There is a stereotype in the US that everyone who is overweight is an over-eater. The more overweight a person is, the more of a glutton he or she is judged to be. While I see this as pervasive in this country, I have reason to believe this is also an accurate portrayal of the attitudes within most modern societies. I say this is a stereotype because is just isn’t accurate. Of course, it is true that there are folks who do consistently eat very large meals, and as a consequence, they can become quite large. The problem is that our culture has adopted an attitude that carries over to everyone who is overweight, even though it is only a small minority that actually fit this stereotype. The stereotype is clearly in play when an overweight person’s problems are being discussed by others and someone chimes in with a thinly veiled criticism/comment like: “His only problem is learning to push away from the table.” I cringe when I hear this kind of statement.
Even within the medical community, where you would expect at least a somewhat enlightened attitude, the stereotype is also common. The criticism is more scholarly sounding in this circle, though: “It is simply a matter of calories in compared to calories out.” Not only is it very difficult for the overweight person to find a medical environment where they are treated respectfully, I frequently witness terrible medical care that results from this attitude. Just about any medical problem a victim of this attitude may seek help for can be met with: “You just need to lose weight.” (The “Now get out of my office” part is usually just implied.)
I can tell you from an extensive experience with treating this problem that it is much more complex and difficult than the “calories in versus calories out” and “pushing away” analysis would lead you to believe. If it were this simple, there would hardly be anyone overweight, ever. There are just too many social, physical, emotional and health problems that result to take it less than very, very seriously. When I evaluate a patient with significant overweight problems and find he is an over-eater for some reason, or he just doesn’t understand good nutritional guidelines, I consider myself lucky, because I know he will likely have very good success with minimal work on my part, and I will look very good as a therapist. The vast majority of people with weight problems, though, require every skill I have to help them over an extended period of time and I know I will not always be successful, even if they are highly motivated and compliant with my directions.
If you look carefully at the research you will get some powerful clues why weight problems are usually so hard to treat. For instance, careful studies that have recorded actual food intake for months at a time show that most overweight people eat less than their normal weight counterparts. Furthermore, metabolic studies show that people with excessive body weight have abnormal metabolic responses and appetite responses to periods of both excessive caloric intake and of inadequate caloric intake when compared to normal weight people. What is particularly enlightening, even when the massively overweight folks are able to be brought all the way down to a normal body composition through some effective strategy, their abnormal metabolism and appetite patterns do not just go away. Once out of the highly artificial research environment, they usually start regaining the excessive weight despite their best intentions and efforts. No one knows why this abnormal regulation occurs nor is it easy to demonstrate outside of sophisticated research programs. What is clear is that it creates a very difficult medical problem.
This is not to say that the situation is hopeless for most people with these problems, just that it is quite difficult and requires a lot of knowledge to help them. Over the years I have learned how to help most of the folks who seek treatment to bring their weight down to healthier levels and keep it there, as long as they will make a reasonable effort and can continue to follow through. This is actually what usually determines long term success or failure: whether they continue their treatment long enough to get to the root of their problem and learn all they need to know. This is in line with what researchers report about the long term outcomes of people trying to lose weight. What correlates best with long term success is whether the person in the study continues to follow up with knowledgeable therapists on a long term basis.
While I am on the topic of stereotypes, let me mention two important consequences. The first is the human suffering that results. Imagine the overweight child and the criticism he receives from classmates. Consider the overweight adolescent who sits at home while others kids her age are out on dates. Among adults, who do you think is often last hired? The list can go on and on. Beyond this, the emotional toll of these attitudes can easy result in chronic depression. I would estimate that about 80% of the folks I treat are depressed when I first meet and evaluate them. It can easily become a vicious cycle: quite often depression causes weight gain which further aggravates the depression. I have learned that I must eliminate the depression before weight control is a reasonable possibility.
In the next installment of this series, I will cover some easy solutions that I sometimes see for people who are struggling with their weight. Such easy solutions aren’t real common, but they do happen. It is important to understand them and keep them in mind.
I am estimating there will be about another eight or nine articles in this series. If you want to follow it easily, you might want to select an email subscription or RSS feed available in the column to the right.