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

yesterday

Oct28

Image via Wikipedia

Yesterday, the big nutritional and societal issues that trouble me did not seem so far away. It was an unusual day as my afternoon was devoted to working with children as part of a new project I am involved in.

In the morning I saw a client who at age 42 weighs 371 pounds and requires a cane. She had recently come to me with uncontrolled diabetes and pending renal failure. Surprisingly, she had made some pretty profound changes in the time since I had last seen her and had greatly improved her blood sugar levels. When I asked her what explained the change, she said being spoken to about her kidney damage; and her love for her nine-year-old daughter made her face that big mighty river that flows through all of us.

I encounter many common themes in my work, and often the same ones coincidentally present themselves repeatedly in the course of a month, a week or even a day. One of my current recurrent themes, represented by that client, has been women in their early forties with way too much pain and far, far too many pounds and medications to bear. I always wonder, where did this story start, how did it get so extreme, how was it not prevented?

These questions often leave deep indentations as I press my fingertips into my forehead while bowing over my desk. On some days, the pressure is so deep I can almost feel my prefrontal cortex. But, yesterday, I knew I needed to ready myself for the children, so I yanked my hand down away from my head and put on my happy face. Little did I know the answers to my rhetorical questions lay in these young kids who awaited me.

First, was a pretty, very precociously developed, thirteen-year-old girl who hates her body and by association herself. As I was speaking with her she picked up her cell phone, pushed a button and brought it to her ear almost as unconsciously as brushing a hair behind one’s ear. As I asked her to put the phone away, I fumbled looking to offer her a better connection with me. I asked her and her mom a few of the perfunctory questions but my words sounded hollow. Even at her age, I could tell there were already too many chapters to her story and too few cutesy nutritional clichés that could assuage her experience of being fat.

Next, was a six-year-old boy. He is a big boy at 100 lbs. He was accompanied by both of his very big parents who were eager to help their son as well as themselves. With the boy quickly picking his way through the things in my crowded office I needed a distraction fast. I passed the dad these fun picture cards I have where different scenes are creatively constructed out of fruits and vegetables–while asking the mom for some history.

Dad did successfully engage the boy while Mom described to me that he started on whole milk as a one-month-old infant because her WIC checks for formula were stolen. Since then he has always drunk a lot of milk at will without limit–until very recently. How much milk did she say he drank a day? Why had she not gotten new WIC checks? Already, six years of details had passed me by due to my split attentions. What else was already missed in this young boy’s story and by how many people? Done looking at the cards, the child slid off his dad’s lap and came and stood right in front of me. He asked me the hardest question to answer simply–Is milk good for you?

And then, a lovely, smart and very insightful thirteen-year-old came and placed her presence before me. Within the passing of our first few shared sentences, she told me that she doesn’t eat breakfast or lunch at school because she does not want the other kids to make fun of her. At 271 pounds she has lost the right to eat in peace. A right so assumed we don’t even define it–has already been denied this child–and who knows what else has accompanied this loss. And dinner, she eats in her bedroom in front of the television.

Her mom, full of appropriate concern then joined us. She assumed responsibility for a household with much dysfunction in regard to structure and care associated with food and eating but she was more guilty of love than neglect. Still, her daughter now has abnormal glucose and insulin levels, has had to undergo an ultrasound for an ovarian cyst related to hormonal imbalance, suffers from depression and has already been on a number of medications for various issues.

Though the session was over, I apologized for having to go. I felt a shadow hanging over me–the connection between these children’s stories and those of the women who I described above. Is it already too late for these kids? Is their situation already too extreme? Was too much already missed and not prevented? And, is twenty the new forty?

But, I had to rush out to go pick up my own daughter. It was her birthday–my, seventeen came suddenly.

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

Broken My Plate

My Plate Haiku

Hunger tiptoes in

From bellies, hearts or minds

Feed me now she calls.

By Eva

some big feet to fit

Oct5

Yesterday, my first patient, Harry, was late and my second patient, Dan, was early. As I went out to the waiting room to call Dan, I saw Harry checking in with the receptionist. I had worked with him a few years back and remembered him well. He greeted me warmly and said he understood that he would have to wait. He assured me that this was not a problem.

This is a story about these two men. It probably should be two different stories. But, since the lines of their lives intersected on that morning, and since they share many commonalities–though Harry is black and Dan is white–merged, for now, they will be.

