This week I stopped weighing a number of clients. A new client asked me at the end of the consultation was I going to weigh her. I said no. She burst into tears. Alarmed and surprised by her outburst I asked her was she ok. She informed me she was dreading through the whole consultation being weighed. Every time she visits a health care professional they weigh her, and tell her she needs to lose weight. Thats what she had expected, and because of this anxiety, she had spent a whole hour sitting in front of me supposedly listening to me talking about diabetes, but not hearing a word. She feared being blamed, she feared being judged, she feared standing on that scales and not seeing the results ‘her health care professionals’ so desperately wanted.
My life seems to revolve around themes and this week has been no exception. This week has been the subject of weight and health care professionals apparent obsession with it, but a very clear lack of understanding of it. I have had several people with diabetes relate to me stories of being practically bullied by health care professionals in relation to their weight. You visit the GP, practice nurse, hospital and out comes the scales. I do it myself with each client. Mea Culpa.
I am aware of all the research in regards to obesity, overweight etc. Some would say and have you believe I have built a career on the consequences of it. My mailbox is flooded daily with articles, research papers, staggering statistics. We are all fat….we all need to lose weight…I am now coming to the point of having a Homer Simpson moment….blah blah blah blah. If I feel like this, how on earth do my clients feel? Weight issues and weight loss seems to be everywhere. My daily life is saturated with it. Ads for the latest weight loss product/service on the car radio in the morning, in the papers on my tea break, on the television in the evening. But yet obesity levels are soaring.
The focus is on what a person hasn’t done, not on what they have already done.
I know the impact obesity and being overweight has on a persons health, I also know the impact weight loss has, both on a professional and personal level. I know the determination, the commitment, the discipline it takes to go from being overweight to normal weight. But what is a normal weight? We have guidelines and tools to tell us, but what use is that to an 75 year old lady who walks a mile a day riddled with arthritis, who eats healthy and in moderation but who keeps getting told by her GP on every visit she needs to lose weight? This is happening over and over and over again, across surgeries, practices, hospitals and clinics around the world, where the focus is on what a person hasn’t done, not on what they have already done.
THE NON-COMPLIANT PATIENT
I find I get referrals from health care professionals for clients who are labelled ‘non compliant’, ‘non adherence’ ‘not adhering to lifestyle’. But what you find with these clients is that, they have never been given any clear simple, concise, realistic, easy to manage guidelines. Neither have they been acknowledged for previous weight loss. Some of them don’t even think they are overweight, or have weight to lose. Some people have already lost weight but not enough in the opinion of the person referring.
Lifestyle management for weight loss and lifestyle management for diabetes are two very different and distinct approaches. Unfortunately advice has been generalized and lumped into the two. This shows a very clear lack of understanding not only by health care professionals, but the public, media and policy makers on what is actually required and needed to tackle not only diabetes but obesity.
A 5-10% WEIGHT LOSS HAS A SIGNIFICANT IMPACT
In diabetes, a 5-10% weight loss from your weight at diagnosis has a significant impact on your health.It will reduce your HbA1c, cholesterol, blood pressure, possible medication and insulin dosage. I always inform clients who need to lose weight of this, as it sets a very realistic target for them achieve. Some may have already achieved this. Once 5-10% weight loss has been achieved, then any weight loss after that not only will benefit your health, but can be solely for cosmetic reasons depending on weight at diagnosis. Also it needs to be asked, when a health care professional discusses weight loss with you, even though you have lost weight, whose target are they setting? Is it yours, or is it their own? When you do lose weight, whose weight loss success is it? Is it yours, or is is their own?
With most health care professionals you will get the standard text book approach …..’Mrs O Brien you are overweight, you need to lose weight’, they give you whatever generalized leaflet that is within easy reach, come back in 3-6 months and hope you have performed miracles in the meantime. Lose weight, change your diet,give up smoking, drink, run a marathon, climb Everest. Health care professionals need to realise lifestyle management for weight loss not only requires an expert approach but a patient centered, holistic approach.
WHO ARE THE WEIGHT LOSS EXPERTS?
But who are experts in weight loss? Is it a dietitian, who never had a weight issue in their lives? Is it the gym instructor, all 180 pounds of beef and muscle who boot camps their way to weight loss? Is it your milkman, who has had to lose weight post a heart attack and swears he has the miracle cure for weight loss (hint: its the heart attack). Is it your GP who believes a leaflet, 1 minute pep talk and a scales is enough? Is it the magic pill/fad you spent your electricity bill money on that ‘expels’, ‘freezes’, ‘busts’, ‘melts’ fat away and makes you look as thin as the envelope it came in after taking it?
In my opinion, the expert in weight loss has been around for years, it is staring us all in the face everyday, it is proven to work through all research, science and evidence based medicine. It knows exactly what to do, it knows exactly whats best for us, it knows that while any weight loss is simple in theory, the difficulty lies in its application. So who/what are they?
It is us….we just pay lots of money to other people to tell us that, to motivate us, to set out guidelines/plans for us, to possibly shout at us, insult us into losing weight, when all the time, all the resources that we need are inside us and around us. Support in family and friends is free, the road for exercise is free, information on the internet is free. What we should be honest about is that we are paying for is expertise, motivation and to feel better about ourselves. Absolutely nothing wrong with that, but ask yourself, are you getting that, or are you just making someone else very rich off of your misery?
So if you have already lost weight, well done. If you are in the process of losing weight, well done. If you are contemplating losing weight, well done. Living with diabetes is hard enough without having extra layers of pressure being put upon you, expectations of what you should be, what you should look like and what you should be doing based on whatever guidelines and research have been issued. The first step in weight management (note not weight loss) is belief. Belief in what you have achieved, in what you are doing and in what you are about to do… that this belief is good enough, if not for a health care professional, but for you.
You are good enough……