According to the 2013 report from the Bureau of Statistics, 63% of Australian adults are overweight or obese. An estimated 280 Australians develop diabetes every day. The 2005 Australian AusDiab Follow-up Study (Australian Diabetes, Obesity and Lifestyle Study) showed that 1.7 million Australians have diabetes but that up to half of the cases of type 2 diabetes remain undiagnosed. By 2031 it is estimated that 3.3 million Australians will have type 2 diabetes (Vos et al., 2004) – stats from Diabetes Australia. These statistics are nothing short of frightening. Every day we are inundated with conflicting impressions – both in reality and in the media – of body image. On the one hand we have a population becoming so obese it is bordering on terrifying. If the trend is not halted, the cost of health care is going to spiral up at a frightening rate. On the other hand, we are inundated with images of sculpted 6 and 8 packs, biceps and pecs that are almost impossible for us to obtain, let alone maintain. They fill my newsfeed with promos from gyms, supplement companies, models, celebrities, health and fitness magazines, clothing and underwear companies. What seems to be missing is a healthy norm. As gay and HIV+ people we are not exempt from the fat/thin dialectic. And some of it seems to be based in history. The problems of being at both extremes affects us as a population in general, and I think it heeds to be tackled from as many angles as possible.

I am just staggered by the number of over-weight (anywhere from obese to chronically obese) people I see every day. While I had a coffee at Brookside a couple of days ago, and at my local cafe today, I made a point of observing people coming and going (referred to as being a flaneur), and a good 90% of them were over-weight, and in the older age group where this is causing the most problems. Considering the constant emphasis on our increasingly over-weight population, and the regular medical bulletins on problems associated with obesity, nobody seems to be particularly alarmed about it. It really is frightening!

And the gay community is not exempt from this problem. In fact everything but! We have developed a sub-culture that celebrates over-weight men, which is certainly nothing worth celebrating!. Not only are they celebrated, but encouraged, and that is the most worrying aspect of this unhealthy adoration. An acquaintance of mine is a bear (I am not going to debate the rhetoric behind the terminology). The fact that his obesity is disguised by the use of cultural terminology, and the acceptance of this as “normal” has far-reaching implications that will only be changed by a huge cultural shift away from this behaviour. Eventually everyone subscribing to this culture will develop most, if not all, of the illnesses associated with obesity. There is no “might happen” about it. This acquaintance regularly posted pictures of himself in various stages of undress, and all the comments were of the “woof” variety. I have yet to read a comment from anyone encouraging him to start losing weight for the sake of his health. And I’m sure any negative comments would be met with a barrage of abusive comments about minding your own business, and what is “wrong with this normal guy”! Nothing like an unhealthy obsession to put the blinkers over peoples eyes. For the last twelve months I have kept my mouth shut – I really can’t see any sense in leaving myself open to abuse, even though a friends welfare is uppermost in my mind. I quickly flick past his massive underwear-clad posts on my newsfeed. After several months of health issues that had seen him avoiding medical help because he knew he would be told to lose weight, he has now been diagnosed with Type-2 Diabetes. Naturally, all the comments about his health update have been sympathetic. Not one person has said…you didn’t expect this! I think he is very lucky it is only diabetes. I was expecting a heart attack. Only months ago his status updates on FB informed us of his driving to a nearby supermarket to stock up on pavlova or marshmallow flavoured ice-cream. That has changed rather quickly. To his credit, he has taken the scare seriously, has changed his diet and is losing weight. He now also advocates change amongst his peers.

So, there are several issues here. One important one is the quite deliberate action of contracting Type-2 Diabetes, a condition we know is avoidable by adopting healthy diet and exercise lifestyles. The incidence of this type of lifestyle-related diabetes is rising at an alarming rate. To actively be a member of a sub-culture that actually promotes this lifestyle aberration defies imagination. The cost to the healthcare system from the combination of this group (which is rising), and smokers (which is decreasing) is going to be staggering, and we will all have to bear the costs of both these irresponsible and selfish behaviours. It has nothing to do with personal choice, as much as these groups like to harp on about it. As soon as your lifestyle choices start to infringe on my health, or my ability to easily access good, affordable healthcare, then your choices are no longer personal. They are far-reaching.

