It was difficult for me to ascertain the precise details of what and how (the why was unambiguous) the founder of a gym in Manakau was doing what he was doing with his lifestyle programme for the obese. But, what was clear was that he is someone who knows how to get big people to regularly attend the gym. I was shocked, therefore to meet a man not content in his success, but someone in a quandary both professionally and personally.
Given what he has achieved, he seemed proud of the fact that he was expelled from school at 15 with no qualifications, barely able to read and write. From what I could gather, apart from a gym instructors qualification and a recent hypnotherapy course, he has received little formal training at all. Speaking with him, this is difficult to believe; his understanding of business and behavioural psychology is incredibly intricate; he is impressively knowledgeable.
Using trial, error, and judgement, an attractive, effective and sustainable exercise programme for obese individuals has evolved.[1]A holistic, personal approach encompasses all the elements of what has been reported to be an effective behavioural intervention in the scientific literature.[2]In fact, this initiative for sedentary individuals has been extremely successful with almost 200 participants losing up to a combined 1000kg per year. The founder of the programme was celebrated in the field and invited to talk at a whole variety of events covering topics from diet and exercise to behaviour change and addiction. He won awards in recognition of his work and was even nominated for New Zealander of the year.
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A programme aimed at obese individuals from south Auckland (the poorer region of the city), requires subsidies to exist. It is well established that poverty is a risk factor for obesity meaning that many with this condition are unable to pay for gym membership or fresh food etc. Moreover, to incentivise individuals who have been sedentary for many years and whom are almost certainly mortified at the idea of joining a gym, to start exercising it has to be free. Fortunately, since 1998, government funding for such programmes has been available.[3]GP’s refer individuals to a partner organisation that has the facilities to train high-risk individuals. That organisation can then be reimbursed for the cost of training that person. It seems surprising therefore, that the number of individuals being referred to this particular club has fallen dramatically.
The founder thinks he knows why, I am inclined to believe him, and the reason incenses me.
It’s fair to say that he is self-taught, with years of experiential on-the-job learning. What stood out to me is the insight he is able to glean from observation of the people and environment around him; a skill that I feel is overwhelmingly undervalued by the, ehem, “intelligencia”.
In summary, what he has learned is this: That obesity is as much a mental health condition as it is a physical one. Therapy therefore, must address psychological as well as somatic issues. As someone who is quite a closed person, when speaking with this man, I couldn’t help but notice myself sharing things about myself normally tucked safely away from the public eye. At no point however, did I feel disarmed and vulnerable, quite the opposite. I felt safe and as if he genuinely cared. No doubt this characteristic leads people to trust in him and feel more confident venturing into unfamiliar territory. Added to this is an understanding of many of the barriers to lifestyle changes; priorities (family, work, church), body confidence (mirrors and scales are things of the past in some people’s lives), financial pressures. All these issues are addressed first in a private initial consultation and then in an open group discussion at the end of every training session. The way this is done is in every way complementary of behavioural change psychology and a lifestyle facilitator’s ideal intervention. He is just doing what works. Using his perceptive judgement he continues to alter and improve his service. It just so happens that what he has discovered that works for his patients is in line with research findings and practice guidelines (funny that, when you think about how science works). It is infuriating to think that Tyler’s lack of formal qualification and accreditation may be preventing organisations from recommending that patients be referred to his facility.
Perhaps more to his disadvantage has been his outspokenness about the food industry. He is a proponent of a low carb, healthy fat diet (even though he runs a gym, he acknowledges the vital importance of diet[4]– kudos). While this alone is enough to cause controversy, he speaks of sugar consumption as an addiction (for which there is mounting evidence – or rather, exposed evidence[5],[6]) exploited, especially in low-income areas, by junk food companies. Neither of us are surprised, for example, that the first Krispy Kreme® shop in New Zealand is situated in Manakau. He is aware of the density of fast food outlets in the district and how it compares to more wealthy areas (highest in Manakau in case you were wondering). He is also prepared to bring this to the attention of policy makers, well aware of how, directly or indirectly, they are lobbied said companies. To me, this silencing is an open admission of guilt by the food industry of its role in the obesity crisis, but the power it has to hide this is frightening.
