Heidi started to gain weight in her late teenage years, after being put on medication for mental health conditions. However, over the years she has developed several other health problems, and put on weight rapidly after being prescribed steroids. Although Heidi has since lost some weight, she faces several barriers to doing so, including her health conditions and poor mobility, the medications she is on, and financial considerations. Heidi suggests that health professionals should adopt a more holistic and patient-centered approach to helping individuals manage their weight.
Heidi is 50, and has 2 adult children. She is not currently in employment, and is white British.
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Heidi started gaining weight from the age of 18, after going on antidepressants following a bereavement. In her late 20s, Heidi had a breakdown. After being prescribed anti-psychotics, she gained 4 stone. Her doctor recommended she change her medication, and Heidi gradually lost weight. However, in 2012, Heidi was diagnosed with mixed connective tissue disease, and several years later, a lung fibrosis condition. Heidi was put on steroids, and started retaining fluid. She gained weight rapidly, putting on around 30 kilos in 6-8 months. Although Heidi’s doctor began decreasing her steroid dose, her weight continued to fluctuate, as some of her other medications increased her appetite, “it was just like a yo-yo effect”. After losing her appetite, Heidi has recently lost 7 kilos in 6 weeks, “I’ve been in a very low mood because of the weight and the pain I’m in”.
Currently, Heidi eats only small amounts of food at a time, “I do tend to pick…my stomach won’t allow me to eat a meal”. Although she tries to eat a balanced diet, getting fruit and vegetables through smoothies, Heidi feels it is the calorie intake rather than the food she eats that is important. Heidi has never cut out certain foods to lose weight, “I believe that you should be able to eat a little bit of what you want”. Although Heidi would like to lose weight, she is “letting nature take its course”, “I won’t try and lose weight because I’m content with who I am…but any bigger than this and I wouldn’t be”.
Heidi mentions the financial impact of eating fresh and healthy food, which means at times she opts for cheaper choices such as ready meals. Although she is aware that prepared food is not always nutritious, this is also convenient for Heidi as her dexterity is not very good. She cannot prepare vegetables independently, which limits what she can cook, “You have to get the more expensive, pre-cooked, pre-diced ones and they’re more expensive and you just get penalised for wanting to lose weight, don’t you?”.
Heidi’s weight has had an impact on her health. She is currently on the borderline of type 2 diabetes, which is her main cause of concern around her weight. Heidi also has heart disease, and was fitted with stents after suffering a heart attack, although she had 2 more heart attacks shortly after. Since being diagnosed with connective tissue disorder, Heidi’s mobility and activity levels have decreased. Heidi has also become breathless, especially when walking. Although medication has improved this, “I can’t even get really past the front door much now”. Heidi also has sleep apnoea, and wakes up “gasping for breath”. Her mental health is also affected by her weight; Heidi has become self-conscious, lacking confidence and self-esteem, “I get more depressed than usual when I’m bigger”.
Although Heidi’s doctor has not explained the reasons behind her weight problems, Heidi has been told that she could lose more weight than she has, “It makes me feel bad as though I’m not doing the right thing… I’m trying my hardest to, you know, find the right foods, and pay for the right foods”. However, Heidi’s doctor has never offered advice on weight loss, a topic she feels is “hush-hush”. After experiences of a rehabilitation nurse telling her to eat plenty of protein and fresh food, without being aware of the financial limitations she was facing, Heidi encourages healthcare professionals to take a holistic approach to care, “If you look at the whole person and the situation around them you can get a fair idea of whether they possibly may be able to afford to healthy eat or not”. Heidi suggests doctors in general could offer more one-to-one support around weight loss, including lifestyle advice, and referring those diagnosed with type 2 diabetes to a nutritionist. Appointments should be “longer” and “people-centered”, with a focus on continuity of care, “Get them to know their bodies a lot better of what they eat, what they can eat and what they can’t eat. Have physical activities on the go somewhere…and keep the person. Don’t lose them in the system”. Heidi encourages others to seek support in losing weight, “just try your hardest. Gain information from everywhere…there is help out there. You’ve just got to make sure you fight for it and ask for it”.
Following a mental health breakdown, Heidi was sectioned and started taking anti-psychotic and anti-depressant drugs. This led her to gain about four stone in weight.
I’m fifty years old and when I was about eighteen I first started on antidepressants because I had a very low mood due to the death of my, my Nanna. I think since then I’ve gradually put on a little bit of weight and because in 1997 I started on, I had a breakdown and was sectioned, and I was started on anti-psychotics. Now that then to me was my first ever major weight gain. I must have put on about four stone due to these anti-psychotics and anti-depressants.
Because she can’t cook from scratch, Heidi eats more ready meals, and buys pre-prepared vegetables which are more expensive so she feels ‘penalised for wanting to lose weight’.
It does always costs more to eat healthy.
And to be honest I haven’t got much to go, to go around, so you’re going to probably with my condition as well, I have to watch for oven things sometimes, you know, oven foods, meals and microwave thing….
Okay because you can’t…
….and things like that because my dexterity’s not very good.
So it, it all depends on how you feel, which day, so you tend to have things like more salt in it because it’s salty, salty aren’t they the ready…
They’re quite salty and you have ridiculous amounts of all sorts in them.
Okay. So, you tend to buy more ready meals because you can’t cut or do much?
Well I’ve done this morning. I’ve cooked myself a chicken lasagne and that’s ready for tonight when we come back.
So that was quite easy to do because I was just managed to, the, everything was all prepared for me. I just managed to put the ingredients in the pan, fry them and then put the pasta things on and put béchamel sauce and then done.
