weight, weight, please tell me

Aug28

This is a post about weight–weighty matters, the weight of the world, mainly the ongoing conundrum of there being too much of it. It is a topic I think about sometimes–trying to wrap my arms around it to contain it properly.

Actually, you will see that I don’t have much to say about it, but instead am sharing the brilliant voices of others who do. It seems these stories have recently, coincidentally collected in my little basket of big dilemmas.

Before I proceed and attempt to offer something up on this largely considered nutritional–but so much greater– matter, let me digress for a moment to share something about me and my nutrition work and my nutritionist status. I have a little explaining to do.

I have experienced a lot of changes in the past few years. Some of these are profoundly personal while others are professional. I will stick to the latter and how they have influenced what I write about–perhaps some of you who follow me have noticed–but they are both intertwined.

When I began writing this blog in the fall of 2010-wow-I was perched in a clinical setting that continued to make me privy to the upfront and personal stories of individuals’ eating lives. I had been doing nutritional counseling for many years at that point in time. My clients’ issues strongly reflected, what I refer to in My Story, the massive changes in our food culture and highlighted the intimate art of eating in response to the personal and cultural milieu. The nutritional crises of our time, including the obesity crisis and its shadowed sister–eating disorders–were about twenty plus years deep in the making.

Professionally, I had been riding this unforeseen wave since its onset in the early 1990s and felt I had something to say to personalize and humanize what was projected as a faceless statistical trend. Having worked with so many people, I was able to synthesize the common experiences that were impacting us all. I could also relate some true experiences of my clients in my writings. I would juxtapose these experiences alongside the larger impacts of poverty, trauma, environmental changes, food adulteration, community access, societal messaging, etc.

What I never stopped to share, was that two and a half years ago, I stepped out of direct care. I began doing nutritional program development and administration for a statewide program serving childcare centers–the preschoolers, families, and educators. It is a good program. Though its implied mission is to prevent childhood obesity, I strongly prefer a redirection of intention to support the full health potential of all our children and mitigate the effects of what I am wont to refer to as nutritional violence and size stigmatization. Anyway, at that time, the nature of my posts changed and their frequency decreased. I had less material and more other things to tend to.

And now, I have just begun a new position. I am working for a breastfeeding support organization. This is a nutritional and health issue I am passionate about, but for the first time in my career, I am not carrying the title of Nutritionist. I seem to be welcoming this change–it is a natural extension of my life work and public health orientation that fits well with my current circumstances. But it also stirs some emotion. Due to a combination of my personal experiences and the fact that I have not done direct care for a few years now, I no longer feel I can assist others with the acute health challenges of our time and the precise nutritional approaches they demand. So, along with other big changes I am now facing, I think it may be that I am no longer a Nutritionist.

So, my dilemma asks me, “Then what’s with the name of your blog?” For now, I will answer that until I have time to reconsider it, it will stay the same. I am still deeply interested in nutrition and how it relates to our individual and collective health. I am still paying deep attention and I still want to be part of the larger conversation. And, I still want to help people. I may present more concise offerings on my Lifeseedlings Instagram page which are budding perspectives and occasional haikus on food politics, nourishment, body respect, eating, and cooking. Join me there.

And so, back to the issue of weight which I raised as the focus of this post. I wish it wasn’t all that it was and is. I wish it didn’t dominate the headlines and pervade our thoughts. I am bothered by my own sometimes prejudiced assumptions and that despite my somewhat larger awareness of its complicated nature, I still conflate weight with health and want to help ease and prevent the physical and emotional burdens it encumbers. But it is about time for all of us, those with or without the business to do so, to stop believing that banishing this weight, this unruly fat, is similar to scrubbing dirt and grit off of a coal miner’s body–some effort no doubt, some soaps better than others, but once undertaken, the job would be done.

From my observations, I think MAYBE things are changing. We may finally be realizing that plain out calorically restrictive diets of any ilk and fat-shaming just don’t seem to be working to solve the problem in the long run nor are they doing anyone much good.

And, while not entirely new, more voices–powerful, angry and/or tender voices, are emerging that challenge the once firmly held ideas and attitudes held by our scientific and medical communities, our society and even our personal selves about the ‘weight problem’. Their words and advocacy may be shifting our perspectives, sharpening our sensitivities, and providing new approaches to care.

Here is a short little syllabus of what I consider to be very interesting insights on the topic. It includes:

Where the story often begins. A post by Your Fat Friend, a personal story about the implications and consequences of early childhood weight interventions; and a discussion on What Harping on A Child’s Weight Looks Like 20 Years Later about the importance of fostering body appreciation for everyone, by Maryann Tomovich Jacobsen on her website, Raise Healthy Eaters.
What No One Ever Tells You About Weight Loss. A powerful and personal look at how expectations about ways to lose weight imply a process that is both isolating and not sustainable, by Nick Eckhart in What I Wish Someone Had Told Me About Losing a Lot of Weight.
How Even Well-Meaning Assumptions about Fat Athletes Can Be Misguided. Here, Ragen Chastain (whose blog Dances With Fat I have written about before) deconstructs such assumptions in her post, What Fat Olympians Prove (and What They Don’t).
Really? Just five amazing stories from an episode of This American Life, entitled, Tell Me I’m Fat. (Transcript or Audio).

This is not required reading, but I hope you find something thought-provoking, attitude- adjusting or maybe even life-changing within. And, though I don’t have Carl Kasell to answer my phone, you can leave me a message here.

Thank you for listening, sharing, following and supporting my writing. Please subscribe in the sidebar to receive notice of new posts. Comments and greetings always welcome.

In health, Elyn

(Update 2019: After a year and a half working for the breastfeeding organization, I moved forward to work for Wholesome Wave, a national organization dedicated to food access and affordability and a leader in programmatic and policy changes related to addressing food insecurity. My work here reunites me with my previous efforts of developing Produce Prescription programs as I described in Inventive Incentive. This work certainly has brought me back into the food and nutrition space, and gives me new types of stories to think about.)

Wholesome Wave’s My Plate

My Plate Haiku

Pick your own today

Happy kids in wide-brimmed hats

Sweet summertime fruit.

by Nan (Blessings on her new little grandson, Orion!)

inventive incentive

Feb15

To make bread or give love, to dig in the earth, to feed an animal or cook for a stranger—these activities require no extensive commentary, no lucid theology. All they require is someone willing to bend, reach, chop, stir. Most of these tasks are so full of pleasure that there is no need to complicate things by calling them holy. And yet these are the same activities that change lives, sometimes all at once and sometimes more slowly, the way dripping water changes stone. In a world where faith is often construed as a way of thinking, bodily practices remind the willing that faith is a way of life. Barbara Brown Taylor ~ (An Altar in the World: A Geography of Faith)

On a cloudy and dreary Saturday morning in October, I headed into Albany to catch up with the ever-busy Veggie Mobile in order to get a glimpse of the Veggie Rx Program in action. It had been almost two years since I began administering this program that I had helped establish at the Health Center, and as a concerned mom, it was time for a periodic check-up to see how it was doing.

Capital Roots Veggie Mobile

Veggie Rx is a “produce prescription incentive” wherein fruits and vegetables are “prescribed” to medically high-risk patients by their health care providers as a means to encourage healthier diets and to improve health outcomes. Similar programs have begun to emerge in the past few years, and are being considered as a model of a viable public health intervention for disenfranchised communities. This medically-housed approach provides powerful messaging, unique for an institution that traditionally proffers mainly pharmaceutical solutions and well-meaning but often weak recommendations for health behavior change. It affirms, “Let food be thy medicine.”

Veggie Rx was initiated as a collaboration between Capital District Community Gardens (CDCG) (now known as Capital Roots) and the Whitney Young Health Center and is funded by the NYS Department of Health’s Hunger Prevention and Nutrition Assistance Program. It was designed as a pilot to serve fifty persons with diabetes and/or hypertension. Once recruited and enrolled, the participants receive “prescription coupons” valued at $7 each, which can be redeemed once per week on CDCG’s Veggie Mobile. They also receive an additional food bag valued at $4 provided as part of the Veggie Mobile’s Taste and Take tasting program each time they shop.

