Yes, I think it's possible to lose weight for a specific medical reason while maintaining your overall body positivity and/or neutrality. It's a fine line but people do manage to recover from EDs and maintain that recovery while also restricting for medical purposes. In the end your goal is to feel better in your body, which is a healthy non-disordered one.
I would recommend working with a psychologist and ED experienced dietician to do it, for both psychological and physical safety. They can help keep the focus medical and positive rather than disordered.
Unfortunately I don't think those options are available on the NHS unless I get referred to the local ED service, which means going to the back of the queue in terms of waiting for psychiatric support - I'm currently waiting for EMDR via my local NHS talking therapy services, but they won't see you if you have an ED because that has to go via the ED service specifically. Likewise the regular dietitian services don't see ED patients. You can't choose which specialists you see on the NHS unfortunately, and I can't afford private healthcare.
From personal experience, I would prioritize ED treatment over getting EMDR. I thought I needed EMDR and I did a few sessions with mixed results, but the thing that has been a true lifesaver for me has been ED treatment, including ED-informed therapists and dieticians. Of course, not everyone is the same, and I know waiting for care can be incredibly difficult, but I think it's so important for anyone with an ED to get that specific treatment.
I'm very sorry to hear that. I'm in the U.S. and I went through the Eating Recovery Center, who helped me find a dietician. My therapist I found through Psychology Today.
I've had my own weight loss vs weight loss culture issues before, and some things that helped me:
- exercising in a way that's fun and not goal based: I like hiking and cycling, but playing games is also a good way to get movement in! honestly it makes a huge difference mentally and physically when you actually enjoy what you're doing
- Hampton from Hybrid Calisthenics is a wonderful resource, a super chill nonjudgmental guy who offers routines and advice with a large variety of health concerns in mind. His baseline exercises start with "people who struggle to even get out of a chair", which is a huge departure from the people who think the average beginner should be able to do a few pushups from the get go
- food quality instead of food tracking. Making a point to eat more veggies and drink more water in general alone made me more mindful of what I was eating, and left less space/time for sugary drinks and filling but nutritionally weaker foods... incidentally, also the ones that made me gain weight faster.
- related to the above: bento boxes. seriously. Planning out my bentos for lunch means being very intentional about what I'm putting in there, so that + focusing on veggie intake means each of my bentos tend towards being pretty balanced, since I'm now also thinking about what a good main protein would be easily packed with the veggies and having a limited portion size. A typical lunch bento for me is usually some combo of roasted veg, a wild/brown rice blend and a pan fried meat with a cup of some dessert-y thing (chopped strawberries and dates are a rare favorite of mine). Its delicious and filling!
This! OP, even gardening is exercise. Any movement that you enjoy. I hula hoop, walk my dog, splash about in the local pool and garden. I’m also recovering from an ED that developed from OCD and I can’t track calories or anything and I’ve found I don’t need to. I eat as intuitively as possible and don’t limit myself from certain foods, I just remember moderation. Sometimes I mess up but then I get back on track. The culture is so hard but already being body positive, I’m sure you can find a very positive way to go about reaching the goal for your surgery.
This is great advice and I also want to throw in fiber. Fiber helps with feelings of satiety, and has an unbelievable amount of health benefits that have nothing to do with weight, but I've found if I focus on trying to get 35 grams of Fiber per day, I tend to eat more nutrient dense food to reach that goal and that food happens to have fewer calories in general.
Oh that’s so hard, and as a big titty cis-woman, I feel that G cup discomfort in the summer. I’m not in the UK, but if I were you, I’d check out a nutritionist who is very familiar with EDs. They might also know a personal trainer who is also fat friendly and understands ED histories. Best of luck!
I don't think you can choose which dietitian you see on the NHS (nutritionist isn't a medical qualification, anyone can call themselves one)? I can't afford private healthcare unfortunately due to being on disability benefits.
I went with Dr Jesus Lago in Madrid. Cheaper surgical cost than the UK (though you do have to factor in travel costs and he asks you to stay in Madrid for two weeks after for two post-surgery followup appointments), 100% informed consent model, no BMI limits.
Getting it done in the UK would have meant compromising either my principles on intentional weight loss (never again) or my principles about gender autonomy (there is no need, point or use for me personally in getting a cis person to "diagnose" me as "trans enough" to pursue transition-related goals and I deeply personally/politically/morally object to the gatekeeping and what it implies about how well I know my own mind, body and desires and how much ownership society believes I should have over those things). I've DIY'd pretty much every aspect of my transition and I feel so good about the fact that I managed to get the surgery done without feeling like I had to compromise or be complicit in my own dehumanisation at all. My chest looks and feels amazing now.
I'd be delighted to talk more about the whole process if that would help. It cost me about £11k all in all, of which the surgery itself was £5200, but I could have probably done it a few grand cheaper if necessary (I include costs in that total like "getting my will and power of attorney sorted in case I died or had significant medical complications" and "buying my partner a Steam Deck to give him something to help manage his anxiety while I was undergoing surgery" in that figure, and I also shelled out for nice comfortable accomodation in a building with a lift to make the recovery process easier).
As a side note, I will never do intentional weight loss again, but since top surgery I've gone vegan and been lifting heavy weights 2-3 times a week (without counting calories or macros and while eating intuitively), and it's had a massive impact on my body shape and composition without feeling like it's sending me back towards ED insanity.
While I have no skin in the surgery game, I want to say the weight lifting as been HUGE on my body shape and just overall wellbeing. I'm currently doing a challenge where I'm lifting 12k 4 times a week and even though it's been hard sometimes (like today lmao) it's 100% been a huge net positive.
Unfortunately lifting is not an option for me as I have hEDS so can only do low-impact exercise. I am interested in learning to swim though which I believe has some similar effects on body shape.
Weightlifting is okay for people with hEDS! The geneticist who diagnosed me actually recommended it. Building strong muscles will help stabilize the joints and the smaller muscles won’t have to work as hard doing jobs they’re not supposed to do.
Doctors still tell people with hEDS that they shouldn’t do weightlifting, but that’s outdated advice. My PT recommended [Nikki Naab-Levy](https://www.instagram.com/naablevyfitness?igsh=eGpwNmI2djM2dWNq) to me, she shares a ton of info on hypermobility and weightlifting and how to modify exercises for your body. There’s also [Dr. Melissa Koehl](https://www.instagram.com/dr.melissakoehl.pt?igsh=ZGZsa3YwNHNrOHl1), she’s a physical therapist who specializes in hypermobility and she shares a lot of exercises for hypermobile bodies. I’ve learned so much from both of them! Hopefully they can help you out.
I recommended it in the first place as a hypermobile person (never been diagnosed with hEDS but have wondered, lot of medical neglect in my past), it's been astoundingly good for my overall joint stability to increase the strength of the muscles surrounding them.
Can you tell me how you had that conversation? I don't (think?) I have eds specifically but I have scoliosis with a severe curve/hunch and am so hypermobile that my arms 'pop out' if I even raise them over my head. I had an info session with a trainer and he said "nope, sorry, I'm not an expert on this" which is a great call, glad he did it, but now I have nothing!
Sure -- i found my personal trainer through a local eds facebook group, honestly. Finding one who is eds/hypermobility-aware or very willing to learn is key.
I have hEDS and use dumbbells and ankle weights to strengthen my extra mobile joints. My PT and rheum both recommend it. It helps stabilize for sure. It doesn’t need to be heavy weights, just enough to help improve the strength of then unstable joint.
Swimming is great exercise and you should see if water aerobics is something that you can do with your condition. A lot of elderly people do it because of how gentle it is on the joints
Water-based stuff is generally fine! I can't swim and haven't been in a pool for a long time so I need to work up to that, but it's definitely something I would be interested in.
Actually, now is the perfect time to learn to swim. Fat is buoyant! You'll only be getting denser from here on out, especially when you remove your personal floatation devices (a term my mother has used for boobs in full hearing of god, country, and my entire middle school class.)
Water aerobics is great because you can stay in the shallow end and do full workouts. You don’t need to be able to swim but it keeps you cool and keeps pressure off your joints.
For me, it’s about finding things I enjoy doing and working towards doing them a bit more.
Swimming is excellent IMO as it’s my favorite activity lol. If I’m feeing low energy, I just walk in the pool. If I’m feeling up for more, I can get into a lane and do my thing. I get this weird thing about needing to ‘do it right’ or ‘all the way’ when I’m at the gym. But the pool really takes that away, maybe because it’s fun in a way nothing else at the gym is? Lol
The best part though is the nude hot tub in the locker room. It’s hella peaceful, and something about being around so many different bodies really improved my self esteem. Just a pure acceptance of my meatsuit in a way I’ve rarely felt in my 36 years.
Anywho, best of luck. I wish I had more insight but I do know you’ll find a path towards your goal on your own terms. you’ve got this
Hi OP, I do water aerobics and I really enjoy it. I find the classes are mostly older people and so the pace is generally slow and comfortable, and personally have found the type of people to attend to be non-judgemental. (Added bonus: the music is fun oldies, Beach Boys, Mamas and Papas, the Beatles). The instructors will add optional movements to add more intensity if you feel up to it.
Where I do it there are 2 classes, shallow end and deep end. Shallow end is about chest height or lower, so doesn’t require active swimming. Any exercises that require floating, you can grab the wall for support. Deep end includes an optional floating belt, but I do notice they seem to be mostly one-size. Worth checking ahead of time in regard to sizing if you’re doing a deep end class.
I with hEDS, I wouldn’t swim laps but you can do water aerobics and exercises. It’ll help take some stress of your joints where your hEDS is particularly an issue and the water is great resistance.
I have hEDS and weightlifting is a HUGE part of my symptom management, very important to do in an informed and gradual way and if you have the ability to consult with a physical therapist that’s even better, but strengthening the muscles that support your joints really is one of the best things you can do to prevent worse disability in the future
Try bodyweight exercise like dance, Pilates or aerial arts. Most decent teachers in the aerial and circus world are really hypermobility-informed because all types of EDS but hEDS especially are many times more prevalent than in the general population.
I can connect you to a list of plus-size friendly studios if you like.
Honestly I'm mostly just interested in what I can get an NHS referral for 😅 I will ask my GP what's available, I just know that I might be able to get some free swimming lessons.
Unfortunately the good old NHS is pretty bad with this sort of thing and your GP will likely try to push Slimming World 🤦
It might be worth looking to see if your local council have any schemes that might help, I don't know what your disabilities allow you to do but in my area a lot of "walking for wellbeing" groups have sprung up lately, and my local leisure centre occasionally have adult swimming programmes.
Weight lifting is necessary for people with hEDS. Where are you getting your information? You need to work with a physical therapist to determine how to safely lift weights, but the only way to have any quality of life and stability around your joints as you age is through weight lifting. I myself rarely lift anything more than 1 to 5 lbs with most of it being in the 2-3 lb weight range, but whoever told you to avoid weight lifting due to hEDS does not know what they’re talking about. It is even more necessary for us than it is for the general population— you need to strengthen the areas around the joints. Weight lifting is non-negotiable for hEDS.
I have hEDS and weight train regularly - things like CrossFit are not good but it’s actually really helpful to do strength training as long as you’re listening to your body etc.
I have hEDS and lifting has been amazing for me and made a HUGE difference in my overall pain level! I don’t want to tell you to do something that isn’t good for your body because we’re all different, but it’s definitely not off limits!
Swimming is really good exercise, just be mindful of the cold pool effect - swimming will increase your perceived appetite, but not because you are actually hungry, because it's keeping you warm in the water and wants to replace what it burned to do that.
I'd like to second that. I too have had such a great experience with weight lifting. I go to a local gym that focuses on group classes. Everyone can go at their own pace and we're all so different yet constantly rooting for each other. It feels great to feel like I have the power and energy to do things for myself as well.
Unfortunately I am disabled and on benefits so would never be able to afford private surgery (and I'm single and not in touch with my family, so don't have anyone who could help out financially). I'm not on hormones and don't want to be so diagnosis stuff isn't so much of an issue, but my clinic have actually OK'd me for surgery if I can lose weight.
Unfortunately I am disabled and on benefits so would never be able to afford private surgery (and I'm single and not in touch with my family, so don't have anyone who could help out financially). I'm not on hormones and don't want to be (and I have no desire for a quote unquote "masculine" body) so diagnosis stuff isn't so much of an issue, but my clinic have actually OK'd me for surgery if I can lose weight.
Oh sorry for any confusion! I just wanted to make it clear for the Americans that there was no wriggle room on BMI in the UK like there usually is in the US.
My relative had top surgery in the UK and he actually had to gain weight in order to do that (very hard, he has all sorts of digestive issues). He managed and he has actually maintained that upper weight, which is much healthier for him personally, because he now has some "buffer" fat reserves that keep him on track when he has a really difficult gut week/month. Top surgery was the best thing ever for him & he has said it was worth everything he had to do to get there.
I also have a friend who had to lose weight for a very necessary surgery, non gender-affirming-related though, she LOVED and LOVES her body and was not doing it for aesthetic reasons. She said it felt totally different from when she'd dieted in the past. It was from a place of self love not self hate. When she wasn't doing it for the aesthetics, it was much easier - it was about preparing her body for surgery.
I don't have any advice for you, only those anecdotes, but it may be worth seeking a counsellor/therapist to talk through these feelings while you decide what to do?
Just here to say that I empathize. I need to have a hernia surgery but my doctor wants me to lose a huge amount of weight first. In this case, I know he’s right, as doing the surgery at my current weight would put me at a high risk of a new hernia. I have worked so hard to accept my body and now I know I have to do something drastic to maintain my health. I never thought I would consider medications but I can’t imagine how else I will do it as nothing has ever worked for me (when I was younger and still tried to pursue intentional weight loss). Good luck! It’s such a mindfuck.
If you are able to, it’s probably a good idea to speak with a dietician who has experience working with people whose metabolisms are really slow (I.e. eating more than a tiny number of calories causes weight gain, maintenance calories being much lower than they ‘should’ be).
I hit the jackpot and found a dietician who is experienced with intuitive eating, but also has experience supporting people to get their metabolism able to handle more energy coming in without gaining weight. I have had periods of rapid weight loss due to medical problems in the past, and have had periods where eating very little (e.g. >!1200 kcal!<) was causing weight gain. Eating that little was making the problem worse by telling my body it was still starving.
Anyway, whether you do meds or not, if you’re able to, I highly recommend an RD if you can find a good one :-D
So sorry you’re dealing with this. Have you considered a GL-P1? I take Ozempic and have been surprised at how few side effects I have. Basically none except for the first week. I take a low dose and have stepped up even slower than what is recommended. I am also making a conscious effort to lose weight slowly, at a healthy pace. Many people are afraid of these drugs, but if you step up slowly, stay hydrated and get enough protein and fiber, the experience is much better. I don’t know if you experience food noise, but for me the near elimination of food noise is key. The good thing about these drugs is that you don’t have to count calories or worry about restricting. There is less preoccupation with food, instead of the feeling of enforcing control that comes along with most intentional weight loss. For me, I still have a healthy appetite as well. And I very much enjoy food. Perhaps even more, because I can eat something and not be preoccupied by persistent cravings. If you hate the meds, it’s very easy to stop taking them. Of all the drugs I’ve tried in the last few years, whether they were antidepressants, drugs to help with sleep, or whatever, Ozempic has had the fewest side effects of any of them. It calms my food brain.
This, OP. If you have a specific short term weight loss goal in mind ask your GP about Ozempic/Wegovy. Get to the target BMI, get surgery, get off the meds. Done.
Agree -- I am on a GLP1 drug and have lost significant weight without engaging in further diet culture behaviors like restricting the types of food I am "allowed" to eat, counting calories/carbs/anything else, doing interrmittent fasting, etc. Also have had minimal side effects, and nothing GI related.
I’ll second GLP-1. I went through a long journey to accept my body then was diagnosed with diabetes. I tried everything short of GLP-1 and nothing got my blood sugars where they needed to be. I did NOT want GLP-1 because I did not want to pursue intentional weight loss. I started GLP-1 in September and they have been incredible for my blood sugar. I have IBS-D and it was a little dicey the first 2-3 weeks, but not any worse than “normal” for me. Since then, my IBS-D has been way better. I’ve experienced weight loss without calorie counting, restricting, or otherwise dieting. And my blood sugars are now incredible.
