A Different Question
What happens when we stop asking how to lose weight—and start asking what we can add
Sarah Unscripted, December column
I used to somewhat dread holiday parties. Even in the days leading up to them, I’d worry. The focus of my worry was on reduction. How little could I eat the day of the party in preparation? What foods at the party had the least number of calories? How could I cut down, reduce, and make smaller? Even in choosing my clothing, I’d focus on what made my body look slimmer.
Fortunately, over the past several years, this approach has changed. Now, I look at the spread of food, and different thoughts come to mind. How will that taste? Have I tried that dish before? What can I add to my plate? This new way of thought includes my clothing choices – last night, I wore a shirt that fit a little tight, but it was festive and silly and matched my husband’s. It made me happy and made me feel good.
This concept is something I think about a lot as I counsel my patients on a so-called “healthy” lifestyle. I urge people to focus on what they can add rather than what they can take away. How can they add fun movement that feels good to their body? How can they add fruits and veggies because they have tasty nutrients that aid biological functions? What can their bodies do? What can they do for their bodies?
For patients who are caught within the web of diet culture, I’ve become well-versed at pivoting the conversation. When I’m asked, “How can I lose weight,” one of the things I do is urge my patient to pivot their approach. “What can you add to your lifestyle or practices that may improve health?” has been a useful question, good for sparking conversation and a candid discussion.
This has been a positive way for me to approach conversations in the clinic (focusing on what can be included rather than what should be restricted), and I’ve also noticed the positives in my personal life. What can I include? How can I grow? What can I bring into my life rather than what can I cut away?
This has become not just a personal belief system, but a more positive way for me to approach the little things, like even a holiday party. And what do you know? This has helped make parties fun again.
Just to add an idea for both clinicians and patients to consider doing: I'm finding it helpful to create clasp folders for my clinicians, and myself, filled with plastic sleeves, with brief articles or bullet point lists about weight-neutral care, and eating disorder recovery healthcare tips, and also about the harms of dieting and the weight-centric approach. This includes a print-out of the restrict-binge cycle image (one that is titled "The Restrict-Binge Cycle," *not* "The Binge-Restrict Cycle," because it is the restricting and resulting excess hunger that causes the make-up eating or binging, not the other way around. It's also the restricting that must stop, first, always, for the binging to eventually stop.)
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I use the clasp folders that have a clear cover, which I fill with plastic sheet protectors for each page, to make it quick, easy and inviting to flip through.
My folder to carry to doctor appointments also has a sheet with photos of me before I was put on a diet at age 14. I was thin back then. It illustrates how dieting completely backfired for me, instead causing 5 decades of restrict-binge, Night Eating Syndrome (a newly recognized eating disorder in the DSM-V), and major weight gain.
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I'm making up these folders with great, brief articles like this one, for each of my providers to keep, as well, so they can have one as a reference/memory jog, and will suggest they reach for and review the folder daily or weekly, at first, and as needed, for the information to sink in and become incorporated into their practice. Because it takes a long time to grasp and accept the concept of weight-neutral care.
Thank you again.
Your ideas and words are beautiful and so, so healing. Thank you. I'm sharing this
widely on social and especially with my doctors. xo