The bio-diesel fueled, hip-hop pulsing, “produce aisle on wheels” Veggie Mobile which I chatted about in No Passing, toodles around many Capital District neighborhoods most days of the week, year-round. It irrigates identified food deserts by arriving at a variety of community locations where anyone can shop, right on the truck. It is somewhat akin to an ice cream truck except that it hawks an impressive array of fresh fruits and vegetables, much of it from local farms.

I met up with the Veggie Mobile that day in the city’s Arbor Hill neighborhood. Parked at the corner of a side street, it was a burst of color in a rather gray landscape. That brightly painted truck always shows up representing the rainbow, but it is the activity that it fosters that is the pot of gold. Among the customers were two Veggie Rx participants. One was a woman whom I had just enrolled in the program. She was there with her two young granddaughters. ‘Patient with diabetes’ instantly transformed into ‘loving grandma’ as I watched her solicit the girls’ advice for what to choose.

The other was a gentleman who had been enrolled for a while but who had not really participated. I had recently called him to discuss removing him from the program—but he asked for another chance. He explained that he had experienced a host of health problems but was feeling better and really wanted to have this opportunity to improve his diet. Sure enough, there he was like a kid in a candy shop–but instead of candy, he was purchasing a sophisticated assortment of produce.

After an hour at that location, the dedicated Veggie Mobile staff women closed up shop. I hopped in my car and followed them as they got back on and off the highway and made their way over to the next scheduled stop at a low-income housing complex—not too far from the Governor’s Mansion. Arriving there, about fifteen people were already waiting–men, women, and children–including two more Veggie Rx participants. They were surprised to see me and greeted me with smiles and hugs.

This was a busy site, so I assisted with bagging while anchoring myself at a good vantage point. Shopping on the Veggie Mobile begs some patience—but perhaps not any more than waiting in a fast-food drive-thru line. Here though, was connection, community and lots of conversation about good food. There was squeezing back and forth as people reached to add another sweet potato, banana or onion to their order. All forms of “monetary green” (cash, SNAP EBT cards, New York State Fresh Connect, and Farmer’s Market Coupons–along with the cute Veggie Rx coupons) were exchanged for “nutritional green” (collards, kale, green beans, green peppers, and broccoli). It was a beautiful sight to behold.

Despite my sheer love of this program, I am still not sure yet if these incentive initiatives are token, feel-good, short-term experiments–or the templates for a new health and food revolution. Are they worth the effort for the few that they serve? Can they put even the tiniest dent in the massive problem they are trying to solve and might a few fruits and vegetables a week really affect change?

What I do know is that I have seen Veggie Rx change the behaviors and well-being of many of those in the program. Let me strengthen that. I have witnessed some profound changes. There has definitely been some powerful “medicine” going down. Participants have started juicing, making smoothies, and taken to more plant-based diets. Many have attested to feeling better and have noticeably become more enlivened. While I have also noted improvements in individuals’ health markers (weight, blood pressure, hemoglobin A1c)–to see these markers shift in a significant way for this highly challenged population will take time. I caution not to base the success of these types of programs solely on those indicators–it is too myopic a lens.

Veggie Rx offers more than just food access and is about something greater than fruit and vegetable intake. Relationship building is the true foundation of this program. This power of relationship–between participants and the Health Center and Veggie Mobile staff–is not to be underestimated. Having undertaken an evaluation of this program and through my direct contact with the participants, I know that they feel better valued as both patients and consumers which increases their engagement in both roles. I also know that they consider this program to be a blessing in their lives–those are their words, not mine.

Participation comes with some requirements which asks something deeper of its recipients–like standing out on street corners in the cold, shopping in cramped quarters, finding a specific time and place to shop, and committing to follow-up medical appointments. Not everyone enrolled has taken advantage of the program, but the majority have–and some quite extensively.

As a metaphor for, or a substitute expression of the universal yearning to return to the land, the capacity to access the bounty of the earth perhaps subconsciously reminds us of the connection to our source and our birthright of health. The mere act of showing up and filling one’s bag with beautiful produce yielded from the soil reflects a powerful commitment to one’s self. Standing witness on that morning shed light on what a new paradigm of healthcare could look like–particularly in response to the problems associated with health disparities–but in the larger context as well. I returned home with a reassurance that my little toddler-aged program was doing well. I can’t wait to see it grow.

Thank you for listening, sharing, following and supporting my writing. Please subscribe in the sidebar to receive notice of new posts. Comments and greetings always welcome.

In health, Elyn

Double Value Coupon Program–Diet and Shopping Behavior Study

Building Healthy Communities Through Equitable Food Access

J’s My Plate

My Plate Haiku

Food is medicine

Farmers are doctors, Cooks priests

Eat, pray, eat, pray, love.

By Gordon

I Speak for the Fat People

Jul29

Although I’ve taken a little writing hiatus, the nutritional discourse continues unabated. The stories of our communal incarnate experience resonate with frustration, guilt, and misunderstandings. This is an older piece that I published previously in three parts. I hope offers some response with a bit of healing balm. Some of its points have been raised and debated among those in the scientific community rather recently. Here it is mended back together. It is longer than my other posts but I think it reads best together.

I speak for the fat people. Like Dr. Seuss’ Lorax who spoke for the trees, someone must speak for the fat people. Unlike the trees who needed a spokesperson because they had no tongues, you would think that the fat people would be able to speak for themselves. Of course, fat people have tongues. If they did not have that taste bud-laden sensory organ, they would not be fat. Given the current weight of the world, this group should not be particularly hard to hear. However, in the huge public dialogue about weight and obesity, the fat people are merely statistics. There are no real people behind the statistics, and this is where they have lost their voice. Therefore, they are stripped of any ability to speak with authority on the topic.

I am not a statistic. Though I have had some years where I toed the chubby line, for the most part, I have done my part in tipping the scales toward societal svelteness. Besides my obligation as a citizen to keep the fat numbers down, as a nutritionist, it is my professional responsibility to pull people out of the fat pool and to keep them from falling in at all.

It is no big secret that the medical and nutritional community has not done a great job in their role as bariatric (the science of obesity) lifeguards. I myself do not have a great track record of turning people into mere shadows of their former selves. But, I have spent my career as a nutritionist hearing the stories and struggles of the fat people and observing the ways of food and eating that define this turn of the century. I am a spy in the house of girth.

The fat community does, in fact, have some spokespeople. There are magazines, journals, books, and websites–written mainly by women–who have spent one day too many in the deprived and depraved world of dieting. There are individuals who are doing incredible and poetic work about re-informing and re-educating on misconceptions about weight and health and respectful self-care. Still, many of these efforts are marginalized or featured in venues that only topic-obsessed people like myself pay attention to. Even Roseanne Barr once said, “It’s OK to be fat. So you’re fat. Just be fat and shut up about it.” For every undertaking that sings the praises of body love and acceptance, there are thousands of counter-voices screaming the imperative to whip this fat away.

Therefore, I believe I must use my credentials to speak out. I hope that the fat people can accept me, a thin person–who is often cold and prone to osteoporosis–and an ex-stress and emotional eater to be their voice. Born of thin mother and fat father, I will try to do the cause justice.

Let’s begin by putting the issue of overweight into perspective. If we look at weight historically, I’m pretty certain that from the beginning of time, there have been fat people. We have all seen the pictures of early Cro-Magnon and Neanderthal men. Even those quintessential hunters and gatherers seemed capable of packing on a few pounds. After them came Confucius, King Henry the Eighth, Mamie in Gone with the Wind, Jackie Gleason, Pavarotti, Aunt Bea, and my grandmother. Chances are your grandmother was fat, too.

English: Luciano Pavarotti in Vélodrome Stadiu...

