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The State of Obesity in America

Or, I liked this too:

Beware the Ides of March

when choosing a title for my March contribution to the NWTC newsletter, What’s Cooking.

This one was a relative quickie, only a couple of hours, but I was pretty revved up after spending three or four hours on an earlier post on another place; however, I did shamelessly plagiarise my good friend, Wm. Shakespeare.

Beware the Ides of March

Perhaps you heard the good news? The obesity rate among adult men and women has plateaued at 35.5% and 35.8%, respectively, when compared to the data from ten years ago. The bad news is that the obesity rate among adult men and women has plateaued over the past ten years, rather than decreasing. Moreover, pediatric obesity has not leveled off; obesity rates for boys (2-19yo) rose to 18.6% from 14% in the past ten years while the rate for girls remained stable at 15%.

Obesity trends have been followed by the CDC since 1960, and the rate remained fairly stable through 1980 at around 10-12% but then increased steadily to their current rates. If you include those overweight, the total incidence of overweight and obese is 68%.

I suppose it’s the old analogy of the cup being half-full, or half-empty. Maybe the US citizenry has reached the apogee of obesity and it’s physiologically impossible to become any fatter. Hmmm…not very likely because I know I could easily become fatter, and in fact have even become so despite the plateauing and my best efforts, and a fifteen pound carrot cake I made last week; but, I am only one out of 300 million, and wasn’t one of the 9000 measured.

Maybe the incidence of obesity is as a baseball thrown mightily skyward, rising steadily, pausing briefly at its point most distant from earth (this would be now) before coasting back to the baseline level of historical normal. I suppose this is possible, but we’ll need to wait ten years to find out. I have my doubts. Something changed after 1975, and I don’t know what it was; if I did, I’d probably be writing this from a private tropical island. There are plenty of suspects that I’ve previously written about; the adenovirus-36 (first isolated from the feces of a diabetic in 1978), High Fructose Corn Syrup (HFCS), which is so ubiquitous in our diet that any attempt to remove it would be akin to trying to remove the argon (0.9%) from the air we breathe, video games, the proliferation and ready availability of high-fat/high carb empty calories, etc., etc.

There have been no new anti-obesity drugs in the past decade because the ones in development proved to be too risky; one was linked to brain tumors in rats, another seemed to cause oral clefts in babies of mothers who took it, and yet another was held up because of a need for a large study about heart risks. There is still no magic pill, and the most effective surgical treatment is a fairly invasive procedure that requires stapling your stomach nearly shut, hooking up a loop of intestine to what remains, and it still requires a lifestyle modification.

Fie, on’t fie! Tis an unweeded garden that grows to seed; things rank and gross in nature possess it merely. Woe unto us! Beware the ides of March, and all that…Perhaps our national epidemic of obesity is as Julius Caesar approaching his demise on the 15th and joking with the seer on the way to the Theatre of Pompey, “The ides of March have come,” to which the seer replied, “Ay, Caesar; but not gone.” Perhaps this leveling off of the obesity rates is our ides of March…to which I would proffer, “Ay, citizenry; but not gone.”

Taking responsibility for your weight and losing weight is no easy matter; and keeping it lost does not become any easier, unless you would be so fortunate as to become infected with a tapeworm that is not of the variety that spreads hematogenously to your liver, lungs and brain. It is not the case that there is a lack of public awareness of the problem of obesity for we are literally surrounded by the evidence if not evidence of it ourselves, speaking as a formerly obese, now merely overweight, adult male. The problem is a lack of education; not that it isn’t there, but that we do not avail ourselves of it; or, if not that, then failing to act upon it.

Pray thee, take heart Citizenry. Take heart you quintessence of dust, you paragon of animals; for you are noble in reason, in apprehension how like a God you are.

 

In Defense of the Marines

Last week, a video was posted on YouTube of some soldiers urinating on Taliban corpses. Here is a clip from ABC News. I posted that link, as opposed to the actual video on YouTube itself because I thought it instructive to see the way it was presented by ABC.

