Mysteriously Obese Child Receives Help

Grande e Pequena

In Colombia, a charitable organization called Gorditos de Corazon (Chubby Hearts) received a heartfelt plea from the unemployed mother of 10-month-old Juanita Valentina Hernandez. For reasons that no one yet understands, the little girl weighs as much as a 5- or 6-year-old child. Her mother, Sandra Franco, is a slender woman who is at a loss to explain her baby’s constant weight gain. All she knows is that an infant who started out on the thin side began to look suspiciously bulky within two weeks.

At birth, young Juanita weighed around 6 pounds, but now weighs 44 pounds and is unmistakeably morbidly obese. The medical team looking into her case desperately wants to halt the inexplicable weight gain and prevent her from developing any of the numerous conditions that could possibly result.

The doctor who founded the Gorditos de Corazon charity, Salvador Palacio Gonzalez, has met three such babies in the past year – all are under a year old and weigh more than 20 kilograms, or 44 pounds.

The concerns, of course, are well known. A morbidly obese child is at risk for a number of alarming problems. These words are from Dr. Kristen Nadeau of the University of Colorado Cancer Center, who specializes in pediatric endocrinology:

Childhood obesity may itself be enough to cause outcomes including metabolic syndrome, cardiovascular disease, type 2 diabetes and its associated cardiovascular, retinal and renal complications, nonalcoholic fatty liver disease, obstructive sleep apnea, polycystic ovarian syndrome, infertility, asthma, orthopedic complications, psychiatric disease, and increased rates of cancer, among others.

That paragraph begins with the words “childhood obesity itself” for a reason. Even if a child who started out obese is able to lose weight later, and to maintain a normal adult weight, it is feared that childhood obesity can leave an indelible mark that affects the entire life cycle. This theory is speculative, because many victims of the childhood obesity epidemic are still young, but researchers have seen enough clues to raise plenty of red flags.

The need for conscientious longitudinal studies is seen as crucial, because following these kids through life – even if they lose weight – could verify these scientists’ suspicions by showing long-term results that are devastating. Dr. Nadeau speculates that because the maturing bodies of children are especially vulnerable, childhood obesity could change the whole metabolism of the body in “long-lasting and profound” ways that can never be corrected.

Once childhood obesity has established itself, reversing the condition is very difficult, and this knowledge highlights more strongly than ever the urgent importance of prevention and early intervention. Literally, every minute counts.

Your responses and feedback are welcome!

Source: “This ten-month-old is morbidly obese – and no one knows why,” Metro.co.uk, 01/14/15
Source: “Health effects of childhood obesity may be long-lasting and profound,” News-medical.net, 02/14/14
Image by Adriano Aurelio Araujo

 

Child Obesity: FAQs and Greatest Hits

children on park merry-go-round

This site is dedicated to exploring the physical, social, emotional, and political issues surrounding childhood obesity.

We invite you to explore some of our most popular — and controversial — posts and series. Here are a few examples:

Why is childhood obesity such a problem right now?

From food engineering to global marketing to the explosion of the video game industry, the world changed in several different ways over the past few decades. Dr. Pretlow calls this the “perfect storm” that led to the childhood obesity epidemic.

Why is fast food such a problem?

Fast food is inexpensive, easy to find everywhere, and tastes good once you get used to it. Dr. Pretlow and many other people believe that fast food is purposely designed to “hook” people into being addicted to it.

Why do many obese children suffer from diabetes, cardiovascular disease, and certain forms of cancer?

Those are a lot of questions! Here is an article about the beginnings of diabetes.

Can a child die from being overweight? 

Yes. When a person is so heavy that it’s life-threatening, that’s called morbid obesity.

What kinds of food make children fat?

Junk food is obviously bad, but a greater, largely unappreciated force is sugar.

Why don’t children just go outside and play more?

