Obesity and Getting Fit for Life: A Teen's Experience

Summary
In this story of a teenage boy struggling with obesity, you will learn how it feels to be overweight and how family dynamics can fuel emotional eating. We'll discuss some obesity information and national trends, and we'll go over a solid program for making exercise a habit for life.

Manuel's Battle with Obesity
Manuel loved chocolate, donuts and potato chips, but he didn't like the effects that came with them. He hated being shunned by his peers, especially girls, but he felt that he couldn't stop eating the foods that were so unhealthy for him. He was not aware that he had an ongoing choice to eat or not to eat, and he felt out of control. He thought of food and automatically ate.

Other kids had been teasing Manuel and calling him names since he was in elementary school. He often felt hurt by these jabs, but he learned to hide his pain with half-hearted joking. When he was 13 years old, Manuel began to isolate himself in his room, gobbling down sweets while he did his homework and spent time on Facebook. Not only was he lonely, but he was starting to feel depressed. He was getting rejected when he reached out toward girls, and he knew it was due to his weight. He was almost 6 feet tall, but he weighed 300 pounds. As the teasing, staring and rejections triggered more pain, his caloric intake kept going up, and his self-esteem plummeted.

Some Facts about Obesity
Manuel's case reveals a disturbing trend among today's youth. Childhood obesity and the number of overweight children nearly doubled from the late 1970s to 2000.The numbers tripled among adolescents from the late 1970s to 2000. Estimates have steadily increased from about 15 percent in 2000 to 26 percent in 2007.

A study by the Centers for Disease Control and Prevention indicates these important facts:
• More than 75 percent of high school students do not eat the recommended servings of fruit and vegetables each day.
• About 30 percent of U.S. children do not exercise three times a week or more.
• An estimated 61 percent of obese young people have at least one additional health risk factor such as high blood pressure or high cholesterol.

Additional research shows that a large percentage of obese kids are depressed, although we do not know if obesity causes depression or vice versa. This growing trend could have a highly negative impact on the health and longevity of the next generation.

Manuel's Visits to the Doctor
For Manuel, going to the doctor's office was becoming very unpleasant because all he heard there were lectures about diets and health risks. His physician, Dr. Bennett, said that his cholesterol, glucose and triglycerides were at levels of serious concern. Dr. Bennett also said that Manuel had a high body-mass index and was obese and, because of this, he was 30 times more likely to be diagnosed with coronary heart disease, stroke, gout, osteoarthritis, hypertension, asthma and/or even some types of cancer. Dr. Bennett brought up the subject medication, but Manuel was opposed to this and promised to start exercising. Unfortunately, like many overeaters, Manuel was a procrastinator. He was headed for trouble and feeling pressured by his family when he decided to meet with me.

After a couple of sessions, I learned that Manuel had good intentions, but he found it very difficult to stay with a diet. He would experience cravings and repeatedly give in to them because he didn't have any effective coping strategies to contain his cravings. Manuel was growing increasingly depressed, and told himself things like "See, you are just a loser, and no one will ever like you." This is the typical distorted thinking of depressed people.

The Relationship between Obesity and Mental Health
Recent research indicates that obesity may trigger psychological disorders such as depression, distorted body image, low self-esteem, and eating disorders. Many obese people are depressed and struggling with the following:
• a lack of motivation
• fatigue
• a lack of interest in normal activities
• hopelessness
• thoughts of suicide
• difficulty sleeping
• sadness and feeling blue

When Manuel was growing up, his parents would remind him not to take third servings, but his parents consistently did so. Manuel rebelled by sneaking downstairs at night to eat sweets. He constantly craved chocolate, which researchers now know improves mood.

Could Liposuction Be the Answer?
When he was 17, Manuel found a reason to feel hopeful when he read about liposuction. He felt that this was the cure he had been waiting for, and he wouldn't need to change his bad habits. Like many overweight Americans, he didn't really want to change, but he wanted the benefits of change.

A 2010 study in Journal Pediatrics revealed that the complications of obesity surgery for teenagers were about the same as for adults. These included bleeding, infection, lung problems (post operative) and kidney failure while in the hospital. These procedures supposedly result in permanent weight loss; however, we do not know where these young people will be in 30 years.

The doctor said Manuel was a good candidate for liposuction because he was very obese, but in order for Manuel to have the procedure, the doctor wanted an evaluation from a psychologist to determine if Manuel had realistic expectations. In my professional opinion, his expectations were unrealistic because he believed that the surgery would magically take care of all his problems. He needed to spend at least six months in an exercise program to gain some positive lifelong habits. Fortunately, Manuel was willing to commit to the seven-week program that would make a marvelous difference in his life. I asked him to cut back on his calories after 8 p.m. because he consumed a lot of calories late at night and to work out four days per week for 30 minutes.

Get Fit for Life
Here are the five steps of my "Get Fit for Life" walking program that helped Manuel get fit and feel good:

1. Set aside 30 minutes to walk.
Manuel decided to walk before he went to school, so he could get it out of the way, but it could be at any convenient time. I usually encourage people to exercise in the morning because some research indicates that people are more likely to continue with an exercise program if they work out early.

2. Decide on the distance.
Manuel would determine how long his walks would be. He and I decided that 10 blocks around his neighborhood was a good start, and possibly 12 if he felt up to it. It was crucial to the program's success for Manuel to commit to walking at whatever pace he wanted. If he wanted to go faster he could, but when he felt like slowing down it was important to do so. Speed-walking and running were fine, too. The key was not to rush things, but to enjoy the walk. We were aiming to develop a positive addiction rather than overexertion burnout.

3. Listen to upbeat music.
I knew Manuel loved music, and research indicates that pulsating, high-beats-per-minute songs motivate people to move faster. During his 30-minute workout, Manuel would often listen to music on his iPod. He decided he wanted to listen to upbeat music, which would drive away his pessimistic thoughts and help him move faster. One of Manuel's favorite CDs was "Black Star" by Mos Def and Talib Kwelli.

4. Continue for seven weeks then decide whether to go on.
Manuel was to continue the walking program for seven weeks (49 days), and then decide whether he wanted to go on or quit. If Manuel decided he wanted to continue, he could commit to another seven weeks. After that time, he was free to decide what he wanted to do regarding exercise.

5. Don't beat yourself up for a missed day.
Manuel reminded himself that "everyone misses here and there." He and I then used therapy time to go over the ways that he sabotaged himself so he could understand himself better and really get with the program. In order to avoid postponing his exercise to another day, Manuel was to get up at 7 a.m., no matter what he felt, put on his shoes and start walking. He could crawl out the door as long as he got moving and went the distance. He encouraged himself by saying "I can do this, walking is easy, and I can do things other people can't do."

The combination of relationship therapy, music, the guidelines for the "Get Fit for Life" walking program, and positive encouragement resulted in Manuel staying with his walking program. Manuel reported feeling better, and he wasn't as hungry during the day. As he became more fit, Manuel's self-esteem began to improve, and he felt better about himself. Teachers and classmates started to reach out and support him in his mission to get fit.

Some people say it takes 21 days to change a habit, but when it comes to developing lifelong exercise habits, I recommend seven weeks, or 49 days. Adding weightlifting to his daily routine helped Manuel become more fit, and he later decided to join a gym. He still had a long way to go, but he had made significant progress: he had lost 25 pounds and was more toned, he knew he could achieve goals he had never thought possible, and he seemed to have a new lease on life. Manuel was in relationship therapy for about six months building a stronger relationship with himself and later with his parents. When I last saw him, he had a steady girlfriend and had lost 90 pounds. Most importantly, he had personal health goals and a commitment to achieve them based on his success.