Recently I saw Betty* in my clinic. She is 44 years old and never had a "weight problem" till her eight-year-old only son met with a fatal road accident.
That was 12 years ago. Since then she has steadily gained almost 10 pounds a year, which is why she is now 120 pounds heavier than she was at 32.
"I desperately need to lose weight," she told me between sobs.
"No," I disagreed with her, "You don't."
"What you need to do first," I added, "is to stop gaining weight!"
This is a conversation I have had with hundreds of patients, who come to me seeking weight loss. Many of them are gaining even more weight than Betty every year -- all of them want to dive straight into losing weight. They are desperate, ready to embark on the next diet or exercise program -- even bariatric surgery -- whatever it takes!
I understand their desperation -- it's not seldom they come to see me because their doctor has suggested they come to our clinic for weight loss.
But here is the problem. Betty is out of control. Steadily gaining 10 pounds a year means she is eating thousands of extra calories a day -- the more weight she gains, the more excess calories she eats (here is why). No diet, no exercise, not even bariatric surgery will address her need to eat.
Before even remotely contemplating weight loss, Betty should be working on gaining less weight next year than she did last year.
Indeed, if Betty could manage to just put on five instead of 10 pounds in the next 12 months, she would have spectacularly succeeded in cutting her weight gain in half -- quite the achievement!
Perhaps, with a professional help and empathic support she can even manage to make it through the next 12 months with no weight gain at all -- imagine the success -- for the first time in 12 years, Betty will not have gained a single pound in a whole year!
Imagine if Betty had only received the help she needed 12 years ago -- she may well have avoided a 120 pound weight gain! Had she even just cut her annual weight gain in half, she would be 60 pounds lighter than she is now.
But, why not simply jump into the next diet or exercise program -- or book the next surgeon?
Because, I do not think that doing so would address the underlying problem -- as a quick visit with the psychologist reveals, Betty is overwhelmed by chronic grief, guilt, shame and remorse -- even thoughts of ending it all. She eats for comfort, to feed the gaping hole, to ease the pain.
I can hardly imagine, that taking away her food -- the only thing that keeps her going -- is the right approach.
Fortunately, there is hope for Betty. An experienced grief counsellor should have little problem guiding Betty along a path to forgiveness, acceptance and control. As she regains control of her emotions, she will regain control of her life and her food.
When she does, do I expect to see her lose weight? Of course not, but I do expect her to stop gaining. After all, why would she continue overeating, now that she is back in control?
That, perhaps, will be when she can begin thinking about losing some of that weight. But, as Betty has no severe or acute health problems (her severe depression is now well controlled), there is no urgency.
Just making it through the next few years with no further weight gain may well be enough to allow Betty to restore balance in her life.
I see hundreds of Bettys in my clinic -- not all have lost a son. But many have experienced trauma -- emotional, physical or sexual abuse. They have lost jobs, spouses, parents, friends, moved to a new town, province or country. They are overwhelmed by life events over which they have little control, if any. They are burned out, exhausted, abandoned, helpless. They have depression, anxiety, cannot sleep, cannot focus, cannot find comfort, have long lost hope.
No diet or exercise program will "fix" them -- surgery, most certainly, will not.
As for Betty, now that she is back in control, anything is possible.
She may well decide to eventually lose some of those pounds by restricting her calories and exercising and perhaps she will be one of the few who succeed in keeping them off (her chances for this are definitely better now than they were while she was still gaining). Perhaps she will opt for surgery; now that she is in control, she can follow the strict diet and exercise plans that she will need to make her surgery work for her.
Sometimes, the best thing you can tell a large patient is that you really don't think they need to lose weight -- you may be surprised at the response.
Previously published on Dr. Sharma's Obesity Notes