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Skinny jabs. Weight loss injections. The new miracle drugs to “tackle the ob*sity crisis” once and for all. Drugs like Ozempic and Wegovy are being hailed as wonder drugs. Oprah raves about weight loss drugs and says “ob*sity is a disease” so it’s not about willpower. This apparently can help get rid of weight stigma…by reinforcing weight loss and thin ideals? This doesn’t make much sense to me. “Ob*sity” is not a disease, nor a behaviour or an eating disorder. It’s a body size measure and there is wide range of people of varying degrees of health within that bracket. It’s not something that needs fixing. However, I understand that many people feel unhappy in themselves and want to make changes, though sadly this often becomes about making themselves smaller using any means possible. I’m not against people who choose to take weight loss intentions, in the same way that I’m not anti people who diet. When I use the term “anti-diet” I mean I stand against diet culture, the thin ideal and weight stigma/biases in our society as these are harmful to so many people. It’s important to make an informed choice, and how can we really do that when we are swimming in diet culture narratives? The decision to take weight loss drugs needs to be based on reliable information, and should you choose to go ahead, it needs to be done safely, through the correct channels and with plenty of support before and after. Having counselling before can help you explore your relationship with food and your body, as it may be that you’re experiencing disordered eating or negative body image thoughts. If this is the case, taking weight loss injections will not help – it will likely only drive the thoughts and feelings that underpin your relationship with food and make things worse. Weight loss injections: what are they and how do they work? Weight injections are for people in higher BMI (Body Mass Index) categories, and in the UK they are usually available through a referral to a weight management service. It’s meant to be more of a last resort, like weight loss surgeries, and only available for those who “really need it” i.e. higher weights. I don’t mention specific weights as this can be triggering and further reinforces weight stigma. BMI itself is very outdated and not fit for purpose – you can learn more about that in this article by Aubrey Gordon aka Your Fat Friend. Weight loss injections work by making people feel full for longer. The idea is, if you’re less hungry, you’ll eat less and that means you’ll lose weight. This may work in the short term whilst you’re on the medication, but when you come off it you will gain it back. However, eating less doesn’t necessarily equal thinness – lots of people in larger bodies have likely tried eating less, perhaps having tried every diet under the sun, and are not thin (if diets “worked” wouldn’t everyone be thin, right?) Even if people do lose weight they may not be thin, as for many people thinness is not just possible. Our weight is decided by many factors and genetics is a big part of that. If people can be “naturally slim” then people can also be “naturally fat”. Your body will work hard to keep you at a “set point range”, your body’s comfortable weight range, in a similar way to how our bodies regulate our temperature and our need to go to the toilet. Our bodies are clever and we should trust them but due to diet culture, many of us have lost that trust sadly.  Do weight loss injections "work"? The long-term “success” of weight loss injections is not yet known as research has not been going long enough to be able to adequately tell. Whilst some diets and weight loss interventions can result in weight loss in the short-term weight is often gained back in the long run. In the UK, weight loss injections are only prescribed on the NHS for a maximum of 2 years, and one study has shown that people regain two-thirds of the lost weight within two years of stopping. Short-term side effects include headaches, nausea, sickness, diarrhoea, acid reflux, constipation and more. Long-term side effects of staying on weight loss injections for many years aren’t yet known, and due to fears of weight regain it is concerning how many people may try to stay on them for life. These drugs were first intended for people with diabetes, so there have been shortages recently since its growing popularity for weight loss. Celebrities, and thinner people generally, are using it to “drop those last few pounds”, many of whom can afford to pay for it privately. Purchasing weight loss injections can be expensive plus there are risks of purchasing them online. The risks of buying weight loss injections In the documentary, “The truth about skinny jabs” with Anna Richardson, she visits some private clinics in London where they were happy to prescribe weight loss injections, without even taking any health markers, and despite her not being fat. They did so with a hefty bill of course. Anna also experiments with buying weight loss injections online, which she does with alarming ease. The risks of this are many; you can’t trust what’s in them, you might get ripped off or scammed, and anyone young or vulnerable could potentially buy them including those with eating disorders. This is a