This blog is an accounting of my personal journey to find fitness. All the content on this blog should be read as a biographical piece of literature, not a medical resource. I am a physician, but I am in no way giving medical advice or establishing doctor patient relationships with my readers. I am simply keeping a diary. If you are starting a diet or exercise program or require medical evaluation or advice, please see your own family physician.

Thursday, September 30, 2010

What Would You Do?

I saw a patient in my office today who posed a puzzle for me. She is a very nice lady. I've been seeing her for a while. She is obese. She's been that way since I've met her. She has diabetes and hypertension. She is in her mid 40s. She is married to a man who is also my patient.

Every time I see her she talks about wanting to lose weight. She talks about how she knows she needs to lose weight. How she knows she needs to follow her diabetic diet and the health risks of not following it. She has talked about getting the surgery, but she doesn't have the money for her large deductible. She has tried WW, Jenny Craig....well, you know what she's tried. We've all tried it. I've treated her for depression for a long time.

Today, she's very upset. She's tearful. She's so so sad. She says she must lose weight and lose it fast. She says it is affecting her life and she just feels like she can't lose weight by herself. She needs medicine or SOMETHING that will help her.  I listen for a while about her job and the stress and how hard it is to exercise or eat right.

Then I ask her why she's so upset today. Why is she so depressed?  Then she hits me with it. Her husband has told her that unless she loses the weight, he feels like he has no choice but to leave her. He's told her that he loves her so much he can't stand to see her die early.  He has harped on her for years. He complains about her weight. She loves him and doesn't want him to leave, but she is so frustrated and hopeless with the whole weight thing.

Here's the deal. He's also my patient and he is also overweight. Not horribly, but he has a gut and he takes BP pills. He doesn't exercise. He eats crap and he expects her to cook it for him, always has. When she's tried to eat and cook healthy stuff, he doesn't like it and won't eat it. They eat out quite a lot because he wants to and always at places that aren't the healthiest.  But, he does seem to be a pretty good guy.

She says they are otherwise happy. He is so good to her and he's a good father to their 2 kids.  She says they don't fight about anything else but her weight. She says she knows he is right and says she'll do anything to lose weight so he won't leave her.

Part of me wanted to say he was a jerk and she'd be better off without him. But, they have kids and they're married. You hate to say throw all that away.  Maybe he was genuinely concerned about her health. Maybe he is using the weight as an excuse to leave her. Maybe he's unhappy with his own weight issues and is projecting on to her. Maybe there are other issues she's not telling me.

I do know this.  Anyone that would end a relationship based on the other person not loosing weight and hold that over their head as a threat has issues.  I told her this wasn't a healthy environment for their relationship. I told her that I agreed she needed to lose weight and I am happy to help her do that, but there is no magic pill. I offered to refer her to a surgeon if she wanted, but I expressed to her that I was very concerned about her making a big decision about surgery while she was under this much emotional stress and pretty much being forced into it by her spouse.

We talked about calorie counting and exercise. She gave me a lot of "excuse talk", but I'm hoping I got through to her that she has to start somewhere. I told her I know it's hard and shared about my weight loss. Then I told her I wanted her and her husband to go to counseling. She didn't think he would. I said he might surprise her and that if not, I wanted her to go alone. She agreed and seemed calmer with a plan of what to do.

I've been thinking about this all day.  Is it fair to hold someone hostage if they don't lose weight?   Is it fair to threaten someone if they don't lose weight?  Is it fair to our spouses and family if we say over and over we'll get healthy and we don't?  What do you do when you know someone is hurting themselves by not losing weight and just won't do what needs to be done?  What do you do when you're trying to lose weight, but your spouse sabotages you by eating and buying bad stuff?

My husband needs to lose weight and he is saying he wants to and get healthy. But, he hasn't really started. He doesn't track although I showed him the program and loaded it on his phone. He doesn't work out and when I try to get him to he won't.  But, he's supportive of me and my efforts. I don't say things to him about the way he eats at times. I don't get mad or nag him about his weight. I try to be positive and lead by example.  He is coming around as he sees my success.  I would never threaten my husband to leave if he didn't lose weight. When you really love someone you love everything about them, even their faults.Doesn't mean you have to like it.  Doesn't mean you have to put up with them trying to de-rail you on purpose.

