Obesity has reached epidemic proportions with 3.8 million people weighing over 300 lbs. and approximately 65% of Americans are overweight. Childhood obesity has more than tripled in two decades. The average adult female weighs 163lbs. The Center for Disease Control reports that in 2006 only four states had a prevalence of obesity less than 20%. One in four children is overweight.
Clearly the statistics indicate a dramatic increase in obesity in the United States, but the trend is true for all developed countries. The causes of obesity are many—some complex and others simple, such as, living sedentary lifestyles.
Jessica struggled with her weight for more than two decades. At times, she had felt in control but for the most part she experienced her eating and weight problem as controlling her. She describes her struggle: “I gained weight as an adolescent. I was very unhappy as a teen. I felt unattractive and unloved and unwanted. The food was a way of making me feel better. I didn’t worry about the eating because I figured I could lose the weight when I wanted and I was very successful at it. As a teen ager I could lose 10lbs in a week but the ease of losing weight gave me permission to eat whatever I wanted. The day came that I couldn’t lose it so quickly. My weight went up and down for a long time and then the general trend was that my weight increased over time. I had phases when I lost weight, but it was a struggle not to put the weight back on. I would re-gain the weight I lost plus add a few pounds. As I experienced the increased weight after a successful round of dieting I became even more restrictive and crazy about my weight loss schemes. I would spend a day or two not eating at all and then decide I would eat only cabbage soup for a few days. This is an example of the wild schemes I would concoct to control my weight. Now I am totally out of control. I am about 86 pounds overweight and I feel completely helpless to do anything about it. The more I try to control the more I want to eat. The more problems I face and the more stressed I feel, the more I eat. Actually most things end up with: ‘the more I eat’ .”
Jessica is typical in that her desire to lose weight is often accompanied by an extreme diet. Sometimes the unusual eating patterns include taking diuretics, laxatives, an assortment of OTC diet pills, but almost always includes an odd concoction of foods or an extreme restriction.
Mark was in the same position as Jessica. He felt out of control with his weight and was seeking to have bariatric surgery to lose weight. He reports that he has multiple health problems that include hypertension, diabetes and knee joint pain. He works as an accountant and his work is highly stressful but is also very sedentary. He describes his eating habits: “I eat at my desk on most days. I have several snack foods that are my favorites, such as chips, cookies and chocolate. I like to munch while I work. As a consequence I never take time out for a meal because I’m not hungry. I seldom sit down to a full meal unless my wife forces one on me. I think I am not eating that much, but I keep gaining weight. I weigh 295. It’s the highest weight that I have been in my life. I want to diet and exercise but I don’t see how I can. I don’t have enough time to have a normal meal. I don’t have time to exercise except some time on the weekends, but, when I try to exercise my knees bother me, so I give up. I feel the only way I can do anything about this problem is if I have surgery. Once I have the surgery then I don’t have a choice, then I have to change my behavior.”
Jessica has behavioral and emotional issues that have played a part in her disrupted eating patterns. She has lost touch with the real purpose of eating which is to nourish her body with the nutrients it needs to function properly. She has become weight obsessed. Mark is overworked and overstressed and has used food as a means of managing his subjective experience of stress. He is unaware how he is actually adding to his stress by relying on the momentary pleasure of snacking. The stress is increasing exponentially as he gains more weight and changes his physiology that makes him even more inclined to store fat.
Kate has a problem that stems from childhood. She experienced her mother as a controlling person. They had struggles over many issues including what to eat and how much to weigh. Kate’s mother was very thin and very preoccupied with her weight, food and body image. Kate was always overweight since early childhood. Her mother would try to control her food intake and Kate craved sweets as many children do. Her mother would force her to sit for long hours to consume her vegetables and if she saw her daughter with sweets she would take them from her. Kate had decided that when she was able, she would access all the sweets she wanted. As a preteen her weight was within 10 lbs of normal but by the time she was 14 she was 50 lbs overweight. Her mother was exasperated with her and tried to get her to lose weight. This became a constant battle between them on a daily basis. The more her mother tried to exercise control over her food intake, the more Kate ate the foods that were “forbidden”.
Kate discusses her issues regarding food in her consultation. “I think my eating problem started in childhood. I had a healthy appetite. My mother may have had one too but she was in a constant state of control over her food choices. She was very particular about what she ate and she tried to exert the same control over me. I use to sneak food whenever I could. I especially like the foods she wouldn’t allow, such as cake, cookies, candy, French fries, potato chips. I would spend my allowance or find money around the house and secret it away until I had a chance to buy the foods I wanted. When I did it felt even more special. The food took on a special significance for me: the food represented my willful disregard for my mother’s control but it also represented my getting something forbidden and special. To this day I still crave these foods even though I know they are harmful to me.”