The Biggest Liar…

On Saturday I might I watched The Biggest Loser. I didn’t really want to, I knew it would infuriate me and I was correct.

I never watched The Biggest Loser when it was showing. Not because I knew better, at the time I was very much steeped in diet culture & self loathing. It just wasn’t available on whatever tv channels I had at the time. So, for me, this was the first time seeing clips of the show. I felt rage, sadness and an overwhelming urge to intervene. The abuse those people were subjected to is appalling. Sadly I remember how commonplace that was at the time. I completely understand why the contestants signed up for this public humiliation.

For me, the documentary went way too easy on those involved in creating this programme. Right off the bat, Bob Harper (one of the show trainers) claims that he regrets nothing he did on The Biggest Loser. No one takes any real responsibility for the fact that they caused real and lasting harm. The film makers allow the producers, trainers and show Dr to dodge accountability with pathetic excuses. I felt that the documentary ultimately reinforced the message of the show; the ends justify the means.

The creators of The Biggest Loser (BL) admit that they purposely used sensationalist tactics to attract attention. They knew the connotations of the name and played on it. They wanted people to tune in thinking they could judge these ‘fat losers’. They encouraged the trainers to be outrageous, they wanted contestants to throw up, cry etc. They knew the vile ‘challenges’ were cruel and unnecessary, but it made good television. They excused this exploitation by claiming that they were improving people’s health. In other words, all was acceptable in the name of thin. Everyone involved knew they were hurting people. Dr Robert Huizenga, the programme’s medical advisor told them so. He claimed that he regularly met with the trainers to explain his recommendations. He also admitted he was aware that they ignored him; they cut the calorific intake to dangerous levels and over trained people to the point of injury. Dr Huizenga tries to paint himself as caring medical professional who was helpless in his attempts to prevent harm. In reality he had a duty of care, he should have left the show and reported the dangerous practices. He could have stopped taking their money and spoken out at any time. He didn’t, he continued to profit from damaging fat people. Not only the people on the show, but all fat people who were impacted by the message of the BL.

That gist of that message was that fat people are lazy and gross. The ‘temptation’ challenges reinforced the idea that fat people can’t control themselves. The cruelty of those challenges is ignored in the discussion, the participants were forced to choose between gorging on ‘junk food’ or missing visits with their families. The footage included in the documentary shows participants crying whilst eating pizza slices; their suffering was entertainment. The show revelled in degrading the fat competitors. Tasks that made them build food towers with their mouths, trainers screaming, participants set against each other. Placing people on extreme diets, working them past exhaustion daily and then capturing their disputes and meltdowns on camera is repulsive. Worse still is the soul destroying message the trainers rammed home. Once the abuse was concluded they would tell participants that it was for their own good. I only shouted because I care about you, I knew you could do it, I didn’t want you to give up. Then the nail in the coffin, ‘don’t make me have to do that again’. The lesson to the participants and the viewing public? This is your fault. It’s your fault you are fat. It’s your fault you don’t apply yourself. It’s your fault that I had to abuse you.

All of this aside, the BL’s main claim, that they were improving lives, was obviously not true. Even if weight loss was a magic cure all, their process was clearly unsustainable. No one can live on 600-800 calories p/d forever. People with jobs, families and lives cannot train for 8hrs a day, everyday. It doesn’t take a genius to conclude that as soon as participants return to their regular life, they will gain weight. I have partaken in enough crash dieting to know how quickly the weight returns. One of the former contestants in the documentary talked of how he asked the BL to set up aftercare and was denied. Other contestants reached out to seek help for injuries sustained on the show and were ignored. Cut to a producer explaining that they didn’t have the budget for aftercare. Plus he didn’t think it was their responsibility. They were making a tv show; what happened after wasn’t their business. Meanwhile we learn the BL franchise earned billions. They licensed their name to every product you can imagine. Further exploiting vulnerable people desperate to lose weight. It was a cash grab and fat people were paying for it.

The only entirely critical voice in the documentary is fat activist, Aubrey Gordon. Her contributions are insightful and impactful. Alas, there was not nearly enough of her. Even the former BL contestants who were critical of the show were still heartbreakingly steeped in fat phobia. They were still seeking weight loss, still blaming themselves and still felt they weren’t good enough. The evidence of the consequence of extreme dieting was somewhat skimmed over. Studies on broken metabolism, life threatening conditions and even Bob Harper’s heart attack are treated as incidental. They place no importance on the fact that a man who adhered to the supposed ideal diet and lifestyle had a massive heart attack at 52. As if that information doesn’t disprove the central argument of The Biggest Loser.

