Roads to Obesity: EmotionsFriday, April 26, 2013
Continuing my discussion of the paper by Julia Temple Newhook, Deborah Gregory and Laurie Twells from the Memorial University of Newfoundland, St. John’s, published in the Journal of Social, Behavioral, and Health Sciences, on what causes some people to gain weight, we turn to what the authors describe as, “emotions”.
In addition to the “life events”, “gradual processes” and “socioeconomic factors” that were raised as contributors to weight gain in the interviews with patients seeking bariatric surgery, the participants described their emotional struggles with their weight
“I guess the most I’ve ever lost at one go is 70 or 80 pounds, which is a lot of work, a lot of time, a lot of discipline and denial. Then, no matter what, it seems like every time, after a couple of months, it starts creeping back. And then all of a sudden, you are where you were or worse. Then it’s like, ‘Oh my God, how did I do that? How could I be so stupid?’ Then you beat yourself up again. – Faith (educator in her 40s)”
Irrespective of when patients gained weight, it was consistently seen as a depart from “normality”:
“I don’t remember ever being a normal size, normal to my peers at any age.”
“I used to be athletic. I played volleyball, I was a synchronized swimmer, and I was a figure skater. … I was a skinny kid, a normal teenager.”
“I was never heavy, never. I was always a normal weight or underweight. … I was always really thin and wore really stylish clothes. … It’s really devastating [because] it’s not like I’ve been fat all my life.”
This departure from ‘normal’ was particularly frustrating with regard to their inability to control their weight:
“It’s just like, I can eat the same and work out the same [as my friends], but still gain weight. … That was frustrating too.”
“…it frustrates me, the fact I can go to university, I can accomplish all of these degrees, I can do whatever I put my mind to, but I can’t lose this weight. It is very, very frustrating.”
“…working out, cutting back, high-carb diets, low carb diets, high-fat diets, low-fat diets, eat-everything-you-want diets, starve-yourself-to-death diets—it’s just over and over and over.”
“It’s practically impossible for me to lose weight, even if I starved myself.”
All of these patients reflect the considerable difficulties to control their weight – not just simply the frustration but also the sense of failure.
Of particular significance is that such frustration and failure is not least promoted by unrealistic weight loss expectations (or recommendations), which generally fail to acknowledge just how difficult losing and sustaining significant weight loss actually is.
Based on their findings, here is the advice that the authors have for clinicians:
“First, we encourage healthcare professionals to become aware of the social context for weight gain and of the destructive force of blame and stigma in discussions of weight gain with patients… Secondly,…we challenge healthcare professionals to move away from a simplified energy-in–energy-out explanation of obesity, which also means discouraging the recommendation of dieting as a treatment. We encourage healthcare professionals to critique the dominance of BMI in patient assessments and consider comprehensive ways of assessing and treating patients, such as the proposed Edmonton Obesity Staging System…. Finally, we emphasize the importance of a compassionate, holistic, empowering approach to the issue of weight, based on an understanding of health and well-being that recognizes the interconnectedness of physical, mental, emotional, social, and spiritual well-being.”
I have little more to add.
Friday, April 26, 2013
Thank you for writing this post. So beautifully expressed. This area is still mostly ignored in the weight debate. I have so many people crying in my rooms expressing the emotional , inner struggle that they have been struggling with year in and year out. They have been ridiculed and judged. Often pressured or even bullied into weight loss programs by loved ones where they are told they just need to eat less move more. It just isnt’ that simple. Compassion and understanding is rarely part of the process. I believe it is an essential and significant part of any discussions around weight and obesity.
Saturday, April 27, 2013
Arya, I would like your take on divorce. In looking over the literature I find that, in general, there are very few studies which inquire about divorce or marital dysfunction at all. When then do, the findings are very limited. Namely, it seems that marriage leads to weight gain and separation leads to weight loss. However, to me, this seems somewhat superficial for such a significant life change.
However, in studies of childhood obesity, I have trouble finding many studies even asking the question if the normal weight or overweight/obese child is in a single parent/two parent/second marriage family status. If we assume that life changes can produce stress which can induce obesity-inducing behaviors, is it not odd that numerous studies on childhood obesity avoid a key family stressor? Is this not just adults doing the research avoiding asking if they have some responsibility? Is is not easier to blame the food industry or television than to look at adult behaviors? Does not the rise in divorce in the 70s and 80s parallel the rise in childhood obesity as much as the rise in sugar-sweetened beverages, for example? Morgan Downey
Sunday, April 28, 2013
Yes Morgan, there is very little work done on the implications of divorces, single-parenting, dual-income households, etc. on the increase in childhood obesity. There is also little work on the relationship between arrangements for before and after-school childcare and childhood weight gain. As you say, these may not be ‘politically correct’ topics to study, because the findings may well be rather uncomfortable.