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Valentine’s Days, Holidays, Obligations, and Associations

Feb 14, 2017

Woman, 63 years of age, history of ovarian cancer, prediabetes, hyperlipidemia, has been trying to lose weight for years but was unable to do so. She is very family-, friend-, colleague-oriented. Every holiday she thought she had to make or bring and eat whatever special holiday food was associated with the holiday. She couldn’t let anyone down by not bringing, or by not eating what other people brought. We met weekly for the past three years. Every week there was some excuse about how or why she “cheated” or if there was a week she didn’t think she “cheated,” then she was afraid she would.

Although I enjoyed visiting with this patient, I have to admit I have had my frustrations. There were times it seemed to me she was not making progress. I would recommend referring her to someone else. She would refuse, saying I’ve helped her so much. “You are helping me look at life different.”  We would talk, teaching her different ways to look at food, relationships, obligations and associations. I discussed using medications to help her appetite and cravings. She is very sensitive to medications so she refused for a long time. Then, after the first year, she did try a low dose of bupropion. 37.5mg daily. Slowly she has worked up to 75mg twice daily, which she is on to this day.

Although she would lose weight, albeit slowly, she did lose, but every week there was some excuse and she told me, “I can’t.” She told me she just can’t have a few bites. If she did, the dam opened and she’d eat all day, all week. No matter  how much I would tell her she could, she didn’t believe it. She had so many excuses as to why she “couldn’t.” The last big hurdle was that she hit a low weight about 3 months ago. She said, “Every time I’ve ever hit this weight (160 pounds), I always gain it back. I can’t lose more.” Although I understand the science of weight regain, I told her she doesn’t have to believe that thought. If she believes it, she will definitely gain it back. She does have a chance.

I spoke with her last week. She said, “I can’t believe it! My weight is 154 pounds. Yes, it’s slowly been going down. She likes healthy foods now, and she has learned that she can have a few bites. Those bites don’t have to derail her. We would always have to plan how to “attack” a holiday. Today is Valentine’s Day. We didn’t need to plan an attack. She already had her plan. She is down 26 pounds now. Her A1c is out of the prediabetes range, there are improvements in her lipids, and she is cancer free at this time. Her BMI was 36.6, but is now 31.1. She has a way to go, and I am reminded of “Slow and Steady Wins the Race.”

Lessons Learned:

  • Losing weight is a real journey. Join patients for the journey. You’ll both learn a lot.
  • Have patience. Don’t expect patients to change overnight. We never know if one sentence each visit has more of an impact than we have awareness of.
  • Explore what the saying “I can’t” means to a patient, and give them examples, plans for “how to.”
  • Explore patients’ relationships and their personal lifestyles.
  • Be there for those patients who seem to come back and support those who don’t seem to be making progress. In time they may. Give them the benefit of the doubt. Don’t blame them. Don’t give up.


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