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SoWhoCaresAnyWay E26 Scales Are For Fish · SoWhoCaresAnyway

• 0:04
  Hi, I'm Ruth Germaine, and this is, so Who Cares? Anyway, a podcast shaped by my deep curiosity about who cares, what do they care about, what do they do, and why does it matter? My aspiration is to build a community that listens with intention.
• 0:20
  And explores care from every angle from the North Yorkshire malls to behind clinical doors.
• 0:27
  Each episode invites people to share their stories, their ideas, and talk about what matters to them.
• 0:34
  Together we reimagine what care could be and how we might shape health and wellbeing through the assets, values, and the lived wisdom of our communities.
• 0:44
  And why does it matter? Because for too long, health and care have been treated as things to be delivered, often depleting systems and the people around them, and it's time to rewrite the narrative to center everyone as a contributor, not just a recipient, to offer joy, hope, and meaningful belonging to invite each of us to shape the future of health and wellbeing with courage.
• 1:09
  With creativity and with care, so who cares? Anyway, to find out more about me, head over to my link Tree Dook four, reflective Ruth.
• 1:19
  Here you'll find links to my website, my LinkedIn profile, and in the future, my Facebook page, and there's the option to support this show by buying me a coffee.
• 1:29
  So now for another episode of So Who Cares? Anyway.
• 1:35
  Hello and welcome to the next episode of See Who Cares.
• 1:38
  Anyway, and I'm delighted to be joined by Helen James.
• 1:41
  Now Helen, um, I, we first met when we were at a do with event with Adam Lent at the Kings Fund.
• 1:48
  Um, and for those of you that have listened to that episode, uh, understand a bit more of what that's about.
• 1:52
  I expect some of it'll come out today.
• 1:54
  But Helen, I was just really interested.
• 1:56
  She's a CEO for New Cherry, which, um, I believe that Helen set up about 10 years ago, if I'm correct.
• 2:03
  And I'm gonna pass over to you, Helen, before I say anymore, um, and take away your introduction and just ask you if you'd introduce yourself and give a little bit more insight about URI before we carry on please.
• 2:14
  Thanks a lot, Ruth.
• 2:15
  I'm really pleased to be here to get to talk about do with and um, a bit more about uri.
• 2:21
  Um, the word nuri means to nurture.
• 2:24
  Um, and as you said, I set it up around about 10 years ago after.
• 2:30
  Really being a lifelong customer of diet, culture and slimming clubs.
• 2:35
  Um, and.
• 2:38
  Vastly changing my weight too many times and I thought I could do something a bit better.
• 2:43
  So started talking to other people about this idea.
• 2:48
  Um, and then talking to workforce as well, whose job it is to deliver on, uh, weight management.
• 2:55
  Um, and yeah, so over 10 years we've been developing what we do with them for.
• 3:01
  Um, workforce and citizens.
• 3:03
  I'm pleased to be here.
• 3:05
  Thank you.
• 3:05
  And you've given a little bit of your background into why you set this up and talking about that culture and slimming clubs.
• 3:12
  And I'm gonna say here that I had no idea that New Cherry was about to nurture.
• 3:17
  I had made this assumption in my head.
• 3:20
  That it was about the fact of nutrition or something, because I remember you talking about the fact of that this came from, that stigma and um, was around that sort of, that slimming and everything that you had gone through.
• 3:32
  So I wonder if you wanna just give us a little bit more before we go into New Cherry and talking about stigma, a little bit more about your drive.
• 3:38
  You've, you've spoken about it briefly there.
• 3:41
  Um, but your driver, before we start talking about that workforce, but also that.
• 3:45
  Approach that you've taken as well? Place.
• 3:48
  So when I first started, um, exploring what we could do better, um, in sort of like that landscape of, um, weekly meetup groups, um, I really didn't know a lot about weight stigma.
• 4:02
  Uh, um, I didn't know it was a thing.
• 4:03
  I didn't know its impact on health and everything.
• 4:06
  So it was just a case of, oh, let's try and do something a bit better than what's currently out there.
• 4:11
  And that's what we did.
• 4:12
  Uh, and then it is over time that we've really learned about the health implications of all stigma.
• 4:19
  Um, but specifically weight stigma.
• 4:22
  Um, and how that is prevalent, not just in slimming clubs obviously, but in, in our family conversations in society, uh, and especially in healthcare settings.
• 4:33
  So, yeah, it, it's been a massive learning journey, um, and.
• 4:39
  Yeah, it, it's, it, it with, with with many twists and turns along the way.
• 4:45
  Thank you.
• 4:46
  So I'm really quite, um, quite intrigued now.
• 4:48
  So do I think probably let's have a little bit about what it is that you are actually doing.
• 4:53
  'cause you talked about that workforce and then you talked about that.
• 4:56
  Approach that you take, which I think fits with the do with approach.
• 4:59
  So I think probably the first place for us to explore is understand what it is that you are actually doing, and then we can start to delve into all of those implications and those different things that you're talking about.
• 5:09
  Please.
• 5:10
  Yeah.
• 5:10
  Thanks Ruth.
• 5:11
  And I'll try and, um, sort of like give it in human terms so I know things can get quite jargony and there can be lots of acronyms around.
• 5:18
  So I'll, I'll try and keep that to a minimum.
• 5:21
  Um.
• 5:23
  And yeah, so we first started off by listening, um, and listening to what other people's issues were.
• 5:31
  'cause I had my sort of like, set of understanding around, you know, why I was using, um, slimming clubs and, and you know, what I was and wasn't getting from that.
• 5:42
  Um, but I needed to hear many other people's, um, points of view, uh, and that.
• 5:49
  Led to us creating something that we call the Food and Body Ease community.
• 5:54
  Um, and we have a focus on intuitive eating and finding movement that we enjoy and, and want to do again.
• 6:06
  Um, so, but mostly it's about stepping away from weight surveillance and, and doing things to create, um.
• 6:18
  Uh, calorie deficits and stuff.
• 6:20
  So, um, and how to step away from that sort of like harmful narrative of that lighter, being lighter is always healthier and being heavier is always unhealthy.
• 6:31
  So yeah, it's, it's, so we did the citizen work.
• 6:34
  What, what we now call the citizen work is, is Food and Body Ease community.
• 6:39
  Um, and that's what, that's what came first with Nuri.
• 6:42
  Um, and then later on we realized.