One reason is, the computer or TV gives an immediate reward, something to feel  good about right away. With exercise, the playing itself feels good, but the real rewards — such as a long, healthy life — don’t show up right away. Also, unfortunately, some children don’t live in places where it’s safe to play outside, and few school districts allow or encourage walking or biking to school.


Image by Ryan Schroeder

Dr. Pretlow on KCTS TV

TV still 2

Dr. Pretlow was one of the professionals interviewed on camera by Sabrina Register, of television station KCTS in Seattle, on the subject of childhood obesity.  The show mentions his W8Loss2Go smartphone app, and visits his very popular Weigh2Rock website, and even quotes three of the young people who have told their stories there. The station was kind enough to provide its public with both a YouTube video and a text transcript.

Update 3/2: The video has been removed. Listen to a brief clip here.

Dr. Pretlow enumerates some of the elements of the low Quality of Life quotient experienced by the one-third of America’s youth who are overweight or obese. These kids come up against one or more negative feelings, including poor self-esteem, shame, depression, and guilt. Often, they are subject to teasing and bullying.

The segment emphasized these challenges by giving the problem a name and a face, featuring high school junior Tana Denmark. We see her waterskiing in a t-shirt and pants, rather than the bathing suit most teens would wear. Ms. Denmark was a participant in the most recent study of the effects of Dr. Pretlow’s W8Loss2Go app, and lost a significant amount of weight.

Missing Pieces

The philosopher Arthur Schopenhauer said of truth:

All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.

In both geographic and temporal terms, this process is uneven. For instance, many people have come to accept that food addiction is a reality. They may be uncertain about the details, like whether it’s a substance addiction or a behavioral addiction, but the basic idea is accepted and established. Of course, other groups vociferously uphold their own received wisdom about what has caused the obesity epidemic, and some think food addiction is the silliest thing they have ever heard of. (Schopenhauer didn’t mention another option, which is to simply ignore a proposed truth.)

The process of producing a TV show involves a great deal of editing, a lot of picking and choosing, to satisfy time constraints and other factors. Quite often, excellent material is, to use the quaint old phrase, left on the cutting room floor, which may explain why some of Dr. Pretlow’s appearances in various media have not included everything he had to offer. But the longer version of this KCTS documentary, which has aired several times, included one of the hosts mentioning that Dr. Pretlow believes obesity might be caused by food addiction and that this premise underlies his W8Loss2Go program studies.

Also, the final product did include one of his examples of what not to do, illustrating a parenting style for which “enabling” is too weak a word. This was the story of a 13-year-old boy, weighing 280 pounds, who conscientiously packed his own school lunches with portion control in mind. But his mom continued to slip candy “treats” into the bag. To the mother, Dr. Pretlow gently proposed ceasing this behavior, but apparently it was not possible to stop because booby-trapping school lunches with calorie bombs was “her thing.”

Your responses and feedback are welcome!

Source: “Obesity’s Emotional Toll,” KCTS9.org, 02/12/15
Image by KCTS TV

 

The Flaky Fringe in a Jar

Marmite on Toast

Marmite on Toast

What causes obesity? This is a fertile area for both speculation and research, and certainly a place to find flaky fringe notions. Out of the hundred or so causes that have been suggested for obesity, at least a few are bound to be ridiculous.

But what if they are all true? Maybe one common factor causes 50 percent of all obesity, and another not-so-common factor causes 25 percent, and another causes 12.5 percent, and so on, in ever smaller increments. Eventually at the end of the spectrum, there could be an obscure factor that is only responsible for 0.0005 percent of obesity worldwide. But they all add up.

To complicate the picture further, out of the more than 100 causes for obesity that have been suggested, very few people belong on just one list. Most people will possess several of the more unlikely traits and characteristics that have been put forward as obesity villains. In the hard sciences, synergy is a known and accepted phenomenon. Small, seemingly unimportant factors, when combined, can result in something bigger than the sum of their parts.