So what do you think of this scenario? Do you have conflicts with your spouse or partner about weight, diet or exercise? 


  1. Oh yeah. I don't think that Kathy will see this so I am going to come clean. I really didn't go off plan cause of me on Saturday, I did it to let her see me fail. She seems to not see my success as my success, but as her failure. I have been spot on for so long that it really seems to make her feel terrible for not really making any efforts or being successful to a large degree. So we had been arguing that day and it seemed to me that it was kinda about that. So I bought a pizza while she went to work and let her see that i had eaten it. It wasn't a big emotional deal to me, just a dog and pony show. So the answer is yes, my weight loss is an issue in my home.

  2. I don't look at it the same way. I think you make a committment to your spouse, your children, etc to take care of yourself. Doing so otherwise is basically saying a big F you to your family that you don't care that you have health problems, could die early, not be around for them, etc. Now I say this if both people started out at a healthy weight. If they were both fat before they were married that throws my idea out the window.

    My b/f was a smoker, ate terribly, etc. We are not married, I didn't feel I could ask him to change. But if we finally decided to get married it would probably be a dealbreaker if he didn't quit yet. He's eating better too. Want to know how I got him to exercise/play tennis with me? I found a tennis partner on craigslist. After a few times of playing with my new partner HE started wanting to play.

  3. I am single so I have none of this partner issue/experience. That having been said it simultaneously breaks my heart and pisses me off. I wish the best for your patient, and I hope that her husband has a change of heart. What an ass he is from what we know of the story.

  4. This is a real dilemma. It sounds like the guy may have one standard for himself and another for his wife, but I think it's best not to judge either party. As you alluded to, no one really knows what goes on in a relationship, except those who are in it. I know from my own experience that no one can force anyone to lose weight until they are ready to make some changes. I have seen people who have been overweight for most of their lives, and then they decide to lose weight when they go through a divorce or have a serious health problem, such as cancer. Diabetes doesn't always motivate people either. Even when obese people decide to force the issue with gastric bypass, they seem to eventually gain it back (or most of it). Anyway, this has been my observation of people that I know who have had the surgery. I can't speak for others.

    This weight loss thing is a real bummer. I wonder how many relationships or people it does destroy. I have heard of men who make their wives-to-be promise they won't gain weight after marriage. Some have put it in prenuptuals. And then there are those marriages where there is enough love and respect that the husband or wife of the obese person would never consider leaving, and they have a happy marriage. I have been fortunate that I have had a husband who has never been hurtful or badgered me to lose it, yet I know that he wishes I would, primarily because I am so unhappy about it myself. Go figure....human nature is unpredictable. That's why it's so hard to know what to do or how to help. I think you did a great job, Doc.

  5. I do NOT think it is fair to threaten someone regarding their weight. I do understand that you would be frustrated if your partner was harming herself/himself and that it could become a serious issue. But, if he is not willing to seek counseling, or to support her in living heatlthy, then the issue is not her weight, really, and he is a coward for using it as one.

  6. "He's told her that he loves her so much he can't stand to see her die early."

    That line is a classic. I might even have believed him if he was telling her all this on his cell phone, (during a break between reps), while he was in the midst of an hour long workout at the gym. There is definitely something else going on in this relationship. If he truly cared about her and loves her as he states; he would eat her healthy cooking even if it tasted like sawdust. I'm just glad you were able to share your success with her and hopefully gave her some hope that she can do this on her own.

  7. I think your advice for them to get counseling was the best thing you could have said.
    All of us who have weight issues know that being overweight is a visible symptom of other issues. Self esteem, fear, you name it.

