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Cara has been seeing me in therapy for several years for help with her food and weight issues.  A bright, attractive woman married to a great guy, she has a significant amount of weight to lose.  Over the years, she has lost weight through dieting only to gain back more than she originally lost. The extra weight holds her back sexually with her husband, decreases her physical activity and has contributed to arthritic pain. She fears that cancer, heart problems or diabetes could be in her future.  

Through the course of our work, she has made tremendous progress in multiple areas. She’s set up her life to pursue her many creative gifts, including building a career that combines her business savvy with her passions.  She and her husband have improved their communication.  She has widened her network of support and developed deeper and more authentic friendships. 

However, her weight has barely budged.  Frustrated with herself and this therapy process, she wonders if the change will ever take place. She has trouble trusting that, in fact, she has been putting the pieces in place for her to finally succeed. 

There is a term in Science called “homeostasis,” defined as: the property of a system that regulates its internal environment and tends to maintain a stable, constant condition.  Family therapists use this term to describe the family system.  Members of a family often feel pressure to remain the same so as not to throw the system off balance. Rigid families discourage change, while flexible families are more likely to evolve in positive directions together.

In a healthy family, the dramatic weight loss of one member may cause everyone to get healthier; the system is flexible enough to “bend” and it can re-organize itself at a higher (healthier) level. But in a rigid family system, one member losing weight may put too much pressure on the family. Sometimes the family cannot bend that far, and it breaks.  

For Cara, the fear of this break is at the root of her weight problem.  Losing the weight for good will take a profound and deep mental shift. In order to consistently make the daily changes, she will have to re-write her family story--a story which was composed generations ago.  Then she will need courage to hold onto her new story while remaining engaged with her closest family members. 

Cara grew up in a working class family in a small town.  Her parents divorced when she was a kid and it was her job to care for her younger sister, do well in school and be the emotional caretaker for her parents.  As a child she comforted herself with food (like everyone in her family).  No one spoke of, nor thought about, the concept of emotional needs.  Life was about daily survival.

Cara grew up fast.  Bright, exceedingly capable and responsible, she pretended that she was fine so as not to trouble her family. Over the years, her weight climbed as she buried her feelings in food.  She went to college, got a job and left her small town for the big city.  

Cara was saddled with two conflicting family messages: while it was her role to bring esteem to her family (they loved to “brag on” her successes) it was also conveyed that she should never act “too good” for her family. The no-win message was: “Succeed!... but don’t make us feel bad about ourselves.  Make us proud, but don’t get too big for your britches.” 

As an adult, Cara can now see from the outside how her family has made and continues to make poor life decisions, how they are often the cause of their own misery. There is a sense of fatalism and passivity in her family. In all the things they say and do, this message is conveyed: We are unlucky.  Bad things happen to us.  Let’s pray things get better some day, but we might as well EAT since our fate is out of our control.

As a successful, married woman hundreds of miles away, Cara has proven to herself that she is the writer of her own script. But when it comes to her weight, Cara has bought the family myth: There is nothing I can do about it.  We’ll just see what happens.  Maybe someday it will change. 

But the core fear is that eating healthy, exercising and feeling good in her body will mean that she has out-grown her last connection to that which is familiar.  When she goes home, their idea of fun is eating lots of fattening and delicious food.  They bond through Food and the misery of being overweight.  If Cara makes a healthy food-choice in their presence, they chide her for being a “party-pooper.”  In her family the unhappy, over-weight women view women in healthy bodies as alien, superior creatures: it is an “Us vs. Them” mentality.

While being an “Us” may kill Cara, being a “Them” feels like abandoning (and being abandoned by) the family she loves.

Cara will need to accept that it is possible to BOTH take care of her body AND love and connect to her family members.  She will have to develop stronger psychological boundaries, so that their suffering does not become her burden to fix.  When they tease her for being healthy, she can learn to not take it personally.  Cara can find a new way be part of her family, with physical energy and healthy self-worth. 

There may be more tears shed in my office as she grieves the loss of the old, familiar way of being close to her family, but she can learn how to forge new healthier bonds without sacrificing her own well-being. 

Dina Zeckhausen is a nationally-known clinical psychologist and author who specializes in treating eating disorders and body image in both adults and adolescents. She is a weekly columnist for ShareWiK.com. You can visit her on the web at dinazeckhausen.com and MyEdin.org.

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