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From behind Medium.com's paywall:Letter from a Reader: “My beautiful 15 year old girl who just poured her heart out to me about how fat she thinks she is and how she doesn’t think anyone will ever love her.”

This is the heartbreaking gist of a mother's seeking help that won't hurt her daughter's self-esteem.


For the purposes of this reply, let's call them Mom and Annie. Further, I believe this question is based on a Psychology Today blog I wrote seven years ago about how to work with your teen who is overweight. Thanks, Mom, for delving so deeply into my past work!


Dearest Annie, I identify. I was a trainwreck at 15, trying to fit my very round peg of a self into very narrow oblong slots. I was just shy of 240 pounds. I wanted to be an actress. I wanted to study ballet. I had recently lost 36 pounds over the course of six weeks by eating 500 calories and exercising for four hours a day over the summer but once I was back in school with after-rehearsal 4-Bs cinnamon rolls and Friday night pizza, I quickly piled it back on — plus more.


That summer's attempt to wrest myself from the beast wasn't a healthy diet, although many anorexics would applaud it. My father was a doctor and approved of what I was doing rather than scouting out a more sustainable plan of eating. I'm so very happy you can pour your heart out to your mother. I never did: she wasn't that kind of mother.


I was criticized for that blog because I told parents to give their overweight kids anything they wanted as long as it wasn't food. Tennis? Sign her up. Basketball? Put up a basket, and put it behind the house where Bobby's jiggles won't be seen. Put it up even if you have to pave a court there. Or sign him up for one-on-one lessons at a time in the gym when the court is most unobserved.


Readers felt I was telling them to spend money they didn't have.


After years of doing social media in the weight loss/health/fitness categories, I feel justified in rebutting, "Can you afford not to do these things? Your kid's life is at stake. Take out a second mortgage or a loan; make a deal that Bobby will pay you back. Do what you have to do but get him moving and be there for him as much as possible."


I can say this now with certainty because 1) it didn't happen for me and my parents could have afforded it, and 2) I've read hundreds of studies on childhood obesity. It's imperative to reverse it, no matter what it costs.


I would have loved to learn tennis, to spend time horseback riding, to be in a swimming pool a couple of times a week. No one asked me what I wanted and that's simply not excusable. It's more inexcusable because I had been educated (nine years of parochial school; a lifetime of attention given to the rivalries and athletic performances of my brothers) not to speak up and ask for these things myself. My parents assumed I would magically take care of it myself.


By the way, Mom, let's not tell Annie about any of the medical consequences of her overweight. She's got enough to handle.


I'm 63 and I've spent the last 20 years trying to figure out how my obesity could have been arrested. Along with the shame of my body, I was ashamed of my life. I'm hopeless at math — as I was failing geometry, why didn't my parents find a good tutor? When I walked into P.E. one new semester and was confronted with a beam, uneven bars, a vault, and a trampoline, why didn't someone gently tell me to go outside and walk around the athletic fields for 45 minutes?


These were the days of Joni Mitchell, Carole King ("You're beautiful as you feel" always made me snort with fury), Diane Keaton, Stevie Nicks, Judy Collins, Michelle Phillips. The girls I was attracted to wore their hair long and flowing, and dressed in long skirts or short skirts, they accessorized with loopy earrings and necklaces they beaded themselves.


(The Good Girls — the ones who were academic and worked on the yearbook — wore other clothes, but I was not a Good Girl. I was arty and angry and snotty.) So why was my mother trying to dress me like a Good Girl? And then, why did she give up dressing me at all?)


The one really good thing she did was to get me contact lenses. Late in my senior year when I was becoming more assertive about my true needs, I asked to be taken to a dermatologist, one of the smartest things I ever did. My father taught me to drive on the eve of graduation — much too late because it tied me down — and I got a car. I asked for a therapist for my graduation present. He saved my life by taking me seriously. I had few friends in university but I adored my classes.


