Redefining public health

I watched a documentary on the BBC this week which focused on women suffering from  Diabulimia. This is a type of eating disorder where someone with Type 1 Diabetes reduces the amount of insulin they take in order to control their weight. Without enough insulin, sugar builds up in a diabetics blood and urine. Chronically high blood sugar, known as hyperglycemia, can cause irreversible damage to the eyes, kidneys and nervous tissue. If the body is starved of glucose for long enough, it will start to beak down muscle and organ tissue in a process called diabetic ketoacidosis which can be fatal if untreated.

I had never heard of the condition before but straight away I could relate to the women as I am well acquainted with that deep sense of inadequacy that could cause you harm yourself in this way. It was so sad to see these beautiful women causing such harm to their body in order to stay slim. It made me angry that as a society we have created such a fear of weight gain that people are willing to risk their lives to achieve the “ideal body”.

The lack of support for this complex condition reminded me so much of my own visits to my GP. Admitting that you have a problem can be so challenging and reaching out for help is often a shameful experience. To  then be told that there is nothing available because you don’t fit into the standard boxes of anorexia or bulimia is ridiculous. It is time for us to open up the definition of disordered eating to include all of those whose preoccupation with food and weight is subtracting from their quality of life. I think we would be shocked at the number of people, especially women, who would come forward.

There is a need for a general education on the harmful effects of dieting and support for building a healthy body image. Children are growing up surrounded by diet products and perfect insta-filtered bodies and they need to be prepared to avoid a generation of damaged self esteem. The focus needs to shift from focusing on weight to teaching people to eat well and move their bodies to improve their health and internal sense of well being. There are some great programs emerging in the NHS which are encouraging healthy habits but for some reason the scale always takes centre stage.

The Health at Every Size movement focuses on encouraging positive lifestyle changes for people in all body shapes and sizes, reducing weight discrimination and improving bodily acceptance and self-confidence. This is an area that I am really interested in and going forward into a career in Public Health, I hope I can help raise awareness and be part of bringing these ideas into the mainstream. This change won’t happen overnight – diet culture is well established and we need a total reprogramming of our beliefs and values. But I do believe the shift has started and it is only a matter of time before people wake up and take back the power over their own health.

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Why it is so hard to stop counting calories

Calories.. since when did they become such an integrated part of modern life?!

We are so used to seeing detailed nutritional profiles on every item of food we buy that it is hard to believe that less than thirty years ago, this information was hardly available. Ingredients and additives, along with allergen and health advice have been included for a long time but, until recently, it was rare for packaging to show the exact number of calories or grams of fat the food contains.

That isn’t to say people didn’t count calories for weight loss – this has been a thing since the early 20th century – but it was something they had to go out of their way to do. Nowadays, calories fill our media world from websites, diet books and government recommendations for how many calories we should consume to magazines covering celebrity diets, hinting at how many calories we need to eat in order to achieve that A list body.

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With the rise of intuitive eating, we can see just how addicted to calorie counting we have become. We now have a name for simply eating according to our natural cues and have to relearn how to do it. For those coming to intuitive eating from a history of chronic dieting, a big part of making this shift is learning how to stop calorie counting and start listening to our bodies. Sounds easy right???

Wrong!

Giving up counting calories is one of the hardest things to do. In part, this is because lots of us have become reliant on this external tool to determine how much to eat each day we have forgotten how to listen to our bodies. Without this life jacket, we feel like we will drown in a sea of chocolate milkshake or disappear into a refined sugar quicksand, never to be seen again. We have heard or seen or read that in order to be healthy or lose weight we should eat X amount of calories per day and we cling onto this for dear life.

In doing this, we discard the inner knowledge that we were born with. We hand our power over to health gurus, scientists or government organisations and let ourselves forget that no one knows our bodies better than we do. That intuitive wisdom of how much and when to eat is never lost but we allow it to shrink further and further away from our conscious mind until it blends into the white noise in the background. Compared to the bright colours and bold text of the media, its no wonder that this faint whisper often goes unheard.

As humans, it is only natural to desire a feeling of control. Following calorie guidelines gives us a sense of being in control but in reality, it is an illusion. If we are following external rules rather than our own inner guide, are we really in control?! But for many of us (and I include myself in this) it is a habit that is extremely difficult to let go of. We might see ourselves as fully functioning, independent adults, but in this area of our lives we feel totally incapable of looking after ourselves. Counting calories allows us to feel safe and grounded, especially when things in the world around us get crazy.

Once we do accept that calorie counting is futile, and even harmful, it is not easy to actually stop doing it! We don’t wake up one day and decide we want to stop and that’s it – we never think of calories again, we eat what we want and live happily ever after. Well, maybe some people can but for the majority it is a much longer process. It is sad to say but many women (and some men too) have spent so long thinking about calories, diets and macros that the neural pathways in our brains which are involved in thinking about these things have become so well worn that the counting happens on autopilot. It happens without us thinking about it and actually takes more effort not to!

Even when we want to stop counting, we can’t help looking at a chocolate bar and automatically thinking 200 calories or silently adding up the calories in the items when we buy a lunch time meal deal. We can’t help looking at the calories on food packages that we buy and comparing similar items. Even restaurants often show the calories in the meals these days and for those of us coming from a background of dieting and restricting food, it is difficult to order a burger and fries when the menu tells us it contains 1500 calories which was probably our “daily allowance” at some point.