• 6:45
  After doing some piloting that we needed to concentrate on the conversations that were happening in in, um, healthcare settings.
• 6:54
  Okay, so you, so you listened, which is typical do with, isn't it? And then you talked about that pilot piloting before you concentrated on the conversations, and obviously you took that sort of healthcare, uh, which sounds understandable.
• 7:07
  What, what were the pilots and what were they about? What did you do? Yeah, so we created this sort of course platform.
• 7:14
  So, um, and there was content on there for finding more ease around food.
• 7:21
  So stepping away from diet culture, um, exploring intuitive eating.
• 7:27
  Uh, interestingly, uh, we used to call it mindful eating, but people would say, oh, I can't be mindful.
• 7:33
  Um, and then we all, we tend to use the, the terminology really interchangeably.
• 7:39
  So whether we call it mindful eating.
• 7:42
  Conscious eating or intuitive eating.
• 7:44
  It's just, you know, how do we step away from that sort of quite disordered behavior that we can develop around diet, culture and food behaviors.
• 7:53
  Um.
• 7:54
  I'm just trying to get myself back on track to answer your question now, which is, um, yeah, creating that course platform and the piloting work, it, it was a way to sort of like, see were we getting the best fit? Were we doing what we need to do instead of doing diet culture? Um, and then that then led us onto the workforce stuff.
• 8:18
  So, um, it was, it's one thing, you know, creating a service.
• 8:23
  That helps the individual out.
• 8:26
  But if the next time they go into their doctor's appointment to talk about their sore shoulder, for instance, and they only have their weight talked about, it's sort of like undo, undo or undo all that work.
• 8:39
  So yeah, we, we, we repeated that cycle of listening to citizens and, and, and listened to the workforce.
• 8:48
  As well to say, right, how does it feel to deliver on weight management and then listened again.
• 8:54
  And that's really interesting because obviously coming from the NHS, I know that there's this thing about every contact counts, which means when somebody comes to see you, you've got tick as many boxes as you can, you know, stop smoking, stop drinking, or.
• 9:07
  Down.
• 9:08
  You think about your weight and all these different things that constantly somebody's come coming to see you and suddenly all these other things matter.
• 9:15
  Um, almost to the point that especially in general practice where there's, um, cough points, which are sort of these quality points that people do, and you almost got to be able to tick them and say you've done them once a year and even if you've done it within the last six months, all of a sudden you.
• 9:29
  You are asking it again because it's coming into the, you know, you're into the next cough point season, it's gone April, you're doing it and then suddenly you're doing it all the time.
• 9:36
  And so, yeah, I always used to think, you know, this must be so disheartening.
• 9:41
  Um, so I'd rather get in trouble for not asking them than asking constantly.
• 9:44
  'cause, 'cause what was I gonna do with that afterwards? And that person, you know, was leaving.
• 9:48
  So that's, it is a really interesting, um.
• 9:52
  Listed and hearing you talk about that, you know, one thing for you to talk to the individual, but how does that work with workforce? So should we move on to that workforce bit and talk about what it is that you're doing in that space? That'd be really interesting.
• 10:04
  Yeah, absolutely.
• 10:05
  And you're right.
• 10:06
  It, it, um, what we heard a lot of the time was it's rubbish to try and deliver on weight management, you know, to deliver those KPIs, those outcome measures of, uh, you know, changing somebody's BMI, um.
• 10:19
  We heard very early on that some, some service providers, you know.
• 10:26
  Healthcare practitioners, their job role includes talking about weight.
• 10:29
  Were feeding back to us that it felt really off.
• 10:33
  You know, that it, some people felt hypocritical.
• 10:37
  Let's say for example, they might be higher weight themselves and were being asked to.
• 10:42
  Produce outcomes of weight change in people that were sometimes lower weight than them even.
• 10:48
  So it felt quite hypocritical.
• 10:50
  And you mentioned there, Ruth making every contact count, you know, and we're, we are very keen to make every contact weight neutral.
• 10:59
  Um, and rebranding.
• 11:02
  There's a, there's a definite rebranding needed from weight management to health management.
• 11:08
  Um, and there's fantastic work that happens up and down the country, um, that's just under the wrong name.
• 11:15
  You know, it's under the banner of weight management.
• 11:17
  But really there's fantastic work going on with supporting people's nutrition, supporting people's mobility and movement.
• 11:26
  Um, perhaps it's smoking cessation work, uh, or, you know, alcohol reduction.
• 11:31
  Um, and, and it's all done under the, the, the name of weight management, which is a real shame.
• 11:37
  On, you know, those that are working hard in the system, trying to deliver on current policy, um, but feeling the, the, um, disconnect in it all.
• 11:48
  So what were the outcomes of that? Because you've spoken quite clearly here about the conversations with, with those individuals.
• 11:55
  The conversations with staff and talk about how the staff were feeling and Yeah, exactly.
• 12:00
  Feeling hypocritical.
• 12:01
  I can remember conversations with friends or feeling things like that myself when I was asking people to perhaps do things differently than I, I was perhaps knowing I was doing myself.
• 12:10
  Um.
• 12:11
  And yeah, just feeling a bit off and, and knowing sometimes I think one of the things, and I often talk about this 'cause I used to run some diabetes clinics.
• 12:17
  People would come in and I'd be talking about what they needed to do.
• 12:21
  And actually I knew that what they really needed was some mental health support or something around that area, or maybe just some social support, you know, just to, not so much that they needed help in the home, but they just needed some friends, perhaps they didn't have any family, things like that.
• 12:35
  So they needed those things.
• 12:36
  So what happened next? Or what are you doing now? What's going on? Yeah, so.
• 12:41
  The whole work piece, if you like, the whole mission is to help workforce feel confident in being able to de-stigmatize services.
• 12:53
  You know, so we have quite a simplistic view that if we just remove the B-M-I-K-P-I, so stop trying to deliver on, um, solving obesity, um, then we can all be freed up.
• 13:11
  To actually work on people's long-term conditions care.
• 13:15
  Um, diabetes management you mentioned there, Ruth.
• 13:18
  Um, and the truth is that because we have this weight reduction rhetoric.
• 13:24
  Built through all of our, um, support systems at the moment, it really is disengaging.
• 13:32
  Um, and I dunno whether you know this, but only one in 10 people engage with their structured education piece around diabetes and about in some areas of the country, only one in 10 people take up their NHS health checks and then really damning to the money that we spend on weight management.
