KEY POINTS:
New Zealanders are getting bigger than ever before and everything from hospitals to grave-diggers are being forced to adapt to super-size bodies.
New Zealanders' expanding waistlines are fuelling a demand for plus-size goods and services.
With half of the adult population now either overweight or obese, what used to be considered "normal" has suddenly become a whole lot bigger.
Hospitals, airlines, retailers and even grave diggers are finding they have to move with the times. And sales of 'he bras' - support garments for men with plus-size chests - are on the rise.
In Wellington, funeral directors now have the option of booking "purpose dug" burial sites - graves specially tailored to larger clients. A new area being developed at the city's Makara cemetery has been designed to cope with increasing numbers of "bigger and wider" coffins, a city council spokesman said.
The crematorium at Karori Cemetery was regularly used by out-of-towners because it had a roomier furnace than others in the region, he added, and the average width of caskets was now 53.5cm, more than 10 cm wider than the average two decades ago.
With 60 per cent of men and 40 per cent of women now overweight, the obesity epidemic is affecting both sexes in similar ways.
Craig Smith of Smarta Fashions told the Herald on Sunday that "man boobs", the bane of the larger bloke, have had an impact on his business.
Sales of the company's male support vest - known in Australia as the "he bra" had increased noticeably. The vests, which come in sizes up to XL or chest size 135cm with either velcro or hook and eye front closure, were a cheaper and more practical option than liposuction, Smith said.
Bendon has also introduced a J cup women's bra after surveys showed the average breast size had increased by several centimetres in just six years.
Obesity is estimated to contribute to more than 3200 deaths (10 times the number of people who die in car crashes) a year, and our expanding girth has also been a factor in Capital and Coast District Health Board's decision to replace its beds.
The three-year programme is expected to include funding for several more bariatric (extra large) beds used in the treatment of people with obesity-related health problems. Currently the hospital has only two such beds, which cost between $10,500 and $11,000 (four times the cost of a standard hospital bed), and has to hire others if they are needed.
And it's not just adults who are getting bigger. Twenty-one per cent of school-aged children are now considered overweight, with another 10 per cent defined as obese.
School uniform manufacturers now make girls' blouses up to a size 24 (the average dress size is 14), and boys' shorts with 120cm waists. A sobering report from Australia last week noted one in five preschoolers in that country was overweight.
Cinemas are putting in wider seating. The Paramount cinema in Wellington's Courtenay Place said it is refurbishing with bigger seats for "comfort" reasons.
And those of wider girth will finally be able to use the little room in comfort after the launch in Australia of the Big John toilet seat.
The ergonomically designed seat, which fits standard toilets, is 49 centimetres wide compared with the normal 40cm and withstands weights up to 500kg.
However, airlines are one industry that so far do not appear to be accommodating bigger people. Debate rages over whether travellers who spill over into their seatmate's space should be forced to buy an extra seat or travel business or first class, or whether airlines should put in bigger seating.
But airlines argue that in their battle to provide cost-efficient travel, reconfiguring fleets would be prohibitively expensive and result in higher fares for all passengers.
Loser's new zeal for life
To call John Barnes a zealot is putting it mildly. The larger-than-life 29-year-old wants to spread the word, and spread it wide.
"If I can do it, shit, anyone can," Barnes says.
Two years ago, the former McDonald's worker - "they were the only place that would give me a job"- weighed a whopping 258kg. He was the guy everyone pointed at, the "mummy", the "fat c...".
He cracked toilet seats, ate a dozen pieces of fried chicken in a sitting, drank Coke like it was going out of fashion, couldn't put his shoes and socks on or go to the movies, crushed a seat in his best mate's car and needed two extendable lap belts on the rare occasion he flew in a plane.
"I was a bloody mess basically. Everything was up the creek."
Barnes has been big since he was kid. A broken hip put him in a full body cast when he was 13. Originally misdiagnosed, he was passed from doctor to specialist and back.
"I had no friends, I didn't go to school and I suffered from depression. Food became my vice."
After what he reckons was "about 50" job interviews - "I was always too fat or I smelled, or got asked: was I serious?"- he scored a job at McDonalds. He was 18 and he was still eating. And eating plenty; as many Big Macs and fries with those as he liked.
There was self doubt, there were snide comments, there was no shopping for clothes in a "normal" store, the shower became the toilet, his legs became ulcerated.
But there was also sup-port. Barnes met his best friend at McDonald's. Another manager became a surrogate dad. And in March 2005 they were still there when Barnes, now a service manager at Placemakers in New Lynn, decided he'd had enough and booked a stomach-stapling operation.
His doctor told him to go away, lose 15 kilos and "come back in three months".
Six weeks later Barnes had lost double that. He was set another target, and lost another 13 kilos over the following six weeks.
He had the operation in August that year.
Now 109kg with a goal weight of 97kg and "very comfortable" in what had become an extremely thick skin, he's become a passionate advocate of educating people on the true nature of obesity.
"It's an addiction. You are hotwired to eat. It's like being an alcoholic or a drug addict. You can't help yourself.
"And unless I can get that through to people then I'll always feel as though I've wasted my time."
He says he feels like a different person.
"I went white water rafting for my birthday, I can go and buy normal clothes, take my shirt off at the swimming pool and go to the beach.
"I've got the confidence to live life. There's a lot of people out there who are eating their way to death. I never thought I could do it, but if they see that John can do it, then hopefully they'll be able to see that they can too."
Florence Magpie
A nurse has told of having to "sneak" equipment from Middlemore Hospital to keep some of her patients alive.
Diana Hart says she has had to "plead on bended knees" to get oxygen concentrator machines for several of the 129 South Auckland outpatients she manages for the Counties-Manukau District Health Board.
The ventilators make breathing easier for obese and morbidly obese patients but because of strict qualifying criteria were not available to dozens of people who needed them, Hart said.
"Health boards don't recognise obesity as being a problem as far as respiratory problems go but it is a major issue. Basically the lungs get squashed so the patient doesn't get oxygen and there's major organ failure. It's a huge problem given the large number of obese people we're now seeing."
Although the machines were expensive at $4000 each, the long-term benefits outweighed the initial cost.
"If these machines can keep people out of hospital, give them a good quality of life and perhaps even get them back to work, then they can be active members of society again ... So that initial spending can well and truly be justified," Hart said. While gastric bypasses were an option earlier on, many of Hart's patients were too large for surgery, so were dependent on the machines, she said.
Her heaviest patient runs an importing business from a chair at her home. "While there's nothing wrong with her brain, her body is literally not working. For most of them getting down to a weight where they can have a bypass is impossible."
Hart cares for 40 people on ventilators but believes they are "just the tip of the iceberg".
Meanwhile UK anaesthetists have just been issued with a new set of guidelines for dealing with obese patients, amid concerns about the risks hospital staff and patients face because of rising obesity levels.
Anaesthetists in New Zealand have raised similar concerns. Anaesthetists Society spokeswoman Philippa Bascand said they were seeing "more obese people more often".
They posed particular challenges for anaesthetists, with obesity the second most common risk factor during surgery after smoking, "and patients we're seeing now are likely to have associated serious health problems".
These included heart disease, diabetes, sleep apnoea and respiratory problems, all of which had major implications when providing anaesthesia.
Of 21 health districts only five currently had the surgical facilities to manage obese patients, and several of those were private.
