OUR STORY, WITH DR. MARGO MAINE,
LISA POWELL, SUE GEBO, D’MARIO SOWAH,
ANDY DEVITO, DR. THOMAS LANE
By the time we reached the halfway point in writing this book, Diane had lost forty pounds. Meanwhile, I was still driving myself crazy with thoughts of food and desperate to find enough piece of mind to achieve, and stop at, a ten-pound weight gain. I was still living hungry most of the time.
As I began confiding more about my eating habits and obsessions to Diane, she began pushing me harder to deal with my attitudes toward food and weight. She thought I was masking some of my emotional issues, instead of dealing with them directly. Finally, I agreed to talk with clinical psychologist Dr. Margo Maine, a nationally known specialist in eating disorders. Margo is also co-founder of the Maine & Weinstein Specialty Group in West Hartford, Connecticut.
Margo presented me with a completely different way of thinking about my eating patterns when she surprised me with a diagnosis of orthorexia nervosa. The doctor who originated the term, Steve Bratman, explained that “orthorexia nervosa indicates an unhealthy obsession with eating healthy food.” The term derives from the Greek word orthos, which means “right,” or “correct,” and orexia, meaning “appetite,” and is intended to sound like a relative of anorexia nervosa.
I was pissed off at first. Now I’m in trouble for eating too well??? As you can imagine, my first session with Margo was a little rocky. I have almost entirely quit the junk food that used to captivate me. And that’s bad?
“We get so much information about food, and if you’re health conscious it can kind of morph into an obsession,” Margo explained patiently. “Lots of people get into that today.”
Food, it seemed, was still owning me.
Orthorexia nervosa is part of a larger category referred to as “eating disorders not otherwise specified.” Margo said, “In that diagnosis, people can have some anorexic diagnostic indicators, some bulimic indicators, sometimes they have a combination of the two, but they don’t meet the full criteria for either one. Their concerns about their body and their eating are a driving force, so that’s the unifying factor.”
Margo said that some 40–60 percent of eating disorders fall into that nonspecific category and suggested my approach to food might put me there, too. “A lot of my patients eat really good foods,” she told me. “They just don’t eat enough of them, and they don’t eat enough of the fats and other things that give you a feeling of fullness. When you get some fat in your gut the message goes back to your brain that you’re starting to feel full, and it will help you slow down your eating.” Without enough fat in my diet, I tend to feel hungry, so I have to use all this willpower to keep myself from devouring more food.
A lot of my patients eat really good foods. They just don’t eat enough of them, and they don’t eat enough of the fats and other things that give you a feeling of fullness.—Margo Maine
Margo said that most of her patients wake up thinking about food. Beginning first thing in the morning, they are already asking, What am I not going to eat today? or How am I going to get rid of the calories I do eat? How much exercise can I get? I can relate to that, because that’s exactly what I do.
Margo thinks food has a lot of emotional meaning for me, and that my obsessive focus is far from healthy. She also thinks I am undereating given the demands of my very, very long day—a power job, two kids and a husband, lots of exercise, and an incredibly active lifestyle overall. She thinks I am not just hungry, I am starving myself.
At first it was hard for me to hear Margo talk about my relationship with food, because her approach is a bit too touchy-feely for me. She talked a lot about how I should love myself and let myself be happy, and that’s not language I usually use. I’m also very uncomfortable assigning any responsibility for my eating issues to my parents because the truth is that they were wonderful and loving. I had everything most of us want to be able to give our kids: culture, travel, strong emotional ties. Everybody in my family loved one another, and nobody screwed me up.
But it is true that I come from a dynamic, well-known family, and my brothers are successful and (I always thought) smarter than I am. That probably puts some pressure on me. “How we relate to food at this moment in time isn’t just how we feel about food now; it’s how we have used food our entire lives,” Margo explained. “You talk about everyone else in your family being brilliant and your not feeling brilliant, about having some learning issues and feeling like you didn’t fit in. Food was the thing that filled you up. You soothed yourself with food, and I think food still has that power for you.”