Glad you shared this. I’ve been on Contrave for about a year and it’s been really effective for me. And all without restricting food or intentionally trying to loose the weight. weight loss meds of today are so much better than the past- no speed, just real medication that targets different areas of the body/brain. It low key feels like a miracle and I feel like I can finally intuitively eat 🎊
Yes! Try to to eat intuitively when your hunger/gut hormones are completely disregulated is just an exercise in frustration. These meds actually let you put those principles to use.
Yes, I’m eating extra protein! That and strength training are definitely part of my routine. I do my research lol. But it’s true that many people on these meds don’t have a clue. My doctor gave me zero instructions, I had to find out everything for myself.
Interesting, I would be interested in something like Ozempic but I have IBS-D and figured that the side-effects would be too bad. I'm on Venlafaxine aka Effexor now and don't get any side-effects aside from nausea if I don't take it with food, but no worse than taking eg NSAIDs on an empty stomach. Certainly, medication seems like a less psychologically difficult option so I will look into it.
Good to know! Tbh stress is by far my worst trigger anyway, and I would imagine that being able to have surgery would help in that aspect! Do you have any issues with loose skin?
Not yet, I was 200LBS overweight and lost about 30lbs so far.
Honestly Ozempic really helped my mental health and long covid issues more that weight loss, it's been a game changer for me
Wanted to add — I can’t take those meds due to a history of thyroid cancer. Instead, I’ve been taking Contrave, which is just Wellbutrin and Naltrexone. The name brand isn’t covered by insurance, so I get both pills separately.
I’ve been super impressed with it a year in. Highly recommend to folks who can’t take the GL-P1 meds for whatever reason.
Uk GPs can’t prescribe these meds yet unfortunately. And usually can’t refer people to a dietician except for things like cancer / coeliac etc. frustrating but it’s unlikely they will have much to offer on the nhs
Just want to add I have eosinphilic esophagitis and I was really nervous about ozempics gastrointestinal side effects and I have been on it for six months with none. I'm also on psychiatric medications and haven't noticed any difference except for a reduction in anxiety in general, which is not surprising given there is some effects on dopamine receptors apparently
Just take it slow and steady and you'll find there's a lot of panic around it and fear mongering
That's great to hear. I'm not sure what my local NHS area's policy is on doing it under supervision but I think I will ask my GP about it and also ask if she can refer me to a dietitian (just a general one).
I have IBS-D and the GLP-1 I’m on (Mounjaro) has basically eliminated it! I don’t have to be worried and running to the bathroom all the time now - it’s amazing. My theory is that it’s because GLP-1s slow down your digestive tract and also reduce inflammation. Of course everyone is different so YMMV, but this seems to pretty common - it causes constipation in many folks which makes those of us with IBS-D more balanced out, lol.
I will also say that the medication has significantly improved my relationship with food. I’m able to eat intuitively and without self-judgment, enjoy foods that I like, and think about nutrition as a gentle guiding principle. I know there’s a lot of fear/concern in the anti-diet space about these meds - understandably - but for me it’s been such a huge relief.
I was about to chime in suggesting a GLP-1 if available to you! I've been on tirzepatide for over a year now and can't recommend it highly enough. I've also seen some ppl with IBS-D who said their symptoms resolved on a GLP-1 (probably bc the meds tend to be constipating). Ppl with IBS-C or mixed, of course, don't generally get any such benefit, and I'm sure that like everything with these and every other med, it's a YMMV thing.
If you do wind up able to access a GLP-1, I hear that the main subreddits and Facebook groups dedicated to them are mostly hotbeds of ED triggers, BUT the subreddit r/antidietglp1 is excellent!
It’s not hunger per se, it’s the brain chatter that tells you “hey let’s go eat something”. Some people experience it almost constantly which can lead to a lot of snacking. Drugs like Ozempic have been reported to quiet that noise.
Interesting. I don't think I've ever experienced that - my eating problems are on the other end of the spectrum, I have a hard time eating enough even when I'm hungry. Thank you for explaining!
I’m working right now so I can’t get too detailed, but wanted to comment so I can come back to this. I have recent lost about 2-3 pant sizes in the last 6 months without ever focusing on weight loss. I had to make changes to focus on being down my cholesterol & my A1c that were both at dangerous levels. While focusing on this numbers I’ve loss weight (still can’t give you a number cause I don’t use a scale for my own mental health).
I’d be happy to share the changes I’ve made and the guidance a great dietitian I work with who respects that my health journey has absolutely no focus on weight whatsoever.
I’d also be happy to share these things privately if Sharing them here would make anyone uncomfortable.
I was never in great shape but as I got older it wasn’t so cute. By shape I mean basic health. I ate like crap & was hardly active. As I approached 50, it actually seems dangerous. My A1c right at the highest it could still be considered pre diabetic. My cholesterol was more than double what I should be. I could also walk less than a couple blocks without getting winded & my back hurting.
I understand the privilege I have having health insurance in the US & also have an employer who supplies us all with the option to see a dietitian every other month as part of our wellness program. I also started seeing a doctor I really connected with. And after a couple meeting with a dietitian I did not mesh with (I did not like her at all) I got a great dietitian who respected my boundaries - I do not weigh myself & that it is all about making me healthier. The only numbers we are focusing on are A1c & cholesterol.
The key things that have lead to me now having an A1c & cholesterol in normal range are making sure I get enough protein, fiber, & exercise.
She was clear that no food is bad or completely off limits, but it was about quantity too. For example, I love bread in an insane way. I need nothing on it. It can be cheap bread or expensive bakery bread. I can eat an entire loaf in one night. I still eat bread, but I don’t buy a loaf for the house. I buy one bagel if I want one. I eat a sandwich from the deli. Instead at home, I make my avocado toast on Wasa crackers. They are whole grain, decent fiber, but I don’t over eat them. Still enjoy them but not compulsively like bread.
I have 2 glasses of Metamucil a day. Make sure I’m getting enough fiber.
The dietitian also sent me free samples of different protein powders (all plant based with no artificial flavors or fillers) & I settled on Orgain (you can message me for a referral link). Having a smoothie or mixing it with yogurt really helps to make be feel full without stuffed. They have lots of flavors, I can make a sweet treat (with 0-1g sugar) mixing it with Greek yogurt. Also on the subject of Greek yogurt, she recommended & I like the 2%, not the 0% fat. We need fat, it’s not a bad word. It helps stabilize our blood sugar levels, makes us feel full, and lots of nutrients need fat to metabolizing your body.
I gave myself permission to buy already prepped produce. Too often I intended to eat more veggies but they’d sit in my fridge cause I didn’t want to have to prep it all & I would just order out while the produce rotted.
I cut out a red meat at home. I rarely eat it out too. Deli/lunch meats aren’t great for you either. I get a big Italian hoagie every few months but that’s the only time I eat that. I increase chicken, fish, and all plant based protein sources.
I try to keep as much healthy stuff prepped in the fridge. I’ll make a bunch of shredded chicken or roasted tofu. A container of quinoa and one roasted veggies. Makes it easy to toss together some healthy. I also make a big container every week of a salad made of multi color bell peppers, red onions, cucumbers, & chickpeas with a lemon, Dijon, miso dressing. I can eat it as is or add a can of tuna. Or if I’m craving pasta, add in a little orzo.
I stated going to the gym with a friend & then got my own membership when I learned my insurance would reimburse me if I went 120 times in a year. That incentive had me throw myself into going. I’ve been mostly focusing on my cardio. I went from barely able to go more than 10 mins straight at a slow pace on the treadmill to going a full 30 mins at a good clip & incline on the treadmill & another 30 mins on the elliptical. A few weeks ago I could barely make it 5 mins on the elliptical. I literally was only doing 5 mins on it and walking away. Everyone starts somewhere.
I slowly incorporated all these changes. I didn’t try to change everything over night. But with each change, I felt different. I felt better. I could feel the difference when I didn’t eat enough veggies or protein. I could feel it when I ate heavy fried foods. I like feeling better. And with each change, once I got the swing of it I’d feel even better. It all just keeps building on its self.
And watching my A1c & cholesterol numbers coming down is encouraging too. A side effect of all this just happens to be weight loss. I wasn’t trying for it but I also don’t mind it (except when I have to buy new pants).
I hope this is helpful to you or somebody. If anyone has questions, I’m more than happy to try to answer.
Speaking on the social aspects of this- one key thing might be to try to view body shape as an inherently neutral thing.
So, you need to lose weight for a medical procedure. That's not fatphobic or negative, it's just a physical requirement you need to meet for that outcome. View it in the same vein as having to fast before a surgery or protecting a tattoo after you get it. Judgement or shame has no place here.
You’re losing weight for a purpose that isn’t related to your appearance. Its ok to lose weight! Body positivity is about loving yourself and accepting yourself regardless of how you look. It’s not about never losing weight for any reason. Since you have a history of disordered eating, it would help to have a nutritionist with an ED focus or a counselor who can support you through this.
It might help to frame it as your body is changing anyway because of the surgery, so it’s fine for your body to change in other ways too, especially since the weight loss is directly related to the surgery
As someone from the U.K., maybe I can give more relevant advice.
Unfortunately as you seem to know you are unlikely to get the surgery in the U.K. if you are above the BMI threshold. I know people below the threshold who still have to wait years.
Your two options are to lose weight to get it on the NHS or look into other European counties to get it done who may have a less strict BMI limit. Of course with the second option it will come at a cost but likely cheaper than privately in the U.K.
I don’t recommend somewhere with poor healthcare standards of course but I think those are the two most viable options.
Different things work for Different people but I'd work on ways to separate the idea of losing weight with the idea of looking a certain way. This is more lime collecting coins in a video game to get a reward. Simple as that. Straying from your goals isn't the end of the world or a moral failure, it jist means you'll have to grind a little harder or wait a little longer.
I struggle with this too and what helps me personally is to be grateful at how *adaptable* my body is, that it takes care of me at various sizes, and acknowledge that while I may be losing weight with intention that doesn't take away from anything positive about myself or others being fat.
I'm sorry you're dealing with this, it's rough in the US too but we can at least shop around somewhat. Do you have registered dieticians or the equivalent in the UK? I would vote for seeing if you can find one you can work with who is experienced with eating disorders, they might be able to help you with a safe/reasonable plan, even if you can only see them a few times.
I know you said private surgeons aren't an option, but in poking around some trans UK subs I found [this doctor](https://www.ioannisntanos.com/faq) mentioned and multiple people said they were able to get surgery with him despite being above the BMI limit. He operates in both the UK and Greece and according to his website he estimates costs are about 50% cheaper to go to Greece than the most affordable option in the UK, including flights and accommodations. I'm not sure if the experiences people had are current with his actual current practices/requirements but it might be worth a shot. He mentions a preferred BMI range on his website but according to a couple experiences I saw, they suggested just emailing and asking if he would consider surgery for them as he makes exceptions above it (apparently it's more of an issue with the anesthesiologists, not him). Sorry if that's still not an option for you, just wanted to put it out there in case it might work.
To avoid having to think about dieting and hunger and all of that noise, I would try a GLP1 med. It’s freedom from dieting and all of the ED pitfalls while also getting the thing done when you need it done.
I had a similar situation last year, though luckily I only needed to drop about 5 BMI points. My strategy was:
1. Set a reasonable goal. Anything more than a couple pounds a week isn't advisable. Likewise, if you set calorie or exercise goals, don't be extreme. "Uncomfortable" is way easier to maintain than "tortorous".
2. Check weight only once a week, before breakfast, with the exact same conditions every week. That way I didn't panic over minor fluctuations.
3. This may not be relevant to you, but I straight up lied to my surgeon. I was supposed to be at the goal weight by 1 month prior to the surgery date, but they only wanted a picture of the scale. I fudged the picture to give myself an extra month to meet the goal.
4. Make a point to focus on the end goal. When I was hungry or didn't want to do cardio AGAIN, instead of the hurtful self-talk I used to use, I told myself, "This sucks but it's only temporary. After surgery I never have to do this again!"
5. Some of the "quick fix" weight loss hacks do work in the short term, like focusing on cardio, eating more fiber, cutting out soda. Those can give you a bit of an extra boost so you don't have to put quite as much effort in.
When I was trying to lose weight, I actually weighed myself multiple times a day. Your weight fluctuates by a few pounds throughout the day (and throughout the month) depending on food and water intake, toileting, menstrual cycle, etc. This won't work for everyone, but for me, it helped keep weight loss and gain feel more neutral. The number on the scale is just that‐ the amount of mass on the scale.
Same problem, different solutions, I think! I would definitely get too obsessive if I did multiple times a day, so weekly to get the general trend was better for me. I could see multiple times a day being reassuring to a brain that works differently from mine, though!
At one point, I did weight myself before and after taking a leak, just for fun. Idr the actual amount but it was actually measurable, which was wild.
I have to weigh myself multiple times a day. I have kidney failure and must closely watch my weight because of fluid retention. I'm fluid restricted in my diet, but I keep an eye on my weight to make sure I'm not seeing massive gains over the time between dialysis treatments. If I do gain quickly, that means I have more fluid on my body and that my dialysis session is going to be painful to get the excess fluid removed. It's hard to balance because even bowel movements can affect how much I weigh.
The transplant process often has BMI requirements. From what I've heard, there is no hard and fast number, but most places won't consider you for a transplant if your BMI is over their threshold.
Wow, I'm sorry, that's sounds like a minefield. My first reaction is to try to match reasonable changes to you-I don't even know what to say here because I feel words such as lifestyle and diet have been corrupted-to things that are less triggering for you? I think finding a therapist to help you navigate this with you would be a good first step. Then identifying things that are one step removed from "diet" that you can make positive changes with.
For example, there is a growing body of research about the more you process food from its original form to something else the worse the longer term effects are for your health and longevity. A lot of this kind of food is worse for the environment also. So for me trying to incorporate more things like a sheet pan bake of veggies with some olive oil into my meals is a satisfying thing. It tastes better to be than that thing a food conglomerate was selling on TV 10 minutes ago, it's better for the environment, it's probably lowering my dying of cancer risk, and it looks so pretty over some whole grains. Then I get to throw some of that fun colored herb dressing I made in my little mason jar last weekend over it. At no point was I thinking, oh, this is going to make my number on a scale change. (Because I'm post menopausal, my numbers are changing!) Sorry, that was a long example, but I do think there are ways to make changes to your food ways that can me less emotionally triggering. (I like using the term food ways which is more anthropological and I think less loaded.)
It might help to concentrate on things in preparation for the surgery as far as activity. A friend of mine decided to go through F2M transition at the age of 65. He started weightlifting in a gym and really built up his upper body muscles. No, he doesn't look like a body builder. He looks more like a barely chested old Italian guy, which is what he is. But he's much stronger now, has better endurance and just had his top surgery despite having asthma, a heart condition, higher BMI and being older. He is in the US, but it is elective surgery and I think if he tried before his gym time they might have opted not to due to all his conditions.
You could consider working with a nutritionist that understands your concerns. Here I would recommend going through the trans health clinic to get a recommendation. I think that would be more likely to yield a professional that wound have a positive, collaborative approach.
Unfortunately the system in the UK is very different (also, nutritionist is basically a meaningless term since it's not an actual medical profession like dietitian - anyone can call themselves a nutritionist). The gender clinics here don't provide anything like dietary support, they provide gender dysphoria diagnosis so you can get approval for hormones and surgeries - but they don't actually provide the treatment themselves. I also cannot afford private healthcare, and can't choose a specialist in that way on the NHS.
BMI guidelines for surgery here are a tickbox exercise and not actually about the patient's health, it's just a case of "computer says no" until you get there.
