Donut-licking is an Aberrant Eating Behavior

ariana keep outBefore this “news” story hits the briney deep, I have something to say about Ariana Grande. She is the 22-year old celebrity of Nickelodeon TV, theater, and music fame who was seen in July, on a surveillance video, licking glazed donuts on an uncovered tray in a donut shop. On the audio, she was overheard saying, “What the f*ck is that? I hate Americans. I hate America. That’s disgusting!” There were entertainment-news stories and hash tags galore: #ilickdonuts – #donutgate – #donutproblems – #arianadonuts –  #arianagrandelickingdonuts –  #ariwearewithyou – #arianahatesamerica. This week I read that Ariana Grande Is Now the 2nd Most Disliked Celebrity, Following Close Behind Bill Cosby. Can you believe that? 

But for me as a clinician, donut-licking raises a red flag. It is an aberrant eating behavior on par with eating in a ritualistic way, chewing food and spitting it out, mixing strange food combinations, eating the same foods over and over, skipping meals, taking tiny portions, cutting food in little pieces, and refusing to eat with others. They are all aberrant eating behaviors that may be seen in eating disordered patients.

Ariana also happens to be extraordinarily thin, which wasn’t the case last year when (according to the Internet), at 5’1” tall, she weighed 106 pounds (BMI 20), a perfect weight within the healthy weight range. But within the past year (according to the Internet), she lost twelve pounds by following a vegan diet. I figure that now Arianna is in the underweight range, weighing 90-94 pounds (BMI 17).

Ariana Before Vegan

Ariana Before Vegan

Ariana After Vegan

Ariana After Vegan

I’ve explained why vegan diets are a problem in Beyonce Promotes Vegan Diet. Tricked by Her Trainer. But that doesn’t stop the knuckleheads on YouTube from praising Ariana’s weight loss. (See Ariana Grande Vegan Weight Loss Transformation.) The photos are telling.

I understand why Ariana Grande might let it slip that, subconsciously, she hates America. After all, we made her into an object that must stay dangerously thin (and hungry) in order to survive. As a role model, she spreads the poison to young fans. How can she feel good about that? When all she wanted to do was sing and dance. I hope she gets help.

How I Use Calories on the Menu

Yesterday, at a rest stop in New Jersey, standing in the combined line for Cinnabon, Popeyes and others, waiting to pay for the blueberry-granola-and (un)real yogurt that I always get, I spied a “MiniBon” roll and mentioned that, calorie-wise, it was better than the classic. (The Cinnabon Classic has 880 calories, while the Minibon has 350 calories per roll.)  My daughter and the woman standing ahead of me, both in their 20s and of slim/normal weight, admitted they had no idea of the number of calories they need. Neither one seemed the worse for the lack of information, but I gave them a tiny lesson on calories (and told them never to “diet.”)

Later that night, I read this on the Intuitive Eaters Professionals Group on Linked-In:
“The other day I went to a restaurant for lunch with friends and was surprised to see calorie counts next to each menu item. My friends, both fairly health conscious “normal” eaters, didn’t seem to mind, but did remark on the counts. I was bothered because I found that the counts drew me away from eating intuitively and back to my days, half a lifetime ago, of dieting. I had to force myself not to look at them and then was okay. My question is: Are menu item calorie counts helpful or not? Might they be useful for different populations, i.e., okay for “normal” eaters who want to eat more nutritiously but not so much for anyone who leans toward dis-regulated eating?”

Calories on the Menu

Expect to see calories on the menu in restaurants with 20 or more outlets as part of the Affordable Care Act upheld by the Supreme Court last week. Restaurants and movie theaters must post calorie information on menus, menu boards, and drive through displays, and provide written information about total fat, saturated fat, cholesterol, sodium, carbohydrates, sugars, dietary fiber, and protein upon request.

For people like my daughter and the woman in line, the information will be meaningless, but for others, it may be extremely informative or downright disconcerting. As a longtime registered dietitian, intuitive eating practitioner, and former dieter over thirty years ago, I think a “calorie information free menu” should be available to anyone upon request, no questions asked. (Heaven forbid the Affordable Care Act returns to the Supreme Court for alleged “actual harm” coming from calories on the menu!) Anyway, I live in New York City where calories have been on the menu since 2008. Real-world studies show that, as a public health intervention, it has only a modest reduction or no effect in the calories purchased by customers. In time, the issue could be a moot point.

For what it’s worth, this is what I told my daughter and the woman in line about how I approach calories on the menu:

  • Women need about 2,000 calories a day and men need around 2,400.*
  • When the calorie count is high – say greater than 20% of the daily total or 400 calories – look askance
  • Decide if the extra calories are from too much wholesome food or from “empty calories” full of added sugar and/or animal fats but with negligible nutrients.
  • For wholesome food, I split the serving with my companion or carry away half, and for empty calories, I decide if I love it enough and have to have it right then. (Luckily, I’m not impulsive.) If yes, then I have it; if no, then I skip it. But if I were to feel guilty or otherwise, awful, I’d ask why and think of it as a growth opportunity.

