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Obesity, it’s complicated: a list of consequences

November 22, 2009

Another attempt at revolutionizing the fashion industry with larger models had people cheering. I think it’s great that we change the standards to reflect a healthy figure. I wonder however, why we must make the leap from zero to fourteen. 0 – 14. Whatever happened to size 6? Or athletic & toned instead of voluptuous & curvy? Too long a leap, I reckon. Yes it’s mentally healthy to embrace one’s own body image and be accepting of all others, but having a BMI outside of the physiologically ‘healthy range’ is not so great. [NB: while Body Mass Index (BMI) is a flawed concept, in almost all cases where BMI is greater than 30, it represents an unhealthy habitus].

I’m not saying that individuals of size 14 aren’t beautiful. I’m speaking strictly of statistically healthy body dimensions and composition. Pure numbers for medicine. Not aesthetics. Because if the argument is “it’s good to see HEALTHY-sized models finally,” (as per the comments on that story) then I think the subjects in questions should be truly a healthy size. I’m also not saying it’s easy, just that it’s important!

I have seen some incredibly fat people. 650 pounds. 450 pounds. There’s no sidestepping or pussy footing here; my “P.C.” language is out the window, because it’s too serious not to be open and honest about.

Obesity is easily detectable; it’s not so easily treated. One day, I looked around the ICU. Eight out of our nine patients that day were obese, two were morbidly so. Coincidence? Not really. Obese people have a greater risk of many negative medical outcomes. So do malnourished people – though they are different problems and fortunately anorexia and malnutrition are not epidemic in North America.

Listing things doesn’t change anything. People know that being fat isn’t healthy; but it’s academically interesting to know why, and there may be some surprises. I’ll write about making changes another time. So, here goes – and FYI this is not a complete list.

Systems-based consequences of obesity:

Neuro/psych (brain): low self esteem is a fairly common and unfortunate state in those with BMIs over 30, but so too are depression, anxiety, and fibromyalgia/chronic fatigue syndrome; diminished mental capacity is also a problem, oddly enough

Occular (eyes): via high blood pressure or diabetes, decreased visual acuity and blindness can ensue; even without concomitant disorders, obese people are at greater risk of developing eye disease, like glaucoma and cataracts

Cardiovascular (heart and blood vessels): high blood pressure, heart attack, stroke, blood clots in the legs (DVTs) that can move to the lungs (pulmonary emboli), and congestive heart failure all occur more frequently

Respiratory (lungs and airway): problems here are variable; restrictive lung disease and obstructive sleep apnea are pretty common; undergoing anaesthesia is also more dangerous

Gastrointestinal (Esophagus, Stomach, Bowels, Liver, Gallbladder): gastroesophageal reflux, stomach ulcers, fatty liver, gall stones, and bowel cancer; some studies suggest an increased prevelence of pancreatic or gallbladder cancer as well

Genitourinary (Reproductive, Kidney, Bladder): Obstetric Complications are manifold: these include gestational hypertension and diabetes, and delivery complications such as higher rates of caesarean sections and prolonged time of delivery (Obesity Review). Fertility is also an issue with higher rates of amenorrhea and infertility, not to mention the fact that susceptibility to endometrial, ovarian, and (postmenopausal) breast cancer is elevated. Oh, and more kidney cancer too. Cancer! Cancer! Cancer!

Dermatological (skin): Dermatological complications are also common; I often see skin folds infected with Candida (yeast), and unpleasantly for all, it’s hard for very large people to wash, so body odor can be a problem

Musculoskeletal (muscles and bones): Generally, with exceptions, obese people are less capable of physical activity; their weight also predisposes them to gouty and osteo arthritis; if sedentary, muscle contractures can arise

Endocrine (hormones): Everyone and their dog knows that there is a link between excess fat and Insulin Resistance/Diabetes Mellitus, but Polycystic Ovarian Syndrome (PCOS) and even thyroid conditions are other hormonal derangements that occur

** As a patient, you would be difficult to examine (I can’t feel the organs in your belly or hear your heart with my stethoscope), difficult to intubate (the weight of your chest compresses neck tissue), and difficult to test (your veins are lost under the adipose tissue, you might not fit in the CT scanner or MRI tube).**

As a doctor, it is a MAJOR struggle to help patients manage a diet, exercise schedule, and (in some cases) food addiction. Most people are pre-contemplative. They know that being obese might have some effects on health, but they don’t think anything bad will happen to them, or they wish to continue as they are, despite negative consequences. More often, people know they should change but don’t believe that they can. Sometimes it takes something as serious as a heart attack to jar someone into action.

Everyone copes differently. Self-control is a factor; this awesome New Yorker article explores Walter Mischel’s marshmallow experiment and the secret of self-control. Diets, portion control, substitutions, exercise, psychotherapy, support groups, and pills or gastric bypass are things people try. Everyone is different. Even if you have a “junk food gene” you can trump it. Like I mentioned above, I’ll write about that another time. Right now, this post itself is tipping the scales, so it’s time to stop!

And in recognition of just how difficult it is…

5 Comments leave one →
  1. Nico permalink
    November 23, 2009 4:18 pm

    Ah, timing. You posted that on the day I ate a big mac for the 1st time in 4 months. *sprints for celery*

    Interestingly, in some regions, I found the rate of obesity to be observedly higher where fresh healthy food is far more costly than the local wage realistically is. While this isn’t a new finding, seeing it in action is eye opening.

    Add in a relative lack of outdoor activity ( because it’s unhospitably winter almost 6 months a year) and it’s no shock. Even I put on weight where living elsewhere, it didn’t happen.

    But that hamburger was good.I’d barely eaten all last week due to dental surgery. I probably won’t touch one for another 6 months though.

    • November 23, 2009 6:35 pm

      treats are okay!

      I know it isn’t easy to eat right, stay active, etc. I struggle with eating healthily because my schedule is bonkers and I often don’t have time to cook a good meal. And I love butter.

      I can’t imagine finding a way to eat right in the true Northern communities or on a social assistance cheque. BUT affluent people and people with access to beautiful fresh foods don’t have the excuse.

      People just need to know what they are heading into if they don’t already know.

      The two best things one can do for their health are
      1. not smoke
      2. not be overweight

      We have made leaps and bounds of progress with smoking cessation, so it’s time to get on the anti-obesity bandwagon.

  2. Nico permalink
    November 24, 2009 3:50 pm

    Wholeheartedly agree there, doc.

  3. mego permalink
    November 27, 2009 10:38 am

    J. – love the blog.

    I hear you about tackling obesity head on. It doesn’t work to pussy foot around the issue … or to try and make it ‘ok’ by moving from one extreme (size 0 models) to plus-sized ones.

    Too often people are shocked/angered/suprised when I see them in a pre-op assessment, and include their weight as one of their ‘medical issues’, like any other systemic disease increasing their mortality & morbidity with anesthetics.

    Too often I hear excuses from patients that their weight issue is ‘glandular’, when in reality I think it has more to do with lack of education around how many calories they are actually taking in (who knew a bran muffin from the hospital coffee shop could have more than 400cals??! A quarter of my daily calorie needs!) vs. what they’re burning in a day.

    Time for particiPACTION and Body Break to make a come back! Time initiate a campaign highlighting the effects of obesity, like those smoking commercials way bay (remember the tubes filled with fat they showed on tv? Effectively shocking …)

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