Tuesday, July 26, 2011

Self-Sabotage as a Spectator Sport

Recently two friends mentioned their deep concern about their husbands: both men are dangerously obese. One has diabetes and cardiac problems. One has diabetes and high blood pressure with numerous complications.  Both women love their husbands dearly and want to enjoy many more years in their company -- but they're afraid that a potentially lethal combination of denial, defiance and emotional over-eating will deny them that pleasure.

As a spectator sport, self-sabotage is the pits.

It's incredibly painful to watch someone you love imperil their health by ignoring an obvious medical risk or by engaging in behavior that worsens the odds against poor health or early demise. And I've spent more time than I'd like to admit on the other side of that equation: causing my husband, my family, my dear friends and several concerned physicians to worry about my medical future.

So I can empathize with both sides in this dilemma: the concerned and loving spouse (I would be similarly distraught if Bob were at risk) and the self-sabotaging spouse with a looming -- or present -- medical problem as a result, at least in part, of poor health habits.

From both perspectives, I know this: nagging doesn't work.  It creates resentment, reinforces unhealthy behavior and frustrates everyone concerned.

My own experiences in this cycle of unhealthy living started just as I was arriving at midlife.  Never naturally slim, but active as a dancer and, later on, a runner in young adulthood, I maintained a healthy weight range of 118-125.  In our early years of marriage, Bob and I used to get up before dawn for a five mile run through the hills of Los Angeles, ringing in the New Year for a number of years with a run with friends in Griffith Park.  We chose to buy a home in Valencia in part because the community had running paths -- paseos-- where you could walk or run for miles without having to cross a street.

But at some point, as I was closing in on my forties,  a combination of work pressures, depression and a rogue medication with a side effect of weight gain caused me to start to overeat and to gain weight at an alarming rate. It snowballed into a nightmare. I gained 100 pounds in a year-and-a-half.  And kept gaining.  It was detrimental to my career -- I began to look terrible on t.v. shows. It didn't do wonders for my mood or my marriage, as Bob registered alarm, anger and desperate worry over my ever-expanding girth. It quickly took a toll on my body: for the first time in my life, I had high blood pressure. My knees and feet ached with the strain of the extra weight.  Family and friends greeted my changing appearance with painful silence, gentle teasing and frank concern.

I'll never forget a lunch I had, about ten years and 130 pounds into my weight gain, with my dear friend (and Teenage Body Book co-author) Dr. Chuck Wibbelsman.  "You know," he said, watching me dig into a plate of pasta. "I love you very much. I've told you already many times how concerned I am for you medically, especially given your family history of diabetes and heart disease. You can't continue to carry this much weight. But I feel like you're not hearing my concern. What would help? Would it help if I told you just how bad you look at this weight? You look like shit."  I fled the table in tears, knowing that what he said was true, knowing that he was speaking out of love and concern, knowing what it cost him emotionally to say what he said to me, but unwilling to deal with a problem that was becoming increasingly obvious and detrimental to my health.

My turn-around point came some time later due to a series of events: some cardiac concerns that broke through my denial, the enduring patience and love of my husband as I tried and failed and tried again to lose weight and the memorable words of one of my patients.

This patient was a very special one: her name is Jennifer and she was the first person I ever saw in therapy. We met on the first day of my first internship. I was at my highest weight -- 252 pounds -- and had asked that I not be given any patients with eating disorders, at least initially. But this young woman, who had a history of bulimia, had already worked unsuccessfully with all other available interns. I was the only one left. And her presenting problem this time was not bulimia but difficulty adjusting to college and with some primary relationships.  But still I worried. She looked at me appraisingly, then shrugged, that first day.  When, prodded by my supervisor before our third session, I finally asked Jennifer how having an overweight therapist felt for her, she shrugged again. "You're not that overweight," she said softly. "I like working with you."

Our work together spanned more than six years. She transferred with me when I went to another internship and stayed with me after I was licensed and in my own practice.  It was only after she had graduated from college and married that she felt ready to leave therapy and move, with her husband, to a city more than 500 miles away.

During our last session together, Jennifer looked at me and said quietly "You know, I've never said anything about your weight because I didn't want to be rude or hurt your feelings. But let me tell you what I wish: I wish you would take care of yourself as well as you've taken care of me.  I wish you could find a way to lose that extra weight and get healthy.  Because I love you so much and I want you to live a long, happy and healthy life."

