BMI and scuba diving

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DrG123

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So I want to learn to dive recreationally and because I have a chronic medical condition, I had to get a doctor to sign me off. I checked the relevant boxes on the form and went for my medical a few days ago. The doctor was fine with my health condition and the medication I take (common mental health condition with no major meds, very stable, and a stable autoimmune condition). He asked me if I was active and I said that I was relatively active, I walk alot and I also swim. I wild swim in the sea and lakes, and also pool swim and while I don't have a specific distance in mind, I can do laps for an hour so I'm confident I could meet the swim requirement without difficulty. Checked my BP - normal. No diabetes, heart or lung problems at all. I'm age 30. He then did my height and weight. Because my BMI came out at >40, he then failed me.
Now I understand that my excess weight is a problem, I know it is. I want to lose weight and I am trying to, but I'm frustrated that I spent the money for a private medical only to be told that I can't dive because of something that wasn't on the form in the first place. If the front of the PADI form said to tick a box if your BMI was above a certain limit, and that was a fail, I would have been fine with that, worked on losing some weight and not wasted my money.

However if I didn't have the mental health issue I would never have needed the medical. I therefore can't see that I would have been stopped from diving unless my physical fitness was insufficient (and I assume at the dive centre they check fitness - of course if I didn't meet that then I can't dive and that's fine). If there's an absolute set in stone BMI cutoff then surely this should be on the front of the PADI form? It was only checked because my local dive shop (correctly of course) said I needed medical approval because of my medications for my autoimmune condition.


Perhaps I'm being unreasonable, I'm just very disappointed and I'm frustrated that I wasted my money and got so excited about something that I now can't take part in. I'll try and lose some weight and come back to it, but this was the perfect time in my life to do it because of the way my work is currently. I think this absolute BMI cutoff needs to be made more clear to stop other people from wasting their money on medicals like I did.

Is there anything I can do? Any recommendations for someone online who would consider my actual level of physical fitness rather than a number on a scale?
 

-JD-

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This might be worth moving over to the Dive-Medicine category for better visibility to more-expert eyes, but maybe some questions first ...

Did the doctor express some particular risk factor that your BMI is immediately causal for rather than maybe long term?

Was this your regular general-practitioner, a doctor with dive-specific medical training, or just a "random" doc?

(If you are able to swim comfortably for an hour+, good cardio-pulmonary, no diabetes, and no other (uncontrolled) explicitly disqualifying condition, it is possible that your doctor is ill-informed, liability-shy, a "fat-shamer", or just a plain putz.)
 
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DrG123

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Many thanks for your reply!

No specific risk factor at all - although I'm an obviously overweight woman, when I first walked in he asked me about my medical history and how active I was, then checked my BP. He said that he was sure everything would be fine - admittedly my BMI is 46, but I think it doesn't look as high to look at me as he seemed very surprised when he actually calculated it.
Never met him before, not my regular GP - he does diving medicals for professionals as well so I assume he knows his stuff. He looked up the BMI limit on a website and showed me the page - I can't remember the name of the website.
On the UHMS.org website, which is linked on the PADI form, obesity is listed as a relative risk and no mention of a specific BMI is made.

I'll try and work out how to get it moved to the medical board!
 

NorCalDM

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First PADI didn't disqualify you your doctor did so the discussion should be with him/her. This also may be a push from your doctor to do something about the weight and again should be a discussion with the doctor. Diving can be both stressful and strenuous so being in the best shape you can be helps.
 

Outbound

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Do you have the financial ability to see another doctor for a physical so you can get a second opinion? I'm in no way endorsing or not endorsing diving with a high BMI. I'm not a medical doctor nor a specialist in dive physiology. But if people with high BMIs were not allowed to dive, then the dive spots I frequent sure would be a lot less crowded on weekends...
 
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DrG123

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I'm getting a second opinion from my GP who knows me better so we'll see what she says - seems to be a discrepancy between the guidelines given on UHMS.org (which the PADI form links to and I had read pre appointment, which does not give an absolute cutoff for BMI) and the DMC guidelines which does give a cutoff, and are what the doc today was using. Of course there is always going to be variation in the guidance and how different doctors approach it, which I have no issue with.
I think because lots of people online had said that they had met/been out with divers who were obese, and when I asked my local shop if they'd have kit to fit me they said it wouldn't be an issue, I got my hopes up that it would be more of a subjective assessment of my cardiovascular fitness.

