Eating Disorder Recovery and the Holidays: a Tough Time for All, Part 2

The holidays are a time to celebrate and be together. Despite the pull towards old and often difficult dynamics, most families crave an easy, calm few days. The presence of a chronic illness that is difficult to treat makes the time much more challenging. This isn't the time to stage an intervention or ignore the member with an eating disorder completely. Instead, the goal is to comfort her and provide support and love and try to create an environment of celebration while acknowledging and being sensitive to this family member's struggle.

Preparing for the holidays with openness and communication also opens the door for education. It's very likely that the family is not aware of the details of their daughter's treatment and recovery and, without clear proof of a full and instant recovery, i.e. completely normal eating, assumes that she is not doing what it takes to get better.

The path to recovery is often long and slow, and families may use the holidays as an annual marker of disappointment. When family members express these feelings, the result is a damaging conversation that casts a pall over the entire time together.

Any concerns are best addressed at another time and often with help from the person's therapist. This is not a time for a complete referendum on the treatment process and path to recovery. Families can broach that large topic without the added pressure of the holidays. In fact, if the person with the eating disorder can ask the family to avoid the topic of recovery in advance, the holidays will proceed much more smoothly. 

But complete avoidance of the topic is just as uncomfortable. Pretending that nobody is aware of the ill person's struggle with food isolates her from the family too. The result is feeling alone and unloved, a very common trigger to return to the eating disorder symptoms for comfort. The typical pattern for families is to reach a state where every conversation about food and the eating disorder leaves anger, disappointment and hurt in its wake. Left without other options, the family resorts to silence and allows the sick one to suffer alone with her illness.

Is a family stuck when discussing treatment or ignoring the illness aren't viable options? What can caring family members do to use this time together to show her they are on her side and want to help? What can make this time easier and perhaps even enjoyable?

The most caring approach a family can take during the holidays is one with love and compassion. Eating disorders are relentless and punishing illnesses. The intense, internal pressure to follow the rules of the eating disorder weighs heavily on the patient's mind and is followed by powerful, degrading thoughts. The imperative to try to avoid any symptoms during the holidays ends in even more punishment and a sense of failure unless everything is perfect. Countering the internal pressure with kindness and love is the foundation to hopefully create a different holiday together.

In practice, the role of other family members is straightforward. Ask her if she is ok and then wait patiently for a response. If the answer is "I'm fine," then ask again until she understands you wanted a real answer. Ask if she needs anything and when she says no, offer something small, such as going for a walk or watching a show together. When the meal comes around, take her aside and let her know which foods have been included to help her feel more comfortable. Offer to make her plate or to sit next to her during the meal. Extending a hand of comfort, solace and love will mean the world to her and will reinforce in action, not just words, that she isn't alone.

If a family can suspend fear, anger and judgment and remember an eating disorder is a difficult illness, the holidays can be a time of peace and love. Spending some time discussing in advance both what food could be available and how to approach the meals can help avoid much of the pressure felt at the most pivotal moment. Similarly, advance planning around appropriate discussions during the holidays will go a long way to bridge the isolation caused by the eating disorder. Most important, kindness, love and compassion, all facets of what the holidays mean, are critical ways to treat the sick family member to help her feel loved and less alone.

Eating Disorder Recovery and the Holidays: a Tough Time for All

The holidays are perhaps the hardest time of the year for people in recovery from an eating disorder. The combination of time with family and the focus on food with little distraction makes for a very challenging few days. Working hard to follow a meal plan and enduring the internal struggle between eating and trusting the eating disorder is hard enough. The next two posts will present guidelines to take some of the stress out of the holidays for people with eating disorders and their families.

Families tend to return to old dynamics this time of year. Living together once again under the same roof, often where the children grew up, immediately brings back the experience of times past. Accordingly, instinct and circumstance triggers familiar situations and emotions for all.

An ill-timed comment or an off-kilter glance can ignite old reactions in a split second. The process of forming new, adult dynamics takes time and isn't ever foolproof. Usually only the introduction of new family members, the aging of the older generation or a serious family illness, like an eating disorder, are sufficient to break these patterns.

None of the family dynamics bode well for the family member home for the holidays while in the throes of recovery. It's much more common than not for someone with an eating disorder to have lived at home at some point in the first few years of being sick. Lost in the illness, the patient was inevitably restricting or binging and purging at home and hiding the symptoms as much as possible, a painfully difficult time for someone with an eating disorder.

Families, clearly scared and worried, in all likelihood monitored their daughter's eating constantly and tracked progress or slips, all the while hoping their vigilance would help. Often any previous dynamic transformed around such a devastating development in the family and all attention shifted to the ferocious illness in their midst.

All together again, the family is likely to adapt its interaction around the eating disorder once again.

The scenario during the holidays is predictable. Families will check every morsel of food their daughter eats while trying to gently urge her to eat a little more. Trapped, she will get angrier and angrier and feel terribly judged: a situation that always worsens symptoms. Faced with the prospect of no privacy, no access to alternate coping mechanisms and food as the sole emotional outlet, she will feel the powerful tug towards disordered behaviors. All well-meaning plans and actions to start the holiday will be quickly challenged within the first few hours of the family reunion.

The real question is how to address the concerns in advance, including backup plans when things go awry, rather than fall into a tense situation with nothing but old patterns to fall back on.

The first and most critical step is to be sure the issues are up for discussion early and often. Without a forum for openness, the holidays will inevitably return to old form.

It takes courage for the ill person to acknowledge her fear and state clearly what she needs to make the visit more successful, especially when there's no guarantee how well a conversation will go. She is typically so used to hiding symptoms at home that this default scenario feels like a much easier route to take, despite the inevitable pain, anger and confusion that will follow.

Acknowledging how difficult the trip may be will make her feel vulnerable in many ways: exposing continued risks for slips or relapse, risking offending family members, and opening avenues for unsolicited opinions about her treatment. Still, the conversation is crucial to head off the likelihood of misunderstanding and anger in the moment and of reinforcing the emotional distance after the trip is over.

A few parts of recovery will need to be out in the open to make a more honest discussion possible. The person has to speak about what food is possible to eat and what isn't. She has to explain to some degree that, holiday or not, it's critical for her to follow her meal plan because straying is likely to lead to worsening symptoms. She also has to try to ask for support and help in preparing either the food available, her plate at holiday meals or both. The stress of facing a table of food all of which is too scary to eat or of serving herself food while everyone watches what she takes is overwhelming. A family member can easily lower the stress by planning in advance to have food she can eat and to offer to help arrange a plate of a safe amount of food. Spreading the word for the family to work hard not to monitor and comment on her food can go a long way to make the visit more successful. These practical steps send a message to the family as a whole that things will go differently this year.