So that actually that’s very important because your condition has a direct impact on you healthy eating…
…because you can’t chop vegetables and…
You have to get the more expensive, pre, pre-cooked, pre-diced ones and they’re more expensive and you just get penalised for wanting to lose weight, don’t you?
Yeah. Would you like to say some more about, something more about it
Yeah, it’s, you just get penalised for wanting to lose weight. Everything is more costly; the fresh veg, the fresh, the organic stuff as well that’s more costly. So, you know, it’s, it’s going to put a hole in your pocket. It really is if you’re, if you tend to sort of want to keep to a healthy, healthy diet.
So, it has a financial impact for you?
Yeah, definitely financial, yeah.
Heidi’s weight has been affected by taking anti-psychotics and anti-depressants and steroids.
I had a breakdown and was sectioned, and I was started on anti-psychotics. Now that then to me was my first ever major weight gain. I must have put on about four stone due to these anti-psychotics and anti-depressants.
And then because of, I’d gained so much weight, I was becoming almost a Type II diabetes candidate and the doctor actually recommended, the doctor, not the psychiatrist that I was seeing, actually recommended me to change my medication, my anti-psychotics and I did so. I went on a different anti-psychotic and then I gradually lost weight. I think it was probably like two stone in a matter of six weeks. I was very, I got down to basically my more natural weight.
I stayed the same weight and then I was gradually over the next few years I was diagnosed with a lung fibrosis condition.
As soon as they noticed I had like a web feature in my lungs, they put me on 40mgs of steroids. Over the last, I think it was over a matter of Christmas and over a matter of into the January, I was left on 40 milligrams without being seen by any GP, any doctor and I ballooned up to an absolute big weight and I was gaining so much fluid, it was unbelievable. And the doctor started then to, my GP, when I went to her and just say, “Help,” because I didn’t know what to do. She just said, “Right, we’ve got to lower, start lowering your steroids.” So, this started and with steroids it’s a gradual lowering, otherwise it can have disastrous effects. Then I’d started ballooning less but my weight was still big but looked even worse because of the fluid that I was full of fluid on my chest, my arms, my legs were swollen. My face especially and then they saw me at the lung function clinic and the lung place, specialist, specialist lung place and they said, “that they were still wanting to lower the steroids,” but I was, I was still big.
I’m trying to think what happened next. I gradually started losing the, a tiny, tiny bit of weight but because I was on pain meds as well as the steroids, they gradually made me put, have an appetite, so it just, it’s only just recently that I’ve lost my appetite completely and I just haven’t been wanting to eat food. I suppose I’ve been in a very low mood because of the weight and the pain I’m in. It’s been very severe in my legs and my hands and my arms. As I can’t, because I can’t walk without a stick, so…
Heidi hasn’t felt able to talk to anyone about her weight since having a heart attack. She is worried about how she might afford to pay for a healthier diet.
If you have talked to health professionals about the weight, especially after you had the heart attack and things like that, have you explained these things to them?
No, I can’t.
Why not? Do you think….?
It’s just not come around I don’t think. It’s, I don’t think it’s, it’s, I want to, you know, what I mean but I haven’t really had the chance to see any yet, the doctors after my heart attack. I’m seeing them next month. So really I did see a nurse about that, a nurse, a rehab nurse, but that was only to see how I was doing as, as, straight after I came home, so not about healthy eating. She just said, “You’ve got to healthy eat, live healthily and, you know, eat your five a day and eat plenty of protein for your everything else,” you know, and no reason, no how am I going to do this budget and how am I going to do this, you know, the actual paying for it.
I think they should work with each other with the person more closely looking at it holistically, like I said before. If you, if you look at the whole person and the situation around them you can get a fair idea of whether they possibly may be able to afford to healthy eat or not, so the best way is to find out if they can. If they’re not, they’re not going to choose the healthy option. They’re going to choose the, to be honest it’s cheaper to eat out at a McDonalds than it is to eat healthily.
So, they don’t give us an option really. For people who can’t manage it, they’re going to opt for a take away aren’t they?
Heidi highlights the importance of listening to patients, believing them and making sure they don’t “get lost in the system.”
What do you think, in cases like yours, health professionals should do, how could they help. What is needed?
I feel to look at the person holistically, look at the whole history and just to, to listen to them and believe them because they’re were so, so many times that I’ve been to the doctors and I’ve come home crying because I’m not believed. You know, if I’ve got this pain somewhere and that kind of thing. I know there’s something the matter I’m just, they’ve just shrugged it off as a nothing.
And regarding your weight gain and what kind of help would you have liked from, from the doctors or from health professionals in general?
Oh, more attitude towards, towards helping the individual lose weight. I suppose it’s like smoking, they’ll only help you to, the NHS will only help you to a certain extent to give up smoking. If you’re hard person to, say, say the person doesn’t want to give up smoking yet and is finding it really difficult to stop smoking even with all the help around them, they need to be sort of listened to and not disregarded because I’ve had that instance before. But doctors could actually give, offer, I know my doctors offer a walk-in, a walk-in.
Club sort of thing.
Class, yeah where they’ll meet altogether and go walking. But I couldn’t manage that unfortunately. But I think just little things like that will mean so much to someone who’s weight, who’s trying to lose weight, just sort of keep, keeping at them. Not bullying them into losing weight but just being there if they need to talk and make it continuous. Make it on, on a one to one level because otherwise they’ll get lost in the system again and they won’t want to bother, keep trying.