Healthy and Lean: The Science of Metabolism and the Psychology of Weight Management

HEALTHY AND LEAN

The Science of Metabolism and the

Psychology of Weight Management

Heidi Wohlrabe, M.D., and Ileana Riverón

Copyright © 2016 Heidi Wohlrabe, M.D., and Ileana Riverón.

All rights reserved. No part of this book may be reproduced, stored, or transmitted by any means—whether auditory, graphic, mechanical, or electronic—without written permission of both publisher and author, except in the case of brief excerpts used in critical articles and reviews. Unauthorized reproduction of any part of this work is illegal and is punishable by law.

ISBN: 978-1-4834-5699-7 (sc)

ISBN: 978-1-4834-5698-0 (e)

Library of Congress Control Number: 2016913253

Because of the dynamic nature of the Internet, any web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

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Lulu Publishing Services rev. date: 10/6/2016

Contents

Preface

Chapter 1 A Disordered Eating Society

• What Happened? What Are the Origins of the Weight Problem?

Chapter 2 Dieting: The Gateway Drug

• Universal Fat Phobia and the Diet Industry

• Reasons for Diet Failures

• Psychological Issues Associated with Dieting

Chapter 3 Diets Gone Wild

• The Development of the Eating Disorder

• Body Dissatisfaction

• Anorexia Nervosa

• Bulimia Nervosa

• Set Point

• The Athlete’s Challenge

Chapter 4 How Our Bodies Use Food

• The Thermic Effect of Food (and Why It Matters)

• Secrets to a Faster Metabolism

• The Physiology of How Our Bodies Use Food

• Protein

• Fats

• Carbohydrates

• Gluten

Chapter 5 The Glycemic Index

• A Spoonful of Sugar

• What Is the Glycemic Index, and Why Should We Care?

• Sugar Addicts

• The Truth about Artificial Sweeteners

• Glucagon—the Natural Diet Pill

Chapter 6 The X-Factor: Xamining Xtreme Xercise

• Correcting the Harmful Misperceptions: What Level of Exercise is Best for Weight Management?

• The Health Benefits of Physical Activity

Chapter 7 The Skinny on How to Stay Lean

• What Is the Optimal Balance of Food Groups?

• Dissecting the Four Dietary Imbalances

• Ideas and Templates for Balanced, Satisfying, Diverse Meals

• Breakfast

• Lunch

• Snacks

• Dinner

Chapter 8 Miracle Foods or Poison?

• Corn

• Soy

• Vegetable Oils

• Sugar

• Finding the Silver Lining

Chapter 9 Superfoods 101

• Carbohydrate Superfoods

• Fat Superfoods

• Protein Superfoods

• Dairy Superfoods

Chapter 10 Cognitive Therapy

• Cognitive Restructuring

• Your Internal Parent Voice

Chapter 11 Practice Makes Perfect—Meal Diary and Journaling

• Eve’s Meal Diary and Journal

• Hillary’s Journal

• Matt’s Meal Diary and Journal

Chapter 12 Final Tips for Success

• How to Eat Healthily on a Tight Budget

• Take the Wheel in Your Life

• Mastery

Appendix: Just for Laughs: A South Park Rendition of the Gluten-Free Craze

Notes

PREFACE

Heidi Wohlrabe, MD

I am many things: a physician, a mom, a girl, a middle-aged woman, a grandma, a wife, a homemaker, a Christian, an amateur artist, a wannabe ballerina, a frustrated pianist, and a board-certified psychiatrist. Though I have been comfortable balancing various roles in my life, I have never considered myself a writer. However, everyone’s life takes unexpected twists and turns, and mine brought me to a point where I could no longer keep silent.

This book was conceived during the period of my life in which I was simultaneously directing an eating disorders clinic and trying to run a home with three young children. While I loved the work I did at my clinic and treasured the time I spent with patients, I found that I was a broken record, reiterating the same educational information week after week. I desperately wanted to get to the point where I was truly listening and doing therapy, not just teaching.

