The vicious circles of chronic health conditions and being overweight

We talked with people diagnosed with an array of chronic conditions related to weight gain. People were usually aware that weight was a factor in their health condition, whether directly or indirectly. Sometimes it was the management of the health problem that had contributed to weight gain, leaving people feeling unsure what they could do.

Here we look at how people talked about being overweight in relation to living with one or more health conditions and the ‘vicious circles’ that were often involved.

Before Lina became ill she was very active – she feels sure that her treatments, for several serious illnesses, have contributed to her weight gain.

Age at interview 49

Gender Female

View profile

When I was diagnosed with asthma, I was already seen by a CBT counsellor. I’d had CBT.

Cognitive Behavioural Therapy?

Yes.

Okay.

Because it was, it was a shock. I didn’t realise I was that ill. I just didn’t, it was only when I kept going in hospital it started to affect me. Obviously, it affects your home life, you have to start finding people to look after your children. You’re worried sick about them. they’re worried sick about you. You don’t know how long you’re going to be in there. Sometimes, I’ve been in, I’ve been in intensive care once with my asthma, so, you know, I know it’s very serious, life threatening thing.

So that was one thing I had to deal with and then subsequently after that they found out I suffered from chronic migraines. The chronic migraines then led to them finding I had a brain tumour, meningioma. it’s a paranasal meningioma and it’s in the left, I hope I’m using my left hand, the left side of my head, so it’s around this area of my brain. It isn’t growing at the moment, so at the moment it’s a watch and wait and that might be down to the fact that I’m on steroids because they use steroid treatment to keep the tumour from becoming inflamed or angry, so that be why it’s not growing or doing anything. So that’s another part of a conundrum of me saying, Oh, I want to get off steroids and then I’m thinking, If I get off steroids maybe my brain tumour might start growing again and maybe my asthma might start getting worse again,’ and you see so it’s, it’s difficult and then finding out that I’ve got Type II diabetes because I’m on steroids, it’s ugh, I feel like I’m juggling, and I don’t know what to do really.

I think a lot of it as well is definitely down to the medication and I’m saying this because previously I was never more than nine stone, ever in my life. Even when I had my children, I went up to twelve stone. I had them, six months breastfeeding, I was back down again. Yeah, I never really struggled through my pregnancies with my weight.

Okay.

I also was fit. I went to the gym three times a week. I was running, I was swimming and then I got sick and then started being on all these medications and a lot of them give you, make you put on weight.

Embed Print Transcript
Mobility

For many of the people we spoke to pain, fatigue and weight gain – either alone or in combination – had a serious impact on mobility and lifestyle, including the ability to go out and have a social life. This could lead people to feel lonely, bored or bad about themselves, which, for some, resulted in comfort eating (see also ‘Emotions, emotional eating and self-esteem issues‘).
‘it’s a sort of spiral that you go down because the depression then gets worse and you feel bad about yourselfit’s all too overwhelming, so you can’t do what you know you should do’. Carole

Joan was getting bigger and bigger’ and had limited mobility. She was becoming isolated from her friends.

Age at interview 57

Gender Female

View profile

it’s a lifestyle change but I’ve had to change my lifestyle dramatically from what I used to do.

In which ways?

I used to every winter go skiing. I would go hill walking in the summer. Loved walking. Can’t do any of that now. it’s an impossibility and I probably isolated myself from friends. The more restrictive or the less that I could do, the less I wanted folk to see me, you know.

Was that because you have put on weight or

I think it was a combination of both. One, because I could hardly walk, hardly move, and secondly, because I was getting bigger and bigger, you know, and I was, don’t get me wrong I had a few close friends that, Look Joan, you know, what are you doing?’ and I was like, you know and I think over a period of time I spoke to my GP and I said, Look could you just refer me to the weight management service and they was like, okay you know. But I mean it took about six months for me to get assessed for that. It was a long period of time.

