eighth grade science class, I learned that strength is a function of more than just muscle mass. For example, the location of where the distal biceps tendon attaches to the radius bone influences mechanical advantage, which means that a relatively scrawny person with a more advantageous attachment point might be able to curl more weight than a more musclebound individual with a different attachment point. Technique also matters, which is why the sixth grader I played tennis with shortly before the pandemic could hit the ball so much harder than I could. 

Back in 2013, I competed in the U.S. Mountain Running Championships (The event was open to everybody, so please do not mistake me for some elite mountain runner.) and finished after scores of men who were older and/or heavier than me. Sure, age and body mass influence running ability, but so do factors such as mechanical efficiency, VO2 max, health conditions, racing strategy, nutrition, sleep, training, tapering, and even footwear.

A few years after that race, I wrote an article for Boston Baseball regarding Red Sox third baseman Pablo Sandoval and the flak he was dealing with because of his weight. The editor suggested the title, “Leave the Fat Kid Alone,” which I liked because it succinctly captured the point I was trying to make about both Sandoval and the general weight stigma that pervades our culture. Sure, maybe Sandoval did not look the part of a baseball player in the eyes of some, but remember that there were approximately 5,500 minor leaguers (according to the Major League Players Association) toiling in the minor leagues while he was earning millions of dollars in the majors because he possessed skills that most of them – including some with more societally-acceptable physiques – lacked.

Having just logged back into Facebook for the first time in a while, I checked one of the aforementioned prank videos because I was curious to see how my fellow viewers reacted to it. Looking at one specific video, I see that of the approximately 34,000 people who selected a reaction emoji, over 28,000 chose the thumbs up while approximately 4,000 people selected the laughing smiley face. My reaction to the videos? On one hand, I was impressed, just as I am when the elite Boston marathoners zoom by me or when my nephew solved a Rubik’s cube in virtually no time at all. On the other hand, the videos made me a little sad since they are only “funny” because they take advantage of a social stereotype. In other words, take away the onlooker’s astonishment and the humor vanishes. In a healthier culture, they would be nothing more than clips of dudes lifting weights, and what would be funny about that?

The Privilege of Intuitive Eating

Posted on by
Reply

While my time working in food service was mostly limited to academic teaching restaurants and hospital cafeterias, I learned that some businesses monitor the food that customers leave on their plates and interpret the observations as feedback for what the patrons thought of their orders. The less food remaining, the more the customers enjoyed it, is the general theory. This summer, I thought about that each afternoon as we opened our daughter’s backpack to see what portions of her snacks and lunches returned home from camp unconsumed.

We packed her an array of snack options each day without any expectation that she would eat them all, but we wanted her to have choices so she could select something that sounded good to her. Sure enough, each day she ate at least one of the snacks, but lunches were a different story. Providing multiple snack options was easy because they were all shelf-stable items that required no preparation; if she did not feel like eating a particular snack one day, it could stay in her bag until a different day when she did. However, the lunch options she said she wanted were perishable and took time to prepare, so sending her off to camp each day with multiple lunch choices was impractical. Thus, when a lunch returned largely uneaten, that got our attention because it meant she did not have much of a meal. 

If she just was not hungry at lunchtime, that would be fine, but our concern was the possibility that she was hungry but did not want the packed food. So we tried a bunch of lunch options, all of which she said she wanted, only to see them return home virtually or literally untouched. Eventually, I realized and accepted that she simply was not very hungry come lunchtime, and it became sort of humorous that she would request a specific lunch option only to not eat it.

As I chuckled at her uneaten food, I reminded myself of our luck and good fortune, and how being able to practice intuitive eating is a privilege. We did not mind if food came back uneaten and went down the garbage disposal, but what if that was the extent of the food that we could afford, and the choice was either to eat it or go hungry? Over the years, I have met people in our community who experience food insecurity, kids who either eat their free school-supplied breakfasts and lunches or have nothing all day, and families who accept what the food pantries have to offer or deal with barren kitchens.

Intuitive eating is embedded with privilege. Going through the matching process to choose one food over others requires having options available. Choosing when to eat necessitates having enough autonomy to be able to make such a decision. Ceasing to eat when comfortably full demands confidence that another opportunity to eat will arise again soon. Any of these privileges go out the window, and so does intuitive eating, at least to an extent.

However, subtle opportunities might still exist to utilize our intuition even in times when privilege is sparse. Buying dried legumes in bulk can be a thrifty way of obtaining protein, and with the prices of each bean being so similar to each other, we could choose the one that we most enjoy. A small array of cheap spices can impart somewhat different flavors on the same food for more variety in tastes. Free school meals include choices, such as chocolate or unflavored milk, and possibly different entree options. Foods that are shelf stable or at least function well as leftovers can be finished later, thus reducing the pressure to eat past the point of comfortable fullness.

The extent to which each of us practices intuitive eating is based at least in part on our circumstances. The laugh I got out of seeing our daughter’s uneaten lunches come home each day was a privileged reaction, and someone in different shoes might understandably have a very different reaction.