I’m a Registered Dietitian. If you’re here, you probably know that already. But what you might not know is that I refuse to sell you weight loss. Most people are surprised by that, and I’ll be honest -- sometimes it surprises me, too. I didn’t get into nutrition to become a Health At Every Size practitioner. In fact, I didn’t know what that was until fairly recently. When I made the choice to get my RD, I thought weight loss was the goal. What I’ve learned since the day I walked into my very first nutrition lecture probably couldn’t have been taught in a classroom alone.
As Registered Dietitians, our jobs are to practice nutrition based on the evidence. This is what sets us apart from the pseudo-science-based pop “experts” who follow trends, and market what is popular or profitable. At this time, the evidence shows me that the most ethical thing I can do as a nutrition practitioner is to encourage my clients to remove a weight goal from their list. Research has now conclusively shown us that dieting does not work, and paints this bleak picture of our current outlook:
“Despite attention from the public health establishment, a private weight loss industry estimated at $58.6 billion annually in the United States , unprecedented levels of body dissatisfaction  and repeated attempts to lose weight [3, 4], the majority of individuals are unable to maintain weight loss over the long term and do not achieve the putative benefits of improved morbidity and mortality .” - Excerpt from Nutrition Journal Article, Weight Science: Evaluating the Evidence for a Paradigm Shift (1)
In research conducted over the last two decades, we have seen that, while some diets lead to short term results, diets repeatedly do not produce long term, lasting weight loss, and participants even often regain weight beyond their starting point. In fact, many studies reveal dieting itself to actually be a predictor of weight gain, not to mention a risk factor for developing disordered eating and body dissatisfaction (2). As Linda Bacon, PhD, author of Health At Every Size, often points out, the research does not show us that weight itself is the issue, or even a risk factor on its own. In looking at a disease like hypertension, researchers see more deaths in thinner people than heavier people (3). In patients with diabetes, hypertension, and other diseases we tend to associate with obesity, it is possible that it is not weight gain that is the cause, but rather the weight cycling that results from chronic dieting (4). Adults 55 years of age and older were found to typically live longer with higher BMIs than their more slender counterparts (5). Not only that, but this same study also saw much stronger correlation between factors like low socioeconomic status and mortality than it did with weight (5). Recommending weight loss as a cure-all for metabolic disorders not only doesn’t fit with what research currently supports, but also blinds us to the bigger issues we face in our society’s relationship to our food and bodies. An analogy I once heard suggests that recommending weight loss to solve metabolic diseases is like seeing a smoker with emphysema, and recommending they begin whitening their teeth. Higher weights might be a side effect of a sedentary lifestyle, and having lost touch with our bodies’ hunger and fullness cues, but attacking the weight itself is not the answer. These studies support that it is not ethical to suggest weight loss -- in fact, it is downright dangerous.
As a dietitian who prides herself on practicing according to what the evidence shows me, I cannot in good conscience sell weight loss. As mentioned, I didn’t start out this way. While studying nutrition, we are taught that weight itself is a risk factor for mortality and morbidity. We are taught to focus on calories in and calories out. When training on how to make positive changes in people's diets, we look at how we can shave off calories and fat, and increase activity through monotonous movement. I’ll be the first to admit it - I practiced this way. Whether working with people professionally, or answering questions for friends and family, my answers went back to my education. But it’s been through my hands-on experience and witnessing the long term impact of this advice that I’ve come to find that weight is not the problem, and therefore not the solution.
The truth is, the cycle dieting creates has far more morbid and, frankly, uncomfortable effects on our bodies than resting at a BMI outside of what is arbitrarily listed as “healthy” (6). Restrictive eating, whether it is as blatant and extreme as pure calorie restriction, or masked as something like fitting your “macros”, or ruling out a certain food group for a “healthy lifestyle”, will always lead to a famine response. What this means is that, due to your body’s basic physiological response to being starved, it is highly unlikely that you will be able to go near anything your body perceives as energy without eating more than you intended. This is not your fault, or lack of willpower or self control. This is survival. This is your body making sure you have enough energy for your heart to beat, for your lungs to breathe, and for your brain to stay awake, even when fuel is scarce. We can see this happen, physically, right in front of us. And it is not your fault, and you are not “bad” or “weak”. This is you, being a living creature who requires fuel. As I always share with my clients who come to me wondering why they feel unable to stick to any diet they try, I would like to emphasize this: You have not failed at these diets. These diets have failed you.
