Archive for the Obesity Category

Your Friends May be Making You Fat

Posted in Obesity with tags , , on March 28, 2008 by Dr. CJ

As with many habits, be they good or bad, health appears to be closely tied to social rituals and the behavior of those in one’s social circles. Consider smoking: how many times a day do I hear “I only smoke when I’m out drinking” or ” . . . only with my friends”, etc. Friends are good and all, but not worth smoking for.

So, why are friends so influential on our weight? According to this NPR bit, the people we hang out with do indeed influence our lifestyle to a significant degree.

I’m sure I’d have a hard time getting in shape if I hung out with nearly anyone on a regular basis. Think about it: every social function is based on food. I probably would feel far too awkward carrying my plastic containers of chicken and sweet potatoes that I diligently prepared at the beginning of the week while my friends indulged in burgers and fries. There are minimal, if any, healthy food options when you eat out. Yeah yeah yeah, so and so has a salad with low-fat dressing – too bad you could make that salad (and even a better salad) at home for 1/10 the cost. Plus, restaurants are in the business to make money – they will be taking shortcuts, which means they will use the cheaper, fattier ingredients to cut costs.

I have a patient, a woman in her 50’s who is morbidly obese, has Type 2 Diabetes Mellitus and all the other metabolic syndrome and cardiac risk factors typically associated with it. Every time I see her, we discuss her weight, and she renews her vows to make a change before the next time we meet. She confided in me once that she was once able to drop 15-20 pounds, but when she did so, her “friends” distanced themselves from her, making snide comments and frowning upon her success because they were never able to achieve the same. She regained that weight and hasn’t made any progress since.

I can absolutely see the findings from this article taking place on a daily basis. Sometimes we all need blinders and need to be selfish for once; you have to take charge, because no one else genuinely cares about your fitness.

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Where does the fat go in my belly?

Posted in Obesity with tags , on March 9, 2008 by Dr. CJ

It’s sometimes difficult to imagine where all the fat is stored in our bodies.  There’s only so much you can grab between your fingers on the outside of your abdominal muscles, there’s only so much it can be distributed beer bellyacross other regions of the body.  A lot of fat, however, is inside the abdominal cavity, lining the intestines and other organs.  Because of this accumulation of fat inside the abdomen, the belly protrudes in the classic beer belly fashion. This article shows a diagram that illustrates this point.

Remember, it is impossible to spot-reduce a fat belly.  Do all the sit-ups, crunches, whatever you want – you will get nowhere.  It comes down to getting rid of fat in general.  The only known method for spot-reducing fat is liposuction.

The obesity epidemic in kids

Posted in Obesity with tags , on February 14, 2008 by Dr. CJ

The other day, I saw a 9-year old, a few months shy of age 10, who was going to have his tonsils out, so he needed a preop exam.

At first glance, any one would be struck by this kid’s appearance – the ultimate Michelin-man fat kid.  5 feet 5 inches, 177 pounds – for an impressive 9-year-old BMI of 40. 

That’s something I can’t let slip by – there’s no way I’m letting that kid go without a little discussion about his weight.  So I addressed it with his grandma(?) who was with him – she insisted that he was “a big build”, “there must be something else in his belly, that can’t all be fat”, “he loves steamed broccoli”. 

Aha! The ignorant guardian syndrome.  “Something else in his belly”!?!?!?  You’ve gotta be kidding me. 

I pointed to the rolls of fat beneath his chin and on his upper arms, explaining to his grandma that he was simply “fat”.  In fact, he couldn’t even put his shoes on; his grandma did. 

I don’t get it….this kid will have diabetes by time he’s a teenager, if he doesn’t already, and his grandma is clueless.  It’s sad to see this kid, knowing that there’s only so much advice I can give and so many ways I can bring them to accept the reality of his condition, but something’s gotta change at home.  This is why obesity is the emerging epidemic that will contribute to all sorts of premature death in the next few decades.

Obesity prevention not cost-effective?

Posted in Obesity, Preventive Medicine with tags , on February 6, 2008 by Dr. CJ

This article recently popped up on the Associated Press circuit, an analysis of the lifetime medical costs associated with obesity and smoking compared to healthy individuals. Basically, it’s suggesting that individuals who are obese or are smokers have less medical costs over their lifetimes, presumably because they die prematurely of lung cancer, heart disease, etc. In comparison, a healthy individual may avoid these diseases but will end up requiring more health-care dollars in the long run because of a longer life, including potentially long-term care when one develops dementia, etc.

Here’s the important perspective from the same issue that’s not discussed in the above article, and of course not in the AP’s coverage:

Most people want to live a longer life, and they do not consider the consequences to society. But a major goal of life is to maximise one’s total quality-adjusted life years (QALYs). Unfortunately, this new study provides little insight into the total QALYs associated with obesity and smoking. Certainly those who are obese and those who smoke will live fewer years on average, but will these people be compensated by enriched quality of their fewer years? Available evidence suggests strongly that quality of life, quite apart from increased illness rates, is considerably compromised by obesity.

That’s more like it. There’s a reason why there is an enormous market for weight loss and fitness, etc. – people do not enjoy being overweight/obese.

I’ll take 50 years of a high level of functioning in a fit state, free to enjoy any activities I so desire, over 80 years of being limited by obesity, unable to see my own toes and feeling short of breath when walking up a flight of stairs.

Obesity/Inactivity – you should run, because you can’t hide

Posted in Obesity with tags , , , , , on January 23, 2008 by Dr. CJ

An obese 50-something gentleman (BMI 32, in fact) I saw yesterday in clinic said to me, “You look crisp today.” 

I wasn’t sure how to take that initially; I thought the shaved head must have impressed him.  “Yeah, you like it?  Low maintenance,” while rubbing my head.

“You look like you just got back from vacation . . . alert, a little spring in the step.”

“Nope, I wish . . . I worked out this morning, though.  That felt good.”

“Ehh, I don’t care for that.” He went on to reiterate his absolute disinterest in getting back into shape. 

       Funny thing is I bet he can’t even remember the last time he did any exercise for the sake of health, rather than for work, home projects, etc.  I’m not surprised that he doesn’t associate exercise with feeling good.  Unfortunately, this scenario is all too common – I wish this guy was the exception, but I continue to be amazed at the number of obese middle-aged individuals I encounter . . . and even moreso at their apathy regarding their health. 

      Yes, it is hard work to get fit.  It’s harder work to recover from the health problems that are bound to strike this typical individual.  This guy is a former smoker (kudos to him for quitting) but his cholesterol panel is awful (Triglycerides over 230 and HDL 24 – somehow has a normal LDL).  I’ll discuss these in detail later, but for quick reference, Triglycerides should be less than 150, HDL should be greater than 39.  The low HDL tells me he is very inactive. 

It’s satisfying (in one sense) when a patient’s labs give such an insight into his/her lifestyle.  Now, if he’ll ever take me up on my advice . . .