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.