Eating & Emotions, Sarcopenia, and the Weight Debate

Last week I returned from the 2018 Food and Nutrition Conference and Expo in Washington, D.C. This is an annual conference for registered dietitians. I spent one day in educational sessions and shared a booth at the Product Marketplace with Jill Castle. We sold our books and talked about the second edition of Fearless Feeding (out later this month!).

Here you can see us with two students from the Nutrition program at Teachers College Columbia University. They use Fearless Feeding as a text. Wowza. So nice of them to stop by and stroke our egos!

I also went to some excellent sessions and wanted to share what I learned with you. Writing it down also helps me keep it fresh in my mind. So here are some key takeaways from three of my favorite sessions.

Emotions play a key role in eating problems

The highlight session for me was A Deeper Understanding: The Intersection of Disordered Eating and The Science of Emotion by Melanie Smith and Becky Mehr.

According to the session description “Decades of research on emotion science point to evidence that extreme or unhealthy eating, exercise or body management behaviors often develop, and are maintained, due to difficulties with accepting and tolerating difficult emotions.

The first speaker, Melanie Smith, MS, LMHC, introduced the audience to “emotion science,” the why, how and regulation of different emotions. She explained how all emotions have a function and are not inherently good or bad. It’s the body’s way of letting people know something’s up.

Most emotional disorders, like eating disorders, are an attempt to change or control painful emotions. The key strategy used is avoidance. Problem is, the attempts to avoid painful emotions can become more dangerous than the emotions themselves. For example, not eating enough food for one’s body or limiting nutrients in the diet.

Common avoidance strategies involving food include not eating certain foods, overemphasis on physical appearance, exercising in response to eating “bad” food, food rituals, must be a certain weight, no food touching, and only eating certain times per day.

Exposure therapy was a key strategy mentioned. This is the process of education, leaning into the fear, and designing planned food exposures.  For example, someone with a fear of gaining weight might gradually become exposed to a feared food (donut). A child with extreme picky eating (ARFID) would confront their feared food as well.

Promoting tolerance of emotions over avoidance is the goal. When individuals lose their crutch they learn to tolerate negative emotions and learn more healthy coping skills.

Speaking of this subject, don’t miss my podcast with Karen Koenig — Food and Feelings: How to Prevent or Cope with Emotional Eating

After 40, strength training and protein are key

I think about my muscle a lot, as I know that aging results in increased muscle mass loss. The scientific term is sarcopenia, defined as age-related loss of muscle mass, strength, and function. Ben Kirk gave an excellent talk reviewing the research in: Use it Or Lose It: Muscle, Protein, Exercise, and Healthy Aging/Protein and Strength Training Help Stave off Sarcopenia.

According to the session description: “Of critical importance to healthy aging is the maintenance of skeletal muscle, as it encompasses a large portion (about 40%) of whole-body mass essential for force output and daily functioning.”

After the age of 40, people lose 1-3% muscle annually increasing to 3-6% at age 80. Muscle plays an important role not just in daily functions and metabolism but in the prevention of type 2 diabetes. What makes matters worse is the inactivity and muscle disuse that often occurs during the aging process.

There are two lifestyle factors that can help: dietary protein and strength training. Of particular importance is the amino acid leucine and the even distribution of protein at meals. In one RCT trial, older subjects were randomized to control, protein only, exercise only and protein and exercise group. The protein and exercise gained the most muscle but exercise alone was not far behind. “Protein only” helped too but was not as effective as “exercise only.”

Kirk recommends older adults is to get 1.2g protein/kg/day (.4kg/kg/meal) with emphasis on leucine (>3g per meal). It doesn’t matter where the protein comes from — protein shake or food. And most importantly to engage in at least two whole body strength training sessions per week. The key is to work out each muscle until failure, that point you can’t do another.

What does that look like? For someone 130 pounds that is 70g per day. At each meal that’s about 24 grams.

Weight Management versus Health at Every Size

In the dietitian community, there seems to be quite a divide — people who support weight loss for improved health and those who believe you can be healthy at any size. The session was entitled: Debate: A Conversation on Weight Management and Health at Every Size. Christy Harrison was speaking on behalf of Health at Every Size and Robert Kushner was on the weight management side.

The session started with both Kushner and Harrison reviewing the evidence for their argument. Kushner highlighted how excess fat (not BMI which he admits is a poor indicator) has adverse health effects including cardiovascular disease and diabetes. He discussed research showing that maintaining weight loss is better than typically touted, especially for weight loss surgery. Harrison discussed the problem of weight stigma and highlighted research showing this stigma along with weight cycling are the real culprits behind the negative health effects in larger people.

I could see points on both sides. Kushner was credible and also emphasized the need to decrease stigma. Harrison brought up points showing how a weight-focus can, and does, do harm.

You couldn’t leave this talk without having some sort of an opinion. I think that as a whole, we focus way too much on weight, which increases stigma and weight cycling. I feel that focusing on sustainable habits that also help people self-regulate their eating (something not mentioned in the debate) is a better choice. But if someone wants to lose weight, they deserve to have accurate information about their choices. Last and maybe most importantly, weight stigma is a huge problem that needs attention and action (it’s the number one reason kids get bullied).

See 5 Lessons I Vow to Teach My Children About Weight and Body Shape

So just some food for thought to get your weekend rolling. Any thoughts/questions on any of these sessions?