Luciano Pavarotti in Vélodrome Stadium, Marseille, France, le 15 juin 2002. (Photo credit: Wikipedia)

Since our early beginnings, human beings have come in varying shapes and sizes and large-size was not necessarily an aberration of medium-size. It is good that there are large-sized people. A world without them would mean a world with fewer great opera singers, chefs, women of ample bosom, football players, construction workers, and cuddly grandmothers.

It is not very difficult to become fat. You do not have to go out of your way to try. If Chinese youth can become fat, then anyone can. Only about 4% of the population has naturally model-thin bodies. That means that many models are starving themselves in order to be models. It also means that the rest of the Size 2 wannabes are expending a lot of physical and mental energy in the pursuit of thinness. Carolyn Knapp, in her book, Appetites, tells the story of a woman who describes the angst she feels putting on her stockings every morning. She wonders what she could have accomplished in her life with the time she has spent worrying about her weight.

There are the naturally skinny–and then there are the neurotically and pathologically skinny; and the metabolically hyper-activated skinny–those who sustain themselves on a steady diet of excessive caffeine and nicotine—or maybe extensive exercise. For the rest of us, the possibility of becoming overweight is just around the corner. We are physiologically and neurologically wired to pack it on. The ability to store fat came in pretty handy a time or two during our multi-millenial evolution. We have about 107 compensatory mechanisms that prevent us from starving to death. A bunch of those certainly kicked in to save our forefathers when they were unable to kill a bison. In people who attempt to starve themselves toward thinness, the body fights back–it regains the lost weight plus more, and then absolutely refuses to budge.

In addition, we are wired for comfort. Research shows that the food habits that sustain us are those that we developed while still wrapped in the loving veil of early childhood. Whether that happened to be gazelle, chicken soup, mashed potatoes or cheeseburgers, you will probably turn to those foods as an adult. Believe me, the corporate world certainly knows this. The Happy Meal ensures that today’s toddlers will become tomorrow’s adult fast-food consumers. The concept of comfort foods is one I hear a lot about during my spy missions. Women have confessed to me that they would choose a good loaf of bread over sex. The quality of the sex is not indicated in this context.

Then, of course, there are our natural temperaments as well as good old genetics. I listened once to the tender story of a woman who was adopted as a child. She never met her birth mother, but she possessed a very old, poor quality home movie that she believes is of her mother. Though she struggles to see the face better in search of subtle resemblances, it is the woman’s thighs that confirm her finding. She states, “Look at the thighs. Those are my thighs.”

On top of all this, let’s sprinkle on a life change, or just daily, chronic stress. Take your pick. Break-ups, abuse, graduate school, poverty, working long hours, caregiving, illness, depression or menopause are possible choices. And, God forbid you should simply possess a deep sensuous life-affirming passion for cooking and eating. Throw any of these on your plate and if your primal wiring wasn’t enough to enlist you, then current circumstances will. Even the once-thins can become the now-fat–especially in this current milieu where food is literally out to get ya. Not even the high school cheerleader is immune. Any emotional state that is heightened, increases for many the desire to seek food for reward. When one is working their way up the weight chart, it is because they are possessed by physical or emotional hunger, or physiological changes that they can neither understand nor control.

I can hear you begin to protest that it has to be more than just this. Aren’t we soooo bad? We ate the piece of chocolate cake (and we loved it). How could we? How dare we? That translates into four hours of floor mopping according to the calorie expenditure charts. That must be fair penance for the crime. As a spy, my days are peppered with the monologues and dialogues of self-hate and recrimination that people utter like a mantra before and/or after each foray into eating. The guilt is palpable. We must have all been ____________ in a previous lifetime. (insert your own response.)

I was heartened once to hear a man describe his joy-spreading tactic. Essentially, he spends half of his time acquiring special little chocolates and the other half gifting them to people as morsels of universal love. I am either becoming a very cynical nutritionist or a very empathic human being. The collective psyche is longing for the morsel of joy even at the expense of the perfect waistline. The truth is that we have appetites and hungers because we are merely human, not because we are bad people. However, when all of these human tendencies accumulate into extra pounds, getting rid of that weight is very difficult.

A few years ago, I attended a conference on an obesity-related topic. As a group, we were to brainstorm how to counsel a postpartum woman with a Body Mass Index (BMI) of 30. The exercise had me squirming from the get-go. As the attendees were getting rather dead-ended in their attempts to master this case-study, the presenter, a physician and researcher at a major university said, “Let me offer this idea. I am often in my office at my desk and on the phone. I could just sit there and talk on the phone, but instead, I stand and pace as I am talking.” My agitated brain said, “Yes, let’s file that idea to use.” 3889254107_2383b9acea_c Not with my clients but in this article. I could picture Homer Simpson stuffing one more donut in his face while muttering “Ah, vigorous pacing. That’s the ticket.” I wondered when was the last time this guy got out of his office and realized the experiences of real people, real fat people.

Hardly are all defined cases of overweight problematic. Some in the field maintain that the goal is for all individuals to attain an “appropriate” BMI. Short of that, they will be at risk for various health problems. My intuition and much science beg to differ. Many people are fine–if not perhaps better off–with a little extra weight on them. Pavarotti once said, “The reason fat people are happy is that their nerves are well protected.” My own observations reveal that the neurotically thin tend to be more frayed than their rounder counterparts. Besides, BMI is just a tool. At times it is a cruel tool—or at least a not very nice one. It makes no allowance for age, fitness, or even natural body type. Whether we like it or not, our bodies will shift and change as we age. Nature, with no ill intent, seems to want to round us out a bit as we mature. That is how we get to be grandpas and grandmas. Appropriate BMI does not necessarily confer lack of health risks–only ones of a particular nature. Last long enough, and we tend to eventually shrink back down.

Do not get me wrong. I am not undermining the seriousness of the obesity crisis that we are facing. I understand its consequences perhaps more than most. I see the implications of excessive weight that people struggle with on a daily basis and I strive to alleviate the challenges through educational, lifestyle, and nutritional support. I bemoan the forces that are propelling our society into ever-expanding levels of girth, especially those that are now affecting our children.

Still, I feel a need to call TIME OUT! To stop the madness that makes those who are the statistics speechless. To stop pointing the finger merely at the individual without an understanding of the deeper forces that are at play. There are multi-factorial causes that lie at the root of the weight gain epidemic. Many are so abstract or insidious that it is very difficult for the experts—let alone an ordinary individual–to understand what is going on. Though overeating, bad eating, food addiction, and poor lifestyle choices are definitely a part of it, the magnitude of the communal weight gain doesn’t seem to make sense based on calories alone. In the causative mix lie politics, hormones, pharmaceuticals, poverty, nutrition misinformation, abuse, dieting, food sensitivities, sensory science, profits, changes in the components of our food, environmental toxins, personal and spiritual alienation and lifestyles spinning out of control. There are strange bedfellows in each and every fat cell.

Now, back to our friend the Lorax. For the record, the Lorax, our venerable spokesperson, was rather portly himself. Based on his picture, I’d put him at a BMI of about 29. I’d describe him as neither apple nor pear-shaped but rather pickle-shaped. According to Dr. Seuss, “He was shortish. And oldish. And brownish and mossy.” The final message of the Lorax in his plea to save the environment was UNLESS. “Unless someone like you cares a whole awful lot, nothing is going to get better. It’s not.”

I too am rather shortish. Oldish, brownish, and mossy may someday also describe me. For now, my intention is not to imply an ultimatum. It is, however, to bring a greater sense of compassion and understanding–and a broader lens to the discussion and to the approaches to care.

I do not intend to deny the role of personal responsibility—be that for everyone. It is a big piece of the puzzle. Though it is critical that we address the current weight epidemic–we should not do it with an assault on the fat people. We must not slap everyone silly in an attempt to squeeze them into a size six dress or Speedo swimsuit. Besides, who would be left to sing the blues? And though I’d have been happy to find my grandmother at the gym, it could not replace the experience of cuddling up on her big, warm lap with wonderful smells wafting in from the kitchen.