Embed Print Transcript
John Y referred to a ‘perpetuating circle’ of pain, lack of exercise and weight gain. Others described how pain disrupted their sleep, leaving them tired, which then led to hunger and overeating. Liz said that fibromyalgia left her so exhausted she did not feel able to go to the gym or exercise.

Carole spoke of the ‘vicious spiral’ of depression, multiple sclerosis, eating and weight gain, while Maxine explained that her joints were failing because she was ‘really, really heavy’ while her joint pain prevented her from almost any activity.

Maxine says that it would be wonderful if she could actually walk without pain.

Age at interview 63

Gender Female

View profile

Yeah that would be good wouldn’t it. If I could actually walk without pain would be wonderful. But then you know, my ankle is playing me up and my feet are in a really bad state. So it’s not just these joints. it’s all of my joints: fingers elbow, wrists, shoulders. You know, all of my joints are completely wrecked.

I was just really, really heavy and my joints were beginning to fail. You know I had catastrophic failure in one joint on my hip. And eventually went and had it replaced, hip replacement because I really had to. I was actually in a wheelchair by the time I had it replaced. So there was no choice.

I was I couldn’t walk at all. And if we were going anywhere we took a wheelchair with us. And my husband would push me around shops and things like that. I could get in, I could walk to the car, so yeah.

And that was it?

That was it really, yeah.

Embed Print Transcript
Loss of mobility was a specific feature of some chronic conditions, such as osteoarthritis and lymphoedema. Being less mobile impacted on self-care and managing around the house. When Joan was still at work, she had to get up a couple of hours earlier to stand under a hot shower so she could move her joints. Her hands were like ‘claws’ and every morning she used to steep them in hot water to get them moving.

Lina said that losing her mobility as a result of multiple health problems and being overweight had made it difficult to do simple things like wash her hair or take her daughter to the park.

Paul X describes how being overweight (and associated gout, joint problems and heart problems) affects his everyday life, including not being able to dress himself or bend over and pick things up.

Age at interview 57

Gender Male

View profile

I said, Obviously I’m struggling just going upstairs, I struggle. Trying to do something, trying to be helpful around the house, I struggle. I get out of breath. it’s horrible, just going for a walk sometimes. Just trying to walk up to the village. Took me, took me two and half hours to walk up the road and back about two weeks ago. it’s hard, hard work

So you don’t do much in terms of,

I don’t and again this is where this [pats tummy] suddenly is now and even more of an issue. Not only can I find myself, I can’t put my socks on and some of my personal care I can’t do, I find now that I can’t walk. Let’s just go for a walk. It has to be planned like a military operation. I can’t just say, Let’s go for a walk Because I can end up somewhere up the road not being able to get back and it’s happened. A doctor called the, called an ambulance for me. I made it to the doctors and he said, I’m calling you an ambulance here Rushed me into hospital. So, you know, again, this sudden weight is impacting on,

So you notice more the effect of the weight now
Yeah. On everything.

on your level of activity?

Yeah, yeah, on, on. I just can’t do it. I can’t, you know pick that up now, pick this envelope up here now. As soon as I get to here, I can’t, this is now in the way. Now if I didn’t have this [pats tummy], it would still be an effort because of my heart to pick that up. To bend over and pick that up with my heart. I’d then get up and go [breathes heavily]. Now how the hell do I pick it up when I’ve got this thing in the way? I’ve never had, what’s this, you know, and believe you me it looks worse when this top’s off. I won’t show you, don’t worry, you’re, you’re all right but I’m, you know, I’m nearly at the stretch marks stage. This thing has just appeared and suddenly it has effects on everything I physically, that I try and do.

There was one stage when I could have done my car. I like, I like cars, I like motors and I, I started to do that car the way I wanted it. I can’t do it anymore because if I get down to do something on the car, I can’t get back up or I’m struggling to get back up or when I get back up [heavy breathing] and it has an impact where I say, Not doing it

Embed Print Transcript

June points out the risk of injury and joint deterioration that comes with obesity.

