About a month ago I made a Tik Tok about wegovy & similar ‘weight loss’ jabs. I had seen a lot of people promoting them, giving advice on how to get them prescribed etc. These positive posts all had notable omissions. I wanted to address the missing information.
I am fully behind bodily autonomy & wouldn’t tell people what to do with their bodies. However, I think it is essential that we have all the information before making medical decisions. It’s impossible to consent to treatment if you aren’t informed of all the risks, side effects and so on.
The current information on medications of this type is that weight loss will be most significant in the first 6months. Loss will peak at 1year and regardless of how long you remain on the drug, you will start to regain after that point. Regaining any weight lost is not only a certainty, it will happen fast. In fact the data shows that the pattern of weight loss & gain is similar to other methods of intentional weight loss. You are likely to regain not only the weight lost, but a little extra on top too.
People who have these injections report many gastric symptoms. Extreme nausea, vomiting & diarrhoea sometimes for weeks or months at a time. For others those side effects never settle. Long term use increases the risk of gallbladder problems & pancreatitis. Both are very painful, the latter can be deadly if not promptly treated. It’s also important to note that these injections have not been licensed for more than 2yrs for use in non diabetics. They have also never been prescribed in such high doses. The truth is there are still many unknowns. What we do know for sure it that these medications have serious risks & promise only short term results.
So, why am I going over all this again? Today I got a notification of a comment on that video. Reading it broke my heart.
I understand that sentiment. I used to feel that way. I’d make jokes about smoking instead of eating; saying as long as I was a thin corpse I didn’t care. I know how painful it is to feel that way. What’s worse is I know that many of the professionals who swore an oath to ‘do no harm’ feel the same way. Fat phobia is so ingrained in the medical profession that Drs recommend harmful meds, diets & surgeries to fat patients. Rushed to market, poorly tested and even known to be ineffective interventions. It matters not, because they’d rather we be sick or even dead than fat.
We deserve better. We should be able to consult our Drs when needed without the dreaded weight loss chat. We are entitled to treatments & procedures without having to first agree to dangerous diets. We are as worthy of respect and compassion as any other patient. And, we can demand it.
There are so many amazing resources to help fat patients deal with medical weight stigma. Two of my favourite fat positive medical folks are Dr Asher Larmie & Dr Joshua Wolrich both have written extensively on the topic. I cannot recommend their work enough.
I too am happy to help if I can. I’m not a medical health professional, but have learned many strategies for dealing with anti fat Drs. I’m always delighted to pass these on.
If Bronan’s belly is cute, so is yours.
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Regular readers might have noticed the downturn in my long form content. There’s a very simple reason for that, chronic illness.
This year has been one thing after another. The last few months in particular have been gruelling. The problem with having chronic conditions is you often find yourself fire fighting. There are so many symptoms, it is impossible to properly deal with everything. You end up addressing the most problematic at any one time. Plus of course it can be hard to get Drs to really investigate many issues. Often they’ll just chalk up to an already diagnosed illness. Sometimes they’ll try to mitigate that symptom & others you are basically told you’ll have to live with it. I always have questions that aren’t answered. Unfortunately I run out of steam to pursue them. When you are always tired & in pain you must pick your battles.
Of course being fat complicates matters. The first response more is usually something about losing weight or questioning my diet. When I fight against that there will be what I call ‘subterfuge tests’. I’ve had more fasting bloods & cholesterol tests than anyone ever needs. After years of Drs refusing to believe anything I tell them, I find it is easier to just go for the bloods & prove myself right.
The last few months have been relentlessly hard. Pain has been consistently more severe. Digestive tract refuses to behave. I’m fainting daily. I’ve had the worst bout of insomnia of recent years, but even when my body eventually gives into the exhaustion; I awake feeling just as tired. Brain fog has punctured my old articulacy. I struggle for words in everyday conversation. I have lists & notes for every little thing. If it isn’t written down, it will never happen. My skin itches, my head hurts, alarming bunches of hair are falling out, I’m breathless, nauseous & anxious. ALL THE TIME.
I have suspected that something was going for a while. I can’t explain except to say that my body didn’t feel like it belonged to me. These ailments have been breaching my outer limits. So, I had some blood tests that revealed elevated numbers. My Gp wanted to test again a few weeks later to rule out a random blip. They came back slightly higher. A new medical mystery was born.
