Review: The End of Overeating, part 2 (a digression)

(Click to start with part 1 of this review.)

The picture on the left shows my maternal grandfather, aunt, and grandmother in the mid 1920s, when my aunt was a young teenager. My daughters dubbed these three "the sturdy ones."

The picture on the right shows my aunt in 1932, the year she turned 20 and got married. Slender, beautiful, and always impeccably dressed, she would never again be an ounce over fashionable.

Yo-yo dieting was not for my aunt. When she lost weight, she lost it for good. But this is not a success story. It is a tragedy.

Tired of being fat, Bessie decided to reinvent herself. As my mother told the story, her sister simply stopped eating. I don't know how long it took or how much weight she lost, but in a fairly short time she plunged from plump to svelte.

She also lost her hair, her eyebrows, her fingernails, and her teeth.

Back in the 1920s people weren't talking about anorexia, and I don't know from my mother's description if Bessie fit the description. To my knowledge, she did not have a distorted self-image, nor did her weight ever go dangerously low. She had a goal and she achieved it, though at the cost of her health. Once she reached her desired size, she started eating again. Her hair and fingernails grew back. She penciled on new eyebrows. She ordered a set of teeth from her dentist.

Unfortunately, her crash diet did not change her eating habits. To use David A. Kessler's term in The End of Overeating, she was still a "conditioned hypereater." Yet she had no intention of ever being fat again. So Bessie, a determined woman, came up with her own weight-maintenance plan. She ate whatever she wanted, and then she excused herself for a few moments in the bathroom. It worked like a charm.

Back in the 1950s when I learned about my aunt's post-prandial pukes, people weren't talking about bulimia. Aunt Bessie seemed normal enough. She was a wonderful cook, she was slender and beautiful, she had a wardrobe to die for.

As it turned out, that's exactly what she did.

The doctors couldn't figure out what was ailing her when she took to her bed in the 1960s. As she grew weaker, her husband flew her hundreds of miles to an excellent teaching hospital for tests. "Failure to thrive" was the best they could do. She didn't eat. She grew thinner and thinner. When she spoke or smiled, her false teeth clattered.

In 1969, at the age of 56, she died, leaving a husband, two children, and approximately 25 linear feet of clothes closets packed with dresses, furs, and shoes.

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I don't believe in diets. Most dieters lose a few pounds, gain them back, gain some more, and then try a different diet. A few dieters like my aunt go off the deep end and never come back.

My mother couldn't help bringing up Aunt Bessie when, at age 16, I went to France for a year and gained 15 pounds from eating 100 grams of chocolate every day. She couldn't help bringing her up again a few years later when I refused desserts, bread, and second helpings and lost three dress sizes in a few months. I don't know what Mother would have said if she'd known that several times in college I literally tossed my cookies (a whole bag of sugar cookies devoured in one sitting can make one want to do that).

She didn't really need to worry that I was going to copy my aunt. Anorexia and bulimia do not appeal to me. I far prefer my mother's philosophy: "I'd rather have a little tummy and eat what I like," she once told me, "than be slim and have nothing but grapefruit and cottage cheese for lunch." Mother sometimes wished she had flatter abs and a smaller dress size, but she was never overweight, she never dieted, and she never gave up desserts. If I fretted about gaining a couple of pounds, she'd say, "Don't eat between meals," or "Remember that the second bite tastes just like the first." For her, sensible eating was second nature.

In parts 3 and 4 of The End of Overeating, Kessler explains how conditioned hypereaters--not necessarily people like my aunt who have eating disorders, but people like me who can't resist chocolate and cashews and ice cream--can break bad habits and become sensible eaters. Superhuman feats of willpower, he says, are not required, nor is giving up everything that tastes good. I'll say more about his approach later this week. Or maybe you should just read his book.

(Click to go to part 3 of this review.)

Review: The End of Overeating, part 1

I first heard of The End of Overeating at a party as I was scarfing down cookies. A friend was reading it, and she told me it was about how certain foods actually change our brain chemistry. I don't recall her looking pointedly at my plate, but it would not have been inappropriate.*

When I checked it out of the library, the circulation assistant exclaimed, "They put the wrong cover on that book!" Well, no, they didn't, at least not for me: I couldn't look at those pictures without strongly coveting the carrot cake. (The carrots would make nice snacks for my dogs.)

