The health care system in the UK is becoming overly expensive and overly burdened, almost to a tipping point.
So now – in an effort to stay afloat – nearly a third of UK hospitals are now denying health care to patients with a BMI over 30.
These hospitals have restricted knee, hip, and other lower body replacement surgeries from obese patients and active smokers, saying that the interventions are “wasted” on the obese.
There are so many unfortunate things about this scenario. One of them, however, is in my opinion the worst of all.
It’s that they might actually be making the problem worse.
Why? Because
Fat shaming causes overeating.
This is something we have been saying here at Paleo for Women for a very long time (read my book on it, here).
Four years ago, I wrote a post on what I call the ‘binge-restrict’ pattern of overeating. This is what happens to people who are fat shamed.
When fat shamed, you feel guilty about your body. This motivates you to starve yourself. You “eat clean.” You do a bunch of whole 30s. You might even “feel great.”
But after a while it wears on you. You begin to obsess over what you’re restricted from. You feel hungry and irritable all of the time, perhaps. And you develop very, very, very strong cravings.
So then you ultimately (and inevitably) fall off the wagon, and overeat.
This makes you feel guilty again, so you starve yourself again. Then you develop cravings again. Then you overeat again.
And again, and again.
Restricting food intake has drastic consequences, especially with an unhealthy mindset.
This is exactly what happens with “obesity awareness”
The more that our culture shames people for the size of their bodies, the more we doubt themselves.
The more we doubt themselves, the less capable we are of making changes that focus on health instead of weight loss.
And the more we doubt ourselves, the more we hate our bodies, and resent our bodies, and therefore develop unhealthy relationships with food. We fall into binge and restrict patterns.
Here at Paleo for Women, I often talked about this phenomenon as though it was definitively true. And I did believe that it was.
But now we know more certainly that it is, and that it affects our society on a broad scale. It didn’t just happen to me. It didn’t just happen to Noelle. It didn’t just happen to you. It happens to cultures as a whole.
It is happening to the world.
With such big players like the UK and US health care systems at bat, there is a lot at stake.
The science
This article interviews Researcher Eric Robinson regarding his study of obesity awareness. He says of obesity and the intentions behind it that:
““There is quite a substantial body of research showing it is not really very much fun being an overweight person in this climate,” said Robinson. “It is a stigmatised condition. Realising you are an overweight individual is in itself likely to be quite stressful and make making healthy choices in your lifestyle more difficult.
“It is a tricky finding for public health intervention work. You would hope that making a person aware they are overweight would result in them being more likely to change and lose some weight.”
What Robinson and others instead found is that, from a study of 14,000 adults in the US and the UK, perceiving yourself as overweight actually has the opposite effect. Thinking you are overweight doesn’t incentivize you to lose weight.
Instead, it is strongly associated with weight gain. And this is entirely independent of people’s actual size. It has everything to do, instead, with their own perceptions of themselves.
In the study, the authors write that, “Individuals who identified themselves as being ‘overweight’ were more likely to report overeating in response to stress and this predicted subsequent weight gain. These findings are in line with recent suggestions that the stress associated with being part of a stigmatised group may be detrimental to health.”
So now we know. This happens to people. It wasn’t just me. It isn’t just you. It’s all of us. It’s a part of how we work. It is basic human psychology – that we do, for any number of reasons, overeat in response to negative body image.
But what do you do about it?
You may find yourself then in a bit of a Catch 22. If you already have these feelings about yourself, what do you do?
Does this study actually help? Can it help you choose love, or self-acceptance, or weight loss for the sake of health or energy, instead of for validation?
I think that it can. It can affirm your humanity. It can provide proof for your suspicions. It can help you throw off the condemnations of people around you, and perhaps start looking for ways to stop thinking of yourself in a negative light.
You may want to sit down and think seriously about the relationship between your size and your health. “Health” is no longer a good excuse to starve one’s self. As it turns out, the relationship between health and weight is much more complex than we ever thought. It is totally possible to be healthy and to be overweight.
You may also want to think about the “health at every size” movement. Since it is possible to be healthy at any size, becoming a part of a community of people focused on living well instead of restricting food intake could be great for you. I wrote about why I love Healthy At Every Size in this post.
You may also want to consider thinking about food intake in terms of setting minimums, not maximums. In this post, I describe the way that I like to do macronutrients. Instead of saying “only 100 grams of carbs a day” or “only 50 grams of fat a day” or “no more than 1800 calories a day” I set minimums: “at least 100 grams of carbs a day,” I say. “At least 50 grams of fat.” “At least 2000 calories.”
