Thursday, December 27, 2012

Shifts in mojo.



I was watching a little girl in the Grady Hospital cafeteria one day. She was standing with what I am assuming was her mother and appeared to be no more than four years old. It was a school day, so I'm guessing she was too young to be in kindergarten.

Anyways. She was an adorable and precocious little thing. I mean just as cute as a little button. Talking up a storm with her hand on her plump little pre-K hip. Her pink bedazzled t-shirt didn't quite clear the length of her torso. I could see her belly button and a roll of tummy skin protruding over her striped leggings.

"I want chicken fingers and I want the fries, too!"

"Okay," her mother replied. She then relayed that information to the gentleman working the grill. "I thought you wanted a burger?"

"I do want a cheeseburger. But I like chicken fingers, too!"

"Okay. Well we can just split it," the mom replied.

"What kind of fries do y'all want?" the grill-guy asked. He stood there waiting patiently with his clear plastic gloves on while patting his brow just below his hair net with the back of his sleeve. 

"Mama, get the mojoes!" the little girl squealed.

"Y'all got some mojoes?" Mama asked.

Grill-guy looked over his shoulder at the fryers. Sizzling behind him was a freshly dropped basket of battered and season-salted potato wedges. "Yeah, we got some."

"Okay. Then give me two orders of those."

And he did. Onto that platter went two cheeseburgers, some chicken fingers and two heaping helpings of mo-joe potatoes fresh out of the peanut oil.

I couldn't help but watch them as they walked off. First, a stop at the soda machine where two cups were filled with what looked like some kind of cola. I'm not sure if they got dessert. My guess is that they did.

That little girl's mother had to be at least three hundred pounds. And I'm almost certain that the child was well above the ninety fifth percentile for weight albeit in a lower than average centile for height.

Now.

Everything about their interaction was loving. The child appeared very well cared for -- from her matching pink outfit to her hair accessories of the exact same hue. Her mother kept her hand on her daughter at all times, and occasionally pulled her close into her side for an affectionate squeeze. That part was sweet.

That part was.

Sigh.

Anyways. The holidays has me thinking a lot about food, as always. That's what made me remember that little girl and her mama.

Yeah.

And speaking of the holidays -- ours always involve a lot of here-there-and-everywhere-ness. As adults, it's not such a big deal, but for our children that's another story. With so many visits to see cousins and grandparents and aunties and uncles, I promised them that today they wouldn't have to go anywhere. They could just stay home and play with their toys at their own house. Eating food from our fridge and hanging out in their own playroom. They were over the moon with that plan.

So that's been the day. Them -- literally in their pajamas for the entire day -- running, laughing and mostly playing games on their Wii console. The sounds coming from their playroom tells me what the game is and that's been quite a variety. Right now, they're bowling. Before that, it was a dance-off to every possible overplayed pop song that you've ever heard in your life.

Anyways. In between all of this, they've occasionally burst into the kitchen or wherever I am to ask me for something to eat. Harry had to do some work-related errands early this morning, so he surprised the kids with McDonalds hotcakes and an oatmeal for me. They love McDonald's hotcakes, so that was a reasonable thing to do. The only problem is that they'd already eaten some Eggo waffles.

"Oh man!" Isaiah said, "We just ate!"

And by "just ate" he meant that they had each held a toaster waffle in each hand while laughing at the kitchen table. No syrup. No sausage on the side or anything else. I guess what I'm saying is that it wasn't the most filling meal in the world. Surely they could make room for hotcakes, especially ones that they love as much as Mickey Dees' version.

But they didn't. Instead Isaiah thanked his dad on both of their behalf and off they scurried back to the video games. And that was that.

"Those kids eat to live. They don't live to eat." That's what I said to Harry as we both stared at the lonely hotcakes.

"I'm glad," he replied. "They just eat not to be hungry pretty much. They're lucky that you don't care about food as much as me. That comes from you."

"Not true. I love food."

"But not enough to eat any-damn-thing you want."

I thought for a moment. "You know? It's just hard to enjoy anything that isn't worth it. Like. . .some Key lime pie? Or a really, really good pound cake? Mmm or some Antico Pizza? Now that's worth every fat gram and every calorie. But a slice of pizza from Pizza Hut? Uhhh. . .naaah."

