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?