FatGirl vs World

A few years ago I went to a new internist for my first physical in a very long time.  After the nurse did all the measurements and blood draw (I'm still not good with needles) the doctor walked in while reading my chart, looked at me and said, "So....you know you're fat?"  I'm not sure how much I weighed at that physical, but those words echoed in my head.  She didn't say "overweight' or "obese" (which technically I was).  Just fat.  As in "you don't need a doctor to tell you this."

I go back to her next week for a physical.  However, today I had two appointments -- one to look at my knee (I get weird pains in it -- I just wanted to make sure it was mechanical (because of my back and the way I compensate for the pain) versus physical).  The x-ray looked fine--my patella is shifted a little medially (towards the mid-line of my body) but nothing too bad.

My second appointment was for the lady parts.  Now here's where things get exciting -- my nurse practitioner that I've been seeing for years walks in and she says.  "Oh. My. God.  Almost 17lbs? Go you!"  In other words, since my physical last year, I've lost 16.7lbs.  We talked about what I've been doing (the GoWear Fit, the nutritionist, etc.) and the implications it might have on my ovarian issues (the dysmenorrhea). 

I'm so excited to go to my yearly physical next week and have my internist see the weight loss.  I'm really really excited.  It seems so real when a doctor says "hey, good job... you're taking good care of yourself."

((however, my taking care of myself today might just be getting back into bed -- i picked up a chest cold on tuesday/wednesday and have been coughing up some yellowish-green gunk.  my body aches all over.  So while I haven't walked much/burned many calories today, my body is telling me to take a break and get well first.  It's okay.  I burned lots of calories yesterday...))

Friend and fellow blogger, Crystal, asked me a few questions about the BodyMedia Fit.  I think the discussion is something that everyone could benefit from, so I'm going to make it a stand-alone post (as well as my first discussion of the device and my discussion of dieting in general).  Feel free to ask more questions.

How are you liking it?
I absolutely love it! It's part of my wardrobe now. I feel like I've forgotten something if I forget to put it on.

Is the arm band comfortable to wear?
Yes.  There are 3 sizes of armbands, so you don't have to worry about it being too big or too small.  It is secured with Velcro.

Does it stay put?
For the most part, yes.  The only time I really have trouble with it sliding down my arm is when I'm Wii Boxing.  But all I do is tighten it a little bit while i'm doing that particular exercise, and then loosen it for normal use.

Do you wear it all the time?
They recommend you wear it for 23 hours a day.  Also you shouldn't submerge it in water.  So I don't wear it when i'm in the shower, or when I'm swimming.  With the BodyMedia site, you can estimate activities done while the unit is not on your arm (yep, including shower and swimming).

Are you finding it helpful for staying on track and accountable?
The bottom line is that it cannot do the work for me, but it does make me more mindful of where I'm at (especially because I purchased the display unit.  The armband can work as a standalone, but with the display unit, I have to-the-minute information about how many steps I've taken and how many calories I've burned.  Oh, and it also has the time.)  It helps remind me that I have good days and bad, but it's the trend that I'm concerned about.  I can print out reports and see these trends and correllate them to how my body felt that day, when my period was, or even the weather.

When I notice I haven't burned enough calories or walked enough, I might scale back the portions of what I'm eating.  I might put down the cheese and pick up my sneakers.  It reminds me that this isn't guess work.  It's plain and simple.

Do you use the subscription program it talked about?
I do use the BodyMedia.com Activity Manager.  The first three months are free with purchase of the armband.  After that, the longer you subscribe the less it costs per month.  I have a 12-month subscription and it's a little under $7 a month.  That's some people's coffee for a day.

You upload the information to the armband to the site and then add in your nutrition information (food journal).  I hear they're working on a phone application to help people keep track.  Many foods are already listed in there, but some are not.  If it's something you eat on a regular basis, you can add foods and recipes.

Do you have to?
Yeah, sorry about that. 

Are you finding it to be helpful?
Yes! I love data.  It gives me lots of information about myself (such as my sleep patterns) and my choices.  I've even set it up to remind me to get up from my desk and walk around (at 1 pm). 

My dietitian uses it as part of her initial assessment into food and behavior.

I was going to suggest, maybe there's a way you can buy a used one, or if a nutritionist/gym allows you to rent one for a month or two...

