Beating the Stress Cookie Monster

Remember Cookie Monster from Sesame Street? Do you ever feel like attacking some chocolate chip cookies with the tenacity that he does? Most of us have probably felt that way on a very stressful day-- just let me at 'em! Last week, I blogged about how stress leads to weight gain. Now, we'll take a look at how to handle that stress differently.

The first key is hidden in the last sentence of the previous paragraph. It's the recognition that you will have to deal with the stress. It's an active proposition; stress can't handle you-- you have to handle stress. For some of us, we feel utterly helpless, and the stress of life can be as terrible as the poor cookies must feel as the Cookie Monster is ripping through the package. This feeling of helplessness causes us to hope for some period where our lives will be stress-free and go according to our perfect plan, but generally speaking, this never happens. Stress can ebb and flow, but it seems to always be there. Understanding that you can deal with it effectively is the first step to being effective in dealing with stress. As many others have said in the past, if you don't think you can, you probably won't.

The other equally critical component that people fail to consider in dealing with stress is the perception of stress. Do you realize that you actually create stress for yourself! Things happen to you all the time...what you do with that information and how you process those events leads to the feeling of stress and thus your emotional, physical, and behavioral response.

There is no denying that your perception is your reality, so you should work on shaping your perception so that your reality results in less stress in your life. It's really the classic glass half full or half empty issue. Some of us look at the upside of everything while others of us look at the downside. If you feel stressed and out of control, take a minute to see how you interpret the things that are happening around you. Contemplate the things that you can control and for those things that you can't control, let them go. When everything in your world seems out of control, food is one of those things that you can exert some control over. So you decide to "reward" yourself by making the choice that you want no matter what anyone says. You have the power to do that with so many other areas of your life! Why exert that control to only hurt yourself more? Don't be afraid to exert that power to do something good for yourself.  You'll find that the Cookie Monster can be tamed, and that he likes other things besides cookies.

In your journal this week, identify things that caused you to feel stressed. Try to figure out why you perceived it as stressful, how much control you had in that situation, and what types of choices you made as a result of the control you had. I'll be interested to hear what you find.

Running from Tigers and Bears

At least 75% of our patients identify stress as a major factor in causing weight gain for them. Dealing with stress effectively can make a huge difference in your ability to manage your eating behaviors and your weight. A lot of the solution boils down to being able to self-soothe without food.

Why does stress lead to weight gain? The basic explanation is that we are hard-wired to respond to stressful situations in a way that makes us ready to defend our lives. Back in the day, our stressors were things like tigers and bears. Nowadays, our stressors are unreasonable bosses and crazy family members. While we don’t have to outrun them or get into physical fights (or least we try not to), our bodies still respond in a way that makes us feel like we need to be prepared for that possibility. To be prepared, our bodies get signals from hormones and chemicals that we synthesize to fuel up for the impending danger. However, we our access to food is ever-present and much more calorically dense than when we were running from tigers and bears. So instead of foraging for nuts and berries, we forage at the vending machine, choosing the 650 calorie honey bun and the 200 calorie soda to get through the afternoon.

Another part of the explanation of how stress leads to weight gain is the behavioral reinforcement to which we unknowingly fall a victim.  Remember when you had a bad day at school and your mother offered you a piece of cake to “make it all better”? That type of experience conditioned you to associate feelings of comfort and solace with cake. The cake didn’t necessarily have anything in it that was a mood altering substance—I don’t think she would have slipped you some Prozac; however, your mother’s comfort and concern for you were linked to the cake. We have the ability to associate memories and emotions with inanimate objects like food. This is especially true for food because the sight, smell, and taste can be an incredibly powerful stimulus.  So now as an adult 40 years later, you’re still looking for a piece of cake when you get home from a tough day at work or after arguing with your significant other.

So if we know all of this, why can’t we simply change how we respond to stress and stop eating? This is a central question to why obesity is so challenging to treat effectively. Food is powerfully consistent in its effects on your brain. Part of this is due to the fact that a lot of our manufactured food is designed to be exactly the same bite after bite. So you know that the last bag of candy you ate is going to taste just like the next one. Even though you intellectually understand that you shouldn’t go for the chocolate just because you are upset, you still do it because you can count on it making you feel a certain way, even if only temporarily. Until you can identify something that helps you soothe yourself and relieve stress as reliably and immediately as food, it’s hard to beat the feeling you get from that food.

All hope is not forsaken though… 

Don't Get Pinched this St. Patrick's Day!

