I take issue with the comment that the morbidly obese should be told to eat less and exercise more.
I am the only medical doctor qualified fitness professional in the north of England and I specialise in the obese so I speak with some authority as to why this proposal has been brought in. That’s not to say I necessarily agree with it. However I have to bring the plight of these people to the public’s attention.
Imagine you have two 20kg suitcases at the airport. You can get help or use a trolley. Imagine they weighed 100kg (each): there was nobody to help and there were no trollies. Imagine walking with them. You’d stop frequently to get a rest. Now can you see why its so hard for them to exercise more and eat less?
The obese live with that. That’s why so many are housebound. They are society’s forgotten prisoners. You would take a 30 feet walk for granted 30 feet can literally kill them partly because the incredible weight the lower limbs carry compounded by excess fat pressing on the lungs putting more strain on the breathing muscles.
Gyms can be very dangerous for these people.
Many obese people legitimately have a blue disabled parking badge. I have worked at several gyms with inadequate disabled parking. Some of these gyms are not within walking distance of public transport.
Many gyms have turnstile access and some can’t accommodate the obese!
Some of these people are far too afraid to go to a fitness class. I have lost count of the number of times I have had to exclude able bodied people from my classes for making fun of the obese who make an effort in one of my fitness classes.
Some gym equipment has weight limits. Ironically it would be unsafe to take them in. Hence sometimes they are refused gym membership because they are too overweight. These people get very embarrassed very so where will they change? I have also seen heavily overweight people get stuck in the fixed resistance machines too.
Most importantly a fitness programme for such people has to be undertaken by a level 4 trained gym instructor of which there are very few. Very often the morbidly obese have associated diseases which complicate matters- diabetes, high blood pressure, high cholesterol, arthritis, shortness of breath, asthma to name a few. At one gym I worked at a basic qualified gym instructor who only had two weekends of training worked out a programme for such a person and I was asked to review it. It’s a good thing that the client never used the programme- it would have killed him!
It’s for the reasons above that frequently I used to train these people in their own homes (not any more). However travelling to these people is very time consuming and expensive. A rehabilitation programme for such people would cost around £5000 over 18 months. Many of these people are on benefit so how can they afford it? Usually they borrow money from their relatives.
These people have no choice but to resort to surgery- even though it does carry a 1–2% risk of death. There are very few routine medical procedures that are so risky. The problem here as your article shows if the body mass index is too low they don’t qualify for surgery. If too high they are a surgical and anaesthetic risk. What does the patient who is desperate to lose weight do? Do they risk going to a gym (see above) or do they let their health deteriorate so that they qualify for surgery.
Ideally there should be 4 people involved in the treatment of such people. A GP to look after the health. A dietician or nutritionist to look after the nutrition side of things. A mental health specialist to look after the client’s self esteem. An appropriately trained fitness instructor to look after the fitness side of things (of which there are very few). However getting public funding for such a programme is as hard as dissolving diamonds in water. I know because I have tried!
Nothing less will work and have long term results.
Sadly at present this is what happens. The client sees the GP who refers them to a dietician (which are in huge demand and very short supply). If the advice that the dietician gives does not work combined with the 12 weeks on the local council exercise referral programme then the patient is referred for gastric surgery. Council run exercise on prescription schemes cannot keep up with demand. That costs the taxpayer a fortune per person.
It’s not as easy as exercise more and eat less. Indeed its common for me to tell a morbidly obese client to eat more. If you eat too little then the body thinks nutrition isn’t coming regularly and will slow down the metabolism and store everything possible as fat. Its best to have 5–7 small meals a day.
Whilst I can understand the criticism being laid at these proposals I can understand why they have been brought in.