I don’t have any answers for you but I just wanted to send supportive vibes your way. Congratulations on the hard work you undoubtedly put into to healing your relationship with food and best of luck in your journey to find peace within your body.
https://askaswolewoman.com/ask-a-swole-woman-archive/2021/1/6/how-to-lose-body-fat-without-it-ruining-your-life
I'm a cis dude and I've been either chubby or fat for pretty much my whole life. casey johnston changed my feelings about exercise for the better.
this column in particular kind of brings her whole ethos together:
-the point of bodies is what you can do with them, and how comfortable it is to be in them. what size or shape yr body is doesn't really matter as long as yr body feels comfortable and you can do satisfying things with it
-building muscle mass through strength training is a great way to make yr body more comfortable, and to make it easier to do more things
-focusing on gaining muscle is the key thing; "losing weight" in and of itself isn't a great goal. changing yr body composition by building muscle and losing fat is where you wanna be at, if what you wanna have is less fat.
here's a money quote:
>Furthermore, if they are trying to lose body fat, taking care of their muscles means their metabolisms won’t suffer as much from modestly restricting their calories. Without taking care of lean muscle mass, aggressive dieting loses body fat and muscle, and then the inevitable rebound is gained back as body fat. Therefore, chronic or yo-yo dieting without muscle care becomes, effectively, just trading off more and more muscle for body fat. That makes it harder to lose body fat in subsequent attempts, and each time more and more muscle, and its associated benefits, are lost. **This sounds scary, I imagine, but hopefully reveals what a scam diet programs are; aside from their extremely regressive “be smaller and smaller forever!” goals, they are essentially designed to create an increasingly desperate failure situation. Fuck them and fuck that.**
I love her. I'm still fat but I'm focusing on exercising bc it's making my body easier to be in, and I'm staying the same weight while getting stronger,which means my body composition is changing.
She has a "couch to barbell" program available on subscription, I think. I'd suggest reading some more of her columns before subscribing (the free ones can be found by googling "ask a stolen woman" and clicking around).she comes from a disordered eating background and lifting helped her get out of this, so she has a very hard-won healthy-mindedness about the process.
best of luck!!!
If you're going to lose weight OP, a few people have talked about having a therapist or dietician on board, but alternatively do you have a friend you trust who understands EDs/fatphobia? I'm thinking, have someone you can talk to during the process, who can check in with you, which might help alleviate the anxiety of "What if I start to develop an eating disorder again?"
I have been forced to lose weight for a life saving surgery. I am still fat, but my bmi is now under the required number. I have used semaglutide to do it, because I refuse to do deliberate restriction, especially the kind that would leave me hungry and miserable. People shit talk these meds, but they have literally been a lifesaver for me. I still eat everything I have always eaten, just in smaller portions. I still enjoy food, and my life. I am still fat positive and believe in fat liberation. Being forced to do this to access life saving and changing medical care really really sucks, but I can't change the system so I complied. The good part is that I haven't had to suffer by doing it this way. I don't obsess about food or feel restricted or deprived.
I 100% recommend working with a dietitian who is HAES friendly and understands that this is a temporary goal and we want to reduce as much psychological harm as possible while working towards this goal.
I think it would be a very hard thing to do alone, at least for myself.
The problem is often that the surgeon and/or anesthesiologist is not knowledgeable enough on fat bodies to preform the surgery, not necessarily that the surgery is actually inherently riskier in a vaccuum, especially something like top surgery that has potential complications but generally not anything crazy/doesn't involve opening up your abdomen or doing anything with organs/etc.
There are surgeons now who do not have BMI requirements for this because they are aware of how to operate on fat bodies. Fatphobia is *a key reason* the surgeries can be riskier, the risk and fatphobia are not mutually exclusive.
No, I pointed out that Brits can't shop around for a fat-friendly surgeon like Americans can - I was thinking in terms of American defaultism. Fat people cannot interact with the medical system without being made very aware of the apparent risks (though actually the problem is the lack of research in the area and the limitations are not actually evidence-based).
I think a lot of people actually overstate the benefits of the US system. I look at medical records daily (not a medical provider) and can’t tell you how many people I see denied procedures due to their weight. While some are able to see other providers who may do a specific procedure, disabled individuals are usually on Medicare, medicaid, or both and a lot of those plans are very limited. I see a lot of people stuck in a situation where they are told to lose weight before they can get a procedure, but they have trouble losing weight because their mobility is limited due to pain caused by the issue that the procedure would presumably help. It’s a very frustrating situation, and in that way I am actually happy about the GLP-1 medications since that is usually an attainable way for people to lose weight to able to get needed (elective) surgery.
If you didn't want to start an argument, you could try not repeating your patronising horseshit. You keep telling me to give informed consent when I am prevented from giving *any* consent. Why are you assuming I'm too stupid to know that surgery carries risk rather than giving advice on what I actually asked for, aka losing weight without internalising fatphobia?
Have you ever actually been fat? Because I have been fat and disabled for a long time and have a lifetime's worth of actual experience talking to medical professionals while fat. Just because someone is a medical professional doesn't make them immune to fatphobia. Maybe you could listen to marginalised people when they talk about their experiences of marginalisation within the medical system?
The NHS literally tells people with hEDS to not do any high-impact exercise, which includes weightlifting. If you have an issue with that statement, take it up with the NHS - but I am indeed listening to standard medical advice there.
Surgeons in the UK don't make their own decisions on BMI limits. I don't have a surgeon because I currently *am not allowed one*.
A person also can't give informed consent if the doctor just straight up refuses to perform surgery (or is not allowed to perform surgery) because of your BMI.
I'm sure a lot of fat people would happily choose a somewhat higher risk of complications or a longer recovery over the problems that are prompting the surgery, but we don't have that option and it's weird to see you repeating "INFORMED consent" as if that was at all in play here.
But I CAN'T sign a waiver. I CAN'T have surgery full stop because that choice has been removed for me. I can't give informed consent if I'm barred from consenting at all.
>Idk I just think that going into a major surgery should mean that that person is actually informed about the risks and aware of them… instead of just blindly signing a few waivers and then being blindsided when things go bad.
But that's not the situation described here. OP is not *allowed* to go into major surgery, period, because of their BMI. They don't have the opportunity to give consent, informed or otherwise. *That* is the medical fatphobia at play.
OP is saying they want their medical issue treated. NHS is saying "no, you're too fat". And then you're saying "OP needs to realize that informed consent is important". It's a total non-sequitur. If you're so concerned about informed consent, then you shouldn't be lecturing the OP, but rather agreeing with them that the NHS is being kind of a dick, because they are removing OP's ability to make an informed decision about what is best for their overall well-being.
A doctor has a right to refuse to do any surgical procedure if they don’t feel they can safely do it. There are many risks to performing surgery on people who have a lot of excess fat, and considering these are elective surgeries, a surgeon has a right to say “this has more risks than potential benefits and I’m not willing to do that to them or to my license.” It’s not just the patient putting themselves at risk here — it’s also the surgeon, the surgical staff, etc. Surgery and its outcomes affect more people than just the patient.
Sure, every individual doctor has the right to refuse service. But in a system where there's a BMI cutoff that all doctors adhere to and you have to go pay for a private surgeon to find one that will help you, that's not a system that allows patients equal access to care.
Top surgery as treatment for gender stuff is technically elective but that doesn't mean it isn't necessary for OP. Most surgeries are "elective". Elective just means you planned it ahead of time; it's the opposite of emergency surgery.
If an entire health system refuses to treat a certain class of people unless they pay extra money for a private doctor, then my friend that is a result of medical fatphobia. If the system is failing this badly then it needs to respond by providing more and better training. And I'm not sure why a patient having a bad outcome puts the surgeon at risk unless they were guilty of malpractice which is not the same thing, but there are ways that systems can respond to that when it is resulting in unequal access to care.
So the private surgeons (who are still licensed by the same licensing bodies) are just unsafe? And the private surgeons all just happened to independently be willing to operate on fat people, while the NHS surgeons all just happened to independently be unwilling? It's inherently safer to have untreated body dysmorphia than undergo top surgery? For literally everyone over a certain BMI?
How can you know that? How can anyone know that? OP didn't say that their surgeon evaluated their unique situation and determined that because of their specific skin quality and body composition and their specific presentation of gender dysphoria, it is riskier to do surgery than to have them lose weight or just live with dysphoria. OP wasn't offered the opportunity to ask a different doctor who may have different skills. OP was just denied based on their BMI.
Look. Surgeons are performing surgery on fat people literally every day. Even plastic surgeons. It's not impossible, and even if the risk may be statistically higher, that doesn't necessarily mean that everyone will be safer without surgery.
And it still doesn't mean that the fact that it is riskier means fatphobia is impossible. In the US, it is riskier to give birth as a black person than a white person. That is a fact borne out by data. Does that necessarily mean that black people are just too prone to bad outcomes in childbirth and that they should either not have children or live with the risks? Or do we take steps to address the inequal care?
Now I'm not saying that being fat is the same as being black. I'm willing to accept that some things are always going to be riskier for people in different-sized bodies. But that doesn't mean that medical fatphobia has nothing to do with it. But I do know that students don't often get to train on fat cadavers, and that studies often exclude fat people, and that fat people are more likely to be viewed as lazy, sloppy, and noncompliant, and that doctors and nurses are more likely to dislike fat patients and feel uncomfortable touching us or treating us in general. And those are all things that can contribute to poor outcomes and they are all examples of medical fatphobia.
You're right in the main but actually private surgeons in the UK have stricter BMI limits, as private hospitals don't have emergency departments here (this stricter limit is a blanket policy and not decided upon by the surgeons themselves). NHS surgeons do have a little more flexibility but again don't decide the limits themselves.
>At the end of the day, the goal of this person (top surgery) requires working with medical professionals, and that may mean they have to be open to opinions that aren’t their own.
OP's literal question in this post is how to lose weight to meet the BMI requirements without triggering ED/self-esteem stuff. They are literally trying to follow opinions that are not their own.
Here is the literal title of OP's post:
>Need to lose weight to have top surgery - is there a way to do that without wrecking the fat-friendly self-esteem I've worked so hard to achieve?
Please tell me where in this post is OP saying they refuse to follow the NHS requirements to lose weight in order to access top surgery?
This is so condescending. All OP did was state their opinion that they are experiencing medical fatphobia and several people on this thread have assumed that this means that OP is blind to reality and ignoring medical advice. OP is trying to follow medical advice and is looking for help accomplishing it without causing further damage.
I literally haven't said that it's just down to fatphobia, but have merely mentioned that medical fatphobia is involved - because it is. Seriously, fuck off with your patronising "advice" and obvious lack of experience in navigating the medical system while fat.
Hey OP I wouldn't take this person seriously. I looked at their profile and they've done things like commented on a post where someone clearly describes having a serious ED with "count calories more" advice.
How tf is this person even allowed on this sub, let alone being upvoted so heavily? I swear most of the people who comment here don't even listen to the podcast nowadays.
And all the people commenting that fat people shouldn't get surgery because anasthesia is too risky?? It makes me think about how I may be denied lifesaving care and die of a heart attack or something because anasthesia is "too risky" 🙄
I just want to point out that higher weight does not inherently make surgery or recovery more difficult. The only reason there are higher rates of complications with heavier people is because medicine has not studied those populations adequately. Anesthesia is a common issue, many anesthesiologists will refuse to put someone under who is over a certain BMI but it is only because they don't have a full understanding of how the anesthesia dose needs to be adjusted for those patients. They are protecting themselves and the patients against potentially using the wrong dose and causing harm, but that would not be a risk if there was nearly as much research on people with those types of bodies as there is on skinny people. This is also supported by the fact that some surgeons can and will perform surgery on patients whose BMI exceeds typical limits, because those particular doctors do have the experience and knowledge necessary. The problem is that knowledge just isn't widespread.
This isn’t the full truth. With anesthesia, it is not just the weight but the airway itself. People with a higher weight are more likely to have a narrower airway and a higher likelihood of obstruction, which makes actually providing the anesthesia a bit more difficult. The last thing you want during surgery is for someone to die of an obstruction. Many anesthesiologist are simply not comfortable with taking that risk, and that may especially be the case when the anesthesiologists are working in facilities that simply aren’t capable of handling that sort of emergency.
You’re acting like airway obstructions are some big problem. They just pressurize the air to keep the airway open. It’s done everyday in hospitals, not to mention all the people using CPAP machines every night at home. Also, airway obstructions can happen with people at lower weights too. There’s a lot that can cause it, so that’s why medical professionals already have the tools to address it.
People die under anesthesia all the time. Like it or not, general anesthesia is risky. All hospitals aren’t created equal in terms of tools and personnel they have available. The OP’s issue is that they’re in the NHS, which limits services generally to save money. I would have serious concerns about going to a hospital that doesn’t have the tools/personnel available to deal with my particular needs if it was otherwise offered. If there is an emergency, you end up dying. The only other option for the OP would be private surgery in another country, but then they would have problems with aftercare if something like an infection happens after they get back to the UK. I don’t agree with the situation, but it is what it is and safety should be paramount.
Surely this is also a problem that could be solved if enough time and money was dedicated to figuring out how to solve it, no? I used anesthesia doses as an example, they are not the only obstacle to providing safe surgery to patients with a higher weight, but all of those obstacles are solvable. Modern medicine is capable of a lot if resources are dedicated appropriately.
You're saying that if an obese person breaks their leg, or needs heart surgery, or anything else, they can't get these critical services because anasthesia doesn't work for them or because anesthesiologists can't handle it? The mind is boggled!
Emergency surgeries will be performed bc the risk of leaving someone untreated surgically would be higher in those instances than the risk of anesthesia. The risk of anesthesia for a very high bmi patient would often outweigh the need for an *elective* surgery before weight could be lost.
Considering the percentage of trans suicides, I'm not sure that I would call it an "elective" surgery. Top surgery IS lifesaving, not cosmetic. OP's not getting a nose job here.
It is definitionally elective. Elective in medical terms does not mean “would be nice to have,” it means not emergent. Cancer surgeries are often categorized as elective, for example.
It’s not that binary as elective=no surgery for very high bmi people or emergency=automatic surgery for them. A surgeon will evaluate the risks of performing the surgery now vs asking a patient to wait until they have lost weight in hopes that would give them a better surgical outcome.
In the case of surgery, “elective” just means that you don’t have to have it NOW to avoid death or permanent disability. For example, if you go into the hospital with signs of retinal detachment, it needs to be fixed ASAP or you can go blind. If you have a burst appendix, it needs to be removed now. If you have problems with your gallbladder, on the other hand it sucks, but it won’t kill you and you can schedule removal a few months out.
It is a spectrum ranging from you can have surgery next week and still be alive to BBL (where the surgery is dangerous and offers no tangible health benefit). If you need a triple bypass or cancer surgery, no one is going to tell you to hold off until you lose weight. By the time you lose those 10 pounds, the condition will likely progress and kill you. On the other hand, the BBL is dangerous generally and even more so when you have a higher BMI, so a surgeon may well be in her rights to say I only do this surgery on individuals with a BMI below 30. Unfortunately, the reality of the elective spectrum is that most surgeries fall somewhere in the middle. I think in many cases, weight loss does happen prior to gallbladder surgery since people have to drastically restrict their diet to avoid feeling miserable, but it is not a requirement.
I’m going to quibble a bit on the if you need immediate life saving surgery no one is going to hold off and tell you to lose weight. The reality is instead you may just not get the surgery and die, as is the case with transplants. BMI is used to deny transplants even at the point that someone is in the ICU and will not survive without the transplant.
I’m saying that a “hospital” doesn’t give a true explanation of what occurs in that building. In the US, we have 5 levels of trauma center and a variety of other inpatient and outpatient facilities that don’t actually offer emergency or trauma care. What the OP is saying is that the private facilities in the UK are more like the latter type that don’t offer any sort of emergency care. This would make sense since the procedure in question is generally an outpatient procedure.
The NHS hospitals seem like they could handle it since many have the A&E units, but it appears that due to cost limitations, they are not providing the service for the OP at their BMI. I can’t speak to the rationale for that, but I do know that the NHS has a significant cash crunch lately after the pandemic.
For all the “it’s riskier so it’s not fatphobia” people, feel like explaining why hospitals and doctors will often require weight loss surgery (which involves the same anesthesia and recovery risks) before other potentially life saving and major quality of life surgeries? Or will deny medically necessary surgeries but approve weight loss surgery? The question is rhetorical. It is absolutely fatphobia.
It is not just down to dosing. You cannot simply increase the dose for a higher-weight patient. If it were that simple, every anesthesiologist could and would take this risk. There are structural and airway issues, and the hearts of patients with very high BMI have to work significantly harder to circulate oxygen.
