Why am I fat?

Why am I fat?

We all have our own story. It will have a unique combination of elements from the complex obesity system. This is the Government’s own 2012 attempt to map the system: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/296290/obesity-map-full-hi-res.pdf

Here’s my story, in so far as I can make sense of it.

Number 1. I faced a lot of trauma from an early age with no support to find healthy ways to process it. Things filling my mouth soothed me. Sugar rush relaxed me. Fatty food made me feel comforted and full.

Number 2. I was treated with oral steroids for eczema as a child as a hospital inpatient for a month. I went in slightly overweight. I came out morbidly obese and still covered with infected eczema.

Number 3. My first diet (under GP supervision) was at age 7. It solely consisted of restriction. It was enforced rigidly and harshly (they did it ‘for my own good’, and didn’t see the harm). I began stealing food.

Number 4. I was ridiculed and bullied for my size and physical lack of coordination and learned to hate PE and hate my body. I stopped doing anything active. I was 8.

Number 5. I was fed the message by media and family that I was unloveable unless I was slim. That didn’t help me feel loved or repair other trauma.

Number 6. I was offered diets in teenage girl magazines. My slimmer-than-me friends were always on diets. Females in my family were always on diets. A female relative died young - because she was fat because she wouldn’t go on a diet. So I tried every diet. I failed. I binged. I starved. My self-loathing grew.

Number 7. I believed the myth that failing to lose weight was my personal fault and I was just too weak and pathetic to stick to a diet. Because it was simple science. All that was required was: calories in must be lower than calories used.

Number 8. Social life revolves around food. To choose to restrict meant to watch others eat freely or to stay at home. Or go, eat everything I could, then hate myself.

Number 9. Foods became ‘good’ or ‘bad’. Eating ‘bad’ foods became an act of rebellion - against what, I’m no longer sure. But it was definitely a feminist issue.

Number 10. Rape meant I felt safer with a thick physical barrier of fat between me and other people. I could hide inside it. They couldn’t touch ‘the real me’. So I self-sabotaged. Once I’d lost enough weight for people to comment how nice I looked, I’d panic and eat as fast as I could to stop attracting attention.

Number 11. When skint, I couldn’t afford lean protein or lovely herbs and spices. Fat is cheaper. And tastier.

Number 12. (And I’m still learning to forgive myself for this) After a few years of successfully improving my relationship with my body and with eating, I panicked about making a weight category for a sporting competition, and after making weight I couldn’t stop over eating. The patterns of over 40 years of disordered eating can reappear when you least expect :(

And if you look at one of the complexity maps about obesity, my 12 reasons hardly scratch the surface of the complexity that creates and sustains someone’s obesity.

All fat people have their own story to tell about why they are fat.

So don’t tell me that it is as simple as move more, eat less, or change advertising, or use willpower.

*My story has a happy ending and I have an increasingly healthy life. My happy ending is because the reasons I am fat have been addressed. Other people’s happy endings will come when their reasons are addressed. No one gets a happy ending from being blamed for being fat.

What matters, what's researched, what's measured

I've been thrown into the world of the 'validation of research instruments'. Or what you and I might call 'surveys and questionnaires that we are told can be trusted to do the job they say they will do'.

My whole self dislikes and distrusts any tool that says it's been scientifically validated, but is then used by humans on humans to find out about things that can't be observed - like wellbeing or health.

My visionary self has a dream of a different way of living together as humans, and my top priority is thinking how to get from the currently reality to something closer to this dream. Dreams usually take lifetimes or more, however hard and however strategically you fumble and work towards them.

My pragmatic self accepts that within the way things currently happen in the policy, practice and research world of health and social care, it is impossible to escape validated research instruments as they have power and credibility with those in power. Validated research tools are therefore key to improving things within the social and public service systems we currently have. It matters to people's lives now that things improve now within systems. We have to live in our present, not just dream for the future.

For validated research tools, therefore, the questions become ones of harm reduction, and opening up the debate about these tools.

I am very grateful to an academic* for linking me to a great 'primer' on the validation of research tools, as I've never really known what validation involves. For a published paper with so much information about such an obscure topic, I found it immensely readable https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6004510/
*She's nameless only because I'm writing this early on a Saturday morning and want to get this blog up before coproduction week finishes, ie before I can show it to her and check if she'd like to be named

Reading that paper made it clear that developing a validated research instrument is not a task to be undertaken lightly. It is time, brain and cost intensive.

But - some research funders for some types of research require the use of validated research instruments. So if there isn't a suitable validated research instrument, you can't get the funding, so can't do the research. Or to put it another way, you can only research something if there is already a research instrument that has been through the validation process. No instrument, no research.

It took a while for the significance of that to sink in for me. Some things that really matter to people's lives cannot be researched because the research cannot be funded because there is no suitable validated research instrument.

And then, add in another two layers of challenge.

