Category Archives: healthcare industry

So Now We Have to Lose Weight to Get Surgery

On Sunday I read the news that obese NHS patients will not get non-urgent surgery until they lose weight.

It made me want to cry. I’m a recovered anorexic who is very active and eats a varied and balanced diet and because of that I am both fit and healthy. I also happen to fall into the “obese” BMI category. In order to lose weight I would have to restrict my food and exercise to the extreme, leaving me both hungry and exhausted; pushing my body below the weight that it sits naturally at. This is unhealthy, and it would mean that my physical and mental health would be in decline. I would also end up spiralling back down into a very dark and dangerous place, with even more devastating and continual effects to my physical and mental health. If I required non-urgent surgery, I would therefore have to force my body into a place where it is not at its healthiest, experience distressing physical symptoms, and in the process would be triggered into a life-threatening mental illness that could leave my physical health in such a bad way that it could kill me – if the torture of living with an active and consuming eating disorder didn’t tempt me to end my life first. In short, I would be put in a life-threatening situation in order to get non-urgent surgery. For me, it wouldn’t be worth the risk.

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Artwork by Francis Cannon

BMI is bullshit. All health professionals know this. And if they don’t, then they should: there’s been so much indisputable evidence that shows us that using a basic BMI chart to tell us whether we are healthy or not is ridiculously primitive, simplistic, and inaccurate. To think that I might not have access to the same healthcare as someone thinner than me after working so incredibly hard to get to this healthy and happy point in my life both physically and mentally makes me feel sick.

We all have individual natural and healthy weight ranges that our bodies choose and we maintain when we have a healthy lifestyle. We don’t get to choose that weight. No one else gets to choose that weight. Our bodies determine it. And those people who don’t fit into the “socially ideal” weight category (that literally wasn’t EVER intended as a way to measure health) get punished for it (whilst those who push the “obesity epidemic” and reinforce the stigma and myths around “obesity” profit from it). There is so much overwhelming evidence that it is possible to be healthy at most weights, shapes, or sizes (depending on yourself as an individual and what your own personal healthy weight is), and it is nauseating to think that people will be forced to make a choice that could cause them both physical and mental distress. 

Even regardless of health, “singling out patients in this way goes against the principles of the NHS,” says Mr Ian Eardley, senior vice-president at the Royal College of Surgeons in The Independent.

The article also reports on more details:

Patients with a Body Mass Index (BMI) of over 40 will not be referred for routine surgery unless they are able to reduce it to under that number over a nine-month period.

Alternatively they will be required to shed 15 per cent of their weight, according NHS Herts Valley Clinical Commissioning Group (CCG) and NHS East and North Hertfordshire CCG. 

Whichever achieves the greater weight loss will then allow them to be considered for surgery.

Patients with a BMI over 30 but under 40 will also be required to reduce that figure to under 30 or lose 10 per cent of their weight before they are considered for surgery.

This decision is yet another discriminatory act against people in larger bodies in the UK, and I’m so tired of it. I’m tired of being told everywhere I look that my body is “wrong”. I’m tired of watching my category of bodies represented by images of men and women with protruding stomachs and their heads cut out of the shots as if they are nothing but  their size (for example right now I typed in “obese patients will not get non-urgent surgery until they lose weight” into Google and the majority of the images are fat people with their heads chopped off – seriously, I’m so done). I’m tired of things like having a “World Obesity day” following the National Mental Health day – which if it wasn’t so revoltingly ironic, would be laughable, without even addressing the fact that there is literally a day to tell us all how bad and unhealthy our bodies are if we are over a BMI of 30.

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Artwork by Frances Cannon

Despite that, I’m someone who exists in a body that is fairly “average”. Even as an “obese” person, I have an amount of thin privilege. I can fit into clothing at regular stores. My friends laugh as if it is absurd when I say that my body fits into the “obese” category. My booty is the UK’s “average” size (although this booty is anything but average, just saying), and my top half is below the UK’s “average” size (and just so you know the average clothing size for women in the UK is a size 16, which is a US size 12, and in the U.S. the average size is between a 12-14, which is a UK size 16-18). I have only had one health professional (physiotherapist) mention my weight in a negative way (AFTER I had told him all about my previous experience with an eating disorder and described to him my active lifestyle and balanced diet. And boy, did he receive an educational six-page feedback letter on eating disorders and health at every size? Yes he most certainly did). The discrimination that I face is significantly less than those who live in bigger bodies than I do, and it can have devastating effects on mental health.