The high numbers are related to my liver function. There isn’t an obvious reason for my liver to be pissed off. I hardly ever drink alcohol, I don’t eat meat or dairy, no signs of diabetes. It doesn’t make much sense. Possible culprits include my missing gallbladder & bile duct complications, covid & no doubt my weight will become a factor too. I await scans & next steps.
All this to say, I am currently operating on a wing & prayer. And I’m not even religious.
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About a week ago I had a telephone appointment with one of the Gps from my practice. I haven’t had much interaction with this Dr and it did not go well.
After a brief conversation about the symptoms concerning me, she suggested we start with some basic tests and swiftly moved on to checking my weight. I asked why she wanted my weight and explained if not medically necessary I did not want to be weighed. The Dr replied that she would like to calculate my BMI. I told the Dr that BMI wasn’t scientifically sound and I didn’t want to discuss it. I’m sure you can guess how the appointment went from there.
It was the usual gaslighting and time wasting. According to the GP she would be negligent if she did not assess my BMI. I reiterated my objections to her weight focused approach, all of which were dismissed. The appointment was taken up with this back & forth instead of actually discussing my actual problems. I have informed various practitioners at the surgery about my preferences with regards to being weighed, discussing weight loss etc. I have disclosed my history of disordered eating and how intentional weight loss is detrimental to my mental health. I’ve also discussed the harm caused to me by weight stigma, which includes near fatal misdiagnosis and long term health implications. All of these conversations should be recorded in my notes as per my request. Yet still, I find myself regularly having these interactions whilst trying to access medical care.
Given our in-depth conversation about why I wouldn’t be weighed without solid medical reason, I had hoped that might be the end of it. I was fairly surprised when I saw the nurse yesterday for bloods and she asked me to ‘hop on the scale’. I gave her my standard, I don’t do weighing unless medically necessary. The nurse then told me that the Dr had specifically noted that she must makes sure she weighs me. I was internally furious, but calmly explained to her that I had already told the Dr I wouldn’t be doing that. Luckily, she left at that.
I am chronically ill. I have lots of interactions with medical folk. I am flat out exhausted before we get to the fat phobia. I often don’t have the fight in me, but I’m forced into battle. There is no let up. If I don’t assert myself I will not get the care I need. I know from bitter experience just how dangerous that is. The problem remains that even when I do stand my ground, the medical profession is want to shove back. Either I am entirely ignored or I am labelled difficult. It’s endless and wearing.
The persistence of these attitudes feels like a war of attrition on the patient side. It’s draining. No matter how many times I make my wishes known, they are ignored. Coming to appointments armed with facts, evidence and clear description of how this weight stigma harms me, makes no difference. Today was a classic example of this. I wasted my time discussing very personal & traumatic experiences with a Dr in order to justify declining to be weighed. She simply set it all aside and took action that she knew would harm me. I shouldn’t have to justify not wanting to do things that are not necessary or helpful to my treatment in the first place. However, it is clear regardless of how much time & energy I invest in explaining why intentional weight loss talk is detrimental to me, medical professionals will not listen. The stress of always having to be prepared for a fight is immense.
I will of course take steps to address this latest event with my practice. I can only hope they take action to protect me. It won’t bring the discussion of my weight to a close. There will still be another specialist, nurse or hospital consultant who views me as first fat and second a person in need of medical care. Right now the knowledge of that is way too overwhelming.
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Last year was tough. Long covid/Pots really did a number on my already subpar health. It was hard to keep on top of even basic daily tasks. All aspects of my life suffered. In an effort to shake that not quite enough feeling I’ve raided the brain for my 2022 highlights.
I contributed to the book Rebel Bodies by Sarah Graham. It’s an incredible piece of work about the gender gap in healthcare. Sarah covers the intersections of gender, weight, age & disability whilst deconstructing the barriers women & non binary people face when trying to access appropriate medical care. I am so proud to share my story of medical weight stigma and be part of this book.
In April we took my Mum on a birthday trip to Salzburg. She had a big birthday at the end of 2021 & we wanted to do something special. Mum loves The Sound of Music & has always talked about going to Salzburg. This year, she finally got there and it was magical. We stayed at Schloss Leopoldskron, where the movie was filmed, took a private Sound of Music tour and had a generally amazing time. Salzburg is incredibly beautiful and taking Mum on her dream holiday was wonderful.
At the very beginning of ‘22 I was a guest on the Anti Diet Club podcast. The pod creators Gillian Wilson and Tamsin Broster are dedicated to helping others divest from diet culture. I love the work they do and was honoured that they considered my voice worth hearing. It is such a pleasure to connect with others who are committed to fighting fat phobia.