• 13:54
  Under that banner, the work that goes on under that banner in tier two, in 21, 22, uh, we spent 30 million pounds and just over a thousand people registered a 5% weight loss for 30 million pounds.
• 14:09
  So, you know, and that's just one year on one tier of weight management services.
• 14:15
  Um, and that's the tip of the iceberg.
• 14:17
  So how much money we're spending on trying to solve obesity.
• 14:21
  Um, so yeah, I'm really pleased to be here, Ruth, to sort of like unpack some of the impact, the negative impact of that.
• 14:28
  Yeah, and that'll be really interesting to hear Helen, because, you know, listening to that.
• 14:33
  As a, as a member of staff, knowing how I co comfortable I felt and listening to this stigma and thinking actually that it's not really even doing much from the figures you are giving me.
• 14:44
  And it doesn't surprise me.
• 14:45
  You know, I know that some of the, the clinics I would just felt like I was, you know, am repeat and repeat and you might get through to, and that sounds awful, doesn't it? Listen to that word after said, might get through.
• 14:56
  Somebody might come in.
• 14:58
  And think, oh, okay, yeah, Ruth saying something that I can buy into there and I can do that.
• 15:03
  You know, I'm really terrible about saying that now.
• 15:05
  Mm.
• 15:06
  But, um, other people will literally going home and thinking to themselves, well, Ruth saying to do this, it's not, it's not gonna work because I've got this family pressure.
• 15:14
  I've got that going on, or whatever else it is.
• 15:17
  So yeah, I can really, yeah, really get what you're saying.
• 15:20
  So I'd really sort of like to unpack some of that stuff around that stigma.
• 15:23
  And I don't wanna say more.
• 15:24
  'cause I think if I ask you too detailed, then I'm gonna take you down a trail.
• 15:28
  I.
• 15:28
  Wanna hear more about it.
• 15:30
  Thanks, Ruth.
• 15:30
  Um, so yeah, I mean, the impact of Sigma we're set, we're setting people up to fail again, aren't we? As, as for as long as we keep that target of weight change.
• 15:41
  You know, whatever the support service is, whatever their health condition is.
• 15:45
  You know, there could be somebody that has multiple long-term conditions.
• 15:48
  There could be somebody that has none and they're metabolically healthy.
• 15:52
  Um, but if we start insisting or keep insisting not start, if we keep insisting on weight change for health, then we keep setting people up to fail, you know, in, in real, in real simple terms.
• 16:04
  And, and that is.
• 16:06
  You know, when people first come into the surgery with a health condition, or it might mean that they don't actually interact at all.
• 16:16
  It might mean that they delay until crisis and end up costing the NHS more.
• 16:23
  You know, that sort of like internalization of stigma, um, is, is already there.
• 16:29
  It's already in place before they're interacting with the health system.
• 16:32
  And that's why we need, you know.
• 16:35
  To get really serious about this and, and recognize that it is the, is the health system's role to lead on this and not prop up diet culture.
• 16:47
  Um, and yeah, I'll probably come on later more about GLP ones and stuff and, and what we need to be doing around those.
• 16:55
  But that stigma piece is, is urgent.
• 16:59
  You know, uh, we all need to learn how to de-stigmatize any situation that we find ourselves in, in work because.
• 17:07
  We need to do that so that people reengage and rebuild trust, um, you know, in healthcare settings.
• 17:13
  That's fascinating.
• 17:15
  And yeah, the stigma part, I'd not thought about this before actually, that people are just gonna not turn up.
• 17:21
  They're not gonna come along.
• 17:22
  There is this stigma and the stigma starts and I am thinking, you know, in my mind, I'm not gonna go into the detail, but I do remember somebody who used to come along to the practice and the stigma they felt from the other people in the waiting room for the moment.
• 17:35
  They walked through the door from the moment they checked and then checked in at reception to then come into the room, and of course, the whole focus was on something that actually they had spent their whole life.
• 17:48
  Trying to deal with and to manage and, and having that stigma probably before they even got to the practice coming up the street, you know, getting in a cab or whatever it was they were doing, that stigma was right through society.
• 18:02
  But actually what we're doing is we are waiting for that crisis point.
• 18:06
  And I'm aware of somebody else who got to that crisis point, and actually it didn't, it didn't bode well and didn't go well for them.
• 18:13
  And you're right, Ruth, it's in the built environment.
• 18:16
  I mean, I know a visit up to my own.
• 18:18
  GP surgery, and I've mentioned it to them on a couple of occasions, that they need to have chairs without arms.
• 18:26
  You know, they have, and, and at one point they had one chair without arms, like in the naughty corner, and I made a joke.
• 18:32
  I was like, look, thanks for the chair in their arms.
• 18:34
  But you have stuck it out on its own in the naughty corner, you know, can't we just have one of the rows with no arms? You know? So I'm making fun of it because I think, you know, that's what I've learned to do is to deflect.
• 18:48
  The real tragedy of how we're currently working, you've got to use humor, and that's what I do a lot of is, you know.
• 18:55
  Uh, because when you speak to any healthcare worker, when I, when I share what I'm doing with them, they're like, really? That's fascinating and we need it here.
• 19:05
  That's the next breath.
• 19:06
  We need you here.
• 19:07
  We need you to come in and train our staff.
• 19:09
  We need to know this, you know? Um.
• 19:12
  Yeah, so, no, it's fine.
• 19:14
  This is the thought of that chair in the naughty corner, but you're right.
• 19:17
  You know, I think a lot of people will actually be saying the same thing.
• 19:21
  We need to know this.
• 19:22
  And I know that you've done, um, a podcast before, haven't you, with the RCN to really.
• 19:27
  You know, going through the, sort of the practicalities of what this looks like, um, which we can touch on.
• 19:33
  It might be worth you just touching on briefly.
• 19:34
  I don't wanna be the podcast sort of teaching people all about what to do, but it might be interesting to listeners to sort of think about that and then we can move on.
• 19:42
  Carry on from there.
• 19:43
  Well, you echoed it yourself, you know, is it.
• 19:46
  That sort of like comprehension that someone's already had an internal battle for however long to even get into the consultation room, you know, to, to come again and ask for support with a health condition that's perhaps previously been dismissed as, uh, 'cause somebody's higher weight and that their own, their, their one fix is to change their weight and everything will be better.
• 20:12
  You know, so that's, you mentioned it earlier, Ruth, that, that just, that bare understanding that this person is already potentially internalizing and stigma for years.