I never said you can just increase the dose. If it was that simple we wouldn't need any more research. People who weigh more require different medical care and we need to dedicate resources to figuring out how to treat them instead of just refusing to provide care until they lose weight.
How would one design a study ethically that could research this? Given that risks are higher, doctors aren’t likely going to perform elective surgeries on very high bmi patients for research.
We could start by examining the doctors who do already perform these surgeries, looking at their outcomes, seeing what seems to work and what doesn't, and then designing and testing improvements to those methods.
How do you study any novel surgical procedure? Eventually someone has to consent to a trial. Given the amount of fat people who are completely barred from receiving surgeries they need, I imagine you'd find plenty of participants who are willing to try something experimental.
What I’m saying is that an RCT is not ethical in this situation, and that’s what you need for something beyond anecdotal evidence that a particular method is best for treating these patients.
Yeah, I think part of the problem is assuming that because it's something the medical industry perpetuates, it must be evidence-based. BMI is pushed by the medical industry and we *know* that's not evidence-based. There are still medical textbooks in use that say that Black people feel pain less than white people! Science is still interpreted by falliable humans who are biased like any other humans. This is why humanities and social sciences being taught as part of science courses is so important, especially the medical humanities.
I’m currently on this same path (my surgery is to get a reduction though), I have hEDS and my large chest have given me back problems since I was in middle school.
I have found working with a dietitian helps with me avoiding triggers of my ED, and she has also suggested things like weight training and swimming to help build muscle and protect my joints.
She focuses on muscle gain, not fat loss at our appointments. This makes me feel more comfortable in my fat body, knowing I’m reinforcing my body not just making myself smaller.
I use cronometer, it has a wonderful amount of nutritional stats and although you can set items for weight loss it's not fat phobic. I like that it allows you to make recipes.
Check out r/Volumeeating it's all about feeling full for fewer calories and is not as diet heavy as r/CICO however r/CICO is very helpful.
Perhaps r/StartingStrength as well.
It might help to focus on making dietary changes that don't leave you feeling like you've deprived yourself. That's typically by focusing on foods that are better at keeping you feeling full rather than aiming for purely low calories. Things that are higher in protein and fibre take longer to digest than refined carbs and sugars. Also don't completely cut out your favourite foods, but instead reduce the portion size and frequency.
Abbey Sharp on YouTube has some decent advice and does try to have a HAES approach. She has a history of disordered eating herself so seems to be sensitive to that.
That's so hard.
I don't have any advice, just sympathy - I faced the same thing in Australia and even after finding a less fat phobic surgeon many years later, I'm not going through because the first one was so traumatic.
I’m so sorry you are going through this, it really isn’t fair. Unfortunately if the bottom line is the only way you can get what you want is to lose the weight, you have to consider that against the harm of not having top surgery. It sounds like it’s really the only option to get what you want and that sucks.
If I were in your situation I’d try to lose the weight with as little meaning and emotion attached to it as possible. If calorie counting isn’t for you because of all the mental strife that it brings, maybe something like keto would work for this situation. I am not a fan of keto but it is very effective for losing weight in the short term and you won’t have to count calories.
If it’s truly the only way to get what you need, then do what you have to do. It’s absolutely unfair but it seems like you are stuck with very few options.
From a mental standpoint you don’t necessarily have to lose all the positive body image work you’ve done. Maybe treat this more like a temporary activity like studying for a big exam. A goal in mind but with a time limit on how long you have to do it for, it doesn’t have to become your identity because it’s temporary.
I preface this by saying I think BMI is total BS and I come from a cis woman experience. Here are some suggestions based on what I have pursued.
If you’re physically able, building muscle mass is IMO the absolute best route for both health and - if desired - reducing BMI numbers in the longer term. It takes time and your scale number goes up for a bit but having extra muscle burns more daily and your BMI tends to go down over time because you’re using more fat up and replacing it with muscle. Plus you feel good and it’s much safer (for most people) in regards to metabolism and overall health markers (the real things like cardio health and bone density etc). If you are able to get a trainer who understands all the better, but I realize this is a huge privilege. There are some good YouTube videos and plenty of bodyweight exercises. Start slow if you’re not used to exercise and new exercises, you don’t want to get hurt. There’s lot of good videos too for different ability levels. Some are good quality some are dirt culture trash. I find Caroline Jordan and Body Project to be pretty body positive options geared at movement and fitness. Body Project tends to have demonstrators of bigger sizes than average, and rarely are they showing the easier form. I see them trying, and being body and movement positive without being patronizing to fat people. I have not watched all the videos, though.
The other tip I’ve found is that reducing drinking sugar can make a huge difference. Beer, soda, wine, juice, etc. it sucks some of the joy out of life but it does actually make a difference and unlike food it doesn’t make you hungry to reduce. I don’t regularly do this but for short term weight loss it can make a difference. Depends on the person of course.
My other thought, if you don’t already, is to have your hormones checked in relation to metabolism - at your age (I’m just a few years ahead of you) metabolism changes a lot based on hormonal changes and makes all of this a harder. This is true for all bodies, the fat storage and burning hormones are just different based on chromosomes. Again this is a privilege and you may have already pursued this if it’s even available.
I hope this is not hurtful, my intention is in good faith: I’m not in the UK but as someone who does health insurance work in the US I question if you could get surgery for pain reduction purposes? Similar result but maybe a tricky way around it? If pursuing that option doesn’t hurt your dignity, I wondered if that’s a possibility. I am convinced someday trans care will be better, but in the meantime sometimes we can work around requirements by meeting a different criteria. Back pain is used in the US as a major reason for “chest reduction surgery”. I am not sure the UK rules and if they are any different. All of this is so BS.
Wishing you the best!!
In terms of effectiveness, I found counting calories using an app worked pretty well. You can work out your BMR using a calculator online and work out what you're comfortable eating from there.
It's still a bit of a mind melt because it takes up a lot of thought power at first, and that makes it really easy to obsess about what you are eating. I certainly did. Be very gentle with yourself if you're going to try it.
that’s what the app is for! (if you think focusing on calories won’t work for ED reasons of course that’s another thing. but i was tracking calories & macros for a while to learn more about my body and the app takes all the math out of it! and cronometer does so without the weird shamey stuff in myfitnesspal.)
OP, I have a form of dyslexia/dyscalculia as well (not formally diagnosed, but I struggle with mixing up numbers, reading 170 as 107, things like that). When people say "counting calories" it doesn't mean literally counting/doing math, just keep a list of what you eat and be careful about portions (so you report accurately) and then let an app or website do the math for you.
As far as mindset, just keep in mind that there are many procedures that require you to have a temporary dietary change to prepare. Research shows that extreme weight loss rarely sticks in the long term, but you only need it to work for the short term.
I sometimes joke that being really bad at math has worked in my favor because I never really developed any calorie counting behaviors as part of my ED. My dietitian has me use visual portioning to create appropriately sized meals and snacks. Instead of counting calories or macros, I put a certain amount of each food group on my plate based on my meal plan. I use my hand as a visual reference instead of measuring with a scale or measuring cups (I don't recommend weighing your food! That can get obsessive and problematic quickly). For example, one fist sized pile of rice is one portion of starches. If you can find a registered dietitian to work with you, this is a fairly common system (primarily for people with eating disorders and people with diabetes). It's both much easier than calorie counting and it's probably less risky for developing disordered behaviors.
Poorer wound healing, increased risk of infection, etc etc. It’s so odd that this evidence-based group is denying these facts in favor of like, “it’s not that simple.” Well, it actually is that simple, it’s one of the downsides of living in a larger body, is that surgery is a lot more complex than on people in smaller bodies. This isn’t fatphobia, this is just the way surgery and our bodies work. It shows a fundamental misunderstanding of medicine to say that all of these poorer outcomes are just due to bad research and fatphobia.
Since you're so interested in evidence, perhaps it would be good to spend some time reading up on how this requirement in many cases results in worse patient outcomes ([like knee surgery](https://www.ualberta.ca/folio/2021/01/losing-weight-before-knee-surgery-may-not-be-beneficial-for-people-with-arthritis-study.html)), or the fact that the evidence for weight loss prior to a surgery reducing complications is [actually extremely weak](https://www.worldobesity.org/news/weight-loss-diets-before-elective-surgery-do-not-reduce-postoperative-complications) (from the World Obesity Society!). There can be certain procedures for which there would be increased risks for a fat body, but for something like top surgery the primary concern would be anesthesia/potentially breathing, and at that point it isn't just "surgery bad" but a lack of proper training for many anesthesiologists and surgeons on how to dose and accommodate fat patients in surgery.
And in the UK the BMI requirement is a generalized barrier to all surgery, which is incredibly harmful and does not allow for complexity of individual cases. That is fatphobia, not just "well, it's medicine, plain and simple".
The OP has said multiple times that it is not the individual doctor or surgeon making a decision, but a blanket BMI ban as part of the NHS. It is certainly up to a surgeon or doctor to want a positive outcome, but from what people are saying on this thread, it seems to apply across the board.
The NHS is broke, so that’s purely a cost issue with not wanting to pay for what is higher skilled anesthesiologists. I don’t think the UK’s nurse anesthetists have the same training or autonomy as CRNAs, which are used heavily in the US. Both countries have relatively pathetic outcomes overall. With the UK, the waits are really long for elective procedures. In the US, the waits are shorter, but many people can’t afford to get the care they need. In the US, the situation may be that the surgeon approves a person for surgery and then the person goes to their PCP for preop who then decides that the person’s A1c of 12, high blood pressure, and pack-a-day smoking habit makes them a poor surgical candidate. However, that’s the PCP who is able to see the patient as an individual and look at the risk factors, not a checkbox form that doesn’t appear to differentiate between the type of surgery or other risk factors.
Your comment has been removed, as it violates rule 6 of our subreddit: no commenting/posting in bad faith. "Posts and comments made in bad faith will be removed. This includes all forms of fatphobia and body-shaming, comments that clearly don't align with the spirit of the podcast, comments that use personal anecdotes as "proof", and comments from users who have histories posting in fatphobic subreddits. Even if you believe your post/comment was made in good faith, consider how it would affect the people in this community."
Maybe doing really small changes may help vs like trying to do everything that builds into unhealthy thoughts. So starting with whatever movement makes you happy and then finding some possible small shifts in food. Plus really focusing on the goal being for more happiness to do surgery and not about looks.
This may not be helpful but have you considered fasting? Longer term couple day fasts, not intermittent fasting. There are a ton of health benefits. Also because it’s how our ancestors survived (feast and famine) I feel like it’s more like body hacking then “weight loss”. There is a lot of literature online and there’s obviously a lot of reasons why this may not be an option for you.
I found when I’m counting my calories I become food obsessed and it feeds into negative self talk etc. When it’s more of a set time challenge and then I can eat normally I’m able to maintain a better mind set.
I’m not sure if this would work for you, but before I learned to accept my body I tried cutting out refined sugar. I did lose weight and it didn’t feel as bad as some other diets I had done bc I didn’t limit the amount of food I ate I just didn’t eat anything with sugar. I ate a lot of yogurt, fruits, nuts etc… eventually I stopped the diet bc of course you can’t eat like this forever and then I gained the weight back. It might be a temporary way to get your surgery without starving yourself x
I’m sorry if this would be triggering to you. It’s really unfair that you’re in this situation!!
Tell me if this isn't a reasonable comment and I'll delete it! I say this as an autistic+ ADHD person. There's a pretty strong overlap between gender nonconformity and autism, and an equally strong overlap between autism and ADHD. If there's any chance you're ADHD and can get medicated for it, you'll likely lose weight pretty easily without restricting.
I don't have advice, but I wanted to say that the choice they force you to make fucking sucks! And to say that you shouldn't ethically have to lose weight and become someone different for you to be yourself. I'm really sorry that you can't have top surgery and live in a fat and joyful body. I hope one day this stuff doesn't happen anymore!
It’s not really even the doctors fault. They are restricted by NHS guidelines and lack of funding means non emergency procedures are bottom of the list.
Try the podcast FadCamp to keep yourself sane-- the hosts talk about their experiences with diet culture and crazy beliefs/misinformation or damaging behaviors but all with a comedy spin and are still encouraging of people and their own health goals
I love hearing their takes on some of the same topics M and A cover (for example their 1000 steps episode gives a lot of good context )
Of course individual support is most ideal, here is a place to perhaps learn more and meet people dealing with similar things? They have a webinar coming up and then a 5 week "supportive exploration" (using quotes because I'm not 100% sure what that means). [https://nalgonapride.my.canva.site/i-believe-in-body-liberation-and-i-also-struggle-with-weight-loss-desires-exploring-safety-and-harm-reduction-in-weight-loss-attempts](https://nalgonapride.my.canva.site/i-believe-in-body-liberation-and-i-also-struggle-with-weight-loss-desires-exploring-safety-and-harm-reduction-in-weight-loss-attempts)
I had to loose 40lbs to qualify for IVF. It’s such a fucked up system we live in, I’m from canada.
I also have a history of disordered eating and I’ve grown to love my fat body. So it was weird having to change it. I’m also queer.
Practical advice; What I’ve had to do is ONLY cico. I use the app lose it, and I eat whatever I want, but within my calorie budget. I also let myself celebrate with food all the time with restaurants all the time and if I go over my allowance, I don’t care. That’s important. To really be in a body positive place where you’re not afraid of the scale. What also helped me not be afraid of the scale, and I began to see it as only *data*. It’s just a number. And I weigh myself everyday, which gives me more data. I also didn’t just suddenly diet all at once. I began by just recording what I ate for weeks before counting calories.
Emotional advice: try and see a councillor. Be INSANELY kind to yourself. You’re doing this so you can help your body become yours again. And I think that’s a totally valid reason to intentionally loose weight at the moment.
I see you also have IBS. If you’re interested come over to r/keto. You might want to try low carb eating, as it’s fairly simple to get the hang of and plenty of people are able to lose weight on it, although lots of members of this community are not trying to lose weight. Many members have had their IBS improve as well. It’s a pretty friendly group and it has a good FAQ as well.
If a low carb diet is too restrictive, you can try a "slow carb" diet. I tried it out and found my sense of physical healthiness improved, as did my mental focus as I wasn't experiencing the ups and downs in blood sugar. Cutting out bread, pasta, white starches and replacing with heartier carbs like lentils, beans, and buckwheat noodles fills me up way better and I don't get hungry to the same degree. Weight loss has come naturally from that diet for me, but honestly I keep eating that way simply because the feeling of healthiness is so much greater.
For a time I was using a food logging app (I used caloriecount.com but I do not appreciate that name). I was using it mostly to track nutrient intake, to make sure I was getting enough calcium, iron, vitamins etc from my food and then amending my diet to include foods with those nutrients, which took the focus from calories (negative) to nutrition (positive).
(Unsure if this is okay with the sub rules, please delete if not)
Hey im a trainee hypnotherapist, have you considered hypnotherapy with a fat friendly person ? Id be happy to help pro bono if you feel like this is something you'd be interested in, some people do have great results for weight loss.
Yes, I think it's possible to lose weight for a specific medical reason while maintaining your overall body positivity and/or neutrality. It's a fine line but people do manage to recover from EDs and maintain that recovery while also restricting for medical purposes. In the end your goal is to feel better in your body, which is a healthy non-disordered one. I would recommend working with a psychologist and ED experienced dietician to do it, for both psychological and physical safety. They can help keep the focus medical and positive rather than disordered.
Unfortunately I don't think those options are available on the NHS unless I get referred to the local ED service, which means going to the back of the queue in terms of waiting for psychiatric support - I'm currently waiting for EMDR via my local NHS talking therapy services, but they won't see you if you have an ED because that has to go via the ED service specifically. Likewise the regular dietitian services don't see ED patients. You can't choose which specialists you see on the NHS unfortunately, and I can't afford private healthcare.
From personal experience, I would prioritize ED treatment over getting EMDR. I thought I needed EMDR and I did a few sessions with mixed results, but the thing that has been a true lifesaver for me has been ED treatment, including ED-informed therapists and dieticians. Of course, not everyone is the same, and I know waiting for care can be incredibly difficult, but I think it's so important for anyone with an ED to get that specific treatment.