Once the ground rules about food are set, the family needs to agree to which conversation topics are appropriate for a holiday visits and which ones are better left to a less emotional time. That's the topic of the next post.

How Therapy Separates Identity from the Eating Disorder

The process of separating identity from an eating disorder is not an intellectual endeavor. All discussing identity will do is lead to a stalemate. The illness dictates the person's every move and decision, like an oracle or a master, so discussion may be interesting but largely distraction. Moreover, perspective on one's identity is hard to come by, especially when that person is in the throes of an eating disorder.

Change will only come from action. Reinforcing the behaviors that go against the eating disorder will highlight the internal conflict between the illness and the person. No amount of discussion can make a person more aware of the powerful identification with the eating disorder than to disobey it.

The food journal, which I discussed in a post a few years ago, introduces a way to contradict eating disorder rules quickly and powerfully. Writing down meals and the rational and emotional responses to them has two immediate effects: engaging another person in the intimate details of the disorder and presenting the disorder as something separate--physically a piece of paper or an email--from oneself.

Even someone's initial reaction to the suggestion of a journal exposes the power of the illness and the fear of confronting it. Some people cannot even start the journal; some only write it for a few days while on "good behavior;" some write food but omit feelings; some write for pages and pages; some are shocked by the effect of letting someone else into the eating disorder. In every case, the effect of the food journal is indicative of how connected the person is with the disease and of the challenges that lie ahead to separate identity from illness.

At many points of treatment, the therapist has to point out new concrete steps to take such as adding in more food or adding in extra treatment. Invariably, these suggestions meet resistance. The patient knows more changes equal more time spent on recovery and more emotional turmoil. Anyone's instinct would be to push back. The therapist's job at these moments is to insist that these steps in treatment are a joint decision. The patient has to take partial responsibility for any change in treatment and to clearly state that her own intentions are different from those of the eating disorder. If the person believes the changes are enforced by the therapist, it's too easy to cling to the identity of an eating disorder. Over time, a sign of identity separating from the illness is the patient initiating discussion about new changes in behaviors.

Although certain moments of treatment are touchstones that highlight the struggle to wrest identity from the eating disorder, successful treatment is a long process. Years of embracing the eating disorder, as captive finds solace in captor, doesn't make separation easy. Even as the treatment makes clear the need to pull away from the illness and find new comfort elsewhere, it's hard to say goodbye to what had been the core of your being. Accordingly, the struggle between  actions that reflect the eating disorder's wishes and those that reflect the person's persists in a long, drawn out battle, with days and weeks leaning one way or the other. The pressure in treatment to stay the course needs to remain firm in the face of the difficult internal struggle the patient must endure.

The growth of a new identity is a slow process but it works. The immediate experience for the patient of letting go of the eating disorder will often be blankness, nothingness. Understandably, that will trigger intense fear and a desire to retreat to the illness and what is known. Even the therapist may despair at times that treatment may not follow the path to recovery. Those times of worry and fear are a standard part of treatment. Those moments aren't a sign of failure but rather signs of the challenges of recovery. Reminding the patient of the process of separating from the eating disorder and learning how to eat and forge a sense of who you are and your life course takes time. The uncertainty may be frightening but experience has proven that the effort of intense personal work bears fruit. Decades of eating disorder treatment shows that finding yourself in treatment pays off with a new and satisfying way to live.

I am not my Eating Disorder: Separating Identity from Illness

Eating disorders begin at a particularly vulnerable time of life. Adolescence revolves around conflict, namely the push for independence vs. the yearning for the safety of childhood. The urge to break new ground and become a separate person combined with the still immature understanding of identity often leads a confused teenager to simple, even comical, shifts in their persona. No reasoning can dissuade the adolescent bent on fashioning themselves an acting prodigy, an expert on political debate, the ultimate savvy socialite, the IT guru or just plain right about everything. The sudden changes in identity, the need to be instantly best at something, the urgency and totality of every self-invention all represent the desire to solve the problem and become someone else, as if identity can be chosen in a moment.

But that's exactly what an eating disorder can do. The eating disorder gives instant purpose in many ways. First, the power to manipulate your body is clearly prized in society. The disorder creates a long list of rules about how to live life: all decisions are made based on when, how and what to eat. The comforting and even superior feeling of having a way to live and a physical identity to cling to is incredibly satisfying. Suddenly, the desire for identity is complete. With the onset of symptoms comes attention and praise. A potentially life-threatening, debilitating illness can be the envy of everyone, at least for a moment or two.

What passes for a magical identity in adolescence is an albatross in adulthood. When identity forms around an eating disorder, the complex and mature inner sense of who we are never comes into being. Linking identity to the goals of an eating disorder leaves a hollow, empty feeling inside. The power to manipulate one's body and the eating disorder rules appear meaningless when the internal struggles change after adolescence and into adulthood.

However, if someone is still stuck in the illness come young adulthood, there is no easy way out just because one's psychology no longer needs the eating disorder. The urgency to find a new philosophy of life isn't enough to escape an eating disorder, and life without the eating disorder feels impossible, as if the core of one's being is being taken away. So the most common result through young adulthood is that identity and the eating disorder fully merge.

A clinician needs to be aware of this psychological process. The patient may be clear about wanting to get better but may not understand that their identity is so tied up with the illness. No one can get better when they are the eating disorder. When the behavioral and psychological symptoms appear to be very fixed, therapists often ascribe stalls in recovery to low motivation. The frustrated therapist's message boils down to: "If you would just buck up and eat, you will get better."

More often, the attachment to the disease as identity makes clear, visible progress so terrifying that the person ends up paralyzed. The desire to get better has little effect in the face of losing who you are. The best analogy is the child sports star suddenly unable to play or the child actor whose career dries up. An eating disorder feels like an achievement in adolescence. It's an accomplishment to have conquered food and body when so many others struggle with weight and self-image every day. Eating and having a normal body feels like letting go of the only true achievement in life. From that vantage point, getting better isn't about motivation. It's about losing your one anchor and entering a terrifying unknown.

The work in therapy is to separate identity from the eating disorder. This concept may make sense abstractly but is harder to imagine practically. The truth is that after years of being sick, the patient does have an identity and personality separate from the eating disorder. That's clear to anyone who knows the person. But identity is not what others see; it's what you see in yourself. The clinician's job is to repeatedly point out what other people see instead. Helping the person see themselves through someone else's eyes can gradually shift identity as well. The goal is to recognize that the internal identity of the eating disorder is, and always has been, false.