History and Mystery

The most intriguing thing about the flaky fringe, of course, is that when we look back 25 or 100 years, it becomes clear that a lot of the most brilliant insights and significant discoveries began with what sounded like the ravings of cranks.

Unlocking the mystery of childhood obesity” is the very promising title of a piece by Amy Kennedy for the Hamilton Spectator. Scientists have known for a while that when pregnant women smoke cigarettes, their babies are more likely to develop obesity, but they didn’t know why. Dr. Alison Holloway of McMaster University and Dr. Daniel Hardy of Western University wondered about this, and did rat studies that showed a connection with folic acid deficiency in the mothers.

This leads the researchers to hope that folic acid supplementation, at the right time and the right dose, could reverse at least some of the damage done by mothers’ smoking. The bad news is, nicotine is nicotine, whether imbibed via the lungs or through a patch, or gum, or whatever. If a pregnant mom smokes cigarettes or sucks on nicotine lozenges, the effect on the developing fetus is the same — undesirable.

So, it would seem like a good idea to try and correct a certain amount of damage by administering folic acid, aka Vitamin B9. Repairing the harm caused by its deficiency might reduce childhood obesity. But this idea is complicated by the fact that apparently B9 can’t do its job unless the person is getting enough Vitamin B12. In this example of synergy in action, researchers have found that unless the necessary amount of B12 is also present, the B9 can instead cause the exact problem that needs solving:

An imbalance in nutrition seems to play an important role, and micronutrients seem particularly important. Normal to high maternal folate status coupled with low vitamin B(12) status predicted higher adiposity and insulin resistance in Indian babies.

To put it another way, the consequence of that imbalance can lead to metabolic syndromes, Type 2 diabetes, and — you guessed it — obesity.

The presence of folic acid in brewer’s yeast has been known for many decades, and people who focus on nutrition have used and recommended brewer’s yeast for at least a hundred years. Folk wisdom occasionally embraces a product, like the concoction known in Britain as Marmite and among the Australians as Vegemite. The favorite eating method it to spread it very thinly on toast, but there are other ways. More than ten years ago, Laura Barton wrote:

Pretty much the Holy Grail of foodstuffs, Marmite boasts a wide range of vitamins… Apparently, a mere four slices of toast and Marmite would provide a pregnant lady with all the folic acid she needs.

But because the lines between establishment medicine and the flaky fringe can be uncertain and shifting, brewer’s yeast proponents always have been and still are accused of quackery.

Your responses and feedback are welcome!

Source: “Unlocking the mystery of childhood obesity,” TheSpec.com, 01/18/14
Source: “Maternal nutrition, intrauterine programming and consequential risks in the offspring,” NIH.gov, 09/09/08
Source: “’It must be spread thinly. T-h-i-n-l-y…’,” TheGuardian.com, 01/04/02
Image by Pleuntje

 

Emotional Eating in Popular Culture

DaVincis Last Supper

Last Supper

 

In the Season 6 finale of the immensely popular TV series Mad Men, advertising executive Don Draper talks about his boyhood fondness for Hershey bars. It’s a saccharine, stereotypical tale reminiscent of a Norman Rockwell painting, and every inch a lie. Then, in the throes of some sort of emotional meltdown, he unexpectedly turns a routine business meeting into a therapy session by revealing the gritty, sordid truth of his traumatic upbringing, when a chocolate treat “was the only sweet thing in my life.”

But Don Draper wasn’t the first. Food as comfort is everywhere in one of the oldest texts around, the Bible. It would in fact be easy to construct an entire syllabus around just the food references, like in the Song of Solomon, where it says “comfort me with apples,” or in Ecclesiates, where it says “Go, eat your bread with gladness.” Eating and emotions, feelings and food.

Sweetness has traditionally been equated with goodness and value. Honey as a simile or metaphor is so familiar that we hardly even notice the significance of it any more. In the Book of Psalms, something that makes a person happy is compared with the most delightfully tasty substance known by humankind at the time. The parallel is so obvious that we completely take it for granted. Here are two examples:

More to be desired are they than gold, yea, than much fine gold: sweeter also than honey and the honeycomb … How sweet are thy words unto my taste! Yea, sweeter than honey to my mouth!