How we relate to food at this moment in time isn’t just how we feel about food now; it’s how we have used food our entire lives.—Margo Maine
“I hope you feel brilliant now! I hope you feel successful now, because you certainly are both of those. But you may still be operating on that old relationship to food, which is ‘I’m not good enough’ and ‘this will fill up the empty space.’”
I was resistant to some of her ideas, but in her patient way Margo helped peel back the layers of my psyche, and I began to get some important insights. One of her questions startled me, but I knew how to answer it.
“Have you felt like an imposter your entire life?” she asked.
“Definitely, totally,” I blurted out. “I’m still an imposter.”
“That’s a common theme with a number of my patients,” Margo responded. “They can be very accomplished, bright, and attractive. No one else would look at them critically, but they don’t believe any of it is real.” Her theory is that as women in this culture, we always have to prove ourselves, and part of proving ourselves is to have a perfect body and a perfect house and a perfect family. That rings true for me. I am always trying to please others. In my career I often did too much for too many people, just to please them and to be liked. It was a terrible cycle that was broken finally when I saw that I needed to recognize my real value, financially and otherwise.
Margo said something else that resonated with me. She said I seemed to be looking for balance and control in life, and wondered if controlling my food intake felt like a way to control the rest of my life, with its hectic schedule and huge number of commitments. Being able to eat well in a life with so much going on is really hard, and sometimes it seems to be the only thing I can really excel at.
“That’s similar to a lot of women who, like you, are not in the throes of bulimia or anorexia,” she said. “You are well enough and well nourished enough that you can live close to a normal life, but the amount of thought that goes into your relationship to food and the amount of planning and the degree to which your food intake and exercise define other feelings about yourself is significant.”
It may be that my diet needs modifying, at least according to a couple of nutritionists we consulted. My typical daily diet consists of three or four meals, plus a steady supply of drinking water. I’m up by three-thirty in the morning and headed to work by four. En route, I’ll eat one or two apples, and by six, I’ll have a Starbucks Venti Misto, half espresso, half steamed skim milk.
My first real meal usually comes at about eight-thirty, and it’s almost always oatmeal with flax seed, honey, and bananas. At lunch I’ll generally have salad or soup. The large green salad comes with avocadoes and extra vegetables, but no dressing beyond a small amount of olive oil. If I choose a bowl of soup, it will usually be organic tomato soup or lentil.
Sometime in the afternoon, I’ll have a snack, typically either Greek yogurt, a cucumber sushi roll, or a cantaloupe smoothie. For dinner, I often have brown rice and some combination of broccoli, spinach, Brussels sprouts, or cabbage. Other favorites include beans and brown rice, broccoli and tofu, or a sweet potato and a salad. I include a lot of tomatoes and avocado with some meals, and occasionally I will eat chicken. Once a week, I’ll have a sautéed onion or spinach omelet, with five egg whites and one yolk. Usually I have whole-wheat bread with olive oil at dinner, along with a banana or apple.
I shared my typical diet with Canyon Ranch’s Lisa Powell and with nutritionist Sue Gebo, who has a practice in Connecticut. Neither of them was very pleased. “Yikes—this seems pretty restrictive to me!” Lisa said. She estimated that I ate about 1,200 calories a day, not enough for someone who exercises and considers this a maintenance menu, not a weight-loss plan.
I shared my typical diet with Canyon Ranch’s Lisa Powell . . . “Yikes—this seems pretty restrictive to me!” Lisa said.—Mika
Both nutritionists thought I should add more calories and more variety to my diet. They felt I was eating inadequate amounts of all three major nutrients—protein, fat, and carbohydrates—and said I’d feel better and have more energy if I increased my intake.
