Paul has always been “fairly big”, but was motivated to lose weight after being diagnosed with type 2 diabetes and sleep apnoea. Paul lost 15 kilos through exercise, but after a stressful period in his life put some of this on again. Paul has found losing weight harder as he has gotten older. He feels healthcare professionals should be more direct in encouraging individuals to lose weight, and should offer more personalised advice on how to do this.
Paul is 55 and runs a B&B. He is white British.
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Paul has always been “fairly big”, but over the years his weight has crept up. Although he was very active in the past, several years ago Paul started sleeping badly. Over time, Paul found he had less and less energy, making it harder to exercise. After seeing his doctor, Paul was diagnosed with sleep apnoea and type 2 diabetes, conditions which are now well managed. However, around this time Paul was warned about the impact of his weight on his conditions, and the value of diet and exercise in managing his health. Paul took this advice “to heart”, and lost over 15 kilos.
Paul initially lost weight through exercise. He started using a rowing machine, and tracked his activity on a wrist device. He was also working as a rugby coach, which encouraged him to be more active. Paul didn’t find it too difficult to make healthy choices, as he doesn’t drink much and has never really enjoyed sweet foods. However, Paul then took another job which was more office-based, “It just caused me irregular eating, weight crept up, less exercise”. After a stressful period of time, Paul had to give up his job and suffered some negative effects on his health, including high blood pressure and cholesterol. He found it harder to exercise, and put on some of the weight he lost.
Although Paul is now past this stage of his life, his weight has remained stable for the last 18 months. Alongside his job, Paul now covers lunch shifts, which means he has long periods of time where he doesn’t eat. Paul finds this encourages poor eating patterns, and he snacks on sandwiches after work, and eats dinner quite late. Indeed, Paul is aware that his diet is heavily based around carbohydrates, as it offers fast meals. Although he enjoys cooking, and sometimes cooks large quantities and freezes portions for another time, Paul doesn’t do this as frequently as he could, “I enjoy cooking for other people a lot better. So living on my own… I don’t cook as often as I feel I ought to”.
Paul is finding losing weight more difficult in middle age, and feels he needs to make changes to his diet to get his weight under control, “I have to work harder to shift the weight that I have”. However, Paul is hesitant to join a weight management programme due to issues of access and feeling the environment wouldn’t suit him. Although Paul walks his dog frequently, he would like to join a sports club as he found exercise helped him manage his weight in the past. However, living in a rural location is a barrier to this, as is his job running a B&B, which means he must be present at home.
Although Paul doesn’t feel his diabetes affects his daily life, having kidney stones recently was a “wake-up call” on his weight. He would like to lose between 8-10 kilos for health reasons, “it would be good not to die at sixty-four like my dad because that only gives me another, less than ten years, so that would be, that’s pretty good motivation”.
Paul suggests that time restraints make it hard to raise the issue of weight with healthcare professionals, as does poor continuity of care, “it sometimes feels that it’s a bit of a turnstile operation”. However, Paul feels that he would be more successful in his weight loss if he was pushed harder to reach goals around diet and exercise, and given strategies to do this. He encourages healthcare professionals to be more specific and direct in their advice, “I’m happy for somebody to say, ‘No, no, you really need to be five kilos lighter …but this is the way you’re going to get there and next time I see you, you’re going to have done this, else we’re going to have to change the regime.” Paul encourages others to fight for more personalised support around their weight, “…all of us are heavy for different reasons…and will get lighter with different motivations and programmes and incentivisation”.
Paul Y describes how his diagnosis of sleep apnoea and type2 diabetes came about and explains the relationship between his sleep apnoea, tiredness and weight gain.
I had always snored since, since I was a young man. If anybody shared a room with me they said, “Oh, you’re really loud.” But I don’t think that other than trying, I’d never gone for, I don’t think I’d ever sought a diagnosis for that just maybe tried some of the sort of sleep breathing, sorry the, the sort of nasal opening strips. I had never realised that it was, it was having such an effect on me. But, but the lack of deep sleep just meant that I had less and less energy. So the two, so the eventual diagnosis of, of Type II diabetes which I think was around 2007 was, was certainly linked to, to sleep apnoea because over time I just had less and less energy because I was getting very, very little sleep but not realising it because it’s such a gradual process that and, and of course having, having that little energy, you just, you know, you’re not inclined to exercise and the job I was doing virtually seven days a week in my business was sitting, was principally sedentary. So even though, you know, I lived in a place where, and I still, still went out for, for a walk with my dogs at the time, I was less, I was doing less and less exercise but that was, it was almost imperceptibly small changes to, to, to my last job so I didn’t realise that I was, I was getting ill.
