I started studying obesity and behaviour change as a grad student, which is now more years ago than I wish to admit. My perspective was, and is, that improving weight control is a kind of learning, so the same principles that explain how we learn anything or develop any new skill must also apply here. If we think of other types of personal projects, such as taking up a musical instrument or learning a new language, these too are difficult tasks, and not everyone who starts goes on to achieve a high level of mastery. What is it that separates those who quit from those who go on to become highly skilled experts? I think about weight control in the same way. I've been at this for long enough and witnessed enough people trying, some failing and others succeeding spectacularly, to understand that weight control is complex. I prefer to think of each case as a unique "weight control story."
What do I mean by "weight control story?"
When I meet a new patient I want to understand what they think about their problem. How important is it? Are they coming on their own volition, or mostly to satisfy someone else (a loved one; a doctor)? Given that the problem has been there for years, why is now the right time to fix it? What changes have happened to create this motivation? Why are they seeking help, and why the specific kind of help that we offer in our clinic? What do they hope to accomplish? What do they hope will happen in the next month, 6 months, 1 year, 2 years....? What are they afraid of? What obstacles do they anticipate?
Of course, the story doesn't start there, and there are roots of the problem that we need to look at. Does it go back to childhood and family traditions? Are there recent or current life situations that are contributing to the weight problem? Do they think that better weight control will solve other problems, or perhaps set the stage for solving them? While people want to lose weight to improve their health and prevent future health problems, there is usually more to it than that. Weight control is seen as a key ingredient in improving one's life, a prerequisite for getting back to favorite pastimes that have been abandoned, improving self-confidence, getting organized, getting into the dating game... in some way or another starting a new chapter in one's life.
So it's a story that we jump into midway. Imagine opening a book in the middle and reading a few pages. You might have some idea what it's about, but surely you'll want to go back to the beginning to fill in the gaps and figure out how it got there, and you might be tempted to jump ahead to find out how the story ends. But my patients are not books that have already been written...that's what makes them so fascinating. There is no jumping ahead to the last page, and even the looking back to understand the history is only a reconstruction. Primarily we are here in the present, trying to get focused, keep it together and move forward. Sometimes I feel like the conductor of the train, sometimes like the co-pilot, sometimes a teacher, sometimes a confidant, sometimes an interested observer, always like a cheerleader. I want to say, "let's go, you'll get there, we'll get there together." When my patient and I are on the same page and trusting the process it sometimes feels like magic.
I really like my work.
When I feel that I've grasped the patient's story and helped them make decisions about what they want to do, or when I feel I've helped them come to terms with difficult emotions that they haven't been able to understand, and when I can offer a new strategy for coping with stress or improving habits, I feel very satisfied. When I do my part it's up to the patient to do theirs....it really takes two to tango!
Obesity is a big problem for my patients, and for society. We really do not have a consensus about what to do about this. I don't think the answer is taxing soft drinks, or campaigns to encourage people to eat vegetables and walk more, although those kinds of efforts can't hurt. I will continue working with people to create real change, and exciting stories!
Stephen Stotland, Ph.D.