The documentary concluded with more diet culture propaganda. They give obesity stats without ever mentioning that those numbers are based on BMI. A measurement that has been conclusively proven to be inaccurate. It’s a non scientific, racist scale. The documentary makers allow the show creators, trainers and Dr to claim good intent and even positive results. Their hearts were in the right place, they say. They made some people thin. Damn the ramifications. After all, anything is better fat.

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Care a little…

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.

A blue bathroom scale that reads doesn’t matter

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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You’re toxic…

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.

Dr Asher Larmie

Marquisele Mercedes

Dr Joshua Wolrich

Gillian McCollum

Alishia McCullough

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On the plus side…

Fatigue is getting the best of me this week. I am out of spoons, but I don’t want to be out of words on this blog. Hence, I wil be sharing some short pieces I have written for other publications. I hope you find them as absorbing as my usual content.

First up a piece on how body shaming & fat stigma makes plus size infertility an even bigger challenge.

Infertility is heart breaking affair for anyone who wants to have a child. With the NHS now reporting that 1 in 7 couples have difficulty conceiving, infertility is more common that we realise. Thankfully many people in UK will be able to access fertility treatment via the NHS. However, some people are not deemed suitable for treatment. One of the groups who may be denied access are those categorised as clinically obese.

Women with a BMI over 30 are routinely refused fertility treatment. Drs advise them lose weight before they can be referred to a specialist. There are a number of issues with this policy and some are tied in with the way society as a whole views fat people. Let’s begin with index used to measure if a person is obese. Body Mass Index (BMI) has been widely discredited. The index has a number of problems including the fact that BMI does not differentiate between muscle & fat. Hence, people who are fit & have healthy body fat can be classified as obese. Another issue is that BMI does not recognise difference in body shape. It is well established that those who carry their weight around the middle (sometimes known as apple shaped) are at much higher risk of health complications than those who carry excess fat around their hips (pear shaped) [1]. Thus women with very different shapes & risk factors can be labelled with the same BMI. Perhaps the biggest failing is that BMI  does not always change with lifestyle alterations. A person may make significant changes to their health without necessarily losing large amounts of weight. Partaking in regular exercise and switching to a balanced (but not calorie focused) diet will have a huge impact on a person’s wellbeing. Sadly, BMI would not recognise these positive changes unless there is also weight loss. This can put women in the position of focusing on how much they weigh rather than how their lifestyle impacts their wellbeing. BMI uses an arbitrary scale to calculate’ health. Since a person’s health can not be determined on their weight alone; it is bound to fail.

Of course, there are also questions to be asked outside the clinical failings of BMI. It is important to note that there is no official policy on women who are under weight. Despite the fact that being ‘too thin’ can have a bigger impact on a woman’s fertility than being ‘too big’. The medical community appear to jump to the conclusion that fat is always bad. A notion that is reflected in society & that causes plus sized women to face wide spread discrimination. It is estimated that half of pregnancies in the UK have obese mothers. Yet studies show that only 5% of admissions to neonatal units and 4% of preterm births could be avoided if all pregnant women had a ‘normal’ BMI at the start of pregnancy [2].The implications is clear, overweight woman are regularly having healthy pregnancies & deliveries. Still the overwhelming message from the medical community is that obese women automatically have  high risk pregnancies.

We must also look at the origins of the BMI scale. It was developed in the 19th century by a Belgian Mathematician. The formula was intended to be used as an easy way to measure populations, not individuals. It was developed for the purposes of statistics not measuring individual health. BMI is not a reliable scientific measure. It is astounding that it is still in use.

The most worrying part of this protocol is that women are often not even referred to a fertility specialist until they capitulate on the weight loss issue. This means that women who have specific medical problems interfering with conception are forced to delay interventions that could solve their problems. The bottom line is that women who are classified as obese get a raw deal. Underlying prejudices seem to be making an already distressing issue much harder of plus size women. Infertility can make women feel powerless and incompetent. When you are fat, those feelings are increased by the prevailing impression that your weight is to blame.

1 Mayo Clinic
2 Public Health England, Maternity obesity and pregnancy outcomes.

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