Episode 189: Chris interviews RD Glenys Oyston about her work with the VA and how to manage diabetes with a plan that doesn't include weight loss.
Glenys Oyston is a registered dietitian who helps people recover from eating and body images issues created by toxic diet culture through the Health at Every Size and intuitive eating philosophies. She is also an advocate for promoting weight-stigma awareness and fat positivity, and is the co-host of the popular Dietitians Unplugged podcast. She is based in Los Angeles, and sees clients both in-person and virtually. You can find Glenys at daretonotdiet.com.
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Chris Sandel: Welcome to Episode 189 of Real Health Radio. You can find the links talked about as part of this episode at the show notes, which is www.seven-health.com/189.
Seven Health is currently taking on new clients, and there’s a handful of reasons that clients commonly come and see us. The first is hypothalamic amenorrhea, which is the fancy name for not getting a period. This is often the result of undereating and over-exercising for what the body needs, irrespective of your actual weight. It’s almost always coupled with body dissatisfaction and a fear of weight gain.
Disordered eating and eating disorders would be another reason clients commonly come and see us. We work with clients along the disordered eating and eating disorder spectrum. Sometimes clients wouldn’t think to use the term disordered eating to describe themselves, but they see that they’re overly restrictive with their eating, with fear around certain foods like bread or carbs or processed foods; they feel compelled to exercise excessively, and/or they find themselves binging or feeling out of control around food.
Moving away from dieting would be another reason. Clients have had years or decades of dieting and they’re realizing it’s not working for them, but they’re then struggling to figure out, how do they live and do food without dieting? What should they eat? How do they listen to their body? What will become of their weight? They’re confused and overwhelmed and scared, and they’re just trying to figure out what to do.
Then the final one would be body dissatisfaction and negative body image. Many of our clients have feelings of body shame and hatred, and they find themselves fixated on weight and determined to be a particular size and just frustrated with what they see in the mirror. They may even have social events that they opt out of, and opting out of photographs and putting off appointments because of their negative body thoughts.
In all of these areas, we’re able to help, and we do so by using a combination of understanding physiology and psychology, so understanding how to support the physical body and understanding how the body works, but also being compassionate and understanding how the mind works and uncovering the whys behind clients’ behavior so they can figure out how to change this.
If any of these areas are things that you want help with, then please get in contact. You can head over to www.seven-health.com/help, and there you can read about how we work with clients and apply for a free initial chat. The address, again: www.seven-health.com/help. I will also include that in the show notes.
Hey, everyone. Welcome back to another episode of Real Health Radio. I’m your host, Chris Sandel. Let’s start the show with our book giveaway. We’re now giving away a book from our Resources page with every new episode of the podcast. This week’s winner is Kate T. Kate, we will be in contact with you to send you a book of your choosing.
Reviews help to increase the visibility of our podcast and enable us to reach and help more people, and they also give you a chance of winning a book. All you need to do is leave a review on iTunes, take a screenshot of that review, and email it to info@seven-health.com, and then you will be permanently entered into the drawing.
This week on the show, it is a guest interview. My guest is Glenys Oyston. Glenys is a registered dietitian who helps people recover from eating and body image issues created by toxic diet culture through the Health at Every Size and Intuitive Eating philosophies. She is also an advocate for promoting weight stigma awareness and fat positivity and is the co-host of the popular Dietitians Unplugged podcast. She is based in Los Angeles and sees clients both in person and virtually, and you can find Glenys at www.darenottodiet.com.
I’ve been aware of Glenys for a number of years. I had her Dietitians Unplugged podcast co-host, Aaron Flores, on the show back in November time. This episode was actually recorded fairly shortly after Aaron’s; it’s just taken a while to come out. We’ve got quite a backlog of episodes.
One of the things Glenys does is run an online course for helping people with diabetes from a weight neutral approach. I wanted to spend a lot of the time as part of this conversation focusing on that topic, which we do.
As usual, I start out by finding out more about Glenys, so her upbringing and relationship with food and dieting, then her training as a dietitian – which was a second career and happened later in life – before we then move on to the topic of diabetes and cover some of the things that are talked about and focused on as part of Glenys’s course – a course that she actually runs with Rebecca Scritchfield, who has also been on the podcast. As part of it, we talk about what diabetes is, how it’s diagnosed, and then how you can manage it without dieting.
That’s what’s covered. Let’s get on with the show. Here is my conversation with Glenys Oyston.
Hey, Glenys. Thanks so much for joining me on the show today.
Glenys Oyston: Thank you, Chris, so much for having me. I feel really honored.
Chris Sandel: I’ve been following your Dietitians Unplugged podcast for a long while now, and I recently did an episode with your co-host, Aaron Flores. We had an awesome conversation. I know we were just talking about this before we hit “record.”
There’s a lot I want to cover with you today. I want to go back through your childhood and your story and journey to become a dietitian, and also how that’s evolved through the years. But also, one of the big areas I want to spend a decent amount of time on is the work that you do with diabetes from a non-diet approach, because I think what you’re doing in this area is really important work, so I want to carve out a chunk of time for us to chat about that.
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But I guess to start with, are you able to give listeners a bit of background on yourself, like a brief bio of sorts, like who you are, what you do, what training you’ve done, that sort of thing?
Glenys Oyston: Yeah, absolutely. My name’s Glenys Oyston, and I’m a dietitian and I live in Los Angeles. I’m originally from Canada, but I’ve been in California for a long time now. I became a dietitian about 7 years ago now; it was a second career for me.
I had long been working on becoming a dietitian, going to school part-time, and yeah, now I have been a dietitian for a while, which is kind of exciting for me. I have a private practice in Los Angeles, and as you said, I have a podcast, Dietitians Unplugged, with my co-host Aaron Flores. Was that brief enough? Do I need to talk more about what I’m doing? [laughs]
Chris Sandel: No, that’s good. That just gives people a very good start, just knowing you’re a dietitian and what you do, and then we can go through more of it.
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Let’s go back to you as a kid and growing up. How was food in your household?
Glenys Oyston: Oh, gosh. It’s so funny because I’ve been really thinking about this a lot. I did a great retreat a few weeks ago. It was for treating people with overeating and binge eating with Francie White and Anita Johnson, and it was great. It started to make me think about my childhood.
I think that up until the point – I don’t remember much about eating except that I didn’t like Brussels sprouts until the age of five or six, and then my parents became separated. At that time, I just remember food suddenly becoming horrible. I feel terrible saying that, because separated and divorcing parents are just struggling to do their best, right? But I realize now that suddenly we had a lot less money to live on. I’m piecing this together as an adult, because my mom passed away a long time ago.
But looking back now, she shielded me as much as possible from that, but as a result, only one of us really got a regular dinner. That was me. Sometimes they were the classic TV dinners that you heat up in an oven – we didn’t even own a microwave. I don’t even know if they existed at that time. [laughs] I don’t want to date myself too much.
But I just remember eating by myself in front of the TV, and that’s really how I grew up eating. I think my mom felt really bad about a lot of stuff, as moms tend towards a lot of guilt, unfortunately, I think. And dads; I don’t want to exclude them from that. But I lived with my mom at that time. I just remember not liking the food and being like, “Ugh, gross, TV dinner.”
My mom started being like, “Is that all you’re going to eat?” and getting really annoyed with me that I was being a typical picky child eater. But as a result, she would also be very lax with foods in between meals. So if I wanted cookies, I could have cookies. If I wanted cake, I could have cake. But it wasn’t just one piece of cake for me; it was a couple of pieces of cake. Orit wasn’t just one or two cookies. I could have the bag and I would just munch away on a sleeve of cookies, and that was it.
What I realize now is that my mom had been a dieter. I can look at pictures and just think, oh gosh, what was she going through at the time? Because she was really, really unnaturally thin for her. I realize now that she had her own dieting history – and I also remember when my parents separated, my mom went on the egg diet. I don’t know what that is, but I just remember her saying “the egg diet.” I was thinking that’s hilarious. Like, how many eggs a day are we eating here? Sounds kind of boring.
But I think she was really compensating for that with me, and probably living through me vicariously to some degree. So I became this young overeating child where I would just overeat on dessert in between meals and then come to a meal not hungry at all. I think we both know, we both follow that division of responsibility in feeding from Ellyn Satter. It’s like, that’s not the best way to support a child’s upbringing with food. But again, she was doing her best.
And I’m thankful that I was never put on a diet, but I did become – whether or not it was just my own body size that was going to happen – I became a pretty chubby child. That did not really have too much impact on me; I wasn’t unhappy. My mom did a really great job of supporting my self-esteem and “your body’s fine, don’t worry about it” kind of thing if kids made fun of it.
