doctor discussing her mega-obese patients

A fascinating read on a very weighty subject, written by a doctor and bariatric surgeon in Australia. She discusses the quandary of informing her patients that they need to lose weight. In the midst of treating someone with an illness made far more threatening in the context of obesity, she feels embarrassed to encourage her patient to lose weight. And yet, she breaks it down for us:

Questions of aesthetics aside, obesity is bad because it causes disease by, for instance, raising blood pressure and cholesterol levels, stuffing your liver full of fat, blocking your throat so you can’t breathe at night, crushing your joints. Fat people are more likely to get blood clots, gallstones, gout and some cancers – as well as type 2 diabetes, which leads to all manner of medical mayhem. Fat men and women make less money, marry less often and are less educated than the lean. They are more often depressed.

She recounts the emotional interview process for prospective bariatric patients.

The emotion in the room thickens; I am acutely aware of the shame my patients feel. They describe to me what it is like to shop, ride on a bus, take a plane. They tell me that they no longer look into mirrors. I do not ask them to describe the biggest meal they have ever eaten or if they’ve ever eaten two dozen doughnuts in one sitting. I ask what I need to know to minimise the chances of harming the patients with inappropriate treatments. I do not wish to humiliate them or shame them. I do not wish to turn my fat patients into freaks. It takes time for them to trust me enough to tell me the truth about the mind-boggling volumes of food they consume.

Read the entire article, as it is enlightening. She hypothesizes that people over-eat out of a desire to consume, as opposed to merely feeling hungry; she further claims that junk food and snack companies look for ways (texture, combination of flavors, etc) to cause people to eat more and more product.

I like this article out of many that I’ve read on the subject because of the very human element it brings to this topic. Years ago, I had a very contemptuous view of “fat people.” I’m not proud of that view, nor do I hold that view today, but that bias isn’t at all uncommon, despite the fact that so many of us are far heavier than our peers in previous generations. It’s not unheard of to know or work near someone who is 400 or more pounds (180+ kg). Excepting someone with a large and muscular frame, such additional weight would put a person into morbid obesity. Their skin around them will die. Drugs can artificially keep them alive, absent motivation to shed the burden they carry.

My own experience in weight loss suggests we have some capacity to change. Knowledge is the key ingredient though. About a year ago, weighing in at 210 pounds, I came to the conclusion that I needed to lose weight, about 20 pounds. In a matter of months, I lost about 30 pounds, bringing my weight down to 180 pounds. I was actually lean, with no “spare tire” to speak of. This was through diet alone, with almost no exercise. Despite that, some people at work asked if I had been working out, playing sports, etc, and were even skeptical when I said that I wasn’t particularly active (I became more active after losing weight; it’s so much easier to be athletic if you’re thin). It’s hard for people to believe that weight loss can be achieved without significant exercise.

But our bodies don’t work that way. We’re adept at keeping on our weight, and we crave foods that help us with this. The reason low carb diets work is because high-glycemic comfort foods (sugars and carbohydrates readily convertible to glucose) cause a chemical chain reaction that causes our body to store energy for later, including through hormones like insulin.

My diet has evolved since I embarked on the weight loss experiment. I eat carbs, even sweets sometimes. But sugar is a very small portion of my calorie intake. I eat a low-glycemic diet, which isn’t “low-carb” by definition, although mine in particular is low-carb. I enjoy delicious meat with non-carby sauces (olive oil and peppery spices on chicken, for eg), along with some non-starchy vegetables.

Can a 400-pound person follow this same dietary regime and lose massive weight? Probably. I can’t guarantee the person will be thin or have six-pack abs, but weight loss is guaranteed. When I started my own weight loss regiment, I knew I would lose weight; I mean, I literally had no doubt. What gave me pause was what I was giving up. Comfort foods, starchy potatoes, tortilla chips, ice cream, cookies. These are things I thoroughly enjoyed for years. Now, it’s unheard of for me to eat any of them. And yet, the craving for these foods passes after a week or so on the diet. The likelihood of hunger pangs diminishes, as the body (and mind) adapt. Candy is, quite literally, less tempting than it used to be. The sweet tooth that I had when I was a kid and that extended all the way until about a year ago is easily held at bay. The initial willpower required becomes habit, such that over time much willpower isn’t even required.

So it is possible for the fat to become thin, or relatively thin, at least for most people. It takes knowledge as well as commitment. But will it happen? For most heavier people, I have little hope, I’m sorry to say. We’ve all been told the benefits of low-fat diets, and perversely, so many low-fat foods are high-carb (which spikes insulin levels, which causes ingested fats and carbohydrates to be retained as “stored energy,” which causes blood sugar levels to drop and for one to again feel hungry). We’re told exactly the wrong way to lose weight; we’re given terrible food choices, ones loaded with carbs (and fat, and salt, but devoid of fiber). Our economic systems’ glorious capacity to produce and distribute food is now a liability to our waistlines and our health, not to mention our healthcare system.

Millions of years of evolutionary forces that encourage our body to retain the energy stored in our fatty tissue coincide with a tendency to eat anything but home-cooked, and to over-indulge, and to remain sedentary. It’s not a shock that some people are morbidly obese. It’s a shock that more people aren’t morbidly obese.

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One Response to doctor discussing her mega-obese patients

  1. Pingback: I’m not paying for your fat ass! | Lamplight News

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