…It was when, when I eventually got a referral the, you wear a monitor for the night and it basically said, ‘Well you know, you wake up every forty seconds.’ [Laughs.] You’re not consciously waking up…
…but you don’t get any deep sleep at all. This is a, you know, that’s quite severe, you know, and falling asleep at the wheel and all those kinds of things. That’s severe sleep apnoea. You need to do, you need to do something about that.
How was your weight at that time?
So, it had just crept up. I mean I’d always been fairly big. Played, played rugby, went, went running, but, you know, I’m big anyway but I think, yes, just, just crept up. So it’s probably, probably 110 kilos something like that.
So, they diagnosed you?
So, two separate diagnosis obviously one for sleep apnoea and I’ve got my sleep app machine and have used it ever since and love it. There was, you know, an almost instant change there. But yeah, when I’d gone to the doctors, you know, one of the things they did was, was do a blood sugar test and just say, “Okay, right you’ve, you’ve, there isn’t any doubt, you’ve got type 2 diabetes.”
Yes if your weight creeps up, one of the ways you’re more likely to get sleep apnoea if you’re, if you’re carrying weight because the weight, if you’re collar size increases I mean that’s the simple measurement that they’ll take, they’ll say you’re more likely to get sleep apnoea because your throat will constrict and, you know, less air through into your lungs and less oxygen to your brain, so [laughs] yeah, so it can develop. So yes, there is a relationship, so you’re more likely to get sleep apnoea if, if you’re heavy, as it happened, I think I’ve probably always, always suffered from a degree of it but whether it, but whether it worsened I don’t know because I didn’t, I didn’t know until I wore that monitor that I was waking up every forty seconds. But that could have been the case for years, you know, years and years.
Paul Y started running with the help of an app on his phone and had maintained his weight through exercise for about eighteen months.
So, it’s plateau?
So, it’s plateauing because I’m doing, because I’m doing more because otherwise I think as I get older a little bit less, a little bit less energy and vigour, I would be, would be, you know, you just need to put the effort in.
Yeah, so you’re quite happy to do the exercise bit?
Yeah, yeah, I mean for, for quite a, for a year or so, up till, up till about eight, I’m trying to think when I, when I stopped running. But I put an app on the phone and, you know, started running round the block and, you know, started running thinking, right I’ll do it once, do two laps, do the three laps, do four laps, you know. Was just about up to 5k.
Okay and how does it make you feel when you look at this app and…?
Yeah, great, good, encourage, encouraging, you know. I think I just as I got busier with the B&B and trying to fit that in around, around visitors and around the dogs needs and then, you know, picking up some shin splints and you just think, ‘Oh,,’ and once I stop, I’m a good trainer once I’m going but once you stop you stop. Difficult to get motivated to start again.
Okay but now you are sort of within the walking routine?
Yes, yeah, yeah. But that’s not to say, not to say, you know, I’ve reaches, I may have reached a plateau but it’s not, it’s not bringing my weight down, so I’m kind of thinking, ‘Okay, well that’s good but what can, you know, I……
…I need to do something else right now.’
Okay, so for how long have you maintained this this same weight?
Probably, probably a good eighteen months.
Daily long walks have boosted Paul’s sense of wellbeing and helped him to avoid gaining weight.
I’m [laughs] generally a good deal happier, yeah, mental health has, has, had, has definitely improved, you know, I, I was, I love being out with my dogs. I think my dogs are a massive contributory factor to, to, to my health, both my mental health and my physical health and you know, I, I, for a while before, when I only had this little dog, I used to, I used to shorter walks. Now I’ve got a slightly bigger dog, we go further and that’s every day, you know, that’s, you know, what I’m doing, doing all the steps, so yeah.
When you said, your mental health, in which way, what did you mean by that?
Just, a sense of wellness I think is things that, I love being outside as well, any problems I have I just, you know, I’m infinitely better once I go, once I go for a walk and get some, get in the open air. I used to live by the sea. Used to go for a walk, you know, spend hours on the beach. Now, you know, it’s down a country lane but I need to be outside.
