At the screening interview, there are times when the first thing I notice about the prospective new patient, seated in my waiting room, is that they are clearly overweight, sometimes even obese. But more often than not, when I ask: “How can I help you?” Weight is not their first or main concern; and sometimes it doesn’t get mentioned at all. In cases like this, I make it a point to ask during the course of the interview:” Are you happy with your weight?” The response is often a clear indication of the patient’s prognosis. The more emotionally disturbed the interviewee, the more defensive is their reaction. Some are so defensive that they bush off the question altogether.
But before too long during the course of treatment, a topic emerges that I can link to food and eating, such as weight related illnesses, physical complaints, depression, eating too much or too little, genetics. In order to rule out organicity, I ask if there has been a full physical exam, blood work. test results in the recent past.
If all tests are negative, I assume that emotional eating may be a factor. I might ask: “Do you eat when you’re not hungry?” “What is your comfort food of choice?” Some people prefer sweet, some smooth, some like salty, some like crunchy. Preferences mean different things to different people. My next question is invariably: “What feelings are you stuffing down with food?”
There are plenty of self-help books on dieting out there but if self-help books really worked there would only be one.