Starting to question our being is the hallmark of adolescence. Even a few years later in life, the disorientation of such urgent self-reflection is more daunting, the pull back to what we know even stronger. When the source of safety is a tenacious illness, the process of forging a new identity is even more frightening. For the gradual separation of identity from disorder to last, therapy must use the person's outside life to reinforce the false safety of the illness. Engaging friends and family in the process will allow the patient to understand that others see a very different person than she imagines. When trying new activities or meeting people in new situations, each opportunity calls into question whether identity is really just the eating disorder. By applying constant pressure to the assumption that the eating disorder is everything, the therapy can gradually drive a wedge between patient and illness and open the door to different expectations in life.

The next post will address more practical steps to separate identity from the eating disorder.

Goals for Treating People with Chronic Eating Disorders

A discussion of goals has to start by addressing the obvious question: can people with chronic eating disorders recover? The answer is an unequivocal yes. The deepest fear for anyone who has been sick for many years is a lifetime sentence to an eating disorder. Unless the clinician directly faces this concern, every patient will leave assuming the worst. Thus, it's essential that a discussion of goals explicitly puts recovery at the top of the list.

The second assumption someone with a chronic eating disorder will likely make is that the stated goal of recovery is just a lie created to give false hope. Who in their right mind would think someone can get better after five, fifteen, twenty five years of a brutal illness? Yet those people can and do get better. The road to recovery is long and hard and painful, punctuated by too many moments when all feels lost. A constant theme in therapy must be repeating the idea that recovery is a real option and that a life not plagued by this illness possible.

Recovery, however, cannot be confused with paradise or nirvana. Anyone who has struggled with a chronic illness will be affected by that experience throughout their lives. They can get well but will always have a different perspective of life. They need to be prepared to face their own life circumstances, persevere and move forward, and not think they can rewind life to what they envisioned before the illness. It's crucial to build resilience into the goals of treatment early and represent recovery as a life not completely dominated and controlled by the eating disorder symptoms, not the imagined life they might have led were they not sick.

With these guidelines, the therapy needs to narrow down from large scale expectations to day-to-day goals. Two aspects of chronic eating disorder treatment are central to understand to establish feasible goals. First, the patient is bombarded by thoughts and instructions by the eating disorder itself all day long. These commands, from thoughts to restrict to urges to binge to constant confusion about what to eat, occupy far and away the majority of mental energy of someone with a chronic eating disorder. It's practically a miracle they can do anything else in a day. These thoughts are all consuming, very unpleasant and impossible to ignore. The eating disorder thoughts easily drown out the few sessions or hours of treatment per week. Whereas more limited treatment can reverse an eating disorder earlier in its course, therapy for a chronic eating necessitates daily, constant intervention to make a dent in the relentless illness. Second, these thoughts become the person's identity. After years of living through constant eating disorder thoughts, it becomes very hard to differentiate between the eating disorder and oneself. 

Since no therapy can last all day, every day, the therapist and patient need to collaborate to extend treatment into a daily intervention. Trying to force this treatment into the standard treatment protocol leads to sure failure. A team cannot present an immediate food plan and expect a person sick for many years to make instant changes because they are suddenly more motivated. Eating disorders are just too tenacious to let go because the ill person wants to get better. The clinicians and patient need to explore the nature of the eating disorder and look for loopholes, ways to insert new thoughts and actions into each day. Through more communication via more hours in treatment, food logs, journaling, emailing or texting, the team can be in regular contact so the patient isn't alone with the illness all day long. Creating a new environment in which several people are putting their minds and time into changing a longstanding pattern of illness opens a new door to recovery.

In this circumstance, the practical goals come into clearer focus: stay in touch regularly, communicate through the day, watch for signals or patterns of distress and create and try out new behaviors to replace the eating disorder. The therapeutic effect of these changes is profound and necessary to be sure treatment heads towards recovery.

It's usually eye-opening for a chronically ill patient to see any change in the eating disorder behavior from simple interventions. That first blush of progress begins a new path of recovery. The psychological imprint of years of an eating disorder feels untouchable, yet the start of relationships that may affect the illness is revelatory. It opens that person's mind to possibilities long forgotten. From the therapist's perspective, the person's identity has completely merged with the eating disorder. One doesn't have anorexia or bulimia; one is anorexic or bulimic. The process of separating identity from the eating disorder is critical to successful treatment because it allows in real hope for recovery once again. Yet it's also the most challenging. The next post will address this topic in detail. 

The Hard Line in Eating Disorder Treatment

The refrain from clinicians who treat patients with chronic eating disorders is that there aren't any standard effective treatment options or any useful literature to read. Without a method to rely on, clinicians have turned to the field of addiction for guidance. The accepted approach for a therapist in that realm is rigid and punitive. The eating disorder version of the hard line is as follows. Present the patient with viable treatment options along with meal plans to follow and weight guidelines. If the patient can follow these rules then treatment can proceed. If not, then come back when you're ready. Outside of this simplistic, punitive approach, therapists are on their own.

The premise behind this kind of therapy is that engaging a patient in unsuccessful work will enable worsening of the disease. The eating disorder symptoms will persist without any immediate change in behaviors. More to the point, responsibility for any deterioration will now lie on the clinician's head.

It's no wonder there appears to be so many people with chronic eating disorders not in treatment. The unspoken agreement to hold the hard line among eating disorder professionals lets us all off the hook. No one needs to worry about the chronically ill. They have brought their desperate state upon themselves by refusing the correct course for recovery. Let them think about it and come back in time.

But people come to treatment for help. A one size fits all approach to treating eating disorders is not only reductive but cruel. These are complex, misunderstood illnesses with moderately effective treatments at best and few viable options at worst. How can we as therapists say we have the answer when there is no evidence behind the rigid approach to treatment?

The fear of enabling the illness can easily mask the fear of the therapist to take on such a challenging case. Working through a complex chronic eating disorder takes a lot of time and energy for the patient and therapist. There is certainly no guarantee of success and a high likelihood of managing serious medical problems that stem directly from the eating disorder. It would be more honest for a clinician to say he doesn't have time or expertise for a complex case than to place the blame on the patient. 

What happens when this patient does find a therapist? Things don't get easier. It's just as hard to assemble a team or find a program willing and able to confront the therapeutic challenge of treating someone with a chronic eating disorder, yet these options are clearly more effective than individual therapy alone.

If the patient agrees to more intensive care, most outpatient programs or residential programs cater best to younger patients earlier in the course of the illness. For someone not yet ready for more involved help, it's often a long, uncharted road to understand the eating disorder and institute behavioral changes with food. No manual exists to explain the baby steps in this type of recovery. No map points to paths to success. And no role models offer hope for the chronically ill. It's no wonder many of these patients stop seeking help.

