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Intimate Lives of Fat People

December 8, 2011 by Beth Rontal Leave a Comment

Surgery Not “A Magic Pill” for Obese Patients

After working at a bariatric surgery center in a major Boston hospital and in my private practice, I’ve seen life changing successes and heart breaking disasters.  Surgical weight loss is not for everyone but it is right the right people. What makes it right is when the procedure is used only after everything else has been tried and when it becomes a spring board to do the hard work of learning to listen to your body; eat when it ‘s hungry and stop when it’s full and pay attention to the feelings that are no longer being stuffed with food.  It’s even possible to learn to love your body exactly the way it is, fat, thin or even with sagging post surgical flesh after weight loss surgery. There are no long term quick fixes.  Even after surgery, it takes time and committment and often support from a professional to maintain the weight what has been so hard to achieve and to develop a self image and intimate relationship that is based on love and acceptance rather than the habit of self hate.  This article, For Obese, Intimate Lives Often Suffer, explains what happened to a couple and their sex life before and after bariatric surgery.

September 21, 2011 from KQED, Part of an ongoing series on obesity in America

It’s well known that obesity can lead to a lot of health problems, but what’s rarely talked about is the impact on people’s sexual health. As the obesity rate has soared in the U.S., more and more marriage and family therapists are getting questions from obese clients about problems in the bedroom.

It’s an issue that Dana Englehardt and her husband, Larry Boynton, of Belmont, Calif., know well.

When Englehardt met Boynton more than a decade ago, she was quite heavy. She was a straight-talking nurse, widowed with three kids. He was a local contractor looking to end his swinging bachelor days and get serious. Boynton says he didn’t focus on Englehardt’s size.

 “Once I decided to put that out of my mind and allow the relationship to grow with the person I was falling in love with — her personality and how much fun we had together — it just really wasn’t an issue,” Boynton says.

After they married, Englehardt gained another 60 pounds. Her joints ached. She could barely stand during her nursing shifts. Grocery shopping and gardening left her winded. She had terrible sleep apnea and was exhausted all the time. And then there was the sex. The thought of making love to her husband felt like a chore.

 “I suffered a lot of guilt because I knew that I wasn’t meeting my husband’s needs. That was the worst part — the guilt,” Englehardt says.

In all this, Englehardt came to see her body as something separate from herself. She wouldn’t look at her reflection in storefront windows. She raised her makeup mirror so she could see only from her nose on up. And when she settled in for the night, she didn’t want Boynton to touch her.

“I just felt kind of hideous. I didn’t like when he would touch me because it reminded me of all the bulk there. And then I just kind of avoided sex for a long time,” Englehardt says.

 “At one point it was six months. And I was almost climbing the walls. She would get intimate, kissing and everything, but then it wouldn’t go anywhere, and that makes a guy very frustrated. And so I didn’t want to get frustrated, so therefore, I just shut down,” Boynton says.

All of this went unsaid. The pair didn’t talk about it. They did what so many couples do: They retreated.

A Pattern Emerges

Clearly, there are obese people who are happy, fulfilled and feel deeply connected in their relationships — emotionally and sexually. But in the interviews done for this story with marriage therapists, sexual health doctors and weight researchers, a pattern emerges: Obese people — especially those trying to lose weight — are more dissatisfied with their sexual lives, and obese women seem to suffer the most.

I suffered a lot of guilt because I knew that I wasn’t meeting my husband’s needs. That was the worst part — the guilt.  – Dana Englehardt

“Instead of enjoying their sexual intimacy, they’re worried about the size of their stomach or, ‘Oh my god, he’s going to touch my stomach. What’s he going to think about my stomach?’ ” says Ronnie Kolotkin, a psychologist at Duke University Medical Center who designed a widely used survey that measures how obesity affects quality of life.

 “Women reported many more problems with sexual functioning than men. And in fact, women’s scores were even lower than a reference group of cancer survivors,” she says. Kolotkin says the problems for men and women are different.

 “Women often talk about difficulties with enjoyment, low sexual desire, avoidance of sexual intimacy, as well as some difficulty with sexual performance; whereas men are more apt to tell me in private practice or in group therapy about performance difficulties and embarrassment related to that,” she says. Some of this is biological: As men’s weight increases, testosterone production can plummet, leading to erectile dysfunction. Weight-related diabetes, too, can result in sexual problems.

But sex is not simply desire and arousal. For many long-term couples, emotional closeness and physical intimacy hinge on trust. Eric Leckbee, a tall and friendly 42-year-old software engineer, knows all too well what happens when that trust is broken. He lives in San Francisco with his wife, who didn’t want to be interviewed. At times, he’s reached 300 pounds. But it was when Leckbee’s wife caught him hiding food that his sex life really took a nosedive.

