Wednesday, August 15, 2012

Obesity and medical reality

Labrat of the Atomic Nerds has written an excellent article about obesity and attitudes towards it.  I was reading it tonight, and was struck by one of her points:

... being fat is regarded as not just undesirable but essentially sinful ... Being fat is like extending a blanket invitation to the world to remind you that you are, and usually accompanied by either a lecture on self-control ... or instructions that seem to assume that you were raised by wolves and have absolutely no idea that cake is fattening or that you should move around some. Befriending or being family to someone who is noticeably fat is like having a permanent ticket to a movie consisting solely of the world’s rudest people offering the most gratuitous abuse or obvious advice.

There's much more at the link.  The whole article is well worth reading.

I've experienced such attitudes all too often, and I'm very tired of them - because I'm clinically obese, and it's not because of over-eating.  Back in 2004, I suffered a serious injury that left me reliant on a combination of pain-killing medications.  They worked fine for five years until, in late 2009, I suffered a heart attack and underwent coronary bypass surgery.  I ended up taking a total of nine prescription medications each day, three for continual pain from my 2004 injury and six as part of my recovery from my heart attack.  Unfortunately, six out of the nine had the documented side-effect of weight gain . . . and some combination of them ganged up on me.  I put on more than 100 pounds over the next couple of years, to my intense alarm and self-disgust.  I watched my diet, joined a gym and exercised, the whole nine yards.  Nothing worked.

It took a well-informed doctor to analyze the medications I was taking and point out the obvious connection.  I eventually cut down to no more than three prescription medications each day, including getting rid of all the high-powered pain control medications I was using.  That escalated my pain level considerably, but it also got rid of the weird drug interaction that had caused my weight gain.  I've tried and am trying to lose the weight, but my metabolism is still pretty messed up from prolonged exposure to the medications concerned, so it's a slow process.  I count myself blessed to have Miss D.'s help and encouragement as I 'fight the good fight'.

There are setbacks, too.  A short while ago I went through a very bad pain episode indeed (I wrote about it here).  For four days I had to put myself back onto the high-powered pain medications I'd used before, in addition to my heart meds.  Guess what?  My metabolism seized up again - digestive functions messed up, solid and liquid retention, the works.  This week, I found that I'd gained eight pounds since I last weighed myself.  It's not because of pigging out on food, either.  It's that old drug interaction, come back to haunt me.  It took me 3-4 weeks to drop those eight pounds before . . . and now I've got to do it all over again.  (Fortunately, I stopped taking the pain meds after four days, or I'd probably have gained even more!)

I know full well what my problem is, and it's not over-eating.  I watch my calories pretty carefully, and seldom exceed 1,500 per day - some days I'm below 1,000 - unless I'm cutting myself some slack on special occasions.  To overhear judgmental comments from others about my weight is both hurtful and frustrating.  I'd love to tell them a few things to their advantage, but there wouldn't be any point to it.  They wouldn't believe me, anyway.

Another blogger who's suffered from out-of-control weight gain is Chris Byrne over at The AnarchAngel, who's presently recovering from a thyroidectomy.  Before they diagnosed his condition and made plans to control it, his weight also ballooned, until he weighed a lot more than I did at my worst.  Fortunately, they were able to find a way to stop the weight gain for him, too, but like me, he's having a hell of a time getting it off again.  It's not easy, and it's no fun - and I'm sure he's heard at least as many negative comments about his weight as I have, if not more so.  Still, like me, he perseveres.

So, next time you see an obese person, try not to be too judgmental.  You might want to send a positive thought their way, or say a prayer for them if you're so inclined.  They may simply be gluttons reaping the just rewards of their over-indulgence . . . but there may be other, more complex reasons for their size.  I'm sure Chris and myself aren't the only people facing that problem.



Melody Byrne said...

Nice to see we're not the only ones dealing with "I'm not sick because I'm fat, I'm fat because I'm sick." It was Chris's completely normal blood pressure, cholesterol, and blood sugar that finally convinced the docs that he wasn't suffering from a lack of self control. At least half of his weight gain was water retention.

Now that the tumor is out we're tracking his weight and measurements at home so we can see what the full extent of the connection is. No adderall, testosterone, or diuretics as of yet; we stopped all of those in preparation for the surgery. That's what we were using to control the weight gain from the thyroid and the water retention. He gained 60lbs in water during the two weeks he was off his meds. We'll see how much just the thyroid replacement therapy does for him.

Yes, we know all about "helpful" advice. And there's nothing quite like a well-meaning nurse shaking her head at you like you're an enabler.