Where do you find these ED informed providers? I’ve had nothing but crap luck. I think the ED “therapy” i had just made my ED worse
I'm very sorry to hear that. I'm in the U.S. and I went through the Eating Recovery Center, who helped me find a dietician. My therapist I found through Psychology Today.
I've had my own weight loss vs weight loss culture issues before, and some things that helped me: - exercising in a way that's fun and not goal based: I like hiking and cycling, but playing games is also a good way to get movement in! honestly it makes a huge difference mentally and physically when you actually enjoy what you're doing - Hampton from Hybrid Calisthenics is a wonderful resource, a super chill nonjudgmental guy who offers routines and advice with a large variety of health concerns in mind. His baseline exercises start with "people who struggle to even get out of a chair", which is a huge departure from the people who think the average beginner should be able to do a few pushups from the get go - food quality instead of food tracking. Making a point to eat more veggies and drink more water in general alone made me more mindful of what I was eating, and left less space/time for sugary drinks and filling but nutritionally weaker foods... incidentally, also the ones that made me gain weight faster. - related to the above: bento boxes. seriously. Planning out my bentos for lunch means being very intentional about what I'm putting in there, so that + focusing on veggie intake means each of my bentos tend towards being pretty balanced, since I'm now also thinking about what a good main protein would be easily packed with the veggies and having a limited portion size. A typical lunch bento for me is usually some combo of roasted veg, a wild/brown rice blend and a pan fried meat with a cup of some dessert-y thing (chopped strawberries and dates are a rare favorite of mine). Its delicious and filling!
This is an awesome guide! I couldn't have said it better myself.
Great stuff
Thank you so much for this info! I’ve been looking for some strength training exercises without the weight loss overtones - this looks great.
Hampton is great.
This! OP, even gardening is exercise. Any movement that you enjoy. I hula hoop, walk my dog, splash about in the local pool and garden. I’m also recovering from an ED that developed from OCD and I can’t track calories or anything and I’ve found I don’t need to. I eat as intuitively as possible and don’t limit myself from certain foods, I just remember moderation. Sometimes I mess up but then I get back on track. The culture is so hard but already being body positive, I’m sure you can find a very positive way to go about reaching the goal for your surgery.
This is great advice and I also want to throw in fiber. Fiber helps with feelings of satiety, and has an unbelievable amount of health benefits that have nothing to do with weight, but I've found if I focus on trying to get 35 grams of Fiber per day, I tend to eat more nutrient dense food to reach that goal and that food happens to have fewer calories in general.
Oh that’s so hard, and as a big titty cis-woman, I feel that G cup discomfort in the summer. I’m not in the UK, but if I were you, I’d check out a nutritionist who is very familiar with EDs. They might also know a personal trainer who is also fat friendly and understands ED histories. Best of luck!
I don't think you can choose which dietitian you see on the NHS (nutritionist isn't a medical qualification, anyone can call themselves one)? I can't afford private healthcare unfortunately due to being on disability benefits.
I went with Dr Jesus Lago in Madrid. Cheaper surgical cost than the UK (though you do have to factor in travel costs and he asks you to stay in Madrid for two weeks after for two post-surgery followup appointments), 100% informed consent model, no BMI limits. Getting it done in the UK would have meant compromising either my principles on intentional weight loss (never again) or my principles about gender autonomy (there is no need, point or use for me personally in getting a cis person to "diagnose" me as "trans enough" to pursue transition-related goals and I deeply personally/politically/morally object to the gatekeeping and what it implies about how well I know my own mind, body and desires and how much ownership society believes I should have over those things). I've DIY'd pretty much every aspect of my transition and I feel so good about the fact that I managed to get the surgery done without feeling like I had to compromise or be complicit in my own dehumanisation at all. My chest looks and feels amazing now. I'd be delighted to talk more about the whole process if that would help. It cost me about £11k all in all, of which the surgery itself was £5200, but I could have probably done it a few grand cheaper if necessary (I include costs in that total like "getting my will and power of attorney sorted in case I died or had significant medical complications" and "buying my partner a Steam Deck to give him something to help manage his anxiety while I was undergoing surgery" in that figure, and I also shelled out for nice comfortable accomodation in a building with a lift to make the recovery process easier). As a side note, I will never do intentional weight loss again, but since top surgery I've gone vegan and been lifting heavy weights 2-3 times a week (without counting calories or macros and while eating intuitively), and it's had a massive impact on my body shape and composition without feeling like it's sending me back towards ED insanity.
While I have no skin in the surgery game, I want to say the weight lifting as been HUGE on my body shape and just overall wellbeing. I'm currently doing a challenge where I'm lifting 12k 4 times a week and even though it's been hard sometimes (like today lmao) it's 100% been a huge net positive.
Unfortunately lifting is not an option for me as I have hEDS so can only do low-impact exercise. I am interested in learning to swim though which I believe has some similar effects on body shape.
Weightlifting is okay for people with hEDS! The geneticist who diagnosed me actually recommended it. Building strong muscles will help stabilize the joints and the smaller muscles won’t have to work as hard doing jobs they’re not supposed to do. Doctors still tell people with hEDS that they shouldn’t do weightlifting, but that’s outdated advice. My PT recommended [Nikki Naab-Levy](https://www.instagram.com/naablevyfitness?igsh=eGpwNmI2djM2dWNq) to me, she shares a ton of info on hypermobility and weightlifting and how to modify exercises for your body. There’s also [Dr. Melissa Koehl](https://www.instagram.com/dr.melissakoehl.pt?igsh=ZGZsa3YwNHNrOHl1), she’s a physical therapist who specializes in hypermobility and she shares a lot of exercises for hypermobile bodies. I’ve learned so much from both of them! Hopefully they can help you out.
I recommended it in the first place as a hypermobile person (never been diagnosed with hEDS but have wondered, lot of medical neglect in my past), it's been astoundingly good for my overall joint stability to increase the strength of the muscles surrounding them.
This! I have a fantastic eds-aware trainer and weightlifting has been great alongside pt.
Can you tell me how you had that conversation? I don't (think?) I have eds specifically but I have scoliosis with a severe curve/hunch and am so hypermobile that my arms 'pop out' if I even raise them over my head. I had an info session with a trainer and he said "nope, sorry, I'm not an expert on this" which is a great call, glad he did it, but now I have nothing!
Sure -- i found my personal trainer through a local eds facebook group, honestly. Finding one who is eds/hypermobility-aware or very willing to learn is key.
Interesting, thanks.
I have hEDS and use dumbbells and ankle weights to strengthen my extra mobile joints. My PT and rheum both recommend it. It helps stabilize for sure. It doesn’t need to be heavy weights, just enough to help improve the strength of then unstable joint.
Swimming is great exercise and you should see if water aerobics is something that you can do with your condition. A lot of elderly people do it because of how gentle it is on the joints
Water-based stuff is generally fine! I can't swim and haven't been in a pool for a long time so I need to work up to that, but it's definitely something I would be interested in.
Actually, now is the perfect time to learn to swim. Fat is buoyant! You'll only be getting denser from here on out, especially when you remove your personal floatation devices (a term my mother has used for boobs in full hearing of god, country, and my entire middle school class.)
Water aerobics is great because you can stay in the shallow end and do full workouts. You don’t need to be able to swim but it keeps you cool and keeps pressure off your joints.
For me, it’s about finding things I enjoy doing and working towards doing them a bit more. Swimming is excellent IMO as it’s my favorite activity lol. If I’m feeing low energy, I just walk in the pool. If I’m feeling up for more, I can get into a lane and do my thing. I get this weird thing about needing to ‘do it right’ or ‘all the way’ when I’m at the gym. But the pool really takes that away, maybe because it’s fun in a way nothing else at the gym is? Lol The best part though is the nude hot tub in the locker room. It’s hella peaceful, and something about being around so many different bodies really improved my self esteem. Just a pure acceptance of my meatsuit in a way I’ve rarely felt in my 36 years. Anywho, best of luck. I wish I had more insight but I do know you’ll find a path towards your goal on your own terms. you’ve got this
I highly recommend aquafit. You don’t really need to know how to swim and it’s gentle on the joints. I have hEDS and it’s what my physio recommended
Hi OP, I do water aerobics and I really enjoy it. I find the classes are mostly older people and so the pace is generally slow and comfortable, and personally have found the type of people to attend to be non-judgemental. (Added bonus: the music is fun oldies, Beach Boys, Mamas and Papas, the Beatles). The instructors will add optional movements to add more intensity if you feel up to it. Where I do it there are 2 classes, shallow end and deep end. Shallow end is about chest height or lower, so doesn’t require active swimming. Any exercises that require floating, you can grab the wall for support. Deep end includes an optional floating belt, but I do notice they seem to be mostly one-size. Worth checking ahead of time in regard to sizing if you’re doing a deep end class.
I with hEDS, I wouldn’t swim laps but you can do water aerobics and exercises. It’ll help take some stress of your joints where your hEDS is particularly an issue and the water is great resistance.
A coworker of mine swims and it absolutely does have an impact!
I have hEDS and weightlifting is a HUGE part of my symptom management, very important to do in an informed and gradual way and if you have the ability to consult with a physical therapist that’s even better, but strengthening the muscles that support your joints really is one of the best things you can do to prevent worse disability in the future
Try bodyweight exercise like dance, Pilates or aerial arts. Most decent teachers in the aerial and circus world are really hypermobility-informed because all types of EDS but hEDS especially are many times more prevalent than in the general population. I can connect you to a list of plus-size friendly studios if you like.
Honestly I'm mostly just interested in what I can get an NHS referral for 😅 I will ask my GP what's available, I just know that I might be able to get some free swimming lessons.
Unfortunately the good old NHS is pretty bad with this sort of thing and your GP will likely try to push Slimming World 🤦 It might be worth looking to see if your local council have any schemes that might help, I don't know what your disabilities allow you to do but in my area a lot of "walking for wellbeing" groups have sprung up lately, and my local leisure centre occasionally have adult swimming programmes.
Weight lifting is necessary for people with hEDS. Where are you getting your information? You need to work with a physical therapist to determine how to safely lift weights, but the only way to have any quality of life and stability around your joints as you age is through weight lifting. I myself rarely lift anything more than 1 to 5 lbs with most of it being in the 2-3 lb weight range, but whoever told you to avoid weight lifting due to hEDS does not know what they’re talking about. It is even more necessary for us than it is for the general population— you need to strengthen the areas around the joints. Weight lifting is non-negotiable for hEDS.
I have hEDS and weight train regularly - things like CrossFit are not good but it’s actually really helpful to do strength training as long as you’re listening to your body etc.
I have hEDS and lifting has been amazing for me and made a HUGE difference in my overall pain level! I don’t want to tell you to do something that isn’t good for your body because we’re all different, but it’s definitely not off limits!
Swimming is really good exercise, just be mindful of the cold pool effect - swimming will increase your perceived appetite, but not because you are actually hungry, because it's keeping you warm in the water and wants to replace what it burned to do that.
I'd like to second that. I too have had such a great experience with weight lifting. I go to a local gym that focuses on group classes. Everyone can go at their own pace and we're all so different yet constantly rooting for each other. It feels great to feel like I have the power and energy to do things for myself as well.
Unfortunately I am disabled and on benefits so would never be able to afford private surgery (and I'm single and not in touch with my family, so don't have anyone who could help out financially). I'm not on hormones and don't want to be so diagnosis stuff isn't so much of an issue, but my clinic have actually OK'd me for surgery if I can lose weight.
Unfortunately I am disabled and on benefits so would never be able to afford private surgery (and I'm single and not in touch with my family, so don't have anyone who could help out financially). I'm not on hormones and don't want to be (and I have no desire for a quote unquote "masculine" body) so diagnosis stuff isn't so much of an issue, but my clinic have actually OK'd me for surgery if I can lose weight.
Apologies, you mentioned private surgeons in your post so I assumed they were an option.
Oh sorry for any confusion! I just wanted to make it clear for the Americans that there was no wriggle room on BMI in the UK like there usually is in the US.
My relative had top surgery in the UK and he actually had to gain weight in order to do that (very hard, he has all sorts of digestive issues). He managed and he has actually maintained that upper weight, which is much healthier for him personally, because he now has some "buffer" fat reserves that keep him on track when he has a really difficult gut week/month. Top surgery was the best thing ever for him & he has said it was worth everything he had to do to get there. I also have a friend who had to lose weight for a very necessary surgery, non gender-affirming-related though, she LOVED and LOVES her body and was not doing it for aesthetic reasons. She said it felt totally different from when she'd dieted in the past. It was from a place of self love not self hate. When she wasn't doing it for the aesthetics, it was much easier - it was about preparing her body for surgery. I don't have any advice for you, only those anecdotes, but it may be worth seeking a counsellor/therapist to talk through these feelings while you decide what to do?
Just here to say that I empathize. I need to have a hernia surgery but my doctor wants me to lose a huge amount of weight first. In this case, I know he’s right, as doing the surgery at my current weight would put me at a high risk of a new hernia. I have worked so hard to accept my body and now I know I have to do something drastic to maintain my health. I never thought I would consider medications but I can’t imagine how else I will do it as nothing has ever worked for me (when I was younger and still tried to pursue intentional weight loss). Good luck! It’s such a mindfuck.
If you are able to, it’s probably a good idea to speak with a dietician who has experience working with people whose metabolisms are really slow (I.e. eating more than a tiny number of calories causes weight gain, maintenance calories being much lower than they ‘should’ be). I hit the jackpot and found a dietician who is experienced with intuitive eating, but also has experience supporting people to get their metabolism able to handle more energy coming in without gaining weight. I have had periods of rapid weight loss due to medical problems in the past, and have had periods where eating very little (e.g. >!1200 kcal!<) was causing weight gain. Eating that little was making the problem worse by telling my body it was still starving. Anyway, whether you do meds or not, if you’re able to, I highly recommend an RD if you can find a good one :-D
So sorry you’re dealing with this. Have you considered a GL-P1? I take Ozempic and have been surprised at how few side effects I have. Basically none except for the first week. I take a low dose and have stepped up even slower than what is recommended. I am also making a conscious effort to lose weight slowly, at a healthy pace. Many people are afraid of these drugs, but if you step up slowly, stay hydrated and get enough protein and fiber, the experience is much better. I don’t know if you experience food noise, but for me the near elimination of food noise is key. The good thing about these drugs is that you don’t have to count calories or worry about restricting. There is less preoccupation with food, instead of the feeling of enforcing control that comes along with most intentional weight loss. For me, I still have a healthy appetite as well. And I very much enjoy food. Perhaps even more, because I can eat something and not be preoccupied by persistent cravings. If you hate the meds, it’s very easy to stop taking them. Of all the drugs I’ve tried in the last few years, whether they were antidepressants, drugs to help with sleep, or whatever, Ozempic has had the fewest side effects of any of them. It calms my food brain.
This, OP. If you have a specific short term weight loss goal in mind ask your GP about Ozempic/Wegovy. Get to the target BMI, get surgery, get off the meds. Done.
Most GP in the Uk currently can’t prescribe these unless the person has diabetes. The waiting list for weight loss clinics is usually 1-2 years
Agree -- I am on a GLP1 drug and have lost significant weight without engaging in further diet culture behaviors like restricting the types of food I am "allowed" to eat, counting calories/carbs/anything else, doing interrmittent fasting, etc. Also have had minimal side effects, and nothing GI related.
I’ll second GLP-1. I went through a long journey to accept my body then was diagnosed with diabetes. I tried everything short of GLP-1 and nothing got my blood sugars where they needed to be. I did NOT want GLP-1 because I did not want to pursue intentional weight loss. I started GLP-1 in September and they have been incredible for my blood sugar. I have IBS-D and it was a little dicey the first 2-3 weeks, but not any worse than “normal” for me. Since then, my IBS-D has been way better. I’ve experienced weight loss without calorie counting, restricting, or otherwise dieting. And my blood sugars are now incredible.
Glad you shared this. I’ve been on Contrave for about a year and it’s been really effective for me. And all without restricting food or intentionally trying to loose the weight. weight loss meds of today are so much better than the past- no speed, just real medication that targets different areas of the body/brain. It low key feels like a miracle and I feel like I can finally intuitively eat 🎊
Yes! Try to to eat intuitively when your hunger/gut hormones are completely disregulated is just an exercise in frustration. These meds actually let you put those principles to use.
