There was an interesting article in the New York Times January 7, 2012 about a young woman who had a Lap-Band weight loss surgery after years of suffering the emotional journey of an overweight kid. The story was very honest about what to expect with this type of surgery, and it also tracked the journey of the young woman. The story is of interest to many as more and more teens and adults are turning toward the option of weight loss surgery. The latest number of weight loss surgeries performed in the United States is 220,000 per year. That is a seven-fold increase over the past 10 years according to the New York Times article. Weight loss surgeries do save lives and also improve quality of lives for sure, but they aren’t for everyone. The surgeons do the surgery and are skilled at centers of excellence, but unless the patients come back, join support groups and stay in contact with dietitians, falling off track is way too easy and, unfortunately, many of them do, including the young woman in the NYT story.

I run several food addiction groups in Houston, and was featured as the psychotherapist for TLC’s hit show “Big Medicine.” On the show, I worked closely with Drs. Robert and Garth Davis. We tried to give the viewer an honest look at what happened with the weight loss surgery and the journey after. My work now is primarily with revisions. Revisions are the surgery done when the first weight loss surgery failed. My office is full, as are my support groups. What happened to the patients that so eagerly came into our offices feeling empowered and ready to give up their morbid obesity forever? They are replaced with patients who hang their head feeling like they failed. Even though they feel defeated, the ones I see are the fortunate ones who were able to step out of their shame cycle, call their insurance company and ask for a second chance. They need a second chance because neither they nor we (the health team) had a full picture of what was underneath their weight. They couldn’t see it prior to surgery, and since they are their own historians telling us their story, we are blinded also.

I believe in weight loss surgery, but I believe more in the knowledge we impart to the patient prior to and after the surgery. Performing an alteration, such as a weight loss surgery, is a huge decision, but in the case of a minor I think the whole bariatric medicine team must be on board. There has to be a built in safety net to handle the transformation of the child as well as their family. Everyone who loves the patient must change when someone they love has weight loss surgery.  The counselor, dietitian, and surgeon must know all of the family members. We must know who is sabotaging and enabling that patient on an emotional level. Enablers are the people still giving the patient food as a source of love. Our bariatric treatment teams must also understand if simply making better food and lifestyle choices worked, it would have worked 20 diets ago. It did not. Obesity has an addictive component, and addictions are kept in place by denial. Most patients will tell you they are not addicted to food exactly the same as an alcoholic will tell you they aren’t addicted to alcohol. The question is: “Do you use food to comfort yourself?” If the patient says “YES,” then treat them for a food addiction. Do this because they are telling you they have a relationship with food that is emotionally based and most likely they are choosing a food with high fat or high carbohydrates (not one of my patients has ever had an addiction/emotional relationship to steamed or raw vegetables).

Whenever a patient feels like a failure after going through the process of weight loss surgery and everything it entails, it is heart wrenching not only to them, but to me and anyone working in this field. If insurance companies won’t cover patient care for years to come after the surgery, then we in the field are going to have to put these measures in place and make them affordable to the patients. We cannot tell a patient they need to continue in groups and follow-ups if they can no longer afford the cost. Whoever said, “Weight loss surgery is a quick fix” truly never had weight loss surgery or worked with my patients. There is nothing quick about it. Obesity is a disease and once you have it, losing the weight is the easy part, managing that loss is a life long journey.

This week I was asked to be an expert for an HLN story involving an 8 year old boy in Cuyahoga Falls, Ohio. This boy is morbidly obese, tipping the scales at 218 pounds. The Department of Children and Family Services took the boy into foster care after they felt the mother was unable to follow through with appropriate measures prescribed for the boy in order to lose weight. The mother’s defense was that she was going to school, in addition to working as an elementary teacher.  She felt that she could not monitor the child at all times.  Apparently, family members and friends were sneaking food to the boy.  DCFS reported that they had worked with mom for a year and saw no improvement. The State Health Department estimates that more than 12 percent of third graders statewide (Ohio) are severely obese. That could mean as many as 1,380 kids in Cuyahoga County alone. This story is the first time anyone could recall a child being taken from a parent strictly due to weight-related issues.

