How to support a friend through a major weight loss program?
September 15, 2017 9:08 AM   Subscribe

A friend has struggled with her weight for many years and lately had some serious health consequences. A few years ago, she lost ~150 pounds through strict dieting and exercise, and still would have another ~100 before reaching a "normal" BMI. She has since gained that weight back and then some, and enrolled in a long-term, medically supervised program to manage it. She has shared this with me, and I know she is enthusiastic but daunted. I'd like to be supportive, so what can I do to help? What should I not do?

I am a genetically slim person and haven't had any weight struggles of my own, so I have no idea what this will be like for her. Feel free to tell me very basic things, as I've never known someone to go through this.
posted by stillmoving to Health & Fitness (12 answers total)
Ask her. Ask her. This is so individual and personal, you cannot guess what she needs.
posted by praemunire at 9:09 AM on September 15, 2017 [15 favorites]

Listen to her kindly. Avoid trying to "fix" anything or suggest anything - she's probably already heard and tried it all. Just listen, love, and don't judge.

Have you read Roxane Gay's new book Hunger yet? Obviously, every body is different and every story is different, but reading that can give you some perspective you may not have thought of before as a slim person. I also highly recommend Lindy West's Shrill for a good read.
posted by jillithd at 9:17 AM on September 15, 2017 [11 favorites]

Best answer: Reading Hunger is a brilliant idea. Also, if you Twitter, follow Roxane Gay and @YourFatFriend.
posted by BibiRose at 9:27 AM on September 15, 2017

Make sure you have activities to do that don't revolve around food? So much of social can be get a coffee/drink/lunch/dinner/cafe and a person could l feel cut off.
posted by platypus of the universe at 9:33 AM on September 15, 2017 [5 favorites]

Response by poster: Thank you! I won't thread sit, but thanks for the great reading recommendations--I've just reserved the Roxane Gay book at the library!

With regards to asking her, I have, but she doesn't yet know as it hasn't yet begun. I will of course continue to check back, and we talk enough that she will feel comfortable telling me if she needs something specific, or a friendly ear, or whatever, but I'm wondering what else might be helpful. Are there any particular challenges or obstacles? If a friend were preparing for a marathon, say, I would know, from other friends' experiences, that good shoes, hydration, etc. are important, ask how their training schedule is going, and wish them luck on the big day. With this sort of program (ongoing for two years, at the start), I'm not quite sure how to be a supportive friend (and cheerleader?) without seeming blase and oblivious. I don't want any support I give to be misperceived as coasting over the grain of the issue, if that makes sense.

Oh and I don't have Twitter, Facebook, or Instagram, so I can't follow any accounts there...but will try to look at any links suggested, if they are open to public viewing!
posted by stillmoving at 9:35 AM on September 15, 2017

Best answer: I am in the process of losing a great deal of weight in a medically supervised program--I've lost about 100lbs over the last 10 months. My friends have been terrific. I made the decision this time to be really open with everyone about exactly what I'm doing (and how I'm doing including telling how much I've lost when they ask). Also why I'm doing it: I was diagnosed with Type 2 diabetes in Jan. 2014 and with very bad arthritis in my right hip but doc wouldn't do a replacement until I lost weight. (Now, I'm feeling like I may not need it for a while). Plus, I was getting more and more sedentary because of other joint issues and because the weight I was hauling around made it hard to move.

Here are things I have found helpful:
1. Everyone has been kind and enthusiastic.
2. No one has pestered me with any "are you sure you want to do this?" "are you sure it's healthy" kind of questions (and or unwanted advice).
3. No one has fought with me about what I am eating/what I choose not to eat at social events. Unfortunately, some people in my "Cohort" were not as lucky--particularly during the Holidays, family, friends, coworkers, tried to force food and or drink on them. We were in our fasting phase during that time and so it was particularly hard on them. My family was lovely and I joined them at the table with my "shake" or "soup" and we had our usual fun conversations.
4. I go spend the weekend with my best friend and her family occasionally and they have been totally fine with my bringing my own food--we focus on conversation, board games, gentle walks instead of going out to eat/having big dinners in.
5. I was and still am really out of shape (though it is getting better) I am up to 4500 steps a day and do Pilates with a coach once a week. It is really nice when friends or a co-worker offer to accompany me on my walk and then don't complain about my pokey pace or try to coach me.
6. I have been through the process of losing 100lbs at least 3 other times in my life and have handled it better each time--but it has taken me all that trial and error to succeed this time.
7. The very biggest thing that I think helped me is doing a lot of therapy ahead of this try. Understanding the reasons I was fat in the first place were really important. Understanding the self-sabotage, fear of intimacy, crappy body image, other baggage like trauma from a sexual assault, etc. has helped me stay on track this time.
8. The second biggest thing that has helped is writing down everything I eat (if I bite it I write it, says one of my cohort). I track food, water intake and exercise. I weigh/measure the food I eat. I count calories. I count steps. My perception of what I ate/how I exercised before was so out of wack from reality that I need to do this to learn what is real.
9.Third biggest thing is show up at the program. This current program has continued after the medical fast was over and just showing up every week to the meetings/classes/weigh-ins has been hugely important to my continued success. I lost 45lbs fasting and the rest has come off while eating regular food.
10. But ultimately, as everyone has said above--you need to let her tell you what she needs. Be open and non-judgey.
posted by agatha_magatha at 9:58 AM on September 15, 2017 [12 favorites]

If y'all hang out together suggest stuff that make choices easier. If you're meeting up for food make it somewhere you can actually get healthy food. Similarly, suggest activities that aren't centered around food (concerts! Walks! Theater!)
posted by raccoon409 at 9:58 AM on September 15, 2017

As she and you have seen, people who lose weight are likely (damn near guaranteed) to gain some to more of it back. With that in mind, don't base your enthusiasm for her solely loss (it will make her feel like such shit if she gains, as though people are only happy when she's losing.) Don't be visibly happier to see her, more drawn to her, more physical with her when she's smaller.
posted by kapers at 10:09 AM on September 15, 2017 [6 favorites]

You may not want to be appearing to be deliberately avoiding food. Some people would take that as a form of judgment or condescension. Others wouldn't. That's why I say it's so personal.

