Monday, August 10, 2009

Never trust a skinny chef. A fat doctor, however...

U.S. President Obama with Dr . Benjamin, Surgeon General nominee. Source: The White House

Today's LA Times has an interesting piece about a new Surgeon General nominee in the USA, who herself is obese. Her nomination has generated discussion about whether or not doctors should be overweight.

Let me explain why this article caught my eye.

Last year, in a family practice rotation, I was in the room when my preceptor was counselling a patient on theimportance of losing weight to cut down his risk of heart and stroke (and countless other diseases). The patient was obviously feeling a bit sheepish about the lecture, and awkwardly tried to draw the attention away from his waistline. He pointed at me, and said, "Well, this guy will be needing to lose some weight too then, won't he?"

This was the first time somebody had said something about my weight since I was teased in high school, and afterwards, my preceptor apologized profusely for the behaviour of his patient. However, even though it was a bit more surprising and amusing to me than offensive, he did have a point.

At that point, I was 6' and weighed almost 280 lbs. That means my BMI was 38.0 - not just obese, but class 2 obese... and my disease risk for high blood pressure, heart disease, and type 2 diabetes was a few pounds short of extremely high.

If you think this is starting to read like a diet book, it actually does. I had always "eaten healthy," and had even done some jogging in the past. My list of reasons to lose weight was long...pages long. But not long enough to get me to have a healthy weight.

At the start of third year, my list of reasons to lose weight got longer. I began to spend over 8 hours a day seeing patients....most of whom were fat, and most of whom were dying or very sick... because they were fat.

In fact, every ward I rotated on showed me new ways people were suffering from obesity. I expected to see fat people with heart attacks on the cardiology wards, but I began to see obesity-related diseases and complications in ALL of my other rotations, almost ENTIRELY due to the patients' obesity, in other words, PREVENTABLE - in orthopedics, ophthalmology, surgery, maternity, emergency, dermatology, anesthesia, and scarily enough, even in pediatrics.

I knew that obesity caused disease, but that didn't really frighten me. Until I saw the complications of the diseases first-hand. They can lead to heart failure (which is a slow death with fluid in your lungs just like drowning), heart attack (pain and sudden death), stroke (paralysis and loss of ability to speak), dementia (to the nursing home we go, and hand in your driver's licence and memories of your family and friends on the way), permanent loss of sensation (can't tell if you stepped on a tack, so it could stay in your foot for WEEKS until you notice - yes I have seen this happen), osteoarthritis (waking up with pain in your knees every single morning increasing until you can't walk anymore), limb amputation (I have seen black toes and feet from the arteries getting so clogged with fat that they stop supplying blood to the feet) and blindness (a complication of diabetes). All because of obesity...all almost entirely preventable.

Seeing all this helped me get my butt in gear. I took a close look at my lifestyle and eating habits, and was surprised to find some mistakes that I was making. That's right - I discovered that even as a reasonably bright, educated medical student, there were simple things staring me right in the face, easy things to change in order to lose weight, that I was oblivious to (I'll talk about these in another post shortly).

And soon, I began to see results. Dramatic results. I've lost so much weight that people barely recognize me anymore.


Anonymous said...

YIKES! I look forward to reading Part II. Add that to my list of reasons to keep running...

BigRigs said...

Good Calories, Bad Calories is an interesting read, especially for those with a scientific leaning. May encourage you to rethink some of what you "know" from "standard" dietary knowledge. Not the easiest read, for the busy medical student though.

Robb Wolf has a lot of interesting thoughts on diet:

Mark Twight also has some good writings on diet: , albeit mostly geared towards athletes.

Good luck.

yogurt said...

It's good you have realized the dangerous effects of being overweight.

You are probably too busy to commit to an all-out diet and exercise plan. But personally I tend to lose more weight if I focus on moderation and longevity.

If you can start small- even 10 min of exercise per day for a month, that is better than doing a hard workout/diet plan setting yourself up to fail. Eat and exercise in a way that the effects will be long-term, and not just spurts of exercise here and there. Take it slow and know your body's limits and you'll be sure to succeed!

Good luck!

Paramed said...

It's a grim reality but obesity is an epidemic. I've struggled with weight as well and I also consider myself a well educated person. Well, at least educated enough to realize that I should life a mush cleaner life so that I don't end up suffering from the plethora of self-induced diseases as a result of obesity.

For me, and many others that I am in contact with, the simply truth is that we have very little self-control. Although genetics play an important role lifestyle ie eating habits play a much much more important role in our waistline than anything.

I wish you the best in your weight loss effort and your healthy lifestyle.

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Fat Doctor said...

As a family physician who has lost the same 100 pounds three times (and kept them off for several months between each regain), I hope your able to keep your weight off. Seriously. I have one foot in the grave and it ain't funny.