Transcript: Barriers to physical obesity

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You're listening to the safefood podcast.

Aileen: Hello, and welcome to the safefood nutrition podcast. I'm Dr. Aileen McGloin, Director of Marketing and Communications at safefood, the all-island agency promoting food safety and healthy eating. On this podcast we talk about nutrition issues like obesity, food, poverty, sustainability and health in the media.

Today we look at the barriers to physical activity for those living with obesity. I'm delighted to be joined by Maura Murphy from the Irish Coalition for People Living with Obesity and Clinical Specialist Physiotherapist, Colin Dunleavy. So you're both very welcome. Thank you for taking part of this podcast today. Maura, I'm going to start with you if you don't mind. And could you please talk a little bit about your experience of physical activity?

Maura: I have had my weight since I was 12 years of age. And I have been doing every diet you could imagine and now I've just learned to live my life the way it is. I live in a rural area in the countryside. And I find you can't really go for a walk on those roads anymore, you’ve to dive into the ditch every so often. So on a given day when I decide I'm going for a walk I have to figure out how much pain and suffering I’m in. Is it a knee pain, a hip pain, there's a back pain, and how far can I walk? And another thing that I would really be worried about is if I walk too far, will I need to be rescued? Because I might end up with my knee going or my back. And all I do is I drive, I get into my car and I drive to an athletics track. It's in my area here in Ballina and if I walk one round around that track I get one thousand steps in, but I can see my car at all times in the carpark so if I feel unwell or I feel too much pain, I can go back to my car. So really, in reality, any day I get onto this track is a good day so I don't go out thinking I'm going to do one lap, two laps, three laps, I am going to do what I can do on the day and I'm delighted to be there. I love swimming and you’re just so light in the water. You really are. It's great for when you're living with obesity and it doesn't hurt your joints.

But I can't go swimming unless I examine the pool beforehand. In other words, there has to be steps in. I can't go down a ladder and come back out a ladder. I'd have to have rails that I can hold on to. But the most important thing is, and possibly a bit of a taboo subject, is personally with obesity at 12 years of age, putting up the weight and arriving at 28 stone, gastric surgery, coming down to 17 and a half stone where I am now, I have an apron of skin now underneath my tummy and that apron of skin underneath it, you have to be very careful about hygiene of that underneath there. So I would have to wash very carefully, but before I go for a walk or anything like that, I would pad that area with cotton wool. And when I come back from my walk, I would take the cotton wool out, of course, and I would wash carefully there and dry very very carefully. And that's very important. For me, I have type two diabetes, I can't afford to have any sores or welts or anything, I have to be totally careful on that subject. So the one thing about the swimming pool, to get back to that, is if the dressing room is a communal dressing room and with the overhanging skin, I really cannot dress or undress in that area if there are small children around. I wouldn't do it to them. So there are certain things that have to be in a swimming pool and one of them has to be a dressing room that I can go into and close the door to undress and dress.

Aileen: Maura, you've described tremendous ingenuity, and with great humour, overcoming these challenges. Tell me about what being physically active means to you in terms of your health and your life.

Maura: Growing up with all the kids on the road, like you know, I'm with all of my friends and they haven't changed size, they put up a pound over Christmas and then take it off again, but me I kept putting up, putting up. But I was the most active person on the road. I played basketball, tennis I mean my mother said to me “please come in off the road”, you know yeah, you know “we'd like to meet you now and again in a family situation”. But I was always active never even still to this day. I'm never not active. I'm always doing something. But I possibly picked the wrong job, in that I'm sitting down all day long. And I put on a lot of weight doing that. But when I had my gastric operation, I came down almost 11 stone. Oh my god the difference in the quality of life for me was amazing. And then with the physiotherapy out in the weight management centre with Colin, who when I had problems, I’d say to him listen there’s something wrong with my hip, what’ll I do and he told me how to get into swimming pool and cure that. So I mean, the quality of life since I lost all of that weight is amazing. I mean my poor grandson who’s almost five can’t keep up with me at times, you know.

Aileen: You've talked a lot about barriers. Are there any other barriers you'd like to let us know about?