Thank you for listening, sharing, following, and supporting my writing. Please subscribe in the sidebar to receive notice of new posts. Comments and greetings always welcome.

In health, Elyn

Related Resources (2010): Women Afraid to Eat (Frances M. Berg); Intuitive Eating (Evelyn Tribole and Elyse Resch); Health at Every Size (Dr. Bacon); Dances with Fat (Ragen Chastain)

The end of overeating. Taking Control of the Insatiable American Appetite (David A. Kessler, MD); Born Round: A Story of Family, Food and a Ferocious Appetite (Frank Bruni)

Erin’s My Plate

My Plate Haiku

Adirondack lake

Soothes us from the heat–weightless

We float like feathers.

By Elyn

obesity, oh wait a minute

Jun6

I have something to get off my chest. Well, really off my dresser. I’ve had this scrap of newspaper lying there for two months. It’s an article headlined, “Town Renamed for Sandwich”. I hope I don’t embarrass myself here because this is about Arby’s and Reuben sandwiches, two things I know hardly anything about. Apparently, the Town Board of the somewhat nearby town of Coeymans, rechristened itself Reubenville as part of an Arby’s Reubenville Challenge. By tacking a red and white banner that said “Welcome to Reubenville” over the regular town sign, the town received 5,000 free coupons redeemable for a Reuben sandwich at an Arby’s in another town fifteen miles away.

The Three Graces by Peter Paul Rubens (Photo credit: Wikipedia)

Is Arby’s famous for Reubens? Last I knew I thought they made roast beef sandwiches. I suppose they could make Reubens as well–doesn’t seem that far a stretch–but I am pretty sure they didn’t invent them. Though I have been rather ignorant of meaty matters for about forty years now, I once did know my way around a good corned beef sandwich–and was vaguely aware of its non-kosher cousin.

A perfunctory visit to the “Welcome to Arby’s” website has just revealed to me a picture of the Reuben, embedded in what is supposedly a marble rye. It doesn’t look like a New York marble rye to me if you know what I mean. Anyway, I am now hip to the 640 calories, 30 grams of fat and 1,610 milligrams of sodium that this town name changing sandwich contains–as well as its plethora of both real and hard to even imagine ingredients. I must commend Arby’s for listing the nutritional information for its complete menu in a very clear and accessible way. If you would like a quick lesson in fast-food gastronomy I suggest you take a peek yourself. I only wish the town council members would have bothered to do the same before getting that banner made.

I am still pretty bewildered. Does Coeymans have anything to do with Reuben sandwiches or with Arby’s for that matter? Named after its early settler, Barent Pieteres Koijeman, Coeymans’ roots are strongly Dutch. Is there some confusion in the town between the possible German origins of the sandwich and the German-Flemish painter Peter Paul Rubens, known for his beautiful paintings of voluptuous Rubenesque women? Rubens apparently died from heart failure related to chronic gout. Is that what this is all about? My bigger question is, why would any municipality waste its time and efforts responding to such a bogus challenge which serves only to promote the purposes of a corporate food giant and does nothing to protect or promote the lives of its citizens?

Interestingly, physician David Katz, Director of the Yale University Prevention Research Center and a prolific writer on many things of nutritional interest, just happened to speak to my burning questions and larger perpetual conundrum about personal health in the context of culture in a piece he posted this week titled “Culture, Power and Responsibility“. This piece is part of his Personal Responsibility for Health (PRH) Chronicles.

Katz writes, “I think we know what it is, and it’s all about power-and culture. Culture is a powerful influence on us all. When personal responsibility involves defiance of the prevailing forces of one’s culture, it becomes a very tall order indeed. Unfortunately, that is just the order associated with personal responsibility for health.”

“In a commentary published in The Lancet in February of this year, a group of scholars made the very point that the power of culture, and profit, is all too often oriented in opposition to health rather than in support of it. We might ask people to take responsibility in spite of it all, but that’s a bit like pitching someone off our boat and assigning them responsibility for keeping afloat- whether or not they’ve ever learned how to swim. Relevant power is prerequisite to responsibility.”

“If you know it’s important to control your weight and attend to your health, but almost everything in your environment and your culture conspires against such efforts- how responsible are you, personally? Are you truly personally irresponsible if you go with the prevailing flow?”

“How can the whole of our collective responsibility for health be so much less than the sum of what we expect from its parts? Do we truly expect every individual- adult and child alike- to compensate with personal responsibility for the collective abdications at the level of culture and corporation?”

Oh, blessed be. I could not agree more. Yes, I believe that it is the cultural, corporate and governmental abdication of responsibility that displaces much of the onus on an unwitting and poorly equipped populace. And, this is why the actions of both the Coeymans Town Board and the Arby’s Corporation drive me insane. This is also why I feel the ubiquitous conversation about obesity must be redirected.

The collective chatter about obesity is still amplifying. Traveling widely around this nutritional universe as I do, I am bombarded with meteoric messages about fighting, fixing, flagellating, and fracking obesity. The mandate is to leave no obesity behind–neither it’s grown-up or childhood varieties–adorable pudgy babies and grandmas included. Millions are being spent on the ammunition to obliterate this planetary scourge. The aims appear community-based, but individuals are the intended targets. The drones attack both bodies and psyches alike, unable to discern the difference. For my own safety I have taken to wearing a helmet–well, at least when I am biking.

The increased prevalence of obesity is a physically evident symptom of a culture whose motives ignored or overrode its responsibility to protect the birthright of health for its citizenry. However, generalizing obesity as a health crisis is complicated by the fact that its definition is too broadly applied, its prevalence poorly defined, its detriment still debatable and its cure misunderstood. There are many other equally important markers of compromised health and well-being. However, by focusing only on the obvious, the approach has been to throw massive resources at obesity programs with uncertain outcomes while abiding the cultural insults.

Rebuilding or restoring our country’s health will necessitate more than these bombastic approaches that seem similar to our political mindset of problem-solving. It will require some deep introspection regarding the constructs upon which we structure personal and public life. It will beg that our corporate and political leaders, as well as our policymakers, take a serious and sensitive look in attending to the environments that either foster or hinder health. There is much to be undone and redone. I have a few ideas of my own.

But while we continue to work toward meaningful change, I will think about the dear people down there in Coeymans in the aftermath of their brief moment of irrelevant fame. I wonder how many of the 7418 citizens even cared if they were one of the 5000 somehow chosen to drive thirty miles for a sandwich. My sincere wish is that those folks may have either a large dose of relevant power or access to good affordable health coverage because neither their council members nor Arby’s is going to pick up the real bill for that Reuben.

Do you know what I mean?

Thank you for listening, sharing, following and supporting my writing. Please subscribe in the sidebar to receive notice of new posts. Comments and greetings always welcome.

In health, Elyn

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Nirinjan’s Plate

MyPlate Haiku

Lagoon watercress

Peppers my tongue

With spring joy.

by Roxanne

(Gratitude to Roxanne, who provided a beautiful dinner of field greens with a maple vinaigrette dressing, and brown rice with wild mushrooms and tofu during my Memorial Day weekend bike trip to Martha’s Vineyard.)

so-duh

Jan22

I have a confession to make. I recently had a soda. Yes, I did. That means, of my own volition, I purchased the vibrantly colored 12-oz. can, pulled up on that little flip top, and brought that fizzy, bubbly nectar–rife with all its high fructose corn syrup–up to my own lips…and swallowed. Then I swallowed again. And, I did all of this under the bright lights of the public eye. I tell ya. That little burst of Sunkist Orange Soda was quite satisfying.

It was a cold winter’s night. Pete and I had gone to our little local community-run movie theater where nice volunteers staff a humble concession stand. I don’t really know how it happened. I was thirsty. Ordinarily, I would have just purchased water–which was what I was assuming I was about to do again as I approached the counter. However, uncharacteristically, my thirst informed me right then and there that it would not be humored this time by just plain water and it insisted that I consider the offerings stocked in the small glass-front refrigerator.

