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CLIENT: I ended up on following through on the journal for the first few days but I do have Saturday, Sunday and today so far.

THERAPIST: Okay.

CLIENT: I mean still it's like you know it's still hard to – large bowl of pasta, small bowl of pasta, what does that mean – I wasn't like measuring it with measuring cups or the food scale so I couldn't be like it's this many ounces so I'm not so sure how helpful it is if I don't have what the portion size was.

THERAPIST: I think it's a start and you can get more specific as you get used to it.

CLIENT: Yeah. It just means I have to like measure things beforehand.

THERAPIST: Well, it means that probably the most helpful thing to do is to serve yourself what you normally serve yourself.

CLIENT: Okay.

THERAPIST: Like one time. Next time you have pasta. Put the amount of pasta on your plate that you would typically put on it. Get out your measuring cup and measure what you've served yourself. Then you've learned to eyeball it rather than feeling like you have to get out a measuring cup every time or a food scale every time. But just getting used to seeing like, what I would normally serve myself is a cup of pasta is two cups of pasta – a big bowl. You know what a big bowl is for you. Find out what that is. Then you don't have to be beholden to the measuring cup every time but you get a more educated guess.

CLIENT: I mean the one way to tell it is like if me and Sydney split it evenly and it's a whole box of pasta then it's like I know a box of pasta is eight servings so that's four servings – each serving is 200 calories so that would be 800 calories. So what I'm trying to do is like – you know since he's a lot bigger than me and therefore needs that –

THERAPIST: Is that typical that you guys would split a box of pasta and finish it?

CLIENT: It is but we've started doing like him getting a bigger bowl and me getting a smaller bowl so then it's like slightly less than a box of pasta or we make a box of pasta and then we like don't take the whole thing and have the leftovers for later. That sometimes happens. So it's a little bit better but it's still not great.

THERAPIST: Well that's a larger serving size than typical – would be typically sort of expected.

CLIENT: I know. Yeah it's a lot. Though I don't know how much when they say serving size, like whether or not people actually already have one serving of pasta, like say at least two servings would be if people were having that like as their dinner and not with other things.

THERAPIST: Right. So this serving size on the package is a unit to figure out how many calories you are actually eating so it's not a rule that you may only have one serving of pasta in a meal but you want to know is if they're saying that there are eight servings in this box and then you can break down how many calories are in each serving you can figure out well dinner for me is two servings of grain, or two servings of pasta and that's this many calories and that feels filling enough. You know it's not that you necessarily can have one serving of the thing but it's a way to just start to have an informed estimate of how many calories are you eating of different types of foods.

CLIENT: Yeah, if I'm putting cheese on it and like the cheese doesn't have nutrition information like if I get the – then I have no clue what I'm doing there.

THERAPIST: Yep. Well if you keep a log we can start to figure this stuff out and it's not – the goal is not to count things to calorie, the goal is to get a more informed idea so they have some place to work from. Because like now you are trying to use hunger as your gauge which is a good long term goal but the fact that you've been continuing to gain weight and using hunger and fullness as your gauge. It's not working right for you so we need to kind of try something else, get a better informed estimate of how many calories you're taking in and work from there and then eventually go back to using hunger as your guide.

CLIENT: Okay.

THERAPIST: It sounds as if right now your hunger/fullness meter is off. CLIENT: Yeah, it must be. Or if I'd stretched my stomach to the point that like filling it up takes more and, but then, even then like I would – it would have – I'm still gaining weight and at least staying at this high weight but you know it isn't like I got to 175 lbs and stayed there.

THERAPIST: Yeah, you've gotten used to a feeling of fullness that's different than the feeling of fullness that you need to use.

CLIENT: Although the thing is like when I was growing up and like sometimes I'd eat like either around Thanksgiving or sometimes in a restaurant you know like so full that you can't eat anymore. I don't get to that now. Like I don't eat enough to get to that feeling like I know full is not that but it's still not working enough.

THERAPIST: It's something different than whatever you're using.

CLIENT: I think I need is like things that will make me fuller for longer and yeah, like I don't know, especially with like you know working and having less time to prepare things and stuff and spending a lot of time at Derek's place like at my place, you know, theoretically I can eat what the house maid's making, theoretically that's probably going to be more healthy than whatever we're making because they'll actually put vegetables in it and stuff. It might also not be as good as what I'm making, but you know I'm more likely to get nutrition. I think it's just like I need things that I can add to my diet that will make me more full rather than working on things to suppress it, because it's not sustainable for me to be like I can only have ice cream like once a month.

