So that gets the tough talking out of the way. If there are genuine reasons why exercise is physically impossible, what should you do? This immediately brings you back to the question of diet. All weight loss depends on you burning more calories than you consume. Some people use exercise as a form of cheating. When they want to continue eating some unhealthy food, they exercise. Even if they do not lose significant amounts of weight, this can keep their weight stable. Anything is better than continuing weight gain. But if you cannot exercise, you no longer have any excuse on the diet front. To lose weight, you must start counting the calories and aim for a net-loss diet with a high-fibre content. Read up on nutrition and start applying that knowledge to shed the pounds.

There are general health issues to consider. If your life is stressful because of work or family commitments or both, you should take time to relax. This means getting enough sleep. It’s easier to stay motivated if you are well-rested. Losing weight is all about making yourself important. There comes a point when the sacrifices you make for others have to end and you take a little time for yourself. This is for your benefit. In short bursts, you should also consider taking phentermine. This has been on the market for fifty years and has demonstrated a good track record of safety. Phentermine is an appetite suppressant. The idea is simple. If you feel less hungry, you eat less. This makes it easier for you to maintain the diet and lose those pounds. But do not fall into the trap of taking it for too long. Weight loss does not come out of a bottle. It requires you to make the commitment and hold to it. Only then will the loss be real and last.

The best way to start is by walking. This is good all-round exercise, improving muscle tone and burning calories. Warm up first by walking at an easy pace for between five and ten minutes. Once your muscles are ready for action, pick up the pace. You need to walk at a pace which significantly raises your heart rate and build up to maintaining this pace for at least thirty minutes. Use the “Target Heart Rate Calculator” to find out your optimum burn rate. As a guide, you should be breathing more quickly but still able to hold a conversation without getting breathless. Over time, increase speed and duration to sixty minutes. Once you have finished the “speed” walking, slow down and walk more normally for a further five minutes to cool down. As you grow more fit, add stretching and flexibility exercises at the beginning and end of the walks.

Walking should become a regular part of your daily routine and, over time in combination with a better diet, this will reduce your weight significantly. There is no major cost in buying special equipment or fees as in joining a gym. A good pair of shoes or trainers is advisable and something waterproof in case it rains is desirable. Other than that, you are ready to go. If you have a bad day when you feel too tired, take a rest but walk the next day no matter how you feel. Build up the habit to three or four times a week without fail. When you start out, you may find the additional exercise makes you feel more hungry more quickly. If this becomes too much of a temptation to snack, think about using an appetite suppressant like phentermine. This drug has been on the market for fifty years and has an unbeaten record for effectiveness. Used in short bursts, phentermine will reduce your awareness of hunger and keep up your morale. Put the entire package together and you have a cost-effective way to feel better by improving fitness, look great by shedding those pounds and still have cash in your hand at the end of the week because eating less saves you money.

The research shows that a range of treatments not relying on medication produces good results. This includes massage and rehabilitation therapy designed to keep muscle tone and get the body moving again after injury or disease has reduced mobility. The benefits come both from the physical work done by the therapist, and also from the supportive bond that can develop between the patient and therapist. This can be allied with learning relaxation techniques and rediscovering swimming as an excellent form of exercise for the muscles not relying on joints overcoming gravity. Moving into the fringe world of technology, there is the long-running TENs machine and the newly emerging pulsed magnetic field equipment (which, as yet, does not have FDA approval). Such machines are said to produce significant relief among patients who believe in the power of the machines – not unlike acupuncture which also requires the patient to have confidence in the system. However, the best approach is cognitive behavioral therapy which teaches people how to maximize their mobility within the limitations imposed by the pain.

The point of these therapies is to avoid you becoming too dependent on the pill bottle for pain relief. If at all possible, you should keep drug costs under control and avoid the risk of a habit forming. That said, there are a number of analgesics or painkillers that can help you manage the pain. The strongest are the opiates. These are narcotic and should only be used in short bursts unless you are managing a severe pain following an operation or a terminal condition like cancer. The middle ground is held by opioids like tramadol which have fewer problems of dependence. The strategy is to slowly build up the dosage until you feel the best level of pain relief and the lowest level of side effects – most commonly constipation, nausea, vomiting and drowsiness. The problem with tramadol is that you also slowly build up tolerance, i.e. your body gets used to the drug and it has less effect. If you have been learning how to get a good quality of life with a cognitive behavioral therapist, this is not a problem. You should be phasing out the drug in any event. But if you have not been learning how to cope without medication, you may be tempted to increase the dosage. This is dangerous because you may end up dependent.