Harry and Dan are both 52-years-old. They are both over six feet tall and over three hundred pounds, though Dan dwarfs Harry in height and weight. They both are caring fathers. Harry has some older boys while Dan has an adorable non-biological three-year-old son he is raising. They are unemployed and poor, have had difficult lives and confront stress on a daily basis. They have diabetes and the usual laundry list of related issues. Impressively, and not commonly seen, they have both successfully and proudly quit 35 year-long cigarette addictions–Harry in the past two years, Dan about three months ago. You can see they were both once very handsome. Harry’s good looks are better preserved. Dan’s are more difficult to perceive due to his lack of teeth, long dirty stringy hair and enormous belly, but his pretty blue eyes and sculpted face tell me he once broke a few hearts. Oh, and they both like ginger ale.

I started working with Dan a few months ago. The loud-talking, heavy-walking, gentle giant stomped into my office in June feeling lousy. He had just been diagnosed with diabetes. He described to me a life marked by serious fatigue and inertia. He spent most of his day splayed on the couch watching television while keeping an eye on his preschool son. He started his day with coffee containing a mountain of sugar, drank iced tea throughout the afternoon and despite his lack of teeth, mainly ate an enormous dinner of starchy, fatty food which he said could probably feed five. At 380 pounds and smoking at least a pack a day, he could barely climb a flight of stairs. His ability to do the odd jobs he got paid for like mowing lawns and shoveling snow was becoming too difficult.

He presented with the common combination of desperation and despair but with a twinkle in his eye. I am always looking for some sign of the life force because making change necessitates pulling something out from the inside. Being illiterate and impoverished as Dan is, can profoundly dampen if not obliterate that inner will, but an eye twinkle is a good indicator that there is still fire within. Illiteracy and diabetes education are not a great combination but he has persevered and has made some amazing changes for someone who has only known mainly one path for half a century. He has literally and figuratively awakened recently and expresses his gratitude for the wake-up call. Though some of his work has been championed from my wonderful little office support team, he actually greatly surprised me by undertaking to quit smoking essentially from his own initiative.

At this week’s visit, he told me that his son just started a daycare program at a local YMCA. He and I had discussed his getting a Y membership which would now be great since he has to take his son there every day. He told me that he had tried to apply for a scholarship as I suggested, but that required bringing in some documentation and filling out some forms. Even as I handed him some free trial membership coupons I have for my clients, I knew that even this simple step requires filling out some paperwork at the other end.

At the end of our meeting, I brought him to the scale. I asked him to remove his old, worn-out heavy steel-toed boots that barely had a lace left between them. I weighed him and I weighed his boots at 4.2 pounds. Cumulatively, that is a lot of weight to drag around. Knowing the answer, I asked if he had sneakers.

With my steps already weary, I then walked back out to the waiting room to call Harry who I knew was waiting. I was still thinking about Dan–wondering how much a pair of good, supportive sneakers for his very large feet would cost. Being able to read and write and having some good sneakers sure would help this man to get moving.

I was abruptly brought back to the moment upon encountering Harry. There he was sitting at an empty table usually reserved for insurance representatives–about to dive into a take-out container of eggs, bacon, home fries, and toast. Though just last week I had to confiscate the bag of Swedish Fish a patient had brought into my office, in all my years I had never experienced catching anyone with a full-blown meal. “Where did you get that?” I asked in shock. “From the diner,” he replied. “How did you get it since I last saw you just a few minutes ago?” “I called them and they delivered it,” he explained somewhat surprised by my reaction and naiveté. “Am I busted?” he asked. No wonder he hadn’t minded earlier if I took my time. I dragged him and the breakfast into my office.

Harry actually has a lot more personal and community resources than Dan, but right now his blood sugar and health markers are much worse–and his situation had deteriorated since I had last worked with him a few years ago. I expressed my concern. He said that he had a lot of personal and family problems recently–though he was not making excuses. He lives alone and barely cooks at home. He is a personable guy and when I asked if there are a lot of local restaurants that know him by name–he confirmed my suspicion. Though he still has his teeth, he could soon not have working kidneys.

We looked at pictures from an old Parade Magazine about the comic Drew Carey’s diet and weight transformation. I told him the story of the film “May I Be Frank” that I discussed in Meditation v Medication. He put down the bacon and he told me he wanted his health.

I suppose I tell these tales to give a face and a fake name to the real people behind the current health crisis. Sometimes, I am hoping to inspire with stories of how people do overcome serious health and dietary challenges. Today though, I am wondering how to really help Harry and Dan a little more. I can assist Dan with the Y application and can call Literacy Volunteers of America; I will loan Harry my DVD copy of the film. But what would those who dream, think and act big do? Who should I call? Oprah, Shaquille O’Neal, Michelle Obama, Drew Carey, the Tom Shoes guy? What do NBA players do with their Nike’s and and1’s after they have worn them on the courts a few times? Is there a healthy food delivery service for patients left languishing while waiting in doctors’ and hospital waiting rooms?