"Yeah. See, I'd eat the Pizza Hut and just pay for it later," Harry laughed.

"Food relationships are complicated. It all depends upon how you were brought up. Like, my mom always cooked for us. But mostly it was to make sure we'd have food. She's a fine cook, but I doubt she would have been cooking like that if she didn't have four kids to feed."

"And see, my mom? Food is love with her. Lasagnas and briskets and ribs and collard greens. A bad day got you something to cheer you up straight from the oven. And a good day? Man, please."

I laughed. Mostly because my sweet mother-in-law is still that way. Her food truly has love in every single bite. You want to clean your plate. And if you want more, she'll heat it up for you. There's love in that part, too.

It's true. Food relationships are super complicated. And let's be clear--do we take our kids to McDonald's sometimes? Sure. Do they enjoy their share of hot dogs here and there? Yep. But demanding them to eat everything (as opposed to something) and giving them carte blanche to the pantry for boredom eating? Nope. And constant celebratory eating? No way, no how. I guess I'm trying to think about their long term food relationships without being oppressive, you know?

I've been thinking about food relationships more and more over the last few years. Instead of telling my patients what and what not to eat, I often talk to them about their food relationship. Do they even have any idea about it? I ask questions like, "Can having the an unsatisfying meal ruin your evening? You know--like if you had your mind fixed on one thing but it either didn't turn out like you'd imagined or even it wasn't available for you to eat?"

I also ask how they feel when eating certain things. Or if there are things that they used to eat but no longer will. If the answer is yes to that last question, I ask why.

Here's what I'm learning from all of that: Food relationships start when we are children. Then, as adults, they can shift in a number of different directions depending upon where we are in our minds. For example, someone who always had full access to their family pantry and who was forced to clean their plate, might do the same with their kids. Or not, if they've shifted their own thoughts on food and eating as they've grown older and learned different things.

Different things? Things like how no matter how much you run, jump, leap and stretch, there comes a point in every adult person's life where weight will never, ever be controlled without redefining food ideas. Period.

Wait.

Let me just say that this is my own opinion. Nothing really scientific, although I'm certain that there is likely some medical literature somewhere to support it. What I mean is, these ideas have a lot to do with my own interpretations of things I've seen over the years. As a doctor and as a regular old person.

So that brings me to mojo potatoes. Have you ever had them? Well, I have. And let me tell you something -- they're delicious. Look. I'm no different than the next guy when it comes to enjoying fried morsels of yummy-ness. But where I am when it comes to such things has changed over the years. Lots of that has to do with my relationship with food growing up. But most of it has to do with the shifts it made in my adulthood.

Will I eat one or two mojo potatoes? Sure. Will I order my own next to a greasy hamburger? Probably not. Of course, the caveats are when such things are at places so good that eating there is more of an experience than a meal. Kind of like the difference between eating a burger at McDonald's and a burger from Farm Burger. In that instance, I would both eat and enjoy my burger and fries.

Just not every day.

I realize that I'm rambling. Mostly because I think a lot about obesity -- in both adults and kids. I have a lot of thoughts on all of it and am recognizing that they aren't exactly organized enough to be writing down.

Oh well.

So the food relationship thing. Okay, so my real point on it is that this is ground zero. Kids who are overweight don't lose weight just by being admonished every time they reach for cookies. Some hard lines have to be drawn in the sand. And the grocery cart. Like, if anyone in the house is the type that can't say no to Oreo cookies or mojo potatoes, neither of those should be in the house. If anyone in the house is the type that has slow as molasses metabolism then foods and drinks that aren't nice to them should stay on supermarket shelves for the most part.

At least, that's how I see it. For everybody to win, somebody's going to have to take one for the team.

And I know. There's always this argument where folks say, "Why should we punish our thin/fit/ideal-weight/healthy kid just because the other is overweight?"

My answer to that is simple: "Because that's how it has to be."

Some don't say that at all. Instead, their response might be to "just let kids be kids" and "if they exercise and run and play they'll grow out of it." This might be completely true -- and often is. But the problem is that the food relationship doesn't go away. That prepubescent pudge might melt away at first, but if mojo potatoes don't cause you to cringe a little bit by the time you turn thirty, that pudge will return just like a Jedi.

Fo sho, honey boo-boo.