Yet those are the available resources. Any work towards recovery either stays isolated to just individual therapy or expands into a team and/or program. The team offers more chance of full recovery because a patient need different providers to focus on all aspects of treatment and more time and energy to compete with the ever-present psychological and behavioral symptoms. Even the best therapy cannot accomplish all components of treatment. But assembling a team or involving a program also means accepting the misunderstanding and confusion that affects even experienced professionals in facing a complex, chronic illness. Although regular communication among team members and with the patient improves outcome, the patient will have to endure many challenges along the way. Being so resilient while dealing with an eating disorder isn't easy for anyone.

If we assume that treatment has begun and a team of seasoned clinicians assembled, the steps in treatment are still hard to determine. More than with people earlier in their illness, the treatment of chronic eating disorders has two critical components for success. First, it's essential for the team and patient to agree upon reasonable markers of progress and a reasonable timeframe for each step. Balancing the severity of the illness and barriers to progress is not uniform so each patient needs an individualized program. These markers fundamentally represent hope for change and recovery, a sentiment that can be hard believe after a patient has been sick for years. Yet without hope, the treatment is even more challenged from the start. I'll start with these two points in the next post.

Eating Disorder Therapy Decisions: the Hard Line vs. the Risk of Enabling

When faced with new, intractable illnesses without clear treatment, the medical field doesn't have the time to really help. The current climate of medicine forces doctors to rush from appointment to appointment without time to think or sometimes even care. Doctors are too harried, overworked and under-appreciated to be capable of more than the basic standard of care.

Challenging treatment for difficult diseases demands both creative thinking and compassion to open up the possibility of clinical improvement, let alone a cure. There's no room for that kind of medicine anymore.

Eating disorder treatment has come a long way in recent years. If the person's disease is relatively uncomplicated, compassionate treatment is enough. For example, the course of care for an adolescent with her first serious episode of an eating disorder is fairly routine. The patient starts in an inpatient program or intensive outpatient program, depending on severity of the symptoms, in order to normalize eating behaviors and weight. An outpatient team takes over treatment after a period of weeks or months while reintroducing the patient back into normal life. The patient is still young enough to allow the strong presence of family to guide treatment decisions, and the enforced cessation of symptoms often is enough to halt the progression of the disease.

Patients with a chronic eating disorder have had a different course of illness. They have adapted their lives around variable eating disorder symptoms and have had to recognize the dominance of the disease in their lives. They are old enough to be independent and not under the aegis of parents' decisions. They come to treatment often not ready to follow the set course of interventions but solely because they are sick of their illness and want help either to manage it or to get better.

What are the treatment options for these patients? Some clinicians follow standard practice. If the eating disorder symptoms are severe, inpatient or intensive outpatient treatment is necessary. In fact, many clinicians will stop treatment unless the patient seeks more intensive care. The reasoning is that outpatient treatment cannot be successful without normalizing eating and weight. Continuing treatment without medical stabilization sends a message of false hope, perhaps even enabling the disease to remain dominant. Many clinicians interpret this approach as tough love, similar to an approach used to treat addiction, while many patients interpret it as rejection and confirmation of the hopelessness of their cause.

Any different treatment for people with chronic eating disorders has no blueprint. The years of being ravaged physically and psychologically by these illnesses takes a toll. The first step in treatment involves a thorough medical and emotional inventory and a reasonable assessment of short and long term goals. Even then, the path to improved symptoms and quality of life won't present itself clearly.

If the initial assessment both on the part of patient and therapist leads to further treatment, it involves breaking new ground. Any progress stems from creative approaches both from patient and clinician and a willingness to try them even if they fail. All the while, the treatment has to include intensive management of the medical effects of the illness and hope that continued care isn't a means to allow the eating disorder to worsen.

There are risks to both approaches to treatment. Taking the hard line leaves the chronically ill patients alone with their disease with nowhere to go for help. Therapy with the chronically ill revolves around the constant presence of uninterrupted symptoms and the medical consequences of an eating disorder. Without clearly successful interventions for eating disorders, patient and clinicians are stuck with these hard choices.

The next few posts will address these two camps of eating disorder treatment and what it means for a patient seeking help.

What Families Should Know about Eating Disorders

Treatment for an eating disorder is a long hard road. Part of the reason relapse rates are so high and full recovery so difficult is the enduring emotional struggle even after normalizing food and weight. It takes personal fortitude and outside support to help people in recovery not succumb to the iron will of an eating disorder. The crucial but often missing piece for families to understand is that the battle isn't over when someone looks normal again.

It's standard to educate families of people with eating disorders for the best chance for full recovery. Most treatment programs provide family groups in which the group members bring families for an education session. Primary therapists usually include the family in sessions from time to time for the same reason. Recommending books to families can help the patient feel better understood and expand what kind of support is available in the treatment. There are a few practical points all families need to best participate the process.

Everyone is aware of the eating disorder behaviors, restricting, binging and purging. Most families assume that ending these behaviors means full recovery. That false statement is especially worrisome when the patient goes to an inpatient treatment program. Upon admission, the relief for the family is significant, and the expectation is that the patient leaves the program fully cured. Unfortunately, that's never how it works. From the moment of admission, families need to understand that a program can jump start treatment, but that support will be even more necessary once the loved one comes home.

Learning how to eat back in the world has new challenges both in choosing and preparing food and in handling the stresses of life without returning to the eating disorder symptoms. In addition, it's very difficult to struggle to eat while trying to accept the changes to one's body. The underlying, internal critical thought process, the main psychological symptom of an eating disorder even after resuming normal eating, is much stronger after treatment. Consistent, loving support is the best antidote.

One inevitable mistake families make is to focus on the food. Patients avoid families most frequently because of feeling constantly watched at meals. The monitoring always comes from a caring place. After feeling so powerless, families wish that just ensuring enough food passes the patient's lips will be enough to lead to a cure. Instead, patients feel exposed and avoid families rather than submit to being constantly watched and criticized. The most effective way to handle meals is to provide food the person feels comfortable with, allow her to choose and eat as she wishes and simply ask if everything is fine. Giving her the freedom to act like an adult will be most encouraging while watching her at every meal only reinforces the eating disorder.

Families understandably want a clear treatment course with a definite prognosis and endpoint. The process of getting better from an eating disorder is a much more complex road. The exigencies of stabilizing the body and mind to relearn how to eat normally and how to function as an adult without the security of the eating disorder rules are cumbersome. The path to recovery involves many ups and downs and demands a resiliency to weather the tough spots and remember the light at the end of the tunnel. It's extremely difficult for the patient, battling daily in the trenches, to see any light at all. One of the most helpful things families can do is to reinforce the need for patience and to remember treatment is a long, arduous process. Believing in the family member even at the toughest of times reflects a level of confidence and love that endures and strengthens her resolve each day.

