John was a bear of a man. At 5’8” and 385 pounds, his BMI was around 56. Now in his late 40’s, John had struggled with weight all his life. As my patient for the past dozen years, I can attest that he had tried so many times to lose weight unsuccessfully. I referred him a couple years ago for bariatric surgery but he backed out at last minute. Since then, he has developed diabetes, obstructive sleep apnea, and severe arthritis of the knees as well as fatigue that keeps him from exercising. A respected worker at his tech company, he has plenty of friends and a stable marriage.
I listened intently as he told me his story — really for the first time — with tears in his eyes. As a child and teen, he always liked to feel safe, warm, and free from anxiety. He discovered he could have those feelings when he ate. “I like to feel like I am living inside a marshmallow,” he told me. Later, his good feelings also came from opiates, marijuana, alcohol, and other sedatives. He didn’t like the feelings of cocaine or stimulant drugs, just those things that seemed to calm him to that marshmallow feeling. He struggled with tobacco dependence as well.
Now, the opiates and pot are gone, even the tobacco and alcohol, but not the food addiction and its attendant co-morbidities. So John has decided to go for bariatric surgery to “save my life.” I congratulated him on his choice and also cautioned him that the bariatric surgery is the first step on the road to serious weight loss. I told him he had to get Dr. Nick Nicholson’s book, Weight Loss Surgery: The Real Skinny.
I explained how the many dimensions of weight loss are well explored in this little book including emotions, addictions, habits, abuse, stress, and more. These are precisely the painful issues that often underlie the unhealthy eating behavior in the first place. They aren’t gone, but perhaps less obvious than the 200 plus extra pounds of weight John was carrying around. He needed to be aware of these and perhaps enlist professional counseling or coaching in order to stay on track and maintain his weight after weight loss surgery.
He said his first task after leaving the office with a referral from me for surgery was to head to Amazon to order a copy of Dr. Nick’s book. We are starting a new journey together and he is now motivated to follow through and has the tools to proceed and succeed.