Writer Erin Davis adds a few interesting twists:

Isn’t it interesting that the original sin centered around food (remember Eve and the fruit) or that Christ’s first miracle was food-and-drink related (water into wine)? … When Christ reminds His followers in Revelation 3:20 of the intimate relationship He desires to have with us, He talks about dining together: “If anyone hears my voice and opens the door, I will come and eat with him, and he with me.”

When Moses led the people out of Egypt, they feared they would starve in the desert before reaching the Promised Land. But miraculous food fell from the sky, a white substance that tasted like honey wafers. It was called manna, which also became the word for a “sudden and unexpected source of gratification, pleasure, or gain.” The Israelites lived on this heavenly substance for 40 years, surely a sign that the deity took a personal, parental interest in their well-being, and expressed love by providing food. Manna was so important that they were instructed to save a jar of it, as proof for future generations — a jar that is (at least according to legend) inside the Ark of the Covenant.

In other sections of the Bible, Jesus demonstrated love for the crowd by multiplying a little bit of food into enough to feed 5,000 people, and often referred to himself as bread from heaven. And there is of course the sacrament of holy communion.

Our bodies need food, and our psyches need to know that others care for us. The two needs are often conflated by humans who are lonely, confused, hurt, and afraid. There is a direct thread between the Israelites who were fed in the desert, and the lost little boy who became Don Draper, and the obese child who absorbs love in what is often the only way available, through the taste buds.

Your responses and feedback are welcome!

Source: “What Does the Bible Say About Food?,” LiesYoungWomenBelieve.com, 09/28/11
Source: “manna.” Merriam-Webster.com, undated
Image by Wikimedia Commons

Opportunism, Charlatanism, and Obesity

Snake oil

2014 was a big year for what William Anderson calls “weight loss quackery,”  with the government making four companies promise $34 million in refunds to customers. Their previous promises, made on behalf of their products, involved the fast and effortless removal of fat from the customers’ bodies. For instance, the HCG (Human Chorionic Gonadotropin) diet combined the hormone, administered intramuscularly or sublingually, with a 500-calorie-per-day diet, and helped people lose weight. Of course, combined with such a skimpy caloric intake, a daily dose of normal saline solution would have the same result.

A chain of skin product boutiques known as L’Occitane sold plenty of what must be the hundredth iteration of another scam — a product that only had to be rubbed onto the body to melt away fat. With “clinically proven slimming effectiveness” it would “visibly reduce the appearance of cellulite.” Uh-huh. Another company,Sensa Products, went broke, and was only able to repay a small fraction of the $364 million it made by selling a product people would sprinkle on their food to allegedly lose 30 pounds.

A company called LeanSpa perpetrated “the largest natural food products fraud ever,” by pushing acai berries and colon cleansing on a series of “fake news websites” the company created. About any prospect of improvement in the field, Anderson is not optimistic. He says:

The FTC has been catching these frauds for years. They just pop back up the next year with new gimmicks with new names and sales pitches.

Coincidentally, his recommendation of acai berries was one reason why Dr. Mehmet Oz was scolded by U.S. Senators at a hearing held by a subcommittee concerned with consumer protection. Nearly a decade of television presence has made Dr. Oz a trusted figure. Critics suggest he may not deserve such trust. Sen. Claire McCaskill derided his blend of news, entertainment, and medical advice as misleading and harmful, saying:

When you feature a product on your show it creates what has become known as the ‘Dr. Oz Effect’ — dramatically boosting sales and driving scam artists to pop up overnight using false and deceptive ads to sell questionable products.

The problem is that whenever the popular TV advisor mentions a generic product, like acai berries, unscrupulous manufacturers publish ads claiming that he endorses their particular brand. Rather than encouraging them, Dr. Oz says he has even sued companies for using his image and name to promote their brands — to no avail.