By focusing on the positive steps and remaining steadfast on the hard days, families express a sentiment that an eating disorder has surely eroded over the years: trust. The shame of being sick pushes patients to sneak and lie and leads families to question this person who had always been seen as trustworthy and reliable. The internal, critical thoughts of an eating disorder only get stronger when families decide they can no longer trust. I routinely suggest families learn to distinguish the hiding that comes with the shame of being sick from one's true character. Re-establishing trust can make the difference between a full recovery and a partial one. When families work hard not to criticize and blame but instead to forgive and love, the effect on the course of recovery is immeasurable.

Practical Steps to Fight Obesity, Part III

Even if parents understand the message about food and weight that can help their kids, it's not clear how to reinforce it. One way parents date themselves is how they discuss the role of television in their family. It's especially quaint when the smug ones boast about not having a TV in the house at all, as if they've risen above the riffraff to aspire to new cultural heights.

But the statement "I'll never let my kids watch television," once considered a critical element in defining ones family, is meaningless today. Sure, television still matters but only as one of many forms of entertainment. At least for now, the internet age has turned us all into consumers of content, however it gets into our home. And that's a fact for no one more than today's kids.

Children no longer need to wait for their favorite show each week, now it's instant gratification. Content in all its forms is available on every electronic gadget in the house and in every possible form to rope in a child. Perhaps even more troubling to adults who aspire to TV-free households would be the definition of content today. Scripted shows, reality videos, YouTube and movies all clearly fall into the content category. What about novels and news outlets? What about research, which, to kids today, constitutes creative googling or emailing questions to an expert they find online? When the only successful internet business model is based on clicks, a website will do whatever it takes to lure readers or viewers. As the line between knowledge and content blurs, there's no easy way to eliminate entertainment from the house. Every bit of information comes with an ulterior motive. It's all content now.

Advertising clued into this new opportunity long ago and capitalized on the easy access to children's minds with, not surprisingly, problematic results. The business goal was to rally children to ask parents to buy products, but the actual effect was to inculcate the suggestible with misguided information. The repercussions of the advertising onslaught were profound, note the toy fads and growing tween culture considers critical to the economy, and not challenged by alternative messages until decades later.

Public health spots and non-profit campaigns, the first alternatives were no competition for advertising. The ideals of consumerism and a free market even for children persisted. However, more recently, the creative freedom allowed by exponentially growing content outlets led some forward-thinking creative types to make shows intended to teach children ethical and moral lessons. These shows are so powerful that kids use and apply the information in school and at home.

That I know of, these lessons, easily tolerated by parents, are from the bottom of the creators' hearts. Among the messages are kindness towards others, tolerance of difference and self-respect. Sometimes the messages are more concrete like do your homework and clean your room. On that list a common theme is eat healthy food, but the message to eat more carrots, as I have written many times, has no real impact on how children learn to live in the world of plenty. 

The last post explained the new paradigm adults can use to teach children about food, weight and identity. The content children consume must reflect the same values to compete with the extant pressures from advertising and the drive to be thin. Older shows like Sesame Street and Mr. Roger's Neighborhood were primarily educational and aimed at younger children. A new genre for older kids provides ready-to-absorb values to take into their world. Coming from coveted content, children accept this information much more readily than anything parents might say. Ironically, content provides an opportunity to challenge what kids learn in the world of plenty.

The momentum needed to start a shift in children's content about food and weight already exists. I began this blog almost three years ago in response to desperate emails from confused parents unsure where to turn for help with their kids' eating. Those emails keep rolling in. As many have told me, it's a full-time job just to get some worthwhile advice. The faulty paradigm of eat less and move more reinforces the problem. As the internet economy attracts the bright, creative minds today, content could quickly spread a new thought process about food and weight to kids, which if accompanied by adults and peers who feel the same way, might start to undo the toxic climate in the world of plenty.

The new approach to food and weight has three simple points. What you eat and how you look do not determine the person you are. In other words, it takes years of growing up to figure yourself out and there's no magic fix, including food and weight. Eating is about pleasure and sustenance. The body needs a variety of foods to survive, and human culture has long connected food with enjoyment and connectedness. Last, kids need to dissociate eating from good and bad behavior. Eating is only about eating, and praise and punishment must be separate from food.

The message is clear and simple. More importantly, rather than attempting to refute the years of successful advertising, this paradigm creates a new way to incorporate food and weight into kids' lives and minds and perhaps a new way to spread the word.

Practical Steps to Fight Obesity, Part II

The conclusions of the last few posts about the obesity epidemic are sobering and perhaps even bleak. The causes of the problem are systemic and deeply embedded in our culture. A drastic change in lifestyle by returning to the era before processed food, agribusiness, the drive for thinness and chronic dieting is highly unlikely. The expectation of an immediate solution to weight loss via surgery, crash diet or miracle pill is pure fantasy. The solution is a hard road through moderation in food intake with reduced expectations for the future. That doesn't mean quick weight loss followed by stabilization but instead slow, steady, sustainable change.

Most epidemics spread horizontally, through a generation, both old and young, and must be contained from sweeping through an entire population. This one grows vertically. A child needs to be taught by adults, peers and advertising how to engage with the world of plenty, how to become obese. The challenge to care for the currently obese isn't enough to stop this epidemic.

The real hope lies with helping future generations avoid the same fate. The current world of plenty may shift slowly over time but not fast enough to save today's youth. Without tools to avoid this fate, children are mere fodder for the societal forces that lead to obesity. Adults and public policy must know what to say and what to do in order to make a difference. The perils of processed food and mass marketing are dire but invisible to kids. They need to be convinced that there's a different way to live around all this food.

Practically, direct education and public health initiatives aimed at children don't do the trick. Certainly, some obedient children will respond to information as law to live by or to fear-based propaganda as horror stories to avoid. However, the innate propensity for children to test adults and rebel against authority will make food rules just another set of parental edicts to disobey. Getting into the minds of children takes somewhat more creativity. Two points are essential to make a difference with kids: educating parents and adults how to talk to kids about food and weight and getting into children's heads through content they'll listen to.

