Person in fragile health needs recommendations!
April 6, 2016 6:48 AM   Subscribe

Asking for a friend: What are some gentle activities and general advice for a substantially overweight fortyish man in weak health who needs to turn things around? He has not received good support from doctors and his job does not permit him to take time off during clinic hours in any case. See inside!

A lot of the problem here is that fixing one thing seems to make other things flare up. Here's the deal:

1. He is overweight enough that it causes knee, foot and back strain and prevents him from doing vigorous activity of any kind. Given family heritage, it is unlikely that he can lose enough weight to be thin but it seems possible to lose enough weight to get to "stout but active".

2. He has all kinds of digestive stuff - that's part of the problem. Attempts at healthy eating in the past have lead immediately to serious GI trouble. His standard diet is bland, fatty, sugary and highly processed - but at least it doesn't make him immediately sick! Even fairly bland but unprocessed things (homemade tomato soup, baby carrots, scrambled eggs) have produced bad results.

3. He has sleep apnea but cannot seem to use a CPAP successfully. Several visits for fittings have been made. He has tried over and over to adjust to the mask, but it dries out his nose and he has trouble falling asleep. He has never gotten more than two or three hours a night of sleep with the mask.

4. All these things add up to fatigue, which means it is more difficult for him to do stuff.

5. He has depression and anxiety; he has had trouble in the past sticking to group meetings, PT, etc, because he gets so tired and wound up that he just can't make himself go. He has medication for these things.

6. Doctors have basically told him "eat better and lose weight" but have not been able to address the tangle that all the above issues produce - no one has been able to come up with a good plan.

7. His job, though great in many ways, does not permit him to take time off during clinic or therapist hours. He has great trouble even getting to a doctor, and regular PT or therapy during business hours are not a possibility.

8. He had his gallbladder removed in open abdominal surgery a couple of years ago, and although he hasn't had any obvious related symptoms (he can eat fatty foods with no problem, for instance) it seems like his health hasn't been the same - every few months there's some fairly big problem.

Basically, it feels like all of the above are self-reinforcing.

But he is hopeful that he could, on his own, start addressing some of these problems in gentle, safe ways. His goal is to make changes slowly and safely in different aspects of his life.

A particular concern is the ability to keep doing things day after day, especially given the fatigue.

What advice do you have? Please consider the interlocking aspect of the problems. He has insurance but not a lot of ready cash.
posted by Frowner to Health & Fitness (19 answers total)
A few suggestions, none of which are intended to be totally all-encompassing.

- make sure he has a humidifying CPAP, this made all the difference for my guy. An alternative to the CPAP (for some) is to lose weight, so if he truly find it intolerable, it might help nudge in that direction
- See if his workplace offers an Employee Assistance Program. They may not, but a lot of places do and people do not know about them.
- He needs therapy of some sort. This might be as simple as joining a support group for people who share one of his conditions (and they frequently meet evenings or weekends or are free). If this person is a close friend, offer to go with him.
- Something is going on with his food/eating/health situation that could be partially addressed at home if he can't get to a doctor. He could keep a food diary and see if he can linkup what he is eating when eating "clean" that may be triggering GI issues. It's super unlikely that eating clean is "causing" these issues as much as something he is opting for or something he has changed (fat content, fiber content, maybe an allergy to a thing or an intolerance to another thing) is specifically doing this and isolating that will be helpful.

Above all, starting small like "I will try to eat a piece of fruit a day" or "I will walk to (some short distance) three times a week" There are nice apps that can help reinforce gentle habits. Any day doing a thing is an improvement over a day not doing a thing. I'm a huge swimming fan but it can be a tough sell for someone who is anxious depending on their specific issues.