To consider the idea that the state can handle this issue by removing an obese child from the home and placing him in foster care is not only absurd, but dangerous to the development of children. Most likely, there will not be enough foster homes and even if there were, will the parents in those homes be able to handle the issues an obese child struggles with? According to recent polls, one out of every three children is morbidly obese. This is not a child crisis; instead, this is a family crisis. In this situation, the child suffered from sleep apnea, which meant he was hooked up to a machine at night that monitors and assists his breathing. Many obese children suffer asthma, diabetes, heart disease, hypertension, anxiety, and depression.

Obesity certainly has genetic components, but to simply throw your hands in the air with complete surrender to the fate is not being a responsible parent.  Taking a child away from the family he knows and loves borders on cruelty. Removal of a child from his/her home should only be done as a last resort to protect that child from imminent harm (the child in this case had no other medical conditions except for sleep apnea). Many times, removing a child from their home is experienced so intensely by the child that they would resort to food even more as the only thing they could control. Depression, anxiety, and a heightened loss of self-esteem may be the result. What are we telling a child if we allow them to be taken from us, because we were not able to change our lives enough to help him? I make it clear to all of the parents I work with that if you have a morbidly obese child, it takes a family to support them with a healthy lifestyle. There can be no enablers and “good guys or bad guys” with offering the child unhealthy foods or a lifestyle conducive to obesity.

If you have a child you are concerned with who struggles with obesity, you have more power within your family than any treatment facility known. The problem is that, many times, you know your child is hurting and that breaks your heart. The guilt you feel from that affects your ability to hold a firm and loving boundary that your child needs. These suggestions will help you get started.

1.     Talk to your pediatrician and tell them your concerns. Make a list of everything you have tried and go over this with your doctor. Don’t let your doctor make light of your concerns. No one knows your child as well as you.

2.     Have a family meeting, and rather than addressing any one child, address the whole family. Become a united team with everyone participating in a healthy lifestyle. Identify the foods that are the most problematic (soda, chips, candy, and pastries) and replace those with raw fruits and vegetables. Make these food visible, keep a basket of raw fruit on the kitchen counter, bottled water in the fridge (or fresh water in pitchers stored in the refrigerator) and vegetables peeled and ready to eat in the refrigerator. The best way to get rid of the junk food is to throw it away. It’s toxic, and why would you donate or give to someone else what is poisonous to their body?

3.     Quit telling yourself that in order for your kids to fit in they need junk food in the house. They don’t, and this thinking is keeping you from being an effective parent in helping your obese child. It is not fair to let the thin sibling eat junk food and not allow it for the child with weight issues. This builds resentment, so get rid of the junk food and make it forbidden for your whole family.

4.     Family activities are so helpful for your family as well as your marriage. Protect and prioritize these types of days. Take a family walk, go to the park, or (in the winter) go ice skating. Anything where there is movement will help everyone be healthier. Activities shared as a family helps the child who is overweight feel less isolated and alone.

5.     If you are unsure of foods and what to serve, a wise investment is to talk to a dietician. Many physician offices have dieticians on staff. Advice and attaining more knowledge of foods can help you help your child.

6.     If your obese child suffers from social anxiety or depression, seek help from a counselor. It is much wiser to begin counseling before your child’s self-esteem is destroyed. Rebuilding an obese child’s self-esteem is much more difficult than learning healthy coping mechanisms that can comfort them so they won’t resort to using food.

Child protective services have a huge job and they do it well. There are so many children that need to be placed with foster parents in order to survive. Morbid obesity should not be a reason we need to contact CPS. Parents must get serious with their children’s health and well being. Being a parent means taking care of your child and making sure they have all they need to be healthy. If your child is overweight and struggling with health issues, begin making changes to the whole family’s lifestyle today.

