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Any left-over motivation, please?
Jim Spira, PhD · 6/16/99 at 7:42 am ET
In my "Coping With Medical Illness Group" the other day, a morbidly obese 48 year old woman with DM-2 and Hemoglobin A1Cs of 10.5 came for the first time. She stated that she was here to get motivation to exercise and improve her diet, since she was not exercising at all, and continued to eat lots of high fat foods. The group tried to suggest various strategies that worked for them, but she quickly rejected them all. I then tried the "stick", since the "carrot" clearly was unappetizing to her, and let her know that if she continued with her blood sugars at this level - due to her weight, diet, and lack of exercise - then she was looking toward painful neuropathies, a series of amputations, blindness, renal dialysis, heart disease, etc. She said that she knew all that, since her mother was on dialysis and died of diabetes related factors, and her uncle who lived with them had his left leg amputated and was blind due to diabetes. I asked her if she was resigned to having diabetes, and felt there was nothing she could do about it, to which she replied: "No. I know that if I exercise and eat right that I can contol it. I just don't have the motivation. That's why I came here." I felt in my pockets, but I was fresh out. Anyone out there have any for this woman? We've all had patients like this one. Short of Wellbutrin for exogenous stimulation (are these people defacto dysthymic?), I wonder if there is really much help for them? In a day treatment lifestyle modification program of 21 day duration I conducted at Duke University, I saw changes for these persons (they had no choice other than to leave the program, which few did). And I saw that many of these maintained their changes for up to six months post-treatment. But I have yet to be able to find a way to make a significant and lasting impact on such persons in an outpatient setting using group therapy (CBT/IPT), hypnosis, individual counseling, etc. Should we treat this like substance abuse and in the same spirit of "tough love" refuse to see the people unless they are actively engaged in some effort toward exercise and diet? Or should we allow them to come and hang out in the group, and believe that this somehow is making an effort? Any ideas out there?
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