At some level though, none of this is going to work if he is exhausted so working on the sleep mechanics (there are a lot of decent support groups for CPAP wearers and people who suggest alternatives that may be partially helpful) would be my first suggestion. Hating the CPAP is a normal part of the CPAP (and can be really helpful to get around for people with anxieties) but with a more relaxed mind some of these other challenges may seem a little more approachable.
posted by jessamyn at 7:02 AM on April 6, 2016 [4 favorites]

Making some small incremental changes would at least get him on the right path. He doesn't need to switch from burgers and fries to salads overnight, but replacing the mayo with ketchup, ordering a grilled chicken sandwich instead of the burger half of the time, switching to reduced-fat or sugar versions of the same brand snacks/drinks can help.

If he wants to get more organized about it he could make a list of what he currently eats on an average day. Then he would make a list of all of the foods that he likes and that don't bother him, classify them by better and worse on the calorie/fat/sugar scale and then make a diet for himself that minimizes the worst foods and emphasizes the less bad ones and has some kind of calorie target that's X% less than what he's now eating on an average day.

Adding some exercise can be the same way - add a 5 minute walk every day and then slowly increase it to 10.
posted by duoshao at 7:11 AM on April 6, 2016 [2 favorites]

Start with moderation: don't try to completely overhaul his diet all at once. Reduce total food intake a bit; even without changing what he eats, slightly reduce the amount he eats daily. And yes, as jessamyn suggests, try to add one piece of fruit a day, if possible instead of another snack.
posted by easily confused at 7:15 AM on April 6, 2016 [1 favorite]

Totally agree that he needs to investigate the CPAP. My husband was prescribed a BiPap machine with the humidifier, both features make it possible for him to sleep through the night. He lost 30 pounds in the weeks and months after getting his CPAP - that's how much better he felt.

And also agree that otherwise, slow, incremental changes make a big difference in the long run. The podcast "Half Size Me" is fantastic - well worth listening to for motivation.
posted by apennington at 7:15 AM on April 6, 2016 [1 favorite]

Three thoughts:
1. Water aerobics - basically exercise in water so joints won't hurt - and short walks.
2. Change diet to low-fat versions of what he is currently eating. In other words, baked chicken instead of fried chicken, and low-fat frozen yogurt instead of regular ice cream.
3. Apps are great and rewards are even better.
posted by Toddles at 7:16 AM on April 6, 2016 [1 favorite]

As an add on, if he has stomach trouble have him avoid high fiber foods. Forget apples, whole grains etc. He can be healthy with easily digestible foods like white rice and baked chicken.
posted by Toddles at 7:17 AM on April 6, 2016 [1 favorite]

Baby carrots to "bland, fatty, sugary and highly processed" is a big spectrum. If he can eliminate the worst of his diet (say, cookies and chips) and add in less-fatty, less-sugary foods (like tv dinners that come with vegetables), that would be a big step in the right direction.

Exercise, which doesn't have to be vigorous to make a difference in mood, motivation, and health, is also big. Maybe he can take short walks, or buy an exercise bike. Combining that low-impact exercise with something he likes (tv shows, podcasts, whatever) will make it much more enjoyable and self-reinforcing.
posted by mchorn at 7:18 AM on April 6, 2016

I've noticed a lot more therapists offering hours beyond the usual 9-5pm. My therapist was willing to see me as late as 8pm, which was definitely helpful because even though she's close, I didn't have to sprint out of work to see her. He may be limited in his options because of insurance, but it may be a possibility to work with someone outside of the usual time frames-- it never hurts to ask.

Has he thought about seeing a nutrionist or someone focused on holistic health? A GP can sometimes be on a quick turnaround schedule, so they may not take the time to step back and see the whole picture of what's going on with your friend. I'll second jessamyn's suggestion of checking out the EAP-- some have programs or specialities covered within the EAP that are not covered by regular medical insurance. An email or call to his HR office should lead him in the right direction.

In general, this is hard stuff. You are being a great friend by asking on his behalf and taking an interest. Support is especially important in making these kinds of changes (or even taking an interest in making some change) and that's one thing your friend will certainly need.
posted by thefang at 7:31 AM on April 6, 2016

A great way to get some low impact exercise would be to walk in a pool. Not actual swimming, not water aerobics, just walking. As fast or as slow as he can manage, to start.