very dangerous way of accessing these drugs, you really don’t know what you’re getting. People on social media also target people for sales and these are often scammers. If you decide to take weight loss injections please do so through the proper medical channels, and if you do not meet the criteria for them, do not take them. Body shame is big money The idea that being thinner equals happier, healthier and more respectable is the entire basis of diet culture. Companies thrive off the body shame people experience when they think they’re not thin enough (even if they’re not fat). A common myth is that people at higher weights are so because they eat too much. This idea is way too simplistic, it is not as basic as “calories in, calories out”. When it is seen as individual responsibility and just an easy “choice” to lose weight, it’s putting more blame and shame on people. Even if two people of different sizes ate exactly the same they could be completely different sizes. The idea that everyone has the ability to be thin, and that thinner is better, causes so much harm in our society and is a major driver for disordered eating. “The best-known environmental contributor to the development of eating disorders is the sociocultural idealization of thinness.” - NEDA Using weight loss injections only reinforces the thin ideal and the fear of weight gain and increases the harmful experiences of fatphobia and weight stigma. These drugs do not help people with their health behaviours, or other aspects associated with better health like reducing stress and better sleep. Weight loss injections offer the same enticing dieting promise that thinner equals happier and healthier, which is simply just not true. Ultimately, in the same way that every other new diet culture fad says they are “the one” that finally makes everyone thin, they’re not. There are lots of fat people in the world and we will always still be here. Eating disorders There are sadly too many people who are overlooked for having an eating disorder due to their body size. Many people may not recognise that their eating is “disordered” as diet culture has normalised restrictive eating, over-exercise and the pursuit of thinness “no matter what”. Due to myths and stereotypes about eating disorders, people often assume you need to be thin to have one, when in fact most people with eating disorders are not underweight. With disordered eating labels such as Atypical Anorexia (Anorexia but not at a low weight) and Orthorexia (a preoccupation with “healthy” or “clean” eating), the lines between eating disorders, dieting and “healthy eating” are becoming increasingly blurred. This, coupled with weight stigma, means that people are often prescribed/recommended weight loss interventions when this will likely only drive the disordered eating. A person who has struggled for a long time with dieting or disordered eating is not going to be helped by yet another thing that attempts to make them thin. The diet cycle thrives off shame, and every time an intervention fails, people blame themselves or their lack of willpower, when it’s not their fault at all. Diets are made to keep you coming back, diet companies wouldn’t make any money otherwise. Weight loss drugs, manufactured by big pharmaceutical companies, are also made so you stay on them, potentially costing you a fortune and taking on the unknown long-term risks as well as short-term side effects. Diet companies and big pharma do not care about your health. It’s all about money and they profit big time off your body shame. In conclusion… If you’re concerned about your health or have fears and anxieties about your weight, please consider exploring your relationship with food and yourself before any kind of weight loss attempts or drugs. Counselling can help, as well as learning more about disordered eating, diet culture, and body acceptance and intuitive eating. Eating and body image issues can have deeper food causes and influences which will not be helped with weight loss attempts, this just keeps the cycle going. To break the cycle and make lasting changes, a deeper exploration is needed. I offer counselling sessions online, please check out my counselling page for more info. I also offer workshops on disordered eating, body image and weight stigma, please check out my workshops page for more information.
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Body image problems affect lots of different people. We live in an appearance-centred society, but it’s not just about vanity or being shallow. Body image issues aren’t something “silly” experienced by teenage girls, nor are they something we can just “get over”. Body image is partly about how we see ourselves and perceive our bodies, but this is influenced by wider issues such as societal views, diet culture, inequalities, power dynamics and discrimination. I struggled for many years, most of my life, with body image problems. For me this centred on weight but I’m aware that other people have body image issues that have nothing to do with weight or size. My work with individuals and in workshops however does sway toward weight because it is such a big factor for so many people. Weight stigma is so prevalent in our society; it can affect people of various sizes, though people at higher weights face discrimination and many more challenges in daily life. Hating our bodies, being unkind to ourselves and trying to change the way we look isn’t the solution. Punishing ourselves only makes it worse. As a counsellor and trainer with lived experience of body image problems, I am passionate about helping others understand body image on a deeper level, to enable them to challenge their perceptions, assumptions and internalised fatphobia. I personally found that learning about wider societal expectations and inequalities, as well as past experiences and trauma, can help build an understanding of why we struggle with body image. Knowing all of this can help us be more compassionate to ourselves, and others.  