 “It causes the question of what else are you hiding? I’m not being honest with her. To be really, truly intimate with someone, sexually and emotionally, you have to be able to trust them. So she puts barriers up, and then I feel defensive and I put barriers up, and then it causes more of a chasm to occur between us,” Leckbee says. “When you start feeling more emotionally distanced from each other, then you’re less likely to want to have sex or even enjoy the sex that you have.”

Leckbee has done a lot of therapy just to talk about all this. Still, he’s often repulsed by his body and has had a hard time imagining that his wife finds him attractive.

 
“I felt it nearly impossible, not impossible, but very, very hard to approach my wife for sex, to hit on my wife, and then I would think, ‘God, you’re a loser, you don’t know how to hit on your wife, the one woman in the world who should be open to your sexual advances,’ and yet, I would have that fear,” he says.

Finding A Path To Openness

All of this would crawl around in his head. It still does. When he feels confident, he’s able to maintain his diet, even go on a bike ride. But those periods give way to darker ones when he becomes quiet and distant.

“When I’m feeling fat and depressed, I’m not communicating very well, and that breaks down the intimacy, which breaks down the amount of sex and the frequency of sexual intimacy,” Leckbee says.

Leckbee’s weight still fluctuates. But he and his wife are now trying a new approach: to separate his weight from their sex life.

 “My wife, saying to me, ‘I love you and I’m attracted to you regardless of your weight.’ That was something I needed to hear and something I needed to believe, though I still struggle with it,” Leckbee says. “But it’s, now I’m more self-aware, now I understand it, now I’m able to look at it and go, ‘My libido is really low right now because I’ve been eating too much and I’m feeling bad about myself.’ I can express it to my wife and let her know I’m feeling this way.”

This process of recovery — both physical and psychological — is messy and seemingly unending. For Englehardt, her health had become so bad she took the drastic step of getting bariatric surgery.

Post-surgery, Englehardt says she fantasized about a renewed sex life with her husband.

 “I think I did have unrealistic expectations that after I got this new body that he was going to suddenly be all over me, and that didn’t happen. And I think he went so long with me being uninterested that when I was interested again, I don’t know if you have trouble believing it, that I was interested again, but you … it took a while for you come around,” she says.

“It took a while for me to realize what the signs were again,” Boynton says.

The couple went to counseling and started figuring out how to communicate — about a lot of things, including sex. Now, Boynton says, he knows the signs.  

TV show(In the CBS swries Mike & Molly, Molly Flynn (Melissa McCarthy) and Mike Biggs (Billy Gardell) show a healthy intimate relationship. While many obese people lead happy and healthy sex lives, therapists are seeing more obese people who say their intimate lives are suffering because of their weight.)

“I know it now, and it’s nice. It’s very, very nice,” he says.

Englehardt sought her own counseling to exorcise her deeply held belief that she was an unlikable fat girl. “It’s kind of nice ’cause I can just kind of lose myself in the moment and not be thinking about, you know, ‘Oh God, he’s touching my belly fat again,’ ” she says.

It’s been several years now of hard discipline to keep the weight off and of painful therapy, but finally Englehardt is able to fall into that fugue state — that dreamy abandon — that lovers often inhabit.

Filed Under: Surgical Weight Loss, Weight and Sexuality

Therapy helps but…

December 7, 2011 by Beth Rontal Leave a Comment

That wasn’t always just coffee in those coffee cups!

Therapy helps but...

Filed Under: Humor

Holiday Eating Anxiety

November 23, 2011 by Beth Rontal Leave a Comment

Holiday Eating Anxiety

The holidays are here and for many this is the dreaded season of “eating anxiety.”  The holiays are a time to share good food with good company.  Company parties, family events and celebrations with friends all mean lots of opportunities to wrestle with temptation. I won’t give you a lecture of what to eat and not eat.  You’ve heard the list so many times you probably have it memorized, if you’re not totally confused by the contraditions and mixed messages.

The multitude of magazine advertisements for wonderful holiday meals and “sinful” desserts are on the opposite page from the articles on how to keep from gaining those unwanted pounds all that wonderful food will inevitably add to your waiste line.  The marketing of the food and diet industry reinforces for many of us, a belief that our desire for the food we want is immoral.  This dicotomy sets in motion the desire to crave what we think we “shouldn’t” eat, eat it immediately and eat a lot of it.

What happens when you eat what you think you shouldn’t is that your body/mind doesn’t easily register the pleasure of eating.  When you are telling yourself that what you’re eating isn’t OK to eat, you have to eat more to feel satisfied than if you allowed yourself to enjoy the experience from the beginning.

