This post is adapted from a post I wrote on my personal social media blog during the summer of 2023. As a counsellor, my sessions are for and about my clients. However, I also believe in being honest about myself and my own journey. Someone meeting me for the first time will not have a sense of my personal journey and experiences with obesity and the medical system. Yet I think this may be helpful information for someone who is looking for a counsellor who understands.
Obesity is a medical condition; it is not about lack of willpower. However, many doctors who have not kept up on the research, our medical system, and much of society still has a huge anti-fat bias and tendency to fat-shame. Sometimes this bias is conscious, but often it is unconscious.
The purpose of this post is three-fold:
To invite you to become aware of whether you have a conscious or unconscious bias and whether you have the privilege of not having had to deal with this medical condition
To talk about the impact that discussing weight loss in front of kids or to kids has on them
Sharing a bit of my personal journey with obesity
DO I HAVE A BIAS? AM I PRIVILEGED AND NEED TO BECOME AWARE OF THOSE FOR WHOM THIS IS NOT THE CASE?
Over the past many years I have participated in a medical weight management program and have lost a significant amount of weight. One of the first things I heard from the obesity specialist medical team when I joined the program was, “The fact that you are at the weight you are is NOT your fault.”
This was the opposite of what I heard from people including the medical community. When I asked for help, the standard response was, “Just eat less and exercise more.” The reality was that I wasn’t eating a ton, and exercising more wasn’t making a significant difference. Yet time and time again, the solution seemed to be that I just had to do better. I know I am not alone in this experience. So much blame is heaped on people by the medical system and by society.
The reality is that obesity is now seen as a disease and there are numerous factors that contribute to obesity including: genetics, stress & trauma, sleep disorders, diabetes, adrenal disorders, thyroid disorders, nutritional deficiencies, and PCOS, to name a few. For me, while my genetics ensured that this was a struggle through all of my life, things really took a significant turn for the worse when my dad was diagnosed with cancer and passed away several months later. At the same time, my husband and I were dealing with the impact of infertility.
I was not eating more than usual, but the stress was significant. In addition, I stopped sleeping well and have struggled with sleep ever since that time. I gained an immense amount of weight that would be difficult to shed for decades.
As a mom of four active children, I wanted to be able to keep up with them rather than to feel like I was holding them back from activities. It wasn't about being a certain weight. Rather, I wanted to feel healthy and able to live life fully.
Joining MedWeight (www.medweight.ca), which is an MSP covered weight management program, felt like the first time I felt seen, heard, understood, and supported when it came to the challenges with my weight. We were told that people can be healthy at higher and lower weights. Just because someone is thin, that doesn’t mean they are healthy. However, society is biased to think that thin equals healthy. This is faulty thinking.
There are studies that show that people make many judgements about people who are larger bodied, simply based on the fact that they are bigger. This impacts how larger people are treated in work situations, whether their physical concerns are addressed adequately by the medical system (many times conditions go unaddressed because any physical complaint is met with “You just need to lose weight”), and even things such as whether a person advances in their job. While this is not true 100% of the time, there is significant evidence that shows these biases are predominant in our body-obsessed culture.
Now, I mentioned that MedWeight is an MSP covered program. MSP is BC’s Medical Services Plan – provincial based health coverage that is part of the larger Canada Health Act universal healthcare system. This is a great first step. However, if patients want to actually be able to use many of the resources, they will have to pay out of pocket. MSP will cover bariatric surgeries for people who qualify. However, MedWeight is about helping each person work out what they need and what their body needs
There are medication options that can help and counselling programs focused specifically on helping people with the challenges of obesity. While I am fortunate that my husband has a great extended benefits program that covered the cost of the things the doctors suggested to me, not everyone has that privilege or the finances to do so. This is another way in which the medical system is biased against this medical condition, not providing adequate care.
The other thing I remember from right at the beginning of the program was when Dr. Lyons told us that if we lost significant amounts of weight, no matter how slowly we lost it, we should anticipate having loose skin. While medical obesity specialists believe that skin removal surgery should be covered by MSP, MSP does not cover this surgery. Lower Mainland specialists continue to research and lobby to have this covered, but there is no indication yet that this will happen. This is inconsistent with how other medical conditions are treated. If someone has a mastectomy as part of cancer treatment, MSP covers the reconstructive surgery. If someone is transitioning, MSP covers the cost of those surgeries. MSP rarely covers skin removal.
To some, loose skin may seem like “just a cosmetic choice.” Yet for people living with loose skin, the impact is significant, even when MSP doesn’t see it as “bad enough.” Chafing of skin that results in blood blisters and scarring, inability to do certain activities because the skin gets in the way, skin uncomfortably shifting within clothing, self-consciousness about the appearance of the loose skin, to name a few.
If you are someone who has or is struggling with weight, I want you to be encouraged. There are specialists who treat people with dignity and care who can be of help. If you have never lived with obesity and the related challenges, I invite you to become aware of your biases, judgements, and misconceptions about obesity. Be gentle with people, be open to hearing their story without judgement, and realize that this is not a simple matter of willpower. Don’t judge someone positively or negatively based on their external appearance.
HOW WE TALK ABOUT WEIGHT
One of the things I have struggled with a lot is how talk about weight impacts my kids. My husband and I have worked very hard as parents to present a healthy perspective on weight and health. We have never focused on weight; we have NOT used phrases like, “If you eat that you’ll get fat”. Instead, we have focused on eating to help your body be healthy and on paying attention to what your body needs, like hunger and fullness cues.
However, as I have lost weight, people have often commented. I get it. It’s a drastic change. However, when people tell me that I look so good because I’ve lost weight in front of my kids, the message it gives them is that unless they lose weight, they are not as ok in other people’s eyes. Comments like “Your dad must be so happy that your mom lost all this weight” equally convey to them that being bigger is bad and being skinny is good. There is so much stigma and blame around weight.
We have tried to protect our kids from this and to give them a healthier outlook and perspective. That has been helpful for them. Yet as I’ve lost weight, the pressure from outside has spoken against these messages and has left us having to pick up the pieces.
So, I challenge each one of you… Think about how you speak about weight. Do you really need to speak about it at all? Or can we just accept people for who they are, not how much they weigh or what they look like? I have heard it said that “My weight is the least interesting thing about me.”
MY PERSONAL JOURNEY
Now the update that started this whole post. As someone who has had the privilege of working with a team of physicians, nutritionists, and kinesiologists who specialize in weight management, I also realize that I have the privilege of speaking up.
Too often, when someone who is overweight speaks up, people make judgements and say things like, “You’re just making excuses.” I hope by now, if you didn’t already recognize this, you will understand that obesity is a complex medical condition, not a character flaw.
I am so thankful for a specialized team of medical practitioners who could speak to this based on the medical research that is being gathered. Thank goodness for learning!
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