I find that "body positivity" can be too fluffy. As much as it can be helpful for some people, it can just be yet another pressure; the pressure to “love yourself”, which is a big jump if you’ve hated your body for years. For me, it just seemed unrealistic to jiggle around in a bikini like the people I saw on Instagram when I couldn't even wear a swimming costume without a big baggy t-shirt over it for many years. "Body positivity" has unfortunately been capitalised on by companies who have noticed its popularity, and by influencers and thin (often white) attractive people online who want to promote themselves. Unfortunately, this has taken the movement away from the very people who need it the moment the most; fat, black, queer, disabled people and others who have faced discrimination and oppression. My body image approach involves taking a "big picture" view, understanding the societal and cultural issues surrounding how we see our bodies, including class, gender, disability, race, and more. Accepting our bodies can feel like a radical act in our society where capitalism needs us to be ashamed of our bodies in order to make money. Accepting living in a larger body can be incredibly difficult for people, given the weight stigma and fatphobia they may face. Self-worth is so often tied up in body image. For me, healing came from understanding experiences in childhood which impacted my confidence and self-esteem. Trauma, bad experiences, bullying and attachment difficulties can all play a part in how you view yourself and your body. Gender expectations also play a big part, and how comfortable you feel in your identity. Neurodivergence, such as autism and ADHD, can also impact how you view your body, and how your body feels. I’ve heard many people talk about not fitting in and feeling like they don’t belong, which in itself is a very difficult way to grow up and can result in anxiety and social isolation. Race, culture, disability, chronic health conditions, visible “differences” and much more affect body image. When the dominant beauty standard (here in the UK) is thin, white, young, able-bodied and “normal”, anyone outside of that can be deemed “different”. We could speculate that in fact, all those “different” people would make a majority, though this is more about power held by dominant groups in our society and the “othering” which maintains that power. If you’re struggling with body image, you don’t have to “love” your body right now, but you could start to explore what makes you feel the way you do about your body. Having counselling may help – if you’re interested in finding out more about my counselling service click here. For professionals, looking at the whole person and intersecting identities, and the context of their life, is so important to understand body image. But the starting point is looking at your own relationship with your own body, and the influences on how you see others’ bodies too. If you’re interested in finding out more about my training on disordered eating, body image and weight stigma, click here. It's Eating Disorders Awareness Week 2024, and BEAT's theme is ARFID (Avoidant/Restrictive Food Intake Disorder), which is what I'm going to attempt to write about today. I'm going to caveat this with I'm not an expert, but I don't think many people are given that there’s very little research, literature or training on ARFID. What there is tends to be about children and young people, mainly from a White Western perspective. So I'm writing this based on having worked with some people with ARFID (adults only) in my counselling practice, and from my own experiences. It’s important to note, that for people who do not have a diagnosis of ARFID (or any other eating disorder), your struggle is still absolutely valid and you are still worthy of help and support.  