So here are the four lessons I want you to pull from my anecdotes. 1) Be there for Annie. Get to know her. Get to know what she wants from life. 2) Sign her up for whatever physical activity she'd like to be involved in. It's less expensive to pay for private ballet lessons than bariatric surgery or insulin. Annie's metabolism is now at its strongest. On a healthy diet, adding physical activity will pull the pounds off like iron filings to a magnet. 3) Let Annie pick out the clothes that best reflect who she is. Same goes for hair, glasses/no glasses, jewelry, etc. Teach her what her best attributes are. I have great hair and good legs and navy blue eyes. That's a lot to work with if you know how to do it. Make sure she sees those people who can work wonders, dermatologists, massage therapists (the overweight/obese suffer horribly from lack of touch, as well as the stress knots caused by anxiety from shame), a really great hair dresser who works with teens and college students, etc. 4) Be her advocate, sometimes as sneakily as possible. I would have been thrilled had my mother stormed the halls over gymnastics, but I would have slunk to the floor under my desk if she'd done it over my geometry teacher's inability to pound theorems into my soft, Hawthorne-ish brain. Academics, being able to drive, being trusted are also a part of self-esteem.


NB: Who else is Annie? Is she a reader, a gamer, a Good Girl or an Arty Girl? What makes her laugh? What, besides her weight, makes her cry? Are there things she'd like to learn — that vaunted beading, or tatting, or making furniture? Hobbies are essential because when you stop wall-to-wall eating, you have time, energy, and obsessing on your hands. Fidgeting burns calories. This means binge-Netflix is not such a good idea, even without the pop corn, because when we're into a binge, we tend to sit or lie without movement. Much better to knit or read (I change positions when I read) than get hooked into one mini-series after another.


You've done a brilliant thing by getting Annie into therapy, Mom, but here are two questions: is her therapist a specialist in addiction, and does she like him/her? If the answer to the latter is meh, then look for a therapist who specializes in addiction.


It's time to face up to two things that should comfort both of you: overweight/obesity is not a moral failing. It's a chronic disease, just like epilepsy or lupus or Crohn's. I won't use diabetes because it's so closely tied to overweight/obesity and thus becomes another thing we can blame ourselves for. You need to let Annie know she has a disease and that, like all diseases, she has to take her medicine.


The second thing is that if Annie had an MRI of her brain, it would look almost exactly like the brain scan of a cocaine addict. The particulars of overweight/obesity is that most of us can not stop eating, any more than a meth user can walk away from a half-full syringe.


No one with a disease, no addict, should feel feel shame. Annie needs to learn hope.


And Mom, you need to get into therapy as well, and with an addiction specialist who will understand the almost impossibility of quitting. You need to know what's going on, what helps (exercise is strongly advised in recovery from addiction, by the way) and what doesn't. And you need to hand some of the burden of Annie's sadness over. You need to grieve her sadness and rage at it, and have a relationship with it that you have the skills to keep separate from your own life.


Here are my last two caveats. As much as is possible for a 15-year-old, put Annie in charge of her life. This has sort of been the message all the way through this answer, but it needs to be stated clearly. Let her plan and prepare her meals, decide on a clothing allowance and let her shop with you as back-up.


The second is to make sure Annie sees a metabolic specialist. (If your community doesn't have a metabolic specialist, which is a rather recent discipline, go to an endocrinologist.) I eschew the idea of bariatric surgery and if you agree with that, make sure the subject doesn't come up. But you need to know whether there is a reason for her weight gain besides eating. Rule out Cushing's disease, for instance, or diabetes. These doctors are the best prescribers for the new classes of weight loss drugs because they've studied the subject much more than an internist.


Mom, Annie: I have a lump in my throat and a sting in my nose as I conclude this. Remember, please, that there are positives in a life of sadness. There is gratitude. There is service — which I hope I have given, because my life is pretty bleak right now, mostly because of my weight. There is hope.

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