    Looking at this from a little different perspective:
    About ten years ago I finally threw in the towel after 12 years of marriage to an alcoholic. Everyone cheered me on. Said it was about time I got out of that situation and got on with my life. (to be honest, that's how I felt too and it was the right thing to do)
    My ex husband was not a bad person. He was an addict who couldn't get a handle on his illness. He wasn't really hurting anybody... just quietly spending more and more of his time passed out drunk.
    His doctor told him if he didn't quit, it would kill him. I made the decision to leave because I figured he was NEVER going to get sober if I stayed. Was I selfish (a little) or wrong in threatening and finally carrying out the threat to leave? Yes, it did eventually cause his death.

    I can kinda sorta see where her husband is coming from. There are underlying problems in the marriage, but they can never dig down and get to that because weight and health issues are always always always right there on the surface. It's the most obvious problem so that's what you talk about and/or fight about.

    On the other hand...
    If she did take the initiative and try to lose weight would that make him unhappy? Because to accomplish that, she would have to make lifestyle changes and personal changes that would affect him. Evidently he doesn't want that or he wouldn't insist on eating the way he does.
    Selfish jerk - make up your mind!

  8. Either he thinks his threat will force her to get healthy once and for all, or there is something else going on, and I believe the second one, as I don't know them. I wouldn't think he would want to break up the marriage just because of her weight, since there are two children involved.

    I think you did the right thing to give her some options and comfort for the moment, and also to tell her you have done this and how.

    In my past attempts, Husband has not been either a help or a hinder. He has only ever been a bit overweight, never obese himself. But he has always urged me to eat, not be hungry, don't skip meals, don't deprive myself. This time, however, he "gets it" that I "get it" and has been very supportive in every way, except he prefers beef or pork every night for dinner. So one of us compromises (so far).

    I really do wish the best for them, and good luck to you in advising them. A tough one, for sure.

  9. I just wanted to add: I was so wordy and had so many thoughts about this topic that I didn't say that the husband has no right to hold her hostage because she is overweight. He sounds very immature. I also don't buy his line about "loving her so much..." Also, if he refuses to go to counseling, then he's not part of the solution, he's part of the problem. There may be something else going on with him.

    As I said prevously, his harsh tactics will not work. It is rare that a husband or wife can force his/her spouse to lose weight with threats of abandonment. Marriage is complicated, however, and people stay in the worst situations for reasons known only to them. It doesn't sound as though she wants to "give him the boot" either. Not a fun way to live.

  10. I think suggesting counseling was the best approach you could take. Ultimatums are seldom successful and I doubt that approach will work regardless of the husband's motivation.

    At home my wife pays lip service to wanting to lose weight but takes no action towards it. I don't comment on her weight but I will protest poor meals or take out ending up on the table.

    It would be nicer to have a shared goal but, in the end, it's a personal journey for everyone.

  11. Wow, dunno what to say to that one...if you have been given the whole unabridged story then the guy really does need a slap. No, i don't think it's fair to hold someone hostage over their weight. Is it unreasonable to ask your partner to lose weight? Hmmmm, it may be a touchy subject to broach, but no, i don't think it's completely unreasonable but then if you want them to change you also have to be willing to support them at every turn...and do the same yourself! Spouses try to change each other all the time, don't they...perhaps in more subtle ways, but still...

    I don't know how you guys feel but, for me, getting fit/losing weight is a decision only I could make for myself. If my family called me fat and issued diet ultimatums all the time it would have the opposite effect on me - i would binge, put weight on and more than likely fall out with my family.

    It's the same as quitting smoking - you have to want it and when you truly do, it becomes so simple you wonder what all the fuss was about - you don't need patches, you don't need surgery, you don't need anything 'cos you have realised that putting nicotine in your body isn't a good thing. It sounds like this lady wants to take a pill, go to sleep and wake up slim (who among us doesn't tho, right) - she hasn't hit her rock-bottom yet and doesn't want weight-loss for herself. Much as this guy might be an arse, she has to want to lose weight, independently and for her own reasons...even if it's just to become fit and fabulous, then dump his ass and exact sweet, sweet revenge for making her feel so bad! ;o)

  12. I agree, it's not fair to hold someone hostage over their weight. We know the simplicity of weight loss -- calories in must be less than calories out. We also all know that simple is not equal to easy, and that there are so many more factors with diet and exercise than strictly calorie consumption and expenditure.