Both parents and public health administrators need to be aware that the teaching points available to educate children are ineffective. Eat less, move more and learn "healthy eating" facts--the trifecta of food education--neither change food behavior nor lessen the risk of obesity. Cooperative, motivated adults are fonts of nutrition knowledge yet find that knowing what to do has no effect on their own behavior and weight. Children, moved more by the innate urge to pick the poison apple, will take on food rules as a challenge to either squeeze extra sweets from exhausted parents or sneak them at any opportunity. The simple education model is a boon to the food industry. Sophisticated marketing and advertising trounces any earnest public health campaign.

Children are all instinct and emotion. The tack of using logic and reason to change clearly preprogrammed urges is hard enough for adults and unrealistic for kids. But there's one thing business already knows: the malleable minds of children are open to suggestion. And much of what draws children in to focusing on food and weight is the promise of a secure identity.

The basis of a child's personality is largely genetic, but the birth of identity forms around relationships. In other words, we are born with many character traits that define how we react to the world, but only by engaging with the world do we learn how to perceive ourselves. Personality doesn't come with a guidebook. Other people provide the feedback to form identity. Self-awareness is a gradual dawning over years that reveals our mental perception of who we are.

In childhood, the powerful desire for an identity comes with the urgency to feel instantly fully formed. Food and weight, the overarching obsession of this generation, is an easy barometer of identity. That can be the kid who eats anything, the kid who doesn't eat, the kid who is thin or who is fat. But food and weight can provide instant identity.

Accordingly, the practical first step is to teach kids to let food be food. Children can't learn food choice is related to good and bad behavior or be praised for eating in any particular way. They can't believe they are special because of how they eat or how they look. They can't learn to associate guilt with dessert or that eating is always a shameful act. They must learn food is necessary for life and a regular part of every day, that meals can be enjoyed and not scary and that weight is not a barometer of success and failure. They have to hear a new philosophy of food and weight every day and allow their internal search for identity bypass food and weight to look for different ways to see themselves. And they need to hear over and over again that it takes time to figure out who you are. Focusing on a quick fix like food and weight won't speed anything up. In fact, it doesn't work for anyone.

If this is the message adults need to teach kids, the second key point is how to get them to listen. That will be in the next post.

Practical Steps to Fight Obesity, Part I

Issues of public health, no matter how dire, can be a hard sell. Unless there's a dramatic angle to the story, few will get fired up by a nation's well being. It's not uncommon for an individual to find the altruistic impulse to help a person in need--there's a bit of a thrill, for example, in the guilty gesture of giving to the homeless--but the overall public health doesn't stir up the same generosity of spirit. With individuals focused on their own extra pounds, the people charged with drumming up support for the obesity epidemic, which shortens lifespans and is very costly to the government, have a tough time building any interest.

The successful public health campaigns in recent decades have gotten creative to generate enough buzz to try to make a difference. The dramatic attempts to shock kids out of drug use (this is your brain; this is your brain on drugs) or to horrify smokers with the medical effects of cigarettes (the public display of emphysematous lungs) elicit most often derision or outright mockery, certainly not the intended effect. Meanwhile, business advertising counterparts, trained in the coercive arts, something not taught in an MPH program, are much more effective in targeting their audience.

Appealing to the national zeitgeist of health at any moment is a challenge. The most effective strategy looks for a dramatic edge, most often the age-old battle of good vs. evil. With a natural enemy or corporate entity to blame, it's a lot easier to frame the solution and rally supporters. It's not hard to understand when the goal is to eliminate the root of the problem.

A systemic change in the way we as a society choose to live, willingly or not, poses a much harder dilemma for the public health rabble rouser. Changes to our food supply, the relentless pressure to be thin and the growing ranks of sedentary media consumers have created a tectonic shift in the public perception and reality of food and weight. A systemic change doesn't present a simple, black-and-white, good vs. evil message to hang the proverbial public health hat on, not when food and weight is on everyone's mind, from industry to the individual. There hasn't been a way to find consensus to galvanize the movement against obesity, not when the solution remains either elusive or incomplete.

Responsibility for the obesity epidemic ranges from business to government to medicine. But pinpointing causes does little more than instigate outrage and blame. Moreover, only information and action can disempower the entities that thrive on the aimless attempts to fight obesity. For future generations to be protected from the endless supply of food and concomitant weight gain, the public health outreach needs to inform the adults responsible to teach children and to connect to kids in novel, memorable ways.

For adults to listen, the campaign needs to present the stark contrast between the assumptions of the food and diet industry and the facts about food and weight. It's patently clear that diets don't work, yet, shockingly, dieting is still the only advice given by professionals and industry alike. That advice tends to come with either disdain for the obese person or with the faulty promise of a swift, magical cure. In other words, a public health advocate needs to debunk the myth of a quick solution to both the common and individual obesity epidemic and present the facts about food and obesity to adults. The caveat, and only reasonable fact the experts agree upon, is that moderation of food intake will lead to weight stabilization and moderate loss, with moderate health improvement. The public won't be eager to hear about lowered expectations, but accepting that reality can be a relief when presented as a true alternative to the diet and weight-obsessed lives that plague most people with obesity. Accepting slow change is worth the liberation from cyclic failure.

Winning over kids to the campaign is a much harder challenge but is essential to avoid passing the crisis down generation after generation. The power children wield in first world culture spurred the formidable advertising and marketing minds to win over the impulsive id of youth. Kids may not plunk down the money for said product but instead must generate enough of a fuss for parents to grudgingly buy the item--be it food, content, toy or electronic gadget--for a moment of peace. Clearly, business has spent significantly more creative energy to attract children than any anti-obesity program thus far. We can ply them with carrots galore, but it's the wont of childhood in this day and age to fight full bore until that candy bar is safely in hand. Add to this scenario the limitless supply of child-friendly content, including television, video games or apps, and a typical child's fate becomes clear: a calorie-dense diet and sedentary lifestyle has become the norm.

Parents may very well want to shape their children's lives into healthy ones, but the information available to do so is confusing and often contradictory. Parents pull blindly from the nutrition cache and try unsuccessfully to replace white bread with veggies and dessert with fruit. They sign their voracious reader up for every sport. The specter of obesity haunts them enough to embrace any half-baked idea about a child's health. The decades of knowledge about child development and the wide and normal variability of a child's body type through childhood and adolescence remain ignored.

Parents need useful information to read and clear guidelines to follow. The basic dietary advice about healthy eating that has little effect on adults is even less effective for children. Given a child's limited, or more likely non-existent, desire to follow any food rules, the endeavor quickly feels hopeless. Just hand over a supersize bag of chips, turn on the TV and give up already. The next post will outline some of the key points to make the public education of children effective and and the important facts for parents to hold onto in order to save their kids from the obesity epidemic.

