Fatties

Much has been said and discussed about the obese. There is no doubt that being clinically obese has its deleterious health effects. Dr Rob at Musings of a Distractible Mind has written a highly popular post “Shame” on a patient who held his head in shame, thinking Dr Rob his family doctor was going to lecture him on his weight and all. His post got highlighted in the NY Times and got a whopping 499 comments!

So here’s what Dr Rob suggests:

Instead of patronizing obese patients with a lecture, I try sympathizing with them. Just because something is simple doesn’t make it easy. How do you quit smoking? You just stop smoking. We should just pull out of Iraq. There should be peace in the middle east. People should stop hurting each other and start being nice. All of these are good ideas, but the devil is in the details. Losing weight is a struggle, and it really helps to have people giving you a hand rather than knocking you down.

I think these are wise words from Dr Rob. Of course, there are two sides to a story. For one, the patient may be obese due to an underlying condition. However, there are some who are not so sympathetic, like Frank Drackman, who said this:

OK I’m gonna piss some people off here, but its Tough Love, and its what everyones really thinking while they’re nodding sympathetically. Its not your Cushings, your slow BMR, your huddled masses, you eat like pigs, and you don’t exercise. I see you guys (How can we miss you) parking in the handicapped or fire lanes, riding your scooters in the grocery store, complaining that the Family Sized bag of Doritos isn’t big enough. Yeah, I know, keep fooling yourselves, you eat like a bird. Yeah right, some huge fucking flightless bird. I go to this little Mom and Pop Pizzeria for lunch, they used to have a Noon Buffet, but had to discontinue it because of the fatties. You’d see these fat bastards take an entire pizza and think it was OK since they had a salad on top of it, and complain that the place didn’t stuff the crust with cheese like Pizza Hut does. I see 2 year old kids who’s BMI doesn’t fit on the page.. So go ahead, have another slice of Cheese Cake, get your 2 am fasting (who am I kidding) random ACTH/Melatonin levels checked. Why run some windsprints when you can get your intestines bypassed.

He mentions some valid points, like the problem of overeating. I’m very sure there are many people out there who feel the same way, but just don’t want to mention it for fear of vitriolic comments hurled their way for saying the unpopular thing. But think about it. Why does Laparoscopic Adjustable Gastric Banding (LABG) work? 

Ok, let’s back it up a little. What’s LABG or lap-band?

The name “LAP-BAND” comes from the minimally invasive surgical technique used (laparoscopy) and the silicone gastric band placed around the top of the upper part of your stomach. The LAPBAND^® System works by helping you control your food intake and supporting long term, sustainable weight loss. (source: lapband.com). For how well it works, check out Ideas for Surgery’s post.

So there you have it. By limiting the amount of food intake with this ingenious device wrapped around the top part of the stomach, it creates a feeling of fullness in a person. The person doesn’t feel like eating. Eventually the patient loses weight. There is little doubt in the medical community on this procedure’s safety and effectiveness. Here’s a FDA report on Lapband.

 

Surely, this has shown that overeating is a key problem in causing obesity, and by modifying this variable, weight loss can be achieved. It must be kept in mind that Lapband is only indicated for those who are severely obese (BMI >40 or BMI >35 with one or more co-morbidity, e.g. diabetes, or CVS problems). What about the rest? What really causes obesity?

Obesity is a chronic disease that is complex, multifactorial, and develops from the interaction between genotype and the environment. While there is not a complete understanding of how and why obesity occurs, it is known to involve the integration of social, behavioral, cultural, physiological, metabolic, and genetic factors. (Source: National Heart, Lung, and Blood Institute)

This brings me to what yours truly commented at Dr Rob’s post earlier:

i think we should be focusing on the solutions rather than reacting to a provocative comment.. no one is talking about how to deal and manage these patients. as i have above.

if a morbidly obese patient presents, obviously the first thing to do will be to rule out underlying disease like Cushing’s that can explain the weight gain. This may not be easy, but should be done first.

If nothing underlying is causing the weight gain, then perhaps we should look at traditional things like diet and exercise. modifiable lifestyle factors, they call it. these should be monitored over time. a couple of years at least. engage a nutritionist’s help. engage a sports instructor if it helps. dispense lifestyle advice. warn of comorbidities.

only as a last resort should surgery be recommended. lap band surgery is proven to help those who are morbidly obese to lose weight and reduce risk of comorbidities. it is proven guys. no debate over this. so lets focus on what CAN be done for the patients then to start the blaming finger. next we know, we should blame FDA for not banning trans-fats in the entire USA, or commercial food chains like MacDonalds’. Come on, get real. 

You can also take Fat Loss Lessons From Manuel Uribe, One of the World’s Heaviest Men, from which the picture above is taken from. 

As for me, its certainly cause for concern as Australia has just overtaken USA as the fattest nation in the world. (Source: The Age)

A grim picture is painted of expanding waistlines fuelled by a boom in fast food and a decline in physical activity, turning us into a nation of sedentary couch potatoes. 

Those most at risk of premature death are the middle-aged, with 70% of men and 60% of women aged 45 to 64 now classed as obese.

Worrisome to say the least. A big boom for Lap Band Surgery in the future. Perhaps i should specialise in upper GI surgery then. I’ve been interested before this anyway.

That said, i believe that just as obesity is caused by multiple factors, the solution should be multi-factorial as well. Other than surgery, behaviour modification, in terms of diet and exercise, with the help of nutritionists and fitness instructors, can play a major role. Then again, who can afford the help of all these? Making them affordable for the fattening population of Australia will be a challenge for the Department of Health. Let’s see how this goes.