Lived Experience Voices: “Nobody should need an advocate in the room”
Lived Experience Voices
Nobody should need an advocate in the room
Morgan Salmon, lived experience advocate
Morgan reflects on how it took his wife's advocacy, not the healthcare system, to finally secure him evidence-based obesity treatment.
When I finally walked back into that consulting room, I was carrying two weeks of food journaling that had taken me two years to write.
My practitioner had asked for it before she would consider helping me. Show me you are motivated. Keep a food journal. I knew what healthy eating looked like. I also knew I was not managing it, and writing that down, day after day, was one of the most frightening things I could imagine. So I did not do it. For two years.
I was about to become a father when I decided to try again. My wife, Ana, came with me. When I handed over the journal, the doctor did not open it. She said: if you ate fewer pizzas.
Ana answered before I could.
"Doctor, you have known Morgan for seven years. You know he has tried. Don't you think he deserves the chance to have evidence-based treatment?"
That question is the reason I have a diagnosis.
It is the reason I have been in treatment for eight years, and the reason my obesity has been managed ever since. I celebrated the diagnosis by eating three donuts - which tells you how much I understood at the time, and how little any of it had ever been about willpower.
What the journal would have shown, if anyone had opened it, was not a lack of effort. It was noise. When I am not in treatment, food occupies my thinking almost constantly. I would wake up and decide I was having a salad for lunch. By noon I had eaten that salad a hundred times in my head, and I wanted something else. The salad was boring. Clinicians now call this food noise.
It is a symptom of a chronic disease, not a character trait.
My grandfather understood that long before any physician told me. He lived with obesity himself, and he once offered me fifty euros for every kilo I lost — doing his best to spare his grandson what he had lived through. It did not work. Motivation was never the missing ingredient. I grew up in Cuernavaca with a mother who kept healthy food in the house, and that was not enough either.
Here is what troubles me about my own story: it has a good ending, and it should not have depended on what it depended on.
I received evidence-based care because someone in the room knew the words evidence-based treatment and was willing to say them to a physician who had already made up her mind. I am a lawyer by training, and I could not say them myself. Seven years of being told that my body was my own doing had convinced me they were not mine to say.
Most people living with obesity do not have an Ana beside them. They have one appointment, a few minutes, and advice that has already failed them many times. Their access to treatment becomes a lottery — of who accompanies them, of which clinician they happen to see, of whether they can pay privately when the system will not.
That is what I want to ask health systems and decision-makers for.
Obesity is recognised as a chronic disease. Reimbursement and clinical pathways in most countries have not caught up: treatment is still positioned as a lifestyle purchase rather than covered care, and clinical training still leaves room for a doctor to close a file she never opened. Cover evidence-based obesity treatment. Fund the training that makes the consultation itself evidence-based. Build lived experience into those decisions from the start, not as a testimonial at the end.
At the World Obesity Federation's lived experience summit in Mexico City, I sat in a room full of advocates who each had their own version of that consultation. What we shared was not only our stories, but the tools to change the systems that produced them.
Our voices count - and there is a great deal of work left to do before nothing about us without us is true in practice.
Blog by Morgan Salmon, lived experience advocate
Lived experience voices
Lived Experience Voices is World Obesity Federation's series sharing first-hand stories from people living with obesity around the world, in their own words. Have a story you'd like to share? We'd love to hear from you - get in touch with our Communications team.
Contact us