Fat patients should use fat doctors

This is the life lesson I have learned, today, and which I am generously sharing with you.

Fat doctors are much more likely to get it. They, like the rest of us, have agonised about the weight loss debate, worried about the damage to their health that their BMI might be doing, have lost weight only to pile it back on again, with a little more for good measure, have hated themselves for being fat, for being unhealthy, for being unable to exercise the required self-control to magically become a thin person. It’s not guaranteed, of course, because a fat doctor can always decide to project their self-loathing onto you, and if they try that, you should seek another doctor. However, if they’ve reached a certain age, and come to the conclusion that, rightly or wrongly, fat is what they are, and isn’t about to change, you stand a good chance of discussing your health with someone who sees your body shape as a parameter, not a problem to be fixed. And that clears the way for an intelligent, grown-up dialogue about what health options ARE available to you.

The other thing I learned, today, is that if you are generally against random health-screening that doesn’t relate to the reason you went to the doctor’s in the first place, you should say so, and loudly, at every interaction. Because if I had been consulted 6 weeks ago, I would never have agreed to the liver function screening, which bore no relation to the random white blotches that had appeared on my face, and I would not now be in the middle of an investigative process to find out what is wrong with my liver, the end result of which will be, us knowing what is wrong with my liver. There is no treatment. There are no symptoms. There is no problem that we are seeking to solve. We just randomly screened my liver function, and now we know it’s abnormal, we can’t possibly resist finding out why.

That annoys me intensely. I don’t believe in random screenings. I think the medical profession – particularly at the policy level, rather than the sitting-in-a-room-with-you level – is inclined to entirely disregard the emotional toll of false positives (generally more likely if testing decisions were not risk-based in the first place), of being presented with a health “problem” you didn’t know about and which doesn’t affect you, of needing to spend your perfectly good and limited time and energy on visits to blood clinics and ultrasound labs, and so on. These things are not nothing. These stresses can actually bring a health cost of their own, though they are rarely evaluated in that way. I believe, instead, in risk-based testing. So, if there is evidence to suggest a child MIGHT be being abused, we investigate – we don’t do spot checks on every family just in case. If there is evidence to suggest that there might be a problem with my liver function, we test it. If we think my complaint might be caused by lipid deposits relating to high cholesterol, we test for that – and nothing else!

Essentially, the uncomfortable conversation I had about dieting, with the previous GP that I saw, and the subsequent five weeks of worrying that there might be something seriously wrong with my liver (there isn’t), and that if there was, I was going to have to face a major confrontation with the medics regarding my refusal to attempt to lose weight, were unnecessary stresses, brought about by the first GP I saw (different one again) who took it upon herself to measure things that had nothing to do with why I had gone to see her.

She should have at least asked me. Because that’s five weeks of stress that I could have been spared.

MPs pay: get the facts right, please

If you like it would appear most MPs don’t have the time / inclination to read the Independent Parliamentary Standards Authority (IPSA) report into MPs pay, you should at least get an idea of what it (not the press) says.

It’s not 11% pay rise it’s 9.26% yes it’s high but lets get the number right – the pay rise happens in 2015 – and between now and then MPs are getting a 1% pay rise a year anyway – so in 2015 values they go from £67,731 to £74,000

The recommendations are cost neutral to the taxpayer (so overall they are not getting more money) – while the headline pay is going up, MPs will lose out on the payments they get when they leave parliament, what they can claim (they won’t be able to claim evening meals for example) and their pensions is being downgraded significantly to be more normal.

Once it’s implemented MPs pay will be linked to average earnings – So this shouldn’t happen again.

IPSA were asked to fix a problem and they have – they have looked at where MPs wages should sit in relation to other jobs, removed some of the rouge payments around the edge and have set out a way for this to remain fixed into the future.

You can agree or disagree with the levels and how but you should probably understand how they reached the numbers they did.

The biggest argument I can see for not paying MPs this money – most of them blatantly haven’t read or understood these reports and that in my opinion raises competency issues.

Guilt – the summing up

A very old friend of mine used to say, “Guilt is a wasted emotion.” I’m not sure I  can make a lot of sense out of the idea of any emotion being a waste, but she wasn’t entirely wrong. Guilt is certainly exhausting. It drives you to second guess yourself, and tie yourself in knots worrying about what other people think of you, and none of that does you a scrap of good.

Because the thing is, most of our guilt doesn’t come from within. It comes from the expectations we let other people lay upon us – sometimes the expectations that we project onto their entirely innocent selves. Guilt is heavily tied up with shame – the fear that other people will find out the terrible, secret truths about who we really are.

If your guilt is genuinely driven by the knowledge that you did a bad thing, then the best thing you can do for your own peace of mind is look for forgiveness – if you’re lucky, from the person you injured in the process. But really, whether that person exists, noticed, and is prepared to forgive you, or not, forgiving yourself is where the growth is going to be. To be able to say, “I did this thing. I should have done something else, or else done nothing at all, but I can’t go back and change it now. I choose to learn from my mistake, I choose to do my best to do better in future, and since I can do no more, I’m through beating myself up over it.” – that’s where freedom lies. Arguably, the entire theological idea of God’s forgiveness is a mechanism to allow people to forgive themselves. It’s a way of saying, “Look – God forgives you! And if it’s good enough for him, why not cut yourself some slack, too?”

But for most of the stuff we feel bad about, most of the pressures we put on ourselves, it’s really not as dramatic as that. It’s just about making your own choices about priorities – whether that’s prioritising how hard you will work, how thinly you’re prepared to spread yourself, what you want to eat at a given time, it’s your life. They are your choices. Only you can make them, and if someone is trying to make them for you, they’re wrong. Don’t let them. Your very freedom depends on it.