Alice and the Cheshire Cat

I was stunned. I did not know what to do. Healthy-oriented me does really enjoy a few lines of lightly sweetened specialized iced teas but there were none of those to be found in that bastion of freon-cooled fare. Instead, there were just waters, sodas and those pouches of Capri Suns that you stick little straws into. I panicked. The cloyingly sweet fruit juice concoctions aroused a mild nausea, the sodas provoked my usual disgust and disdain and the concession people were beginning to look at me funny.

Suddenly, the sun logo on the little orange can seemed to wink at me and I found myself saying, “Yes, I’ll have an orange soda.” When I went back to sit in my chair, Pete turned to tell me that the seat was saved…for me. He really did not recognize me with that can in my hand. The last time he saw me with a can of soda was about 1981 when we were parched and poor living in Dallas, Texas.

Now, you might not think this was such a big deal without appreciating that I have about the lowest per capita soda consumption and am kind of like the Carrie Nation of the soda-drinking world. I tote around soda bottles emptied of their original content and refilled with their hidden sugar equivalency. Like I described in Private Health, I paste pictures of skulls and cross-bones on these bottles. I make my victims hold those bottles while I read them the insidious list of ingredients that their beloved brands contain. I make them weep as they promise to not ever imbibe again. When forced on rare occasions to empty the bottles of their original contents so I can use them for my own devices, I don plastic gloves and a face mask. That is how corrosive I consider these substances to be. And, if anyone had ever dared offer my own kids a soda in my presence, who knows what their fate may have been.

So, imagine my inner confusion as I leaned over and whispered to Pete during the movie, “This is pretty good.” Now, don’t get me wrong. It is not like I never had the stuff. I was raised on soda. The only thing that had stopped me from having a relationship with it long ago was an early adoption of a whole foods, crunchy granola lifestyle, an understanding of the depleting aspects of white sugar and resistance to large multi-national corporations. If I had not had such a strong philosophical position on such matters way back, I might have just gone along enjoying these nice little fizzies with the rest of the masses. Especially the innocent flavors like orange, black cherry, and ginger ale. Sometimes they do just hit the spot like nothing else can. If not bolstered by my iron-clad conviction that soda should be a banned substance, I could easily imagine getting another one of these little cans of sunshine the next time I go to the movies. And then, maybe when I go to a restaurant or if I am on a trip. I could then just keep a few in my own fridge.

Maybe I should have relaxed a little last week with my lovely 300 plus-pound 35-year-old client who was diagnosed with diabetes a year ago. His blood sugars are better but still not in good control. He is drinking way less Pepsi than he used to. Now, he only has one or two cans a day, sometimes none, while on the job during the day as a building maintenance supervisor. Should the fact that he is the father of five– the youngest of which was with him during our consult and who was the cutest thing ever–matter? Is it just a coincidence that he sees a connection between his blood sugar levels and his soda consumption?

Maybe I shouldn’t have tried so hard last week to figure out what was up with my 34-year-old pregnant client. Prior to this pregnancy, her chart indicated that there was evidence of high blood sugar–hyperglycemia–without a full diagnosis of diabetes. She came in bemoaning her foul moods, agitation and lack of both patience and energy. Came to find out she has been consuming 2 to 3 liters of Cherry Coke daily for a long while. Imagine her surprise when I pulled out a sugar-filled bottle of her favorite blend from under my desk.

Once again, there is a new hoopla in the divisive soda world as Coca-Cola is releasing these commercial spots touting their supposed corporate responsibility in the fight against obesity while at the same time ignoring the true effects of their confectionery concoctions. You can watch one of them here. My peeps, Mark Bittman, Marion Nestle, CSPI, and others are thankfully responding to this deceptive campaign accordingly. This is good because I am busy in the trenches.

These little stories I cite above are just examples of situations I really encounter over and over, even in the course of a day. Corroded teeth, eroded stomachs, poor mood regulation, extreme belly fat and of course, diabetes lie in the wake of soda consumption and its adherent addiction. It is this that fuels my manic reaction to the stuff–and will continue to do so.

Being diagnosed with diabetes is like falling down Alice’s rabbit hole. Every day I meet the people who have unfortunately fallen into the hole chasing some elusive White Rabbit. Reality changes mighty quickly and quite extremely. Simply awakening from a strange dream will not make it go away. Eating cake will certainly not help and the Red Queen is apt to yell, “Off with her toes!” And, Coca Cola and Pepsico will have nothing to offer except a Cheshire Cat smug grin.

So, though I enjoyed that little refreshment, it will be a long time until my next one.

Thank you for listening, sharing, following and supporting my writing. Please subscribe in the sidebar to receive notice of new posts. Comments and greetings always welcome.

In health, Elyn

A Bank of Beverage Machine’s My Plate

My Plate Haiku

Did you really think

That you could hide fish in rice?

Oh, the green paste burns!

by A Cat

(from I Could Pee on This and other poems by cats collected by Francesco Marciuliano)

of poverty and light

Dec22

Amid all of the celebrations of the holiday season it sure is easy to overindulge and to gain those few–oh excuse me for a moment–my dilemma is tugging at my sleeve. Sorry, it seems to be interrupting me to say something about property. Property? Puberty? You know, despite its omnipresence in my life, I don’t even understand my own dilemma sometimes.

It is like when my son was little and (prematurely) learning to talk, he would get so frustrated when his word was misinterpreted. When I would repeat the statement to make sure I had heard it correctly, like, “You want some bed?”, he could only surmise that his mother must be severely limited and he would implore the heavens for some relief. Who on earth he would beg says, “I want some bed”, and even if they did, why would they say that when standing in the kitchen after nap time? What part of “bread” does my mother not get?

My dilemma is reacting the same way now. So, with a deep breath, I will take its sweet little face between my hands and ask it to calm down and try to tell me again. Oh, I get it now. Poverty. My dilemma is asking me if I could please not write about holiday eating, but instead about poverty.

Oh, poverty. “Right now?” I ask, in the midst of this season of tinsel-tinged holiday cheer? Yes, it replies. Write about it on this darkest day of the year when we most crave the light to illuminate all that should be revealed. “Can you just try?” it says in that adorable little voice. “About poverty and nutrition?”

What do I know about this topic and what credentials do I have to write about it? Well, I do work in a Federally Qualified Health Center that serves the economically poor–the uninsured, the underinsured, those who sit at the bottom of the economic ladder, those lacking in many of the resources that others easily possess. And, I do educate on nutrition. Yet, I am still nervous to presume that I have the right to tread here. My own perceptions are actually a bit blurry.

Though every day I am deeply privileged to have my clients share the stories–somewhat intimate–of some parts of the realities of their lives, I cannot claim to really know what their impoverishment feels like. And, though yes, the majority of my clients are poor, some poorer than others–they all mainly go to sleep with some roof over their head and some food in their tummies. Furthermore, they possess a richness that nourishes and inspires me as well–whether it be of spirit, honesty, feeling, fortitude, resilience, wisdom, story-telling, family and community connection, self-reflection, humility or appreciation.

Yet, I am still perplexed, so I look back at my dilemma and ask, “But, don’t people already know about poverty and nutrition? That it is complicated but it has something to do with the cheapest (hunger-slaying) food often being the least healthy; the battered economy; governmental food subsidies; food deserts; reliance on convenience and processed foods; income inequality; the history of supplemental and commodity food programs and the lack of a just and sustainable food system?

And, haven’t I already discussed things like food addiction and the impact of excessive sugar-sweetened beverages on emotional and physical health? And, I probably have already ranted about even bigger, more amorphous issues like lack of breastfeeding, TV advertising, health disparities, a stress-based society and may I now even add environmental toxins and gun violence which disproportionately affects our poorer neighborhoods–and how I believe all these things affect our bodies and who we are as eaters.