• 20:25
  Um, and that e everybody at any size needs to have equitable access to, you know, whatever they need access to.
• 20:34
  So I can hear people saying, what does that look like? When somebody comes to see me and I'm doing diabetes and or doing diabetes, I, you know, doing diabetic clinics, diabetes reviews, whatever, or, or whatever else it is.
• 20:48
  Somebody's come with the pain in their shoulder and actually, or their knee, and people are saying, well, actually, you do need to lose weight for surgery or whatever else.
• 20:55
  What, what does that look like when I'm, let's put me in a situation when I'm supporting somebody and my first thing in my head is for.
• 21:06
  Maybe they need to lose weight, because that's what I'm used to and that's what I've been taught.
• 21:10
  What does that look and feel like? I think there's a balancing out of, um, parity of, uh, you know, how, how you, would you give the same advice to somebody that has, you know, is straight size, has lower weight, you know, um, question the longstanding.
• 21:30
  Rhetoric of they need to lose weight to do this.
• 21:34
  I mean, we have barriers to, to care and we have barriers to treatment that are BMI based and they, they need to be reevaluated and questioned.
• 21:45
  You know, we say that people can't have surgery until they.
• 21:48
  You know, lose weight and that's, that's problematic in and of itself.
• 21:53
  You know, because they're not excluded from bariatric surgery.
• 21:57
  Why are they excluded to a knee operation that would get them more mobile? Yeah, I was thinking that as you were saying it, you know.
• 22:02
  Exactly.
• 22:03
  I didn't think about the bariatric surgery, but actually if we're excluding people, but I know that when I'm referring somebody on or when in the past when I was referring somebody on that, that would be the conversation that was had.
• 22:13
  So.
• 22:14
  Yeah, it's a really important thing, isn't it, to think about and if you, I hadn't thought about, you know, with, yeah, you can go for bariatric surgery, you can't have your knee made better, which might help you to mobilize a bit better and et cetera, et cetera.
• 22:26
  Yeah.
• 22:28
  It really questions.
• 22:29
  It doesn't it? It does, it does.
• 22:30
  I mean, let's take a scenario where you've got an individual going into their gp, their next health check appointment, let's say they do sign up for their.
• 22:38
  NHS Health Check, and they're there and they're having their, you know, checks done.
• 22:43
  Um, and they say, right, please, can you help me to lose X amount of weight? I've been trying to lose weight.
• 22:49
  Please, can you help me? So there you go.
• 22:51
  In front of you, you know, you've got a really active and engaged, um, citizen in front of you.
• 22:58
  You know, what's the next best thing you can do to keep them engaged and, and, and through a weight neutral lens, it's about letting them know that actually surveilling weight is, is problematic.
• 23:09
  And if they, if they want to measure something, then.
• 23:12
  Not only will you measure their clinical markers for whatever health conditions they present with, um, but you'll also help them measure balancing their nutrition, getting more active, stopping smoking, and reducing their alcohol.
• 23:25
  'cause those are the four behaviors, the beneficial behaviors that bring health.
• 23:30
  Um, it's yet to be proven that it's weight change itself that brings the health, it's the behaviors that we do in order to change our weight.
• 23:40
  That bring the improved health outcomes.
• 23:44
  Yeah, I, well, you are right.
• 23:45
  You don't listen to that and it makes so much sense.
• 23:47
  And I know it's a little bit different, but one of the things, and I dunno if you would've, if you've, uh, listened to Dr.
• 23:53
  Mark Spencer's, um.
• 23:54
  Podcast, but he was talking about his do with approach that he's taken, um, up in Fleetwood.
• 24:00
  And one of the things he spoke about, one of the early things they'd done was a choir and there was a lady that came along and she had lots of health issues, including her weight and.
• 24:11
  He said to her, what would you like to join the choir? What would you like to do? You know, he didn't focus on any of those, any of that prevention stuff or that cough, you know, meeting target stuff.
• 24:21
  He just said, you know, what would you like to do? And there was various things.
• 24:25
  And one of the things was the choir.
• 24:26
  And she joined the choir and he said, then slowly she noticed after about six months that she was losing weight.
• 24:33
  That she was living better and healthier and she was more active and doing all these other things because actually her issue hadn't been around that it had best been around the social side of life.
• 24:45
  You know, she hadn't got that interaction.
• 24:47
  She didn't have those people, and suddenly where she felt needed, and she really took a key part within that choir.
• 24:52
  She was needy, she was doing things, and suddenly everything else just started to fall into place.
• 24:57
  He said, I didn't need to say to her.
• 24:58
  Lose weight, you said? I don't have those conversations.
• 25:00
  I don't say stop drinking.
• 25:01
  I don't say lose weight.
• 25:02
  I don't say stop smoking because you're taking away from somebody, something that they're doing to fill a space.
• 25:09
  What I do is I give them other things to fill those spaces and then just imagine how much better that whole process can become if we remove the, and then they lost weight.
• 25:18
  'cause that's an expectation.
• 25:20
  You know, we've, we've got a compassionate approach.
• 25:23
  It's well researched, you know, the evidence for working weight neutrally is, is decades old now.
• 25:30
  Um, but if, if we make it a compassionate approach to weight, the expectation is that weight change is expected.
• 25:38
  And if the individual is asking for that or not, the fact that it's still there in the picture is the problem, you know, because, and, and, and I can be very clear about this.
• 25:50
  Because weight change is a temporary fix to a chronic problem.
• 25:55
  And the chronic problem, when we say weight issue, it's not a weight issue.
• 25:59
  It it, it's a behavior issue.
• 26:01
  You know, sustaining beneficial behaviors is the issue, you know, so we need to bring in practices that encourage, you know, if say somebody takes up walking and they produce weight loss through that, which is, which is.
• 26:16
  Yeah, in and of itself, highly unlikely, but it's the fact that the body and the metabolism works doubly hard to regain, to re, to re restore that weight.
• 26:27
  Um, and it's, well, research, research weight restoration is a, is a massive thing.
• 26:32
  You know, weight regain happens in 95% of cases.
• 26:35
  So, you know, we come back to that question is why are we still focusing on weight as a health metric? I'm trying not to sound too on me high horse because it's a hard thing to hear if you've been focused on delivering weight change, feel.
• 26:48
  Yeah, it is.
• 26:49
  And that question there, you know, yeah.