A New Public Health Approach to the Obesity Epidemic

The original public health problems pitted man against nature. Bacteria in unsanitary water causes chronic diarrhea. Iodine-fortified salt fixes goiters. These days first world public health issues are manmade. Without a common, uniting cause, human instinct leads the search for a villain to blame for the crisis and subsequently purge from society. It's the superhero approach to public health.

Sometimes that's easy. The big, bad tobacco industry played the villain well. It took a while to break down the marketing juggernaut, and the powerful nicotine addiction, but the end result was secure. Sometimes finding the villain is much harder. Who's the bad guy in the obesity problem? If you're an activist looking to stir the pot, who exactly are you fighting?

The obvious first culprit is the food industry and agribusiness. Taken broadly, these companies create processed food that's extremely tasty, inexpensive and minimally nutritious. It's been easy to target industry as the cause of the crisis and embrace the newest David vs. Goliath battle. There's no doubt these companies haven't done society a service, but they're only a cog in the machine. Maybe the diet industry, which encourages a generation to await the newest miracle weight loss plan, is the evil villain. Playing on our deepest desire, its promises are patently false and only worsen the problem. Chronic dieting slows down individual and collective metabolism to a crawl and only leads to more weight gain in the end. Perhaps the fashion industry is most at fault by instilling the impossible goal of near-emaciation in generations of girls.

Even the academics themselves may just make things worse by peddling their solutions to the obesity crisis as if weight loss and maintenance couldn't be easier. The experts' insights into the causes of obesity are eye-opening, but every book ends with the same tired rhetoric. Let's all learn how to have "healthy" diets and exercise, and the obesity epidemic will miraculously disappear.

People who've turned to doctors for help know that the medical field can be implicated too. Internists blindly watch patient after patient fall into the same obesity cycle and scornfully shame each one saying, "Well, if you just eat less ... " Pediatricians hide behind BMI thresholds and ply meaningless suggestions to parents about cutting out extra ice cream or white pasta, as if simple food choice is the issue. And Bariatric surgeons reap financial rewards by mangling perfectly healthy gastrointestinal systems without any sense of the long term success or risk of these procedures.

And then government, regulators, journalists and chefs who do want to help don't know where to turn. The bland advice to eat more vegetables and less fast food, to move more and sit less, to cook more and have family meals is all sound but wholly ineffective. The growing number of desperate people fall into the hands of the powerful industries ready to capitalize with false hopes and dreams.

So whom do you fight? Who's the bad guy? What's the obvious target for a budding idealist? When all the facts are clear and the activists gather around the table to develop a plan, there is no real answer. The problem is systemic. The entire society lost its way with eating. There's no villain to be found. It's a new type of public health problem grounded in how we have chosen to live.

As of now, activists focus on the periphery, the tiny nibbles that won't really matter. Transparent food labeling in supermarkets and restaurant chains helps people know what they're eating even if it doesn't affect food choice. Banning large sodas might help some people decrease sugar intake. Increasing availability and affordability of Farmer's markets looks nice on paper. The slow shift to slightly larger fashion models certainly leads many to breathe a sigh of relief. But when a society expects availability of any food at any time, when the farming industry runs on the subsidized price of corn, when everything a population does is sedentary, when competitive dieting has become television fodder and replaced softball as the national office sport, the writing is on the wall. And a few political gimmicks won't do a thing.

The success of activism lies in its target. Effective public health campaigns have to focus on the future. All eyes on the obesity crisis have addressed the current obese. The paltry ideas of the experts are as ineffective as every diet on the market. The only choice with the current generation is to debunk the myths of a magic cure and encourage steady, sustainable diets with reasonable expectations of, at best, moderate weight loss and improved health.

The only real place for activism is for future generations. That means proactive programs to teach children a different way to eat. Kids may need to learn what balanced meals look like and feel like in their stomachs. They also need to know that food means sustenance, health and pleasure. Kids need the basic facts about how eating is critical to body function and to the success of our species. And then they need a crash course to understand the wholesale changes in how we eat and how we want to look in recent decades. They need to be aware of the endless ways our world can hijack their minds and bodies into food obsession and the obesity epidemic. The world of food might change in years to come, but children have to cope now with the delectable treats on every corner, the endless pressure to diet and lose weight and the confused adults around them unable to find their way. Activists can take a stance to create a smart public health program that offers an alternative to this current world of food and supplies real ammunition to fight the daily pressures to succumb to the starve/overeat cycle which inevitably leads to obesity.

The Unspoken Reality of the Obesity Epidemic: What the Experts Won't Say

From the fame of Michael Pollan to the outcry about agribusiness to the first lady's signature Move Your Body! program, it's impossible to ignore the American struggle with weight. The interest in the issue may be apparent, but the proposed fixes remain rudimentary. Anyone curious how and why the rate of obesity has skyrocketed in recent decades can find a growing library of well-researched, thought-provoking books. Looking for an expert speaker to summarize the country's dilemma? They abound.

However, if you're searching for an effective approach to the problem, you're in trouble. Some experts focus on regulation of agribusiness and the food industry, similar to the fight against tobacco, but that's a long-term project complicated by the fact that people can live without tobacco, but not without food. Others emphasize the truisms of the diet industry, eat less and move more, without divulging the fact that 99% of diets fail. So why would anyone believe the collective national diet will have any more success? And the physicians obsessed with "evidence-based" treatment are holding out for the miracle weight-loss drug while chastising their mostly overweight patients. That's no more than a pipe dream at this point.

Food and weight are not particularly complicated. The real issue is that no one wants to reveal the truths this country faces, much better to pretend that a magic solution is just around the corner.

The clear facts about food and weight are as follows. There is much more food available than ever before, and most of the increase is highly processed and inexpensive. The combination of successful marketing and the development of irresistible foods decreases any one person's ability to manage daily intake effectively. The regular person's life is much more sedentary than in years past. Chronic dieting leads to rebound weight gain  and a gradual weight increase over time. Due to these factors, rates of overweight and obesity have skyrocketed. 

Similarly, the facts about ways to fix the obesity problem are clear. None of the current suggestions work. If any one idea had merit, the word would spread like wildfire. As it is, every new crash diet or exercise program has its fifteen minutes of fame, while the well-meaning "healthy eating" programs are the neglected stepchild compared to the advertising and delectable offerings of the omnipotent food industry. Everyone is desperate for a new solution to cling onto, but no one wants to be clear about what really can be done.

The problem needs to be split up into two parts. First, what are the practical approaches for the currently overweight and obese? And the second part of that question no expert wants to address: what are reasonable goals for long-term weight loss? Second, what can the country do to ensure the obesity problem is limited to a few generations and does not become the new norm? Although the two pieces overlap, separating them clears up the difference between realistic expectations and activism.