It wasn’t until I got into high school and then I got on the scale when I was 15 or 16 and the doctor said, “You’ve gained too much weight. You need to lose weight.” At that point I knew, “Oh, I know I’m bigger, but now it sounds like it’s really wrong.” I was sort of making it work for myself – and looking back, I actually wasn’t very big at all. Again, I’m a short, chubby person.
I don’t know what happened – I think my mom had a stern talking to the doctor after I came home crying, because he never mentioned it again. [laughs] You did not want to cross my mother when it came to her child. But at that point, then I think I really started to have some rebellion eating and learning to feed myself, but not doing it very well at that point in high school.
I got into my early twenties and I still hadn’t thought about really seriously dieting. I remember Susan Powter was big in the early ’90s, like just eat all the carbs and no protein. “Oh, okay, sounds good. Give me two bagels” kind of thing. [laughs] Just bad diet advice generally.
But around that time in my early twenties, my mom got sick. She had cancer. It was towards the end of her life where I was really very alone in the world, and I was like, “I need to do something to control my world,” and that’s when I went on my first diet, which was with Weight Watchers. I should say that was my first and only diet. It was just one long 16-year diet that more or less “worked” – and I put worked in quotes because we know we need to redefine what “worked” means when your whole life is food.
It started out really normally; I didn’t have to think that much about food. I was actually eating pretty normally. But I learned that if you eat less, you lose weight, and that’s just the result. I kept pursuing that more and more over the 16-year period, to the point where I became completely restrictive of everything and trying to be really thin, and my body was so unhappy. At that time when I was trying that, I was in an unhappy relationship, and I didn’t know how to really deal with it. I didn’t understand that that’s why I was unhappy. So there’s a trend of me, when things are going wrong in my life, I pick up a diet and go for it.
But it was during that restrictive time that I decided to become a dietitian because I thought, “Well, ‘diet’ is in the word. I could do that. It’s going to help me think about food 24/7, and I’m so obsessed with food, and I can’t understand why sometimes I just overeat so much.” Spoiler alert: it was because I was starving. I just thought, I’m going to become a dietitian.
I was working, so I started to go to school part-time, and it was during those years – it was 2010 when I had my first intro nutrition class, and it happened to be taught by somebody named Linda Bacon. I didn’t know who that was at the time.
Chris Sandel: Wow. That’s interesting that you’ve got that as a first intro.
Glenys Oyston: So – I don’t know, so lucky or something. I just feel so lucky. But I didn’t know who this person was, and the class fit into my schedule. My friend that was also becoming a dietitian that I’d met in school, she was also taking Intro to Nutrition in an evening class with a dietitian who was much more like a traditional dietitian, so we were able to compare notes all semester.
But I would say my first few classes with Linda Bacon, I was like, “She keeps saying things like ‘fat’s okay, dieting is bad.’ How am I going to survive this? What is she talking about? I don’t believe this.”
By the end of the semester, I was sick of counting out my 12 almonds for one Weight Watchers point and starving before lunch, and I was a total convert, because I realized how unhappy I was, the way I was eating. I was living in fear of eating and simultaneously lusting after food and feeling really bad that I had gained a little bit of weight back, and “how am I going to keep this going?” It was just my inner turmoil. It was a mess.
This message was like, hey, you know what? It’s actually okay to be in a larger body. I’d never heard that before in my life, and I realized how much I needed to hear that. After that, I stopped dieting. I had a total crisis of conscience where I was just like, “What am I going to do? Why am I becoming a dietitian? I don’t want to help people lose weight.” Because that’s what I had wanted to do. I’d wanted to become a dietitian and help people lose weight. I didn’t want to do that anymore because that seems ethically wrong.
Then I realized, oh, there’s this whole world of Health at Every Size that I can practice in. It’s non-diet. I don’t have to talk about diets. I can talk about nutrition without thinking about weight loss or forcing people into this weight loss paradigm. That was a huge revelation. Then I thought, “I don’t know how I’m going to get through the rest of my schooling because nobody else thinks this way.” But I was wrong, because I met a lot of people along the way that did think this way.
Flash forward to now, I’m a dietitian with a private practice who helps people with their eating, and I help people stop dieting and any problems that arise from that, and it’s really, really gratifying.
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Chris Sandel: Nice. There’s bits of your childhood that I’d love to go back and find out more about. You mentioned about your parents splitting up when you were five, and obviously that then having an impact on the meals that were served. Do you remember pre-that, like what eating used to be like in your household before it was just you and your mom?
Glenys Oyston: I feel like for me, it was a non-event. I remember ’70s style casseroles. I really have a very strong vision of one casserole that had hot dogs in it. [laughs] I’m thinking, “Weird, but also, great. Isn’t that fantastic-looking?” don’t remember if I liked it or not.
I just don’t remember food being an issue at all. There was a time when my parents split up a bit earlier, temporarily, and we went to live with my grandparents, and I don’t really remember that at all because I was probably four. But there are pictures of me, and when we came back from that, I’d gained a lot of weight.
What I know now is that my grandmother was also a long-term dieter, but how she showed love was like, “Here, eat this, eat this, eat this,” all the time. “Here’s a big huge bowl of ice cream in the middle of the day for no reason.” Not that there’s anything wrong with having ice cream in the middle of the day for no reason, but it wasn’t just one day. It was all the time. So food for her I think was her way of showing love.
So I came back – I gained a lot of weight over 3 months. Then my parents got back together for a while, and the pictures of me go back to what I’d looked like previously to some degree. It’s great to know that when you have those periods, your body just tends toward your set point, I think, when things are more normal.
But that’s the only thing I remember. I feel like food was kind of a non-event. I think I was probably a frustratingly picky eater, but that’s true of a lot of children, and I’m an only child, so my mom didn’t have experience with other kids. I have some vivid memories of food before my parents split up, and one was my mom saying, “Can you just try one Brussels sprout?” I was like, “Okay,” because I was a good, compliant little kid. I remember eating it and swallowing it and then just projectile vomiting it right back up. I was never asked to eat Brussels sprouts again. But I do like them now if you cook them properly.
But yeah, I feel like food was just not something I thought about at all. My mom was pretty lax; if friends were over, they always asked for candies because they knew my mom always had candies.
Chris Sandel: Then what about after they spilt up? Did you ever have a point where you were staying with your dad or seeing your dad? If so, how was your eating when that was going on?
Glenys Oyston: I don’t think I stayed with my dad until a year or two later, when I was a little bit older. I was a homebody, so probably disrupting my schedule wasn’t the first thing on their list.
But yeah, I would stay with my dad. My dad’s a really good cook. My mom was a terrible cook, unfortunately. I only remember her not liking cooking and overcooking things and TV dinners, like I said. But when she did cook, it would be good; I think she just thought she wasn’t going to put on a big production for two people – and one of them probably wasn’t eating (her). We also probably didn’t have a lot of money.
I remember going to eat with my dad, and that was probably when I would have the most normal meals, where it’s like the adults are just putting food on the table and you eat it or you don’t eat it. I remember thinking, okay, I can figure this out. It’s funny, because I don’t really remember food so much when I was with my dad. I think, too, the other thing is my mom ended up doing a lot of short-order cooking for me. She’d say, “What do you want?” Thinking back, I’m like, Mom, I’m eight. I don’t know what the possibilities are. I’m going to say the same thing every time: cake. [laughs]
So I think my mom really struggled with figuring out how to feed a child when we probably didn’t have that much money. I think she really didn’t want to waste money on food. I sympathize with that. I don’t blame her for any of that. You know what I mean? Parents are doing the best they can.
Chris Sandel: Totally. You said about eating meals in front of the TV; was that with her next to you, or were you ever having meals together? More than just the food as being a meal, but the shared experience of a meal? Or that just didn’t really happen?
Glenys Oyston: I’m going to say that my memory back to 6 years old is pretty dodgy, but I would say most of the time I ate by myself in front of the TV. I do remember occasionally eating at the table, but less and less as I got older. We had the old TV table or the TV tray. I was pretty much by myself, I think.
Because I was picky, I’m just guessing now, thinking back – oh, that makes sense – yeah, I think she was eating my leftovers a lot of the time, so she didn’t have to cook extra food. I wouldn’t always eat it all, and I think she would probably eat my leftovers, because I don’t ever remember food being thrown out. So I was definitely by myself.
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Chris Sandel: You mentioned your mom getting cancer and then passing away. I’m getting the impression from what you said that a lot of that was you on your own, so your dad wasn’t around, you don’t have any other siblings. What was that like for you? Did you have other support during that time?
Glenys Oyston: Let’s see. I was 23 by that point. In the early ’90s at 23, you were considered fully an adult. I was not close with any of my family, so I didn’t really have – no, I had no support through that time, actually, looking back. Except for my friends; I had really good friends and I had really supportive friends.
