WOD Map

Surviving Obesity is something i am incredibly passionate about, as I am an obesity survivor and absolutely thriving in my health & fitness going on 8 years now. I was always overweight as a child, always having quality food but large portions. moving onto young adult years i kept gaining weight, trying every diet, shake, pill and with all of them i lost weight but soon after pile it all back on and some, because the chronic dieting had turned me to binge eating, everything i missed out on for 8 weeks i would consume too much of. At my largest of 127kg and a BMI of 42 i decided to have gastric banding surgery, as i was afraid of having the more permanent option. Gastric banding changed my life completely, loosing 20kgs, it gave me hope and confidence that i could change who i was destined to be, which then gave me the confidence and the fire to search for more for myself. But Banding was a major operation and the flood of emotions that came with the start of this new way of eating was really hard. With the monthly surgeon check ins & the two dietician appts I received, it was really not enough to understand my new stomach, my ever-changing body & the mental strain it took to forcibly break my old habits.

It was then that I met my personal trainer. An incredible man that helped educate me about proper nutrition, gave me an opportunity to try new things that I had deemed impossible, renewed my enjoyment for physical exercise & movement and gave me the self confidence that i needed to lose weight & tone my body. Navigating this weight loss journey became increasingly difficult with the band, as the more weight I lost the tighter the surgeon would make my band. When my band was tight it restricted every food that I could consume, no matter how much I chewed or cooked it down to nothing. I developed different aversions to food and I found myself opting for easier foods to consume ( generally these ended up being unhealthy or full of sauce in order for them to go down ok) The food that I enjoyed couldn’t be consumed anymore even the healthy food, my relationship with food changed negatively and my social interaction around food had once again become embarrassing, no longer because of my size, but because most of the food I would eat would have to come back up.

With the continued help of my personal trainer, I went back to my surgeon, explained to him my grievances and agreed upon having the band remain empty & dormant in my body while I pushed and challenged myself every day to lose 30kgs. After a few years of learning about proper nutrition, strength & conditioning & living an active lifestyle I finally went back into my surgeon and asked to have my band removed. The surgeon was highly reluctant to remove my band explaining that statistics say that without it I would re-gain all the weight I lost and more. It took me a long time to stand up to him and although grateful for his service and the start I needed for weight loss, having the band removed was the only way I could fully control my destiny & my health in a positive way. Much to my surgical teams disappointment I had my band taken out, (with no follow up) I went back to the new life I had created, training consistently, moving everyday and eating nourishing foods without guilt or restriction. Loosing a total of 65kgs and maintaining it for 8 years.

Because of my journey and the incredible impact my trainer had on my life, I went on to study to do the same. I am now a personal trainer & body transformation specialist in Perth Western Australia, offering in person coaching and online programs to guide the others trying to overcome obesity & for those that are undergoing bariatric surgery. By giving them the support & guidance, they need to get the most from their journey.

For me, my coaching is all about educating my clients & the community around obesity and how to overcome it. I want to be able to help others who are struggling, whether just starting out or to support their WLS journey through healthy lifestyle habits, nutritional education & providing comfort & safety from someone who has navigated her way through from surviving to thriving.

Obesity has become a challenge, a big one, in Nepal (a South Asian nation which continues to struggle with persistent under-nourishment among her people). Our review of evidence illustrates the increasing prevalence of overweight and obesity over the past two decades, while official responses from the federal government remains sub-optimal.

Traditionally, Nepal's malnutrition problem was characterised by undernutrition as expresssed in terms of sub-optimal growth among children, thinness among women and deficiencies of selected micronutrients such as iron. This still remains at high prevalence levels, despite the decreasing trends in prevalence. However, obesity, particularly amongst adults, has risen to epidemic proportions in the past two decades. So, Nepal faces the double burden of high - though declining - levels of undernutrition (including micronutrient deficiencies) and the rising challenge of obesity. 

This has occurred simultaneously with changes in society and economy. Owing to the easy and widespread availability of low quality foods produced by the industries and marketed aggressively using a host of business strategies, Nepali people's eating habits are changing towards increasingly high consumption of food products with refined carbohydrates, salt and fat. Also, prevalence of insufficient levels of physical activity has risen. 

In urban areas, a plethora of fitness centres have emerged, offering commercialised facilities and services to lose weight. Yet, there is no indication that the prevalence of obesity would decrease in the next several years, unless the marketing of unhealthy foods are controlled, and an environmental conducive for adequate physical activity is developed. 

Dana speaks to the importance of remembering the support offered by the loved ones of those living with obesity.

My name is Sandra Elia, I'm passionate about the work I do to help those living with obesity because my story includes overcoming obesity.

