Monique: I think that the bulk of weight management programs don’t go deeply enough. People don’t just wake up one day and find they’re morbidly obese. The causes of obesity are usually complex and multi-faceted, and addressing the symptoms rather than the core reasons behind the obesity, can only go so far. For me, it took years to get to a point of being able to grapple with the issues behind my obesity. It then took years more to find a way through the myriad barriers to me losing weight, physically, psychologically, emotionally and relationally.

Bronwen: It’s important to take an evidence-based approach when discussing weight loss. Diet and exercise are always important but on their own they rarely result in significant weight loss for someone who is obese. I think patients should be made aware of this and given all of the available information regarding other tools that can assist them. This may include medication, meal replacement diets and surgical options.

Monique: There was both a negative and a positive turning point for me. The negative turning point was finding myself nearly in a wheelchair because of severe osteoarthritis in my knee that could not be addressed in any other way than losing weight. The positive turning point was the inspiration of a friend who had originally been even larger than me, but lost a massive amount of weight. Until that point, I had only read of “success stories” in books and magazines. My friend’s support, encouragement and example put a human face on the process of losing weight, and made it finally seem possible. In the end, however, if these two factors had occurred even a few years earlier, I don’t think I would have had the success I did, because I wasn’t internally ready to make the change until this point. The key turning point was finally feeling ready to make the change, and to understanding and embracing all that would involve.

Monique: As is the case with others in the general public, health professionals bring their own biases and prejudices. The biggest difference I felt amongst health professionals was between those who judged me, which just made me feel even more stuck, and those who felt and expressed genuine compassion towards me, which empowered me. I didn’t need to be told I had a problem – I lived with the problem every day of my life, and knew it from the inside far more deeply than anyone could observe or advise from the outside. What I needed was informed support to help me start to feel I could make a change, and steady and consistent encouragement as I made even small changes over a long period of time.

Bronwen: This is always a sensitive topic. As Monique has already mentioned, patients are likely to be very aware of the issue but can be fearful of judgement or disappointment when they try to lose weight. I usually just try to offer hope that there are tools available now that can help, and that there is increasing evidence regarding what works for successful weight loss and weight maintenance. I always try to encourage patients that staying weight-neutral (i.e. not gaining weight) is a win (as the average weight gain is half a kilo each year) and that a small amount of weight loss has significant health benefits. For instance, losing 5% of your body weight can reduce osteoarthritis knee pain by 50%.

Monique: To my mind, the key point is not assuming or implying that the answer is quick, easy, or simplistic. Even just an acknowledgment of the complexity of obesity, including the struggle to change, goes a long way. I was also helped by seeing a video that talked about understanding that I was a “victim” of my lymphoedema, not a “perpetrator”. Whilst that language may sound somewhat extreme, it did help me feel that it was not my fault that I found myself in the situation I was in. The next step, then, was to feel that I had the support and resources to make positive changes to escape the victimisation. A multi-disciplinary approach to weight management certainly helped me – addressing the issues over time with a dietician, a psychologist and an exercise physiologist – as well as with other health professionals like Maree and Bronwen. A multi-disciplinary approach helps to recognise the complexity of the issues, rather than just applying a “band-aid”.

Bronwen: The numbers on the scale do not tell the whole picture. And weight loss is all about playing the long game. If food is a source of emotional comfort and the patient has had a tough week then it’s important not to add to their stress and sense of failure. I think it’s important to acknowledge that some weeks are tough. It’s much better to start again the next day or week, rather than to spend another day feeling guilty or disappointed.

Also the most important health benefits occur with fairly moderate weight loss. Losing 5-10% of one’s body weight can reverse Type 2 Diabetes, control blood pressure, reduce the risk of heart attacks or strokes, improve mood and digestion, increase energy levels and reduce pain. Patients can often “miss” the bigger picture when they are purely focused on a number.

Monique: I think the key to avoiding the roller coaster, is to not become complacent with my “success”. Just as recovering drug addicts recognise that they are only “clean” one day at time, I need to remain conscious of my choices every day. This doesn’t mean I will never eat unhealthily or slip backwards – it just means that I need to remain as conscious as I can of what might be motivating the slips, and to remind myself of why I chose to embrace living health, and what a difference it has made in every area of my life – and then to choose, and re-choose, to live healthily.

Bronwen: Monique’s story is incredibly inspirational to both myself and to others, because she did overcome so many fears and barriers along the way. Her weight loss exceeded the amount experts said was possible. Prior to losing weight she was told that she would need a knee replacement and she was in constant pain – and now she has almost no pain and she exercises everyday.

I think her story demonstrates how important it is to individualise patient care and to have a team approach to treatment. And to never give up. As a patient or as a health professional it is important to believe in change and to empower patients to find their own path.

Monique: I guess the main thing I would like to remind all health practitioners, is that every patient or client comes to them with a back-story. You may not know or understand their back-story, but you can rest assured that it is far more complex than can be summed up in a page or two of clinical notes. The back-story is also often even far more complex than the client themselves might know. So, I would like to see practitioners avoiding giving simplistic advice, learning to listen deeply over time, recognising their own limitations and biases, and extending compassion rather than judgment.