The Obesity Discussion

Hello my zebras and spoonies, thank you for coming and hanging out with me today. I am glad that you are here.

Today I’m going to be talking about obesity, because this is a complicated and touchy topic. For those of you who don’t know, I’m going to start by talking about a little bit of my own personal history in that I used to be morbidly obese. I have been struggling a lot with my weight and have historically had some good success. I have lost enough weight that while I am still obese, I am no longer in the category of being morbidly obese and this is a huge win for me. But the fight is constant and every day and really difficult. And I don’t need to tell anybody who has tried to lose weight how amazingly difficult of a task that is.

There’s a lot going on right now in the public conversation about obesity. And there’s a lot of discussion about obesity shaming and obesity bias and body positivity. And mixed up in all of that is the real and very important fact that being obese, especially if you fall into the category of being morbidly obese, comes with really significant and severe medical risks. So how do we navigate all of that as both patients and healthcare providers in a way that is compassionate and productive? How do we have conversations where we talk about the risk and we support people in the process of losing weight without making people feel like they don’t have value or feel like they are bad people because of their weight? And, you know, I don’t have any magical answers to any of this. I just think that that these are important things that we need to be talking about.

Having obesity I am definitely very fully aware of the reality of weight shaming and obesity bias in the health care system. And as a health care provider, I fight against it. Whenever I see it happening, and unfortunately, I see it happening all too often. I frequently hear people talking about how “they brought it on themselves” or “this is a choice that they have made” or things like that, and I don’t think that people really realize how complex and just difficult all of this is. I mean nobody wakes up one morning and says you know I am gonna go get fatter. I’m gonna work really hard and become obese. That’s that’s not a thing. Nobody decides one day that they’re going to go and become morbidly obese. There’s a lot of things that happen that lead a person to becoming morbidly obese. Majority of people who end up in that category have a lot of things going on. They have mental health issues, they have social issues, they have other medical issues, and it’s a lot of question about chicken and the egg. But when it really comes down to it, it doesn’t really matter which happened first, it doesn’t matter whether or not the obesity happened first or whether or not all these other confounding issues happen first, you can’t ignore the reality that they need to be dealt with all together and you can’t look at someone’s obesity in isolation of the reality of the complexity of these these topics and these issues.

From a patient’s perspective, I think that it’s important for us to keep in mind that if a healthcare provider is bringing up our weight, it is normally not because they are being hateful. My personal experience as both the patient and health care provider is that the majority of health care providers genuinely want their patients to do well and are genuinely working hard to help other people and are working from a perspective of genuine compassion. It’s important to know that about these people. Know that even if they might have these conversations poorly or awkwardly or approach it badly, know that they are approaching and taking on this difficult topic because they care about your health, your well being and they want to see you thrive. Medically speaking, they want you to do well. So try to keep that in mind when healthcare providers have approached you about your weight. We carry a lot of emotional baggage about our weight. We’ve been picked on. We’ve been bullied. We’ve been emotionally abused. We’ve been judged. We’ve been shamed. That’s all very, very real. So it’s really difficult for us emotionally to have conversations about our weight without all of that baggage coming with that conversation. And professionals are not, generally speaking, trained in how to navigate all of this trauma that we’ve experienced over the years of our lives. So be mindful of that and try to give them a little bit of grace.

Now, that being said, there are definitely jerks out there who will just dismiss all of your problems as being because of your weight. And we need to challenge that narrative. We need to challenge the idea that if we were not overweight, we would have no medical problems because the reality is is that that’s very rarely true. While my having lost weight does make a lot of my medical problems better and it absolutely improves my medical prognosis. It does not erase the fact that I have a genetic disease. My connective tissue does not just magically get all better, because I have lost weight. It just doesn’t work that way. I still have Ehlers Danlos Syndrome. I still have my OCD. I still have ADHD. I still have interstitial cystitis. I still have endometriosis and all the other stuff. These things are still all causing me problems, and they will still continue to cause me problems. Even if I get to a weight that is considered ideal and even if I were an underweight individual, these things would continue to be problematic for me. We do need to challenge the narrative that all of our medical problems are because of our weight.

That’s a lot of where this bias is. A lot of health care providers are aware of the health care consequences that obesity generates, and it absolutely does cause a lot of stress on the body and absolutely does cause a lot of illness within the body. So it’s an intellectual trap to see an obese patient and then to assume that obesity happened first, and that therefore this person only has medical problems because of their obesity. That’s where the bias comes in. And that’s where we need to do most of our work. As healthcare providers we need to realize that the issues surrounding obesity are very complex and very layered and are very nuanced and nothing in healthcare is black and white and obesity is no exception to that rule.

I do have some thoughts on how we can have better conversations about weight and obesity in the healthcare setting. But I don’t think there is any way to keep these from being difficult conversations for either the provider or the patient. As the patient we have to navigate all our emotional trauma and the bias that is being given to us while trying to stay open minded to what the provider is coming to the table with. As a provider, we have to figure out a way to talk about obesity without being insensitive to the trauma obese people have experienced and we have to remain mindful of the diverse complexity that each individual patient brings to the table. These conversations will not be easy, but they are important.

I think that it is important to remember on both sides, whether you’re the patient or the health care provider, that we’re individuals and that we come to the table with a myriad of life experience and we come with complex backgrounds and we we don’t leave any of that at the door. We can’t. That’s a lie. I’ve heard a lot of people say “leave your baggage at the door.” Well, you can’t. I’m a nurse, and when I walk into a hospital the reality is that I don’t leave any of who I am when I’m not a nurse at the door. I carry with me all of my biases. I carry with me all of my preferences as a patient. And I carry with me all of the things that matter to me and my values as both a patient and as a person. But this is also true when I’m coming to the table as a patient. I don’t stop being a nurse. I don’t leave all my nursing opinions and preferences of practice at the door just because I’m a patient. We don’t leave who we are at the door when we enter a healthcare setting, that that’s just silly, and we shouldn’t.

