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 Switch 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.