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?