I really want to get to 100 followers...

As an incentive, I'll put it to you all this way:  when I reach 100 followers (42 more!), I will post a mini-interview with Registered Dietitian, Rebecca Scritchfield that was done specifically for this blog!  Not only is she my dietitian, but she was also recognized by the American Dietetic Association as 2009's Young Dietitian of the Year.  Pretty cool, right?  She's an amazing resource, a wealth of information (always posting great articles like this one), and one of my biggest supporters (she's been there and done that).

Until I reach 100, you just get the questions (her answers are fantastic, btw)!

Question 1:  Who should see a nutritionist/ can you break down your patients into a few categories?

Question 2:  What insights might a nutritionist have that the average GP/internist might not?

Question 3:  How does your own weight loss struggle inform your practice as a nutritionist?

Question 4:  Do you have a few quick & easy changes people can make to improve their diets?

Question 5:  If someone isn't meeting their caloric targets, what's usually the suspect? How should they meet their target in a healthy way?


Thanks to all who share my blog!  I'm really excited to not only reach one of my goals, but by doing so help you reach your goals!  To all my new followers, welcome to my blog and I can't wait to have some fun!

My life began to change when I moved out on my own-- away from a family that didn't know how to be healthy, and away from a university with fast food in its food court (as well as ridiculous portion sizes).  The biggest change was living with my now friend Katie.  I originally met her when I was listing a room in my apartment to be rented.  She responded and we instantly hit it off (mainly because my cat really liked her). But I didn't realize how much she would change my life until we began to cook together, and she taught me one of the biggest lessons I can ever impress upon anyone:  Beans!

Okay, it wasn't just about beans, it was about so much more than that.  Before Katie, the only beans I had ever eaten were Campbell's Pork & Beans (my mom would add maple syrup, butter, marshmallows, onions, bacon, or pineapple depending on her mood).  With Katie, I learned the simplicity of a bean.  The garbanzo, the kidney bean, and even non-bean ingredients such as lentils. The lesson was more than the bean, it was about exploring food, honoring ingredients and honoring the body I was putting the food in. Before Katie, I had never eaten Indian or Thai cuisines, and now I'm infatuated with them.

Stephen Sondheim wrote in Into the Woods "The difference between a cow and a bean is a bean can begin an adventure."   And in my case that was so true.

Over the years I've become more comfortable with trying foods that I had never tried before (just think, I was 17 before ever having a non-maraschino cherry, and I didn't even know what it was). I'm also more confident that the food I create from scratch is much healthier than something that has been pre-packaged.  I even started venturing out to farmer's markets on a regular basis to see what they had (among my discoveries, I love buffalo meat, eggs from chickens that live as chickens should, unhomogenized milk, mache, etc and so on.

Recently, one author has really summed up much of what I feel about food -- and that's Michael Pollan.   He's not a doctor or a nutritionist but a journalist.  In his books ( The Omnivore's Dilemma, In Defense of Food: An Eater’s Manifesto, Food Rules, for example) he often reiterates the same points (so while I love his message, it's not necessary to read everything he's written unless you want to know the back story behind everything). On the cover of "In Defense of Food," he sums it up all very nicely in 7 words:  "Eat food. Not too much. Mostly plants."  The largest part his books have been about describing what he means by "food."  He began his journey, I believe, with the premise that "food" isn't as intuitive as it used to be because of the industrialization of food and the distance each person has from the origins of the food they eat.  In Food Rules, he explains to the reader what he considers to be food.   Here's the Reader's Digest version: 

1. Don't eat anything your great grandmother wouldn't recognize as food. "When you pick up that box of portable yogurt tubes, or eat something with 15 ingredients you can't pronounce, ask yourself, "What are those things doing there?" Pollan says.
2. Don’t eat anything with more than five ingredients, or ingredients you can't pronounce.
3. Stay out of the middle of the supermarket; shop on the perimeter of the store. Real food tends to be on the outer edge of the store near the loading docks, where it can be replaced with fresh foods when it goes bad.
4.  Don't eat anything that won't eventually rot. "There are exceptions -- honey -- but as a rule, things like Twinkies that never go bad aren't food," Pollan says.
5. It is not just what you eat but how you eat. "Always leave the table a little hungry," Pollan says. "Many cultures have rules that you stop eating before you are full. In Japan, they say eat until you are four-fifths full. Islamic culture has a similar rule, and in German culture they say, 'Tie off the sack before it's full.'"
6. Families traditionally ate together, around a table and not a TV, at regular meal times. It's a good tradition. Enjoy meals with the people you love. "Remember when eating between meals felt wrong?" Pollan asks.
7. Don't buy food where you buy your gasoline. In the U.S., 20% of food is eaten in the car.

