Marita is receiving 50-60% more schooling than her old friends in the public school system. Marita will likely advance to a private school in New York City, instead of falling back to the public school system in the South Bronx. Marita will likely attend college and graduate, because most college students have never illustrated the work ethic Marita implemented during her time in the KIPP school. She'll be like many of these kids in the South Bronx who graduate from college, the first in her family. Here's Malcolm's conclusion on Marita's life: Her community does not give her what she needs. So what does she have to do? Give up her evenings and weekends and friends -- all the elements of her old world -- and replace them with KIPP. He called them mine--not my previous husband's problems. I was clearly taking my fears of abandonment, my anger, and my pain from my previous relationship and dumping them into my new relationship. MAKING THE DECISION In the long run, the decision to stay or leave often involves incremental steps to garner a stronger foundation to make that decision. Over the years, in spite of my suspicions and even some knowledge, I stayed in the marriage because I craved safety more than anything. But when we had a real name for it, when he and I both recognized it was sex addiction, by then there was so much muddy water under the bridge that the additional knowledge was too much. I needed a time-out. I pretty much knew that right away. I couldn't contain my anger in his presence, and I had so much to deal with--my breast cancer in particular. A separation was suddenly a very clear and viable option. Obesity and Hypertension Before we talk about obesity, we need to define the terms.

Obesity is often based on the body mass index (BMI), which is weight in kilograms divided by height (in meters) squared. There are many calculators available on the internet to aid in calculating your BMI. Being overweight is defined as having a body mass index between 25 kg/m2 and 29. BMI is not a perfect assessment for obesity. BMI does not take into account thin people who have high fat percentages and central obesity (fat around the abdomen) or heavier people who have high muscle mass. We feel fat percentage and muscle mass are more informative than BMI. However, many of the national assessments are based on BMI. As noted earlier, as of 2009 over two-thirds of the population is considered overweight or obese. - Malcolm Gladwell The KIPP School is a miracle to these kids, but it literally forces them into action. It rips them from any means of retreating back to what was comfortable. And, if the children end up not wanting to participate, or, if the parents think it's too cruel, then they lose their chance. That's the real attitude that wisdom shows to all people eventually. If you ask and plead for wisdom, you will be granted it with pleasure and abundance. If you continue to ignore the many signals and signs about how life works, wisdom will rebuke you and level you into the ground without mercy. Just read how Proverbs 1 describes how wisdom treats people, and carefully marinate over each verse. This will sound cruel, but yes, you should leave your terrible friends. You should abandon family members who are keeping you down. But he was motivated and getting the kind of help he had needed for years. I didn't know for sure what I wanted.

The time-out gave me clarity and I could go forward. After nearly a year of separation, we both arrived at the same decision: since we had been together in the addiction, we wanted to try being together in recovery. Sara realizes that she and her husband didn't have the opportunity to know what was possible in their relationship in a healthy way because for years he was trapped in his addiction and she in her trauma. The timing of learning about the depth of betrayal was complicated as she was also battling cancer. She knew herself well enough to know that her judgment about any decisions she would need to make regarding her physical care and her marriage was severely impaired by the depth of her anger. The anger was so great that she wanted the physical separation; She needed to gain clarity. After months of separation she was now experiencing her husband differently. Being overweight and obese are associated with an increased risk of death. What is it that our overweight and obese population is dying of? In one study, overweight men and women had a 52 percent and 62 percent risk, respectively, of death from cancer. On the other hand, there are multitudes of studies to corroborate that the leaner we are, blood pressures decrease, sugars become more controlled, and we feel better. Obesity is strongly associated with high blood pressure (hypertension) and high cholesterol. Obese people typically eat more saturated fats and highly salted foods, which are felt to be significant causes of not only obesity but also of worsening blood pressure and high cholesterol. More than 100 million American adults, about 33 percent of the total adult population, have total cholesterol levels greater than 200 mg/dL (ideal is less than 200 mg/dL). With the new American Heart Association hypertension guidelines, now almost 50 percent of Americans are considered hypertensive. Hypertension causes damage to the blood vessels, and high cholesterol boosts plaque formation. Both are directly linked to increased risk of heart disease. You should move to a new city and stop committing to a dead town. You should keep your commitment with your spouse and figure out how to make it better.

If it's an abusive or unfaithful marriage, you should leave the relationship for a healthier life. Is it harsh to leave your former foolish friends in the dust? I'd argue that you're being harsher against yourself by settling for what's already lackluster. Life is harsh. If we can't rely on friends and family to give any comfort or positive guidance, then we must find new ones. We can find a new family that will adopt us into their homes. They are waiting and available if we simply look hard enough. We can find new friends who can give us guidance. Even more important to her, she was experiencing herself differently and she wanted to see if there was potential for them as a couple. She understood that there were no assurances about her husband's behavior, but she saw a commitment on his part to be in therapy and attend workshops and twelve-step meetings for his sex addiction. She also experienced him differently in his communication. She didn't see or feel any of the old behavior. This gave her hope. But, more important, she was learning a lot about herself in her own therapy process. She realized she had a self-destructive pattern with men and that it was not about her choosing a different man but about being different herself. She was finding her voice in her ability to know what she wanted and needed; She was learning about boundaries. She was learning to focus on herself more and to act from a place of self-care instead of self-protection. In the Framingham Study, obese people had more than twice the risk of heart disease compared to their leaner counterparts. There is also a link between obesity and stroke, liver disease, and arthritis.

The more weight we carry on our joints, the more traumas those joints suffer. Arthritis is one of the most costly morbidities associated with obesity. We have even linked skin changes, such as thickening of the skin (acanthosis nigricans), stretch marks, and increased hair production in women to obesity. We weren't always so fat. We can all recall that when we were younger, people were smaller. When Dr A was 20 years old, she weighed 120 pounds and wore a size four. Three babies and 15 years later, she now weighs a bit more than that, but she still wears a size four. Why is that? Even if we have to sacrifice time and money temporarily to prove our commitment, it's worth it. Even if we need to move somewhere else for a fabulous job opportunity, live below our means for several months, to work our ass off without ceasing, we should do it. It's worth it. You could have the greatest deck of cards in the world. You could've been the son or daughter to a giant business mogul. You could've been born into royalty in some far off land. You could've been blessed with wealth throughout your life. This still doesn't negate the fact that, no matter what cards you're dealt, you must play the game well. That means we need to learn and develop our skills to play the game. How do we develop these skills? THERAPEUTIC SEPARATION The process Sara has described is a therapeutic separation.