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Diving, Fitness, Obesity and Personal Rights

Discussion in 'Basic Scuba Discussions' started by String, Dec 25, 2015.

  1. agilis

    agilis Solo Diver

    # of Dives: I just don't log dives
    Location: N.J.
    The mention of air embolisms took me back to my earliest experiences with scuba more than 50 years ago. I learned to scuba dive from a book back in the early 60s. This scuba self-taught (not unusual back then) text emphasized over and over that holding your breath while breathing compressed air was suicidal, that even moderate changes in depth might easily result in air embolisms. "Continue uninterrupted breathing at all times" was the rule.

    I remember my first dive very clearly. I kept repeating over and over to myself "do not hold your breath". I'd been snorkel diving since I was a little kid, so naturally my automatic response to being underwater was to hold my breath.

    Years later, when I was formally certified, this was not as strongly emphasized. Lots of divers skip breathe, but I never have, still under the influence of the alarming illustrations in that old book.

    As a diver well past my 70th birthday I've experienced unpleasantness from some scuba operations who see me as a high risk customer. I'm in good physical condition and appear younger than I am, but the statistics regarding age and coronary events are quite clear, and I've gotten used to the frown that develops when the DM reads my DOB. I think the best approach for me is to obtain a forged C card with a more recent date of birth, but I'm not sure what obese or out-of-condition people might do.
    ZephyrNYC and diving4ever like this.
  2. Centrals

    Centrals Barangay Pasaway

    # of Dives:
    Location: Hong Kong
    Where did I say I was diving in USA?
    US coast Guard has no jurisdiction outside US coastal water.
    ZephyrNYC likes this.
  3. drrich2

    drrich2 Solo Diver

    # of Dives: 200 - 499
    Location: Southwestern Kentucky
    Vertically striped wetsuits. I hear they're slimming. Problem is, since I'm chubby I often don't need a wetsuit...

    tridacna likes this.
  4. MMM

    MMM Giant Squid Staff Member

    # of Dives: 1,000 - 2,499
    Location: Sask. Canada/Cozumel, MX

    A ScubaBoard Staff Message...

    This thread has been split from another thread located elsewhere... http://www.scubaboard.com/forums/ac...519645-diver-dies-st-maarten.html#post7578513

    The content is interesting, but of a general nature not directly connected to the referenced death and hence, inconsistent with the TOS for that forum. Political comments have been removed as that is a subject for The Pub. Please avoid making such if you comment in this thread. Marg, SB Senior Moderator
  5. Rusty Liam Booth

    Rusty Liam Booth DIR Practitioner

    # of Dives: 200 - 499
    Location: Southwark, United Kingdom
    People have been talking about administering tests to see if you are physically fit to dive. When should that test take place? well i have annual dive and travel insurance and I tick the box saying no underlying "health issues" i personally would describe overweight / obese which in the usa

    1. Adults Age 20 and Older 2. More than two-thirds (68.8 percent) of adults are considered to be overweight or obese. More than one-third (35.7 percent) of adults are considered to be obese. More than 1 in 20 (6.3 percent) have extreme obesity.

      [h=3]Overweight and Obesity Statistics | National Institute of ...[/h]www.niddk.nih.gov/health-information/.../overweight-obesity-statistics.asp.

    this is a serious issue and people really need to start taking responsibility for their health.

    ps i understand i technically (if using bmi) am technically overweight but i am a rugby player and so i've been told it doesn't count for us.
  6. bowlofpetunias

    bowlofpetunias Oh no, not again! Staff Member

    # of Dives: 500 - 999
    Location: Sydney Australia
    I have to say I question BMI as an appropriate measure when physically fit athletes don't "pass" I personally know someone who was teaching Phys Ed and representing the Nation on a sporting team who didn't "pass".

    It also annoys the heck out of me that people are willing to judge others without an idea of their fitness level. Some people don't win the hereditary sweepstakes that allow them to eat without weightgain. I know people who can eat anything and stay skinny but are unfit. I know others who barely look at food and gain weight but are quite fit.

    Before people say .. oh they are just making excuses for eating too much animals have the same issues. When we bred and showed horses we had some we had to bog the feed to and feed them specially for weight gain. It was still a struggle to keep them in "show shape". We had others I felt sorry for because they stayed fat on nothing! We would put them in the pasture after it was eaten to nothing by the herd so they had to hunt for the blades of grass, they got no grain and embarrassingly little hay.