Dr. Kessler's point exactly.

When we eat certain combinations of sugar and fat, or salt and fat, or sugar and salt and fat, Kessler says, our endorphins go wild ("I feel good!") and our dopamine levels rise up and induce us to race back to the cupboard for more. Alas, the more we eat of these "hyper-palatable" foods, the more we want. Unlike, say, apples or whole-wheat bread or broiled salmon, which satisfy hunger and leave us feeling full, foods like ice cream and chocolate-chip cookies and potato chips leave us craving more and more. Some people gorge on such foods until they puke. Others just eat them until their waistlines disappear and their extra chins emerge.

Kessler, who has a medical degree from Harvard and a law degree from Chicago, was commissioner of the U.S. Food and Drug Administration from 1990 to 1997. During his career, he has noticed a big change. "In 1960, when weight was still relatively stable in America, women ages twenty to twenty-nine averaged about 128 pounds," he writes. "By 2000, the average weight of women in that age group had reached 157."

What happened--did we suddenly grow taller? Not so much. The Center for Disease Control reports that "the average height of a woman 20-74 years increased from slightly over 5'3" in 1960 to 5'4" in 2002"--not nearly enough to support nearly 30 pounds of additional weight.

Kessler partly blames the increase in American heft on "larger portion sizes, more chain restaurants, more neighborhood food outlets, and a culture that promotes more out-of-home eating," and he discusses all of those contributing factors in detail in part 2. Did you know, for example, that Starbucks' strawberries & crème frappuccino with whipped cream contains "more calories than a personal-size pepperoni pizza, and more sweetness than six scoops of ice cream"? (With my consciousness newly raised, I checked online before eating at Famous Dave's a couple of weeks ago. I learned that their rather small corn meal muffins--surely a harmless accessory--have 600 calories apiece. Yikes.)

But although the section on the food industry is interesting and revealing, that sort of exposé has been adequately done elsewhere, and it is not Kessler's focus. His main point is that if we have conditioned ourselves to overeat, it is possible to recondition ourselves to eat sensibly. It isn't easy--after all, in response to our choices, our brains have changed--but it can be done. And he offers a program for doing it.

Later this week I'm going to critique his program in some detail. For now, I'll just say that what he suggests is true, helpful, and insufficient. If you eat as he suggests, you will reprogram yourself and you will lose weight. But will you ever smile again?

(Click to go to part 2 of this review.)

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*Some friends have implied that I, being long and lean, have no business reading books on overeating. Kessler points out, however, that conditioned overeating is not the exclusive province of well-rounded people: "Some 50 percent of obese participants [in the Reno Diet Heart Study] and 30 percent of overweight participants demonstrated the features of conditioned hypereating, as did 17 percent of those who were lean." I, alas, am in that select group.

Very berry waffles

Here's a lunch that tastes like dessert, is as good for you as it looks, and can be made in 10 minutes once you get the hang of it. You'll need a Belgian waffle maker--the kind with high hills and deep valleys. Mine is about 40 years old and makes just one waffle at a time, but if you have a bigger one, everyone can sit down to eat fresh waffles together.

For people who don't like recipes, this is all you need to know:

First layer: one small whole wheat waffle topped with slightly sweetened plain yogurt or ricotta cheese topped with your favorite berries (hot or cold). Second layer: the same. Sprinkle sliced almonds or put a sprig of mint on top, if you like.

For people who want the details, here they are:

This recipe, loosely based on the recipe "Quick and Easy Waffles" in Mark Bittman's How to Cook Everything, makes an ample lunch for two, a small lunch for four.

First make the berry topping.
About two cups of strawberries (sliced or halved), blackberries, blueberries, raspberries (or sliced peaches or sliced bananas or ...)

