PSYCHOLOGICAL IMPLICATIONS OF METABOLISM TESTING

Dear Dr. Diet

Ask Dr. Diet American Association of Bariatric CounselorsI don’t eat a lot and certainly not more than most women I know. Why would I weigh 100lbs more than them?

 

CASE HISTORY

PSYCHOLOGICAL IMPLICATIONS OF METABOLISM TESTING

Rational Emotive Behavioral Therapy (REBT) is founded on the concept that our irrational beliefs transcend to negative emotions and ultimately to dysfunctional behavior.

When a person that has continually been plagued with “the slings and arrows”  of lifelong obesity discovers that they have a very low Metabolic Factor (MF) and likely the primary cause of their obesity….they can begin to shed a good deal of the shame and self-blame that has become their unconscious belief system that has riddled their lives.  Often when they have reported to their medical doctors, “I don’t eat a lot,” and their doctors question their veracity by rolling their eyes….they themselves question their own veracity. After all how can I be so fat and not eat a lot. While not every patient has a low metabolic factor, It is a very prevalent cause of a specific kind of obesity.(hypo-metabolic). A simple 10 minute Resting Metabolic Rate (RMR) breathing test can begin to unravel the enduring angst that this patient lives with. This rational numeric test could be the beginning of mediating irrational beliefs and subsequent negative behaviors and feelings

 

METABOLIC TESTING

I worked with two female diabetes research partners  …one a biochemist who weighed 250 lbs. (lifelong obesity) and the other an endocrinologist who has always weighed 135 lbs.(since her teens)

I did their Resting Metabolic Rate tests (RMR) and reviewed the results with both of them at the same time.

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Dr. Diet – A True Case History

Dear Dr. Diet,

Ask Dr. Diet American Association of Bariatric CounselorsA True Case History

This is how I remember Norma telling me her story in her initial visits with me. From my detailed and copious notes I have summarized her struggles and saga in her voice.

 

 

 

Transcript below:

It is hard to believe I was a beautiful and joyful child. I was chosen from thousands of little girls to be the face of a national brand laundry soap and posed for all their promotions. I am an only child and until the age of 7, I was doted on by my very trim-prim and proper mother and even my German born father, a very strict, authoritarian, expressed his love for me.

They both were very proud and very protective of me and would not allow me to play outdoors with neighborhood kids, for fear I would get hurt or bruised and would be not able to pose for pictures. I had one friend, Jo Ann, who lived next door and she was permitted to play with me, in our house only, and we were always supervised. I was special.

It all abruptly changed when the ad agency told my father that I gained too much weight and they could not renew the contract until I lost weight.

My father was angry and outraged with my mother and she cried. Even at 7 years old I knew it was my fault and I lived with the shame. My mother put me on my first diet. I vividly remember it because my mother baked a red-velvet cake for my birthday and had me blow out the candles, cut the cake, they took pictures, but would not allow me to have a piece. I cried myself to sleep. That was the turning point of my life…I was no longer special and no longer happy.

I began sneaking all the food I was not allowed to have. Furiously, my father weighed me each week and could not understand why I was not losing weight. The more food I was not allowed to have, the more I would steal. The more bitter my life was, the more sweets I wanted. The ad agency never renewed the contract.

Elementary school was a nightmare for me. Like my father I was very tall, a head taller and fatter than the other girls. And as a result of not being able to play with them after school…I was always the outsider.

Even my only friend Jo Ann would no longer sit next to me on the school bus. When choosing up sides in the school yard or gym…I would hear whispers of I don’t want her.

My worst grade school memories were when the school nurse would bring the scale into the classroom each year. I was always the heaviest and the tallest. Every year she would give me a note that notified my parents that I was overweight, and the note required a parent signature. I still shiver at that memory.

Middle school and high school were worse than elementary school. I was called thunder thighs, the fattest and tallest girl in the school. Nobody was ever fatter, all through high school.

My father never stopped taunting me about my weight and never forgot about losing the contract. Even when I went to the dentist and had some cavities, he told the dentist it was from all the candy I ate and not to give me Novocain. I was fat and not deserving. To this day I avoid the dentist and have many missing teeth, that I am sure you have noticed.

My mother was a piano teacher and we had a baby grand in the living room, where she gave lessons to the neighborhood kids. The same kids that tortured me every day came to my home after school. My only refuge in my whole world was my bedroom where I could eat and hide the food that I would steal while my mother was teaching. As long as I heard the piano, it was safe.  My father died when I was in High school. On the same day as my father’s funeral I bought a dozen Duncan Donuts and snuck them into the house in my book bag and ate them, in spite of him.

When life was bitter all I ever wanted was sweet.

With every diet I tried, my mother would encourage me and say, “Do it in your fathers’ memory,” that same memory that still haunts me.

When I finished high school, my mother told me I should become a teacher or a nurse. Not too many options back then. I figured if I became a teacher the students would make fun of me every day but if I became a nurse, patients in pain would not care what I looked like. I became an RN.

