Kyle sits across from me and glares. "I've been here for months and I'm still FAT!!!" He derisively pats, or rather smacks, his belly, pulls up his Mickey Mouse T-shirt and shows me the way the waistband on his jeans rolls down. "I'm sick of this," he moans. "What are we going to do?" What indeed, Kyle? He is absolutely right: he has been here for months and, yes, he is still...fat. What's next?
Obesity rates in America are the second highest in the world, second to Mexico, according to the most recent statistics from World Health Organization. Kyle, based upon his Body Mass Index, weight and size would be considered morbidly obese. And it's not as though he hasn't tried to lose weight He has lost and gained back more weight than he can calculate. He has entered at least two different hospital-based weight management programs but to no avail. Kyle is still fat.
There are myriad reasons why people struggle to lose weight. Those who do not have this particular challenge find it tough to understand. They tend to generalize the reasons why people gain weight and cannot lose it, even when there are health risks involved. Overweight and obese people are written off as lazy, or under motivated or self-indulgent. But everyone with this challenge has a unique story that led them to this place.
Throughout our months together I have explored Kyle's eating habits, his attitudes toward food, his feelings about his body and body image, what role food played in his family, when did he begin to gain weight and what his history has been with weight loss. The one question I hadn't asked was the toughest one: Do you really want to lose this weight?
You see, Kyle, like many individuals these days, is a "foodie." Food for Kyle and his husband Jorge is not merely nourishment. It is sport; it is art; it is entertainment; it is comfort, it is love. The couple enjoy a vast array of gourmet restaurants regularly. They have an impressive wine cellar. They own an enviable collection of kitchen tools. They are both excellent chefs. They share a deep appreciation of haute cuisine. What they don't share is Kyle's weight problem.
Food is celebrated in a way that makes it impossible to ignore its many charms aside from its being our nutrient source. So how can a person who is deeply invested in this food culture now turn away from this, begin restricting portions, keeping a food journal and retool his whole diet? It's not so simple for someone who associates food with so much more than sustenance to change his relationship with it so easily. It means on some level, possibly a loss of identity and the loss of an important bonding experience with his husband.
So does Kyle really want to lose weight? He does, but not at the risk of losing something very precious to his self-concept. It is imperative that Kyle feel confident that while amending his relationship with food he will not be rendered bereft of something he loves with nothing to fill the void. In those times when Kyle had gotten down to his goal weight, he said he had not felt completely satisfied. He sensed something was missing or alluding him. Maybe, he posits, because he knew would never look like an underwear model no matter what he did, he felt Losing weight was supposed to make him feel good about himself. But instead he felt empty, almost betrayed. So food served to fill that emptiness and soothe that sense of betrayal until all the weight he lost returned.
How do we help Kyle retain his love of this wondrous thing and still take the necessary steps to begin losing weight? I believe our first step (of many first steps in this journey) is to address what Kyle will gain, emotionally, when he makes these changes. Once identified, Kyle, and only Kyle can decide if the trade-off is worth it and he can really answer that tough question and follow through to make it happen.