September 19, 2008

You Ask, I Answer: Friend's Weight Loss

I have a question concerning my friend's health.

He is an obese 34 year-old man with a thyroid problem (which slows down his metabolism).

As far as I know, he eats very little throughout the day, and what he eats consists mainly of hamburgers, beef, pizza, etc. He does not -- and will not -- eat vegetables, and his taste for fruits is very limited.

He does not eat chicken or seafood either. He also skips breakfast every morning, and does not take vitamin supplements.

I'm really concerned about his healthy but can't seem to sway him to eat better.

What are the risks he's up against with his health if he continues to eat like this?

What kind of eating plan would you advise he go on?
Should he be eating more food in a day, but with fewer calories and in smaller quantities?

I feel like the food he is eating isn't getting properly broken down because of the lack of other foods in his diet. Is that true?

-- Kara (last name withheld)
St, Louis, MO

There are many things worth covering here, so let's take everything in order.

Your friend is certainly in a fragile situation.

The few statistics you provide (thyroid issues, obesity) as well as your observations of his eating habits (a diet lacking fruits, vegetables, and, I'm assuming, whole grains) paint quite a bleak picture.

I do find it interesting that you are curious to know what negative health effects this may have on him, because I have a feeling he is already experiencing some of them.

I am sure he feels short of breath when exerting the slightest bit of physical activity, experiences pain in his knees, and may even have sleep apnea (a potentially fatal condition in which people stop breathing for short periods of time in their sleep.)

The examples mentioned above give us a clue of what is happening to some of your friend's organs (i.e.: the heart may be working overtime, and joints can have too much pressure put on them.)

Although the human body is very resistant, years and decades of these conditions really run it ragged, and "system malfunctions" (or meltdowns) can begin to happen.

A heart that is put through the wringer every day for 10 or 15 years is not a healthy heart. Although your friend may be 34 years old chronologically, his organs very likely resemble that of an older person (depending on how long he has been obese.)

You mention not being able to sway him to eat better, and it appears you aren't too sure why.

I'd like you to go back and re-read the questions you sent me. Pay attention to the feelings they conjure up.

Perhaps you feel overwhelmed, not knowing where to start with your friend. Or hopeless that it will be hard to break this behavioral mold. You might even feel like whatever the "solution" is, it will be one that will take a lot of time, effort, and patience.

I ask you to think about this because the thoughts and feelings that come to your mind will very likely reflect what your friend is feeling about all of this.

A lot of tweaking needs to happen here -- eating more small frequent meals, consuming more fruits and vegetables, cutting back on calories, increasing physical activity... I could go on.

Believe it or not, though, that isn't really the issue right now.

Why? Because, most likely, your friend is already aware that some changes need to happen.

The issue here is what is keeping your friend repeating behavioral eating patterns that keep him at an unhealthy weight.

I am willing to bet that he either doesn't know where to start, or the entire concept of eating healthy and losing weight is so overwhelming that the mere thought of it makes him want to forget the whole thing.

It isn't uncommon to contemplate a "can of worms" scenario like this one and be at a complete loss as to which particular worm to untangle first.

All change, no matter how small, is difficult.

I can't provide an eating plan without knowing his medical history, food preferences, and bloodwork numbers, but here is what I suggest you do:

Once, and only once, sit down with your friend and thoroughly explain your concerns to him.

Let him know you are concerned about his weight from a health perspective, and ask him what his feelings and thoughts are on the matter.

Be mindful, though, to stay away from tips, suggestions, or recommendations about what he should or should not eat. The point of this conversation is not to tell him what saturated fat does to the body or which diet book he should read.

Simply recommend to him that, if his insurance covers it, he has the option of meeting with a Registered Dietitian, a trained professional who will work WITH him one-on-one to achieve whatever his goal may be.

Once this conversation is done, you have to make a promise to yourself to let the issue go.

That, my dear Kara, is really all you can do. Until your friend is ready to make a change, there is very little you can do.

Lastly, your question about whether the food he is eating is being broken down properly even though his diet isn't balanced? The answer is yes.

The human digestive system breaks down all foods, regardless of how healthy -- or unhealthy -- they are.

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