The stigma driving patients away
There is no doubt that obesity in Australia is at an all-time high, an alarming statistic that only looks to be worsening. Based on the Australia Institute of Health and Welfare BMI index, 67% of the Australian population are reportedly overweight with 31% classified as obese. The financial cost was $11.8 billion in 2018 and it is estimated to rise to $87.7 billion by 2032 if nothing is done to stem what is being termed an epidemic.
The undeniable truth is that being overweight can make you sick. Obesity can lead to a multitude of serious health problems such as heart disease, diabetes, cancer, kidney disease and sexual dysfunction, and it can drastically effect self-esteem. It can also be fatal. The latest reports show that BMIs of 30-35 can cause people to die 2-4 years earlier than people in a healthy weight range and BMIs of 40-45 can cause premature death 8-10 years earlier.
Medical professionals deal with this problem daily, and it seems only logical and indeed sensible that they warn an overweight patient of the dangers they potentially face. They also need to diagnose if the health issue they suffer from is caused by excess weight and what the benefits to losing / consequences of gaining would likely be.
Unfortunately, many overweight people complain that the way they were treated was not only insensitive, it eroded their trust and left them unwilling to seek medical help for fear of being dehumanised. Recent studies support that bedside manner is crucially important in health care, and that the relationship between patients and carer/doctor greatly impacts both the treatment and outcome. In short, many overweight patients simply won’t come back.
But are they ‘just being sensitive’?
According to Dr Anastasia Kalea and her colleagues at the University College London, the answer is clearly ‘no’. Kalea analysed studies featuring over three and a half thousand health professionals and extensive evidence was found of a strong bias of stigma and blaming towards the overweight. This including a wide range of health professionals including, most disturbingly, obesity specialists.
Kalea concluded that many of them believed their patients to be ‘lazy, lack self-control, overindulge, (be) hostile, dishonest, have poor hygiene and (that they) do not follow guidance’. Commonly, this began with GP’s, creating a barrier to help from further services. The consequences of patients avoiding medical care can be grave, with research showing that the pervasive belief that shaming people will motivate them to lose weight is completely false. In fact, it leads to greater morbidity and shorter mortality.
There’s no doubt that weight stigma is eroding sectors of the health system. It’s also increasingly prevalent in society with one in two overweight adults across six westernized countries (including Australia) reporting that they’ve been fat shamed. Yet, obesity is a complex issue, the causes of which are often outside a person’s control, and for many it’s as a result of a society saturated with advertising for unhealthy foods, drinks and lifestyle. It can also be due to mental health issues, including depression.
So what needs to be done?
Overweight people are certainly being victimised, but their health is also suffering, and their life span is shortening. This is an epidemic that simply cannot be ignored and yet the messaging of available help isn’t being adequately delivered. Somewhere in-between fat-shaming and life-saving lies the answer: understanding and proper medical care.
With this in place, the good news is that weight loss can dramatically increase longevity and wellbeing. Patients need to be shown manageable, healthy changes such as low impact exercise, better lifestyle choices, how to lower sugar and fat in their diets and, most importantly, what pitfalls to avoid. Crash dieting, ‘wonder pills’, fads and gadgets, too-hard, restrictive dieting and quick fixes simply won’t work long-term. A sustainable, manageable plan is the the only real answer.
So what’s the ‘best’ way to lose weight?
The best way to lose weight is what works for the individual, and often this comes down to being able to maintain it with the most comfort and ease. For this reason, experts such as Dr Krista Varady from the University of Illinois, Chicago, are supporting the increasingly popular intermittent fasting model of ‘part-time dieting’ which advocates short periods of calorie restriction followed by periods of normal, healthy eating. This could be as simple as having low calorie days 2 days a week and higher calorie days the other 5 (the 5:2 method).
‘People love intermittent fasting because it’s easy,’ Dr Varady says. ‘(They) need to find diets that they can stick to long term. It’s definitely effective for weight loss and it’s gained popularity because there are no special foods or apps necessary.’
Varady and other researchers report that intermittent fasting isn’t only good for weight loss. Clinical evidence shows a wide range of health benefits including better heart health, a reduction in inflammation, cell renewal and potentially reversing Type 2 Diabetes.
A Mediterranean diet is also recommended and can be included with intermittent fasting for maximum benefit. Whatever people find most manageable, experts agree that adequate advice and care and from health professionals is imperative to help them to find, and succeed at, their method of choice.
So what is being done?
Researchers and leading experts agree that judgement and prejudice need to be eradicated in the industry if the divide between fat-shaming and potential life-saving can be addressed. Steps are underway to increase education and improve the communication skills of medical students but according to many, this has a very long way to go.
‘We call them softer skills, but they’re really the harder ones to learn,’ says Lisa Howley, (Association of American Medical Colleges). ‘We have a lot more work to do in this space.’
Case study: Mary-Anne
“I lost weight to look and feel better. I didn’t expect my new doctor to tell me I’d potentially added 5 years to my life.”
Like many people carrying excess kilos, Mary-Anne had been embarrassed by comments by health professionals on occasion.
‘I’d been called ‘hefty’ and comments like ‘well, there’s nothing wrong with the scales!’ have been directed my way. I just saw it as my fault but I realise now that made it harder for me to maintain my self-esteem.’
As a writer constantly sitting at a computer, Mary-Anne’s life was sedentary and she was gaining weight. She also suffered from acute pain in her neck and shoulder.
‘I just wanted to lose weight because I was turning 50 and felt unattractive and old before my time, however I didn’t realise that by dropping kilos and feeling good I was actually doing so much more for my health.’
Mary-Anne spoke to a new, supportive doctor and chose to do the intermittent fasting method of 3 days on, 4 days off and utilized the support of the online fasting program, SuperFastDiet.
‘I’d tried every other diet and exercise program under the sun but I just couldn’t seem to stick to anything or keep it off when I somehow did.’
Mary-Anne reports that ‘not dieting’ on the four other days made all the difference.
‘The part-time idea really appealed to me. I liked the fact that I could eat what I wanted on the other days and still socialize like everyone else, enjoying a wine or some cheese. No one likes to feel deprived and this way of life gave me that.’
She lost a total of 23kgs over 8 months and felt great but she it wasn’t until she spoke to her doctor that she realised she’d also given herself a longer life.
‘I was quite shocked to discover that my weight loss equated to over five years more life. In theory, it’s healthier years to be gained too, as I am taking pressure off my joints and bones. Already, my shoulder and neck pain is all but gone.’
Mary-Anne says that the good news has encouraged her to keep the weight off by including fasting as an ongoing maintenance lifestyle and she walks regularly and has lowered her alcohol consumption.
‘I’m not looking a gift-horse like this in the mouth,’ she says. ‘What a difference a good program and a good doctor have made. They’ve literally saved years of my life.’
Want to find out more about intermittent fasting with SuperFastDiet? Click here