An Easy Keeper

My last patient the day after Thanksgiving wasn’t happy with her two-pound weight loss. Everyone else who got weighed in that day had gained some weight, and each person had an excuse.

Cheyenne Mott is a striking young woman of twelve, going on seventeen. She has some of the features of her tall, reddish-blond father, yet seems like a spitting image of her dark, fiery-eyed mother. Like both of them, she is big-boned, but unlike her concrete-laboring father and her highly disciplined mother, Cheyenne has not been able to keep her weight under control.

Cheyenne has been on antidepressants for a couple of years. I have known her parents for years, but her for only a few months. It quickly became clear that her weight is her biggest issue. Last year her parents sent her to a camp for overweight girls, and during a few short weeks of strict dieting and rigorous exercise, she lost an impressive twelve pounds, yet gained it all back very quickly.

We talked about her efforts at self-discipline and her two-pound weight loss over the Thanksgiving week. She wasn’t able to see losing two pounds as a modest victory, but thought of it as a frustrating experience.

She pointed out that other girls eat more than she does, and are thinner. “It’s not fair,” she exclaimed. “I can’t even look at food without gaining weight,”

I tried to reach through her frustration.

“You are what we call an easy keeper,” I began. “You have a genetic ability to survive starvation, and that may have been a really great thing a thousand years ago, but now it means that if you eat like everybody else you will somehow gain more weight than they do on the same number of calories. And if you cut down your calorie intake, your body will slow down enough so you won’t lose as much weight as other people do when they go on a diet.”

She rolled her large, deep-set eyes.

“It’s like everybody else drives a Hummer with a 32 gallon tank and you drive a Toyota Prius that holds 12 gallons. What happens if you try to put 32 gallons of gas in a 12-gallon tank? It overflows, and when that happens it doesn’t matter if you think it’s fair or not, it’s just the way it is!”

She nodded with understanding, and I continued: “You’re just more fuel-efficient than your friends, and that can be a good thing in some ways, but it means you can’t keep comparing yourself with them,” I repeated.

She seemed to get it, and her mother acknowledged how hard she always had to work to keep her own weight in check, yet she threw in: “So you don’t think there is a medicine that could help Cheyenne?”

“No,” I answered, adding, “You already know you lost twelve pounds at camp. I know I sound like an old fuddy-duddy, but you don’t need a pill to do what you already proved you could do last year at camp. And look at what you just did; you are the only person I saw today that lost any weight over Thanksgiving!”

“I did lose two pounds,” she said with just a hint of a smile.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.



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