T Nation

My Brother is Morbidly Obese


#1

I just finished a conversation with my grandfather who is a physician and he advised me to reason with my brother about proceeding with bariatric surgery. My brother is over 300 pounds and his BMI is in the range for morbid obesity.

At his last recent physical the doctor said there were no problems with his bloodwork (I'd personally like to see those results for myself). My brother is resistant to my grandfather's micro intervention because of his botched perineal surgery from years ago, though I understand that perineal surgery is very difficult and often causes complications.

I personally would like to give my brother another chance to solve his problem without resorting to bariatric surgery, though I have no fears over the safety of the procedure or doubts about it's efficacy. I'd just rather see him eat a healthy diet no matter what.

My Brother has declared that he will lose weight on a number of occasions, but it has never lasted very long. There is no prior incidence of obesity in my family or extended family (though my brother is actually my half brother). So he's living with family members who are for the most part considered "lean". Until my brother turned 15 he was considered lean himself (he is now 28).

Unfortunately I live a province away and I can't really be there to monitor his dietary habits. Fortunately he has the palette to eat a healthy diet, but clearly he doesn't always "eat like an adult".

Does anyone have experience with this sort of conundrum?


#2

You are between a rock in a hard place for sure. I heard it from my nutrition coach a long time ago and I have almost (almost) always found it to be true. He said "you can change almost anyone, even total random strangers literally just pulled off the streets but the hardest, most stubborn people to change, is your own damn family."

I have very rarely seen this not to be true. The other family member may get dragged some where, to a nutrition lecture, diet-guru, doctor, super markets - make promises and swear only to return to normal habits within a few days or worse hours.

I know this sounds like a "no hope" reply but that is kind of the way it is. When I watch shows like Intervention I see a lot of similarities of people with food and diet. They wont change unless they want to change. You cant make them. He has to do it for himself. You can sit there and cut your heart out and bleed it dry for him and it wont do anything. Ive seen people lose family members this exact way.

If you can try to find out what provokes him. Why does he eat trash? Did something happen to him a while back? Why wont he change? What can possibly make him change? Does he even know what this is doing to him? Do you even know? Who is going to take care of him when he is sick? Then really sick? Then hospitalized.

Watch the documentary Sick, Fat and Nearly Dead with him. See if it strikes a cord. Is he depressed? On medication (of any kind?)? Is something else making him fat?

Some people you have to hit them just the right way, with the right string of words, thoughts and ideas in order to produce change.


#3

I can answer some of these.

He is aware of his situation and it's clear he wants to lose weight. I don't think there's anything to this problem other than the habits he picked up when he went to a private school around age 17. Chocolate milk was on tap at the cafeteria. Daily consumption of pasta, pizza and the like probably got the ball rolling. I recall when we were young he used to eat unusually large quantities of cheese and was never often to be seen without a bag of chips and a coke.

Nowadays he's a fairly "gifted" drinker and he's a tradesman so he spends his time in pubs with his colleagues. In my opinion if the quality of his foods changed and the frequency of his drinking was measurably reduced we would see a significant change, without having to get into the business of logging his macros (at least in the beginning). And he has the palette for meat fruit and certain vegetables.

We're also pretty certain that his weight problem is affecting him emotionally, and it's part of the reason that he's been single for a long time because it affects his confidence.

What I don't know is if there is any special reason why he keeps falling off the bandwagon other than submission to his cravings. I live too far away from him to have a very accurate picture of the situation.

The fact still remains that my family has decided that he'll listen to me if no one else.

Hopefully when they all get to see the results of the cut that I'm on (7% is my goal) he'll broach the topic with me, so that he doesn't feel like he's being harassed about this.

I also looked at the trailer for that documentary and I noticed that it's fairly focused on the concept of juicing, which isn't the worst thing you could do I suppose.


#4

dropping that booze would certinley help. when i hit 18, my friends and i were down the pub nearly every day, and i ballooned up to 250lbs (this was before i lifed weights). Simply not drinking every day brought me down to 225lbs without any other changes


#5

Yeah I think this would be the best place to start for him. One vice at a time rather than trying to control every variable right from the beginning.


#6

Ok cool, so there is a lot of hope invovled with this particular situation. If you PM me I may be able to direct you on an approach to help with this situation.

Better nutrition would be helpful but I think the first goal would be to limit or ideally completely stop drinking. Everything from insulin, carbs, sugar, alcohol all seems to be striking his reward center and further fueling the problem. Its a cycle that can cause depression which causes more poor choices which causes depression etc etc and it just keeps spinning. An ideal situation may be complete detox from all of the above and reset.


#7

I myself was about 300 pounds and have lost over 100. I went back and forth constantly and always said I was going to lose weight and then fell off the wagon a couple of months into it every single time. I eventually got my act together when I started weight lifting.