The video shows four young men, probably all in their twenties, or younger, and I remembered being twenty, and in the army:

Shaun Melarvie in basic training

In Basic Training

and, I wonder what I would have done. I’d like to think that I’d have done the honorable thing; but, when you put it in the context of being “in country” for seven months, losing seven comrades and suffering additional non-lethal casualties, I honestly don’t know.

My eighteen years in the Army was most notable for finding a prostatic nodule in a 40yo while doing an over-forty physical exam, which required a rectal exam. It was an exam he would not have otherwise had, and would have likely went on to develop metastatic disease. So, that is the only life I may have saved, that I know of, and that alone, made my eighteen years worthwhile. Nothing heroic, no charging up a hill or throwing myself on a grenade or weaving through crossfire to a fallen soldier, nothing like what we are asking of these young men and the thousands of other men and women serving today.

I have an acquaintance who was in Iraq and heavily involved in combat. He doesn’t talk about it, but when I’d ask him how he did it, he mentions ” I’d just put on my military face…” and that’s pretty much all he’d say.

These men live in brutal conditions, in a constant-threat environment, existing in the reality of kill or be killed that we cannot even imagine.

I would not presume to judge these young men. I will leave that to their conscience and developing maturity.

I do not like that ABC made no attempt to consider their actions in the context of the theater of war in which it occurred–shame on them. We do not send saints to war, we send men; men who are all too human; we send them to make war so that we, ahome and asleep in our beds, might be free.

Cutting For Stone

by Abraham Verghese

We all have dreams, call them fantasies, of what we would wish to be or wish to do. Some would like to swim like Michael Phelps, or take an NFL team down the field like Aaron Rodgers, or enchant millions of people with a voice like Pavarotti, or hypnotize audiences, in front of celluloid screens, like Meryl Streep. I, would like to write like Abraham Verghese, not in the syntactical sense of course, but in the emotive sense; to take the reader on a journey: to have the reader take a giant breath and go under, swimming down into another world filled with foreign sights and smells assaulting the senses that overwhelm in their beauty and complexity of story, pulling you deeper, luring you into dark recesses that lead to grottos of translucent bluish-white light glittering off of sandy bottoms, until your diaphragm begins contracting and you are forced to surface, reluctantly, your head breaking the surface with a spray of water and your only thought being to breath and dive down again. Unfortunately, there is not the comfort of a physical impossibility separating me from Dr. Verhese; and I cannot help but feel like Salieri in Amadeus, who has the intellect to appreciate the genius of Mozart and feels frustration in the recognition of his own mediocrity; and I am reminded of the scene where he’s being wheeled down a hall, demented and crazy, blessing those he is passing, saying, “I absolve you, all you champions of mediocrity.”

Much of my fascination with the novel is the medical part of it, which is accented by the large role played by my chosen specialty of Surgery. I enjoyed the common aphorisms, many of the familiar, but some not, such as the 13th commandment, “thou shalt not operate on the day of a patient’s death.” And another aphorism of Thomas Stone, which is so true: “when the abdomen is open, you control the abdomen, but, when you close the abdomen, it controls you.”

I enjoyed the undercurrent of faith throughout the book, and the interconnectedness of the story that if I wrote about would diminish the impact for the reader not yet exposed to this wonderful work. God, missionary medicine, forbidden love, betrayal, emperors, war, disease, doctors, nurses, nuns, redemption, miracles; what a piece of work.

I read this book when it first came out, and when George, the member of my book club who suggested it, sent out the group email to fellow members, I didn’t say a word because it gave me a reason to read it a second time.

