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.
“HI, Dan, how are you today?”
Dan walked toward me with his arthritic limp, grinned, and held out his hand. “Better than I was,” he answered predictably, “but not quite where I wanna be.”
Dan was a client I always looked forward to seeing. A witty 46-year-old, he owned a flooring business in a nearby town. He’d managed to finish college after a childhood of poverty, worked hard, and built his business from the ground up. He often smiled as he talked about his loyal employees, many of whom had stayed with him since the business opened 15 years earlier. When he talked about his family, Dan’s eyes would soften and shine. “My wife is the greatest woman in the world. My daughter’s getting married in the fall and my son will graduate with his engineering degree next spring.”
Dan was living a life that far exceeded his childhood dreams. Though not wealthy by Wall Street standards, in his mind he was the richest man in the world. However, while living the American dream Dan had ignored his health to focus on business and family. Although his doctor advised him to make lifestyle changes, Dan didn’t follow that advice. His wife worried about his weight, bad knees, and rising blood pressure. He responded to her concerns with his usual you-only-live-once, happy-go-lucky attitude and continued his unhealthy patterns.
Dan’s eating habits were to blame for his worsening health. He often bought lunch for his entire office staff and would eat whatever they ordered on any given day. Although his wife was willing to cook, Dan enjoyed taking her out to eat. He spent most evenings winding down with one or two rum and cokes and a salty snack or two. This lifestyle led to a steady weight gain over ten years.
An eye-opening experience led Dan to seek treatment at our center. One morning after a restless night of sleep, he decided to check his weight. Maybe the seeds planted by his wife or doctor had started to germinate, or perhaps for some reason he noticed the dusty scale tucked away in the bathroom closet. He dragged the old analog scale out from behind a box of cleaning supplies, set the scale on his tiled floor, and stepped on the black rubber surface. The red dial quickly snapped to the 300-pound maximum and vibrated slightly as it tried to go beyond its limits.
Dan was shocked. He had no idea he weighed that much. “This is really bad,” he muttered. “I can’t even weigh myself on a normal bathroom scale.” All day he thought about his weight, his blood pressure, the difficulty he had playing a round of golf, and the sleep apnea that left him feeling drowsy throughout the day, even occasionally dozing off at his desk during work. And he had pain. A once-in-awhile ibuprofen pill had become a regular medication to help him walk during the day and control the knee pain that awakened him in the middle of the night.
Dan’s wake-up call came from seeing that red dial max out on his bathroom scale. He realized if he didn’t stop this weight trajectory, he wouldn’t be able to live the way he wanted — and he had a lot to live for.
Dan’s motivation translated into action. Every two weeks he came to my office, down another four or five pounds. Occasionally Sheila, his office manager, called to tell me Dan was running five or ten minutes late, but he never missed.
After five months of treatment, Dan had lost 60 pounds. He was playing more golf, helping prepare dinners at home, and his office staff had shaped up too, keeping the refrigerator stocked with fruit, raw veggies, and low-fat dip to accompany the sandwiches they ordered for lunch. Dan told me Sheila and one of his salesmen had lost over 20 pounds each since he started the program.
Even though he’d found his groove for weight loss, Dan wanted to keep meeting with me every other week because it kept him accountable. We discussed that at some point in time things would get harder and he accepted this as a challenge.
Then one day Dan didn’t show up for his usual Tuesday afternoon appointment; Sheila didn’t call either. Somewhat concerned about his out-of-character absence, I called his personal phone and office phone, but nobody answered, so I left messages. No one returned my call. A week went by and I called his home phone and again had to leave a message. A month had passed and I had thought a lot about Dan. Why did he stop treatment? Although I don’t make a habit of harassing patients who no longer want to remain in treatment, Dan wasn’t a typical patient and his absence didn’t make sense. “I’ll try one last time,” I thought. Like before, six rings and voice mail. Three weeks passed and finally I got a return call.
“Hello Dave, this is Suzanne Smith. My husband Dan Smith was one of your patients at the weight loss center.”
“Of course, Suzanne, thank you for calling me.”
“You left a couple of messages for Dan and he wanted me to call you. He would talk to you himself, but he’s very sick and weak. A few days after you last met with him he started to have abdominal pain and nausea that wouldn’t go away. He went to his doctor and at first they thought it was his gallbladder. Then they ran some other tests and found out he had pancreatic cancer.” She spoke in a matter-of-fact, well- rehearsed tone.