A small change that I made when I was at the beginning of my own weight loss journey was I switched from coffee (with full cream and sugar) to tea in the morning. Not starting my day with sugar translated to not wanting sugar all day long, and it made a big difference in the kind of things I craved. Still took a while to change my habits, but it was an excellent start.
posted by vignettist at 7:34 AM on April 6, 2016 [3 favorites]

I'd recommend a Fitbit Charge as part of the plan. It's helped me dramatically increase my daily activity just through ongoing awareness throughout the day and a 10,000 step goal. He could also start it at a lower goal, say 5000. The phone app gives lots of badge rewards and honestly makes being active and walking pretty addictive.
posted by amileighs at 7:38 AM on April 6, 2016

Get him a cheap pedometer and have him wear it for a few days to establish a baseline. Then suggest he improve on that baseline by a very small amount---so let's say his baseline is 500 steps, then for the first week, he aims for 505 steps a day. Then the second week, 510 steps. Keep raising it by very small, can't fail amounts.

Now, diet. What helped for me was to reverse-engineer the better choices based on what my triggers were. Most of my diet was decent but my trigger time was when I get to the bus stop and the app on my phone says the bus is more than ten minutes away. So I would go to Starbucks and wait inside---and get junk. I made a small tweak to that. I still get treats, but I get the mini ones. That's just an example. But I found my past mistake was to try and begin with what I should be eating, and not really look at what I actually WAS eating and focus on trying to make those choices slightly better.
posted by JoannaC at 7:39 AM on April 6, 2016 [1 favorite]

eating "clean"

Please don't call it that. It implies that other ways of eating are dirty. It's rude to those who eat in other ways and also likely to be discouraging to the person in question, who probably already feels plenty of shame concerning how he eats and the state of his body.

The sleep apnea problem is brutal: so many of his other problems might be eased if he could address it. He should probably try another CPAP device, as discussed above, but, failing that (and CPAPs are tough for many to tolerate), perhaps he could try Provent? It is clearly not nearly as effective as CPAP, but this is a condition where even some improvement is of benefit.

Short walks can help him build stamina and confidence and don't require much in the way of gear or the social anxiety of going to the gym. Recumbent or semi-recumbent exercise bikes are much more comfortable to use than an ordinary "stand-up" bike and can easily be combined with watching TV, reading a book, etc. He can set his own, gentle pace.

You are very kind to be trying to help your friend with this tangle of issues. Above all, it's important to keep showing him (in whatever way you do that) that you care for and value him as he is. He probably doesn't get much of that message. Trying to change your body out of self-loathing is triply difficult. You just want him to feel better and be able to do more of whatever it is he wants to do.
posted by praemunire at 7:45 AM on April 6, 2016 [7 favorites]

The unspecified digestive stuff -- is this just a bunch of problems you didn't list, or is it a general, undiagnosed issue?

Have you tried introducing healthier foods more slowly? One thing that can put people off changing a diet is bad digestive results from switching too fast, esp. if you increase fiber a lot. It can take a couple of weeks for your body to adjust to more fiber, so you can definitely induce bad results (flatulence, diarrhea, etc) by upping the intake too quickly.

Like... can he eat an apple?

If he genuinely can't eat a wide range of foods because it causes intestinal distress, and it's not because of sudden changes, this is something that he needs to get diagnosed and treated!

Also, he can try making healthier versions of the bland foods that do work for him. It seems unlikely that he needs a dish to be fatty or sugary. The challenge would be to make it still appealing.
posted by Kutsuwamushi at 7:47 AM on April 6, 2016 [3 favorites]

myfitness pal for food tracking is pretty great - it stores foods you eat often and has the ability to scan bar codes from packaged foods so you dont even have to search the (very large) database.

before changing anything he is doing it might be helpful to track a week or two of what he is currently eating - most people are not too attuned to what they are eating.

if he can manage to get into the mode of weighing and measuring and logging the things he eats he can work on strategies to change it - as some have suggested subsituting less caloric or less fatty versions of foods he is eating, or eating smaller portions of the things he currently eats are both reasonable approaches, but i would hesitate to pick one without looking at some data.
posted by Exceptional_Hubris at 7:59 AM on April 6, 2016