And somewhere amidst all the pain and frustration that had surrounded my weight gain, her words resonated. Maybe I had reached a point in life where I was ready to hear the message of necessary self-care. Maybe the messenger -- a wonderful but sometimes challenging patient with whom I had struggled so over the years and from whom I had learned so much as a clinician -- was simply the right one at the right time. But from that point on, I slowly began to shed the pounds and regain my health.

It has been a long journey and it's not nearly finished.  Bob and I work out at the gym together every day. I swam laps for over an hour today. I've worked hard to change my eating habits and I've had a dramatic weight loss. But I still have a way to go before I reach a truly healthy weight.  Bob, long a frustrated and frantically worried spectator to my self-sabotage, is cheering me on. And that means so much.

So what can make a difference if you have a spouse -- or other loved one -- who is struggling with unhealthy eating habits, a sedentary existence or denial of a serious medical condition like diabetes?

Become an active participant in promoting a healthy lifestyle.  Don't just tell your sedentary spouse to get off the couch and get active.  Involve him or her in your own healthy lifestyle. And if you don't have a healthy lifestyle, start building one -- for both of you. You might start small, suggesting an after dinner walk together.  Your daily walk can be a chance to be alone together, to talk, to enjoy each other's company as you begin your fitness journey together. Even if your out-of-shape spouse can't join you in a run or in a spinning class you enjoy, find a way to be active together.  Present the walk -- or going to the gym together -- as a positive in your own life: "I really enjoy doing things with you, especially when we're able to be active together."

And be willing to sacrifice some treats of your own in the interests of healthier eating.  There is no reason -- not for you, not for the kids -- to have cookies, sugary sodas or other sweets in the house.  Replacing these with fresh fruit and vegetable snacks can help the entire family enjoy better health. If you're in the habit of grabbing fast food or eating out on busy evenings, try to prepare healthy meals to freeze on weekends for quick at home dinners during the week. You'll save money, time and calories. Think of it from the health-challenged person's perspective: if there are chocolates in the fridge, cookies in the cupboard and fast food on the menu most nights, it's very hard to get a start on healthy eating and living.

Research and follow through with a plan for healthy family meals.  "I don't know what to do about my husband because he likes and demands his full meals!" one friend told me recently.  Her husband, who has diabetes, could have a full, satisfying and healthy meal -- from soup to dessert -- if both did some research into how to choose and cook the right foods.  It's a matter of finding a satisfying balance between old food preferences and healthy choices. Initially, this can require learning to make healthy choices and, perhaps, new cooking techniques.  But it's well worth the effort -- for the whole family.

Give healthy changes a realistic time frame.  Some current weight loss reality shows feature contestants with the stated goal of losing 100 pounds in three months.  Most medical experts would agree that such a rapid weight loss can, in itself, be a health risk and requires such severe calorie restriction that it would not be sustainable over time.  Most medical experts agree that slow and steady loss is best.  While some medical or hospital based programs for the morbidly obese -- such as UCLA Medical Center's Risk Factor Obesity program where I received treatment several years ago -- may feature a rapid weight loss initial component for patients at extreme risk as I was, the emphasis is on a slower loss over time as one learns new healthy eating habits meant to last a lifetime.  You can't change the habits of many years instantly.  But you have to start somewhere -- and today is a good day for a new start. You can't lose a huge amount of weight on a supervised fast and expect it to stay off unless you learn a new way of eating, dealing with feelings and becoming more active in the meantime.  Stopping self-sabotage and adopting self-care is a process that takes time. 

Encourage your loved one to get medical help.  Everyone, especially someone who is middle-aged or beyond with a sedentary lifestyle and medical risks, should see a doctor for a check-up and recommendations before starting serious exercise or a weight loss program. After that point, whether your loved one chooses to see the family physician or go to a therapist or to start a weight loss program like Weight Watchers and/or to get serious about exercise, you can help with your encouragement, and by helping them to find resources. Then step back a bit, ever encouraging and supportive. In order to be successful in stopping self-sabotaging behavior, the person at risk needs to take responsibility for his or her own behavior and healing. 

There are some instances, however, when a concerned spouse has to take a stronger stance. One friend in California, whose diabetic husband's eating habits and blood sugar had spiraled so out of control that she feared for his life on a daily basis, called his doctor, accompanied her husband into the examining room and told the doctor what was going on.  Her husband was shaken and angry at first.  But, as he worked with his doctor and his wife to get back in control of his health and his life, he felt relieved and grateful.  "She pulled me back from the brink," he says now. "How do you begin to thank a person for that?"