You might also want to think about fitness in a new way. Many people do work outs because they have to, because that’s what you do in order to lose weight. But what if you engaged with fitness because it was fun…because you found an activity that makes you come alive? I talk about that a bit in this post on why I will never run a marathon.
I have provided a few of our resources in the paragraphs above that I think could be helpful for your relationship with your body fat percentage, whatever that may be. Of course it is all insufficient – our need for self-affirmation and love in this society is truly never ending. So perhaps I should just leave with this thought:
They may that you are not enough. You may sometimes feel like you are not enough. But what you are is beyond enough. You are acceptable, and then some. You are a powerful human being with a body that lives and breathes and thrives no matter how rocky your relationship has been in the past, no many how many hardships it has been through. You are a body that is strong and lovely and your home, and seriously screw any body, any resource, any lingerie company that may make you feel otherwise. You can be healthy at any size, and you deserve it as much as you might deserve anything. You deserve to be nourished more so than anything, to let food be your friend, to let your body be your friend. Your body really does love you. All you have to do is let yourself love it back.
<3
(“Your body is a natural body with natural needs, that, when loved properly, loves you right back” is actually the “golden rule” of our community’s best-selling manifesto, Sexy by Nature. Check it out on Amazon!)
Note - some links above may contain affiliate links. You don't pay more, but we get a small cut to help keep this organization running. It's tough to balance ethics with the need to stay alive. Thank you for your patience and understanding!
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i <3 you. That's all. OK, bye.
Love this!
Hi Stefani. The obese are not the only ones who are denied treatment, and even if you manage to get treatment, it might be best to go private. I am a EU national and have been working in the UK for a decade. For the first 4 years, I was unable to register with a GP surgery (the first necessary step to get a NHS number, which allows you to get ‘free’ treatment’). Everywhere they were ‘full’. One receptionist even told me that after I had handed back my questionnaire: no family history of diabetes, cardiovascular disease and cancer, non smoker, teetotaller, low BMI… The GPs have targets to meet in diagnosing and treating those diseases: if you are not at risk for one of them, they are not interested in taking you on as a patient. I eventually moved to a different town and managed to register with a GP surgery in another town half way between the town where I work and the town where I live (the GP surgeries in my town are all rubbish; you can find that information on NHS/reviews): I cannot register in the town where I work because it is in a different county. Even though the GP surgery where I registered is half way, as they only see patients between 9am and 4pm and do not work Saturdays, I have to take a half day off work every time I go there. I started to get peppered with letters inviting me to come and have a smear test (GPs have targets such as getting x% of their female patients to have these, whether they are sexually active or not). As I have a gynaecologist for that in my home country (and haven’t been sexually active for aeons anyway), I declined. I got summoned to an interview with a really aggressive male GP who wanted to do the smear test himself, there and then, and threatened to have me struck off the patients list if I refused to comply (I refused). He also told me I could get the HPV virus without having sexual intercourse (he refused to explain how – I guess I am the kind of woman who looks like she goes to orgies with other women where everybody share the same sex toys), tried to make me confess I was a smoker, former smoker, or had asthma (I was recovering from some kind of bronchitis at the time, which I had treated with home remedies), was very reluctant to look into my mouth (I had a bit of thrush/Candida albicans at the back of my throat) and told me it wasn’t Candida and all I needed to do was drink a lot of hot drinks (I nearly asked him whether I should have sugar in them, just to trip him up, but I was afraid that might get me fired as a patient), and then proceeded to try and make me confess I had a eating problem or was on some kind of diet (as in, anorexia), as he found me too thin, really sweaty and ‘agitated’. I explained that my thyroid gland was slightly hyperactive and that this was being monitored in my home country (I really wanted to tell him as well ‘your bedside manner doesn’t help’), but he refused to ‘believe’ me. He did a prick test and found out I was slightly anaemic, which further bolstered his conviction I was on some kind of ‘mad’ diet: he proceeded to tell me to take iron supplements. There is a high incidence of haemochromatosis in the part of the world I come from, I haven’t been tested for it as I have my periods and used to be a blood donor (so my iron levels used to get monitored before each donation) but there is a risk I might carry one of the mutations for the disease, so iron supplements are out. I didn’t want to overburden him with my