Michael weighs approximately three-hundred-seventy
pounds, give or take twenty on any different day. He is forty-two years old and has been that heavy for at
least a dozen years. Because of
his weight he cannot walk very far, and his back, knees and ankles hurt.
Walking from the parking lot into my office is such a strain that he is
breathing heavily and sweating by the time he arrives, and he sweat does not create a
fragrance that will sell. He knows that his weight has put a strain on his heart, that he has fatty deposits around
his liver, and that he is living example of a health high-risk.
Yet, at many of his
appointments Michael comes in carrying a large container of caramel-mocha
coffee. He often talks about
driving for an hour to find a special bakery, or to get pancakes with maple
syrup.
Does Michael
exercise? Yes, regularly. He walks on the treadmill in the building where
he lives, for ten minutes, once a month.
He finds it exhausting and he hates it.
Does Michael have
psychological problems that contributed to his keeping his huge bulk? Of course, he has a chaotic family
history, he clearly has a sugar addiction, and he eats for many emotional
reasons. He also probably has some
genetic factors that help him gain weight and keep the weight on. Because of his weight he has social
problems, and because of his social problems he eats. He also eats too many of the kinds of
foods that some corporations have spent millions of dollars designing so that
people will crave those foods.
Of
course, there are many more contributing factors that I won’t get into in this
post.
So
the question for all you psychotherapy friends out there is:
does Michael stay heavy
because he really doesn’t want
to change? He doesn't have the
will-power, or the motivation, the energy, or care enough to put in the huge,
consistent effort it would take for him to lose weight?
Can
Michael change if he really wants to?
Is it my job to make him really want to?
Or
does Michael stay heavy because he can’t change? Because there are too
many factors, built up over too long a time, and they make it impossible for
him to break his bad habits, fight off his addictions or even go for an
operation that will allow him to lose weight?
Is
there a difference?