If you have any ideas let me know. Besides, these guys deserve something. They have taken the biggest step to health by quitting smoking. I am thinking of lauding them by posting their photos in the Health Center. Maybe we could write them a Haiku? What do you think?

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 Posts: Meditation v. Medication; Inventive Incentive

Update 2020: The 2018 Farm Bill allotted $25 million dollars in funding to Produce Prescription Programs. These dollars have ferried in an increase in the number and types of programs designed to provide food as medicine. They are an extension of the pilot program I developed and managed beginning in 2012 at the Health Center where I worked and described in Inventive Incentive. These programs have evolved over time, becoming increasingly sophisticated, supported by additional dollars, research confirming savings in health care spending, and new technologies. Programs increasingly do include the provision of medically tailored meals for specific health conditions and home delivery. Harry certainly had the right idea, just the wrong food.

The Yellow Deli My Plate

My Plate Haiku

We serve the fruit of the Spirit

At the deli. Why not ask?

The Yellow Deli

be kind to animals

Sep28

It is Vegan Week in my anachronistic village. Almost a year ago, when I first began to dispense my little stories about food and eating, I was about to join with a few neighbors in adhering to a foodscape that did not include any animal products for one week. To celebrate this intention, we were to share dinners–with a different person hosting each evening.

Round Lake Village Auditorium

This idea had sprung from the fruitful minds of two of my neighbors–extraordinary women though just ordinary carnivores. One beautiful, sunny summer day, Carrie and Sharon had taken a day trip to the Culinary Institute of America, where it just so happened that in the bookstore, or perhaps more aptly, cookstore, of all things mind you, it was a vegan cookbook that caught their eye and nipped them in the tongue. The drive home stirred up their giddy excitement of deciding to live in the colorful, ingredient-rich world of the herbivore–for a week. They laid out the table and one night invited me–the vegetarian next door–over for a beautiful and delicious repast.

We all live within the confines of some dietary codex whether we are conscious of it or not and we get quite cozy there. My own vegetarian diet has certainly lost some of its philosophical punch throughout the decades that I have been living it and my food choices can be mundane. So, even though I have many days where my eating may be vegan, when the opportunity arose to be part of the spontaneously conceived next seasonal Vegan Week, I chose to participate.

Our little neighborhood group now has a few Vegan Weeks under our belts. We stroll leisurely over to each other’s homes, sit and relax, eat amazing food, discover nuances and ingredients that a truly vegan dietary requires, hear how badly someone is dreaming of a big, juicy burger and home we go–with no dishes to do. We once shared a vegan picnic at our local performing arts venue.

I realize that for the meat-eaters in the group, going vegan is a big and abrupt change–and they have all been really good egg-replacement-products about it. They have to plan all their meals differently, buy some special ingredients and do without that big chunk of flesh on their plate. By week’s end, they begin to feel the effects of the dietary change usually in a positive way. They seem to appreciate the change though admit that it is not easy.

However, even for me, for whom the omission and inclusion of these foods are not as extreme, the very act of dietary consciousness applied to each bite is profound. Ordinarily, one does not experience this, unless related to a religious ritual like Lent, Ramadan, keeping Kosher or fasting. Or, when going on a diet. Personally, this week brings up a lot for me to think about.

To begin with, it heightens my vegetarian consciousness. It makes me think about my relationship with the animal world as it relates to the procurement or processing of eggs, dairy, and even honey. How many big resources of the animal kingdom does it take to bring me the little gifts my vegetarian choices allow?

It then makes me wonder about choosing to eat for health, kindness, philosophy or sustainability; and the difference between feeding my mind, my taste buds or my body. Is there compatibility or dissonance between these concepts? Though I am a very happy plant-eater, I must see if my body feels it needs some of the energy provided by animal food; and, I have to decide if I am comfortable with some of the substitution processed foods sometimes used in a vegan diet.

Lastly, it makes me very mindful of the fact, that every day as a nutritionist, I am asking each and every client who sits before me, to make a commitment to some form of conscious dietary change–and usually, not just for a week, but possibly for the rest of their lives. As Vegan Week was approaching I was doing a lot of doubting. I’d had a lot going on lately and was not sure that I had it in me to pull up the resources I would need to get it together for hosting, extra cooking, special shopping–let alone the sacrifice and consciousness required. This made me appreciate that this is the same resistance that even just the thought of scheduling an appointment with a nutritionist raises.

Interestingly, last November, just after my first Vegan Week, Carrie and I went to see the film, May I Be Frank, about a guy from Brooklyn, whose life is changed when he accidentally steps into a raw food, vegan cafe called Cafe Gratitude in San Francisco. I wrote about this in Meditation v. Medication. A few months later, Carrie was in San Francisco. She ate at the restaurant, texted me a photo of her gorgeous meal and came home with a copy of the cafe’s beautiful cookbook, I Am Grateful.

