Saturday, September 8, 2018

Dear Ellen "My sister is sick and won't help herself"

We have another question via the anonymous form (closed):

Dear Ellen, I'm writing to seek some advice regarding my sister, who is in her early 30s. She is currently staying with my parents and we're worried about her health.

She is overweight and a body checkup revealed that she has fatty liver. She has an inactive lifestyle and all she does is go to work, then spend the rest of her time either on the computer or on sleeping.

We've advised her to move around more and have a healthier diet but she does not heed our advice.

Could you please provide some suggestions on how to motivate her to change her lifestyle? Thank you!

Oh lord, what a frightening situation for you all.

Okay, first things first. I am sure you’ve read the superb overview by the doctors at The MayoClinic  on Nonalcoholic fatty liver disease

It’s one of those things that can hit anyone, and the nasty thing about it is that one of the effects includes fatigue.

It is entirely possible that your sister is going to bed rather than the gym because of the disease. 

It is also possible that she’s had a shock from being diagnosed and that she’s down or possibly depressed.

As the doctors advise a change of diet and exercise, you are right in that she must make some changes. But advising her has to be done with great care and compassion.
I suggest this:

You cannot force an adult to do things they don’t want to, therefore, you have to recognise that your current communication strategy is failing. Junk it and start afresh.

Prepare yourself for the discussion by throwing away all of your past impressions, thoughts and experiences. You are going in fresh and this is the first step of a negotiation.

Pick a time when your sister is most likely to have some energy. She needs to be in a calm spot where she’s open to talking.

Make sure it’s just the two of you, nobody else. The fewer people, the easier it is to talk.

Start by telling her you won’t be advising her. This is important because she may be fed up with people telling her what to do.

Tell her you love her.

Ask her, what is she feeling about this new situation?

Then listen.

Ask only questions, don’t give opinions. The trick is to aim away from advising and towards understanding. Ask until you are certain you see it from her point of view.

When you get how she feels, you can say, “Okay, sis, I want to help but I need you to tell me exactly how.” You say this because this is her issue and she's the one in control.

If she doesn’t have any concrete ideas, here are some of mine:

Schedule some happiness into her week, every week, in order to keep up her spirits. There’s a blog post here on how to do that.

Everyone is worried and that can lead to endless “How are you?” health conversations that would drive anyone bonkers.  Negotiate how you talk about her health. It may be that she limits you to asking about it only on Fridays, or that you have to respectful and back off when she says, “I’m not talking about it today.”Whatever she wants, do it.

Changing over to a new eating style can be bothersome, so make at least part of it fun. Discover some delicious healthy food dishes together. Either swap recipes or cook for each other. Set up family Healthy Lunch or Healthy Dinner outings.

About exercise. Usually, people suggest that you buddy up for walks and swims. In my experience, that’s usually a disaster because people very quickly find reasons not to go.

My best advice is that your sister hires a personal trainer once a week. With a personal trainer, you get proper routines and as it’s a business, you turn up on time and there’s no nonsense. Tell that person what the doctor said, and figure out a custom action plan.

Also, get her signed up for one class, in dancing, swimming, yoga, pole dancing - whatever. You can go with her if you want, but it has to be a regular group and it has to be awesome fun. Any kind of movement will do.

tiger meme
Most importantly, she will need an advocate, someone who can help her stand up to family, friends and complete strangers who will be drowning her in unsolicited advice. Worse, there will also be people hoping to cash in by selling her miracle drugs from overseas.

Be totally on her side, and work out between you how you deal with kindly but meddlesome types, rude imposing types and scummy swindling sales types.

Important: this is about how your sister wants to manage her life, and so she makes the decisions and you are her enforcer. Don’t let anyone bully you.  Be a tiger!

And finally, talk to her about the possibility that she may also be suffering from depression. If she is, and the symptoms last for a fortnight, being assessed might be a good idea.

Making lifestyle changes is not easy, so expect setbacks and obstacles, but do know that it can be done. 

Your sister has you and your parents, so start with that and gradually build up her support network. Again, there’s a blog post on how to do that here.

I hope this helps. I’ll be thinking of you.