Only one weight loss approach works. And it's completely obvious and intuitive. In order to change ingrained behavior, one needs a long-term, sustainable, consistent meal plan developed with a professional or a program since an individual who struggles with food inevitably reverts to old patterns without external intervention. That means working with a doctor, nutritionist or a reasonable program such as Weight Watcher's to implement and follow a clear daily approach to food. The plan needs to provide adequate calorie intake to sustain health and to stay within the person's energy needs. After years of excess food, it will take years for a body to adjust hunger cues and adapt its weight range to a lower food intake. All of the evidence makes it clear this is the only effective option.

There's a reason no expert will make this point. The diet industry preys on the collective desperation to lose weight now. Even the smartest, most experienced dieters know that no magic diet will ever work. Yet the masses suffer under the delusion that permanent, speedy weight loss is in their immediate future. No one will hear otherwise and no one is brave enough to face the wrath of saying it like it is.

What is the benefit of blowing the secret? And at this point would anyone really listen? No one wants to believe that the current overweight generation will remain overweight. Yet, with a little perspective, that fact is evident. As I have written before, chronic overeating drives up an individual's set point weight range. Since the body protects itself against weight loss much more than weight gain, as the set range increases, the low point of the range increases as well. The body will move easily within the range but will resist weight loss at the bottom of the range, even if the bottom of the range is still significantly overweight. Moving within the weight range is easy. Shifting the entire set range down is a much harder long-term proposition that involves sustainable, consistent decrease in food intake over years. It's not a big leap to realize how improbable that result is for an entire country.

It's important to recognize that even if this generation as a whole remain overweight, many individuals will find the right meal plan, rely on considerable support and gradually bring down the set weight range. As more clinicians and programs provide effective solutions, more people will find an approach to weight loss and maintenance that works. But the likelihood a country will do so is very slim.

In the fight against long-term obesity, the current generation will have a very specific role. The fate of the overweight generation is to attempt to reject chronic dieting in favor of a sustainable change in eating and live with the modest weight loss and health benefit. Adults can teach children how to survive the world of plentiful food and how to avoid the cycle of overeating and dieting and thus not become obese themselves. That's the topic of activism in the fight against obesity, and I'll address it in the next post.

What do the Experts Say about the Obesity Crisis: A Summary of the Current Information

The clamor for practical, effective information about obesity and weight loss is growing rapidly. Although the latest fad diet, magic cleanse or false nutrition claim still attract the most attention, word has spread through the major news outlets that 99% of diets fail. A quick review of the available resources reveals that the recent global transformation of lifestyle and food supply created and now perpetuate the obesity epidemic. More scientists, researchers and clinicians recognize that the issue needs thought, concern and action to counter the disastrous effect of unregulated food and diet industries. So what's the verdict of these newly minted experts thus far?

Even a quick summary of the available data about dieting is unequivocal. It doesn't work. Diets pretty much always fail. Any combination of severe calorie restriction, magic nutrient compositions and newfound supplement concoctions are sheer quackery meant to capitalize on the desperate willing to try anything for success. The underlying motivation of every diet guru is monetary gain. The diet industry is huge business and is sure to quash the obvious conclusion that diets fail at every turn.

Another consensus opinion is that nutritionism is man made myth, not true science or medicine. Nutritionism, as explained in previous posts, is the process of creating meal plans based on food components, protein, carbohydrates, fat, vitamins, minerals, etc., rather than actual food. The concept implies that current knowledge of nutrition is complete and that the best, healthiest meal plan is easy to create based food components and is completely effective for weight loss. Experienced academic nutrition professors and scientists dismiss nutritionism and instead expound on the dangers of spreading such misleading information. Omnivores one and all, humans need to eat a wide range of foods, not food components. We adapted to survive on an extremely wide range of diets, a trait sure to extend our longevity. The sage advice of the experts is that the best meal plan is simple and general: not too much food with ample variety. These are simple words to live by.

Yet the simple advice has been woefully inadequate to make a dent in the problem. At this point, the conversation inevitably turns to metabolism and weight management, basic facts needed to tackle the problem of obesity, which are incompletely understood and surprisingly complex. Metabolism encompasses how the body uses food, our energy source, to function. Weight is generally stable within a range but varies according to overall food intake and energy expenditure. The body stores energy during excess and uses that stored energy during lean times. And that balance has been very effective to maintain weight, until the last few decades. Put simply, the recent introduction of significant excess food with high fat and sugar content apparently overrides the mechanism that maintains weight and has triggered the obesity crisis. Human evolution protects against weight loss effectively but much less so against weight gain, something that has never before been a problem in human history. The experts then conclude with this statement: years of human function and evolution show that moderate food intake and moderate physical activity lead to a stable weight range, and we need to return to that basic concept. Beyond that, the experts, one and all, throw up their hands. As of now, they all seem to agree: that's all we have to counter the issue of obesity. Since everyone is still hooked on a quick fix for the crisis, the experts' message is largely ignored. Although the experts' opinion is undoubtedly accurate, it's the presentation that needs a little work.

The underlying premise of the obesity crisis is that we need a fix now. Our current knowledge about weight and metabolism relies on the largely unchangeable evolutionary adaptations of the human body. Maintaining stable weight and energy stores is essential for life. Human survival depends on a body that can adapt easily to change and is resilient in hard circumstances. In fact, we even have multiple backup systems for any possible failures to essential organs, much like a backup generator for a power failure, all to maintain the status quo, or in medical jargon, homeostasis. Homeostasis means that the body always will work to keep things stable. This can refer to blood levels of various electrolytes and blood cells, heart rate and blood pressure, hormonal balance and pretty much all body function. Of course, metabolism and weight are included. In recent decades, the average weight range has gone up but that hasn't done away with homeostasis. Instead, the body recognizes the new norm is a higher weight range, and the body uses the evolutionary system to protect this new range. So a quick fix tests an age-old system and repeatedly fails. But if we apply the experts' advice, any approach to the obesity problem has to respect that homeostasis is here to stay.

The next step is to combine expert opinion and change the time of the conversation. Moderate food intake with variety and moderate exercise will, slowly and steadily, chip away at the obesity problem. Weight loss can only come with a gradual decline in each person's normal weight range as the body slowly reacts to a more moderate daily calorie intake. The key to effective weight loss is sustainable, consistent and small calorie decrease over a long period of time. For this message to work, the focus needs to shift from a quick fix to a reasonable, sustainable solution, one that takes into account how our body functions, not the desire to just fix the problem.

The next post will address how to apply this information practically and how to spread the word.