knowledge so smiled sweetly and said yes, I will take iron supplements. Fast forward 1 year, I developed a toothache (I had been unable to go to my own dentist for a check-up as I had no holidays left due to rental accommodation problems), couldn’t find a NHS dentist (they are all full). Before I could get time off work to see my own dentist (overseas), I developed a dental abscess. The GP at the surgery (a trainee doctor) wouldn’t even look in my mouth, let alone prescribe me an antibiotic. I contacted a dozen NHS dentists in 5 different towns, two of them a mere 1-hour by train from where I live, one of them a 2-hour journey from where I live (the receptionist at one of the GP surgeries I called gave me the tip: they often have time to see emergencies). Turned out the most remote one could see me that afternoon at 14:40. I barely made it in time, but they lanced my abscess and gave me a prescription for antibiotics (not free by the way, you pay for both). I ended up getting two teeth treated in my home country (root canal/extraction; implant; crowns). A couple of years later, I developed sciatica (I have ongoing back problems – a souvenir of physically demanding jobs in my youth) and went back to the GP surgery (that is, I had to wait 2 weeks to get an appointment). The first time, I got a ‘referral’ for physio…. which happened 4 months later! The physio told me she could see me privately but not on the NHS as there were cuts. Less than a year after the first episode, I had a relapse, far far worse. I went to the GP surgery directly and did a stand in: this got me drugs which I could not take for more than a couple of days because of the side effects and a referral for physio… which turned out to be a ‘back class’. Basically, AA/WW type sessions with a bunch of people on benefits because of ‘back pain’ (only one of them had a slipped disc like me – oh, did I mention that I had to have the MRI done privately?), all on morphine, tramadol, antidepressants etc., all overweight, very fond of booze etc. The physios (2 for the 8 people who turned up at the first session, only 1 by the 4th session as there were only 3 of us left) just sat us down (great with sciatica) and talked about whether we had managed to ‘be active’ and ‘be good’ (diet to lose weight, avoid alcohol and try to reduce your intake of painkillers) during the week. I did not drive, did not have a TV, had a low BMI, and did not take meds. I don’t particularly enjoy to be told to watch what I am eating by one obese and one overweight health professional either. After the talking, we would be told to run on treadmills or cycle on stationary bikes to ‘raise your heart rate’ (great, with my tendancy for palpitations), then do… crunches! Exactly what my physios and gynaecologist told me to avoid like hell. The piece of advice I liked best was to ‘do volunteer work to get out of the house’. I was (and still am) working f/t, and on the day of the back class, as I only arrived at work around 1pm (the back class was in a town 1 hour away from where I live and 1 and a half hour away from where I work, and ran from 10am to 11:30am, great for people in work), I had to stay in the office until 11pm, and still risked getting fired for absenteeism: I eventually dropped out after the 6th session (out of 8) and sought a private physio who could see me outside work hours. I have now been seeing a physio privately for over 2 years, it’s cost me about £4K so far, but my back is fine. I don’t think I would ever have made such a recovery just doing exercises on my own. Thanks to my back pain (and side effects of the drugs: weight loss and fatigue) I was diagnosed with cancer (in my home country). My employer demanded confirmation from a British GP, then from a British surgeon, so I had to see a GP then get a referral for the hospital (2 and a half months after asking for it!). As many people will know, the UK do not have the same resources as European countries to treat cancer: lack of MRIs (the tool of choice, with ultrasound scan, for young women with dense breasts), antiquated equipment in radiology (the joke is that if you are having radiotherapy, at best it will be ineffective, at worst it will speed things up), no expensive but minimally invasive equipment for biopsies/surgery, no expensive tests to ‘assess’ the removed tissues in the lab and tailor the treatment to the type of cells; most blood tests are ‘out’ (for example they won’t monitor vit D levels or TSH levels, let alone circulating tumour cells) and a complete dearth of tools for adjuvant (systemic) therapy (Trastuzumab was long deemed ‘ineffective’ by NICE, hence not available on the NHS) or for dealing with the side effects of chemo. Not to mention that they don’t have beds, either for treatment or for end of life care: if you have chemo as an outpatient, you have to find ‘friends’ who can drive you to the hospital every day (1 hour and a half each way if there are no traffic jams; expect at least two hours each way if you use public transport) and look after you (prepare you meals, take your laundry to the Laundromat, do your supermarket shopping). I think I am going to have to become a Jehovah witness :0 If you absolutely require a bed, there is a waiting list: someone I know (who has since died) had to wait 4 months for a bone marrow transplant as the hospital (same one I’ve been referred to) had no beds available, he had to call them twice a week to