• 26:51
  They went off and they happen to lose weight.
• 26:54
  You know, why are we measuring their weight in the first place? Why aren't we measuring.
• 26:59
  The other things that you mentioned earlier on.
• 27:01
  So yeah, there's a huge amount to that.
• 27:03
  I think the hardest sort of like obstacle for us at the moment is around getting people's thinking out of a dichotomy.
• 27:11
  So it's like, oh, if you're not monitoring weight.
• 27:14
  That means that it's okay for people to be gaining weight.
• 27:17
  And I'm like, no, who's saying that? And if you, if you're not monitoring weight, you are saying that weight doesn't have an impact on people's health.
• 27:23
  No, we're not saying that either.
• 27:25
  Do, I mean, weight very much does have impact on health, but produce, trying to produce weight loss and sustaining weight loss is having, you know, more harmful impacts than the weight itself in many cases.
• 27:40
  So.
• 27:41
  And we've got to allow for that fluctuation of weight through any, you know, behavior change.
• 27:50
  Um, and so making the, the target something other than weight.
• 27:55
  So if they are diabetic, you know, blood sugars is an obvious thing to measure.
• 28:01
  You know, if they have, you know, they're, if they're cardiovascular disease patient, then, you know, measuring lipids and, um.
• 28:09
  Measuring the clinical things rather than the weight measure.
• 28:12
  Health, not weight.
• 28:12
  There's a good tag.
• 28:15
  Yeah.
• 28:15
  Measuring what matters to an individual.
• 28:17
  It might be that they first come in asking for weight management support and that just goes back to that, um, comment earlier.
• 28:24
  Is that okay? That's the opportunity to let the individual know that surveilling their weight is probably the least helpful thing to do.
• 28:32
  Um, and that supporting them in their long-term health, um, and behaviors.
• 28:38
  Sustaining behavior change is, is the better support model.
• 28:42
  Um, but.
• 28:44
  I really wanted the opportunity to clarify around, you know, we support people at Nut Tru who are intentionally changing their weight and those who definitely aren't.
• 28:55
  And what's really important now in this age of um, GLP ones, is that if we are not creating services.
• 29:04
  And support mechanisms for the people that are contraindicated for those medications or choosing not to take them after they've gone through really robust informed consent, which most people haven't.
• 29:17
  Um, if we're not providing services that cater to.
• 29:20
  There need, um, then we're really failing, aren't we? As a system? I think what's happening here, Helen, is I'm being quite challenged in my thinking, uh, because I've spent so much time just thinking actually, you know, I live in a society where we, we think about people's weight, I think about my weight all the time, you know, constantly.
• 29:41
  And that's how we've been brought up to think.
• 29:43
  And then I've gone into a clinical world where we've been told that, you know, weight affects whether or not you can have an operation.
• 29:49
  Everything is about weight.
• 29:51
  Diet, exercise, weight loss constantly.
• 29:54
  And yet we live in a world where there's hundreds of foods around us and suddenly, you know, as you say, these GLP ones have come along, which is the, for people that are listening that perhaps aren't clinical, and I, I'm probably, if I say this wrong, Helen, correct me, this is the injections, isn't it, that people can have in order to lose weight.
• 30:11
  But actually.
• 30:11
  In the long run, if they stop taking them, I think most of the evidence is that the weight will go back on again.
• 30:17
  So how do we make sure that people are doing that in a way that works? And start to think about that.
• 30:23
  And I really like your, your talk there around measuring what matters to people.
• 30:27
  I can imagine sometimes it changes that it's, people were thinking that their weight mattered, but actually later on, because society expects us to think about weight being the bit that matters, that that might change later on as well.
• 30:41
  I don't know.
• 30:42
  I think we can't really, um, be harsh on people's choice to take these medications because it's crappy to live in a world in a higher weight body.
• 30:53
  You know, it's.
• 30:56
  Existing in a fat body is hard work.
• 30:59
  It's constant trauma.
• 31:01
  In fact, we know we do a lot of work around trauma-informed care and trauma-informed systems.
• 31:06
  Weight stigma is perpetual trauma, um, because we don't yet as a system widely understand the health impact.
• 31:15
  I'm not just talking medical, uh, sorry.
• 31:17
  Mental health impacts, physical health impacts of stigma.
• 31:21
  A significant, um, I can badly quote from a research piece of paper, piece of paper from a research paper around not liking yourself triples your risk of diabetes.
• 31:36
  So there's a, there's a study and, and my good friend Dr.
• 31:40
  Angela Meadows speaks about this a lot better than I can.
• 31:43
  Um, but around the impact of, you know, body dissatisfaction, the stress.
• 31:51
  And the allostatic load from literally not liking the body that you are in right now triples your diabetes risk.
• 31:58
  And really interestingly, if you go through an intervention around body acceptance and weight neutral understanding, um, then it normalizes, it balances that risk back down.
• 32:11
  To where it would've been if you'd liked yourself.
• 32:13
  All along, you talked about the impact of stigma and what that causes, and to sort of ask you to talk a bit more about that.
• 32:21
  So one of the, you know, you've just said about that, not liking yourself.
• 32:25
  Yeah.
• 32:25
  That's so interesting, isn't it? Because we have this thing and actually that can increase our.
• 32:30
  Uh, markers for diabetes and other things.
• 32:33
  Is there anything else? That's what I'd like to know.
• 32:34
  Is there anything else with stigma, whether it's about weight or anything else? I dunno whether you've explored it in other areas that, you know, we can really start to think, oh, actually this is why it matters.
• 32:43
  This is why it's important.
• 32:45
  It's got, we've, we've got to always come back to the impact of stigma on physical and mental health and the impact on health engagement.
• 32:53
  Um, so we like to frame weight stigma as a health disparity.
• 32:59
  You know, um, of that, we've, we, uh, back two years ago became NHS Core 20 plus five ambassadors, um, to learn more about, um, health disparities and both the core and wider determinants of health.
• 33:17
  Um, and when you get into all that and it's like, it's really incredible that we think that solving someone's body weight.
• 33:27
  Solves anything other than their body weight.
• 33:31
  It doesn't solve their poverty level, it doesn't solve their access to more nutritious food.
• 33:39
  It doesn't solve their social isolation if they're socially isolated.
• 33:44
  Um, and yeah, I think, I feel like we've got on a bit of a tangent there, but yeah, that, that, that impact of stigma, it, it is so intersectional.
