T Nation

Advice To Give Someone That Is Morbidly Obese

So the stats:

Person: My father
Weight: 305 lb (probably mostly fat, he’s had a few heart attacks already)
Height: 6’-1/2"
Age: 60
Dietary Limitations: Gluten Free and prefers not eating red meat, which is probably smart because his cholesterol and blood pressure are both terrible
Wakes up: 6:30 am
Sleeps: it fluctuates but for now lets say that I will nap 3 hrs straight and then I am up overnight

He claims that if I help him make up a diet and simple exercises he will do his best to stick with it. For exercise we’re talking stuff like walking. Whether or not he actually does it, I don’t know, but I’ve been trying to get him to be healthier his whole life and it seems he is finally willing to listen to some of my advice. Would it better to have him get a nutritionist and personal trainer? yes it probably would. But he won’t agree to that and probably wouldn’t listen to them anyways. He’s stubborn. He will listen to me.

If nothing else I’m looking for a good Protein-Carb-Fat Ratio for someone of his size to use when losing weight and how many calories to start with.

What type of exercise can he do that will be enough that he will lose weight but won’t give him a heart attack? Should he maybe wear a cardiac monitor watch and make sure his BPM stays below a certain point to prevent any accidents?

Thanks for any help,
-Ender

Does he drink? Alcohol needs to go if he wants lose weight. Sugars need to go, and any other drinks with calories. Water and green tea. Fasted cardio in the morning–he needs to get up a start walking. I don’t think a protein, fat, carb ratio makes that big of a difference at his weight and age, but the more lean meat and green veggies he eats the better, as long as the portions are relatively small and frequent.

Less carbs is better but no need to go crazy. Just no processed sugar and the less processed the food the better. Get on fit day and figure out his caloric needs and go from there.

Edit: If there is a way to get him moving in a pool, that is good too. Just walking around in three feet of water on a regular basis won’t hurt his joints, but it will burn some extra calories.

No please don’t send him to a nutritionist and personal trainer. Just do some research and create him a tolerable plan.

For exercise? Have him bike. Not only at the gym, but encourage him to bike to the store.
Or after he gets down to 265, have him do the V-Diet.

As he loses weight through better eating and exercise, make sure he knows his health problems will improve. Make him realize he doesn’t have live in fear of heart attacks.

Pool is out, even when he was skinny he never goes in the pool, I don’t know why. And yes he was skinny at one point and has gotten progressively worse.

No he doesn’t drink.

How many calories should should I be shooting for, I don’t think the usual calorie counters will give me an accurate number for him to lose weight steadily?

I always thought those pool exercises class were a great idea for very heavy and/or older people. Easier on the joints, no need to try to ‘keep up’, etc. Combined with a good meal plan would go a long way.

[quote]Enders Drift wrote:
Pool is out, even when he was skinny he never goes in the pool, I don’t know why. And yes he was skinny at one point and has gotten progressively worse.

No he doesn’t drink.

How many calories should should I be shooting for, I don’t think the usual calorie counters will give me an accurate number for him to lose weight steadily?[/quote]

I ran a couple different BMR calculators and they all put maintenance for a lightly active person of his age and weight and height at around 2500. So he needs to be slightly less than this to lose weight, if he also adds in walking. Also, if he won’t get in the pool, just walking is awesome.

Any activity that won’t hurt his joints and just gets him moving will do. He probably should not lose more than a 1/4 to 1/2 pound a week. He just needs to do it steadily to make progress–but he needs to do it for the long haul. And he should check with his doctor whatever he decides to do.

Well, what’s he eating right now on a daily basis? Take the junk out of his diet and add in lean meats/veggies/fruits/nuts/complex carbs. Doing that will be a huge step. My dad is also overweight and he’s started walking, eating healthier, and he likes stretching.

Maybe you can get your dad to wake up early in the morning and then go walking and when he gets back do some basic easy stretching. That should be good for now. Baby steps, imo.

[quote]jjackkrash wrote:
Fasted cardio in the morning–he needs to get up a start walking. [/quote]

This.

Get him a puppy. Have him walk it twice a day, morning and night. As the dog gets bigger he’ll be able to walk further and your pops will be in better shape and be able to walk further.

The pup will help with motivation and companionship too.

Nah that won’t do it, he’s got 3 dogs already and a large fenced in back yard he puts them in.

I’ll try to just tell him to walk. Thanks for the ideas so far.

Any input on actual numbers though, if I just tell him to walk he’d probably walk for 10-15 minutes and then think its enough. Likewise if I just tell him to eat lettuce and tuna he wouldn’t eat enough. Right now he usually skips breakfast, barely eats lunch, snacks a bit all day, and then eats a mediocre to almost good dinner.

[quote]Enders Drift wrote:
Right now he usually skips breakfast, barely eats lunch, snacks a bit all day, and then eats a mediocre to almost good dinner.[/quote]

  • This needs to be reversed. Load up earlier in the day and taper off.

  • Move more. Start with little lifestyle changes. Unless he has high internal motivation, if you make the change too dramatic it likely won’t stick. If there is a chance to walk instead of drive, do it. Park farther from the entrance. If 15 minutes feels like a worthwhile exercise interval to him, then do two of them a day…one early, one in the evening.

  • Eat less. Portion control is often easier for people to deal with than changing foods. Reduce, then eliminate the shit foods such as simple sugars. He will / should be hungry sometimes (not ravenous) but he needs to understand that this feeling should be associated with progress and he needs to embrace it not fight it.

  • Set goals and track progress. Focus on the behaviors rather than the results. Example, his goals could be 2 brisk walks a day (time defined as 15 minutes, intensity defined as breaking a light sweat), a decent breakfast (proper foods defined…not a bowl of cereal), snacks limited to one in the morning and 1 in afternoon.

  • take a longer-term view. If he does the right things the results will come. Really the goal is a lifestyle change that will ultimately lead to better health not short-term fat loss.

  • if he is motivated get him to update you regularly on how he is doing (accountability). example, a quick email / call every Friday on the behavioral goals.

It probably all those snacks that are causing him to keep his weight on. I would imagine they are all processed foods and seem low cal but are adding an easy 1000 cals a day. Even just eating two meals a day with some nuts in between would be fine for a 60 year old guy. Also, I think he could stand to lose a lot more that a 1/2 pound a week, this is more life and death than holding on to muscle.

[quote]rageradios wrote:
It probably all those snacks that are causing him to keep his weight on. I would imagine they are all processed foods and seem low cal but are adding an easy 1000 cals a day. Even just eating two meals a day with some nuts in between would be fine for a 60 year old guy. Also, I think he could stand to lose a lot more that a 1/2 pound a week, this is more life and death than holding on to muscle.[/quote]

Good point about the snacks. They need to make sense given the objectives.

giterdone had excellent advice.

Keep it simple. Put him on a very limited diet for 4 weeks. Nuts, veggies, berries, and chicken breast for 4 weeks. Get him some Flameout too.

Exercise - walking is good, but he needs strength training too. Come up with something you know he can do, but something that he will do. Maybe something like bodyweight squats, pushups with feet on ground and hands on a hand rail of some sort, and single arm rows with a gallon jug filled with water.

Start it off very easy like 25 reps of each twice per day which would take about all of 5 minutes. Then have him add one rep each day, so for example on the 8th day, he would be doing 32 reps of each twice per day, and by the last day, he would be doing 52 reps of each twice per day.