What is ARFID? ARFID - Avoidant/Restrictive Food Intake Disorder – is a lesser-known eating disorder, categorized in the 5th edition of the DSM-5 (the Diagnostic and Statistical Manual of Mental Disorders). ARFID is described as an “eating or feeding disturbance” which may include sensory sensitivity, fear of aversive consequences of eating, or lack of interest in eating. This can manifest in various ways, such as avoiding certain food textures, colours, or smells, experiencing a lack of appetite, or having a limited range of acceptable or safe foods. My personal experiences I describe my own experiences usually as "disordered eating" as I've fleeted around different difficulties in my life but never been diagnosed with an eating disorder. I never considered there was even an issue, until I started learning more about eating disorders, and learnt about the influence of diet culture and weight stigma in my life. When I learnt about ARFID, I could definitely relate with some of my experiences of being fearful of foods. I was fortunate enough to travel quite a long time in my 20’s, but was not so great on my guts. I had food poisoning numerous times and became anxious about what I could eat as almost everything seemed to make me feel nauseous, bloated and have a bad stomach. I saw various professionals - medical and holistic - many of whom seemed to want to tell me what not to eat. I did various elimination diets and nothing worked. I just got gradually more scared of what to eat. I even cut out tomatoes for a while, which for an avid pasta and pizza eater was really no good! My poor stomach has taken the brunt of most things in my life, emotionally and physically, which I manage on an ongoing basis still though it is much better now. It took me many years to start building up what I could eat again. It didn’t start with challenging myself to eat more foods, it started with finding more routine and stability when I moved back to the UK. I started having counselling, doing yoga and building up my relationship with myself, and food. I also had a lot of diet culture stuff I was trying to unpack, which was an added complexity. I didn't hate my body anymore but I certainly didn't love it. I was starting to be a little kinder to it at least. I felt brave enough gradually to try new things, but it’s scary when you’ve had bad experiences with food and it’s made you ill. I wanted to have variation in my eating and to reduce worrying about food, and some of that meant challenging diet culture narratives I’d picked up growing up, and societal ideas about “healthy” eating. I aimed for more of an intuitive eating approach and tried to get more in touch with my body, hunger signals and focus on what my body needs and how it felt instead of external influences. Like many people who have struggled with eating, I have foods and places I feel safer with, and I like to know what’s on the menu at places I eat beforehand. “Recovery” means different things to different people, there is no one-size-fits-all because everyone’s experiences are so nuanced and complex, but sometimes it just means managing a little better. Norms and expectations I feel way more at ease with food now, but I will never forget what the fear of eating feels like. I know what it's like to feel anxious about eating out, and eating at other people's houses. To be scared that there won't be anything for you to eat, and that people will judge you for being picky or difficult. To feel like you can’t eat like a normal person. It can be incredibly shaming to feel like the odd one out, that you're being too dramatic, and is easy to blame yourself for these things. This has a huge impact on your life; socially, at work, career choices etc. It can really hold you back. As a counsellor now working with eating disorders and disordered eating, I feel my lived experiences are important and beneficial in this work. Some people with eating difficulties will have experienced things very differently, but I still have some insight and I understand the turmoil, frustration, shame and various other underlying feelings associated with eating disorders. The main thing I’d like to let people know is that your struggle is valid, it’s a tough way to live, it is definitely not your fault and you absolutely do deserve help and support. 
Normal eating? So what even is normal eating anyway and who makes the rules? Spoiler… “normal” eating doesn’t exist. Diet culture has a lot to answer for, but we also start learning about food from the moment we're born. Early childhood experiences and narratives around food can create templates which run through your whole life. We learn how to eat from others, which is heavily influenced by culture and society and “norms” can become ingrained. Some people, like myself, will learn that there are “good and bad foods” and that healthy equals being thin and fat is bad. As babies we cry and get fed, but then everything changes once we’re faced with a dinner table; there are rules and expectations. I am aware I’m speaking from the position of being a white British person, so only from one limited cultural perspective, but I was taught about how meals had to be “balanced” to be healthy and to eat 5-a-day and all the other generic stuff. Even in the past few years, I’ve been handed “how to eat” type leaflets from medical professionals that were literally from the 80’s. It’s just not realistic to have one “right” way of eating, our bodies are so different. It also assumes the “right” way is based on White Western approaches to eating, assuming this is the “normal” way. It is not. We all need to find our own normal and not feel ashamed for this. Neurodiversity We can’t talk about ARFID, or any other eating disorder, without talking about neurodiversity. I use this term here to refer to the natural differences in the way everybody thinks and processes information. Through my own practice I’ve learnt the importance of looking through a neurodiverse, and intersectional, lens. Even working with people