Some Things To Consider When Behavioural Change Might Seem Too Hard

Just like any chronic complex health condition, obesity management needs careful and ongoing interdisciplinary care. This might be any combination of medication, surgery along with dietary and exercise guidelines and counselling.

It is for some of the reasons below, why attending to a person's inner psyche, their pain, or their trauma might be important when discussing their weight struggles. Of course, for many people living with obesity, none of the points I have written below will be relevant at all. However, after working with thousands of clients over the years, these kinds of worries and experiences tend to come to the surface. If we are just asking them to change their behaviours through a behavioural change model and don't take into account what is going on below the surface we miss a very important opportunity to support them.

I see it time and time again in my practice where people have been told repeatedly they are failing because they didn't implement the behavioural changes asked of them. They are being blamed and criticised which leads to despair and isolation, and worst of all a resistance to seek out help in case the same blaming happens again.

However, making changes, even when what seems to the practitioner as quite simple can be very challenging if there is underlying trauma or ongoing current life difficulties.

For example if a women in mid life asks for help with her weight and she is told to cook healthy meals and go and walk for 45 mins a day, and to join a gym, and then is criticised for not doing it, it is not the fact she hasn't been able to do it but all the challenges she may have in being able to do it. She may be going through menopause and is totally sleep deprived, experiencing debilitating hormonal symptoms, she may be also be looking after elderly unwell parents and teenagers. Maybe money is tight, time is tight, exhaustion is ever present and meal prepping, shopping, cooking, cleaning and cooking and walking after dark when she gets home is all too much.

Instead of berating her, we need to support her and work out ways she can do some things that may support her wellbeing. Help her get sleep; help her find very easy affordable healthier food options. Listen to where she is at, not lecture her about what she ought to be doing.

Some of the other traumas that may be under the surface that have impacted coping mechanisms over the years might be:

They might have been raised in a physically or emotionally abusive family

They may have suffered childhood sexual assault and abuse

They may have suffered massive grief and loss as a little one

They may be part of the stolen generation

They may have been displaced from their land

They may have escaped a war torn country

They may have suffered, or are suffering from domestic violence

They may be a survivor of sexual assault

They may have had an unwell parent and were their caregiver from a young age

They may have watched a loved one suffer from a debilitating physical or psychiatric condition, or are caring for someone now

They may have grown up in extreme poverty

They may have suffered childhood abuse

They may have suffered from childhood abuse that was not overt, like neglect

They may have had undiagnosed ADHD or autism and had sensory or food processing troubles that were dismissed as being difficult or impulsive.

They may have suffered from a serious childhood illness like cancer

They may have had troubles with rapid weight gain, hirsutism, acne, fertility problems, receding hair loss but nobody took them seriously and it wasn't till much later in life that they received a diagnosis of PCOS

They might suffer from anxiety and or depression so crippling that they need to be on medication, but this medication interferes with their weight

They may have grown up feeling like an outsider and didn't feel like they belonged at school and food was a form of solace

They may have been bullied at school

They have had a serious accident and are no longer able to be mobile

They may have an eating disorder or disordered eating

They may have insulin resistance, a metabolic syndrome, a thyroid problem but has not been diagnosed or recognised as causing significant weight challenges

They may have trouble sleeping, ie insomnia or sleep apnoea

They may have an autoimmune illness, which impacts their daily life

They may have fertility struggles

They may have ante or postnatal depression

They may be or are peri or menopausal

They may have suffered or are suffering trauma due to the covid pandemic

The experiences mentioned above might not be a contributing factor at all for some people living with obesity, and many people suffer immense trauma and do not have weight concerns.

However, it is worth factoring in the possible history of trauma when speaking with people who are looking for some help to manage their obesity. Not necessarily because trauma is a cause, but to help understand why  there may be daily struggles in many areas of life.

This is extremely important especially since the shame and stigma that people experience on a daily basis about their weight is deeply traumatic in itself.

This is why it is so important to have a space, a place and a time where you can share your story when you seek help for weight management. And, when you share it, you are given the care, respect and space you need to feel safe. Safe from harm, safe to be heard and safe to ask for help.

Ginette Lenham © May 2023