1. I have yet to see a validated research instrument that can be used inclusively, across the diversity of people who experience whatever it is that is being researched. If used in line with the validation, this means research will perpetuate the exclusion of people who are already unheard, or heard but ignored when decisions are made that affect their lives. If used outside of the validation, for example by rephrasing and reframing questions or changing the response options in order to allow a more diverse group of people to take part, the tool is no longer validated.

2. Step 1 of developing a validated research instrument, according to Boateng and the rest of his research team (ie the people who wrote the paper that I found so helpful), is having a clear conceptual grasp of the topic. Say the topic is 'quality of life'. Whose conceptual grasp of the topic should provide the conceptual framework for the tool? I will always prioritise the conceptual framework of the potential participants whose lives will be affected by any decisions made on the basis of the research. And it is possible to do that. But it is also possible to use pre-existing academic conceptual frameworks. Yep, you can design a new tool based on the frameworks that are based on research that is shaped by what could be done using a previously validated research instrument. I suspect that route is more common, as it is much cheaper and easier to do a literature review than brand new qualitative research with people recruited from your pool of potential future participants.

So what?

So those of us who would prefer to avoid validated research instruments need to engage with the creation of validated research instruments if we are to avoid the perpetuation of exclusion and silencing of some groups of people from the kind of research that policy makers and governments listen to.

And it would be doable. But it is a big investment of effort. So it would be important to make sure that the effort is being invested in developing a tool that would allow research to be carried out on a topic of crucial or strategic importance to those who are usually excluded or silenced.

And that means starting with the research on 'what matters', so we know what is worth that investment.

And that is where coproduction comes in.

Doing research to identify 'what matters' cannot be done just by academic researchers, or just by people with lived experience, or just by think tanks, or just by government research teams. Doing this research needs the skills of academics, the skills of people with lived experience who are already involved in policy or practice work, the skills of policy makers, the skills of people responsible for providing public services, the skills of members of the public. What everyone in that list has in common is possessing a set of expertise, experience and perspective that others on that list do not have, but that are needed for top quality health and social care research. In other words, to do top quality health and social care research means developing our skills as research coproducers. And by 'our skills', I mean the skills of everyone in that list.

I would argue that everyone involved in coproducing research needs to learn the skills that are needed to be research coproducers. It does not come naturally to any of us. For those of us with professional training, it won't have been part of that training so we need training. For those of us without professional training, we need training too.

And I would argue that we need the same training, a training that helps us work out for ourselves how to apply the principles of coproduction to the professional training or lived experience we bring. And a training that helps us see other people's skill sets and ways that the skill sets work together to make us and our research stronger.

Where do we go from here?

I don't know!

I'm putting this out in Coproduction Week, because it is probably the best week of the year to wave a flag saying 'over here!' about something that I've not seen discussed. PLEASE come and find me if you are already grappling with this. I won't be doing anything practical about any of this until I've submitted my doctoral thesis. But this is something that would benefit from a long brew on the back burner. Here's to Coproduction Week 2021 when I will hold myself accountable for what I have (or haven't) done to start developing these rough ideas into actual life changing research changing work.

Telling tales (The Unconventional Doing of a Doctorate)

If you haven't heard of 'complexity theory', this may not make sense. Check out the fabulous Noreen Blanuet and Dr Toby Lowe for versions that may make sense to you.

If you haven't heard of Wittgenstein, and French philosophy isn't your thing, skip the bit in italics. You don't need to read it to make sense of the rest!

So rarely have I lived out the truth that the language and conceptual framework are the story and not just a vehicle for communicating a story. I have told many stories of the last five years. This no more true or false than the other stories I have told about doing my doctorate. This telling of the story does not falsify other tellings, nor does it mean I am lying now by changing 'the truth' of what has happened in the last five years. What I have done is try for size different language and conceptual frameworks as I try to make sense of the story for myself. I have finally found one that fits me.  

  

Starting point 

Start with a real world problem that is ‘wicked’, where it feels as if there is something missing from my real world understanding of the problem which – if only I could lay my finger on the 'something' – would deepen my understanding of ‘the problem’ in a way that would enable real world people to reframe what the problem is and in so doing either solutions become self-evident to those involved, or the reframing opens new avenues for exploring possible solutions.  

My starting problem: public involvement in policy making excludes so many people, either because they choose not to get involved or because the way it's done excludes them. 

  

Complicated 

The usual doctoral approach would be classed as ‘complicated’. I would pick an academic lens from within one or possible two academic disciplines through which to inspect the problem. 

I tried that. It was called trying to use social policy ideas and standard social research methods to create a new method or technique that would deal with the problem of exclusion. 

It failed. 

Restarting

I restarted, having realised it was a bit more complex and would need some sociological thinking to work out a way to understand and explain why just producing a better method wouldn't solve the problem.

That didn't work fantastically well either. 

Chaos 

Instead my approach became to pluck ideas, facts, research findings and language from across academia as they seem relevant or potentially relevant to informing my understanding of a real world problem. 

