It shouldn’t be surprising to learn that doctors and healthcare providers are often frustrated when patients with eating and weight concerns don’t follow their advice. They caution and cajole, nudge and lecture these patients often to no avail. An unspoken question comes to mind, “Why do these people continue to sabotage themselves?”
Here are five possible explanations for what why patients ignore their doctors’ advice on weight loss and fitness.
1. Fear of failure and hopelessness
Most patients with eating and weight concerns are not new to the concept of diets and exercise. In fact, providers may not know that their patients have gained and lost 50, 75, or more than 100 pounds several times in their lives.1 These patients have been there and done that, and it hasn’t turned out as well as everyone had hoped.
For most of them, the deprivation they felt while dieting was stupefying, and the restraint they had to muster daily was insufferable until they finally ran out of self-control and self-discipline and gave into eating normal portions, sweets and treats, and foods that they enjoyed.2,3 While providers are trying to psych them on starting a new health regimen, they’re recalling the last time they let their gym membership lapse and the closet full of smaller-sized clothes they fear they’ll never squeeze into again.
Many patients with eating and weight concerns have neurotransmitter imbalances causing depression and anxiety.4 Maybe they started out with the happy genes, but more likely not. Even if they did, the weight stigma and fat prejudice that runs rampant in society, not only through the media but from surgeons to secretaries in medical offices, would have demoralized them and shattered their self-esteem.
Patients who misuse food when they have the blues or the blahs may not even know that they’re depressed. Those who have social anxiety may not realize that eating is their way of coping when out to dinner with friends or attending a work party. They don’t want to hurt they bodies; they only want to feel the way that others appear to feel—relaxed and normal—when they’re around people.
3. Lack of life skills to attain and maintain health goals
Most of us weren’t raised with a full complement of life skills that foster effective self-care, healthy relationships, work and play balance, emotional management, goal achievement, problem-solving, and self-regulation. Moreover, we don’t all start out on an equal playing field. Sadly, dysfunctional families too often produce children who are lacking in life skills and end up with a diminished quality of life in adulthood.
Expecting these patients to make healthy choices when they’ve never been taught how to delay gratification or tolerate frustration is a waste of time. Hoping that they’ll call a friend when they’re upset rather than down a pint of Häagen-Dazs is misplaced optimism if they were raised in an insular family that mistrusted outsiders. Encouraging them to take a walk to unwind is wishful thinking if they feel they must be productive 24/7. We need effective life skills if we’re going to effectively take care of mind and body.
4. Mixed feelings about eating healthfully and losing weight
It may seem like a no-brainer to medical professionals that everyone would want to lose weight and be attractive. This is not always the case. Sexual abuse survivors often feel less vulnerable and safer with more meat on their bones. People who are more sexually active when they’re thinner sometimes fear that weight loss will compromise their marital fidelity.
Patients who’ve suffered emotional and physical abuse may insist that they want to date, but are afraid of relationships because of what has happened when they’ve let their guard down in the past. In other cases, holding onto excess weight may be a badge of suffering, a way to signify that life hasn’t been good to them. These are serious psychological dilemmas that won’t go away without clinical attention.
One of the most common reasons for not following medical advice is unconscious rebellion, which happens frequently with people who are confused about care versus control.5,6 If they had parents who were domineering, critical, and demanding (and parental dependence was encouraged), they, while wanting to follow providers’ advice, would resent being told what to do. They dislike being pressured, even to do what’s good for them, and will avoid doing it out of misplaced spite.
Rebellion is a complex dynamic which most patients and providers are unaware of. While professionals try to care for them, patients only feel and fear that they’re being controlled. No wonder what doctors say seems to go in one ear and out the other. It’s easy to see why this dynamic may seem like self-sabotage, but it’s much more unconscious and complicated.
Doctors and healthcare providers need not feel that without a graduate degree in psychology they can’t possibly do right by their patients who have eating and weight concerns. As long as they recognize that patients are not intentionally trying to remain unhealthy and hurt their bodies, and can offer empathy and compassion for their minimal and inconsistent efforts, they’re on the right track. Providers would also benefit from encouraging patients to get support from eating disorders therapists so that no one has to wrestle with eating and weight concerns by themselves.
Eric Stice, Kyle Burger, and Sonja Yokum, “Caloric Deprivation Increases Responsivity of Attention and Reward Brain Regions to Intake, Anticipated Intake, and Images of Palatable Foods,” abstract. NeuroImage (February 2013): vol. 67, 15: 322–330. Accessed May 2, 2017. https://doi.org/10.1016/j.neuroimage.2012.11.028.
Paul S. Maclean, Audrey Bergouignan, Marc-Andre Cornier, Matthew R. Jackman, “Biology’s Response to Dieting: The Impetus for Weight Regain,” abstract. American Journal of Physiology: Regulatory, Integrative and Comparative Physiology (September 1, 2011): vol. 301, no. 3, R581-R600 DOI: 10.1152/ajpregu.00755.2010. Accessed 5/2/17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3174765/.
A. G. Dulloo and J..P Montani, “Pathways from Dieting To Weight Regain, To Obesity and To the Metabolic Syndrome: An Overview,” abstract. Obesity Reviews (2015), 16: 1–6. doi: 10.1111/obr.12250, accessed 5/3/17, https://www.ncbi.nlm.nih.gov/pubmed/25614198.
Karen R. Koenig and Paige O’Mahoney, Helping Patients Outsmart Overeating: Psychological Strategies for Doctors and Health Care Providers. (New York: Rowman & Littlefield, 2017), 36-7.
Chelsea Fielder-Jenks, “Binge Eating Disorder and Anxiety,” Eating Disorder Hope, Accessed 5/2/17, https://www.eatingdisorderhope.com/information/binge-eating-disorder/binge-eating-disorder-and-anxiety.
Barbara Brody, “The Link Between Binge Eating and Depression,” WebMD, Accessed 5/2/17, http://www.webmd.com/mental-health/eating-disorders/binge-eating-disorder/features/binge-eating-depression#1.