Judy Anne Swift, with personal reflection from Eve Simmons
A small flurry of excitement rippled through our colleagues last night as we prepared for the BBC2 documentary “Obesity: How prejudiced is the NHS?” I didn’t actually watch until this morning and had purposefully kept away from Twitter beforehand (my favourite colleagues are a sceptical, critical bunch). Weight stigma, particularly among healthcare professionals and researchers, is a subject close to my heart and one which I have researched and presented on many times. I was nervous; this is not a subject that receives a lot of air-time and I dearly wanted the documentary to be sensitively handled and well balanced.
Professor Batterham is clearly passionate about bariatric surgery and it’s potential to improve health, and the shame she felt at being part of a system (the NHS) which serves people with higher weights so poorly, was affecting. Unfortunately, her repeated claims that surgery is “incredibly effective” were not balanced by any real coverage of the risks involved and this clearly rankled some healthcare professionals.
I was a bariatric dietitian for 5 years and saw endless complications. It’s alarming. It’s not such a perfect solution as portrayed https://t.co/luQSYUnuhj
— Ella Segaran (@ESegaran) April 12, 2017
When bariatric surgery goes wrong – either early post-op or as severe malnutrition a few years later – it goes badly wrong. Both emo and £££
— Catherine Collins (@RD_Catherine) April 12, 2017
BBC2 prof on prejudice against bariatric: it is very biased itself: can we also have the other side of bariatric please
— Gaynor Bussell (@GaynorBussell) April 11, 2017
We were simply presented with unhappy, unhealthy people before surgery and happy, healthier people who have had surgery. This is shamefully crude, lazy, and actually serves to reinforce prejudice.
Prejudice occurs when people are pre-judged to have certain characteristics, beliefs and behaviours because they can be assigned to some ‘group’. In this instance, the ‘group’ is ‘fat’ and relates to higher bodyweight, but ‘group’ could also reference skin colour, gender, or age. Common stereotypes about obesity include fat people are lazy, fat people are unhealthy, and fat people are unhappy.
But hang on a minute, isn’t there some truth in this? Isn’t obesity associated with low physical activity and poor health? Perhaps, but this is not relevant. Prejudice does not consider the individual and his/her own characteristics, but instead categorises the person based upon his/her bodyweight. So, fat person = lazy. Regardless of who they are and what they do.
Clearly this blind categorisation doesn’t bear scrutiny – some fat people are not lazy, some thin people are lazy – but it is deeply ingrained and easily perpetuated. The NHS clearly states that we all deserve respect as individuals but the extent to which NHS workers subscribe to negative attitudes was poorly covered. It was suggested that some healthcare professionals are ‘probably’ biased, but this does not represent the extensive literature which clearly demonstrates that even those with the very best knowledge and experience with obesity are biased.
For Professor Batterham prejudice in the NHS relates first and foremost to access to bariatric surgery. It is not for me to judge whether it is right or wrong for a person to choose surgery but at the very least the documentary should have covered the wider fat-shaming that makes it so incredibly challenging to be a larger person in society. When individuals make decisions about undergoing major surgery they take into account the potential benefits and risk, and the desire to ‘fit in’ must surely feature for many.
Professor Batterham’s lament “I can’t understand why we aren’t doing more?” resonates with me. But for me, the question isn’t confined to the availability of bariatric surgery. Why aren’t we doing more about prejudice in healthcare? Research clearly demonstrates that negative attitudes have direct and indirect effects on people’s health. Experiencing negative attitudes and prejudice have been shown to be associated with substandard healthcare and decreased utilization, psychological disorders, poor self-esteem and poor body image, and stress-induced pathophysiology. As a healthcare system, the NHS is there to serve the people and this mean regardless of size. Prejudice has no place. Full stop.
Coming to terms with my own prejudice ~ Eve Simmons
Last night, I recoiled in horror as I watched journalist Amanda Platell embark on a verbal bender in which she insulted, patronised and vilified the entire obese population. Somewhere amidst my utter disgust for the ignorant woman who infiltrated my TV screen, was a sharp sense of guilt. I myself am of course guilty of exactly the same vitriolic schpeil that I accuse Platell of.
It wasn’t until very recently that I was forced to become aware of my own intrinsic thin ideal. You see, you can’t make a full recovery from anorexia without confronting, and quashing, your fear of being fat. After a couple of years in recovery, I’ve given this very issue some comprehensive thought. The first question I asked myself being; what is it about ‘fat’ that is so terrifying? Or, even negative at all? Well, we’re constantly told that being obese is associated with poor health – so maybe it’s the fear of ill-health, and inevitably death, that perpetuates the terror.
Given that I regularly forget to take medication, remain unphased and continue to use factor 10 in the midday Mediterranean sun, I don’t think an overarching concern for my health is the issue here.
As much as it makes me loathe myself to admit it, my fat fear was rooted in one thing only: appearance. And once my fat phobia had set up camp in my anxious, neurotic mind, it morphed into something a little less hard to ‘police’. As the years went by, not did I not want to be ‘fat’, but I also didn’t want to be ‘fatt-er’. Which, in my case, meant any bigger than a size 8. It’s only a couple of years (and a shit tonne of therapy) down the line that I’ve explored the “fear” in depth and come to the conclusion that, of course, it had nothing to do with body image, “fatness” or indeed, food. A deep-rooted aversion to being the odd-one-out and a sheer terror when faced with rejection has left me afraid of the potential consequences of looking “different”. Perhaps, if the world hadn’t joined me in my rhetoric, it wouldn’t have taken me so long to realise that the only thing I had to fear was fear itself. Next time you silently judge someone for being larger than your average person, think about what it is exactly that you find so aversive. Chances are, it’s probably yourself.