My dilemma nods and whispers, “Well, is there anything else you’d like to add?” I sigh. Maybe it is on to something. There are many disparaging assumptions made regarding how the poor feed themselves. Maybe what I can do for today is to shed some light on how poverty in modern-day America infringes upon the hunting, gathering, and metabolic fundamentals required for normal human nutrition–a process that has become quite enigmatic for many, but more profoundly for those who must often do with very limited resources. In the daily conversations that I have about this elusive, ill-defined quest for proper eating–oft imagined as being as simple to prescribe as popping a pill–I am perpetually filtering many realities that are probably rather obscure.

So, here it is. Most of my clients would like to eat better. They would–but there are numerous hindrances. Many are tired. Very tired. Those who work, often work very exhausting types of jobs. Many of them–the home health aides, the certified nursing assistants, the truck drivers, the cleaners, the warehouse stockers, and even the retail workers–work variable hours, often with overnight shifts which distress the natural circadian rhythms and thereby the sleep and eating patterns. Those who don’t work are often depressed or in chronic pain. Food provides easy relief. They live in neighborhoods where people get shot and murdered. They forget how to use and move their bodies. Many over their lifetimes have cared for so many others that self-care is just an amusing oxymoron. Often, just the physical requirements that cooking entails become difficult.

Additionally, when money is tight for food, so commonly it is for all the things associated with food preparation and eating. This includes appliances like stoves, ovens, dishwashers, refrigerators, and freezers–and even the kitchen table and chairs. Some of my clients live in accommodations where not all of these are provided or where they are not properly working. Some only have a microwave to cook their food. Some live in settings where they have to share a kitchen with random roommates. Some people keep food in their bedrooms to prevent others from eating it. Those who live in group programs have no control over the type of food that is provided.

And, then there are the even smaller things like a set of good knives, measuring cups and spoons, pots and pans, a blender, a cutting board, a steamer or a food processor. For many a modern cook, one could not imagine even basic food preparation without most of these accouterments, if not even more. Yet, for some, these are downright luxuries. Just recently, I did a display on winter squashes to promote these nutritionally blessed, fiber-dense and delicious denizens of the food kingdom–but even so, I was cognizant that unless one buys them pre-cut and frozen these pretty gourds demand a whack of a proper, well-sharpened knife to reveal their inner gifts.

Each person has their own circumstances. Though I must serve my clients quickly and effectively I have to obtain some information before I venture in with suggestions. I cannot assess for all of the above. I must pry for information with the utmost gentleness and respect to get a quick sense of where we are starting from. Depending on the person, sometimes it is obvious, sometimes not. The foods that are now commonly touted to be required for a healthy diet, I sometimes must ask permission to utter. I say things like olive oil, brown rice, walnuts, almond milk, and on a good day, quinoa, preceded by “may I?” and followed by “thank-you.” What might seem like a molehill of a price differential could quite truly be a mountain.

Thankfully, there is usually space for an appropriate conversation about food and eating when the context is understood and appreciated. And, fortunately too, the realm of health-giving foods contains some low-cost and readily available options. My clients are glad to be reminded of them. Usually, they learned of them from their grandmothers as well. But, most importantly is when that light goes on that says that they are worthy of nourishing themselves in the best way that they possibly can. That they matter. Then this abstract matter of nutrition begins to make some sense.

So, I guess, my main observation is that bottom line, despite our economic differences, we are foremost eaters–doing the best we can with what we know and what we have at the moment. And, that somewhere, somehow, it is always about love. I look back at my dilemma for some confirmation. Oh well. It has fallen fast asleep.

Thank you for listening, sharing, following and supporting my writing. Please subscribe in the sidebar to receive notice of new posts. Comments and greetings always welcome.

Read below on the new My Plate Invitational

In health, Elyn

USDA MyPlate Plate

My Plate: In honor of the New Year, I invite you to submit a photo of your own beautiful plate to be placed in the rotation along with the My Plate Haikus. My Plate (your plates) will offer a prettier and more personal representation of the MyPlate put forth by the USDA as a model of how Americans should feed themselves–which replaced the MyPyramid. I can’t wait to see your plate. It can portray whatever nourishment, pleasant eating, or mealtime means to you. It can contain a meal you have prepared or been lovingly served, a depiction of feeding, or just some beautiful dishware. My Plate Haikus always welcome too.

You may include it in a comment or submit to zimmermanelyn7@gmail.com/Subject Line: My Plate Photo

private health

Apr29

My dilemma was really excited. We hadn’t been to a conference in a while. Usually, I try to keep my nutritional dilemma quiet and out of sight. But, last week as I was heading to a meeting of the New York State Public Health Association I figured nothing would be too controversial, so I relaxed my grip on it a bit as we headed out. It was an unusually warm morning and as I rolled down the car windows, my dilemma, riding shotgun, stuck its head out into the fresh air, giddily taking in all the sights and smells like a golden retriever.

We arrived at the hotel, easily found a parking space and the right room, and settled in. I applauded the availability of Tazo Tea and forgave the choice of bad white bagels. I knew there was some consciousness on the part of the Association to be mindful of the food so I appreciated that there was an alternative to the usual sugar-laden breakfast pastries.

The title of the conference was “Transforming Communities through Public Health Practice”. The keynote speaker was Michelle Davis, Deputy Regional Health Administrator for the US Department of Health and Human Services.

As I sat through the morning, I checked the program to remind myself of the focus of the day and why I had chosen to apply my limited continuing education benefits here. Though I mainly do my nutrition and health thing privately within the confines of my small offices, working with one member of the public at a time, I also try to promote health messages to a larger audience as well. I practice what I term stealth health–introducing information or programs that enhance well-being in both supportive and unsuspecting ways. Here was an opportunity to listen and learn from others who are out there doing community transformation. This is what motivated my choice–to be with my peeps–like-minded people doing great things in this arena.

As an attendee I learned of the new goals of the Healthy People 2020 initiative; I heard about some worthy activities happening on the local scene; and, I sat in on an interesting session that reviewed a relatively well-funded menu labeling education campaign that encouraged consumers to choose fast food meals containing 600 calories or less. The initial results were apparently somewhat disappointing though the evaluation data was limited. The research ironically showed that those who did not receive the message curtailed calories more than those who did.

I thought I had my dilemma well-leashed, but in retrospect, I realize it was already starting to whimper and whine. However, it was not until I attended the first session of the afternoon, “Development and Implementation of Formal Policies and/or Local Legislation to Increase the Availability of Non-Sugar Sweetened Beverages in Public Buildings: Reports from the Field” that its bark became disruptively loud. The session was facilitated by two women who had overseen a project of the NY State Association of County Health officials wherein monies and other resources were allocated to a handful of county health departments to assist their county governments in achieving this goal.

They effectively reviewed how the different counties applied their efforts–which really were intended to decrease the availability of sugar-sweetened beverages (SSBs). They described media campaigns, seltzer water promotion activities, revenue concerns, working with government officials from the top down and with procurement managers from the bottom up. They discussed vending contracts and how these are virtually impossible to change until the contract runs out. They explained the challenges, push back and resistance that each county encountered and the small changes that were made. This was an absolutely positive action, but it required that they had to play nice politics with these good public dollars.

I suppose I know this is how the process works but the cumulative view of the public health community working so hard for such small gains–even in the public sector–turned my dilemma rabid. It circled wildly, foamed at the mouth and even raised its hand and expressed its opinion. To calm it back down, I had to go get it a fruit kabob at the next break.

Who do we still have to convince at this stage of the game that vending machine revenues will not outpace health care spending? Who do I need to invite into my office to hear the daily stories of health compromised by tepid health care policies and timid action? How many cases of people addicted to Mountain Dew, Pepsi, and other such SSBs must I detail as evidence to show how they suffer from rotted teeth that cannot be repaired; ravaged digestive systems bandaged with a plethora of damaging antacid medications; excessive weight that has literally brought them to their knees; anxiety propelled by excessive caffeine; and, destroyed glucose control that relegates them to a life with diabetes? Is it not tragic how many are children and young adults are already affected?