This has led to my sitting in an uncomfortable but essential extended chaotic phase, as the fragments grew from multiple branches of academia as apparently disparate as quantum physics, socio-linguistics, creative media studies and social policy. Each attempt to grasp and organise the fragments into something recognisable as a complex system failed, until I was stopped in my tracks by an expression of complexity theory that made sense to me and gave me a vocabulary to communicate with those inside and outside academic. I found I could use complexity theory to make sense of the original real world problem and the academic problems I had created for myself by trying to made academia revolve around the ‘real world’ whilst being located within the academic world.   

  

Complexity 

And thus, as predicted by complexity theory (and physical chemistry!), my chaotic fragments of knowledge are beginning to align and self-organised themselves into something approximating a complex system. 

In other words, I am at a stage of assembling everything into a form that makes sense (in my mind) of the original problem, and which I think I can use to explain the original problem in a way that will make sense to at least some of those involved in the practical tasks of policy making.

One principle with qualitative data analysis is checking that the participants, or an advisory group of those sharing characteristics with the participants, can recognise the academic’s interpretation of their knowledge as being a valid way of interpreting the phenomenon. It does not require the participants to agree with the interpretation, merely to be able to recognise their knowledge of the phenomenon after their knowledge has been analysed and written.   For me, this approach is currently providing an essential check for how I have used the academic knowledge plucked from across disciplines. I need to ask myself “Do academics from within those disciplines I have ‘raided’ recognise that my interpretation of their knowledge has legitimacy?”. 

Receiving the answer 'No' was a significant personal fear - until I added the work of Deleuze and Guattari into my complex system.  They took from what is rightly the academic property of botany (a rhizome and a tree) and used what they took in a way that would never be recognised as legitimate by an academic botanist. I acknowledge to fellow academics that I may have done the same in the course of my doctorate. By going broad, I have not been able to go as deep as I would have wished in relation to some of the concepts I have assimilated. It may be that I have mis-used them in relation to their original academic discipline. However what I have done with them all is doing great service in making sense a problem in a way that makes sense to the people who are living with the problem.

  

End point 

(or, as Deleuze might call it, the InterMezzo, a kind of pause where things are sufficiently in place to attempt to communicate them)The end of a doctorate is a thesis that meets the assessment criteria required to earn the writer a doctorate and the right to be known as Dr Collis.
What I will seek to present as my thesis is an example of what can be done when the deeply significant and vital expert work of academics within their specialised disciplines is laid out and put at the disposal of a real world approach to solving a real world wicked problem.  

And to underline that, the right hand page of my printed thesis will be written for an academic audience. The left hand page will be a version of what it says on the right hand side that is written for that proverbial 'man on the street' - in my case, for my colleagues at Barod, for The Women (four lovely middle aged women who gamely got involved in my research) and for all those people who might get roped into the public involvement activities of universities and policy makers. 

Oh, and there's a modern art assemblage too. But that's a story for another day.

I will always fail

[prompted by a discussion about wanting/failing to be a White ally, by thinking about the impossibility of achieving what I want with my thesis - because it is actually impossible (maybe), and thinking with love of the people who keep believing in me when I don't believe in myself]

The fact I will always fail does not mean I have failed. There is no need to give up. There is no need to feel guilt.

By tackling that which is impossible, I highlight a problem. The problem is that what I am doing should not be impossible. I highlight it by noticing something that is so deeply woven into the current reality that in general no-one notices it. If I point out, I get comments like 'but that's just how things are' or 'that's life' or 'just accept it' or 'there's nothing you can do'.

Defiance in the face of that is a powerful weapon. "Hold my beer" or "Watch me!" followed by failure. Followed by failure. Followed by failure.

And so I continue to attempt the impossible. Perhaps it makes others see the problem. Perhaps it makes them wonder if the current reality is the only reality.

Do you know what keeps me going? It is those who tell me that they see what I am doing. That they could not do it. That if anyone can, it's me. That they are relieved and grateful and quietly (or loudly) cheering me on.

I know they mean it. They are there for me when I am broken. They never tell me I should get back up and get into the fight. But when I do, they shout or whisper encouragement.

And I wonder. They talk about me 'giving them a voice' in places they don't want to try to go but where they want what they say to me to be heard. There's an entire research literature about the rights and wrongs and impossibility and moral necessity and methods and reasons and contested meanings of speaking for and giving a voice. But maybe the reality is that they give me a voice. They patch me up. They actively support my healing and mental stability. Without them, I have no voice because I give up. They trust that, when I speak in places they cannot or will not go, what I say will be as full of them as it is full of me.

As Michelle Fine puts it, I'm not a ventriloquist, and I am not a tape recorder replaying their literal voices (page 12, Just Research in Contentious Times, 2018. If you can't pop to a university library, on Amazon you can search in her book for 'voice'. It's worth doing that). Maybe I am someone they have heard speak out about things *they* have put in my head, and who they choose to speak to, so I can speak of more things.

Will I fail in the impossible challenges I set myself? Undoubtedly.

Will that keep me from trying? Hold my beer.