The recent statistics from the CDC (Center for Disease Control and Prevention) has reported that about one-third (33.8%) of U.S. adults are obese. That number rises every day, and keeping up with it is more difficult than keeping up with your stocks. I work with the finest bariatric surgeons in the U.S. They are dedicated to helping their patients lose weight in an effort to thwart diseases, and minimize current disease progression. I also run several 12-step food addiction groups in the city of Houston and online in many cities. I talk to morbidly obese patients everyday. I teach them, counsel them, eat with them, and spend endless hours reading their journals. These patients have a story to tell, but we aren’t listening and we continue asking the wrong questions.

To be sure, obesity is genetic and many times the social milieu of obese patients I work with is chaotic with issues of abuse, abandonment, shame, ridicule, and anger. The genetic role helps explain the body type; the way food may be processed, stored, and proportioned. It cannot explain what keeps the person from changing the behavior that contributes to obesity. In my work, during step 4 of the 12-step addiction group, the group members begin making amends. They look at how their behavior got them where they are. They quit thinking about how they were abused, and begin to consider how they hurt/abused others. The step is painful, gut wrenching and overwhelming for all of these patients. It is also the step I ask them, “How do you benefit from being obese?” At first they look at me as if I am crazy. After all, they are weight loss surgery patients, and have gone to extremes to lose weight. They laugh, shake their head, and say, “Mary Jo, what are you smoking?” Then the room gets quiet. One of the bravest patients will say, “My obesity gives me an excuse. I am not held to the same standards as others; they don’t expect it, because I am morbidly obese.” Another will chime in, “My obesity keeps men away; I was sexually abused by my dad for 4 years of my life.” A statistic that no one likes to talk about was one mentioned in Bariatric Times in 2007. As many as 20 to 40% of obese women have been sexually molested, harassed and/or perpetrated (they know it’s higher than that but can’t ascertain the exact amount). Yet another will talk about how her/his marriage is so distant that food has become their lover/best friend. They are lonely, and they eat to comfort that incredible sense of loss.

Another part of my job focuses on the group that failed the weight loss surgery. If you have never been morbidly obese, or gone through a weight loss surgery only to have the weight come back, you cannot understand the depth of failing these patients feel. They are cursed by their unresolved reasons for going back to food. They don’t understand it, and often those who love them most don’t either. A Gastric Bypass, Gastric Sleeve, Lap Band, or Duodenal Shift is never going to successfully keep weight off if the patient has no idea why they are eating, and experience a fear of stopping. Many of the cravings patients feel are emotional; totally unrelated to real hunger. How can a weight loss surgery of any kind manage emotional hunger? It cannot.

When we evaluate patients who struggle with obesity we talk frequently about denial. I am beginning to think they are no more in denial than we, the health care professionals. We can talk food all we want, but most of my patients know what healthy food is; they could write a cookbook with the calorie count included! They know food like most of us know our lover. What they need help with are the tough questions. One of those questions is, “What are the benefits you are experiencing from your obesity?” We have to ask this, and we should ask it prior to weight loss surgery so we can begin the process of helping them understand this part. People drop old behaviors when they are no longer benefiting from them.  You don’t need to be a weight loss surgery patient to begin the yoyo dieting process. If weight protects you from receiving attention, and you have been sexually abused in your childhood, then when you begin losing weight you are going to turn to food to manage the anxiety you feel when a man  gives you eye contact. When patients begin to understand what they are protecting or avoiding with their weight, they can effectively work a weight loss program and keep the weight off.

It is also important to look at obese children’s homes especially if there is a substantial weight gain. Many times, something is going on at home that is causing this child to medicate their anxiety with food. Society continues to be judgmental and negative with obese people. One thing is clear: shaming or ignoring obesity is not helping curb or decrease the numbers.