How can I help a morbidly obese person with an MR diagnosis set and achieve weight loss goals?

February 11, 2012 7:47 AM

I am a Direct Support Provider working with an adult who is morbidly obese. She weighs over 500 lbs and is barely mobile. She says she would like to lose weight, but she seems unable to visualize herself doing so. What can I do to help her become more healthy?

She has an MR diagnosis, but I question it. She seems very intelligent to me, able to plan well into the future, write in nice cursive, assemble puzzles with 1000+ pieces, etc. But she has profound emotional issues which lead to binging. Because of her MR diagnosis she lives in a group facility where her behavior is under constant scrutiny, and I suspect this feeling of surveillance, because she's reasonably intelligent, intensifies her emotional dependence on food and leads her to avoid leaving her bedroom at all, except of course to prepare meals.

I have considered putting together a motivational video of people losing massive amounts of weight, or perhaps emailing her such videos regularly and maybe watching them with her. I've also considered providing a weight loss hypnosis seminar which, believe it or not, has helped people I know with less profound weight loss goals actually take steps toward them.

I'm no motivational speaker. I'm certainly not a weight loss coach. Any advice would be much appreciated.

posted by anonymous to health & fitness (19 answers total)

Can she walk at all? My first thought is to get her outside and moving around, even if that's just her taking a motorized scooter to the park and taking a few steps.

It gets her "out from under" the surveillance you note in your post, it gets her some fresh air, if you're with her then there's some companionship. The idea is to make that excursion the most pleasant thing in her day, so she's up for it again tomorrow, etc.
posted by LN at 8:02 AM on February 11, 2012

I was morbidly obese once. (I'm still overweight, but I'm now in the range of "typical American fatass" instead of "holy shit, look at her!")

In my case, my size was getting in the way of living the life I wanted to lead. I love to travel and it was at the point where not only could i not fit in the airplane seat, but even when I got to my destination I couldn't enjoy it. I would get tired from walking a few blocks, I couldn't walk fast enough to keep up with other people, that kind of thing.

Still, it took me saying "enough is enough!" to myself to actually make it happen. There's nothing that anyone could have said that would have made me lose weight.

So one idea is to talk to her about the kinds of things that she would want to do if she could. Not in a threatening "well you'll never ride a bike again if you don't lose weight!" but in a way that might wake her up so she can remember those dreams she used to have. Encourage her to come up with things that she wants to do someday so it gives her a goal to work towards.
posted by cabingirl at 8:10 AM on February 11, 2012 [6 favorites]

I am a huge fan of walking. While I am overweight, I have excellent cardiovascular health, which my father and younger brother (who are more physically similar to me than my other siblings) don't. The only sure difference I know is that I walk at least 30 minutes/day at a brisk pace and have for pretty much my entire life. This is obviously just anecdotal, but I have had some casual conversations with medical professionals and researchers that lead me to believe that my observation is correct.

So, I would recommend walking. Obviously, with someone who is that heavy, there is a lot of building to do -- at first, walking more than a quarter block may be hard. But, if she keeps it up, day in and day out, she will likely find that soon she enjoys it, and then that she expects it. She should also see her endurance increase pretty noticeably. If she can avoid "rewarding" herself for walking with a food treat (a mistake I made with myself in my teenage years, contributing to my excess weight), she will likely see some weight loss as well -- it will be slow, but, if she can keep with it, it should be noticeable fairly quickly.

Because she is so heavy, you may want to talk to her physician (assuming she has one) about what limits she needs to follow to avoid injury (which would interfere with regular walking).
posted by GenjiandProust at 8:24 AM on February 11, 2012

Can she use the Web? The sparkpeople site has quite a few users who are disabled by obesity, so there are many stories, blog posts, member profiles, exercise suggestions, etc. from people with morbid obesity. You could look at the site for inspiration if she can't.
posted by medusa at 8:34 AM on February 11, 2012 [1 favorite]

I know that you're trying to help, but I think you may be in over your head here. This is far beyond what motivational videos can help with (and, I should add, motivational videos can be profoundly demotivating if they just make you think, "those people make it look easy, and it's not easy for me, so I must be a failure as a human being"). Hypnosis is a medical treatment that should be provided by a mental health professional after a doctor agrees that it's a good idea, especially given that you're talking about altering the mental state of a woman with mental and emotional disabilities. I think you need to take a step back and figure out who the appropriate people are to help, not try to do this yourself.

Is she receiving medical treatment for her mental and emotional issues? How about for her physical health? If so, I think you need to defer to those professionals. If not, however, I think the best thing you can do for her is to help her get medical assistance in those areas. She should have a full blood panel and be screened for obesity causing illness and comorbidities. She should have a mental health professional whom she can talk to about the issues she has living in the group home. If she wants to lose weight, she should have help from a registered dietitian who can help her figure out how she wants to do that safely.