LabRat said...

Yup. Metabolism is actually still kind of a black box as far as medicine is concerned, and some of the things we take can make it just flat sit down and quit.

There were at least two people in my life growing up that had the same thing happen to them... their weight skyrocketed eating a normal diet, but immediately after the introduction of medications that were necessary but completely inimical to a brisk metabolism. It tweaked my perspective a bit.

LabRat said...

Oh, and speaking of that nurse- some M.D.s have absorbed that attitude as well and it is freaking near impossible to get them to either believe an obese patient when they say they aren't eating entire boxes of cookies whenever they get the chance, or to see that patient's medical problems in any context other than "you're obese, if you lost weight you wouldn't have that medical problem".

Yes, well, sometimes your gall bladder stops working and it has nothing to do with being fat- or you can get Creeping Death Flu- or you can get an autoimmune disease... having to actively talk your doctor into considering the possibility there is something going on other than "you're fat, therefore you feel like crap, lose weight" is yet another cost, and one that should not exist.

Carol said...

It is interesting that obese and morbidly obese people get this kind of abuse's not like the majority of people weigh what they should. I don't have the figures at hand, but I seem to recall that well over half of Americans are obese (30 lbs. or more over weight). I could look it up, but I'm feeling lazy today.

Medications may have an impact on weight gain, but our diets are clearly the main culprit. For anyone who has an interest, I'd recommend a book called "Why We Get Fat." It's a detailed explanation of how our bodies are still biologically just as they were tens of thousands of years ago, but our diets have changed substantially. Our increased consumption of processed carbs, sugar and sodium-laced foods is playing havoc with our systems. Worse, these types of foods are virtually addictive, particularly sugar. It was a great relief to me to read this, as I've struggled with my weight for years. I no longer feel guilt about what I perceived and was told was a lack of self-control. That said, I still have to cut out the carbs and sugar, but I feel better doing that and that's the reward.

Anonymous said...

Correct. It is not overeating. In general, those drugs that cause the increase in weight are actively causing insulin resistance in the cells. THAT means that your muscle cells are not getting the glucose they need (because they are resistant to insulin, that paid escort of glucose into the cell).

So not only do the drugs cause weight gain, they can also cause exhaustion, as you are not getting fuel into your muscle cells - and organ cells by the way. Your fat cells do, however, remain insulin sensitive much longer than the other cells, ergo you get fat. You're starving to death. You're getting fat.

You're hungry (and I don't care what all the skinny minnies say, you cannot resist grinding hunger forever... All those skinny models are getting something added to their diet, or they are getting surgery).

I hate to sound like one of those folks who 'have the answer'. But in fact, there is good (and growing) evidence that removing carbohydrate from your diet will allow the insulin sensitivity to return. You will feel 'energized' as a result, and you will start using your fat, rather than storing it.

In fact, the reason that the Atkins diet encourages the 'induction' phase is that it does not try to 'wean you away' from carbohydrates, it makes you go cold turkey. Just like with smoking. I don't think anyone has quit smoking by 'cutting back'. You can't live with the grinding need for a smoke forever.

If you want to feel better in a couple of weeks. Stop eating carbohydrates. Period. Quit all sugar and starch. (No FRUIT! Green leafy vegetables are the safest bet with lots of fatty meats - like bacon!!! See there's an upside!)

Sorry to chew your ear. I wish I had the time to make this more articulate. I hope you will look into this, as there is a lot of information out there.

Here is a link to a video you should watch (it is technical, but it is certainly not beyond you!).

This is a lecture at University of Texas at San Antonio:

If that link did not come through. Look for UTSA 2012 Gary Taubes on youtube.

Please Bayou Renaissance, I want you to be around for a long time.

I enjoy your blog and read it daily (comment seldom)

Cap'n Jan

Anonymous said...

Sorry, I forgot to add that Gary Taubes is no charlatan.

His background degree in applied physics from Harbard, an aerospace engineering (physics) degree from Stanford and a journalism degree from Columbia U.

He's been a science journalist since then. The man does not lack credentials. (He has turned his considerable mind to nutrition on the recommendation of a friend and has pursued that for the past 10 years).

So. You will be doing yourself a favor to listen to someone who is capable of understanding what science is (physicists, it could be said, are the only people doing actual science).

Fair Winds

Cap'n Jan

Firehand said...

Daughter has thyroid problems which cause her weight trouble; she's heard some downright nasty shit from people over her weight.

And trying to get a doctor to effing LISTEN and actually do something about the real problem...