Mental Health Vacation

Happy holidays, dear readers.  I wish you and your loved ones a joyous holiday and blessed new year.

I am taking this week and next off work because I seriously needed a break from the grind.  It became clear as I intentionally slacked off (by taking my time replying to patient emails and returning calls) that I was nearing the point of burning out.  In healthcare that can lead to dangerous mistakes and serious consequences.  So with more than enough PTO banked up and one month's notice, I was approved to check out for the last 2 weeks of the year.  

I confess to reading my work emails form home because if I didn't I would return in January to about 200 unread messages (damn you daily listserv communications!) and a I did log into to our patient care program to see if any cancer patients had kooky questions (a recent curveball: "Someone told me to drink aloe juice, honey and rum everyday to keep the cancer from spreading") or if tube fed patients were not tolerating their formula, etc.

Now it seems I've traded one set of tasks and deadlines (clocking in, seeing patients, attending meetings, etc) with another (today it was buying the last couple of gifts for family, wrapping the pile that has amassed this holiday season, dusting, unloading the dishwasher, washing the two counters-worth of used dishes, cleaning the bathroom, hanging up my clothes from earlier this week, finding time to exercise, make dinner, prepare a salad for 42 friggin people on Christmas, and on and on)...

What I DIDN'T need was cleaning up red wine/pizza/salad/taquito barf last night (which was not mine).  Or a speeding ticket (51 in a 35).  Or wrapping my car around a parking garage column.  (Insert every bad word you can think of and you've echoed my sentiments exactly).

So now I confess to *desperately* needing a time out.  I am forcing myself to sit quietly and do nothing but close my eyes breathe at regular intervals throughout the day.  I am giving myself permission to be flawed and to not have everything done perfectly.  And most of all, I am reminding myself that Christmastime is about family, hope, and love.  Here's a perfect example of that, courtesy of my 4 year old cousin:

A holiday jingle

Sung to the tune of "Deck the Halls"

Fill the 'fridge with seasonal produce
Fa la la la la la la la la 
'Tis the season not for berries

Fa la la la la la la la la 
Give the winter crops
A fighting chance
Fa la la la la la la la la 


Sad tomatoes just aren't worth it

Fa la la la la la 
la la 
la
laaaaaaaaaaaaaaaaaaaa 


I admit to not making it down to the farmer's market every week so from time to time I rely on grocery stores for my produce (like most of the world).  It's shocking to see anemic looking summer month crops trying to be passed off as yummy year-round.  Just look at how pale the poor fruits are in my photos.  Look, I love strawberries and tomatoes as much as the next All-American foodie but I respect the seasonality of foods and patiently wait for the right season (or buy them frozen) to thoroughly enjoy and maximize on their nutritional value.
To find out what's in season, visit Sustainable Table and enter your state and the time of year.  See you in summertime, berries.

Giving thanks

Happy Thanksgiving, readers! I am thankful for each of you taking the time to read my posts and commenting. I hope you have a delicious day ahead!

The secret ingredient is...

... red cabbage!  My bf's mom dropped off some Korean food (cuz we all know I can't pull that off) this week as well as some miscellaneous produce.  When I saw the cabbage I was taken back to the last time we squared off: junior year of college in my organic chemistry lab.  The task: isolate the essential oil.  The challenge: gagging my way through each noxious step at 8:00 in the morning.  Yep, that day red cabbage won and since then I've kept my distance.
Well, I have a hard time throwing away perfectly good food (except for the red onion; had NO problem throwing that monster away) so I turned to my trusty sous chef, allrecipes.com, and tried to find a way to even out the Erica-Cabbage score.  I present:


Sausage Smothered in Red Cabbage

Ingredients

• 1 small head red cabbage, shredded
• 1 apple, cored and diced
• 3 teaspoons salt, divided
• 1 tablespoon lemon juice
• 1/2 cup water
• 1 tablespoon butter (didn't need because I skipped the next ingredient)
• 1 small onion, chopped (definitely omitted)
• 1/8 teaspoon ground black pepper
• 1 tablespoon wine vinegar
• 1 pound kielbasa sausage, cut into 1 inch pieces

Directions

1. Place the cabbage in a large kettle, and add the diced apple, 2 teaspoons of the salt, lemon juice, and 1/2 cup water. Bring to a boil then simmer, covered, about 15 minutes stirring occasionally.
2. In hot butter, saute the onion until golden. Add the onion to the cabbage along with 1 teaspoon salt, pepper, vinegar and sausage. Cook, covered, 20 to 30 minutes until sausage is heated through. To serve, spoon the cabbage onto a heated platter, topping it with the sausage.