Again, these are just my thoughts. And if I ever get a chance to break bread with Mrs. Obama, I'll chat with her about this since she has childhood obesity on her radar. Just another reason for me to love me some Michelle Obama.


But I digress.

So the taking one for the team thing. When my mom was on Weight Watchers some five trillion years back, I recall watching our whole house drop a few pounds. Why? Because everybody was on skim milk. There wasn't a cookie in sight. And full sugar soda pop? Chile please. We all took one for the team. And if you have a teammate that you love living in your house, that's just how it has to be.

Or else somebody is going to lose.

Hmm. I just thought of something. The more you have family members take one for the team, the less it feels that way to them. Like, eventually we got used to skim milk and no cookies. And because I have a full understanding of the BHE's food relationship and I do the grocery shopping, our kids don't even realize that they've been taking quite a few for the team for their entire lives.

Yep.

So I ask about those food relationships. I ask who is up in that house and what's up with them and they're health/body situation. Is Jack Sprat your husband? Meaning, is your spouse a hundred pounds soaking wet? And if so, does he or she do the grocery shopping? Whoever that person is and whatever their situation, that person has to get on the same team as you. Be willing to eat smaller portions with you and to forgo certain foods being in the house to help you win.

That is, until your relationship and body shifts enough to make you feel like mojo potatoes aren't even worth it. So much so that seeing them on a platter before you does little to affect you. But see, for a lot of people, that kind of shift never occurs -- especially if they are starting from a place where food is synonymous with love and comfort.

Yeah.

So anyways. I looked at that sweet little girl with her gelatinous middle and her delightful smile happily chatting and almost skipping with excitement. Following right behind her markedly obese, yet equally delightful mother, in more ways than either of them even realized.

What will happen next with that little girl? Honestly, I'm too inherently positive in my thinking to assume the worst so it's hard to say. It really all depends upon where her food relationship shifts.

I don't have a crystal ball to say what the future holds for her. But here's what I do know:

It's a hell of a lot easier to shift your food relationship just a little bit than a whole lot. And square one for food relationships start with the person doing the feeding . . . . and how far they're willing to shift their own relationship first.



***
Happy Wednesday-almost-Thursday. What are your thoughts on all of this?

31 comments:

  1. These are sobering thoughts -- and written with your usual generous, caring and nurturing spirit.

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    1. Thanks for reading my ramble, Elizabeth. :)

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  2. So true! My relationship w/food was an unhealthy one until I made up my mind that I didn't want 2 walk down the aisle fat. It has Been 10 years since I made my WW weight goal...now 2 children later and I have yet to allow that almost 80 pounds to return. Now, clean eating is a lifestyle for me...no more counting points. I still have about 20lbs that I aim to take off, but Obese NO, and feeling good/looking good YES. That being said, I aspire to feel/look even better. More importantly, my children have a good relationship w/food. I refuse 2 let them grow up obese, insecure, and lacking confidence. like I did. Great Post.

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    1. Thanks for your input. Congrats on getting to your goal and for maintaining! It's a tough thing, the food relationship thing. It sounds like your kids will have less to shift away from.

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  3. My thoughts are many on this subject and the main one is that people are not even eating food anymore...mostly sugar, salt and chemicals. For an exchange present this year I received a plastic popcorn bucket full of "movie treats"...mostly candy etc. I read all the ingredients...just gross to me what everything is made of...I tossed it all. I kind of think of it as ignorance (like smoking used to be) and people just don't want to learn about nutrition and GMO's and what their food is really made of...and I don't buy into the thing of eating organic or healthy is more expensive...just what they paid for the junk / fast food for lunch would have bought several healthy meals cooked at home....lol..as you can tell I feel strongly about this...would love to read more about it in your future posts. My favorite "diet" advice is "Don't bring the enemy home"...

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    1. Wow! You are probably more disciplined and hard core than I am with the fast food but I'm sure you're right. I do think moderation is the key but part of this does come down to being willing to altogether kick a few things to the curb.

      Hmmm. That's something for me to think on.

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  4. The children I see the most are children of 2 vegetarians. But they don't keep their kids from eating meat when they want it. Mostly mom cooks non-meat/meat substitute meals, and they're none the wiser. They can have chicken mc nuggets on occasion or some chicken wings at the neighbors house. The most interesting thing about them is that they eat what they want off the plate & that's all they have to eat. The Clean Plate Club does not exist, and I think it really works for them.