But it was like, “Well, I’m on my own. I’ve got to pay for an apartment.” I’d lived at home until my mom passed away because I didn’t want to move away while she was sick. So I almost felt like “this is delayed adulthood, and now I’m going to live on my own and that’s okay.” I’m a bit of a “soldier through” kind of person. I’m just like “stuff it all down, stuff the feelings down and continue on.” [laughs] Not maybe the healthiest model, but it’ll get you through in a crisis.
But yeah, not really. I think my dad came more into my life at that point, but we lived a few hours apart still at that time. It was pretty much just me after that.
Chris Sandel: You said that dieting is your way of controlling the world or trying to control the world or giving yourself a semblance of control. When your mom was ill and then she passed away, did your dieting really ramp up after that?
Glenys Oyston: Not so much then. What happened was – this was about maybe 3 or 4 months before she passed away. She was getting quite sick, and I was feeling very depressed and not really understanding why I was feeling depressed. I mean, maybe I guess I do in a larger way. I feel like I’ve spent most of my life disconnected from my body and not understanding why I’m feeling certain things. Maybe that’s just youthful folly, but I am much more connected and understand why I get sad about things now.
But instead of feeling really depressed, what I wanted to feel was like I was doing something somehow or distracted. So I went to my first Weight Watchers meeting, and that, going back to your support question, that was what felt like support to me at the time. Just being in a group of people – they didn’t know what was going on in my life, but that was fine. I didn’t need them to know. I just wanted to be around people who felt in a way like I did.
Honestly, that first Weight Watchers meeting was like going to a church or something when you’re really low in your life, and you’re like “Oh, this is amazing. I feel the love.” It was a small town. It was in the bottom of a church, and there weren’t a ton of people there. The leader was so nice and comforting. I was like, “Okay, I’ll try this. Let’s see how it goes.”
And to be honest, I’d been overeating so much up until that point that I really didn’t have to restrict that much to see weight loss. So what I’m thinking is at that point in my life, I may have been over my set point – I was overeating a lot at that time, and the way I know that is because being done with a meal meant I felt slightly sick. That’s when I stopped eating. It’s all gone and I feel a little bit like “oof, I don’t feel that well, I feel really distended and overstuffed” – that was done for me. So I was learning a whole new level of doneness, which was “now you can only eat this much, and good luck for the rest of the day” kind of thing.
But it was also different at the time. It wasn’t their point system; it was actually a little more balanced. It was much more like the old diabetes selections, were you had five breads or five starches and four proteins and three fruits and three vegetables. Something like that. So you had to really figure out how to distribute that through the day, and that was the first time I’d ever figured that out.
It was this great distraction from the grief that I was going through, which is a little bit sad. I mean, there’s nothing wrong with wanting a distraction, but I think now it was such misplaced grief.
So because I was in that when my mom passed away – she’d been sick for a few years, so it was like, “Well, I still have my diet thing that’s working for me.” I’d lost a bunch of weight by that point, and boys were being much nicer to me now. I just had that kind of distraction to keep me going through the whole time, so I didn’t have a total meltdown where I couldn’t work. I went right back to work.
Boy, thinking back now, I was really, really distracting myself a lot. The diet provided that major distraction to get through that time for me.
Chris Sandel: Yeah. It also sounds as though – as problematic as Weight Watchers is, and it’s not the ultimate solution – it was potentially better than what you were currently doing and gave you some bits that you maybe even do today that then helped you along that journey.
Glenys Oyston: Yeah. I have really mixed emotions when it comes to Weight Watchers. One, I feel very strongly that they are a diet company and that ultimately they’re not helping people’s health. But at the same time, back then what I probably needed was somebody to teach me (1) some structure, (2) how to make a meal, (3) how to get in touch with earlier fullness signals, (4) not to go past extreme hunger signals – so I probably needed some help with nutrition, but I would’ve preferred a non-diet dietitian, thinking back. But those didn’t exist. They may have existed in small numbers in 1994, but certainly not in a small town.
It did teach me meal planning, which I still do, and it taught me how to put together a balanced plate – albeit those were a little small. So there were things that it helped me do. And I would say initially, those early days, I was not restricting. I was really eating three meals and three snacks a day. I didn’t have to restrict that much to get results. Also, I was 23 and I’d never dieted before, so my body was so compliant when I was asking it to do something.
So yeah, those are things that I still value knowing now. I like to meal plan, and I like to have regular meals. Eating before I went to Weight Watchers was chaotic, and after, it was more ordered. I prefer having it a little more ordered, and I think that most people benefit from structure around eating.
So there were some good things I got from it; it’s just that it taught me that weight loss was the most important result. It also taught me during that time that if you’re not feeling good about life, you should diet more. [laughs] That became my stress response. Whenever I was feeling insecure about something, I’d get my journal out and start writing my food down more, and “I’m going to get a little more tight on things.” I was always trying to push my weight lower than it was, and that was not a good thing.
Yeah, I have really mixed emotions around it. It was a little bit like a replacement mother.
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Chris Sandel: That’s an interesting way of thinking about it. You then went on to become a dietitian. Had you seen a dietitian at any point along your journey? You obviously went to Weight Watchers, but did you ever have individual consults yourself with someone?
Glenys Oyston: No, never. By that time after the Weight Watchers, I was in the “normal” BMI category, so nobody was concerned about my eating or my weight. And I grew up without a lot of money; you don’t go and pay for that kind of thing. I didn’t even know what a dietitian was in my twenties.
I didn’t learn what a dietitian was until I started getting really obsessive in my thirties about food and restriction and eating, and I started looking around like, “I really want a different career. I don’t like what I’m doing.” It was just a lot of office jobs. I was doing event planning at the time, and I didn’t want to do that. I knew I didn’t want to do that for the rest of my life. I didn’t have a degree at that point, so I really wanted to go back and get that.
I don’t know how I stumbled along dietitian, but I think I got to EatRight.org, which is our Academy of Nutrition and Dietetics website. In the quest for sating my food obsession, that’s one of the websites I stumbled on. I was like, “Ooh, dietitian. I could probably become a dietitian, maybe.” I thought, wouldn’t it be great to help other people lose weight? That’s when I started to pursue that. That was in the early 2000s, around 2003.
Chris Sandel: You said it took a while to actually complete that because you were doing it part-time. How many years were you going through the training?
Glenys Oyston: I went part-time, really slowly, for 5 years. I would do one or two classes a semester. And I was starting from scratch. I didn’t have a previous degree or anything, so I was really starting from scratch as an adult in her thirties. But I also accepted that I’m a little bit changeable at times, so I was like, “Maybe I’ll change my mind along the way, so I won’t go all-in. I’ll just dabble my way through.” But I didn’t change my mind. I think I tried to at one point. [laughs]
Chris Sandel: To what? Do you remember what you wanted to change to?
Glenys Oyston: No. it was something much more nebulous. It was like “Maybe I’ll just get a liberal arts degree or whatever.” I was working in fundraising, in development, at the time, for schools. I was like, “Maybe I’ll just become a fundraising officer.” Now I think, why did I want to do that? I don’t want to ask people for money. [laughs]
But it was like, “Oh God, dietitian just seems so far away right now. I have to take chemistry? Are you kidding me?” I think it was when I had to take chemistry I freaked out and was like, “I’m not going to be able to take chemistry.” I hated science in high school. Turns out I like chemistry.
Anyway, I forged ahead, and then at some point during that time I got divorced. I was married and I got divorced. My extreme dieting did not save that relationship, turns out. PSA: Losing more weight will not save a relationship that you’re not enjoying.
Then I was with somebody new at that time, and we were together a couple years and he’s like, “I’m getting a promotion at work. Why don’t you quit your job and go to school full-time and get this thing done with?” I was like, wow, great.
I did it – that’s during that time I met Linda Bacon, had a total ideological shift in how I thought about weight and food and eating – and then I finished in 2012 and did my internship in Los Angeles. I was in San Francisco when I did my schooling and moved to Los Angeles for my internship with the Veterans Administration. Finished that in 2013, and I guess the rest is history. I hope that answered the question you just asked. [laughs]
Chris Sandel: Yeah, it did. When you were doing your internship and then as soon as you started as a dietitian, were you 100% onboard with the Linda Bacon, Health at Every Size style of practicing? Or was there still some ambivalence about it and unsureness of “maybe I agree with some of this, but some of this I don’t necessarily agree with and maybe I’ll do some weight loss”? How were you feeling at that point?
Glenys Oyston: I was 100% converted. I was like, I don’t want to have anything to do with weight loss; it’s evil. I was all-in at that point. The nice thing was when I transferred to my 4-year university, I did a lot of classes at what we call junior college here, and then transferred to a 4-year in San Francisco, and one of the instructors there was also very much a Health at Every Size person. So she was great. She was like a lifeline for me. My close friend that I went through classes with didn’t believe in dieting because she had also had Linda Bacon.
