The beginning of a New Year is tough on our bodies and minds – particularly our body image, as the pressure of fitness and diet-related “new year, new you” resolutions pervade our social media feeds.
And this isn’t just a January problem. According to YouGov, half of Britons report feeling somewhat pressured to have a certain body type, with women in their 20s and 30s feeling it the most.
To compound this issue, our healthcare system isn't doing all it can to ensure that our body image values are as healthy as they can be.
Beyond the devastating impact of the gender health gap on female-identifying bodies – conditions such as PCOS and endometriosis are under-researched, and 57% of women fear they have been misdiagnosed, a quarter of which believing this is due to being female – the way in which weight loss and gain is discussed during healthcare appointments is also being criticised.
Women are increasingly speaking out about unsolicited and damaging advice from the NHS when it comes to their weight, and how triggering and unhelpful it can be.
Laura, 28, recently tweeted a screenshot of an unsolicited text message she’d received from the NHS informing her “you have extra weight”, and referring her to “weight management programmes tailored to your needs and lifestyle”. She tells GLAMOUR that receiving this message left her feeling “upset” and “offended”.
“We already have to endure endless conversations about weight around Christmas and diet culture in January, which could be triggering for a lot of people,” Laura says.
I experienced my own version of this harmful bias myself a few years ago during a routine contraception appointment with a nurse. She took one look at her screen, which detailed various elements of my medical history, and smiled. “Well, congratulations,” she said, “the good news is you’ve lost weight since the last time you were in.”
Research consistently shows that restrictive diets don't work—and cause much more harm than good.
I smiled back, trying to make sense of my discomfort. I called my mum immediately after, trying to work out why a woman (who has undoubtedly faced the pressures of body image herself, because what modern woman hasn’t?) would congratulate me for losing weight, without having any idea why this might have happened.
I tend to lose weight most rapidly when I’m stressed, depressed, heartbroken or all of the above. So when a healthcare professional saw nothing but positivity when it came to me dropping a few pounds, I felt pretty uncomfortable at this evaluation. It didn’t feel like it was grounded in medical progress, but internalised fatphobia.
“Weight loss and weight gain have been taboo topics amongst the population for many years, and is still an area that is often overlooked and misunderstood within the healthcare sector,” Rhiannon Lambert, a registered nutritionist and master practitioner in eating disorders, explains.
“The way we speak to people who have disordered eating or eating disorders is of utmost importance, because when in this vulnerable situation any passing comment may potentially trigger more of these negative thoughts or emotions towards their relationship with food or body image, and lead to further complications down the line.”
For many, this damaging attitude can have incredibly deep-reaching consequences, especially for those who have a history of disordered eating – a fact that healthcare professionals seem to overlook when having these important conversations with us about our bodies.
“I was concerned about how other people might react to [the message I received] and how dangerous it could potentially be,” Laura says. “I am more comfortable in my own body these days, but I have previously struggled with body dysmorphia, low self-esteem and shame around my weight – so I was immediately concerned about how my message could affect someone who has an eating disorder or a more serious mental illness relating to their weight.”
Alexa, 31, describes a troubling visit to her doctor’s surgery shortly after having a baby. After measuring 0.1 over a “healthy” BMI, she was instructed that she needed to lose weight – to cut her carb intake and replace her usual evening meal with a salad. Having struggled with disordered eating in the past, this advice caused old habits and thoughts to resurface.
“I was taken aback,” she told GLAMOUR. “I have extremely poor body image, and this has worsened since I had a baby. I also have struggled with disordered eating. None of this the doctor knew as they didn’t ask before prescribing weight loss.
“To have a healthcare professional – someone we place a lot of trust in – to tell me that I needed to lose weight, shook me. I’ve been trying hard to get to a place of body neutrality and it felt like this took me right back to all the negative thoughts I have about my body instantly.
“I didn’t know how to react, and I definitely didn’t feel strong enough to challenge it. I just wanted to get out of the doctor's office as soon as possible.”
We all deserve better than a lifetime battling our bodies to fit an impossible beauty standard.
The complete lack of sensitivity towards potential disordered eating or body image issues further underlines the fact that our healthcare system – as well as our society – views weight loss as good and weight gain as bad. This is a dangerous oversimplification that could have huge consequences for so many patients.
Now, Alexa describes feeling “reluctant” to go to the doctor now for other problems, in case she encounters the same experience again. That said, she doesn’t blame the individual she spoke to, but the shortcomings of the wider organisation.
“I don’t blame that particular doctor, but I think the NHS in general needs more training around these types of issues,” she adds. “To be better equipped and to understand the actual science between health and weight, rather than use this extremely damaging blanket BMI, which is really just an arbitrary number that is not a good reflection of what is healthy.”
The Women and Equalities Committee called for a move away from using BMI to a more size-inclusive approach in their 2021 report. While it has its uses for tracking disease and chronic conditions, Lambert points out that it doesn’t show us more complex elements of our weight such as “the amount of fat or muscle you have within the body, bone weight, cultural factors, age or gender”. This is mostly due to the fact it was devised based on average white European men.
Certainly, a number can’t encapsulate someone’s health, and shouldn’t be used to solely determine whether a woman needs to lose weight.
This advice – or unhelpful commentary – around weight loss and gain from healthcare professionals also seems come unsolicited. Alexa*’s appointment was not weight-related, neither was my contraception appointment, and Laura did not opt in to being texted about her weight.
“I didn’t go in with any weight issue, so why did the appointment become about my weight?” Alexa* asks.
Eating disorder charity Beat agrees with Alexa* and Lambert when it comes to the need for eating disorder training within all medical schools, so that healthcare professionals can handle these problems more sensitively and with a more holistic knowledge of what’s at stake.
Beat report that GP receive an average of less than two hours’ worth of specialised training around eating disorders and how to deal with those who suffer from them. While medics have disputed this, they have conceded that a standard 10-minute doctor’s appointment isn’t enough to cover the complexities of eating disorders.
In order for large scale changes to be made, though, it needs to come from the hands of our biggest decision makers. “The Government must also invest in eating disorder training for healthcare staff,” Tom Quinn, Beat's director of external affairs, adds.
The way in which weight gain and loss is discussed needs to change – for the safety of those suffering with disordered eating, as well as all other individuals who may be sensitive about their body image.
Even in 2023, society still glorifies thinness above all else.
“If someone is sensitive to their body image, being classified as overweight may exacerbate these internal thoughts and in some cases may lead to disordered eating habits in the long term,” Lambert explains.
“What’s important to remember is there are so many other non-weight related measures which we can use to define our overall health and sense of well-being, as well as how we feel in ourselves.”
Back in 2020, Psychology Today argued that “we are all casualties in the war on obesity” due to the “internalised size bias” that we and our healthcare systems apply to our bodies. And honestly, not much seems to have changed since this article was written.
We need to feel like we can trust our healthcare professionals with our bodies, and that includes our weight and the issues we carry with it. The world is full of misogynistic, body shaming rhetoric, we certainly don’t need to be hearing it in a doctor or nurse’s office.
*At the request of the interviewee, a pseudonym has been used. GLAMOUR has contacted the NHS for comment on this issue.