As my resolve to do the week was weak, I curled up with my now own copy of the cookbook for some culinary inspiration–much like I had done with Mark Bittman’s How to Cook Everything Vegetarian and shared in So, What’s the Dilemma? The story of this film, the restaurant, the cookbook and the people behind it, Terces and Matthew Englehart is quite remarkable and I invite you to get a glimpse or a taste of what they present as a possibility for both eating and living. As the restaurant’s name suggests, gratitude is the foundation of their purpose. Each recipe is named with some affirming attribute like I am Ravishing, I am Whole, and I am Courageous.

Thus informed, I planned my menu which included the cafe’s I Am Giving Marinated Kale Salad and was on my way. I am glad to have the question of what am I grateful for placed before me right now. At this moment, I am grateful for all who share their stories with me and who are open to some dietary consciousness change; of incredible food and the creative people who know what to make with it; and, for my charming neighbors for choosing a culinary theme that includes and nourishes me on many levels.

Is there any particular diet or food change you would like to consider being conscious of making now? Would you like to know what we ate this week? What are you grateful for?

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 Resource: LIVEKINDLY

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

touched by the tempted temperament

Sep5

Last week, I wrote about The Tempted Temperament. Just days later, I had a related experience I just want to share.

A sweet, 8-year-old girl came to see me along with her mom. She was a beautiful child with long, dark black hair and piercing eyes that carried the wisdom of her ancients. She was rather quiet. And, yes. She was overweight and has already endured bullying by other children.

Healthy Eating Art

The mom, a tall, slender woman told me part of her child’s story. They have just returned back in the area after living for a year near San Antonio, Texas. I did not get a lot of the family’s history during this consult, partly due to the fact that not all can be disclosed in front of a child, but it was not difficult to glean that there were problems.

I learned that this child is the youngest of four children. Her oldest sister who is nineteen has a more full-bodied figure. The mom, is a loving parent and provides generally well-prepared foods and has nicely established boundaries on fast food and the watching of television. The child has no health problems. I did not, as I would write in my progress note, assess any significant dietary indiscretions.

The mom’s concern is that her daughter is not inclined to want to go out and play much and resists her mom’s offers to go exercise with her. They live in a cramped house in a difficult neighborhood.

This is not an environment for the outdoor spontaneous combustion of calories that should be the birthright of all our children. I learned that the girl enjoys eating and adores musicals, swimming and doing artwork. I knew I was in the company of a pleasant phlegmatic.

Together we discussed community resources, walking to school, school lunches and simple options for play. We addressed the preservation of her self-esteem which her mom already had a good handle on. I then looked into the deep eyes of this dear girl, deciding what to offer her that would be respectful of who she is. As always, and as I hope I am conveying in my stories, there is a deep responsibility in this task of balancing the societal scales, to honor the individual and the circumstances of their lives. And, I usually only have a few minutes to do so.

I glanced around the meager library, medicine cabinet and market basket that metaphorically describes my office. Though I wished I had something richer, I handed her a calendar book that comes with two types of stickers. One sticker is of a fun pair of sneakers, the other of a fork, knife, and spoon in a happy face kind of configuration. It’s designed to encourage a child to keep note of their healthy choices, hopefully in a fun way. Kids generally like it because they tend to love stickers.

The child’s face lit up. After having been rather reserved throughout the meeting, she perked up and said, “I know what I can do with this.” I asked her what that was. She replied, that instead of using the stickers if she ate healthy food or played something, she would draw a picture of that instead. I breathed a sigh of relief. The world will be a more beautiful place graced by the gifts of this young artist.

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.

Also, big news this week. I am now on Twitter at http://www.twitter.com/lifeseedsnutrit. You can follow my little bird there and share my stories.

In health, Elyn

My Plate Haiku

Peach baskets brimming

Raspberries ripe on the bush

Apples soon to come.

by Crystal

the tempted temperament

Sep1

The Adorable Four Temperaments Image via Wikipedia

Chances are you know a child like Sam. Sam, was a classmate of my daughter since kindergarten and I have watched him grow up. He is a sweet-natured kid. When he was young he was a really big boy with hands like mitts. His eyes used to almost pop out of his head with excitement when food was presented. Once, when my husband brought brownies to my daughter’s class in celebration of her birthday, Sam sized him up quickly and befriended him immediately. While waiting, he sidled up to my husband and whispered, “We better eat those brownies soon before they go raw.” The well-being of those brownies was of his utmost concern.

We know that there are two types of people–those who live to eat and those who eat to live. This attribute in individuals is one of those things we seem to just be born with. It is not necessarily defined by genetics or the environment. It is not inherently good or bad.