So the great thing was in that program, there were so many people that had had Linda Bacon as a teacher by that point, because a lot of us went through City College of San Francisco, so a lot of us were onboard with that. Like “ugh, diets, gross, eww.”
But also in San Francisco, you had the other side of it, which was a lot of healthism around food. I call it the Michael Pollan syndrome, where even if we don’t believe in dieting, the food’s got to be local and organic and gently massaged [laughs] and pastured and whatever. The cows have to have therapists before we eat them. It was just really extreme healthism. That had become a part of my dieting before I quit, so I was still a little bit caught up in that, like “I still want organic food and I still want it to be local and sustainable.”
So I was still a little bit in that mindset, probably, but definitely very much like “I don’t want to talk about weight loss.” I had stopped dieting, and I was gaining weight because, you know what? My body did not want to be thin. There was a moment when I gave up dieting, I thought “Maybe I’ll still stay this size because I’ve been this size or close to this for 16 years.” No. I am not a thin person by nature. And we know that dieting really throws off weight regulation, so I’ve probably gained back even a little more than I ever would’ve been because of that.
But definitely, no, I did not want to do any kind of weight loss. I remember when I got to my internship here in Los Angeles, I was panicked because the dietetics were always filled with people who believe in weight loss, and they believe that fat bodies are wrong bodies. I was panicked.
And then in our orientation, I met Aaron, now my podcast partner, and he was very much into intuitive eating. He was in a larger body at the time. It was just like hearing the angels singing, like “I’m going to make it! I’m going to make it through this!” The nice thing about that internship was that a lot of the dietitians had been influenced by him and by their own histories, and most of them at the time were not very diet-y.
So it was this wonderful fortuitous experience where I didn’t really have to teach a lot of weight loss during that time. I just feel so lucky that that was supported and that everybody as onboard with how I felt about that. It was so nice. I’ve been lucky that I didn’t have to dip my toes back into the weight loss paradigm too much.
Chris Sandel: That’s awesome. I forgot when I was chatting with Aaron to ask how you guys first met, so I was like, I definitely want to find that out today. That’s great to hear that that was how you first came into contact. How many years ago was that? You said 2013, that was?
Glenys Oyston: That was 2012, yeah. The beginning of my internship, 2012. I know he mentioned this on your show, so I can say it, but he was working in their weight loss program at the time. I remember specifically asking him – I always laugh and say there’s some kind of divide between the Bay Area and Los Angeles.
Everybody in Los Angeles knows about intuitive eating, but not so much Health at Every Size. It’s different now, but this was about 7 years ago. Everybody in the Bay Area knew about Health at Every Size, but not so much intuitive eating. I think it’s because Linda Bacon was in the Bay Area; Elyse Resch and Evelyn Tribole are down here in Los Angeles. So it just radiates out from those people.
So he had said, “Yeah, I’ve heard about Health at Every Size. I don’t know, I haven’t read the book.” I said, “How are you doing intuitive eating but you’re in the weight loss program? How do you square that?” [laughs] This is so Aaron. He just shrugged his shoulders. He’s like, “Eh, I just do.” I was like, “Okay, let’s just go with that. I’m not going to judge.”
We became friends, and it was a few years later I remember him saying he was getting much more into the Health at Every Size world, and he said, “I’ve got to get out of here. This isn’t the right thing for me anymore.” I was like, “Great.” Then he really left and went into the eating disorder world and is a gigantic hero in those circles. People love him, and he’s great. He has so much great stuff to say on that.
So that was the trajectory of our relationship, and now we have a podcast together.
00:42:00
Chris Sandel: All of that sets us up nicely in terms of giving your backstory. How did you then get into – I said at the top that I wanted to spend some time on diabetes because this is an area that you do a fair bit of work around. How did you get into that?
Glenys Oyston: After my internship I was hired by the VA, which was great because I really loved it there. I was working with veterans. I started out inpatient, in a spinal cord injury unit; I’ve since then moved to outpatient, in a home-based primary care setting where I visit people in their home.
Throughout working with all of those patients, many veterans have diabetes. There is a link to Agent Orange that’s recognized now, that people exposed to Agent Orange might have a higher risk for diabetes. So I’ve had a lot of patients with diabetes over the years, and because I don’t do weight loss, you have to figure out, what does nutrition look like when you’re not doing weight loss for somebody?
Weight loss, we know, first of all, it doesn’t last for most people. It often makes people larger in the long run. So if they’re trying to lose weight for their diabetes, then it’s going to have the exact opposite effect in the long run. They’re just going to regain all of that weight.
And we know you can actually improve blood sugars through a lot of different modes of self-care – changing the way you eat to some degree, getting movement, and then a lot more beyond that. What’s the stress level like? Just looking at the whole person.
But I’m also working with people who are often financially strapped, so you have to be really inventive around, hey, maybe fast food is your only way of getting food. You don’t cook for yourself; you might not have a stove or a kitchen. How do we look at that?
I’ve worked with a lot of people with diabetes over the years. How I got into it more in my private practice was a few years ago, Rebecca Scritchfield, who’s another dietitian – she wrote the book Body Kindness.
Chris Sandel: Yeah, I’ve had her on the podcast. People can check out that episode as well. I’ll put it in the show notes.
Glenys Oyston: Great. We had met at a conference, and we kind of knew each other. She’s been super supportive. She called up and said, “Hey, do you want to do something around diabetes? It’s just not being addressed as much as it should be.” I was like, “Okay, sounds good.”
What we started to do was run support groups. The big problem in diabetes care is that when somebody gets a diagnosis like prediabetes or diabetes, if they’re in a larger body, the first thing the doctor says is “You have to lose weight.” Except we know that that doesn’t work for most people. Most people can lose weight in the short term, but in 3 to 5 years, everybody regains all the weight, and sometimes more.
So we wanted to provide this Health at Every Size-oriented support group for people with diabetes, but also prediabetes – really any sort of medical related condition. It could’ve been hypertension or cholesterol or anything, PCOS. We started running these virtual groups, and they were small groups. We found that people were so grateful for having the space to learn non-diet stuff and be supported in non-diet ways of caring for themselves that it really was something that was needed.
What we’ve done since then is we’re still working on – we’re going to probably launch it pretty soon, but we’ve expanded the groups into an online subscription program with online content, and also the support groups, because people really need those, and a monthly support group. What we found was we would do it over 4 weeks, and I think people just needed more time with the support of dietitians and other people to help make changes if they wanted to make changes.
So that is what we’re doing. It’s called Self-Care for Diabetes, and we can put a link in the show notes as well if people want to sign up or find out more. It should be launching early in the new year.
Because of that, I’ve also somehow become the go-to dietitian in the area for anybody that has an eating disorder and also diabetes. I see a lot of people that have say binge eating disorder and pre-diabetes or a diabetes diagnosis. You can do great things without recommending weight loss or pursuing weight loss.
Often when people start to eat in a much more regular way – because what I find in my clients with binge eating disorder and any kind of overeating issues is they don’t actually have an overeating issue. They’re actually starved through the day. This has been my typical experience with clients. They’re just not eating breakfast and then they’re skipping lunch, and they’re like, “I don’t understand why I’m so hungry at night.” I’m like, “Well, you do have to eat as a human.”
What we find is when they start to eat regular meals through the day – and it almost doesn’t matter what they’re eating; just their meal pattern starts to even out – their blood sugars get a little bit better. So that’s been a great thing to be able to work with people who the only thing they’ve ever been told their whole lives is “lose weight,” and it’s never worked for them. They’ve tried, and it’s never worked long-term for them. And now they have diabetes. We can’t ask them to try that again. It’s a poor intervention.
So it’s been really gratifying to be able to offer that to people.
00:48:10
Chris Sandel: I would like to go through some of the stuff that you cover as part of that course and talk a little bit about diabetes and some of the information that you give out. Just backing up to start with, do you want to describe – I think most people have an idea of what diabetes is, or a rough idea, but can you talk about what diabetes is and what pre-diabetes is and what’s type 1 and type 2, just so that people are on the same page when we start going through this?
Glenys Oyston: Yeah, absolutely. I’ll talk about type 2 diabetes because it’s much more common. That is usually something that tends to be diagnosed more in adulthood, and often older. It is a chronic condition. Once you have diabetes, you always have diabetes.
Your body is not using the sugar from food, the carbohydrates from food, the way it should be, basically. You’ve got your cells that are becoming resistant to the insulin, perhaps. Insulin takes sugar into the cells, and if it’s not getting into the cells, it’s hanging out in the bloodstream, and our bodies don’t like to have a lot of sugar in the bloodstream. It needs to have some, but not a lot, so it’ll build up and cause a lot of problems. In the meantime, you’re not getting the energy into your body that you need to.
