Obesity behind the blinds

It’s been a bad few of months for me as disabled benefit scrounger (I guess I still qualify since I am unemployed and don’t have any regular income source other than DLA). First of all there was George Osborn’s October speech in which he asked where “the fairness” was “for the shift worker, leaving home in the dark hours of the early morning, who looks up at the closed blinds of their next-door neighbor sleeping off a life on benefits?”

Well, since you ask, George, yes I am sleeping my life away, jobless. Not because I don’t see why I should bother getting up, but because my current dose of antipsychotic is such that I sleep up to 12 hours a day. That’s just what it takes to get my moods near enough stable, so that I am less of a drain on primary care and my mental health team. I understand that from the outside, it may look like I’m lazy, answering the door to the postman in my dressing gown at 11am, but often that is the earliest I can drag myself back to consciousness. It’s not like I go to bed late; I hardly ever experience that simple pleasure of pillow talk, because I’m usually fast asleep by the time my partner’s ready for bed. Because you see, that’s the problem with jumping to conclusions. A closed blind is simply a closed blind; the “striver” leaving for work has no means of guessing at his neighbour’s true circumstances behind that blind.

This week, it was the turn of obese benefit claimants to be singled out. A local authority and a conservative think tank have built on suggestions that benefits could be dispensed via “smart cards”, floating the idea that benefits claimants’ use of leisure facilities to improve their health could be monitored via the cards. Obese or otherwise unhealthy claimants who fail to carry out exercise programmes prescribed by their GP could, the report suggests, have housing or council tax benefits reduced for non-compliance.

What do you know, according to my BMI calculator, I am obese as well as lazy. I’ve gone beyond the “overweight” band and have become what NHS Choices describes as “somebody who is very overweight with a high degree of body fat.” I’m clearly not alone; at a 16, I am now the size of the average British woman. NHS Choices goes on to tell me that my obesity places me at risk of a number of serious health conditions – Type 2 diabetes, diseases of the cardiovascular system such as heart disease and stroke, and even certain cancers (in particular breast and colon cancer).

So who in their right mind would let themselves become and remain obese, with all the attendant risks? My problem, of course, is that I am often not in my right mind, and the treatments for bipolar increase the risk of obesity. Sleeping 11-12 hours a day (with my blinds drawn) automatically makes my lifestyle more sedentary than most people’s. Then there’s the fact that both quetiapine and lithium have a reputation for stimulating appetite causing weight gain in users.

But there are plenty of people without mental health difficulties who find it impossible to keep to a “healthy” weight for various reasons. There are vast numbers taking other sedative medications for chronic pain or life-threatening diseases. Physically illness or disability may also reduce a person’s ability to participate in mainstream exercise. Despite the prominence of the 2012 Paralympics, many gyms and swimming pools still lack the resources to allow people with mobility problems to use their facilities, and staff have insufficient knowledge about how to help disabled people use equipment. Even people who are entirely well and able-bodied clearly find it difficult to incorporate exercise into their working lives or parenting/caring responsibilities. Our environment has been described as “obesogenic” – never have so many calories been available to us so easily, and never have we used our bodies less.

I should, of course, do something about it. Would it help if my GP prescribed attendance at a fitness activity, such as a walking club, gym or swimming pool? Not really. Because if I am feeling well and stable, I am able to motivate myself to exercise anyway. But if I am feeling depressed or anxious, it will be difficult enough for me to manage to leave the house, and I will experience social anxiety that makes it very hard to attend unfamiliar groups and locations. I worry about my body size and shape anyway; if I am feeling low, my self-disgust reaches epic proportions, making it highly unlikely I will want to exercise publically. If I am manic, I will forget all about what I am supposed to do and ditch my gym sessions for socializing or writing; if I do remember I need to go, I won’t see the point because I will believe that I am already 100% gorgeous. I already experience all these emotional difficulties attached to exercising in a park or leisure centre. Now imagine that in addition to the distress caused by my bipolar, and all the anxieties about what my obesity may be doing to me, I have to worry that I will face economic sanctions if I don’t make it the gym.

What I find most offensive about this suggestion is that it treats a prescription as if it is a sentence. All of us are free to obtain medical opinion, but we are also free not to take up the suggested treatment. So long as we possess the capacity to make decisions about our health, we are entirely within our rights to say to a medical practitioner, “Thanks for your advice, but I have thought it over, and decided not to take up treatment” – even if it is likely that our lives with be shortened by that decision. A person with cancer, for example, is at perfect liberty not to accept surgery or chemotherapy, even if this means there is a greater chance that they will not survive. As long as they are capable of understanding the risks and the benefits of the proposed treatment plan, as an autonomous adult they can refuse something which most would see as clearly good for them.