Amidst the fray about childhood obesity, there is an urgent need to uncover the causes and to implement solutions. External factors such as fast food, school lunches, excessive TV and computer use are the usual culprits, and of course, they are a part of the problem. However, missing from the dialogue is any mention of children’s natural dispositions. Though the external forces must be addressed, in overlooking or disregarding the nature of the individual child and the powerful relationship with the act and art of eating, we lose an opportunity to be sensitive to children with particular natures. Considering this piece may reveal some approaches to care and serve to remove the element of blame or human weakness from the child, as well as the parent.

Hippocrates and the ancient Greeks spoke of the four temperaments. The temperaments described different formative forces that human beings possess that give rise to different soul types. The model of the temperaments as a tool for understanding human nature was popular until the end of the Elizabethan Age. It has been the inspiration for many artistic endeavors and in the 1920s, philosopher Rudolf Steiner integrated it into his work on childhood development where today it remains an active piece of the Waldorf School Movement, which he developed.

The four defined temperaments are choleric, sanguine, melancholic and phlegmatic. In brief, they can be defined as such: the choleric is strong-willed; the sanguine is light, wispy and perhaps flighty with many curiosities; the melancholic is sensitive, suffering, and self-conscious; and the phlegmatic is dreamy and slow in movement. The characters that inhabit A.A. Milne’s Hundred Acre Wood can serve as archetypes of the different temperaments. Tigger is choleric; Piglet is sanguine; Eeyore is melancholic; while Pooh is quintessentially phlegmatic.

In young children, one can easily see distinct aspects of the temperaments and a predominant constitution–though most healthy kids do exhibit some sanguine tendencies. The temperaments can manifest in all aspects of our beings. When it comes to a deeply passionate relationship with food, it is here that Sam and the phlegmatics reign. They live to eat, and accordingly, tend to have soft, round bodies and are most prone to becoming overweight. Remember Pooh’s sheer love of honey and how that devotion caused him to become stuck in the doorway of Rabbit’s house. Dear Pooh.

As most parents can attest, children’s natures become evident almost from birth. In the early years, one can often tell the phlegmatic children by body type along with behaviors. Phlegmatic infants are most likely roly-poly and slow and steady feeders. They are happy to lie in the crib cooing, playing with their hands and feet. With the introduction of solid food, they euphorically greet the oncoming spoon and are not easily distracted from eating. Phlegmatic children may take to walking and talking later than their peers and are generally easy-going.

With the attainment of verbal skills, these children frequently say “I’m hungry.” Though most healthy young children are often hungry due to high growth demands, the phlegmatic’s request for food seems to come less from actual physical hunger and more from a desire to be eating and digesting. This seemingly constant refrain of “I’m hungry” becomes one of the greatest challenges to the parents of a phlegmatic child, especially if the parents do not share that temperamental tendency themselves.

How does one respond to this repetitive declaration of hunger and cry for food? How does a parent distinguish between true physical hunger and emotional or digestive hunger? Does non-physical hunger lack validity and deserve to be ignored or denied? How many times can a mother just look her cherubic child in the face and say no? Phlegmatic children are quite endearing and can easily work their way into our hearts in Pooh-like fashion. Over restriction or overindulgence in feeding are both understandable reactions.

In being sensitive to the innate natures of our children at an early stage, we can adopt some feeding practices to better assist them in a healthy unfolding to adulthood. Phlegmatic children can be best served by being mindful of their enjoyment of eating but by providing them satisfaction with foods that are as healthy and naturally sweetened as possible. If no serious emotional issues seem present, then the parent sees to the careful provision of a varied diet at scheduled times and the child sees to their appetite. As the child gets older, helping them to find interests and activities, including physical pursuits that fit their temperament is important. If extreme weight issues can be avoided, the growing child will not be distracted by these matters and can then focus on the development of his or her natural abilities.

It is tempting to believe that we will one day whip all the children into proper shape by successful programming. It is also a commonly held belief that the overweight child is destined to a life of obesity. However, there may be more to be gained and less damage to be done from working with our children’s tendencies than fighting against them. I have observed many round kids morph into lean adolescents through a combination of factors including their genetic blueprint, hormonal changes and their own conscious ability to choose how to feed themselves. Sam is now sixteen. He is a high-level competitive rower. I think he might now be described as highly buff. He recently told me, that once he discovered what he was interested in he found a way of eating that served his purpose.

The gifts of the phlegmatics are many. They are compassionate, serene, steady individuals capable of faithful and abiding love. They often possess natural musical and artistic abilities, and in the final analysis are the true geniuses–the slow, steady and thoughtful thinkers of our times. By viewing such children through this more compassionate lens we can tend to their care more appropriately and be inspired to feed them well with good intentions.