So what you end up with is high blood sugar, and that’s how they tend to diagnose it. You can do a fasting blood sugar. They also diagnose it with the hemoglobin A1c. That’s primarily the way they tend to be diagnosing it now. Your hemoglobin A1c is a measure of your blood sugars over 3 months, so that is over – I’ve forgotten the numbers. I think it’s over 6.2% here. It’s different in different countries, too, which gives you a little view into how things are – it’s just not a cut and dried thing, necessarily.
Often, once somebody has diabetes, they might need medication to help get that blood sugar into their cells and out of their bloodstream. You can also do a lot around – I’m going to say diet, but really what I mean is your pattern of eating or your way of eating. You can do a lot with movement to help blood sugar.
I can talk in a minute about all of the other things that we cover, because there’s a lot of different ways that your blood sugar can go up. It’s not just eating and it’s not just lack of movement, but stress impacts it, and shame impacts stress.
So that’s type 2 diabetes. It’s different from type 1 diabetes in that that is an autoimmune disease. They used to call it juvenile diabetes because it was diagnosed in young people, usually – although people can get it when they’re older as well. The body attacks the beta cells in the pancreas, which are what produce the insulin, so they eventually have no insulin left and they become dependent on exogenous insulin, meaning they have to inject it into their body.
They differ a little bit, because somebody with type 2 diabetes might not become dependent on insulin. They could, if it progresses, because it is a progressive condition, but they might never become insulin-dependent or need to use insulin versus somebody with type 1, who does require injections of insulin to be able to live. So that’s the difference.
I was just on another podcast the other day and we were talking about the shame around type 2 diabetes versus type 1 diabetes. Type 1 diabetes does tend to be diagnosed in younger people; it can happen to a person of any size. I think generally, there’s no shame around getting that condition versus type 2 diabetes. I think people tend to get blamed for getting this condition, like “you’ve done something wrong and that’s why you have it.”
I didn’t say earlier, but for type 2 diabetes, there’s a strong genetic link, so often if somebody’s at the doctor, they’ll ask, “Do you have a family history of diabetes?” They’re asking that because that means it increases your likelihood of getting it. I’ve just found out it runs on both sides of my family. Probably stronger on my mother’s side. So I have that family risk as well that interested me in the whole thing.
So that’s a very probably clumsy overview of diabetes. I’m pretty sure somebody else could tell it much better than I could. [laughs] But that’s my layperson – like when I have a patient or client and I say, “Did anybody tell you what diabetes is?”, with my veterans, all of them kind of shrug and they’re like, “Sort of? It’s like sugar?” That’s their answer. I’m like, “Let’s talk about this, because we need you to understand.”
They need to understand what’s happening in their body, and you want to use simple terms. So that’s how I’ve gotten used to explaining it to some degree. I probably use much easier terms when I’m talking to somebody maybe with a lower education level or something like that, but I want them to understand me, and if they have questions, they can ask.
But yeah, I’m sure somebody else would describe it in a much more elegant way. [laughs] But that is my explanation.
00:52:25
Chris Sandel: That makes sense. It’s interesting your comment about the difference between type 1 and type 2 diabetes and how that’s thought about within society. Type 1 is an autoimmune condition and it’s more thought about that that’s just something that the body has done on its own. The person’s not “responsible.”
And then type 2 diabetes is very much in the category of lifestyle disease, where people talk about it as if this is very preventable – preventable meaning “if you’d done the right things, you wouldn’t have necessarily gotten it” and making the person accountable or responsible for why they’ve ended up with type 2 diabetes. So yeah, I can understand how it gets felt like that and talked about like that, and then the shame or guilt or whatever that gets attached to ending up with that condition.
Glenys Oyston: Yeah. That’s why, in our program, the first module is help with shame resilience. People have been told “this is your fault,” and that’s how people were coming into our groups, like “I feel blamed for this.” Many people would be in larger bodies, and they felt like “this is somehow my fault.” Or even if they knew it wasn’t their fault, it’s like, “I’ve been told it’s my fault.”
Nobody can flourish with that much shame around something that’s not their fault at all hanging around for them. So we really talk about shame resilience and recognizing shame thoughts and how to hold yourself in those moments. If you want to make changes or you need to make changes, you can’t really shame yourself into that. Some people maybe are successful at doing that, but most people might do it for a while, and then I think there’s a saving mechanism that comes in like, “Eh, I don’t want to do that. Screw that.”
So yeah, we spend a lot of time on shame in our program.
Chris Sandel: I completely agree with that. I was having a call with someone before we started recording this and talking about why I think fear is a terrible long-term motivator, and the same with shame. If you’ve got to keep up negative feelings consistently to help you do something, at some point you’re like, “I’m just feeling tired with this.”
I know when I had Rebecca on the podcast, we talked about spiraling up and getting people to define the positives and to find their strengths and getting them to a better place through that. That is much more sustainable and is much more helpful than getting people down on themselves as a mode of changing.
Glenys Oyston: Absolutely. Ragen Chastain is a great fat activist that I have followed for years and I know now, and she’s always said, “You can’t hate yourself healthy.” I truly believe that. We don’t want to take care of something we’re upset or ashamed about.
And just knowing there’s no reason to have shame around diabetes – even if you caused it yourself, which I doubt most of us have the power to be able to bring disease on ourselves, but even if you did cause it yourself, it’s just a condition that people get. There’s no reason to have shame around it. It’s unfortunate that people are encountering shame in the doctor’s office. It’s really paralyzing them, and they can’t move forward.
00:58:25
Chris Sandel: What are the symptoms that clients are typically getting that lead them to that diagnosis of diabetes? Or is it simply that they’re in the doctor’s office, the doctor tests them and says, “Hey, by the way, you’ve got diabetes”?
Glenys Oyston: A pretty normal test to be run here is an A1c. I have had young friends who had it run, and no history of diabetes in the family. It’s just a pretty standard lab test that doctors run here.
I often think, too – it’s kind of a funny story. My partner is a thin person, and he’d never had his A1c taken. He’s so funny; he just went in and said, “I want to have my A1c done.” They’re like, “Why? You’re not overweight or obese” – their words, not mine. He’s like, “So? I should know if I have it or not.” [laughs] He demanded having a test, versus somebody who goes in in a higher weight body, I think that they automatically assume that there’s going to be some blood sugar abnormality and they run that test.
So people are probably getting diagnosed because of weight stigma, to some degree – which is ironic. I mean, if you have diabetes, you want to know because then you want to get appropriate treatment for it. But I do think that people in higher weight bodies are probably getting diagnosed more, and I think people that are thinner are being missed.
A couple of patients I’ve had through the VA who were thin developed diabetes and suddenly had these really dramatic, overnight things happen to them. One gentleman basically lost kidney function in a very short time. He had a very short-term memory, so I don’t know how long he’d had diabetes, actually, thinking about it. [laughs] But it was a surprise thing, and he was thin. I don’t think anybody ever thought he would have diabetes. Somebody else literally lost his eyesight overnight with snowflakes developing in his eyes. They call them “snowflakes.” They improved, but again, he was in a thinner body. I’m just wondering if he was missed being diagnosed.
So I think using weight, unfortunately, as a way to diagnose people is terrible because we’re going to under diagnose thinner people that might have diabetes and possibly over diagnoses larger people in that they might have a borderline, pre-diabetic A1c, and it’s like, “You have to go on a diet immediately.” I see a lot of people like that. If their A1c’s aren’t that high, they may never develop diabetes, but the panic button has been hit for them. They might benefit from some changes, but at that point there’s no reason to panic, but the panic button has been pressed.
That I think is why and how it’s getting diagnosed here. I think it’s a pretty uneven application.
Chris Sandel: Wow, that’s super interesting. I’d never even thought of how many people in thinner bodies are potentially getting missed because doctors just don’t even think about diagnosing them. The same way with people in larger bodies, they take a look at someone and make some assumptions, and then they decide based on those assumptions. The assumption is that they can’t have diabetes.
I know when I had Julie Duffy Dillon on the podcast and we were talking about PCOS, this was a similar thing where she said that when they did a huge amount of research on PCOS, it affects people all across the weight spectrum, and it doesn’t even particularly skew towards people being in heavier bodies. But if you asked most doctors, or even just most people in the lay public who’ve heard about PCOS, the first thing they would probably think is it’s something that happens to people in larger bodies. So yeah, I think that’s fascinating.
Glenys Oyston: Yeah. We’ve had people with PCOS in our group, and they also felt shame about having that because they were in a larger body.