I’ve lived two lives. One life suffering from morbid obesity, eating out of control, and experiencing paralyzing depression, my entire life was spiraling out of control. Another life as a happy, healthy, vibrant woman, mother, and Food Addiction Counselor!

Travel back with me to 2001 where I begin my journey from the darkest point in my life. A point I never thought I would reach >>>

>>> I'm 29 and I’m out of control, detached from my body, my feelings, and my passions; merely going through the motions of the day, only seeing what’s exactly in front of me and nothing more. I have blinders on. I have no interest to plan, dream, or focus on anything but surviving.

Using food as my only source of power and comfort, it is my almighty drug. But this drug has left me feeling beyond empty, and with the reality of being 100 pounds overweight, I am uncomfortable and unhealthy.

My entire body aches from the extra weight, I can’t move freely. I isolate myself from friends, activities, and family. I feel like an outcast, as though I have no right to be a part of this world that values beauty so highly. My worth is measured by my size' the bigger the size the less I am worth.

The truth is my weight is merely a manifestation of the life I'm living . . . a life completely out of control. I am clinically depressed and in a bad marriage; it's chipping away at my spirit. I'm on extended sick leave from work taking care of my sick, bipolar, obese mother.

From this shallow point, I rebuilt my life.

Somehow through the fog, I realize no diet or get thin quick scheme could help me. No number on the scale can give me peace, acceptance, or love. The diets have all failed me. They've robbed me of money, dignity, and self-respect. They've given me false hope and brought me further into my disease.

Yes, I have a disease, it's called obesity and I sought treatment.

I start this journey by looking inward. I had to see my beauty and learn how to love and accept myself exactly as I was --- all 262 pounds of me. I had to change the mental tapes that had been on replay for so much of my life, that I was undisciplined, lazy, and ugly. This could no longer be my truth. I had to choose to love myself. Unconditionally.

What I learned very quickly was that love is energizing, and I needed all the energy I could muster to recover. I also discovered that no different than if I spent time with a negative hateful person, my own self-hating thoughts drained and exhausted me.

I could no longer speak to myself about myself that way. I made a pact with myself to not say anything unkind about myself. Ever.

Obesity is a disease that will require lifelong treatment that will give me a more rewarding life.

I'm a clinical dietitian and nutritionist, and currently, I'm a PhD researcher at UCL School of Pharmacy.

Weight-based stigmatisation in healthcare settings is associated with physical and mental health concerns and inequitable healthcare, health disparities and a lack of engagement due to discriminatory practices. Substantial evidence demonstrates that weight stigma can contribute to disordered eating, such as binge eating and emotional eating, increased caloric intake regardless of hunger and the risk of developing obesity.

Educating healthcare professionals in using non-stigmatising language and communication in managing obesity may positively affect the quality of healthcare and adherence outcomes in weight loss programmes and interventions.

Healthcare professionals have a strategic role in delivering brief opportunistic interventions and signposting patients to appropriate services. Interventions to reduce weight stigma in clinical practice with a patient-centred, health-focused approach are more important than ever. Techniques such as motivational interviewing and the 5A's model may facilitate health behaviour change in managing obesity in the primary care setting. Such training sessions can also support primary care practitioners in engaging with patients about weight in a non-stigmatising way.

More research is needed to develop a best-practice model that can be routinely implemented in healthcare settings to foster health behaviour change by using a weight-inclusive, more respectful, empathetic, health-enhancing approach.

Weight is a very complex issue, and solving it is not as simple as telling people to move more and eat better or by putting everyone on a diet. As well as our individual biology, genetics and behaviour, there are many more factors that affect our weight. For example, how much money we have, where we live, our culture and our family. In decades of public health intervention, nothing has worked in the way we had hoped, including dieting and education.

So, we have taken a different approach! We want to stop blaming individuals and claiming the problem is simply lack of knowledge or willpower. We will support people, value and accept them, and work hard to make their lives fairer.

Our vision is to create an environment where everybody in Doncaster is fully able to pursue their own health goals and are fully supported to do so by society, without judgement or assumptions. They feel valued as an individual just the way they are. Compassion is at the heart of how we move together towards a healthier society for future generations.

To realise our vision, we need to change the way we think, talk and feel about weight and health, and bring everyone along with us.

What have we done so far?

In 2020, we began our Compassionate Journey at Doncaster Council.

This started with building an evidence base through a scoping literature review, developing our Compassionate vision and principles, including what we want to adopt and what we want to reject, mapping the approach locally and embedding our principles into other streams of work. Read more about this here: Doncaster's Compassionate Approach to Weight

We know that a lot of different settings are looking to implement more Compassionate approaches to weight and health, so we set-up a Practice Group, which brings together colleagues from across the country who are passionate about ending weight stigma. The group provides peer support, shares learning, and changes perspectives about obesity.

