Discussion Topic

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

“I get really discouraged,” Josh says. “It’s not like I neverhave will power, and at times I have starved myself for days andspent long afternoons on the treadmill while watching TV. But thenI get so hungry that once I start eating I can’t stop. At othertimes, I work hard at dieting and exercise for so long, but I’m sobig that I can’t see any difference. Of course, the stares when Igo 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 giveup and turn to comfort food. It’s very discouraging. I feel likeI’m living inside my own personal prison.”

On further intake, the nutrition nurse learns that Josh has verytense relationships with his four older brothers, who havesometimes bullied him. “Even when we get along, they make jokesabout my size,” he says.

Josh reveals that when he was small, he was not overweight, buthe was also not very athletic like his older brothers. He feltseparated from them by the fact that he had no interest in ortalent for the athletics his brothers constantly engaged in athome.

“Plus I was just a lot younger, and when they’d tease me, I’dcry and my mom would comfort me with treats. As I got heavier whenI 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 brotherwould 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’dbe so angry, I’d do it. The more I did it, the more they harassedme, 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 sotrapped by my own compulsions.”

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

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

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