Warm variation: Lightly cook the blueberries with a tablespoon of water and sugar. (Or used sliced apples cooked with a little water, sugar, and cinnamon, or sliced peaches very lightly cooked with a little nutmeg, or ...)

Then prepare the filling.
That can be as simple as removing a small carton of part-skim ricotta cheese from your refrigerator. You'll need enough to spread over each waffle, filling the wells. You don't need to doctor it up with anything.

Variation: Use lowfat (not nonfat) plain yogurt instead of the ricotta. Mix in a little sugar--about a teaspoon per cup of yogurt--and, if you like, a splash of vanilla or almond extract. You'll need at least enough to ladle a dollop on each waffle and spread it to the edges. If you like yogurt a lot, use more.

At the last minute, bake the waffles.
While you've been preparing the fruit and the filling, you've been heating up the waffle iron, right? If not, there's still barely enough time.

In a medium bowl, stir together the dry ingredients:

• 1 cup white whole wheat flour (you can use all-purpose white, but it won't be as nutritious; or you can use regular whole wheat, but it won't be as tasty)
• a pinch of salt
• 1 tablespoon sugar or Splenda
  
• 2 teaspoons baking powder

In a small bowl, whisk the liquid ingredients:

• 3/4 cup milk
• 1 egg
• 2 tablespoons canola oil
• 1 teaspoon vanilla or almond extract, if you didn't use it in the filling

Spray the hot waffle iron with canola oil spray. Shut the lid.
Whisk the liquid ingredients into the dry ingredients.
Plop the batter onto the waffle iron, using about 1/2 cup for each of 4 waffles.
Bake until crisp and browned. In my ancient waffle maker, that takes only about 2 minutes.

Assemble your lunch.

1. Waffle
2. Ricotta or yogurt filling
3. Berries
4. Waffle
5. Ricotta or yogurt filling
6. Berries
7. Sliced almonds or a sprig of mint
   

What most of us want to say to Congress

Dear Senators and Members of Congress:

A lot of us out here--in red states and blue--would like to get your attention about health-care reform. Some of us are terrified of government inefficiency, and some of us are terrified of big business price gouging. That’s a divide that looks hard to bridge, until you consider the things we agree about:

• We are not influenced by the lawyers’ lobby, and we would like caps on malpractice lawsuits.

• We are not influenced by the pharmaceutical lobby, and we do not care for incessant drug marketing, high-priced duplicate designer drugs, or drugs that cost ten times more in the U.S. than in other countries.

• We are not influenced by the insurance lobby, and we would like a lot more direct health-care service with a lot less red tape from middlemen. Also, we don’t want to lose our insurance just when we need it.

• We are not influenced by the medical lobby, and we would like more primary care from pharmacists, nurse practitioners, physicians’ assistants, and midwives. We also would like to know what procedures cost so we can comparison shop.

• We would like existing government programs to operate more efficiently.

• We would like our health care to be independent of our employment.

• We are smart enough to understand that no government and no insurance company can pay for every possible procedure for every individual, but we agree that Americans should be able to figure out a way to provide basic health care for most.

Many of our fears—and many of your proposals so far—have been heavily influenced by lobbyists’ exaggerations, misrepresentations, and lies. This is true whether we, or you, are Republicans or Democrats.

Suggestion: put all the money you’ve received from lobbyists into a fund that provides free health care clinics for the poor. (This may not be enough money to do much for the millions of uninsured, but it will certainly clear your mind.) Erase all thoughts of fine meals or vacations you have shared with you lobbyist friends. Try not to think about the fact that you may lose the next election and will become a lobbyist yourself.

And then listen to what we want from you.

You can do this, if you are not already hopelessly entangled in a corrupt system.

Review: Black Water Rising

Why didn't Professor Gates just politely thank the cop for checking out what a neighbor feared was an attempted burglary? If you're white and that question has crossed your mind, you may learn a lot from Black Water Rising.

Whatever your skin tone, if you like a thriller that goes beyond the requisite car chases and explores human passions, motivations, fears, and convictions, Attica Locke's debut novel belongs on top of your nightstand stack.