One Natural Foods Con Artist Down; Hundreds to Go

As con artists go, Charles Davis is probably pretty typical. In 2007 and 2008 the California man raised more than $2 million from 40 people who thought they were investing in a product that would treat childhood obesity. Also, they were promised that in just over a year, they would get a 15 percent return on their money.

Late in 2011 Davis was sent to prison, and then tried again last summer on additional charges resulting from another venture — a company making a product called DT2 that would treat Type II diabetes. That scam affected only 25 investors and took in under a million dollars, which Davis used for personal expenses, including attorney fees to defend against the original charges. In June he was convicted of mail fraud, wire fraud, and money laundering, which reporter Matt Coker noted could earn him as much as 240 years in prison. Apparently the sentencing, scheduled for October, was delayed, because no information is available on how that turned out.

Your responses and feedback are welcome!

Source: “ 4 Top Weight Loss Scams of the Year (So Far),” HuffingtonPost.com, 01/29/2014
Source: “The ‘Dr. Oz Effect': Senators Scold Mehmet Oz For Diet Scams,” NBCNews, 06/17/14
Source: “Investment Scam,” OCWeekly.com, 06/24/14
Image by Wesley Fryer

Heaviness and Happiness

my first steps

As Dr. Pretlow has observed, it can be difficult to get young people to express their thoughts and feelings about their own obesity.  For this reason, the relationship between weight and quality of life in adolescents is a topic somewhat shrouded in mystery. Adults are easier to read, according to William Anderson, licensed mental health counselor and author of The Anderson Method, a book commemorating his own journey.

Thirty years ago, Anderson lost 140 pounds. He has kept it off since then, and has guided a large number of clients and readers of his work to the accomplishment of similar feats. In response to the titular question “Will Losing Weight Make You Happy?” he says,

As they shed the pounds, my clients show an amazing transformation in their mood and quality of life. To describe them as ecstatic would not be an exaggeration in most cases. There is no question that losing weight makes people happy.

This affirmation comes with a caveat or two. For starters, to focus solely on weight loss is not The Answer, and may in fact add to the problem. Losing weight can pump up self-esteem, but only if there was a certain amount of pre-existing self-esteem. Something can’t be made out of nothing. A weight-loss victory can, figuratively speaking, be a trophy on a person’s shelf — but only if there was a shelf there in the first place to build on.

To alleviate the misery, a person needs to focus on the underlying issues that led to weight becoming a problem. Until those issues are resolved, the project is doomed to failure. The priority, Anderson says, must be “fixing your relationship with yourself.”

A Paradox of Acceptance and Change

It is a truism in the mental health field that unless a person is accepted for who she or he is, that person will have a very difficult time changing. It’s not impossible, but it’s very, very hard. Conversely, acceptance is almost magical in its ability to unlock the potential for personal evolution. Acceptance is the WD-40 of psychological dynamics. It unsticks things, and there can be discovery and healing and forward motion.

Nowhere is acceptance more important than in the relationship with the self, and Anderson recommends an inner restructuring equivalent to a “conversion experience.” This involves “replacing some of your most closely held beliefs with more worthy ones.” One thing we need to do is to value and respect all people based on criteria more meaningful than their appearance. And it goes without saying that we need to value and respect ourselves, even on a day when we look like something the cat dragged in.

Anderson suggests that we look to small children for inspiration. A baby tries to walk, falls down, and maybe takes a break for a while before trying again — but she does try again. Except for a very few in special circumstances, every child eventually learns to walk, and the average toddler teaches a major lesson:

Persistence is not a matter of having never quit. Persistence is getting up and working at it again … Like a baby, people who are successful fail and quit many times. But they keep getting back up, and eventually, they are doing well enough to be fit for life.

