Why don't mental health professionals conduct interventions for morbidly obese people?

[MoonRiver]

One of my favorite shows is "My 600 Pound Life." Dr. "Now" puts a lot of pressure on his patients to lose weight, but family members are usually the enablers. Seems if there were interventions like the ones done for individuals with drug and alcohol addictions, the outcomes might be better than less than 5%.

[jpak]

1. The morbidly obese are mentally ill?

Who knew?

[MoonRiver]

2. People with food, alcohol and drug addictions are addicts who need help.

One doesn't need a DSM dx to benefit from an intervention.

[hlthe2b]

3. I doubt any more are DSM IV - "mentally ill" than the public at large; but psychological problems

that might benefit from intervention? I think it likely for many.

[kcr]

4. But it's Dr. "Now"

And he's on a reality show. Seems legit.

[MoonRiver]

6. I can't quite remember how his full name is spelled.

He's a surgeon in Houston, who treats morbidly obese people, many who can't go anywhere else. His patients call him Dr. Now, because the full name is difficult to pronounce.

[B2G]

8. Dr. Younan Nowzaradan

He rocks.

[Different Drummer]

45. Dr. Younan Nowzaradan. n/t

[B2G]

10. He is legit.

He's helping desperate people no one else will touch.

[kcr]

13. Maybe so

It's clear it comes at a price for some of them. I can't help but wonder why he feels the need to do it on a reality show called My 600 Pound Life for people to gawk at and wonder why these so-called mentally ill people aren't getting interventions.

[B2G]

15. It's not about 'gawking'.

He has done a lot to bring attention to the very real problem of life threatening food addiction.

[LanternWaste]

48. It's exploitation for profit pretending to bring awareness.

It's exploitation for profit pretending to bring awareness.

In this case no profit, no awareness.

So yeah... gawking is accurate.

Don't get hung up on television personalities.... it's just another a bill of goods you'll be purchasing.

[Tipperary]

5. Excellent question.

People that get upwards of 200 pounds without the height to carry it - i simply do not get it.

[maxsolomon]

11. 200? that's the tip of the iceberg

I see SHORT women who have to be 250, 300 on a near-daily basis. Men easily over 300, nearing 400. I see a lot of American tourists.

I'm 200# on a long-waisted 6' frame.

[Tipperary]

16. True.

I used to work with a man who had to be in excess of 400.

[B2G]

17. There is a tipping point where is becomes life threateing vs detrimental to one's heath.

The focus of the show and Dr. Now's efforts are the former.

[Tipperary]

20. Absolutely.

Not familiar with this doctor, but good for him.

[B2G]

7. And many of them have a history of abuse.

A lot of it sexual.

It's an excellent question. Addiction is addiction. And in the case of the food addict, they can't just abstain. Which presents some very real and unique challenges.

[MoonRiver]

19. Yes, that is discussed on the show a lot.

Sometimes it is also a traumatic divorce and/or neglect, but sexual abuse is usually in the mix. Patients frequently state they think by getting fat they will prevent attraction from the opposite sex, and possible resulting abuse.

[splat]

9. There go the nation's Food Editors!

600-pounders aside, most heavy people are highly functioning and happiest when sitting. To be large is their choice. I've watched a newspaper friend go from slender Fashion Editor to morbidly obese Food Editor over the course of her career. She's not a mental health intervention candidate, rather she's a happy working wife and grandmother.

[Blue_Adept]

12. As a morbidly obese person that struggles daily with this

Thanks for this thread.

Now I feel even shittier.

[B2G]

14. BlueAdept, Have you seen the show?

Do you know what population the OP is referring to?

If not, I'd suggest you do. MoonRiver's observation is spot on.

[Runningdawg]

18. Overweight people don't need mental health interventions

What they need are people who care about their overall health.
I am a retired nurse and the prejudice I have seen against overweight people is appalling!! I have also been on the receiving end. I have been 20- 30 lbs overweight my whole life. When I developed severe pain in my L foot 3 different doctors told me it was because I was fat, without ever examining the foot.
It was an acupuncturist that diagnosed the tumor that had already broken 2 bones. 2 surgeries later, I was left with severe nerve damage. After a lifetime of standing 8-16 hours a day for work when Drs ask me if that foot (only that foot) ever hurts and I tell them yes they say....it's because you are fat.
I'm sure most of you aren't aware of this problem but more and more Drs are refusing to accept patients who are overweight.

[B2G]

21. These people aren't '20-30' pounds overweight.

They are at risk of dying, poste haste.

Big difference.

[MoonRiver]

22. People who care about morbidly obese people, who are often bedridden,

shouldn't bring in food which is killing their loved ones. I think interventions would help define the guidelines about what will and will not be done by family members and friends. Lives are literally on the line.

[Fix The Stupid]

24. Same thing happened with my mom...

She is a little overweight...