From November 2021 to January 2022, we ran a public consultation to inform the development of our compassionate approach. This consultation included two public surveys:

Survey 1 asked questions about food, eating, and physical activity, to understand the local factors that influence how decisions are made regarding health and wellbeing.

Survey 2 asked questions about experiences of weight management and weight stigma to understand local attitudes and beliefs about weight and health.

The feedback from the survey has helped to inform our services at Doncaster Council moving forward, and more details can be found on our ‘You said, we did’ webpage.

Using the community insight gathered by our public consultation, we have developed a Compassionate New Year communications campaign. We know that the New Year can be a great time to make an impact for our residents, but we also know that it can feel like there is a lot of pressure to change our lives overnight. Resolutions are a journey of wellbeing goals, not just for January. Sometimes, we blame ourselves for giving up on a resolution – but maybe it is the resolution that’s not working! This year, we provided our residents with positive messages, alternative inspiration, and support through our website, social media pages and in-person engagement, and created a set of resources which promote self-compassion when creating resolutions or goals.

What does 2023 look like?

Continuing our journey to change perspectives in 2023, on the back of our Compassionate New Year campaign, we have further public messaging campaigns in the works, as well as developing a toolkit of training and resources to support professionals to implement a Compassionate approach practically!

For World Obesity Day 2023, on the 4th of March we will be keeping the momentum going from our public engagement and releasing tailored comms to start the conversation with our residents about weight stigma. As part of this, we will also be spotlighting the lived experiences of our community, by sharing a case study from a Doncaster resident, about their experience of weight stigma and the Compassionate Approach!

Get Involved

If you are a health and wellbeing professional interested in implementing a more Compassionate approach to weight and challenging weight stigma in your setting, consider joining our Practice Group to learn from colleagues across the country. Get in touch with us by email: compassionate@doncaster.gov.uk

The Nigerian Obesity Cohort Program is a prequalification pathway to SCOPE Certification for interested clinical medical students in Nigeria.

The program involves completing Step 1 (the Core Learning Path of 8 modules), Step 2 (a minimum of 16 additional modules), and subsequently, Step 3 (clinical postings and a case report on obesity management). On successful completion of the SCOPE program and upon qualification as a medical doctor, the students will be awarded a SCOPE Certificate.

The pilot program is happening in the South-south zone of Nigeria and comprises 26 students. Over 90% have completed Steps 1 and 2 and are currently engaged in clinical postings. Registration scholarships were awarded by the World Obesity Federation (WOF) to students who successfully completed Steps 1 and 2. Since beginning Step 3, the students have been actively promoting obesity education and management and have contributed videos for the World Obesity Day celebrations in 2022.

This program was borne out of an initial desire to provide in-depth knowledge and skills in obesity management to resident doctors in Nigeria, irrespective of their area of specialization. The strategy was to leverage the doctor-patient relationship to begin to tackle obesity in a society where it appears to be culturally and socially acceptable. Generally, our patients do not see their overweight or obesity as a disease requiring medical attention; however, the doctor-patient relationship provides an opportunity for the SCOPE certified doctor to counsel and address obesity issues when such patients seek treatment for other conditions.

It was a challenge to promote and generate interest in obesity education among the resident doctors. During the post-implementation stage, we re-evaluated and changed the strategy to involve clinical medical students soon to be qualified as doctors, with the intention of addressing some of the challenges we encountered with the resident doctors.

The program so far has been successful. Moving forward, the plan is that highly motivated, committed, and successful students within this pilot program will be identified and selected as ‘Youth Ambassadors’ to promote obesity education and SCOPE certification in other medical schools in the country. To make the program sustainable, we plan to promote it in the medical institution and enroll subsequent sets of interested medical students.

Watch the student videos here.

Alina has lived with overweight and obesity since adolescence, and for twenty years was not offered appropriate support. Then she found her local patient organisation and became an advocate. Here is her story.

Transcript:

Hello, my name is Alina Constantin. I live in Bordeaux, France, and I have lived with overweight and obesity since my adolescence.

My obesity is linked to metabolic syndrome and insulin resistance.

My pre-obesity became obesity in my twenties, although I tried having a healthy lifestyle, including physical activity and dietary control, as we were advised back then.

I felt alone for more than twenty years, because I had environmental challenges and I did not receive appropriate medical support, since my obesity was considered a choice, more of a moral failure and lack of willpower. This led to internalised stigma, preventing me to seek medical assistance on a long run.