Were you a Tigger or a Pooh?

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

Avocado’s My Plate Plate

My Plate Haiku

Pick your own today

Happy kids in wide-brimmed hats

Sweet summertime fruit.

by Anna

lose 14 pounds in three years

Aug24

It is always a blessed day when one is seeing Miss Henry. Miss Henry usually comes to see me early in the morning, so she is often already in the waiting room when I arrive at work. Sometimes, she is sitting alone with a book, but more commonly, she is engaged with someone nearby who she may or may not know. Many people in the community know Miss Henry. For those who don’t, it will only be a matter of time until they do.

Miss Henry should be staying at home writing her fascinating life story, but it is hard to keep that woman in one place. For someone reliant on a walker due to a very bad knee and whose abdominal girth way exceeds her height, you might imagine that getting around would be difficult. However, when one has many kind words to say and good deeds to do, staying at home is not an option.

I have been working with Miss Henry for three years and she has lost fourteen pounds. That is about 4.6 pounds per year or .09 lbs per week! I am very proud of her and she is tickled pink too. I know what you are thinking–these are not very impressive results and that this is not headline-making news. Pounding down the pounds are the hallmarks of success in this business and the goal of effective nutritional counseling.

However, if you sat where I sit every day, you might see a different picture. When we focus only on the numbers we miss a lot of important subtleties and positive changes that occur in the process of optimizing our health. To ignore these is a serious disservice to both the individual and the model of care.

Miss Henry is 65-years-old. She was born and raised in the south as one of ten children and has raised children and grandchildren of her own. She has been responsible for the care and feeding of more people than most of us can even fathom. She still babysits, walks someone’s dog, tends to her partner, serves her church, cooks for others and takes a bus a few times a week to go visit her 91-year-old mother. She is black, and also Cherokee, Irish, and Jewish. Besides the bum knee, she has high blood pressure; and she has survived breast cancer. When I first met her she weighed about 300 pounds and used her shopping cart as a walker.

Through the time I have spent with her, she could have easily given up, and I could have too. Just for the record, in case you haven’t noticed, weight loss does not happen or sustain itself easily for most people–and some circumstances make it extremely difficult. It takes a lot of momentum and the attainment of a certain critical mass to move mountains so to speak, no matter what someone’s size.

Miss Henry knows food. She loves cooking it, sharing it, and shopping for it. For someone without a car, she always amazes me how she gets around for the best deals. Three supermarkets, Walmart, the Asian market, and the food coop are all within her domain. Oh, and she loves talking about it. For three years we have talked a lot about food. Even if I have not seen her for months, she will come in and tell me what she made for dinner yesterday or what she is planning for the next day. We have discussed eating more of some things, less of others and ways to support cleansing and elimination.

Miss Henry has had much to consider over the course of these three years including why she chose to overeat for much of her life. She has come to realize that she can care for herself as she has always cared for others. She asked for some support from her spiritual community, began to see the possibility of herself in a smaller body, focused on a red dress she so wished to fit into–and she watched Dr. Oz. Again and again, she slipped back into eating habits that she had hoped were behind her. Eventually, her excuses for overeating and her hunger began to decrease. She is now choosing to eat mainly vegetables two days of the week. Most powerful for me to observe was when she decided she no longer needed to say yes every time someone asked her to cook for a family, church or holiday event.

At first, she began walking the hallway outside her apartment and then joined an exercise program offered in her building. She started using some step machine that she had, and soon she was walking all over the city. Her frequent aches and pains began to lessen, her body became less puffy, her fat stores began to shift making her clothes fit more loosely, her blood pressure decreased and amazingly she began to rely on her walker less and less. If I had not been inquiring about these changes, and if we had not honored these transformations, the stubborn scale would have proved too discouraging.

When Ms. Henry next sees her doctor, the slightly lower number of pounds will hopefully give some modest proof of her efforts. However, for me, the important measurement that is often overlooked is how someone feels physically and mentally. I find that encouraging healthy practices is more beneficial than focusing on weight loss. Though by no means the biggest loser, this week, as Ms. Henry fit more comfortably in the chair in my office, she joyfully described just feeling lighter and having more energy. She is still the same beautiful and amazing woman but her face is glowing a little brighter.

Miss Henry always ends our visits with two exhortations. She says, Miss Elyn, whatever you do, don’t get fat. And, Miss Elyn, you have a blessed week. Bless you, too, Miss Henry.

How fine do you think the line is between health and weight?

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 Haiku

Hearts are not

Just reserved for romance

Every living thing is in love. by Kat

the amazing mr. s.

Aug21

heirloom tomatoes at slow food nation’s garden

I had a visit this week from my friend, Mr. S.