Not bad, eh?


I firmly believe that the key to success when it comes to either losing weight or gaining health (they sometimes go hand-in-hand) is by eating actual food -- and tuning out what the Food Industry has to say about what you have to eat.  Yes, there are guilty pleasures that we all succumb to (cheetos!), but the reason why they're a guilty pleasure is that despite wanting something we know what's better.  We know what is better and yet the Food Industry has a louder voice.  Why is this so? 


What if we lived in a world where we walked into a grocery store or food market and 90% of the food there was truly good for us, and only 10% were the guilty pleasures.  What if those guilty pleasures cost three or four times the cost of the good things for us? 


Seriously, read this (and the numbers are marginally increasing, not decreasing--and I think the reason for the numbers not increasing at such a great rate is because the number of obesity-related deaths have increased):  


Among Americans age 20 and older, 145.0 million are overweight or obese (BMI of 25.0
kg/m2 and higher):
⎯ 76.9 million men. 
⎯ 68.1 million women.
Of these, 74.1 million are obese (BMI of 30.0 kg/m2 and higher):
⎯ 34.7 million men. 
⎯ 39.4 million women.  

(NHANES [2003-2006], NCHS and NHLBI.)
Also good info: http://www.cdc.gov/obesity/index.html

Seems to me that the Food Industry, despite all their claims, are part of the problem, not the cure. 

Yay! Landmark post!


And very little of it will be my own content.
There was a Women's Health article a few months ago ("Slim Body, Fat Wallet") that I just re-read and I wanted to share some of it with you. 

His [James Prochaska, Ph.D.] fundamental belief is that the big reason so many people relapse on their New Year's resolutions by (you guessed it!) February, is that they didn't do enough to prepare themselves to take on those shifts. "Change is a process," he says, "not an event. And 80 percent of people aren't prepared when they start." 

So how do you lay the groundwork? Getting ready involves moving consciously through several stages. In what Prochaska calls the "precontemplation" stage, change is just nibbling at your mind, and your job is to raise your awareness of the benefits of changing. That might mean thinking about the cool vacation you could save for when you no longer have those big credit-card bills to contend with, or the thrill of fitting back into your favorite skinny jeans.

Then comes the next stage, "contemplation," when you are seriously thinking about making a change. When you're at this stage, it helps to focus on how the pros of taking some kind of action outweigh the cons. Sure, you might miss your morning full-fat latte and your Friday-night pizza outings, but seeing the pounds melt off is so much more gratifying. "People who can't see a good balance of pros over cons are likely to give up and say it's not worth it," Prochaska points out. When you can list twice as many pros as cons, you're good to go!

I think this is a worthy exercise and something I'm going to endeavor to do -- to see more pros than cons.  I'm generally a positive, upbeat kind of person, but I think this will help me put my head in the right place.

The article ends with this:

Remember: Change is a process, not an event, as Prochaska says. It takes time, and you're likely to hit the occasional setback or bad day. When (not if, but when) that happens, take a deep breath and remember that these are changes you want to make for the long-term. If on a particular day you find you don't have enough willpower to attack both challenges, look at it as a sort of muscle fatigue and ease up. Count calories today. Stick to your budget tomorrow. And over time, you'll build up enough strength to reach both goals.

Now, I don't get many magazines, as I don't like being wasteful and/or becoming a magazine collector and I don't think that they're always putting good information out there.  But this made me wonder if all my failures in the past to stick to change have been because I had no idea what I wanted the end result to be, or what I wanted my lifestyle to resemble.

With that, the sun just came out and it's time to get my ass in gear!  What to do today... what to do...

