Day in, day out, it’s like a broken record. Patient comes in with uncontrolled diabetes. Patient gets sick. Patient gets patched up. Patient could care less about their health. Patient goes home to live another day, before coming back in a month. Everyday you just accept the reality of reckless self destruction, do your best to help them while they pretend to care and then send them on their way.
Except when a patient actually shows some interest in their health. Let me give you an example. I was asked to consult on a woman with shortness of breath, unbearable heartburn, aches and pains, low energy and sleep apnea. This woman weighed close to 400 pounds. Her husband was close to that as well. Together I sat them down and talked to them for darn near an hour. We talked about all the complications that come with folks in their age group. I asked them if they had a plan for success. What their motivations were. What their goals and expectations were.
They talked about how their exercise regimen. When I tried to pin down exactly what they were doing and how much and how often, it turns out that the twice a week walk around the lake was their idea of trying. They swore up and down about the their appropriate food choices, until they admitted that their biggest problem was not what they eat, but how much they eat. For an hour I heard about how hard it was. About how frustrating it was not to see any success. About how life wasn’t fair.
And then I met their polar opposites. A man and his wife both pushing 300 pounds. He was admitted with cellulitis of the leg. But both had lost a combined 220 pounds in just seven months. I was floored. 220 pounds? That put the biggest smile in the world on my face that day. I congratulated them probably 20 times.
I asked them, “I have so many patients who just can’t find a way to lose weight. How and why did you do it?” The answer was exactly what I expected.
“We had to. We were always tired. I was always hurting. I could barely walk. My wife could barely move. We considered gastric bypass but they wouldn’t do it without first doing six months of diet and exercise. Now I’m not even considering surgery. We went through our cupboards and we got rid of all processed foods. We eat healthy. We control our portions.”
Their motivation was their own. They realized they didn’t want to live their current reality. They took the initiative to make positive change in their lives and were basking in the glory of their success. What was the difference between these two couples? It was their attitude. One couple chose to make excuses for their plight. The other was doing something about it.
For this week’s episode of CBS Doc Dot Com, I went back to camp. OK, it wasn’t my camp – Camp Algonquin in Argyle, New York – now defunct, where I spent many an idyllic summer growing up. It was Camp Shane in Ferndale, New York, listed on their website as “The original, longest running weight loss camp in the world” at 41 years and counting.
This is a tough time to be overweight or obese. Last week the Centers for Disease Control announced that obesity-related diseases account for 147 billion dollars in medical costs every year in the United States.
About a quarter of Americans are obese and two thirds are either obese or overweight. Over the past twenty years, obesity in teenagers has increased from 5 percent to almost 18 percent. Obese children and adolescents are more likely to become obese adults. Which brings us back to Camp Shane.
I spent an hour talking to about a dozen kids ranging from ages 11 to 17 who had been gathered into a group by Camp owner David Ettenberg and his wife, Zipora. They came in all shapes and sizes but shared a common sentiment – they felt safe at camp, surrounded by people who accepted them for who they were. It brought tears to my eyes to hear how supportive they were of each other, how open they were about their emotions and fears.
In school other kids often mocked them. There’s no way that would be tolerated at camp – not just by the staff but, more importantly, by the campers. “We’re all in this together,” one boy offered. A girl added, “It’s a safe zone for us.” A teenage girl said “You can wear a bikini without being made fun of.” I asked, “What would happen if you wore a bikini at home?” She answered, “You’d most likely get made fun of and like pushed in a pool. Ah ha, you’re fat.”
A boy told me that kids at his school would ask him, “‘Why are you so massive?’ And like usually I’d just laugh it off but sometimes it does get a little annoying. I’m like, how long until I get back to camp?”
The kids all said they had lost varying amounts of weight at camp through portion control and exercise, a program supervised by pediatrician Dr. Joanna Dolgoff. The challenge has been trying to stay on track once they leave camp and return home.
If they can do it at camp, they can do it at home. But not without the support of parents and schools who have been educated about how to help their children make healthy choices. My good friend, Dr. Mehmet Oz, has launched a wonderful organization called HealthCorps “to help stem the crisis of child obesity through school-based health education and mentoring, as well as community events and outreach to underserved populations.” Click here to see the HealthCorps website.
Click here to see this week’s CBS Doc Dot Com about my trip to Camp Shane.
They gathered around the figure who was lying with face toward the ground. Holding stones, they demanded justice – that the sin of this person be exposed for what it is: inferiority. Her sin had been exposed for all to see and the righteous rage of those who were pointing fingers and holding stones was pounding at her on the inside, just as the stones would soon pound her on the outside.
“Her BMI is over 30! It may even be over 40!” one of them cried out. The others responded to this with a howl.
“How can she be fit for leading the country’s health if she can’t even fit into her pants?!” another asked, causing raucous laughter to echo from the crowd.
Nearby, a news reporter spoke into a camera: “People are questioning her fitness for surgeon general, as she obviously is overweight. The president had initially hoped the popular TV doctor would take the job, but fell back on Dr. Benjamin as a substitute. Clearly a president, who himself is a closet cigarette smoker, doesn’t see the fact that she is overweight as a disqualifying factor. These people, and many others around the country, disagree with that assessment.”
———————–
Forty years ago, people would also have cried out about this nomination. They would have said that a woman shouldn’t be in charge of the nation’s health, or that a black person doesn’t have the wherewithal to manage such a big task. Times have changed, as her nomination shows – nobody is talking about these facts that have nothing to do with her ability to do this job. We have truly progressed.