I don’t want to be fighting to be seen as equal to other people because of my BMI. I don’t want to fight for those bigger and smaller than me to be treated the same. I don’t want to fight to get rid of negative associations with certain body sizes. I just want it to BE like that. Right now. I will, of course, keep fighting this fight, but man, am I exhausted of having to argue with at least one person every time I say that to be obese is okay and that someone who is obese can be just as healthy as someone who is not. And now we have our healthcare to fight for, too.

Hopefully, one day, we will all be at peace with our own bodies, and each other’s, and regardless of our weight, shape, or size, we will be treated equally and our health considered individually. Until then, let’s keep being angry, let’s keep speaking up, let’s keep pointing out the evidence, and let’s never give up.

Artwork by Francis Cannon

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Health At Every Size and Big Is Beautiful/Fat Acceptance: What These Movements Stand For and Why They Are Important

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Health at Every Size and the Fat Acceptance Movement started as small, barely recognised movements. Due to the hard work of those involved and the (very) gradual shift in views around weight, shape, and size, these movements are now beginning to get the acknowledgement and publicity that they deserve. The more exposure these movements get, the more people will start to be enlightened to the real facts, figures, and evidence around size, health, and weight set point theory. Hopefully with time weight-based myths, discrimination, and stigma will be something that we as a society look back on and cringe with shock and humiliation that we got something so wrong and treated millions of people so badly. However, we still have a really long way to go until then.

You might be new to these movements, or you might not be, but either way, you may be unsure about what they stand for and why these things are so important. So let’s have a look at each movement and discuss a little bit about them.haes-4

Health At Every Size (or HAES) was first developed by American psychotherapist and nutritionist Linda Bacon, who wrote the book Health at Every Size (first published in 2008), and the sequel, Body Respect. Health At Every Size is a movement that is promoted by those who believe that health and fitness can be achieved regardless of weight, shape, and size, and that weight-loss is not a requirement for those deemed “overweight” or “obese” by BMI in order to live a healthy and happy life. HAES encourages people to accept their weight as it is, and promotes mental and physical well-being without weight loss as a goal. HAES cites studies that have shown that weight loss often leads to worse health regardless of the starting weight, and presents evidence that suggests that obesity is not the cause of health issues or premature mortality. It provides strong arguments for the idea that correlation does not equal causation, and picks apart flaws in studies that apparently connect obesity to poor health. HAES supports self love, self care, and body positivity, as well as healthy physical lifestyle choices such as being active and eating a balanced diet. HAES promotes this in a way that is conductive to mental health: it urges people to engage in activity that is enjoyable first and foremost, and not gruelling and repetitive work-out routines, and it supports the idea that food is not just for survival but also for pleasure. It maintains that weight loss should never be a goal, and that weight loss is frequently damaging, and encourages people to follow intuitive and instinctive eating and activity. It also supports weight set point theory.

The Health At Every Size® Principles are:

  1. Weight Inclusivity: Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.
  2. Health Enhancement: Support health policies that improve and equalize access to information and services, and personal practices that improve human well-being, including attention to individual physical, economic, social, spiritual, emotional, and other needs.
  3. Respectful Care: Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma, and support environments that address these inequities.
  4. Eating for Well-being: Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure, rather than any externally regulated eating plan focused on weight control.
  5. Life-Enhancing Movement: Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement, to the degree that they choose.

Health At Every Size is a movement that I strongly agree with. Its main principles on exercise, food, weight, and body positivity are ones that I advocate with every fibre of my being. It’s incredibly important because we live in a culture obsessed with dieting and weight loss; a culture preoccupied with attaining the “perfect body – a body that is not achievable for the majority of people without sacrificing their mental and/or physical health. Even if you are someone who naturally has society’s idea of the “perfect” body, the dieting and weight loss industry will find ways to make you feel inadequate and flaw-ridden in a bid for you to buy their products to “fix” yourself with. The diet and weight loss industry controls much of our research into food and weight, and sweeps any evidence that contradicts their interests under the rug and publicises in a selective and biased way research that has questionable study methods or sample sizes, contentious results, and tenuous correlations. So do I have any criticism of the HAES movement?