I just wanted to say about the weight stigma piece, we did have one person in our group who said, “My doctor said I had pre-pre-diabetes.” We’re like, “What is that?” None of us knew what that was. What we realized is that person was probably a victim of weight stigma at the doctor’s. If your A1c is in the normal category, that’s called “not diabetes.” But because this person was in a larger body, we think that she was a victim of weight stigma, essentially. Pre-pre-diabetes? “You’re in a larger body, so you’re just going to get it.” I just wanted to end that part on that story.
Chris Sandel: Wow. That is a horrible term to be using and just shows someone’s assumptions if they’re labeling something in that way, because it’s clearly not showing up on a blood test, but it’s like, “Oh yeah, definitely from looking at you, I know that this is going to be your endpoint, so I’m going to tell you about it.”
01:03:55
I know with intuitive eating that Gentle Nutrition is the last principle. When you’re either working with clients or when you’re doing the program that you do with Rebecca, are you talking about nutrition more up front, or is that still left to the end?
Glenys Oyston: We hit that in the middle of the program, because I think people want to start to know – they get a little itchy around “But what do I do with food?” But we do preface it with a module on mindful eating first, because we’re not taking people through the whole intuitive eating process. It’s not a complete “here’s how to do intuitive eating.” But we do talk about the mindful eating component because we do think that that is a really useful tool to use in honoring hunger and fullness signals and preferences.
We do talk about intuitive eating, and we do say if you have an eating disorder, treating the eating disorder comes first. If you are still in the middle of having binge eating disorder and you’re not feeling good about all foods, that all foods can fit, for me, I think the foundation is not there to be able to make any nutrition changes. You really do need to believe that all foods can fit. And I do believe, even in diabetes, that all foods can fit; it might just be you have to eat them in a slightly different way or in a different pattern. But restricting foods doesn’t tend to help people.
So we do say think about your eating disorder first. If you need treatment for that, call us, call somebody else. Get the help you need. But that needs to come first, to some degree, in order to heal that relationship to food.
So we kind of hit it in the middle, but we also have a very flexible – you can skip that module, go on to another one, leave it to the end. There’s no reason to do things in order, necessarily. We say look at the titles; whatever’s affecting you the most right now, you can do that one first. So there’s a lot of flexibility in that. We did put it in the middle, but again, it can be tackled last.
And again, if somebody’s not ready to hear nutrition information, they don’t have to listen to that. There’s many other ways that you can perform self-care that’s going to be supportive – not just for diabetes, but for anybody, really. So we do talk about nutrition a little bit, yeah.
Chris Sandel: I was just going to say, something you made reference to earlier in your own story with Weight Watchers is the importance of structure.
Even with the clients I work with, yes, it will vary depending on the person, but a lot of the time that is where we start, because that is the foundation of everything. If eating is all over the place and it’s chaotic, if you can bring some structure into that and that can be done fairly early on, that one change can make a really big difference. It’s often trying to find, what are the levers that make the biggest difference to start with? And that one is often one of them.
Glenys Oyston: Absolutely. We spend more time talking about structure than what you should eat. We’re not actually telling you what you should eat. We know that fruits and vegetables and fiber are all good things for everybody, and especially for blood sugar control.
What I find is most people come into this – it’s not a knowledge deficit around nutrition, necessarily, but unfortunately what they’ve been taught is to diet, and that’s not necessarily nutrition. It has led to really chaotic eating for people, so yeah, I’m a huge fan of structure. We need to get fed regularly. Many of us have jobs where we have to eat in a fairly structured manner. You can’t just have lunch whenever you feel like it at a job.
I also believe that hunger and fullness still play a factor in that and that you can have structure and still have normal hunger and fullness cues. I find that when we introduce structure for people – I call it appetite training. Basically, your appetite starts to fall along that structure so that you’re getting hungry at your lunchtime.
I’m a big fan of Ellyn Satter’s Eating Competence Model, and I draw a lot from that as well as intuitive eating. That really spoke to me when I stopped dieting. Like, “Oh, structure, that’s a good thing to have” kind of thing.
We talk more about that and meal mixes, what it looks like to play with the macronutrients on your plate for a balance that works for you. It’s very much about being experimental and learning what works for the individual. It’s not a one-size-fits-all, “you must eat this way.” It’s very much like, find out what works for you. That is maybe novel for people as well.
And it can be difficult, because it’s a gray area, and sometimes people are like, “Just tell me how to eat.” It’s like, “I could tell you how to eat, but you’re not going to do it. You know that. You’re going to do it for 5 minutes.” It has to come from you, the individual. That’s where I think that our approach is fairly novel as well. It’s really helping you build the skills to learn how to care for yourself in a way that works for the individual.
Chris Sandel: What you’re describing is also the way that I work with clients. You and I can both have a huge amount of nutrition knowledge, but people react to that differently. I can talk to clients who tell me, “This is the breakfast I do best on,” and I’m like, gosh, if I had that for breakfast, I’d feel terrible. And vice versa. Both of us could be having highly nutritious breakfast; it’s just we prefer different things. We perform better on different things. Someone could be like, “When I have chocolate,” for example, “I do better when I have that on its own.” Someone else is like, “I do better when I have that as part of an actual meal.”
If someone’s like, “Can you tell me some nutritional advice?”, it’s more of, “This thing could work, or there’s this other thing that could work. Why don’t you try these things out and see what you notice for your body?” As you were saying, trying to get people to understand that there isn’t just one way of doing this. There’s lots of different ways of doing this, and not every way is going to work for them. There’s some ways that will work for them; there’s others that won’t.
But they then have to learn the ability to listen to their body and to be able to pay attention, to prioritize food or the experience of eating enough so that they’re able to get that feedback. And all of these things take time. There isn’t just one easy handout that you can give them that’s like “this is all you need to do.”
Glenys Oyston: That’s exactly how I work with my individual clients as well. They say, “I just want you to tell me what to eat.” I’m like, “That’s not really going to work. We’ve got to figure out what works for you.” Like you said, I can offer, “Hey, if you’re getting really hungry immediately after, what about some more protein? Do you want to play with that and see what that’s like?”
I think for some people who have been on the diet cycle so many times, that feels kind of relieving to some degree. They’re like, “Oh, I get to choose and I get to choose what I like.” I wouldn’t want to work any other way. A cut and dried approach, we know this doesn’t work. Everybody has their individual preferences, and we want to honor those.
Chris Sandel: You said for some clients they feel relief with that, and I think that is definitely the case with some people, and then for others, it’s completely paralyzing because of the realization of “I genuinely don’t know what I want. I don’t know what I like because I’ve become so numb to all of those things, because I’ve had to over the years of ‘you’ve got to follow this list and you can’t have that list.’” Someone has just lost the ability to be able to even understand what they like or what they want.
And that’s not a permanent thing; that can be relearnt. But yeah, for every person who feels free in that moment from that realization, there’s the other client that feels utterly terrified and doesn’t know where they’re going to go with that information.
Glenys Oyston: Absolutely. I love those clients, too, that are so like “What do I eat?” I’m like, “We’re going to do some deep dives into what you like.” It’s kind of a fun challenge. But yeah, they’re in total disarray of like “I don’t even know.” They’ll skip meals because it’s just terrifying to figure out what to eat. And for my clients, sometimes they’ll binge later. I’m like, “Well, we know that you probably like that binge food, so can we work it in earlier in the day?” That’s definitely a fun challenge to have in a client, I think.
Chris Sandel: You mentioned the mindfulness piece as being a big part of what you’re teaching. What aspects of mindfulness with eating do you teach?
Glenys Oyston: Mostly paying attention and calming down – permission to eat, I start with. I think that’s the number one thing that we need to have, and taking a deep breath before meals, and then seeing if you can tune in to the food and the taste of it. Eventually learning your own hunger and fullness signals, if those are dampened for you.
I’m trying to think. It’s a pretty good module. We recorded it a while ago, so I’m trying to remember what’s in it. [laughs] We try not to overwhelm people because ultimately, we want them to get the point that it’s about being present with the food rather than being distracted, and really just being curious about what your hunger and fullness signals look like. This isn’t cut and dried. This is experimental and just a skill that you practice. Over time, it may change for you, to your experience.
But really, just being present with the food is a big one. We know that people eat with a lot of distractions as well, and I’m a big fan of saying, can we put the distractions away? When I’m working with clients individually as well, that’s when you see where all the feelings come up. What we expect fully when people start this mindful eating practice is that they might become aware of emotions that they have around food. Just note them.
It’s not a super deep dive into mindful eating in that they’ll spend like 3 months trying to learn different aspects of that, but really just early steps of listening to hunger and fullness if you can sense them, paying attention to your food, and then the permission and doing some deep breathing.