I expected a bitter-tasting dish so I doubled the vinegar and used apple cider vinegar instead because I thought that would tie in the apple flavor well. It did, but came out a little salty so I would cut back to maybe 1-2 teaspoons salt and probably add another apple. (Korean mom practically gave us a bushel.) I served this alongside smashed potatoes (too lazy to peel them) and voila! Dinner is served :)

Mad scientist makeup

The longer I work in oncology, the more suspicious I am about everyday items contributing to cancer development.  It just doesn't make sense why young people have advanced forms of cancer or really rare forms of cancer that doctors don't know how to best treat.  You can't blame the patient- it's not like they intentionally messed up their DNA or swallowed the tumor whole- so what gives?
The state of medicine and health seems to prioritize treatment rather than prevention.  I appreciate the advances thus far after reading The Emperor of All Maladies: A Biography of Cancer and understanding the horrific surgeries and excruciating chemical cocktails used to treat cancer in the past.  Yet that big question- WHY- has largely been ignored. 
One reason why I participated in Breast Cancer Fund's hike last month was because they are committed to identifying and advocating for the removal of environmental exposures to prevent the disease.  While we may choose to eat organic foods and watch the alcohol intake, lather on sunscreen, and exercise diligently to take care of ourselves we don't consider the carcinogens found in personal care/beauty products.  Starting with bright purple j.a.n.e. eyeshadow and frosted pink Bonne Bell lipstick in 7th grade, who knows what's accumulated in my body over the years or why I got my period when I was 10 (a risk factor for breast cancer)!
I've spent hours looking up the insanely long chemical names in my beauty products and I am *so* glad that I did.  I've basically scrapped all my hair, nail, shower, makeup, and body products in favor of alternatives that don't contain parabens, phthalates, lead, or triclosan, among other nasty ingredients.  I think the Environmental Working Group's Skin Deep Cosmetics Database should win a Nobel Prize for making this information readily available.  I've searched by brand name (shame on you, MAC!), ingredient (see above list of nasty names), and by product type (i.e. foundation, deodorant) to find the lowest rated health hazards. 
Fortunately, Bare Escentuals is a low risk product line easily found at Sephora and lots of acceptable cosmetic, hair, and body products can be found on drugstore.com and beauty.com.  I've been introduced to the wide array of products from Maia's Mineral Galaxy and Honeybee Gardens by the EWG database.  I am proud to support their company's efforts at making people feel happier and having fun with their appearance without jeopardizing their health in the process.

Lead used to be an ingredient in lipstick.  Not cool.

Peekaboo

It's hard to love your body when it's bursting at the seams of your pants. Good thing today is the first day I can use my $30 off a $100 purchase at Banana Republic. I'm on the hunt for stretch-blend trousers!

Reaching the peak with a pain in the arse

Ugh. I've been sick all week and haven't formally exercised since Monday! I considered overriding my body's indications that we are not alright (breathing out of one nostril while the other alternates dry spells with snot faucets) but backed out. Still went into work though ;)