[[Edit:  my nutritionist posted this link.  20 Worst Drinks in America 2010]]

In celebration of my 100th follower (the lovely Frannie Dee), my wonderful dietician Rebecca Scritchfield has agreed to answer five question that hopefully will help you on your journey to becoming a healthier you!  She's helped me identify areas where I need to be more mindful and can improve.  I've lost 13 lbs since first meeting her!

So a hearty thanks to her on a personal level, but also for answering the questions below for all of my blog followers.  First, get to know a little about Rebecca!

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First, let me explain something about nutritionists. Technically, anyone can hang up a sign and call themselves a nutritionist because it is not a real health professional term. This is important because there are for-profit companies that offer weekend and online courses in nutrition and provide a "certification," but it's not actually anything that let's people legally provide nutrition services in Washington, DCt and many states.

I think anyone can benefit from a visit with a nutrition expert. Look for a registered dietitian (RD). These are health professionals who have completed the minimum criteria of graduating with a 4-year degree from an accredited college or university, an accredited dietetic internship, and passed national board examinations.

I specialize in healthy weight management and sports nutrition. I help people fuel with good food to meet their lifestyle needs whether they get 2 hours of exercise a week or 20.

[Rebecca has 3 main areas in her practice:  sports nutrition; weight management; and medical nutrition therapy.]

First off, how many people actually see a general practitioner once a year? Most doctors will weigh their patients, but they fall short of talking to them about their weight, nutrition habits, and exercise schedule. In fact, a March 2010 survey of physicians showed that 72% of doctors said that nobody in their office is trained on dealing with weight management problems.

Enter the nutrition expert. That's our expertise. We have a nutrition care process for accurately assessing and diagnosing nutrition problems and working with clients on a plan for making behavior changes. We're also on top of the latest scientific evidence and research on weight management and we follow trends in the culinary and food industry worlds as well.

I've been on and off diets since I was 12 years old and if there's one thing I learned it's that they are a total waste of time and energy. In fact, UCLA research has even shown that people who diet are worse off than people who don't.  They gain all the weight back -- and more! I don't diet anymore and I don't let my clients diet either. We talk a lot about healthy nutrition, hunger/fullness, and emotional eating. We also talk about exercise and stress management. It's much harder to commit to exploring the barriers to achieving a healthy weight, but the rewards are worth it.

"Quick and easy" depends on the person's perspective. For example, I can say "don't drink your calories, switch from soda to water or calorie free beverages", but some people may find that to be a hard change. Maybe they could try to cut their beverage calories in half to start.

The best thing I can suggest to everyone is don't do anything you can't keep up the rest of your life. That's why I tell people to pick a "small change" and commit to one week or even one day of trying it out. You may decide to eat two fresh fruits a day as a small change. After the first week, you're willing to try it again... and again... and before you know it, it's your behavior.

The second best thing I can suggest is eating 3-4 times a day and moderate portions. Many people eat only twice a day and it's just not possible to get the vitamins, minerals, fiber, and balance of nutrients in only 2 meals a day. They might meet your calorie needs, but it is not just calories that determine your health.

When I do a nutrition assessment, I analyze their current usual eating habits and compare that to their estimated needs. I'll figure out the differences between where they are and where they should be to reach their goals. Calories are definitely involved, but I really try to make sure we're not spending our time in sessions talking "numbers" because it is behaviors that matter.

If someone is under their calorie needs it could be a lack of knowledge  -- people want to eat healthy, but they are being too restrictive. They're undereating and won't lose weight because the body is resistant. It could also be an eating disorder, which has a whole other set of signs besides inadequate calorie intake.

If the calorie intake is excessive, usually the biggest barrier is not enough of a balanced plate, where 1/3 to 1/2 the plate as fruits or veggies with the meals. Fruits and veggies are low in calories and full of nutrition. Usually people are going for quick grab-and-go foods they don't make and the calories from the prepared foods add up very quickly.

If people want to meet their nutrition needs, they should invest in themselves and have a nutrition assessment done with a registered dietitian. They will get custom and specific advice for eating healthy based on where they are at right now. It's information that can help them for the rest of their lives.

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I highly suggest you follow Rebecca on Twitter -- as she always has some great information.  Til next time, my loves!

**does a dance**
100 followers, not lbs lost, silly!!

I'm so excited!
Tomorrow morning at 9 am, I'll post Rebecca Scritchfield, RD's long awaited answers to the following questions:

Question 1:  Who should see a nutritionist/ can you break down your patients into a few categories?

