When I first met Paula, she weighed more than 325 pounds, was shy and withdrawn, and spoke with a muted tone of heavy sadness. She was referred to me by her mother, who was seeking help with her daughter's obesity. Both had resigned themselves to the apparent intractability of her obesity, but still desperately hoped that something could be done.
A lengthy consultation included review of her history (I learned that an uncle had fondled and molested her when she was a teenager), examined her, and got the necessary laboratory tests. I then discussed her potential treatment options. These included bariatric surgery, but she felt that wasn't something she wanted. She said she might consider medications in the future, but for now she wanted to make some changes herself and take control of her weight. With the help of a food journal, she stopped consuming all regular soft drinks, abandoned her afternoon and evening snacks, and reduced her meal portion sizes. But despite my strong advice and pleading, she would not talk with a psychologist. We worked together for more than six months, building a relationship of respect and trust, during which time she lost about 90 pounds.