So I have been left reminiscing about recent physical accomplishments and the Peak Hike for Prevention, a fundraiser for Breast Cancer Fund, was a bright spot.
It took place in October on Mt. Tamalpais in Mill Valley, north of San Francisco. My vibrantly young aunt, Angela, survived breast cancer last year and recently finished surgical reconstruction (yay!). She assembled a team, Angela's Angels, and we took off for the peak on a cold Sunday morning. Within 15 minutes we encountered a disaster: a yellowjacket nest on the ground that must have been disturbed by the people before us on the trail. They were not buzzing happily.
The leader of our group, my sister-in-law, was stung all along her backside and I, second in the line, just froze in place and took it. I covered my ears, neck and face thinking my long sleeves and pants would protect me. Ha. In seconds I felt sharp pains along my forearms and one my left buttcheek. Score: angry yellowjackets: 7, Erica: 0.
The first aid tent didn't help much but I was determined to finish what I started. So a steep 3 mile climb up and 3 mile zig zag hike down was in order. As active as I am I figured I could pull this off without training and while yes, I did survive the hike, I had to take frequent breaks on the way up to catch my breath.  Perhaps I should add altitude to my fitness mix.
It was well worth it, though.  What I experienced that cold morning was nothing in comparison to what my aunt has faced undergoing bilateral mastectomies, adriamycin/cytoxan/taxol chemotherapy, radiation and the fear of cancer returning in the the future.  She's always in my prayers.
Here we are on the summit:

Don't dig your grave with your own knife and fork (English proverb)

Today is Food Day, created by Center for Science in the Public Interest, and to a foodie dietitian like myself, it's as exciting as Christmas Eve (even after learning who "Santa" really is!).  These are the six principles of Food Day:
1. Reduce diet-related disease by promoting healthy food
2. Support sustainable farms & limit subsidies to big agribusiness
3. Expand access to food and end hunger
4. Protect the environment and farm animals by reforming factory farms
5. Promote health by curbing junk-food marketing aimed at kids
6. Support fair conditions for food and farm workers
My job is written into principle #1.  However, in school we're not really taught about agriculture systems so the remaining principles- and bigger picture food issues- have been ignored by future nutrition professionals. There's a huge disconnect between the farm and how food ends up on our plate and we're supposed to be the nutrition experts!  Unfortunately we pass along the naivete to our patients and unknowingly perpetuate the drive toward current factory farming practices. 
Modern industrial farming is shameful, in my opinion, and documentaries like Fast Food Nation, King Corn, Food Inc., and Super Size Me got me thinking "I don't want to participate in this anymore" and "I will make a serious effort to find alternatives."  My dream is to one day grow my own fruits, vegetables, and herbs, but I just don't have the land or space to do so.  Thus, I spend my money to support people and companies who do their best to grown food the responsible way.
Living in Northern California I feel so lucky to have fresh produce available year-round that I try not to take it for granted.  I support my local farmer's market for seasonal fruits, vegetables, eggs from pasture-raised hens, and occasionally some grass-fed meats.  It sucks to not eat tomatoes and berries year-round but I prioritize eating locally grown food as a way to minimize the environmental impact of flying produce in from all over the world.  Every now and then, though, the bananas call my name and I can't resist :)
I'm also grateful for Sigona's, a family-run grocery store in town, that also supplies me with organic produce, pasture-raised chicken, and grass-fed beef, with an abundance of products from California.  Sure, I'll probably never be able to afford a house in the Bay Area but the richness of our food supply makes it *almost* worth the financial stress!  
I encourage you to decide for yourself how you'll be a part of Food Day today and everyday hereafter.  Lots of buzzwords are out there if you'd take the time to do your own research:
Local... seasonal... organic... sustainable... food deserts... subsidies... Farm Bill... genetically modified organisms... grass fed... pasture-raised... fair trade... confined animal feed operations... and so on.

Need inspiration?  Browse Food Day Recipes from celebrity chefs!

First of all, I'd like to thank my body. Without it I wouldn't be here...

Heyyyyy youuuu guys!  It's Love Your Body Day and seriously, if just for one day, I encourage you to celebrate what that fine machine of yours has given you the ability to do.  Modern media has convinced us that a teeny, tiny, practically non-existent body is supposed to be the holy grail of shapes and in reality few people naturally fit that build.  Therefore, potentially many wasted hours/days/years of the greater majority's life is spent lamenting why those curves and rounded tummies won't go away.  It's time to GET OVER IT and appreciate what you got, just like my body hero, Christina Hendricks.

She WORKS IT and makes no apologies for being the way she is.  She (and/or her stylist) know what flatters her shape the most and she looks amazing.  She told Health.com "Q: What is your best advice for reaching total body confidence? Do you have it?
A: I guess my mom raised me right. She was very celebratory of her body. I never heard her once say, 'I feel fat.' " So for that, I have to agree and give major props to my mom for raising me similarly.  Our family consists of various shapes and sizes and never once did I get a memo that my size was unacceptable (apparently I was put on blast in dance class but luckily that blew over my head.  I wasn't trying to be a Rockette, ya heard?!) 