    I'd buy the guy's "I love you so much I can't watch you die early," comment except I've watched my mother fret over my father's weight for decades. Most of my life, my father has been obese. I've seen Mom lose sleep over my father, nag him, cry over him. But never ever have I seen her threaten to leave him "because she loved him so much".

    So I'm calling B.S. on your patient's husband. Something else is up. Not saying the weight isn't an issue -- I'm very sure it is -- but you were absolutely on target about the counseling, both together and separately.

  13. Wow, it's like Jane was in my head with her comment.
    My husband is 5'10", 170 pounds. He used to be 160. Middle age I guess has crept up on him, although 10 pounds is nothing. He only recently started to work out because his mid-section has gotten a little bigger than before.
    I, on the other hand, have been fighting my weight for a good portion of my life. Even when I really wasn't that big, I thought I was.
    My problem was my mom far more than my husband. And even though hubby didn't sabotage my efforts on purpose, it was really hard being wtih someone who basically ate what he wanted without consequence.
    And I tried. I made made promises. and I broken them. over and over and over again. And he rarely said anything. about it.
    Until my mom died and I was suddenly free. I decided it was time. Time to claim my life. For me. Not her. Not him. Me.
    Perhaps your patient has felt too much pressure to lose. Perhaps she's not ready.
    Who knows what truly goes through the mind of another person?
    Good luck. I hope she reaches that point where enough is enough. Might I suggest the Body for Life book; either the original by Bill Phillips or the BFL for Women by Dr. Pamela Peeke. It helped turn my life around.

  14. I have a suspicion that this jerk already has one foot out the door. My guess is he already has someone else lined up ready to take her place. Spouses (husbands or wives) that are getting ready to leave start finding major faults with their partner. Faults that are nearly impossible to fix, that have always been there, but are now "impossible" to live with. If she drops all her weight by tomorrow, the next day he'll have another excuse as to why he needs out.

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    - The Heavy Man

  16. When they start making ultimatums, it's pretty much over - regardless of the thing demanded.

  17. Doc to doc: I spent my research and practice career on evaluating effective methods to motivate individuals to change. There are great, brief, motivational tools a physician has to work with patients. When other family members become part of the problem, motivation becomes harder because the pressure becomes external rather than internal. You have a bonus as a Family Physician of being able to work with both parties.

    Her depression is a real barrier to change and has to be addressed separately. First assess her readiness to change her eating and physical activity. Is she even ready to act? If so, then giving her advice on the "how to" will be received, (what to eat, get support, etc.) and she needs her confidence bolstered (something hubby ain't doing) and asses how important these changes are for her. You can do this with positive feedback on any steps she is making and providing role models like herself who have been successful.

    If she is not yet ready to change (pre-contemplation) or thinking about but not actively planning (contemplation), then have her generate her own lists of pros and cons for changing and not changing. Include reasons important to herself, her self esteem, and other's that she cares about. It's important that the reasons come from her, although you might fill in medical indications that she leaves out. Then just let her sit with that list and see her back to have her reflect and see if she has progressed toward change. Sometimes that is all that is needed to move forward into action.
    Personally, I would somehow wrangle an appointment with her asshole husband and discuss his health issues related to fat... Use the same techniques with him. If they both miraculously get to the stage of readiness to change, they could be remarkable buddies, and you could help them do that, along with being another source of support.

  18. I had a similar situation with my ex, and I finally broke up with him over it. I realized that I absolutely could not lose weight under those circumstances. It was slightly different in that my partner didn't claim it was for health reasons; he simply found me unattractive at a higher weight. But, for me, having a partner who couldn't accept my faults caused me to want to rebel, and it sabotaged my efforts. My b.f. also was unwilling to do counseling or support me in my attempts at eating healthier. Ultimately, I think if you use your partner's weight as a bargaining chip and don't support their efforts, it's about control and not health. And yes, without him nagging at me, I am down 15 lbs since we broke up 2 months ago.