Also, we need to recognize that whether people want to be the same, or different, more forces are at work than just their wanting to be a certain way. If willpower was the answer, a whole lot more people would be successful, good-looking, healthy, adorable and irresistible. It behooves us to have compassion for others and for ourselves because:

We are born into a body and brain that we did not choose or create ourselves, and then we have to figure out how to live in it….We need to love ourselves regardless of circumstance, fat or fit, with our successes and our failures … If you are overweight, I guarantee that losing weight will make you happy…. At the same time, I guarantee that there are other things you need to change about yourself, and with that, you have a chance at lasting happiness….

Your responses and feedback are welcome!

Source: “Will Losing Weight Make You Happy?,” HuffingtonPost.com, 02/04/15
Image by Gustavo Devito

Mental Illness Impacts Quality of Life

Hansel and Gretel

In the fairy tale “Hansel and Gretel,” a child is captured by a witch who feeds him so he will be nice and plump to cook and eat. The story has analogs in many cultures. The website TV Tropes gives more than 30 examples of stories (including a Simpsons episode) in which one or more characters are overfed for the eventual purpose of becoming the main course of somebody’s meal. The page, titled “Fattening the Victim,” explains:

A character tries to fatten another character like livestock … in order for the latter to be bigger to eat, or die of obesity. If the guest refuses to eat, the character might try force feeding them instead … Another variant is when the victim convinces their captor to “fatten them up” first to bide time for an escape plan.

Ideas make their way into popular culture, as they did into fairy tales (the pop culture of their era) for deep archetypal reasons. At some point in human history a psychologically valid principle was recognized, and, through storytelling, taught to children and the population at large. The process of fattening is the precursor of victimhood. A victim is someone with a throwaway life, a disposable unit sacrificed for the selfish or sick needs of another. Nobody wants to be that.

Do some parents suffer from mental illnesses that compel them, like fairy tale witches, to fatten up their kids? Do some children instinctively recognize that, like Hansel, they are trapped by a powerful and dangerous adversary? Can kids intuitively sense when they are being used to serve a parent’s selfish or sick needs? What does that do for their quality of life?

FDIA

Childhood Obesity News described emotional incest and Folie à deux, two parental mental illnesses that would negatively impact any child and could very well account for a percentage of childhood obesity cases. There is another rare and potentially deadly condition. Picture this harrowing plotline:

A person acts as if an individual he or she is caring for has a physical or mental illness when the person is not really sick. The adult perpetrator … directly produces or lies about illness in another person under his or her care, usually a child under 6 years of age … even willing to have the child or patient undergo painful or risky tests and operations in order to get the sympathy and special attention given to people who are truly ill and their families.

While it sounds like a Stephen King story, this is actually a real mental illness, Factitious Disorder Imposed on Another (FDIA), which used to be called “Münchausen syndrome by proxy.” The people diagnosed with FDIA are usually mothers, usually notorious liars, and often they have enough medical knowledge to dole out slow poison or otherwise control a lengthy course of illness in the victim. FDIA is so serious that dealing with it requires a whole raft of personnel— “a team that includes social workers, foster care organizations, and law enforcement, as well as the health care providers.” But wait, it gets worse. The Cleveland Clinic says:

In some cases, a child victim of FDIA learns to associate getting attention to being sick and develops factitious disorder imposed on self.

In other words, a certain number of FDIA victims find their condition rewarding enough to take over and purposely cultivate it, either consciously or unconsciously. At some deep level, the psyche believes it is better to be special, even in a messed-up way, than to be nothing. This disease of “factitious disorder imposed on self” used to be called Münchausen syndrome. Put it together with the fact that in our society, the condition of morbid obesity is very easy to self-perpetuate, and a causal relationship might be found.

But although it is a mental illness, FDIA is also criminal child abuse. It is beyond shocking, and no one wants it to be true. But since there is such a disease, why not ask an interesting question? Has a mother, suffering from FDIA or a similar mental aberration, ever purposely allowed a child to become morbidly obese? Would that be a prosecutable offense?