    My relationship with food has definitely changed in the last 5 years... coincidentally when I met the mom above. I was such a social eater. Every time I went out, it was based around a meal. I'm no foodie by any stretch of the imagination, so that was never a lot of fun for me. Now, I rarely choose a meal as way to socialize with friends. And if I go, we are sitting around the kitchen with some homemade grub (usually my favorite vegetarian tacos!)

    I eat to live and fuel my body. Sure, I like food... I will go in on some Mexican food or a good steak... or Mardi Gras Cafe later LOL. But I do it in moderation. I don't keep snack food in my house (except some smart pop popcorn.) Daddy always fusses that I have nothing to munch on when he comes over. I know my weaknesses. If it's in the house I'll eat it, so I don't bring it in.

    Great post! Sorry for the long comment!

    Xoxo,
    Biz

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    1. I love your long comment, little sis. Thanks for sharing this. I got the "no clean plate club" rule from Claudine, too. Our favorite vegetarian mama!

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    2. AWWWW- I totally love you guys. Funny thing is that before reading this particular blog post, I was considering writing my own blog about my LOVE for GOOD food.
      My writer brain was following your "convoluted" path through this tangled and delicate subject. To love good food does not always go hand in hand with overeating. It is a gift to be able to stop when your body says 'I'm NOT hungry.' And your kids have been given that gift, which is why they did not consider eating their favorite hotcakes after already filling their bellies.
      There are so many ways to reward our children and allow them to feel loved and special. I would venture to guess that the loving mother of the 4 year old has a relationship with food that she has unconsciously transferred upon her child. If we know better, we do better. Continue to TEACH and PREACH Kimberly. I absolutely love your blogs.

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  5. I'm a single parent and I'm very conscious of what my son sees me eating and how I eat, and I try to reinforce that by suggesting that he finish his greens...or have another bite of protein...etc. We go to McDonald's, but maybe once a month. I tell him why, because it's not good to have it all the time. We eat dessert, but not all the time. He also spends time at his dad's house, though, and that's another story! I can't control that, but I can try to show him how to make good choices and explain it.

    Mostly, though, this post made me think of my niece who is diabetic and how I wish my sister's family would change their whole relationship with food...

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    1. Thanks for your insights and thoughts, Blue gal!

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  6. I've never been a big fan of the "clean your plate" idea. I have implemented the eat something vs. everything with my 6 year old since he was born. I just continued my practices from when he was bottle feeding and would push the bottle away through eating table food. I allow him to listen to his gut, keep him active in karate and the church (hopefully these active relationships are enough to fill the soul).

    Oh yeah, vegetables are a must! He can choose to eat out or buy hot lunch once per week.

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  7. I appreciate that you didn't demonize the mother. Too many people would have presented her as a monster who too weak to discipline the way her child ate. It's reasonable to assume that is the way they always decide what to eat, but we don't know that there isn't a reason for this. You say they were at Grady, so it is also reasonable that the child is being exposed to a great deal of stress and eating is a way of distracting her.

    I was watching my grandson while both of his parents were out of town on business. His school called me to tell me that he'd fallen from the top of the slide and an ambulance had been called to take him to the children's hospital in Birmingham. My grandson is a severe hemophiliac and falls like that have to be checked out. After an hour long ambulance ride, an IV for two doses of factor and a CT scan Jack and I were discharged around dinner time. Jack looked at me and said "Nana, I would really like some ice cream now." His parents don't have many sweets of any sort in their house. They are saved for very special occasions like birthdays and holidays and are planned for, not impromptu snacks. I knew that getting ice cream was a very special request and ther was no way I was going to decline. I found a Baskin Robbins near the hospital and got him two scoops of his choice, with sprinkles and whipped cream. Jack is only in the 25th percentile for weight, but it was dinner time and I was giving him ice cream. Anyone who wanted to judge wouldn't have known about the rotten day he'd just had.