For several years I worked in a multiagency serious substance misuse team, where practitioners from the police and probation services, drug treatment agencies and housing and employment services came together to support people with entrenched opiate and or stimulant use. Our aim was to help them in getting clean and avoiding further criminal activity. Often our clients were presented with a stark choice by Magistrates, weary of seeing them in their local Court over and over again: engage in a community Drug Rehabilitation Requirement, or go to custody. It may not have been much of a choice, but it was, nonetheless, a choice. Magistrates and Judges cannot sentence someone to community drug treatment unless a) the drug treatment provider agrees that the offender requires treatment, b) and the offender signs an agreement indicating their willingness to participate. Once they’ve said yes, however, they are committed to that option; if they persistently fail to attend for drug testing, key work sessions or the groupwork programme, they will be deemed to be in breach of their Community Order and will be brought back before the Court, where they may be resentenced to a stiffer punishment.

The reason that clients were required to give their permission is simple: people cannot be forced to undergo medical treatment unless they come under the remit of the Mental Health Act or the Mental Capacity Act. However, once under sentence, they faced serious consequences for failure to engage. Once sanctions become attached to non-attendance, people are no longer freely choosing continue with the treatment. If people with weight problems get the sense that they are being “sentenced” to exercise, rather than it being offered via prescription, they are likely to begin viewing GPs with some of the mistrust and hostility with which defendants view sentencers – and this would be absolutely disastrous for people with those very health conditions we know are linked to obesity. And if GPs begin to feel that the treatment they are offering is coercive, rather than supportive, serious questions about the ethics of that may lead them to cease prescribing exercise for the people who need it most.

Who, exactly, will that benefit?

About purplepersuasion

40 something service user, activist, writer and mother living with bipolar disorder. Proud winner of the Mark Hanson Prize for Digital Media at the Mind Media Awards #VMGMindAwards
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15 Responses to Obesity behind the blinds

  1. onmybiketoo says:

    Before i was forced to give up my life to look after Hubby because of his paralysis I used to cycle about 150 miles a week. I loved my sport. Since 2009 even though OH qualifies for cont care which should mean we have care workers here helping him, I have been confined to home so guess what my weight has become harder to control. exercising at home just is not the same. I just can not fathom what these stupid uncaring idiots are going to say next, they just have no idea.

    • Nick says:

      One glaring act of total prejudice that I haven’t seen picked up on (probably because the propaganda might be working – God forbid). The accusations and sanctions on fat suggested are aimed purely at those in receipt of benefits. What about the rich fatties who don’t need benefits – fat as a bankers bonus. I suppose they never use any state resources then? It seems to becoming true that if you are in receipt of certain benefits the state has the right to your soul as well as your fat. And its a given your automatically an underclass fat oik if your on benefits unlike people like Eric Pickles Minister for local government.

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  4. jaynel62 says:

    I can relate to this as a Fibro & Sjorgens sufferer with the pain regularly so bad I can’t walk (ever tried walking on hot gravel -that’s what it feels like) Add this to the Meds of which only ONE of the debilitating side affects is weight gain!!

    The creatures behind these ridiculous notions live in cuckoo land. – Thanks for this xx

  5. Thanks for drawing attention to this issue. The knee jerk, one size fits all (pun not intended!) approach of the government on this one defies belief – surely it’s nothing more than seeking the votes of the ignorant?

    In all my years as a weight loss coach and therapist I have learned so much about the complexity of weight problems – family habits, life circumstances, health issues, self esteem etc etc. I teach 20 weight loss habits, reinforced by self hypnosis. My clients are not lazy.

    Thanks, Lesley Jefferson @Zlimm123
    ps Following you on twitter.

  6. Layara says:

    Here in Germany, we have a very similar debate going, with very similar measures proposed to get the “work-shy” back to work and the obese to exercising…

    I have a lot of empathy for your situation – as a result of chronic MDD, I currently sleep 9 hours per night; it used to be 12 before psychotherapy. When still taking antidepressants, I also had to nap during the day, making it a total of about 14 or 15 hours of sleep, and I still felt tired the rest of the time. There was nothing I could do about it then, and nothing I can do now: if I fall short of those 9 hours, it immediately has a negative effect on my mental capacities.