This summer I got to revive a love from my youth. I thought festivals were a thing of the past for me, but thank to TRNSMT’s comprehensive accessibility accommodations I was back in the game. Watching bands, whilst sipping cider in the sun with my bestie & sister made me feel 22 again. Screaming along with The Strokes as the the sun went down was such a highlight.
This one might seem small, but felt significant to me. The Guardian journalist Martin Belam recommended me in his Friday Reads. Having a writer I respect enjoy my work enough to share it felt good. Especially in a year when my health has interfered with my creative output.
Last, but never least is of course being an Auntie. It is my biggest joy. I am so excited to watch all of my niblings grow. Last year they continued to surprise & impress. I am endlessly grateful to be part of their lives.
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I got an email from photobucket. Actually, I got several that I had ignore because I had more pressing issues. I should have continued pressing because opening the 12th email and clicking that link was a mistake.
Amongst page after page of self harm photos I found pictures of a girl I don’t fully remember. I don’t know why I say a girl, I was a woman. I seem more like a lost girl, though. I look like someone who wants to disappear. I was someone in the process of vanishing. Looking at those photos hurt. It’s painful to see how desperately Ill and unhappy I was. Even more agonising to realise how much the world approves of that version of me. A person who hated themselves so much they wouldn’t eat properly & spilling their own blood felt reasonable. But hey, look how I thin I was.
I lost ridiculous amounts of weight in a very short time. I started with what I believed to be a very reasonable calorie restriction. A nice round number that I saw in magazines & tv shows. The weight came off quickly. People around me were pleased. I enjoyed the positive reinforcement. Everything else in my life was a disaster, I liked doing something that everyone was happy about. I also liked my discipline; how strict I could be. I began to relish the hunger pangs and how good I was at ignoring them. When the weight loss slowed I reduced the calories. I limited how many each meal could contain. I couldn’t eat before or after certain times. I filled up on Diet Coke. I had ‘fast’ days and just eat veg days. Rules piled up and weight fell off.
I did this more than once. The weight loss was never maintainable. Each time I started again I believed I would just follow a ‘healthy’ diet. Every attempt at lifestyle change descended into extreme behaviour. The only people who questioned this were the few who’d had their own food issues. I assured them I was ok. This weight loss was good for me. I wasn’t doing anything crazy, in fact I felt so much healthier. I’m sure the believed (or almost did) me because I didn’t think I was lying. I honestly thought the means justified the ends. Being fat was horrible. I was disgusting, I ate too much and it was terrible for me. Having some restraint was improving my body inside and out. I knew I was fudging the details a little, but I really didn’t think I was doing anything dangerous. I did eat. I very rarely threw up. The things left in my diet were all ‘good’ foods. The congratulations rolled in. Besides, I wasn’t even very thin.
I don’t even blame the people who did all the high fiving. They knew I had been unhappy with my bigger body. Those close to me knew how appalling my mental health was. It looked to the outside world like I was doing something good for myself. I seemed more confident, more at peace with my body. Of course we all live in diet culture. Thinner bodies are better. I understand why my weight loss was something to celebrate.
The professionals are another story. They should have known better. I was so very Ill. I was in regular contact with all manner of Drs. My self harm was out of control. I was getting stitched up multiple times a week. The blood loss was wreaking havoc. I had angina attacks, constantly passed out. No sooner was a blood transfusion in than I was working on getting it back out. I had already started to experience the problems that led to pancreatitis. They watched my weight rapidly drop. Climb back up. Then fall off again. Not a single medical professional ever thought to question that. They were the opposite of worried. I was praised. They loved seeing the change on the scale. I was explicitly told how good this shrinking was for me. I didn’t even lie about how I was doing it. I’d joke with nurses about ‘just not eating’. I explained my calorie restrictions and the extent of my diet to Drs. It was all excellent. Keep up the good work. Well, done you!
Even the mental health teams I was working with didn’t raise any alarms. We only ever talked about my weight loss in positive terms. They were glad it was helping my self esteem. There was never any in depth conversation about how I really felt, what I was doing or why. There should have been. They knew my history and my problems. There are so many links between self harm & disordered eating. Control being the most obvious. The triggers for the behaviours can be the same; shame, self hatred, feeling a failure, punishment. They can achieve similar results like a feeling of release or a sense of achievement. My self harm was compulsive and so was the weight loss. I was atoning and deleting the parts of me I despised. The only real difference between the two was how acceptable it was to want to be thin.