 

Mr. Hayden

My monthly obligation, a burden with no renumeration other than a vicarious pleasure in suffering others the effort of my thought, ideally should relate, at least obliquely, to food, or education of some sort, or self-improvement even. Sadly, this month falls far short of that. Perhaps it’s the product of the book I’m re-reading for my book club. At any rate, for what it’s worth, I’ll put it out there with everything else. I called it “Mr. Hayden.” And, yes, I changed the name.

Mr. Hayden

After 25 years of seeing patients, there are those who’ve left an indelible imprint in my memory, as familiar as an old photo in a frame hanging in the hallway that you pass by every day. This is one of those.

In the third week of my internship I met Mr. Hayden when my team switched from the GI surgery service to the vascular service at the VA hospital. He was in his sixties at the time, a veteran of the Korean War. His hair was iron grey and cut close to the scalp, more of a stubble, as though he shaved his head but had neglected it while in the hospital. He reminded me of Anthony Hopkins in Silence of the Lambs, or I should say that Hopkins reminded me of him because the movie hadn’t been made yet.

Pale blue eyes and a square face that seemed to crack in half with a smile were further complimented by an offset nose that had been broken several times and a scar running from below the left eye down to the side of his mouth, almost parallel to the nasal-labial fold. When I pulled open his hospital gown to auscultate his lungs early that morning before rounds I saw a curious red and black tattoo over the left breast with two crossed swords and a shield with the initials “A.B.” in the center of it; there was a faded scroll below with words I couldn’t make out in the dim bedside light. I didn’t ask him about it because it struck me as somehow ominous, and besides, I couldn’t understand Mr. Hayden. He had a neurological condition that wasn’t specified in the charts that were at the nurse’s station (charts 11 of 12, and 12 of 12). He could say only simple words in drawn out monosyllables, mouth stretched wide with the effort of speech; and he moved his arms in a reptilian fashion next to his face as he talked, trying to form the words with his hands, and even that was laborious, as though he moved through an invisible medium of thick molasses.

Mr. Hayden was what we called a frequent flier. He was in about as much as he was out. His most frequent problem was severe venous stasis disease, a vascular problem from impaired return of the blood from the legs back to the heart. He had chronic ulcers on both legs that would heal up, then he would be discharged, wouldn’t comply with the treatment plan, and end up back in the hospital, often with infections and other related complications.

His body was a proving ground for interns and medical students because of his frequent visits and needs. I did my first central line on Mr. Hayden, my first skin graft, my fist unna-boot. Some other lucky resident got to fix a right inguinal hernia and I remember checking to see if I could find one on the other side for me to fix. “That’s alright, Mr. Hayden,” I said as I helped him stand at the side of the bed on swollen legs, “just turn your head and cough.” I didn’t find one.

My chief that year was Joe Long. He rolled in every morning at 6:30 with a 32oz Big Gulp Coke, and me, two other residents, and three medical students would take him on rounds. We had already written all the notes and collected all the a.m. labs and x-ray results. As we stood outside of Mr. Hayden’s room, Joe asked, “Who saw Mr. Hayden?”

“I saw him, Joe.”

“Did you like his tat?”

“A.B.?…not sure what to make of it; wouldn’t say I liked it though.”

“Stands for Aryan Brotherhood.”

“Oh,” I said, feeling stupid.

“Yeah. Seems that Mr. Hayden got into a knife fight while stationed overseas and when the anesthetist put him to sleep he didn’t realize that the oxygen tank was empty…six minutes of anoxia. When Mr. Hayden woke up, he was the way you see him now.”

“Hmm…” I nodded, “I’m guessing the anesthetist was not a member of the A. B.”

Five years of my life race by. I’m standing at the foot of Mr. Hayden’s bed. He’s recovering from a Carotid Endarterectomy I did on the right side. It’s my last day on the Vascular Service. I’m moving to the University Hospital for my final four months.

“Good bye, Mr. Hayden.” I said, “You’ve always been a good patient, and taught me much. Thank you.”

“Goh….Baaaah…”he said, with splayed fingers, palm out, straining at the side of his mouth.