Take Your Breath Away
August 23, 2016
Electronic Doctor Onboard
August 23, 2016

Obesity is a big problem

“DOCTOR AT SEA” a monthly Column in The Islander Magazine

Obesity is a big problem

“Not another medical moan about something else I enjoy”, I hear some of you say. Most of us enjoy our food and resent nanny State interference in lifestyle choices including what we eat and how much of it. Most of us living in Mallorca away from various homelands or thrusting out on the high seas away from sight of any homeland probably feel much the same way about bureaucracy and nit-picking advice seen as intrusive fussing.

However there is a big problem.

The World Health Organisation says more than one billion people are overweight and more than 300 million are obese. Excess weight is a major risk factor for chronic disease such as diabetes, heart disease, blood pressure problems and stroke.

The prevalence of overweight and obesity is commonly assessed by using body mass index (BMI), defined as the weight in kilograms divided by the square of the height in metres. A BMI over 25 is defined as overweight, and a BMI of over 30 as obese – normal is 20-25. According to WHO, adult BMI levels of 22-23 are found in Africa and Asia, while levels of 25-27 are prevalent across North America, Europe, and in some Latin American, North African and Pacific islands.

BMI is generally useful for most people but as soon as it is applied to very active and very muscular individuals it breaks down because these people can be extra heavy due to muscle. They turn in a high BMI but you just have to look at them to see there is no spare fat. The defining feature, especially for men, is the shape of the waist. Men tend to accumulate excess fat around the waist but a very fit muscular man will have a firm waist without a spare tyre and, in a fit and active man, that over-rides the BMI – not so easy for women because they put on weight on the buttocks and probably are better served by the BMI.

The yachting industry does attract young fit thin individuals but they do eventually turn into older less fit less thin experienced individuals who may feel they have earned their wrinkles and that their extra pounds, or stones, are just par for the course and should be worn with pride.

This is a big mistake.

There is a huge amount to be gained by keeping the weight within sensible limits. We are all in an excellent part of the world to enjoy a healthy and enjoyable diet where we can do this by:

– eating more fruit and vegetables, as well as nuts and whole grains; – engaging in daily moderate physical activity for at least thirty minutes each day; – cutting the amount of fatty, sugary foods in the diet; – moving from saturated animal-based fats like rich dairy products to unsaturated vegetable-oil based fats like olive oil.

The MCA provide guidance notes for ENG1 certification and, not surprisingly, body weight and obesity features in these. What may be surprising is that a BMI over 30 is a cause for concern with respect to safety in an emergency and can restrict a candidate to near-coastal only.

At the beginning of March, I attended an oil and gas industry medical conference in Aberdeen and we heard about problems with obesity on oil-rig platforms. In the past, the industry decided that a BMI over 35 was not acceptable for offshore work but in 2008 this was raised to 40 and the onus was placed on employers to make a safety risk assessment. The oil industry works in some isolated locations both at sea and on land (we heard about a 1500 Km pipeline across the Caucasus Mountains) and there are concerns about rescue and casualty handling issues and also emergency escape from helicopters in distress. In February, a Norwegian doctor put his head on the block and proposed a body weight of 120 Kg or waist above 115cms as a disqualification for offshore work – political strikes are threatened! Perhaps better to wait for UK national or professional guidance!!

The oil and gas industry are considering an industry-wide standard on waist measurement combined with the ability to get through a standard helicopter window as a way of assessing individuals for the industry. A maximum weight for safe stretcher handling is also under discussion. Some of these offshore concerns are shared by the yachting industry especially when you think about the logistics of getting a very heavy person on a stretcher up the possibly tortuous nooks and crannies to the deck and hospital help – and that is without even thinking about the unregulated situation for guests on board.

Many of the concerns in seafaring and in oil and gas exploration stem from the remote location of the potential medical problems and, whilst the final specific guidelines may differ a little, the risk assessments have many similarities and safe emergency handling of an obese individual can be a big problem in more ways than one!

Dr Ken Prudhoe, MCA Approved Doctor, can be contacted at Club de Mar Medical Centre, Palma de Mallorca.

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