As I write this I recognise all the signs of an eating disorder. Yet I cannot accept that diagnosis fits. I can admit I had an unhealthy relationship with food. I know I used extreme methods to lose weight, but disordered eating is as far as I can allow myself to go. Intellectually I know why. I was never dangerously thin. In the midst of it I didn’t ever believe I was thin at all. Those old pictures were shocking because I have no recollection of being as slim as that person. I began my diets fat. Eventually I always returned to fat. That’s why no one ever considered an ED a possibility. It remains why I could never accept the label. For all my learning and activism there is an internalised fat phobia that I’m not sure I will ever shake.
I have compassion for my former self. I am angry at the people who should have helped me. I am happier in my fat body than I ever could have dreamed of in my dieting days. I don’t want to go back. Nor do I want to be smaller. I do however still hold this feeling that I have no right to talk about myself in certain ways. I feel fake. Despite knowing all that I know, I still can’t change the feeling that it wasn’t bad enough for an official title.
That realisation is painful. It hurts to know that nothing has really changed. There are people in the same situation right now. The medical community is still exceptionally fat phobic. If you are fat, disordered eating is encouraged. Prescribed, even. We’re still insisting people fall below a certain BMI before they can be referred for treatment. The fact that Drs are even using BMI is in itself horrendous. People are hurting themselves and the world loves it.
This is why body liberation is essential. It is so much deeper than loving one’s body. Weight stigma is systemic. Built right into the places we are supposed to turn to for help. Fat phobia is in us all. It is insidious and deadly. We all deserve better.
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If you are at all interested in dismantling diet culture you will be aware that new government legislation regarding calories on menus has now come into force. The legislation is part of the government’s plan to tackle ‘obesity’. Whilst I have a lot to say on that larger topic, I’ll stick to the calorie information for now. It will come as no surprise that I am not in favour of this development.
As a fat woman who spent years of my life embroiled in yo-yo dieting I know how dangerous constant calorie counting can be. In the depths of my disordered eating I was obsessed with calories. They were my enemy and required constant monitoring. I had calorie based rules for everything. Limits for every meal and limits for the entire day. If I was going to drink alcohol I wasn’t allowed any food. I counted the calories burned during exercise in an attempt to cancel out what I had consumed. I knew & counted the calorie content of everything; a smint, a grape, a sip of wine. Calories were omnipresent. It was an exhausting battle against my body’s basic needs and I was miserable. My quest to be thin damaged me, physically & mentally.
I’m not the only one nor am I the most severely impacted. We live in a world that is constantly reinforcing the message that smaller is better. Putting the calorie content of every item in every menu only compounds that. It won’t encourage ‘healthy eating’, everyone already knows what foods are full of saturated fat. What it will encourage is distorted view of what a healthy lifestyle is. It will support the diet culture narrative; fewer calories are better. Looking at the numbers every time we go out to eat will reinforce an unhealthy relationship with food. People will feel guilty for ordering the dish they want. It’ll trigger obsessive thoughts and behaviours in those who are dealing with or have experienced disordered eating. It will cement the connection in the collective mind between health and calorie control.
I posted about this legislation on my Instagram stories today and have already received multiple messages from people who have been distressed by seeing these menu additions. These are people trying to claw back control of their eating. People who have worked hard at ignoring that voice in their head telling them what they can and cannot have. They’re scared. Genuinely frightened of how they feel when they see signs telling them how many calories an adult shout eat in a day. Worried about the thoughts the calorie count on their coffee provokes. This isn’t a surge towards a healthier society, it’s a huge step backwards.
The problem with this move is the thinking from which it stems. Our government is telling us that being fat is a problem. That fat people are a burden we must shift. That isn’t true. There is no proven way to permanently make a fat person thin. Diets do not work; within 5 years 95% of those who intentionally lose weight will regain all they have lost and more. Calorie restriction is not sustainable. More over, it is not good for you. It ignores the intersections between weight and poverty & disabilities. Not to mention the impact of medical weight stigma on the health of fat patients. There are many lifestyle changes a person can explore if they want to improve their health. Focusing entirely on calories and weight loss is not one them. Health and weight are not intrinsically linked. Adding the calorie content to menus is dangerous. It sidesteps the issue of public health and props up stale old diet culture tropes.
I am not a doctor or an expert. I am merely an informed former victim of the diet industry. I am a fat activist and as such I can see that many people may dismiss me as having an agenda. With that in mind I point you towards the following resources.
Something in the way she moves... 
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