The Importance Of A Strong Therapeutic Relationship When Working With People Living With Obesity

Reaching out for help and support when you are vulnerable is never easy.  The weight loss market place has become cluttered and crowded with noise and  such ridiculous promises, that it has completely muddied the waters without acknowledging there is a huge difference between people who may want to lose  a few kilos and those who live with obesity.

In this muddied crowded marketplace they have been bundled up as being the same thing and consequently when people reach out for help they are bracing them selves for more feelings of being told they are just not trying hard enough. They also feel they have to defend themselves over and over again saying "I have tried that,"  "I do exercise, I do eat well "but they are rarely believed. I have sat with thousands of people over the years and even though they have been referred for weight management, when we talk a bit more about what brought them to me, there is an underlying thread, and although each persons story is unique the common thread is one of being disbelieved and essentially being fobbed off. The recommendations are usually the same eg, being told to join a gym to try keto/paleo /calorie count, drink beetroot juice, or to stop being greedy.It doesn't matter where they go or how often they say 'I honestly am struggling with my weight and nothing is working' they get a prescription of the same old advice which has never really worked and yet the message is reinforced that somewhere along the way they must be lying or exaggerating.

Of course exercise and a healthy diet is a good idea in life generally but for many it is simply not enough when it comes to living with obesity.

There is another aspect that I feel is strongly missing from many consultations about obesity management when people seek help.

That aspect is that no two people are the same. When people are referred to me for managing their weight, my most important role is to listen. I mean really listen to their story.

I know I talk about this a lot but I feel it is often overlooked . For example If a young 18 year old girl with PCOS is seeking help, her needs will be different to a fifty year old man who has had a heart attack and has been made redundant. I've used two examples but there are so many different life stages, cultures, upbringings, personalities and circumstances that we must take into consideration when working with each patient.

As patients stories unfold, and of course this is not everyone, but more often than not there are stories of shocking abuse, sexual abuse, multiple losses or recent grief, relationship breakdowns, domestic violence, trouble with teenage children, retrenchment from a job they loved, financial strain, a diagnosis of autism or ADHD, depression, anxiety, eating disorders, and so many other tough stories.

I am not saying this is what caused their weight by any means, however when we ask them to make too many changes to their lifestyle which commonly happens when people seek help, it can be too overwhelming for some of the reasons mentioned above and can lead to disengagement. A first step may be helping them find ways to get rest and sleep. Or it may be helping them with a safety plan for domestic violence and abuse. Or it may be being with them through grief and loss, and when they feel ready we can look at ways to begin managing their weight.

The therapeutic connection is really important, just to be there, to listen to truly try and understand their world can help us work out what would be most supportive for them.

This is why a really strong network of other healthcare providers is so important.

Being able to refer to practitioners who understand the complexities of obesity and understand prescribing and managing the new medications. Referring to to a relationship therapist if there are serious relationship struggles. Referring to a sexual assault services for support if needed. Being able to refer to Psychiatrists for assessment of autism, ADHD or managing other complex mental health symptoms.

Referring to a fertility expert if there are fertility challenges or a practitioner who understands perimenopause and menopause. Or, being able to refer to a caring dietician if special dietetic input is needed.or an exercise physiologist who can work with someone living with chronic pain or illness, so they don't feel lost or humiliated in a regular gym.

Keeping an open mind without judgement or preconceived ideas about who is sitting opposite us is an important starting point for creating  the best care possible.

Ginette Lenham © October 2023