who are neurotypical there are benefits to this, as everyone has different communication and learning preferences. With ARFID, there can be sensory sensitives in many people, meaning that different textures of food, mix of foods, and variance of foods can make life very tricky. Think about how much fruit and veg can vary in texture (and taste) from day to day! There is no consistency, therefore no safety, in those foods at all, but with some crackers or a packet of crisps, it’s the same each time. For neurodivergent people (which in this sense I’m referring to autism and ADHD mainly), there can be a pressure to “mask” and try to “fit in”, which may mean added pressures and anxieties around eating “normally”. The idea that we have to help people fit in with what we perceive as a “norm” (which is often a position of privilege) is not acceptable, especially in the case of neurodivergent people and those with disabilities. The world needs to accommodate, not reinforce a “norm” which is inaccessible for many. This again can lead to self-blame and shame. The same is true for eating – the “healthy” and “right” way of eating is too limited to accommodate everyone, and to enforce this is potentially harmful to people. For some people, the pressure, expectations and feelings of not being “normal”, and self-criticism and shame that come from this, are arguably the issue more than the food they don’t want to eat. The pressure from others, especially on children struggling to eat (who have little autonomy and choice) can exacerbate the situation, which is often due to understandable concern for their loved one but is underpinned by “norms” and expectations of what they think they “should” eat. Acceptance Many people with ARFID want help to be able to widen their food options, reduce anxiety around food and live an easier life, so I’m not suggesting that people just accept the limitations as that’s not going to be realistic. But I feel it can be helpful to start building self-acceptance and reducing critical thoughts as this will help recovery and healing. Putting in boundaries with others, and unlearning some narratives around food might be important too. Safety is such a big part of this, in the sense that food needs to feel safe to eat, but also places and people need to feel safe too. For people with ARFID seeking help, they may be nervous about seeing professionals in case they are forced to eat, or met with judgement or dismissal. The main issue with ARFID is that it’s so different for everyone, so there are no specific ways to help. It would involve working on a case-by-case basis, in a person-centred way. It is important that the person feels they’re not being judged, but that they have control and can make choices for themselves. There are currently no evidence-based treatment recommendations for ARFID but some treatment options in the NHS can involve Cognitive Behavioural Therapy (CBT), exposure therapy, or family therapy for young people, with nutritional support too. For many people, it may be difficult to get a diagnosis (or they may not feel safe to go to their GP in the first place) so they may opt to seek help privately. I work in an Integrative way, with a person-centred foundation, meaning I incorporate different theories and approaches but I am collaborative and adaptable to suit clients’ needs. This is not a “how to work with ARFID” list but there are some approaches which might be helpful:
A wider understanding of ARFID in society is needed and more literature on this subject. I’m pleased ARFID is the theme for Eating Disorders Awareness Week this year, and I hope we can keep the conversation going. If you have any helpful resources or training for professionals, do let me know. NEDDE are running an ARFID course for practitioners in April, more details here. To find out more about my counselling practice, click here. Both First Steps and BEAT offer support services for ARFID. Just also a big shout out to Dr Chuks and Bailey Spinn who recently wrote a fantastic book called “Eating Disorders Don’t Discriminate: Stories of Illness, Hope and Recovery from Diverse Voices” – check it out! I recently saw “Your Fat Friend”, a documentary about Aubrey Gordon made by Jeanie Finlay. I’m a big fan of Aubrey’s work, her books, blogs and podcast - Maintenance Phase, and she’s been a huge influence on me both personally and professionally. I am a counsellor and trainer working with people struggling with eating, body image and the impact of weight stigma. I’m passionate about highlighting the importance of helping those in larger bodies with eating disorders, and training other counsellors in understanding disordered eating and weight stigma, and this film just lit even more of a fire in me.  