Age at interview 70

Gender Female

View profile

nd the other thing that I didn’t mention as far as health issues are concerned is you constantly injure yourself. Therefore, your joints and there’s always a joint or something which is giving you real problems.

That’s part of it. If you, I don’t know how many people you’ve been interviewing who’ve had sticks and various assistances for daily life, but I would have said there’s a pretty high proportion of people who are disabled in some way or another to varying sort of sad degrees.

Last year I had, what did I have last year? I ended up having, oh my right foot wasn’t working properly, giving me, you know, fairly tedious pain because it has to be fairly serious pain before I start. But I was having X-rays and things like that and being told severe arthritic deterioration and de, de, de, and, of course, the unspoken end of that is the same as it always is, and if you lose a significant amount of weight, it will have a significantly palliative effect on it.

Embed Print Transcript
Being overweight and its associated mobility problems could present a barrier to exercising, in a variety of ways. People who had enjoyed exercise in the past felt the loss keenly. Carole had given up swimming because of embarrassment, fatigue and a lack of private changing facilities at the pool. Sue Y used to belong to a walking club, but had had to give it up because she couldn’t keep up. She had also had to stop dancing due to a knee operation, but hoped to start this up again.

Carole says the bigger you get, the less you can do. Being overweight and multiple sclerosis combined with a lack of adequate facilities in her area make it hard to control her weight through exercise.

Age at interview 59

Gender Female

View profile

I can’t just go on as I am now because the bigger you get, the less you can do and the, so and that tied in with the things that I can’t do with the multiple sclerosis. The exercise is like hardly any at the moment because so and the bigger you get, the harder it is to exercise and the more embarrassing it is to exercise. I’ve stopped swimming now because I’m so embarrassed of getting undressed in the in the pool, to go in the pool. And I can’t walk for because of the MS so I do little bits in the house and I’ll, and I go to a chair yoga class and we sit and we do, you know, stretches and thing and I do that at home but it’s not enough for me. it’s, you know, I need I need more.

Aqua aerobics. I’ve done that, I did that, I did do that when I was I did do that for a while and loved it but then getting out afterwards and the fatigue with the MS, I just couldn’t get myself dry. I couldn’t get myself dressed and there was nowhere to sit to recover and it was too much. Plus the woman, even though I told her about my issue, my problems, she’d say, Come to the front, Carol. You’re not doing enough And you can’t, you know, ah, but I love swimming and I will, that did me so much, physically and mentally. So.

Okay.

I did go to there used to be like a chair exercise class. Chair-aerobics, we used to call it, which sounded a bit more better than chair mobility classes. It sounded a bit more go but that was run by the council, which was great, and we do, we’d sit in a chair and do our exercises but they closed that down for funding reasons. So no there isn’t one. There is the other side of [city] but, if they do go to that, I then can’t get back because I’m too worn out from it.

I think it’s harder, when you’ve got like mobility problems and stuff. it’s harder, obviously, with the exercise and stuff, so you’re more likely to put the weight on so there’s less, there’s less choice there I suppose than if I was very fit, if I was able to move around a lot with my, you know, if I was able to go, you know, on a ten mile walk like I used to do or go to the gym or, you know, those sort of things. So that’s not choice, that’s, you know, that’s, it’s unfortunate that I can’t do those things now and that obviously won’t help my weight.

Embed Print Transcript

Sue Y tries to keep physically active despite her limited mobility, but it is hard and she fears having another fall.

Age at interview 69

Gender Female

View profile

it’s a problem when you’ve got arthrit-, such bad arthritis in my back, in my lumbar region and on my left hip and I didn’t realise I had osteoporosis as well which I’m taking something to hopefully stop that from getting worse. So, you know, just trying to keep healthy.

But you see, undertaking physical activity, is difficult for me.

