Saturday, September 4, 2010

Erin hit 300 pounds Wednesday. And was she happy?

Ecstatic! She hit the 300lb. mark for the first time in more than two decades, and she was delighted. Her total weight loss came to 91 ¼ pounds since we started our work together. How did she do it, you ask?

Well, I could give you that simplistic response that many medical experts reply—“she just took in fewer calories than she was burning”. Oh, that answers it! That’s a statement of the obvious. But how did she really do it? I mean she presented to my office at almost 400 lbs. and at 5 ft. 1inch that’s a lot of extra weight to carry around.

First, she ignored her doctor. That is, when her doctor repeatedly hounded her that she should resolve her weight problem by getting gastric bypass or lap band surgery. Doctors love to recommend these treatments. Faced with a patient like Erin they are likely feeling quite useless and ineffective. No quick and easy solutions, as in “take these antibiotics and the infection will be gone in 48 hours.” They seem to see surgery as a quick fix, failing to see the challenges that patients face even afterward. No, bypass surgery doesn’t cure the problem, although it does help get some weight off in the very overweight and can improve some medical conditions including diabetes and hypertension. And for certain individuals it is something I would and do support.

But patients are left without the skills to manage their feelings and thoughts contributing to their pattern of overeating. That part doesn’t simply get rebooted or surgically removed. If you’ve always relied on food to self-sooth, to comfort, to numb out or simply to enjoy—to excess, you’ll continue to struggle with the very same issues, even after bypass surgery. And you’ll learn to work the system, so to speak. You’ll find ways to get your food “needs” met, with or without feeling ill—perhaps with milkshakes or other liquids spread throughout the day, perhaps enduring the “dumping syndrome” resulting in diarrhea, that follows.

Confronted with a problem that is complex and requires much time and patience, the wise doctors refer to me and others with my experience. And that’s how I came to meet Erin.
Erin could write a book on losing weight. She had been on all the conventional diets—the Weight Watchers, Jenny Craig, Diet Center types. And she had done the less conventional treatments as well, including the physician supervised protein sparing modified fast, under the direction of a leading obesity researcher at a Harvard teaching hospital. She had even attempted a more holistic approach at the highly regarded Mind Body Institute in the Boston area. These strategies were not without success. Erin would lose some weight, learn some skills, but fail to sustain the changes. Until now.
How do I know that this time is different? Because it’s been 19 years. No, she hadn’t seen me continuously for 19 years. Erin first came to see me in 1991 and has worked with me over long intervals, returning periodically as needed. And, it’s different this time because Erin has made some major changes that she hadn’t made in the past.

Like cooking. And shopping. As Erin found out, liquid diets and frozen meal plans are effective for weight loss. That is, if you’re looking for short-term weight loss. 

But nobody sticks to protein shakes or prepackaged food long term. Who can? Even if you love the taste, they don’t allow for living a normal life, for living in the real world. So what do you do when you are invited to someone’s home to eat? Or want to be social and eat out? Or take part in a celebration? Or not feel deprived? Ultimately, you have to learn to prepare foods, even if, like Erin, you didn’t even know how to boil rice. Or had never had a vegetable other than potato. And even if it’s “just you” at home.

So we started small. And basic. But Erin increased her confidence in cooking. Slowly. And she dramatically expanded the variety of foods she purchases and consumes. She now looks at her shopping cart with amazement. From asparagus, peppers, and broccoli slaw salads to brown rice and chicken soup ingredients. Her shopping cart does not look like what you might assume you’d see a 300-pound woman purchasing!

But Erin has not been without setbacks. Imagine experiencing this one. She has just gone shopping, at Trader Joe’s in fact, and has loaded the groceries in her car. She is now quite hungry, as things took longer than expected while she was out. Erin takes my recommendations to heart. So she realizes that the best thing to do is to honor her hunger, to have a snack to tide her over until she could get back home for lunch. She rummages through her paper bags and pulls out an individually portioned snack. And then proceeds to eat it, mindfully, while parked, in the Trader Joe’s parking lot in Hanover, Massachusetts. Until a woman approaches her car. Yes, a total stranger comes up to Erin's car and starts to lay into her about her eating. “Should you be eating that?” she demands. “You should really watch what you eat at your weight, it’s not good for your health”, she continues.

Could you even imagine how Erin felt? I was in tears listening to the abuse she endured, feeling the shame she experienced. And here she was doing all the right things—listening to her needs, her hunger, making wise choices (no, she didn’t manage her hunger at the drive through), eating mindfully, versus driving and eating as she had done so many times before. And yet in spite of all the good she was doing for herself some arrogant, unenlightened soul had the nerve to open her mouth and utter what she did. So yes, Erin had a slip that week.

But she also had a recovery. Her binge didn’t last as long as it had in the past and she was able to get back on her feet sooner than she had in the past. She didn’t get into the all or nothing thinking about her eating, thinking that she ruined it and may as well keep going. And she didn’t bury her feelings in her food late at night. Rather, she came in to talk about them in sessions with me and with her therapist. And as a result, the damage was kept to a minimum.

The struggle is far from over, and Erin has lots more weight to lose. Her latest goal? She wants to lose 8 ¾ pounds. Yes, just 8 ¾ pounds to bring her total weight loss to 100 pounds. That’s her short-term goal. Yes, Erin has learned something else through all this. She has learned to set realistic goals, goals she can achieve and maintain. And with her new pedometer, she plans to increase her activity one step at time.

Yes, Erin is thrilled to have hit 300!


  1. Honestly, some people! I know just how Meg feels, and I'm at the other end of weight spectrum (but it certainly doesn't stop people from making unhelpful and blatantly hurtful comments).
    Your mention of realistic goal setting was really interesting too - I recently went to my dr with a great list of goals I wanted to achieve, and was absolutely floored when she simply said 'how about you stop one of your weigh-ins?'

  2. I always wanted to be thin, but all the diets I tried never worked. I started to take over the counter diet pills which helped me to NOT get hungry. I was down
    quite a bit of weight, when family members were concerned. I did not care, I just wanted to be THIN. Soon my best friend(my ex-husband) would not even hug me, because he could feel my bones. If I did not start to eat - I would loose his friendship forever. I could not handle that. So, I got help and gained more weight that I wanted. Now I am on the other end of the spectrum.
    I so wanted to have bypass or lap band surgery, I did not weight enough I need to GAIN about 20 pounds. I had tried just about every diet. Unlike Meg, I thought bypass surgery was the answer.

    Meg has opened my eyes. I hope I can be as wise as Meg, when learning to set realistic goals. I applauded her for her latest goal. That’s what I need, is to set short-term goals for myself. She has learned to set realistic goals, goals she can achieve and maintain. Thank You, Meg!

  3. I can totally relate. I also struggle with emotional eating and have been trying very hard to work through my issues, lose weight, and get fit. I was devastated when at the grocery store, I heard a mother say to her daughter "She really needs to go for a walk RIGHT NOW" while looking at me. I had just lost 40 pounds, my clothes were hanging off of me, and I had a cart full of fresh produce. They were thin but had a cart full of frozen pizza and chips. I was so angry that I wanted to cry or smack them but I just walked away. People can be so insensitive and cruel. I'm glad that your patient was able to let it roll off her back and keep going, I know how difficult that can be.

  4. Thanks, Anonymous, for your well-stated comment! I plan to post more pieces of inspiration, true patient stories, in the near future. Thanks for reading!