Tuesday, August 31, 2010

T'is probably not a good idea to go directly from the endocrinologist visit for 'Inability to Lose Weight' consult to the McD's 4 floors down.
I hope she at least took the stairs (and no, in my defence I stopped by to drop off a DVD). We pretended to not see each other there (I knew she saw me when she turned away at her table). Obviously I'm making some generalizations here, that 1) This is a frequent occurence 2) Most fast food is unhealthy. And no, the irony of having a fastfood restaurant in the hospital isn't lost on me; I have no say in this matter, unfortunately.

It's true though that excess weight and obesity is the new epidemic. A third of Americans are obese. And while this is probably reflective of numerous factors, it's pretty clear a lot of it has to do with the changing environment. Less physical activity (in part due to the conveniences of daily life technology has given us), more easily accesible high caloric junkfoods, perhaps financial (healthy food is more expensive than fastfood).

Obviously, it's really more complex than this. Nonetheless, there is a tendency as well to find a medical explanation. To find a condition, a disease, that has caused all this weight gain. And (perhaps judgmental of me, I apologize) some denial as well (maybe because of the shift of cultural norms, of what's considered 'good' and what's 'bad' for health). And so, I see at least 5 consults a month to work up issues like inability to lose weight. I suppose it's human nature and I speak from personal experience too; it's far easier to find a disease and to take a pill, than to actually change one's habits. Far, far easier.

And while certain rare endocrine conditions may cause one to gain weight, frustratingly enough for my patients this often is not the case. And yet there is a tendency to blame the 'hormones' for anything. While I see hypothyroidism frequently, often you gotta have pretty pronounced hypothyroidism for a long time to gain a lot of weight. Conversely I've seen a ton of hyperthyroid patients who get mad at me for telling them that they are 'hyper' and not 'hypo', who refuse to believe that a low TSH really implies the thyroid is overactive because they're overweight (I partially blame this on the referring physicians who label patients with low TSH as hypothyroid; yes this is basic medical knowledge but believe me many make this mistake!). And then there's the issue of Cushing's. Every patient I see seems to know about this condition. I can't attest to be an expert on Cushing's, since I'm relatively young (and probably stupid) in my career, but I'll say this: of ALL the patients I've seen for Weight Gain in the last 2 years who have demanded a screen for Cushing's, the number of real cases I diagnosed: Zero. Of the 2 patients I did diagnose with Cushing's, one had a normal BMI, while the other had other clear pathognomonic signs that you could spot from a mile away. And obesity wasn't the presenting complaint.
And yet, I continue to get consults from referring physicians, and from self refers, for weight issues. It turns out to be frustrating for the poor patients, because they wait 2 months to see me, then undergo a series of tests, only to be told the hormones are normal.
Unfortunately, this epidemic will only continue to rise in our lifetime. And I'm afraid I won't have any easy answers to this problem.