I first met Mr. S. three years ago, when he was 85-years-old. So, he is now 88. Like clockwork, he comes to see me every six months, as close to the exact date as possible. He gets signed onto my schedule as a patient, comes to my office and sits in the chair, and hands me his glucometer to show me his blood sugar readings–which are always normal. That is about as far as I can fairly say his patient status extends. For the rest of our encounter, he serves in the role of my inspiration.

Mr. S. is a lifetime military man who served in three wars. Yes, three wars. He was born before the Great Depression. He has had colon cancer, some heart irregularities, and a touch of diabetes. He has a handful of doctors he sees religiously. He is by all usual accounting, old. But, when I go out to the waiting room to call him, he is always sitting there in a nicely pressed, often comical T-shirt, stylin’ sneakers and with his MP3 headphones in his ears. He is muscular and fit and he truly looks like a kid. He still works part-time, walks almost everywhere, and has a profoundly full and secure memory bank.

Six months ago, when I last saw him, his appointment was on a day we had a really big snowstorm. Instead of driving to work, I took the commuter bus. I had to trudge, in Dr. Zhivago-like fashion, down streets that plows and shovels could not yet tend to and that cars and buses could not negotiate. I came in the back door of the building, frosted with ice and quite bedraggled. As I turned on my computer, I realized Mr. S. was there waiting for me. Apologetically, and still dripping and bothered, I went to receive him. There he was–serene and bone dry, as if he had come in from an alternate climate and mindset zone–like Key West.

Though he is the consummate gentleman, and will not let me hold the door for him, he hails me by my last name, as if we are old war buddies. Each visit plays out essentially the same. He bemoans the physical impairment he witnesses around him due to collective ill-health, he is shocked by the corpulence of young people and he is disturbed by how poorly most are eating. He always asks me if I know who invented those little motorized scooters that assist those who are mobility impaired. He considers them a serious hindrance to most who rely on them. I reply that I don’t know.

He maintains that most folks hear, but they refuse to listen. Whereas I tend to see the current health crisis as being due to a combination of societal failures, he is mainly about personal responsibility. He god blesses me frequently, confounded that I have the patience to do what I do–repeatedly trying to knock sense into people, as he says. He is a philosopher and a sage, and though I do infer that he has a few skeletons in his own closet, he awakes each day committed to being the best that he can be.

He buys good old regular food, he cooks it and he enjoys it. We chat about what he has recently prepared. Beans and veggies are usually in the mix and he loves fresh local tomatoes. I have on three different occasions had Mr. S. accompany me to little talks I have given, as my daily quest is to try to inspire health. When I introduce him, I ask the audience to guess how old he is. The oldest guess so far has been 71. When we reveal his true age, the crowd goes crazy.

Now, it could be said that Mr. S. has just been blessed by a good set of genes or that he is just lucky. He has had not only one, but three big opportunities to have been blown to pieces and yet, here he is, still intact both mentally and physically. He obviously has some good collection of the factors that we seem to understand as longevity promoting.

However, before our sessions come to an end, he always reminds me of one more thing. Mr. S. has a Mrs. S. She is frail with some dementia. Above all else, he says, it is his job to be healthy in order that he may take care of her. If he wasn’t able to be there for her, who would?

Although I have heard it before, I am always a sucker for this part of the story. It seems that we are not wired fully for self-preservation as self-destructive behaviors are too easily inclined. This is especially true for men who don’t seem to take as good care of themselves as women do. What Mr. S. understands is that love is a necessary ingredient in the big gestalt of health.

He is also not too far off in his perception that my work entails a high degree of trying to knock sense into people. However, rather than using a sledgehammer approach, I too try to offer and prescribe as high a dose of Vitamin L(ove) as I can. Perhaps, it is really all we need.

Do you have a Mr. S. who inspires your life?

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 Plate

My Plate Haiku

Love is a deeper season

Than reason

My sweet one. by e.e. (cummings)

Update February 4, 2013: Two weeks ago, Mr. S came to see me. He is still ticking and kicking butt. Today he celebrates his 90th birthday. We discussed vegetable juicing. He was about to purchase a juicer–actually two, one for him and one for his daughter. The rest of the story is still the same.

skinny boys

Aug12

Skinny boys. Now there is a group that could use some love. Skinny boys usually, though not always, start out as skinny little kids and stay that way into their teens and young adulthood. You see them everywhere. In spite of this obesity epidemic, these poor boys far outnumber the fat kids everyone is clamoring about, but still, they get no attention.

It was not too long ago that skinny boys had their pants buckled up under their armpits for the protection of their private parts or they were required to wear corny suspenders. Nowadays, it is quite common for their pants to fall below the level of their BVDs even with the use of securing devices like belts and drawstrings–so they are often walking around with their undies showing. How embarrassing. If they do have a belt, they have to force a homemade hole into the leather or hemp, whatever, and the non-buckle end goes wrapping around them like a snake, in order to fit.