THERAPIST: So let's take a look at – did you bring your log with you?

CLIENT: I've got it on Google drive, so let's get it. I didn't put in today's lunch because I made it before I went out to lunch.

THERAPIST: What I want to do first is just take a look at what are the foods that you're eating.

CLIENT: Okay. Do you want this in alphabetical order?

THERAPIST: Okay.

CLIENT: I'm going to be putting them into categories for you.

THERAPIST: Okay.

CLIENT: So, yeah. So on the ninth, Saturday, okay so I had a medium bowl of pasta with bleu cheese and olive oil. I think it's like – this was the split a box of pasta and take the smaller serving. And I had cheese and olive oil on it.

THERAPIST: So for cheese, I know we don't know total amounts but like is this like shredded cheese.

CLIENT: It's shredded.

THERAPIST: A big handful?

CLIENT: I don't know. Probably medium handful.

THERAPIST: Okay.

CLIENT: Like I sprinkle some and then I mix it around and then sprinkle on more.

THERAPIST: Okay. CLIENT: So I'm not filling up my hand.

THERAPIST: Okay. What do you usually drink – or, what did you drink with your meal?

CLIENT: That one I had like there are these tiny ginger ales that are like this big and like this wide so I had one of those. They can't be more than 4 oz. They're like really tiny. And then for dinner I had a crepe with strawberries and Nutella. And then –

THERAPIST: No snacks.

CLIENT: No snacks. Then I guess after dinner, later that night we were hungry again so I had a small bowl of mac and cheese and what we usually do is make two boxes and split it in half, but we made two boxes and I had less than half, so I'm guessing it's like a third of a box of mac and cheese.

THERAPIST: Okay.

CLIENT: And I know each of those boxes is like three servings or something. And then yesterday I got a crepe with strawberries and Nutella again for breakfast. This is not normal for me but for some reason I've been wanting them lately. I guess that was really lunch because we woke up late. For lunch I had a medium bowl of pasta which we split the thing in half and we didn't finish the whole thing of it and so I'm guessing it was about two or three servings and it also was with cheese and olive oil. I don't put on that much olive oil but I don't know how much I put on. I guess what I didn't put on here is I had a couple of Girl Scout cookies, I think I had about five of them. And then after rehearsal we were both hungry so I had a small bowl of pasta with cheese and olive oil. It was like leftovers from previous so it was like probably closer to two or one serving, like one half of it – probably no more than two servings. For breakfast I had a small bowl of Crispix with like I don't know, I think it would be an 8 oz glass of coffee milk – milk plus coffee syrup.

THERAPIST: Was there milk in the cereal as well?

CLIENT: Yep.

THERAPIST: What kind of milk?

CLIENT: Whole milk. And then lunch which I didn't put on here because I didn't have a chance was a small, probably I don't know, quarter pound, not even, hamburger and like fries and a large soda.

THERAPIST: So I think we have, looking at this, we have some places that you can make some changes that would be probably a start. So what I did is I just tried to break down – even not paying attention to serving sizes which I think you're having more serving sizes than is probably necessary at each meal and you're going – one of the things you talked about is you're kind of wanting to feel fuller longer. It may actually be helpful for you to eat smaller servings and allow yourself more snacks because that way you don't have to feel like you're eating so much to stay full for a long time, like from one meal to the next but actually planning to have a healthy snack in between meals might allow you to do that, like cut back on the serving size and not feel deprived. So in terms of the foods you are eating you are really limiting yourself here. Pasta, crepes, the cereal, Nutella, fries, hamburger once, and then the only veggies and fruit were the strawberries on the crepe. So there's a place right there that you can totally add in, rather than take away things, adding in things that will allow you to – not necessarily not take away any of the things off the list. I don't think you have to take anything off the list. We just want to reduce the amount without feeling deprived. So if you added either some veggie snacks or add veggies to your pasta, cook up some veggies and throw them in with your pasta it will allow you to eat less pasta which is more calorically dense and give you some other healthy stuff. You know, give you more nutrients.

CLIENT: I mean if I'd written down like Mondays – like this last Monday we made, or I because I was making it all, was making rice with like there were onions and green peppers and carrots and parsnips. They were sautéed so –

THERAPIST: So that type of thing more often would probably, you can do that, would probably help you.

CLIENT: It's just the matter of buying vegetables for Sydney's place I think.

