"Overweight people who are avoiding moving around aren't lazy – they're sensible." So says Krista Scott-Dixon, a researcher and nutrition coach who lost 23kg (around 3st 8lb) over three years. "Being heavy changes your physical experience of the world," says Scott-Dixon Unless you have experienced the physical discomfort of significant surplus weight, she says, then it can be difficult to comprehend the dangerous cycle of inertia that heavy people inhabit.
When weight is gained, it becomes harder to move. The harder it is to move, the harder it is to shift the excess weight. "You have all the mechanical stress of excess weight, but then you also have the metabolic problem." The internal hormonal environment of someone who is obese (someone with a body mass index of 30-34.9) is different from that of a person with a healthy weight, says Scott-Dixon. "Fat is a metabolically active organ. It's not just storage, it actually secretes hormones that affect your energy levels." In short: "Even if you don't really feel that much pain, you just feel like crap."
For many of us, exercise simply isn't part of our daily lives, and for people who are significantly overweight this can be compounded by the fact that conventional advice about exercise sometimes just isn't possible to follow. Personal trainer Steve Barrett explains: "Exercise is stressful for the body – but for those who are severely overweight, their bodies are already stressed, their blood pressure is already raised, they are already fatigued, their joints already strained."
For the overweight, the wrong type of exercise can cause injury. (Scott-Dixon, for instance, said she had to take painkillers before every workout.) So to start off, Barrett suggests the gym represents a safe, controlled environment; even budget gyms have quality equipment designed with heavy people in mind. "A lot of overweight people find they have balance issues, so the treadmill is a very predictable and safe place to start," he says.
Cross-trainers and recumbent bikes all alleviate impact on the joints and lower back as do swimming and aqua aerobics, he says. Yet despite the availability of equipment, Barrett concedes that often the people who need it most aren't even getting to the front door of the fitness industry.
Is that because gyms just aren't that fat-friendly? Scott-Dixon thinks so: "You're walking into a space where other people are already fit. You think everyone is looking at you. Probably your knees hurt, probably your back hurts. You already don't feel good."
In her view, "gyms take away that sense of autonomy and self-efficacy which is exactly what overweight people already don't have." Scott-Dixon's advice is "shrink the change". Find the smallest thing you can do right now and commit to doing it every day. Make three simple lists, she suggests. First, identify a set of activities you know you can do without any pain – which could be as simple as moving your arms. Second, write down the movements that you can do with tolerable discomfort – walking, perhaps. Third, list the exercises you simply cannot do. All your primary activity should be from the first list, with one or two exercises from the second. Focus on what you can do, not what you can't. "Think in terms of months and be patient with the understanding that something is always better than nothing." If you can't walk for 15 minutes, she suggests doing three five-minute bursts instead.
Steven Blair, professor of exercise science at the University of South Carolina, agrees: "We don't all have to become gym rats or triathletes." In his view, we focus too much on weight loss and not enough on simply living a healthy lifestyle: eating a sensible diet and being physically active. Blair's studies reinforce that tenet. His research, based on obese men and women aged over 60, found that the least fit 20% had the highest death rate. For those who were in the next 20%, the death rate was half that. "Do the best you can to get out of that bottom 20%," is his advice.
Both Barrett and Blair emphasise the importance of monitoring and recording your results. "Whatever your target," says Barrett, "those who closely monitor both the positive and negative outcomes of their regime achieve better results." Set realistic goals and if you don't meet your goals, then ask why not. What got in the way? Was there a recurring problem? Can you work around it?
Another undisputed strategy for success is the use of social support. Find someone in your life – a colleague, family member or next-door neighbour – who will support and encourage you. "Listen to your body," says Blair. "Be aware of problems. But the bottom line is almost all of us can do physical activity to make us healthier: it is not a hopeless cause for anyone."
