The Excess Weight We Carry

Undercurrent subscriber Lori Ann Krushefski, who belongs to a Facebook Group called Plus Size Scuba Girls, contacted us after another member asked the group for dive operations in San Diego that don't have restrictions on Body Mass Index (BMI). A measure of body fat, BMI is a person's weight in kilograms divided by the square of height in meters. Apparently, Scuba San Diego lists on its website that it doesn't take out divers with BMIs over 30, the score at which Center for Disease Control (the CDC) says a human is obese.

That's totally discriminatory, Krushefski says. "In recent years, I've seen a number of articles and studies showing that BMI is not a good measure of fitness. And PADI doesn't rule someone out of scuba based on weight alone. The way [Scuba San Diego] words it on their website makes this look like an absolute as opposed to their own narrow-mindedness."

According to the CDC, a BMI of 30 and over is considered obese, and a BMI over 40 is "extreme" or "severe" obesity. The CDC verifies Krushefski's take by stating on its website, "BMI can be used as a screening tool but is not diagnostic of one's body fatness or the health of an individual."

Still, you may have seen many divers gearing up next to you who look squarely in the 30-40 BMI range, and thus, according to Divers Alert Network (DAN), they're at greater risk for suffering a dive accident or fatality. We've written plenty of "Why Divers Die" articles about overweight-to-obese divers who died during boat and shore dives from heart attacks and decompression sickness.

"I'm 5'10," 285 pounds, why should that matter?"

Scuba San Diego owner Rod Watkins does not take people with a BMI of 30, a requirement he put in place when he started the business in 1968. "The BMI qualification to dive with us is not a training agency requirement; [it] is in place because Scuba San Diego desires to keep its perfect safety record," he told us.

Scuba San Diego offers shore dives at La Jolla Cove, north of San Diego. "It is off limits to all powered craft; hence there is no easy entry into or exit out of the water unless it is an unusual dead-flat-calm day," says Watkins. "There is no platform, such as a boat, to fall into the water from or get out from. This is no problem for even beginning divers -- if they are fit to dive our conditions."

Watkins says La Jolla Cove is not only famous for its kelp forests but also famous for a high number of divers unaccustomed to swimming through surf and dealing with strong currents who need rescuing. "Most of these rescues are people exceeding a BMI of 30 who obviously never passed their swim qualifications and are physically unable to dive safely here. Incredibly, many of these rescues are not out on the reef or in the kelp forest, but at the entry/exit point. This is where a large person who is wearing a 7-mm wetsuit, weights in excess-of-28-pounds, a 45-pound cylinder, five pounds of breathing system, etc., falls, gets knocked down by surge and waves, or loses footing in soft sand. Also, will this person experience hyperthermia standing around in the sun in a 7-mm wetsuit? Will this person be able to climb back up the 50-odd steps to the shoreline? Many have gone to the hospital as a result of the battle to get up, during which they get severely bashed around on the rocks and the steps. Once they are down in the soft sand, they almost never can get up without assistance. Even lifeguards have been injured helping these divers."

When potential customers call, Watkins grills them with questions -- height and weight, what they do for a living, types of conditions they normally dive in, are they diabetic ("many above the 30 BMI are Type II diabetic or pre-Type II diabetic," he says), how many dives they did in the past year. "We need to access their ability to enjoy our kind of diving and whether it is safe for them," Watkins says. "If the prospective diver is a desk jockey or a UPS delivery person, it helps us get answers to vital questions. Telling us you're an experienced diver with a medical clearance does not answer the question, 'Will you enjoy this dive?' Emailing us that a BMI is not a standard PADI requirement is a meaningless comment to us."

Many divers have hung up on Watkins over the years, but he uses this example of what later happened to a diver he denied to hammer home his reason for a BMI requirement.

"He called, saying he had only tomorrow to dive, had over 400 dives worldwide and was a semi-professional photographer. When I asked for his height and weight, he responded, '5'10," 285 pounds, and why should that matter?' I said, 'Sir, this is a rigorous dive, you will not enjoy it and . . .' He hung up on me before I could recommend a local boat dive run to the wrecks or Coronado Island.

"The next day, one of my divemasters called and asked if I had heard about the Jet Ski rescue of a diver about a mile off Point La Jolla. He said a competitor's divemaster couldn't tow his customer in once they got outside the point. The guide abandoned the diver to return to shore for lifeguard assistance. The lifeguard service sent a rescue jet ski out from two miles away. It deposited a huge guy with a large camera on the beach at La Jolla Cove. I'm not psychic, but I'm pretty sure that was the guy who hung up on me."

The 250-Pound Mark

Another dive operator with a weight restriction is One Ocean Diving, which runs shark dive and snorkel trips out of Haleiwa, HI. Caroline Kwong, a self-proclaimed "big girl," recently went on a trip to the Big Island with two friends, one a plus-sized guy who had never dived or snorkeled but was excited to try. Kwong had heard great things about One Ocean and its owner, Ocean Ramsey, who has gotten much media coverage for freediving with sharks. But after she booked their spots and started to enter payment information, she saw a disclaimer at the bottom of the page. "It stated that if you are more than 250 pounds, they might not be able to accommodate you, and they may deny you boarding.

