David gained weight in middle age due to work commitments and a sociable lifestyle, where he was exercising less and eating more. David was diagnosed with type 2 diabetes and high blood pressure around 15 years ago, but started taking his weight loss more seriously after being warned by his diabetic nurse that his health was in danger. David lost some weight by following an NHS program, changing his diet and exercising regularly. David would like to lose more weight but has found this difficult.
David is 71 and works as an engineer. He is married with adult children, and is white British.
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David has gained weight since middle age. Although he ate large portions when he was young, he had a very active lifestyle in the military, and later cycled to work. After moving to a more sedentary job his weight increased and as he got older and had more disposable income to spend on food, he began exercising less and eating more. Much of his overeating was work-related, “I was entertaining customers and eating well, drinking well, smoking a lot and it all caught up with me”. David was diagnosed with type 2 diabetes around 15 years ago, and was also told he had high blood pressure. At this time, although David was given a diet sheet, “the emphasis was very much on sorting out the medication”. With medication, his diabetes and blood pressure were brought under control, but David was aware that these conditions were also affected by his diet, so he started to try and reduce his weight.
After his diagnosis, David successfully lost some weight by changing his diet. Although David still enjoys eating out, over time, he has learnt what foods are bad for him, and has started avoiding certain foods, “it was mainly just a case of being more sensible about what I ate”. However, David found maintaining diets over a long period of time difficult, “I would I would stick to a diet for a few weeks and then … I’d start having things that really were bad for me and I enjoyed eating”.
David got “more serious” about dieting after a warning from his diabetic nurse, who told him that he was not controlling his diabetes effectively, “she frightened me, basically, into being a bit more careful about it”. David started to monitor his own blood pressure and blood sugar. David also began following an NHS diet program, which he found “very useful”. David now eats more vegetables, less red meat, and smaller portions, “I’m more conscious of the effect of diet and exercise on my health…but it’s been a long, hard struggle”. David continues to keep track of the calories he eats, and weighs himself every day. Although David has lost some weight, this has become harder with age. David has “plateaued” at a level that is “heavier than I would like” for the last 3 years.
Currently, David tries to maintain a diet of around 1000 calories a day, which keeps his weight stable. There are occasions where he allows himself a ‘treat’, but this helps him maintain a healthy diet more generally, “if I stop, stop and stop and don’t cheat a little bit then I end up cheating a lot”. Although he feels he would lose weight if he cut his calorie intake to 800 calories a day, “it’s difficult for me to maintain that for a long time”. David also tries to exercise regularly. He has started to track his exercise through a “magic watch”, “having the watch helps me record it, and gives me a bit more confidence”. David feels that although the internet makes it easy to find information on weight management, the difficulty comes with putting it into practice, “you’ve got to have the willpower to make use of it yourself…you can you can let yourself get into bad habits and things like that”.
David hasn’t received much assistance from the health service in managing his weight, and his GP seems satisfied with his weight loss. David suggests that time restraints prevent GPs from giving patients the help they need, “I think most healthcare professionals are too busy to work out whether people can look after themselves or not”. David encourages healthcare professionals to be honest with patients about the dangers of weight gain, as this can help them in the long term, “you need some sort of, something big to make you change direction and I would say, based on my experience, don’t worry about frightening somebody. That might be what they need”.
David’s realised that his lifestyle and work had contributed to him being overweight.
If I look back at what I was eating back then, you know, such, I couldn’t do it now. I couldn’t face it. I was definitely overeating. A lot of it was entertaining, a lot of it was work related.
So it was overeating and eating the things that do not agree with you or.
I think it was a lot of a lot of restaurant eating.
And it it’s, I’ve, the sort of places I went to anyway, it was difficult to get a low cal, it’s easier now than it was then, to be quite honest, but, you know, there was a lot there was a lot of high calorie food involved in the sort of food that I was eating, whereas now I rarely eat such high calorie meals.
