SUE STANNARD, TIM CARTER
E.10.1 Acute and Long Term Harm
Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health. A body mass index (BMI) over 25 is considered overweight, and over 30 is obese[1].
The health risks of being obese are well documented and include[2]
- All-causes of death (mortality)
- High blood pressure (Hypertension)
- High LDL cholesterol, low HDL cholesterol, or high levels of triglycerides (Dyslipidemia)
- Type 2 diabetes
- Coronary heart disease
- Stroke
- Gallbladder disease
- Osteoarthritis (a breakdown of cartilage and bone within a joint)
- Sleep apnea and breathing problems
- Many types of cancer
- Low quality of life
- Mental illness such as clinical depression, anxiety, and other mental disorders4,5
- Body pain and difficulty with physical functioning
E.10.2 Risk assessment
Similar principles apply to these as for other health risks. The ‘Guidelines on the Medical Examination of Seafarers’[3] state that BMI should be used as an indicator for further assessment, and this must include physical capability testing relevant to the position and job tasks to be performed on board. Examples include
- Handling mooring cables and fuel lines, especially dragging them and other manual handling tasks
- Entry and movement through narrow confined spaces
- Accessing all areas of the ship with breathing apparatus as part of the firefighting team
In addition, the increased likelihood of a medical incident associated with the conditions listed above must be calculated. This will not only include being overweight or obese but other risk factors such as the known presence of diabetes etc.
E.10.3 Risk management
Appropriate risk assessment at PEME should identify those seafarers thought to have a higher than acceptable likelihood of a medical incident over the next 2 years and the consequences of such an event based on factors including the seafarer’s position on board, trade routes, medical care available on board etc. In addition the seafarer needs to have the physical capabilities to perform routine and emergency duties. If the risk is not acceptable, with or without mitigating measures, the seafarer should not be given a medical certificate and an appropriate management plan should be instigated to encourage weight loss and an increase in fitness.
All seafarers on board, obese or not, should have access to an appropriate diet, exercise facilities and health promotion advice on these topics. Good collaboration between shore side management and cooks, purchasers etc is essential.
[1] https://www.who.int/health-topics/obesity#tab=tab_1 Accessed November 14th 2021
[2] https://www.cdc.gov/healthyweight/effects/index.html Accessed November 14th 2021
[3] https://www.ilo.org/sector/Resources/codes-of-practice-and-guidelines/WCMS_174794/lang--en/index.htm Accessed November 14th 2021