Instead of asking, 'What do you Eat', I ask, 'How do you Eat ?'
At the 10th International Congress on Obesity in Australia it was announced that for the first time in history, the planet-wide population of overweight (over 1 billion) outnumbered the hungry (roughly 700 million). This is staggering and sobering. To me, its the same difference. It is all malnutrition. When I see photos of starving wide eyed children taken in Africa or India, I get that feeling in the pit of my stomach...I feel sadness, frustration and the intense need to feed them. When I see photos of obese children on a school playground or care for obese babies and toddlers in my office, I get that same feeling in the pit of my stomach; sadness, frustration and an intense need to help them lose weight. But it is an uphill task.As David Katz (From Nutrition in Clinical Practice) writes so eloquently, " In short, our patients and we are getting fat in record numbers for the simple reason that they and we can do so. It is scarcely an exaggeration to say that human intelligence has been dedicated to making obesity possible by establishing a reliable supply of palatable food. The world is powerfully and ever more obesigenic. Schools, families, industry, media, policy makers and public health practitioners have roles to play and we may accomplish little until such efforts align. But in pursuit of that alignment who better than we to lead ? Certainly it would be shameful to merely follow and it would be disgraceful to get out of the way." Powerful words indeed.I look back over the last 18 years of practice; watching these cute chubby babies grow into adorable chubby toddlers and then into charming chubby preschoolers. That is where the chubbiness ceases to be sweet anymore. And I find myself with a whole slew of obese teenage patients who were once really cute babies but are now dealing with adult size diseases like arthritis, high cholesterol, metabolic syndrome, hypertension, diabetes, sleep apnea and depression. The word 'epidemic' takes on a whole new meaning.The efforts of Michelle Obama to get kids moving has been inspiring http://www.letsmove.gov/ and the plans for the FDA to radically change food labeling is overdue and most welcome http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm387114.htm But I wondered what could I do on a day to day basis ? Talking to families about their diets, encouraging them to exercise and giving them handouts on healthy lifestyle choices has not really worked at all over the last many years. And then I stumbled on this amazing fellowship in Integrative Medicine http://integrativemedicine.arizona.edu/education/fellowship/ that opens doors to tools like motivational interviewing and mindful eating.Now I am trying to focus on something as small and as significant as mindful eating with my patients and their families. Instead of asking them WHAT they eat I ask them HOW they eat. I ask them if these habits sound familiar?
And then I give them a handout on a Mindful Eating Practice. I ask them if they could turn off the television or radio, put away the magazine, and clear the dining table of clutter. I suggest breathing deeply before starting the meal and maybe offering gratitude for the food as a reminder of the network of people and natural forces that connects and sustains us. I ask them if they could take one meal a day or even a week and eat it slower paying more attention. How are you holding your fork or spoon ? What sounds can you hear in the background? Is the food triggering any memories or emotions? I discuss trying to notice the appearance, texture, and aroma of the food before you even put it in your mouth. Then to taste it, feeling it on your tongue and against your teeth as you chew, and pay attention to every nuance. The children and their parents are much more interested in this conversation than another lecture about calories and treadmills. I save that discussion and those handouts for a future visit. This is my way of aligning with the greater forces of government, policy makers, industry and other public health practitioners. My way of helping one obese child and family at a time. My way of reminding myself to eat mindfully too.