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Since my partner started research into vaccine design[7]I have had more conversations about the role of the pharmaceutical business. There are a lot of people wary of vaccines, in part because of the profits pharmaceutical companies make from widespread, mandatory vaccination. To this argument I often counter that pharmaceutical companies would make far more were children not vaccinated since treatment, particularly ongoing treatment, is far more profitable than a one-off shot. I have used a similar argument when it comes to health; “healthy” people are far less profitable than individuals with chronic conditions. Paradoxically, almost every report I have written for the last five years has begun with something along the lines of: “The burden of lifestyle disease is crippling the NHS[8], costing over 10% of the entire health budget and resulting in billions of pounds worth of lost productivity per year.”How can both sentiments be true assuming that private and public funds are not completely independent pots? Without knowing it, when confronted that the notion that lifestyle disease is a burden is rubbish, I was totally caught out and I had to go home and reflect upon the implications of this claim.
From a socialist perspective, it is true that unhealthy people require more from and are able to contribute less to public services. That is why they are there. However, sustaining public services is undesirable in societies which capitalists actually hold the power. Therefore, from this perspective, the goal is to manipulate the masses to a point where the costs of service provision exceed an ‘acceptable’[9]taxation rate or budget allocation and those who can afford the services they don’t really need don’t have to pay for those services for those who can’t and do. This goal is possible, happening in fact, because inequality is increasing in almost all developed societies. Furthermore, the voice of those at the top is by far the loudest despite this group representing the minority of the population.
In my opinion this trajectory is an inevitable result of the selfish human condition. More importantly though, I believe that what makes humans special is our ability to overcome our natural instincts. We are in the privileged position where we are not obliged to act solely in the interest of species continuity; the pressures against survival are so small. It is also short-sighted to dismiss the importance of inherited wealth (financial, health, education, location) and expect everyone to be able to climb the social ladder. Given my position as an almost middle class liberal[10]therefore, I consider it a duty to contribute to the fairer distribution of resources (I deliberately avoid the use of the word equal).
This point is not as far a digression from the question of whether the chronically ill are a financial burden or blessing as it may seem. For me, it means that the privatisation of health care is nefarious (see the USA for a perfect example) and that addressing the health of the nation is, above all, a moral issue. Until capitalism collapses in on itself (again)[11], or big food is held accountable[12], the fight against obesity cannot be fought from a financial perspective. People like the man I met are thus caught in a vicious cycle whereby they need external funding to survive, but the powers that be are reluctant to support such enterprises. I hope, and will dedicate effort to achieve, that while there is funding available, lifestyle programmes are judged based not upon their carefully written, referenced practice guidelines or the number of accredited health professionals etc., but their results. Long term results like those that have consistently produced in Manakau.
Dr Jelley
[1]These are individuals for whom surgery is too dangerous and medication is practically ineffective. For example, someone above a certain BMI must lose weight in order to be eligible for a knee replacement else the surgery might kill them or the knee will fail due to the strain.
[2]https://www.sciencedirect.com/science/article/pii/S0091743512001107
[3]https://www.health.govt.nz/our-work/preventative-health-wellness/physical-activity/green-prescriptions/how-green-prescription-works
[4]http://bjsm.bmj.com/content/early/2015/05/07/bjsports-2015-094911
[5]https://www.sciencedirect.com/science/article/pii/S2352154616300638
[6]https://www.ncbi.nlm.nih.gov/pubmed/24132980
[7]http://publicscientistno1.blogspot.com/2018/05/trust-me-im-vaccine-researcher.html
[8]The UK National Health Service which is essentially free to all; https://www.nhs.uk/pages/home.aspx
[9]In inverted commas because we all know about attitudes towards tax and tax avoidance by big business which I shan’t go into here.
[12]https://insulinresistance.org/index.php/jir/article/view/39/112#CIT0019_39
