We are pleased to bring you this regular column by Dr. David Creel, a licensed psychologist, certified clinical exercise physiologist and registered dietitian. He is also credentialed as a certified diabetes educator and the author of A Size That Fits: Lose Weight and Keep it off, One Thought at a Time (NorLightsPress, 2017).
Do you have a weight loss question for Dr. Creel? Email him at [email protected]. He may answer your question in a future column.
When you’ve failed at weight loss many times, your desire to change can turn into something that seems like motivation but isn’t. Loretta’s story is a good example.
Loretta showed up 15 minutes late for her psychological evaluation for bariatric surgery. I knew little about her aside from the information in her medical records. In her chart, I found that Loretta weighed well over 400 pounds and had diabetes, sleep apnea, arthritis, and low back pain. She checked the African American box on her intake form, and I noticed her address was in the middle of a crime-ridden part of a nearby city. When I met her in the waiting room she rocked backward and then forward while pushing on the arms of the chair in order to get to her feet. She groaned and grimaced with pain while walking with me to my office, barely acknowledging my introduction. She didn’t apologize for being late and seemed uninterested in small talk about weather or traffic. After we sat down, I explained the purpose of the required evaluation was to make sure surgery was a good fit for her, and if so, determine what things she could do to best prepare for the operation.
As Loretta began telling me about herself, it was clear our lives were only similar in the sense that we were both raised without much direct influence from other cultures and races. Her urban speech patterns were unlike mine, and her life was riddled by poverty and family members incarcerated or addicted to drugs. She casually admitted to having a drug problem in the not-so-distant past. On the other hand, I grew up in a Mayberry-like small town insulated from most of the problems found in inner cities.
Although I’ve tried to educate myself about other cultures and interact with people different from me, I can’t change the color of my skin or how I grew up. I could not simply, without invitation, step into Loretta’s world and understand her life. Our differences were important to her and she didn’t want to talk about the thing that was most personal to her—her weight—with someone like me. How could I blame her? After all, it’s hard enough to talk about personal struggles with someone who understands where you come from. Revealing these things to a stranger from a different culture and race adds to the difficulty.
I listened intently to Loretta and paid close attention to her body language. Although I tried hard to connect, she spoke to me with distrust, answering my questions with curt frustration. She was holding her cards close to her chest, afraid if I got a glimpse I’d take advantage of her. She feared I would win the game and taunt her with condescending psychobabble. Like many patients in this situation, she probably believed I’d use her words against her when it came to deciding if she was an appropriate candidate for surgery.
My attempts to convince her we were “on the same team” and I wanted to help did not resonate. I had real concerns that her lack of a support system, combined with financial hardships, would cause problems for her after surgery. Would she be able to afford the vitamins she needed to take daily for the rest of her life? When she couldn’t use food to cope with life difficulties would she turn to drugs again? Although she couldn’t see it, surgery could make her life worse if she wasn’t ready and equipped to make the necessary changes. As I continued to probe about how she would manage various aspects of her life after surgery, she stopped me.
“I don’t like where this is going.”
I put down my pen and stopped taking notes. “What are you concerned about?”
“I want to change my life.”
“How do you want your life to be different?” I asked, as our eyes finally connected.
Her expression softened and her eyes welled with tears. Like the small movement from the torque on a lid of a never-opened jar, I could sense something was about to give way. At that moment I didn’t notice her body that 30 minutes earlier had fallen into the oversized chair, out of breath from walking to my office. I didn’t notice her skin tone or the fullness of her face. Our age difference and dissimilar upbringings were insignificant. I just looked into her eyes and felt the gap between us closing. In a strained, high-pitch voice required to delay an ensuing sob, she quickly exclaimed,
“I can’t even wipe my own ass anymore.”
I didn’t know what to say. There it was, one of the most personal and embarrassing aspects of her life, out in the open. In those few words, she ripped through the veil I’d been tugging at the entire session. But I wasn’t ready for it; I could no longer sustain eye contact. It was like I accidently saw her naked and was sorry I embarrassed her. As I felt the weight of her troubles, compassion stole my words. I looked down, nodding my head.
“I can only imagine how that makes you feel,” I said, after a long pause.
Her size had robbed her of her dignity. She was angry. As we continued talking, I learned she had been this size for quite some time. She depended on her husband to prepare food and help her dress, bathe, and get into and out of her car. It seemed illogical that up to the point of seeking bariatric surgery, she had done little to change course. How could it be that Loretta, like many other people, hated her situation so much, wanted to change, yet seemingly did nothing about it for so long?
Clearly, Loretta wanted to lose weight. In fact, she told me she’d wanted to lose weight for a very long time. Despite her desire for a different life, I imagine she had misguided family members who said, “When she wants it bad enough, she’ll do it.”
But Loretta’s problem wasn’t lack of desire. She had a strong desire to lose weight, but she wasn’t motivated: Loretta was desperate. A simple comparison will help explain what I mean.
Imagine you’re stranded on an island by yourself. You have sources for food, water, and primitive shelter. You’re happy to be alive, but also desperate to leave the island, interact with other humans, and enjoy a hot shower. Month after grueling month you try everything to escape the island—sort of like the old TV show Gilligan’s Island. After years of failed attempts, you still want to leave, but you’ve given up hope. Deep down you believe nothing will work—and you’re losing motivation. Any new idea to get off the island leads to a half-hearted pursuit before giving up. You’re so demoralized that you can no longer tell the difference between good ideas and dead ends—they all seem alike.
This is the point Loretta reached with weight management. Someone told her about bariatric surgery and she felt so desperate she made an appointment. She wanted to lose weight, had many good reasons to change, but wasn’t motivated. Our conversation revealed that, to her, bariatric surgery was no different than the grapefruit diet, the cold shower and potato diet, or having her mouth wired shut. In her desperation she hadn’t considered how this procedure was different than everything else she had tried.
Because of her perspective, she wasn’t ready to do the work required to be successful with bariatric surgery. When we offered to help Loretta prepare for surgery by changing her diet and beginning a modest physical activity program, she seemingly lost interest. Maybe over time she became motivated and pursued help elsewhere. Perhaps she’s still on her island—I hope not.
Desperation occurs at the intersection of hopelessness and motivation. We want to change, but have lost hope. We consider drastic efforts without truly believing they’ll lead to success, and after a while the drive to change begins to fade away.
Desperation can lead to motivation, but not always. Desperation can also rob us of clear thinking and make us vulnerable to things that will harm us, while safer solutions rest quietly within our reach. Many times people repeat the old saying: “You have to hit rock bottom before you can change.” In other words, life has to get really bad before we’re desperate enough to make changes. This can be true for weight loss, and sometimes it works, but it only works if someone will help you out of the mire and offer a safe, realistic plan. Even then, you must accept the help, believe in the plan, and do your part to make it happen. Otherwise, desperation usually leads to taking whatever someone will give you and hoping things will miraculously work out.
Come back each week for more healthy weight loss advice from Dr. David Creel.