When we help our patients living with obesity, whether it is through surgery, medication, behavioural change, or a combination of interventions there are many other factors that declare themselves in my consultations, that I think are worthy of support and help, and an important part of holistic care for the persons wellbeing.
I speak daily with people who are waiting for surgery, have had surgery, have tried medications with lots of success, or have commenced medication, or have been on medication for a while. Some are embarking on new ways of eating and exercising. Some have lost a lot of weight, some are losing weight, and some are struggling.
I find that along with many of these interventions it is important to acknowledge the significance of each individual's thoughts, behaviours, feelings, emotions, and relationship with food and eating. For example, their history, life stage, their culture, their mixed and unexpected reactions to weight loss and ongoing weight management.
There are people with ASD or ADHD, who talk about the challenges they have with certain textures of food, certain tastes, and food combinations. Some talk about forgetting to eat when hyper focused, or, constant grazing and impulse control around food intake. There are people with OCD who talk about the challenges with obsessions and compulsions around weighing themselves; and for some, if they don't focus on their calories in and out they become anxious and distressed.
There are the people who have found weight loss has triggered disordered eating thoughts that they haven't had for some they haven't had these thoughts up to twenty years, but have noticed them remerging.
Then there are people who feel immense sadness about not being able to eat the way they used to. They miss the social connection that food provided them with. This might be due to the fact that they can only eat very small amounts post surgery or the medications have blunted their taste sensation or they feel full so quickly that they express a lack of joy that they used to feel.
There are people who have used food to soothe uncomfortable emotions and are feeling lost because they have not been able to find a replacement behaviour that soothes them the way food did.
There are the people who grew up in immense poverty, and so going without food causes anxiety even though they are no longer financially stressed. There are the people who went to boarding school and had to eat as much as they could, as quickly as they could or they would miss out. Or the adult who grew up in a very large family and if you didn't eat your food quickly and in volumes you might miss out.
Even though they are no longer at boarding school and are now adults, these patterns and behaviours are entrenched, and hard to change.
There are the people who live with painful chronic illnesses and it makes many of the aspects of weight management extra hard. They are not only managing their obesity, but the pain and restrictions of their chronic illnesses.
There are the people who talk about the toll on them from the years of carrying shame and stigma, which has caused deep psychological scars. There are the scars from public and private humiliation that they have endued and they want to talk about it as they are quite traumatised.
Some people talk about being sad about the loose skin they have after weight loss.
Some talk about a gnawing fear of weight regain and that this is making them anxious and scared. Some talk about self-sabotage and they are not sure why.
These are just a few examples of the many considerations that I feel can provide additional support and individualised and personalised care. If we can support people with these worries at the same time as helping them manage their weight, we are supporting them as a person in all the complexities not just as a result on a scale. This is not to say that the health benefits they are experiencing are not of enormous importance and necessity, but to be able to support them with some of the other aspects of their life mentioned above seems like a critical part of holistic care.
No worry or concern or question is too small or big when it comes to helping people feel safe and supported while navigating the complexities and challenges of living with obesity.
Ginette Lenham © December 2022