check too. Finally end of life care is non existent. Everyone wants to ‘find a cure for cancer’, nobody wants to talk about death and dying (and physical pain). Palliative care just does not seem to exist in this country, and most people I know who died of cancer in the UK died in a ICU. Those lucky ones who got to a hospice often had to pay for it (i.e. go private), and only got about 2 weeks there. Fortunately I am in work so have been able to pay to have treatment (surgery, on a bank holiday weekend so that I did not miss a single day of work) in my home country and the team there have decided to do watchful waiting, which is lucky as my employer told me that if I wanted to have treatment I would have to choose between resigning or being fired. Still, a couple of years ago, I wouldn’t have been able to afford it: the first year medical bills made up half my net income for the year as I had no private medical insurance; for the second year I had to spend a little over 10% of my net income: my home country makes health insurance available to expats who want to have treatment at home –the crucial point is that as this is government sponsored there is no underwriting and no exclusions, otherwise I would have been a declined. The premiums for that insurance policy come on top of the nearly £2K I spend in physiotherapy each year: I would need a prescription to get part of the sessions reimbursed, but the NHS GP surgery won’t prescribe physio privately (even though UK Private Medical Insurance providers like BUPA are starting to ask for prescriptions too) but want me to attend another back class in yet another town, 1 hour and a half from where I live and 2 hours and a half from where I work (so I would have to go part time to attend it, which of course my employer would refuse). Oh, and I forgot to mention that the GP surgery tried to strike me off as a patient when I moved house, on the grounds that I was no longer in their catchment area (according to the NHS website I still am). I know from other patients (cancer, cystic fibrosis) that it is very difficult to register with a GP surgery if you have an ‘expensive’ disease, and I just couldn’t take several days off work to tour the GP surgeries in my ‘catchment area’ (I bet they would all have been ‘full’), so I made a big fuss, explaining I only needed them to ‘confirm’ any diagnoses made by ‘foreign’ doctors, but was getting all my treatment done privately, either in the UK (physio, dentist) or overseas (cancer), at no cost to the NHS as I had medical insurance, so they eventually agreed to take me back in. I was then invited to a ‘screening’ session for my 40th birthday (they get brownie points if they get x% of their patients to attend these), where I had prick tests for cholesterol, glucose, and iron. Everything was ‘normal’, including my BMI (just at the bottom of the normal range, not outside it ) so the nurse told me ‘your chances of dying in the next 10 years is 0.04%’. That’s very sweet of her, but I have one of the many many types of cancer, not a common one, not a predictable one, and not one with a good prognosis either. The problem with the NHS is that they spend &*()loads of money on the staff and have no money left to spend on patients. The staff also have a civil servant culture (there is no patient/doctor relationship like you have in other countries where you choose your doctors and stick to them for decades). And guess what? Staff themselves (especially doctors who have 6-figures salaries and pensions) have private medical insurance and go private… or have holiday homes overseas (France, Spain) and have treatment there rather than in the UK. They might lose that right post Brexit though, same as I may lose the right to work here. Good job I chose to start treatment overseas: at least if I have to ‘go back home’, I won’t have to go through the whole palaver of interviewing doctors (I did not hire the first one, I met three of them), while looking for a job and for rental accommodation.
Thank you Stefani ❤️
I am huge on no fat shaming, however, working in X-ray and closely with orthopedic surgeons, I know a few things. I believe the average knee replacement lasts about 10 years. That’s why I have friends in their 30s who are so active that they’ve already blown out their knees, yet are waiting on surgery because it’ll mean less times they’ll have to get it revised in their lifetime. This is for an average sized, active person. When you throw extra weight into the mix, you’re greatly reducing the time that knee replacement is going to last. Also, in how effective it’ll be to begin with, as you have to be ready to get up and go right away to help them function at their best. So although bmi alone is a horrible way to determine who gets these surgeries, if you ask me who will have better luck with a successful surgery – a 6’1 185 lb guy or a 5’7 250lb one, I’d go with the leaner guy for sure. Signed,
Way over 30 bmi right now 🙂
yes, I do agree with you, I acknowledge the realities here. All I’m saying is that telling people to lose weight, instead of trying to be healthy, is probably a less good long term strategy
>Thinking you are overweight doesn’t incentivize you to lose weight.
But if you don’t think you’re overweight, why would you ever lose weight? It’d seem that thinking you’re overweight (ie. recognizing there’s a problem) would be a necessary step to beginning to live a healthier lifestyle.