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<p>Has it been established that this young man is morbidly obese? If he was within the normal weight range before gaining the 50 pounds, he may not be.</p>
<p>Mspearl, is there anything that you do that you know is bad for you but continue anyway? Riding a bicycle without a helmet? Going outside without sunscreen? Getting too little sleep on a regular basis? Avoiding the mamogram or the dentist? Driving too fast? Taking xanax a little too often? Eating buttered popcorn at the movies? Most people are intellectually aware of behaviors that are self destructive or bad for them. Other than actual physical addictions, most of us could change these behaviors immediately, if we really wanted to.</p>
<p>Sure, many of us are shocked when we read articles about how many calories a Chipotle burrito or an Outback bloomin’ onion have…information like that is good to have. But in general, an obese person has a pretty good idea of what is causing the weight issues. I don’t know that “being direct” will provide new information to many adults.</p>
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<p>I think morbid obesity is in general, a BMI over 39. His is around 32. “Obese” is typically 30+.</p>
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<p>mspearl, I get what you are saying, but your examples do not show that “being direct” gets results. None of the incidents you described resulted in those people having a light bulb moment and going out to change their lives. As you said, they got offended and one even basically fired her doctor.</p>
<p>If being “aggressive” with patients about their weight (or smoking or drinking or any number of other self destructive behaviors) actually WORKED, I’d be all for it. But it doesn’t work, because as has been said already, permanent change rarely occurs as a result of outside pressure. It must come from within. People who don’t want to change are not suddenly going to see the light just because a doctor or nurse gets brutally honest with them. They already KNOW that they are fat, they KNOW it’s not healthy, but they are not willing to make the changes necessary at that time to remedy the situation. It’s the same with smokers. You cannot pressure them, cajole, manipulate them into doing it - they have to want to do it for their own reasons, not ours.</p>
<p>I am not sure other people’s motivations would work here because the OP’s son has some issues that I assume could directly cause what he is doing with his eating. Among other things, the kind of foods he is eating, sugary foods, high fat foods and so forth are so called comfort foods that in a sense are a form of self medicating for many people (and if he is suffering from depression makes it a bit more likely IMO, fwiw). I am sorry that professionals haven’t been able to help him, I know nothing about issues like the OP’s son has, but could there be people who specialize in someone with his kind of issues and compulsive issues like eating? The other thing is, if he is using this as comfort food, maybe there are healthy alternates he might find appealing to eating heavily sugared things? Things like frozen berries sprinkled with stevia, or maybe non fat yogurt with a bit of maple syrup mixed in (maple syrup is more healthy for you then sugar, and when used sparingly adds a lot of flavor with a lower caloric load). </p>
<p>I also understand about him bringing food home, but even so, having others in the family model healthy eating habits doesn’t hurt, even in this case IMO. One of the things they teach about resolutions to lose weight, is that in general people fail because of situational issues, of temptation, that while trying to lose weight, for example, a partner or family members have things like chocolate, ice cream and so forth around (be kind of like holding poker games at your house when a family member has a gambling addiction). Maybe modelling will help him want to eat differently…and it isn’t going to hurt the rest of the family if they are eating more healthy. </p>
<p>In a general comment, the idea of doctors <em>getting tough</em> with patients is a crock of bs, quite frankly, and it doesn’t do anything. As someone who has battled weight issues since I was a teenager, and having had parents (stupidly, but with good intentions) ridicule me as a means to get me to lose weight, it doesn’t work, and all that happens with an overweight person who goes to a doctor and gets lectured is probably not to go to the doctor much, which is counterproductive. More importantly, most people who are overweight know the risks, they know that it is a cause of diabetes, heart disease and other problems, they know it isn’t healthy, and being lectured does nothing except make the patient feel like a kid being lectured.</p>
<p>The other problem quite frankly is IMO, most doctors are woefully ill educated when it comes to diet and nutrition and also about issues around weight. For example, most doctors look at weight as a statistic, and you have today the BMI tables, that while helpful, are also that, a statistical based model on ‘normalness’. There are people who are incredibly healthy, who exercise, who are otherwise are in perfect heallth, whose BMI is above the ‘norm’ (and take a look at a BMI table and tell me what is wrong…among other things, it has height, but doesn’t take into account body frame size, musculature and the like). You can be perfectly healthy and still be declared “overweight”, my father’s doctor kept telling him he was overweight, when my dad weighed within 5 pounds of what he had coming out of the army in WWII, and I am talking someone who was a combat veteran, not someone manning a desk somewhere, and was eating that wonderful army food…</p>