    It's true, if unhealthy food isn't readily available, it's unlikely to be eaten. If healthy snacks are readily available they are more likely to be eaten. It's also true that everyone in the family has to eat in the same way. But I don't see it as taking a hit. It is just as important for every one to eat healthy. Jack may not have a weight problem, but on a normal basis ice cream for dinner is a bad choice. And he doesn't feel deprived because the nutricious food he does eat is well prepared. And it doesn't matter that he's a little underweight. He's getting the proteins and minerals and vitamins and healthy fats that he does need.

    I have been seeing a family practicioner in Marietta who only treats obesity who has a philosophy very close to what you have expressed here. She has helped me lose 60 pounds because she helps me understand the reasons that I eat.

    I don't know where I'm going with this, I just very glad that you didn't demonize the mother.

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    1. Nope. That mother surely had a mother who had modeled these things for her. She obviously loved her daughter and that was evident in their interaction. There was nothing to demonize her for--it's just one facet of a big issue.

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  8. This is such a complicated issue with Americans. Obesity is the norm , rather than the exception. I find myself regularly evaluating patients of say, 5'5" height and 180 pounds and thinking they are normal weight. But they are not. I regularly take care of patients for bariatric surgery, and while effective as a surgical intervention- I have seen patients who have had bypasses, lap bands etc come back because they have regained the weight by eating -plain and simple. I think it is a multifaceted problem, not the least of which, I believe, has to do with additives and hormones fed to animals that we consume. I take care of pediatric patients-and these kids are BIG-like under ten years old and pre-puberty and over 100 pounds. They for all intensive purposes have an adult physiology. And so-I ramble....but we as Americans, at least, need to be retrained on how we view food-myself included.

    Maria, fellow Meharrian

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    1. Yeah. It's pretty deep when you start thinking about it. I'm glad so many people are thinking about this with me.

      Kimberly, fellow Meharrian

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  9. If I was still a student I could probably write an entire paper or thesis on this subject. This post was quite timely for me, as I recently discovered I need to get back to working on my relationship with food before it causes me serious health problems. There's so much baggage that many of us carry because of our upbringing, but our culture doesn't help, either. I see the consequences of our generally warped relationship with food constantly in the records, and they're often not pretty. Shifting perspective isn't easy, and I'm thinking that perhaps small steps at a time might be helpful rather than trying to change it all practically overnight. We shall see where this goes.

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    1. Small steps are always the best and most sustainable kind. :)

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  10. This reminds me of a story I read which was written by a woman who struggled with her weight. She wrote that when she was a child, her father would almost always come home from work drunk. He and her mother would argue and fight while she and her younger sister cowered in the corner. But every now and then, he would come home sober - with ice cream and cookies, and they would enjoy these treats and laugh just like a "normal" family. For her, those were the happiest times of her childhood. As an adult, whenever she felt any type of anxiety, she would eat ice cream and cookies and everything would seem OK. For her, food was more about feelings than nutrition. I totally get that. It's so complicated...

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  11. I knew a woman who was very very close to my heart, like a mother to me, and she had weight issues. She ended up having bariatric surgery because of her weight. Food = love, for her. Being in her house was like food heaven because I was allowed to eat anything I wanted and she was constantly baking and cooking my favourite foods. It was kind of like, 'I love you so much, so here is some food to show you'. She passed away earlier this year (not due to weight problems) and I love and miss her dearly, but reflecting on her food relationship helped me to understand how much our families and upbringing affect our own relationships with food. Unhealthy food was so accessible to me when I spent time with her that I began to understand the role that parents have in the food that their children eat. I have grown up in a family where we hardly ever (maybe 5x per year) ate fast food, and we were always encouraged to make healthy food choices (aided by the fact that other choices simply didn't exist in our house). Sure, I'll go out occasionally and enjoy french toast for brunch, or a burger and fries at a fast food place, but it's not an everyday thing for me. There is something lovely about knowing that the food that I put into my body is (mostly) nourishing and healthy.

    Thank you for examining food relationships though, they are far far more complex than a lot of people make them out to be, and it's not a matter of simply abstaining from certain foods.

    Peace and blessings,

    NZ Lucy

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    1. My NZ Lucy!! I've missed you!!

      Thanks for chiming in. It's obvious that this isn't just a U.S. issue.

      Hope you are well!

