Too Much FoodI lost a patient a little while ago.
That’s nothing unusual; my specialty is critical care, so I’m asked to consult on many patients with life-threatening problems, and routinely some of them don’t make it. But in this recent case I was involved in, the death was really due to too much food.
Obesity has reached epidemic proportions in the United States, where many of us walk around with 15 or 20 pounds of extra fat. In extreme cases, the obesity is so severe that doctors call it “morbid obesity” to imply that it is deadly in and of itself. My patient was a woman who weighed over 400 pounds, and I have taken care of some patients who weighed over 500 pounds.
At her size, we were very limited in our ability to care for her. She came to the hospital for a flair of her asthma. She then developed severe abdominal pain and we had to do an operation to release some trapped bowel. This impaired her breathing so much we could not get her off the life support and had to create a tracheostomy (airhole in the neck) so she could stay on the machine. Meanwhile she had a series of other problems, but her large size made everything extra difficult. We could not do any CT or MRI scans because she was too heavy to put on the scanning table. It was hard for nurses to turn her to prevent bedsores or to ever get her up into a chair. God knows what we would have done if she had ever fallen out of bed onto the floor. We had trouble getting an IV in her as her skin is so stretched by fat that it is impossible to find the superficial veins. Over the course of several weeks she eventually succumbed from complications.
It would be fair to say that if she were not obese, she would still be alive and in good health. The human body was not designed to support several hundred pounds of tissue, and in these patients it is the heart that often fails due to the stress caused by this level of obesity.
Obesity is a disease of modern life. For most of human existence, the best survival strategy was to eat every scrap of food you could get your hands on. Humans are designed to live in an environment of hard physical labor and shortage of food. Those best adapted for this are most likely to survive and pass their attributes to their children. We all enjoy the taste of high calorie foods, especially fats and sugars. I dimly recall as a toddler munching on a stick of butter. In times of food plenty, those people who could eat a lot and store that food as fat would be more likely to survive the next episode of food scarcity or famine. This has built into us a powerful tendency to deposit fat, although some ethnic groups have more of this ability than others do. Each individual also has an inner limit to how much fat they can easily put on.
In modern America, and even among the affluent in Pakistan, there is no such thing as food scarcity. Even the bums on the street have a layer of fat picked up from their diet of fast food cheeseburgers. In fact, obesity is even more common among the poor than among the rich in America. The abundance of food in the US is startling even to Europeans. No business meeting is complete without a spread of snacks and delicacies. Doughnut shops sell huge sugary fried treats for pocket change. If you go to a restaurant, you are bombarded with food. Just last night, I went to dinner with my wife. It was one of those “casual dining” Italian places with table service but nothing fancy. We started with a loaf of fresh bread served for free covered in butter and garlic. It tasted so good you could fill your belly with that alone. Then came the salad, which was actually a big bowl of salad left at the table, and they would be happy to refill it if you wanted. For dinner I ordered some rotisserie chicken and potatoes, so of course they send an entire half of a chicken. Who can possibly eat that? For dessert the slice of cheesecake was so large that even sharing with my wife we only finished half of it.
The restaurants do this intentionally. They give you far too much food so that you will feel you have gotten your money’s worth, even if much of the food is wasted or brought home to be eaten later. This culture of plenty makes it very easy to gain weight. Obesity is a troubling epidemic that will be hard to bring under control because it results from our basic desire to eat. On the other side of this problem, very few of us do hard physical labor and actually get very little daily exercise. It is getting to the point that people need to exercise Ramadan-like self-control for every meal.
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