This hit me strongly, as I've been diving off boats with no issues ever. I really didn't want my friend's first snorkeling experience to be one where he felt judged. I ended up booking with a different organization out of the same harbor. It was a great day; none of us had any issues."

When we asked One Ocean to clarify the policy, office manager Blake Thompson replied that the dive operator is happy to take people over 250 pounds, but safety is the top priority when swimming with sharks. That means having extra crew on hand for overweight passengers, especially if they're novices. "Each crew member is certified to lift up to 125 pounds -- with two crew lifting a total of 250 -- and we would be considered negligent if we didn't have the physical ability to assist [in an emergency]. If we ever had to get a guest out of the water quickly for safety reasons, it may not be physically possible for them to come up the ladder backwards, facing away from the boat, and quickly without assistance. For that reason, we sometimes have a third crew member on board. However, it is on a case-by-case basis, as we understand some people are simply tall or have a bigger build. If a guest is just over 250 but is an experienced snorkeler and physically active, then an extra crew member isn't needed."

How Important is Your BMI?

There's an ongoing debate about how true of a rating the BMI is for one's fitness level. For example, specialized athletes like heavyweight boxers and weightlifters may have high BMI due to muscle mass, but they're still very fit.

On its website, DAN states BMI may underestimate the proportion of body fat in older persons and others who have lost muscle mass. "Accordingly, BMI is just one of many factors that should be considered in evaluating whether an individual is at a healthy weight, along with waist size, waist-to-hip ratio and a measurement known as 'skin-fold thickness.'"

However, a study published last summer in the European Journal of Preventive Cardiology summarized that older, overweight scuba divers should shed pounds to avoid an underwater heart attack. "Cardiac issues are now a leading factor in diving fatalities," lead author Peter Buzzacott, a research fellow at the University of Western Australia, told Science Daily. "Divers who learned to dive years ago and who are now old and overweight, with high blood pressure and high cholesterol, are at increased risk of dying."

People who go through the dive-certification process must be screened for fitness, but after that, the certification lasts for life, with no other screenings required. "This is where we see an increase in risk," says Buzzacott. "It's not commonly new divers who have health problems, because they have been recently screened. It is older divers who have not looked after their health."

The best indicator of diving fitness is your general health and level of physical fitness. Diving requires you to lift and carry scuba gear, climb onto Zodiacs while wearing it, and swim through currents underwater and on the surface. How good you are at it often depends on your exercise regimen or lack of it. Also, consider whether you're fit enough to rescue your buddy -- and yourself -- if a dive goes downhill.

Should Doctors and Dive Operators Be More Vigilant?

Watkins, the taskmaster at Scuba San Diego, says BMI is not an issue with the vast majority of dive situations. "A person who does not meet my requirement is usually OK rolling or jumping off a boat in calm, tropical seas and blowing bubbles for an hour on a couple of dives while on vacation. This diving scenario doesn't involve waves pounding the shoreline or offshore current to deal with."

He takes issue with dive agencies and dive operators that ignore divers' obvious health factors because they're so focused on the bottom line. "All training agencies have a (supposedly mandatory) swim test that must be passed before being allowed into a basic scuba class. But I personally have witnessed dive certification classes with applicants who you can tell have never passed that swim test. A dive shop has [bills to pay], and this often mitigates their desire to tell an applicant they have to come back when they can pass the swim competency test. In my experience, it is clear many card-carrying divers never passed that test."

PADI allows divers to do self-certification fitness tests, or go to their doctor's office with a Medical Statement and Guidelines for a Recreational Scuba Diver's Physical Examination for the physician to fill out. However, the physician may not fully understand the ramifications of scuba diving and the wide range of conditions their patient encounters on a dive.

"A doctor's clearance to dive does not guarantee a person's ability or safety to dive," says Watkins. "It just says, 'You look OK.' A doctor's 'OK' is often given without the doctor's firsthand knowledge of the physical and mental stamina required to dive and snorkel in our waters on any given day. Too often, the examining physician is not a scuba diver."

That's why he believes more dive operators should follow his lead and be more vigilant in keeping unfit divers from risky dives, and make better judgments about whether they can accommodate the needs of divers who could be potential risks.

Buzzacott advises all divers to have routine fitness assessments with their doctor, and tackle risk factors that otherwise could lead to them having a fatal cardiac event while diving. "For the first time ever, we now have a large number of people who have spent their entire lives regularly scuba diving. But none of us are as young as we once were, and it is important that we stay in shape for diving. Jacques Cousteau, the father of diving, was diving at 90, and the current world's oldest diver is 94. He looks like he's in great shape, and that is the role model for us all if we want to keep diving into our senior years."

- Vanessa Richardson