I taught my patients about the flaws of the diets they saw being advertised in magazines, on TV, and even by the United States Department of Agriculture (USDA); the damaging consequences of dieting in general; the medicinal benefits of health foods; the road to a healthy and fast metabolism; and the necessary steps to physical and psychological recovery from disordered eating. I knew that if my patients first understood the science behind their disorder, they would be able to align their own personal goals with the goals of therapy. Then we could both venture toward health together, as a team.

The alignment of goals and the establishment of a trusting doctor-patient bond are essential for effective medical treatment. Unfortunately, these goals were difficult to achieve in our clinic. Our patients felt successful and psychologically safe when they were in control of their own diets and when they felt thin. The nurses and dietitians, however, felt safe when our patients religiously followed the government-prescribed food pyramid and when they were pleasingly plump; after all, plump is always preferable to emaciated or dead.

The fears of the staff were warranted. Eating disorders are serious and deadly, and health-care professionals who are monitoring the recovery of eating-disordered patients must take great care to prevent a lapse or relapse into anorexia. Furthermore, the path to recovery from anorexia includes a difficult transition period in which patients need to allow their bodies to do the very thing they fear most: gain a moderate amount of weight in order to compensate for past dieting and starvation behavior. In my view, it was our job to help patients through this especially challenging period by offering them a long-term plan that promised healthy weight stability.

Our recovering patients needed to know that we valued their concerns so they could recover a sense of security. Additionally, they needed to learn what a safe lean weight is—one where their body fat never drops below 18 percent for women and 7 percent for men. The food pyramid diet achieved none of these goals. Instead, it merely fed into our patients’ fears of long-term weight gain and made treatment a constant patient-staff struggle rather than the partnership it was meant to be.

For rejecting the USDA guidelines, I was seen as a heretic. It took fifteen years for the world to accept the dietary recommendations that I was making back in the nineties. Meanwhile, I grew more and more frustrated by the absence of educational material that would benefit my patients, and I ruminated over the futility of trying to reach people after they were already struggling with a serious disease.

Eventually, I closed the clinic in order to give my family my undivided attention but with the intention of returning to work when life slowed down. It never did. (It never does.) Nevertheless, it was not lingering thoughts about my clinic that propelled me to write this book in the end. Instead, it was my experiences outside of the clinic, with my children, husband, and acquaintances that convinced me I must.

I followed my eldest daughter as she traveled around the country for her musical theater career. On college campuses, in Busch Gardens, in New York City, and on a Disney cruise ship, I heard her sing and act her heart out to my absolute delight. At the same time, I witnessed many of her musical theater colleagues, male and female alike, struggling with body image and weight management issues—issues that held the tremendous power to either derail or accelerate their careers. These individuals suffered in silence; they never considered seeking help for the disordered eating behavior that was a normal part of their chosen industry.

I watched my son struggle to climb the ladder toward a career in medicine, surviving twenty-four-hour shifts on minimal sleep, coffee, and a few handfuls of gummy bears. As I spoke to him about his own health-care needs, I was shocked to learn just how lacking nutritional education in medical schools remains today. It reminded me of my own medical school education on these topics thirty years ago. My husband, a cardiac surgeon, shares this feeling; even today, he comes to me for advice on how to advise his patients to optimize their health through their diets.

It was in my seven years as a ‘Dance Mom,’ however, that I found my most compelling reason to write. My youngest daughter, Ileana, attended two ballet boarding schools and danced professionally until an injury made her change career plans. Throughout her time in this incredibly demanding and competitive world, I helped Ileana tackle complex issues like athlete nutrition, disordered eating, and excessive exercise, not just for herself, but for her friends, colleagues, and role models as well. The stories of countless individuals, imprisoned by disordered eating and weight-related issues, appeared to me as a cry for help, and ideas for this book percolated constantly.

