Alan X
Alan X says that for the last 20 years, he has been overweight with a weight of about 14.5 stone. On average he tries to diet once a year, usually after Christmas. Over the years there have been periods of weight loss and periods of weight gain. In 2006, he had a heart attack and later underwent CABG (coronary artery bypass graft). He has also been diagnosed with type 2 diabetes and high blood pressure and had 2 episodes of atrial fibrillation. Alan plans to join a weight management program in the future.
Alan X is a retired university lecturer. He is married with 2 grown up daughters.
More about me...
Alan X has been diagnosed with 2 weight related chronic conditions, type 2 diabetes and high blood pressure, both of which are well controlled with medication. In 2006 he had a heart attack, and in the same year he had CABG, coronary artery bypass graft surgery. In 2007 Alan was diagnosed with atrial fibrillation (AF). He has had 2 episodes of AF, the last one in 2012, but he hasn’t experienced AF since then.
Alan says that for the last 20 years he had been overweight, with a weight of about 14.5 stone. On average he tries to diet once a year, usually after Christmas. Over the years there have been periods of weight loss and periods of weight gain. At present, he is about 15.5 stone, and is thinking of joining Slimming World.
In the past, Alan’s approach has been to reduce weight by eating smaller portions, cutting out alcohol and carbohydrates from his diet, and eating mostly vegetables, some meat and fish. He loses weight, but says that such eating routine do not last because he becomes ‘bored’ with what he eats and wants to eat ‘proper meals’. Thus, boredom and inability to sustain a diet lacking in variation have characterised Alan’s experiences. Another issue that makes it difficult for him to commit long term to dieting is the pace at which he does lose weight. He explains that when dieting he loses weight very quickly in the first couple of weeks, and then it plateaus and he maintains weight but does not lose any more.
Alan has received advice by dieticians but he describes it as ‘theoretical advice’ that doesn’t apply to the real world. Moreover, he points out that it is usually given by young female professionals that don’t seem to have to worry about weight, making rapport difficult. Alan’s goal now is to lose a stone and keep it off, and he is considering joining a weight management program to achieve this. He is looking for information and advice about ‘sensible ideas on eating’.
Due to heart conditions, Alan is limited about what he can do to keep active and help himself to lose weight besides walking and swimming. His doctor’s advice has been to keep his pulse rate down below 150. He is not keen on exercise, but he is willing to do if it would help with weight loss.
Alan says that health care professionals always mention the need for him to lose weight and that according to BMI measurement; his weight should be around 12 stone. However, he thinks that BMI measurement tends to be misleading because it is only useful to people with a non-sturdy build and he describes himself as a ‘fairly sturdy build’ man. For him, a more realistic possibility would be to go down to 13 stone, but he is doubtful if he could achieve that.
Another issue is health professional’s advice on the effects of weight loss on his chronic health conditions. Alan feels that he receives general ‘statements’ like ‘if you lose weight you will feel better’. What he would really appreciate is to be given more evidence-based information on the ways in which weight loss will improve the management of his diabetes and high blood pressure. At the same time, he feels that over the years he has absorbed all the medical advice he has been given, but that it is up to him to make the commitment to follow a lifestyle that will enable him to reach and maintain a healthy weight.
Alan’s heart condition and diabetes are stable, but if his health gets worse it would probably prompt him to lose weight.
Alan’s heart condition and diabetes are stable, but if his health gets worse it would probably prompt him to lose weight.
So, and what are your reasons now for wanting to lose weight, and maintaining weight?
Well, I think as much as anything, I'm going to have to have a new wardrobe if I continue at this rate [laughs]; it's going to be very expensive. But in other terms, I'm assuming that I will feel better again if I go... if I lose weight, but I don’t know. As I say, I go back and say I haven’t seen any evidence which says if I lose ten kilos, that'll be the effect; none of that evidence has ever been shown to me, if it exists.
What would help you to become sort of fully committed to losing and maintaining weight now?
I suspect if I had to have new medication to guard against vastly increased problems with diabetes and heart, then it would convince me I'd have to do something. But as it is it's been stable for so long that there's no incentive to do something from a medical point of view. From a social point of view, I don’t have any problem being the weight I am, it's just in family pressures to some extent. You know, they say, 'Well, oh you're looking a bit fatter than you should be,' you know.
Alan sees GP appointments as “like gold dust”. He isn’t surprised that GPs don’t seem to have time for a discussion about weight.
Alan sees GP appointments as “like gold dust”. He isn’t surprised that GPs don’t seem to have time for a discussion about weight.
You sounded surprised when I said, 'Have you talked to your GP about your weight issues,' and you said they don’t have time.
Yeah
Can you elaborate a little bit more on that?
Well, GPs have got very limited time to speak to you. The slot size you get to speak to somebody is related to having one problem which can be resolved by either a referral or a prescription. They don’t have time for a discussion. And to be fair, if you took time for a discussion, slots with GPs are hard to get so you're depriving somebody else of something that they might need for, you know, to get medication or something like that. So, going in for long, you know, conversation type advice is not the sort of thing that I would think is the good use of GP's time, unless they said, "We will have a clinic," or something which says... which is aimed at people who need, you know, advice on X or Y or Z, whether it's diabetes or heart condition or exercise, or whatever it happens to be.
Or weight control?
Yeah. But for standard GP appointments, they are... they're like gold dust, and you’re very lucky to get one really. I mean for instance, if I wanted a GPs appointment tomorrow, I would have to be online on their website at seven thirty in the morning to book a slot for that day, and goodness knows what happens if you're an older person who doesn’t have internet access, for instance – I don’t know how you do it, because by the time the receptionists come online, half past eight, all the slots have gone. So, that tells you, you know, you don’t want to waste the GP's time in that respect.
Alan would be more likely to follow advice if he was shown the evidence behind it.
Alan would be more likely to follow advice if he was shown the evidence behind it.
Do you have any messages for healthcare professionals who want to help people with weight control?
Yes, give me evidence.
OK
Simple as that, because if you can convince me through evidence then I'm far more likely to follow it up.
OK
But if it's... if there's no evidence involved then I'm not necessarily going to take it seriously.
OK. And do you have any recommendations for improvement to services and intervention; weight management interventions?
If the money was there then they could send us on weight management courses, but the money isn't there. So, you're left to your own devices, aren't you; you're left to... it's your responsibility to maintain your weight or lose weight, and whatever. I'm not sure what they can do to be honest. They could have dieticians who were mid-thirties [laughs].
Or older
Or older, yes [laughs], but just not being, you know, too young to have any life experience; it doesn’t help. You know, it's just ... you need to have been through the mill a bit.