Lisa’s biggest concern was that I was getting very little protein on most days. She encouraged me to include at least two ounces of lean animal protein, or some form of plant-based protein, with both lunch and dinner. Adding beans, a hardboiled egg, tofu, chicken, or fish to both my lunch salad and dinner meal would be an easy way to do this, she suggested. Lisa also encouraged me to include a little more fat in my meals, primarily extra olive oil, nuts, seeds, or avocado. She also wanted me to take a multivitamin-mineral supplement because she didn’t think I could meet my most basic nutritional needs on so few calories.
Sue Gebo agreed, noting that “there are several missing items that would affect satiety.” My afternoon snack did not have the right balance of protein and carbs, she said. The sushi roll had no protein, the yogurt had no starch, and the cantaloupe smoothie had neither one, unless I added milk or yogurt to it. Likewise, Sue said that my dinners needed a better balance of protein and carbs, along with some fat.
“It is no surprise that this meal pattern leaves Mika hungry,” she told Diane. Her prescription was clear: I needed more food! “The omelet is a good idea, but with bread or some other starch. She would benefit from a more in-depth analysis of her intake (provided there are clearer portion sizes on her food record), a professional assessment of her calorie needs (which would require a detailed exercise record), and a meal plan designed around those needs to improve satiety and provide energy while preventing weight gain.”
Lisa really nailed my problem when she encouraged me to include more variety in my food choices, and said I was stuck in a rut of “safe” foods. Adding new fruits and vegetables would not only ensure that I have a broader scope of nutrients in my diet, but also make my meals more interesting.
So it looks like my agenda is to adjust my diet and maintain my weight at a healthy level—not too thin, but not climbing steadily upward, either. Margo helped me recognize that if I can accept my “set point,” my struggle will become a whole lot easier. Although my weight has been up and down since I was fifteen, I never fully realized that every time I gained weight I seemed to top out at 135 pounds. That is actually pretty reasonable for my height of five foot seven at the age of forty-five. Maybe that’s the right weight for me now. It sounded so obvious when Margo and I discussed it. She almost has me convinced that if I just let myself reach my natural set point, I will not gain more weight.
Begrudgingly, I have to admit that our sessions have given me the freedom to nudge closer to that set point. I have let myself gain a little weight, and I am trying to feel okay about that. I’m trying to be less rigid about what I eat in the hope that I can get off the hamster wheel for good.
I am known for wearing body-hugging sleeveless dresses with very high heels on TV. I noticed the dresses getting a little too tight, and I was afraid the yellow one would pop open, live on television. I am now officially a size 4, pushing a 6, but stuffed into a size 2. Usually when this happens, I start running twice a day. Usually when this happens, I stop eating after 7:00 p.m. Usually when this happens I am very unhappy.
If you watch the videotape of the August 2012 Republican Convention in Tampa, Florida, and the Democratic Convention in Charlotte, North Carolina, a few weeks later, you will see something that has never happened in my twenty-five-year career. I’m not wearing my trademark sleeveless dresses as much (they were too damn tight). I’m in loose-fitting J.Crew button-down shirts and sweaters, comfortable Capri pants, and even more comfortable flats.
What you’ll also see is a fuller face and even a little chin action. I hope you’ll also see that I look happy—or at least comfortable with myself, and proud to be just the tiniest bit plump . . . in a good way. I have never been able to reach 135 pounds and feel this good before. In fact, I am shocking myself because I should be horrified at this moment. That’s what I usually am when I hit 130 and a size 6. In the past, that’s when I have turned and started the long road back to a size 2.
Believe me, I’m not completely at peace yet with what I hope will be the new me. I find that the tyranny of thin is never very far from reclaiming me. I still struggle with the tension between accepting a realistic set point and the need to please myself, my television station, and the public by looking picture-perfect.
I also have found that letting myself eat a little more “normally” has opened me up to fears that I will revert to past behaviors. Now that I allow myself a little more of the foods I like while I am on the road, the hunger pangs sometimes seem to grow worse. In fact, I am sometimes voracious. I am desperately afraid that will lead me to start bingeing again.
Obviously, I still have some work to do.