This article includes an extraordinary image of how much plastic surgery the model would need to achieve Barbie proportions.  Let's cut to the chase:

Yikes.  I don't think a carved out neck like that could hold up a human head.

An eating disorder survivor made a life-size model of Barbie and it looks like a circus act!

I'm not going to lie, there are some days I wish my pants slid over my hips a little easier and it makes me temporarily sad to get rid of clothes that don't fit anymore, especially since I have a scrapbook memory and remember how long I've had the item and the approximate last time I wore it... but I quickly snap out of it and remember that feeling comfortable and confident in my chosen outfit is head and shoulders better looking that squeezing into something a size too small.  Vanity sizing doesn't do much for our psyche either so rather than stress about the number or size on a hidden tag, I buy clothes based on how they fit and tailor them to fit me even better.  (Shout out to my "teachers" Stacy London, Clinton Kelly, Tim Gunn, and Nina Garcia for preaching that expecting clothes to fit perfectly off the rack is NOT typical!)

Besides being a medium for me to dress up, I've got to thank my body for being intelligent and healthy to get me through grad school, able-bodied to work, hike mountains, finish 5 and 10ks, bench press, chase around my silly dogs, love, laugh, and dream.

Respect.

Completing my first 10k last year :)

Woohoo! Thinking about thinking about making a change is part of the process

Coming out of school and my dietetic internship I was ready to transform lives and help people overcome their eating challenges.  I was bright-eyed and optimistic that my patients would achieve all their dreams in just one or two visits with me.  Therefore, that first meeting was a blitzkrieg of information, a verbal diarrhea if you will.  Never once did I consider how the patient was taking it all in, just assuming they instantly knew what I was talking about and so it was ok for me to plow forward.  It was time to stop talking when our appointment time was up, not when I could identify the glazed over look, a telltale sign the patient had mentally checked out of the conversation. 
I expected them to come running back a month later to proudly report all the positive changes that were going on in their lives.  In reality they would half-heartedly make an attempt to come in for a follow up or they would take the same-day-cancellation or no-show route.  We'd never be in touch ever again.  What went wrong?
Memories of learning about nutrition counseling as an undergrad and dietetic intern are hazy.  The lesson usually involved ridiculous/embarrassing "role play" so I never paid attention to the point of the exercise.  Such a waste of an opportunity to show baby dietitians how to be most effective on the job. :(  Besides at the time I was more focused on knowing "book knowledge" and having an answer for everything, not so much how to get to the desired outcome (controlled blood sugars, lowered blood pressure, begin exercising, losing some weight, etc). 
With my brains, sparkling personality, and extremely good timing in the job market, three years ago after finishing grad school I landed an outpatient dietitian job.  Having a supervisor and colleagues very cognizant of the complexities of behavior change has defined my career.  I finally began to see the bigger picture: there's no need to pester/use scare tactics/drag them to do something, or a need to waste your breath talking about something you fully know they will not follow through with.  You simply elicit what information they'd like in this moment and present them with a menu of options to meet that need. 
First it takes some exploring how aware the patient is that there is a problem.  Prochaska and others best described this in the Transtheoretical Model (TTM).  Depending on the patient's stage of change it's most effective to tailor your information to match their level of thinking and motivation.  Someone in denial they have diabetes?  Don't even think about giving the "carb talk" or show them how to use their glucometer.  Touch on the objective data like labs with reference ranges and leave it at that.  Even then some patients might deny their blood sugar is that bad but you've done what you could.  Someone all fired up to throw away the junk in their house?  Awesome game plan, so then what will you do when someone invites you to their house or you see treats in the break room at work? 
Most patients fail to recognize that their eating and exercise choices are lifelong so relapse is also part of the change process.  It does NOT mean the patient is stupid, lacks self-control or is a failure when old habits creep in again.  I encourage my patients to reflect on the experience and learn from it.