So, today I advocate for lifetime obesity management.

I first found support in a local patient organisation, four years ago. We mainly offer moral support and adapted physical activity for people living with obesity in our region.

I also joined the Ligue Contre l’Obésité, which is a French national obesity organisation, in order to contribute to communication and advocacy programmes.

I am also very proud to be a member of ECPO – which stands for European Coalition for People Living with Obesity – and support collective action throughout Europe.

I can only say, I never feel alone anymore.

The World Obesity Day is the perfect occasion to showcase actions from all advocates and stakeholders addressing the major public health issue that obesity is, as well as stigma for people living with obesity.

France has yet to recognise obesity as a chronic relapsing disease, and therefore, provide the necessary means for research and offer the appropriate treatment for all people concerned. Pre-obesity and obesity concern 45% of the French population.

I hope people feel empowered to live their best life with obesity and come join the patient organisations all over the world. It is a great place to start and feel connected.

The most important thing I learned from experience was that I had to act in order to contribute to change mentalities that took a toll on me in the past.

Like this year’s slogan says, “Everybody needs to act.”

Thank you for watching this video. Bye.

By Alina Constantin.

The Ligue Contre l'Obésité is holding the Connected Challenge, showcasing more than 75 local events in France and overseas territories. Find out more on their dedicated website: https://journeemondialecontrelobesite.com.

Dr Ada Cuevas of the Centro Avanzado de Medicina Metabólica y Nutrición (Cammyn) in Chile speaks to Melyna about her experience of living with obesity and facing weight stigma. Watch their interview below (in Spanish).

Transcript (in English)

Dr Cuevas: Hi Melyna

Melyna: Hello dear Ada

Dra. Ada Cuevas: First of all, I want to thank you for agreeing to participate in this important worldwide day; World Obesity Day. We are striving to recognize obesity as a disease and that patients living with obesity are respected.

Melyna: I am very grateful and honored to have been invited. I am pleased to be able to share my personal experience and how I have lived with excess weight, and hopefully this can help other people.

Dr Cuevas: Of course, thank you very much. World Obesity Day is celebrated around the world and the World Obesity Federation is working hard for this day. So, you will be a part of this campaign of the World Obesity Federation!

Dr Cuevas: Tell me Melyna, at what age did you start having problems with being overweight or living with obesity?

Melyna: Since a very early age, and in adolescence I already had a few kilos on me, and after becoming a mother it got out of hand without [my] realizing it. I began to have problems like depression and other emotional problems and that led me to weigh up to 120 kilograms.

Dr Cuevas: What you say is so important, because often people – and unfortunately some healthcare professionals – blame it on the fact that someone "eats a lot" or "is lazy [and] doesn't move". It is good that you have mentioned those other aspects that people do not know as causes of obesity.

Melyna: Many people discriminate against us, thinking that the only thing we like doing is eating and eating. In reality, eating is like a drug, and we are addicted to eating. But there is a reason why we are eating.

Dr Cuevas: Yes, there is a reason…

Melyna: We eat for our sorrows, our joys, happiness, or any emotion that we have, we regulate them with food. When we invite our family, we welcome them with a table full of food. When we are sad at a wake, we also have to have food. So, we eat for the sake of our emotions, and unfortunately, we don't have access to psychologists. Many times, we do not know how to act and that is what makes us gain this weight.

Dr Cuevas: Exactly, deep down it is also important to know that these emotions, for example, sorrow, generate the release of certain hormones in the brain that cause these thoughts of wanting to look for something to calm you down, just as you say, like a drug that calms those emotions of anguish, fear, sorrow, etc. Very clear as you say.

Dr Cuevas:  Do you believe that there is discrimination against people? How this has impacted you in work, emotional aspects, or with your partner?

Melyna: Look, the extra kilos kill you physically, but society kills you before you reach that point, because it closes the doors to work thinking that having excess weight must mean you are stupid, that we cannot understand something or exercise a job or profession just because we have excess weight. That's in the workplace. Now in society, for the bus, you have to pay double tickets; on the bus when you sit down, people don't want to sit next to you. We are everyone's joke, and everyone has to laugh at us. Another example is when a large person enters a room (I prefer to say large person rather than obese or fat), people expect them to turn up in sandals and baggy clothes, and they are shocked when you turn up wearing a short skirt, dressed up with high heels. And why is that? Because “the fat woman” must dress a certain way, according to them. Society begins to shut you off and slowly destroy you. This depression means we end up shut up in our rooms and homes and we don't go out. And this is caused by the way society treats us. We have to be more empathetic, but not in a condescending way where we say, “look at that poor thing”, because being big does not mean being poor, being big is having a big mind too.