    Some creatures are "easy keepers" and some are "hard keepers" neither deserve to be judged better or worse than the other based on weight.

    I'd say people have the right to determine for themselves what dives they are or are not capable of provided they do not put others at risk without their consent.
  7. Neilwood

    Neilwood Loggerhead Turtle

    # of Dives: 50 - 99
    Location: Scotland
    The use of BMI as a rating of health is a poor one as it is such a blunt tool for assessing fitness.

    For those that don't know it works out as (mass in kg)/(height in metres)^2 or for our imperial cousins ((mass in lbs)/(height in inches)^2)*703

    Of course with such blunt figures (which take no account of body composition ie muscle is denser than fat), active sports people can have very high BMI figures but be in peak physical condition.

    Professionals using BMI should be versed in deciding whether it is actually a good tool in a particular case or whether more accurate methods should be used (skinfold thickness for example).
  8. freewillie

    freewillie Loggerhead Turtle

    # of Dives: 50 - 99
    Location: SoCal Beach Cities
    I apologize for not responding earlier but I have not been as active recently. My daily work activities as a general primary care doctor have been keeping me busy during the day. My fathering duties have kept me even busier with my kids afternoon and evening activities.

    But as a board certified internal medicine MD I just wanted to clarify some comments. I don't mean to single out Hatul's post but it is the first one in this thread. There have been a few others in the same light and I just wanted to clarify the limitations of assessing a person's health.

    First, the standard treadmill test is a poor test to assess the person's underlying risk of heart disease. It cannot reliably predict a person's underlying risk for having a heart attack. What it will tell a doctor is that the person does not have any "clinically significant reversible ischemia." Let me interpret that last quote. For a standard Bruce protocol treadmill test to be positive there must be a significant lesion that restricts the blood flow in a coronary artery to either produce symptoms and/or ischemic changes on the EKG while the test is in progress. Also, the heart rate must exceed a certain level of oxygen requirement from the heart muscle to produce either the symptoms and/or ischemic changes on the EKG.

    For example. If the patient has an underlying blockage in a coronary artery of say 90 % and the heart rate exceeds the heart's demand for oxygen (say at 80% maximum effort for age) then the patient will start to complain of some fatigue or shortness of breath or chest pain. The EKG will show signs that the heart muscle is not receiving enough oxygen due to the restricted blood flow and the characteristic ischemic changes will be present on EKG (seen as ST segment depression of 2 mm or more). And by definition reversible so that during the rest and recovery phase the symptoms disappear and the ST segment depressions go back to normal. That would be a positive stress test.

    But current theories for how a patient suffers from an acute coronary event (i.e. a heart attack) is that the victim suffers from an acute atherosclerotic plaque rupture. In other words, the build up of cholesterol plaque in the arteries and hardening of the arteries ruptures and then causes an immediate formation of a blood clot in the artery. This takes place over seconds if not minutes and the patient will immediately start experiencing the symptoms of a heart attack. Also by definition the heart muscle starts to die due to lack of blood flow and lack of oxygen caused by the blood clot. If the patient is lucky and gets to medical attention quickly and a cardiologist can restore blood flow in an emergency angiogram the patient may survive and have a good outcome. But even under the best of circumstances 1 out 3 patient's with their first heart attack will still die even with appropriate medical intervention. Because it is virtually impossible to get medical intervention while scuba diving the odds of surviving drop dramatically.

    You will notice that I did not give a percentage of how blocked the artery was when the person suffered the heart attack. That is because the plaque can rupture at any level of atherosclerosis. You can have heart attack with minimum plaque build up say 10% or extensive plaque build up of 99% and any level in between. It just so happens you are more likely with stable coronary disease to have symptoms at some level and get diagnosed and subsequently treated before the plaque rupture and possible heart attack.

    Bottom line is you can have a "normal" 13 MET treadmill and still have a heart attack. That is the way Jim Fixx died training for a marathon. He was the author of The Complete Book of Running and was by all accounts in great physical shape. He would have short circuited the treadmill and EKG machine for his stress test. But he suffered a catastrophic plaque rupture at age 52 while running. Autopsy confirmed significant underlying atherosclerosis with one artery as much as 95% blocked.