 STAGES-OF-CHANGE CHARACTERISTICS AND STRATEGIES

STAGE	CHARACTERISTICS	STRATEGIES
Precontemplation	The person is not even considering changing. They may be "in denial" about their health problem, or not consider it serious. They may have tried unsuccessfully to change so many times that they have given up.	Educate on risks versus benefits and positive outcomes related to change
Contemplation	The person is ambivalent about changing. During this stage, the person weighs benefits versus costs or barriers (e.g., time, expense, bother, fear).	Identify barriers and misconceptions Address concerns Identify support systems
Preparation	The person is prepared to experiment with small changes.	Develop realistic goals and timeline for change Provide positive reinforcement
Action	The person takes definitive action to change behavior.	Provide positive reinforcement
Maintenance and Relapse Prevention	The person strives to maintain the new behavior over the long term.	Provide encouragement and support

(Source: Zimmerman et al., 2000; Tabor and Lopez, 2004)

So you have someone ready and motivated to make changes?  Learn from my mistakes and don't overwhelm them with all the possible choices to make.  One of the most respected techniques for promoting behavior change is motivational interviewing.  Research shows it to be effective in helping people overcome substance abuse/addiction, eating disorders, and manage chronic lifestyle-related diseases like diabetes.  Patients who use their own personal motivations as the reason for making changes are more likely to stick to the plan than if they were told to do something by someone else.  What do they care if you think they eat too much salt or fat?  It clearly doesn't bother them (at least up front). Or maybe it does bother them but they haven't thought of a solution to beat that rut.  If there is a hint of dissatisfaction somewhere in their choices, carefully chip away at that barrier.  Training sessions from Molly Kellogg and Steven Malcolm Berg-Smith have helped me craft the right open-ended questions and forced me to be a better listener so I pick up on when a patient expresses something personal and motivating to them.  Then I use that to get the ball rolling on trying out a new behavior. It all ties back to them and what's ultimately going to matter most in their lives.  I get to be the supportive coach watching on the sidelines.

Chuckles from the HAES community

Like I mentioned in my last post FNCE was an eye-opening, shameless display of the influence Big (Processed) Food has on "educating" fellow health professionals and how to spin a message in their favor.  Reviews of "The War on Obesity: A Battle Worth Fighting?" are rolling in and I have to say Marci Klein's review is my favorite because she captured the 5 most ridiculous comments from double chinned obesity researcher John Foreyt.  I was too shocked to listen that well, so I appreciate the efforts by others in helping remind me that fat stigma and the "Everyone wants to be skinny deep down inside" dogma still exists.
Linda Bacon's HAES blog added some behind-the-scenes information that brought to light Foreyt's multiple weight loss industry ties and that he had no problem taking money from ADA just to be there.  I know it's more painless to keep our head buried in the sand but what's at stake- clients'/patients' long-term wellness and healthcare professionals' ability to safely promote lasting behavior change- really depends on knowing the truth!
So what else makes me laugh?  This graph from another HAES blogger:

Lastly, I love the cajones on "super class 3 obese" dancer Ragen Chastain for posting her hate mail but linking it to the ad-supported blog page so she makes money off the ignorant haters!  Genius!  She and other inspiring (and a few sad) people are profiled in the limited released documentary "America the Beautiful 2: The Thin Commandments".  I can't wait for wide release and hope you make an effort to see it too.
Be well!
YFD

Nice to see you again!