    As for weight and the associated health problems: what many people ready to “sentence” you to a fitness regime fail to realize is that many medical conditions also have an effect on your body shape and weight, and that these are resistant to any amount of training. Depression (and other mental & physical health conditions) does not only make it harder to motivate yourself, it also directly influences your metabolism.
    In 2009, during one of my better phases, I used to do 90 minutes of Tae Bo and 180 minutes of gym exercise every week, over the course of half a year. I lost about 4.5 kg during that time, the rest of the weight just would not go anywhere – and I am well beyond a British size 16. I was training with professional supervision, making sure I did everything correctly, that my pulse was in the optimal range for fat burning at all times, and I should have shed 20 kg during those 6 months. Never happened.

    In the end, my failed exercise regimen just became another thing to be depressed about.

  7. Pingback: Obese face 'exercise or lose benefits' threat, council says

  8. mumsmental says:

    Thanks, as always for your blog. You mention the lacking of qualified workers at gyms and the like and it reminds me of my mum at her lowest attempting to keep up exercise at her local pool and behaving strangely. It hurts my heart thinking about the responses she sometimes receives from ignorant, untrained staff who unknowingly hinder her attempts and increase her anxiety.

    • Ugh, horrible. People of all backgrounds and abilities should be helped to use gyms, fitness centres, swimming pools, etc. I always end up exercising in my own front room because I worry about things like that.

  9. Vicki watson says:

    I would just like to say thank you for your blog. I have only found it couple of weeks ago but it has really helped me to be able to put into words how I feel. Struggling with rapid cycle bipolar I have now been offucaly diagnosed and started on the health checks for lithium. It has took me ages to fully express my experience although they were plain to see. You blog has
    helped me write my cycle down to show my cpn. I have to admit it felt like I had got somewhere els and thought things were going to get better straight away. But now as I a
    Lye back in my bed feeling the clonds coming in I know I am only being to take my steps to recovery. Thank you again for the blog, I will be sure to keep reading

    • That’s great to hear! I just try to be honest about my own experiences in the hope it will help someone else. I also thought when I was first off sick (April 2011) that I would get better fast – in my mind, I just had to find the “right” (magic!) drug and all would be well. And here I am, only starting to respond to fairly high levels of quetiapine and lithium. It really is a question of baby steps, so hard to be patient, I know, but keep going! C xx

  10. MrsHaterade says:

    I apologize for commenting so late on this. I read the excellent BBC article that was out recently and found out about your interesting blog and have been reading it ever since. I am very recently diagnosed, based in The Netherlands where my Dutch partner bought me to – we abandonded everything and came here after my crash from my last manic period. It was only thanks to my fab GP in London that we even had an inkling it was bipolar. In my manic phase I stop eating and I thrive on seeing how thin I can become. I survived on two pieces of nutella on toast a day for quite some time. And then I get the depression and balloon because I can’t get out of the house. Now having recently been diagnosed I struggle with weight again and try as I might I can’t shift it. I have again put on weight thanks to the lithium which on the one hand stops me freaking out and enables me to just hold down a job, but on the other I’m curled up in bed by 9pm waiting for the waves of sickness to go. I don’t eat badly but I have to eat lots – and lots of salty food too on doctors orders. I feel so unwell I can’t even get to the gym and I used to love exercise. Now the double whammy of lithium causing weight gain and causing the illness which prevents me from doing anything means I sit here feeling fat and horrible (thank you for the tip on chocolate with meds I now have a kit kat with mine and it really helps!). If there is one thing I have learnt from bipolar is to not be judgemental. People are so quick to assume the worst with having no idea of what the other may be going through. Some days at work I want to scream at people for not even beginning to understand the effort it takes just to get out of bed, let alone have to be sociable and produce some work. Thank you for your insightful blog posts and for being so open about your condition. I hope I am able to be one day.

    • Thanks so much for leaving a comment – it really doesn’t matter if it’s on a “past” post 🙂 I am actually doing better since I wrote that post in that I have managed to lose over a stone and a half of weight – but ONLY because my moods are much more stable. And last month I was depressed for a few weeks and immediately felt back to being unable to find the strength to control what I ate. So for me I think it’s pretty hopeless while my moods are in flux. Maybe if I could afford to have meals planned and cooked for me, and a personal trainer! But as things are I just have to accept that controlling my weight is not something I can do while I am overwhelmed by my emotions.

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