Medical and health issues are extremely complicated for morbidly obese people, especially those with complicating conditions such as you've described here. Eat less and move more, while good advice, likely won't cut it in this case. I think the best thing you can do for your client is to make sure she gets the best possible help from qualified professionals who have worked with people like her successfully in the past and understand how best to assist her.
posted by decathecting at 8:38 AM on February 11, 2012 [19 favorites]

Please don't send her the videos. She'll have seen them. Depending on her state of mind, she'll have thought "Oh man, I could never do that, I'm a miserable failure" or "Wow. I'm going to lose weight too, starting NOW". And in the latter case, she may have succeeded in eating a bit less. For an hour, or two. Maybe a day. And she'll have discovered that willpower is NOT an infinite source. That she can't do this by just wanting it badly enough.

Get her some professional help. Be the one to drive her to a doctor or a dietician if she decides to see one. Be the one to go walking with her if that's what the physician recommends. If you help her dream, as cabingirl suggests, please also provide her with the tools (professional help) to achieve those goals.
posted by Ms. Next at 9:04 AM on February 11, 2012 [1 favorite]

Could part of her "stumbling block" be that while she knows she wants to lose weight, she doesn't know how to without feeling overwhelmed?

I have a physical disability (hemiplegia since birth) and while I have never been morbidly obese or overweight, I've often struggled to find the appropriate exercise/physical activity that can be useful at me and not make me like I need to compete with others. For example, because I can walk independently (albeit with a limp), I have never participated in team sports (like soccer, hockey, etc.) even though I want to (and still desire to). Why don't I just do it you ask? Because there are not enough highly independently mobile people who are disabled in the area to make one team, yet alone two to put on even an informal game. I've tried adult recreation leagues, but because I was the one person with a disability, it was obvious to me and everyone else on the team that I was "the weakest link" and other teams would try to exploit that weakness to win. Even in fun/recreation leagues, people can be competitive and I WANT TO WIN! Trial and error, so I learned not to seek team sports as a form of exercise even though I really want to learn to do so.

For years, doctors and physiotherapists suggested "low impact" activities such a swimming or yoga as exercise, but often I felt uncomfortable as the one 14 yo girl in a pool of senior citizens doing aquafit. Coupled with the fact I never had a 'passion' for swimming, it was a well-meaning adaptation that just didn't quite fit. So what do I do? Well, for many years after my knee reconstruction surgery I was quite sedentary (and I was on Dr orders not to engage in exercise beyond physiotherapy for a year...it was an easy 'out' to avoid my struggles with exercise).

Enough time passed though that I naturally wanted to become active again, but I was stuck...I didn't know how. Every form of exercise in the past had led me down the path to disappointment and frustration. I avoided gyms because I had the (wrong) perception of them being full of body-builders/competitive meatheads who would stare at me and wonder why I would have a limp/hold equipment slightly different than someone with two fully functioning hands. I was scared of gyms because I get enough 'discrimination'/ignorance just in day-to-day activities (being yelled at senior citizens for sitting in the courtesy seating because I can 'pass' as fully able-bodied with my physical disability being invisible to the untrained eye) that I didn't want to subject myself to more ridicule. (As you can see, self esteem/adaptation/stereotypes on top of my obvious physical limitations played a role in my apprehension to a steady routine of physical activity).

One day it was suggested by someone I trust that I go to a certain gym that doesn't have meatheads and is much more community minded and full different age ranges that was near my house. I was scared and nervous, but after I got a very patient/awesome personal trainer that helped not only to teach me how to use the equipment properly but how to adapt safely and ensure it would be a useful exercise for my needs. She has a degree in Kinesiology, and while she had never had a client with a disability before she understood body mechanics and was able to understand how different abilities/limitations can impact one's exercise regime. We quickly developed an appropriate and adaptive training schedule for me and I still use it. I often go during what I jokingly call "senior citizen peak hours" and be the youngest person by 30-40 years but quickly found that now they were some of my biggest cheerleaders and great in celebrating my mini achievements, in or outside of the gym. So now, I stand out by being one of the younger clients when I work out but am old enough to embrace it and enjoy their friendship. The switch from a teenager feeling awkward with the large age gap due to adaptation to my needs to one embracing the joy and friendship of those 40+ years older than me didn't happen overnight. It took a loooooooong time (I'm just under 30 now to give you a time frame of the events).

tl;dr: Adaptive Fitness may be something you want to google/seek out as a video/key word in your quest to helping out your client. It can be done, but as you saw just from my HEAVILY condensed journey (yes, I could've given lots more detail, sorry for the length).

