Long before I was a Board Certified Family Medicine physician involved with Obesity Medicine, I was a Teaching Fellow and Performing Arts Consultant working for the Kennedy Center for the Performing Arts in their Very Special Arts Program. I had an assignment to travel to a remote and rural area of Vermont to do a week-long workshop for a local school district, working with classroom teachers, physical education teachers, and administrators on how to integrate dance into the classroom and how to integrate movement into the academic curriculum.
On touring this small town, population under 3,000, I was initially struck by the quiet beauty of the area and then quite literally by the size and body habitus of the community. Everywhere I looked, it seemed that people, children and adults were incredibly large, with round faces and protuberant bellies hanging over their belts — those who could wear belts, that is; many were simply wearing pants with elasticized waistbands.
The next day at the school, a teacher remarked to me that most of the kids in her classroom were extraordinarily overweight and depressed, unable to concentrate. She stated that most of them got that way because, in this community, there was a high incidence of alcoholism and domestic and sexual violence. It had become almost a cultural custom: “Protect your kids from the predator (usually in your own home) by making them fat, ugly, and hence unappealing. Fat boys and girls were not the ones who got raped, beaten, or otherwise abused in this small community.”
The school had specifically wanted workshops and teacher training for their staﬀ that included dance in the hopes that it would inspire the student population to get motivated to move and that the creative aspect of dance arts would inspire their souls. In his book, The Body Keeps the Score, Bessel Van Der Kolk, M.D., describes that one avenue toward healing trauma is to let the body have experiences that deeply and viscerally contradict the helplessness, rage, or collapse that results from trauma.
In her recently published book, Hunger a Memoir of (My) Body, New York Times bestselling author, Roxane Gay, writes about how her path to morbid obesity, self-loathing, despair, desperation and depression was precipitated by a gang rape at the hands of a school mate and his friends. Like the youth of the rural town in Vermont, Gay writes, “I was swallowing my secrets and making my body expand and explode. I found ways to hide in plain sight, to keep feeding a hunger that could never be satisfied — the hunger to stop hurting. I made myself bigger. I made myself safer.”
Many years later, I would come to learn that the trauma was often the common denominator lurking behind the twin symptoms of depression and obesity. I would also learn that sometimes the obesity came first and that mental and emotional collapse would follow years later as a person struggled throughout their lifetime within a culture that tends toward cruelty, intolerance, and indiﬀerence towards people living with larger bodies.
Every day across all medical specialties, physicians see people living with obesity. At the very least, I would encourage all of our colleagues to fine tune their listening skills when taking the history of their patients. Use available tools to assess for depression, anxiety, and domestic violence — regardless of why the patient has initially sought out the visit. When there are any signs of depression, mood disorder, or mental illness, refer the patient to an Obesity Medicine Specialist whose four cornerstones of treatment are: Nutrition, Physical Activity, Medication, and Behavior. If the patient is in need of further support or treatment for psychosis, the Obesity Medicine specialist can also supply the appropriate referral to Psychiatry. With the proper continuum of care the result can be an engaged patient in a healing partnership that can change the outcomes of our system of providing healthcare.
Behavior change and extensive patient education materials are interwoven into all of Robard’s medially-supervised weight loss programs. If you’re a medical provider and would like more information, click here.