Then then I started studying, working in an office, spending more time sitting down. I still exercised because I couldn’t afford, you know, I had to had to ride a bike to work and I had to, didn’t have a lot of money still. As I as I got more wealthy, I exercised less. I ate more and more rich foods and, by the time I was middle aged, I was eating too much and not exercising enough and, by the time I was late middle aged, I was paying for it. And that’s, that’s basically it, so it was it was lifestyle.
Being overweight didn’t worry David – that was until he was diagnosed with type 2 diabetes and heart disease.
What caused me to start? I think [whistle] obviously, being diagnosed diabetic was a watershed. In other words, realising that your lifestyle had, you know, what causes diabetes, realising that your lifestyle is having an adverse effect and that, for me, was compounded by the fact that these can blame the same thing for my heart condition. So that sort of stage, was quite a watershed.
Up until then, I’d been rather enjoying the fact that I could afford to eat well and you know, be the life and soul of parties and all that sort of thing.
I was aware that I was I was,
I know but,
I was a jolly fat man [laughs].
I was, I was generally aware that my weight was above average and that didn’t worry me a great deal. It didn’t interfere with my lifestyle. It didn’t affect my work. It didn’t, I ate well. I, I went diving and I went sailing and I was perfectly happy but I was overweight. I was enjoying myself. I was eating wonderful food. I could afford the lifestyle I liked and then somebody said, “Oh, you’re hyperglycaemic.” What does that mean? And people used to say, “Oh, you ought to stop smoking. You’re smoking too much.” I was enjoying life. I was thirty five, forty and I was living well, thank you very much. You know, tell me I’m fat, “yeah, I’m a bit overweight. Let’s go and have a steak” and.
Okay. So there was no.
I but the, what. I was aware that I was overweight. I knew that that was unhealthy but I was all right. I was diving. I was sailing. I was strong enough to manage a boat around the place. I was, it wasn’t interfering with my work. Worked well. It wasn’t until I was not given a trackside pass because of they were they were suddenly worried I might fall over on the on the track. And they said, “Go and see a doctor. You’re not well.” “What?”
And that was a shock.
And how were you feeling, at that time?
Fantastic. [laughs] Up until then.
When David got a more sedentary and highly paid job in his 40s he started to put on weight and developed diabetes and high blood pressure. Success at work meant more money to spend and he started driving rather than cycling to work.
I, yes, when I was younger, I used to exercise a lot and I continued to exercise quite heavily through my twenties up until I was sort of thirty-ish sort of time. Then I went abroad, worked abroad for a number of years. I got a much more highly paid job and I got more involved with entertaining clients and I started to put on weight like there was no tomorrow and I ended up in a situation around about forty, forty five, I had a responsible job, basically, sedentary, involving a lot of entertaining. I was eating too much, putting on far too much weight and not exercising enough to worry about. And that was the situation I found myself in and as part of my job, I had a regular medical because I’m a railway engineer, you have to have a medical to go track-side.
And they detected that I was hyperglycaemic and referred me back then.
And, at that time, I was not, my doctor, when I was referred to my GP for hyperglycaemia, he was much more concerned about my hypertension and both of which were treated with drugs.
But it was it was, yes, I was getting less and less exercise and I was eating more and more because I do enjoy eating, so I was eating more and more.
I think I think there was a tendency, with my generation, because my parents, of course, were restricted on what they could eat through the war and when they started having children after the war, we were all very well fed. My mother used to say we were very well fed. Well fed, by her definition, largely meant a lot of starch and sugar and calories and things like that. Now, when I was younger, of course, that didn’t matter because I burnt most of it off and certainly, when I left school, I joined the military and we burnt off calories like there was no tomorrow. When I left, I still, because I didn’t have any money then, I used to ride a bicycle everywhere, so I quite regularly used to cycle twenty or thirty miles to work and it wasn’t until I progressed through my career, sort of mid-twenties, early thirties, when I, sort of, bought myself a car and didn’t, and drove to work instead of riding to work and continued to eat, so I wasn’t burning calories and I started to put on weight.