Maura: Yeah, well, that would be like for instance, in this area here where I live. I'm not too bad, but I lived in Leitrim, it was very remote. But today, the mail advertiser came in the door and they have this new system, it’s the Link Bus and they now have a kind of a door-to-door service for people, over 65 or people who have disabilities or mobility issues that they can pick up and say be brought to the post office or to their health care unit or to whatever or to the community center for whatever. So that's a big jump forward that I'm delighted to see. I had the knee operation that I told you about, the knee replacement. Brilliant, absolutely amazing. But I had to go physiotherapy two weeks after that. And living in Leitrim, I literally had to ask my friends to come down and stay with me, because when I rang the local hospital, they had said that the bus or the ambulance bus that normally did this was now not working. In every hospital it was now taken off the roll. And we found that in the ICU support meetings the people were saying well, I'm sorry, but I can't get my appointments anymore. They've taken the ambulance away. Now it's a bus ambulance, you know what I'm talking about. So that if that was reinstated, that would be great. You know, not just the local link but if that was put back on the road.

Again like that, down I Carrick-on-Shannon I used to see the old people that have been brought there for day’s respite. And I used to play music with Comhaltas, so I’d be down playing the music or they'd be having their little gin and tonics or whatever. So all of that needs to be put back. I think for people not just living with obesity but people with mobility problems, it would be great to see that service coming back in again.

Aileen: Something else you mentioned earlier on Maura if you don't mind talking about a little bit more, was your feelings about changing and changing rooms for swimming. And I suppose this touches on the idea of weight stigma. Now we have covered weight stigma in other podcasts here. But could you tell me a little bit more about your experience of that in your life?

Maura: Yeah, well, that from the early age I told you I've always had my weight, from you know the yobbos passing by in the vans or the cars shouting out the window when I was 28 stone. How did I handle that? Well I thought about the other five drivers that passed me by, they might be saying, well fair play to her for trying. So I concentrated on them rather than the lads. But with 60% of the population now overweight or living with obesity, they’re not going to be shouting at their grannies or their aunts or their uncles. Any they’re not going to be doing that for long I can tell you. I think it'll be brought home to every household. What weight is, how it needs to be addressed and how we need to fund that as well you know. And stigma in the workplace, like I've been passed over twice for promotion. This would be in the 90s. For starters, when one of the people on the interview panel came to me afterwards, a very nice lady. She said you did a great interview, top of the panel, it’s a shame about your weight, you are not really suitable for front of house – that was the civil service. Now there was no redress in ‘93 and you know, I actually just felt more shame than anything else. Again, you go on the mad diets, but, you know. In fact, three weeks later, I was actually sent to the front office. I worked there for 14 years, but that's how the civil service works. No one knows for sure. And when I  went back to work after having my children I was in an office working in accounts and the lassie that came in behind me was sent for the permanent job before I was so when I went into the administration manager and asked why, he said, well, Maura we knew you wouldn't pass the medical.

Aileen: Colin, if you don't mind, I'll bring you in here. Could you tell us a little bit about your experience as a physiotherapist of working with people to address their weight, their physical activity.

Colin: I've been working in the weight management service in Loughlinstown since 2008 as a physiotherapist, so I think over the years, things have changed and our understanding of what we're dealing with has changed. Maura’s great story there was that she was the most active kid on the block. And yet she's the one who is living with obesity. So that in itself tells us the direction that our thoughts have gone. So I think it's when we started at this, or certainly my impression coming in was this is a very eating less and moving more and stuff that's not that complicated. But that's not actually it. Now the science says, since then, has informed us of that. So I suppose I’d probably answer that question a little bit differently.

So what generally happens and Maura can come in and back this up is that your ability and your functional capacity gets rolled and taken away by obesity and it's not the other way around. So it's not the person doesn't become obese because they're not moving enough. Their movement ability is taken away by the disease. So I suppose it suits me being a physio even better. I thought at the start I was having to do like a TV style on the treadmill and sweat it out and it's gone away then. And I soon found out that it wasn't going to happen. And that way of thinking about it is so erroneous but yeah, it's still on our TVs unfortunately.

