In contrast to Mark (the Golden Boy), Julie (the Fitness Enthusiast) and Gertrude (the Poor Eater), who all appear to be managing rather well, Janice, is having a hard time and continues to struggle with her weight.
While the folks in the other clusters had either no (Mark) or rather mild (Julie and Gertrude) family histories of obesity and did not have a significant weight problem till their late teens or adulthood, Janice’s mother and older brother are both severely obese. As Janice clearly recalls, teasing and bullying about her weight started back in Kindergarten.
Not surprisingly, Janice, at 45, is younger than most NWCR registrants and despite having lost over 100 lbs, still has a BMI of 29 (down from 45). Although, she has maintained a significant amount of weight loss for the past 5 years, she continues to weight cycle often regaining 10 or more pounds, before getting “back on track”.
Janice is single, has a few years of college (which she never finished), and works as a stocker at a local super market.
Despite her relatively young age, Janice has struggled with hypertension, type 2 diabetes, sleep apnea, arthritis and major depression.
Janice has tried almost every commercial weight loss program, has taken over-the-counter diet-pills and prescription anti-obesity medication (which she can ill afford), and has even seriously considered bariatric surgery (but lacks coverage).
Her current “success” is the result of continuing struggle using virtually every trick in the book (keeping meticulous food and exercise records, counting calories, limiting her intake of many high-caloric foods, occasionally using meal replacements and low-calorie diets, regularly weighing herself, not eating out).
She struggles to maintain an exercise routine of about 2500 Cal per week and tries to limit her caloric intake to about 1500.
She is the first to admit that any challenge like vacation, illness, change of season, or increased stress at work is likely to make her “fall off” her diet.
Despite her considerable weight loss, she is anxious to lose even more weight, is very dissatisfied with her appearance and feels stressed out about most things in her life.
While Janice makes up about 25% of registrants in the NWCR, she is clearly the kind of patient, most likely to be seen in a bariatric centre (where average BMIs tend to be around 50 and childhood onset obesity is the rule rather than the exception).
Having met many patients like Janice in my practice, I would not be surprised if Janice also has a history of childhood trauma or abuse, an alcoholic dad, has struggled with anxiety and panic attacks most of her life and has more than once contemplated putting an end to it all.
I am certain that many readers of these pages will immediately recognize patients like Janice and it is no surprise that these are not the people for whom simplistic “Eat-Less-Move-More” mantras are likely to work.
Indeed, I am surprised that Janice has even managed to make it into the NWCR; very few people in her situation do.
Whilst, Mark, Julie, and Gertrude, may well have found their “Best Weight”, Janice, even at a BMI of 28 is well below a weight that would be considered reasonably sustainable. This is clearly evident in her constant and daily struggle.
Thus, although, Mark, Julie and Gertrude may seem to have “conquered” obesity and are often held up as exemplary “success stories”, it is Janice who commands my deepest admiration and respect.
Of all clusters in the NWCR, it is clearly Janice who has fought the greatest battle and continues to put in the greatest effort (in my books, if you spend a lot of time doing something you either don’t mind or even like doing, it does not count as “effort”).
It is clearly people like Janice who will likely benefit most from ongoing interdisciplinary medical and perhaps surgical care as well as psychosocial support.
Now that we have met the typical “success” stories in the NWCR, we should discuss what this exercise perhaps teaches us about obesity management – but I’ll save that for next week.