I am not saying by any means that it is wrong for this information to be available. I do think that it is useful in making healthy choices but we are all individuals with different needs when it comes to our health and well being so it can be difficult to find a one-size-fits-all solution. In this case, for those of us trying to undo years of dieting habits, having these numbers glaring us in the face does not make it an easy process!

So if you are trying to give up counting calories and finding it hard, please know that you are not alone. The media and your human brain make up are both against you on this one. It is a challenging process but so worthwhile so stick with it and you will get there 🙂 this post is getting quite long already so I will save my tips for giving up calories and finding food freedom for next time!

HA recovery diaries #9 The scale, friend or foe?

A couple of weeks ago in my progress update blog, I mentioned that I had fallen back into the habit of weighing myself and that I was going to go scale-free for the next 30 days.  Since I started trying to get my period back 4 months ago, I stayed away from the scale for fear of setting myself back. But then thoughts started to creep in I wonder how much I weigh these days?  And this eventually I caved. Before long I was back into the habit of weighing myself every few days.

I wasn’t consciously trying to lose weight or change what I was eating as a result of the number and it definitely didn’t have the same power over me and my emotional state as it has in the past.  But I found myself experiencing mild disappointment if I saw the number rising and secretly was glad that my weight was finally pretty stable after my initial gain.  Even though I told myself I was ok with my new weight, I can’t deny that knowing it still brought some anxiety.  In the back of my mind I still had the thought that I was “big enough” now and I think on some level this was reflected in the choices I was making, whether I was aware of it or not.

I found myself questioning myself more often about whether I was really hungry for that snack.  Or whether I should have the fruit instead of the chocolate I was craving.  Or thinking that maybe I should go out for my usual walk even though its pissing down with rain outside.  When my third period didn’t come as I expected I had to reevaluate what I was doing.  I needed to ask myself some questions and be totally honest with myself. Where did this need for me to monitor my weight come from?  And was it really helpful in my recovery journey?

For sure it really is a tough topic with regards to recovery from restrictive eating and weight suppression.  On one hand, if you are trying to gain weight, weighing yourself can be a useful tool to monitor your progress and check you are eating enough to repair your body and get to where you need to be.  It can also be useful to have a goal to work towards i.e. the “fertile BMI range” of 22-23 where a lot of women tend need to reach in order to recover their menstrual cycles.  But for those coming from a much lower weight, this can seem like an unthinkable goal, a huge mountain that is near impossible to even imagine climbing.

And for those of us who are already close to this target weight at the start of our recovery journey, it can become more of a limit on how much we are willing to gain.  In order to fully heal, we need to surrender to the process and let go of all restrictions on our body, including the self-imposed limitations on what we should weigh.  For many women, it is necessary to go above the “healthy” BMI range for our bodies to feel safe enough to menstruate.  How can we label a BMI healthy if our body cannot perform one of its basic functions?!  BMI is such a generalised approach and is in no way suitable for all individuals but I will talk about this in more detail in another post..

Right now I want to focus on how weighing ourselves makes us feel in our bodies.  When you are trying to recover, there is always the risk of setting yourself back mentally.  For lots of us chronic dieters, weighing ourselves has been a regular ritual which we relied on to determine our self worth.  I know from personal experience that you can feel really good and confident and then step on the scale, see a number higher than you were expecting and all of a sudden your self esteem is through the floor.  Even with all of the work towards changing my attitude towards my body I still had a mini eeeeeshhhh moment in my head when I first saw how much I had gained a few months into recovery.  And bear in mind that this is when I had been trying to gain weight on purpose.

In the past I have often let the scale rule my life.  If the number was up I would try to restrict my food or exercise even more, constantly seeking that thrill of seeing a smaller number next time.  Often this restriction would lead to me over eating and feeling even worse when I stepped on the scale and saw an even higher number than before.  If the number was down it could go one of two ways.. either I would chase the high and continue restricting or I would go into self-sabotage mode and end up overeating. Total insanity.

And this time round the habit had got sneaky.  I wasn’t using the scale as a way to measure how good at dieting I had been but I was still judging myself based on what I saw.  I was assuming that if I was truly listening to my hunger and fullness cues then my weight should stay the same.  I was using my weight as an external guide of how successful I was at “intuitive eating” which of course goes against the definition of intuitive meaning that I wasn’t successful at all.  It is much better to rely on your own internal compass to determine how you feel.

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Our bodies provides us with all of the feedback to tell us whether they are happy or not, we just have to learn to listen to them instead of handing all of our power over to a useless piece of machinery.  Turning inwards and looking at our energy levels, our digestion, our mood and our quality of sleep provides us all of the information we need to know whether we are “on track” or not.

In my opinion, there is simply no need for anyone to keep track of their weight, regardless of whether they are in recovery or not.  It is not the weight that determines the our health but our behaviours and self-esteem.  For those who are underweight, adopting healthy behaviours and truly providing the body with the nourishment it needs will bring the body to a healthy weight.  The goal is full recovery, not just weight restoration.  We want to make sustainable changes to the way we treat our bodies, to find that inner caretaker who is going to help us look after ourselves through all of life’s twists and turns.

And to update on my progress – two weeks after my scale freedom I got my period right on time!  It has now been almost four weeks of liberation and I don’t see myself going back anytime soon.  I feel so much calmer and hadn’t even realised the underlying anxiety until it lifted.  It was as if I had been carrying around an invisible burden which was pressing down on me and suppressing my ability to relax and feel happy, without me even realising.

I hope that this post will give strength to anyone who still has that emotional attachment to the scale to just throw it out.  It is definitely not your friend. Make some new friends that will make you feel good about yourself and watch your whole attitude and outlook change.