England & Wales, Global, Scotland Communities and society, Health and social care

Where are the fat people in obesity policy?

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Photo by Piret Ilver on Unsplash

Ingrid is Head of Content at LGIU. She’s been struggling with weight and with obesity policy approaches throughout her adult life. In this very personal post, she highlights her frustration with approaches to obesity policy that focus on calorie restriction. 

I’ve been overweight most of my life. And now I’m really fat. Like really fat. Obese. I’m cringing as I type. It’s tough to use those words even though everyone can plainly see it. Dark fabrics and strategically draped clothing won’t hide it.

I’m a professional, well-educated, with some ostensible control over my life. I have access to good food and the means to pay for it. I understand nutrition, portion control and caloric deficit. I think it’s fair to say that, as a fat person, I’ve read and studied extensively on diets and weight loss and living a healthy lifestyle.

I don’t want to be fat, although I don’t mind being a little overweight. And at this point, I really don’t want to be as fat as I am, my weight is preventing me from doing things I’d like to do and is harming my health.

As our recent briefing on obesity policy states, since 1992 in the UK there have been at least 14 strategies, 689 policies and 10 targets, and at least 14 key institutions and agencies created and then abolished. I don’t know how many of those policies were developed by or with fat people, but I would hazard a guess that it’s not many. Even looking at local implementation of policies, I’ve been in workshops or talks on obesity policy where people wouldn’t look me in the eye and where I felt my presence was limiting what people felt they could and would say. I felt unwelcome in spaces where policies and practices were being discussed that could directly impact me. I felt the weight of their emotional response to my body. I don’t attend workshops like that anymore.

In clinical spaces, I’ve been told that everything from a sprained ankle, to tennis elbow, to chronic pain is being caused by my weight. Sometimes it’s true or at least partially true.. But sometimes it’s baffling at best and humiliating and frustrating at worst. And I’m not alone, as this study from the University of Leeds highlights.

Mostly I’ve just been told to lose weight to nearly any health complaint. I’ve rarely been told how. Occasionally I’ve been told to count calories. I want to tell these skinny doctors that I’ve actually lost more pounds than they weigh over the years. I know how to lose weight through calorie restriction. I, like most people, cannot maintain weight loss. It’s well known that diets do not work in the long term and may even be harmful.

No one has ever asked me why I was fat. They assume they know the answer. They only know part of the answer. Eating too much and moving too little is definitely part of the answer. But it’s more complicated than that. I have several conditions that make losing weight long-term difficult. I have thyroid disease. I have lipedema, which is a genetic, progressive and chronic condition of fat accumulation in the legs and sometimes arms (it’s both for me). I also have ADHD,  and people with ADHD are four times more likely to be obese (read more).

But if someone were to ask me, I’d say the primary driver is an ongoing trauma response or emotional eating. I have a relatively high Adverse Childhood Experience (ACE) score. This has been strongly linked with obesity – this National Institutes of Health study links multiple ACEs with a 46% increased chance of adult obesity. I’ve always been solidly middle class, but there are severe compounding effects for those who are poor. Overeating has always been my go-to form of self-medication.

Like many people with high ACE scores, I made some bad relationship choices. This lead to more chronic stress, some extremely traumatic events and further reduced my emotional resilience. My latest bout of weight gain can be directly linked to compulsive eating after a prolonged and spectacularly traumatic event which hit me at the same time as Covid and menopause (which often pushes lipoedema into further stages of progression). This time age and pre-existing conditions plus that significant weight gain meant my mobility took a nosedive and exercise previously had been the only I’ve been able to maintain health. Until recently my weight had little to no impact on other vital statistics, but it does now.

Being aware of all this hasn’t necessarily helped me to change my behaviours around food, but could it help a clinician or a policy maker develop better responses to support me or people like me? And if I were treated with more understanding, would it make a difference at this point when trust is broken and I’ve several times come out of GP appointments for a physical injury with a fresh new emotional injury.

I rarely see policy responses to obesity that are trauma-informed. While I do agree that obesogenic environments (easy accessibility to high-calorie, low-nutrient foods) are part of a wider problem. Food deserts are real and nutritional knowledge among the general population could be improved, but it isn’t clear to me as a fat person how much difference this would make for me.  And of course, it has to be said, that there are plenty of thin people with many of my health conditions or worse and my history of trauma and worse.

Our latest briefing, perhaps not incidentally written by a thin person, outlines the history of efforts to reduce obesity in the general population, current approaches and new possibilities. Will it work? Fat chance.

Until there is a personalised, supportive and trauma-informed approach to weight loss, it’s unlikely to help individuals already struggling with weight. Without a holistic approach to health and mental health, obesity prevention efforts will continue to fail.

And finally, please, nothing about us without us. We have lived experience of what doesn’t work and insights into what might.


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