01:16:15
Chris Sandel: Non-food suggestions – you made references early on, and I’m also a big believer in this. Food and nutrition are an important part, but I think they are given way too much weight in terms of their importance. This is for diabetes, but also for health in general. What are the other things that you’re talking about as part of the course or with individual clients that can be helpful for blood sugar regulation outside of food?
Glenys Oyston: We talk about sleep being a big one. That’s what we started out with in the 4-week groups initially. We would talk about sleep, movement, mindful eating, and nutrition, and then we would weave in a lot of other information depending on what problems people were bringing to the group.
So we’re definitely talking a lot about sleep and improving sleep patterns and getting help if you think you have sleep issues.
We talk about the self-compassion for shame and building self-compassion. I think that’s something that people really struggle with, is self-compassion, period. We’re always saying, “I should be doing this, I should be doing that,” and ‘should’ing all over ourselves does not really work to get things done.
We talk about making sense of your blood sugar labs and taking blood sugars in a way that doesn’t feel judgmental, but that can be information and feedback so that you can make decisions about “Did this meal work for me, or do I need to mix it up a little bit? Do I need to change the mix of that?”
We talk about really defining your values and living according to those. It’s really important for somebody to know what’s valuable or what’s a value for them, and then how do you live that? How do you bring that through in your self-care?
The mindful eating, the nutrition part of it, building boundaries with people, because people are getting a lot of diet advice. So how to come up with boundaries around that.
Oh gosh, I’m trying to remember everything. There’s 14 of them. Some of them are shorter, so it’s not like 14 hours of information. Some of them tend to be a little bit shorter.
Movement is a huge component of this, talking about movement and finding out, what’s enjoyable for you? What’s fun? What do you like? What can you make work for your life? Versus the advice of “you just must exercise.” I have so many people in my practice that really struggle with exercise resistance. They’ve been traumatized by exercise since they were young, and they’re like, “I don’t want to do it,” because it’s always been about weight. It’s always been about doing something they don’t enjoy. So we have a gentle way of easing you into thinking about movement.
Stress is another big module, and how stress can affect your blood sugars and your life, and then what you can do to help yourself around that.
Those are some of the big ones. We talk a little bit about weight-inclusive care and how to bring it all together and commit to yourself. Those are the main ones.
You can see it’s not just about food, right? There’s so many different ways to care for yourself. So if you don’t want to hear about the nutrition piece, move on and just think, “Okay, what else do I need?” We have a self-assessment that’s going to help people figure out where they need help.
That’s the big part, because not everybody comes with the same problems. They need to know, “What can I do to help myself with what I have now?” We think that’s going to be really helpful, because this is about building, “What is my self-care plan going to look like, and where do I need help and support?”
01:20:50
Chris Sandel: Of some of those things that you touched on, I have mentioned so many times on this podcast just how important I think sleep is and how much I prioritize it because I know how much it impacts on me and how I perceive the world and how I’m able to function. I know in Matthew Walker’s Why We Sleep book, he starts out in the beginning talking about just how much improper sleep impacts on blood sugar levels. I think there was some example like if you disrupt someone’s sleep by even 2 or 3 days, you can get them into pre-diabetic blood sugar levels just because of the lack of sleep and how important that is.
So I think the sleep piece, and then the other one connected to that is the better sleep that you have, that has a direct impact on the kind of foods that you crave and your ability to listen to hunger and fullness. If we’re talking about getting structure in place and having that side of things working, I would again say sleep can be so important.
Glenys Oyston: Around sleep, too, a lot of people might have sleep problems that need treatment. I always want to recommend, could you go and do a sleep study? But the problem with getting tested for sleep apnea is that there’s so much weight shame in that process.
The first thing they say to you if you have sleep apnea, before you even get diagnosed – the HMO, the medical system I’m in, you go to a class and they say, “The first thing you need to do is lose weight. But if you have sleep apnea and you get the machine, then you’ll sleep better and you should be able to lose weight.” It’s like, argh, stop! [laughs] We don’t know if that’s true or not.
A lot of people avoid going to get tested for sleep problems, I think, because they are likely to be weight-shamed and told “this is your fault.” Whether it is or it isn’t – it might be, but again, we don’t know a long-term cure for turning a larger body into a thinner body permanently. We don’t know how to do that, and especially, we might make the problem “worse” in terms of they want somebody to lose weight and then they might end up larger. In the long run, that’s what a diet will do for you.
So it’s unfortunate that people aren’t really getting the help they need around sleep disorders.
Chris Sandel: Yeah. I’ve had a number of clients who, when they’ve had it diagnosed, have then been told, as you said, they need to lose weight.
Also, though, when they started using the CPAP machine, how beneficial it has been. They’re like, “Oh my gosh, I wake up feeling so much better than I have in so long.” It really shows them how much sleep was impacting on them when they didn’t realize. They were like, “I don’t think I’m sleeping well” or “I feel a bit under the weather when I wake up” or “I just don’t have great energy,” but it’s by starting to use the CPAP machine that they’re like, “Wow, it is really night and day with how I’m feeling now since starting to use this.”
Glenys Oyston: Full disclosure, this year I was diagnosed with mild sleep apnea, and I’m feeling the results of treatment. I have so much more energy through the day. It’s kind of shocking. I could not use the CPAP machine, but my sleep apnea was so mild, I could probably have ignored it – which I didn’t want to do.
But there’s also something called – I only have sleep apnea when I sleep on my back, so the idea is to keep me off of my back in the middle of the night. You can buy devices that you strap onto yourself to do that. But there’s also a very DIY way to do it, which is to put a tennis ball in a sock and pin it onto the back of your shirt while you sleep. [laughs] And it really works.
I just wanted to say that because to have better sleep is amazing, to wake up feeling not so exhausted. So when I have somebody saying to me, “I am so exhausted in the morning,” I’m like, “Let’s get you tested. Let’s see if you can get a sleep test.”
I give them strategies for getting through the whole process without being completely destroyed by the weight shaming. We strategize on what will work for them to get through the process. But yeah, being able to sleep better is so health-giving, I feel.
Chris Sandel: Totally. As someone who has a two-year-old child, I know the difference between good sleep and not so good sleep, because it happens regularly. [laughs]
01:55:55
You mentioned about movement. Again, I think it is so beneficial for so many areas of life, but we just need to change the way that we think about movement. Movement can be so many of the little things that we do on a regular basis, or the things that we scoff at as not being sweat-inducing. Like, why would you bother going for a walk, or why would you bother doing some gardening?
Just so many things that people really enjoy, and they would probably enjoy them a lot more if they didn’t feel like they should be doing more than just that. Or “I’m going for this walk, but I really should be going and doing a boot camp.”
I think that if we can change the way that this is approached – and I know this is the case with a lot of clients. It’s like, what do you really enjoy? What do you enjoy doing in terms of moving your body that if you found out in 10 years’ time that it had no health benefits, you’d still want to keep doing it? If you have any of those, let’s start there, because that can be a really great way of being able to move your body without all of the beliefs around exercise or the baggage around exercise that someone may be bringing to the table with it.
Glenys Oyston: Yeah, absolutely. The baggage that people bring with exercise – and I hate using the word “exercise.” That’s like capital ‘E’ exercise. It really brings up images for people of like “I’ve got to be sweating or lifting weights” or whatever. I’m like, you really don’t. Any kind of movement is great.
I’m like, hey, let’s count what you’re already doing. You go to the grocery store and walk around the aisles. You have to do laundry. Maybe you have to go up and down the stairs for that. All of that counts as movement. I say let’s give ourselves credit for what we’re already doing, and see if there are ways to include more of that in your life, if that feels good for you.
But yeah, just a walk. One of my clients actually said to me, “I really didn’t want to walk because I felt like I had to pound the pavement and go really fast.” What she found one day is if she just strolled and enjoyed things, she actually enjoyed doing that and felt like she wanted to do that again. It’s like, yes, that is so much better than nothing at all. You found a way to do it and make it work.
All movement is going to be beneficial. But finding out what those blocks are for people – because I think, again, people have been so traumatized by exercise. They’re like, “I want to exercise, but I don’t know why I don’t want to exercise.” I’m like, I get it. It’s become this draconian punishment for you, and they don’t want to do it.
I do a lot in my private practice with helping people move through exercise resistance, and that’s been really helpful.
Chris Sandel: I’m trying to remember the exact details, but there was this really great paper that looked at people who were already doing movement – I think it was maids that were working in a hotel or something along those lines. They split them into two groups and had a control group, and then they had the group that they talked to. The group they talked to, they were like, “You are on your feet for however many hours a day, 8 or 10 hours a day. You’re doing so much movement by cleaning the rooms and changing bedding and all of this.” They then left them to it and checked in with them again in a month’s time.