Question 2:  What insights might a nutritionist have that the average GP/internist might not?

Question 3:  How does your own weight loss struggle inform your practice as a nutritionist?

Question 4:  Do you have a few quick & easy changes people can make to improve their diets?

Question 5:  If someone isn't meeting their caloric targets, what's usually the suspect? How should they meet their target in a healthy way?

And who knows... maybe if everyone is nice and receptive, Rebecca might do this again (with your questions)......

My funk seems to have a temporary reprieve -- but the forecast for next week makes me worried that there will be many migraines to come :(  I'll just have to deal with things as they arise.  No use in worrying about the future when there is so much I can do now.  Like finish up my Starbucks Vivanno Banana Chocolate Shake with 18 grams of protein, let my stomach settle, and then go to the gym for weights & a good run.

As I have mentioned in my last post (and many others), I have a dietitian in my weightloss/health gain arsenal.  I wanted to take the time to explain to you why I meet with my dietitian in the hopes that you might consider meeting with your own dietitian (I guess I can share mine...).*

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First of all:  there is a difference between a dietitian and a nutritionist.  A dietitian is a registered health care professional that has not only studied in their field and had practical in-the-field experience before being certified, but they have to take a nationally recognized certification test.  Nutritionists don't have the same certification requirements and are not licensed titles.  They can both be helpful, but I strongly suggest consulting with a registered dietitian.

Secondly, dietitians bridge the gap between doctors and (cognitive/behavioral) psychologists. A doctor might tell you that you need to lose weight, and you might know you're an emotional eater, but a good dietitian can help pinpoint the area where those two things intersect.  They can help you understand your biology, psychology, and behavior around food. 

Also, as many of you might already know, many doctors will tell you that you need to address your weight/diet but give you no direction as to how to achieve the results they want.  A doctor might tell you that you need to rework your diet to lower your blood pressure, a dietitian can tell you how.  A doctor might tell you that you need to lose weight, a dietitian can show you why you're not at a good weight right now.  Dietitians have the scientific know-how, the experience, and the time to help guide you whereas a doctor might leave you alone to figure it all out.

(Personal aside:  I've cried at my dietitian's office.  I don't think I really need to explain to 90% of you that food and weight issues are emotional for people that have been obese/overweight most of their lives.  Part of taking the leap to see a dietitian is recognizing that you don't know how to do something that seems so basic:  nurture yourself healthily.  It's hard to recognize that you've failed yourself and you need help.  Luckily, this humility and awareness is part of remodeling your life.  A dietitian will recognize this as a healthy step and hand you a box of tissues. Don't worry, things get much better from that point on.)

Thirdly, if you're a disordered eater (not just eating disorders, but someone who doesn't eat well as an instinct) a dietitian can help give you the tools to get back in touch with yourself and put you on track.

As I suggested above, many of us have lost or suppressed our natural instincts to feed one's self in a healthy manner.  Our diets are wrought with emotional complexities that never used to be there before -- guilt, shame, anxiety, loneliness, panic, etc.-- that often pushes us to the extremes of people restricting calories or people inundating themselves with calories. A dietitian can help you remove emotions from the equation, or at least put them in context.

And lastly, a good dietitian will help you kickstart your process as well as fine tune your diet once you are on track with food and exercise.  You might be trying to lose 50lbs, gain 15lbs or just feel better in general.  A dietitian will be able to look at your current eating habits and make suggestions to help you progress in your desired direction in a healthy manner (no tricks up their sleeve!).  They might even send you back to the doctor (as mine did) to get some follow-up tests or to get everyone on the same plan.

Please feel free to ask me questions about me, my dietitian, or the process in general. 

*I also wanted to raise this issue up again because of the Marie Claire article and its backlash.  While the fitness/health blog community can be helpful in giving suggestions and sharing their own story, nothing will ever take the place of you seeing your doctors, consulting your dietitian, and trusting your own instincts.  Please do not use my blog, or any other blog that I might provide a link to, as a substitute for common sense or as a justification for hurting yourself, your body, or your mind. 

Many companies are beginning to realize that the health of their employees has a strong correlation to health insurance premiums.  In response, they're beginning wellness programs.