Has had bad knee pain (both knees) for years now. Her old Dr. kept telling her "lose 20 lbs"...

She finally went and seen another Dr. He ordered x-rays and found out her knees were so shot she needed double knee replacement...asap.

The X-rays were Dec. of 2017.

She had 1st knee replaced Feb. 2018 and the 2nd knee replaced 2 weeks ago.

She is now pain free and cannot believe the difference...

It's not always the weight...

[Adrahil]

28. I had both my knees replaced last year.

For YEARS my doctors kept putting off knee replacement because I am very fat and they said the replacements would wear out too quickly.

I finally got a new Orthopedic surgeon. He called those arguments bullshit. He told me knee replacements could vastly improve my quality life and enable a more active lifestyle. He was not wrong. Both replacements went great and I feel better than I have in 15 years. I am slowly returning to levels of activity that have not been possible for a decade.

[nini]

30. That's exactly what my dr did for me.

He said you'll never lose weight if you're in pain and can't exercise. he was right.

[Adrahil]

36. Thanks so much for adding that!!!

It's made a huge difference to my life!

[nini]

43. No kidding. I never realized the pain was making me depressed too

Which didn't' help either.

It's like getting that second chance at life.

[Adrahil]

44. Yeah.... I think my wife is getting tired of me...

telling her excitedly that I'm not in pain!

[Ilsa]

27. The OP isn't about overweight people. The thread is about morbidly

obese people, at least 100 pounds overweight. The ones who cannot be put on a regular operating table or even bathe themselves.

[dsc]

40. I am over 100 lbs overweight by the chart they use

I figure more like 60 for reals but I am able to be operated on (I was in Oct of last year) and I can bathe myself (I prefer showers but I am able to bathe). I am not proud of how overweight I am but over 100 lbs overweight isn't one foot in the grave either. I am supposed to weigh 150 according to the scale they use but I would be happy with 200.

[Runningdawg]

35. The next to last couple of people to comment (and their Drs) get it

People won't end up at 600lbs IF someone takes them seriously and helps them take care of health problems NOT attributed to their weight before then. I guarantee you those 600lb people had Drs fat shaming and refusing to treat them most of their lives until they just stopped going completely. When a Dr says "I won't operate on your bad knees, hernia, foot - until you lose X amount of lbs." what the overweight person hears is "You are not worth of being treated like other humans who are in pain".

[raccoon]

23. Some medications cause weight gain.

Some medications cause weight gain.

Everyone I know who is on SSRIs, the meds have caused them to gain a lot of weight.

[nolabear]

25. Because interventions are delicate things and seldom work.

It helps the family sometimes to feel as though they’re heard but calling people out on things they know without them being on board often creates more problems in the long term.

And-people are morbidly obese for a host of reasons. I assume you mean people who have an addressable addiction and dependence. But remember if it was a quick fix they’d have done it. If confrontation would help without a careful backup plan and some way to keep the client from being shamed and driven even further into the pain of their situation without a whole lot of help it would be done more. Interventions are great for drama but poor for outcome. Long term famly therapy where everyone is willing and supportive and the designated patient (I say that because it’s so much more than one person, though families like to think they’re not part of the problem) can sometimes have better outcome. Sometimes.

Yes, I’m a retired therapist.

[Adrahil]

26. Welcome to THIS weeks episode of "Dehumanize the Fat People"

I'm a very fat man.

Thanks, but I do not need or want your pity or intervention.

I hold a full time, demanding, well-paying job.

I have a family.

I'm getting my MS.

I weigh 370 lbs.


It's great to log on here and read shit like this. Thanks!

[B2G]

29. You don't fall into the category the OP is referring to.

Honestly, if you haven't watched the show, I don't know how you can form an educated opinion on what's being discussed.

[Adrahil]

37. Hey, thanks for the patronizing reply!

The OP referred to "morbidly obese" people. At 370 pounds, I DO fit into that category.

And the dude who can't imagine how people might tip the scales at 200?

Yeah... not helpful.

How about we just treat people as individuals?

[B2G]

39. The show she was referring to is super morbidly obese.

600+ pounds. Sorry you're offended. I'm sure that wasn't their intent.

[Ligyron]

31. Don't a lot of morbidly obese people avoid health care pros?

Hell, some can't even get out of the house. How the hell are they ever going to see a MHCP?

[moriah]

32. Since not all cases of morbid obesity have Binge Eating Disorder or...

... even compulsive overeating as their root causes, no.

For some, they need changes in medications -- the overuse of the atypical antipsychotic class for treatment of Bipolar Disorder and even simple depression is leading to more people being exposed to these meds that have a STRONG link with inducing diabetes And obesity in previously normal weight individuals.

