Question

Discussion Topic

Josh has been slightly overweight since grade school, but, as he progressed into the junior high years, his weight grew worse; by the time he graduated high school, he was considered obese. At 20 years of age, Josh has been diagnosed as prediabetic with metabolic syndrome. He has come to the dietitian’s clinic for a consultation.

“I get really discouraged,” Josh says. “It’s not like I never have will power, and at times I have starved myself for days and spent long afternoons on the treadmill while watching TV. But then I get so hungry that once I start eating I can’t stop. At other times, I work hard at dieting and exercise for so long, but I’m so big that I can’t see any difference. Of course, the stares when I go out in public are depressing, and then I just give up and think, ‘What’s the use? I can’t ever escape my own body,’ and then I give up and turn to comfort food. It’s very discouraging. I feel like I’m living inside my own personal prison.”

On further intake, the nutrition nurse learns that Josh has very tense relationships with his four older brothers, who have sometimes bullied him. “Even when we get along, they make jokes about my size,” he says.

Josh reveals that when he was small, he was not overweight, but he was also not very athletic like his older brothers. He felt separated from them by the fact that he had no interest in or talent for the athletics his brothers constantly engaged in at home.

“Plus I was just a lot younger, and when they’d tease me, I’d cry and my mom would comfort me with treats. As I got heavier when I was older, they’d criticize me for everything I put in my mouth, and if I didn’t eat, they’d sometimes try to be supportive, sometimes indifferent, and at other times, my second oldest brother would say, ‘I know as soon as we’re not looking you’re gonna binge, aren’t you.” It wasn’t my intent, but then when he’d say that, I’d be so angry, I’d do it. The more I did it, the more they harassed me, and it turned to anger on their part as I started to get fat. It just sort of skyrocketed from there. I hate this. I feel so trapped by my own compulsions.”

The text says, “Health is the merging and balancing of physical, intellectual, emotional, social, spiritual dimensions, and environmental dimensions.”

a. Food, of course, is in the physical health dimension, but how might other dimensions be affecting Josh’s food choices?

b.  One of the reasons Josh has often “failed” in the past is that he “starves” himself for long periods and then binges out of intense hunger pangs. The nurse starts to discuss healthy snacking strategies, but he says, “Stop right there. Snacks have been my whole problem. Running to treats out of depression. No, snacks are what make people fat. They make me fat. I want a diet that limits me to three meals a day, or maybe even just two.” How might the nurse counsel Josh?

Answer 1

a. Food is the physical dimension of being overweight. The intellectual dimension is his inability to understand the harmful effects of binge-eating. The social aspect is governed by the society. The looks he get in public and bullying by his siblings have brought his confidence down. This has led to emotional crisis for him since he feels that his body is a prison he can't escape. Spiritually, he is not at peace owing to his weight. Obesity hasn't only impacted his physiological well being but also his overall stability of soul and mind.

b. The nurse should first handle the emotional aspect. She should make Josh comfortable that it is possible to lose weight and become healthy. Some inspiring words would bring back Josh's will power. Next, she should scientifically explain the value of taking meals at the right time. All the three main meals hold their own importance. The snacks too are essential to not deprive brain of oxygen intermittently.

Snacks can be healthy too. He may consume fruits, dry nuts like peanuts, a healthy sandwich as snacks. They don't only mean junk food. For better taste, he can take baked stuff instead of fried.

The nurse should also tell about ill effects of starving. It leads to deprivation of oxygen and energy to the body and cause production of ketone bodies which can be harmful in long run.

Overall, to become healthy and fit, Josh should maintain regularity of exercise and honesty with the diet. A positive attitude would help him to burn down the excessive fat and defeat his disease.