MEDICAL FAQs

QUESTION

ANSWER

This is a very interesting point as there are several guidelines involved, but also the question of how accurate is the BMI or Body Mass Index as a measure of obesity.

The standard BMI under which you have to be is 30. If you are above this when you learn to dive then you are passed on to a medical referee who will assess your general health and wellbeing.

In BMI terms 30 is the break point above which you are considered obese, below 30 and above 26 you are overweight and below this healthy.

The reason BMI is important if you dive is like any other sport, if you are obese then there is a greater chance of all the knock on effects such as cardiac problems. This is why you are referred on to a referee to see whether you are a risk to any diver underwater and also if your fitness is going to pose a risk.

There used to be a thought that bodyfat released nitrogen at a slower rate and so would increase the chance of DCS too. However the evidence for this is fairly scanty so this is not really a factor in the equation.

Having said all of this though I do have personal reservations about the accuracy of the BMI. Basically it is calculated as a ratio of height to weight but the charts that doctors use are the same for men as for women but more importantly they do not take into account body morphism. This is a factor where some people are naturally very big and often their BMI comes out as obese when in fact they are obviously healthy and fit.

For example a prop forward in a rugby team may well be 5 foot 8 and weigh 16 stone, but he would have the same BMI as a woman of the same height and weight who hadn't done any exercise for the last 10 years and whose only past time was eating pizza and drinking cider. So would they both have to be referred to a medical referee?

Of course not. So you can see the problems involved with BMI. Perhaps in the future the body fat monitors will increase in accuracy and be used as the standard to pass or fail a diver.

But for now if you are below 30 you should be fine, above it you will be fine so long as you are fit and you have a strong and healthy cardiovascular system.

QUESTION

ANSWER

Like they say, if you drink and smoke less than your doctor, you are in pretty good health. So, if you are fitter and less fat than your dive doc, you'll be fine to dive.

So bad luck everybody, I am 75kg, can run a marathon in under 2 hours and am dead hard too. Enough of the lies, seriously, it's not a question of your weight, but fitness is the really important factor. If you can do 120 step ups to 18 inches in under 5 minutes, without collapsing then you will be fine. If your pulse then returns to a normal pre-exercise rate in, say 4-5 mins, then you are good enough to be a pro.

The issue with weight is that it is normally associated with fitness, but we all know heavy people who are fitter than a butcher's dog. The Pontypool front row for example. I wouldn't tell them that they couldn't dive as they weighed over 16 stone.

As for swimming, things have changed since my day. A swim for 200m is needed as part of the open water course I believe. You have to pass that, though I've got to say I have never swimmed in my life as a diver. Bobbed, drifted, finned yes. Swam, no. so don't get too hung up on being the next Thorpedo before you dive.

Now, you want an incentive to lose weight. Try this. For every kilo above 80, you have to earn a million a year before a supermodel will date you.

QUESTION

ANSWER

BMI is now perceived by the medical profession to be a rather outmoded measure of body composition. It has actually been around since the early 1800’s, and was meant to be a simple way of classifying people’s fatness or thinness. There are numerous factors that distort its accuracy: fitness level, muscle mass, age, gender, ethnicity, to name but a few. Most of the England rugby team would be likely to exceed the BMI of 30 that is often taken as the cut-off for “obese”. Its value in the HSE medical is to flag up those who are likely to be unfit, or more susceptible to DCI, as there are links between obesity and both these factors. So rather than automatically disqualify those with a BMI of above 30, it is more sensible to look at more accurate measures of body fat (such as impedance or skin calipers), and to look at fitness level closely. If these are satisfactory then there is discretion in our ability to pass suitable individuals. After all, we are mainly concerned with in-water safety – being able to fin over to a buddy or student in trouble, for example. So concentrate on the fitness, don’t be tempted to go under the knife for the sake of cosmetics, and listen to your GP’s (very sensible) advice.

QUESTION

ANSWER

Will you pass? That depends on how unfit and how heavy you are. The HSE issued new guidance on this last October, which tightened up the parameters somewhat – there are now flowcharts to aid interpretation of the measurements, which you can see on their website. The LDC dive medical pages have been updated with the changes too, so it would be well worth looking at these before making an appointment. In essence, once the BMI (Body Mass Index) reaches 30, we’re obliged to take waist circumference into account, and need to reject those in whom it exceeds 102cm (men) or 88cm (women). At this level and above, physical fitness usually suffers as well, and the step test we use now has strict cut off points too. In truth it’s this rather than the absolute BMI value that fails people, so if you’re not doing any exercise then I’ll let you draw your own conclusions as to whether it’s worth attempting the medical now.

The abundance of miracle weight loss cures on the net suggests that few, if any, of them actually work. It’s a simple sum really: if calories out exceed those in, you’ll lose weight. This translates to diet and exercise – no short cuts I’m afraid. In some circumstances medications or surgery are justified, but without knowing more details of your situation it’d be wrong of me to suggest these. A couple of tips though: rather than watered down soup for eternity, make dietary changes that you can stick with, and try and build some exercise into your daily routine, so that it doesn’t all go to pot once the new gym fad wears off. Best of luck.

