Friday, March 7, 2014

How to Stop Undereating

This post is not meant to substitute for medical advice. Although technically I'm a doctor, I am in training and certainly not an expert in this field. If you think you may have a problem with food or eating, consult your doctor or call the helpline at 1-800-931-2237.

This post is based on my personal history, and I hope it's helpful.

This lifestyle is meant to be healthy, but also happy, abundant, and not restrictive. 

All kinds of food, without guilt.

Right around the time Jenn [Peas and Crayons] was starting What I Ate Wednesday, I did a couple posts called Thorough Thursday - before I found her and just joined WIAW because that was way cooler. Anyway I missed WIAW this week, but it's been ages since I did a "what I ate today" post and I was planning on doing one.

In preparation, I was looking back at the "What I Ate Today" posts from the beginning of the blog in 2011, and I was really thrown by my intake. I rarely posted the calorie counts for my day on the blog (though see the above Thorough Thursday link for a nutritional breakdown) but during that time I was using the Lose It! App on my phone and counting calories every day. It's been a couple years since I counted calories and I know eat much more intuitively.

The problem with my intake back then isn't necessarily the calorie counting (although that can be a point of obsession for many) - it's that the goal I set for myself was far too low. I would end up sticking to it for a little while, and then I couldn't figure out why I would go on a tear and eat everything in sight when I'd been doing so well.

Truth was, I had been undereating and my body was not having it. The result wasn't really any compromise to my health, because I never stuck to my calorie goal at the time, but there was a lot of guilt and anxiety centered around why I couldn't meet these goals I had set myself.

So, embarrassed as I am at the bad example I was setting back then, I thought I'd write a few quick thoughts on that subtle undereating that can happen so easily when you're trying to be healthy and counting calories:

Step 1
Realize that someone else's diet, that online calculator, or that app may not give you an adequate picture of the minimum fuel your body needs.
I was shooting for 1200-1400 calories a day as an active person in my early 20s. I thought that was a reasonable number because I was trying to lose weight. The "1200" calorie rule as a minimum you may have heard of does not apply to everyone. I thought because 1200 was the minimum, the extra 100-200 would fuel my exercise and my busy day and that would be enough for me. It was not. My basal metabolic rate (BMR) is well above 1200, and my total daily needs are well above that. Fortunately and unfortunately my body would catch me up every once in a while with overwhelming cravings. This meant I'd feel guilty and totally physically sick from eating way too much. I needed more in order to have balance and improve my fitness, but I was way too stuck on the numbers.

Step 2
Recognize what may be disordered or unrealistic thoughts.
How could this have happened while I was actively in medical education? Shouldn't I have known better?
The answer is probably. During this time, there was certainly a component of stubbornness to my goals. I wanted to lose weight, even though I was not overweight, as a matter of comfort with my body and confidence. I wanted to lose weight relatively fast, because I was impatient, and I didn't want to hear that it would be healthier to do it slower. There's a body of information out there that says "cut out 500 calories a day between diet and exercise, and you'll lose a pound a week." Historically, that was the prevailing paradigm, and if you have lots of weight to lose, that may be a nice way to think about it. However, if you're a small person, you may not have room for a 500 calorie deficit before you're below your BMR and undereating. A pound a week weight loss doesn't sound that fast, but for me and many other people my size it's unrealistic and not really a safe goal. Despite knowing in the back of my mind that it didn't seem to be working, there was a long time before I was willing to give up the idea that I should be losing weight at that pace.

Step 3
Let go of the fear of what could happen if you eat more.
Whether it's patients who are dealing with paying close attention to their eating, or peers who are trying to lose weight, frequently I get the impression that they feel the worst possible thing would be to gain weight - and I think I felt the same.

Chances are, if you're eating healthfully and exercising, you won't gain size. You may gain weight in the form of muscle, but in fact be smaller. It's much more satisfying to judge progress on how you feel and how your clothes fit.

Let's say though that you did gain weight and size. What's so wrong with that? You might have more energy, and your body might be the size it's supposed to be. Does being a few pounds heavier make you any less valuable or able to contribute to your world? No. And with more energy, you can do that much more good.

Don't believe me?

Let's compare some photos:

Feb 2011, Northern California

Feb 2014, Hawaii


What's the difference between these 2 photos? Besides 3 years and the fact that one was taken with an iphone? 

I'm probably about 8 pounds heavier in the lower one, which is somewhat visible I think. And my point is this - it just doesn't matter. 

2011 Me: What you can't see is that the girl in this one was wildly anxious about eating too much, gaining weight, "How many calories are in this?", "Will I be able to work out?" etc. I was an anxious second year medical student, paralyzed with fear that I wouldn't pass Boards, make it out of medical school or match to a residency. Instead of facing that, I spent a lot of unnecessary energy on my size. I was certainly wonderfully happy sometimes, but it was a really hard period of my life.

2014 Me: This girl does not calculate calories, does not weigh herself, and made a lot of room in her brain for things that she really cares about. I'm an M.D. now, working hard at becoming the best possible pediatrician I can be. 


That absolutely comes with a commitment to myself to be healthy. Eat well, get some physical activity, but not with the goal of being a certain weight or size, just with the goal of feeling well enough to accomplish all my other goals. That's the point of healthy living.

I think with that realization, it's easier to stop worrying and just be grateful. 

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