We have been friends for more than 20 years and have shared much about our lives with one another. But despite being able to talk (and complain) about our spouses, rejoice or despair over our children, and support each other through work and family crises, there is one topic that neither of us touches: her weight.
She was never thin but maybe a little too curvy in places during the early years of our friendship. Three pregnancies, a mother who died of a neurological disease, and job uncertainty added pounds to the curves. Now, weighing almost l00 pounds more than she should, she was recently diagnosed with high blood pressure and has difficulty walking up and down stairs because of her knees. Her excess weight is on her middle. It is difficult to hug her but more important, those many extra pounds on her mid-section are specifically linked to cardiovascular disease and diabetes.
I had hoped that her physician would motivate (nag?) her into a diet when he wrote the prescription for her blood pressure medication. If he did, she never mentioned it. She only said that she hated taking pills but the doctor said she must, or risk a stroke.
Of course I will say something about her weight issues; not to do so implies, at least in my own mind, that I do not care enough for our friendship to care enough for her health. But urging her to lose weight is hardly sufficient. She has been on diets before, they never last long and the weight is always regained.
Like so many people who struggle constantly with their weight, my friend needs more than a diet. She knows exactly what to eat and what to avoid, how to measure her food, the importance of exercise, and the necessity to restrict fat and alcohol. She once told me, âDonât you think that if I could make myself eat right and exercise regularly, I would? I laugh and I cry at people who are preaching that message. They must assume that fat people donât want to lose weight, and so deliberately make themselves eat too much and lie on a couch all day. â
When we finally did talk, seriously and honestly, about the medical consequences of her obesity, she confessed that she felt hopeless about losing her weight and assumed that she would, again, fail on a new diet. It was the distance she had to travel to reach her weight-loss goal that so discouraged her, she told me. âSo why start something I know I canât finish?â she concluded. âI rather not start.â Anticipatory disappointment is a killer of many a new diet, but I persisted.
Our own discussion ended with my commitment to, ââ¦traveling the distanceâ¦â to her weight-loss goal with her. She would need my support, encouragement and presence for the months to come. Inevitably, as with all dieters, she would become frustrated at a slow rate of weight loss, bored with her diet regimen, and/or find it difficult to exercise routinely. She would need my help in convincing her friends and family that she had no intention of going back to her previous weight, no matter how much they tempted her with fattening foods and excuses to stop exercising.
Do people like my friend fail on diet after diet because after the novelty of the first month or so of the changed habits, and the joy in losing those first 10-15 pounds, they succumb to the realization that the diet is not going to be over tomorrow? Those people who applauded the initial weight loss may be indifferent to the dieterâs subsequent slower weight loss. Families rebel against a junk foodâfree kitchen, friends get tired of going to restaurants that serve only fish and bok choy, and relatives are offended that their special high-calorie holiday dishes are rejected by their dieting relative. Further resentment may develop when the dieter insists upon going off to the gym or taking a long walk, instead of staying home and baking cookies. Plus weight-loss programs, including many bariatric surgery clinics, do not put the effort into intensively supporting the dieter after the first year or even earlier.
Perhaps what is needed are weight-loss programs specifically designed to sustain the dieter through the middle and end range of the diet program. Their goal would be to keep the dieter committed to losing weight, no matter how long it takes. New foods might be introduced to decrease boredom, and new exercises taught as the dieter becomes more fit and has increased stamina. Clothing, hair style and make-up advice could be offered to reveal and enhance the slimmer figure. But most important, the diet program would function as a cheering squad, supporting the dieter slogging through those final months of weight loss.
Weight loss interventionists could learn from those who cheer the middle- of-the-pack marathon runners with, âWay to go and looking good!â Maybe this should even be the name of the program.