Weight loss is “one of life’s victories” for Paul Y.
What is your goal regarding weight?
I think if I could get below 95 kilos again, I’d be, I’d be happy, so…
Now you are 110?
No, I think I’m, I could run upstairs and jump on the scales but probably about 103.
Is there any emotional impact to weight gain or to weight loss?
To, to weight loss definitely. Yeah, yeah.
In which way?
Just, it’s, it’s, it’s one of life’s victories isn’t it.
You feel happier?
Get the weight down feel happier. Just think, yep, yep,….
….I’m winning [laughs].
Paul lives in a rural area and would have to “drive for miles” to attend weight management classes. He would prefer to join a sports team rather than a weight management group.
And what about taking part in kind of a management, weight management programme, like, I don’t know, Slimming World or…?
Well, I’d be driving miles, I don’t know, you know. I really, yeah
I live where I do and, you know, you’ve, you’ve just driven here, it’s, you know, a good twenty minutes to the nearest very small town…
...so, no, a) no it doesn’t appeal but b) I wouldn’t have access anyway.
Why doesn’t appeal?
It’s part of a, it would, it would appeal if somebody said to me, you want to be part of our sports team, our cycle team or our rowing team, come and train with us.” That would appeal. Going along to Sliming World, no.
Okay, so a activity.
Yeah, that sort of team effort I get. You know, I don’t think I would draw a lot from a group meetings of that kind.
Paul did not find the DESMOND programme for diabetes motivating and would have liked a more empathetic approach.
Well I did bring it up, last, last meeting I had with a GP I’d never met before and I just said, you know, he was looking at my latest blood test and, and was saying, “Okay blood sugar’s up very slightly again, you know, going to need to put you on two metformin.” Said, “Well, you know, I’m not happy about that. What can I, what can I do?” “Oh, have you heard about this programme called DESMOND?” I said, “No, I haven’t but, you know, if that’s what’s going locally then yeah get me along.” “Right, well it’s a day course.” “Okay, fine.” I kind of signed up for it without knowing what it’s about. I’ve read through it now. An awful lot of it looks fairly familiar to me and doesn’t necessarily do what I’ve been talking to you about doesn’t, you know, doesn’t tick my boxes as far something particularly motivational but perhaps I’ll meet somebody, or get the chance to meet somebody or talk to somebody who kind of empathises. You know, there’s some empathy there that says, “Okay, that’s what, that’s what makes Paul tick. Let’s adapt our approach for him.”
Paul Y describes how time pressures affect the type of conversation it’s possible to have with the GP.
I do feel that doctors and health professionals are busy people and they, you’re just going, you’re in and out and they, you know, they haven’t necessarily, you know, it’s ten minutes per appointment and by the time they’ve taken your blood and you’ve had a quick chat about the weather, you’re out the door again. I don’t think health professionals are always good at saying, at starting what might be meatier, more lengthy interviews.
Okay and what…?
There is, it sometimes feels that it’s a bit of a turnstile operation and they, they’re under pressure to, you know, to see an awful lot of people in quite a short time and, you know, yeah if you’re at the end, certainly if you’re at the end of the day and you’ve already, you know, it’s a typical situation isn’t it that you know, that doctor, you know, you’ll have an appointment. Your appointment will be twenty minutes late, twenty-five minutes late and you’re just thinking, ‘Well, that means that they’re pushed. They don’t want to have this long conversation about looking at, you know, how I was eight years ago or six years ago or four years ago. Yeah, they just want to, you know, the next person is waiting behind you and they’re appointment is twenty minutes late as well.’
Paul Y suggests that healthcare professionals should communicate more frankly about weight.
I mean I think what you said earlier about, you know, sort of medical professionals sometimes being quite sensitive as to the subject of weight, you know, I’m not, I’m happy for somebody to say, “No, no, you really need to be five kilos lighter, ten kilos lighter. This is, but this is the way you’re going to get there and next time I see you, you’re going to have done this, else we’re going to have to change the regime. You’re going to have to work harder or we’re going to look at a different way of helping you get there.” Okay, but let’s not just say, “Oh it’s crept up a bit or it’s fallen.” Let’s just say, “let’s link it to your activity or your diet.”