I’m a doctor, and I’m obese (BMI above 40). I work in a stressful job where getting a break isn’t guaranteed, so when I get one I eat more than I probably should as I don’t know when I’ll next get to stop.
I haven’t always been this weight. I’ve lost and gained the entirety of my body weight more times than I can remember. I started using food as a primary school child to help deal with an difficult childhood and dysfunctional parents. Then, as an adult, when I was a normal weight I was sexually assaulted and piled the weight on. After almost a decade I lost weight, and was sexually assaulted by someone else. Guess what? I put even more weight on.
For me, being thin feels unsafe. For much of my life I’ve just had to carry on functioning by squashing my feelings down through using food. I don’t drink often, I don’t smoke, I take regular exercise and do a job that involves being on my feet most of the day. Food is pretty much my only vice.
At the moment, due to (non-BMI related) health conditions I am not able to do my usual job. I now have more time so can eat healthier and have lost some weight. My BMI is now just above 40 and slowly continues to fall.
I’m fully aware of the health impacts of severe obesity, but the over-simplistic “eat less, move more” approach entirely overlooks the psychological and social determinants of obesity, as well as some other biological factors. I have an eating disorder, but it’s never been recognised as one. I haven’t received psychological support in the same way someone with anorexia or bulimia would, and I’m aware that diets etc won’t fix the underlying problem.
Obesity is a multifactorial problem. There is no simplistic answer to solve it across our society. For some, it’s a case of needing education, some need drugs or surgery, some need psychological support, and some need lifting out of poverty.
The data from ICNARC quoted in much of the press seems to show obese people (even those with BMI above 40) are no more likely to be critically ill than any other group, just that there are more of them as a proportion of the population than people with lower BMIs. It’s also not yet possible to disaggregate BMI from other underlying health conditions when looking at COVID mortality figures.