Facing the Stress of Success

Lee Kern, M.S.W., L.C.S.W., Clinical Director for Structure House

Ol' catfish in the lake we called him Big Jim
When I was a kid my only wish was to get my line in him
Skipped church one Sunday rowed out and throw'd in my line
Jim took that hook, pole and me right over the side
Went driftin' down past old tires and rusty cans of beer
The angel of the lake whispered in my ear
"Before you choose your wish son you better think first
With every wish there comes a curse"

~ from Bruce Springsteen's With Every Wish

Weight loss seekers enter the journey with the wish to be successful. While success may mean different things to different people, studies suggest a typical goal is to lose enough to arrive at what is called a "dream weight." In psychology there is a strategic intervention called motivational interviewing, which draws on the principle that change is often "ambivalent," meaning that there are pros and cons to healthy change. Could it be that success, by its very nature, poses stresses that could undermine it? It may be too strong to call these threats to success a "curse," but if they exist and are denied or unrecognized, they will only have more power to undo the best of intentions. Let's take a deeper look at some of the potential obstacles success creates

THE ROADBLOCKS

Loss of power. Bob ran a successful business of 50 employees and was proud he never had to raise his voice to manage his staff. He attributed this in part to administrative skills, and in part to a physically intimidating appearance. At 6'4" and 285 pounds, when he said, "jump", they jumped. After shedding 30 pounds during an intensive treatment stay, he worried that upon returning to work he would lack his old physical presence, making managing people more difficult. Loss of weight meant fear of loss of power.

Unrealistic expectations. After a 50-pound weight loss Sharon felt lighter both physically and emotionally and honored the new sense of freedom by planning a two-month trip to third world countries, something she had put off for years. As we planned eating strategies based on her itinerary, she indicated the hope to lose weight at her treatment center pace. I cautioned against such elevated hopes and advised that maintaining weight during the trip would be a huge accomplishment. In addition, she expected weight loss to dramatically improve her dating quotient upon returning home. She needed to learn to set realistic weight loss goals and avoid setting herself up for disappointment by exaggerating the benefits of success. Getting dates required strategic social networking, not just losing weight.

Destabilized relationships. After Bob got back home, he found that his new eating patterns had triggered marital tension. Before treatment he and his wife bonded with cocktails and snacks while watching the news; however, new healthy eating strategies called for replacing the TV and its associated calories with a stress reducing walk. His wife felt unappreciated and together they had to explore other ways to nurture the relationship's need for relaxed entertainment time. When one member of a relationship changes, it impacts the partner and negotiation needs to occur to accommodate new patterns of eating, activity and role.

Loss of protection. Martha, a physician, did not realize how much she used her weight to provide interpersonal safety. Introverted by nature, she tended to keep to herself at medical society meetings, but after a diligent weight loss from 270 to 210, she became the subject of a lot of compliments. The result was a variety of thoughts that displayed discomfort: 1) She distrusted the compliments, knowing how much more weight she wanted to lose and feeling they were undeserved. 2) She interpreted them as a sign of the superficiality of others focused on her body and not the person inside. 3) She felt judged, imagining the negatives that people must have thought about her when her weight was up. 4) She had a sense of lost ownership of her body, which was now the target of attention, and was tempted to regain in order to enjoy the invisibility of the past. The boundaries that weight created were gone and needed to be handled in more functional ways.

No more excuses. Eileen felt she worked hard and could not understand the poor performance review she received. She concluded that that the problem was not her, but her boss's prejudice toward her weight. This motivated her to lose weight, but when she continued to get bad reviews, she reluctantly accepted that she was not doing a good enough job. She realized she had been using her weight as a container to pour excuses in to that allowed her to save face. Without the weight, she had to take more responsibility for her performance outcomes

New role for food. Imagine a new medicine that is touted to lift your mood, induce a good night's sleep, give you energy, and entertain you when you are bored. Drug companies work hard to discover effective agents for any one of these things; one pill that did it all would be a miracle profit maker. Before her by-pass surgery, Cindy used food for all these effects, contributing to 100 pounds over her desired weight. Post-surgery was another story, as the role of food narrowed to eating for basic nutrition. She felt raw, like a friend had died, when she began to confront the loss of eating as a quick and easy way to cheer up or give herself pleasure. She had to develop new, more healthful methods to address the old needs.

Complacency. John was dedicated to using all the nuts and bolts of behavioral weight loss. He kept a detailed food diary and daily weight charts, planned meals ahead and developed grocery lists, weighed and measured portions and calories, and exercised an hour a day. After a loss of 70 pounds, his confidence turned into cockiness. He worked more hours, exercised less, and thought he could get by making meals plans "in his head" instead of in writing. Complacency occurs when confidence leads to a shift in priorities and cutting corners. It is hard, but necessary, to accept that the strategies that led to losing weight are the same ones that keep it off.

CLEARING THE WAY

The path to success is not unidirectional. We may encounter roadblocks, but if we consult a map, and remain persistent, we can get to the destination. It helps to know what the roadblocks are, that we are not alone in facing them, to expect them and view them as challenges.

The following principles can assist in clearing the way:

1. Weight used for interpersonal power needs to be replaced with greater assertiveness and improved communication skills.
2. Set realistic goal weights; expect a slow paced loss with fluctuations. Consider planned periods of maintenance.
3. Losing weight does not solve everything. It won't cure shyness or every health problem. Improve social or career skills if you hope to make more friends or get promoted.
4. Keep track of the small benefits of weight loss, like changes in clothing sizes, greater mobility, or reductions in medication.
5. Put yourself in the shoes of significant others; recognize that your changes may threaten them. Listen, empathize, educate and negotiate.
6. Practice accepting compliments. Tell yourself it is OK to feel uncomfortable with them, and affirm that you are looking and feeling better.
7. Take responsibility for the boundaries you need with others. Claim alone time; remember it is OK to not feel ready for high amounts of socialization.
8. Admit shortcomings without weight as an excuse and view them as challenges or opportunities for growth.
9. Food is for nutrition. Allow yourself to grieve the loss of using it for love, reward or entertainment. Take responsibility for meeting those needs in more functional ways.
10. View the problem as life-long in nature. It is less about weight and more about living healthy the rest of your days.

The Springsteen song ends with a sense of optimism. We may get lost at times during the journey, but we can quench our thirst and move forward, cross the next river and get to the other side. Face the roadblocks, clear the path and take the next step to success.

About the Author
Lee Kern, M.S.W., L.C.S.W., is the clinical director for Structure House, a residential weight loss facility in Durham, N.C. Kern leads the bariatric surgery program. Designed for patients preparing for, or following weight loss surgery, the program offers surgery-focused medical assessments and personalized eating and relapse prevention plans. For information, visit www.structurehouse.com or call 800-553-0052.