It is critical to gain a sense of the behavioral, as well as the medical aspects, of the patient's situation. This can be accomplished by referral to an appropriately skilled behavioral psychologist and/or through your own discussions with the patient. First, it is important to assess not only specific behaviors, but also the impact of these behaviors and the obesity itself, on the patient's level of functioning and quality of life. It may only emerge with inquiry that the patient has withdrawn from all unnecessary social interactions, or is no longer able to enjoy certain activities or interests because of weight gain, or has suffered job discrimination, to name a few examples.
Also related to quality of life are the patient's expectations about what changes will occur with successful weight control. Although it may be motivating for the patient to believe that life will improve with weight loss, disappointment may follow unless the changes likely to occur have been placed in proper perspective. Medical benefits can certainly be expected with weight loss in the obese suffering from medical complications. For example, patients with type 2 diabetes can often discontinue insulin or oral agents, antihypertensive medications may become unnecessary, sleep apnea usually disappears with as little as a 10 to 15% loss of initial weight, and gastroesophageal reflux disease can improve with weight loss. On another level, however, although self-assurance often increases, the wallflower does not become the life of the party and the competent worker does not get a promotion upon losing weight. Encourage obese patients toward a balanced view by reminding them that societal prejudices about body weight and character are in no way based on fact, and that they are the same good and worthy people whether they weight 300 or 150 lbs. In exploring specific behaviors, it is useful to assist the patient in identifying various eating cues. These cues are situations or feelings that lead to eating, often in an inappropriate way. It is axiomatic in our society that physical hunger is rarely a significant part of life, even for the poorest among us. In fact, physical hunger is not an important eating cue for many people, in part because they rarely let themselves get to the point of true hunger. Instead, they may eat in response to a whole host of other cues, most of which are inappropriate. The most common eating cues cited are as follows:
1. Habit ("It's 12:30 so I guess I'll have lunch" or "I have a jelly doughnut and coffee in the car on the way to work")
2. Stress ("I've got to finish this paper, and eating while I work helps me concentrate")
3. Boredom ("There's nothing else to do; a subcategory is watching television and eating at the same time)
4. Emotions ("I eat when I'm depressed or upset")
5. Food as a reward ("After a hard day, I deserve a rich dessert").
Underlying some of these cues is the association of food with love, care, and comfort, which may have its antecedents in early childhood but persists into adult life and, indeed, pervades our culture. The patient should be helped to recognize that using food to deal with stress, boredom, and emotions is, at best, ineffective. The stressful situation, for example, does not resolve with eating. In fact, eating may worsen the problem by distracting a person from dealing directly with the situation while adding the stresses of obesity and its sequelae.
Was this article helpful?
All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.