I hope my parallel story might have shed some light on the secondary issues that might have your client holding back. As you can see, it won't be an easy road, but it's important to persevere!
posted by carabiner at 9:16 AM on February 11, 2012 [11 favorites]

If she is binging and emotionally dependent on food, she needs to work on that first. I think the very best thing would be for her to start seeing a therapist who specializes in eating disorders.
posted by insectosaurus at 9:17 AM on February 11, 2012 [1 favorite]

If she is binging and emotionally dependent on food, she needs to work on that first. I think the very best thing would be for her to start seeing a therapist who specializes in eating disorders.

Seconding this - it appears that therapy will be a necessity before anything else happens. If she's in a group home with few things to do or people to interact with, and her carers treating her as if she is less able than she is - perhaps she feels trapped and depressed and food is her only joy and comfort in life. And so she binges because she has no pleasures outside of tasty food. This is something that will have to be addressed before you (or anyone) can help her with a fitness program.
posted by Rosie M. Banks at 9:23 AM on February 11, 2012 [1 favorite]

As an addendum, I completely agree with others who say therapy is an important component that is necessary for improving the overall health of your client. There is absolutely no way that I could have had the tools and ability to overcome to roadblocks without the help of different therapists (who I still see to this day).
posted by carabiner at 9:29 AM on February 11, 2012

Focus on only one behavior at a time, say, dinner menus. Its a series of small hills not a mountain.
posted by Ironmouth at 9:55 AM on February 11, 2012 [2 favorites]

I work with a similar population and struggle with this as well. What is the group home staff doing to support this woman in her goal to lose weight? Some of the things we do in my facility are walking (either at the park or at the gym, depending on the weather), dancing (usually to Just Dance!-type video games), and individual fitness classes (aerobics, swimming lessons, etc. depending on the women's interests).
MeMail me if you want to talk more and we can bounce ideas off of each other.
posted by whatideserve at 10:11 AM on February 11, 2012

Rather than watching motivational videos, could she study cookery? It would give her some mental exercise without necessarily having the baggage that school-type activities have, and would also give her a way to focus on food without eating compulsively.
posted by Acheman at 11:47 AM on February 11, 2012 [1 favorite]

Here's an inspiring story that I saw on TLC a couple of years ago: David Smith weighed 650 lbs, carried a lot of shame, didn't go outside and wanted to commit suicide. He made a choice not to and reached out to a local fitness trainer for help. Without surgery, he lost 400 pounds in 2 years. I remember seeing that one of the first exercises he did was squats. Squatting while carrying 600 lbs was quite a lot of exercise. Apparently the show is airing again on TLC on Feb 16 at 10 am; it's a really great story. (I think it's kind of cheesy that the show is called "650-lb virgin" but hey, that's the spin they put on it...)
posted by foxjacket at 12:36 PM on February 11, 2012

Based on what you've said it sounds like she has an eating disorder and I think it would help to consider it in that light. Motivational videos wouldn't be likely to cure someone with anorexia or bullimia and they are unlikely to provide a cure in this case. It's great that she has your support and I would recommend that she talks to a therapist or someone who can assist with the emotional issues which cause her to overeat. A lot of the ideas suggested here would help in conjunction with that but I think the first priority has to be helping her overcome the emotional issues involved.
posted by Laura_J at 1:27 PM on February 11, 2012

What is MR?
posted by QuakerMel at 3:45 PM on February 11, 2012

I'm guessing that stands for a diagnosis of "mental retardation"? That's what I thought of that made sense in the context.
posted by Secretariat at 4:10 PM on February 11, 2012

Give her a copy of this. It is ah-MAY-zing. Guess what? It's not her fault she's obese! And there's stuff she can do about it that isn't totally fucking miserable! Bonus: it's full of science!
posted by goblinbox at 4:19 PM on February 11, 2012

Focus on things she can do, and on rewarding her with things other than food. For example, puzzles, if she really enjoys those.

Walk with her. 5 minutes one day. When she can walk that without feeling like she is going to die, she can move up to 8 or 10 minutes. Anytime she goes up in walking time, reward her. When she can walk for, say, 45 minutes without pain, she can use part of her time for a light jog. Do this in the middle of the exercise time, so she has time to warm up and cool down. Progress as she is able. Take it slow. If it's too hard, she won't want to do it and you won't see results.

Don't bring up food until the walking is an established habit. And when you do, recognize that her body is likely used to taking in a lot of food, so you can't cut that too dramatically. Help her come up with tasty, healthier options than what she previously ate. And help encourage her to continue, even if she makes a misstep she just has to make better choices the next time. Good luck and have fun!
posted by Night_owl at 5:15 PM on February 11, 2012