Getting the Super Obese to Lose Weight: It May Take a Family

Anyone who ever saw any of the television programs focused on the attempts of individuals 600 pounds (or heavier) to lose weight often wonders why their family members are enabling the obesity. The viewer watches the mostly bed-ridden obese individual demanding food, lots of it, and then being served large portions of whatever has been requested. The camera lingers over the individual crunching potato chips, spooning up macaroni dripping with melted cheese, or eating a gallon of ice cream. It is possible that the television crew doesn’t film the subject of the show when he or she is eating kale salad, or fat-free cottage cheese, so we get the wrong impression. But given the stated food demands of the obese individual, the viewer has the impression that if kale salad, or indeed anything resembling low-calorie healthy food were offered, he or she would be in the unique position of saying no to the food. The occasional trips to the supermarket by some of these TV stars who are able to ride in car (and use a motorized shopping cart) also focus on the purchase of junk food. Although it is obvious that some nourishing foods must be bought and eaten to avoid nutritional deficiencies like scurvy or anemia, the healthy menu items are rarely, if ever, shown being consumed.

The viewer wants to shout at the family members bringing food to the massively obese person, “Why are you enabling this?” Indeed, in one particularly poignant episode, a father buys a large pizza for his son who has been told he must lose 60 pounds before weight-loss surgery can be performed. The son has demanded the food and as the father watches the son gobble the entire thing, he asks for a piece for himself. “No,” was the reply, “I am going to eat the entire thing.”

Internet comments predictably share the bewilderment over the enabler function of family members as depicted on the show. As the fattening foods are prepared and served, the enabler expresses concern on air about the likelihood that the obese family member will die in a few years from the massive weight gain. And yet the food is served, and the concerned warning is absent. But to be fair, perhaps saying something is useless. The obese individual expresses concern over the pain caused by living in such a large body, and also worries about dying. So what good could it do if a family member states the obvious? It may even have the opposite effect. But still, we the viewers still wonder why the family members enable the continued weight gain.

What if the family member was a chronic alcoholic and developing liver disease, collapsing from frequent blackouts, and cognitive impairment? Would the same restraint be used, that is, “Don’t criticize, nag, cajole and threaten?” Would family members buy alcohol for the abuser who might be too drunk to get to the store?  Or drive the alcoholic to the nearest liquor store?

People say that one can’t compare alcoholics to excessive overeaters because the latter have to eat to live, so they cannot be abstinent. True, but one can live quite nicely without consuming highly caloric food in mega quantities, and drinking sugar-filled soda and juices.

Nevertheless, it is hard for family members to take corrective action alone. Professional help is needed, yet there is no process by which a concerned parent, for example, can force the adult extreme overeater to see a physician, dietician and/or therapist. Medical privacy laws forbid sharing the information with healthcare providers unless written permission from the family member is given. But waiting for the heart attack, stroke, skin infection, or cancer to occur in order to obtain medical intervention to start the weight- loss process is hardly an option either.

Family members of an alcoholic often turn to Al-Anon, whose meetings offer advice and support. Inpatient rehabilitation facilities often insist that family members be present for some of the therapeutic sessions to support recovery.

O-Anon is a spin-off of Al-Anon and runs with the same rules of privacy and espousal of the twelve-step process. But is this enough? Can a family take upon itself to provide only healthy, portion-controlled meals and beverages without medical and nutritional advice? Can the family handle the emotional fallout when the obese individual no longer has access to foods that for many are the only reason for living? What happens if anger, anxiety, and depression follow the imposition of a new eating regimen? Must someone be home all day to prevent fattening foods from being delivered, or the obese individual from finding these foods hidden in the house?

It is hard not to notice that often family members on the show are also obese, but may be 100 pounds overweight rather than 600. Will these folk be willing to change their eating habits to support the dietary changes they are imposing?

It may be as hard for the family to change its role with the patient as it is for the patient to lose the weight. In an ideal television series or world, such issues would be raised and solutions found. The bariatric surgeon would insist that both patient and family members meet privately, and as a group with a dietician, therapist, and even personal trainer instead of telling the patient to go home and lose sixty pounds.

People don’t gain 500 pounds simply because they like doughnuts or French fries. Their reasons for their morbid weight gain are complex, and their success in losing weight permanently depends on the family with whom they live and eat understanding these reasons. Maybe the producers of these television shows ought to realize this, even if it doesn’t make such interesting viewing.

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