Like most doctors, I used to think that a person’s health was always defined by their weight. I judged patients who came to hospital based on their size and sometimes thought they were less worthy of compassion because they had “done it to themselves”.
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I treated some symptoms with more skepticism when I’d labelled a patient as overweight. I’d love to justify all of this by just saying that it was all unconscious, yet that wouldn’t be true.
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What I now know to be blatant weight-stigma I thought was just a part of being “cruel to be kind”. It wasn’t. I’m sorry. I can’t take back any of this. What I can do is admit wholeheartedly that I was wrong, and speak out when I see it happening.
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I started my Instagram as a weight-loss account. My own internalised weight stigma led me to believe that I couldn’t be a good doctor unless I lost weight. I thought that deliberately inviting shame by posting all the ‘bad’ foods I ate was a good method to keep me accountable.
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When I ended up losing weight by flirting with eating disorder behaviours along the way, instead of understanding my unusuality and privilege, my ego told me I’d found the answer and that it was my responsibility to teach others. Sound familiar?
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We can’t lead the change from a weight-normative to a weight-inclusive approach to health if we keep disregarding good evidence just because it doesn’t fit our narrative. We need to get over ourselves when our rhetoric turns out to be problematic.
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We need to have conversations with people outside of our bubble. We need to be considering things that challenge our position.

Let me end with a few statements so you know where I stand.
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1. Weight loss isn’t guaranteed to improve heath. Shocker, I know.
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2. BMI can be useful at a population level but is a grossly inaccurate (and oddly racist) measure of health at an individual one.

3. Intentional weight loss, whilst not impossible, can be harmful both physically and mentally, and has incredibly poor long-term sustainability.
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4. Our weight is incredibly multifactorial and not a question of choice. Just one example of that: in lower-income countries, the rich are more likely to be at a higher weight. In higher-income countries, the poor are (PMID:15743649).
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5. Weight stigma has a much worse negative impact on both physical and mental health than people are willing to admit.

6. Doctors overwhelmingly harbour stigmatising opinions about those at a higher weight and it leads to shockingly unacceptable levels of patient care.
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Due to that (and more), I identify as a HAES practitioner. I advise health behaviours, not weight loss, with an understanding of privilege and capacity.

I don’t disregard the potential health consequences of body size, I hold it in tension with all else I know to be true.
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This conversation has never been more relevant mid-pandemic with @GOVUK announcing a ‘war on ob*sity’, and some GPs are deliberately labelling COVID-19 a lifestyle disease in order to be ‘controversial’. That’s not the word I’d use, but my word isn’t very professional.
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Every time this conversation comes up, someone claims I’m promoting ob*sity. I’m promoting compassionate care for patients regardless of their size, with a true understanding of the risks of intentional weight loss (amongst other things). Save your nonsense for elsewhere.
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If you want to learn more, follow me on Instagram under the same name. More of my time outside of hospital work is invested over there.