The Modern Epidemic

I saw Andy the other day. One of my oldtimer type 2 patients. And in the midst of the usual banter (this time, about the state fair), he joked about his weight. And then he asked me why this was a bigger problem these days (no pun intended) compared to his parents' generation.

Obesity. It's staggering, the numbers. In some parts of the country, more than 1 out of 3 adults are considered obese, with a Body Mass Index greater than 30. In my practice, many of my patients have a BMI in excess of 50. And it's not only the USA; this is a worldwide phenomenon. And perhaps a greater tragedy is, childhood obesity is becoming much more prevalent. No longer are the lines well-defined: "Type 1 diabetes occurs in childhood, and type 2 occurs in adulthood.." my medical students often quote to me. Not anymore, buddy.

Why is this? There is always an inherent need to find a 'medical reason' for obesity. I see consults for these every week; patients who won't believe their thyroid or adrenals are working fine. "There must be a reason for this. There must be a pill I can take/surgery I can have..."

The reasons are complex. And probably too many for me to fathom. But methinks this is due to the modernization of man. Technologically, but also socially. And unfortunately, what's right as a society may not be the best for its health.

Due to the conveniences of life, we just aren't as active. Believe you me, I'm not referring to things as a 3rd person; I know I am guilty of this too. We just don't move as much.

True, dedicated exercise is great. You know, running, going to the gym etc. However I'm also a firm believer in non-exercise activities. Things that don't require special preptime, or special trips to a facility. Things we can do all the time, during our usual everyday motions. There are numerous studies out there demonstrating this concept. Just any kind of movement, burns calories albeit in small amounts. But as a society, we are just walking, moving around less. We depend so much more on modern automatons. There are escalators everywhere. We use the elevators even to go up (or even down!) a floor. We drive everywhere we go, and walk less. We use the phone to call a colleague and not actually stroll over to their desk (I've called my wife's cellphone from the basement, when I was too lazy to walk upstairs at home!).

Now, not only is the output less; the input is more as well. There tends to be a close relationship between the ease/price of food, and its health value. The cheapest, quickest foods tend to be the least healthy. I admit, the crap I wolf down at lunch every day isn't exactly good for me. As a society, things seem to have shifted to the wrong end of things. How many times have I seen a family with everyone being obese, even the kids, at McDonald's. And the children having 2 servings of fries each, plus a burger and sundae? And I'm just as guilty, having MY Big Mac and fries. Oh, how I wish broccoli and all things green made us fat. And chocolates/fries were full of fiber and protein and vitamins!

But the more difficult thing to admit for me as a physician and as person is, what we do to support some people, may end up backfiring. Some of my patients struggle with weight so much that they have difficulties ambulating, so they instead use a motorized wheelchair to get around. Now, from the civic and societal standpoint, this is great- this offers some people freedoms they would otherwise have difficulty experiencing. But if you looked at things purely from a (robotic) medical view, then this would decrease their activity levels even more, feeding into the problem. And so, both of these views are discordant, and in conflict with one another. In addition, many of my patients feel that they can do longer work because of their excess weight, and apply for disability, allowing them to obtain special benefits, like strategic parking spaces, and a (small) monetary compensation. Again, I see the need for these, but I am also conflicted in saying that these may not help alleviate the underlying medical condition. One can say these in a way rewards the problem.

And so, I wish I had the answers. I wish the CDC, or the NIH, or the government, or Obama, or even Najis did. I wish there was a simple solution to this worsening epidemic. As an endocrinologist, I wish it was as simple as, "Oh yes, you have hypothyroidism, take this pill" or "A laparoscopic adrenalectomy will cure you of your Cushing's and your weight problems".

Unfortunately the answer is probably much more complex than that.

In the meantime, society suffers.