In the series of blog posts, we’ve covered a lot of theory, so now it is time to give a real life example. As doctors, we see this picture often and more so in America. If you read the last blog post, you would see that the USA is the numero uno in obesity rates.

USA Obesity figure

What is wrong with this picture?

A pleasant woman presents for a hand surgery. There we are, myself, her husband, and this pleasant woman in the pre-op consultation area. She’s sitting in the chair, and her husband is sitting across from her. She is obviously morbidly obese and her husband is not. As we go through the preoperative evaluation, I asked the inevitable question, “what is your weight?” She looks as if she’s stunned that I would even ask for this. She asks her husband to leave the room because “he cannot know her weight.” Her husband makes a slight joke about it and says that he will never know her weight and has not for over 30 years. She laughs alongside with him.

Obviously there are some issues here such as the fact that I need to know her weight in order dose the anesthetics properly and to avoid an overdose which could possibly kill her. We also need to know what dosage of medications are going to be needed during and after the operation. Finally, the operating team is responsible for moving her safely from the operating table to the recovery bed, and everyone involved should know the weight of the person.

The other major issues are denial of her obesity and imminent health problems. It’s a sad state of affairs that people get themselves into where they can’t even look at each other or accept the dire situation. Obviously there are issues in that she cannot face the reality of her obesity. She has multiple health issues such as diabetes, cholesterol, high blood pressure, and other things. It would be so easy if we could just work with her one-on-one and get her to start eating whole foods, nothing processed. It’s a seems like a weird question to ask, but I am not sure if her husband would be any happier. You can just see the two of them sitting together it is not apparent. Obviously they’ve been married a long time but they probably sleep in separate rooms. They probably have separate lives. She continues to live her life run by her obesity. What have we come to in such a society, where two people are together yet they know the situation is in front of them and the inevitable is that she’ll die from complications of obesity. Why is this an acceptable situation?

The crazy part about it all is that it’s not her fault.  Of course her diet and environment has something to do with it. But she doesn’t eat so much to be this obese. Her hormones that tell her when to stop eating (leptin) are in dysregulation. A good analogy is that her receptors are numb to the levels of her insulin, Leptin and CCK (Cholecystokinin). These are all effects of the additives in food nowadays such as food coloring, anti-caking agents, and sweeteners. She likely drinks sodas, probably diet, which helps her rectify that it is ok to do so. All the food coloring’s, preservatives keeping the food on the shelves are among the major dysregulation of her hormones; not to mention the endocrine disrupters like bis-phenol-A (BPA). Again, this is not her fault. She probably eats more than 400 grams of carbohydrates per day, mostly processed. Again, it’s not her fault.

This human being could easily be helped. It’s time to figure out how.

Next time more on timing is everything