Righteous indignation seems to fuels me. You can’t get me to eat most of the crap sold in American chain restaurants. I don’t value filling my body with junkie food. I am attracted to fresh food well prepared, mostly by me. Usually, I’m sated at don’t care about dessert. If I really want dessert, then I eat it only a little at the meal.

Your thoughts: What do you think about calories on the menu?

*To find your calorie requirements, use this chart from the government or use a calculator fromany one of the online diet websites.

My Intuitive Eating “Aha” Moment

On LinkedIn, I am a member of the Intuitive Eating Professionals Group, where Evelyn Tribole, MS, RD, group founder, asks us to “share something…that is not included in your profile, perhaps an “aha” moment in your career.”  I am inspired to share my “aha” moment after attending the BEDA (Binge Eating Disorder Association) national conference on Saturday, where I learned that, treatment-wise, not much has changed over the years.

In 1985, I worked in a large gastroenterology practice affiliated with a teaching hospital. I saw lots of eating disordered patients because one of the docs did medical evaluations of patients with bulimia and AN. At the same time, another gastroenterologist performed a procedure with a device called the Garren-Edwards Gastric Bubble. A deflated ‘bubble’ made of stretchable plastic (like a pool toy) was placed by endoscopy in the stomach of a severely overweight patient.  With the pull of a cannula, the bubble was inflated and left in place to fill the stomach while the patient followed a low-calorie diet. That’s where I came in. The bubble was developed by a team at Johns Hopkins. It was all above the board. The hospital asked us to do the procedure, but we stopped after a patient got a small bowel obstruction from the bubble. Those were interesting days. My patients’ eating patterns were all over the map.

But my “aha’ moment came by way of a patient referred by an internist for a simple weight loss diet.  She was a favorite patient, a young woman of my age, overweight but far from obese, with my mother’s maiden name. We were doing the balanced, flexible diet thing with a focus on behaviors when one day, she looked at me and said, “Mary, you don’t understand. I peek behind the curtain, and when my husband drives away, I make a batch of scalloped potatoes, and I eat the whole thing.” Aha! I thought, “they didn’t teach us this in school.” And then I thought, “this is really real.”

I was lucky because psychologists who specialized in EDs would stop into  the office. They turned me on to Susie Orbach, Fat Is a Feminist Issue (1978); Geneen Roth, Feeding the Hungry Heart (1982) and Breaking Free from Compulsive Eating (1986) and, of course, Hilde Bruch. Evelyn’s book, Intuitive Eating (1995), wasn’t published yet and there was no Gurze catalogue. But, I read and read and saw lots of patients, and attended Geneen’s workshops,  consulted with therapists, and taught others how to do it. And now it’s wonderful to see so many dietitians espouse the non-diet approach. But, after all those years, the pills, shakes, meals, stomach stapling (but not swallowing pool toys) are all still here.

Your thoughts: Why don’t more people give up dieting and follow a non-diet approach?

Orthorexia Nervosa, Cleaner Than Need Be

One of the hardest parts about wanting to clean up your diet is learning where to draw the line. At one end of the spectrum is a careless diet of non-nutritive, highly processed foods and at the other end is ‘clean eating’ to the point of malnutrition and social isolation. Some people have orthorexia nervosa, an extreme obsession with eating healthy food.  Their righteous eating patterns are mixed up with low self-esteem, OCD tendencies and other anxiety disorders.

I wrote about the unofficial eating disorder, orthorexia nervosa, for Calorie Count. See  my article, Orthorexia: Obsessed with Healthy Food. What I like most about that article is the 7-item (non-validated) tool from the book, Health Food Junkies: Orthorexia Nervosa: Overcoming the Obsession with Healthful Eating, by Steven Bratman, MD.  Here are the questions; if you answer “yes” to two or three, then you’d better loosen your grip on food – and get some help from a psychotherapist and registered dietitian who specialize in  eating disorders.

1.    Are you spending more than three hours a day thinking about healthy food?
2.    Do you always skip foods you once enjoyed in order to only eat the “right” food?
3.    Does your diet make it difficult for you to eat anywhere but at home, distancing you from friends and family?
4.    Do you look down on others who don’t eat your way?
5.    Does your self-esteem get a boost from eating healthy?
6.    When you eat the way you’re supposed to, do you feel in total control?
7.    Do you feel guilt or self-loathing when you stray from your diet?
8.    Is the virtue you feel about what you eat more important than the pleasure you receive from eating it?
9.    Has the quality of your life decreased as the quality of your diet increased?

Your thoughts: Do you know someone who might have orthorexia nervosa?  What makes you think so?