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Wednesday, 22 June 2011

Obesity Treatment: Enthusiasm and Desperation

Last week I led a 3 day course on managing weight problems. It was really interesting and the delegates, some with long standing weight problems themselves brought many good ideas into the room. The issue of helping people to be motivated was raised. It’s one thing trying to persuade someone to lose weight, and it’s quite something else to help someone to be fully committed to the hard work that weight loss involves. Goodness ! it would be hard for me to lose half a stone, how much harder to lose even more.

It’s easy and hard to lose weight. You can lose a few pounds without even touching your fat stores. A few days of eating very little will remove a great deal of water and stored sugars from your body. People think they have lost weight and congratulate themselves but nothing has really changed at all. Losing fat is something else entirely and floaty-light- fat is so energy-dense that you use up very little to meet your daily energy needs. Your motivation must be realistic and stand up over time in the face of the stresses and strains of life.

We mustn’t confuse motivation with enthusiasm or desperation. Wanting to lose weight is not the same as wanting to stop eating your favourite foods. It’s now clear that obesity is a long term medical condition which is self perpetuating and which needs lifelong management. Some people might be better off not trying at all. If people engage in dietary oscillations, like eating little all week and feasting at weekends, they will regain their weight. If people do not move around a great deal, they will regain all their weight. If people return to baseline behaviours, like keeping crisps at home for the children, they will regain all their weight. Unless healthy behaviour becomes intrinsically gratifying, people will regain all their weight.

Susie Orbach said that fat was a feminist issue. I think we have moved on. It’s a commitment issue, with enthusiasm and desperation playing very little part in changing behaviour at the end of the day.

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