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  12. As a person with some experiences in the medical profession, I think if Americans don't do something quick about the obesity epidemic, the medical profession and eventually the country will be financially destroyed. The cost of caring for people with diseases related to this epidemic are going to continue to rise to the point of eventually being unsubstainable.

    If the stats are correct, 70% of all Black women are obese, and some of that is understandable. The worst food I've ever seen is what's available in lower income communities. But this number seems to extend to higher income Black women too, which means we have a deeper rooted problem in our society.

    IMHO, the "elephant in the room" with weight control and Black people is stress induced by racism, and the use of food to deal with it.

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    1. Hmmm. This is an interesting perspective. I can't say that I fully agree about the "elephant in the room" you mentioned for African-Americans in general -- but I will agree that for many people stress, from whatever the source, is a huge issue that drives a lot of how the food relationship evolves. Food consumption, spending, exercise -- all of those things are often tied to stress and self esteem.

      Very, very complex stuff. Thanks for your thoughtful input, friend.

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  13. This hit home. #takingonefortheteam

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  14. What a great post and important topic. My husband lost close to 100lbs with WW and exercise. And what an interesting journey it was to watch his relationship with food change as his weight dropped. I am so proud of him because his relationship with food is much more complicated than mine.

    I do think that with the right education, support and love it is possible to fight this obesity epidemic, one family and one person at at time. One of my favorite attending physician's always try to tackle the topic with each and every obese patient she takes care of. And maybe 99% of the time nothing comes of it... but any change, any hope is worth the effort. And we have to talk about it and think about and write about it so that change can happen. So thank you dear Grady Doctor for another amazing post!

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  15. Wow. This is so on time for me. I had always struggled with being underweight, until I had my last child. Amazingly for me I have put on pounds that used to be very easy to shake. But food for me now is more of a health issue since I deal with higher than avg sugar and cholesterol numbers, and hypertension. I am certainly at the ugh! stage for certain unhealthy foods, but I have sometimes felt reeeeeally guilty by changing up the food habits of the entire house just because of me (6 of us). When I cook with no salt, buy sugar free drinks, or cook nothing from a can, no pork, shellfish, etc, I feel it's not fair to them. After reading this post, I am soooo adopting the 'take one for the team' concept! That will cut my stress level as well from worrying about it! lol

    Thank you for being you. -Renee

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  16. I wanted to share that 8 years ago when I was your age and my three sons were closer to your sons' ages, I was like you in that I bought and provided the food. My boys accepted what I bought and it was pretty easy. And my boys look like yours: active and fit (and um, I was too--I had more time for me).
    Be prepared that one day your boys will be Very Interested in food and lots of it and with sports, lots of chat about protein and bulking up, etc. So what happened when they got older? I have to cook a lot of food and dessert (mine do not have weight or health issues) so to show my love and care I am constantly cooking real food...like what you have described what your mom cooked for you. So what I am saying is the amount of food in the house will most likely change when the boys get older and if you don't have a scale at home they will request one to see how much they gain (they want to see an increase in pounds as the months go on) and lots of requests for more food and you won't even believe how many times a week you will need to grocery shop!
    --Michele R.

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  17. I am obese. Ok no, I am morbidly obese. I am addicted to food. Those food relationships? Yeah,you are so right that it's complicated. I am much like BHE's Mom. Food is my love language and I don't know for sure when or how it happened. I would say I became addicted to food when I gave up alcohol and drugs if I'm going to be blatantly honest. My oldest is 21 and also overweight. My stepson is 20 and his bmi is perfect. My 16 yo son is underweight. My 8 year old daughter is starting to get a belly and is just short of being overweight.

    So, I am hiring a trainer and starting Saturday (I am working on the menu plans and grocery list and cleaning out cabinets, etc...) I am going on The Daniel Fast (essentially going vegan) for 21 days. My family doesn't know it, but they are as well. I have decided I can love them with food and do it in a healthy way. I refuse to let my daughter become me.

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  18. Its a difficult subject. We can't really tell people to only feed their kids certain things. I have 2 boys, one overweight and the other not even close, and trying to get the overweight one to eat healthy and exercise is like pulling teeth.

    Some countries have school systems where overweight kids are given extra exercise and nutrition classes, but here that would likely be seen as damaging to their self-image. Which is unfortunate. This sort of thing needs to be taught both at school and home, and reinforced both places.

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