If a parent’s mental illness causes a child’s morbid obesity, can she or he be punished? Forced into treatment? Held morally responsible? Taking children into protective custody and releasing them to foster care are measures usually considered extreme. Sometimes, even to seasoned and non-judgmental health care professionals, they discouragingly seem to be the only answers available.

Your responses and feedback are welcome!

Source: “Fattening The Victim,”? TVTropes.org, undated
Source: “Munchausen Syndrome by Proxy,” clevelandclinic.org
Image by Morgaine

 

Food Addiction: Alternate Diagnoses

One Month Old Today

Here is the confluence of two trains of thought. The first concerns the omission of food addiction from the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders. The other is the quality of life experienced by an obese child – not as a result of the obesity, but beforehand. Not just the inconveniences and humiliations of being overweight, but the challenges of life in the home of origin, the ambient psychological atmosphere of the nest in which the person is raised.

Between the covers of DSM-5 are many categories, but one diagnosis that might explain a portion of child obesity cases seems, like food addiction, to be missing. Regardless, we are assured that this aberration does exist by Dr. Patricia Love, who wrote The Emotional Incest Syndrome: What to Do When a Parent`s Love Rules Your Life. Emotional incest is described as a “surprisingly common but rarely identified” condition, in which the afflicted parent will overly bond with a “chosen child.” Physical acting out may not take place, but the child becomes, in all other ways, the needy parent’s surrogate spouse. Dr. Love says of a typical patient with father issues:

She now understands that their overly close relationship was the source of many of her problems – including her most vexing one, obesity. “I think I’m avoiding relationships by stuffing myself with food,” she told me. “A part of me is still connected to my father. It feels wrong to be with anyone else. So I eat and eat.”

Folie à Deux (Madness for Two)

Folie à deux is the discarded terminology for a type of mutual mental illness that also used to be called Shared Paranoid Disorder. (A clinician seeking its DSM-5 identity would have to choose between Delusional Disorder or Other Psychotic Disorder.) The primary patient is typically older, more intelligent, and possessed of a stronger personality – qualities that describe most parents – and indeed more than half the known cases involve same-sex relatives, usually mother and daughter. The delusions fostered by the psychiatrically ill primary patient are unquestioningly accepted by, and become reality for, the impressionable secondary patient. The literature says:

The acceptance of these beliefs results from a lack of critical evaluation by both members of the dyad and in the secondary patient it may be aggravated by the social isolation recurrent in these patients.

Like a cult leader, the delusional primary patient has a vested interest in cutting the weaker person off from other influences. Although Folie à deux was responsible for some widely publicized historical homicides, it can also appear in humbler guises. A mother, for instance, might take advantage of living with a daughter “for a long time in a close relationship, sharing their lifestyle, feelings, beliefs and hopes without any outside influence.” Such a mother might indoctrinate a daughter with the belief that being overweight is not only okay, but desirable. It is, after all, a big cruel world out there, and staying home Saturday night to bake cookies with Mom is a safe choice.

Other Suspect Family Dynamics

Dr. Sigmund Freud blew lid off the institution of the family and identified it as the root of quite a few problems that will not go away any time soon, no matter how many case studies we read. Behind closed doors, between people whose main interest should be caring for each other, things get crazy. A reader sent this in:

Years ago, I met a guy who was just released from his 26th stay in the mental ward of the local hospital. Every time he got admitted to the looney bin, he felt like he was scoring a point against his rich and powerful father, who had to pay all the bills. I wonder if any teenagers stay fat as a way of getting revenge?

What a chilling thought. Could there be such tormented young people, so angry that, consciously or unconsciously, they want to stay obese forever to punish their parents? Is there a kid somewhere whose mission is to be a living, breathing reproach to paternal neglect, a constant reminder of maternal narcissism, a 500-pound monument to parental failure? In the face of such egregious dysfunction, what can a school nurse or a social worker do?

Your responses and feedback are welcome!