A frank discussion with the diabetic nurse shocked David into losing weight.
So the diabetes nurse gave you a shock in 2012, when she said…
That was what that was what kicked it into, that was a diabetes nurse who basically said, “Look, you’re not managing it probably and, if you don’t, this is what’s going to happen to you. Your life expectancy is.” [aah] [Laughs.] “So and you’ve got to lose weight and you’ve got to do this.” And that that’s what started it off and that was followed up I think after six months but that nurse left. That the shock was what was started me monitoring it myself and I’ve kept that up since. That’s demonstrated to me personally that I can correlate between how I feel and how much I weigh and how much, and my blood sugar, if I if I put on weight, my blood sugars go up and, if I take off weight, they come down. And it that, it correlates more to that than to anything else.
Do you think the nurse who actually gave you a fright, how did she put it? Was she kind of forceful?
How did she do it? Can you explain to me a little bit more?
She was quite straightforward and she told me that I, you know, that I wasn’t helping myself. You know, we can give you all these drugs but you’ve got to help yourself and you’re not controlling it and the reason you, and you’ve got to control it because you’re going to have to diet more. You’re going to have to do this, she emphasised the weight and she told me that if I didn’t control the weight and the blood sugars and the blood pressure, my life expectancy was and she went into the computer and she put my weight in and she did this and she said, “Oh well, you know, you’ve got this many years.” And I went ‘Oh that doesn’t sound very many’.
And she gave me another copy of what I’d already had, the diet and she said, and the other thing she said was, “At that stage,” she said, “If, you’re going to have to go onto insulin.” You know, I wasn’t on insulin then. I’m still not. And so she, she painted quite a bleak picture and she had a follow-up more frequently than my normal follow-up had been.
When I went back to her, I had lost weight and my blood sugar had gone down and she very much pointed that to me.
And she, that was the kick-start. That was the kick-start.
So she really frightened you.
She frightened me, yeah. I was getting, I was I was bumbling along whereas, subsequently, she’s left now, she did me a lot of good. Thank you very much. I don’t know where she’s gone. Now I go in for an annual check-up and they’re, “Oh yes, Mr [Name], you’re doing very well and this is very good and that’s very good.” And it’s much more pat.., that’s not what, I need a, you know, they don’t say, “You need to lose another five pounds.” Which is what, you know, I know that. But they don’t tell me that.
David says that while it sounds simple to ‘use more energy and take in less energy’ changing habits is never easy. But the longer you work at it, the easier it gets.
Any kind of advice or, for people who are trying to, living with chronic, with weight related chronic conditions and are trying to lose weight? What do you think?
You’ve, you’ve got to you’ve got to change your lifestyle. That’s very easy to say that and it’s very difficult to do because we’re all, you know, our whole lives are formed of habits. We do things from habit and what you’re being asked to do is to change your habits and that’s not easy. You you’ve got to, I don’t know whether you’ve got to do it, different people do it in different ways.
You can do it gradually, you can do it suddenly. You could, some people you could get advice, you know, changing habits, stop smoking, one thing works for one person, a different thing works for a different person. The biggest thing I’d say is you’ve got to want to do it and it’s the same with changing any habits. If you if you’ve got to lose weight, whatever you’ve got to do, it’s not too difficult. You’ve got to use more energy and take in less energy. It’s a fairly simple relationship. Very easy to work out, very easy to say it, very difficult to change the habits and maybe the way to do it is to is to sort of make a big change and stick to it, you know. Cut out meat, if you want to, or cut out sugar or do, I, but you’ve got to you’ve got to change the habit and it’s, you’ve got to make the change for it to be any good. It’s no good saying you’re going to start tomorrow. You’ve got to start today and you’ve got to make a big enough change.
So, you’ve got to realise that changing a habit is difficult. If it was easy, everybody would do it. It’s difficult. You’ve really got to work at it but the longer you work at, the easier it gets.