• 33:56
  Because body weight is intersectional to every protected characteristic and every unprotected characteristic.
• 34:04
  Hearing that, I mean, how does it feel to be someone who's been trying to deliver just on weight management all these years? It's quite disabling, isn't it? It's like, yeah, I, I don't know how, how does it feel, Ruth? It makes sense, and as I say, I knew sometimes that people were going home and they were thinking to themselves, well.
• 34:24
  I'm not gonna eat those things because my partner expects me to eat like this.
• 34:29
  They'd say, but I cook for a family, or My husband likes these food, or my wife likes that.
• 34:35
  You know? So they had that piece that actually they couldn't really, they weren't even empowered to change their diet or we don't have access.
• 34:41
  And I knew people didn't have access to funding or money or ability to.
• 34:47
  Or, or knowledge should I say about cooking and, and what good nutrition was in the first place.
• 34:52
  So I knew that quite often I was sending people out and.
• 34:57
  Actually, I've sent them out, probably more frustrated than they came in, and as gentle as I'd try and be in and sometimes sort of think, well, yeah, okay, I get that.
• 35:06
  That's not gonna happen.
• 35:07
  So let's think about something else.
• 35:09
  I still knew that the system wanted me to record their weight, record their, their girth.
• 35:14
  Yeah.
• 35:15
  Um, you know, to, to do all of those things.
• 35:18
  And sometimes we didn't always have the equipment available within the surgery to do that for people because.
• 35:23
  People were beyond what we, our equipment was able to do that.
• 35:26
  For us, that was even worse.
• 35:27
  'cause then I had to just put, you know, write something about why I hadn't recorded it.
• 35:31
  'cause otherwise when it came to those points.
• 35:33
  So yeah, it, it feels like the frustrations that I felt, um, were.
• 35:43
  Right, because I felt frustrated in those situations.
• 35:47
  Um, but it feels like there was a lot that I didn't know and probably people don't know where actually we could start to think about, um, things differently.
• 35:58
  And there's good reasons to think about things differently and that what matters to you question and how can I support you to achieve that? It, I think we really need to be turning it round and I'm beginning to think that actually, do we need to change our markers to start to talk about those social determinants of health and almost be, so how engaged do you feel? Um, how lonely are you? Almost like a loneliness marker.
• 36:21
  Are you engaged with your community, your family, or friends? Is there something else that you need beyond that, that, that actually be a better question than worrying about somebody's weight and what they're eating for dinner? You know? So, yeah, that's what I'm thinking.
• 36:36
  Yeah, that's it.
• 36:37
  That's it.
• 36:37
  Because it about finding something that's within their control.
• 36:43
  Isn't it that that something that they can actually affect change If, if someone's coming in asking for, you know, behavior support change, for example, you know, or they, they have a health condition that they want to know that they're doing the best they possibly can for themselves.
• 37:01
  You know, they might be in treatment for, let's say diabetes, but they also want to know.
• 37:06
  That they're doing all that they can for themselves.
• 37:10
  Um, you know, that needs to be weight neutral.
• 37:13
  It needs to be weight inclusive and not, not focused on weight measures at all.
• 37:18
  You know, it needs to be faced around the things that they can actually, you know, have an impact on.
• 37:24
  'cause they can temporarily have an impact on their body weight, you know, but temporary is the word here.
• 37:30
  And the impact of changing their weight over and over has its own health risks.
• 37:36
  You know, um, that weight cycling effect, even by just a few pounds up and down, I think it's about seven pounds up and down, you know, that, that carries its own cardiac risk.
• 37:50
  Um, and I can, I can supply the evidence links to that, but it's, it's out there.
• 37:56
  You know, it's, I think what we're trying to do at URI is to just be able to.
• 38:04
  Have these difficult conversations, you know, yourself just doing this podcast, Ruth, that it, it feels, you know, it feels edgy.
• 38:11
  It feels like, oh, okay, hold on.
• 38:12
  I've been doing this one way.
• 38:14
  How can that be not the right way? Do you know what I mean? It's what I was trained to do.
• 38:20
  How can that not be right? So when we go back to policy and say, right, okay, policy's won.
• 38:25
  Key policy needs changing.
• 38:28
  You know, the And nice.
• 38:30
  Both agree now that there is a lot of diagnostic overshadowing happening and that body weight is overdiagnosed overtreated.
• 38:39
  Um, and that weight stigma gets in the way of effective policy and effective healthcare.
• 38:46
  You know, we've got two major organizations that are held in high esteem, the Lancet and Nice guidelines.
• 38:53
  You know, they're saying that weight stigma is a problem.
• 38:57
  Um, and Nuri is just using the 10 years of experience to support policy change and.
• 39:07
  Train workforce to be more inclusive.
• 39:14
  Of everybody's health needs.
• 39:15
  So what would you like to see happen? Helen? Ire I'll, I'll go right back, Ruth.
• 39:22
  So my original dream, if you like, and it was very naive to get going.
• 39:27
  I had to be really naive.
• 39:29
  I realize now in hindsight.
• 39:31
  So I started nru by opening a weekly meetup group.
• 39:35
  I didn't know what the group would do, what it was about.
• 39:38
  And over 10 years we've learned that.
• 39:41
  So now.
• 39:42
  We'd love to fund a rollout of neighborhood health hubs that can ultimately take the place of weekly meetups, slimming groups, because people get a lot from going to those weekly meetups.
• 39:59
  You know, they, they're in with a crowd of people that are supporting each other's wellbeing, um, and are naturally social prescribing as well.
• 40:09
  Natural social prescribing always goes on at slimming clubs, so we want to create these neighborhood health hubs that actively de-stigmatize, um, going forward and support people's holistic wellbeing rather than zeroing in on.
• 40:28
  An arbitrary number on this scale.
• 40:31
  Um, somebody very close to me once said, scales are for fish.
• 40:37
  That's really good.
• 40:38
  I like that.
• 40:39
  Scales are for fish.
• 40:40
  And um, so we've got the health hubs.
• 40:44
  Which is the ideal mm-hmm.
• 40:46
  Within a neighborhood.
• 40:48
  Um, we've got social prescribing mm-hmm.
• 40:49
  Which is referring people to choirs or whatever else that is, um, walks different things.
• 40:58
  What, what about when people come along to general practice or they go to see the consultant about their, their knee op.
• 41:04
  Um, and those sort of things.