I would like to argue that our nation’s struggle with weight and food has so much more to do with getting out of touch with our bodies’ cues due to dieting, than it does with any one particular ingredient, cooking method, restaurant chain, food group, or even weight itself. Our bodies want us to be healthy. Keeping us alive is their primary objective, and they call on complex mechanisms on a second-to-second basis to keep us in equilibrium. Why would our hunger and fullness cues be any different?
Do I think that some people are at a weight outside of what their body is most comfortable at? Sure. But do I think we are going to remedy this through dieting and fixating on weight as our data point? Absolutely not. I think Dr. Bacon said it best in her response to one skeptic :
“Health at Every Size is not anti-weight loss. We understand that weight loss is a side effect that sometimes occurs when people adopt healthy habits – and we also recognize that many people who adopt healthy habits don’t lose weight. Our goal is to be weight neutral – to encourage the habits and attitudes which we know are valuable, and to let the weight settle where it may. And to support people in appreciating themselves no matter what the outcome. They don’t have to wait until they lose weight to feel good about themselves.”
So, I do not, and will not, sell weight loss. I sell permanent, lasting change. I sell a positive relationship with food, and never having to call yourself “bad” for listening to what your body is telling you. What I have on offer is the opportunity to stop battling your body, and learning, through hard work and dedication to your well being and emotional security, that you can trust the signals you hear, and trust your body to do what it needs to do. I sell peace and partnership with your mind and body. I urge you to take the first step toward listening to your body today. This might look like having one meal at the kitchen table today without distractions so you can enjoy your food. It might mean putting down a “healthy” food that doesn’t sound good, and picking up what your body is really asking you for. It might mean giving yourself a scoop of real ice cream instead of the dairy-free, fat-free, sugar-free, fuel-free version; or it may mean going for a walk outside, even though it burns fewer calories than that class at the gym, because it feels good to be outdoors. I can’t promise your journey will be easy. It may not be pretty. And it most definitely will not be linear. But I can promise you it is worth it. If this is something you’re willing to work for, and are looking for help, you know where to find me.
Yours In Everlasting, Messy, Imperfect Wellness,
Sam the Dietitian
Happy August (for a few more days), readers! The sun is shining, even for us here in San Francisco today. As the days get hotter, one of the top goals a lot of my clients have when it comes to their wellness is getting enough water. Although this may be a time of year when we can physically feel our need for that sweet, pure liquid more than ever, it is VITAL (literally!) for us to get enough water year round. Let's talk about why, and how to make sure you're getting enough. But FIRST - some fun facts!
Did You Know...?
Why Drink Water?
Most already know that water is the best choice for hydrating our bodies (hydro = water, soo....). I'll mention for emphasis that water is the most efficient choice from a purely hydration standpoint over sugar-sweetened beverages, since water is inherently 100% water, while sugar-sweetened beverages contain more than just water, although they do contain some. I recommend reserving consumption of non-water beverages for times when they sound good (like OJ with Sunday brunch, or the occasional soda with that cheesy Friday night pizza), rather than relying on them daily to quench your thirst. Many foods also contain water, which contribute to our hydration status, as well; however, the amount in foods alone is not enough to keep us adequately hydrated. In short: it can be difficult to meet your hydration needs without drinking any actual water.
Check this chart out for more on water content of different foods.
So, what are the reasons it is important that we consume water so regularly? Water plays a major role in many of our bodies' processes -- processes that allow us to extract fuel from the foods we consume -- and also makes sure we are functioning properly, all around.
Without enough water, we can see symptoms like:
As mentioned above, humans could go a fairly long period of time without food, but not very long without water before things started to shut down. This is because, unlike our hump-ed camel friends, humans do not have a mechanism by which to store water. We lose water through a number of mechanisms daily, like urination, bowel movements, sweating, and more. We even lose a tiny amount of fluid every time we breathe! We have to replenish our fluids so our bodies can carry on doing the many incredible things they do on a second to second basis that keep us upright, and kickin' butt in the world.
