Tag Archives: weight stigma

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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Celebrating the Day that I Chose to Live

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TRIGGER WARNING.

This article contains before and after photographs of someone who has previously suffered with an active eating disorder, and also names eating disordered behaviours that they previously engaged in. This article could be triggering for vulnerable people, those with eating disorders, and those recovering from eating disorders.

Today holds an extortionate amount of significance for me: four years ago today I made the decision to make the first steps towards recovery from my mentally and physically destructive and severe mental illness: atypical anorexia. It didn’t feel like much would come from the vague, half-hearted decision, but it was a monumental moment that put me on the road to recovery. That moment has gotten me to where I am now: a healthy, happy woman who has been in remission from an eating disorder for over one and a half years, after an intense two and a half year battle in which I emerged victorious.

I’m well aware that I wrote a post last year which will probably be very similar to this one, but the topic isn’t an insignificant one: this day four years ago saved my life in many ways, and celebrating it is, in reality, celebrating the day I decided not to die slowly, and to fight tooth and nail for my health, my happiness, and ultimately, my life.

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Four years ago today I was entirely, unequivocally, weary of being sick and miserable. I was weary of being in a living hell. I was weary with the despair and the darkness and the anger and the devastation. I was weary of watching my hair fall out in clumps in the shower; of watching it become thin and dry and brittle; of being dizzy; of living in a grey world where my senses were dulled as if my brain was smothered in cotton wool. I was fed up of the insomnia; of the nightmares; of the calories circling around my head all day and all night, leaving little space in my mind for much else. I was tired of counting down the minutes until I was “allowed” to eat; of the starving and compulsive exercising, and eventually, the purging; of the intense fear I felt at going anywhere near food; of the absolute and utter desolation of my mind and body that meant that I lived in a starving shell that could not function, and a mind controlled by  a single focus: lose weight lose weight lose weight. A focus that meant I could not think about anything else; could not deal with anything else. A focus that meant that I did not have to confront the emotions and experiences that had caused my eating disorder in the first place. A severe mental illness caused by a combination of genetics and my environment was my way of handling the world and myself, but finally, after 8 years, I had decided that this could not go on. At first, I viewed death as the only escape from the torment my eating disorder wreaked upon me, but moments of clarity started to push their way to the forefront of my mind, until the possibility of recovery developed from rejected thoughts to cautious actions. And over time my strength grew, and grew, and grew.

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I know: you’ve heard it all before. You’ve read my posts or the posts of others, you’ve watched a loved one battle an eating disorder, or you’ve experienced it first hand. But today I also want to talk about where my recovery took me and how it might differ from that of others.

I have come across a lot of people who live under the title of “recovered”. It may be a title they have given themselves or a title a professional has given them. It doesn’t matter. What I see are a lot of very slim people who use the word “recovered”. Some of those people will be naturally slim – people whose natural, healthy weights are down the lower end of that “healthy” BMI category. And that’s great! All weights, shapes, and sizes are fab, as long as the person is at their natural, healthy weight and is healthy and happy. However, I tentatively would suggest that there are those that maintain a certain weight by closely monitoring and restricting their intake and controlling their exercise. And if that is where you end up at in recovery because you are unable at that point in time to go any further or feel that that is all you can manage, then I applaud your progress and your strength and bravery in getting to that point – you are amazing and strong and wonderful. Some people will manage their eating disorders and live with it in a state halfway between being free of their eating disorder, and being utterly consumed by it. That is absolutely okay, and if you want to call that full recovery, who am I to decide that it is not by your own personal definition? But I also want to stress that that is not where you have to be if you want to choose differently. You can push further. Whether that is now, or in the future, there is the option to press on forwards to a life where you live pretty much entirely free of your eating disorders influence. I know, because I decided to take the path to that place.

I decided to reject the idea of an “ideal” body. This took me a very long time. It took years of research into health at every size and weight set point theory. It took getting involved with feminism and the body positivity movement. It took learning about the impact of diet culture and how the diet and weight loss industry intentionally make us hate ourselves for profit. It took deciding to be as healthy and happy as I could possibly be in both body and mind. It took deciding to let go of the importance that I had placed on being a certain weight.

I turned out to be one of those people who naturally have a higher body weight than others. It can mean dealing with increased stigma around weight and size, and comes with knowing that I am at a weight where some people will look at me and decide that I am unhealthy/lazy/greedy, whilst knowing nothing about my lifestyle, or indeed myself as a person. Some people will look at me and see me as a weight/shape/size. I am also aware of my own weight privileges in that there are people at far higher weights than me that suffer a hell of a lot more stigma and discrimination. I am aware that although I am far from society’s “ideal” body weight, shape, or size, I still wear “acceptable” clothes sizes (as in, the clothes stores that I shop in cater for my size, even if it is a size some feel shameful about). It is also a size that I maintain effortlessly eating a balanced diet (and by that I mean I eat what I want, when I want, which leads me to eat a wide variety of foods from all food groups), and with physical activity that I do for enjoyment rather than to alter my weight, shape, or size, or any other disordered reasons. It is the size that I can live my life as a healthy and happy person. If I wanted to be smaller, I would have to focus on calorie restriction and possibly an excessive amount of exercise, and we all know where that would lead. Don’t misunderstand me: I’m not going to lie and say that if I had to option to do all this at a smaller size, then I would choose not to. Because of the importance society places on our bodies, being at a smaller size would mean not having to think about or deal with the discrimination of being at a higher weight, and I would rather choose not to deal with that. But my body and its weight/shape/size is not at fault for those stigmas, and nor am I. I accept my body. It is everyone else accepting my body as happy and healthy and beautiful that is the problem, because not everyone does. But that’s okay, because I choose my health and happiness over the approval of others. I choose me.

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To get to where I am now, I chose to reject the ideas and ideals that are so entrenched in our culture and our society. I chose my actual health over the idea that you have to be a certain weight, shape, or size to be healthy. I chose my happiness over the absolute lie that you have to be a certain weight, shape, or size to be happy. Those lies are fed to us all day, every day, everywhere we look, but I just don’t buy it any more. I’ve seen enough evidence of all kinds to call bullshit. And I have decided to live my life in a way that means working with my body and letting it be whatever weight, shape, or size it needs to be to enable me to be healthy and happy. I will not change that for anyone. I choose me.