    Essentially life is a terminal event. The only question for any individual is how and when will you die. You cannot legislate any number of rules and regulations that will prevent you from dying. Now, you can minimize your risks of having a heart attack by regular office visits to a doctor and taking aspirin, cholesterol medications, and blood pressure medications. You can minimize contributing risk factors by maintaining a healthy body weight, avoiding or quitting tobacco, regular exercise, and a having a healthy diet. But even with those measures there is always the possibility that under certain circumstances (say a genetic predisposition as in Jim Fixx's family history) you may still have an unfortunate medical event.

    Being overweight is also not an immediate indication that the person is automatically at risk for a cardiac event or is inherently unhealthy. Weight in and of itself is not a maker of physical fitness. The body mass index (BMI) is simply a marker of how heavy you are relative to your weight. That is all it is. It is not a marker of your physical fitness or aerobic stamina. You cannot look at a person either overweight or "normal" weight and predict how long or how short they will last on a treadmill. Being overweight may increase your predictive value that you will perform at a shorter time but that is an association only and not an absolute. To use an analogy, speeding in the rain will increase the likelihood you will have a car accident but is not a guarantee that you will have an accident.

    And what about older divers in general? If we are advocating limiting the personal rights of overweight people shouldn't we limit the rights of older people too? (this is a rhetorical statement people and not meant to be taken literally) After all, the biggest correlation to fatal diving accidents is age over 55. That is because age over 55 is a risk factor for heart attack and increased risk for underlying medical illness as the underlying cause of death in a scuba accident. You are more likely to die of a medical issue over the age 55 while participating in scuba diving than dying in a scuba related accident due to scuba itself. I'm almost 50. Should I consider quitting scuba diving because I statistically have a higher risk of dying while diving?

    I am not trying to downplay the emotional impact having a diver die on a dive boat has for the witnesses and good Samaritans forced to help in an emergency. But at some point life itself is a risky proposition. Should we avoid skiing because a skier might have a heart attack on the slopes skiing. Should I not go to the gym this afternoon and work out because I might have a heart attack on the treadmill. Do I avoid going to the bathroom? Seriously, there is a very high correlation to passing out and being on the toilet. At what point do we stop worrying about trying to legislate and govern with rules and regulations to prevent emergencies? You might as well try and develop rules to stop the sun from rising tomorrow.

    Personally I am not going to worry about having a heart attack. That doesn't mean I'm going to sit back and just let one happen. I'm trying to exercise and maintain a lean body weight as much as possible. With a personal family history of heart attacks and not being able to take Lipitor (makes my muscles ache) that's about all I can do for now. I still eat more fats and red meat than I should but that goes to my underlying philosophy of life as well. Life is meant to be enjoyed. I enjoy a good steak and a hamburger every once in a while. And I really, really enjoy both skiing and scuba diving. So I'll continue to do both as long as my age and physical activity will allow.

    Fun and safe diving to all.
  9. wetb4igetinthewater

    wetb4igetinthewater Instructor, Scuba

    # of Dives: 500 - 999
    Location: Seattle
    I think we can all agree that there really isn't a solution here. There is on one hand the fiscal pressures to have the largest market possible and on the other, how to address/mitigate people without the proper health to dive in adverse conditions.

    There isn't a solution that can address both points. We are going in circles here. The reality is that money talks. I can't say that I want people turned away from diving, as it may be a motivator to get themselves into a fitter, healthier state so that they can enjoy more challenging dives safely.
    Last edited: Jan 12, 2016
  10. Nemrod

    Nemrod Solo Diver

    It has become more than a problem. The diver population largely reflects the population at large and that population is LARGE.

    I have a coworker, he was quite the jolly fellow and somewhat at my urging began a fitness program. He eventually used professional help and a doctor supervised diet. He lost a hundred pounds or more. When he joined the program he shared with me a few things that startled him, one was that the counselor told the class that they would have to resist pressure from the "new normal" who will pressure him to eat and who will consider him to be the abnormal. I know people hate the BMI, it is not a perfect tool, especially for pro athletes and high zoot athletes in some disciplines but frankly, for most of us, we should conform pretty close to it.

    As has been pointed out, age can be an issue but the real problem is obesity and general lack of fitness and the fact is that a significant number of divers are obese, even morbidly so. It is just worse for the older person. Younger folks still have their inherent strength, older people just do not. Fitness is something requires effort. I have strived not to become a hostage to my body, not PC but a cripple.

    Last edited: Jan 12, 2016

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