Wednesday, January 17, 2007

Morbidity, Obesity and Healthcare

If you think not being able to fit into that outfit you just bought because you gained a few pounds over the recent holidays is depressing, being morbidly obese will kill you. When I first started working with L., (370 lbs, diabetes, high cholesterol and blood pressure, among other issues) he knew nothing about how his body really worked. He knew a lot about his disease, what drugs to take and nothing else. His doctor told him he was doing fine. I told him his doctor was full of fecal matter and that he was going to die, probably within the next few years, probably sooner.

That rocked him back on his heels, but then I'm not known for sugarcoating the truth. I get that little trait from my mother. There were no excuses, everybody dropped the ball in treating this man. He wasn't always that large. He has many doctors for his different conditions, there is more to helping a patient than writing a prescription and nobody did a single thing.

At any time while his foot doctor was scraping the dead skin off his feet and draining the leg ulcers, it could have been explained to him that the same thing that was happening to his feet was happening all over his body. That the lack of fresh blood and circulation caused the swelling that was pressing on the nerves in his feet and helping to make them feel hot and irritated all the time, when they weren't numb. That the leg muscles use the most amount of calories and walking will help them build up and use more calories so in addition to having better circulation and less parasthesia, he will lose weight. And oh, by the way, the same stagnation thing is happening to the penis which prevents it from working correctly.

The ophthalmologist could explain that swollen red vessels in the eyes are the same everywhere in the body and if the eyes aren't getting the oxygen they need, neither are other small muscles of the body, like the kidneys or the sexual organs.

When he saw his internist, she could have spent some time (a few minutes) explaining that while the drugs are controlling his diabetes after a fashion, they overall destruction is continuing, his sex life is likely never to return under these conditions and that while his parents and grandparents lived into their 80s and 90s, he probably won't live through his 60s and even if he does, his 70s will consist of doctors visits, tests and pills. Meanwhile society will shun him even as they suffer they same problems.

She could have explained that the side effects from the medications were increasing some of the problems with the little general and that if he was willing to do a little exercise, both might be mitigated. Nowhere along this path was nutrition discussed in any meaningful form. He was sent to a nutritionist who gave a piece of paper with most of it crossed out and told to eat from what was left. No wonder America is getting fatter. Not just fatter, morbidly obese.

We started his new lifestyle the weekend of Labor Day with a meal you wouldn't believe. Barbecued ribs, sweet potatoes and southern greens from Trader Joes. I took him shopping, we stood over vegetables and discussed them. We looked at packaging and how to read the labels. We discussed liquids. Thoroughly. Then I introduced him to a butcher so he would start eating cleaner foods. No additives or saline solutions. Why pay for seasoning that is bad for you. We cleaned out his spice cabinet and replaced it with stuff he would use. I gave him cooking tips.

He now tips the scales at a 304. He walks approximately four miles a day, six days a week. He once went for six weeks straight without missing a day. And I reward him with praise every chance I get. He felt bad that he cheated a little bit on Thanksgiving and Christmas (and he could tell, it made him feel bad physically). I pointed out that unlike everyone else, he lost fifteen pounds over the holidays and that is a major accomplishment.

He has had to have his medications adjusted. Twice. Today he goes back to the foot doctor. The last time he went, he had a substitute and she made fun of what he was doing, told him he was only doing it to impress me. Not that that is his motivation, but who cares? At least he's trying. His instructions are to complain about her. A true medical professional should never make fun or belittle their patient. Especially not to their face.

Losing weight is a daunting task. For those of us who want to lose twenty pounds, we act like it's the end of the world and we are being forced to suffer major indinities. When you have to lose a whole person, such as L. does, it has to be approached in a different fashion. Ten percent is our goal for each section, much easier to attain and manage and it has a built in reward system.

L. feels a sense of accomplishment every day. He makes choices that benefit him because never once did I tell him he couldn't have something. He eliminated milk from his diet, he eliminated bread. All by himself. He couldn't fit it in with what he was doing. He very rarely eats out since he found this little booklet that tells him the calories from the popular restaurants. He didn't have a clue that he was getting that many calories and still felt unsatisfied. Now he enjoys every bite of his food, because it has flavor and a richness that makes him feel his food is special, just like him. He's also saving money by eating healthier, so he can spend it on the new clothes he has to get.

Has anybody noticed besides the medical people who were oblivious in the first place? That answer is a resounding yes. He is treated with respect when he discusses food and since he can now out walk the skinny guys around him, he is getting called for better projects.

Knowing how and why is helpful to most people. Treating them like they are rats in a maze only produces a well trained rodent, not a healthy patient. If you have any questions please feel free to comment or to email me. A healthy diet is important.



  1. Thank you for this. I wish my friend and "brother" J. had a doctor like you. He's at 500 lbs. He lost a hundred pounds already, but cannot seem to manage to lose more. His friends are trying to replace his sugary colas with diet ones, at least, and taking away the breads and desserts once he's had a portion, so that he's not further tempted, but he does have some of that mysterious morbid obesity going on. Much of this weight is probably not due to diet, because in the dozen years that I've known him, he has gone from about 240, my husband's current weight, to his present weight without eating more than my husband. I'm concerned about J.'s health. He's in a lot of pain and has to be on oxygen these days. Medicaid will pay for as many pain pills as he likes to control the pain he is in from movement with morbid obesity, but refuses to cover any diet drugs or lap band surgery so that he can get the help in weight reduction that he needs.

    How long has L. taken in losing the weight? And is it possible for J. to get his weight down with diet alone, since, at this point, he is unable to exercise?

  2. It has taken about 6 months so far. Dieting and exercise seem to account for the same amount of weight loss.

    Have him add more color to his diet and see if you can get him into a swimming pool. The water will support him and even if he just walks from one end of the pool to another, it will eventually help.

  3. Thanks for this nice article.

    Smith Alan