Mrs. M. is a 34-year-old married African American female with a long history of issues relating to food. On initial presentation to the authors’ weight management clinic, she was obese; her height was 5 feet 5.5 inches tall; and her weight was 188.5 pounds with a BMI of 30.9 kg/m2. In addition to being obese, she had a history of reported polysubstance dependence in full sustained remission (alcohol, LSD, cocaine, cannabis, crystal meth), reporting that she had not used for 20 years and was never professionally treated for substance use (i.e., never went to drug rehabilitation program or took part in a 12-step program). The patient’s family history was significant for alcohol dependence. At the time of initial evaluation, she was being treated in a psychiatric clinic for generalized anxiety disorder and major depressive disorder and was being prescribed fluoxetine, buproprion XL, and trazodone. She had a significant psychiatric history for inpatient hospitalizations as a teenager for depression, including one suicide attempt, and had tried multiple different psychotropic medications for treatment of depression, including venlafaxine, sertraline, paroxetine, lithium, escitalopram, and norpramin.
With regards to her weight, she reported that her weight had fluctuated throughout her life from her lowest adult weight of 118 pounds and BMI of 19.3 kg/m2 when she was 21 years old to 280 pounds and a BMI of 46 kg/m2. She had tried multiple weight loss programs in the past. She reported that she would lose the weight for a while but would end up gaining back the weight. Her chief health concerns included joint injuries, and she reported a history of surgeries on knee and shoulder that had limited her ability to exercise and thus contributed to her weight gain.
In addition to her concern about her weight, she also described having an unusual relationship with food. When she first presented, she reported binge eating daily and estimated eating up to 6,000 kilocalories in one binge that would sometimes be random and consist of food such as ketchup, sweet foods, or sometimes savory foods or foods like ice cream or fast foods that she normally did not eat. She reported eating despite feeling sick afterward and reported sometimes engaging in compensatory behaviors such as self-induced vomiting or excessive exercise following the binges (prior to her injuries). She also endorsed poor body image and reported binge eating to feel comfort when she was feeling depressed or sad. She also reported binge eating when she was not hungry and would binge eat in secret leading to subsequent guilt. She stated her teenage daughter appeared to have similar behavior, and she found her daughter hoarding food to the point that the patient would restrict what kind of food she had available in her house. In the past may have had bulimia nervosa, although she denied any compensatory behaviors at this time.
She reported difficulty when she tried to cut back sweet, salty, or fatty foods and reported feelings of withdrawal if she removed these foods from her diet completely. The patient also reported that her food addiction affected her relationship with others in a similar way to how her alcohol dependence and polysubstance dependence affected her relationships with others in that she would engage in binge eating in secret instead of spending quality time with her teenage daughters and husband. She also reported challenges in her work as a nurse, as she felt more sluggish after eating a lot of food. She reported that food was now providing less comfort and help for her negative emotions than it did previously, and she has grown somewhat tolerant to the food. She also reported inability to eat a moderate amount of food despite having negative physical consequences of acid reflux and increased joint pain due to her excess body weight.
