The journey so far:
If you've been following my Gazette, you will have been expecting this post! However, if you just stumbled upon this you will need a brief overview. This blog post is going to be discussing my weight loss journey with the NHS weight loss programme. I may also discuss other aspects of my weight loss journey too. There may be mention of EDs (eating disorders), general difficulty around eating and food, and other areas that may be triggering. If you feel these topics may impact you, please refrain from reading.
Earlier this month I discussed a possible hysterectomy with my GP. While they said it is possible for me to be referred to the hospital, they said I would first have to lose weight as there is a weight limitation on the surgery. They suggested I self-refer/sign up for their 12-week weight loss programme. So, that is what I did. I signed up online, and the day after that I received a phone call to tell me that the programme is run via a group meeting. There were both in-person and online options. However, the online option was only mentioned to me when I stated I have difficulty going places on my own. During that phone call, they also scheduled my initial assessment for the programme.
I was a bit surprised that so far during the process I wasn't asked about disabilities, mental health, history with (or current) EDs, or any other barriers to weight loss. This shocked me as I feel it is important to know what could be impacting individuals; in order to provide better care for them.
I held out hope that they would discuss these topics during the initial assessment. Speaking of the assessment, that was the next step in the process. This was also done over the phone, which I don't mind. The phone call was fairly simple and short. The assessor asked about my height and weight, which he then used to calculate my BMI. They did ask about disabilities but only about if I had any. There were no questions about how things impacted me, if I had any present or previous EDs, or if I had any other barriers. Even though I hoped it would come up, just to show it mattered to the providers, I wasn't surprised that it wasn't mentioned. From the looks of it this programme is made in a one-size fits all kind of way, very generalised and not at all catered to individuals. Which seems to be how most things are lately. After this phone call, I received a welcome email with information, a food-diary template, and some other bits. Although the welcome email called me Sarah, which was not a good impression :').
My thoughts:
As you may have noticed, my thoughts around this are gravitating towards a more negative light. This should only be partly taken as a reflection on the NHS programme, it is more so a reflection of my feelings towards weight loss in general.
This programme, and other weight loss programs, tend to use BMI as an indicator towards health. As a blanket one-size fits all approach. I don't think BMI is the best way to do this though. For starters, this method isn't supposed to be used by those with EDs or who may think they have one. The NHS website itself states this (1). However, not once so far in the programme, have I been asked if I have or think I have an ED. BMI also does not take into account other factors that could contribute to weight. Such as economic status, disability, age, support etc. One study I found agreed that BMI should not be used as the sole factor when making a health-care plan, which seems to be the case in my instance (2).
Speaking of barriers towards weight loss and ED's, one of my barriers is my autism. Eating is one of the many things my autism impacts. It restricts my eating due to sensory difficulties, I have speculated that ARFID (Avoidant/restrictive food intake disorder) is something I should discuss with my doctors. This is something that is common in folks with autism and other disabilities (3). One study I looked at explored autistic individuals and their relation to weight. It was found that other aspects of autism contribute to finding weight loss difficult. One of them being medical professionals being unprepared to provide weight-loss assistance to autistic folk (4). Another one of my barriers is the fact I have PCOS. Which is known to interfere with weight loss and gain (5). None of these barriers were discussed with me, which is actually often the case when I try to seek help.
It is obvious that these types of interventions are made with neurotypical or "normal" people as their focus. It is generalised and not individual. Another study I found suggested that a more individual approach is best for autistic people as then the care plan can take into account other barriers individuals may have (6). A different study found that self-weighing and calorie counting increased the severity of ED's, which a lot of these weight-loss programmes use these methods as their main way to monitor how "well" you are progressing (7). This isn't the only study that had these findings, another study showed that using calorie counting apps (also recommended on this weight loss programme) elevated ED symptoms (8).
It is a little disappointing that health-care professionals don't take into account individual needs which just assume a one-size fits all approach. Although it is what I have come to expect.
With all that said, I think I can leave this first post here. Thank you for joining me on this journey. I will continue to update and review this programme. I am due to be on it for around 12 weeks. Until next time, stay curious!
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