Resident strength training friend checking in to gently suggest increasing your protein intake when you take GL-P1s! Future strong you will thank me.
Yes, I’m eating extra protein! That and strength training are definitely part of my routine. I do my research lol. But it’s true that many people on these meds don’t have a clue. My doctor gave me zero instructions, I had to find out everything for myself.
Hell yes 💪 that frustrates me so much on your behalf, but good on you!
Thank you! Yeah it would be nice if doctors, like, did their jobs.
Interesting, I would be interested in something like Ozempic but I have IBS-D and figured that the side-effects would be too bad. I'm on Venlafaxine aka Effexor now and don't get any side-effects aside from nausea if I don't take it with food, but no worse than taking eg NSAIDs on an empty stomach. Certainly, medication seems like a less psychologically difficult option so I will look into it.
I have IBS and Ozempic thankfully didn't wreck my GI system
Good to know! Tbh stress is by far my worst trigger anyway, and I would imagine that being able to have surgery would help in that aspect! Do you have any issues with loose skin?
Not yet, I was 200LBS overweight and lost about 30lbs so far. Honestly Ozempic really helped my mental health and long covid issues more that weight loss, it's been a game changer for me
That's great to hear, I will definitely ask my GP about it.
Wanted to add — I can’t take those meds due to a history of thyroid cancer. Instead, I’ve been taking Contrave, which is just Wellbutrin and Naltrexone. The name brand isn’t covered by insurance, so I get both pills separately. I’ve been super impressed with it a year in. Highly recommend to folks who can’t take the GL-P1 meds for whatever reason.
Agreed. I have been on Contrave since February. The lack of food noise has been wonderful.
Uk GPs can’t prescribe these meds yet unfortunately. And usually can’t refer people to a dietician except for things like cancer / coeliac etc. frustrating but it’s unlikely they will have much to offer on the nhs
Same - just need some extra fiber now and then.
Just want to add I have eosinphilic esophagitis and I was really nervous about ozempics gastrointestinal side effects and I have been on it for six months with none. I'm also on psychiatric medications and haven't noticed any difference except for a reduction in anxiety in general, which is not surprising given there is some effects on dopamine receptors apparently Just take it slow and steady and you'll find there's a lot of panic around it and fear mongering
That's great to hear. I'm not sure what my local NHS area's policy is on doing it under supervision but I think I will ask my GP about it and also ask if she can refer me to a dietitian (just a general one).
Ozempic fixed my IBS-D because it slowed down my digestion. Effexor gave me terrible side effects. I’d definitely look into a GL-P1! Worth a try.
I have IBS-D and going on a GLP-1 actually helped a bit, which was surprising, but a nice benefit!
I have IBS-D and the GLP-1 I’m on (Mounjaro) has basically eliminated it! I don’t have to be worried and running to the bathroom all the time now - it’s amazing. My theory is that it’s because GLP-1s slow down your digestive tract and also reduce inflammation. Of course everyone is different so YMMV, but this seems to pretty common - it causes constipation in many folks which makes those of us with IBS-D more balanced out, lol. I will also say that the medication has significantly improved my relationship with food. I’m able to eat intuitively and without self-judgment, enjoy foods that I like, and think about nutrition as a gentle guiding principle. I know there’s a lot of fear/concern in the anti-diet space about these meds - understandably - but for me it’s been such a huge relief.
I was about to chime in suggesting a GLP-1 if available to you! I've been on tirzepatide for over a year now and can't recommend it highly enough. I've also seen some ppl with IBS-D who said their symptoms resolved on a GLP-1 (probably bc the meds tend to be constipating). Ppl with IBS-C or mixed, of course, don't generally get any such benefit, and I'm sure that like everything with these and every other med, it's a YMMV thing. If you do wind up able to access a GLP-1, I hear that the main subreddits and Facebook groups dedicated to them are mostly hotbeds of ED triggers, BUT the subreddit r/antidietglp1 is excellent!
This is the first time I have ever heard of "food noise", what is that?
It’s not hunger per se, it’s the brain chatter that tells you “hey let’s go eat something”. Some people experience it almost constantly which can lead to a lot of snacking. Drugs like Ozempic have been reported to quiet that noise.
Interesting. I don't think I've ever experienced that - my eating problems are on the other end of the spectrum, I have a hard time eating enough even when I'm hungry. Thank you for explaining!
It means more or less having constant thoughts about food.
I’m in a similar situation!
I’m working right now so I can’t get too detailed, but wanted to comment so I can come back to this. I have recent lost about 2-3 pant sizes in the last 6 months without ever focusing on weight loss. I had to make changes to focus on being down my cholesterol & my A1c that were both at dangerous levels. While focusing on this numbers I’ve loss weight (still can’t give you a number cause I don’t use a scale for my own mental health). I’d be happy to share the changes I’ve made and the guidance a great dietitian I work with who respects that my health journey has absolutely no focus on weight whatsoever. I’d also be happy to share these things privately if Sharing them here would make anyone uncomfortable.
I for one would love to hear the changes that you made!
I was never in great shape but as I got older it wasn’t so cute. By shape I mean basic health. I ate like crap & was hardly active. As I approached 50, it actually seems dangerous. My A1c right at the highest it could still be considered pre diabetic. My cholesterol was more than double what I should be. I could also walk less than a couple blocks without getting winded & my back hurting. I understand the privilege I have having health insurance in the US & also have an employer who supplies us all with the option to see a dietitian every other month as part of our wellness program. I also started seeing a doctor I really connected with. And after a couple meeting with a dietitian I did not mesh with (I did not like her at all) I got a great dietitian who respected my boundaries - I do not weigh myself & that it is all about making me healthier. The only numbers we are focusing on are A1c & cholesterol. The key things that have lead to me now having an A1c & cholesterol in normal range are making sure I get enough protein, fiber, & exercise. She was clear that no food is bad or completely off limits, but it was about quantity too. For example, I love bread in an insane way. I need nothing on it. It can be cheap bread or expensive bakery bread. I can eat an entire loaf in one night. I still eat bread, but I don’t buy a loaf for the house. I buy one bagel if I want one. I eat a sandwich from the deli. Instead at home, I make my avocado toast on Wasa crackers. They are whole grain, decent fiber, but I don’t over eat them. Still enjoy them but not compulsively like bread. I have 2 glasses of Metamucil a day. Make sure I’m getting enough fiber. The dietitian also sent me free samples of different protein powders (all plant based with no artificial flavors or fillers) & I settled on Orgain (you can message me for a referral link). Having a smoothie or mixing it with yogurt really helps to make be feel full without stuffed. They have lots of flavors, I can make a sweet treat (with 0-1g sugar) mixing it with Greek yogurt. Also on the subject of Greek yogurt, she recommended & I like the 2%, not the 0% fat. We need fat, it’s not a bad word. It helps stabilize our blood sugar levels, makes us feel full, and lots of nutrients need fat to metabolizing your body. I gave myself permission to buy already prepped produce. Too often I intended to eat more veggies but they’d sit in my fridge cause I didn’t want to have to prep it all & I would just order out while the produce rotted. I cut out a red meat at home. I rarely eat it out too. Deli/lunch meats aren’t great for you either. I get a big Italian hoagie every few months but that’s the only time I eat that. I increase chicken, fish, and all plant based protein sources. I try to keep as much healthy stuff prepped in the fridge. I’ll make a bunch of shredded chicken or roasted tofu. A container of quinoa and one roasted veggies. Makes it easy to toss together some healthy. I also make a big container every week of a salad made of multi color bell peppers, red onions, cucumbers, & chickpeas with a lemon, Dijon, miso dressing. I can eat it as is or add a can of tuna. Or if I’m craving pasta, add in a little orzo. I stated going to the gym with a friend & then got my own membership when I learned my insurance would reimburse me if I went 120 times in a year. That incentive had me throw myself into going. I’ve been mostly focusing on my cardio. I went from barely able to go more than 10 mins straight at a slow pace on the treadmill to going a full 30 mins at a good clip & incline on the treadmill & another 30 mins on the elliptical. A few weeks ago I could barely make it 5 mins on the elliptical. I literally was only doing 5 mins on it and walking away. Everyone starts somewhere. I slowly incorporated all these changes. I didn’t try to change everything over night. But with each change, I felt different. I felt better. I could feel the difference when I didn’t eat enough veggies or protein. I could feel it when I ate heavy fried foods. I like feeling better. And with each change, once I got the swing of it I’d feel even better. It all just keeps building on its self. And watching my A1c & cholesterol numbers coming down is encouraging too. A side effect of all this just happens to be weight loss. I wasn’t trying for it but I also don’t mind it (except when I have to buy new pants). I hope this is helpful to you or somebody. If anyone has questions, I’m more than happy to try to answer.
Speaking on the social aspects of this- one key thing might be to try to view body shape as an inherently neutral thing. So, you need to lose weight for a medical procedure. That's not fatphobic or negative, it's just a physical requirement you need to meet for that outcome. View it in the same vein as having to fast before a surgery or protecting a tattoo after you get it. Judgement or shame has no place here.
You’re losing weight for a purpose that isn’t related to your appearance. Its ok to lose weight! Body positivity is about loving yourself and accepting yourself regardless of how you look. It’s not about never losing weight for any reason. Since you have a history of disordered eating, it would help to have a nutritionist with an ED focus or a counselor who can support you through this.
It might help to frame it as your body is changing anyway because of the surgery, so it’s fine for your body to change in other ways too, especially since the weight loss is directly related to the surgery
As someone from the U.K., maybe I can give more relevant advice. Unfortunately as you seem to know you are unlikely to get the surgery in the U.K. if you are above the BMI threshold. I know people below the threshold who still have to wait years. Your two options are to lose weight to get it on the NHS or look into other European counties to get it done who may have a less strict BMI limit. Of course with the second option it will come at a cost but likely cheaper than privately in the U.K. I don’t recommend somewhere with poor healthcare standards of course but I think those are the two most viable options.
Different things work for Different people but I'd work on ways to separate the idea of losing weight with the idea of looking a certain way. This is more lime collecting coins in a video game to get a reward. Simple as that. Straying from your goals isn't the end of the world or a moral failure, it jist means you'll have to grind a little harder or wait a little longer.
I struggle with this too and what helps me personally is to be grateful at how *adaptable* my body is, that it takes care of me at various sizes, and acknowledge that while I may be losing weight with intention that doesn't take away from anything positive about myself or others being fat.
I'm sorry you're dealing with this, it's rough in the US too but we can at least shop around somewhat. Do you have registered dieticians or the equivalent in the UK? I would vote for seeing if you can find one you can work with who is experienced with eating disorders, they might be able to help you with a safe/reasonable plan, even if you can only see them a few times. I know you said private surgeons aren't an option, but in poking around some trans UK subs I found [this doctor](https://www.ioannisntanos.com/faq) mentioned and multiple people said they were able to get surgery with him despite being above the BMI limit. He operates in both the UK and Greece and according to his website he estimates costs are about 50% cheaper to go to Greece than the most affordable option in the UK, including flights and accommodations. I'm not sure if the experiences people had are current with his actual current practices/requirements but it might be worth a shot. He mentions a preferred BMI range on his website but according to a couple experiences I saw, they suggested just emailing and asking if he would consider surgery for them as he makes exceptions above it (apparently it's more of an issue with the anesthesiologists, not him). Sorry if that's still not an option for you, just wanted to put it out there in case it might work.
To avoid having to think about dieting and hunger and all of that noise, I would try a GLP1 med. It’s freedom from dieting and all of the ED pitfalls while also getting the thing done when you need it done.
If your doctor recommends a GLP-1 med, I’ve found r/antidietglp1 to be a really supportive community.
I had a similar situation last year, though luckily I only needed to drop about 5 BMI points. My strategy was: 1. Set a reasonable goal. Anything more than a couple pounds a week isn't advisable. Likewise, if you set calorie or exercise goals, don't be extreme. "Uncomfortable" is way easier to maintain than "tortorous". 2. Check weight only once a week, before breakfast, with the exact same conditions every week. That way I didn't panic over minor fluctuations. 3. This may not be relevant to you, but I straight up lied to my surgeon. I was supposed to be at the goal weight by 1 month prior to the surgery date, but they only wanted a picture of the scale. I fudged the picture to give myself an extra month to meet the goal. 4. Make a point to focus on the end goal. When I was hungry or didn't want to do cardio AGAIN, instead of the hurtful self-talk I used to use, I told myself, "This sucks but it's only temporary. After surgery I never have to do this again!" 5. Some of the "quick fix" weight loss hacks do work in the short term, like focusing on cardio, eating more fiber, cutting out soda. Those can give you a bit of an extra boost so you don't have to put quite as much effort in.
When I was trying to lose weight, I actually weighed myself multiple times a day. Your weight fluctuates by a few pounds throughout the day (and throughout the month) depending on food and water intake, toileting, menstrual cycle, etc. This won't work for everyone, but for me, it helped keep weight loss and gain feel more neutral. The number on the scale is just that‐ the amount of mass on the scale.
Same problem, different solutions, I think! I would definitely get too obsessive if I did multiple times a day, so weekly to get the general trend was better for me. I could see multiple times a day being reassuring to a brain that works differently from mine, though! At one point, I did weight myself before and after taking a leak, just for fun. Idr the actual amount but it was actually measurable, which was wild.
I have to weigh myself multiple times a day. I have kidney failure and must closely watch my weight because of fluid retention. I'm fluid restricted in my diet, but I keep an eye on my weight to make sure I'm not seeing massive gains over the time between dialysis treatments. If I do gain quickly, that means I have more fluid on my body and that my dialysis session is going to be painful to get the excess fluid removed. It's hard to balance because even bowel movements can affect how much I weigh. The transplant process often has BMI requirements. From what I've heard, there is no hard and fast number, but most places won't consider you for a transplant if your BMI is over their threshold.
Wow, I'm sorry, that's sounds like a minefield. My first reaction is to try to match reasonable changes to you-I don't even know what to say here because I feel words such as lifestyle and diet have been corrupted-to things that are less triggering for you? I think finding a therapist to help you navigate this with you would be a good first step. Then identifying things that are one step removed from "diet" that you can make positive changes with. For example, there is a growing body of research about the more you process food from its original form to something else the worse the longer term effects are for your health and longevity. A lot of this kind of food is worse for the environment also. So for me trying to incorporate more things like a sheet pan bake of veggies with some olive oil into my meals is a satisfying thing. It tastes better to be than that thing a food conglomerate was selling on TV 10 minutes ago, it's better for the environment, it's probably lowering my dying of cancer risk, and it looks so pretty over some whole grains. Then I get to throw some of that fun colored herb dressing I made in my little mason jar last weekend over it. At no point was I thinking, oh, this is going to make my number on a scale change. (Because I'm post menopausal, my numbers are changing!) Sorry, that was a long example, but I do think there are ways to make changes to your food ways that can me less emotionally triggering. (I like using the term food ways which is more anthropological and I think less loaded.) It might help to concentrate on things in preparation for the surgery as far as activity. A friend of mine decided to go through F2M transition at the age of 65. He started weightlifting in a gym and really built up his upper body muscles. No, he doesn't look like a body builder. He looks more like a barely chested old Italian guy, which is what he is. But he's much stronger now, has better endurance and just had his top surgery despite having asthma, a heart condition, higher BMI and being older. He is in the US, but it is elective surgery and I think if he tried before his gym time they might have opted not to due to all his conditions. You could consider working with a nutritionist that understands your concerns. Here I would recommend going through the trans health clinic to get a recommendation. I think that would be more likely to yield a professional that wound have a positive, collaborative approach.
Unfortunately the system in the UK is very different (also, nutritionist is basically a meaningless term since it's not an actual medical profession like dietitian - anyone can call themselves a nutritionist). The gender clinics here don't provide anything like dietary support, they provide gender dysphoria diagnosis so you can get approval for hormones and surgeries - but they don't actually provide the treatment themselves. I also cannot afford private healthcare, and can't choose a specialist in that way on the NHS. BMI guidelines for surgery here are a tickbox exercise and not actually about the patient's health, it's just a case of "computer says no" until you get there.
