560 POUNDS??!!!??! Bless your heart. Did he/she live?

A quarter of a tonne! Wow! And I betcha s/he claims to have "a slow metabolism". To paraphrase Jasper Carrott, "the reason you are so fat is because this hole" (points to mouth) "is bigger than this hole" (points to arse).

I completely forgot about that. It's a guilty little secret of mine, but I love Jasper.

If I ate myself silly I could never get my weight up to 560lbs. Maybe 250, maybe.

It does take that kind of metabolism plus unlimited food supply to reach those huge weights. And never, in the evolutionary history of humans, has refusal of available food been any kind of evolutionary advantage. We have never had fat or sugar enough until modern times, and only in the past 50 has fat and sugar been cheap 'junk' food. So, when there is much cheap available sugary fat, those with a genetic predisposition to deposit fat readily ( those who would survive a famine- another common feature of most human experience for the past many millenia) will become huge. Unhealthy in this world, these are survivors from our bloody difficult past.

I hate dealing with them, I've hurt myself trying, they smell and are so labor intensive. But the obesity is NOT a character flaw or a moral issue. Not to say fat folks are saints, but let's not get cause and effect confused. Trap yourself inside their bodies, and how good a person are you likely to be? If you were that much overweight, would you go on a diet, or would you just say- what the hell? And eat whatever you wanted because it really made no difference?

But it's silly to keep chomping away on cakes and crisps and fizzy pop and getting bigger and bigger.

Someone realises they're diabetic, they change their eating habits, have sweetner instead of sugar, take a packed lunch to work instead of eating stuff out of vending machines. Someone realises they're intolerant of wheat or lactose, they minimise their intake of it. Someone realises they smoke too much, they try to quit or at least cut down.

It involves big lifestyle changes but they know it will make their lives better or at the very least stop them getting/feeling worse.

Any sensible person knows they don't need a whole 14inch pizza and a portion of chips for dinner for one. That you don't reward sticking to a diet for a day with a cream cake the next day. That a Bic Mac has calories even if you eat it while walking and order a diet coke with your meal.

Many people who are obese are not eating like that, and it still doesn't make a difference. Just as there are brittle diabetics who do all the right things, and still lose limbs and die of kidney disease.

Not being healthy is not a moral issue.

All I ask is to imagine yourself in their place, have compassion, and not judge. That is a moral issue.

It is still ok to hate to have to deal with the consequences, as I do, every day. It is ok to educate and try to deal with nationwide obesity issues. But the ones who top a ton are not *just* out of diet control- that kind of morbid obesity has to have a huge genetic component.

Surely a job for Trumpton?

Maybe in the good old days. However LFB doesn't stand for London Fire Brigade anymore. Instead it seems to stand for Lasy F*****g B*****ds. It is no longer their policy to send aid to ambulance crews except when a matter of life and death...

So they refused to come out. Probably interupted their dinner or something...

So - when are we as an ambulance service allowed to say 'we ain't coming out unless it's life threatening'? Oh that's right...never!

...and don't get me started on the local hospital either...

Perhaps I'll post something when I am a little less frazzled, and a little more objective.

My working relationships with certain members of the LFB aren't that good, something to do with me calling it a Fire and Rescue Service instead of brigade.

Victorian Services has just started upgrading stretchers to a 230kg model. Sometimes that isn't enough. Currently building an ambulance for the transport of "bariatric" patients. with an oversized ground level stretcher. Options for loading are going to be a power lift, or a ramp and winch....scary isn't it?

For us, at a certain point, you are no longer transported on a backboard or stretcher, but rather on "The Motherboard," a double-wide ultra high capacity stretcher, which can fit into the back of a cotless ambulance.

I believe generally speaking that when it comes out (dispatched in a utility pickup,) so does the high angle team or a rescue squad to handle logistics...

A doctor friend mentioned that they had to deal with a patient weighing an estimated 55 stone.

Six fire brigade guys to lift said patient into the hospital after removing the front doors and handrails.

They couldn't weigh the patient because they were just too heavy for any scales that the hospital had. I suggested a commercial vehicle weighbridge to weigh the ambulance, with full fuel, with and without the patient...

350kg. I've flown aircraft that weigh less than that. A good weight for a pit pony...

Places with large scales (smaller than weighbridge) that spring to mind are a meat market for weighing sides of beef, or a racecourse (I know they weigh the jockey + saddle, so they might possibly have facilties for weighing horses).

Or a zoo, of course....

Cadbury Moose.

Mmm yeah, but dragging some hapless fattie down to the racecourse or cattle market would be a bit undignified. Admittedly if you're so fat you need six very large people to lift you - don't forget that we're talking about someone who weighs as much as half a Nissan Micra - then you've probably surrendered a certain amount of dignity anyway.

At least keeping them in the back of the ambulance would be nicely anonymous.

There are people out there who do have "Slow Metabolisms". Morbid Obesity is a disease in many cases. I am not saying all of those who are Morbidly Obese have a disease, but many do. Why is that so hard for so many to believe?