Dr Cuevas: Incredible, what a coincidence! You may not know but there is a published study from another country where health professionals doing training in obesity were asked about the characteristics of people living with obesity compared to thin people, and obviously they said that those living with obesity were dumber and lazier. That people living with obesity may be considered stupid caught my attention: one usually hears that they are lazy, but stupid?!

And regarding the double air-ticket that people with obesity were asked to pay some years ago, fortunately that is now prohibited. But clearly, in shared taxis (at least in Chile) the problem persists. In schools, there was also a study in the United States where children were given photos of who they would like their friend to be – a child with an obesity problem or a child with normal weight – and they always chose the child with normal weight to play with and become their best friend. So, it is a problem that comes from childhood.

Melyna: It is something that society tells us; we see the commercials, the television shows, [and] there is always a thin woman, a thin handsome man, those are the models to follow. Today I want to break with that; that's why I give talks with my excess weight – I have my entire community organized and that makes me neither more nor less stupid. It makes me an equal with everyone else.

Dr Cuevas: On the contrary, it makes you very intelligent and innovative. It would be good if you could tell us a little about that important program that you have developed in your community helping people, because curiously and unfortunately in our country, obesity is very prevalent in the most vulnerable areas. People with the lowest incomes are those who have more obesity.

Melyna: In these communities, we do not have access to medicine; it is very scarce. In “Bajos de Mena”, my neighborhood, we are 180,000 inhabitants in three square kilometers. We have two outpatient clinics and in each of them, there are two psychologists. Sometimes psychological care is just limited to receiving some medication for several years. Moreover, the conditions such as diabetes, hypertension and others are treated just with some medications, such as metformin, glibenclamide, or others. But they do not treat the root of the problem, which is obesity. So, what do the doctors do? They give pills for diabetes, but they don't treat me for obesity, which can lead to so many other diseases.

Dr.Cuevas: Of course, obesity leads to hundreds of diseases such as some types of cancer, kidney disease, neurological disease, myocardial infarction, and the list of diseases goes on. So, as you say, we have to fight so that the problem is approached from the root.

Melyna: That’s why we want obesity to be considered as a disease and to be included in "GES" (Chilean public health system) so that we can have access to treatment.

Dr. Cuevas: Fortunately, things are being done worldwide. Big companies are using models that are not the typical underweight female model. We hope that this tendency spreads everywhere and to our country.

Melyna: Many people see this as a war between thin people and large people! But the situation must reflect reality. We would all like to be thin and not burdened with any disease, but this is our reality. We need to have representation of the realities.

Dr Cuevas: Exactly, and we also need for people who have these problems to have access to treatment and for obesity professionals to help them. There are many bad experiences [when] you go to the doctor and he does not give you adequate treatment. I do not know if this has happened to you?

Melyna: It has happened to me many times where they tell me that the solution to obesity is to “shut your mouth". It's easy for them. It is easy to tell an alcoholic to stop drinking, a drug addict to quit drugs. You have to understand that, as I told you at the beginning, we regulate all our emotions with food [and] if it were that easy we would not have this weight. It is not easy to live like this, I have almost two people in my body and my daughter has three people. Look at the discrimination: my daughter wants to adopt and she went through a whole process to adopt a child the last time, but the adoption institution told her that she cannot adopt because "she is obese", and perhaps for that reason she will not be a good mother. You will not love your son because you have obesity? She will not take care of the baby because "she is fat"?

In other words, I'm not going to be able to be a grandmother because I'm overweight? It is this discrimination of society that continues to shut us off. Believe me, that child who is in an institution will not care that his mother has obesity. He wants her to love him, to be taken care of. Even in our desire to become mothers we are discriminated.

Dr Cuevas: Of course, how shocking.

Your experience and that of your daughter is very powerful and well, we hope that this message you are giving, and that this campaign will help us to make a change so that your daughter will never live a bad experience again.

Melyna: And that no one may go through this again. I thank you Ada, because we must make this more public [and] create networks. Many people are locked up in their houses who need a word of encouragement, an image, and to say, "if they can, why can't I?" "Why can't I show myself?" Believe me, we would all like to close our eyes, open them and be thin, [to be] able to pick things up easily, move easily. But today what we invite you to do is close your eyes, open them again and say, “this is who I am, and I love myself as I am”. Go out on the street, walk, begin to get to know each other, talk with others. Often, we do not have easy access to healthcare professionals, but we do have our friends and our neighbours who can support us with our emotions. Thank you very much for this invitation, believe me, it will do a lot of people a lot of good.

Dra. Ada Thank you very much Melyna and congratulations.