What personally does it for me is to look at a piece of food and ask myself if eating it is worth more to me than my life and my happiness. That's the kind of mental frame of mind that you have to get him into. He needs to ask himself if he's really happy how he is and how much more happy and fulfilling his life can be if he can get himself on track.


#8

Just tell him that if he doesn't lose the fat, he's going under the knife.

Even you're not going to be able to help him if he's not motivated. If he IS motivated, and like, really trying, then you might be able to help him put together a solid plan.

I say "if" because it sounds like he's having a pretty good time with his current habits.


#9

^I agree. That is like being for an intervention because you want 20" biceps. What we do isn't normal. I say "we" even though it is very clear very few here really stand out as far as carrying more muscle than the average gym goer. To be for forcing someone to have surgery they don't want would be like being for putting someone into a mental institution because you think they have "bigorexia".

Being fat doesn't always mean you are drastically unhealthy...and if surgery goes wrong, he will only have his family to blame for pushing him.

Unless this is part of some deep seated attempt at self suicide or food addiction, what is with the need to force a change in this way?


#10

I hear your concerns. So far no action has been taken other than my grandfather's recent "micro-intervention" as his profession calls it.

If you went in for a physical and mentioned you smoked the physician will usually give a micro-intervention such as "have you considered quiting smoking", then the patient will usually say "no, my life is too stressful right now, blah blah blah", and you leave it at that. But they're finding that later the patient will return having thought about it.

This is essentially what my grandfather did with my brother. My brother's reply was that he was concerned about the safety factor (though bariatric surgery has become quite advanced and the safety is very high I will note).

In any case I've heard from my brother's mouth that he wants to lose weight in the past and I'm personally for lifestyle change rather than gastric banding or a gastric bypass. And I'll also note that since his obesity began in his teens he has been single (which is not so reflective on the obesity as it is lack of confidense).

For now I plan to do nothing until my brother tells me he wants to lose weight again.


#11

My brother takes the low road and just calls me fat every chance he gets. Its actually quite motivating. Also humorous. He's pretty good at making up new fat jokes. My guess is that you can probably berate and belittle him into actually wanting to lose weight rather than just saying it. Just a thought.


#12

lol ^


#13

Well I'm thinking more about laparoscopic banding in this case, but I am still with you concerning the wtf factor about either concept.

If complications due to obesity arise (he's only 28 right now) the benefit to risk ratio will also rise. But yeah, just so everyone has it clear, I'm not telling him to get bariatric surgery when and if we talk about the subject. And I'll also say that I haven't seen or spoken directly to him in 5 months or so.


#14

I feel sorry for your brother. I was a fat kid, and even though my parents pushed me to loose weight, until I hadn't made up my mind, it was in vain. He needs to decide to change for himself. And I really don't see the point in the surgery. My father had a gastric band implanted few years ago, he was constantly vomiting after meals. Not a glamorous way to go. Reducing the length of absorptive surfaces in GIT sounds more dangerous to me. I wouldn't push this.

He needs to change his habits, bit by bit. He's under 30, later, with every year it'll become more difficult. The sooner he decides, the better. Try to reason with him, but hell, say no to surgery.

I'd love to see my cousin on scale. The guy was 140 kgs ('bout 310 pounds) a year ago (15 yo computer geek) and by the look, he added at least 10 kilos. Insane. I know he's 6feet tall, but I don't think a 16yo guy shouldn't be able to walk to the sec. floor without taking rests..

His parents just ignore his weight completely. They feed him with incredible quantity of shit, one meal of his contains probably more calories than an average post-competition binge for a BB. High BP, troubled breathing, fucked up body, the guy is constantly hungry.


#15

Interesting that you mentioned height. My brother is 6'4, and his legs are actually quite dense, when we were younger he seemed to put on muscle from doing nothing (but eating of course). I'll bet there's actually some decent mass under there. By no means is he a powerlifter but his height does offset things.

Anyway, I know he's a reasonable and intelligent guy, and I know he hate's being fat, we'll just have to wait and see what he'll do next.


#16

Punch your brother in the face.


#17

6'4" and 300lbs doesn't even sound that fat to be discussing surgery.


#18

^^^ i agree, i used to be 265 @ 5'10 and never would of considered surgery. IF he cuts his cals and works outs for months he could easily drop 40 lbs just as a start.


#19

I have friends who are about 6'1" and over 300lbs. While they are built more like linemen, I have a hard time understanding why surgery would even come up here.

Surgery is for people who are literally so far gone that their only choice to live more than a year or two is to cut down the size of their stomach so they stop killing themselves with food.

We are fucked as a society the moment this becomes a bandaid for mild obesity.


#20

Let him live his own fucking life. Maybe he just doesn't care about losing weight. There are some people in the world who know the dangers of their lifestyles but simply choose not to care. In his case he is apparently not even that unhealthy. The best you can do is tell him the facts, the consequences, but let him make the choice. It's his body.