• 41:06
  What, what's happening there? Perhaps start with general practice, and I say general practice because my personal thing is that there's so many people in general practice now, I don't say GP practice, so a person comes along to see us and, and I say, or me, as I will will say, and whoever it is now, what, what's happening there? Yeah.
• 41:24
  So the training, the weight neutral training that we offer.
• 41:28
  Um, an ecosystem.
• 41:30
  Um, and that could include, like you say, any member of staff in the practice from front of house to, you know, the diabetic nurse, the, the GP themselves, um, or any onward referral.
• 41:46
  We want that to be stigma informed and weight neutral.
• 41:51
  So a weight neutral triage system.
• 41:55
  Um, that involves a wider ecosystem as well out from the PCN to the primary care network out into the, um, third sector, the VCSE, the voluntary community, social enterprise center sector that always, it does all the heavy lifting, a lot of the heavy lifting around community care.
• 42:16
  Um, we'd like to see all of that to be stigma informed.
• 42:23
  In time and able to make really holistic signposting and referrals into services that actively de-stigmatize the situation and the individual.
• 42:39
  Um, so that we can see an increase in engagement and a a, a benefit to, um, positive health outcomes.
• 42:51
  For more people and when they go to the hospital, whatever that's for.
• 42:57
  Is it the same or is there something else? Yeah.
• 42:59
  That we, we've got to sort of envision a ripple effect of how that can be.
• 43:05
  I think there's even, we've got to have a no wrong door approach, so let's take somebody who definitely knows they don't want to focus on their weight.
• 43:20
  And someone who definitely wants to go and try the medications or even have surgery.
• 43:25
  Okay.
• 43:26
  Um, we've got to create a no wrong door approach because following medications and following surgery, the need may well still be there for accessing, you know, welcoming movement classes and.
• 43:46
  Um, creating those spaces where people feel that they're included.
• 43:52
  Uh, information about, um, nutrition, balancing nutrition, you know, because the medications and the surgery aren't fixes to that.
• 44:03
  Issues that, um, and behaviors that led someone to poorer health.
• 44:11
  In the first place.
• 44:12
  They're sticking plasters, you know, the the and the me.
• 44:16
  We've got to be creating services that support everybody every size, and those that in are intentionally changing the way and those that definitely aren't.
• 44:26
  And I mentioned earlier about that contraindication for medication and surgery.
• 44:30
  If we are not creating services specifically for people that cannot or do not want to take those medications, then we're failing a big.
• 44:39
  Portion of, um, the general population.
• 44:42
  Thank you, Kelen.
• 44:43
  And then, uh, the other thing I wanted to ask was stigma.
• 44:47
  Obviously this is very much about weight, but have you come across or, or even done some work around any other stigmas? What others are out there? Uh, and what, what are their implications? Do they mix? Are they the same? Are they telling us the same thing? Because I haven't thought about it, obviously, as I said at the beginning before.
• 45:05
  So I'd really like to hear your.
• 45:07
  What you know about this or what you think about this? So, couple of things.
• 45:10
  Couple of major things.
• 45:11
  So we've been banging on about weight stigma for a long time now, and then it might have been from getting involved with the King's du with movement.
• 45:24
  We, we started to talk about stigma.
• 45:29
  In a more vanilla way.
• 45:31
  So in that more, you know, so not just making it about weight stigma and the health impacts of weight stigma, but stigma just generally, and it, it's surprisingly similar, the health, the mental health and physical health impacts of all stigma.
• 45:47
  It, it's pretty much the same whether, whether someone's experiencing weight stigma or maybe they're experiencing, um, racism.
• 45:58
  Um, classism, you know, any, any ofm it's the same.
• 46:06
  So, and to that end, so the funny story is, sorry.
• 46:10
  The funny story is that people listened more when we made it about other stigma as well, as well stigma.
• 46:15
  People could listen more.
• 46:18
  They were open to hearing more about it.
• 46:20
  You know, now that's a really sort of like.
• 46:23
  Veiled way of saying we were experiencing weight stigma.
• 46:28
  You know, we're trying to talk about weight stigma.
• 46:30
  We are, we and we do, we experience weight stigma.
• 46:34
  People are, it, it, it's like people are very barrier to it.
• 46:37
  So when you open the conversation up.
• 46:40
  To be more just about, generally about stigma in general.
• 46:44
  People are more open to having that conversation.
• 46:47
  It's messed up, isn't it? Um, but anyway, to that end, we've, we just about to, um, have signed off a new charity that we've set up and it's called Free From Stigma.
• 47:01
  Um, and.
• 47:03
  The work that we did through the Kings Fund do with initial, um, kickoff event.
• 47:09
  We made that about all stigma, uh, and people shared with us, you know, where they focused their work, their do with work is focused in other STRs, if you like, of, of, of stigmas, you know, anti-stigma practice.
• 47:24
  And that's really interesting because what you're saying is that I, I'm just recapping here, so.
• 47:30
  You talked about all sorts of other stigma, racism.
• 47:33
  I'm just trying to top of my head, ageism, sexism, whatever they are, all of those sort of things.
• 47:38
  And I think last time, yeah, when we first met, prior to this podcast, we talked about things like dyslexia and A DHD.
• 47:45
  So they're, all of those come with stigmas.
• 47:47
  They're all having the same.
• 47:48
  Mental and physical health implications that you were talking about with weight I impact.
• 47:54
  But actually when you start to talk about those, people will find it more acceptable to talk about those ones than they were about weight one weight stigma, which quite interesting, which shows the stigma that there is around weight.
• 48:07
  And I wonder if that is because we are so ingrained in us that actually if you are overweight, you are unhealthy.
• 48:16
  And we live in a world where, or, um, a society, should I say, I, in the uk where actually the NHS is there to provide.
• 48:25
  Pride all our health and care for us.
• 48:26
  And that's something really obvious.
• 48:28
  You can see somebody and think, well, they're going to need all of this stuff that you know that they're gonna need from the NHS.
• 48:34
  So I wonder if it's almost so ingrained into us as what healthy is, that we can ignore all the other things, whether they be behaviors or we can accept them when there are other things that there's stigma about, because we've seen them and spoken about them for such a long time.
• 48:49
  But weight, which we can see.
• 48:52
  Quite obviously, or think we can see obviously, because it's not always obvious as to if somebody's overweight and it's affect affecting their health.
• 49:01
  But we think we can see that as a society, don't we? And we think we, we are know the impacts of that weight.