I guess one can’t address the issue of bear-culture without looking at how it has come into being. The opposite extreme also has a lot to answer for. I, for one, am sick of looking at guys on fitness and health magazine covers, in gay magazines, in modeling, in movies, in advertising and even in pornography whereby the now accepted norm is over-emphasised washboard abs, and over-developed musculature that has nothing to do with a healthy body image. The sudden move towards this portrayal of the male physique as “normal” is as frightening and concerning as the move towards obesity. We don’t seem to be able to find a happy, healthy middle road. Given that maintaining this type of body is both time and money consuming – does in fact involve almost daily doses of gym and supplements (and for some, steroids) – and is not sustainable in the long term, it is surprising that it is promoted as much as it is. Whatever happened to men wanting to look trim, fit and healthy? Why the move away from developing lean muscle mass? Why a move away from diet and exercise that is both low maintenance, and sustainable long term? I really have no answer to that, other than to hope it is just a current “trend”. It certainly makes no sense to me. At my own gym I regularly see guys hefting huge amounts of weights, grunting and groaning and banging their way through routines, with no different an end result than my routine of combined isometric/Swiss exercise ball/body weight exercises, a method that does take longer to show results, but is easier to maintain and add to over a long period of time. As to diet, in our household it has been low-sugar/low-fat/portion-controlled for so long now that it is now lifestyle.

So, back to my acquaintance. If he had listened to the warnings, if he had seriously thought about the consequences of his choices, the outcome may have been – positively – different. To date, I have seen no signs of his fan club encouraging him. Indeed, I have to wonder just how many of them will hang around, just how many will give him a “woof” if he were to suddenly become fit and healthy. It has become notable that if parents who are obese have children who are obese, it is seen as normal. Society as a whole really needs a good kick up the arse. We don’t need to spend as much as we do on fast-food; we don’t need to eat as much as we do – we don’t heed to fill our dinner plates; we have to stop making excuses like time-poor, time-consuming and too hard as far as healthy food choices and preparation goes; we need to stop seeing exercise as something hard; and we need to stop looking at each other and thinking “they are bigger than me, so I must be all right”. We need to think of the health implications of decisions we are making NOW! Do we want to be fat; have mobility problems; increased risk of diabetes; coronary heart disease; risk of stroke; circulation problems; high blood pressure; loss of flexibility; breathing problems; low bone density; joint problems and replacements due to just wearing the joints out from having to carry all the weight around; and a multitude of other problems all of which are preventable by some simple lifestyle changes. Given the choice of a fit and active old age, or a quick decline into bad health and misery I know what my choice is! There are 168 hours in a week. Surely it is not too hard to devote two or three of those hours every week to exercise.

The HIV community is also faced with problems of obesity. There is some research into the problem that indicates that for many long-term survivors the problem is a flow-on from the dismal days of the 80s and 90s, when emaciated bodies were a common site. To them, over-weight means healthy. It appears that the longer people are healthy, the more common it becomes to end up over-weight or obese. This trend signals a need for doctors to change their approach to caring for HIV positive people. It’s time to shift the focus to the prevention of heart disease, high blood pressure and weight gain.

HIV positive people who need to lose weight must follow general weight loss recommendations. You must eat a balanced meal that does not exceed your caloric needs, and you still need to exercise and avoid junk food. If you are overweight and HIV positive, where should you start?
The best place to start a weight loss plan is a food diary. Knowing what you are eating, how much you are eating, and when and where you are eating can help you adjust your diet and eating habits. Each time you eat, be it a snack or a full meal, write down what you have eaten, how much, and under what circumstances. For instance, if you eat a bowl of chili at a party, write down how much chili you have, what’s in the chili, and the circumstances surrounding your eating the chili. Was it your dinner? Were you hungry? Or was a bowl offered to you and you ate it so not to insult your host? Enter your meal into the diary as soon as you can after eating. It is difficult to keep accurate records if you wait too long after eating. Not to mention we often underestimate the amounts we eat after too much time has past.
Like anyone who is overweight, adjusting what and how much you eat is the first step to weight loss. An all-too-common problem is that we try fad diets and quick loss diets that may work in the short term but do nothing to keep the weight off. The key to an effective diet is one that teaches you healthy eating habits that will serve you a lifetime. By learning healthy eating habits, you will take the weight off and keep it off for the long term. The bottom line: Watch your calories, your fat intake, and your portion sizes to maintain a healthy weight. If you find your are eating for reasons other than hunger, talk with your doctor or a dietitian. They can help you lose the extra weight and keep it off — and in turn that will help you live a healthier live with HIV.*

I wish my acquaintance well, and I’m truly sorry that his lesson had to be learnt the hard way. Should I have thrown caution to the wind and spoken up? Truth be told, it wouldn’t have made an iota of difference. His fan club would have beaten me down, and the cries of “woof” would have drowned out the voice of reason. People only hear what they want to hear. Until these attitudes change, until these sub-cultures are given their proper place and are not seen as ‘normal’ nothing is going to change, and stupidly, more people will get seriously ill. Time for a rethink people, before it is too late.

*HIV dietary information from http://aids.about.com/od/nutrition/a/obesity.htm

Tim Alderman
(C) 2013