A guilt-free existence: Part 4: Guilt-free food

Between you and me, I don’t mind telling you that am a rather rotund person. Cuddly, maybe. What my doctor cheerfully described as “morbidly obese” a while ago. Not that she seemed to mind, except insofar as it minutely limited my contraceptive choices to the thing I would probably have chosen anyway.

I’ve always been fat, ever since I hit puberty, pretty much. I went on my first diet at the age of 13, which horrifies me a little, looking back. It, like every diet I’ve tried since, didn’t really work. I lost weight, I felt a huge sense of achievement, but diets never end, they just peter out, and when they do, the weight inevitably comes back on, usually with a few pounds more for good measure. So, I lost weight at 13, I lost it again at 22, I lost it again at 28, and then I stopped bothering. For a while I was distracted by all the small children running around my feet – the idea of organising a separate meal-plan for myself was more work than I could face. And during this time, a couple of revelations hit me, and robbed me of any motivation for dieting that I had left.

One was that I look just like my mother. Nobody ever wants to admit that, but I do. I have her precise body shape, which makes my weight issues genetic, and much harder to fight. She, mind you, does still try to fight it. Me, not so much.

The other was that obesity is not the be all and end all. It is a symptom, not a cause, and that means that diets are really only addressing the symptom. And you cannot live your whole life on a diet – it’s depressing, and hard, and sooner or later it always goes wrong. It is a symptom that is associated with other problems, but if you are basically healthy, then being fat isn’t, by itself, a health problem. There’s certainly evidence to suggest that it’s less of a health problem than significant fluctuations in weight, and every diet I ever did resulted in a fluctuation, not a permanent change.

As a result, I resolved, some years ago, to stop torturing myself about food. I like food. I like bad food. I like food with sugar and butter and cream in it. I like pasta and bread. I like cheesecake. Actually, scratch that – I like cheese, in almost every form it comes in. I had had it with depriving myself, because successfully depriving myself was at best a temporary fix, and failing to deprive myself made me feel terrible.

I was through with feeling guilty about food. People do, after all, need to eat food, and the business of how much, and what it should be was just too nuanced for me to manage it coherently. I gave up.

If I’m going to feel guilty, I decreed, then I will choose to feel guilty about being unhealthy, rather than about being fat. I will just buy better clothes, so that fat doesn’t matter. Because by itself, fat doesn’t matter.

For a couple of years, I ate what I liked (started buying real butter for the first time in my life – and it’s so good!), didn’t put significant amounts of weight on (maybe I’m just designed to be roughly this size? I said it was genetic, didn’t I?), and focussed lots of energy on trying to feel guilty for being unhealthy, instead of feeling guilty for being fat.

That sounds kinda stupid, now.

Because, feeling bad about what you didn’t do, is pretty stupid. Celebrating achievement, that’s where it’s at. I went for a walk – Woman of Valour! I swam – Eshet Chayil!

In the last few months, I have been trying to consciously add exercise to my routine. The first time I got my dusty old Wii Fit out, and tried some jogging on the spot, I lasted about 90 seconds. But do you know what? That’s 90 seconds more than I did the day before. Eshet Chayil!

Now, having worked very hard, not out of guilt, but out of choosing a goal that mattered to me (to be physically fit, and therefore not die of heart failure at 55), there has been something distinctly galling about the fact that I have not lost a single pound. Because, I know I said I don’t care about being fat any more, but guess what? I was totally lying. I would love to suddenly and easily become a size 12, and stay that way. But we both know that it’s not going to happen, and I’m no longer interested in a short-term strategy. I am taking regular exercise for the first time in my whole life, because regular exercise has to be a part of your whole life, if you want to stay healthy. I’m not swearing off cheesecake for a fixed period, hoping to solve a problem. I am changing my routine, my expectations, my default, because I want to be healthy. I am eating cheesecake, because I want to be happy.

People have the audacity to disapprove of what others eat. It’s an extraordinary imposition, but they do it. They see the fat girl, and automatically pass judgement on the cream cake. Actually, they also see the thin girl, and pass judgement on the salad. Maybe she likes salad! Maybe she’s not eating salad because she wants to be even thinner, when you already think she’s too thin to be allowed. Maybe what other people eat is entirely none of your business!

So, I say, let’s reject other people’s disapproval. You get to be as fat or as thin as you are, and you get to eat whatever you fancy. It’s up to you. Feeling bad about what you ate totally sucks. Not least, because nothing makes you want cheesecake like feeling bad about the cheesecake. But you can never really win, that way, because no matter how many days in a row you resisted the cheesecake, the emphasis is always on the day you succumbed. We quite naturally focus on the things we do, not the things we consistently avoid doing. So diets are made of feeling bad for what you did, without much in the way of achievements to celebrate, in day-to-day terms. Weight Watchers will give you a pat on the back when you’ve lost so many pounds, but you have to have resisted a lot of cheesecake on a lot of days to get to that point.

On the other hand, feeling thrilled and delighted by the tiny bit of exercise that you did, is a great thing. It’s a way to celebrate the good. You do something, and you feel proud of it. And more inclined to do it again. It’s a positive cycle of happiness, instead of a negative cycle of sadness.

If you want to be healthier, you could try some exercise. You might like it. You might hate it, but decide it’s important to you. You might decide you’d rather take your chances – it’s totally your choice, and other people don’t get to dictate to you. But do you know what? Feeling good about something you did knocks into a cocked hat feeling bad about something you failed to resist.