Meeting of Thirty-Five Heads of Expression

Meeting People on Own Their Terms in Obesity Care

I am a psychologist working in a bariatric medicine and surgery program. To give some context, the average BMI for a patient referred to our program is approximately 45. We receive referrals from a wide variety of medical specialties in our practice. So I am constantly learning from meeting people with obesity who come with very diverse feelings and thoughts.

A Wide Spectrum

Some patients are absolutely certain they want to have bariatric surgery. They are well-informed. So they already know bariatric surgery is likely to be the best treatment for their obesity and related medical problems.

In contrast, I am often meeting patients with obesity who need bariatric surgery for medical reasons. They might need a lower BMI to receive an organ transplant or a knee replacement. Yet they present with uncertainty and deep skepticism. So they have serious doubts about the safety and effectiveness of bariatric surgery.

The vast majority of these people have tried many diets and lost hundreds of pounds over the years. They cling to a simple idea. I’ve done it before, I can do it again. It makes sense. Because the only tools they have ever received are eat less and exercise more. Thus, patients firmly attribute the cause of weight regain after every diet attempt to lack of willpower. Or worse, they attribute weight regain to the firm ideas about personal responsibility. So they tell themselves they need to work harder at weight control.

Facts Are Not Enough

For these patients in particular, presenting science and facts doesn’t move them. I often focus on the biological causes of obesity and weight regain. It leads me to think how my approach might be too narrow. Presenting facts often feels uncomfortable, like walking a high wire. That is, I try my best to help patients view their struggle with obesity through a different lens entirely. But I rather hear myself sounding like a bariatric surgery salesperson. The unfortunate consequence is an ineffective interaction. Perhaps I have only been attending to one dimension of these patients.

Taking Time

I’ve learned another important lesson. Few, if any, patients will experience a complete revelation about the complexity of their struggle with obesity in the one-hour initial visit. This is true with me or for any obesity medicine provider. Changing lifelong, deeply rooted beliefs about obesity and acceptance of bariatric surgery will take some time.

The analogy of the rider and the elephant is quite helpful to me. The rider is the rational side of the our selves. But the elephant is the unspoken and emotional side. We must attend to both sides. A good start for attending to the elephant may be listening better with curiosity. I am learning not to get too far out ahead of where the patient is in the moment. In this way, I can support their autonomy. I can come closer to meeting people with obesity on their terms.

Today’s guest post comes from Gretchen Ames, who is a clinical psychologist in the Mayo Clinic Bariatric Center in Jacksonville, FL. Her clinical practice focuses on patients seeking treatment for obesity. This includes bariatric surgery, very low calorie diets, and cognitive behavioral therapy. She also has wide-ranging research interests. One is cognitive behavioral therapy for weight regain. Metabolic adaptation to weight change with large weight loss is another.

Meeting of Thirty-Five Heads of Expression, painting by Honore Daumier / WikiArt

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August 29, 2020

3 Responses to “Meeting People on Own Their Terms in Obesity Care”

  1. August 30, 2020 at 3:29 pm, Allen Browne said:

    Excellent suggestions and observations – thank you.


  2. August 30, 2020 at 4:32 pm, John DiTraglia said:

    I often tell people it is certainly possible to walk through hot coals. But it is very hard to keep doing it.

  3. September 02, 2020 at 1:03 pm, Victoria Bruce said:

    Thank you so much for this insightful article. Too often those of us with obesity are met with skepticism and judgement in the clinical setting. I was the former patient you spoke of. When I elected to have bariatric surgery, I knew it was what I needed to combat this chronic disease. However what you’ve so accurately depicted is the norm for most patients that come through our bariatric center doors. Combine that with prior negative experiences with medical practitioners, and it’s no wonder the rate of those that qualify for bariatric surgery electing to have surgery is so low. Thanks again, and here’s to making change for our future patients!