I always say that if I was the ruler of the food planet, I would remove sodas immediately. There is a heavy toll on health from such irresponsibly marketed products available for consumption with the clink of just a few coins in most public places–not only here but around the globe. And, though soda addiction knows no boundaries, as usual, the economically poor, are disproportionately affected. Recently, a client of mine told me that the school bus company that he works for removed soda vending from the employee break room. Cannot our own government agencies venture such a commitment? Bearing such witness, I am perforce required to display the amount of sugar in various SSB bottles wherever I may be. Right now in the lobby of the health center, I have such a display with associated handouts. People truly gasp when they see the load of sugary stuff that otherwise stays dissolved in the highly acidic medium.

This week, just a few days after the episode at the hotel, a fifteen-year-old boy who has lived a large part of his life in a home for troubled youth was brought to see me–ostensibly for his high weight problems. He was accompanied by a case manager–and another boy who came along. We had a pretty good chat and among other things, we talked about his soda drinking. I told him I really felt sodas were toxic substances that deserved some type of poison label. He asked me if I had a Sharpie. I said, of course, dug it out for him–and he drew me a page full of well-executed skulls and crossbones. I thanked him profusely for his contribution to my crusade. Who knows, perhaps through this experience of participation, he will become a stealth health advocate. When we were done, I gave him and his little buddy two water bottles that I had actually picked up at the conference.

Afterward, I realized my dilemma had been watching the whole encounter from under my desk. It pawed at me and looked me squarely in the eye. It bemoaned that private health is truly a deeply public health matter and vice-versa, and with its tail between its legs, it quietly crawled away.

Let me know what you think about this issue. Thanks.

In health, Elyn

My Plate

My Plate Haiku

Lagoon watercress

Peppers my tongue

With spring joy.

by Roxanne

The Twinkie Affair

Jan11

Today, I was about to sit and write about a little train of thought that had been following me around this week. I thought I had some more serious things I wanted to discuss, including returning to the subject I raised in To She Who Loves Us Before She Meets Us, on the consequences of taking away women’s power in the birthing of babies. But, I figured I would just tap out this other idea first even though I was questioning its relevance, significance, and general cohesiveness.

I had planned on talking about the very interesting work of an old friend of mine, whom I had recently reconnected with. Quite coincidentally, just as I had cleared away my other duties of the day and was gearing up for a mid-afternoon snack to fortify my writing, I got an email from this very friend, asking if I had seen Mark Bittman’s tofu recipe in the NY Times today. She sent me the link.

After returning from snacking, cleaning the cat litter box, emptying the compost and bringing in the spring water, I curled back up on my computer and found myself in the Dining and Wine section of the Wednesday Times. I did not see the tofu recipe but was quickly sucked in by a few other articles.

One was about a spontaneously created cafe in the Hurricane Irene flood-ravaged town of Schoharie, NY. My life was touched by the hurricane so the story of survival in nearby Schoharie is meaningful to me. Miraculously, food prepared and provided by angels from near and far has swirled its way into the town, first amassing under a cluster of trees and then with the coming of winter at a local DAR Hall. These offerings give those whose homes and lives were affected a free lunch and a sense of continued community. Just as spontaneously as this epicenter of nourishment created itself, so did a sign that named the cafe, Loaves and Fishes.

Next, was an amusing piece about a vegetarian New Yorker on assignment in the Midwest–the meat capital of the country; and, also–though still no mention of tofu–a Mark Bittman editorial on the decrease of meat consumption in the past few years. Of course, those would speak to me.

Just as I was about to get back to work, one more thing caught my attention. By the time I hit the publish button tonight, this may already be old news to you, but apparently, Hostess Foods is declaring bankruptcy and the fate of the Twinkie is in serious jeopardy. Before my eyes, I could tell the food world was in a tizzy. The article, musing about a world without Twinkies, actually interviewed a renowned baker and pastry chef who I know from my own little community. That seemed silly. What would he have to say about Twinkies?

English: Hostess Twinkies. Yellow snack cake w...

Image via Wikipedia

But for me? Don’t I have to say something academic, relevant or amusing about the Twinkie affair? And, don’t I have to say it really soon or my writings will be considered as fresh as a stale pastry? Unlike Twinkies, my words do not contain the ingredients that will ensure their shelf life into the next millennium. Instead, they will be moldy by Monday. Well, here it is. You have heard it here probably second, third or fourth. I have no quick or witty assessment of the situation and I will probably defer to those who do. Like to Michael Pollan discussing Twinkies vs. Carrots.

It is a dilemma that stories from the food, nutrition and eating world amass very quickly. My queue of articles that I want to address or reference gets longer and longer every day. Pete saves podcasts for me or reads me articles straight from his Kindle; friends from afar send me links to interesting or absurd articles; radio stories infiltrate my driving commute; my professional networks post really relevant material; and, blogs I follow are deserving of mention. On top of that are the real-life stories that I am privileged to hear from my clients every day. No story is purely personal. There is always a larger cultural context such as explored in this powerful and sensitive NPR story about a woman’s struggle to lose weight. There is much to react to. I cannot keep up.

So, for now, I must continue at my own small-town pace. I thank you for your patience. I’ll get back to the piece that includes my old friend, a Mayan elder– and, actually, now that I think about it, it may have everything to do with Twinkies; back to the mommas–and, as I have promised before–all the menopausal women. Time for dinner.

In Health, Elyn–A once upon a time Twinkie eater. How about you?

attacking the causes of obesity, really?

Oct29

I have been having what I suppose you could call a blog clog lately, or maybe a blogade. Lots of stuff and stories going around in the brain but they are experiencing a log jam while trying to get out in some type of orderly fashion.

Howard Johnson’s Restaurant

This seems to have started when Pete showed me a Jane Brody article from the New York Times a few weeks back called, “Attacking the Obesity Epidemic by First Figuring Out Its Cause”. I should probably just have considered it a moot subject and ignored it, but it wrapped its little serifs around me and wouldn’t let go. You mean we haven’t already figured this out? Apparently not. And, this is the missing piece that has still been feeding the epidemic so to speak?

According to Ms. Brody, an impressive team of experts spent the last two years investigating the big O and published their conclusions in a series of reports in The Lancet. I will assume that what she goes on to describe is a reflection of their findings and not a cover-up for some obscure but shocking discoveries that will remain hidden in a boring medical journal.

Apparently, the impressive experts determined that the demise of the following is responsible for the puddle of fat we now find ourselves in. From the 1940’s through the 1970’s more or less– the years that preceded the epidemic–we played, walked and biked more; watched less TV, ate meals prepared at home by moms who mainly did not work, ate out only for special events, downed mainly hot or cold cereal for breakfast, had fewer mass-produced convenience foods, and consumed fewer refined carbohydrates as well as fewer calories.

I will try to keep my cynicism to a minimum but remember I did warn you about this side of me in Diet for a Small Caterpillar. Maybe this is breaking news or perhaps fascinating ancient history to those born after those more svelte decades, but two years of research, really? Those impressive experts could have just come and asked me, or better yet could have paid me. I’d love to be a paid impressive expert. I was actually one of those referenced skinny, cereal eating, hop-scotching kids on a bike, who occasionally ate out at Howard Johnson’s with my family when my non-working mother was too tired to cook. Wait, how old are those exalted researchers, anyway?

With all due respect to Drs. Gortmaker and Swinburn, et al who were cited in the article– unless I am remiss for not reading the source material, this is superficial and obvious stuff. A lot has changed since that time and the changes have had many effects on the human experience besides causing obesity. I think it is myopic to put the attack and hence the shame and blame only on those walking around with the visible consequences of our societal shifts or imbalances. Many things have increased since the 1970s besides weight like rates of divorce, cancer, childhood poverty, autism, learning disabilities, alcoholism, underage drinking, the perverse pursuit of thinness and high school dropout rates–and all carry a high cost as well–but these conditions are invisible in the rising tide of humanity. Still, even if we are to keep our attention just on the problem of obesity, one could identify other significant and more profound influences.