<p>More importantly, many doctors still have the mental attitude that being overweight is somehow a moral failing as existed for so long, that the answer is simply ‘eating less and pushing yourself away from the table’, which is both insulting and also about 50 years behind the times. Diet and nutrition based illnesses represent a major threat to the health of the country, yet unless things have changed recently, MD training includes little or no training on nutrition (Tufts was one of the few med schools several years ago that had at least a series of courses on it). Doctors instead of saying “lose weight” need to counsel people on the kind of things they can do, the options, and also understand that being overweight is caused by many factors, genetics being one of them (sorry, but a lot of ‘normal weight’ individuals out there aren’t eating particularly healthy, they have metabolisms that burn calories fast), as well as emotional issues and so forth, and the last thing anyone needs is judgement or being yelled at. </p>
<p>The motivation does need to come from within, in my case it was looking at myself, looking at my relationship with my wife, and realizing that I had been letting myself go for a number of years, that as much as we love each other what was I telling her by doing that to myself…was I telling her I didn’t care how we lived the next 30 years together or whatever we have, that I didn’t care if I went through my later years constantly sick or vital, or that I didn’t care to try and make myself look good for her? I am just starting the path to recovering what I let go, but it is a powerful motivation (doesn’t help I have been reading a series of books about a couple who fall apart in middle age, and one spouse letting themselves go played a role in it…).</p>
<p>“in my case it was looking at myself, looking at my relationship with my wife, and realizing that I had been letting myself go for a number of years, that as much as we love each other what was I telling her by doing that to myself…was I telling her I didn’t care how we lived the next 30 years together or whatever we have, that I didn’t care if I went through my later years constantly sick or vital, or that I didn’t care to try and make myself look good for her? I am just starting the path to recovering what I let go, but it is a powerful motivation (doesn’t help I have been reading a series of books about a couple who fall apart in middle age, and one spouse letting themselves go played a role in it…).”</p>
<p>musicprnt, you are very brave to share this. I am tearing up. May you have an effective journey to your new goals, may you and your wife enjoy many more happy and even healthy years together. </p>
<p>As to missypie’s son, this type of motivation is probably not available to or appropriate for a young man. But there may be something analogous.</p>
<p>One can model healthy eating when one is awake…but when it’s 2 am and the box of cookies or sausage he brought home from the store is calling…what I’m trying to model at 2 am is “people go to bed and fall asleep and stay there without eating until morning for goodness sake” but it’s not taking hold.</p>
<p>It won’t surprise you to learn that he is a gamer. Lots of kids on the spectrum are very into video games - the real world is hard to understand but inside a video game is a world they control. I mention this because he has every bit enough energy to do what he loves to do most…sit on the couch and play video games. (And please don’t anyone recommend Wii Fit as a substitute - you know it’s not the same.) It’s not as if his favorite thing is skiing or playing tennis and he is having trouble keeping up.</p>
<p>Some people are naturally sedentary - his favorite things to do are playing video games, reading and watching movies. I’m pretty naturaly sedentary myself. People who just adore physical activity sometimes don’t understand that not everyone feels the way they do.</p>
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<p>But does he have the same body composition (muscle percentage, fat percentage) that he had as a recent combat veteran at the end of WWII? (quick assessment – is his waistline the same as when he got out of the Army, with no extra overhang?)</p>
<p>musicprnt said:
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<p>Oh, I wish you could say these words to my DH. He desperately needs to eat healthier and lose weight, and when I express concern, he says, “Well, at least I’m well-insured.” Took him 11 years before he finally went to a doctor last month, and he told the doc his plan is to be “less non-compliant.” </p>
<p>As for what motivated me, my mom has diabetes, is severely overweight, congestive heart failure, a clotting disorder, is on supplemental oxygen and had a catastrophic broken femur that left her totally bedridden at age 64. My dad cares for her 24/7, with evening help from one of my sisters who lives nearby. I am almost ten years into leukemia, am on BP meds, had an A1C close to diabetes, have PCOS, the same clotting disorder my mom has, and have struggled with my weight all my life. I do NOT want to live out my life as a burden to anyone else. Have lost 35 so far and have another 50-60 to go. I don’t need to be skinny; I just want to be healthy.</p>
<p>missypie, S2 grumbles all the time about wanting to lose weight. He has never been skinny, but being in sports helped him stay in shape. This year, he has found the club Tae Kwan Do team at his college to be a good source of exercise and socializing. (He got his black belt in Tang Soo Do his senior year of HS, and I wasn’t sure he’d continue with it. I am delighted that he has picked it up again.) There are many martial arts studios that offer adult classes for beginners – would this be something your S might consider?</p>
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<p>Totally agree with this. This has been an ongoing debate within the medical community. The hospital I work at is trying very hard to figure out how to deal with employees who are obese, smokers or have other chronic conditions. The biggest concern of all is if you start penalizing people with these conditions then they stop seeking preventive care leading to even more serious health problems which eventually needed to be treated at a much higher cost.</p>
<p>Now they make all employees on the health plan get a health risk appraisal which includes blood tests, BP check and weight check. Those employees identified as having issues are asked to enroll in a free medical program to help them address those issues. Next year all employees will be required to get a A1c test.</p>
