Sunday, July 8, 2012

Obesity, A Rant

I found this fascinating.

Yesterday we saw a young family, the parents and two little girls probably 8 to 10 years old. The parents were noticeably overweight but not what I'd call obviously obese. I'd say average based on the majority of people I see these days. But the little girls were both fat, in my opinion, at least working on obese.

I wonder, what are these kids eating, how much are they eating and what, and what are they doing all the time?

Allow me to rant for a while.

Obesity is one of the most pressing issues we have to deal with not only here in this country but worldwide, as it's spreading. Pun not intended.

It caught my eye not only because I'm interested in the topic, but I used to work for this organization, Scottsdale Healthcare, it's a good hospital system and good place to work, doing some cutting edge work in certain areas like bariatrics. 

I first saw this in one of the e-mail medical newsletters I read daily.

Diabetes is an extremely costly disease. The complications: cardiovascular disease, neuropathies, infections, organ dysfunction especially of the kidneys and eyes. Limb loss. Sepsis. Dialysis. Premature death.

We also need to attempt to stop it before it happens, like not letting people get to a BMI of 30 in the first place, even though some people are more likely to go there due to genetic influences. The video doesn't talk about changing behavior early on, intervening before a person starts to become obese and the metabolic signaling results in diabetes.

Years ago people were not so fat. They were more active. They didn't have the range of sedentary activities to keep them mesmerized. There wasn't the range of bad food, and the ingredients, and the portion sizes.

There is a huge genetic influence on obesity. But that doesn't mean we throw up our hands and say, wait until the person is diabetic then give them a sleeve gastrectomy.

We need thinkers like Dr. Blackstone to manage the medical approach to managing this disease, but we also need more action on the prevention end of things. We certainly aren't doing enough lifestyle interventions to help solve the problem.

Workplace habits, city planning, commuting time, work schedules, stress, availability of healthy foods, lack of leisure time, leisure time choices, lack of physical education that truly teaches kids how to develop healthy lifestyles, all of these things and more add up to what? Sleeve gastrectomies?


Exercise and nutritional screening, behavioral screening for tobacco and alcohol consumption, electronics use and TV watching. Simple things! Doctors aren't necessarily good examples at all.

I'd like to see total screening in preventive care as an ongoing intervention, education and practice throughout the lifespan. It doesn't belong primarily in the domain of preventive health care in a doctors' offices. The schools could play a huge role, along with the community organizations that sponsor youth activities. What to eat, how to cook, what to buy, what to avoid. How to increase activity, emphasizing less sedentary time.

As people get older, include thyroid screening. You wouldn't believe how many patients I see, when I look at their labs, I see elevated TSH and they're not on thyroid meds. When I ask about it, they look perplexed. Many cancer treatments can affect thyroid function but many of these patients are not getting treatment for cancer. They say they are tired.

The thing is, we already know all this stuff. We know what would work. But there's a lack of organized, coordinated societal effort. In the video, Dr. Blackstone acknowledges that some of the other medical disciplines such as oncology and cardiology have had a lot of success with combination therapies, including behavioral interventions and medications, in addition to surgery. It is a multifaceted problem and needs to be treated accordingly.

But when I see little kids who are well on their way to becoming obese adults, it makes me cringe, and I know we are setting them up for failure early on, before they ever get a chance to learn to make healthy choices for themselves.

And I think that's a major failure on the part of the adults in this country. We know better, and it's outright negligence to continue to allow this to happen.

end of rant, for now.

(cross posted at Journey to Badwater )