Throughout our lives, we’re all given orders or encouraged to live or work in a certain way, often for our own good. Sometimes we take orders and obey them and other times we ignore them or rebel against them, for one reason or another. The way we react to orders or suggestions will change and develop as we mature, but they will also depend on many factors; namely who is delivering the advice and the manner in which they do so.
As we all know, obesity is a massive and growing problem, costing the already strained NHS an estimated £6billion per year and if the current trend continues, half of all UK men could be obese by 2030. Campaigns such as 5-a-day and endless changes to nutritional labelling systems have so far failed to make a significant impact on obesity in both adults and children; finally we’re starting to realise that weight loss is about more than calorie counting – it’s about how we talk to those who are overweight about how they deal with the problem and make their own lifestyle choices.
This week, NICE have published new draft guidance on managing obesity in adults, addressing the issues around weight stigma and highlighting the tone professionals should take when talking to their patients. NICE strongly emphasised the need for health professionals treating obese patients to remain ‘respectful’ and ‘non-blaming’.
Treating patients with respect should really go without saying and not need to be pointed out in guidelines, whether specifically geared towards obese people or not. ‘Non-blaming’ is more interesting. Many people are of the opinion that obese people are to blame and it’s more than likely that among them are some medical professionals. It is a blind judgement that some people make without knowing anything about underlying health issues, mental health issues, background or triggers; those judgements have no rightful place and absolutely no place at all in a medical environment.
Blame is a difficult theme to associate with such a complex medical issue. Obesity is not simply the result of greed or a lack of nutritional education. Over-eating over a long period is very often a symptom of something underlying where food is associated with comfort or escapism; it could be a symptom of stress, depression or an eating disorder such as COE (Compulsive Over-Eating), BED (Binge Eating Disorder) or Bulimia. Obesity is not necessarily a choice and it certainly isn’t successfully treated with a diet plan and orders to start exercising.
Talking about obesity and the patient’s feelings about it are key to treating it and ensure that any weight loss has longevity. This is where the importance of understanding that we all react differently to different things, in different situations. Piling on the blame is more than likely going to make a person feel ashamed or guilty about their weight, resulting in either rebellion against advice (over-eating/drinking) or feelings of worthlessness or hopelessness and the need to seek comfort or escape (over-eating/drinking).
People with obesity do need to be aware of the seriousness of the problem, though, and this is where the new guidelines come into action. Medical professionals need to aim, one way or the other, not only to treat obesity but to encourage the patient themselves to want to make sacrifices and change the behaviours they have become so accustomed to. It’s not an easy feat. In the same way that helping a patient with anorexia to gain unwanted weight, helping an obese person to lose weight is a huge ask if that person is happy with their weight, reluctant to take advice and too stubborn to allow themselves to even think about the ways in which getting to and staying at a healthier weight would benefit them. Very often, denial or apathy are huge stumbling blocks; but they are problems that can be overcome if medical professionals and loved ones take the right approach.
This is where individuality comes in. It’s all very good and well dishing out guidelines telling doctors and nurses to be nice with obesity patients; lovely. The risk is that if we lean too far into the softly, softly approach, a lot of people simply won’t respond. Obviously, some people need that; sympathy, understanding, a listening ear or a shoulder to cry on, but definitely not everyone. Everybody, people with obesity included, must be treated individually according to their needs; this includes tone.
When I read the NICE guidelines for the treatment for obesity, I couldn’t help think ‘but some of us NEED tough love, whether we like it or not!’ I know for a fact that the harsh words about the stark realities of my own weight, delivered by nurses who cared but wouldn’t take my bulls**t excuses, helped to save me from endless cycles of eating disorders. The softer nurses didn’t stand a chance of getting through my steel exterior. I was stubborn; I didn’t care that my life was in danger as long as I could keep my eating behaviours; I was utterly resilient to change. A turning point for me was accepting that although I wasn’t completely to blame for my weight struggles and understanding that becoming ill as a result was beyond my control, not my choice; recovery was a choice.
Nobody chooses to become obese, but they can choose to change their lifestyle for the better. The likelihood that people will make that choice depends massively on the way they’re encouraged to do so – and whether that’s softly softly or via regular a**e-kicking, it HAS to be tailored to the individual.