One of my impressive experts, Marc David, who I introduced previously in Three Good Mark(c)s, meaningfully and sensitively addresses this topic in his article, ‘A New Way to Lose Weight–Listen to It’. Moving beyond the easily observed poor food choices that plague us, he explores causes of the emotional hunger we face these days that propel people to overuse or abuse food. These are very important, and when personified, they are what present in my office every day–repressed feelings, unmet needs, self-doubt, chronic stress, disconnection from one’s body and loneliness.

These are associated as well with the larger cultural issues that he dares expose. These are not new, but the ramifications are coming to a head, perhaps similar to global warming. He speaks of a nation that has valued excess and overconsumption; a culture that values speed and ease; a world filled with fear, anxiety, and mistrust; and, a people separated from their spiritual source.

Though I don’t fit their demographic, I have come to enjoy reading the magazine, Outside. It is for those who live the active life–in a rather bold way–and is a tad less dry than The Lancet. In a recent issue, there was an article, Jamie Oliver Will Work 4 Food about renegade British chef, Jamie Oliver, who is sincerely trying to clean up our country’s food mess. I admire Oliver’s means and message. I share his penchant for crying. The author, Jeff Gordinier, describes the obstacles Oliver is facing here in America. He writes, “As one wag put it, Oliver “just doesn’t get the fact that excessive consumption is woven into our national DNA.” This concurs with some of what Marc David is saying.

If a lack of identifying causes is impeding solving the problem, then acknowledging our national and personal constitutional makeups is as important as looking at what we are eating for breakfast now, well, compared to in my day. Doing so would help to explain why we lay down reason in the feeding of ourselves and our children.

My own causative list would go even further. It implicates the usurping of the practice of medicine by the pharmaceutical industry, unethical corporate practices and the disempowerment of women in pregnancy and birth for starters. I’ll leave it there for now. As I’ve hopefully unclogged the blog, I will be able to pick up on those topics soon.

Stay posted. I promise that will be fun. And tell me what would be on your list.

Thank you for listening, sharing, following and supporting my writing. Please subscribe in the sidebar to receive notice of new posts. Comments and greetings always welcome.

In health, Elyn

my plate

My Plate Haiku

Hunger tiptoes in

From bellies, hearts or minds

Feed me now she calls.

By, Eva

how can you say no to a brownie?

Sep17

Yesterday, I attended a conference on Bariatrics and Nutrition, put on by the Bariatric Department of my local university medical center. Bariatrics is the science of obesity. Spell check is questioning my use of this word, so let me go appease it. My quick search into its derivation informs me that its root bar is the same as in the word barometer–the measure of the weight of air. The word was created in 1965 and first used in 1977. It rhymes with allopatric, geriatric, pediatric, podiatric and psychiatric, in case you wish to use it in a song or poem.

The seductive brownie (Photo credit: Wikipedia)

We mainly use the word regarding bariatric surgery or the surgical approach to weight reduction. I have worked with a few people who have had this surgery. There are increasingly newer and easier procedures and more centers doing them–and thereby more people having them–so I chose to attend the conference to better inform myself.

I walked into the dimly lit hotel conference room, with bad feng shui, grabbed the last seat at a table with a few other women, put my stuff down and made my way over to the breakfast spread in the adjoining room. From left to right there was coffee, tea, small glasses of orange and cranberry juice, a big tray of danish, another of white bagels with little individual cream cheese servings, a platter of fruit and an icy bin filled with Sierra Mist, Pepsi, Diet Pepsi, and Brisk iced tea.

The morning session was well presented by highly credentialed physicians, a pharmacist, and a psychologist. I did learn some things that were of professional interest to me, but I was finding myself with another one of my nutritional dilemmas. An endocrinologist spoke about how these procedures and their concomitant weight loss results are greatly reducing blood pressure, cholesterol, sleep apnea, and even the high blood sugar levels of diabetes–and are thereby also reducing the cost burden to our health care system of these conditions. However, I was still unsettled by such invasive methods with major implications for nourishment and still uncertain as to how these experts felt about their own program.

After a few hours, I was drained from the bad room energy and hungry. I stuffed my dilemma and headed out to the more naturally lit lunch area. I was pleased to find myself satisfied by a meal that met my own personal nutritional needs and headed back feeling much better and fortified for the afternoon session. It was a good thing too. Three surgeons, whose mothers or kindergarten teachers must have taught them very good craft skills, were soon to reveal to me the gorier aspects of the art of bariatrics.

Currently, there are three major types of either restrictive or malabsorptive bariatric surgeries that are performed in this country–gastric bypass, gastric banding, and sleeve gastrectomy. Sleeve gastrectomy is the newest of the three. While I imagined something more benign, a young boy wonder doctor described the procedure by way of both schematic and actual slides of our insides. He explained that the procedure entails using a stapling device that creates a thin vertical sleeve of stomach while the other two-thirds of the stomach on the other side of the staples–is lopped off. Oh.

The next surgeon, who at least looked like he was born before the first use of the word bariatric, also described various procedures. He was very careful to explain that all of these come with some significant complications. Despite his obvious experience and calm demeanor, transparent in his message was that the safest surgery is no surgery.

As I was digesting this, the woman I had been sitting next to all day raised her hand and asked that if one had already had gastric banding, which has the highest weight loss failure, could they be a candidate for sleeve gastrectomy.

At the next break, at risk of being intrusive, I asked the woman if she’d had the band procedure. She replied that she had, and was frustrated that she only lost 50 pounds. She had the band re-tightened which is done by filling it with more saline solution. Quietly, she admitted that she was responsible for having made some bad choices. I left it at that.

A few minutes later she returned from the break room which had been freshly stocked with a new array of sodas and sweets, with a Pepsi and a brownie. The other women at the table, who I had come to realize were not medical professionals, muttered something to her and she replied, “How can you say no to a brownie?”

The final speaker of the afternoon was a plastic surgeon. This guy was a Michelangelo in GQ clothing. Through a series of slides, I witnessed the graphic photos of about twenty post-bariatric surgery patients clad only in their underpants, before and after the liposuction and body contouring procedures he had sculpted on them. I saw the flaccid flesh of breasts, bellies, arms, thighs, and butts hanging in folds from alien-looking bodies. One woman’s belly flesh reached almost to the floor. Matter-of-factly, he showed how he lifted skin, sucked out fat from one area, stuffed it back into another, and sewed people back up often around their entire circumference. He told of removing up to twenty-five pounds of skin and fat during a single procedure.

As shocked as I was by what he was showing, it was what he explained in closing that was more distressing and deeply telling. He shared that some patients have said to him, that in retrospect, even though they may even feel better, they actually liked their bodies more before the procedure. They may have been fat but they felt they at least had a healthier glow or more natural body. Some, express dissatisfaction with other minute parts of their bodies that they had never thought about before, and many still perceive themselves as fat as they ever were. There is no guarantee that the person will experience a greater sense of well-being and less depression–though many do.

At the end of the day, the Bariatric Program Director and conference facilitator asked the panel of presenters, where did they think we are heading in the next five to ten years. Are we going to be doing way more procedures as the obesity rates continue to increase? Do we fully know what percentage of people who have undergone these procedures truly keep the weight off and the diseases at bay? Do we know the correct prevention measures? The presenters looked a bit deflated in response.

Regarding the prevention question, I left one respectful suggestion on my evaluation form–that the medical community should be particularly mindful of the food it offers at conferences. We talk about healthy eating and yet are unable to establish a new food paradigm in this culture.

Digging for my car keys, I found my dilemma at the bottom of my pocketbook where I had stuffed it. It looked me in the eye and asked, “How can you say no to a brownie?” “It’s tough”, I responded. I headed out into the late afternoon traffic.

How do you say no to a brownie?

Thank you for listening, sharing, following and supporting my writing. Please subscribe in the sidebar to receive notice of new posts. Comments and greetings always welcome.

In health, Elyn

my plate

My Plate Haiku

Adirondack lake

Soothes us from the heat–weightless

We float like feathers. by Elyn

the nutritionist's dilemma

a nutritionist's musings on the realities of eaters and eating

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how can you say no to a brownie?