Yeah, so how are you managing that?

Well as much as I can. Walk as much as I can, etc. So I do and, and there’s a reservoir just down behind those houses at the bottom where you can go and walk round which I often do but of course in the winter it’s, it’s difficult and as you get older and now of course, I’ve got the problem of I’m a bit afraid of going out where I might slip because I broke my arm and so, so that was, how are we doing on time?

But I try and walk as much as possible but there’s a limit to how far I can go now. I used to belong to a walking club, but I can’t now because I can’t keep up with them. So, but with this I can, I can do quite far because I’ve got something to lean on. But otherwise, I’ve got some walking sticks as well. I never thought I’d use walking sticks, you know, you don’t realise. Had an arthroscopy done on my, my left knee which, you see this side was injured in a terrible road traffic accident when I was fifteen. [Points to face] So, this side is paralysed
Yeah, so, also, I like to dance. So, line dancing, all kinds of things like that. But I haven’t been recently because when I had the arthroscopy in my left knee it put strain on, on that knee so I stopped and of course you, you lose track of all the dance sequences. I’ll have to start again though. I’d love to get going and that helps lose weight. Gives you the motivation.

Embed Print Transcript
Joint problems and particularly the loss of manual dexterity sometimes made it difficult to prepare food from scratch. Carole, Heidi and Ellie all said they were no longer able to chop vegetables or cook for themselves due to the effects of their health problems.

Because she can’t cook from scratch, Heidi eats more ready meals, and buys pre-prepared vegetables which are more expensive so she feels penalised for wanting to lose weight.

Age at interview 50

Gender Female

View profile

It does always costs more to eat healthy.

Okay.

And to be honest I haven’t got much to go, to go around, so you’re going to probably with my condition as well, I have to watch for oven things sometimes, you know, oven foods, meals and microwave thing

Okay because you can’t
and things like that because my dexterity’s not very good.

Okay.

So it, it all depends on how you feel, which day, so you tend to have things like more salt in it because it’s salty, salty aren’t they the ready
Ready made

eady meals.

Okay.

they’re quite salty and you have ridiculous amounts of all sorts in them.

Okay. So, you tend to buy more ready meals because you can’t cut or do much?

Well I’ve done this morning. I’ve cooked myself a chicken lasagne and that’s ready for tonight when we come back.

Okay.

So that was quite easy to do because I was just managed to, the, everything was all prepared for me. I just managed to put the ingredients in the pan, fry them and then put the pasta things on and put béchamel sauce and then done.

So that actually that’s very important because your condition has a direct impact on you healthy eating
Yes.

ecause you can’t chop vegetables and
You have to get the more expensive, pre, pre-cooked, pre-diced ones and they’re more expensive and you just get penalised for wanting to lose weight, don’t you?

Yeah. Would you like to say some more about, something more about it

Yeah, it’s, you just get penalised for wanting to lose weight. Everything is more costly; the fresh veg, the fresh, the organic stuff as well that’s more costly. So, you know, it’s, it’s going to put a hole in your pocket. It really is if you’re, if you tend to sort of want to keep to a healthy, healthy diet.

So, it has a financial impact for you?

Yeah, definitely financial, yeah.

Embed Print Transcript
Depression and low mood

The difficulties of living with a chronic condition and being overweight were often linked to low self-esteem, loneliness, feeling useless, depressed and overwhelmed. For example Heidi, who had been diagnosed with mixed connective tissue disease and lung fibrosis, described how the pain of her illness and the weight gain contributed to her very low mood. Carole explained that ‘the weight is linked to depression and the depression is linked with the weight’.

Carole feels that life events, her MS and her weight have all contributed to her depression. Doctors tend to focus on her MS but she thinks her depression is the worst problem because it affects her weight.