So I encourage you to avoid eating anxiety.  Don’t make what you eat a moral dilemma with legalistic rules for what’s allowed and what isn’t.  Legalize food this holiday season –and all year long.  If there is any other advice, it’s to taste what you eat and savour it so that you really enjoy the experience.  You may be surprised to find that the chances of eating just the right amount are greatly increased.

Filed Under: Managing Holidays and Celebrations, Mindful Eating

Menopause and Weight Loss

November 20, 2011 by Beth Rontal Leave a Comment

Menopause and Weight Loss

Menopause can be a real kick in the butt when it comes to weight gain. It certainly was to me and adds insult to injury for those women who have always carried more weight than they wanted (or that the culture thought was pretty) prior to going through menopause.  

I think my story is reflective of the stories of some other women in this predicament.  Prior to menopause, I was not unhappy with my weight until I slowly started gaining when I went through “the change” and gained 25 pounds.  In general, I ate well and have for over 20 years. My definition of eating well is organic with a minimum of reduced sugar, flour, grains and dairy. I don’t count calories. I eat as much healthy fat as I want.  I drink moderately.  But after a year of exercising a 2-4 times a week I still didn’t lose weight.  Even after the impulsive parts of me that wanted to binge on a box of cookies or a bag of chips relaxed and didn’t overeat, I didn’t lose a pound.

What I didn’t know is that fat cells produce estrogen. An increase in fat during menopause is the body’s natural resistance to estrogen loss.  So it’s natural, normal and even healthly good to gain some weight. It was the 25 pounds that had me baffled.

This is where I believe biology and chemistry come into play. I decided to work with a holistic wellness coach who prescribed supplements targeted to specific organs of my body that needed support. After a month I dropped a couple of pounds. After 5 months I’d lost 15 pounds. My desire for sweets almost disappeared as did my feelings of deprivation.  I could easily pass up the cookies at work. My need for caffeine also diminished. It appears that my body needed nutritional support to cleanse, repair, feel satisfied and energized. As I cleansed the toxins, I was able to shed the weight with a great amount of ease.  So what I’m saying is that even when we are …

  • no longer trying to rigidly control what we eat,
  • not yelling at ourselves for eating too much,
  • able to eat mindfully; eat when hungry and stop when full
  • feel nutured by our food, friends and family
  • and still not lose weight …

there may be a bio-chemical issue that needs attention that healthy food choices alone can’t address. This is why, at some point in my work with clients, I recommend they work with a holistic nutritionist. I work with the emotional and psychologicial issues. The nutritionist works with the food.  It’s proven to be a highly effective combination of support.

Filed Under: Healthy Choices, Nutritional Counseling

Don’t Believe Diets Don’t Work? Try This.

November 5, 2011 by Beth Rontal 2 Comments

Don’t Believe Diets Don’t Work? Try This…

Many people have heard that diets don’t work but have a hard believing it even though they’ve tried and failed many times.  Diets don’t work for all the reasons that I wrote about in my July post called, “It Makes Sense to be Confused About Diets.” Briefly:

  • Diets end because they are based on deprivation
  • Deprivation is unsustainable
  • Willpower fades because it’s an imposition of your determination to restrict your food over a natural desire to eat

An intellectual understanding of why diets don’t work can’t compare with knowing it on an experiential level; not by “failing” at dieting but simply by breathing.

If you’re adventurous, try this 30 second exercise to get a firsthand experience of what happens after you deprive yourself of food. … Ready?

Take a really really deep breath.  (Think of it as bingeing on air.)

Then blow it out… more,

more…

more…

and even more…

until you have not an ounce of breath left.

Now hold your breath for 10 seconds or until you just can’t hold it anymore.

Now… breathe… finally.

Notice what happened? What kind of breath did you take?  If you found yourself taking a really really deep breath in an attempt to replenish what was missing, you just experienced how your body reacts to a diet.

You have to eat just like you have to breathe.  Diets end because they are based on deprivation and deprivation is unsustainable — just like depriving yourself of air is unsustainable.

You can’t hold your breath indefinitely no matter how determined – just like when it comes to food, your willpower fades because it’s an attempt to restrict your food over a natural and perfectly normal desire to eat.

So if diets don’t work and weight loss or maintainance is important, what do you do?  Read “It Makes Sense to be Confused About Diets” (found under “Mindful Eating”) as a start on your journey to learning how to eat in a way that feeds you body and soul.