In 1981, Jay Porter is a young, intelligent, but not very successful African-American lawyer in Houston, Texas. A chance encounter plunges him into a murky world of politics, unions, and big business--and reignites old terrors left over from his student-activist days in the late 60s and early 70s. Is his life in danger? Or is he paranoid?

Locke, a screenwriter, knows how to write action scenes. She also writes well, though sparingly--this is a thriller, after all--about relationships. Jay's wife is seriously pregnant, and wondering what in the heck is going on with her taciturn husband.

"You got to stop this, Jay.... You can't grab a gun every time the phone rings," she says. "I can't have this around my kid, Jay." Then, a whisper, "I won't."

"Don't start that now."

"You're not right, Jay."

He stands in the middle of the room, eyes on his shoes.

Bernie looks up at her husband, her voice halting. "You're not ... right."

Read Locke's description of why she--a woman in her mid 30s who, though African-American, grew up in a nearly all-white environment--wanted to tell Jay's story.

Read the fine New York Times review by Janet Maslin, "What's Black and White and Muddied? A Byzantine Houston Case."

Read Black Water Rising. I'll be returning it to the library in about ten minutes, but you'll have to put a hold on it--there's a short waiting list.

Mix-and-match bread ideas

People have asked for my bread recipes, and I don't exactly have any (except for my challah recipe here). When I bake loaf bread, I use Mark Bittman's bread recipe for inspiration. You can read my adaptation, with instructions, here. I do not use a bread machine, but I do allow my food processor to do the kneading.

Rather than making Bittman's bread as written, though, I like to try including different ingredients each time. So here's an ingredient idea chart (note that I have reduced the salt from 2 tsps in Bittman's recipe to just 1 tsp, which seems to be enough). Use anything you like from the first column; add anything you like from the second; choose what sounds good to you from the fourth, fifth, and sixth--or come up with your own ideas.

This "recipe" makes one 8.5" x 4.5" loaf that weighs 1.5 to 2 pounds. Bake at 350 for 45 minutes. If that makes the crust too brown, turn the heat down to 325 for the last 20 minutes.

1 lb – 500 gm bread flour	1.5 tsp active dry yeast	1 tsp salt	2–4 Tbl sugar	2 Tbl butter	1 ¼ C warm milk
or white whole wheat flour	or use 1 tsp and let rise overnight in refrigerator		or honey (decrease liquid)	or canola oil	or water
or stone ground whole wheat flour	or use 1 packet and watch very carefully—it will get bubbles		or brown sugar		or warmed applesauce
or a mixture of flours, possibly including 1 C rye or oat flour			or molasses (decrease liquid)		or bananas
or ½ C corn meal + flour to equal 1 lb or 500 gm			or no sugar at all, but use fruit for all or part of liquid		or plain yogurt
or ½ – 1 C oatmeal + flour to equal l lb or 500 gm					or buttermilk
or add nuts and/or raisins to flour before spinning in food processor					or one beaten egg + 1 C liquid

Health-care reform--what can we agree about?

I had my own "beer bonding" moment this weekend, though the beverage was water. A close friend and I--whose political views are usually so divergent as to be better left unspoken--had a civil, productive discussion about health-care reform. We brought up no positions or persons about whom we presumably disagree, but we came up with a short list of reforms that we would both like to see implemented, and that we both fear will not be (does anyone know if these are in the 615-page Senate Bill or the 850-page House bill under consideration?):

• Put a cap on torts (as Peggy Noonan pointed out Friday in a WSJ article, this needs to be rephrased: "Stop calling it 'tort reform'; normal people think a tort is something you eat for dessert. Call it the Limiting Lawyers’ Windfalls bill")
• Put a cap on pharmaceutical prices
  
• Require health-care providers to post their prices so consumers can compare (I blogged about that here)
• Rewrite laws so that nurses and pharmacists can provide more primary care, as they do in most European countries.
  

Here's an idea. What if we just asked one another, "If you were changing the way health care is delivered in the United States, what changes would you make?" That might spark a heated argument, of course--but then again, it might not. When we move away from the ideological (and often idiotic) screaming at the far right and the far left, we Americans often agree on quite a lot.