So once you know what you're talking about, when you're when you're trying to help people who are living with this disease as a physiotherapist, you are not trying to burn calories. We don't think like that anymore. So we just recognize that there's a load of different parts of lived experience that takes a person's ability to move away. And then my role, and our role, and anyone providing health care to this wonderful group of people, is getting them to be able to maintain and recover and rehabilitate their movement and their ability to move. Because Maura has touched on some really important bits there. Maybe some some of those we’ll address. Maura was talking about pain. So pain is very prevalent in this, this group of people. And there's loads of reasons for that. I used to think it was just a mechanical loading thing that the joints most of us had to do more work so therefore they get it, but that's not actually the problem. That's a part of it. But there's a whole physiological side where there's some what we call pro inflammatory status, that makes things a little bit more sensitive, sensitized and sensitive. But I think there's an the more I'm in this area you can see there's a huge psychological load when you're living with the disease of obesity, and Maura was talking about the experience when you're dealing with others. And they are what's called othering you and making you different and making you outside the group. But actually you probably do it to yourself too. Would that be a fair shout Maura?

Maura: Yeah, there's definitely self-discrimination that you do in yourselves stigmatization that to do because you know, you just have all these doubts and things that build up in your mind, you know?

Colin: And it makes you come down on yourself and anybody's going round with a psychological load to carry, the line between your body experiences and your psychological health is very blurred. And again, when I left college hundreds of years ago, I thought it was very simple. The brain lives up there and the body is down there. They don't really do much together.  But they share loads, and the whole thing is you can't separate them. So if somebody's feeling chronically, like I'm a bad person, look, I'm a failure at this. That's another massive part of why people are living with pain. They express that bit and there's a little bit of the load and a little bit the inflammatory status, and then you probably come a bit deconditioned because of the disease and all that processes with it, and then that in itself will make moving a little bit harder and a little bit more painful.

Maura: Can I just say there Colin, that the first day I met you and I was 28 stone at the weight management clinic in Loughlinstown and you said to me let's go for a walk. My heart went out my boots, I thought I’m never going to do this. And I have to say, fair play to you. It took us a long time to get around that car park. You kept the chat going. You had a thing on my finger taking my pulse or whatever it was, and you kept the chat going. And after that I thought, hang on, I got around that car park, that wasn't too bad at all, so it wasn't. So that made me realize I can actually do this. I said that to you before, and that was the start of me getting back on the road.

Colin: Thanks Maura. And I suppose part of that is what people think, and again, the mixed messages that we give unfortunately, in this area as well. It probably needs to be hard and you probably need to be sweating and you need probably need to be out of breath, and that's just again reinforces that the negative experience of that. So if it's a negative experience, as we say if medicine is a poke in really, who's gonna take that. And it's not about that. It must be about rehabilitation and just working with your joints. I think a big definition to get right, as well as the expectations and the reasons for it to engage in physical activity when you're living with this difficult disease, and giving yourself permission to work in your, if you like, your golden window: I can do this amount. If I do less than that I don't feel good. If I do more than that, I feel sore. So where is my golden window of movements that I can engage with, and then trying to use that to rehabilitate your function.

Aileen: You both articulated beautifully the interaction between physical barriers, psychological barriers and the social barriers and it's been a real pleasure to listen to you to discussing personally Maura how you've overcome those barriers and Colin on your experience of helping people overcome those barriers. Is there any other advice or insight you would give to us on overcoming barriers for people living with obesity in relation to physical activity?

Maura: Don't live with the stigma, don't do nothing, get up and do something about it. Your first port of call would be your GP. Get them to refer you on to either a physiotherapist or a weight management clinic content. St Colincille’s weight management clinic in Loughlinstown - I know there's a waiting list but at least be on the waiting list. Contact our organization ICPO the Irish Coalition for People living with Obesity. The Find us on Facebook at ICP obesity will have a website up soon. It's confidential. It's great for people who have weight or who are living with obesity. And it's great to find other people, like-minded people who understand your journey. And then there's the National Obesity Program, the clinical program launched by the HSE for the management of overweight and obesity in 2019. And we really look forward to that being implemented. There's a lot in that 94 pages which I’ve read. There's a lot in it. And if all that is implemented it should improve the life because it will be in your local area. You won't have to travel so far, which will be amazing, you know.

