PART 2: THE ENEMY WITHIN: THE GLOBAL OBESITY EPIDEMIC

Medicine Globally by Dr. Rene Menguy

By Dr. René Menguy


Gastronomy rules all life: the baby’s tears demand the nurse’s breast, and the dying man receives with some pleasure the last cooling drink.
-- Brillat-Savarin
What are the consequences of this problem and how big is it? I’ve already alluded to some: high blood pressure, diabetes and cancer.
More about that later, but for now, here are some less obvious ones.

An event, worthy of the “Twilight Zone”, happened on Lake George, in upper New York State, on a fall day in 2005. Forty-seven people boarded a boat headed for a tour of the lakes. Barely under way, the 50 foot craft capsized and twenty people drowned. What happened? Overloaded or encountered a rogue wave? Survivors testified that there was no rogue wave. Was it overloaded? Manifestly not! Built in 1964, it was certified for fifty passengers and only forty-seven had boarded. However, in the 1960ies, the average weight of a passenger was 140# according to US Coast Guard standards, a figure revised to 185# by 2005. The boat was indeed overloaded by about 2000#.

Here’s another example:

“Hi Rene, I’m calling about you’re referral for a CT scan.”

“Yeah, Yeah Charlie, see any liver metastases?”

“Rene, did you know she weighs almost four hundred #?”

“Sure I know. So?”

“Our machine’s not rated for that weight. Sorry buddy.”

Tough indeed! Most medical paraphernalia, from gurneys to needles, are not designed for the obese.

The involuntary loss of urine is called urinary incontinence; occurring while coughing, sneezing, or lifting, it’s called stress incontinence. Men are rarely affected. Years ago, I had occasion to see a 60 year-old woman with a sad story. Without means or family, she suffered, as a result of her 350 pound weight, from stress incontinence so severe that she dribbled urine continuously. The supermarkets blocked her from shopping for food. They really did; wouldn’t let her in.. I operated on her and made her stomach smaller. She lost enough weight so she could have the bladder suspension that cured her incontinence.

Over the years, I’ve taken care of many fascinating patients. A memorable one reached me in a pick up truck, via the hospital’s delivery dock, the only place where we could weigh her 700 pounds.

There are many, more, some sad, some humorous. Later, I’ll discuss the ones most talked about.

How extensive is the problem at home? One can get a handle on it by looking at people in the streets. A few years ago, New York City experienced a power outage, and for hours, TV news showed New Yorkers walking home. An incredible number were clearly overweight; and by clearly, I mean at least by 30 pounds. It came as no surprise to find out later, that New York City has the highest incidence of Diabetes in the Nation.

Then, there are figures. Yeah, yeah I know that one about how figures don’t lie, but liars figure. Humor me. For example, a recent survey (NDP Group) found that only 24% .of Americans view overweight people negatively; it used to be 55%. Is it because obesity has become so commonplace that we no longer see anything unusual about a fat person?

We should. Even moderate overweight is dangerous. A recent study out of Northwestern University followed 17,000 patients for 30 years. Those, who were obese at the outset, had a 43% greater risk of dying from heart disease than the lean ones. Only slightly overweight participants with normal blood pressures and cholesterol levels also had a higher risk of developing heart disease than lean participants. Thus, even modest overweight increases the risk of a cardiac death.

Here’s what we face: About 60 percent of American adults are overweight, and about 25 percent are obese (the distinction between overweight and obesity will be clarified in another blog). The prevalence of diagnosed diabetes has increased six fold from 1958 to 10 million in 1997, with most of the increase being of the obesity-related type II variety (more about that in another blog). Today, one out of every five children is overweight, a sorry statistic since they’re our future. The incidence of obesity among adolescents (12-19) has tripled since 1976 and today is about 16-17%. Childhood obesity is especially frightening because it’s worsening at an increasing rate. Children with the highest BMI scores were far heavier in 1990 than they were in 1970.

Between 8 and 10 million US individuals have the severe kind of obesity called morbid obesity (100 pounds or more above normal weight. Those poor people are really head turners.

To be continued

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