Firstly, I think that although HAES is absolutely correct in that we should intuitively eat and listen to hunger and fullness cues, it underestimates how difficult that can be to relearn, especially if you are someone who has suffered with an eating disorder or severe dieting. In our society, feelings of guilt, self-loathing, shame, anxiety, and, on the other hand, superiority and control, have become inextricably linked with food and weight, and so it can be incredibly difficult (and perhaps even impossible) to entirely disentangle our emotions from our biological signals. That’s not to say that it cannot be done, but we need to address the context in which we live in our bodies  before we can start to challenge and relearn the way that we feed and view our bodies. Being presented with the principles of the Health At Every Size movement can feel like ordering flat-pack furniture and taking it home, only to open it up, lay out the pieces of the floor, and realise that the instructions aren’t there. You’re left with all the parts, but with no idea how to assemble it. And in reality that’s not exactly a flaw of the HAES movement itself, as HAES aims to educate and promote a mentally and physically healthy and positive way of living, but it is an area it sometimes fails to recognise and address.

Secondly, I’m not really a fan of the name. Heath At Every Size is misleading. Although I absolutely 110% agree that the what we view as “healthy” should be a much much much broader range of weights, it is undeniable that there are certain weights at which you just cannot be healthy at. You cannot be a healthy adult at 50lbs, just like you cannot be a healthy adult at 500lbs, and so the name of the movement leaves it open to criticism from the onset. Prader-Willi syndrome, hypothyroidism, cancer, depression, anxiety, or eating disorders are a few examples which can cause a person’s weight to plummet or skyrocket, and there are weights that are too low or too high for anyone to be healthy at. So for me, I believe in Health At (Pretty Much) Every Size, and whilst Health At Every Size is much more catchy, it’s technically incorrect, allowing those against the movement an easy starting point on which to discredit it.

Last but not least, HAES aims to provide people with the information to start working towards accepting their bodies whatever their weight, shape, and size in order to improve both physical and mental health. However, it also has to be addressed that we live in a society where fat people are constantly subjected to prejudice, body-shaming, weight stigma, and discrimination. Fat people who agree with HAES may still struggle to accept their body size in a culture so cruel to them, and their inability to find peace with their bodies may well become yet another source of shame. Again, this isn’t a flaw in the principles of HAES, but a topic that may need more recognition.

So what is the difference between Health At Every Size and the Fat Acceptance Movement? Let’s take a look at the latter:
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The Fat Acceptance movement (also known as the size acceptance, fat liberation, fat activism, fativism, or fat power movement) is a social movement seeking to change anti-fat bias in social attitudes. Those involved seek to change attitudes towards fat people in areas of life including the aesthetic, legal, and medical approaches to people whose bodies are fatter than the social norm. The Fat Acceptance movement focuses more on the way fat people are perceived and judged due to their weight, shape, or size, and although it does address physical health and the research to back up the same principles as the Health At Every Size movement, it is more focused around changing the way fat people are treated and discriminated against. Fat people are often dehumanised and shown far less respect than those that are at a socially “acceptable” weight. One of the main examples is medical care. Fat people’s medical issues are often inaccurately dismissed as being caused by their weight, are shown less respect, and are often shamed for their body size.

The Big Is Beautiful movement is a smaller movement that comes under the Fat Acceptance movement, and focuses more on aesthetics. Its message is that people whose bodies are bigger than what is considered socially “acceptable” are beautiful too, and that you don’t have to be a certain weight, shape, or size to be attractive. Its aim is to help people find beauty in their bodies regardless of any contributing factors that make them look a certain way: health is besides the point.

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Both movements are focused around respect, and also talk about health as irrelevant. The ideas is that even if you believe that someone IS unhealthy due to their weight, its not your business what lifestyle choices they make, and they should be treated with respect regardless of those choices. For example, we all know people who smoke or binge drink, but we do not treat them as less human on an everyday basis because those choices lead to poor health. We do not assume their personality, or directly link their personal lifestyle choices with their moral character. This is why these movements are so important: they address the way society perceives and treats people who are fat.

My only criticism of these two movements (Fat Acceptance and Big Is Beautiful) is that there are some people involved in this movement who look down on those who diet as betrayers of the movement, when they should be seen as victims of a diet and weight loss obsessed society. As I stated above with HAES, it can be forgotten how powerful and pervasive “thin ideals” are, and all of us are affected by it in some way, even if we do constantly work to disentangle ourselves from it and rise above it. We should all be working together to support one another and help to lift each other up not put anyone down. We should aim to educate, not shun; support, not vilify.

Health At Every Size, the Fat Acceptance movement, and Big Is Beautiful, are all extremely important in terms of physical health, mental health, feminism, and education around food, weight, and health, amongst other things. They are powerful and uplifting; inspiring and motivational; enlightening and passionate. They can give us the information and confidence to live in a better way; a way that makes the aspirations of health and happiness more achievable.