I think that it becomes important for us to acknowledge with each other that we are individuals and that we are complex and to just put that on the table and maybe just start our conversation about weight and obesity with maybe talking about where we’re at with that. Like how how do we feel about it and are we ready for change rather than giving us the speech? You know, I feel like a lot of doctors give us speeches and I really don’t think that there is anybody who is obese, that doesn’t know that being obese, has health risks. I think that this is a really well established, well known reality. It’s kind of everywhere. If you’re obese, you know that it’s putting your health at risk. I think that it’s kind of redundant and unnecessary to have that conversation.

I think that it could be more useful to instead start talking in context of asking the question, are you ready for change? And if you’re not ready for change, what are the barriers? What is keeping you from wanting to take on your weight and the challenges that are keeping you from moving forward? What can we do as a team and a partnership to get you closer to being ready to accept change? And I think that might be a much more productive way to have these conversations, is looking at readiness and what makes this person ready or not ready for change? And sometimes it’s just that there’s so many other things going on that we feel too overwhelmed to take on another thing. Sometimes it’s not that we don’t feel like our weights important. It’s just not the highest priority given everything else is going on. And you just have to address other things.

I know that this was really true for me. I personally had to tackle my ADHD symptoms before I could really tackle anything else in my health care. While my ADHD was raging out of control I was so disorganized and so impulsive, and there’s just no way for me to be able to take on a really good organized systematic health regimen that is necessary to achieve good effective weight loss and sustainable weight loss. I was too impulsive in making health choices. I would see food and I’d be like, either it looks appealing or doesn’t. Things would go into my mouth based on that appeal. There was no thought about future consequences because of that impulsivity. I was so disorganized that I wasn’t always making my healthcare appointments because I would miss them because I forgot about them. Or I couldn’t get there on time because I was too disorganized and then I had to reschedule. It can be very important to look at what those hurdles are and I had to spend literally three or four years working on my ADHD and getting my ADHD under control and those symptoms well managed before I could reasonably tackle a lot of my other health care problems. I couldn’t consistently take medication before I managed my ADHD, which made managing my other health care problems are really difficult. When you can’t everyday take medications that’s a huge hurdle. When you can’t make doctor’s appointments regularly that’s a big hurdle.

It’s important for us to have conversations about what are the hurdles and what is getting in the way. What’s keeping us from being successful? I truly believe that every person on this planet, wants to be successful, wants to be happy and wants to thrive. And if a person is not achieving happiness, and is not thriving and is not being successful, it’s because there’s something getting in the way and we need to look at what is getting in the way and we need to start helping people break down barriers rather than judging people for not being able to climb over those barriers by themselves. Because once I got help with my ADHD and my ADHD symptoms were controlled. I found that it was really amazingly so much more manageable to take care of my other health care problems. Other things just started falling into place. I started having so much more success with other things and I can’t imagine how difficult it would be to try to have a conversation about my weight when I was still having ADHD symptoms that were wildly out of control.

I think that those are my two pieces for this whole conversation. We need to remember that we all carry bias and baggage. On both sides of the table, we need to be very mindful of our biases and baggage so that we can have a better conversation and a more open minded conversation and a more honest and compassionate conversation. And I think that we need to look at this and pretty much I think every healthcare problem from the perspective of what the barriers are, rather than looking at people and saying, “Well, you just need to really need to do the thing.” Well, we know that we need to do that. That’s not helpful.

I think that the body positivity stuff has been interesting. There’s a part of me that thinks that it’s great. And then there’s a part of me that that has a lot of cringe because it’s been a mixed bag, what I’ve been seeing in the media. I think that everyone needs to have and deserves to have body positivity regardless of what their body looks like. And I think that absolutely needs to be promoted. But I think that we need to be careful that we are not also promoting that really overweight or really underweight bodies are healthy because that’s not true. If you are all skin and bones and are just starving yourself to get to be a thin person you are at a ridiculously high health risk. If you are morbidly obese you are at a really high health risk. And while I feel that you still deserve to have body positivity and you still deserve to love the body that you’re in, we need to still acknowledge that being one extreme or the other with our weight comes with risks. We really have to be careful that we’re not dismissing those risks when we’re promoting body image positivity. Because absolutely everybody body is different and everybody’s healthy body will look different. What my body looks like when it’s healthy, will look different than what someone else’s body might look like when that person’s body is healthy. And we need to be more mindful of that. We need to be more accepting of that as a culture. I’m absolutely behind the idea of body positivity. But when we’re having these conversations, we need to make sure that we’re also including in that conversation, that extremes of weight come with risk and come with health consequences, and it has nothing to do with how the person looks but it has to do with the consequences of what it does to our bodies.

So yeah, it’s a it’s a balancing game. And I think it’s like that with everything in life. It’s not black and white. It’s not absolute. It’s complicated and it’s messy, and I’m glad that we’re talking about it in in the public forum. I’m glad that is something that is getting a lot more light because I think that it needs to be something that’s talked about more. I think that people who have obesity are not always given a voice and a place to talk about their life experiences. And I’m glad that more of us are feeling comfortable about getting out there and saying what it is like for us and I think that that’s really important and really powerful. So yeah, let’s keep that stuff going. But while we’re talking about that body positivity, let’s be sure that we’re also really holding on to the fact that weight extremes come with risk.

Those are some of my thoughts on the obesity discussion that I’ve been seeing in the media recently. And what do you guys think? Where are you at in all of this discussion? How do you feel about the body shaming and obesity bias and the body positivity movement? I’d love to hear your thoughts.

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