Source: “The Emotional Incest Syndrome: What to Do When a Parent`s Love Rules Your Life,” google.com, undated
Source: “Folie à deux: how it fits in DSM-5,” handle.net, 2014
Image by Tom Page

 

Obesity: The Worst-Case Scenario

Noodle looking out the window

Hector Garcia called himself “the worst-case scenario” for reasons clear to anyone familiar with the thorough and revelatory account of his last four years on earth, as compiled by San Antonio Express-News staffers Jessica Belasco and Lisa Krantz. Garcia started out as an overweight child and ended up weighing over 600 pounds and dying of an officially unspecified cause, though it was probably chronic obstructive pulmonary disease, as he himself had predicted. He was working on a memoir called “Life Behind the Glass,” relating to the idea he expressed like this:

I always pictured myself as a child with my head up against glass looking at life happening and I was stuck behind the glass. Because no one, no one wanted the fat kid.

That was a bit of emotional exaggeration. Hector Garcia was not shunned like a leper, or tarred and feathered, or ridden out of town on a rail. In actual fact, he had a slew of relatives who were fond of him, as documented by the reporter/photographer team. With such a large family, he was probably seldom alone, unless he wanted to be.

Of course, loneliness comes in various flavors, and he did miss out on other kinds of relationships. He told the news team how he regretted being unable to marry or father children. Technically, he could have done either, especially during the intervals when his bulk was drastically reduced (once by bariatric surgery and another time by diet and exercise). But Garcia explained that because of being an overweight child and teenager, he had never developed social skills, especially with girls. He had learned at an early age, he said, that it was better if he kept to himself.

The Bitter End

Still, it is not true that no one wanted the fat kid. His mother, Elena Garcia, doted on him. In a video clip, the two of them ride scooters through the aisles of a grocery store, symbolizing with grim appropriateness that for both, feeding Hector was a top priority. Still, there is something not just touching, but disturbing, about the photos of Hector and his mom tossing a basketball back and forth. Back home, on his 49th birthday, Hector embraces the cake, as his mother sings to him.

Of all the strands making up this tragic tapestry, the most devastatingly ironic detail is how Hector Garcia met his end – indirectly, through the mother who cared for him so devotedly for almost 50 years. Discharged from a short hospitalization, she did not call ahead but arrived home unexpectedly and rang the bell. Hector answered the door, his breathing labored as usual. Then he collapsed, turned purple, and expired.

Toxic Environments

The news story mentioned the various factors that make up the current “toxic food environment” in America, but never suggested the possibility of a toxic parent. It was not the job of the reporter and photographer to psychoanalyze their subject or his parents, diagnose their mental states, or even point out their human shortcomings, if any. To suggest anything awry in this family dynamic would be a serious overstepping of bounds. Sensitivity is always of primary importance when dealing with a bereaved family.

Unconditional love is a miraculous thing, and no one provides it better than mothers and fathers. Still, encountering a similar story to this one, a cynic influenced by Freudian theory might point an accusatory finger at one of the obese person’s parents. Feeding a son or daughter into a state of un-dateable obesity could effectively keep that child at home forever, with the parent never challenged by a rival. Surely, somewhere in the world there has been a mother so crippled by insecurity or a father so blinded by possessiveness as to carry out such a plan.

In the context of a movie based on a Stephen King story, the birthday cake scene would look pretty creepy. In this true-life documentary, the editor chose to place these words immediately before that scene. Hector Garcia says:

A lot of the times we’re like this not because we want to be but because certain circumstances in our life have set the table in a certain way. This is a path that we’ve almost been forced to follow, and we don’t know how to get out of that path.

He said something else that could be interpreted in more than one way:

I want people to know what happened to me…. I don’t want other people to go through the suffering that I went through.

Your responses and feedback are welcome!

Source: “A Life Apart: The Toll of Obesity,” expressnews.com, 12/27/14
Image by MsSaraKelly

 

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