For instance, in my company we have:

• a Wellness Committee
• weekly yoga classes
• lectures
• nutritionists
• sports trainers
• a lumbar specialist
• health screenings
• access to smoking cessation resources
• a yearly "wellness reimbursement" of $200
• access to Lifeworks (a comprehensive resource for just about everything, including health care advocates, advice and tips for just about everything from health, to finances, to happiness)
• a "Lose to Win" challenge 
• A gym/sauna in the building (though i wish the towels were an inch or five bigger)
• Discounts to local gyms

And i'm positive I'm forgetting something....

I was glad for the nutritionists that came in, but I don't think it was very comprehensive or motivational.  I searched the internet for a local nutritionist to come in that I thought could put a new spin on what we've already heard (calorie restriction, exercise, cheese is evil).  I hit paydirt when I came upon Rebecca Scritchfield. Part of the reason why I liked her is because she was an adjunct professor at my alma mater.  Secondly, she used the GoWear Fit system, which I had already purchased and had begun to utilize.  And thirdly, I thought she could speak to the people who were looking to lose lots of weight or even a few pounds.

So, not only does she have her own practice, but she also works with The Biggest Loser Season 5 At-Home winner, Bernie Salazar, in spreading their "Nurture Principles."  (you can follow both on Twitter: @nurturprincipls, @berniesalazar, and @ScritchfieldRD -- all twitter feeds have lots of great information and tips)

So I mentioned this to someone in Human Resources (who is also on the Wellness Committee) when she asked about my GoWear Fit.  Little did I know that they were looking to bring in a nutritionist for part of their Wellness-themed Staff Appreciation Week.  SCORE!  It just goes to show you that sometimes if you ask you actually do receive.

Instead of inundating the people in the seminar with information about calories, percentages, facts, figures, doom and gloom, they were fun and addressed the very first question that any dieter really faces -- "Do I want to change?" 

They gave us some facts, figures, tips and tools, but from talking to the participants in the seminar, what I really got was that people didn't feel like they were being being talked down to.  It was mainly the absence of the doom & gloom talk about the consequences of failing to make the change.  They were being reminded of their ability to make good choices and effectuate positive changes even if they weren't out running marathons, competing in triathalons, or starving themselves skinny.  That and there was a life-size photo of Bernie pre-TBL standing in the room. 

So the point of this entry is to OPEN YOUR MOUTH for something other than food.  Had I not mentioned Rebecca to HR, they might not have brought her in to give the seminar (and I'm hoping they'll ask her back!).  Sitting next to me in the seminar was a dear friend who has promised at every turn to help me and motivate me because I shared with her how painful it is to have injured myself over the past 16 years with all this weight.  I ask people for recipes, training tips, or general questions about health and well-being.

I highly recommend going to the Nurture Principles site as there is lots of great information there.  And if your company has a wellness/health committee, perhaps ask if they can invite Rebecca and Bernie to give a talk.

So yesterday was Pay It Forward Day. 
I think the overweight/obesity epidemic is something that requires a societal change, and most of all, support from each other. 

A while ago, I wrote my father an email, and I find myself forwarding it to a few people at work.  I'm going to share it with you all here.  Now keep in mind, I'm not a doctor, I'm not a nutritionist, and I've not yet won my battle. But these are the things I've picked up along the way:

You asked for some information regarding the GoWear Fit device that I'm wearing. The links to their Web site are below, as well as to Amazon.com (where there are reviews, and it's a little less expensive). You get 3 months of the Web application with purchase of the devise. If you sign up for 1 year, it's 7-8 bucks a month. That's two Starbucks chai lattes.

In typical Robby fashion, I didn't want to give you that information in a vacuum, so I've provided a ton more information to you.

I love you lots! Good luck.

-Robby

Good things come to those who write!
I have some exciting stuff on the horizon to share with you when the time is right...but man am I excited!!

The one thing I do want to share with you is that my dietitian has agreed to let me interview her for Fat Girl vs. World!! Exciting, right??  So I thought I'd ask her a few questions but also ask you all if there is anything you've been dying to ask a nutritionist.  I'll select the best questions to ask Rebecca! 

Send me an email -- fatgirlvsworld at gmail.com with
(1) your first name
(2) your location
(3) your blog address
(4) your question