  19. By the way, I think how you are supporting your husband is perfect. Lead by example and he will follow. When the people around you are looking healthier and feeling great, it's hard not to want to follow!!

  20. I can understand it being an issue. my weight has fluctuated wildly over my eight year marriage. my wife's has too although to a lesser degree. health issues, attractiveness issues, ability to have a regular sex life, to be an active parent are all important issues. there are times when I'm kicking wl ass and she is sucking down burgers or the opposite. but I thought the whole idea behind I do is that there is no give up. no climbing out of the foxhole when your buddy is shot and bleeding. no fair giving up on a partner in trouble...

  21. That was a thought provoking post. I can understand where that hubby is coming from, except the fact that he is also overweight. Obviously in denial about his own issues. And the fact that he is holding her hostage as far as her losing weight and marriage is ridiculous.

    But here is the deal: my deal: My hubby is tall and thin. He has always cared for himself well, but 7 years ago he had an attack of atrial fib that landed him in the hospital. You can imagine, plus you know the medicine behind this, it was scary. He became even more committed to taking care of himself (remember he was thin), but started exercising and regularly. As a result, a couple of years ago his cardiologist dismissed him as a cardio patient because of his progress.

    Now me, I have been obese for at least 12 years. You would think that heart issue of my beloved hubby would have triggered something for me, but no it didn't. I was in denial and too afraid to face what I needed to do (this is what I know now). My hubby never directly told me that I was killing myself or at risk for all kinds of diseases. But, we were having a conversation about diabetes and the chronic nature of this disease and the impact this has on families of the patient when it hit me like a load of bricks (I have blogged about this): If I choose not to take care of myself, my family will be stuck caring for me. They will suffer!! I do NOT want that to happen. That was it. That is what happened to me. That what’s lead me here to getting healthy and blogging.

    SO, in the case of this husband of your patient, I wonder if that is the message he is trying to get across to her. Get it together and take care of your health and if you cannot then I am done. Is he really saying I cannot emotional deal with the suffering you will cause all of us because you (wife) did not care for yourself?? Maybe. But then there is the question of his own weight issues. As you can see I am no psychologist.

  22. I've had a busy week at work and am just catching up. This must be really challenging work. And it adds such an interesting dynamic with your own weight loss. I hope you can find and share some answers.

    Just noticed you posted a new picture of yourself. WOW, such a difference!

  23. Wow. Mine field actually.

    Wife only wants to lose weight because hubs wants her to. Failure waiting to happen. Need to want it for yourself. She came to you for a magic fix. She's not willing to put the time and effort into a diet program, she wants the weight gone now. Don't we all?

    Husband saying he's going to leave....blah blah blah. BS. If he cared about her health like he says he does, he'd care about his own. That's a line of crap and an excuse for something else.

    Counseling was an awesome suggestion. My guess is he won't go. He thinks she's the one with the problem and is playing ostrich about his own.

    Outcome will be interesting.

    I'm a do it yourself kind of girl. Hub will join in eventually. He always does. He's very supportive and would do/eat anything I asked. I just don't ask. As soon as he says he's ready to start eating healthy again, I'm his biggest cheerleader.

  24. Hubby and I drive each other to get healthier. If he threatened me with an ultimatum like that, I would assume he was looking for a way out.

    HOWEVER, I have to play the devil's advocate and wonder if she bitches and complains about her weight at home to him all the time, like she does when she comes to see you...and he is sick with her not pulling the switch and making excuses...

    Maybe he thinks making this push to her will make her actually take action for once.

    If not to all of the above, then he is a shithead for making that push when he won't bend his own eating preferences at home-or at least give her the support she needs.

    Seems like there are too many unknowns in this equation, and I don't know if anyone other than them will really know the whole truth. Therefore, I think the therapy was a good idea, maybe she/he will get the truth out of them and get to the heart of the matter...

    Polar's Mom


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