Hi friends.
My goodness, life has been busy!  I've been swept up in Missoni for Target madness (more like borderline obsessed with making sure I get every last piece via eBay and checking my Target online order status to make it sure it hasn't been canceled), family events, and a recent trip to San Diego for the American Dietetic Association's annual Food & Nutrition Conference & Expo.  I visited fellow CSULB internship survivors friends in Orange County and had a wonderful time catching up with them.  Newlyweds, babies, and careers, oh my :)
Continuing the theme, I reconnected with classmates and professors from my undergraduate years, my former boss and co-workers from my first dietitian job, and grad school classmates.  It was fun to reminisce on our evolution from uncertain students to full fledged professionals and everything in between.
I was so happy to see the Health at Every Size-themed debate "The War on Obesity: is It a Battle Worth Fighting?" and had no idea of ADA's history with rejecting a practice group for like-minded dietitians and for previous conference sessions.  So shady!  The pro-weight loss researcher was not only a rotund hypocrite but said absurd things like "Everyone wants to be skinny" and "Intuitive eating is responsible for the obesity epidemic."  Oh man.  I had to laugh at his stupidity.  Go HAES!
On a sour note, I was disappointed by the corporate presence at the expo and one-sided presentation topics. I gave the stink eye to Monsanto, Cargill, Corn Refiner's Association and "big food" reps with apartment-sized booths like Coca Cola, McDonalds, and Mars.  Sessions like "Hot Topic: A Fresh Look at Processed Foods" and "How Risky is Our Food? Clarifying the Controversies of Chemical Risks" may as well have been re-titled "Industry Sponsors Downplay Their Role in Making Cheap Junk Food" or "Look!  We Have A Few Healthy Foods to Choose From."  Please.  It's so blatant and ugly though it's nice to I know I'm not alone in my feelings.
I was introduced to the work of the Hunger & Environmental Nutrition dietetic practice group and am pleased they also share my disgust for corporate sponsorships, among other passions.  I guess I'm among the black sheep of RDs who see the networking and educational value of ADA but feel dirty for the affiliation.
All in all, I must say it was a nice break from the work grind.  I'm happy to he home and settling into my routine again, including blogging!  
P.S. Sorry for the white background as it is different from my usual template but I can't figure out how to undo the background text color.  

Return to innocence

Part of the Health at Every Size(SM) philosophy includes eating according to individual hunger and satiety (the feeling of being full) cues.  Forget the sexy TV commercials or billboards or our initial panic response to stress, feeling sad or excited, or any other reason to gravitate towards food.  A healthy relationship with eating involves paying attention to our stomach and listening to rumblings as a signal to eat.  Or a comfortable filling that it's time to stop.  Return to the trust that babies exhibit when they make it known they are HUNGRY NOW and when they've HAD ENOUGH.
Easier said then done, right?! 
I think one reason why alot of people eat in a distracted environment is that the honest pleasure of food is too enjoyable for them to admit.  It's almost shameful to have a 30 minute date with just you and your food.  Thirty minutes could be spent checking emails, catching up on TV shows, doing laundry, you name it. 
It's also a little sad to be alone with food.  Many society and cultural traditions emphasize celebrating using food; in a quiet home or at a table for one in a restaurant, it's just not the same experience.
Given the increased processing and chemical manipulation to our "food" supply, getting the task of eating over with as quickly as possible makes it somewhat more palatable and easier to forget that we subjected ourselves to dissatisfying stuff.  Would slowly savoring a slice of frozen pizza really do it for you the way a homemade slice out of a wood burning oven might?  I doubt it.  But noticing that the frozen pizza is too chewy or bland is beginning to trust your instinct that you are not satisfied.  Ultimately we would be ok with not eating that particular pizza at all and search for something more satisfying to please us.
With this in mind, I am constantly reminding myself of the principles of intuitive eating(TM).  At some point in my early years of life, these feelings were inherent and worked for me.  Somewhere along the way, cleaning my plate, Sally Struthers and the starving children in Africa, and boredom beckoned food in a different way.  So I am a work in progress and wholeheartedly believe it's never too late to return to a place of  trusting your instincts. 
 After the fact I relaized this was too much for me to eat at once but I sure enjoyed the meal itself!

15 minutes (and I'm not talking car insurance)

Bodies were meant to move.  Period.  The stigma of exercising 'til exhaustion and "no pain, no gain" have robbed joyous movement of it's best intention: to make our bodies strong, healthy, and functioning at its best.
I occasionally suffer from "all or nothing" syndrome where if my rush to leave work and head to the gym isn't timed just right, if my hair is too nice to get sweaty or mussed up, if I miss my dogs and want to play with them first, etc. I skip an opportunity to show my body what it can do. 
This study has reframed my thought process about exercising "perfectly."  Simply doing something moderately-paced (which my natural walking stride accomplishes) for 15 minutes a day will lengthen one's life by 3 years.  We definitely have 15 minutes to spare everyday to commit to this and if you think you don't, we need to re-evaluate your priorities.
Even better, a new iPhone app rewards its users when they log 15 minutes or more of continuous exercise.  After each exercise, you have a chance for a discount based on your geographic location.  Then you are entered into a monthly grand prize, and a smaller daily prize drawing.  I can't wait to see what spoils this brings!