THERAPIST: Yeah helping yourself out by keeping the two places that you eat at Sydney's and at your house, keeping both of those stocked with options for yourself.

CLIENT: Yeah. (Unclear) [00:15:21] It's hard at Sydney's place. Like there's just – especially because they only have one fridge. They have five people sharing one fridge and no one is co-opting food so you know what that means, we'll have multiple containers of milk or something and so –

THERAPIST: So it's a space issue.

CLIENT: Yeah, part of it is a space issue. So keeping veggies that we're not using that often. I mean the other thing is – THERAPIST: Ah, but you're going to be using them often. (Chuckles) Let's get into that mindset.

CLIENT: Keeping around veggies I'm not going to use for a few days will be problematic I think.

THERAPIST: What about fruits that you don't need to refrigerate? Like apples, plums, pears (inaudible) and Clementines.

CLIENT: Yeah. I need to get new Clementines because the old ones are a few weeks old and probably are like squishy at this point, not that old, but they're also (inaudible) like buying a box of Clementines and I will eat tons of them. They don't really do a good job of filling me up.

THERAPIST: No, Clementines are not going to fill you up. CLIENT: Even if I had five Clementines but that might be over kill. Yeah, that might be something to get more of and then I can take them to work and like eat them for a snack.

THERAPIST: Yeah. And so I think trying to change like that, like are you going to expect a Clementine to fill you up? No. But having two Clementines as a snack will fill you up somewhat and add that in and have that as a dessert after dinner, you can cut back on a little bit of dinner and get yourself pretty much free food. Fruits and vegetables are pretty much free calorically.

CLIENT: I thought vegetables were more free calorically than fruits were.

THERAPIST: So if scientifically – yes, that's true. Fruit has sugar in it, it does have calories. In terms of like let's just think, not counting calories by ones, a serving of pasta to five Clementines the Clementines are basically free. And just – I don't want you to start counting calories down to the 151 for this serving of pasta – that's not necessary. But getting into the mindset of which foods are going to give you more nutrients, fill up your belly a bit, give you some variety in your diet which is really healthy to have the variety and allow you to cut back a little bit on the things that are so dense. That's, I want to sort of give you the general idea of altering your diet rather than being really nitpicky about it because we don't have to count that specifically, to help you get closer to where I think it's going to be getting to more of your goal of starting to lose rather than continuing to gain.

CLIENT: But also there's like at least two hours of walking yesterday.

THERAPIST: Great.

CLIENT: I wasn't really counting how long it was but I think it was at least two hours and I like got to rehearsal a little early to walk around and stuff so – yeah, I guess it's just like well I think – ‘cause if I took like a little salad with me or think of like veggies that I had like –

THERAPIST: What do you like?

CLIENT: I really like cucumbers and green peppers. It does take a little work.

THERAPIST: Yeah.

CLIENT: It's just then I'd have to, well, I guess the cucumbers I could eat whole but like the green pepper I would have to like in advance take out the center and wash it and cut it up and so I guess finding the – Having the discipline to do that ahead of time is what will probably trip me up.

THERAPIST: We need to find a way I think to make it possible.

CLIENT: Yeah. Because I mean like they're tasty. It isn't like it would be something I force myself to eat. It's just the forcing myself is like getting prepared. I need to do that.

THERAPIST: Do you bring food with you to work?

CLIENT: I do.

THERAPIST: What do you typically bring on a workday?

CLIENT: Sometimes, especially since Sydney has been so depressed, we'll order pizza and I will – like a medium pizza. We'll each get a medium pizza because we both want radically different things and like he'll eat his and I'll eat half of mine and put the other half in a zip lock bag and then bring it to work the next day or couple of days. So, and if I don't have that I also have pastrami which I make into pastrami sandwiches and have those at work. Which at least then I'm getting more meat. So that might be better than having pizza, but –

THERAPIST: Are there other deli meats that you like? CLIENT: There are but I mean the thing is the pastrami was that there's this place, (inaudible) [00:20:15] that like it's –

(Beep)

THERAPIST: Replace the battery.

CLIENT: Okay. So yeah, they sell kosher meat online and so Sydney was like we should get you deli meat for your job and so he ordered 12-1/2 lbs. of meat because that's how much would fill up the thing – you know, their little vacuum packs. I have a lot of pastrami to get through. Yeah.

(Beep)

THERAPIST: Sorry about this interruption.

CLIENT: Okay.

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