To find out more about weight set point theory, and to read discussions around and evidence to support Health At Every Size, you can visit the resources section on this website. There is a drop-down menu that displays many sub-sections, including one for each of these topics.

And as a last little titbit of information, check the photo out below:

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Vyvanse and BED: Money-making in Disguise as Treatment?

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Fairly recently, Vyvanse – a drug known for treating ADHD – was approved to treat binge eating disorder (BED). I was first made aware of this drug via a message sent to my blog from a woman living in the US who was angry about the effects this could potentially have on people who were prescribed it. I did a bit of reading up about it, but soon forgot about it. The topic came up again when a friend linked me to an article about the drug being used for treating BED, which I read, and my interest was piqued. I started thinking about the problems that would arise from it’s approval to treat BED that are both numerous and highly concerning.

In May 2013, the DSM-V was published, with BED being newly recognised as a psychiatric disorder. On the surface, this sounds great: sufferers of BED were finally being recognised and validated, but a further look into this and the subsequent approval of Vyvanse to treat it raises some serious questions.

In a society where almost two in five (37%) women and one in six (18%) men in the UK are dieting “most of the time”, and 108 million people are on diets in the US, a huge amount of us are restricting on a daily basis, and when we “fail”, we feel shame, guilt, hopeless, and anger at ourselves. And failing is inevitable, because diets do not work. Dieters often end up in a restriction/binge cycle, and mistake their dieting for normal behaviour, and so only take note of their binging and see this as a weakness rather than a normal biological response to starving the body. If the body has an energy deficit due to restriction, it will seek to restore balance by compensating later on. So with that in mind, we can now look at the criteria for BED:

  • Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
    • eating, in a discrete period of time (for example, within any 2-hour period), an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances
    • a sense of lack of control over eating during the episode (for example, a feeling that one cannot stop eating or control what or how much one is eating)
  • The binge-eating episodes are associated with three (or more) of the following:
    • eating much more rapidly than normal
    • eating until feeling uncomfortably full
    • eating large amounts of food when not feeling physically hungry
    • eating alone because of feeling embarrassed by how much one is eating
    • feeling disgusted with oneself, depressed, or very guilty afterwards
  • Marked distress regarding binge eating is present.
  • The binge eating occurs, on average, at least once a week for three months.
  • The binge eating is not associated with the recurrent use of inappropriate compensatory behavior (for example, purging) and does not occur exclusively during the course Anorexia Nervosa, Bulimia Nervosa, or Avoidant/Restrictive Food Intake Disorder.

For me, this criteria is extremely problematic. This criteria is pretty vague, and in conjunction with a society that vehemently fears over-eating and weight gain, becomes a fit for a large proportion of people. Let’s take a look at it in more detail:
– “an amount of food that is definitely larger than most people would eat in a similar period of time under similar circumstances” – this is particularly non-specific, and in our society, many people have a distorted view on what is larger than most people, especially when so many are restricting. It is also normal for someone who has been restricting to experience eating more than normal, because of the body trying to restore itself to being energy-balanced.
– “a sense of lack of control over eating during the episode” – many people feel out of control when it comes to food because we are made to feel that out of control if we are not eating in some strict and regimented way. That feeling is even more accentuated when the drive to survive overcomes the person’s desire to diet, and the body makes up for lost energy by “binging”.
– Eating rapidly is also part of the drive to get energy in as fast as possible when it needs it.
– Eating until uncomfortably full is easy to do when the body requires more energy than the stomach has room. The desire for food is just another way for the body to communicate hunger, and people often do not recognise this as a type of physical hunger (the brain is part of our physical being as well).
– Eating alone when eating what someone considers more than normal, or when someone is experiencing reactive eating in response to restriction, is – unfortunately – normal because of the way our society has surrounded food in a thick layer of shame.
– And if you are dieting, or misinterpreting your eating as a “binge” (because I would argue that many people have a distorted view of what a binge actually is), this is likely to happen “at least once a week for three months”.

“With these diagnostic criteria [for BED], there is huge potential for a false positive. Do a lot of people struggle with binge-eating? Absolutely. Are all of these people actually ill? That is the major question around this diagnosis and the Vyvanse treatment,” said Lisa Cosgrove, a professor and clinical Psychologist at the University of Massachusetts, Boston.