I realize that it is difficult to say the least handling a morbid obese person, especially in transporting.

These people depend on you, they rely you, and on your sense of compasion, strength, health, and respect for them to aide them in their weakness, illness, and hour of need.

For the most part these people are extremely grateful to you for what you suffer to care for them.

'Streetwatch' did a post recently on bariatric patients, seems the US has specialist vehicles for very large people.
Key I suppose is remembering they are people.
I eat like a horse but I'm not even 11 stone wet through.
Easy to judge though.

But the thing is, if you eat things that cannot physically be metabolised to fat (eg salad; how much fat is there in a salad, ffs) then you don't GET to that weight.

It's like Ricky Gervais said about Rik Waller... once you got to 30 stone, did you not think 'hmm, maybe I'd better stop eating'?

Yes, fatty, sugary food is available; that doesn't make it right that people should abuse their own health and put themselves and their carers at risk by getting to 50 stone and then blaming it all on genetics. Genetics may mean you don't eat like a horse and stay thin as a rake; it doesn't predispose you to eating like Michelle McManus (who incidentally went from a size 26 to a 16 by healthy eating and exercise which epitomises the fact that it's not all about genetics, it's about not eating your own body weight in empty calories every week).

Claire
BMI 24-25
Moderately healthy eater and cake addict

Yes it is about what you eat. There are many out there who are obese for many reasons. Food is to ready available to all of us, especially the wrong types of food. Sugars and carbs are a real problem. Lack of exercise is another real problem.

I work with the Morbidly obese and until I started working with them, getting to know them, and their habits from eating to exercising I was very judgmental. I know longer am, for the truly morbidly obese are nothing what you expect on a majority.

We all have to have fuel (food) to function, if these people eat enough to get that fuel they gain weight, whether they exercise or not. Their weight just keeps creeping up little by little. If they starve themselves they can loose weight but not very much, and they don't have the energy to exercise. It is a cruel and vicious circle for them.

The research we are doing with the truly morbidly obese so far is showing these patients are suffer from many disorders most of them leading to mitochondrial disease and how there bodies process natural insulin's.

There metabolic systems stay in a permit state of storage, instead of using the fuel to create energy for the body it is storing it. Like the nomad theory of old.

One of my saddest cases is a 46 old diabetic lady who was brought to us in a horrid state of health six months ago. She has been obese since the age of 7. She has battled her weight all her life. Her highest weight to date had been 366. She had balloon this round to 433, couldn't function so she put herself on "her diet" to bring her weight down again. Which she had, she brought it down to 256 but couldn't walk to the bathroom 10 feet away without oxygen deprivation or passing out she was so weak. She was also in a state of chronic diabetic crisis. Her daily food intake consistent of a 4 oz glass of orange juice for breakfast, a bowl of iceberg lettuce for lunch, and a apple with a glass of skim milk for dinner. For a treat once a week she would eat a bowl of oatmeal for breakfast, two poached eggs for lunch and hamburger patty with a steamed green vegetable for lunch, spread out thru the week. She was trying to live on less than 500 calories a day.

She stated to us on admission that if she ate like normal people did she gained weight a pound at a time. She hates food, she considers it her enemy. We put her on a 1000 calorie diet, knowing that she would gain weight at first, but then would stabilize out and start loosing weight. She threw a fit said she could not eat that much she would start gaining weight again etc. We told her the plan, we had to tube feed her at first, got some strength back in her, had her exercising twice a day, eating her 1000 calories a day, her health improved, her diabetes stabilized. but she we were still waiting for her weight gain to stabilize and for her to start loosing weight. It is six month now and she has steadily gained weight. She is now 312, on a thousand calorie diet and exercising three times a day, plus walking twice a day.

Her test have shown that she has multiple metabolic disorders, multiple endocrine disorders, and multiple immune systems disorders all link to mitochondrial diseases she was born with. Her internal power house was built wrong and doesn't work right, genetics.

Most our truly morbidly obese have given up, they get tired of the fight and struggle it takes for them to keep their weight down to a manageable level. Mentally and emotionally they give up. They are accused of stuffing their faces, cheating on their diets, being lazy coach potatoes and mentally ill. They are discriminated against, shamed, humiliated, embarrassed, ridiculed, made fun of, laughed at, called names, nicknamed, joked about, ignored, hated, loathed, and shunned by society at large. There family and friends are embarrassed by them or for them.

Most these people have hearts so full of love, mercy, kindness and caring for others, learned because of there situations, they are true gifts to humanity. Yet they are the unloved, untouched, unaccepted, and the unwanted of our society. Obesity especially Morbid Obesity is the last known acceptable prejudice practiced in the world today.

Wow.

I know that in such cases of morbid obesity there was a genetic component, but have never really looked into it. Your comment is basically a health paper in and of itself.

Thanks.

By the by I was impressed with the completely professional manner in which all nine of us treated the patient. Although I'll admit that we did have a general debrief afterwards that mainly involved the words, "F**K me! That was a big one" and "Yes, I did see you subtly trying to avoid being urinated on".