As I keep up my side of the bargain, Diane has managed to shave off sixty pounds with a weight-loss plan that seems solid. After signing up with D’Mario Sowah as her personal trainer, she is becoming much more physically active and following the healthy eating plan he recommends. She’s on her way!
Here is Diane’s account of what is going on with her.
The initial sessions at the gym were discouraging. I was so out of shape and so fat, I couldn’t even get up off the floor mats without help from D’Mario. Fearful of losing my balance and falling, I felt like someone a lot older than I am.
But D’Mario was a rock of support. True to his philosophy at Akua Ba, he started from the inside out, working on my attitude first. “It wasn’t the physical weight that I noticed when you started at the gym. I saw the emotional and mental weight,” D’Mario told me later. Pulling me out of the emotional depths where I had landed was as important as helping me make progress physically, he said.
“I had to find words that were true and were encouraging to let yourself go as far as forgetting about the journey to lose weight, and just letting the process apply itself. That was the first thing I was thinking: let’s get her to start. I didn’t want you to be thinking, I’ve got to lose weight! I’m fat! I’m this and that and that! I wanted you to just think, okay, I’m going to Akua Ba, I’m going to take one day at a time.”
With D’Mario’s encouragement and Mika’s cheerleading, it started to work. I became a regular at Akua Ba, working out at least three times a week for at least an hour at a time. I was the fattest person in a room full of clients who mostly looked like finely toned athletes to me. But the workouts were so challenging I couldn’t really focus on anything else. Using my considerable body weight as the resistance was more interesting and more difficult than using the machines I had been accustomed to at other gyms. Whether I was doing modified pushups and planks or pulling myself up from a nearly seated position, I was working hard.
D’Mario treated every bit of progress as though I had won the Boston marathon. The day I got up from the mat without his help he fell to the ground shouting, “She did it!” and beat his hands on the floor. Good thing we were the only ones there, but I was grinning like a fool.
He had such empathy and really understood the damage my weight had done, not only to my body, but to my mind. “What stuck in my head,” he recalled, “was the story you told me about one of your speaking engagements where an audience member stood up and commented that you had gained a lot of weight. That always stayed with me. I’m always pushing my clients to be successful, but I feel a special dedication to you, because I never wanted you to feel like that again. Ever.”
I was on the road toward weight loss again, but this time it had to be different. It just had to stick. Not only was I wearing plus-sized clothes, but for the first time I was really seeing the health damage my weight was causing. I started Mika’s challenge in October 2011, and a month later my doctor put me on medication to lower my blood pressure. That was discouraging, but I clung to the hope that losing as little as 10 percent of my body weight could reverse that.
But there was something else; the nagging ache in my left hip, which had been diagnosed as bursitis, was becoming more and more painful. When I wasn’t at the gym, I was nearly sedentary, nursing the hip with either heat packs or ice packs. It really hit me when my husband said, “Do you realize you haven’t gotten out of that chair all weekend, except to eat and go to the bathroom?”
Honestly, I hadn’t realized how much the pain in my hip had changed my life. I was turning down social and business invitations, because it took everything I had just to get through the day at work. I couldn’t walk the dog more than a block or two. I’d been in pain for nearly three years and had tried physical therapy and medication. They had worked initially, but the relief didn’t last. I was running out of options.
After my orthopedist took another X-ray, he asked bluntly, “Ever seen a German shepherd dragging its hind legs? That’s hip dysplasia, and that’s what you have. Eventually you will need that hip replaced.” I was ashamed and embarrassed. Had my eating brought me to this point? Had my weight worn out my hip? The doctor never said so, but I was sure it was just one more shameful way I had allowed obesity to mar my life. At first I was afraid to tell my family, my friends, my colleagues, even Mika.
I got a second opinion, and when that surgeon told me the hip had been worn down to “bone on bone,” I knew it was time. The soonest the doctor could schedule me for total hip replacement was February. I choked up when I told D’Mario about my impending surgery, sure that my plans to lose weight and meet Mika’s challenge were crushed. I should have known that he wasn’t going to let me drop out in despair. Instead he promised, “After that surgery, you’re going to lose even more weight. You’re just going to keep going, like a tiger let out of a cage.”