Psychiatrists are MAKING people fat just because they have this "new drug", without trying the older ones first. At least Depakote weight gain *is* mostly manageable by strict diet. Latuda? Ability? Zyprexa/Seroquel/that whole famn damily of medications "? They should NOT be first-line unless a person has an accompanying issue causing delusions and psychosis outside of mood episodes (aka schizoaffective and not just Bipolar.

For some, they need actual endocrine disorders managed correctly. Like insulin resistance and PCOS that didn't come from meds l, but actual genetics.

And yes, I've seen the show. More to the point, I've battled weight issues "mental health professionals" had caused by their irresponsible prescribing of drug-rep pushed meds over generics, and then other doctors made money prescribing me 800 calorie a day bariatric diets which I didn't lose a pound on, though at least I didn't gain. I wasn't delusional, was paying good money to lose, and I don't think anyone was feeding me burger slurry at night in my sleep to keep me fat. It was doctors who refused to accept that not all meds cause weight gain by increasing appetite.

When they finally got my meds straight -- only changing two, but obviously those two didn't like me -- I could eat 1200 and lose. 1500-1700 and maintain, though not the 2000 for men. Before I was gaining at 1200, and maintaining at 800.

---

Sadly, having focused so much on food, and finally getting the positive feedback from losing once it started coming off, and having gone years barely eating because if I ate like a normal person I gained, I now struggle with keeping at 110-115. I was 107 this morning. When I get sick physically I have to make myself drink Ensure, or I drop below 100 and given I still have loose skin, that's not really healthy or a good look on me.

Because I spent so many years measuring and logging my food intake, and choosing foods that were easier to log, low calorie, and tasted good, I have a very limited number of foods that feel "safe" psychologically to eat without fear and guilt, even when the scale was saying 92 after a bout of pneumonia.

I guess *now* I have an eating disorder! Thanks, mental health docs who didn't think to try Lamictal!

[ismnotwasm]

33. In some cases they do

Especially prior to surgical interventions.And “morbidly obese” is a kind of catch all phrase that doesn’t actually describe everyone who is overweight. For instance, there is a type of lymph edema that is almost untreatable—we do a surgical intervention at my facility that is considered “barbaric” yet people seek it out when just one leg weighs 50 or 60kg. This particular condition is no ones fault, yet these people suffer the same bigotry any other overweight person does. I also had a patient who had a rare condition where her fat cells almost acted like cancer and multiplied abnormally

There is also an assumption that people haven’t “tried” to lose weight. Or haven’t sought out mental health intervention. This assumption is usually bullshit.

It’s a difficult issue. I just heard about this show. It won’t be one I watch.

[nolabear]

34. I'm horrified by the treatment of the people on the show.

I’ve watched maybe three over the years. The surgeon treats them terribly, maybe because he seems to have no social skills. But it’s a pretty painful thing to watch.

Btw I suffer from a relative of the disorder you mention. It’s lipedema or lipoedema. Same lymphatic problem but in the fat cells in the lower body. It’s miserable and worsens in all kinds of conditions-stress, heat, Tuesdays... I’ve spent my life struggling with eating healthy, constantly dieting, taking supplements and natural remedies, trying to force a balky lymph-logged body to get exercise, and being dismissed as all the things people like to lay blame for. Thanks for the realistic attitude.

[ismnotwasm]

42. You are welcome

I’ve taken care of several patients who have gotten a “Charles procedure”—basically the surgeon hacks off the lymph-filled tissue. It is barbaric, a decision of last resort and it’s not necassarily a permanent one either. Every one of my patients have been the nicest people ever, living in a world that judges with no information

https://link.springer.com/chapter/10.1007/978-3-319-14493-1_26

[workinclasszero]

38. So what could they do?

Lock them in a room for a month and starve them? I smoked for twenty years and quit about 30 years ago but that was easy compared to losing say 200 pounds and keeping it off for life.

Surgical intervention works in many cases but lots of insurance companies refuse to pay for it so..yeah.

[Sgent]

41. Because most mental health professionals rely on science

to guide their approach, and interventions like this don't work.

In fact the only thing that has been found to effectively help morbidly obese people lose weight long term is surgery.

[malaise]

46. I can't watch that show

I can't fathom how someone could reach the stage where he/she can't even come out of their own front door

[MoonRiver]

47. I know but they do explain how it can happen.

Most of the time it has to do with childhood trauma. The people use food similarly to how others use drugs and alcohol to cope. What I love to see are the success stories!

[Cal Carpenter]

49. I'm very glad there are a few informed and compassionate people posting on this thread

because otherwise it would be trash-worthy, frankly. I don't doubt that the OP had good intentions but filled with misconceptions, and it seems like a lot of people cannot see that shows like this are obscenely exploitative, and reinforce stereotypes and misconceptions, and that there are a plethora of medical realities that lead one to be so overweight.

Judgment and fatphobia all over the place