My throat tightened. “Oh, no, I am so sorry, Suzanne.”
Her voice softened as she explained his prognosis. “The cancer is progressing fast and there isn’t much we can do other than try to keep him comfortable. We wanted to thank you for your help; Dan felt so good until his symptoms came on all of a sudden.”
“I can only imagine everything that’s going on for you guys right now, and your call means a lot to me. Please tell Dan hello for me.” I hung up the phone and stared at my office wall.
The news shattered my expectations. Dan worked so hard to change his lifestyle — and what was his reward? The things we both believed would prolong his life probably wouldn’t give him a single extra second on this earth. Everything he worked for was taken away without warning. I wondered if he had regrets. If Dan had known he’d become so ill, would he have tried to lose weight? About three weeks after my conversation with his wife, Dan died.
I decided to attend his wake with the plan of quietly signing the registry, introducing myself to his wife, and then leaving. I wanted to pay my respects, and to be honest, I needed to find closure to my relationship with him. I arrived at the funeral home to find the parking lot overflowing with cars and a mass of people gathered outside. I quickly realized what I learned about Dan in a clinical setting only scratched the surface of who he was and the impact he made on people in his community. The visitation line stretched from the front to the back of the seating area and then twisted back and forth in the foyer like an amusement park line. The length of the line told me it would be hours before I reached the front to pay my respects. On another night I might have been able to wait, but that night I needed to lead a bariatric support group.
Even though I wouldn’t be able to see Dan or his family members, I wanted to stay as long as possible. So I stood in the back of the barely moving line, far from the seriousness of what was taking place at the front of the funeral home. No one was crying, hugging, or being introduced to family members. I couldn’t hear anyone saying “I’m so sorry” or “If you need anything, please let me know.” At the back of the line I was in a space somewhat removed from the emotion, stuffed into the foyer with seventy or eighty other people. I saw middle- aged people with their young adult children waiting in line. These were probably families who knew Dan through his kids. I spotted a few fidgety men wearing khakis and three-button shirts who seemed to be talking about sports or something more superficial than the event of the evening. “Golfing buddies,” I told myself.
I listened to the conversation from a small group of Dan’s close friends in front of me. They had seen him regularly over the past year and began discussing his intentional weight loss as well as the weight loss he suffered from cancer.
“He looked and felt so good before he got sick,” one man said.
“Yeah, I’d never seen him that trim,” another responded before changing the subject.
After hearing those brief comments, I felt a sense of accomplishment. Even though our time together was short, I had a part in helping Dan feel better and achieve something important to him. Dan was not on a miserable diet, denying himself everything he wanted. He didn’t isolate himself from others to eat special food or to spend hours at a gym. In fact, it was quite the opposite. Dan unintentionally became a health advocate, a leader of sorts. People saw what he had and they wanted it, too.
Dan’s death reminded me that our time on this planet isn’t guaranteed and can be cut short for no apparent reason. As a result, I became less interested in helping people follow pitifully unpleasant diets. I focused more on encouraging people to find a peaceful balance in their journey to a healthier weight.
Purposeful living often means finding joy in self-denial. The daily satisfaction we feel when overcoming challenges, caring for ourselves, and knowing we’re an inspiration to others far outweighs the feelings we get from feeding our immediate desires. Although Dan didn’t reap all the long-term benefits of losing weight and living a longer life, the short-term effects of his efforts were just as meaningful. He lived life fully until he became sick and his weight loss was part of a broader personal transformation that made an impact on others, even me.
I began to wonder what would have happened with Dan if the cancer cells hadn’t invaded his body. Could he have kept the weight off? Or, like most others, would he have succumbed to the neurochemical, metabolic, psychological, and environmental influences that contribute to weight regain? Would those weight-gain promoting factors have been as powerful and persistent as his unstoppable cancer cells?
Even though statistics tell me Dan would probably have regained his weight, he seemed to have a perspective that could defy the odds and prevent a relapse into old patterns. My time with Dan led me to think a great deal about who succeeds long-term with weight management efforts. I began considering relapse prevention early in my work with other clients, focusing on behavior and perspectives they could sustain long-term.