Letter from a British Mum

London Tower BridgeRecently, Dr. Pretlow heard from a very distressed mother who lives in a large city in England. Her letter is reproduced here with identifying details removed for privacy, and slightly condensed for space. Dr. Pretlow replied with an extensive list of suggestions. Some of those are included here while the remainder will appear in the next post.

Hi Dr. Pretlow,

I am a single Mum, as my husband left about 10 years ago. I am desperately searching for some kind of guidance to help me with my 17-year-old daughter, who currently weighs in the region of 380 pounds and is 5 feet 5 inches tall. She was a normal, if slightly skinny toddler, and a normal-sized child, but when she was about 14 she changed and became very withdrawn and started to self-harm.

We got help with this, and it has stopped, however she began to overeat alarmingly. I told the General Practitioner and her counselor, but the advice I got was to offer healthy foods, etc. But that is not the issue. She eats an enormous amount of food. If she is allowed to have any money she spends it on fast food or calls to have takeout food delivered. She stays up very late at night and eats and eats.

I do not have unhealthy food in the house, but my daughter will make up stuff to eat—the other night she mixed confectioners sugar and butter together and ate that. She will also eat bread and cheese in vast quantities. If I try to intervene and tell her not to eat, she becomes very aggressive and tells me that I am a food Nazi, or that I am making her feel bad about herself.

Her weight means that her fitness level is almost zero. She gets out of breath on exertion, and sweats profusely. She lies on her bed most of the day and does no walking or exercise at all. She used to play hockey, tennis and dancing, but can barely walk now. She is at high school, but often cannot get up of a morning to go in, and no amount of cajoling or chastising will get her up. She has no friends anymore because she can’t do the things that the other kids do.

My doctor says that she will refer my daughter to a dietician, but that is not the issue—she KNOWS what not to eat, but eats it anyway—a lot of the time in secret, as she doesn’t want me to know. I am out of my mind with worry about her, and here in England there is not a lot of help available in terms of advice.

There is nutritional advice, but when I spoke to a psychiatrist, he said that my daughter was making a lifestyle choice, and unless she was in danger of being an imminent threat to herself or others, they would not intervene. I just don’t know what to do and am at my wit’s end.

Dr. Pretlow’s Reply

Rest assured that you are not alone. Parents frequently post on our Parents Board about their frustration with a morbidly obese, housebound teen, and also chat about this in the Parents Chat Room.

Here are some suggestions:

  • Try to talk to your daughter as caringly as possible. Forget about her overeating and weight gain for the time being. It may take time for her to open up and trust that you won’t criticize her. Perhaps try peace offerings, things to build her self-esteem, like taking her out to purchase makeup or to a plus-size clothing store. When going out, you can try to avoid food as much as possible, but don’t make it an issue.
  • Try to distract her by taking a walk or going to see an interesting place. When she will finally talk, again don’t mention anything about her weight. Focus instead on what she’s feeling, and convey the idea that you care about her and want to help. She’s obviously in great pain—even though she probably won’t admit it. Most likely, she is caught in multiple vicious circles of depression, isolation, and poor self-esteem. Eating to ease that pain brings more weight gain, and more pain. There is also a willpower vicious circle, where trying to resist eating is stressful—and your daughter handles stress by eating.
  • Something traumatic apparently happened to your daughter at age 14 to cause her to seek relief first by cutting. (What was behind the cutting?) Then she replaced cutting with overeating, which is more socially acceptable, but the initial pain/trauma was/is still there. After turning to food to cope, she got into the vicious circle of withdrawing and turning more and more to eating as her main coping mechanism. Your daughter’s brain glommed onto eating as a way to escape from pain and stress and be comforted.
  • Brain wiring changes took place to keep this going. Now when she tries to stop, withdrawal symptoms occur (nagging urges, agitation, and nervousness). Plus, she probably feels a subconscious fear of losing her major coping mechanism of eating with nothing to replace it.

More next time!

Image by Larry Johnson

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