Filed Under: Binge Eating, Mindful Eating, Mindfulness

Being a Psychotherapist and Costume Designer

October 30, 2011 by Beth Rontal Leave a Comment

Being a Psychotherapist and Costume Designer

I recently read a very interesting blog by Zelik Mintz, a psychoanalyst in NYC.  He wrote about the similarities he experienced between being an actor and a psychotherapist.  He also discussed the controversial topic of what psychotherapists tell or don’t tell clients about themselves.  He got me to thinking (again) about self disclosure and my own transition from being a costume designer to being a psychotherapist.

After 18 years as a theatrical costume designer, I became a psychotherapist in my 40s.  When I first thought of changing careers, I saw the connection between the two but others, particularly other therapists and academics, could not.

 Costume designers need to ask several questions in order to create costumes that make sense in the show and on the backs of the characters. Some of these are the same types of questions as the ones we ask ourselves and our clients as therapists. 

  1. What is the relationship of the character/client to him or herself? 
  2. What is the relationship of the character/client to the other characters in the play/client’s life?
  3. What is the relationship of the character/client to his or her environment?
  4. How did the character/client get in this situation?
  5. In what direction does the character/client want or need to go?

As a designer, we explore these answers by studying the text, researching the time period and discussing these questions with the director, set designer and actors.  We then design the costumes choosing colors, textures, fabrics and all the other design elements to highlight these multi-faceted relationships.

As a psychotherapist, the colors and textures are not of our choosing.  These are what the client brings to the “show.”  Simply put, our job is to help the client find the relationships between his or her own colors and textures and then choose paths designed to bring more happiness than grief.

Here is where self-disclosure comes in.  A client may not know details of our lives but we cannot be a blank slate even if we try to hide all our own design elements.  How we dress and decorate our office can speak volumes even in silence.  The words we use reflect our education and even perhaps our spiritual beliefs.  How we help clients explore their colors and textures is a result of our own world view, life experience and training.  I just happened to get some of my training in the costume shop.

Filed Under: Self Disclosure

Food Matters

October 18, 2011 by Beth Rontal Leave a Comment

Food Matters

Don’t stop eating your favorite foods.  Just try shifting to a healthier version.  Watch this video to find out why.  Then switch from classic Oreos to the Newman’s Own brand as a good start to a healthy life-style.

Filed Under: Food, Healthy Choices

Transforming Overeating

September 30, 2011 by Beth Rontal Leave a Comment

Transforming Overeating

FREE introductory mini-workshop

Created by: Beth Rontal, LICSW & Patricia Thatcher, LICSW

Tuesday, Oct. 25th, 7-8:30 PM EST

You are cordially invited to attend a FREE mini-workshop to introduce you to our Transforming Overeating group process. You will have an opportunity to explore what’s blocking your quest for a healthy relationship with food and experience the Tapas Acupressure Technique, a heart opening and gentle process that reduces stress related to the issue.  We will gladly answer questions you may have about how the Transforming Overeating Group can help you get what you really want out of life.

Dr. Judith Rodin, Pd.D. says, “Dieting may be one of the root causes of disordered eating.” Discover why diets don’t work and how you can learn to self-soothe without food.

TRANSFORMING  OVEREATING  IS  ABOUT…
*  Making peace with food and your body
*  Trusting yourself
*  Eating when you’re hungry and stopping when you’re full
*  Having nurturing relationships
*  Being free to have more fun and joy in your life

Results of pre- and post-assessment questionnaire from five previous groups reveal a dramatically improved relationship with food and feelings and realistic weight loss. “Eating to soothe my feelings” was reduced by 50%. More results of the group are detailed in the article, Weight Loss That Lasts; A Group Program Offering New Hope for an Old Problem, and published in the February 2011 issue of NASW Focus Newsletter.

TO REGISTER: We need to know if you’re coming so please let us know by sending us a message.  If you’d like to participate by phone, we’ll send you the conference call number once you contact us. 

Did I mention this is free?

Come get a taste of what you’ve really been craving…

Filed Under: Transforming Overeating Group

The Greatest Love of All

September 27, 2011 by Beth Rontal Leave a Comment

The Greatest Love of All

Imagine what you could do if you believed in yourself and experienced a fraction of the joy that this little girl fully embodies?

Fill in the blank:

When I believed in myself and feel this much joy I can/will ____________________.

(Let me know what you think.)

Filed Under: Hope, Motivation, Overeating

How Many Tries Does it Take… ?

September 5, 2011 by Beth Rontal Leave a Comment

How Many Tries Does it Take…

… to get one good video?

And you thought I was talking about diets.

Diet’s don’t work but having fun does.

Filed Under: Humor, Tapas Acupressure Technique, Transforming Overeating Group

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