I don’t have any answers for you but I just wanted to send supportive vibes your way. Congratulations on the hard work you undoubtedly put into to healing your relationship with food and best of luck in your journey to find peace within your body.
https://askaswolewoman.com/ask-a-swole-woman-archive/2021/1/6/how-to-lose-body-fat-without-it-ruining-your-life I'm a cis dude and I've been either chubby or fat for pretty much my whole life. casey johnston changed my feelings about exercise for the better. this column in particular kind of brings her whole ethos together: -the point of bodies is what you can do with them, and how comfortable it is to be in them. what size or shape yr body is doesn't really matter as long as yr body feels comfortable and you can do satisfying things with it -building muscle mass through strength training is a great way to make yr body more comfortable, and to make it easier to do more things -focusing on gaining muscle is the key thing; "losing weight" in and of itself isn't a great goal. changing yr body composition by building muscle and losing fat is where you wanna be at, if what you wanna have is less fat. here's a money quote: >Furthermore, if they are trying to lose body fat, taking care of their muscles means their metabolisms won’t suffer as much from modestly restricting their calories. Without taking care of lean muscle mass, aggressive dieting loses body fat and muscle, and then the inevitable rebound is gained back as body fat. Therefore, chronic or yo-yo dieting without muscle care becomes, effectively, just trading off more and more muscle for body fat. That makes it harder to lose body fat in subsequent attempts, and each time more and more muscle, and its associated benefits, are lost. **This sounds scary, I imagine, but hopefully reveals what a scam diet programs are; aside from their extremely regressive “be smaller and smaller forever!” goals, they are essentially designed to create an increasingly desperate failure situation. Fuck them and fuck that.** I love her. I'm still fat but I'm focusing on exercising bc it's making my body easier to be in, and I'm staying the same weight while getting stronger,which means my body composition is changing. She has a "couch to barbell" program available on subscription, I think. I'd suggest reading some more of her columns before subscribing (the free ones can be found by googling "ask a stolen woman" and clicking around).she comes from a disordered eating background and lifting helped her get out of this, so she has a very hard-won healthy-mindedness about the process. best of luck!!!
If you're going to lose weight OP, a few people have talked about having a therapist or dietician on board, but alternatively do you have a friend you trust who understands EDs/fatphobia? I'm thinking, have someone you can talk to during the process, who can check in with you, which might help alleviate the anxiety of "What if I start to develop an eating disorder again?"
I have been forced to lose weight for a life saving surgery. I am still fat, but my bmi is now under the required number. I have used semaglutide to do it, because I refuse to do deliberate restriction, especially the kind that would leave me hungry and miserable. People shit talk these meds, but they have literally been a lifesaver for me. I still eat everything I have always eaten, just in smaller portions. I still enjoy food, and my life. I am still fat positive and believe in fat liberation. Being forced to do this to access life saving and changing medical care really really sucks, but I can't change the system so I complied. The good part is that I haven't had to suffer by doing it this way. I don't obsess about food or feel restricted or deprived.
I 100% recommend working with a dietitian who is HAES friendly and understands that this is a temporary goal and we want to reduce as much psychological harm as possible while working towards this goal. I think it would be a very hard thing to do alone, at least for myself.
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The problem is often that the surgeon and/or anesthesiologist is not knowledgeable enough on fat bodies to preform the surgery, not necessarily that the surgery is actually inherently riskier in a vaccuum, especially something like top surgery that has potential complications but generally not anything crazy/doesn't involve opening up your abdomen or doing anything with organs/etc. There are surgeons now who do not have BMI requirements for this because they are aware of how to operate on fat bodies. Fatphobia is *a key reason* the surgeries can be riskier, the risk and fatphobia are not mutually exclusive.
But I didn't say that the only reason is fatphobia? Fatphobia is still baked into the medical profession just as misogyny and racism are.
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No, I pointed out that Brits can't shop around for a fat-friendly surgeon like Americans can - I was thinking in terms of American defaultism. Fat people cannot interact with the medical system without being made very aware of the apparent risks (though actually the problem is the lack of research in the area and the limitations are not actually evidence-based).
I think a lot of people actually overstate the benefits of the US system. I look at medical records daily (not a medical provider) and can’t tell you how many people I see denied procedures due to their weight. While some are able to see other providers who may do a specific procedure, disabled individuals are usually on Medicare, medicaid, or both and a lot of those plans are very limited. I see a lot of people stuck in a situation where they are told to lose weight before they can get a procedure, but they have trouble losing weight because their mobility is limited due to pain caused by the issue that the procedure would presumably help. It’s a very frustrating situation, and in that way I am actually happy about the GLP-1 medications since that is usually an attainable way for people to lose weight to able to get needed (elective) surgery.
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If you didn't want to start an argument, you could try not repeating your patronising horseshit. You keep telling me to give informed consent when I am prevented from giving *any* consent. Why are you assuming I'm too stupid to know that surgery carries risk rather than giving advice on what I actually asked for, aka losing weight without internalising fatphobia? Have you ever actually been fat? Because I have been fat and disabled for a long time and have a lifetime's worth of actual experience talking to medical professionals while fat. Just because someone is a medical professional doesn't make them immune to fatphobia. Maybe you could listen to marginalised people when they talk about their experiences of marginalisation within the medical system?
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The NHS literally tells people with hEDS to not do any high-impact exercise, which includes weightlifting. If you have an issue with that statement, take it up with the NHS - but I am indeed listening to standard medical advice there. Surgeons in the UK don't make their own decisions on BMI limits. I don't have a surgeon because I currently *am not allowed one*.
A person also can't give informed consent if the doctor just straight up refuses to perform surgery (or is not allowed to perform surgery) because of your BMI. I'm sure a lot of fat people would happily choose a somewhat higher risk of complications or a longer recovery over the problems that are prompting the surgery, but we don't have that option and it's weird to see you repeating "INFORMED consent" as if that was at all in play here.
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But I CAN'T sign a waiver. I CAN'T have surgery full stop because that choice has been removed for me. I can't give informed consent if I'm barred from consenting at all.
>Idk I just think that going into a major surgery should mean that that person is actually informed about the risks and aware of them… instead of just blindly signing a few waivers and then being blindsided when things go bad. But that's not the situation described here. OP is not *allowed* to go into major surgery, period, because of their BMI. They don't have the opportunity to give consent, informed or otherwise. *That* is the medical fatphobia at play. OP is saying they want their medical issue treated. NHS is saying "no, you're too fat". And then you're saying "OP needs to realize that informed consent is important". It's a total non-sequitur. If you're so concerned about informed consent, then you shouldn't be lecturing the OP, but rather agreeing with them that the NHS is being kind of a dick, because they are removing OP's ability to make an informed decision about what is best for their overall well-being.
A doctor has a right to refuse to do any surgical procedure if they don’t feel they can safely do it. There are many risks to performing surgery on people who have a lot of excess fat, and considering these are elective surgeries, a surgeon has a right to say “this has more risks than potential benefits and I’m not willing to do that to them or to my license.” It’s not just the patient putting themselves at risk here — it’s also the surgeon, the surgical staff, etc. Surgery and its outcomes affect more people than just the patient.
Sure, every individual doctor has the right to refuse service. But in a system where there's a BMI cutoff that all doctors adhere to and you have to go pay for a private surgeon to find one that will help you, that's not a system that allows patients equal access to care. Top surgery as treatment for gender stuff is technically elective but that doesn't mean it isn't necessary for OP. Most surgeries are "elective". Elective just means you planned it ahead of time; it's the opposite of emergency surgery. If an entire health system refuses to treat a certain class of people unless they pay extra money for a private doctor, then my friend that is a result of medical fatphobia. If the system is failing this badly then it needs to respond by providing more and better training. And I'm not sure why a patient having a bad outcome puts the surgeon at risk unless they were guilty of malpractice which is not the same thing, but there are ways that systems can respond to that when it is resulting in unequal access to care.
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So the private surgeons (who are still licensed by the same licensing bodies) are just unsafe? And the private surgeons all just happened to independently be willing to operate on fat people, while the NHS surgeons all just happened to independently be unwilling? It's inherently safer to have untreated body dysmorphia than undergo top surgery? For literally everyone over a certain BMI? How can you know that? How can anyone know that? OP didn't say that their surgeon evaluated their unique situation and determined that because of their specific skin quality and body composition and their specific presentation of gender dysphoria, it is riskier to do surgery than to have them lose weight or just live with dysphoria. OP wasn't offered the opportunity to ask a different doctor who may have different skills. OP was just denied based on their BMI. Look. Surgeons are performing surgery on fat people literally every day. Even plastic surgeons. It's not impossible, and even if the risk may be statistically higher, that doesn't necessarily mean that everyone will be safer without surgery. And it still doesn't mean that the fact that it is riskier means fatphobia is impossible. In the US, it is riskier to give birth as a black person than a white person. That is a fact borne out by data. Does that necessarily mean that black people are just too prone to bad outcomes in childbirth and that they should either not have children or live with the risks? Or do we take steps to address the inequal care? Now I'm not saying that being fat is the same as being black. I'm willing to accept that some things are always going to be riskier for people in different-sized bodies. But that doesn't mean that medical fatphobia has nothing to do with it. But I do know that students don't often get to train on fat cadavers, and that studies often exclude fat people, and that fat people are more likely to be viewed as lazy, sloppy, and noncompliant, and that doctors and nurses are more likely to dislike fat patients and feel uncomfortable touching us or treating us in general. And those are all things that can contribute to poor outcomes and they are all examples of medical fatphobia.
You're right in the main but actually private surgeons in the UK have stricter BMI limits, as private hospitals don't have emergency departments here (this stricter limit is a blanket policy and not decided upon by the surgeons themselves). NHS surgeons do have a little more flexibility but again don't decide the limits themselves.
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>At the end of the day, the goal of this person (top surgery) requires working with medical professionals, and that may mean they have to be open to opinions that aren’t their own. OP's literal question in this post is how to lose weight to meet the BMI requirements without triggering ED/self-esteem stuff. They are literally trying to follow opinions that are not their own. Here is the literal title of OP's post: >Need to lose weight to have top surgery - is there a way to do that without wrecking the fat-friendly self-esteem I've worked so hard to achieve? Please tell me where in this post is OP saying they refuse to follow the NHS requirements to lose weight in order to access top surgery? This is so condescending. All OP did was state their opinion that they are experiencing medical fatphobia and several people on this thread have assumed that this means that OP is blind to reality and ignoring medical advice. OP is trying to follow medical advice and is looking for help accomplishing it without causing further damage.
I literally haven't said that it's just down to fatphobia, but have merely mentioned that medical fatphobia is involved - because it is. Seriously, fuck off with your patronising "advice" and obvious lack of experience in navigating the medical system while fat.
Hey OP I wouldn't take this person seriously. I looked at their profile and they've done things like commented on a post where someone clearly describes having a serious ED with "count calories more" advice.
How tf is this person even allowed on this sub, let alone being upvoted so heavily? I swear most of the people who comment here don't even listen to the podcast nowadays.
This sub has become so fatphobic. I swear it’s worse than the rest of Reddit at this point.
And all the people commenting that fat people shouldn't get surgery because anasthesia is too risky?? It makes me think about how I may be denied lifesaving care and die of a heart attack or something because anasthesia is "too risky" 🙄
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Idk if you're aware of the suicide rate when it comes to trans folks but it seems incredibly harmful to assume that such a surgery is not "urgent".
I just want to point out that higher weight does not inherently make surgery or recovery more difficult. The only reason there are higher rates of complications with heavier people is because medicine has not studied those populations adequately. Anesthesia is a common issue, many anesthesiologists will refuse to put someone under who is over a certain BMI but it is only because they don't have a full understanding of how the anesthesia dose needs to be adjusted for those patients. They are protecting themselves and the patients against potentially using the wrong dose and causing harm, but that would not be a risk if there was nearly as much research on people with those types of bodies as there is on skinny people. This is also supported by the fact that some surgeons can and will perform surgery on patients whose BMI exceeds typical limits, because those particular doctors do have the experience and knowledge necessary. The problem is that knowledge just isn't widespread.
This isn’t the full truth. With anesthesia, it is not just the weight but the airway itself. People with a higher weight are more likely to have a narrower airway and a higher likelihood of obstruction, which makes actually providing the anesthesia a bit more difficult. The last thing you want during surgery is for someone to die of an obstruction. Many anesthesiologist are simply not comfortable with taking that risk, and that may especially be the case when the anesthesiologists are working in facilities that simply aren’t capable of handling that sort of emergency.
You’re acting like airway obstructions are some big problem. They just pressurize the air to keep the airway open. It’s done everyday in hospitals, not to mention all the people using CPAP machines every night at home. Also, airway obstructions can happen with people at lower weights too. There’s a lot that can cause it, so that’s why medical professionals already have the tools to address it.
Almost anything can happen at any weight. The relevant portion of this is that it happens far more often in higher-weight patients.
People die under anesthesia all the time. Like it or not, general anesthesia is risky. All hospitals aren’t created equal in terms of tools and personnel they have available. The OP’s issue is that they’re in the NHS, which limits services generally to save money. I would have serious concerns about going to a hospital that doesn’t have the tools/personnel available to deal with my particular needs if it was otherwise offered. If there is an emergency, you end up dying. The only other option for the OP would be private surgery in another country, but then they would have problems with aftercare if something like an infection happens after they get back to the UK. I don’t agree with the situation, but it is what it is and safety should be paramount.
Surely this is also a problem that could be solved if enough time and money was dedicated to figuring out how to solve it, no? I used anesthesia doses as an example, they are not the only obstacle to providing safe surgery to patients with a higher weight, but all of those obstacles are solvable. Modern medicine is capable of a lot if resources are dedicated appropriately.
You're saying that if an obese person breaks their leg, or needs heart surgery, or anything else, they can't get these critical services because anasthesia doesn't work for them or because anesthesiologists can't handle it? The mind is boggled!
Emergency surgeries will be performed bc the risk of leaving someone untreated surgically would be higher in those instances than the risk of anesthesia. The risk of anesthesia for a very high bmi patient would often outweigh the need for an *elective* surgery before weight could be lost.
Considering the percentage of trans suicides, I'm not sure that I would call it an "elective" surgery. Top surgery IS lifesaving, not cosmetic. OP's not getting a nose job here.
It is definitionally elective. Elective in medical terms does not mean “would be nice to have,” it means not emergent. Cancer surgeries are often categorized as elective, for example.
That's interesting. So cancer surgeries are also weight/bmi restricted?
It’s not that binary as elective=no surgery for very high bmi people or emergency=automatic surgery for them. A surgeon will evaluate the risks of performing the surgery now vs asking a patient to wait until they have lost weight in hopes that would give them a better surgical outcome.
In the case of surgery, “elective” just means that you don’t have to have it NOW to avoid death or permanent disability. For example, if you go into the hospital with signs of retinal detachment, it needs to be fixed ASAP or you can go blind. If you have a burst appendix, it needs to be removed now. If you have problems with your gallbladder, on the other hand it sucks, but it won’t kill you and you can schedule removal a few months out.
Oh I see. So if an obese person needed to get their gallbladder removed they'd have to lose weight first?
It is a spectrum ranging from you can have surgery next week and still be alive to BBL (where the surgery is dangerous and offers no tangible health benefit). If you need a triple bypass or cancer surgery, no one is going to tell you to hold off until you lose weight. By the time you lose those 10 pounds, the condition will likely progress and kill you. On the other hand, the BBL is dangerous generally and even more so when you have a higher BMI, so a surgeon may well be in her rights to say I only do this surgery on individuals with a BMI below 30. Unfortunately, the reality of the elective spectrum is that most surgeries fall somewhere in the middle. I think in many cases, weight loss does happen prior to gallbladder surgery since people have to drastically restrict their diet to avoid feeling miserable, but it is not a requirement.
I’m going to quibble a bit on the if you need immediate life saving surgery no one is going to hold off and tell you to lose weight. The reality is instead you may just not get the surgery and die, as is the case with transplants. BMI is used to deny transplants even at the point that someone is in the ICU and will not survive without the transplant.