Some people want to hear how "great" they're looking. Some people don't. And some may enjoy it at first, but then will be crushed if during fluctuations you stop telling them they look great. Etc.
posted by praemunire at 10:50 AM on September 15, 2017

Mostly the answer is "this is not your business". Like a good friend to someone who's doing or experiencing any private personal thing, you respond to her informing you about it that you support her 100% and to please let you know if there's anything you should or shouldn't do. This will be a living agreement and the parameters will change over time.

Your job is to be reactive. I mean, yes, be mindful and don't be a dick, don't send candy, don't make her a cake, try to disengage your socialization from food. If she talks to you about it, listen and be neutrally supportive and encourage her to use whatever professional support resources she's given. Do not initiate any action without asking for permission, and clarify if you are uncertain whether you are being asked for advice or just updated or being vented to before you take an unrequested action.

Part of the massive emotional baggage of fatness is a real loss of consent about the privacy of your body, because being fat is permission to the world to abuse you for being fat. Of course, all women lose a certain amount of bodily autonomy just for the crime of being women in the world, but it's worse if you are not a "good" woman because of your size or attractiveness or able-bodiedness or skin color or wealth indicators etc etc. Just give her that privacy, as you should all humans, and allow her to offer consent to you on a case-by-case basis for any attention to her body or her engagement with food.
posted by Lyn Never at 11:39 AM on September 15, 2017 [9 favorites]

Friend, how can I help you with all this weight and health stuff? I'm happy to listen if that would help. I'm here if you need me. Ask it 1 time.

I need help with my weight and depression. If a friend wanted to go walking a couple times a week, I'd love that. In my case, that means I call a friend and say I'll be in town later today, wanna go for a walk? I like it when friends are up for that. If a friend said How can I help, I'd tell them.
posted by theora55 at 12:15 PM on September 15, 2017 [1 favorite]

One of the things that would have helped me when I was in that situation is knowing that you'd familiarised yourself with the latest research about Leptin, Ghrelin, and the brain triggers that make me different to you.

A friend of mine is a professor of genetics at a leading UK university, and someone who lives with obesity. She recounted the situation that really crystallised this for me a few weeks ago as the World Congress we were both attending. She described going into make a bid for a multi million pounds research project, having prepared for months to answer any and all questions this national funding body would ask. They have just cleared away the teas and coffees but they left a plate of biscuits on the table and she describes making her pitch with that plate of biscuits screaming in her mind, a kind of madness ensued internally :-obeseBrain 'biscuits!!!!! on science ......Biscuits!!!! no, no science!
She literally had to ask them to clear the plate of biscuits before she could focus on what she was doing. That is not my lived experience but it really, really brought it home to me how much all of those endocrine signals are influencing your brain against your best interests, (because of course those complex systems developed over millions of years of food scarcity)

For example I married somebody who is genetically slim, he joked that he chose his parents well! It was incredibly difficult in the early years of us living together to see me literally eating half of what his calorie intake was and gain incremental amounts of weight that built up over the years until I yet again dieted to lose the 50lbs.

All of his textbooks in Med school told him that this was physically impossible, it was a simple physics & willpower issue and therefore the obvious conclusion must be that I was secretly eating when I was not with him.

Luckily I married somebody who trusted that what I said was true and kept trying to find the reasons why we were so different. ( so the opposite of a red flag, reader, I kept him!)

Through his constant research I discovered that average calorie recommended intakes are simply that, average, and that I literally needed 400 cal less per day than the so-called average, it was a huge wake-up moment. He could cheerfully consume 3000+ calories while we had a similar exercise routines and never gain weight. I could then reframe the situation into a 'blue eyes vs brown eyes' inheritance thing, where I have such an efficient metabolism I literally could survive a famine, and therefore given that inheritance I would have to consume c. 1700 cal a day for the rest of my life. ( going down as I aged)

There are a huge amount of resources at #obsm & #obsmuk ( caveat: I'm a lead member of the UK group) that demonstrate why we differ from people who don't easily gain weight.

Another thing that would have helped me from my slim friends is if they had read any of the key research into obesity stigma, Puhl 2001 and 2009 Also this

But I'm going to end on a bit of a downer, while I absolutely value you asking this question, in trying to be a good friend, if I received any or all of the above from my thin friend I might have been resentful. I simply don't know the dynamic between you guys enough to be able to judge whether this might be a feature, but of course you run the risk almost like mansplaining'

(I'm not going to use the verb thinspaining as that is something completely different, that's people who do not live with the chronic long term condition that is obesity, do not have a weight problem other than maybe gaining up to 10lbs or ...god forbid ...20! telling you how their diet plan is what keeps them slim and that's all you need to do to be successful.)

Another tip is to intervene or change the subject when she's being thinsplained, be an ally then if she's too polite.
posted by Wilder at 2:55 AM on September 17, 2017 [1 favorite]

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