St. Patrick’s Day is right around the corner. Wearing green will prevent a pinch on the arm but eating green can prevent a pinch at your waistline! There are TONS of great green vegetables. To name a few: broccoli, spinach, green beans, peas, asparagus, brussels sprouts, and cabbage…and the list could go on. The good news is that you can eat large amounts of green veggies for very few calories. One cup is only about 25 calories! Now, that’s a big bang for your (calorie) buck!

This St. Patrick’s Day I’d like to highlight three green superstars--kale, artichokes, and edamame.

Kale: This leafy, green vegetable is loaded with vitamins A, C, and K. It’s also stacked with minerals like potassium, iron, manganese, and calcium. It can be cooked many ways including baked, steamed, and boiled. Check out the recipe for Kale Chips below. You can’t get more festive than that on St. Patty’s Day!

Homemade Kale Chips
Prep: 5 minutes
Cook: 12 minutes
Yield: 4 servings

Ingredients
3 cups fresh kale leaves
2 tablespoons olive oil
1/4 teaspoon sea salt
1/4 teaspoon freshly ground pepper

Preparation
1. Preheat oven to 450F.
2. Place kale on a large lightly greased cooking sheet. Drizzle with olive oil and sprinkle with salt and pepper. Bake in preheated oven for 6 minutes; toss gently. Reduce oven temperature to 300F and bake 6 minutes more. Let cool and serve immediately. Enjoy!

Artichokes: This unusual looking veggie is filled with magnesium, folate and potassium. One medium artichoke contains 10 grams of fiber! [Note: We should shoot to eat 25-30 grams of fiber per day]. You may have passed artichokes in your grocery store and thought, “what in the world do I do with those!?” Check out http://www.youtube.com/watch?v=_FT8iSDxFq0 for help on how to clean and prep your artichoke for baking, steaming, grilling, or boiling. Once you’ve prepared and cooked your artichokes you can add them to soups, salads, or roast them with spices and herbs! Delish!

Grilled Artichokes:

Ingredients
6 artichokes
1 tablespoon plus 1/2 teaspoon salt
1 lemon
3 cloves garlic, minced
3 tablespoons olive oil
2 tablespoons lemon juice
1/4 teaspoon pepper

Preparation
In a large pot, bring 1 to 2 inches of water to a boil. Add 1 tablespoon salt, the juice of 1 lemon, and artichokes; cover and steam until artichoke bottoms pierce easily, 20 to 40 minutes. Drain artichokes. When cool enough to handle, cut each in half lengthwise and scrape out fuzzy center. In a bowl, combine garlic, olive oil, 2 tablespoons lemon juice, 1/2 teaspoon salt, and pepper. Brush artichokes with garlic mixture and set, cut side down, on a grill over medium heat. Grill, turning once, until lightly brown, 8 to 11 minutes.

Edamame: AKA soybeans or “branched bean”. These little pods make for a fantastic snack or side dish. A ½ cup serving has about 60 calories and they are loaded with protein (about 12 grams/cup), fiber (5.7 grams/cup), and B-vitamins. They are easy to cook and mix well with other veggies. Shelled edamame is a wonderful addition to salads and pastas and it’s a killer addition to succotash. You can find edamame in the freezer section of your grocery store either shelled or in the pod—it’s your choice! Your next snack is waiting…

Steamed Edamame:

Ingredients:
1 package frozen edamame in the pod
Your favorite low-sodium spice blend (I love The Delicious Dietitian spice blends because they have no sodium—check them out at http://www.thedeliciousdietitian.com/lindseylee/).

Preparation:
Place edamame in a microwave safe bowl. Add 2 tbsp water. Sprinkle with your favorite, low-sodium spice blend. Cook on high for 2 minutes. Enjoy!

I hope you are a lean, mean, green-eating machine this St. Patrick’s Day!

In the words of one of my favorite bloggers...until next time...."Healthy Eating!"

Lindsey

The Battle between Consistency and Perfection

In the journey to lose weight and adopt better lifestyle habits, perfection is NOT the goal. Consistency, however, IS the means and the end.


In working with one of my patients this week, I noticed that she was apologizing throughout our session. We were reviewing her food journal, and every time we came across a food she deemed "unacceptable" she apologized for "messing up" or making a "mistake." This is not an uncommon experience—patients tend to approach weight loss as if there are hard and fast rules that can't be violated. In the worst form, people give up after breaking these rules or "cheating" as most people call it. They find that they can't get back on track because they only anticipate that they will find themselves breaking the rules again very shortly.