Sort of.
This objection, of course, is that her weight shows that either she doesn’t understand what is causing her obesity, or that she doesn’t have the moral fortitude to successfully fight it. Either way, she’s disqualified for the job. Right? It’s a sign of weakness to be overweight, and we certainly don’t need someone with a personal weakness to be in a leadership position!
It is clear that some view the overweight (which, by the way, constitute 2/3 of our adult population) as being emotionally weak and somehow inferior to everyone else. After all, study after study has shown that the way to beat obesity is simple: eat less and exercise more. It’s simple; and those who don’t do it are weak, lazy, dumb, or just plain pathetic.
It angers me to hear these suggestions. Racist and sexist people put down others because of the fact that they are different than themselves. But the moral judgment against the overweight and obese is not meant to be a judgment against something inherent in the other person; it is a judgment against their character, their choices, and their weaknesses. The implication is that they are somehow either smarter, stronger, or just plain better than the overweight. The implication is that the other is weak and they are not.
There is a word for this attitude: hypocrisy. A bigot is a person who hates those who are different; a hypocrite is one that hates others for something they themself have, but choose to ignore. Both mistakenly act as if they have the moral high-ground. Both disqualify themself from any argument based on morality.
Healthcare exists because of human weakness. We all are weak in various ways, and we all will eventually die when one of our weaknesses overcomes us. Obesity exists because of human weakness – either the genetic or biological miscalibration of the person’s metabolism, or the inability of that person to act in ways that are in their own best interest.
I have to say that I probably fall in the latter category, as my lack of desire to exercise and my exuberant desire to eat rich foods make it so I have struggled with my weight for years. Somehow the prescription: eat less and exercise more, is not very helpful for me. Yes, it is simple; but it is not easy. Having others explain it to me at this point is not only unhelpful, it is insulting. Of course I know that my weight is a problem! Of course I know I should exercise more and avoid that cookie dough in the refrigerator!
To successfully fight the battle against obesity in our country, we have to stop the condescending finger-pointing and instead ask the question: why is it that we humans don’t always act in our self-interest? Why do smokers smoke? Why do alcoholics drink? Why don’t people take their medications, eat enough vegetables, or go for walks instead of watching The Biggest Loser on TV? This seeming self-destruct switch is, to some degree or another, present (in my opinion) in everyone. It is the same drama with different actors and props. We all sell our birthright for some soup at times. We all go the route of easy self-indulgence rather than personal discipline.
Does that mean we are all weak? Yes, in fact, it does. My admission of my weakness has actually made it easier to have frank discussions with patients about their own personal struggles – be they weight, smoking, or other self-destructive behaviors. They listen to me because I don’t insult them with statements of the obvious. If it was easy to lose weight, don’t you think we’d have a little less than 2/3 of the population being obese? Does 2/3 of the people remain overweight because they want to be that way? No, the problem is not that simple; and suggesting otherwise won’t do much to deal with our national problem.
Dr. Benjamin has impressive credentials. She is a practicing primary care physician who cares for the poor. She’s not some subspecialist TV personality; she’s a doctor who has spent a lot of time face to face with the neediest people in our system. She doesn’t just know about the poor and needy, she knows them. She’s one of us; and her weight does nothing to lessen that – for me it actually makes her more relevant, not less.
So put down your stones, people. We are all weak. Having someone who understands the real struggle of the overweight may actually give us a better chance to successfully fight it. And if some of you still hold stones, let me rephrase a famous statement: The person without personal weakness can throw the first stone.
Dr. Jim Hill is a friend of mine and co-developer of the National Weight Control Registry – the nation’s largest database of individuals who have lost at least 30 pounds and kept off the weight for at least 1 year. Jim has been studying their commonalities – and has determined that there is in fact a recipe for long-term weight loss success. I shared the recipe with ABC news today. My interviewer (Natasha Barrett) was really funny, and had tendencies to blurt questions in the middle of our conversation (such as: “what do you think of granola bars?”)
Do you know that most adults should eat less than 2,000 calories a day? Sounds like a lot, until you consider that if you eat out, you can get your entire days worth in one meal. Here are some amazing facts (chosen at random):
At Burger King – a triple whopper with cheese has 1,230 calories – add medium fries (360) and medium chocolate shake (690) and you are up to 2,280 calories!
The Cheesecake Factory brings you beer battered fish & chips at 2,160 calories, add a piece of Adam’s Peanut Butter Fudge Ripple Cheesecake (1,326) for a total of 3,486 calories!
How about Chicken & Biscuits instead, with 68 grams of saturated fat? Yes, that is more than four days worth of saturated fat (for a 2,000 a day diet, <16 grams a day is suggested).
Right now you can usually request the nutritional information at chain restaurants and someone will point you to or produce a pamphlet, but the information is not apparent. The idea of having those nutritional facts printed clearly on menus is meeting some serious resistance from the restaurant industry. I wonder why?
Public health advocates however are pushing hard to get this information in front of consumers hoping that people will make healthier choices when faced with the facts! The Senate supported a federal labeling law last month as part of comprehensive health-care reform, but we shall see what happens when it all comes to a vote.
Until then, it would be good to know when ordering – and passing on these facts to our teens who are likely to be eating out.
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