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My friend called me after the recent visit of her adult son. "I was so annoyed at him!" she complained to me. "He gained so much weight during the pandemic that he can barely fit into his clothes and believe me, he already wears a very large size."
"I hope you didn’t criticize him about his weight," I said, knowing that she probably did.
"Well... yes," she admitted. "I lectured him on how important it was for his health, but of course he knows it is. There is heart disease and diabetes in our family and his weight makes him vulnerable. But my lecture fell on deaf ears," she concluded. "I don’t know what to do."
Many of us are in a similar position in regard to family members or, less frequently, friends. We fret over the weight they gained and try very hard not to say anything when we notice the individual eating excessively and/or snacking constantly. We suggest walks, but try not to criticize when the individual prefers to sit and read, or watch television. We talk about our own diets and struggles to keep off the weight we have lost in the hope that something will resonate, but often there is no response—indeed, if there is any response, it is likely, “Stop nagging me!” And we all are quite conscious of engaging in fat-shaming—or we should be—and realize how counterproductive making someone feel bad about their body can be.
Many people who are obese don’t weigh themselves, and sometimes avoid going to their physician for annual check-ups because they don’t want anyone else weighing them. They know they are gaining (or perhaps losing) weight by changes in how their clothes fit. Wardrobes of different sizes may hang in their closet, and shifting from one size to another tells them all they want to know about what their weight is at a given time. In short, it is possible to deny the reality of weight gain until the excess pounds begin to affect mobility.
At some point, the excess weight will make it difficult to get up from a chair, to walk quickly, to carry something heavy, or to simply climb a few stairs. My friend’s son had to climb to the second floor of his mother’s house to get to his old bedroom, and she heard him panting when he would reach the upper landing. The start of a useful conversation about weight loss began because of his breathlessness after a climb that, at a lower weight, would not have even been noticed as being difficult.
"Yes," my friend told me, "he is concerned about how his excess weight makes it difficult to catch his breath when he has to climb stairs. He worries about his lack of stamina, and confessed that he fears being in a situation where he would have to move very quickly...as in a fire or fleeing a tornado." (He lives in the Midwest.) "And he told me that he is in knee pain. He worries that he may need to have knee replacement operations, but doing so as heavy as he is doesn’t make sense."
Extreme weight gain may leave an individual in so much pain when moving that the person becomes almost bedridden. Anyone who watched the television program My 600-lb. Life saw examples of people who need constant care because the act of getting out of bed is so difficult and painful. But the effect of too much weight on one’s back, legs, or feet is always perceived long before it reaches that point.
Conversely, excess weight may have no effect on physical prowess. Some competitive athletes—Sumo wrestlers, for example—are certainly obese and yet have no lack of stamina and strength. And we shouldn’t assume that gaining weight will automatically decrease the ability to run, climb stairs, or lift heavy objects. However, a diminution of the ability to carry out these normal aspects of daily life should be a wake-up call to start losing weight.
Thus, changes in mobility can and should be used to determine whether weight should be lost, even if an individual does not want to know how much he or she weighs. There are standard measurements of mobility used routinely by physical therapists during rehabilitation sessions. Anyone recovering from orthopedic surgery, stroke, or injury, or suffering from a neurological disorder, is usually tested on these measures to obtain a baseline evaluation: How quickly can the individual walk a specific distance? How many times can the patient go up and down a step? Can the individual rise from a chair without help? Does the rate of respiration and heart rate increase abnormally upon physical exertion? Does the individual begin to sweat during mild exercise, or claim that he or she is too tired to continue walking a short distance?
These tests are very simple and basically reflect a person’s ability to carry out typical daily activities. Most people are aware of their inability to climb steps or get up from a chair or walk quickly without having to go through standardized testing. What is important is the willingness to perceive a decline in mobility and an increase in physical effort to do what was once easy to do. What is important is to realize that if weight is not lost, then it will become harder and harder to carry out these aspects of daily life.
Interestingly, the dieter’s increased mobility and stamina may improve before much weight is lost. It may not be necessary to reach one’s weight-loss goal to experience significant improvement in mobility. Walking faster, standing more easily, and no longer panting going up stairs may occur fairly early in a diet, and that is fine: The immediate goal is a return of physical function, not a smaller clothing size or a lower number on the scale.
Moreover, it is likely that the physical improvement from the initial weight loss may motivate continued dieting. People often state that they feel and act more energetic even after a loss of only a few pounds. Regardless of when (or even if) a weight-loss goal is reached as determined by numbers on a scale or a chart, the individual has reached a critically important goal: the ability to rely on his or her body to carry out the functions of daily life. And for the present, that may be enough.