• 49:07
  And I wonder if it's something about the fact that we're so hooked up on delivering health and health being delivered to us rather than creating our own health.
• 49:16
  I wonder if it's something around that.
• 49:18
  I'm, I'm.
• 49:20
  I getting myself a little bit muddled, but I Do you get where I'm coming from, Helen? I do.
• 49:24
  I do.
• 49:24
  And so there's a couple of things.
• 49:26
  There is, is the presumptions of when, when I walk into the GP surgery, for example, in the body size that I am in, um, it.
• 49:36
  Assumptions are made, judgments are made in a split second.
• 49:40
  Here's someone that's not eating the right things or moving their body enough is the main assumptions that are made, and that's where the issue lies.
• 49:49
  Because nobody's yet asked me actually what I do eat day to day, you know, and they've not asked me how much I move my body.
• 49:58
  They've not asked me what my access to better nutrition is like.
• 50:02
  You know, they've not asked me what are the stresses I have going on in my life.
• 50:07
  You know, it, it's like, it is such a, a narrow focus to presume that anybody of higher weight is not looking after themselves.
• 50:19
  It's almost that BMI is the least interesting thing about me.
• 50:22
  But I will also say, you know, language is really important and when we say that overweight, when we say overweight, I always wanna say straight away over what weight, you know, if, if we are actually believing that BMI is useless and I call it basically meaningless information.
• 50:38
  That's my acronym for BMI, the terms overweight and underweight become obsolete.
• 50:44
  Over what way? Under what way? You know, if we're saying that there are no classifications that personify, you know, health and that health is available at every size.
• 50:56
  You know that we have to stop using the words overweight and underweight, which I probably just used, I dunno how many times in that little reflection to you.
• 51:05
  Don't worry, don't worry.
• 51:06
  Sorry I left it.
• 51:07
  Don't worry.
• 51:08
  No, it's fine.
• 51:09
  It's fine.
• 51:10
  People will probably remember it more.
• 51:11
  So what next? I know you've talked about the fact that you've got this charity free from stigma and that you're broadening that out.
• 51:18
  Mm-hmm.
• 51:18
  I suppose what I'm thinking about now is for the, for our listeners, be they.
• 51:22
  Clinicians, be they from social care, be they from charitable sector, be they my mom and dad, who I know, listen, you know, in other words, just members of the public, just people that are out there who are listening.
• 51:35
  What, what do we need to.
• 51:37
  Do.
• 51:38
  What's your challenge to those people, whether they be somebody who's underweight, overweight? Um, I know, there I go again.
• 51:45
  I've said it again, shows how ingrained it is, doesn't it? Um, be people that consider themselves or other people consider that they are, let's just put that bit in there.
• 51:56
  But what, and all those other stigmas as well that we've spoken about, which really brings us into that sort of, um, as you said, theisms, the racism, sexism, you know, really talking about that.
• 52:07
  Inclusion.
• 52:09
  What's your challenge? What, what do we need to think about? What do people need to do? It? It depends on what their, who they are, first of all.
• 52:18
  So what we're trying to do here is lift the burden.
• 52:22
  Off of the individual and place it back on the system to change.
• 52:25
  So when we talk about behavior change, we definitely mean about changing the behavior of our healthcare system to not regard weight as a, as a valid health metric.
• 52:34
  Um, because it's not, it's really problematic to be using weight as a health metric in this day.
• 52:40
  And h um, so if they are, if they are part of an organization.
• 52:46
  Let's say, I think, and, and this, this, yeah, this, this call goes mainly out to, to those people is, is recognized that they aren't disempowered.
• 52:56
  They have power within them to advocate for weight neutrality and inclusive healthcare.
• 53:04
  You know, if they look at their role, for example, you know, they, they can, you know, stop perpetuating weight stigma by, you know, learning.
• 53:16
  The language that stigmatizes and learning the practice that can de-stigmatize, um, and for the individual.
• 53:27
  So if you're talking about the individual in conversations with their loved ones, um, or their social groups, you know, it's body weight is the least interesting thing, but we spend a lot of time talking about it and it all has an impact.
• 53:46
  You know, even if I like to give this scenario, even if I'm talk, if, say if I'm, I dunno about weight neutrality and I dunno about the impact of weight stigma and I'm in a conversation with friends and loved ones, people that I trust and we've probably had the same conversation a thousand times.
• 54:04
  But even if I'm talking about my own body weight in a close circle of friends, those.
• 54:12
  That conversation has unknown impacts on people in that conversation.
• 54:17
  And to myself, you know, so that's placing value on body size every time.
• 54:25
  It's placing value on that, that as a, you know, appearance as a currency to being accepted.
• 54:33
  You know, it's like if I'm a fat person, I've got to be seen as a, a good, fat person.
• 54:38
  So I go to the gym, you know.
• 54:41
  And I do this and I talk about what I'm eating and how I'm exercising because I've got to show people that I'm a good fat person and looking after myself, you know, it's, we'll always find some way of framing this.
• 54:56
  I'm going off on a tangent myself now, Ruth.
• 54:58
  Sorry.
• 54:59
  But that sort of, you know, I think that.
• 55:02
  It, the what, what would I wish everybody knew is that body weight was the least interesting thing about them as a person.
• 55:10
  Um, and also it's the least interesting thing to their healthcare provider.
• 55:14
  I think that sums it up really well and I like that.
• 55:17
  And one of the things I was gonna say, you know, that I've really picked up from that last little bit that you've said is actually, weight is the least interesting thing about people, but it is the thing that we talk about.
• 55:27
  The most.
• 55:28
  So thank you.
• 55:29
  Thank you for joining me today.
• 55:30
  I've really enjoyed our conversation.
• 55:32
  I've smiled so much, laughed so much, um, realize that I've used really poor language, so I'm gonna have to go off and reflect afterwards.
• 55:43
  I'll, I'll do absolutely fantastic.
• 55:49
  And so, yeah, thank you for joining me today, as I say, it's been a great conversation.
• 55:54
  Bye.
• 55:54
  Uh, thanks for hosting.
• 55:55
  Thanks.
• 55:58
  I hope you found this episode interesting and inspiring.
• 56:01
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• 56:06
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• 56:10
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• 56:14
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• 56:16
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• 56:28
  Let's shape a space into something reflective and purposeful.
• 56:33
  So for now, stay caring, stay connected, and stay curious.
• 56:41
  I.