I am an ER nurse and always work the graveyard shift. I never got my driver’s license for fear that I would not fit behind the wheel of some driving school car. So take buses. Buses are empty at night and I always get a seat alone so I don’t have to worry about the looks I would get when I would spill-over to the other passenger’s space. ER patients are in and out, so I didn’t have to worry about personal contact.

Every day of my live I have had to carefully plan on how to avoid the punishment of humiliation. When I leave for work each night all I want is to return to my room, the only comfort and refuge I have known, alone with my secrets.

The other nurses were pleasant to me but kept their distance, especially when they would gossip about their love lives or how they avoided some of the doctor’s sexual advances…if they only knew how I would have welcomed that. I am proud of my nursing. You know I am very good at pleasing people.

My mother was always vigilant with her health and her morning constitutional walk…that I always refused to join in. She was especially holier than though with her perfect diet, even loved Brussel Sprouts. “Norma, if you just eat like me you can lose the weight”.

At forty years old I weighed 280 lbs., and still lived with my mother in the same bedroom I grew up in. I never had a true friend or a boyfriend or any kind of romance or sex life. The only sensual thing I have ever known are sweets. I still hide them in the very same spots I did when my father was alive.

My healthy mother went for her annual check-up and they discovered a cardiac blockage and she needed a bi-pass. The cardiologist said, that because of her health, she was an excellent candidate for the surgery. She had it done in the hospital I work in. They took her from the OR to surgical recovery where I sat vigil at her bedside. When she awoke, she stared into my eyes and tearfully said, “I only hope to live long enough to see you thin”. She died the next morning.

Many of the doctors in the hospital have sent their obese patients to see you and I thought I would use some of the money my mother left me and see if you could help me.

Writers Comments

This is how I remember Norma telling me her story in her initial visits with me. From my detailed and copious notes I have summarized her struggles and saga using her voice. Norma died some years ago but gratefully I still hear her voice, it is that voice that continues to inspire me and has helped shape more than three decades of counseling

If was a reader I probably would want to know if Norma succeeded in losing the weight ..but then of course I would be among all her tormentors that judged her solely on her size

What Norma needed to lose was the undeserved and unearned shame that shaped and riddled her entire life. Success for Norma was not a number on a scale but rather finally winning her own approval and perhaps some love and approval from you and me. Whether someone is thick or thin or different than us, in mind or body wehave a responsibility to celebrate their lives and decisions. They are no more or no less human and deserve our humanity without judgement. 

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If Fat Shaming Worked Nobody Would Be Obese

“Ask Dr.Diet” is a pseudonym for Stephen Phillips, a Board Certified Bariatric Counselor and public health director for the American Association of Bariatric Counselors (AABC).

TO ASK DR. DIET
send your question to: Dr. Diet

A Waist of Effort

Featured

Ask Dr. Diet American Association of Bariatric CounselorsDear Dr. Diet,

I’ve lost the same 30 pounds…10 times! When I feel strangled by my waistband I go back to my keto diet.

Dear “A Waist Is A Terrible Thing to Mind”,

Veteran dieters are experts at the all-or-nothing, stuff/starve syndrome…one day broccoli, the next day is ice cream. (Perhaps Ben & Jerry should consider a broccoli flavored ice cream.)
It appears that your body has a weight settling point, that’s higher than your mind approves of.  If I can’t convince you to accept your nature…let me offer some suggestions. Continue reading

Preventing Diet Hunger

Glycemic Index Pyramid Diet Hunger

Glycemic Index Pyramid

Diet Hunger

A common problem with reduced calorie diets is the nagging hunger that is generally experienced. So understanding which foods and combination of foods that offer optimal satiety be can be ideal for mitigating “diet hunger”. The longer it takes for foods to be digested and absorbed the greater the satiety. Meat, fish and fowl, contain fat and protein.. the two nutrients with the slowest gastrointestinal transit time (slow digesting).

Glycemic Index: All Carbohydrates Are Not Equal

All carbohydrates are not equal and have a great deal variability, some digest quickly and some very slowly. Continue reading

Mystery of 4th of July BBQ Solved

BBQ Mystery

Case History

Jack had a gastric sleeve surgery and is able to sustain his 75 lb weight-loss for over 4 years His BMI went from 38 to 27 and he no longer had diabetes, or hypertension, had no evidence of disease and was an excellent example of a successful and healthy WLS patient. He was compliant with post-surgery dietary guidelines, and followed a keto styled diet. Being a Southerner he attributed much of his success to his love for BBQ (rib eye steak, baby back ribs, pork belly, pork chops etc).

Symptoms Begin

Several hours after one of his Sunday BBQs he developed a headache. had stomach cramps , became dizzy, nauseous and itchy  He had a sleepless night and just attributed to have eaten something that was spoiled. During that week he started recognizing similar symptoms in the early afternoon and more severe symptoms that would wake him at night. He reported this to his internist who thought it might be related to his gastric sleeve surgery. He made and appointment with his surgeon who then referred him to a GI doctor that performed an upper endoscopy and found nothing that could explain Jacks symptoms and referred him to an allergist. Continue reading