I’ve finished my surgical rotation and I’m currently doing a month of outpatient medicine. This means being in the clinic, doing prototypical doctor visits. It’s spread across a variety different areas, with a lot of general medicine, some urgent care, arthritis clinic, endocrine clinic, renal clinic, etc.
However, one of the common threads is obesity. Daily now, I’m confronted by people whose health problems all stem from just too much food and too many calories. There are all the associated problems of hypertension and diabetes leading to renal failure. There is a nice discussion of health issues in obesity here.
What I often hear is that patients will promise to be more active. However, it’s not even really a matter of exercise, because just moving around is a lot of work (including on the heart and circulatory system), and it can be so hard on the joints that I’m seeing patients getting arthritic joint degeneration in their 20’s in their knees, hips and lower back. In theory, swimming would be a great activity, both because it helps lift the weight off of the joints, provides a lot of resistance and being in cool water can help burn calories, but most of the patients I interact with don’t have access to a pool.
It’s also not just an issue about the chronic health problems of obesity, very heavy people can have other problems, such as being in a car accident or having a bad fall. Being very heavy makes surgery incredibly difficult, even from just the mechanical difficulty of working with such big person, but also all the complexities of general anesthesia and the recovery process.
Recently covered in the news are some of the health issues and problems with the popular show, The Biggest Loser. Previous participants talk about how the show misrepresents what is happening and the time scales involved, and the health effects of the process. We can debate some of the issues of why these shows are popular and exploitative, but the problem remains. Obesity is a serious health epidemic.
It’s hard to tell what treatment is really effective. Obviously, someone just doesn’t wake up with a BMI of 45 one morning. That patient has probably been trying to lose weight for years. There is a lot of discussion surrounding low carb diets vs high fat diets, but when someone starts to get up near 400 lbs, it’s not an issue of these fine specifics, but just too many calories. I’ve started recommending people try one of the calorie counter apps for their smart phones. There are many free ones which let you do things like scan bar-codes, enter commonly used foods, etc. Through this, I’m hoping to promote better awareness of calorie intake as the first step to managing diet carefully. When you measure something, at least you objectively know what is happening and many foods are admittedly non-intuitive in their actual calorie content (particularly any beverage with any calories, from orange juice to energy drinks to “sports drinks”, the latter full of both salt and sugar).
It’s hard though, food is something which is comforting and pleasurable. Its consumption is totally legal and actively encouraged by all sorts of advertising. That’s why food can be so insidious.