Resistance training is a standard form of fitness training in most commercial fitness centres. Yet it is a mode of exercise that has not been extensively studied in conjunction with fat loss. From a commercial perspective it might be seen as important because it is a means of maintaining a membership in a commercial centre. However, scientific research carried out to date holds no definite answers on the role of resistance training for fat loss, or indeed to indicate that it may be more relevant to use this than another less vigorous activity. Several studies show an increase in metabolic rate with resistance training in obese people, but other studies show no effect. Some show decreases in body fat levels while others do not. To date there has been little if any conclusive research comparing the two forms of activity over a set period of time in a homogeneous group of individuals.

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Obesity is often associated with increased fat deposition in the tongue and throat structures and this can cause the airway obstruction in many sleep apnoea sufferers. Reducing body fat— even by as little as 10 per cent in some people—can reduce the problems of OSA. OSA is most common in men and has a direct role in injury, particularly in the workplace. Disruption of the deepest stage of sleep at night can lead to excessive daytime sleepiness (EDS), which results in a vicious cycle of reduced exercise capacity, stress, over-eating and hence an even greater level of obesity. Daytime tiredness is now known to increase the risk of injury; truck drivers with OSA are now banned from driving in some countries.

In many instances of OSA it may be necessary to improve sleep patterns before the patient has sufficient daytime energy to break the cycle and carry out physical activity which can lead to fat loss. Devices such as a constant peak airways pressure (CPAP) machine, which keeps the breathing passage open by maintaining a positive pressure in the airways, can be valuable. Although dealing only with symptoms, this allows a patient to feel rested and suffer less excessive daytime sleepiness and thus perhaps to be more active during the day, potentially decreasing the overfatness which caused the problem.

Joint problems, such as knee pain, are also common in very big people. This is because of the extra pressure put on the joints by carrying excessive weight. Often this can be a limiting factor in getting big people to exercise. However, it’s not uncommon to find that these problems improve on a fat reduction program as the individual begins to lose fat, and hence some body weight.

Skin infections can be a further problem. A fungal infection called intertrigo which causes itchiness and a rash, can flourish in the hot, damp environment under the ‘apron’, or fold of belly fat in very big people. Fungal infections are also common on the insteps of the feet, which often never see the light of day, because of the extra weight forcing them into and against the inner surface of the shoes and the heat created by synthetic socks and leather shoes. This is one reason why big men often insist on wearing thongs’ or sandals which air the feet, without knowing that it is their obesity which is causing the problem. Tinea pedis, an infection between the toes or under the feet, is also more common in fat men because of the hot and sweaty micro-environment of the feet. Pitted keralysis is a bubbling form of rash under the soles of the feet, also common in the obese, which causes the feet to smell. Regular washing only aggravates the problem as this reduces the skin’s natural oiliness and dries it out even more. Regular airing by wearing open shoes or punching holes in the insteps of shoes with a nail punch can help overcome the problem. Acanthosis nigrocans is another skin problem, characterised by velvety, pigmented patches around the underarms, sides of the trunk, knuckles and groin. Acanthosis is occasionally a sign of severe insulin resistance.

Finally, sexual difficulties and psycho-social problems can also result from excessive body fatness. In relation to sexual difficulties, poor self-esteem, lack of fitness and lack of flexibility all combine to make this a significant psychological problem. Recent research has also shown that abdominal fatness in men is associated with a decrease in testosterone levels. This is quite contrary to the notion of a ‘pot belly’ being a proxy indication of manhood. Other psycho-social problems come from the widespread prejudice against fatness. Obese people are often judged to be lacking willpower and to be lazy, over-indulgent and stupid; fatness is strongly associated with ugliness.

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Debbee, a 38-year-old resident of Spokane, Washington, doesn’t remember a time when she was thin. At 5 foot 11, she carried her weight well—for a while. But the scale never seemed to stop climbing upward. By age 33, she had reached 414 pounds.

Self-conscious about her appearance and concerned about the effects that her weight might have on her health, Debbee felt that she had to slim down. She just couldn’t get herself motivated to do it. That changed one day in 1994, when she turned on her television and saw rescue workers extricating a large woman from her home and placing her in a special van to take her to the hospital. “The reporter mentioned that the woman weighed 560 pounds, and I was mortified,” Debbee says. “That wasn’t much more than I weighed.”

With the image of the woman fresh in her mind, Debbee launched a self-styled weight-loss program that consisted primarily of eating low-fat foods in more sensible portions and riding a stationary bike’. “I knew what I had to do,” she says. “I just needed the motivation to do it.”

Exercising was tough at first because Debbee was so overweight and out of shape. “I’d just tell myself, I’m going to pedal that bike for as long as I can,’” she says. “I made myself sit on it for an hour every day, whether or not I was actually riding.”

Debbee had an easier time adjusting her eating habits, but dinnertime remained a struggle. How could she eat a carefully portioned meal while watching her family help themselves to seconds? How could she just throw away perfectly good food that her kids didn’t finish?

Rather than wrestle with these temptations, Debbee decided to walk away from them. Every evening, she prepared dinner and served it to her family. Then she took her meal into the living room and ate by herself. She didn’t return to the kitchen or dining room until everything was cleaned up and put away. “This kept me from dipping into the serving bowls for extra helpings and from finishing off the kids’ uneaten food,” she says. “It also gave me a few minutes of peace and quiet.”

Her strategy worked like a charm. Over the next 3 years, Debbee took off 234 pounds, reaching her goal weight of 180. She has held steady ever since.

Were all of those dinners alone worth the effort? Debbee thinks so. Now that she’s fit, she has even more opportunities to enjoy life with her family. “I used to be a very active person, but I hadn’t been on a bicycle since I was 11 or 12.1 really wanted to go riding with my kids, which we now do all the time,” she says. “I’m able to do the kinds of things that I couldn’t do before.”

WINNING ACTION

Go solo. If being around your family at dinner tempts

you to overeat, do what Debbee did and eat your meal away from temptation. You’ll feel satisfied with what’s on S your plate and avoid the urge for seconds. As a bonus you can even enjoy having quiet time for yourself.

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