This past week, severe bronchitis and a high fever confined me to bed for a few days, and television reruns. The series, “My 600 Pound Life,” filled several hours but left me alternately feeling sorry for and annoyed with the people who were attempting to lose enough weight to qualify for bariatric surgery. Some did, others didn’t, and one died. The program followed a fixed sequence of events: the excessive overeating of a potential patient, consultation with the bariatric surgeon, the requirement to lose some weight before being eligible for the surgery, and the surgery for some and its aftermath. The viewer is rarely given any information about the social-psychological background generating the enormous weight, although in some cases, horrific childhood experiences are revealed. And a fair amount of time is spent on the struggles the patient has in following the surgeon’s diet, which of course eliminates all the foods the patient was eating, and eliminates much food in general. Patients often fail to lose weight and are told they are not trying hard enough. Rarely is an explanation given as to why they fail.
But in one episode, the young male being featured did say something that dramatically underscored why he was eating constantly. His mother had come to visit for a few weeks, and we see her cooking and then serving him breakfast. She puts a large serving of scrambled eggs and bacon on a plate, covers it with a ladle of cream sauce, adds two large waffles, and ladles more cream sauce until everything is saturated. As her son begins to eat this dish with obvious enjoyment, he tells the camera and us that he is anxious about his mother’s departure because he will be alone again. He says he wants to eat slowly but his anxiety is making him eat very quickly. As long as he is able to put food in his mouth, he doesn’t feel that anxious. But as he cleans his plate, he says the anxiety of being alone is coming back. He says that he must keep on eating; he must keep on putting food in his mouth in order to deal with his unbearable anxiety. He takes a pizza out of the freezer, microwaves it and starts eating, again.
Having fallen asleep before program ended, I don’t know how his problems were resolved. I wondered if the son’s obvious compulsive eating would be addressed, but I doubted it. I knew from watching other episodes, that if he were suffering from a mental disorder like Obsessive-Compulsive Disorder, it would not be discussed, at least on air. If the young man repeatedly failed to lose the requisite amount of weight, he might be seen by a therapist. But the focus would be on his incessant overeating, not the psychopathology behind such behavior. This was a show about bariatric surgery, not psychiatric disorders.
“That poor kid”, I thought. Would he ever be worked up for generalized anxiety disorder? Obsessive compulsive disorder? Depression? If he went on the surgeon’s restrictive diet and was no longer able to engage in the kind of eating that made his anxiety bearable, did he get worse? If he had the surgery and now could eat only tiny amounts of food, did he try to eat more than he should because he still had no other way of decreasing his anxiety?
But what if he weren’t on this reality television program. What if he presented himself as a compulsive eater at an eating disorder clinic? Or joined Overeaters Anonymous or checked into a residential eating disorder program? Would he be treated differently?
Obviously he would not be allowed to continue his eating behavior, because unchecked it may kill him. But what would be the primary focus of these programs? The mental disorder causing the compulsive eating? Or the eating itself? There is of course an urgency in controlling the eating. But once the unhealthy foods have been replaced with large salads, fresh vegetables, lean protein in small controlled quantities, what then? Will the reasons, psychosocial or neurochemical, be probed to understand the roots of his compulsive behavior? Will cognitive-behavioral therapy be used to develop behavioral patterns to replace his compulsive eating when the anxiety strikes? Will medications be used if these interventions do not work?
If this young man had compulsively washed his hands hundreds of times a day so that the skin was peeling from his finger and he was in pain, then the treatment for this compulsive behavior would have gone far beyond halting the handwashing per se. His treatment would not have started and stopped by making it impossible for him to engage in the compulsive behavior by making him wear a pair of thick gloves and limiting access to water. But if the therapy for helping compulsive eating focuses exclusively on removing excess food, isn’t this like focusing only on the water used by the compulsive hand washer?
Bariatric surgery has been successful in producing significant, and in many cases, permanent weight loss. Some of these successes have been shown on the 600 pound weight loss series. But this program is not designed to disclose the psychological reasons for the weight gain and/or failure to lose weight of its patients, except in very superficial ways. The viewer becomes annoyed, as I did in my somewhat fevered state, with those who can’t lose the weight. “Stop eating”, one wants to say, “You are going to commit suicide with food. “ What we don’t know, and are not told, is that for some their emotional pain, their distress, their depression is made bearable only by constantly eating, and unless and until these are helped they are not giving up the only remedy they have. Taking away the food is only the beginning of the solution.