<p>IMO, offering free support programs and the like is about the best you can do. Or maybe even following up with those patients who already have major health issues to make sure they are indeed seeing a physician regularly, taking their meds, etc. Beyond that, short of outlawing unhealthy foods, there’s not a lot you can do.</p>
<p>Ok, I get that I come across as insensitive but I am not. I have never been cruel to a pt or lectured them on obesity. And trust me, I know exactly what it means that one needs to be motivated and want to get better. That being said, I believe healthcare professionals need to take the time to spell out exactly what the risks are while the pt is in the office, face to face, and offer education and support.</p>
<p>And perhaps all the smart people on here think people understand why they or others are fat but many do not. Try coming to my neck of the woods. There is poverty and a lot of hs dropouts. I have had people tell me they eat candy because t is low fat and hot dogs because they are a good source of protein. So before you jump all over me think about my perspective, it may be a lot different than your own.</p>
<p>*I will admit, there is a lot of resentment toward obese pts in healthcare. I have seen plenty if physicians make snide remarks about pts. It is very sad. I worked in surgery with a gyno and one of the surgery techs would rate pts by their weight. Say things like “we have an elephant tomorrow.” And the surgeon and her would laugh. And while I am not excusing their behavior, healthcare workers grow weary. I struggle with resentment when killing my back to lift 300 and 400 lb pts. It is hard to be a nurse and even worse a nursing assistant.</p>
<p>Okay, I understand that some may eat candy and hot dogs for the reasons you stated, but I think we can agree that the CC crowd is pretty well informed.</p>
<p>^ Correct me if I’m wrong … but don’t candy, hot dogs and creme pies represent three of the five food groups? (I don’t recall what the other two are, but I’m sure they’re bad for your health.)</p>
<p>Okay, I’m correcting you:</p>
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<p>SYRUP … that was one of the missing ones! Where is my mind lately?</p>
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<p>So far I have seen no one jump all over you, just simply completely disagree. And as said before, the examples YOU gave showed that whatever method was being used did not work. </p>
<p>In my experience in nursing, very few obese patients truly don’t see the connection between their weight and their diet. Now true, they may not know the best way to go about losing weight, which foods are the best and what ratio of them to eat, but since even the “experts” disagree, it’s no surprise that they are confused. As a health care worker, education is one of our responsibilities, and our obese patients are always offered education about proper nutrition, particularly as it relates to specific health problems. But “being aggressive” can backfire and frankly, rarely works. I don’t offer the alternative of “being gentle.” That doesn’t work either. Because, again, the person needs to have a desire to change and if they do not have that, it won’t matter whether one is blunt or one is gentle. Either one will fall on deaf ears.</p>
<p>I fear that at this time, the OP’s son is in that exact position. He doesn’t see a problem worthy of changing. Her challenge is to find something that he will connect to and embrace, some kind of valuable currency which he realizes a change in lifestyle will be necessary in order to obtain. I think missypie realizes that playing hardball with her son would be wasted energy.</p>
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<p>Do you mean that sugar, fat, and salt are three of the food groups in the typical American diet?</p>
<p>I agree with the end of Nrdsb4’s post - he has to find something that will be his motivation to change. For me it was a health issue that was not something within my control - but it made me want to take control of the areas of my health that I could change. I got angry with myself. For my H it was pre-diabetes - his doctor finally got through to him to change his diet and exercise. Also, he took up scuba diving, and his weight and being out of shape affected his ability to stay underwater for a decent length of time. His employer is now giving monetary incentives for weight management, so that may keep him going too.</p>
<p>One thought I had was whether he would be impacted by reading about processed or fast food, so that he comes to view it differently.</p>
<p>As just some examples, I became vegetarian after reading the book, Diet for a New America back in the late 80s/early 90s. It completely turned me off meat when I came to realize how the livestock were treated and how it impacted the environment. As an aside, I’m not vegetarian at this time but that one book really impacted me for years. Likewise, one of my kids, at a really young age, was completely turned off McDs after reading about how chicken mcnuggets were produced at the time with mechanically separated chicken. Supposedly its changed but here is a glimpse of what it looks like:</p>
<p><a href=“HuffPost - Breaking News, U.S. and World News | HuffPost”>HuffPost - Breaking News, U.S. and World News | HuffPost;
<p>And today I was just reading about how cocoa production in the Ivory Coast (a main source of our chocolate) relies upon child slavery. I never thought I’d find something to turn me off chocolate but this might do the trick:</p>
<p>[Chocolate’s</a> Child Slaves – The CNN Freedom Project: Ending Modern-Day Slavery - CNN.com Blogs](<a href=“http://thecnnfreedomproject.blogs.cnn.com/2012/01/12/chocolates-child-slaves/]Chocolate’s”>http://thecnnfreedomproject.blogs.cnn.com/2012/01/12/chocolates-child-slaves/)</p>
<p>Any one suggestion is a long shot, I realize, but I did want to mention that, the motivation to change how one eats sometimes comes from starting to view ones’ food through a different lens. It is possible that food which was once associated with joy and pleasure comes to instead be associated with disgust.</p>
<p>About the girlfriend,is she supporttive or enabling</p>