Image: https://www.yrfatfriendfilm.com/ In the film, Aubrey talks about having an eating disorder and the barriers for fat people trying to access help, she says eating disorder treatment/support for fat people literally doesn’t exist. This broke my heart to hear, even though I’ve heard so many stories like this from people who have been judged, dismissed and turned away. I’ve worked for eating disorder charities in different roles for over 7 years now and it’s always disheartening to hear stories of being turned away from NHS services for not being “thin enough” and the assumptions made about fat people. As Aubrey says in the film, if a fat person has an eating disorder it is assumed that must be binge eating. This is absolutely not the case; people in smaller bodies can struggle with binge eating, and fat people can struggle with restrictive eating. Binge eating can often include restriction anyway (eating less than your body requires), it’s part of what keeps the cycle going – restrict, binge, feel guilty/ashamed, and double-down on restriction again. It’s called a binge cycle and can also be applied to dieting – diet, “fail” at the diet, shame, back to dieting. This is how diet companies make money (sometimes now not using the word diet, but “wellness” or some other fluff), because it’s never the diet’s fault, right? It’s ours for lacking willpower, being lazy/not good enough etc. This is why dieting does not “work”, it’s just creating more shame, more anxiety, more self-blame, and ultimately creating more eating disorders. Aubrey also mentions Atypical Anorexia, basically just the same as anorexia but not fitting the low BMI threshold to tick the box of being “sick enough”. This is extremely harmful as it’s stopping so many people from accessing services (though in the UK this is likely largely due to significant underfunding of ED services), and means we have no hope of “early interventions” which the NICE Guidelines state are so important for eating disorders. Being turned away for help, or anticipating not being able to get help, can often just exacerbate the disordered eating, with people feeling there is nowhere to turn. This was very much the sense I got from Aubrey talking about having nowhere to go as a fat person with an eating disorder. It’s so hard to have trust in professionals when they have all grown up in the same fatphobic, diet culture, and have little to no training in this. When I was training to become a counsellor I realised this was very much the case for our industry too – nobody talks about eating, body image, weight stigma or fatphobia, yet it is extremely likely all counsellors will encounter people affected by these issues at some point. This is why I am so passionate about this work and filling this gap – we must make it safer for fat people to access therapy. Counsellors must know about eating and body issues through an intersectional lens, looking at power, privilege, class and biases. Sadly, in my experience, this is not happening anywhere near enough as the industry is prominently white and middle class, and this is even more so in the eating disorder world. A huge amount of research into eating disorders, and treatment centres and charities, are run by thin, white, middle-class women, focussing on helping thin, white, female clients. There are so many people left out of eating disorder treatment, not only fat people but black people, disabled people, trans and non-binary people, and many more minoritized people. Treatment and therapy isn’t safe enough for so many people. This has to change. In all honesty, the difficulty I find in writing about all these issues is that I don’t want to scare people or put them off trying to find help and support. I want to raise awareness of what’s going wrong so we can work on changing it, but for individuals seeking help, I don’t want this to be another thing that reinforces the idea that there is no help for them. There is help, there are people doing great work out there, and I believe it is possible for fat people to access the help they deserve. As Aubrey says in the film, “you can’t self-love your way out of oppression” which I totally get, but you deserve help to be able to cope, as a bare minimum. There are ways to start healing. It may always be hard navigating the world as fat person but there are ways to build resilience and compassion for yourself, and help create a better relationship with food, if that’s what you would like. I’m holding in mind that people reading this may be either looking support for themselves (or individuals who are just interested) or some may be counsellors/therapists or professionals looking for what they can do. So I’ll suggest some ways counsellors/therapists/ED services can help, and if you are looking for support you can perhaps use these as green flags (good things) to look out for!
I am proud to work with people in larger bodies (and all kinds of bodies) who are struggling with a range of eating problems and body distress. Sometimes I feel like I’m the only person in their life who doesn’t tell them they need to lose weight or make them feel like their body is not good enough. We need more counsellors, therapists and people working in the eating disorder field to help fat people feel that they are safe, welcome, and cared for. I’m keen to hear other ways we can help fat people access help safely as I know there’s way more needed than just the tiny list above. We need to share ideas, so please let me know! Thanks for reading. If you’re interested in having counselling please head to my counselling page for more info. If you’re interested in my workshops and trainings, I’ll be offering more soon so check out my workshops page and sign up to my mailing list and I’ll let you know when more dates come up. Thanks! Your Fat Friend trailer: |