Between my visits and conversations with my children, I received calls from friends and family members about loved ones, from every walk of life, who were also struggling with disordered eating, whether they knew it to be that or not. I watched people all around me slip in and out of one fad diet after another. I saw friends and acquaintances endure huge weight swings. Everywhere I went, people were eager to share their stories, eager for help, and eager for a weight management plan that would not leave them starved and weak.

As I said, I have never considered myself a writer. But my daughter, Ileana, loves to write. I can honestly say that without her collaboration, this book would not exist. Together, we have written and rewritten various versions of this book. Together, we outline plans for proactively tackling problems with body image, disordered eating, obesity, dieting, and all their associated health complications.

Some people might think that writing a book that addresses eating disorders and obesity together is antithetical or that the topics are unrelated. Others may argue that this approach is overly ambitious since confronting each issue is overwhelming in its own right.

In my opinion, there is no other way to tackle these issues except in tandem. Eating disorders and obesity are highly connected by underlying psychological baggage, social stigma, and medical consequences. What’s more, these illnesses are symptoms of our society’s failed dietary practices and decades of nutritional misinformation. Thus, knowledge about what works, what doesn’t work, and why is crucial to recovery from every manifestation of these eating-related problems, be it anorexia, binge-eating disorder, bulimia, obesity, or unspecified disordered eating behavior. In every case, the victim’s injured metabolism needs to be resuscitated through the establishment of long-term healthy lifestyle practices, not just temporary quick fixes.

Yes, this book is far-reaching. It needs to be. The solution must be as comprehensive as the problem is pervasive, and if we look around, we can see that this problem has indeed become disastrously pervasive.

Obesity-related diseases are literally killing our society. They create and contribute to most of our major illnesses, such as type-2 diabetes, high blood pressure, strokes, heart attacks, heart failure, cancer, gallstones, below-the-waist degenerative osteoarthritis, sleep apnea, gout, and metabolic syndrome. All of these diseases rob individuals of both their quality and quantity of life, and moreover, they place a huge burden on everyone involved in the cycle of their care: family members, employers, taxpayers, insurance carriers, health-care providers, and the government.

In 2015, the State of Obesity estimated that America spends roughly 210 billion dollars, or about 24 percent of the nation’s total medical budget, on obesity related health problems.¹ Worse yet, the 2016 obesity statistics reveal how ineffective our so-called War on Obesity has been: In fact, the problem has reached an all-time high with 38% of adults and 17% of teenagers meeting the criteria for obesity.² Unless something is done to reverse this momentum, millions of individual victims and our nation as a whole are doomed to carry the weight of a crippling health catastrophe.

The introduction to this book, A Disordered Eating Society, more fully dissects the statistics on obesity and examines the connection between this epidemic and our extremely high rate of disordered eating. By dispelling the idea that these topics are unrelated—a dangerous misconception that impedes our society’s ability to recover—I advocate for the health of every reader, no matter where he or she falls on the disordered eating spectrum (including those health-conscious readers who fall safely in the middle).

My hope for my readers is that they will experience the joy of living a life free from diets, expensive weight-loss products, grueling workout regimens, weight management fears, and psychological shame. I want to steer them away from the patterns that lead to metabolic failure or ill health and guide them into lifelong patterns that create a stable, healthy, and lean future. When the knowledge of nutritional science is our road map for eating and the practice of cognitive therapy is our daily bread, this future is attainable. With this book, I aim to empower my readers with the intellectual and psychological tools necessary to realize the healthy, satiated, and abundant life.

Ileana Riverón

My mom and I sometimes joke that, in me, she’s created a Frankenstein. Everything Dr. Heidi Wohlrabe learned in her training—everything she put in this book—was part of my upbringing. While other kids grew up on SpaghettiO’s, Fruit Roll-Ups, and chicken nuggets, I grew up on a colorful diet of fresh produce, nuts, cheese, avocados, and lean protein sources. Even more important, I understood the reasons why, because my mom fed me with not just nutritious food but also nutritional education. And Goody-Two-shoes little me followed this knowledge to a T.