So what we have here is a list of things that those with BED suffer from, but written in a way that it could easily fit someone misinterpreting their eating habits because they have distorted ideas of what binging is, or are not aware of the effects that dieting has on the body. This means that these people could go to the doctors, tick all the boxes, and receive a diagnosis. Our fatphobic society steeped in diet culture would have no problem with that. A quote from Ray Moyniham in  Motherboard talks about this:

“You have to be extremely sensitive to the fact that there are people who are really suffering severe and debilitating symptoms from a condition,” said Ray Moynihan, a senior research fellow at Bond University in Australia and the author of Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All Into Patients. “But when we put so much energy into medicalizing normality, it takes resources and attention and care away from people who are seriously ill.”

Now on to June 2014, where Shire wins the key patent ruling for the drug Vyvanse. The Telegraph writes:

Shire hopes to increase sales of the drug by broadening its uses into other patient groups, such as very young children and sufferers of the newly-recognised psychiatric problem binge-eating disorder (BED).
The drug maker told investors on Monday that it expected to make $300m from sales of Vyvanse to BED patients by 2020, following a successful clinical trial showing the drug helped control binge eating.

This raises a red flag for me: Shire will desperately want to make as much money as possible before its patent expires, and this means expanding its treatment to those with other illnesses other than ADHD. Shire had already thought of BED as an option, and already had that idea in the pipeline. Is the fact that BED was finally recognised and put into the DSM-V just when Shire needed a new illness to treat a convenient coincidence, or something more dubious?

In January 2015, Vyvanse was approved to treat BED. The fairly vague criteria for BED could mean that BED is over-diagnosed and over treated, with a drug that is an amphetamine. Hang on, what?

Amphetamines became extremely popular in the mid 1900s as a weightloss drug, before concerns about the dangerous side effects caused the FDA to ban amphetamines from diet ads.

The most serious risks include psychiatric problems and heart complications, including sudden death in people who have heart problems or heart defects, and stroke and heart attack in adults. Central nervous system stimulants, like Vyvanse, may cause psychotic or manic symptoms, such as hallucinations, delusional thinking, or mania, even in individuals without a prior history of psychotic illness. The most common side effects reported by people taking Vyvanse in the clinical trials included dry mouth, sleeplessness (insomnia), increased heart rate, jittery feelings, constipation, and anxiety. – take from here.

Vyvanse was approved for treating BED after only two 12-week studies.

“I tried (and failed) to persuade the DSM 5 group that BED was a premature and dangerous idea precisely because I feared it would be a backdoor excuse for drug companies to promote stimulant diet pills,” Dr. Frances Allen, a psychiatrist and frequent critic of the DSM-5, told Motherboard in an email. He has had particular concerns about the new criteria for diagnosing eating disorders. “The rushed approval of Vyvanse realizes my worst fears”

People actually suffering from BED are desperate to get rid of their mental illness, but therein lies the issue: BED is a mental illness. I have severe reservations about an appetite suppressant being used to combat an eating disorder that for a lot of people has roots in trauma, and other deep-seated emotional problems. The appetite of that person isn’t the issue: the drive to eat as a coping mechanism is. And not only are we going to be dealing with actual sufferers, but those misdiagnosed because of the ill-defined criteria, and those faking the illness to get a hold of Vyvanse, either because of its street value, or because of its use as a weightloss drug. Which brings me to the dangers of those with restrictive eating disorders reeling off the list of BED symptoms, and getting a prescription of Vyvanse to continue their downward spiral that only leads closer and closer to death. Because a binge eating disorder diagnosis relies on self-reported behaviour, it means that it is not difficult to fake, and consequently, it is not difficult to get a diagnosis. Pro-ana sites are already sharing their experiences with Vyvanse, and tips on how to get hold of the drug. The consequences of this could be catastrophic.

I received a message to my blog recently when the subject of Vyvanse came up:

I was recently diagnosed with BED and prescribed Vyvanse. My psychiatrist gave it to me because he said I was gaining too much weight. He gave it to me to use as a weightless pill. I don’t think that’s okay. In the past I have suffered from anorexia and bulimia. So of course, I accepted the pill. Hoping it would be easier to not eat at all. I think this may be a problem for a lot of people very soon.

This shows that already Vyvanse is being misused by doctors themselves, who are supposed to be people that we trust with our healthcare. But with the pharmaceutical industry being all about the money-making, it’s hardly surprising.

In my opinion, the inclusion of BED in the DSM-V, the vague diagnosis criteria, the subsequent research into using Vyvanse to treat BED, and the swift approval of that usage, are linked together. The pharmaceutical company have helped themselves to make more profit off both those with BED, and so many without it, with a drug that in my opinion will not successfully treat the disorder it has been approved for. And this drug is likely to have devastating consequences.