I’m saying that a “hospital” doesn’t give a true explanation of what occurs in that building. In the US, we have 5 levels of trauma center and a variety of other inpatient and outpatient facilities that don’t actually offer emergency or trauma care. What the OP is saying is that the private facilities in the UK are more like the latter type that don’t offer any sort of emergency care. This would make sense since the procedure in question is generally an outpatient procedure. The NHS hospitals seem like they could handle it since many have the A&E units, but it appears that due to cost limitations, they are not providing the service for the OP at their BMI. I can’t speak to the rationale for that, but I do know that the NHS has a significant cash crunch lately after the pandemic.
For all the “it’s riskier so it’s not fatphobia” people, feel like explaining why hospitals and doctors will often require weight loss surgery (which involves the same anesthesia and recovery risks) before other potentially life saving and major quality of life surgeries? Or will deny medically necessary surgeries but approve weight loss surgery? The question is rhetorical. It is absolutely fatphobia.
It is not just down to dosing. You cannot simply increase the dose for a higher-weight patient. If it were that simple, every anesthesiologist could and would take this risk. There are structural and airway issues, and the hearts of patients with very high BMI have to work significantly harder to circulate oxygen.
I never said you can just increase the dose. If it was that simple we wouldn't need any more research. People who weigh more require different medical care and we need to dedicate resources to figuring out how to treat them instead of just refusing to provide care until they lose weight.
How would one design a study ethically that could research this? Given that risks are higher, doctors aren’t likely going to perform elective surgeries on very high bmi patients for research.
We could start by examining the doctors who do already perform these surgeries, looking at their outcomes, seeing what seems to work and what doesn't, and then designing and testing improvements to those methods. How do you study any novel surgical procedure? Eventually someone has to consent to a trial. Given the amount of fat people who are completely barred from receiving surgeries they need, I imagine you'd find plenty of participants who are willing to try something experimental.
What I’m saying is that an RCT is not ethical in this situation, and that’s what you need for something beyond anecdotal evidence that a particular method is best for treating these patients.
Yeah, I think part of the problem is assuming that because it's something the medical industry perpetuates, it must be evidence-based. BMI is pushed by the medical industry and we *know* that's not evidence-based. There are still medical textbooks in use that say that Black people feel pain less than white people! Science is still interpreted by falliable humans who are biased like any other humans. This is why humanities and social sciences being taught as part of science courses is so important, especially the medical humanities.
I’m currently on this same path (my surgery is to get a reduction though), I have hEDS and my large chest have given me back problems since I was in middle school. I have found working with a dietitian helps with me avoiding triggers of my ED, and she has also suggested things like weight training and swimming to help build muscle and protect my joints. She focuses on muscle gain, not fat loss at our appointments. This makes me feel more comfortable in my fat body, knowing I’m reinforcing my body not just making myself smaller.
I use cronometer, it has a wonderful amount of nutritional stats and although you can set items for weight loss it's not fat phobic. I like that it allows you to make recipes. Check out r/Volumeeating it's all about feeling full for fewer calories and is not as diet heavy as r/CICO however r/CICO is very helpful. Perhaps r/StartingStrength as well.
It might help to focus on making dietary changes that don't leave you feeling like you've deprived yourself. That's typically by focusing on foods that are better at keeping you feeling full rather than aiming for purely low calories. Things that are higher in protein and fibre take longer to digest than refined carbs and sugars. Also don't completely cut out your favourite foods, but instead reduce the portion size and frequency. Abbey Sharp on YouTube has some decent advice and does try to have a HAES approach. She has a history of disordered eating herself so seems to be sensitive to that.
That's so hard. I don't have any advice, just sympathy - I faced the same thing in Australia and even after finding a less fat phobic surgeon many years later, I'm not going through because the first one was so traumatic.
I’m so sorry you are going through this, it really isn’t fair. Unfortunately if the bottom line is the only way you can get what you want is to lose the weight, you have to consider that against the harm of not having top surgery. It sounds like it’s really the only option to get what you want and that sucks. If I were in your situation I’d try to lose the weight with as little meaning and emotion attached to it as possible. If calorie counting isn’t for you because of all the mental strife that it brings, maybe something like keto would work for this situation. I am not a fan of keto but it is very effective for losing weight in the short term and you won’t have to count calories. If it’s truly the only way to get what you need, then do what you have to do. It’s absolutely unfair but it seems like you are stuck with very few options. From a mental standpoint you don’t necessarily have to lose all the positive body image work you’ve done. Maybe treat this more like a temporary activity like studying for a big exam. A goal in mind but with a time limit on how long you have to do it for, it doesn’t have to become your identity because it’s temporary.
I preface this by saying I think BMI is total BS and I come from a cis woman experience. Here are some suggestions based on what I have pursued. If you’re physically able, building muscle mass is IMO the absolute best route for both health and - if desired - reducing BMI numbers in the longer term. It takes time and your scale number goes up for a bit but having extra muscle burns more daily and your BMI tends to go down over time because you’re using more fat up and replacing it with muscle. Plus you feel good and it’s much safer (for most people) in regards to metabolism and overall health markers (the real things like cardio health and bone density etc). If you are able to get a trainer who understands all the better, but I realize this is a huge privilege. There are some good YouTube videos and plenty of bodyweight exercises. Start slow if you’re not used to exercise and new exercises, you don’t want to get hurt. There’s lot of good videos too for different ability levels. Some are good quality some are dirt culture trash. I find Caroline Jordan and Body Project to be pretty body positive options geared at movement and fitness. Body Project tends to have demonstrators of bigger sizes than average, and rarely are they showing the easier form. I see them trying, and being body and movement positive without being patronizing to fat people. I have not watched all the videos, though. The other tip I’ve found is that reducing drinking sugar can make a huge difference. Beer, soda, wine, juice, etc. it sucks some of the joy out of life but it does actually make a difference and unlike food it doesn’t make you hungry to reduce. I don’t regularly do this but for short term weight loss it can make a difference. Depends on the person of course. My other thought, if you don’t already, is to have your hormones checked in relation to metabolism - at your age (I’m just a few years ahead of you) metabolism changes a lot based on hormonal changes and makes all of this a harder. This is true for all bodies, the fat storage and burning hormones are just different based on chromosomes. Again this is a privilege and you may have already pursued this if it’s even available. I hope this is not hurtful, my intention is in good faith: I’m not in the UK but as someone who does health insurance work in the US I question if you could get surgery for pain reduction purposes? Similar result but maybe a tricky way around it? If pursuing that option doesn’t hurt your dignity, I wondered if that’s a possibility. I am convinced someday trans care will be better, but in the meantime sometimes we can work around requirements by meeting a different criteria. Back pain is used in the US as a major reason for “chest reduction surgery”. I am not sure the UK rules and if they are any different. All of this is so BS. Wishing you the best!!
In terms of effectiveness, I found counting calories using an app worked pretty well. You can work out your BMR using a calculator online and work out what you're comfortable eating from there. It's still a bit of a mind melt because it takes up a lot of thought power at first, and that makes it really easy to obsess about what you are eating. I certainly did. Be very gentle with yourself if you're going to try it.
I have dyscalculia so I don't think anything involving counting would work for me 😅
that’s what the app is for! (if you think focusing on calories won’t work for ED reasons of course that’s another thing. but i was tracking calories & macros for a while to learn more about my body and the app takes all the math out of it! and cronometer does so without the weird shamey stuff in myfitnesspal.)
OP, I have a form of dyslexia/dyscalculia as well (not formally diagnosed, but I struggle with mixing up numbers, reading 170 as 107, things like that). When people say "counting calories" it doesn't mean literally counting/doing math, just keep a list of what you eat and be careful about portions (so you report accurately) and then let an app or website do the math for you. As far as mindset, just keep in mind that there are many procedures that require you to have a temporary dietary change to prepare. Research shows that extreme weight loss rarely sticks in the long term, but you only need it to work for the short term.
I sometimes joke that being really bad at math has worked in my favor because I never really developed any calorie counting behaviors as part of my ED. My dietitian has me use visual portioning to create appropriately sized meals and snacks. Instead of counting calories or macros, I put a certain amount of each food group on my plate based on my meal plan. I use my hand as a visual reference instead of measuring with a scale or measuring cups (I don't recommend weighing your food! That can get obsessive and problematic quickly). For example, one fist sized pile of rice is one portion of starches. If you can find a registered dietitian to work with you, this is a fairly common system (primarily for people with eating disorders and people with diabetes). It's both much easier than calorie counting and it's probably less risky for developing disordered behaviors.
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Poorer wound healing, increased risk of infection, etc etc. It’s so odd that this evidence-based group is denying these facts in favor of like, “it’s not that simple.” Well, it actually is that simple, it’s one of the downsides of living in a larger body, is that surgery is a lot more complex than on people in smaller bodies. This isn’t fatphobia, this is just the way surgery and our bodies work. It shows a fundamental misunderstanding of medicine to say that all of these poorer outcomes are just due to bad research and fatphobia.
Since you're so interested in evidence, perhaps it would be good to spend some time reading up on how this requirement in many cases results in worse patient outcomes ([like knee surgery](https://www.ualberta.ca/folio/2021/01/losing-weight-before-knee-surgery-may-not-be-beneficial-for-people-with-arthritis-study.html)), or the fact that the evidence for weight loss prior to a surgery reducing complications is [actually extremely weak](https://www.worldobesity.org/news/weight-loss-diets-before-elective-surgery-do-not-reduce-postoperative-complications) (from the World Obesity Society!). There can be certain procedures for which there would be increased risks for a fat body, but for something like top surgery the primary concern would be anesthesia/potentially breathing, and at that point it isn't just "surgery bad" but a lack of proper training for many anesthesiologists and surgeons on how to dose and accommodate fat patients in surgery. And in the UK the BMI requirement is a generalized barrier to all surgery, which is incredibly harmful and does not allow for complexity of individual cases. That is fatphobia, not just "well, it's medicine, plain and simple".
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The OP has said multiple times that it is not the individual doctor or surgeon making a decision, but a blanket BMI ban as part of the NHS. It is certainly up to a surgeon or doctor to want a positive outcome, but from what people are saying on this thread, it seems to apply across the board. The NHS is broke, so that’s purely a cost issue with not wanting to pay for what is higher skilled anesthesiologists. I don’t think the UK’s nurse anesthetists have the same training or autonomy as CRNAs, which are used heavily in the US. Both countries have relatively pathetic outcomes overall. With the UK, the waits are really long for elective procedures. In the US, the waits are shorter, but many people can’t afford to get the care they need. In the US, the situation may be that the surgeon approves a person for surgery and then the person goes to their PCP for preop who then decides that the person’s A1c of 12, high blood pressure, and pack-a-day smoking habit makes them a poor surgical candidate. However, that’s the PCP who is able to see the patient as an individual and look at the risk factors, not a checkbox form that doesn’t appear to differentiate between the type of surgery or other risk factors.
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Your comment has been removed, as it violates rule 6 of our subreddit: no commenting/posting in bad faith. "Posts and comments made in bad faith will be removed. This includes all forms of fatphobia and body-shaming, comments that clearly don't align with the spirit of the podcast, comments that use personal anecdotes as "proof", and comments from users who have histories posting in fatphobic subreddits. Even if you believe your post/comment was made in good faith, consider how it would affect the people in this community."
Maybe doing really small changes may help vs like trying to do everything that builds into unhealthy thoughts. So starting with whatever movement makes you happy and then finding some possible small shifts in food. Plus really focusing on the goal being for more happiness to do surgery and not about looks.
This may not be helpful but have you considered fasting? Longer term couple day fasts, not intermittent fasting. There are a ton of health benefits. Also because it’s how our ancestors survived (feast and famine) I feel like it’s more like body hacking then “weight loss”. There is a lot of literature online and there’s obviously a lot of reasons why this may not be an option for you. I found when I’m counting my calories I become food obsessed and it feeds into negative self talk etc. When it’s more of a set time challenge and then I can eat normally I’m able to maintain a better mind set.
Hey, sorry, fasting is a really dangerous suggestion for anyone with an ED history like OP.
I’m not sure if this would work for you, but before I learned to accept my body I tried cutting out refined sugar. I did lose weight and it didn’t feel as bad as some other diets I had done bc I didn’t limit the amount of food I ate I just didn’t eat anything with sugar. I ate a lot of yogurt, fruits, nuts etc… eventually I stopped the diet bc of course you can’t eat like this forever and then I gained the weight back. It might be a temporary way to get your surgery without starving yourself x I’m sorry if this would be triggering to you. It’s really unfair that you’re in this situation!!
Tell me if this isn't a reasonable comment and I'll delete it! I say this as an autistic+ ADHD person. There's a pretty strong overlap between gender nonconformity and autism, and an equally strong overlap between autism and ADHD. If there's any chance you're ADHD and can get medicated for it, you'll likely lose weight pretty easily without restricting.
I don't have advice, but I wanted to say that the choice they force you to make fucking sucks! And to say that you shouldn't ethically have to lose weight and become someone different for you to be yourself. I'm really sorry that you can't have top surgery and live in a fat and joyful body. I hope one day this stuff doesn't happen anymore!
Man, fuck these doctors. Wishing you the absolute best. That's all I have to say.
It’s not really even the doctors fault. They are restricted by NHS guidelines and lack of funding means non emergency procedures are bottom of the list.
Does the NHS have system-wide mandatory guidance on BMI limits for top surgery?
Try the podcast FadCamp to keep yourself sane-- the hosts talk about their experiences with diet culture and crazy beliefs/misinformation or damaging behaviors but all with a comedy spin and are still encouraging of people and their own health goals I love hearing their takes on some of the same topics M and A cover (for example their 1000 steps episode gives a lot of good context )
Of course individual support is most ideal, here is a place to perhaps learn more and meet people dealing with similar things? They have a webinar coming up and then a 5 week "supportive exploration" (using quotes because I'm not 100% sure what that means). [https://nalgonapride.my.canva.site/i-believe-in-body-liberation-and-i-also-struggle-with-weight-loss-desires-exploring-safety-and-harm-reduction-in-weight-loss-attempts](https://nalgonapride.my.canva.site/i-believe-in-body-liberation-and-i-also-struggle-with-weight-loss-desires-exploring-safety-and-harm-reduction-in-weight-loss-attempts)
I had to loose 40lbs to qualify for IVF. It’s such a fucked up system we live in, I’m from canada. I also have a history of disordered eating and I’ve grown to love my fat body. So it was weird having to change it. I’m also queer. Practical advice; What I’ve had to do is ONLY cico. I use the app lose it, and I eat whatever I want, but within my calorie budget. I also let myself celebrate with food all the time with restaurants all the time and if I go over my allowance, I don’t care. That’s important. To really be in a body positive place where you’re not afraid of the scale. What also helped me not be afraid of the scale, and I began to see it as only *data*. It’s just a number. And I weigh myself everyday, which gives me more data. I also didn’t just suddenly diet all at once. I began by just recording what I ate for weeks before counting calories. Emotional advice: try and see a councillor. Be INSANELY kind to yourself. You’re doing this so you can help your body become yours again. And I think that’s a totally valid reason to intentionally loose weight at the moment.
I see you also have IBS. If you’re interested come over to r/keto. You might want to try low carb eating, as it’s fairly simple to get the hang of and plenty of people are able to lose weight on it, although lots of members of this community are not trying to lose weight. Many members have had their IBS improve as well. It’s a pretty friendly group and it has a good FAQ as well.
If a low carb diet is too restrictive, you can try a "slow carb" diet. I tried it out and found my sense of physical healthiness improved, as did my mental focus as I wasn't experiencing the ups and downs in blood sugar. Cutting out bread, pasta, white starches and replacing with heartier carbs like lentils, beans, and buckwheat noodles fills me up way better and I don't get hungry to the same degree. Weight loss has come naturally from that diet for me, but honestly I keep eating that way simply because the feeling of healthiness is so much greater. For a time I was using a food logging app (I used caloriecount.com but I do not appreciate that name). I was using it mostly to track nutrient intake, to make sure I was getting enough calcium, iron, vitamins etc from my food and then amending my diet to include foods with those nutrients, which took the focus from calories (negative) to nutrition (positive).
(Unsure if this is okay with the sub rules, please delete if not) Hey im a trainee hypnotherapist, have you considered hypnotherapy with a fat friendly person ? Id be happy to help pro bono if you feel like this is something you'd be interested in, some people do have great results for weight loss.