"Eat Less and Take More Exercise"

Yay!  The plateau has been broken and I've lost over 4 lbs this week (279.5 lbs); soon after the catharsis I had while writing my last blog entry in fact. 

Given this hurdle jump, I'm reminded of more than one instance when I've had disagreements with past personal medical providers and one or two Licensed Medical Provider co-workers; many of whom discount the benefits of psychotherapy in favor of physical medicine.   I'm all for checking for a physical cause when someone first comes into my care.  In fact, many psychological pathologies and/or behavioral difficulties stem from imbalances or problems in a person's physical health.  At the same time there are many conditions/situations that either are the complete providence of mental health or can benefit when counseling is provided in concert to physical treatments. 

Take weight loss for instance.  One of my pet peeves is when I'm in a medical provider's office and my weight difficulties are summed up as "eat less and take more exercise."  In good conscience I won't fault my medical colleagues completely.  In this age of managed care they get maybe 5-10 minutes with a patient before they are typically forced by management policies to move onto the next person.  So there is not often time to give the appropriate attention to this important issue.

And it is an important issue that is quickly becoming an epidemic. The United States leads the western world in obesity prevalence at 30.5% of the general population (OEDC 2005).   A recent report by the CDC comments on the "dramatic increase in obesity in the United States" over the last 20 years (CDC 2008).  Obesity is the prime variable when looking at cardiovascular problems, certain cancers, and type 2 diabetes (2008).  Diabetes, heart difficulties, and cancers are not something minor like a stubbed toe.  So, it perplexes me that general practitioners, on the front lines of confronting these issues, typically do not spend more time discussing weight with their patients.  What truly kills me is, even if you don't have time to get into a the weight difficulties of a patient, at least suggest a referral to a mental health provider; especially for individuals who have struggled with weight for more than a year.  If I can be cheeky for a moment, I want to scream out to the physical health community, "dudes!  We can help!"  :-)

A friend and fellow blogger had me thinking recently about a relevant bit from a "britcom" known as Absolutely Fabulous. "AbFab" is about a lot of things, but one central theme has been the struggle of a woman in her 40s named Edina Monsoon with her weight in the very appearance-conscious entertainment industry.  In one episode, after she is coming down from a mighty eating binge, her daughter, in all seriousness, parrots the medical provider line referenced above of "eat less and take more exercise," to which her mother (the main character) responds loudly, "well if it was that easy everyone would be doing it!"

What the main character said for comic effect I repeat with sincerity.  Despite over 1 in 4 US Citizens being obese, only a minority of health policy makers, medical providers, and even mental health clinicians are seriously looking at WHAT IS BEHIND this issue; instead choosing to focus on the superficial goal of getting the weight down.  Even our current First Lady, whom I applaud for the attention on this issue, is only encouraging simple, surface-skimming interventions in support of this effort.  Incidentally, I get concerned sometimes that she might be doing more harm than good, because ultimately there is a real risk of stigmatizing these kids further, and subsequently reinforcing the emotional drivers of guilt and shame that can lead to problem coping behaviors like overeating.

The sad truth that most people seem to be dancing around is that significant weight loss, like the over-the-top Edina Monsoon screamed to her daughter and the world, IS NOT EASY.  Not to put too fine a point on it, but it sucks.  It takes a tremendous physical, mental, emotional, and spiritual effort (and preparation) to not only change long standing habits but also to sustain them.  Yet this gets brushed aside and is diminished; much like people who live with other problems related to substance use.

Mental health therapists CAN HELP.  There's a diversity of methodologies and theoretical orientations that inform the practices of mental health clinicians.  One thing that the vast majority of us have in common though is we assess a difficulty, and then, through counseling, identify a root cause (or causes) and apply a treatment that has demonstrated efficacy through supported research (at least those of us who support the use of Empirically Supported Treatments follow this course, but that's another posting for another time).  That's because, unlike our medical counterparts, WE HAVE THE TIME. 

Seriously docs, do you even make the effort to consider the 'whys' of the increase in obesity?  Of course there's the common scapegoats:  'laziness', television, media, the Internet, the whole 'couch potato' theory.  C'mon guys, you can do better than that. 

Do I have an answer?  No.  I don't think there's one reason why people choose life-coping methods that lead to behaviors that relate to weight gain.  My M.O. is to encourage people to explore 'the whys', rather than resort to the easy cliche of "eat less, take more exercise."  For my friends in the medical community, you would be surprised how far a simple phrase such as, "I can't imagine what this struggle with weight must be like for you and how frustrating it can be to have to deal with it.  If you ever want someone to work with you to understand what's behind it, I'd be happy to recommend some good counselors..." will get you in rapport building with a patient, rather than shutting them down with tired lip service about exercising more and eating less.

Again, 1 in 4 people in this country are obese.  Breaking out of the habit of a quick diet and exercise routine recommendation seems worth the effort to me.