The All or None way of thinking can dominate your approach to healthy lifestyle behaviors, and when you're on track, you feel invincible and incredibly focused. However, when you're off track, you're a train wreck full of despair. The All or None approach may be helping you in some aspects of your life. For example, you may be able to block out distractions and have laser-like focus on work projects. This can lead to you being incredibly successful and accomplished, but it won't help you when you're trying to modify your lifestyle.

Sometimes, you may miss the mark. Just keep aiming in the right direction

Why can't this approach work? Healthy living and losing weight is not governed by some set of rules and regulations. Despite what some people may have you believe, there are many effective strategies to achieving a healthy lifestyle and weight. You have to find a way of doing things that works for you, based on your situations and unique challenges. As you develop this approach, your goal is to implement it consistently. You also have to take ownership of the actions and choices you make using a framework other than "cheating." You're not cheating anyone if you eat the chimichanga and your original intent was to get the grilled fish. That was a choice you made, and you should own it. When you own it, you have to then understand why you made the choice and how you can make other choices that are consistent with your goals the next time.


Liberate yourself from the unattainable goal of perfection and go for consistency. See how much easier that feels already!

Dear Dr. Benjamin

I had the privilege to hear and meet our Surgeon General, Dr. Regina Benjamin, at UAB yesterday as we kicked off National Nutrition Month with a great event sponsored by the Department of Nutrition Sciences. In one of the introductions describing the wonderful person that she is, Dr. Benjamin was described as the health care Santa Claus for the nation. She has been preaching a message of joyous health and working hard to bestow the gift of healthiness for all. As the nation's doctor, she has worked to deliver a message that our health care system should be focusing on health promotion and prevention of disease just as much as we focus on developing the best medical technology in the world for treating disease. Since we were there to focus on nutrition, a lot of her remarks dealt with obesity. I figured that I might follow up with a Christmas list of things I'd hope to see as we all try to fight the obesity issues we face.
My list for healthcare Santa Claus:

1. Prescriptions for healthy eating- as a primary care trained internist, I know and appreciate the benefits of modern medicine. Prescriptions for medications to control acute and chronic diseases are wonderful to have available; the insurance coverage for these medications is even better (when available). I would like to see us use prescriptions for healthy foods in a similar way. Let those of us with the appropriate training (physician nutrition specialists, dietitians, nurses, etc) prescribe healthy food options for those at risk for or those who have preventable diseases. The prescriptions would provide a voucher or some discount on the prescribed foods (primarily low energy dense fruits and vegetables, lean protein, nuts, beans, and healthy fats). By paying for these foods, we may save money on medications that don't prevent the conditions or expensive procedures that are needed because the conditions are out of control. We have an exercise is medicine movement that has been active for some time now…I see food as medicine as the next step.
2. Provide insurance coverage for obesity treatment by obesity specialists- I know that Medicare has announced that reimbursement for obesity counseling will be provided to primary care practitioners in the near future. Most of us still doubt that this will lead to effective treatment because the primary care practitioner has little training and fewer resources to deliver the type of therapy that has been shown to be most effective. With all of the great resources I have at my disposal and the primary focus of my career being obesity treatment and weight management, I still find it challenging to do the things we do. I would like to be able to prescribe the most effective treatment for my patients, regardless of considerations about the patient's ability to pay, but I can't because all of the effective medical therapies we have available are not covered by insurance. So, those who often need it most are forced into an alternative that may be less than ideal, even when they have good insurance. I'm not suggesting that primary care practitioners shouldn't be involved…I believe they play a critical role in raising awareness, helping patients make the connection between body weight and health issues, and providing referrals to credible treatment options. However, we need to develop medical and behavioral specialists (physicians, psychologists, dietitians, exercise therapists, nurse practitioners, PAs, etc) who can treat complicated obesity just in the same way as the surgical field has the bariatric surgical specialist.
3. Get rid of the junk- My last wish is for Santa Claus to get rid of the snake oils and phony treatments being peddled as "cures" for obesity. If we could limit the amount of time and effort being put into these supposed treatments that have no scientific evidence as being effective, our patients would save a lot of time and money. This time could otherwise be focused on developing the skills and knowledge necessary for people to take better care of themselves and develop healthy lifestyle habits. We've finally gotten the FDA to declare HCG treatments for obesity as fraudulent. Hopefully, this trend will continue, and we can elevate the practice of obesity treatment to a higher standard. I think my wish list item #2 is critical to seeing the evolution of treatment and disappearance of the snake oils.