ST. LOUIS — Laura Moore is a woman with gumption, and that's a good thing because she intends to lose weight. A lot of weight.
Moore, 65, of St. Louis, weighs 465 pounds. That's 45 pounds less than she weighed a year ago, but not where she needs to be to get knee replacements. She has osteoarthritis so bad that she's wheelchair bound.
Moore exercises five times a week, a feat that can only be fathomed by others who are obese. Recently, she's been asking management at her fitness center to help ease her access to their pool. She said it isn't properly outfitted with railings and wide enough stairs for people with disabilities like hers.
"I have to do this for my life, if I want to survive and be happy," Moore said.
Exercise can be difficult for the thinnest and fittest among us. But it's daunting, and often impossible, for people who carry excess fat tissue on their bodies. People who are more than 100 pounds overweight or have a body-mass index greater than 40 are morbidly obese. They often must battle physical and emotional barriers the rest of us don't encounter and often can't see.
Merely walking with the extra weight, for instance, is taxing.
Marie Stallman, 63, of Barnhart, compares it to walking a mile while carrying several giant bags of dog food. Stallman lost 130 pounds and has kept it off for more than a decade. She weighs 190 pounds.
In addition, a lot of exercise equipment won't support weight over, say, 300 pounds.
Moore doesn't let anyone or anything stand in her way when it comes to getting exercise. But not everyone is like her.
She remembers the day a woman bigger than herself came to the gym pool where she swims.
"She wore a dress, because she didn't have anything else to wear," Moore said. "I was so proud of her for even thinking of coming out of her house and into that pool area, because I know what it takes. But then I didn't see her again, which was sad."
Losing a lot of weight requires cutting calories. But exercise, experts stress, is important too. It's key to a healthy lifestyle and to keeping the weight off. It burns fat, builds muscle, elevates the mood and decreases the risk of cardiovascular disease, Type 2 diabetes and some forms of cancer. It also helps prepare us for functions of daily living.
Fourteen years ago, Susie Deusinger, professor of neurology and director of the Program in Physical Therapy at Washington University, created "On The Move," an eight-week exercise program designed for obese people, that focuses on four categories of fitness: strength, endurance, flexibility and balance.
Obese people are often told by health experts to walk, said Deusinger. "That turns out to be a very difficult instruction when you're not able to move normally anyway."
The fall rate among people who are morbidly obese is high. Most have strength problems in their hips, knees and ankles, Deusinger said. Their posture and center of gravity are different, making it extremely difficult for them to move normally.
The first thing "On The Move" does is evaluate their capabilities, and therapists usually find a lot of deficiencies in each of the fitness categories, Deusinger said.
Beth Henk remembers when she started the program. She weighed 450 pounds — down from a high of 745 pounds — and she was feeling light as a feather, she said. Then a therapist asked her to balance on one foot.
"She said, 'Ready, set and go.' I couldn't do it," said Henk, 45, of St. Louis. "I was shocked that I'd lost that ability. But after eight weeks, I could stand on one foot for 18 seconds."
Henk, now program manager for the Weight Management Program at Washington University, enrolled in "On The Move" several times before starting a daily walking regimen and working her way up to two-mile jaunts.
"Before that, I was scared to walk. I always thought, 'What if I fall? I'll break something, then what will happen to me?'" she said.
Falling isn't the only thing that puts obese people at risk for injury.
Sherry Muir, assistant professor of occupational therapy at St. Louis University, estimates that each pound of body weight adds four pounds of pressure to the joints.
"Exercise with any impact is made physically more difficult just because of stress on knees," she said. "If you're talking about someone who is even 20 or 30 pounds overweight, that stress is significant."
It's important, she said, that obese people find a program that takes this into account. Non-weight-bearing activities such as swimming and cycling are good options until some of the weight comes off. Going slow and keeping workouts short are, too.
As a society, we have high expectations for what we're supposed to be doing, Muir said. People push themselves too hard and too far and end up with significant soreness or injuries.
She recommends clients measure steps they take in an average day using a pedometer before starting an exercise program.
"You'll be sad that it's a very small number of steps, because experts recommend 10,000 a day," she said. "But if you're only taking 300 steps, going to 10,000 right away is almost impossible. So I'd love it if you increased your steps by 100 a day. It's also very helpful to keep a log or journal so you can see your progress."
Nancy Roorda jogs two miles every morning and sometimes at night too. When she's waiting for the family's puppy to piddle outside, she does jumping jacks. And when her daughter's playing soccer, she walks laps around the field.
Three years ago, Roorda, 56, of Barnhart, weighed 230 pounds. Now she weighs 155 pounds.
Until two years ago, she'd never exercised. Ever. She always had an excuse. Usually, she said, it was that she was too busy raising her three daughters. Then she started thinking about all the time she spent watching TV and eating snacks. She had to change her mindset. She couldn't view exercise as punishment, but rather a function of normal living, like brushing your teeth.
"I've learned to incorporate it wherever I can," she said.
Muir has found that obese people often have mental blocks when it comes to exercise. They say they don't like it and can't distinguish between true pain from an injury and the discomfort and soreness they're supposed to feel when exerting themselves.
"If you've never been around people who are really active then you've never learned the real amount of effort it takes to do that," she said.
And when they first begin an exercise program, they don't get the immediate payoff of endorphins and other feel-good chemicals produced by the brain that highly active people do.
Then there's the shame and embarrassment.
"My experience working with people like this is they never feel as clean as they want to be," said Muir. "And they also probably sweat a little more so they feel like they smell bad."
They feel like they're being judged, and often they actually are. Henk recalls hearing cruel words hurled at her from a passing car when she was walking one day.
"It made me wonder why I even bother," she said.
Moore thinks the woman who wore the dress to her gym pool might have overheard other swimmers' comments. She confronted them on it.
"I said, 'Well at least she's trying to do something,'" Moore said. "I couldn't believe it — the ignorance. Until you've been there or know someone you love and care about who has, you really can't understand what it's like."