In addition to the suggestion of a humidified CPAP, as noted above, you could also consider an ENT consult to see if there's anything physically preventing the CPAP from working well. It could be something like nasal valve collapse making the CPAP therapy non-effective.
posted by pie ninja at 8:05 AM on April 6, 2016 [1 favorite]

If this were my friend/client, I'd suggest the following:
1. Figure out the CPAP thing (I don't use one so I don't exactly know what to suggest).
2. Get into a pool as many days as possible. In the beginning just walk around and play...enjoy the weightlessness the water gives and just move around. Eventually he will feel comfortable in it and increase the amount of moving he does. You want him to move towards walking measurable laps or whatever.
3. Log everything he eats and drinks for a few days, then figure out one thing to change. There are many frozen dinners out there that are healthier than eating a ton of carbs (yes, they are processed but we're doing small steps!) and he can test out what works and what doesn't.
4. Continue tracking all food intake and GI symptoms. Something doesn't sound right with what you are saying that his GI symptoms get worse when he eats healthy foods. Could be related to his gallbladder removal, could be he's choosing the wrong foods or overloading on them (fiber) without adjusting, could be a sensitivity, could be an excuse that he doesn't want to change his diet. Change is scary.
5. Find him some sort of tiny weights or a rubber band thing or something he can do with his arms while he's watching TV. Some calorie burn is better than no calorie burn, and if you start with something small enough it shouldn't overtax his joints.
6. Track everything (sleep, food, exercise, mood, etc) everyday and have him review once a week with a non judgemental friend or therapist/coach.

You don't want to overwhelm him by changing too many things all at once, so paying attention to "task saturation" is a good thing. If it's too overwhelming he will quit everything (I know from experience). There are days where I consider spending 20 minutes at the gym a big win. Give him a win in one area and keep building from there.
posted by MultiFaceted at 8:29 AM on April 6, 2016 [1 favorite]

If he braces himself for a few grumpy responses (because it's a forum dominated by detail-oriented, 40+YO dudes), CPAP Talk is an incredibly helpful place. If he posts with his model and his issues, they'll try to help. Seriously, having sleep apnea and not treating it can a) make a person so exhausted that all of the other great ideas above will be impossible to actually carry out, and b) kill you, full stop.

A video game system might be a good idea, such as a Wii (if he isn't over its weight limit) or whatever else is out there.

It might also be a good idea to look for a HAES (health at every size) doctor in his area, through online fora or sites like this one. A HAES doctor won't just skip the nutrition and exercise recs, but may be more reasonable about them. For example: get 15 minutes of exercise, even if it's walking in the mall, 1 day a week. Do this successfully for one month. Then aim for twice a week. Do that for a month. Then three times a week, also for a month. Then either go for 5 times a week, or if the person is feeling a bit better already, look into adding an activity like a yoga class or something.
posted by wintersweet at 8:31 AM on April 6, 2016 [1 favorite]

Seconding the 'walking in a pool' suggestion, which is common. Just getting into bathing shorts and the pool can help you feel like you are taking care of your body more.
posted by colie at 10:03 AM on April 6, 2016

Focus all efforts on the apnea issue. If he's not getting enough oxygen while he sleeps, none of the "other" concerns can be addressed sustainably.

Segmented sleep can double the amount of sleep he's getting with the mask. It might take further (annoying & expensive) experimentation to get a mask that's the right fit, and sleeping with a mask won't ever be pleasant. He absolutely needs a humidifying machine.

Some people see results only gradually, so stories of immediate dramatic improvement can be discouraging.

MeMail me if you want personal experience details. I'm not going to post them here, because my enthusiastic raving about successful apnea treatment quickly sounds like I'm recruiting for a cult.
posted by wonton endangerment at 12:18 PM on April 6, 2016 [2 favorites]

« Older How do I stop feeling overwhelmed?   |   Programs for people with autism Newer »
This thread is closed to new comments.