Little do they know our daily jaunts are also motivated by mommy's desire to win prizes!  Muah ha ha ha ha!

Health not determined by a scale

Part of the goal of writing this blog to explain why being "healthy" doesn't mean thin/skinny/BMI 19-25/vegan, etc.  Through the dedicated work of professionals like Linda Bacon and the Association for Size Diversity and Health I, as a reformed, free-thinking dietitian, am beginning to see the light (pun intended): FAT DOES NOT KILL!
Bullocks, you might shout!  Revoke her license, they might say.  But if you honestly spend a little bit of time reviewing the data you'd understand.
This review paper explains it all.  Just because a health condition (diabetes, high cholesterol, sleep apnea, etc.) is associated with being overweight doesn't mean the weight caused the disease.  This is so important to keep in mind: association is not as powerful as causation.  Since the 1950s atmospheric carbon dioxide and obesity have increased.  Does this mean carbon dioxide caused obesity?  Of course not; but more cars on the road meant less people walking or biking and more car emissions.
In an effort to stop wasting a substantial amount of our lives trying to fight our internal war against the weight and passing judgement onto strangers, let's focus our time and resources on embodying healthy behaviors.  Some people lose weight as they improve the quality of the foods they eat and become inspired to move their bodies but this is clearly not the primary goal.
So where does that leave us?
Basic Principles of Health At Every Size^®
1. Accepting and respecting the diversity of body shapes and sizes.

2. Recognizing that health and well-being are multi-dimensional and that they include
    physical, social, spiritual, occupational, emotional, and intellectual aspects.

3. Promoting all aspects of health and well-being for people of all sizes.

4. Promoting eating in a manner which balances individual nutritional needs, hunger,
    satiety, appetite, and pleasure.

5. Promoting individually appropriate, enjoyable, life-enhancing physical activity, rather
    than exercise that is focused on a goal of weight loss.


Join me on this side of the fence.  It's so much nicer and friendlier!  

 As a teenager I wanted to be skinny and felt so self-conscious in my dance costumes.  Looking back at myself all these years later I can't help but smile because I looked GREAT!  (And again, with age comes wisdom in the personal care department: roots like those are but a distant memory.)

Seeking penance

Heavenly father,
Please forgive me, for I have sinned.  I used to be a stereotypical dietitian in my first 2 (ok more like 4) years in practice.  I'm now in my 5th year of practice and STILL learning my style.
I was a very good student and sought to do the best job I could on every homework assignment, project, presentation, and test.  I knew what my career path would be by age 12 thanks to reading Reviving Ophelia and wanting to help people overcome their fears about eating and their bodies.  I haven't regretted that decision at all over the years and feel pretty lucky to have discovered this at such a young age.  Looking around the workplace I see people decades older than me uninspired and unhappy on the job.  That will never be me.  (Check back in 15 years, just to be safe.)
In college I learned certain diseases like diabetes and high blood pressure can be treated by modifying one's diet, exercise habits, and losing weight (not quite true, it turns out, but more on that later).  As a baby dietitian I spoke non-stop at 100 miles per hour in my patient visits.  I handed out pre-designed meal plans and miscellaneous handouts to solve everyone's problems.  Then I wondered why no one ever came back to keep working at their problems.
Three years ago I was hired by my current company and credit my boss and colleagues for being knowledgeable about understanding resistance to making behavioral change and "non-diet" approaches to weight management.  I finally understand why a dietitian's counseling skills make all the difference in truly helping someone, more so than their book knowledge.  I am still working on the nuances of being a better "nutrition coach/counselor" but am confident in the direction I am heading.
So to those patients I saw from 2006-2010 I'm sorry for not doing my best.
Your friendly dietitian,
Erica

I'm thrilled to report my professional skills and fashion sense have improved since internship days (circa 2005).