Express your concern with love.  It's true that obesity can lead to some life-limiting, even life-threatening consequences. The point is that, most of all, you're not looking to criticize your spouse -- but to let him or her know that you want the maximum time together. You want to expand the number of healthy, active years you can enjoy as a couple.  That can mean a lot at this stage of life as we watch friends and family members pass away or become incapacitated. As the toll mounts around us, it becomes harder to deny the frailty of life or the consequences of not taking care of ourselves.  So "I want us to both be well as long as possible" or "I want us to be able to be active together for years to come!" may touch your spouse's heart in a way that nagging never could.

Reflecting on my own struggles, I think with love and gratitude of those who cared -- thanks to Dr. Charles Clegg and Dr. Larry Mayer and his nurse and wife Graciela Mayer and to the Risk Factor Obesity program at UCLA. Thanks to Dr. Chuck Wibbelsman and to my dear husband Bob for his daily patience, encouragement and love.  And thank you, Jennifer, for speaking from your heart at just the right time.


  1. I read this last night and was too tired to comment. I am amazed to read of your weight struggles. Thankfully, you heard what others, especially Jennifer, were telling you. I struggle just to lose a few pounds here and there, I can't imagine the journey you took. Congratulations on conquering that demon in your life.

  2. It is like a huge mountain in front of me and I know had hard it is, that´s a part of what is holding me back from starting. I know I need to loose weight and my hubby is a sweetheart but he has no idea how to encourage me, because he´s never had this problem. So it´s all up to me, to wait for my "aha" moment and hope that I will be able to pull it off.

  3. Thanks for your comments! Sally, thanks for your congratulations -- though conquering the demon is an ongoing process. I've lost a lot of weight, but still have a way to go. The difference is that I'm living a healthy lifestyle and determined to get down to a healthy weight. Betty, I know your struggle so well! I think the hardest thing, if you have a lot of weight to lose (or even just a little for someone who hasn't ever been seriously overweight) is just to take that first step. After I had more than doubled my weight, I would think with despair what a long way it would be to lose 120 to 130 pounds. But the thing is, when you're losing weight, you feel better at every level. On the way down, you feel healthy and adorable at a weight that would have horrified you when you were thin. So every five or ten pounds down is a joy!

  4. First of all, since I didn't have your email to reply directly, thank you for your wonderful comments on my blog -- you do know how to make a person feel good about their creative work! And I appreciate it tremendously. I've been MIA in the blog world these days -- intense work stress that I can't even vent about on The Marmelade Gypsy, so I appreciate it when people come back, even if I've been absent.

    Weight has been a lifelong struggle for me. My first diet as a kid was when I was eight and I rationed my own Halloween candy. More followed -- I ate only salad during my junior prom dinner because of Weight Watchers; I did high protein, low carbs, liquid stuff and even tossed my cookies for awhile. Ultimately, I knew that only self discipline works and I don't always have that. I know that Rick, health nut and skinny biker that he is, worries and once said, "You know, I want you around for a long time and to be able to do things together." He didn't say I looked awful or anything. Just love, as you said.

    I struggle all the time -- from my 20 pound loss over a year, I've gained eight that seem to stick. I know it's my discipline (or lack thereof) that makes it work. I can do 40. Reading something like this helps me realize I CAN do 40. Thank you.

  5. Thank you, Jeanie, for sharing your struggle! Wow, you've really been through it! I really believe that stress can exacerbate eating/weight problems and if you've been under such intense work stress lately, that can make weight loss harder. I guess it's a matter of self-care, as my patient Jennifer pointed out to me. If you can view eating mindfully as a way of taking care of yourself during stressful times that may help. I've stopped picking on myself about the rate of my weight loss. I lost 60 pounds very quickly under medical supervision. Since then, the weight loss has slowed down considerably. In some ways, it feels frustrating because I'm still overweight. Not morbidly obese as I was some years ago. But zaftig, a bit rotund. On the bright side, I'm exercising every day, eating healthy foods and I feel good. I'm strong. My stamina has improved dramatically in the past year. So it's all good. If you do good things for yourself, the weight comes off and, just as important, you build your health, strength and stamina. Jeanie, believe me: if I can do it, you can, too! It's a daily decision -- and gift to yourself.

  6. Wonderful story, Kathy! Thank you for sharing that. My husband and I are both overweight, but learning to eat healthier. We made two rules four months ago: no espresso or desserts except on the weekend, and no eating in front of the TV. We're pretty good about it. Still a challenge are the sweets that he love and the butter that tempts me. But we're active - exercise class three times a week, plus the gym.

    I've done everything I can to encourage my husband to get his weight down - did finally succeed in getting him to get his blood pressure under control but have decided his cholesterol is up to him. Ultimately, as you said, the person has to make that decision for themselves.