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Day 9: Fat is a four letter word

May 5, 2007


Recently we had a clinician come in and start a debate on weight and diabetes. Its unfortunate that his message was lost with him being so argumentative about it. Because, more than trying to convince us that genetics and a person’s biochemistry plays a MUCH larger role in weight control than a person’s will, he was trying to preach compassion for our overweight patients.

In America, IT IS NOT OK TO BE FAT. I’ve done posts on this before and how it affects young women’s self-esteem, but I’m not about to launch into a long critique on the media and our focus on the superficial. I think we all realize this. But as physicians, we tend to think we are more enlightened on such things.
-We don’t look down on the poor, we treat them whether they can pay or not.
-We don’t look down on drug addicts, we say they have a disease and try to get them help.
-We don’t look down criminals, we with withhold judgment to give them proper treatment.

But we think its ok to silently or openly judge the overweight as being lazy people who don’t stick to the diet & exercise we prescribe. We’ll even write them off as a waste of our time.

Don’t get me wrong. I’m sure a good chunk of overweight people are lazy. As are a good chunk of thin people. But did that cause them to be overweight? We can’t assume that.

1) The body is resistant to weight loss
When you start to lose fat, a chemical called leptin decreases. When leptin decreases, metabolism slows and hunger increases to preserve that fat. One chemical that doesn’t decrease is ghrelin- a hunger stimulant. The larger your stomach, the more ghrelin is produced, so obese people have that extra obstacle unless they get a large portion of their stomach removed in bariatric surgery.

2) You can’t choose your genetics…or your family

Some people claim genetics as being the sole reason for their obesity, and that is a cop-out. I say this b/c it is multi-factorial. BUT, a person never would have gotten in that condition were in not for their genetics. Some people can eat & eat and they will never be over 100 pounds. Those people are rare. What isn’t rare are people who will be overweight if they don’t work out everyday and monitor every single calorie. I mean, how many families have you seen where all the men are scrawny and all the women are fat?

But what about those families where everyone is large? Those who eat way too much and all the wrong things? Like I said, genetics determined how easy it would be to get large, and how big one could get. But there could also be an issue of poor education of nutrition. There could be the difficulty of overcoming years of this miseducation and learning of poor habits. This is especially true if you are poor. (They don’t have access to gyms, they don’t see nutritionists, and plain & simple- junk food is cheaper than healthy food). They could have emotional issues and poor self-esteem stemming from being ridiculed growing up large, and based on the rest of your large family, believing you will always be fat.

What if they are the only large one in the family? They could have been the unlucky one genetically, or there could be an emotional issue there. They could have been abused.

3) Speaking of genetics, food is an addiction

Many have accepted that there is a genetic component to addiction. This could be another explanation of family obesity- you’ve produced a family of food addicts. Statistics show that the success rate of an obese person losing weight and keeping it off is about 10%. Thats around the chance of an alcoholic never relapsing after rehab.

Though some argue addiction is only a symptom of emotional issues. Even more reason to be compassionate to a food addict. They need counseling, not the same speech about how they need to work out more.

In saying this I am not giving obese people an excuse to not be healthy. Rather, they have to be briefed by their doctor that this is something they must commit to just as hard as an alcoholic has to work on his sobriety. They have to be encouraged and given proper education. They need to be asked WHY.

4) You know better and you still do it
We have all the education and opportunity, but we med students don’t eat right all the time. We don’t get enough exercise. Some of us even smoke or do drugs. Dr. Phil often quotes that when someone bugs him, he would think “there’s just something about that guy that I don’t like about myself.” We need to look inward at our own insecurities about weight when we find ourselves judging others on their weight and laziness. Then thank God we’re the lucky people who can stay a reasonable weight with complete daily commitment.

3 Comments leave one →
  1. May 7, 2007 2:18 pm

    5.) Increased stress = increased cortisol = more fat concentrated around the abdomen

  2. May 7, 2007 2:33 pm

    =more of Katie to love!

  3. May 10, 2007 6:40 am

    Dude — story of my life. I actually just saw a doctor the other day (thankfully, not my primary care physician) who was a total asshole to me about my weight. While he is accurate in saying I need to lose weight, there’s a way to say it without being a dick. What really surprises me is that he hasn’t figured this out after practicing medicine for 36 years.

    My suggestion to those doctors who, like this one I saw Tuesday, say some downright mean things to their overweight patients (he told me I could survive a famine) is to think of a way of solving the problem instead of poking fun at it.

    This guy is a sleep specialist, and I only went to him because I had a sleep study done and it came back normal, so he wanted to see me in person to figure out why I’m not sleeping (we’re thinking sinus issues — this IS St. Louis after all). Anyway, I’m totally never going back to this guy if I can help it. My regular doctor (who is a delightful person) can order bloodwork and prescribe Flonase all the same.

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