"GP surgery & weight stigma"

I lost a fairly significant amount of weight (about 4 stone, roughly 20% of my body weight). I was with an exceptionally good doctor who when I had a BMI of 40 referred me to a dietician who helped me lose weight. Then I moved out into a different area of the country.

When I moved, I was asked if I had "considered losing weight" so told them I had but this was scoffed at- I was still quite overweight despite having lost 4 stone, so the assumption was, I assume, that I must be lying. This happened on a number of occasions until I asked my new GP to get my notes from my old practice and to *read* them. 

I continued to lose weight at this time, and ended up at 12 stone 8 (down from 18 stone) having lost 30% of my body weight. There was a particular interaction with a healthcare professional who, again, with no reference to my weight loss history asked me if I had "considered losing weight". At this point, I became severely demoralised. I also, as a person with a history of mental health issues, increased my efforts and engaged in some very unhealthy weight management related behaviours. I was eating 1200 calories a day, and doing the 5/2 diet on top of that so 500 calories for 2 days of the week, 1200 calories the other 5 days. I was doing 4 days a week of high-intensity interval training. I never ate any food high in fat, salt or sugar- no junk food, no fast food, crisps, chocolate, etc. 

This was already quite extensive and probably quite unhealthy- the comments from this HCP meant that I increased to doing 500 calories a day for 3 days a week. 

Despite increased efforts- my weight plateaued (probably due to the additional stress). My anxiety shot through the roof, and I began to disassociate in response to the anxiety (as someone with a borderline personality disorder diagnosis). My mental health was spiralling out of control and I began to experience a form of disassociation called "depersonalisation". This was an incredibly frightening experience.

I knew I had to stop so I went back to a slightly reformed version of my older diet (not as unhealthy as it had been- but I stopped all dieting activity). I also stopped going to the gym. My mental health continued to be poor- however the disassociation stopped. I regained some weight at the time, however, I never returned my previous weight of 18 stone. 

Following on from this I continued to be asked about weight loss (this time with it being noted how much I had already lost)- but was not willing to engage due to the deterioration in my mental health from weight loss efforts. Still, at my GP surgery, my mental health concerns were repeatedly dismissed. As someone with BPD which has symptoms of paranoia- it began very much to feel as though HCPs thought I was lying when I discussed my mental health issues related to weight loss. As someone now in recovery, I think this may have been paranoia that was BPD related and psychiatric in nature. However, none of my mental health concerns were addressed and that I should lose weight continued to be something that doctors discussed with me- regardless of the fact that I did not consent to these discussions and repeatedly asked for it not to be discussed as I was worried about triggering the disordered eating patterns that had made me so unwell. 

This all finally came to a head, when I became hostile (again I think this was a symptom of untreated BPD) due to believing doctors thought I was lying to them and also their refusal to make any note of my informed dissent to these discussions (or, alternatively, that such discussions were not clinically suitable- either outcome would have been fine with me). I threatened to take my GP surgery to the PHSO - and finally, they noted my informed dissent on this topic and began to take my mental health issues seriously. 

I just want to add, additionally, that I was never once offered a referral to a weight-loss service during any of the above that I have described. I even, on multiple occasions, asked to be referred to a dietician again as I was when I started my weight-loss journey. I recognise that due to a reduced BMI, I may not have fit the criteria for a dietician any more, and definitely wouldn't have been referred to a Tier-3 service. However, having surveyed the information of the CCG for my area, there were multiple options of local pathways where I could have been referred for further support but none of these were offered. I do recognise that is is, of course, possible they were full. It is also possible that I wasn't referred because HCPs were viewing weight management as an issue solely of personal responsibility. It is additionally possible that they weren't fully aware of the local pathways.

I do not think it should have taken me to raise the threat of the PHSO to get my doctors to listen but I believe multiple forces were at play here:

- bpd stigma

- weight stigma

- a lack of knowledge over local referral pathways

- a lack of competence over what to suggest for more serious mental health symptoms like disassociation

- a lack of knowledge about what helps with borderline personality disorder