Dear DOCTOR Owen:

Both my teenage son and husband are seriously overweight. They refuse to make any changes in their diet and laugh at me whenever I go out for a walk or leave for the gym. It makes me crazy because I know they will become sick. What can I do?

Mary the Meddler

Dear “Mary”:

Nothing. You can do nothing to make them change any aspect of their lives. While both of them may be subject to influence, few people, in my experience, can be made to change if they are not so inclined. Torment, threats, fear, and anger directed at them will only cause further resistance.

Think of it from their perspectives: Their bodies. Their health. If they want to injure themselves, it is their business. Of course, this is a self-serving philosophy. But do we not, in America, pride ourselves on being able to make choices and forge directions in life using our own free will?

Of course, you and I know that they will be the first to whine and be panicky about their sudden loss of health or social impairment. They will moan, look to you for sympathy and understanding, and ask you to help care for them and bail them out of the situation. Because you love them, you will accommodate—but it will “chap your butt,” as the cowboys say. You know that their self-delusion, or denial of the consequences, will affect you one day. That is what upsets you.

I do not have a good answer for you. However, I can repeat the profound advice of one of my behaviorists, who was an experienced drug rehab counselor before becoming a diet counselor (many similarities between the two behaviors): “If you are working harder at helping someone than they are at helping themselves, then who has the problem? What conflict in you needs to be rewarded by changing someone else’s life?”

Those of us in the medical profession must deal with this every day. I believe that we must learn coping mechanisms to deal with our frustration. Consider, for example, cigarette smokers who seek breathing treatment while puffing on their cigarettes; drug dependents who are always in “pain” and constantly seek narcotics; back- and joint-disabled patients who refuse to do prescribed, therapeutic exercises.

We healthcare providers are always in an emotional “crack” between anger and frustration. Our anger results from caring about a patient’s illness more than the patient cares. Our apathy develops out of frustration that our anger or education tactics aren’t working. Of course, both our anger and our apathy are defense mechanisms. When we succeed and when we fail, we put our own self-values and reputations on the line. Who wants to fail?

I can certainly be empathetic to your plight. People feel the most helpless when they know that a solution, which is readily available, is out of their hands.

Even more frustrating in your case is the love factor. You will never quit loving these two “goobers”! For better or worse, they are yours. If there is potential for change, it lies in the fact that you love them very much. And they, likewise, love you—even if it is sometimes discounted or “blown off” when you try to help them. What I hear from you is the pain of rejection. You try to help, but get rejected. Likewise, I hear their rejection: “Accept me for who I am. Must I change in order to be accepted by you?”

In reality, two separate issues are at play here: (1) Your concern for their health because of your love, your fear of the consequences, and the pain that the consequences will cause them—physical and emotional. (2) Total, unconditional love. Both you and they want the same thing! However, by talking around the subject, the real issues are never really addressed. Worse, a wedge may be developing that will make future communication between the three of you even more difficult.

Make sure the TV is off and the doors locked so they can’t escape when you follow these suggestions:

• Sit down with the two of them.
• Express your real fears.
• Express your unconditional love (if it exists) for them.
• Confront the issues of their rejection of you and your rejection of them.
• Tell them that you believe that their obesity is a serious, factual issue. Say that they, in turn, also must believe that this issue concerns them. If they say that they aren’t concerned, explain that your unconditional love for them won’t prompt you to comment, “I told you so” when they are disabled or rejected; rather you will always love and care for them.
• Then, never mention it again.
• Set your rules of behavior in the house and accept little else.

Regardless of their action or inaction, you will have earned their respect.