QUESTION

ANSWER

Obesity is a huge topic (haha). Chocolate taxes, fire crews being called out to rescue 30 stone people stuck in the bath, a third of us obese by 2012… the media is full of fat. Briefly, the major issues with diving are:

1. Increased risk of DCS: nitrogen loves dissolving in fat. Obese divers will produce bigger bubble loads, which can overwhelm the normal lung filter and force bubbles into the systemic circulation. This puts them at higher risk of all forms of DCS.

2. Increased risk of diseases such as high blood pressure, diabetes, heart attacks and strokes. Every year dive accidents occur as a result of these conditions.

3. Decreased physical fitness tends to go hand in hand with being overweight, meaning it’s going to be harder to rescue yourself or your buddy. It also leads to higher risks of panic and more gas uptake on exertion (increasing DCS risk again).

4. Decreased lung function: sheer belly bulk can significantly restrict lung capacity, and overweight divers have lower oxygen levels, and higher carbon dioxide levels. In extreme situations these gas disturbances can cause breathlessness, confusion, and ultimately drowning.

A little bit of fat is good for you of course: it helps insulate you against the cold and cushions the internal organs. The much maligned BMI is still the best lay guide to body fat: square your height in metres, and divide that into your weight in kilos. If the result is over 25 then you’re overweight, and if it’s more than 30 then you’re officially obese. There are lots of caveats around this method, but if you’re worried about training someone because of their weight then just contact your local dive doc to discuss it.

QUESTION

ANSWER

I would imagine that with children and work commitments there’s been little time for exercise in the last 2 years. Diving is not the best form of exercise to get you fit; it will put strenuous demands on your system, so getting back some semblance of physical fitness should be your first goal. Swimming, cycling, and aerobic or cardio gym workouts would be my suggestions.

As for the weight loss medications, they vary in their modes of action and side effects. One called orlistat (XenicalTM) reduces absorption of dietary fat (giving rise to the mouthwatering “oily stool”) and if you can stomach the side effects, you can dive safely on it. Another called sibutramine (ReductilTM) acts on the brain to reduce cravings and hunger pangs. It works in the same way as some antidepressants, and is therefore subject to all the caveats of that class of drugs. Rather than relying on pills, however, I would encourage you to perservere with diet and exercise as this is really the best, safest and most sustainable way forward.

QUESTION

ANSWER

I think I can. Gastric bypass surgery has been around for nearly 50 years, so surgeons are well aware of the possible complications of the procedure. The pleasant-sounding “dumping syndrome” is the most troublesome – cold sweats, butterflies, bloating and diarrhoea after eating (particularly whilst watching any form of reality TV). Small meals low in sugar are the order of the day (which is the whole point). On the whole results are good and weight loss sustained. A newer surgical approach is to wrap a band around the stomach, the size of which can be adjusted by injecting or removing saline through a port placed under the skin. This can be done via keyhole surgery (“laparoscopically”) and is hence commonly called a “lap band”. In Europe we are also blessed with the similar variant “Swedish adjustable gastric band”. Aren’t we lucky people? One charming complication of this procedure is Productive Burping, the regurgitation of swallowed food. Slower eating and more thorough mastication normally sort this out. Ascent from a dive can cause some acid reflux which might be an issue with either of these procedures, but this can usually be treated with antacids or similar drugs. Air trapping is unlikely as the gut is still “open” at either end for the important release of expanding gases. So assuming you have none of the above problems, go dive.

QUESTION

ANSWER

No need to panic - Arnie, Sly and Jonah Lomu would all be classified as obese by their BMI’s. The Body Mass Index (BMI) was originally invented by a Belgian statistician to look at the relationship between fat, height and weight in human societies. Although explicitly cited as being inappropriate for individual diagnosis, it became popular simply because it’s easy to calculate (see box). Unfortunately this situation has persisted and it is still the favoured method to assess body composition, despite not actually measuring body fat at all. Age, gender, race and physical fitness will also skew the figures. In fact, the best marker of health risk is simply waist circumference – carrying fat round your middle is associated with high cholesterol, future heart disease and diabetes. The risk rises with waist measurements over 32 inches in women and 37 inches in men.

As far as divers are concerned, I’m more interested in body fat percentage and physical fitness, as these are the key parameters that guide their underwater safety. If you don’t have excess fat (above 30% would be regarded as a reason for rejection) and can pass the step test, then we can show a little leeway with the BMI.

How to calculate your BMI
Measure your weight (in kilograms)
Measure your height (in metres) and square it
Divide your weight by your height squared

BMI (kg/m2) Weight Category
Below 18.5 Underweight
18.5 – 24.9 Normal
25 – 29.9 Overweight
30 & Above Obese

QUESTION

ANSWER

There’s a sort of no-man’s land in blood sugar levels, between the upper limit of normal (usually 6.0) and the diagnostic value for diabetes (usually 7.0). Anyone who’s in this range is classified as having impaired fasting glycaemia, and 1-2% of them per year will progress to diabetes. You should have had an oral glucose tolerance test, or be due one, which is used to exclude diabetes, but even if this is normal, you’re still at higher risk of heart disease. Lifestyle changes are vital if you want to stave off full blown diabetes – less chips ‘n’ gravy and some old fashioned exercise would help to sort the weight out. You need a dive medical to assess your physical fitness for diving and it’s probable you’ll need an exercise ECG (some pounding on a treadmill whilst wired up) to make sure your heart’s up to it. Even shallow submersion causes a fairly significant increase in the heart’s workload, so we need to know it’s got the capacity to cope.