Then, their ribs stick out something terrible. Even nicely developed abdominal six-packs cannot cover up those ribs. Ouch. It must be hard for them to sleep–their bones jabbing into even soft forgiving mattresses. When they walk down the street, even strangers like Italian and Jewish grandmothers, are apt to want to take them home and feed them. What is up? Are their parents not feeding them?

Despite these emotional and physical challenges, there are no programs, whatsoever, designed to help them. There is no foundation for the Prevention of Adolescent Scrawniness, nor a Let”s Chill! initiative coming from the White House. Teachers, mothers, and fathers everywhere need assistance in just getting these kids to sit still. Instead, they are flying off concrete ramps on skateboards, incessantly shooting basketballs, playing guitars and drums with manic enthusiasm, and turning everyday household items into objects d’sport. TVs, video games and writing angst-ridden poetry are the only way to get these kids to stay in one place for any decent amount of time.

One might assume that these skinny boys, when they do eat, are eating carrot sticks and turkey rolled in lettuce leaves. How else could they be so skinny? But, what’s that? They are eating sugar and junk food just like those fat kids? How can that be?

A few months ago, I saw two teen-aged skinny boys walking. One of them carried a two-liter bottle of Mountain Dew, the other a big box of Cap’n Crunch cereal. I say carried, but it was more like they were cradling these products like a young child might cuddle their favorite stuffed animal. As there had been rumors circulating wildly that the Cap’n might be retiring from the high seas as well as from supermarket shelves, their procured box might have generated even additional testosterone excitement and the desperate attachment for the two.

And, just the other day, as I was doing my usual investigative journalism in the local supermarket, I came upon two young, lanky, twenty-somethings crouched down in the cereal aisle, doing some serious nutrition label and ingredient reading. I was touched. After serious deliberation, they stood up and strode confidently away–a box of Frosted Flakes in hand.

Liquid, syrupy, intense, colored sugar, seems to be the lifeblood of skinny boys as coffee is to adults. As many rational grown-ups swear that they cannot survive without their daily Joe, keeping the skinny boys from their sugar would be akin to blood-letting. How else would they thrive? With their powerful internal engines burning high and hot enough to power a jet plane, what else could better serve as jet fuel?

So, that is where skinny boys are at a serious disadvantage in this whole weight war. We direct a societal finger-wagging at fat kids and their parents, preaching of the pain and woe that awaits them should they continue their wanton eating behaviors–but no one has given these skinny kids even a glimpse of what could just as easily be in store for them–that even their propelled metabolisms could be headed for a serious nosedive.

Because, when those adolescent male hormones finally begin to mellow out, even the best of the metabolically privileged, can find themselves in trouble. Tushies sink deeper into the couch in front of the TV, remote glued to hand; the zillion hours of organized sport become a thing of the past once that diploma is received and such play at best becomes an occasional weekend past time; all the pints of beer downed in solidarity or solitude accumulate in the expanding bladder of the belly and a gut begins to cover those once nicely sculpted abs; and the stress and worry of the real world turn acquired food from active fuel into evil, disease-producing stored fat. Excessive sugar intake is detrimental to everyone, and, I have never seen Mt. Dew, do a body good. A pair of true skinny genes or a life pursuit that includes significant physical activity or hard labor are required to stave off the accumulation of pounds in this current climate.

Whereas only 12.7 percent of 15-24-year-old males are obese as defined by Body Mass Index, (BMI), 22.2 percent of 25-34-year-olds fit that classification. That could be a pretty big shock for the unsuspecting ten percent who suddenly find themselves in the holes at the other end of their belts. Their husky elementary school classmates, once the brunt of jokes, have been way better prepared for their impending corpulence and may, in fact, get the last laugh.

Essentially, we need to provide all our children with the template of the basics of a healthy lifestyle and to have a society that ensures fundamental support so they can take better care of themselves throughout their lives.

So be kind to the thinnest amongst us. They have a hard road ahead of them. Chances are, you were once a skinny boy too. The next time you see a skinny boy, hold the judgment, give them a big hug and a prayer for a healthy life–but remember to be gentle, for they are pretty fragile creatures.

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 Haiku

Smooth peanut butter

Spread on a peeled banana

Snack time perfection. by Gretchen

the nutritionist's dilemma

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

attacking the causes of obesity, really?

yesterday

some big feet to fit

be kind to animals

how can you say no to a brownie?

touched by the tempted temperament

the tempted temperament

lose 14 pounds in three years

the amazing mr. s.

skinny boys