For whatever reason – we don’t really understand a lot of this stuff, but because they now started to think that what they were doing as a job was actually movement as opposed to constantly feeling like “I don’t have time to get any exercise done because I’m doing this job all the time,” they had remarkable changes within themselves. I’m blanking on what the changes were. Maybe there was some weight loss; that’s probably what the study was focusing on. But it was changes in terms of blood sugar levels, changes in terms of lots of different markers. And nothing had changed in their life apart from the fact that they were told that actually, what they were doing counted as movement and was helpful for their body.
So yeah, I’m a big advocate of just getting more NEAT (non-exercise activity thermogenesis), more small movement into people’s lives and for them to understand that that is really beneficial because that’s the majority of movement that we’ve done throughout evolutionary history.
Glenys Oyston: Yes, absolutely. It’s sad; I think the ’80s came along and just ruined it for everybody, like Jane Fonda and her exercise videos. All of a sudden you’ve got to be doing all of this. But we want to think about people who are on their feet all day and moving for their job. And then they feel guilty about “I should be getting exercise.” It’s like, hold on, you’re moving all day. Why aren’t we counting that? “Oh, that doesn’t count. I didn’t sweat enough. My heart rate didn’t get up.”
I think it’s so important to give credit where credit is due, like that NEAT movement that people are doing. People are probably moving way more than they actually realize, too, and they need to feel good about that, because that is taking care of yourself. Even if it’s not something you’re doing on purpose, that’s just how you live. That’s how you do it.
So really just telling somebody to exercise does not work, and we don’t do that in our program. We’re inviting you to explore this if you want to.
01:31:55
Chris Sandel: You said a lot of the work you started out doing was with the VA, and you said obviously there’s a lot of stress, but also I would imagine huge amounts of trauma and PTSD. Is there a lot of overlap between that and diabetes? And do you talk about that a lot with either clients or in the course, or are you referring out to people, getting them support in that area with the intention of helping their mental abilities and emotional life and how they deal with life, and also because it is going to be benefiting their diabetes?
Glenys Oyston: Within the VA, I’ll start off by saying this. There’s very much this traditional model of “They have diabetes. Go give them nutrition education.” It’s like, yeah, okay, we are going to do that. Of course that’s available.
But I happen to be so lucky in the team that I work on. It’s home-based primary care. We are a team, a pretty close team, and we go out to the home and do visits in the home for people. On our team, we have a psychologist, we have an occupational therapist, we have nurse practitioners, we have a dietitian, and we’re all working closely together.
It’s been amazing because we’ll talk about like, yeah, we’ve given them nutrition education, but this thing has come up where they used to depend on their wife to help get their medication, but that relationship is going south. We have to figure out other ways to help that person get their medication. There’s amazing tools. There’s timed pill boxes and all sorts of things.
Our team – which is a pretty respected team within the VA too, because it really helps prevent hospitalizations, keeps veterans in the home longer – our team I think is this amazing model of an interdisciplinary team where we’re like, “Hey, this person’s going through a lot of stress right now. Can the psychologist maybe give a visit?” I’ll just go and talk to the psychologist and say, “Hey, he’s going through this tough time. Can you maybe go and see him or connect with this person?” Or somebody else will approach us and say, “He’s really struggling with getting enough food. Can you help out there?”
So within our little program of the VA, we have this really multidisciplinary approach. We all sit in the same area, so we all see each other. We all talk weekly about the patients. They also have the clinics that operate in a similar model. I do think that there is definitely an interdisciplinary approach throughout the VA; I just happen to have worked in this little area for the last 4 years, and it’s been amazing to see.
It’s very much a whole health kind of situation. So yeah, we’re definitely looking at all the factors in somebody’s life – and a lot of the time, we’re dealing with somebody who doesn’t have a lot of money. The main thing we’re trying to do is figure out, how do we get you food that you need, and how do we get you the care that you need, and how do we support that?
That’s been a very fortuitous, nice team to work in. I do think that does resonate through the rest of the VA.
01:35:40
Chris Sandel: Nice. To be able to offer that kind of support for people who are so in need, I think that’s wonderful. One of the other areas I wanted to touch on before we close up is I know you do work with children and childhood feeding problems. Do you want to talk a little about this?
Glenys Oyston: I don’t do it as much as I did before, just because I moved more into helping people with binge eating disorder, overeating issues, and diabetes, and people in higher weight bodies and adults. But yeah, I feel fairly passionate about childhood feeding.
My idea was really, when people approach me like, “My child has this eating issue,” when we start to look deeper down into it, the child doesn’t have an eating issue so much as there are problems in the feeding dynamics. When I’ve worked with some parents, what I’ve often also found is that the parents themselves have eating issues as well that might be coming to the table a little bit.
Really, the work I have done in the past was much more about parent coaching than it was working with the child. I don’t really see adolescents for eating disorders. It’s just not my niche right now, so I refer to my brilliant friends that are in the area for those kinds of things.
I have moved a little bit away from childhood feeding, but I am so passionate about it because of how I grew up eating. Oh gosh, there’s just so many good ways to do it, but it’s often a struggle to work with parents to see that you might have to change in order to get your child’s eating to change. That is often a big struggle, I find.
Chris Sandel: So the parents weren’t so receptive to hearing that this is not just a child thing, this is very much a dynamic of your relationship and potentially your relationship with food being reflected upon through the child, and just not wanting to own up to that or see their own problems?
Glenys Oyston: Yeah. Actually, one of the reasons I’m moving away from that work is I think parents – I mentioned earlier, I think parents feel an incredible amount of guilt all the time. I feel that is unfortunate, because again, everybody’s doing the best that they can.
But I think often, parents will show up – and I have only worked in Los Angeles as a dietitian, so I do sometimes think this tends to be a very orthorexic city. People are like, “My child must eat broccoli. My child must eat all the vegetables.” It’s like, that’s not going to work at all, just forcing somebody to eat.
So getting them to understand, “Hey, we don’t know what your child’s weight is going to do, but this is how we best support eating.” Often I find parents don’t want to hear that. Again, maybe part of it is an LA thing, where it’s like, God forbid you have a fat child, or a fat adult child eventually, like somehow that might be the worst thing. But that might be everywhere, not just LA.
But I do remember my mother being so supportive, and I’m so grateful for her to have been supportive of my body size growing up. I really do think that helped, even though she herself dieted.
But going back to – yeah, really, with childhood feeding, it’s a group project. Parents need to be the people in charge, often, and I think they struggle with that because you want to think “this is just a kid problem and we’ll go and get it fixed.” Unfortunately, it takes a multidisciplinary approach. It takes all the caregivers involved and the child and everybody.
But it is something that I feel like – I love Ellyn Satter’s division of responsibility in feeding. I do think that is the gold standard for how we should feed kids. If people are wanting to know, I’m sure you’ve done an episode on this.
Chris Sandel: I did one with Paige Smathers. We did a whole episode on feeding dynamics, and we talked a lot about Ellyn Satter.
Glenys Oyston: I love her and her book. I use her book and I use the Eating Competence Model for adults. It’s not that different, in a way. But yeah, I eventually moved away from doing parent coaching, but I will still do it if somebody’s like, “I can commit to this.” At this point I would really only coach parents and not see the children, necessarily. I have found in my experience a lot of it is easily identifiable things that we can change in the feeding dynamic.
But like I said, I’ve moved more into my niche of binge eating disorder, overeating. Working with people in larger bodies is really my jam, and a little less – actually, a lot less with parents and children.
Chris Sandel: I’m sorry, then, that we didn’t get enough time or much of a chance to talk about binge eating disorder, so maybe we’re going to have to have a Part 2 to talk about that. But this has been a wonderful conversation. Where can people be going to find out more about you? Where do you want to point them to online?
Glenys Oyston: Mostly my website is where I’m active, www.daretonotdiet.com. You can find my podcast there as well, but my podcast is called Dietitians Unplugged, and we’re on all the places that you can listen to podcasts.
I’m on Facebook, too. Not so much though. I’m not so much into the social media. I’m not on Instagram, I’m not on Twitter. Just on Facebook. But really, if you want to get in touch with me, go to my website and use the contact form. I love talking to people. So that’s mostly where people can find me.
Chris Sandel: Perfect. I will put all of that in the show notes, and thank you so much for coming on. I really enjoyed this conversation, getting to talk about diabetes and hearing your take on it. I think you’re really doing wonderful work in this space.
Glenys Oyston: Thank you so much, and thanks for having me on.
Chris Sandel: That is it for the interview. Glenys, thank you so much for your time. I’m grateful that we were able to have this conversation.
As I mentioned at the top of the show, Seven Health is currently taking on new clients. If you are struggling with dieting or disordered eating or body image issues or any of the topics that we cover on the show, then please get in contact. You can go to www.seven-health.com/help, and I will then catch you next time.
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