D’Mario brought in a new trainer, Andy DeVito, who had experience in helping people recover from injuries and surgery. Andy spent several weeks prepping me for surgery, helping me strengthen the muscles around my hip and build strength in my upper body. It was another good match. Andy, too, was incredibly supportive and gracious. I asked him later about his impression of me, and he was very kind. “One of the first things I really noticed is your smile. Your energy was just so positive. I could see that you were working hard, and you were in a lot of pain, and I really appreciated the effort you were putting into this. I could see how hard it was for you to do the things most people take for granted, just being able to get up and down from the floor, get in and out of the car, or take a flight of stairs.”
Andy is also a trained chef who specializes in healthy cooking, and he started coaching me on my eating. His dietary approach focused on reducing refined starches, processed foods, and alcohol. In their place he substituted lean protein, fiber, fruits, and vegetables, and kept telling me to drink a lot of water.
I was getting stronger, but my weight wasn’t going down much, despite Andy’s help. I knew that keeping a food journal could help keep me honest and aware, but frankly, I was too distracted to do it. I wanted to believe D’Mario and Andy when they told me the impending surgery would be a short detour in my progress, and that I would eventually get back on the road to wellness and weight loss. But in my heart I wasn’t sure.
Just after Valentine’s Day 2012, I got a shiny new titanium hip. Two hours after I was off the operating table, the nurses had me standing using a walker, and I took a few steps down the hall. At that moment, something just clicked in my head: I had been given a second chance, and I was going to make the most of it.
The next day I learned that eleven laps around the joint replacement unit were equivalent to walking a mile—and I set my mind on doing two miles. I did, with the whole staff cheering me on as I passed the nurses’ desk again and again. I texted D’Mario and Andy with the good news.
“That brought a tear to my eye, I was so happy,” said Andy. “When we’re working with people, we take it very personally. And when a client does well, it makes me feel good about myself, too.”
At the hospital, there was a daily afternoon reception for patients and their families. I noticed that several of the patients having hips replaced were younger than me, and some of them were very lean. They had worn out their joints through tennis, skiing, martial arts, and other sports. In talking to them I felt some of my shame melting away. Maybe this would work out after all.
I was out of the gym more than eight weeks, but Tom and I walked the halls of our condo building every day. At first I used a walker, then a cane, and eventually I was on my own. My friend Joan came and walked with me, giving me some security in those early days when I wasn’t too steady on my feet. An occupational therapist showed me I could climb stairs again and so I did, several times a day. The pain was easing, and I was enjoying the walking. It still wasn’t doing much for my weight, though. I had gone from 256 pounds at the beginning of my pact with Mika to about 248 by the time I was cleared by my surgeon to go back to the gym.
As I was healing from the hip replacement, I had to follow certain precautions, but Andy found plenty of ways to challenge me during our workouts. He created an integrated program with point-specific, body-weight rehabilitation exercises, such as hip abductions, which I could do while lying on a bench. We also worked on functional body movements incorporating resistance bands and medicine balls and other exercises to correct my body alignment.
For balance and lateral movement, we incorporated Pilates-based core and leg exercises and added boxing drills. We avoided getting down on the floor (a no-no in the early weeks of recovery) and instead focused on exercises I could do standing or lying on a bench. When we added elastic resistance bands around my ankles, I felt as though I had a sandbag weighing down my surgical hip whenever I did leg lifts. Andy promised that would get better, and it did. “I’ve always enjoyed puzzles, and when I look at the human body, it’s just a puzzle to me,” Andy said. “So my whole philosophy is looking at your body and saying, ‘What can we do to take care of this? We needed to strengthen the surgical area, help you regain your balance, and work at reducing the limp.’”
Andy’s faith that we could fix this, and that I would improve, made all the difference.
