Dear DOCTOR Owen:

I work with about 28 other nurses and support staff on a hospital floor where everyone seems to have a perennial birthday celebration. I try to avoid these situations because they always have the same food: cake, ice cream, chips, and cola. I have diabetes, and receive no mercy from the staff—even though they know I have this serious medical condition. It seems to make them feel better if I “take a bite.” Of course, you know how hard it is for a diabetic to just take a bite. I don’t remember going to so many parties earlier in my career. What’s going on?

Birthday Bored

Dear “Bored”:

Food is the cheapest present to give and somehow it has become a custom. Once a person gets “rewarded,” it seems that everyone feels obligated to not slight the rest of the group. Before you know it, everybody’s birthday is on the calendar—and don’t you dare forget! Yet, these customs are relatively new. Even the “Happy Birthday” song became popular and widespread only toward the mid-1900s.

At this time, it also became a Mardi Gras custom (in the New Orleans area) to bring a King Cake, with a small plastic baby embedded inside, to work. Whoever cuts the slice with the doll must bring the next King Cake to work. People who don’t participate are made to feel like cheapskates. Ten years ago, the cake was plain bread with a sugar-coated icing. A small rural pastry shop in the area started adding cream cheese and the cakes really “took off.” To compete, other pastry shops also started to add cream cheese. Now King Cakes are shipped around the world, and today’s average young person does not realize that the “dry” cake ever existed.

The dry cake had about 80 calories/ounce. The cream cheese cake, though, has about 150 calories/ounce. The serving size is about the same. The slice of dry cake was 2 ounces at 160 calories, but the same-size moist cake has about 4 ounces at 600 calories and tastes great. It’s tough not to go back for seconds. The difference is 440 calories of “payback,” or 4.5 miles of walking. Do you think most people add that exercise regimen to their day after eating one piece?

The average slice of birthday cake is 6 ounces. At 125 calories/ounce this is 750 calories. Do you add ice cream? Regular ice cream averages about 500–600 calories/cup; the average serving is  estimated to be about one cup. The total is 1000–1400 calories—yet all you wanted was to wish someone well! That amounts to 14 miles of payback, or walking 2 miles/day for the next 7 days. How good was that cake? Was it worth it?

Most of us get “sucked into” the situations you describe in your letter without any forethought. And, as you describe, often these “habits” are very recent in our social environments. I’ll bet that King Cake is not routine in Des Moines—yet! The “let the good times roll” atmosphere in Louisiana is taking over the planet.

Skills and education are the keys to not allowing custom to run your health and life. For instance, do you think anyone would feel deprived if you would bring to these parties an angel-food sponge cake; fresh berries; and a non-fat, sugar-free whipped cream topping? Given the choice, I’ll “put my neck on the block” that this would be the first party “gift” to be gobbled up by the group. The angel-food sponge cake is only 70 calories/ounce (2 ounces is a big piece), the cup of berries is 20 calories/ounce, and the whipped cream is 30 calories/ounce for a total of 170 calories vs. over 1000 for the other choice. So, what do you think the group will get next time—when you bring the yummies?

You can take back control by example and by teaching. But you cannot teach what you do not know—right? You can learn these math examples in a few weeks. The skill to using that math effectively may take a little longer, but what do you have to lose? No kidding!

For the umpteenth time—this stuff isn’t rocket science.