I am of course also trying to lose weight and have been exercising more recently in preparation for learning as I've been considering it for a while, so hopefully even if the cutoff remains absolute it won't be an issue in the future, but I would love to be able to learn sooner.
 

NorCalDM

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I'm getting a second opinion from my GP who knows me better so we'll see what she says - seems to be a discrepancy between the guidelines given on UHMS.org (which the PADI form links to and I had read pre appointment, which does not give an absolute cutoff for BMI) and the DMC guidelines which does give a cutoff, and are what the doc today was using. Of course there is always going to be variation in the guidance and how different doctors approach it, which I have no issue with.
I think because lots of people online had said that they had met/been out with divers who were obese, and when I asked my local shop if they'd have kit to fit me they said it wouldn't be an issue, I got my hopes up that it would be more of a subjective assessment of my cardiovascular fitness.

I am of course also trying to lose weight and have been exercising more recently in preparation for learning as I've been considering it for a while, so hopefully even if the cutoff remains absolute it won't be an issue in the future, but I would love to be able to learn sooner.
The good side of this is you where truthful on the medical form and are addressing the issues that have come up. Many students lie on this form and just check no on everything or instructors will say "if you mark yes on anything you have to get medical clearance" so that just tells them to mark no. If there is an issue during the class and you lied on the form you're not just putting yourself at risk but you are putting your fellow students and DM/Instructor at risk as well.
 

-JD-

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For everyone following along:

We advise the British Sub-Aqua Club, Sub-Aqua Association and Scottish Sub-Aqua Club on diving medicine issues, which is conducted through a national network of medical referees with accredited diving medicine expertise.
Although the PADI logo is (also) shown on the landing page but without textual attribution.


Obesity (Recreational Diving Guidance)​


Obesity may exclude a candidate from diving as it frequently betrays a lack of general physical fitness. Additionally it may create difficulties when conducting a rescue either with the obese diver attempting to tow with an unconscious diver or when a diver is attempting to get an obese diver into the boat or to another place of safety.


A BMI (Body Mass Index) of more than 39.9 should exclude diving. Due regard should be taken to weight distribution, obesity concentrated in the abdomen should be less acceptable than evenly distributed fat and due allowance should be given to the individual whose excess weight is visibly muscular. Enquiry should be made as to the amount of exercise taken.


A BMI between 30 and 39.9 is not ideal but may be acceptable. The formula tends to discriminate against tall or muscular individuals. In these circumstances taking account of waist measurement may be helpful. A waist measurement in men of greater than 105cms and in women of greater than 90cms is a cause for concern and should be discussed with a Diving Medical Referee.


Qualified divers with a borderline BMI may be given a provisional pass for two or three months when they would be required to produce evidence of improvement to have their certificate extended.


To calculate BMI go to BMI www.nhs.uk and put BMI in the search box at the top right of the page or use the formula body mass index= weight (kg) / (height in metres)²

In fairness to your first doctor: from that, it does seem that you would not pass the UKDMC standards or could possibly be "provisional" depending on how much greater than 40 BMI you are.

In one sense fully dealing with an obese diver who is having a "emergency" can be significantly more difficult (to, frankly, impossible) depending on the manpower capability & resources at hand. While it is not per-se a direct "medical" issue, it does elevate the total risk associated with a divers participation. Of course the same thing would apply to the Hulk without a gram of body fat.

Please let us know what happens with your GP!
 

KatieMac

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Do you have the financial ability to see another doctor for a physical so you can get a second opinion?

If they can't pay for a second opinion, diving is probably not in the budget. :wink:

Sorry. This made me laugh.
 

NorCalDM

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Your GP will most likely sign you off because they know you but they probably know nothing about diving or the UKDMC. The first doctor you went to does diving physicals so understands the information needed to make an informed decision or so we hope. When you do see your GP give them the UKDMC website if they are not familiar and let them have all the information needed to discuss it with you..
 
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