Why you're never too fat to get fit
Finding the motivation to get fitter with regular walking deserves a pat on the back - so imagine how it feels if instead you get yelled at from passing cars by people poking fun at your size.
Welcome to the world of people whose weight makes it harder to get moving. It's a world that exercise physiologist Dr Adam Fraser knows well. He specialises in helping people with diabetes get fitter and many of his clients have BMIs of 40 plus.
"Many people don't understand how physically and emotionally complex obesity can be - including some health professionals," he says. "Often their approach is 'you've just got to lose weight' but with no attempt to see what might be driving someone's weight problem or finding out what exercise they might enjoy and be motivated to do," he says. "Some health professionals think if you just beat people over the head hard enough with guilt and statistics they'll lose weight."
Fraser believes more GPs should work with Accredited Exercise Physiologists who can tailor exercise programs to suit overweight people with physical problems such as pain in overloaded joints that make exercise harder.
"We have to find something that doesn't hurt and is sustainable," he says. "Ideally it's a mix of different exercises that give a range of health benefits. If walking is difficult, using a stationary bike and exercising in water are good - they help bear the weight and are easier on joints.
"If you're very overweight strength training is good because it allows you to stay in control of the movement. It burns kilojoules, improves blood glucose control and strengthens muscles around joints - that's important because if you've been inactive and are very overweight exercising puts a load on the body that you're not used to," he says. "Strength training is under-recognised for overweight people - if you strengthen the muscles that support the joints physical activity becomes easier."
Once people become more active, it doesn't take long to see results, especially with blood pressure and blood glucose control which improve quickly, Fraser says. The challenge then is getting people to stick with an exercise habit if they're self-conscious about walking in public, let alone joining a gym.
In New York or Chicago this could be easier - there's a gym chain, Downsize Fitness, catering especially for overweight people. But in New Zealand that's not an option yet.
"Some people cope by going to the gym during the day when there are few people around - others learn to suck it up," he says. As for walking outdoors, some people stick their ear buds in to block out any abuse.
Staying motivated also depends on having specific exercise goals rather than good intentions.
"The goal isn't to 'exercise more' it's to exercise four times a week at 6am for 45 minutes," says Fraser. "You also need to set up your environment to maximise your chances of success - like having workout clothes and shoes laid out the night before.
"But if you're very overweight see your GP first to make sure there are no underlying problems with your heart or with blood pressure, or check if any medication you take is likely to be affected by exercise - exercise can increase the potency of some medication."
As for the rest of us, Fraser's message is that obesity isn't as simple as we think.
"I know women who eat little and exercise a lot but still have difficulty losing weight because they have problems like Polycystic Ovary Syndrome that make weight loss harder.
"Self-worth can also affect our ability to lose weight - we need to cut overweight people some slack."
If you have a chronic health problem that can be improved with exercise, like high blood pressure, high cholesterol or diabetes, you may be eligible for five rebated visits annually to an exercise physiologist - ask your GP.
Have you improved your fitness despite your size - and did other people make it easier or harder?
Sydney Morning Herald