A few weeks into my recovery, I decided I needed another weight-loss plan. Akua Ba’s healthy eating guidelines weren’t dramatic enough for someone with so much weight to lose. The pounds were coming off too slowly. I needed a clean break: a way to change my bad habits, reduce portion sizes, and stop looking for that glass of wine every night. After all the diets I had tried and failed, I knew I needed more professional help and support.
I did some research and found a body of compelling studies that told me what I already suspected: very low-calorie diets do work, but they are best when combined with behavior modification. A behavior modification program most likely to lead to a permanent lifestyle change should include nutrition education, advice for changing patterns of eating, training in self-awareness and assertiveness, and instruction in coping techniques.
I turned to a program like that at the end of May. Offered as an alternative to bariatric surgery at the Hospital of Central Connecticut, the Take Off program limits food intake to 800 calories a day, taken in protein shakes, with a little fruit and some salad greens on the side. It’s a drastic approach, but I had a drastic problem. The Take Off program generally lasts twelve weeks, but I am still on it after six months. It requires weekly weigh-ins, weekly visits with a nurse and a doctor, and a series of twelve hour-long classes on nutrition and behavior modification. Just as it takes a village to raise a child, it also seems to take a village, or at least a sizable team, to help me meet Mika’s challenge.
As I listened to the other patients in the Take Off classes, I realized that our struggles are very much the same, although some people weighed a hundred pounds more than I do. They are men and women, some younger and some older than I am. Several are a lot sicker. A few are limping because of bad knees or hips, and a couple are toting oxygen tanks. I wondered how they had overcome the discrimination they must have faced, but it wasn’t something we talked about. It’s good to be in their company, because it reminds me of where I am headed if I don’t lose the weight this time, and make it stick. I’ll never forget the week when the lecture described the relationship between obesity and diabetes. “How many of you are diabetic?” the lecturer asked. Nearly every hand in the room went up, except mine. At least I had dodged that bullet.
The Take Off program has given me a chance to wipe the slate clean and to learn something new. And it’s working. Who wants a glass of wine after drinking protein shakes all day? I’m not hungry and the salad greens at night are fulfilling my desire to sit down with Tom at the end of the day and share a meal. As the weight falls off, I am really encouraged and excited.
By the third week on the program, Take Off’s physician, Dr. Thomas Lane, cut my blood pressure medication in half. The next week, my blood pressure readings were still good. I was starting to see another impact of losing weight. Week after week, the weight loss has been steady, though shockingly slow for a diet this restrictive. Two pounds a week at most, and for several weeks in a row only half a pound. But as I leave the weekly sessions, often heading to the gym, I try to concentrate on where I was when Mika challenged me, and how much better I am doing now. That’s a lot more productive than dwelling on how much I still have to lose.
By mid-July, Dr. Lane had taken me off blood pressure medication entirely. Yeah!
When I begin to move beyond the Take Off program, I will also need to learn how to eat again. Over the long haul, cutting back on processed foods and eating more plant-based whole foods is clearly the way to go. I will also need to relearn what appropriate portion sizes are, something I had really lost track of in the last few years.
By August, the other clients at the gym start noticing the change in me. One woman says, “You’re glowing.” She’s right, and it’s not the sweat. Andy has me boxing, and even though I am still a klutz, I am moving a lot better. Lateral movement, which was drastically inhibited by my hip pain, is so much better. I realize I am no longer afraid of falling. By mid-September I am down to 203 pounds. I’ve lost 40. I still have 35 more to go, and now Mika is upping the ante. She is redefining the challenge and telling me I should lose a total of 100 pounds! I might just do it.
Meanwhile, I have been reminded that weight is about a lot more than dress size and how I look. My weight was stealing my life from me, piece by piece. Refocusing on health, instead of size and looks, has helped me recognize that I have to make a commitment for the long haul. That’s the only way.
Dieting does not work. I know, you’ve read that before, but it’s really true. I should know, because that’s what I’ve done all my life. I dieted my way up to weighing 256 pounds. No more. This time I am remaking my life.