I’ve thought deeply about this. For me I started to gain weight as a junior doctor working 100 hour weeks often on night shifts, that plus stress of the job probably wrecked my metabolism. I was exhausted all the time and had to be alert for the job so felt I needed the sugar rush to stay awake/alert on duty. I also had little opportunity to exercise due to long working hours, also the hospitals had zero healthy options in canteens and we were a captive audience (I even lived on site at one point).
I had started to lose the weight again after the European working time directive reduced the punishing working hours, and I deliberately tried to eat more healthily and started biking to work instead of taking public transport (I was only able to do this because I was working on a neonatal unit which had some shower rooms for staff at the time for infection control reasons, it remains rare, otherwise I would have been sweaty and smelly and looked unprofessional all day).
Then I got pregnant (before I’d lost as much weight as I’d have liked, I had assumed it wouldn’t happen the first month of trying…) I felt like absolute shit all through my pregnancy, in retrospect that’s probably when I developed my underactive thyroid but at the time I thought it was normal to feel that exhausted in pregnancy especially as I was still working full time, commuting, doing night shifts and evening shifts etc. Again in retrospect maybe I should have taken time off work or started my mat leave early as I just felt so awful but taking sick leave especially while pregnant is culturally very frowned upon in the medical profession. So I felt I had to keep pushing through. Eating was the only thing that made me feel marginally better for a short while so I ate a lot, I also found it hard to judge how much weight I was gaining in pregnancy as traditionally I went by whether my jeans fitted etc and of course they didn’t anyway due to pregnancy. But I had gained too much weight. Though I was surprised after I had the baby that it wasn’t as much as I’d actually thought.
Initially while breastfeeding the weight dropped off me fast but I then got puerperal psychosis and ended up sectioned and put on olanzapine. I went from a size 12-14 to a size 20 within literally weeks, and I was so out of it at the time I didn’t even realise. Didn’t even work, they had to stop it and put me on lithium. It was only later when I’d recovered enough to understand reality again that I was like “what the hell happened to my body?!”. At the time I was manic and psychotic and genuinely saw myself as super slim and attractive in the mirror. It was like it happened overnight to me. I was very depressed about it and because I was sectioned I had no control over the unhealthy food I was again being offered as a captive audience and had no opportunity to exercise. There was a swimming pool where I was sectioned in a mother and baby unit by that point, but I had to beg for permission to use it and for a staff member to look after my baby while I went so it didn’t happen that often. It only happened at all because I put in a formal complaint about the food and exercise opportunities for someone like me who was gaining significant weight under their care while deprived of my liberty under section and not able to make free choices.
I was only really able to try and lose weight when I got out of the hospital, but it was difficult while still on lithium which made me sluggish and I ended up getting very depressed to the point of being suicidal and my psychiatrist asked me to forget the focus on my weight for now as being on a diet was clearly making things worse, and focus more on my mental health. He said there would be time to lose weight later…
Almost 20 years later and I haven’t managed it. I genuinely think it’s so much harder to lose weight once it’s gone on than prevent it going on in the first place. It affects your hormones, appetite, everything. I’ve had a constant series of major adverse life events and stress since then including domestic abuse, divorce, child custody battle, child abduction, sudden death of a sibling, and let’s not forget two economic crashes and a pandemic in the background, all while trying to do a stressful job as an NHS doctor. I also developed an underactive thyroid at some point which I believe went unrecognised and untreated for years. I was going to Slimming World and eating less than everyone else around me, while gaining 4 pounds every week, it was soul destroying and really broke a previous link for me between being able to restrict my food to lose weight and know that that would work.
After my thyroid was treated I did really well for about 9 months when I moved from one soul destroying NHS job to another, in the “honeymoon period” at the beginning of a new job where they’re glad to have recruited you and are careful not to overload you with work in case you leave again, and you can actually stick to the work hours you have on paper. I started eating more healthily with home cooked food and less prepared food, and went swimming very regularly. Got down to a size 16. Then they started overloading me and my sibling died, then the pandemic happened and I couldn’t go swimming regularly anymore and I was very stressed and again turned to comfort eating. So gained again.
Now I have gallstones which is again making it hard to eat healthily, and the pandemic and neglect of the NHS for the past 10 years plus patient abuse is still making the job super stressful. I’m now a size 22 and don’t know that I’ll ever manage to lose weight now. I want to but I am basically pretty burned out from both home and work stress at this point and feel I need to find a way to resolve that first before I can get anywhere, while still earning money as a single parent to support us in the basic living essentials of life. I’d like to try the weight loss injections but they’re too expensive, hard to physically get these days, and I’m a bit scared of potential side effects especially with my gallbladder problems. Argh!! These days I am trying hard to go with the body positivity or at least body neutrality movement, accept myself as I am and try to look as good as I can while this size, while also trying to eat healthily and exercise more whether that results in weight loss or not.
In conclusion, olanzapine has a hell of a lot to answer for in my case, along with pregnancy, work stress, bereavement, domestic abuse and all of the fallout from it. And my tendency to turn to comfort eating to deal with stress (I often wonder if I was a smoker instead I’d be slim, or just fat with a smoking habit also!) But I also blame a background of coming of age in the very fat phobic 90s and childhood of 70s-80s poor dietary advice. And a background U.K. culture of long working hours and tendency to squeeze as much out of employees without giving anything, without adequate provision for exercise and showering facilities and healthy food options at work, and a focus on the car pushing out lots of bike lanes on the road, creating “food deserts” etc. We definitely live in an obesogenic environment so although I accept some degree of personal responsibility I also think my personal challenges in life and the wider U.K. policies and accepted culture (including ongoing “fat phobia”) makes it very difficult to remain slim. The cards most definitely feel stacked against me. But I haven’t totally given up yet.
OK this turned into a bit of an essay lol which nobody may actually be interested in reading but it still feels good to get that off my chest!