Age at interview 59

Gender Female

View profile

I think it’s I think it I think it’s all linked and I think the weight is linked with the depression and the depression is linked with the weight. I know I’ve had a couple of periods of, a couple of really bad things in my life like when our mum was very ill, I got, when I first started putting weight on when I was young, that was really difficult. That was when I first got depressed. And then my twin sister died suddenly and I had like a massive breakdown and, since then, my depression goes up and down and I I’ll cope for a while and suddenly it’ll go down again. I do get depressed because I’m so big. It upsets me. it’s I can’t do things that I want to do. I get depressed because of the MS. I’m scared it’s going to progress like my mum’s did. It upsets me, because of that, it stops me doing the things. I can’t do the, I can’t go to the gym, I can’t, you know, my legs just don’t work properly and the fatigue is too bad. But also, when I am depressed, I eat more, so it’s all, they’re all linked up to each other I think.

Okay.

And again, the health, the doctors and things [sighs] they see my worst problem as the MS. I see my worst problem as the depression because it affects so many other things like the, like my weight and like my, I feel, I hate myself because I’m [sighs] I just hate myself because of because of my weight and the fact that I can’t manage to do anything about it at the moment. The fact that I can’t, that I’m embarrassed with it.

Embed Print Transcript

June talks frankly about the multiple ways in which obesity affects her daily life: everything is more difficult.

Age at interview 70

Gender Female

View profile

I had an epiphany of sorts last summer. I hadn’t been doing very well and had been looking at various levels of despair again and because we can talk about prediabetes and diabetes in deed and lots of health conditions, heart disease, rotten circulation, all kinds of attendant health conditions. Danger of stroke, all sorts, but there are lower level practical daily considerations which impinge possibly until perhaps total health disaster hits and impinge on you possibly even more. it’s just the physical problems of living your life.

Like?

Like, you want me to be frank?

Yes.

Like, getting up off a chair, cutting your toenails, going to the loo and wiping your bottom and whatever you do, that can become almost impossible. In order to stretch your body far enough to be able to get past all the mountains of fat, you end up with interesting lumps and bumps of knotted muscle and all kinds of things. it’s very, very difficult not ever being able to get through any spaces. Being terrified if you go out, meet a friend for coffee or anything like that, when you get up you’re going to clear tables, just moving. Just the day and daily parts of living your life or attempting to live your life.

Okay, so everything is affected basically?

Oh utterly, utterly, yes of course it is.

Embed Print Transcript

Christine feels that she is caught in a vicious circle: when on antidepressants she puts on weight and off medication she loses weight but feels miserable.

Age at interview 53

Gender Female

View profile

Can you pinpoint the times in which you have gained weight?

When I’m stressed and anxious.

Okay.

it’s been in relation to depression.

And tell me about these sort of evening kind of trips to the freezer.

Yeah, well, all it is I get too tired. So, say anytime at night, sometimes I go to bed early, like I nine o’clock and I just watch TV in bed and I’d fall asleep quite happily. But sometimes if I stay up I’ll think, Oh, I’ll just have some ice cream and I’ll just watch tele,’ and I’m comfortable and I’m happy and I’m relaxed but I’m just eating for the sake of it and I cannot physically stop myself doing it.

But the problem is with depression, it’s a vicious circle with your eating because if you’re depressed you lose weight, I lose weight because I’m not on any antidepressants. As soon as you go on them, you’re a lot happier mentally but then you pile the weight on, so you can’t win. You’re either depressed to the point of suicide or you’re on antidepressants and pile the weight on. You know, this is why we’re trying to cut the dose of it down to the minimal. it’s only a very small dose anyway. it’s the tiniest dose you can have, but if I can cut it down it might trigger something that, that makes you able to motivate and able to focus and, and lose weight.

Embed Print Transcript
Changes in lifestyle were a common part of living with a chronic condition. For some, their condition led them to give up work, like Alan X and Meeka, who gave up their jobs after having heart attacks. Regardless of when in their life their illness occurred, some of the people we spoke to said they were left questioning why this had happened to them.