But of course, that is our secret stress relief skill - black humour.

Thanks,

This touches my heart in more ways than I can count.

Only six of you...you did very well...By the way there is nothing wrong with a debrief...lol...privately and no possibility of being overheard....

Thank you for that enlightening post - I read it with tears in my eyes and promptly registered with Blogware so that I could reply to it.

I am, to use the phrase here, morbidly obese. I know it, everyone around me knows it. I'm 45 years old, male, 6'1" tall and 20st10lbs (that's 185cm and 132kg if you don't do imperial, and 290lbs for anyone who doesn't know what a stone is!). However you look at it, it's big.

I'm reasonably healthy, work 37 hours a week and generally look after myself quite well. I eat brown bread, pasta, rice, vegetables, salad and the fridge is stocked with "Tesco Healthy Living" this, that and the other. OK, sometimes I blow it - I had a curry last night complete with Nan bread and a lager - but it's not the norm - the norm is I eat pretty well. I go to the gym two or three times a week, for an hour at a time, and my weekend hobby is walking. I did 12 miles last weekend and my main holiday next year will be walking the West Highland Way - all 95 milles of it.

But I'm still fat, and if anything it is gently, inexorably, gradually increasing.

I don't want to be this way.

I would love to have boundless energy, to be able to eat what I like and not gain an ounce. I would love to go into Marks and Spencers and buy what I like - not what fits. I would love to be able to fit into those fixed plastic chairs in motorway service stations without having to force my stomach behind the table. I would love to go on roller coasters without having two of the ride staff force the shoulder harness shut by leaning on it.

I've tried everything. Weight Watchers, Slimming World, Slimming Magazine - you name it, I've either been on it, or am on it. They don't work. I cut out bread - no difference. Tried nothing but fruit and enough salad to make my nose twitch - no effect. I don't eat red meat at all, very little fat, tons of vegetables and still I gain weight. Next week I'm trying hypnotherapy - wish me luck!

My marriage broke up because my wife couldn't stand the sight of me. My self-confidence is shot to hell and I strongly suspect I'm actually suffering from depression because of it all.

Just thought you might like to see the "other" side of the fence.

Strange how there was no one with a "slow metabolism" at Belsen...

Weight gain occurs because more calories are being ingested than the body needs. Like all self-indulgent behaviour, this is a moral issue - and to say "don't judge" reveals a moral insensitivity that should not be tolerated.

Have you noticed though, speravi, that it's still a question of proportion? Not everyone was identically thin / emaciated in Belsen (look at the photographs). Please read sassy's comment above and learn a bit. By the way, under-eating can be equally 'self-indulgent' if you care to take such a view, but in fact people with anorexia sometimes have as little control over their body state as very overweight people. I hope you never experience either but I'd like you to understand more.

Thank you, I hope that you too avoid such experiences. I do agree that the prisoners were not identical in body shape - they had different calorific input-output histories, of course. I also agree that anorectics have as much (as little, if you prefer) control as the morbidly obese. My earlier concern, which I should perhaps have elaborated, is that it disempowers patients presenting with these problems to tell them that they have an illness, when the remedy rests in themselves. Many of my colleagues argue that this is another manifestation of the contemporary "victim culture". Telling people who are overweight that they are ill, and by implication that they are powerless, may appear "caring" but it does the patient no favours and is rarely clinically defensible (some would say it may be expedient for the hard-pressed clinician but abusive of the patient). The only time that such diagnoses are defensible is when the patient is mentally ill.

I should close by saying that I had read the comments to which you refer - it is possible that people with whom you disagree may be at least as well-informed as you.

Indeed speravi, people with whom I disagree are often as well informed as me and in many cases more so.
I agree when you say "My earlier concern, which I should perhaps have elaborated, is that it disempowers patients presenting with these problems to tell them that they have an illness, when the remedy rests in themselves. Many of my colleagues argue that this is another manifestation of the contemporary "victim culture".
Personal responsibility is a hugely important part of any successful treatment and we have seen a decline in this in all areas.
However, I feel you are now taking a slightly different stance from that which you took originally which seemed (to me) to be much more judgemental when there are sometimes sound physiological reasons why the of weight gain or loss differs from one person to another irrespective of personal responsibility.
I am quite willing to concede, however, that I come to this from a mental health service perspective which is the one exception you made. I see many folks who have had opportunities for the taking of personal responsibility severely restricted for years and so tackling obesity against this backdrop and whilst receiving strong medication(s) can make weight control (up and down) very much more difficult.

My position remains the same, so perhaps I've sugared my articulation of it. Drawing the line between behaviour that is "merely" self-indulgent or stupid (or both) and behaviour that is so grossly self-indulgent, etc. as to be constructive mental illness, and identifying the factors that enable us so to do, is probably where we differ. I remain as judgemental as ever (and anyone who disapproves... well, aren't they being... judgemental?).

Anyway Reynolds, after all those comments on your post... How's your back?

My back is fine, only because of our new bit of kit.

The Mangar Elk.