Aileen: Colin, is there anything you'd like to add to that, in your experience of supports that are available?

Colin: I think that Maura said it all really and I 100% back it. I think the key bit is recognizing if you're a person living with obesity, listen to this. But it can be a really lonely place. And again, there's an experience of living with others and unhelpful language and ideas that that sometimes form some of those relations. And then your own thoughts and feelings about it is rarely positive. So sharing that and getting a support network and talking to somebody about how to, I suppose in terms of function, how to rehabilitate yourself, what's the expectations of that? You know, but I think starting in a group such as the ICPR is fantastic as resource for people. I suppose in terms of habits and getting off the floor with some physical activity, knowing why you're doing it. You're doing it so your future self will be able to interact with their environment a little bit better, every move a little bit better.

Aileen: Colin, what advice would you give to healthcare professionals who might be listening to the podcast in relation to physical activity for those living with obesity?

Colin: I suppose really understanding what success and failure are. And that is any engagement in terms of improving somebody's function is important. And getting your language right about that. Now, when I started off, I realized or I thought I realized that language was a minefield, and I could easily say the wrong thing. But actually, then, after I remember being at an inservice about mental health, and the person talking was, was was a tackling the same issue, but how do we address this with our language from a healthcare professionals delivery point of view? And they said, if you really understand this, if you really accept it, as this has nothing to do with this person, they were dealt this hand and you're in this privileged position, to be able to try to offer some help with it. And if you truly are empathetic to it, you don't have to worry about your language, it will just come out normal and you won't say things that are offensive or threatening to your collaborative relationship because you couldn't because you're actually there in that space. So I think if people can really make that journey, their own emotional journey with this, that they can accept what their role is, that this person is looking for and seeking help. Let's make it through all the professional things, make your problem list and ask them what is the thing that they want most from this consultation? And how can I help? And make sure that you're there to be that person in a respectful manner, mannerly way, and I think you will sail every consultation from then on.

Aileen: And one last question. If you don't mind for both of you. If you have a conversation with a policymaker, and you could ask for just one thing. What would that one thing be?

Colin: I think if we could all the policymaker could implement the model of care that would be a fantastic achievement. I think we just need to change the narrative even from the decision makers, that this isn't a disease of eat less move more. This is a disease that's complex. It is and it needs to be thought of as such. And without any stigma attached from people making the decisions in a more empathetic way. And I think public health decisions could be made. I think they could be made around the availability of top shelf foods. Financial implications, or financial controls and such things probably would help. I wouldn't be an expert on that. For me, my job is dealing with people with severe disease. And I just like to make sure that if somebody is living with a severe disease that they'll get access to a service, I suppose like ours.

Maura: If I found some policymakers that would even listen to me, I'd say to them at this moment in time one in five children suffer from obesity. So if you can come in at level and help, really help, that level, and put the funding into see what's causing it, see what the problem is. It would have to have cross-government support and funding for the full implementation of the newly launched model of care, which would be a terrific help. I would say please invest in long term treatment for people who believe in themselves, especially when they regain weight. It's ongoing, you don't treat obesity just once, it's the same as other diseases, heart diseases, it's for life. And I would hope that the policymakers would have somebody in their family who would be overweight. With 60% of the population I think I'll be hitting on it alright.

Colin: I wonder, could I add something there? And that is also how we influenced higher education institutes. We were talking about a stigma from yourself from other strangers on the street, but I think the worst thing is when you meet stigma and negative bias from a healthcare professional, and, again, we talked about pain, look at the amount of people who come back to me after going to an orthopedic consultation, or a vascular consultation, and unfortunately, the expert they're not understanding the process of this disease and putting it down to a 1980s concept of eat less move more when they learned it and not realizing that things have changed completely, and how negative and damaging that is. So I suppose I would like to make sure that that that the policymakers would also extend as far as the higher education institutes, that they address this in a robust, up to date scientific manner, and that people aren't leaving college with the negative, stigmatizing views, and realizing that they can help and profoundly help those who live with this particular disease.

Aileen: Well, thank you both for participating in this podcast. You've given us tremendous insight understanding and indeed increased empathy, which we hope we can spread to those who are listening to the podcast.
Thank you very much, and thanks for sharing your great stories.

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