By our society’s standards, my pipsqueak self was a freak of nature for loving broccoli and hating popsicles and for knowing that counting calories is idiocy but having an understanding of the glycemic index is important. I certainly don’t blame people for finding my quirkiness amusing and frankly, a bit absurd. Yet when I became a preprofessional and later professional ballet dancer, my unusual upbringing became one of my greatest assets.

While dancing at the Harid Conservatory, the Royal Ballet School, and the Boston Ballet, I was able to eat more than 2,300 calories per day, almost double what some women eat, and still maintain the desired ballerina figure. Logically, most people attributed this to my physically demanding career. But that wasn’t the reason. After all, many of my fellow dancers ate far fewer calories than I did and put themselves through grueling workouts in addition to our daily rehearsal schedule, yet still struggled constantly with being told they were too heavy. Nevertheless, even I couldn’t shake the idea that the only reason for my good fortune was the athletic nature of my profession. After I stopped dancing professionally, I kept waiting in fear for the inevitable weight gain, as if my body was going to spontaneously balloon up and carry me into the sky with its newfound phantasmic buoyancy. I am relieved to say that no such thing has happened to date.

The real reason that I never fell prey to an eating disorder or to the terrible cycle of insecurity and shame, calorie restriction, reactionary bingeing, and then more shame and calorie restriction was because of what my mom had taught me and how she had presented it. Instead of giving me a list of oversimplified dos and don’ts, like most diet resources do, she taught me the biology of how food breaks down in the body. Equipped with this knowledge, I was able to build my own meals and snacks around scientific principles and the understanding of what my instrument (my body) needed to optimize stamina, strength, and satisfaction. And the best part? I grew up learning that healthy food was delicious and life-giving—a beautiful thing, not a negative thing. Eating healthily was never something I needed to impose on myself. As a result, I never felt restricted by rules, and I never had anything to rebel against through bingeing.

When I left my ballet career and entered Harvard College, I was surprised and dismayed to realize that body image issues, disordered eating, and dieting are not just a ballerina problem; they are prevalent among people of every body type and from every socioeconomic and cultural background. This sad realization reinforced my gratitude toward my mom for giving me the tools necessary for lifelong physical and psychological health. Odd as it may sound, I am immensely thankful to be her greatest test case, her Frankenstein.

Since my life is in many ways a testimony to the effectiveness of what Dr. Wohlrabe teaches, I am happy to have had the opportunity to coauthor her book. Over the past six years, Dr. Wohlrabe put into writing her expertise as a psychiatrist and eating disorders specialist, and I helped her research, edit, and rewrite the material so that it is user-friendly and entertaining. Adding funny (at least in my mind) side notes and references to South Park, Mean Girls, Harry Potter, and (keepin’ it classy) Aristotle made my job a pretty sweet gig. Perhaps I got carried away at times, but I’ll let you be the judge of that.

Dearest Reader, I want to end by telling you some really good news: it is possible. It’s entirely possible to have a positive relationship with food and with your body—one that is free of shame or obsessiveness—to enjoy meals that are as delicious as they are nutritious, to feel satiated but not guilty, to eat healthily on a budget, to be active and fit without torturous workouts, and to be thin as well as strong and full of energy. Whether you’re a ballerina, a student, an overworked mom or dad, an athlete, an academician, you name it, this kind of life is absolutely within your grasp. Don’t sell yourself short. You are more than worth it.

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A Disordered Eating Society

Our society is fixated on diet, body shape, and exercise. And yet, despite our obsessions, weight-related health issues continue to spiral out of control, including hypertension, diabetes, and all forms of eating disorders. The shocking statistics tell the tale all too well. In the early 1980s—not very long ago at all—very few of our children were struggling with obesity or eating disorders. Only 4 percent of children in the United States were overweight.¹ Today, we’ve reached an all time high; 33 percent of children are considered overweight and 17 percent obese!² Continuing on this trend, half of the next generation’s children will be