I am often asked what the deal is with coffee and tea. Theories circulate, stating that these drinks contain water, so may count as water. Others state that these drinks are diuretics, meaning they cause us to excrete more water, so they actually count negatively against you water goal for the day. It's true that we do get some water from caffeinated beverages like coffee and tea, but we also do lose some water. I recommend keeping your caffeine intake moderate, like most things, and wouldn't recommend relying on lattes to meet your daily H2O goal. Try to meet your goal using the real stuff to make sure your body is really getting what it needs in this department.
How Much Do I Need?
You've likely heard the recommended 64oz per day before - and I'm guessing you've also heard that this recommendation has changed. It's not that 64 oz per day is not a good starting point. But as science has given us new information, it's become possible to give more precise recommendations, which are listed above.
You can speak to your own dietitian, who can help you calculate what exactly your needs might be, and help you set goals to get you there, or you can monitor your own body to determine what's right for you. The most sure-fire way to tell if you're properly hydrated is to note the color of your urine. If it's a dark yellow after you've had 64oz of water for the day, you definitely need more than that. As a marker of good hydration status, you should look for urine that is such a light yellow, it is almost clear. You can check this throughout the day to gauge whether you've had enough. Remember, if you're feeling thirsty, you may already be dehydrated! If you're feeling constantly thirsty, while drinking plenty of water, this could be the sign of a medical condition, so be aware of that, and see your doctor if this persists.
In making sure you start to get enough water, proper goal setting is key. Even if 64oz is not quite enough for you, it's a great goal to start with. It's imperative that your goals are attainable -- start with whatever feels reasonable for you today, whether that is 64oz, or 40oz, or 24oz. Congratulate yourself as you hit your water goal milestones, and continue to make progress until you reach the right amount for your body.
What About Lemon Water?
Haven't y'all heard? Lemon water will save you from dehydration, bloating, acne, leprosy, and gives you X-Ray vision? (DISCLAIMER: JUST KIDDING)
Good for you, Lemon - you and your once largely unloved sour family have finally got your time in the lime- err, lemon-light.
I have heard some pretty wild claims about the "miracles" of lemon water, as my snarky intro to this section connotes. Briefly -- I wouldn't believe the hype. There's no harm, for the average, healthy Joe, in adding a wedge to your glass, except for maybe a little bit of tooth erosion, or acid reflux. Especially if it helps you drink a little bit more water overall, adding lemon (or cucumbers, mint, berries, or whatever sounds good) to your H2O isn't a terrible idea -- I've been known to do it, as it tastes so good and refreshing, and can help make a normal day feel like a spa day. And drinking enough water can absolutely lead to some of the amazing results lemon water pushers purport, including clearer skin, fewer tummy troubles, and a feeling of overall wellness. But these benefits are also seen when folks simply drink an adequate amount of plain water.
Bottom line: If you hate lemon water, no need to choke it down. If you love it, get drinkin'!
There You Have It...
All you ever wanted to know about water, and maybe even a little bit more. If you've still not had your fill, check out the TED-Ed video below. You'll hear a lot of what I discussed here, plus more about the bodily mechanisms around water -- including what happens during dehydration, and over-hydration. Enjoy!
Hippocrates once said that "all diseases begin in the gut," and an unhealthy gut environment may affect more people than we realize. And what may be one of the answers to this affliction? You got it -- PROBIOTICS. Probiotics are one of the latest buzzwords in and around the health and nutrition world. As with all the topics I cover here, there are a lot of claims out there, and it's hard to decipher the truth from outrageous claims. Also, even if probiotics do work, how do you choose the best product for you, with entire shelves full of options at your local health food store, pharmacy, etc? Fear not, little health nuts -- Nerdy Girl to the rescue.
First... What are probiotics?
Probiotics are live microorganisms that are similar to beneficial microorganisms that are found in the human gut, and may elicit health benefits. You may have heard these healthy gut organisms referred to as "good bacteria". Probiotics can be found in food sources such as yogurt, and fermented foods like kimchi, kombucha, and sauerkraut. Additionally, probiotics come in the form of pills that can be taken daily.